efile GRAPHIC Form rint - DO NOT PROCESS As Filed Data - DLN: 93493325011203 OMB No 1545-0047 Return of Or g anization Exem p t From Income Tax 990 Under section 501 ( c), 527, or 4947(a)(1) of the Internal Revenue Code ( except black lung benefit trust or private foundation) 0 201 Department of the Treasury • . 0- The organization may have to use a copy of this return to satisfy state reporting requirements Internal Revenue Service A For the 2010 calendar year, or tax year beginning 01 -01-2010 B Check if applicable and ending 12-31-2010 D Employer identification number C Name of organization CLINTON HEALTH ACCESS INITIATIVE INC F Address change 27-1414646 Doing Business As F Name change E Telephone number fl Initial return Number and street (or P 0 box if mail is not delivered to street address ) 383 DORCHESTER AVENUE NO 400 F_ Terminated F Amended return Room /suite (617) 774-0110 G Gross receipts $ 67,060,090 City or town, state or country , and ZIP + 4 BOSTON, MA 02127 1 Application pending F Name and address of principal officer H(a) Is this a group return for affiliates? H(b) Are all affiliates included? Yes I' No IRA C MAGAZINER 383 DORCHESTER AVE BO STO N, MA 02127 Yes Nc If "No," attach a list (see instructions) I Tax - exempt status J Website :1- WWW CLINTONHEALTHACCESS ORG F 501(c)(3) fl 501 (c) ( ) I (insert no ) fl 4947(a)(1) or H(c) F_ 527 K Form of organization F Corporation 1 Trust F_ Association 1 Other 0- Group exemption number 0- L Year of formation 2009 M State of legal domicile AR Summary 1 Briefly describe the organization's mission or most significant activities SUPPORT GOVERNMENTS TO BUILD AND STRENGTHEN INTEGRATED HEALTH SYSTEMS IN THE DEVELOPING WORLD AND EXPAND ACCESS TO HIGH-QUALITY CARE AND TREATMENT FOR HIV/AIDS, MALARIA AND OTHER DISEASES 2 Check this box Of- if the organization discontinued its operations or disposed of more than 25% of its net assets 3 Number of voting members of the governing body (Part VI, line 1a) 4 Number of independent voting members of the governing body (Part VI, line 1 b) . . . 3 7 4 3 5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) 5 281 6 Total number of volunteers (estimate if necessary) 6 54 7a 0 . . . 7aTotal unrelated business revenue from Part VIII, column (C), line 12 b Net unrelated business taxable income from Form 990-T, line 34 . . 7b Prior Year 13- 0 Current Year 8 Contributions and grants (Part VIII, line 1h) 0 66,874,152 9 Program service revenue (Part VIII, line 2g) 0 0 10 Investment income (Part VIII, column (A), lines 3, 4, and 7d 0 185,938 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 0 0 12 Total revenue-add lines 8 through 11 (must equal Part VIII, column (A), line 12) . . . . . . . . . . . . . . . . . . . 0 67,060,090 13 Grants and similar amounts paid (Part IX, column (A), lines 1-3) 0 8,714,332 14 Benefits paid to or for members (Part IX, column (A), line 4) 0 0 15 Salaries, other compensation, employee benefits (Part IX, column (A ), lines 5-10) 0 29,961,992 Professional fundraising fees (Part IX, column (A), line 11e) 0 2,760 0 30,886,751 16a sC LLJ b . . . . Total fundraising expenses (Part IX, column (D), line 25) X750,653 17 Other expenses (Part IX, column (A), lines 11a-11d, 11f-24f) . . . . 18 Total expenses Add lines 13-17 (must equal Part IX, column (A), line 25) 0 69,565,835 19 Revenue less expenses Subtract line 18 from line 12 0 -2,505,745 Beginning of Current Year End of Year ell 'M ZLL 20 Total assets (Part X, line 16) 21 Total liabilities (Part X, line 26) 22 Net assets or fund balances Subtract line 21 from line 20 Big= . . Signature Block Under penalties of perjury, I declare that I have examined this return , including acco knowledge and belief, it is true, correct , and complete . Declaration of preparer (othe knowledge. Sign Here Signature of officer JULIE FEDER CHIEF FINANCIAL OFFICER Type or print name and title Print/Type preparers name Paid Preparer Use Only Firm's name Firm ' s address Preparers signature CRAIG KLEIN CRAIG KLEIN CBIZ TOFIAS 500 BOYLSTON STREET BOSTON, MA 02116 May the IRS discuss this return with the preparer shown above? (see instructs For Paperwork Reduction Act Notice, see the separate instructions. 