CLINTON HEALTH ACCESS INITIATIVE November 25, 2014 New York State Office of the Attorney General Charities Bureau Registration Section 120 Broadway New York, NY 10271 RE: 2013 New York State Annual Filing for Charitable Organizations - Article 7- A Registration No. 41-82-73 To whom it may concern: Clinton Health Access Initiative, Inc. (CHAI) would like to submit its 2013 New York State Annual Filing for Charitable Organizations as an Article 7-A registrant. The annual filing contains financials for the fiscal year ending December 31, 2013, and we have enclosed the following with our annual charitable filing: . 2013 NYS Annual Filing for Charitable Organizations - Form CHAR500, 2013 IRS Form 990, 2013 Audited Financial Statements, and $25.00 check (no. 8512) for the 7-A registrant's annual filing fee. Although we only listed U.S. government agency contributions in Schedule 4b of Form CHAR500, CHAI also received foreign government contributions and can provide those in more details if needed. We trust that your office will not share the application externally and safeguard CHAI's 2013 IRS Form 990 to preserve confidentiality. Should you have any further questions, I can be reached directly at 857.401.9963 or the email below. Thank you, Alyssa Contracts Assistant amcclureclintonhealthaccess.org 383 Dorchester Avenue, Suite 400, Boston, MA 02127, USA 1 617-774-0110 1 www.cIintonhealthaccess.org CHAR500 2013 Send with fee and attachments to: NYS Office of the Attorney General Charities Bureau Registration Section 120 Broadway New York, NY 10271 NYS Annual Filing for Charitable Organizations www.CharitiesNYS.com Open to Public Inspection ij 2 ll I 1 1 / I 21 0 1 ii l For Fiscal Year Beginning (mm/dd/yyyy) 0 1 i i i 0 1 1 /2013 and Ending(mm/dd/yyyy) I Name of Organization: Employer Identification Number (EIN) Check if Applicable: Clinton Health Access lnitiative,lnc. I 21 I I 1 1 4 1 1141614161 Address Change Mailing Address: Name Change NY RegistrationNumber: I I 1 I -8 383 Dorchester Avenue, Suite 400 Initial Filing 2 - I ' I I :ity / State / Zip: Final Filing Amended Filing Reg ID Pending your organization's ation category: Boston, MA 02127 (617) 774-0110 http://www.clintonhealthaccess.org/ Email: contractsdepartment@cIintonhealtl 7A only EPTL only EJ DUAL (7A & EPTL) EXEMPT Find your registration category in the Charities Registry at www.CharitiesNYS.com instructions for certification requirements. Improper certification is a violation of law that may be subject to penalties. We certify under penalties ofperjury that we reviewed this report, including all attachments, and to the best of our knowledge and belief, they are true, correct and complete in accordance with the laws of the State of New York applicable to this report. President or Authorized Officer: Chief Financial Officer or Treasurer: C nature Chief Executive Officer Chief Financial Officer Title / Date the exemption(s) that apply to your filing. If your organization is claiming an exemption under the category (7A and EPTL only filers) or both ries (DUAL filers) that apply to your registration, complete only parts 1, 2, and 3, and submit the certified Char500. No fee, schedules, or additional ments are required. If you cannot claim an exemption or are a DUAL filer that claims only one exemption, you must file applicable schedules and ments and pay applicable fees. 3a. 7A filing exemption: Total contributions from NY State including residents, foundations, government agencies, etc. did not exceed $25,000 and the organization did not engage a professional fund raiser (PFR) or fund raising counsel (FRC) to solicit contributions during the fiscal year. Or the organization qualifies for another 7A exemption (see instructions). 3b. EPTL filing exemption: Gross receipts did not exceed $25,000 and the market value of assets did not exceed $25,000 at any time during the fiscal year. Seethe following page for a checklist of schedules and attachments to complete your filing. See the checklist on the next page to calculate your fee(s). Indicate fee(s) you are submitting here: Yes n No 4a. Did your organization use a professional fund raiser, fund raising counsel or commercial co-venturer for fund raising activity in NY State? If yes, complete Schedule 4a. Yes No 4b. Did the organization receive government grants? If yes, complete Schedule 4b. 7A filing fee: $ 25 EPTL filing fee: $_____________ CHAR500 Annual Filing for Charitable Organizations (Updated June 2014) Total fee: $ 25 Make a single check or money order payable to: "Department of Law" Page 1 CHAR500 Annual Filing Checklist Simply submit the certified CHAR500 with no fee, schedule, or additional attachments IF: - Your organization is registered as 7A only and you marked the 7A filing exemption in Part 3. - Your organization is registered as EPTL only and you marked the EPTL filing exemption in Part 3. - Your organization is registered as DUAL and you marked both the 7A and EPTL filing exemption in Part 3. II %0hecklist of Schedules1and Atta c hments Check the schedules you must submit with your CHAR500 as described in Part 4: If you answered 'yes" in Part 4a, submit Schedule 4a: Professional Fund Raisers (PFR), Fund Raising Counsel (FRC), Commercial Co-Venturers (CCV) RX If you answered "yes" in Part 4b, submit Schedule 4b: Government Grants Check the financial attachments you must submit with your CHAR500: IRS Form 990, 990-EZ, or 990-PF, and 990-T if applicable All additional IRS Form 990 Schedules including Schedule B (Schedule of Contributors). IRS Form 990-T if applicable If you are a 7A only or DUAL filer, submit the applicable independent Certified Public Accountant's Review or Audit Report: Review Report if you received total revenue and support greater than $250,000 and up to $500,000. J Audit Report if you received total revenue and support greater than $500,000 No Review Report or Audit Report is required because total revenue and support is less than $250,000 Note: The Audit and Review requirements are set to change in 2017 and 2021 in accordance with the Non Profit Revitalization Act of 2013. For more details, visit www.CharitiesNYS.com . For 7A and DUAL filers, calculate the 7A fee: $0, if you marked the 7A exemption in Part 3a $25, if you did not mark the 7A exemption in Part 3a For EPTL and DUAL filers, calculate the EPTL fee: $0, if you marked the EPTL exemption in Part 3b Is my organization a 7A, EPTL or DUAL filer? - 7A filers are registered to solicit contributions in New York under Article 7-A of the Executive Law ('7A") - EPTL filers are registered under the Estates, Powers & Trusts Law ("EPTL") because they hold assets and/or conduct activites for charitable purposes in NY. - DUAL filers are registered under both 7A and EPTL. Check your registration category and learn more about NY law at www.CharitiesNYS.com $25, if the NET WORTH is less than $50,000 $50, if the NET WORTH is $50,000 or more but less than $250,000 $100, if the NET WORTH is $250,000 or more but less than $1,000,000 $250, if the NET WORTH is $1,000,000 or more but less than $10,000,000 $750, if the NET WORTH is $10,000,000 or more but less than $50,000,000 Where do I find my organization's NET WORTH? NET WORTH for fee purposes is calculated on: - IRS From 990 Part I, line 22 - IRS Form 990 EZ Part I line 21 - IRS Form 990 PF, calculate the difference between Total Assets at Fair Market Value (Part II, line 16(c)) and Total Liabilities (Part II, line 23(b)). $1500, if the NET WORTH is $50,000,000 or more Send your CHAR500, all schedules and attachments, and total fee to: NYS Office of the Attorney General Charities Bureau Registration Section 120 Broadway New York, NY 10271 CHAR500 Annual Filing for Charitable Organizations (Updated June 2014) Page 2 2013 CHAR500 Open to Public le 4a: Professional Fund Raisers, Fund Raising Counsels, Commercial Co-Venturers CharitiesNYS.com Inspection If you checked the box in question 4a in Part 4 on the CHAR500 Annual Filing for Charitable Organizations, complete this schedule for EACH Professional Fund Raiser (PFR), Fund Raising Counsel (FRC) or Commercial Co-Venturer (CCV) that the organization engaged for fund raising activity in NY State. Use additional pages if necessary. Include this schedule with your certified CHAR500 NYS Annual Filing for Charitable Organizations. 4 [1] - [11 -II] RegistrationNumber: Name of Organization: Clinton Health Access Initiative, Inc. . Iflfl 11MV11=7101fl flhETr 111 NY Registration Number: Fund Raising Professional type: Name of FRP: The Helen Brown Group LLC Professional Fund Raiser rXj Fund Raising Counsel 8121-17131 Telephone: 617-393-1983 48 Summer Street, Suite 2 Commercial Co-Venturer Watertown, MA 02472 C. Contract Informa Contract Start Date: 11/01/2011 . 12/31/2013 iN P4 I [1ku] ii ) &Services provided by FRP: The Helen Brown Group initatiates and provides professional prospect identification and research services on an as needed basis. arrangement with FRP: 72 hours of researcher's time at $5600 per month for 12 months, additional time at $150/hr unt Paid to $67,200 Yes nX No If services were provided by a CCV, did the CCV provide the charitable organization with the interim or closing report(s) required by Section 173(a) part 3 of the Executive Law Article 7A? A Professional Fund Raiser (PFR), in addition to other activities, conducts solicitation of contributions and/or handles the donations (Article 7A, 171-a.4). A Fund Raising Counsel (FRC) does not solicit or handle contributions but limits activities to advising or assisting a charitable organization to perform such functions for itself (Article 7A, 171 -a.9). A Commercial Co-Venturer (CCV) is an individual or for-profit company that is regularly and primarily engaged in trade or commerce other than raising funds for a charitable organization and who advertises that the purchase or use of goods, services, entertainment or any other thing of value will benefit a charitable organization (Article 7A, 171 -a.6). CHAR500 Schedule 4a: Professional Fund Raisers, Fund Raising Counsels, Commercial Co-Venturers (Updated June 2014) Page 1 CHAR500 Schedule 4b: Government Grants www.CharitiesNYS.com 2013 Open to Public Inspection If you checked the box in question 4b in Part 4 on the CHAR500 Annual Filing for Charitable Organizations, complete this schedule and list EACH government grant. Use additional pages if necessary. Include this schedule with your certified CHAR500 NYS Annual Filing for Charitable Organizations. me of Organization: NY Registration Number: 1 -8 2 - Clinton Health Access Initiative, Inc. Amount of Grant Name of Government Agency 1. Centers for Disease Control 1. 1,762,083 2. USAID 2. 174,020 3. 3. 4. 4. 5. 5. 6. 6. 7. 7. 8. 8. 9. 9. 10. 10. 11. 11. 12. 12. 13. 13. 14. 14. 15. 15. Total Government Grants: Total: CHAR500 Schedule 4b: Government Grants (Updated June 2014) 1,936,103 Page 1 Fm IRS e-file Signature Authorization for an Exempt Organization 8879E0 For cafendar year 2013, or and ending 2013 20 - Do not send to the IRS. Keep for your records. Department of theTrearuty Name of exempt facet year beginning OMB NO. 1545.1878 identification -1414646 Name and title of officer JULIE B FEDER CFO Part I I Type of Return and Return Information (whole Dollars Only) Check the box for the return for which you are using this Form 8879-EO and enter the applicable amount, If any, from the return. If you check the box on line lo, 2a, 3a, 4a, or 5a, below, and the amount on that line for the return being filed with this form was blank, then leave line tb, 2b, 3b, 4b, or Sb, whichever Is applicable, blank (do not enter .0.). But, If you entered -O• on the return, then enter .0 . on the applicable line below. Do not complete more than 1 line in Part I. I to Form 990 check here b Total revenue, it any (Form 990, Part VIII, column (A), line 12),,., ........ _ ....... [] 2a Form 990.EZ check here El b Total revenue, if any (Form 990-EZ, line 9) .......................................... 3a Form 1 120-POL check here No . [J b Total tax (Form 1 120-POL line 22) ................................................ 4a Form 990-PF check here ED b Tax based on Investment Income (Form 990-PF, Part VI, line 5) 5a Form 8868 check here b Balance Due (Form 8868, Part I, tine Sc or Part II, line Bc) ....................... I Part II I lb 117439074 2b 3b 4b Sb Declaration and Signature Authorization of Officer Under penalties of perjury, I declare that I am an officer of the above organization and that I have examined a copy of the organization's 2013 electronic return and accompanying schedules and statements and to the best of my knowledge and belief, they are true, correct, and complete. I further declare that the amount in Part I above is the amount shown on the copy of the organization's electronic return. I consent to allow my Intermediate service provider, transmitter, or electronic return originator (ERO) to send the organization's return to the IRS and to receive from the IRS (a) an acknowledgement of receipt or reason for rejection of the transmission, (b) the reason for any delay in processing the return or refund, and (c) the date of any rotund. If applicable, I authorize the U.S. Treasury and its designated Financial Agent to Initiate an electronic funds withdrawal (direct debit) entry to the financial institution account indicated In the tax preparation software for payment of the organization's federal taxes owed on this return, and the financial Institution to debit the entry to this account. To revoke a payment, I must contact the U.S. Treasury Financial Agent at 1 .888.3534537 no later than 2 business days prior to the payment (settlement) date. I also authorize the financial institutions involved In the processing of the electronic payment of taxes to receive confidential information necessary to answer Inquiries and resolve issues related to the payment. I have selected a personal identification number (PIN) as my signature for the organization's electronic return and, if applicable, the organization's consent to electronic funds withdrawal. Officer's PIN: check one box only Eli lauthorize CBI TOFIAS 14646 to enter my PINt I Enter five numbers, but do not enter all zeros ERO firm name as my signature on the organization's tax year 2013 electronically filed return. If I have Indicated within this return that a copy of the return Is being filed with a state agency(ies) regulating charities as part of the IRS Fed/State program, I also authorize the aforementioned ERO to enter my PIN on the return's disclosure consent screen. As an officer of the organization, I will enter my PIN as my signature on the organization's tax year 2013 electronically filed return. Ill have indicated within this return that a copy of the return is being filed with a state agency(ies) regulating charities as part of the IRS Fed/State program, 1 will ejter my PIN pp the gatump disclosure consent screen. Officer's signature Date ERO's EFIN/PIN. Enter your six-digit electronic filing identification number (EFIN) followed by your five-digit self-selected PIN. I 04737791068 I do not enter all zero. I certify that the above numeric entry Is my PIN, which is my signature on the 2013 electronically filed return for the organization Indicated above. I confirm that I am submitting this return in accordance with the requirements of Pub. 4163, Modernized e-File (MF) Information for Authorized IRS c-life Providers for Business Returns. ERO's signature IN- Date 7/cl ERO Must Retain This Form - See Instructions Not Submit This Form To the IRS Unless Requested To Do So LHA For Paperwork Reduction Act Notice, see instructions. FOfrn 8879-EO (2013) 10-01.13 08580709 756948 25760.001 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01 Return of Organization Exempt From Income Tax 990 Form Department of the Treasury Internal Revenue Service A For the 2013 calendar year, or tax year beginning applicable: ]i El1 open to Public Inspection -D Employer identification number CLINTON HEALTH ACCESS INITIATIVE, I: Name J chang Initial return E _^ F - C Name of organization B check if 1 Under section 501(c), 527, or 4947(aXl) of the Internal Revenue Code (except private foundations) Do not enter Social Security numbers on this form as It may be made public. e 27-1414646 Doing Business As P.O. box if mail is not delivered to street address) 383 DORCHESTER AVENUE Number and street (or Amend ed return JglIca. pendng City or town, state or province, country, and ZIP or foreign postal code BOSTON, MA 02127 F Name and address of principal officer: IRA C. I Trust MAGAZINER (Insert no.) Li 4 Room/suite E Telephone number 617-774-0110 400 117 450 463 , , G H(a) Is this a group return for subordinates? ...... Li:]Yes []No ________ H(b) Are all subordinates Included? [] Yes [I] No If 'No," attach a list. (see instructions) or 527 Gross receipts $ Other Part It Summary GOVERNMENTS TO BUILD AND STRENGTHEN INTEGRATED HEALTH SYSTEMS IN THE DEVELOPING WORLD AND . T-1 Briefly describe the organization's mission or most si gnificant activities: SUPPORT 2 Check this box 00 . 