0 113,424,316 0 98,202,001 0 15,222,315 Form 990 ( 2010) Page 2 Statement of Program Service Accomplishments Check if Schedule 0 contains a response to any question in this Part III 1 .F Briefly describe the organization 's mission SEE SCHEDULE OTHE CLINTON HEALTH ACCESS INITIATIVE IS DEDICATED TO IMPROVING ACCESS TO HEALTHCARE FOR ALL INDIVIDUALS RESIDENTS OF DEVELOPING COUNTRIES OFTEN CANNOT AFFORD AND DO NOT HAVE ACCESS TO SYSTEMS THAT PROVIDE BASIC HEALTHCARE, INCLUDING MEDICINES FOR DISEASES THAT ARE PREVENTABLE, TREATABLE OR CURABLE THIS IS WHERE CHAI INTERVENES - BY PARTNERING WITH GOVERNMENTS AND WORKING WITH OTHER NGOS TO PROVIDE SOLUTIONS TO THE BIGGEST CHALLENGES IMPEDING EFFECTIVE HEALTHCARE IN DEVELOPING COUNTRIES USING A BUSINESS-ORIENTED APPROACH, CHAI ENDEAVORS TO ALTER COMMODITY MARKETS TO DECREASE THE COSTS OF CARE AND TREATMENT, AS WELL AS EXPAND ACCESS TO HEALTH SERVICES 2 Did the organization undertake any significant program services during the year which were not listed on the prior Form 990 or 990-EZ? . . . . . . . . . . . . . . . . . . . . fl Yes F 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? . . . . . . . . . . . . . . . . . . . . . . . . . . F Yes F No If"Yes,"describe these changes on Schedule 0 4 4a Describe the exempt purpose achievements for each of the organization 's three largest program services by expenses Section 501(c)(3) and 501( c)(4) organizations and section 4947( a)(1) trusts are required to report the amount of grants and allocations to others , the total expenses , and revenue , if any, for each program service reported (Code ) ( Expenses $ 12,114,902 including grants of $ 2,888,200 ) ( Revenue $ RURALIN A SELECTED NUMBER OF COUNTRIES CHAT WORKS TO STRENGTHEN NATIONAL HEALTH SYSTEMS IN ORDER TO PROVIDE HIGH-QUALITY AFFORDABLE HEALTH CARE TO THOSE IN RURAL COMMUNITIES AND POOR TOWNSHIPS IN ETHIOPIA, MALAWI, TANZANIA, AND PAPUA NEW GUINEA, WE WORK WITH THE GOVERNMENT TO IMPROVE TARGETED ASPECTS OF THEIR HEALTHCARE SYSTEMS, SUCH AS HUMAN RESOURCES, SUPPLY CHAIN, OPTIMAL SERVICE DELIVERY AND THE COLLECTION OF DATA TO BETTER INFORM SUCCESS OF TARGETED INTERVENTIONS 4b (Code ) ( Expenses $ 8,293,808 including grants of $ 1,678,602 ) ( Revenue $ PEDSCHAI'S PEDIATRIC PROGRAM IS FOCUSED ON EXPANDING ACCESS TO HIGH QUALITY TESTING AND TREATMENT SERVICES FOR HIV-EXPOSED AND -INFECTED CHILDREN ACROSS 10+ HIGH-BURDEN COUNTRIES IN AFRICA AND ASIA 4c (Code ) ( Expenses $ 5,732,130 including grants of $ 1,088,089 ) (Revenue $ PREVENTION OF MOTHER-TO-CHILD TRANSMISSION (PMTCT)CHAI'S PMTCT PROGRAM HAS PIONEERED SUCCESSFUL APPROACHES TO REDUCING VERTICAL TRANSMISSION OF HIV BY INCREASING ANTENATAL CARE, MATERNAL HIV DIAGNOSIS, UPTAKE OF EFFICACIOUS REGIMENS , AND PROPHYLAXIS AND TESTING OF EXPOSED INFANTS 4d Other program services ( Describe in Schedule 0 ) See also Additional Data for Description (Expenses $ 4e 36,520,348 Total program service expensesl-$ including grants of $ 3,059,441 ) ( Revenue $ 62,661,188 Form 990 (2010) Form 990 (2010) Page 3 Checklist of Required Schedules Yes 1 No Is the organization described in section 501(c)(3) or4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule As . . . . . . . . . . . . . . . . . . . 1 2 Is the organization required to complete Schedule B, Schedule of Contributors (see instruction) ? 2 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 I . . . . . . . . . . 3 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 II . 4 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 III . . . . . . . . . . . . . . . . . . . . . . . 5 Did the organization maintain any donor advised funds or any similar funds or accounts where 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 Is . . . . . . . . . . . . . . . . . . . . . . 6 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," completeSchedu/e D, Part II 7 No Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III . . . . . . . . . . . . . . . . . . . . 8 No Did the organization report an amount in Part X, line 21, 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 D, Part IV . . . . . . . . . . . . . . . . . . 9 No 10 No 4 5 6 7 8 9 10 Did the organization, directly or through a related organization, hold assets in term, permanent,or quasiendowments? If "Yes,"complete Schedule D, Part VS 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 b c d e f 12a Yes No No Did the organization report an amount for land, buildings, and equipment in Part X, linel0? If "Yes,"complete Schedule D, Part VI.95 11a 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," completeSchedu/e D, Part VII. 11b 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 D, Part VIII.95 11c 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. 11d Yes lie Yes Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, PartX.95 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 D, Part X.95 Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete Schedule D, Parts XI, XII, and XIII b Did the organization maintain an office, employees, or agents outside of the United States? 15 . IN 1 Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U S ? If "Yes," complete Schedule F, Parts III and IV . IN 1 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 11e? If "Yes," complete Schedule G, PartI (see instructions) 17 18 12a No Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II . . . . . . . . . No 14a Yes 14b Yes 15 Yes 16 No 17 No 18 No 19 No No 19 Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes,"complete Schedule G, Part III . . . . . . . . . . . . . . . . . . . 20a Did the organization operate one or more hospitals? If "Yes, "complete Schedule H . 