0 if the organization discontinued its operations or disposed of more than 25% of its net assets. 3 I Number of voting members of the governing body (Part VI, line 1 a) ............................................................. 9 7 307 1 ........................4.. 4 Number of independent voting members of the governing body (Part VI, line 1 b) 5 Total number of Individuals employed in calendar year 2013 (Part V. line 2a) ................................................ .....................................................................6 6 Total number of Volunteers (estimate if necessary) ....................................................7 7 a Total unrelated business revenue from Part VIII, column (C), line 12 7 b Net unrelated business taxable income from Form 990-T, line 34 Contributions and grants (Part VIII, line lh) ............................................................... 9 Program service revenue (Part VIII, line 2g) ............................................................... 10 Investment income (Part VIII, column (A), lines 3,4, and 7d) ....................................... .................... 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and lie) 12 Total revenueS add lines 8 through 11 (must equal Part VIII, column (A), line 12) 51 - 0 -0. 8 C a, a, 13 Grants and similar amounts paid (Part IX, column (A), lines 1-3) ................................. ............................. 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) ..... 16a Professional fundraising fees (Part IX, column (A), line lie) .................................... to Total fund raising expenses (Part IX, column (0), line 25) , .................................. 17 Other expenses (Part IX, column (A), lines 11a1 id, ilf.24e) 0. 0. 98,029. 129,444. 148,563. 38,717. 8,695,247. 117,439,074. 6.416.733. 10,948.408. 14 Benefits paid to or for members (Part IX, column (A), line 4) U) C a, 0. 899 558. 59,500. 18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) ..................... 3,270,412. 6,970,166. 19 Revenue less exoenses. Subtract tine 18 from line 12 ................................................ 1,725,081. 20 Total assets (Part X, line 16) 21 Total liabilities (Part X, line 26) 8.838.138. tTsI.P 1 ning of Current Year Part II Signature Block Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge. Sign Signature of officer Here JULIE B. FEDER, CFO Date Type or print name and title Print/Type preparer's name Paid C RAIG t P7eparer's signature KLEIN Preparer Firm'sname b, CBIZ TOFIAS Use Only Firm's address 500 BOYLSTON STREET BOSTON. MA 02116 332001 10-20-13 Date ched If I set-emoyd PTIN 1P007 34640 Firm'sEINb, 26-3753134 Phone no.617-761-0600 LHA For Paperwork Reduction Act Notice, see the separate instructions. SEE SCHEDULE 0 FOR ORGANIZATION MISSION STATEMENT CONTINUATION Form 990(2013) Form 9 gO(2013) CLINTON HEALTH ACCESS INITIATIVE, INC. Part Ill Statement of Program Service Accomplishments 1 Check if Schedule 0 contains a response or note to any line in this Part Ill Briefly describe the organization's mission: 27-1414646 Page2 .................................................................................... THE CLINTON HEALTH ACCESS INITIATIVE (CHAI) WAS FOUNDED IN 2002 BY PRESIDENT BILL CLINTON AND IRA MAGAZINER TO PROVIDE SOLUTIONS TO THE BIGGEST CHALLENGES IMPEDING EFFECTIVE HEALTH CARE DELIVERY IN DEVELOPING COUNTRIES. SEE SCHEDULE 0. 2 Did the organization undertake any significant program services during the year which were not listed on the prior Form 990 or 990' EZ? ElVes i:i1 No If "Yes, describe these new services on Schedule 0. 3 Did the organization cease conducting, or make significant changes in how it conducts, any program services?EJVes Eli No If 'Yes," describe these changes on Schedule 0. 4 Describe the organization's program service accomplishments for each of Its three largest program services, as measured by expenses. Section 501 (c)(3) and 501 (c)(4) organizations are required to report the amount of grants and allocations to others the total expenses, and revenue, If any, for each program service reported. 4a (code: __________ ) (Expenses $ 29 , 686 , 378 . including grants of $ 2 , 586 , 770 . ) ( Revenues HIV/AIDS: CHAI IS WORKING TO SCALE-UP ADULT AND PEDIATRIC HIV/AIDS AND TB PREVENTION, CARE, AND TREATMENT IN THE HARDEST HIT COUNTRIES, INCREASE THE SURVIVAL RATES OF INDIVIDUALS ON TREATMENT GLOBALLY, REDUCE TRANSMISSION RATES AND LOWER THE COST OF TREATMENT AROUND THE WORLD, INCLUDING OPPORTUNISTIC INFECTIONS. 4b (code: _________ ) (Expenses $ 4c (code: ___________ ) (Expenses $ 18,324,309. including grants 013 3,722,193. ) ( Revenue $ MATERNAL AND CHILD HEALTH: CHAI FOCUSES ON STRENGTHENING SYSTEMS NECESSARY TO REDUCE MATERNAL AND NEONATAL MORTALITY IN TARGETED COUNTRIES WHERE CHAI IS ALREADY SUPPORTING GOVERNMENTS TO IMPROVE KEY COMPONENTS OF THE CORE HEALTH SYSTEM, CHAI HELPS TO RESOLVE THE SYSTEMIC WEAKNESSES THAT UNDERMINE THE COVERAGE AND QUALITY OF INTERVENTIONS PROVEN TO REDUCE MATERNAL AND NEONATAL MORTALITY. FOCUSING INTERVENTIONS WILL INCLUDE EMERGENCY OBSTETRIC CARE AND THE INCREASED USE AND SUPPORT OF MIDWIVES. CHAI SIMULTANEOUSLY WORKS WITH GOVERNMENTS OF THE HIGHEST-BURDEN COUNTRIES TO DEVELOP AND IMPLEMENT INTENSIVE NEW PROGRAMS TO EXPAND ACCESS TO ZINC AND ORAL REHYDRATION SOLUTIONS - AND NEW EFFECTIVE DRUGS AS THEY BECOME AVAILABLE - FOR THE TREATMENT OF DIARRHEA, ONE OF THE MAJOR KILLERS OF CHILDREN UNDER FIVE. 22 , 310, 968. including grants of 5 1 , 421, 995. ) (Revenue S GLOBAL HEALTH SPENDING: CHAI IS WORKING AROUND THE WORLD TO INCREASE THE EFFICIENCY AND EFFECTIVENESS OF GLOBAL HEALTH SPENDING TO MOVE TOWARDS MORE SUSTAINABLE FINANCING SYSTEMS AND REDUCE FINANCIAL BARRIERS PREVENTING ACCESS TO ESSENTIAL HEALTH SERVICES. 4d Other program services (Describe in Schedule 0.) (Expenses$ 28, 811 ,915. including grants of$ 4e Total program service expenses ' 332002 10-29-13 08580709 756948 25760.001 3,217,450.) (RevenueS 99 ,133 , 570. Form 990 (2013) 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01 [c] Part IV I Checklist of 1 Is the organization described in section 501 (c)(3) or 4947(a)(1) (other than a private foundation)? ........................................................................................................................ If 'yes, • complete Schedule A ......................................................... 2 Is the organization required to complete Schedule B, Schedule of Contributors? 3 Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for ......................................................................................... public office? If 'Yes, complete Schedule C, Part! 4 Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If 'Yes,' complete Schedule C, Part!! ................................................................................................... 5 Is the organization a section 501 (c)(4), 501 (c)(5), or 501 (c)(6) organization that receives membership dues, assessments, or ......... similar amounts as defined in Revenue Procedure 98-19? If 'Yes," complete Schedule C, Part Ill 6 Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If 'Yes, complete Schedule D, Part! X 7 Did the organization receive or hold a conservation easement, including easements to preserve open space, .............. the environment, historic land areas, or historic structures? If 'Yes,' complete Schedule D, Part!! 8 Did the organization maintain collections of works of art, historical treasures, or other similar assets? If 'Yes" complete Schedule D, Part Ill 9 Did the organization report an amount in Part X, line 21, for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? ..................................................................................................... If 'Yes,' complete Schedule 0, Part IV 10 Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent .............................................................. endowments, or quasi-endowments? If 'Yes,' complete Schedule 0, Part V 11 If the organization's answer to any of the following questions is "Yes,' then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable. a Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If 'Yes, complete Schedule 0, Part W b Did the organization report an amount for investments - other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes,' complete Schedule 0, Part VI! ........................................................................... o Did the organization report an amount for investments . program related in Part X, line 13 that is 5% or more of its total ..................................... assets reported in Part X, line 16? If "Yes,' complete Schedule 0, Part VIII ji 11c d Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes,' complete Schedule D, Part IX ...................................................................................................... e Did the organization report an amount for other liabilities in Part X, line 25? If 'Yes,' complete Schedule D, Part X f Did the organization's separate or consolidated financial statements for the tax year include a footnote that addresses ... the organization's liability for uncertain tax positions under FIN 48 (ASC 740)? If 'Yes,' complete Schedule 0, Part X 12a Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete ..................................................................................... Schedule D, Parts XI and XII Was the organization included in consolidated, independent audited financial statements for the tax year? .. If 'Yes,' and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional 13 Is the organization a school described in section 1 70(b)(i)(A)(ii)? If 'Yes,' complete Schedule E .................. 14a Did the organization maintain an office, employees, or agents outside of the United States? b Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 .................................................................................................... or more? If "Yes," complete Schedule F, Parts land IV 15 Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If 'Yes,' complete Schedule F, Parts II and IV 16 Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to ......................................................................... or for foreign individuals? If 'Yes," complete Schedule F, Parts III and IV 17 Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, ...................................................................... column (A), lines 6 and lie? If 'Yes,' complete Schedule G, Part! 18 Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines ......................................................................................................... 1c and Ba? If 'Yes,' complete Schedule G, Part II 19 Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If 'Yes,' X ....................................................................................................... complete Schedule G, Part III ........................................... 20a Did the organization operate one or more hospital facilities? If "Yes,' complete Schedule H If 'Yes' to line 20a. did the oroanization attach a coov of its audited financial statements to this return? .............................. Form 990(2013) 332003 10-29-13 08580709 756948 25760.001 3 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01 21 Did the organization report more than $5,000 of grants or other assistance to any domestic organization or government on Part IX, column (A), line 1? If 'Yes," complete Schedule!, Parts land!! 22 Did the organization report more than $5000 of grants or other assistance to individuals in the United States on Part IX, column (A), line 27 If 'Yes, complete Schedule!, Parts land!!! 23 Did the organization answer "Yes' to Part VII, Section A, line 3, 4, or 5 about compensation of the organization's current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes, complete Schedule J 24a Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If "Yes, answer lines 24b through 24d and complete Schedule K. If "No", go to line 25a Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception? ................................. Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease any tax-exempt bonds? Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year? 25a Section 501(cX3) and 501(cfl4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year"? If Yes," complete Schedule L, Part! b Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization's prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part! X 26 Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If so, complete Schedule L, Part II 27 Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes,' complete Schedule L, Part I!! 28 Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions): a A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV b A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV 29 Did the organization receive more than $25,000 in non-cash contributions? If 'Yes," complete Schedule M 30 Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation C X contributions? If 'Yes," complete Schedule M 31 Did the organization liquidate, terminate, or dissolve and cease operations? If 'Yes," complete Schedule N, Part! 32 Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets?!! "Yes," complete Schedule N, Part!! 33 Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If 'Yes,'complete Schedule R, Part! 34 Was the organization related to any tax-exempt or taxable entity? If "Yes, complete Schedule R, Part II, I!!, or IV, and Part V, line l 35a Did the organization have a controlled entity within the meaning of section 512(b)(13)? b If 'Yes" to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If 'Yes," complete Schedule A, Part V, line 2 36 Section 501(cX3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes,' complete Schedule A, Part V, IThe 2 37 Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes,' complete Schedule R, Part VI 38 Did the organization complete Schedule 0 and provide explanations in Schedule 0 for Part VI, lines 11 b and 19? Form 990 (2013) 232004 10-29-13 08580709 756948 25760.001 4 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01 Form 990 (2013) 27-1414646 CLINTON HEALTH ACCESS INITIATIVE, INC. Page5 Part V I Statements Regarding Other IRS Filings and Tax Compliance Check if Schedule 0 contains a response or note to any line in this Part V I 4 Enter the number reported In Box 3 of Form 1096. Enter -0- If not applicable .................................Ia .......................lb b Enter the number of Forms W-2G included in line la. Enter -0- if not applicable c Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ................................................................................................................................ la 2a Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements, I I iUI filed for the calendar year ending with or within the year covered by this return ..............................I 2a I X ........... 2b b If at least one is reported on line 2a, did the organization file all required federal employment tax returns? Note. If the sum of lines la and 2a is greater than 250, you may be required to e-file (see instructions) ................................. 3a Did the organization have unrelated business gross Income Of $1,000 or more during the year? .......................................... .- it ............................. 3b - b If "Yes," has filed a Form 990-1 for this year? If No," to line 3b, provide an explanation in Schedule 0 4a At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a .............4a I X financial account in a foreign country (such as a bank account, securities account, or other financial account)? b If "Yes," enter the name of the foreign country: SEE SCHEDULE 0 See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts. .................................. 5a 5a Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? b Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction? ...........................Sb .......................................................................................... so c If "Yes," to line 5a or 5b, did the organization file Form 8886-1? - - X - - 6a Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit6a any contributions that were not tax deductible as charitable contributions? .......................................................................... X - b If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts werenot tax deductible? .................................................................................................................................................... 7 Organizations that may receive deductible contributions under section 170(c). a Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? 7a - X b If "Yes," did the organization notify the donor of the value of the goods or services provided? .............................................. 7b c Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required tofile Form 8282? .......................................................................................................................12... 7d d If "Yes," indicate the number of Forms 8282 filed during the year ............................................... e Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? ......................7e I X f Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..........................7f - X g If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? .. h If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098 .C? 7h - 8 Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year? 8 - 9 Sponsoring organizations maintaining donor advised funds. a Did the organization make any taxable distributions under section 4966? ................................................................................ - b Did the organization make a distribution to a donor, donor advisor, or related person? .......................................................... 9b - 10 Section 501(c)(7) organizations. Enter: a Initiation fees and capital contributions included on Part VIII, line 12 .................................... . ........ . IDa b Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities ...................lOb 11 Section 501(c)(12) organizations. Enter: ............................................................................ I Ia a Gross income from members or shareholders b Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) .......................................................................................... I lib I 12a Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041? b If 'Yes," enter the amount of tax-exempt interest received or accrued during the year ------------------- 12b I 13 Section 501(c)(29) qualified nonprofit health insurance issuers. a Is the organization licensed to issue qualified health plans In more than one state? ................................................. Note. See the instructions for additional Information the organization must report on Schedule 0. b Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ................................................................ 13b c Enter the amount of reserves on hand ......................................................................................... 13c ..................................... 14a Did the organization receive any payments for indoor tanning services during the tax year? Form 990(2013) 332005 10-29-13 08580709 756948 25760.001 5 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01 Form 990 (2013) I Part CLINTON HEALTH ACCESS INITIATIVE, INC. 27-1414646 Page For each "Yes" response to lines 2 through 7b below, and bra "No' response to line 8a, 8b, or lOb below, describe the circumstances, processes, or changes in Schedule 0. See instructions. VI Governance, Management, and Disclosure Check if Schedule 0 contains a response or note to any line in this Part VI Section A. Governing Body and Management ................................................................................. I la Enter the number of voting members of the governing body at the end of the tax year ................... la If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule 0. b Enter the number of voting members included in line 1 a, above, who are independent ...............lb 2 Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? 3 Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors, or trustees, or key employees to a management company or other person? ......................................... 4 Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? 5 Did the organization become aware during the year of a significant diversion of the organization's assets? 6 Did the organization have members or stockholders? 7a Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? b Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? 8 Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following: aThe governing body? ......................................................................................................................................................... b Each committee with authority to act on behalf of the governing body? 9 Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the about lOa Did the organization have local chapters, branches, or affiliates? b If 'Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ha Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? b Describe in Schedule 0 the process, if any, used by the organization to review this Form 990. 12a Did the organization have a written conflict of interest policy? If "No," go to line 13 b Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? .................. c Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes, • describe in Schedule 0 how this was done . 13 Did the organization have a written whistleblower policy? 14 Did the organization have a written document retention and destruction policy? 15 Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision? a The organization's CEO, Executive Director, or top management official b Other officers or key employees of the organization If 'Yes' to line 15a or 15b, describe the process in Schedule 0 (see instructions). 16a Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? b If "Yes,' did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization's Section C. Disclosure 17 Ust the states with which a copy of this Form 990 is required to be filed 00-AR, CA, CT, FL, IL, MA, NJ, NY, PA, RI 18 Section 6104 requires an organization to make its Forms 1023 (or 1024 if applicable), 990, and 990 .T (Section 501 (c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply. Own website Another's website ii Upon request Other (explain in Schedule 0) 19 Describe in Schedule 0 whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year. El fl 20 State the name, physical address, and telephone number of the person who possesses the books and records of the organization: JULIE B. FEDER - 617-774-0110 383 DORCHESTER AVENUE, #400, BOSTON, MP 02127 33200 10-29.13 Form 990 (2013) 6 08580709 756948 25760.001 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01 -1414646 Paoe7 Part VII j Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors EI ............................................................... Check if Schedule 0 contains a response or note to any line in this Part VII Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization's tax year. la • List all of the organization's current officers, directors, trustees (whether individuals or organizations), regardless of amount of compensation. Enter 0 in columns (D), (E), and (F) if no compensation was paid. • List all of the organization's current key employees, if any. See instructions for definition of 'key employee.' • List the organization's five current highest compensated employees (other than an officer, director, trustee, or key employee) who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the organization and any related organizations. • List all of the organization's former officers, key employees, and highest compensated employees who received more than $100,000 of reportable compensation from the organization and any related organizations. • List all of the organization's former directors or trustees that received, in the capacity as a former director or trustee of the organization, more than $10,000 of reportable compensation from the organization and any related organizations. List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest compensated employees; and former such persons. El Check this box if neither the organization rinr any related nrganization compensated any current officer, d i rector, or trustee. (A) Name and Title (B) (C) Position Average (do not theöc more than one hours per box,unless person is both an ctorIthte officer week (list any hours for related N organizations below 2 ti line) (D) Reportable compensation from the organization (W.2/1 099-MISC) (E) Reportable compensation from related organizations (W.2/1 099-MISC) (F) Estimated amount of other compensation from the organization and related organizations (1) WILLIAM J. CLINTON lip (2) BRUCE LINDSEY BOARD MEMBER (3) PAUL FARMER BOARD MEMBER (4) RAYMOND CHAMBER II 'Is 'I _ (5) CHELSEA CLINTON II _ (6) MAGGIE WILLAIMS BOARD MEMBER (7) MALA GAONKAR (8) TACHI YAMADA "I II "I II I,' U. _ _ 0. 0 0. 0 0. 0 0. 0 0. 0 _ (9) IRA MAGAZINER (10) MUSTAPHA LEAVENWORTH BAKALI nfl., III 'SI 'IS III SI, (11) JULIE B. FEDER (12) JEANNE BROSNAN (13) DAVID RIPIN (14) ALICE KANGETHE EXECUTIVE VICE PRES (15) OWENS WIWA (16) KELLY MCCRYSTAL INNINIM _ 111101M 1111NIM 8,266. 0 REDWA 3,452. 0 4,846. 0 3,712. 0 .1 17.292. 5,808. 0 0.000. 0 0.1 14.4 Form 990(2013) 332007 10-29-13 08580709 756948 25760.001 7 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01 27-1414646 (A) Name and title lb (B) (C) Position Average (do not check more than one hours per unlessperson is both an officer and adcreOtor/trustee) week (list any hours for 'a related a organizations below line) - Sub-total ................................................................................................... (D) Reportable compensation from the organization (W-211 099-MISC) (continued) (E) Reportable compensation from related organizations (W-2/1 099-MISC) 306. c Total from continuation sheets to Part VII, Section A .............................. d Total (add lines lb and Ic) .................................... ..................................... I 1,607,306.1 379,30 2 Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable '4 • Page (F) Estimated amount of other compensation from the organization and related organizations -. I I l .1 a 0. 0. 0.1 175.591. rnrnnnnotinn 1mm Ihnnrn-..-4t..., - No 3 Did the organization list any former officer, director, or trustee, key employee, or highest compensated employee on line 1 a? If "Yes," complete Schedule J for such individual ............................................................................................ 4 For any Individual listed on line la, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If 'Yes,' complete Schedule J for such individual ...................................... 5 Did any person listed on line la receive or accrue compensation from any unrelated organization or individual for services +k- is " II C'L.JI a g_. Section B. Independent Contractors I Complete this table for your live highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year endinct with or within the oraanization's tax year. (A) (B) (C) Name and business address Description of services Compensation IDINSIGHT 789 COLRAIN ROAD, GREENFIELD, NA 01301 CENTRE FOR ENVIRONMENT, NO. 19 OKOMOKO, SUDEHI COMPANY INTERNATIONAL, SUITE 3, NO. CONTINENTAL RESEARCH, BLOCK A, NO. 11 BtJMBUNA ST., WUSE ZONE 1, FCT, NIGERI COMMUNITY HEALTH AND RESEARCH S SI ONAL ['HCARE SERV] S SI ONAL PHCARE SERV] S SI ONAL ['HCARE SERV] S SI ONAL ['HCARE SERV] S S IONAL 683,126. 623,614. 595,267. 456,943. 382,311. 2 Total number of independent contractors (including but not limited to those listed above) who received more than 332008 10-2913 08580709 756948 25760.001 Form 990 (2013) 8 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01 27-1414646 Page Form 99Q(2013) CLINTON HEALTH ACCESS INITIATIVE, INC Part VIII I Statement of Revenue Check if Schedule 0 contains a response or note to any line in this Part VIII ........................................................................... Total revenue 9 0 L_ Co Related or exempt function revenue ijevenue from ta s ecti 512 - tinrèlàted business revenue I a Federated campaigns .................. ______________ b Membership dues ........................ .______________ c Fundraising events ......................_______________ d Related organizations .id 2,000 000 e Government grants (contributions) le 55.858.566 I All other contributions, gifts, grants, and similar amounts not included above If 59 .412.347 g Noncash contributions included In lines la-If: $ o h Total. Add lines la-if Business Cod 2a b vJc ea o CL - w cc C d e I All other program service revenue ................ ____________ g Total. Add lines 2a-2f Investment income (including dividends, interest, and 3 other similar amounts) ........................................... Income from investment of tax-exempt bond proceeds 4 Royalties ..................................................................... 5 F (ii Real I flil Personal 6 a Gross rents b Less: rental expenses c Rental income or (loss) d Net rental income or oss) ..........................................I (ii) Other 7 a Gross amount from sales of (I) Securities assets other than inventory 45.6! b Less: cost or other basis and sales expenses ......... 11. 3 c Gain or (loss) 34 d Net gain or (loss) .........................................................I 8 a Gross income from fundraising events (not including $ of contributions reported on line ic). See Part IV,line l8a ________ b Less: direct expenses .............................. b c Net income or (loss) from fundraising events ...............I 9 a Gross income from gaming activities. See Part IV, line 19 a b Less: direct expenses .................. ......... b c Net income or (loss) from gaming activities .................. I 10 a Gross sales of inventory, less returns and allowances a b Less: cost of goods soldb II a b OTHER REVENUE 900099 1 38.717. 38.717. C d All other revenue e Total. Add lines lia-lid 11111.38.717._ Total revenue. See instructions ........................................ 12 0. fl7439,074 0 33200Y 10-29.13 08580709 756948 25760.001 168. 161. Form 9 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01 Form g9O(2013) CLINTON HEALTH Part IX I Statement of Functional Expenses ACCESS INITIATIVE, INC. 27-1414646 Section 501(c)(3) and 501(c) (4) organizations must complete all columns. All other organizations must complete column (A). Check if Schedule 0 contains a response or note to any line in this Part IX (A) (B) (C) Do not include amounts reported on lines 6b, Total expenses ram service Management and 7h Ph Oh nd ITh .,f D I/Ill I I 1 Grants and other assistance to governments and organizations In the United States. See Part IV, tine 21 2 Grants and other assistance to individuals in PagelO (1)) Fundraising I El 5.1 1.780.885. the United States, See Part IV, line 22 ......... .3 Grants and other assistance to governments, organizations, and individuals Outside the United States. See Part IV, lines 15 and 16 4 Benefits paid to or for members 5 Compensation of current officers, directors, trustees, and key employees 6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) 7 Other salaries and wages 8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) 9 Other employee benefits 10 Payroll taxes 11 Fees for services (non-employees): a Management bLegal c Accounting d Lobbying .- 167.523. 065. .- 736. 34,012 057. 904. .- ................................................ .- 1,584 5.389 ..- .- ............................................. 3. 2. ............................................................ .- e Professional fundraising services. See Part IV, line 17 f Investment management fees g Other. (If line I ig amount exceeds 10% of line 25, column (A) amount, list tine 1 lg expenses on Sch 0.) 12 Advertising and promotion ..13 Office expenses 25,763. 28,402. 29,924. 79,450. 57,108 1 46,165. 44,851.1 05.330.1 7,200. 2.40 67,200. 278. 216,852. 10,600. 905. 245,852. 8,552. 700. 286.954. 14 Information technology ............................................... .- 15 Royalties ....... 16 Occupancy ............ .................................... ..17 Travel 18 Payments of travel or entertainment expenses for any federal, state, or local public officials 19 Conferences, conventions, and meetings .20 Interest .- ......................................................... 67,564. I 74.711. 057 .................................... .- 21 Payments to affiliates 22 Depreciation, depletion, and amortization ...... ....................................................23 Insurance 24 Other expenses. Itemize expenses not covered above. (List miscellaneous expenses in line 24e. If line 240 amount exceeds 10% of tine 25, column (A) amount, fist line 24e expenses on Schedule 0.) ...... .- a DIRECT PROGRAM EXPENSE b CAPITAL CHARGES c TELEPHONE d PROCUREMENT & SHIPPING - e All other expenses cm 084. 233. 191. 168. 837. 6,636,846. 3,962,233. 1,714,443. 1,668,868. 1,681.831. Check hero 0, [1] If following SOP 8 .2 (ASC 958720) - 332010 10-29.13 08580709 756948 25760.001 1.707. 458.2 25 Total functional expenses. Add lines 1 -ithrough 24e 10 0 26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. - 10 Form 990(2013) 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01 -1414646 to I Cash- non-interest-bearing . 2 Savings and temporary cash investments ...................................................... 3 Pledges and grants receivable, net .............................................................. ....................................................................... 4 Accounts receivable, net 5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete .................................................................................. PartII of Schedule L 6 Loans and other receivables from other disqualified persons (as defined under section 4958(t)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instr). Complete Part II of Sch L 0 01 ............. Inventories for sale or use .............................................................................. ...................... Prepaid expenses and deferred charges 8 9 ba Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D ....... .bOa Less: accumulated depreciation ------------------- lOb b Investments- publicly traded securities 11 1,985,927 1,775,130 ...................... ..................... 12 Investments - other securities. See Part IV, line 11 13 Investments program-related. See Part IV, line 11 14 Intangible assets .......................................................................................... ...................... 15 Other assets. See Part IV, line 11 0 U 4.0 10 -J CO ............................................ Accounts payable and accrued expenses ...................................................... 18 Grantspayable 19 Deferred revenue 20 Tax-exempt bond liabilities ........................................................................... Escrow or custodial account liability. Complete Part IV of Schedule D ........... 21 22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified persons. 4U 10,524,428. 9,331,223. 787 .924. 61 7 215. 8 9 638,419. 683. lOc 210,797. 12 789. 13 14 15 61.754.028. 1.526.701.1 19 I 38.11 Complete Part II of Schedule L 27 28 29 C Z - ..... 23 Secured mortgages and notes payable to unrelated third parties 24 Unsecured notes and loans payable to unrelated third parties ........................ 25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not Included on lines 17-24). Complete Part X of 30 31 32 33 037. ............................................................................................... Organizations that follow SFAS 117 (ASC 958), check here 110. LXJ and complete lines 27 through 29, and lines 33 and 34. Unrestricted net assets ................................................................................. Temporarily restricted net assets Permanently restricted net assets Organizations that do not follow SFAS 117 (ASC 958), check here U. U 3 (B) End of year ScheduleD UI U a C - Notes and loans receivable, net 7 17 (A) Beginning of year Page II -2.097.229. [1 *ED and complete lines 30 through 34. Capital stock or trust principal, or current funds ......................... Paid-in or capital surplus, or land, building, or equipment fund ....................... Retained earnings, endowment, accumulated income, or other funds Total net assets or fund balances .................................................................. Form 990(2013) 332011 10-29-13 08580709 756948 25760.001 11 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01 CLINTON HEALTH ACCESS INITIATIVE, INC. Part Xli Reconciliation of Net Assets Form 99O(2013) a 27-1414646 Page12 Part XI 1 Total revenue (must equal Part VIII, column (A), line 12) 2 Total expenses (must equal Part IX, column (A), line 25) 3 Revenue less expenses. Subtract line 2 from line 1 ....................................................................... 106,491,333. 10,947,741. 4 Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) 5 Net unrealized gains (losses) on investments 25,424,213. 6 Donated services and use of facilities 7 Investment expenses 8 Priorperiod adjustments ........................................................................................................................ 9 Other changes in net assets or fund balances (explain in Schedule 0) 10 Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, -153,440. 0. 36,218,514. Financial Statements and Reporting Check if Schedule 0 contains a resoonse or not I Yes r No I Accounting method used to prepare the Form 990: [II] Cash L] Accrual LI] Other If the organization changed its method of accounting from a prior year or checked "Other," explain in Schedule 0. 2a Were the organizations financial statements compiled or reviewed by an independent accountant? If "Yes," check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both: Separate basis Consolidated basis Both consolidated and separate basis b Were the organization's financial statements audited by an independent accountant? If "Yes," check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both: LIII Separate basis L1 Consolidated basis Both consolidated and separate basis LII fl c If Yes" to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? ......................................... If the organization changed either its oversight process or selection process during the tax year, explain in Schedule 0. 3a As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular Al 33? b If 'Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit - or audits, explain why in Schedule 0 and describe an y steDs taken to underno siirh audits Form 990(2013) 332012 10-29.13 08580709 756948 25760.001 12 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01 OMB No. 1545-0047 SCHEDULE A I (Form 990 or 990-EZ) I Department of the Treasury Internal Revenue Service I Name of the organization Public Charity Status and Public Support Complete if the organization is a section 501(c)(3) organization or a section 4947(aXl) nonexempt charitable trust. Open to Public Attach to Form 990 or Form 990-EZ. Inspection Information about Schedule A (Form 990 or 990-EZ) and its Instructions is at www.Irs.gov/t rrn990. I Employer identification number 9 1 7_1 Al LIfA (All organizations must this part.) See instructions. The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.) A church, convention of churches, or association of churches described in section 170{b)(1)(A)(i). 1 A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.) 2 A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(lii). 3 A medical research organization operated in conjunction with a hospital described in section 170(b)(1XA)(iii). Enter the hospitals name, El El El 6 7 El city, and state: An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.) A federal, state, or local government or governmental unit described in section 170(bH1XA)(v). An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(bX1)(A)( vi). (Complete Part IL) II- ioEl iiEl MW A community trust described in section 170(b){1)(A)(vi). (Complete Part II.) An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions -subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509{a)(2). (Complete Part Ill.) An organization organized and operated exclusively to test for public safety. See section 509(a)(4). An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(aR3). Check the box that describes the type of supporting organization and complete lines lie through 11 h. Type III- Non-functionally integrated Type Ill . Functionally integrated d Type I Type II b c a El El El El By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). If the organization received a written determination from the IRS that it is a Type I, Type II, or Type Ill ..................................................................................................................................... supporting organization, check this box Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons? Yes No (i) A person who directly or indirectly controls, either alone or together with persons described in (ii) and (iii) below, i ...................................................................................11 the governing body of the supported organization? El I h ...................................................................................11 ii (A ii) family member of a person described in (I) above? .................................................................1. Ig(llI) (A iii) 350A controlled entity of a person described in (i) or (ii) above? Provide the following information about the supported organization(s). (I) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1-9 above or IRC section (see Instructions)) LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. (yl) Is thein col. (vii) Amount of monetary ) Is the organization i (v) Did you notify the I organization Support I col. (I) listed in your organization in coT. (i) organized in the iverning document? I (i) of your support? U.S.? Yes I No I Yes I No I Yes I No Schedule A (Form 990 or 990-EZ) 2013 332021 09-25-13 08580709 756948 25760.001 13 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01 Schedule A (Form 9900r990.EZ)2013 CLINTON HEALTH ACCESS INITIATIVE, INC. 27-1414646 Part lI Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) Page2 (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part Ill. If the organization fails to qualify under the tests listed below, please complete Part Ill.) Section A. Public Sur,port Calendar year (or fiscal year beginning in) 1 Gifts, grants, contributions, and membership fees received. (Do not include any 'unusual grants.') FDII] 2 Tax revenues levied for the organ. ization's benefit and either paid to or expended on its behalf 3 The value of services or facilities furnished by a governmental unit to the organization without charge 4 Total. Add lines 1 through 3 337 5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (t) Section B. Total Support Calendar year (or fiscal year beginning in) 7 Amounts from line 4 .................... 8 Gross income from interest, dividends, payments received on 2009 2012 securities loans, rents, royalties and income from similar sources 9 Net income from unrelated business activities, whether or not the business is regularly carried on 403. 469.022. 10 Other income. Do not Include gain or loss from the sale of capital assets (Explain in Part 1 11 Total support. Add linesIV.)... 7 throgh 0 12 Gross receipts from related activities, etc. (see instructions) * ...... ** I 1 109, 811. 148,563. 38, ..................................................................... 12 I 13 First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) 14 115 16a 33 1/3% support test - 2013. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box and stop here. The organization qualifies as a publicly supported organization b 33 1/3% support test - 2012. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this box 14 Public support percentage for 2013 (line 6, column (0 divided byline 11, column (f)) 15 Public support percentage from 2012 Schedule A, Part II, line 14 % % and stop here. The organization qualifies as a publicly supported organization 17a 10% -facts-and-circumstances test - 2013. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in Part IV how the organization meets the "facts-and-circumstances' test. The organization qualifies as a publicly supported organization b 10% -facts-and-circumstances test -2012. If the organization did not check a box on line 13,16a, 16b, or 17a, and line 15 is 10 0/0 or El more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization LI 18 Private foundation. If the organization did not check a box online 13, 16a, 16b, 17a, or 17b, check this box and see instructions ETJ Schedule A (Form 990 or 990-EZ) 2013 332022 09-25-13 08580709 756948 25760.001 14 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01 Pane 3 Schedule A (Form 990 or 990-EZ) 2013 Part III j Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to A. Total Calendar year (or fiscal year beginning in) 1 Gifts, grants, contributions, and membership fees received. (Do not include any 'unusual grants.") 2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished In any activity that is related to the organization's tax-exempt purpose 3 Gross receipts from activities that are not an unrelated trade or business under section 513 4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf 5 The value of services or facilities furnished by a governmental unit to the organization without charge 6 Total. Add lines 1 through 5 ......... 7a Amounts included on lines 1, 2, and 3 received from disqualified persons b Amounts included on lines 2 and 3 receIved from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the 'e c Add lines 7a and 7b Section B. Calendar year (or fiscal year beginning in) 9 Amounts from line 6 ..................... lOa Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975 cAdd lines 1 O and 1 O 11 Net income from unrelated business activities not included in line lob, whether or not the business is regularly carried on ..................... .______________ 12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) 13 Total support. (Add lines 9, lOc, Ii, and 12.) 14 First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501 (c)(3) organization, C. Comnutation of Public SuDDort Pe 15 Public support percentage for 2013 (line 8, column (1) divided byline 13, column (I)) .................... Section D. .........17 17 Investment income percentage for 2013 (line lOc, column (f) divided byline 13, column (f)) ................................................... 18 18 Investment income percentage from 2012 Schedule A, Part Ill, line 17 19a 33 1/3% support tests - 2013. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ............................ b 33 1130/6 support tests - 2012. If the organization did not check a box on line 14 or line 1 9a, and line 16 is more than 33 1/3%, and line 18 Is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization M Priu n te fniindtinn If the orcianization did not check a box on line 14.19a. or 19b. check this box and see Instructions ........................ Schedule A (Form 990 or 990-EZ) 2013 332023 09-25-13 08580709 756948 25760.001 15 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01 ScheduleA(Form 990 or990•EZ) 2013 CLINTON HEALTH ACCESS INITIATIVE, INC. 27-1414646 Page4 Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions). Part IV Supplemental Information. 332024 09-25-13 08580709 756948 25760.001 Schedule A (Form 990 or 990-EZ) 2013 16 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01 SCHEDULE D -- Supplemental Financial Statements (Form 990)' Complete if the organization answered "Yes," to Form 990, Part IV, line 6,7,8,9, 10. 11a, 11b, 11c. lid, lie, 11f, 12a, or 12b. ) Attach to Form 990. 'r'reit orti 'e .'.ury - !Y'3"0 $'0041 2013 Open to Public lnsoeclion Employer identification number Name of the organization 27-1414646 CLINTON HEALTH ACCESS INITIATIVE, INC. Complete if the anizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Part I 1 Org - organization answered Yes to Form 990, Part IV, line 6. _____ (a) Donor ad'ised funds (b) Funds and other accounts - Total number at end of year 2 Aggregate contributions to (during year) 3 Aggregate grants from (during year) L. i4 Aggregate value at end of year 5 Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organizations property, subject to the organizations exclusive legal control? 6 Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring Ei Yes LII No Part II I Conservation Easements. Complete if the organization answered 'Yes' to Form 990, Part IV. line 7. 1 Purpose(s) of conservation easements held by the organization (check all that apply). LI111 Preservation of an historically important land area Li Preservation of land for public use (e g., recreation or education) LIII Preservation of a certified historic structure Protection of natural habitat Preservation of open space 2 Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last - -- Held at the End of the Tax Year 2a day of the tax year. a Total number of conservation easements . . b Total acreage restricted by conservation easements c Number of conservation easements on a certified historic structure included in (a) d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register . . . . 3 Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the tax year 4 Number of states whore property subject to conservation easement is located 5 Does the organization have a written policy regarding the periodic monitoring, inspection, handling of LIII No LII] Yes ......... . violations, and enforcement of the conservation easements it holds? 6 Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year ' $ 7 Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year 8 Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) [1111] No and section 170(li)(4)(B)(ii)? ............... LII Yes . 9 In Part XIII. describe how the organization reports conservation easements in its revenue and expense statement, and balance sheet, and include, if applicable, the text of the footnote to the organization's financial statements that describes the organization's accounting for conservation easements. Part Illj Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets. Complete if the organization answered 'Yes to Form 990. Part IV, line 8. la If the organization etected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items. b If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, his treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items: $ (i) Revenues included in Form 990, Part VIII. line 1 $ (ii) Assets included in Form 990, Part X 2 If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the following amounts required to be reported under SFAS 116 (ASC 958) relating to these items: a Revenues included in Form 990, Part VIII, line 1 b Assets included in Form 990, Part X . . LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990. . $ .. > $ Schedule 0 (Form 990) 2013 O :5.13 08580709 756948 25760.001 22 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01 27-1414646 Page2 CLINTON HEALTH ACCESS INITIATIVE, INC. Part Ill I Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets(continued) ScheduleD (Form 99O)2013 3 Using the organization's acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply): a LIII Public exhibition d Loan or exchange programs e C] Other_____________________________________________________ b L1 Scholarly research c LJ Preservation for future generations 4 Provide a description of the organization's collections and explain how they further the organization's exempt purpose in Part XIII. 5 During the year, did the organization solicit or receive donations of art, historical treasures, or other similar assets Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21. la Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not included ............................................................................................................................................... L:JYes F-1 No onForm 99O, Part X? b If "Yes, explain the arrangement in Part XIII and complete the following table: Amount cBeginning balance ..................................................................................................................................J. . ...................................................................................................................id dAdditions during the year e Distributions during the year ................................................................................................................... le IEnding balance ....................................................................................................................................... If No 2a Did the organization include an amount on Form 990, Part X, line 21? ...........................................................................El Yes b If "Yes.* exolain the arranaement in Part XIII. Check here if the exolanation has been orovided in Part XIII .......................................El if the orcianization answered "Yes" to Form 990, Part IV, line 10. El Three years back la Beginning of year balance ......................______________ b Contributions c Net investment earnings, gains, and losses d Grants or scholarships ..........................______________ e Other expenditures for facilities and programs .......................... ............. .______________ f Administrative expenses ......................._______________ .............................._______________ g End of year balance 2 Provide the estimated percentage of the current year end balance (line 1g. column (a)) held as: a Board designated or quasi-endowment b Permanent endowment % % c Temporarily restricted endowment 11o, The percentages In lines 2a, 2b, and 2c should equal 100%. 3a Are there endowment funds not in the possession of the organization that are held and administered for the organization Yes No by: 3a(i) unrelated organizations ................................................................................................................................................ (i) .. .............................................................................................................................................. .3a(ii) (ii) related organizations ......................................................... 3b b If "Yes" to 3a(ii), are the related organizations listed as required on Schedule A? 4 Describe in Part XIII the intended uses of the organization's endowment funds. I Part VI I Land, Buildings, and Equipment. Complete if the organization answered "Yes" to Form 990, Part IV, line 11 a. See Form 990, Part X, line 10. (c) Accumulated (b) Cost or other Description of property (a) Cost or other depreciation basis (other) basis (investment) I I ................................................... la Land bBuildings ...................................................... c Leasehold improvements .............................. ................. d Equipment 125,938.1 296.1 631.1 1.649.192.1 (d) Book value 3 17 Schedule D (Form 990) 2013 332052 09-25-13 08580709 756948 25760.001 23 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01 Schedule D (Form 99O)2013 CLINTON HEALTH ACCESS INITIATIVE, INC. jPartV1I Investments - Other Securities. 27-1414646 Page3 Complete if the organization answered 'Yes' to Form 990, Part IV, line 11 b. See Form 990, Part X, line 12. (a) Description of security or category findudng name 0* seUrt4 (la) Book value (C) Method of valuation: Cost or end-of-year market value (1) Financial derivatives (2) Closely-held equity interests (3) Other Villj Investments - Program Related. Complete if the organization answered 'Ye (a) Description of investment rn 990, Part IV, line 11 c. See Form 990, Part X. line 13. (b) Book value I (C) Method of valuation: Cost or end-of-year market otal. (Col. b) must equal Form Part IX I Other Asset Complete if the (1) ASSETS LIM: (2) DUE FROM AJ Part answered 'Yes" to Form 990, Part IV, line lid. See Form 990, Part X, line 15. (a) Description TO USE (b) Book value 61,567,2 I Other 2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII Schedule D (Form 990) 2013 332053 09.25.13 08580709 756948 25760.001 24 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01 CLINTON HEALTH ACCESS INITIATIVE, INC. Schedule D (Form ggO)2013 27-1414646 Page4 Part Xl I Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered "Yes' to Form 990, Part IV, line 12a.1 Total revenue, gains, and other support per audited financial statements ......................................................... . _j._ 118,000,927. 2 Amounts included on line 1 but not on Form 990, Part VIII, line 12: a Net unrealized gains on investments .................................................................. 2a 561,853. ............................................................. 2b b Donated services and use of facilities ......................................................................... 2c c Recoveries of prior year grants d Other (Describe in Part XIII.) ............................................................................2d eAdd lines 2a through 2d .................................................................................................................................. 2e 561,853. 3 Subtract line 2e from line i ...............................................................................................................................3 117,439,074. 4 Amounts included on Form 990, Part VIII, line 12, but not on line 1: a Investment expenses not included on Form 990, Part VIII, line 7b ......................... 4a b Other (Describe in Part XIII.) ..............................................................................L4 oAdd lines 4a and 4b ............................................................................................................................................ 5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) 0. _.. 1117,439,074. Part XII I Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered "Yes" to Form 990, Part IV, line 12a. ....................................................................J... I Total expenses and losses per audited financial statements 2 Amounts Included on line 1 but not on Form 990, Part IX, line 25: 715,293. a Donated services and use of facilities ................................................................. 2a b Prior year adjustments 107,206,626. ................................................................................... 2b ............................................................................................... 2c cOther losses d Other (Describe in Part XIII.) ............................................................................... 2d 715,293. eAdd lines 2a through 2d ................................................................................................................................... 06,491,333. 33 3 Subtract line 2e from line 1 ............................................................................................................................... 4 Amounts included on Form 990, Part IX, line 25, but not on line 1: ......................... 4a .................................... 4b a Investment expenses not included on Form 990, Part VIII, line 7b b Other (Describe in Part X1111.) o Add lines 4a and 4b 5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I. line 18.) 