20a If "Yes" to line 20a, did the organization attach its audited financial statement to this return? Note . Some Form 990 filers that operate one or more hospitals must attach audited financial statements (see instructions) 20b b Yes 13 Did the organization report on Part IX, column (A ), line 3, more than $5,000 of grants or assistance to any . organization or entity located outside the U S ? If "Yes," complete Schedule F, Parts II and IV . 95 16 No No Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, and program service activities outside the United States? If "Yes," complete Schedule F, Parts I and IV Yes 11f 12b Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes, "complete Schedule E 14a No I b 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, XII, and XIII is optional 13 Yes Form 990 (2010) Form 990 (2010) Page 4 Checklist of Required Schedules (continued) 21 Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If "Yes," complete Schedule I, Parts I and II . . 21 22 Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If "Yes," complete Schedule I, Parts I and III . 22 23 Did the organization answer "Yes" to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization's current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes,"completeScheduleJ . . . . . . . . . . . . . . . . 23 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-24d and complete Schedule K. If "No,"go to line 25 . . . . . . . . . . . . . . . 24a b Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception? 24b c Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease any tax-exempt bonds? . 24c Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year? 24d d 25a b 26 27 28 . . Yes No Yes No Section 501(c )( 3) and 501 ( c)(4) organizations . Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I . 25a No 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 I . . . . . . . . . . . . . . . 95 25b No Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization's tax year? If "Yes," complete Schedule L, Part II . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 No Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If "Yes," complete Schedule L, Part III . . . . . . . . . . . . . . 19 27 No 28a No 28b No 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 . . . . . . . . . . . . . . . . . . c . A n 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 . 28c 29 Did the organization receive more than $25,000 in non-cash contributions? If "Yes, "complete Schedule M 29 No 30 Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes, "complete Schedule M . . . . . . . . . . . 30 No Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I . . . . . . . . . . . . . . . . . . . . . . . . . . 31 No Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes, " complete Schedule N, Part II . . . . . . . . . . . . . . . . . . . . . . 32 No 33 Did the organization own 100% of an entity disregarded as separate from the organization under Regulations ISI 33 . . sections 301 7701-2 and 301 7701-3? If "Yes,"complete Schedule R, PartI . . . . . . No 34 Was the organization related to any tax-exempt or taxable entity? If "Yes,"complete Schedule R, Parts II, III, IV, and V, line 1 . . . . . . . . . . . . . . . . . . . . . IN 31 32 35 a 36 37 38 Is any related organization a controlled entity within the meaning of section 512(b)(13)? . 1 Yes 34 Yes 35 Yes 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 R, Part V, line2 . . . S fYes F7No Section 501(c )( 3) organizations . Did the organization make any transfers to an exempt non-charitable related . . organization? If "Yes,"complete Schedule R, Part t<, line 2 . . . . . . . . . 95 36 No 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 37 No Did the organization complete Schedule 0 and provide explanations in Schedule 0 for Part VI, lines 11 and 19? Note . All Form 990 filers are required to complete Schedule 0 . . . . . . . . . . 38 Yes Form 990 (2010) Form 990 (2010) KEW Page 5 Statements Regarding Other IRS Filings and Tax Compliance Check if Schedule 0 contains a response to any question in this Part V Yes la I No Enter the number reported in Box 3 of Form 1096 Enter-0- if not applicable b c 2a 33 lb 0 Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? . . . . . . . . . . . . . . . . . Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return . . . . . . . . . . . . . . . . . . . . b la Enter the number of Forms W-2G included in line la Enter-0- if not applicable 2a 1c Yes 2b Yes 281 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? . . . . . . . . . . . . . . . . . . . . . . . b 4a . . If "Yes," has it filed a Form 990-T for this year? If "No,"provide an explanation in Schedule O . . . . . . . . . 