4c 7106,491,333. 5 Part XllII Supplemental Information. Provide the descriptions required for Part II, lines 3, 5, and 9; Part Ill, lines la and 4; Part IV, lines lb and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information. PART X, LINE 2: EXPLANATION: CHAI ACCOUNTS FOR THE EFFECT OF ANY UNCERTAIN TAX POSITIONS BASED ON A "MORE LIKELY THAN NOT" THRESHOLD TO THE RECOGNITION OF THE TAX POSITIONS BEING SUSTAINED BASED ON THE TECHNICAL MERITS OF THE POSITION UNDER SCRUTINY BY THE APPLICABLE TAXING AUTHORITY. IF A TAX POSITION OR POSITIONS ARE DEEMED TO RESULT IN UNCERTAINTIES OF THOSE POSITIONS, THE UNRECOGNIZED TAX BENEFIT IS ESTIMATED BASED ON A "CUMULATIVE PROBABILITY ASSESSMENT" THAT AGGREGATES THE ESTIMATED TAX LIABILITY FOR ALL UNCERTAIN TAX POSITIONS. CHAI HAS IDENTIFIED ITS TAX STATUS AS A TAX EXEMPT ENTITY AS ITS ONLY SIGNIFICANT TAX POSITION AND HAS DETERMINED THAT SUCH TAX POSITION DOES NOT RESULT IN AN UNCERTAINTY REQUIRING RECOGNITION. CHAI IS NOT CURRENTLY UNDER EXAMINATION BY ANY TAXING JURISDICTION. CHAI'S 09.25.13 08580709 756948 25760.001 Schedule 0 (Form 990) 2013 25 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01 Schedule D (Form 99O)2013 P art CLINTON HEALTH ACCESS INITIATIVE, INC. 27-1414646 Pape5 X111 Supplemental Information (continued) FEDERAL AND STATE INCOME TAX RETURNS ARE GENERALLY OPEN FOR EXAMINATION FOR THREE YEARS FOLLOWING THE DATE OF FILING THE RELATED RETURN. Schedule D (Form 990) 2013 332055 09-25-13 08580709 756948 25760.001 26 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01 SCHEDULE F Statement of Activities Outside the United States 2013 Complete if the (Form 990) organization answered "Yes" on Form 990, Part IV, line 14b, 15, or 16. Attach to Form 990. 00, See separate instructions. Open to Public Department of theTreasuy Inspection Information about Schedule F (Form 990) and its instructions is at www.Irs.gov1f0rm990. Internal Revenue Service Employer Identification number Name of the organization I Part I I General Information on Activities Outside the United States. Complete if the organization answered 'Yes' on Form 990, Part IV, line 14b. 1 For grantmakers. Does the organization maintain records to substantiate the amount of its grants and other assistance, the grantees' eligibility for the grants or assistance, and the selection criteria used to award the grants or assistance? ......Yes No 2 For grantmakers. Describe in Part V the organizations procedures for monitoring the use of its grants and other assistance outside the United States. vities per Region. (The following Part I, line 3 table c be duplicated if additional space is (f) Total (e) If activity listed in (d) (a) Region I(b) Number of j(c) Number of (d) Activities conducted in region expenditures employees, (by type) (e.g., fundraising, program is a program service, I agents, offices and for and describe specific type services, investments, grants to In the region independent investments contractors of service(s) in region recipients located in the region) in region EAST ASIA AND THE CENTRAL AMERICA AND RUSSIA & THE NEWLY EUROPE (INCLUDING ............. 3 a Subtotal b Total from continuation . sheets to Part I c Totals (add lines 3a LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule F (Form 990) 2013 332071 10-03.13 27 08580709 756948 25760.001 2013.03061 CLINTON HEALTH ACCESS INITI 2576001 Schedule (Form 9901 CLINTON HEALTH ACCESS INITIATIVE INC . Page 1 Part I Continuation of Activities per Region.(8chedu1e (Form 990). Part I. line 3) Region Number of Number of Activities conducted in region If activity listed in Total offices employees or (by type) fundraising, is a program service. expenditures in the region agents in program services. grants to describe speci?c type for region region recipients located in the region) of service(s) in region EAST ASIA AND THE PACIFIC 0 0 GRANTS HEALTH 1.468 869. SOUTH ASIA 0 0 GRANTS HEALTH 1.442 330. CENTRAL AMERICA AND THE CARIBBEAN 0 0 GRANTS HEALTH 350 815 . RUSSIA 8: THE NEWLY INDEPENDENT STATES 0 0 GRANTS HEALTH 95 840. EUROPE (INCLUDING ICELAND GREENLAND) 0 GRANTS HEALTH 6644639. NORTH AMERICA 0 0 GRANTS HEALTH 84 . 826. Totals 4_1oe 320. 332181 05-01-13 28 08580709 756948 25760.001 2013.03061 CLINTON HEALTH ACCESS INITI 25760__01 Schedule F(Form99012013 I CLINTON HEALTH ACCESS INITIATIVE INC. 27-1414646 Page ert II Grants and Other Assistance to Organizations or Entitles Outside the United States. Complete if the organization answered Yes' on Form 990, Part IV, line 15, for any IP recipient who received more than $5,000. Part II can be duplicated If additional space is needed. 2 Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501 (cX3) equivalency letter 3 Enter total number of other organizations or entities 0 128 Schedule F (Form 990)2013 332072 15-03-13 29 Schedule LForm 990) CLINTON HEALTH ACCESS INITIATIVE INC . Page 2 Continuation oi Grants and Other Assistance to Organle lions or Entities Outside the United States. (Schedule (Form 990). Part il, line 1) 1 - Amount of Desert tion ii) Method of . IRS code section Pur ass of Amount Manner of (9) Name of organization . . Region . non-cash of noncth valuatlon (book, FMV, and EIN (ifapplicahle) grant of cash grant cash disbursement assistance assistance appraise?. other, EAST ASIA AND THE PACIFIC Aura 240 729 . a . sun swam AFRICA EALTH 224 .484 . . AFRICA 210 579 . o. SUBXSAHARAN AFRICA 200 an. sun SAHARAN AFRICA 164 630 . . CENTRAL AMERICA AND THE CARIBBEAN HEALTH 151 . 642 . 0 . SUB AFRICA EALTH 14B 638 . . AFRICA HEALTH 142 152. o. ERICA HEALTH 132 667 . 30 Scheduie iForm CLINTON HEALTH ACCESS INITIATIVE INC . Page 2 Part II Continuation 0 Grants and Other to Organizations or Entities Outside the United States. (Schedule (Form 990). Part ll, line 1) (1) Name of or anization IRS cede sewn? ion Purpose Of Manner Of (glimvcagitad (hgfazsr?gg?n 9 and EIN (ii applicable) eg grant cl cash grant cash disbursement assistance assistance appraisaL 0156,) SOUTH ASIA HEALTH 131 554. 0. AFRICA ELI-TH 129 387 . . OUTH ASIA mm}! 115 . 680. 0 . SOUTH ASIA EALTH 114 758 . 0. SUB-SW AFRICA HEALTH 112 999 . 0 . EAST ASIA AND THE PACIFIC EALTB 1.12 727. 0. AFRICA 111 E77 . 0 . ASIA HEALTH 104 713. 0. EOUTH ASIA EALTH 103 839. 0. aaziaz 05-01-13 3 1 CLINTOE HEALTH ACCESS INITIATIVE, INC. 27?1414646 mez Continuation 0 Grants and Other Assistance to Organizations or Entities Outside the United States. (Schedule (Form 990). Part II. line 1) 1 - Amount of (hiDescri lion (1) Method of IRS code Pur se of 9 Amount Manner of (9) Name of organization Em .f 1 m6 (c)RegIon non-cash oinoncash valuation (book. FMV, an (I appica grant ofcash grant cash disbursement assistance assistance appraisai?mhe? aenxca Lama-m 92 915. o. OUTH ASIA HEALTH 90 658. 0. EUB-SAHARAN AFRICA HEALTH 81 158. o. 5313'!? ASIA EALTH 82 486. 0. ASIA 30 575. 0. SUB SAHARAN AFRICA HEALTH 76 596. 0. CENTRAL AHERICA AND THE CARIBBEAN HEALTH 71 100. 0. EAST ASIA AND THE PACIFIC 62 626. 0. EAST ASIA AND THE mum 58 000. o. 332:3: 05-01-13 3 2 Schedule (Form 990) CLINTQN HEALTH INITIATIVE Page Part II I Continuation 0 Grants and Other Assistance to Organizations or Entities Outside the United States. (Schedule (Form 990), Part II, line 1) 1 - (9) Amount of Description Method of 5 ho Pul? Seof Amount Manner of . Name of organization ms Fade ?c Region I non cash ofnon-cash valuation (book, FMV, and EIN (Ifapplicable) grant of cash grant cash disbursement assistance assistance appraisal. other} SOUTH ASIA HEALTH 5? 468. 0. NORTH AMERICA HEALTH 53 012. 0. ERICA 51 434. 0. EAST ASIA AND THE PACIFIC HEALTH 50 914. 0 . EAST ASIA AND THE PACIFIC HEALTH so 182. o. AFRICA HEALTH 50 178. 0. EAST ASIA AND THE PACIFIC HEALTH 49 693. 0. EUROPE (INCLUDING ICELAND GREENLAND) HEALTH 49 MS, 0 . EOUTH ASIA mum 47 053, 332182 05-01-13 3 3 Schedule [Form 9901 CLINTQN HEALTH ACCESS INITIATIVE . INC . Page 2 Part 1 Continuation 0! Grants and Other Assistance to Organizations or Entities Outside the United States. (Schedule (Form 990), Pan II1 line 1) 1 - Am of h) Descri tion Method or IR sect: Arno 0? 5? (a)Name of organization sciatic (c)Fiaglon urpo eat .annem non-cash of noncash valuation (book. FMV. and EIN (lfapplicable) grant 0! cash grant cash disbursement assistance ass-mime appmisaL other) RUSSIA 5. THE INDEPENDENT TATES HEALTH 45 . 733 . 0 . scum ASIA EALTH 45 076. 0. EAST ASIA AND THE PACIFIC EALTH 45 000. 0. SUE-SW AFRICA HEALTH 43 525. o. BUB AFRICA HEALTH 43 206. 0. EUROPE (INCLUDING ICELAND GREENLAND) HEALTH 41 300, 0. EAST ASIA AND THE PACIFIC ALTH 41 482. 0. CENTRAL AMERICA Ann THE CARIBBEAN mm 41445. 0. UB-SAKARAN PRICA EALTH 38 357. 0 32152 05-01-13 Schedule (Form 4930) CLINTON HEALTH ACCESS INITIATIVE . INC . Pa_ga_2_ Part II I Continuation 0 Grants and Other Assistance to Organizations or Entities Outside the United States. (Schedule (Fon'n 990). Part II. line 1) 1 )Amount of (A) Description Method of Am. 9 Name of organization IRS cede 5mm Region M) Purpose Of ?0 .anmr 0' noncash oi non-cash valuation (book, FMV. and EIN (it applicable) grant of cash grant cash disbursement assistance assistance appmisaL other) SOUTH ASIA HEALTH 3? 062 . 0 . EAST ASIA AND THE ACIPIC HEALTH 36 000 . SUB-SAHARAN AFRICA EEALTH 35 684, O. SUB-SW AFRICA Emu 32 915. 0. gown ASIA HEALTH 31 930 . . AFRICA HEALTH 31 106. 0 . SUE-SWEAR AFRICA HEALTH 30 000 . 0 . SAHARAN AFRICA HEALTH 28 061 . . OUTH ASIA 27 760 . 32132 05-01-13 35 Schedule Form 990) CLINTON HEALTH ACCESS INITIATIVE INC . Page Part II I Continuation 0 Grants and Other Assistance to Organizations or Entities Outside the Unlted States. (Schedule (Form 990). Paul. line 1) 1 Amount 1 Descrl tion i Method of . IRS code section Pu (9) Name oforgamzatton . Raglan moss Amoun ,annemf noncash of non-cash valuation (book. FMV. and EIN(1IapplIcahle) grant ofcash grant cash dusbmsement assistance assistance appraisawther) ASIA HEALTH 26 905. 0. AFRICA HEALTH 26 650. 0. CENTRAL AMERICA AND THE CARIBBEAN EEALTH 26 405. 0. RUSSIA 8: THE NEWLY INDEPENDENT STATES 25 189. 0. AFRICA EALTH 25 039. 0. BUB-SW AFRICA 23 799. 0. CENTRAL AMERICA AND THE caarnam 2mm 23 535. o. sumsmum AFRICA HEALTH 22 736. 0. ASIA Jignyru 22 710 o. 332182 05411-13 3 6 Schedule 9gp) CLINTON HEALTH ACCESS INITIATIVE . INC . 2 7 141 4 6 46 Page 2 Part II I Continuation of Grants and Other Assistance to Organizations or Entities Outside the United States. (Schedule (Form 990). Part II, line 1) 1 Am nt of Descri tion i Method of IRS code section mou (9) 0" 1 1 1 Name of organization Region Purpose or A .anner non-cash of non-cash valuation (book. FMV, and EIN (Ii applicable) gtant of cash grant cash disbursement assistance assmance appraisal other) SOUTH ASIA HEALTH 22 541. O. AMERICA 22 500. 0. SUB-SAHARAN AFRICA HEALTH 22 200. 0. SUB ERICA ALTH 22 026. 0. EAST ASIA AND THE ACIPIC HEALTH 21 615. 0. OPE (INCLUDING ICELAND imam 20 230 . 0 . SUE-SAHARAN AFRICA HEALTH 19 503 . 0 . AFRICA HEALTH 16 253. 0. ERICA EALTH 16 128 0. 332132 0541-13 37 Schedule F(Form 990) CLINTON HEALTH ACCESS INITIATIVE IISC . 27?1414646 Page Part II I Continuation 0 Grants and Other Msistance to Organizations or Entities Outside the United States. (?cheduta (Form 990). Part II. line 1) 1 Arno nt of (h Desc? tion Method of IRS code section (1 Fur so Amount ann (9) Name oi oranlzation Region pa 0 are non-cash of noncash valuation (book. FMV, and EIN (liappticabie) grant of cash grant cash disbursement assistance assistance appraisail other) SOUTH ASIA HEALTH 15 666 . . SWRAN AFRICA EALTH 15 000 . . AFRICA Ann; 14 735 . 0. SOUTH ASIA HEALTH 13 991 . 0 . CENTRAL AMERICA AND THE CARIBBEAN HEALTH 13 450 . 0 . SUB-SAHARAN AFRICA HEALTH 13 240 . 0 . SUB-SAHARAN AFRICA HEALTH 13 con . 0 . AFRICA ?ns 12 880. D. ERICA 12 494 gas-23:15:: 3 8 Schedule (Form 990) CLINTON HEALTH ACCESS INITIATIVE . INC . Page 2 Pan Continuation 0 Grants and Other Assistance to Organlz: tlons or Entities Outside the United States. (Scheduta (Form 990)LPart ll. line 1) 1 - )Amountof Description Method of IRS code sectlon Pu 053 of Amount Manner of 9 . (atNama oforganization I . Region nan-cash otnon-cash valuation (book. FMV, and EIN (If applicable} grant of cash grant cash disbursement assisiame assis?ame appraisal, other) SUB-SAHARAN AFRICA 12 354. o. SUB-WW AFRICA HEALTH 12 200. o. 3113 SAHARAN AFRICA EALTH 12 145. 0. EAST ASIA AND THE PACIFIC mm}! 12 139. 0. CENTRAL AMERICA AND THE CARIBBEAN HEALTH 11 200. 0. EAST ASIA AND THE PACIFIC HEALTH 10 786. 0. sumsmm AFRICA martyr}! 1o 13?. 0. EAST ASIA AND THE PACIFIC HEALTH 10 439. 0. EAST ASIA AND THE ACIFIC LTH 10 1'78. 0. 3253.33: 39 Schedule (Farm 990} CLINTON HEALTH ACCES INITIATIVE . INC . Page Part II I Continuation 0 Grants and Other Assistance to Organizations or Entities Outside the United States. (Schedule (Form 9 . Part II line 1) 1 - Amount at Description Method of Amou i 9 . Name 0! organization ms was steam Region (6) Purpose 0' Manner noncash of non-cash vahJatIon (book, FMV, and EIN (if applicable) grant of cash grant cash dxsbursemenl assistance assistance appraisa" other) SOUTH ASIA HEALTH 10 143 . 0 . SUB SAX-MEAN AFRICA EALTH 10 059 . 0 . RUSSIA THE NEWLY INDEPENDENT STATES mum 10 014 . . SUB-SAHARAN AFRICA HEALTH 9 840 . a . USSIA THE NEWLY INDEPENDENT STATES HEALTH 9 836 . 0 . SOUTH ASIA 9 419. 0 . AFRICA EALTH 9 357 . 0 . NORTH AMERICA HEALTH 9 314 . 0 . UB-SAHW FRICA ALTH 9 2 0 2 . 0 332182 05-01-13 40 Scheduia [Earn-i 990) CLINTON HEALTH AQCESS INITIATIVE . INC . Page Part II Continuation 0 Grants and Other Assistance to Organizations or Entities Outside the United States. (Schedule (Form 990), Patti]. line 1) 1 - )Amount of Description Method of . code section Pur se 01 Amount Manner 01 9 . Name or organization (c)Fiegion p0 noncash of noncash vaiuatronibook.FMV, and EIN (Ii applicable) grant of cash grant cash disbursement assistance assisxance appraisal, other) EAST ASIA AND THE PACIFIC HEALTH 9 199. u. EUROPE (INCLUDING ICELAND GREENLAND) HEALTH 3 834. 0. ST ASIA AND THE PACIFIC HEALTH 5 514. 0. SUB-SAHARAN AFRICA HEALTH 3 343. o. SUB-SW FRICA EALTH a 155, 0. EAST ASIA AND THE PACIFIC HEALTH 3 058. 0. sue-sum AFRICA HEALTH 8 . 045 . . EAST ASIA AND THE PACIFIC HEALTH 7 617. 0. ma FRICA 1 565 o. 332132 05-01-13 41 Schedule 990) CLINTON HEALTH ACCESS INITIATIVE. INC . 27 -1414646 Pagez Part II I Continuation 0 Grants and Other Assistance to Organizz tions or Entities Outside the United States. (Schedule (Form 990). Part II. line 1) 1 - to! h) Descri tion Method of IRS code section Amoun Name of organization .1 . Region Purpose 0 ,3 "er 0 noncash of non-cash valuation (book. FMV. and EN (I applicable) grant 0! cash grant cash dlsbursemant 355mm,? assistance appraisat other) EAST ASIA AND THE PACIFIC HEALTH 7 329 . 0 . SUB-SAW AFRICA HEALTH 1 328 . . SUB--SAHARAN AFRICA HEALTH 5 952 . 0 . SOUTH ASIA 6 215 . 0. RUSSIA THE INDEPENDENT STATES HEALTH 6 068 . . CENTRAL AMERICA MD THE CARIBBEAN HEALTH 6 .039 . . SUB - AFRICA HEALTH 5 038 0 . CENTRAL AMERICA AND THE CARIBBEAN 6 000. . PRICA EALTH 5 354 . 0 . Sf?t??a 4 2 Schedule Form 990) CLINTON HEALTH ACCESS INITIATIVE INC . Page 2 PM ll Continuation to Dr ?law United States. (Scheduie (Form 990), Part II, line 1) 1 - )Amount of Description (I) Method of Amou 9 Name of organiza?on IRS cede Region Purpose Of Manner or non-cash of non-cash vahJation (book, FMV, and EIN (Ii applicable) grant oi cash grant cash disbursement assistance assistance appraisal. other) SAHARAN AFRICA 5 514 . . SUBISAHARAN AFRICA [Laura 5 364 . . EAST ASIA AND THE EALTH 5 08 . . EAST ASIA AND THE PACIFIC HEALTH 5 . 