5a No 3b At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? . b 3a Yes 4a BY,CB,CH,DR,ET,HA,IN,ID,KE,LT,LI,MI,MZ,NI, I f "Yes," enter the name of the foreign country 0_ P P , RW, SF, WZ J Z , U G , U P , V M , ZA , ZI See instructions for filing requirements for Form TD F 90-22 1, Report of Foreign Bank and Financial Accounts 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? c If"Yes" to line 5a or 5b, did the organization file Form 8886-T? 5a No 5b No 5c 6a Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible? . . b 7 6a If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? . . . . . . . . . . . . . . . . . . . . . . . . No 6b 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 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 to file Form 82827 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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? . . . . . . . . . . . . . . . . . . . . . . . . . . 7c I . No 7e No No Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? 7f g If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? . 7g h If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? . . . . . . . . . . . . . . . 7h 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 I I 7d f 8 No Sponsoring organizations maintaining donor advised funds. a b 10 Did the organization make any taxable distributions under section 4966? 9a Did the organization make a distribution to a donor, donor advisor, or related person? 9b Section 501(c )( 7) organizations. Enter a Initiation fees and capital contributions included on Part VIII, line 12 b Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities 11 . 10a 10b Section 501(c )( 12) organizations. Enter 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 ) . . . . . . . . 12a b 13 . . 11a 11b Section 4947( a)(1) non -exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041? If "Yes," enter the amount of tax-exempt interest received or accrued during the year 12a 12b Section 501(c )( 29) qualified nonprofit health insurance issuers. a b c 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 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 13a 13b Enter the amount of reserves on hand 13c 14a b Did the organization receive any payments for indoor tanning services during the tax year? . If "Yes," has it filed a Form 720 to report these payments? If "No,"provide an explanation in Schedule 0 14a No 14b Form 990 (2010) Form 990 ( 2010) Lam Page 6 Governance , Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule 0. See instructions. Check if Schedule 0 contains a response to any question in this Part VI .F Section A . Governing Body and Management Yes la b 2 Enter the number of voting members of the governing body at the end of the tax year . . . . . . . . . . . . . la 7 Enter the number of voting members included in line la, above, who are independent . . . . . . . . . . . . . . . . lb 3 No 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? 2 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? 3 4 Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? 4 No 5 Did the organization become aware during the year of a significant diversion of the organization's assets? 5 No 6 Does the organization have members or stockholders? 6 Yes 7a Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? . . . . . . . . . . . . . . . . . . . . . . . . 7a Yes Are any decisions of the governing body subject to approval by members, stockholders, or other persons? 7b b 8 No Yes No Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following a The governing body? 8a Yes b Each committee with authority to act on behalf of the governing body? 8b Yes Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization's mailing address? If"Yes," provide the names and addresses in Schedule 0 . 9 9 No Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.) Yes 10a b 11a Does the organization have local chapters, branches, or affiliates? 10a Yes If"Yes,"does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? . 10b Yes Has the organization provided a copy of this Form 990 to all members of its governing body before filing the form? 11a b 12a No Describe in Schedule 0 the process, if any, used by the organization to review this Form 990 Does the organization have a written conflict of interest policy? If "No,"go to line 13 . 12a Yes 12b Yes Does the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule 0 how this is done . . . . . . . . . . . . . . . . . . . 12c Yes 13 Does the organization have a written whistleblower policy? 13 Yes 14 Does the organization have a written document retention and destruction policy? 14 Yes 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? b Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? . . . . . . . . . . . . . . . . . . . . . . . . . . c No . a The organization's CEO, Executive Director, or top management official 15a No b Other officers or key employees of the organization 15b No Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? . . . . . . . . . . . . . . . . . . . . . 16a No If "Yes," has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization's exempt status with respect to such arrangements? 16b If "Yes" to line 15a or 15b, describe the process in Schedule 0 16a b (See instructions Section C. Disclosure 17 List the States with which a copy of this Form 990 is required to be filed- AR , CA , IL , MA , NJ , NY , PA 18 Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable ), 990, and 990 -T (501(c) (3 )s only) available for public inspection Indicate how you make these available Check all that apply fl Own website fi Another' s website F Upon request Describe in Schedule 0 whether (and if so, how ), the organization makes its governing documents , conflict of interest policy , and financial statements available to the public See Additional Data Table 19 20 State the name, physical address, and telephone number of the person who possesses the books and records of the organization0JULIE FEDER 383 DORCHESTER AVENUE BOSTON,MA 02127 (617)774-0110 Form 990 (2010) Form 990 (2010) Page 7 Compensation of Officers , Directors , Trustees , Key Employees, Highest Compensated Employees , and Independent Contractors Check if Schedule 0 contains a response to any question in this Part VII .F Section A. Officers, Directors, Trustees, Kev Employees, and Highest Compensated Employees la 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 * List all of the organization' s current officers, directors, trustees (whether individuals or organizations), regardless of amount of compensation, and current key employees 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 1 Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee (A) Name and Title (B) Average hours per week (describe hours for related organizations in Schedule 0) (C) Position ( check all that apply ) _ 3Z 2 CD C r' m (1) WILLIAM J CLINTON DIRECTOR AND OFFICER 1 00 X (2) BRUCE LINDSEY DIRECTOR 1 00 (3) MARGARET WILLIAMS DIRECTOR (4) PAUL FARMER DIRECTOR (D) Reportable compensation from the organization ( W2/1099-MISC ) =• 0 (D 5 CD - E q^ 4 -D rD ( E) Reportable compensation from related organizations (W- 2/1099MISC) T a (F) Estimated amount of other compensation from the organization and related organizations D m a, X 0 0 0 X 0 276,298 32,245 1 00 X 0 0 0 1 00 X 0 0 0 (5) STEPHEN LEWIS DIRECTOR 1 00 X 0 0 0 (6) LYN TALIENTO DIRECTOR 1 00 X 0 0 0 (7) IRA MAGAZINER CEO/VICE CHAIRMAN 50 00 X X 0 0 14,828 (8) ANIL SONI CHIEF EXECUTIVE OFFICER 50 00 X 132,604 0 12,267 (9) RANDALL WALTHER ACTING CHIEF FINANCIAL OFFICER 50 00 X 74,569 0 7,684 (10) EDWARD WOOD CHIEF EXECUTIVE OFFICER 50 00 X 89,249 0 5,820 (11) MARK ALCAIDE CHIEF FINANCIAL OFFICER 50 00 X 78,654 0 12,870 (12) JOSEPH HARWELL REG MEDICAL OFFICER, SE ASIA 50 00 X 125,481 0 20,968 (13) KATE CONDLIFFE EXECUTIVE VP, HIV/AIDS 50 00 X 123,192 0 8,180 (14) DAVID ELLIS EXECUTIVE VP, ACCESS PROGRAMS 50 00 X 120,273 0 15,252 (15) VISHAL BRIJLAL COUNTRY DIRECTOR 50 00 X 175,376 0 0 (16) OWENS MOWENI WIWA REGIONAL DIRECTOR 50 00 X 120,000 0 7,551 Form 990 (2010) Form 990 (2010) Page 8 Section A. Officers, Directors , Trustees, Key Employees , and Highest Compensated Employees (continued) (A) Name and Title lb Sub -Total . . . (B) Average hours per week (describe hours for related organizations in Schedule 0) . . . . . . (C) Position (check all that apply) _ C r' . . . Total ( add lines lb and 1c ) . . _0 a (E) Reportable compensation from related organizations (W- 2/1099MISC) (F) Estimated amount of other compensation from the organization and related organizations 0 , -D & Total from continuation sheets to Part VII, Section A . 5 m - (D d . E 0 'D " 0 a : _0 m -D 74 2_ c . (D) Reportable compensation from the organization (W2/1099-MISC) . . . . . . . . . . . 0- . . . 0- 1,039,398 276,298 137,665 Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organization-16 No Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line la? If "Yes," complete Schedule Jfor 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 $150,0007 If "Yes," complete Schedule -7 for such individual . . . . . . . . . . . . . . . . . . . . . . . . . . 3 No 5 No . Did any person listed on line la receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes,"complete Schedule J for such person . Section B. Independent Contractors 1 Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization (A) Name and business address DR PETER BARRON KALK BAY CAPE TOWN SF 2 (B) Description of services CONSULTING (C) Compensation 209,000 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization 0-1 Form 990 (2010) Form 990 (2010) N Page 9 Statement of Revenue (A) Total revenue la C C 45 • Cx^ i Federated campaigns . b Membership dues . c Fundraising events d Related organizations e . (B) Related or exempt function revenue (C) Unrelated business revenue (D) Revenue excluded from tax under sections 512, 513, or 514 la . . lb . 1c ld 2,350,000 Government grants (contributions) le 26,740,319 f All other contributions, gifts, grants, and similar amounts not included above if 37,783,833 g Noncash contributions included in lines la-If $ h Total. Add lines la-1f . . 