027 . . 3.32182 0501-13 43 Schedule F (Form ggO)2013 CLINTON HEALTH ACCESS INITIATIVE, INC. 27-1414646 Page Part III Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered Yes' on Form 990, Part IV. line 16. Schedule F (Form 990) 2013 332013 10.03-13 44 Schedule F(Form99O) 2013 Part IV 1 2 3 I CLINTON HEALTH ACCESS INITIATIVE, INC. c: Yes No Did the organization have an interest in a foreign trust during the tax year? If 'Yes," the organization may be required to file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A) ................................................................ EJ Yes [] No LJ Yes EXI No .......................................................................... E] Yes [] No Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization maybe required to fife Form 8865, Return of U.S. Persons With Respect To Certain ........................................... Foreign Partnerships. (see Instructions for Form 8865) Yes [] No Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization maybe required to file Form 5471, Information Return of U.S. Persons With Respect To 6 ......................................................... Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) 5 Page4 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization maybe required to file Form 926, Return by a U.S. Transferor of Property to a Foreign ............................................................................. Corporation (see Instructions for Form 926) Certain Foreign Corporations. (see Instructions for Form 5471) 4 27-4414646 Foreign Forms Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization maybe required to file Form 5713, International Boycott Report. (see Instructions ............................................................................................................................ forForm 57l3) E:lYes EE No Schedule F (Form 990) 2013 332074 10.03-13 08580709 756948 25760.001 45 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01 CLINTON HEALTH ACCESS INITIATIVE, INC. Part V Supplemental Information Schedule F (Form 9gO)2013 27-1414646 Paqe5 Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part Ill (accounting method); and Part Ill, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information. PART I, LINE 2: EXPLANATION: FOR GRANTS OUTSIDE THE US, EACH COUNTRY OR PROGRAM TEAM REQUESTS THEIR CASH NEEDS EACH MONTH WITH AP. AFTER THESE AMOUNTS ARE VERIFED, THE HEADQUARTERS TEAM DISBURSES THE FUNDS TO THE COUNTRY/PROGRAM TEAMS. AT THE END OF EACH MONTH, THE EXPENSES FOR EACH TEAM ARE REVIEWED TO SEE WHERE FUNDS WERE USED AND WHAT PROJECT WAS CHARGED. SCHEDULE F, PART II, LINE 3: EXPLANATION: THE GRANTEES COUNTED ON LINE 3 CONSIST OF GOVERNMENT MINISTRIES OF HEALTH, HOSPITALS, AND OTHER ORGANIZATIONS IN FURTHERANCE OF OUR MISSION. 332075 10-03-13 08580709 756948 25760.001 Schedule F (Form 990)2013 46 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01 OMB No. 1545-0047 SCHEDULE G (Form 990 or 990-EZ) Department of the Treasury Internal Revenue Service Supplemental Information Regarding Fundraising or Gaming Activities Complete If the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19, or If the organization entered more than $15,000 on Form 990-EZ, line 6a. 10- Attach to Form 990 or Form 990-EZ. Fundraising Activities. Open To Public Inspection Employer identification number Name of the organization Part I 2013 Complete if the organization answered 'Yes" to Form 990, Part IV, line 17. Form 990-EZ filers are not required to complete this part. Indicate whether the organization raised funds through any of the following activities. Check all that apply. a EJ Mail solicitations e E1 Solicitation of non .government grants Solicitation of government grants I b E1 Internet and email solicitations Phone solicitations o 9LJ Special fundraising events d 2 a lIIII In-person solicitations Did the organization have a written or oral agreement with any individual (including officers, directors, trustees or ERI Yes key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services? b If Yes, list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is to be compensated at least $5,000 by the organization. LIII No 3 List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing. AR,CA,CT,FL,IL,NiJ,NY,PA,RI ,WA,MA LI-IA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EL Schedule G (Form 990 or 990-EZ) 2013 SEE PART IV FOR CONTINUATIONS 332081 09-12-13 47 08580709 756948 25760.001 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01 Schedule 0 (Form 990 or 990-EZ) 2013 Part II CLINTON HEALTH ACCESS INITIATIVE, INC. 27-1414646 Page 2 Fundraising Events. Complete if the organization answered Yes to Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990EZ, lines 1 and 6b. Ust events with gross receipts greater than $5,000. j (c) Other events (a) Event #1 (b) Event #2 1 I U) IVIC) vUL I (event type) a) (event number) (add col. (a) through col. (c)) C 1 Gross receipts Cr 2 Less: Contributions 4 Cash prizes 5 Noncash prizes U, 0) (I) 6 Rent/facility costs 0. tia) 7 Food and beverages ........................... 0 8 Entertainment 9 Other direct expenses .............................. 10 Direct expense summary. Add lines 4 through 9 in column (d) ..................................................................... ming. Complete if the organization answered Yes' to Form 990, Part IV, line 19, or reported more than .000 on Form 990EZ, line 6a. C) I (b) Pull tabs/instant I bingo/progressive bingo (a) Bingo C 0) > (c) Other gaming (ci) Total gaming (add 01. (a) through col. (c)) a, a: u 2 Cash prizes C) 'I) a 3 Noncash prizes E 4 Rent/facility costs 0 Other direct Yes I L...J Yes______ % j L.J Yes 6 Volunteer labor 7 Direct expense summary. Add lines 2 through 5 in column (d) 9 Enter the state(s) in which the organization operates gaming activities: a Is the organization licensed to operate gaming activities in each of these states? ..................................L1i EJ No ........................... ED Yes El No Yes b If No," explain: lOa Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? b If Yes, explain: 332082 og ia-is 08580709 756948 25760.001 Schedule G (Form 990 or 990-EZ) 2013 48 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01 Schedule G (Form 9900r99O . EZ)2013 CLINTON HEALTH ACCESS INITIATIVE, INC. 271414646 Page3 11 Does the organization operate gaming activities with nonmembers? ................................................................................LI Yes ED No 12 Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity formed No Yes .............. ........................... .... ............................... to administer charitable gaming? 13 Indicate the percentage of gaming activity operated in: % ....................................................................................................................................... 13a aThe organization's facility LI LI % bAn outside facility ......................................................................................................................................................... 13b 14 Enter the name and address of the person who prepares the organization's gaming/special events books and records: Name Address 15a Does the organization have a contract with a third party from whom the organization receives gaming revenue? ........ b If 'Yes, enter the amount of gaming revenue received by the organization 100. $ of gaming revenue retained by the third party $ c If "Yes, enter name and address of the third party: Name LI Yes LI No and the amount Poo. Address 16 Gaming manager information: Name Gaming manager compensation $ Description of services provided - LI Director/officer LI Employee LI Independent contractor 17 Mandatory distributions: a Is the organization required under state law to make charitable distributions from the gaming proceeds to LI LI No Yes retain the state gaming license? ............................................................................ b Enter the amount of distributions required under state law to be distributed to other exempt organizations or spent in the organization's own exempt activities during the tax year 10, $ Supplemental Information. Provide the explanations required by Part I, line 2b, columns (ii)i and (v), and Part III, lines 9, 9b, lOb, 15b, Part lvi I 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions). SCHEDULE G, PART I, LINE 2B, LIST OF TEN HIGHEST PAID FUNDRAISERS: (I) NAME OF FUNDRAISER: THE HELEN BROWN GROUP LLC (I) ADDRESS OF FUNDRAISER: 48 SUMMER ST., SUITE 2, WATERTOWN, MA 02472 332083 00. 12-13 08580709 756948 25760.001 Schedule G (Form 990 or 990-EZ) 2013 49 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01 Schedule G (Form 99Oo,-99O .EZ Part IV I CLINTON HEALTH ACCESS INITIATIVE, INC. 27-1414646 Supplemental Information 332084 05-01-13 08580709 756948 25760.001 Page4 (continued) Schedule G (Form 990 or 990-EZ) 50 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01 OUR Nu. 1545-0047 Grants and Other Assistance to Organizations, Governments, and Individuals in the United States SCHEDULE (Form 990) Dpvrtnvet ol the T,00Sv,y h,tthmi Revo,oe Siv. Complete It the organization answered 'Yes to Form 990, Part IV, fine 21 or 22. Attach to Form 990. Open to Public Employer identification number Name of the organization 17_I Al AAiZ General Information on Grants and Assistance 1 Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees eligibility for the grants or assistance, and the selection criteria used to award the grants or assistance? ...........................................................................................................................................................................1J Yes 2 Describe in Part IV the organizations procedures for monitoring the use of grant funds in the United States. Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered Yes' to Form 990. Part IV, line 21, for any Part II I (a) Name and address of organization (b) EIN or government IU (c) IAC section I (cf) Amount of I (a) Amount of I ualion (7?0k, if applicable cash grant I no non-cashFMV.aPpraBOi, assistance other) (h) Purpose of-grant or assistance (g) Description of I non-cash assistance I No I FAMILY HEALTH INTERNATIONAL 359 BLACKWEtL STREET, SUITE 200 DURHAM, NC 27701 23-74130 YALE UNIVERSITY P.O. BOX 1873 NEW HAVEN. CT 06500 06-06469 POPULATION SERVICES INTERNATIONAl. 1120 19TH STREET NW, SUITE 600 WASHINGTON. DC 20036 56-09428 NEW YORK UNIVERSITY 70 WASHINGTON SQUARE NEW YORK. NY 10012 13-55623 PARTNERS IN HEALTH 888 COMMONWEALTH AVENUE, 3RD FLOOR BOSTON. HA 02215 04-35675 HOWARD UNIVERSITY 2400 6TH STREET, NW 2 Enter total number of section 501 (cX3) and government organizations listed in the line 1 table ............................................................................................. 13. 1. 3 Enter total number of other organizations listed in the line 1 table Schedule I (Form 990) (2013) LHA For Paperwork Reduction Act Notice, seethe Instructions for Form 990. 332101 51 Continuation of Grants and (a) Name and address of organization or government tance to Governments and Organizations in the (b) EIN 1RC section if applicable (C) (d) Amount of I cash grant rio I (Form 990). Part (e) Amount of non-cash assistance (I) Method of valuation 0700k, FMV, appraisal, other (g) Description of non-cash assistance I (h) Purpose of grant or assistance BOSTON UNIVERSITY 595 COMMONWEALTH AVENUE CONCERN WORLDWIDE 355 LEXINGTON AVENUE, 19TH FLOOR PATHFINDER INTERNATIONAL 9 OALEN STREET, #217 HARBOR PATH 2201 WESTLAXE AVENUE, SUITE 200 SCYNEXIS, INC. P.O. BOX 12878 VIRGINIA COMMONWEALTH UNIVERSITY 800 EAST LEIGH STREET, P.O. BOX FLORIDA STATE UNIVERSITY 600 W COLLEGE AVENUE PRINCETON IN AFRICA 194 NASSUA STREET, SUITE 219 Schedule I (Form 990) 335245 05-01.13 52 Schedule l (Form 99O)(2013) Lt!q.!IIj CLINTON HEALTH ACCESS INITIATIVE, INC. 27-1414646 Page Grants and Other Assistance to Individuals in the United States. Complete if the organization answered Yes' to Form 990, Part IV, line 22. Part Ill can be duplicated if additional space is needed. PART I, LINE 2: EXPLANATION: FOR GRANTS INSIDE THE US, EACH COUNTRY OR PROGRAM TEAMS REQUESTS THEIR CASH NEEDS EACH MONTH WITH AP. AFTER THESE AMOUNTS ARE VERIFED, THE HEADQUARTERS TEAM DISBURES THE FUNDS TO THE COUNTRY/PROGRAM TEAMS. AT THE END OF EACH MONTH, THE EXPENSES FOR EACH TEAM ARE REVIEWED TO SEE WHERE FUNDS WERE USED AND WHAT PROJECT WAS CHARGED. 332102 10.2013 53 Schedule I (Form 990) (2013) SCHEDULE J (Form 990) Department 01 the Treasury Compensation Information OMB No. 1545-0047 For certain Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees Complete if the organization answered "Yes" on Form 990, Part IV, line 23. Attach to Form 990. See separate Instructions. Name of the organization Open to Public Inspection Employer Identification number 27-1414646 on la Check the appropriate box(es) if the organization provided any of the following to or for a person listed in Form 990, Part VII, Section A, line la. Complete Part III to provide any relevant information regarding these items. LIII First-class or charter travel Housing allowance or residence for personal use LII I Travel for companions El Payments for business use of personal residence El Tax indemnification and gross-up payments EJ Health or social club dues or initiation fees El Discretionary spending account Personal services (e.g., maid, chauffeur, chef) El El b If any of the boxes online la are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If 'No," complete Part Ill to explain 2 Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all directors, trustees, and officers, including the CEO/Executive Director, regarding the items checked in line 1 a? .................................... 3 Indicate which, if any, of the following the filing organization used to establish the compensation of the organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part Ill. El LT] Compensation committee El El Written employment contract ERICompensation survey or study Approval by the board or compensation committee Independent compensation consultant Form 990 of other organizations EJ 4 During the year, did any person listed in Form 990, Part VII, Section A, line la, with respect to the filing organization or a related organization: a Receive a severance payment or change-of-control payment? b Participate in, or receive payment from, a supplemental nonqualified retirement plan? o Participate in, or receive payment from, an equity-based compensation arrangement? ............................................................ If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III. Only section 501(c)(3) and 501(c){4) organizations must complete lines 5-9. 5 For persons listed in Form 990, Part VII, Section A, line la, did the organization pay or accrue any compensation contingent on the revenues of: a The organization? b Any related organization? If "Yes" to line 5a or 5b, describe in Part Ill. 6 For persons listed in Form 990, Part VII, Section A, line la, did the organization pay or accrue any compensation contingent on the net earnings of: a The organization? X X b Any related organization? If "Yes" to line 6a or 6b, describe in Part Ill. 7 For persons listed in Form 990, Part VII, Section A line la, did the organization provide any non-fixed payments not described in lines 5 and 6? If "Yes," describe in Part Ill 8 Were any amounts reported in Form 990, Part VII, paid or accrued pursuant to a contract that was subject to the initial contract exception described in Regulations section 53.4958 . 