0- 66,874,152 Business Code 2a b c d e f All other program service revenue g Total . Add lines 2a-2f . 3 . . . . . . . Investment income (including dividends, interest 10- and other similar amounts) 4 Income from investment of tax-exempt bond proceeds 5 Royalties 6a Gross Rents . . . . . . . . . , . . c d (ii) Personal . . (i) Securities c Gross amount from sales of assets other than inventory Less cost or other basis and sales expenses Gain or (loss) d Net gain or (loss) b 8a 0- Less rental expenses Rental income or (loss) Net rental income or (loss) 7a 185,938 . 0- . (i) Real b 185,938 . . . . 0' (ii) Other . . . . .0- . Gross income from fundraising events (not including $ W 3 of contributions reported on line 1c) See Part IV, line 18 a b Less c Net income or (loss) from fundraising events 9a direct expenses . . . b . . Gross income from gaming activities See Part IV, line 19 . a b Less direct expenses . c Net income or (loss) from gaming activities b . . .0- 10a Gross sales of inventory, less returns and allowances a b Less cost of goods sold . b c Net income or (loss) from sales of inventory 0- . Miscellaneous Revenue Business Code 11a b c d All other revenue . e Total .Add lines 11a-11d . . . 0- 12 Total revenue . See Instructions . . . 67,060,090 , 0 0 185,938 , Form 990 (2010) Form 990 (2010) Page 10 Statement of Functional Expenses Section 501 ( c)(3) and 501 ( c)(4) organizations must complete all columns. All other organizations must complete column ( A) but are not required to complete columns (B), (C), and ( D). ( A) Total expenses Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII . 1 Grants and other assistance to governments and organizations in the U S See Part IV, line 21 2 Grants and other assistance to individuals in the U S See Part IV, line 22 3 Grants and other assistance to governments, organizations , and individuals outside the U S 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 contributions ( include section 401(k) and section 403(b) employer contributions) 9 Other employee benefits 10 Payroll taxes a . 1,767,337 1,767,337 6,946,995 6,946,995 428,545 (C) Management and general expenses (D) Fundraising expenses 428,545 26,364,956 22,455,634 3,354,263 555,059 3 ,168,491 2,686,538 431,169 50,784 108 ,360 65,223 42,727 410 77,478 75,498 1,980 . Fees for services ( non-employees) Management . . b Legal c Accounting d Lobbying . . e Professional fundraising services See Part IV, line 17 f Investment management fees g (B) Program service expenses . 2,760 2,760 . Other 3,286 ,451 3,035,454 16,030 988 Office expenses 1,681,520 1,496,144 172,490 12,886 14 Information technology 1,510,682 1,288,709 207,043 14,930 15 Royalties 12 Advertising and promotion 13 230,203 20,794 15,042 16 Occupancy 1,996,315 1,767,057 229,258 17 Travel 7,489,920 6,975,693 453,741 60,486 18 Payments of travel or entertainment expenses for any federal, state, or local public officials 3,366,946 3,359,804 6,995 147 19 Conferences , conventions , and meetings 20 Interest 21 Payments to affiliates 22 Depreciation , depletion, and amortization 23 Insurance 24 Other expenses Itemize expenses not covered above (List miscellaneous expenses in line 24f If line 24f amount exceeds 10% of line 25, column ( A) amount, list line 24f expenses on Schedule 0 a . . . DIRECT PROGRAM EXPENDIT 512,695 512,695 . 10,302,272 10,300,329 487 1,456 538,082 439,785 82,398 15,899 69,565,835 62,661,188 6,153,994 750,653 b c d e f All other expenses 25 Total functional expenses. Add lines 1 through 24f 26 Joint costs. Check here 1F- if following SOP 98-2 (ASC 958-720) Complete this line only if the organization reported in column ( B) joint costs from a combined educational campaign and fundraising solicitation Form 990 (2010) Form 990 (2010) Page 11 Balance Sheet (A) Beginning of year 1 Cash-non-interest-bearing 2 Savings and temporary cash investments 1 . 5,674,455 3 Pledges and grants receivable, net 3 7,827,100 Accounts receivable, net 4 574,831 5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees Complete Part II of . Schedule L 5 Receivables from other disqualified persons (as defined under section 4958(f)(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 instructions) Schedule L 6 7 Notes and loans receivable, net 8 Inventories for sale or use 9 Prepaid expenses and deferred charges 10a b . . . . . . . . . . . . 7 8 9 10a Less 10b accumulated depreciation 439,200 2,626,250 Land, buildings, and equipment cost or other basis Complete Part VI of Schedule D 1,533,692 0 . 10c 11 Investments-publicly traded securities 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 16 Total assets . Add lines 1 through 15 (must equal line 34) 17 Accounts payable and accrued expenses 18 Grants payable 18 19 Deferred revenue 19 20 Tax-exempt bond liabilities 20 21 Escrow or custodial account liability Complete Part IVof Schedule D 22 Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified persons Complete Part II of Schedule L 1,092,558 11 12 . 