4(a)(3)? If "Yes," describe in Part Ill ................................. 9 If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule J (Form 990) 2013 332111 09-13-13 08580709 756948 25760.001 54 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01 ScheduleJ(Focm99O)2013 CLINTON HEALTH ACCESS INITIATIVE, INC. 27-1414646 Page I Part II I Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies If additional space is needed. For each individual whose compensation must be reported In Schedule J, report compensation from the organization on row () and from related organizations, described in the instructions, on row Do not list any individuals that are not listed on Form 990, Part VII. (lb. Note. The sum of columns (B))-(ii) for each listed individual must equal the total amount of Form 990, Part VII, Section A. line 1 a, applicable column (D) and (B) amounts for that individual. I (A)NameandThle I (B) Breakdown of W2 and/or 1099 MISC compensation (C) Retirement and I (D) Nontaxable 1(E) Total of columns I (F) Compensation reported as deferred (B)(i).(D) benefits other deferred (ii) Bonus (ill) Other (i) Base in prior Form 990 compensation reportable incentive compensation compensation compensation I I I I & I BRUCE LINDSEY (1) BOARD MEMBER (2) IRA HAGAZINER CEO/VICE-CHAIR OF THE BOARD (3) WJSTAPHA LEAVENWORTH BAKALI Coo (4) CFO JULIE B. FEDER JEMNE BROSNAN (5) EVP, HR MANAGEMENT DAVID RIPEN (6) EVP, ACCESS PROGRAMS (7) ALICE KANGETHE (8) OWENS WIWA (9) KELLY MCCRYSTAL Schedule J (Form 990) 2013 312112 09-13-I3 55 Schedulej(Form ggO)2013 I Part Ill I Supplemental Information CLINTON HEALTH ACCESS INITIATIVE, INC. 27-1414646 page Provide the Information, explanation, or descriptions required for Part I, tines la, 1 b, 3, 4a. 4b, 40, 5a, 5b, 6a, 6b, 7, and 8, and for Part H. Also complete this part for any additional Information. PART I, LINE 1A: EXPLANATION: STAFF WHO ARE ENROLLED IN THE CHAI DOMESTIC MEDICAL PLAN ARE ELIGIBLE FOR REIMBURSEMENT OF THEIR GYM MEMBERSHIP UP TO $250 PER CALENDAR YEAR. THE REIMBURSEMENT IS TAXABLE INCOME. Schedule J (Form 990)2013 332113 09-13-13 56 Supplemental Information to Form 990 or 990-EZ SCHEDULE 0 Complete to provide information for responses to specific questions on Form 990 or 990-EZ or to provide any additional information. - - 00. Attach to Form 990 or 990-EZ. (Form 990 or 99o-EZ) Department of the Treasury Name of the organization FORM - - 2013 Open to Public Employer identification number 990, PART I, LINE 1, DESCRIPTION OF ORGANIZATION MISSION: EXPAND ACCESS TO HIGH-QUALITY CARE AND TREATMENT FOR HIV/AIDS, MALARIA AND OTHER DISEASES. FORM 990, PART I, LINE 5: EXPLANATION: THE NUMBER REPORTED ON PART I, LINE 5 REFLECTS THE NUMBER OF PEOPLE REPORTED ON FORM W-3. CHAI EMPLOYS 965 PEOPLE AROUND THE GLOBE. FORM 990, PART III, LINE 1, DESCRIPTION OF ORGANIZATION MISSION: CHAI APPLIES THE RIGOROUS THINKING, ANALYSIS AND URGENCY OF THE BUSINESS WORLD TO SAVE LIVES AND STRENGTHEN HEALTH SYSTEMS RAPIDLY AND MORE EFFICIENTLY. IN ADDITION TO RETAINING ITS INITIAL FOCUS ON HIV/AIDS CARE AND TREATMENT, CHAI IMPLEMENTS PROGRAMS ON VACCINES, MALARIA, AND HEALTH SYSTEMS STRENGTHENING MATERNAL AND CHILD HEALTH IN MORE THAN 25 COUNTRIES. FORM 990, PART III, LINE 4D, OTHER PROGRAM SERVICES: HUMAN RESOURCES FOR HEALTH & HEALTH SYSTEMS STRENGTHENING: CHAI IS ASSISTING GOVERNMENTS IN RESOURCE POOR COUNTRIES TO INCREASE HUMAN RESOURCES FOR HEALTH CAPACITY BY EDUCATING, DEPLOYING, AND SUSTAINING AN ADEQUATE NUMBER OF HIGH-QUALITY HEALTH CARE PROFESSIONALS. EXPENSES $ 12,298,275. INCLUDING GRANTS OF $ 2,814,505. REVENUE $ 0. VACCINES WA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule 0 (Form 990 or 990-EZ) (2013) 332211 09-04-13 08580709 756948 25760.001 57 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01 EXPENSES $ 10,631,296. INCLUDING GRANTS OF $ 221,987. REVENUE $ 0. MALARIA EXPENSES $ 5,882,344. INCLUDING GRANTS OF $ 180,958. REVENUE $ 0. FORM 990, PART V. LINE 4B, LIST OF FOREIGN COUNTRIES: CAMBODIA, CAMEROON, ETHIOPIA, INDIA, INDONESIA, JAMAICA, KENYA, LESOTHO, LIBERIA, MALAWI, MOZAMBIQUE, NIGERIA, PAPUA NEW GUINEA, RWANDA, SOUTH AFRICA, SWAZILAND, TANZANIA, UKRAINE, UGANDA, VIETNAM, ZAMBIA, ZIMBABWE, LAOS, BURMA FORM 990, PART VI, SECTION A, LINE 2: EXPLANATION: WILLIAM J. CLINTON AND CHELSEA CLINTON HAVE A PARENT/CHILD RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6: EXPLANATION: UNDER CHAI'S BYLAWS, THE WILLIAM J. CLINTON FOUNDATION HAS THE POWER TO DESIGNATE FIVE (5) SUCCESSOR MEMBERS OF THE BOARD, TWO OF WHOM SHALL BE PRESIDENT WILLIAM J. CLINTON, WHO SHALL, SERVE AS A DIRECTOR AND CHAIR OF THE BOARD UNTIL SUCH TIME AS HE RESIGNS, DIES OR BECOMES INCAPACITATED, AND IRA C. MAGAZINER, WHO SHALL SERVE AS A DIRECTOR AND VICE CHAIR OF THE BOARD FOR SO LONG AS HE REMAINS AN EMPLOYEE OR CONSULTANT OF THE CORPORATION OR UNTIL SUCH TIME AS HE RESIGN, DIES OR BECOMES INCAPACITATED. FORM 990, PART VI, SECTION A, LINE 7A: 09-04-13 08580709 756948 25760.001 Schedule 0 (Form 990 or 990-Z) (2013) 58 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01 Name of the organization Employer identification number HEALTH EXPLANATION: UNDER CHAI'S BYLAWS, THE WILLIAM J. CLINTON FOUNDATION HAS THE POWER TO DESIGNATE FIVE (5) SUCCESSOR MEMBERS OF THE BOARD, TWO OF WHOM SHALL BE PRESIDENT WILLIAM J. CLINTON, WHO SHALL SERVE AS A DIRECTOR AND CHAIR OF THE BOARD UNTIL SUCH TIME AS HE RESIGNS, DIES OR BECOMES INCAPACITATED, AND IRA C. MAGAZINER, WHO SHALL SERVE AS A DIRECTOR AND VICE CHAIR OF THE BOARD FOR SO LONG AS HE REMAINS AN EMPLOYEE OR CONSULTANT OF THE CORPORATION OR UNTIL SUCH TIME AS HE RESIGN, DIES OR BECOMES INCAPACITATED. FORM 990, PART VI, SECTION B, LINE 11: EXPLANATION: THE ACCOUNTING MANAGER COLLECTS AND CONSOLIDATES THE INFORMATION AFTER THE 2013 AUDIT IS COMPLETED. THE RETURN IS PREPARED BY OUR EXTERNAL TAX ADVISOR. THE GLOBAL CONTROLLER, SENIOR DIRECTOR OF FINANCE AND OPERATIONS, AND THE CFO REVIEW THE FORM 990, WHICH IS SUBSEQUENTLY REVIEWED BY THE AUDIT COMMITTEE. THE BOARD OF DIRECTORS WILL RECEIVE A COPY OF THE 990 AT A MEETING PRIOR TO THE FILING OF THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C: EXPLANATION: INTERESTED PERSONS MUST DISCLOSE ANY TRANSACTION OR ARRANGEMENT WHICH RESULTS IN A CONFLICT OF INTEREST TO THE BOARD OR COMMITTEE OF WHICH THEY ARE A MEMBER. THE BOARD MEETS, REVIEWS AND DISCUSSES ANY DISCLOSED CONFLICT OF INTEREST. CHAI SHALL TAKE APPROPRIATE DISCIPLINARY ACTIONS, AS DETERMINED BY THE BOARD, WITH RESPECT TO AN INTERESTED PERSON WHO HAS VIOLATED THE CONFLICT OF INTEREST POLICY. THIS APPLIES TO DIRECTORS, OFFICERS, KEY EMPLOYEES, OR COMMITTEE MEMBERS AND ALL OTHERS WHO ARE PERMITTED TO VOTE AT BOARD OF DIRECTOR MEETINGS. FORM 990, PART VI, SECTION B, LINE 15: 332212 09-04-13 08580709 756948 25760.001 Schedule 0 (Form 990 or 990-EZ) (2013) 59 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01 Name of the organization Employer identification number EXPLANATION: CHAI CONTRACTED WITH AN OUTSIDE CONSULTANT IN 2011 TO CONDUCT A MANAGEMENT STUDY TO HELP ASSIST IN DETERMINING EXECUTIVE COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19: EXPLANATION: THE GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII: EXPLANATION: THE COMPENSATION REPORTED ON PART VII FOR IRA MAGAZINER REPRESENTS COMPENSATION FOR HIS SERVICES TO CHAI AS CEO. SEPARATELY, THE CLINTON FOUNDATION HAS A CONSULTING AGREEMENT WITH SJS ADVISORS, OF WHICH IRA MAGAZINER IS A PRINCIPAL. THE CLINTON FOUNDATION PAID SJS ADVISORS $124,980 FOR SERVICES RELATED TO THE CLINTON FOUNDATION'S CLINTON CLIMATE INITIATIVE. 0904-13 08580709 756948 25760.001 Schedule 0 (Form 990 or 990-EZ) (2013) 60 2013.03061 CLINTON HEALTH ACCESS INITI 25760.01 Related Organizations and Unrelated Partnerships SCHEDULER (Form 990) Complete if the organization answered "Yes on Form 990, Part IV, line 33,34,35b, 36, or 37. See separate Instructions. Attach to Form M. Departirnent of the Treaury 10- Open to Public Inspection Information about Schedule R (Form 990) and its inslructions is at www.1l5.gov/f0ffn990. Name of the organization Employer identification number 27-1414646 CLINTON HEALTH ACCESS INITIATIVE, INC. Part I Identification of Disregarded Entitles Complete it the organization answered 'Yes' on Form 990, Part IV. line 33. (a) Name, address, and EIN (if applicable) of disregarded entity (b) Primary activity (c) Legal domicile (state or foreign country) End-of-year assets Total (d)(' income (I) Direct controlling entity Part 11 Identification of Related Tax-Exempt Organizations Complete if the organization answered 'Yea' on Form 990. Part IV, line 34 because it had one or more related tax-exempt organizations during the lax year. (a) Name, address, and EIN of related organization (b) Primary activity (c) Legal domicile (state or foreign country) (cI) Exempt Code section (a) Public charity status (if section 501 (c)(3)) (1) Direct controlling entity (g) section 51ZLbX13) entity? Yes No 'r.Tw'NTh, w,,rrnvp Tiea - Schedule (Form 990) 2013 For Paperwork Reduction Act Notice, see the Instructions for Form 990. 33215? 02-12-13 WA 61 Schedule R (Form 99O)2013 CLINTON HEALTH ACCESS INITIATIVE S INC. 27-1414646 PO1 III Identification of Related Organizations Taxable as a Partnership Complete if the organization answered Yes on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year. (a) Name, address, and EIN of related organization I (b) I Primary activity I (d) (e) (I) I I I Direct controlling Predominant income I Share of total entity i (related, unrelated I income (state W excluded from tax under I fbfWgn I I (!yi I I sections 512514) I I I (a) Legsi demule Share of end-of-year assets I (h) (i) Code VUSt I DapaSoizin I amount in box Nn I 20 of Schedule I K'l (Form 10651 I (j) aene, II Pace (k) cilPercentage ownership Partiv Identification of Rotated Organizations Taxable as a Corporation or Trust Complete if the organization answered Yes on Form 990, Part IV. line 34 because it had one or more related organizatiocls treated as a corporation or trust during the tax year. 3312 05.12-13 62 Schedule R (Form O9O)2013 Schedule R (Form 99012013 CLINTON HEALTH ACCESS INITIATIVE, INC. 27-1414646 page Part V Transactions With Related Organizations Complete if the organization answered "Yes on Form 990, Part IV. line 34, 35b, or 36. Note. Complete line 1 if any entity is listed in Parts II, lit, or iv of this schedule. During the tax year, did the organization engage in any of the following transactions with one or more related organizations listed In Paris II-IV? a Receipt of (I) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity ......................................................................................................................... bGift, grant, or capital contribution to related organization(s) ........................................................................................................................................................ c GIft, grant, or capital contribution from related organization(s) .................................................................................................................................................... dLoans or loan guarantees to or for related organization(s) ............................................................................................................................................................ e Loans or loan guarantees by related organization(s) ............................................................................................................................................................................. ................................................................................................................................................................................................... .................................................................................................................................................................................................. hPurchase of assets from related organization(s) ..................................................................................................................................................................................... iExchange of assets with related organization(s) ........................................................................................................................................................................ Lease of facilities, equipment, or other assets to related organization(s) ................................................................................................................................................. Dividendsfrom related organization(s) gSale of assets to related organization(s) kLease of facilities, equipment, or other assets from related organization(s) ..................................................................................................................................... ................................................................................................................ I Perforrnaçice of services or membership or fundraising solicitations for related organization(s) ..................................................................................................................... .......................................................................................................................... ........................................................................................................................................... m Performance of services or membership or frmndralsing solicitations by related organization(s) n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) o Sharing or paid employees with related organization(s) p Reimbursement paid to related organization(s) for expenses qReimbursement paid by related organization(s) for expenses Other transfer of cash or property to related organization(s) 332103 02-12-13 ............................................................................................................................................ ................................................................................................................................................. .................................................................................................................................................................... 63 Schedule R (Form 990) 2013 Schedule R (Form gSO)2013 CLINTON HEALTH ACCESS INITIATIVE, INC. 27-1414646 Page Part VI Unrelated Organizations Taxable as a Partnership Complete it the organization answered "Yes" on Form 990, Part IV, line 37. Provide the following information for each entity taxed ass partnership through which the organization conducted more than five percent of its activities (measured b y total assets or oross revenue) Schedule R (Form 990) 2013 332104 0012-13 64 Schedule R(Form 990) 2013 CLINTON HEALTH ACCESS INITIATIVE, INC. 27-1414646 Panes Part VII] Supplemental Information Provide additional Information for responses to questions on Schedule H (see Instructions). 33215 09-12-13 08580709 756948 25760.001 Schedule R (Form 990) 2013 65 2013.03061 CLINTON HEALTH ACCESS INITI 25760_01