13 14 . 0 15 97,816,172 0 16 113,424,316 17 8,625,614 . 82,881,932 21 . 22 23 Secured mortgages and notes payable to unrelated third parties 23 24 Unsecured notes and loans payable to unrelated third parties 24 25 Other liabilities Complete Part X of Schedule D 26 Total liabilities . Add lines 17 through 25 . . 0 25 6,694,455 0 26 98,202,001 Organizations that follow SFAS 117, check here 1- F and complete lines 27 through 29, and lines 33 and 34. co L) r_ 15 2 4 6 0 (B) End of year 27 Unrestricted net assets 27 -3,711,550 28 Temporarily restricted net assets 28 18,933,865 29 Permanently restricted net assets 29 Organizations that do not follow SFAS 117, check here 1 F- and complete lines 30 through 34. LL. 30 Capital stock or trust principal, or current funds 30 31 Paid-in or capital surplus, or land, building or equipment fund 31 < 32 Retained earnings, endowment, accumulated income, or other funds 32 Z Z 33 Total net assets or fund balances 0 33 34 Total liabilities and net assets/fund balances 0 34 15,222,315 113,424,316 Form 990 (2010) Form 990 (2010) « Page 12 Reconcilliation of Net Assets Check if Schedule 0 contains a response to any question in this Part XI .F 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 4 Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) 5 6 67,060,090 2 69,565,835 3 -2,505,745 4 0 5 17,728,060 6 15,222,315 . Other changes in net assets or fund balances (explain in Schedule O) . Net assets or fund balances at end of year Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) GZ MM- 1 Financial Statements and Reporting Check if Schedule 0 contains a response to any question in this Part XII . (Yes No Accounting method used to prepare the Form 990 fl Cash 17 Accrual (Other If the organization changed its method of accounting from a prior year or checked "Other," explain in Schedule 0 2a Were the organization's financial statements compiled or reviewed by an independent accountant? 2a b Were the organization's financial statements audited by an independent accountant? 2b Yes c If "Yes," to 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 . . . . . . . . . . . . . . . . . . . . . . . . . . 2c Yes d If "Yes" to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both fl Separate basis 3a b . No F Consolidated basis fl Both consolidated and separated basis 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 A-133? . . . . . . . . . . . . . . . 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 any steps taken to undergo such audits . 3a No 3b Form 990 (2010) Additional Data Software ID: Software Version: EIN: Name : 27 -1414646 CLINTON HEALTH ACCESS INITIATIVE INC Form 990, Part III - 4 Program Service Accomplishments (See the Instructions) 4d. Other program services (Code ) ( Expenses $ 36,520,348 including grants of $ 3,059,441 ) ( Revenue $ UNITAID CSDHUMAN RESOURCES FOR HEALTH DRUG ACCESSLABMALARIAPROCUREMENTSUPPLY I CHAINVACCINESNUTRITIONGLOBAL HEALTH FINANCING l efile GRAPHIC p rint - DO NOT PROCESS As Filed Data - DLN: 93493325011203 OMB No 1545-0047 SCHEDULE A Public Charity Status and Public Support (Form 990 or 990EZ) 201 0 Complete if the organization is a section 501(c )(3) organization or a section 4947 (a)(1) nonexempt charitable trust. Department of the Treasury Internal Revenue Service ^ Attach to Form 990 or Form 990-EZ . ^ See separate instructions. Name of the organization CLINTON HEALTH ACCESS INITIATIVE INC Employer identification number 27-1414646 Reason for Public Charity Status (All organizations must complete this part.) See Instructions The organization is not a private foundation because it is (For lines 1 through 11, check only one box) 1 1 A church, convention of churches, or association of churches described in section 170 ( b)(1)(A)(i). 2 1 A school described in section 170 (b)(1)(A)(ii). (Attach Schedule E ) 3 1 A hospital or a cooperative hospital service organization described in section 170 ( b)(1)(A)(iii). 4 1 A medical research organization operated in conjunction with a hospital described in section 170 (b)(1)(A)(iii). Enter the hospital's name, city, and state 5 fl An organization operated for the benefit of a college or university owned or operated by a governmental unit described in 6 fl A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v). 7 F An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170 ( b)(1)(A)(vi) (Complete Part II ) 8 fl A community trust described in section 170(b)(1)(A)(vi ) ( Complete Part II ) 9 1 An organization that normally receives section 170 ( b)(1)(A)(iv ). ( Complete Part II ) ( 1) more than 331/3% 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 331/3% 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 III ) 10 1 An organization organized and operated exclusively to test for public safety Seesection 509(a)(4). 11 1 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 ( a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h a fl Type I b fl Type II c fl Type III - Functionally integrated d fl Type III - Other e (- 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 III supporting organization, check this box F Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons? (i) a person who directly or indirectly controls , either alone or together with persons described in (ii) Yes No f g h and (iii) below, the governing body of the the supported organization? 11g(i) (ii) a family member of a person described in (i) above? 11g(ii) (iii) a 35% controlled entity of a person described in (i) or (ii) above? 11g(iii) Provide the following information about the supported organization(s) 0) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions )) (iv) Is the organization in col (i) listed in your governing document? Yes No ( v) Did you notify the organization in col (i) of your support? Yes No (vi) Is the organization in col (i) organized in the U S ? Yes vii Amount of support No Total For Paperwork Reduction Act Notice, seethe Instructions for Form 990 Cat No 11285F Schedule A (Form 990 or 990-EZ) 2010 Schedule A (Form 990 or 990-EZ) 2010 Page 2 Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1) (A)(vi) (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 III. If the organization fails to qualify under the tests listed below, please complete Part III.) Section A . Public Su pp ort Calendar year (or fiscal year beginning in) ^ Gifts, grants, contributions, and 1 membership fees received (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (Do not (f) Total 66,874,152 66,874,152 66,874,152 66,874,152 include any "unusual grants ") Tax revenues levied for the organization's benefit and either paid to or expended on its behalf The value of services or facilities furnished by a governmental unit to the organization without charge 2 3 4 Total . Add lines 1 through 3 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 (f) Public Support . Subtract line 5 from 6 41,582,684 25,291,468 line 4 Section B. Total Su pp ort Calendar year (or fiscal year beginning in) III 7 Amounts from line 4 8 Gross income from interest, (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total 66,874,152 66,874,152 185,938 185,938 dividends, payments received on securities loans, rents, royalties and income from similar 9 10 11 sources Net income from unrelated business activities, whether or not the business is regularly carried on Other income Do not include gain or loss from the sale of capital assets (Explain in Part IV ) Total support (Add lines 7 67, 060, 090 through 10) 12 Gross receipts from related activities, etc (See instructions 13 First FiveYearslfthe Form 990 is for the organization's first, second, third, fourth, orfifth tax year as a 501(c)(3) organization, check this box and stop here 12 Section C. Com p utation of Public Su pp ort Percenta g e 14 Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f)) 14 15 15 Public Support Percentage for 2009 Schedule A, Part II, line 14 16a 331 / 3%support test - 2010 . 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 llik^Fb 33 1 / 3%support test - 2009 . If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this box and stop here . The organization qualifies as a publicly supported organization F17a 10%-facts-and -circumstances test - 2010 . 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 llik^Fb 10%-facts-and-circumstances test - 2009 . If the organization did not check a box on line 13, 16a, 16b, or 17a and line 15 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 F18 Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see instructions llik^FSchedule A (Form 990 or 990-EZ) 2010 Schedule A (Form 990 or 990-EZ) 2010 Page 3 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 qualify under the tests listed below, please complete Part II.) Section A. Public Support IMMITM Calendar year (or fiscal year beginning in) llik^ 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 year c Add lines 7a and 7b 8 Public Support (Subtract line 7c from line 6 ) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total Section B. Total Su pp ort Calendar year (or fiscal year beginning (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total in) 9 Amounts from line 6 Gross income from interest, 10a dividends, payments received on securities loans, rents, royalties and income from similar sources Unrelated business taxable b income (less section 511 taxes) from businesses acquired after June 30, 1975 c Add lines 10a and 10b Net income from unrelated 11 business activities not included in line 10b, whether or not the business is regularly carried on Other income Do not include 12 gain or loss from the sale of capital assets (Explain in Part IV ) Total support (Add lines 9, 10c, 13 11 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 section501(c)(3) organization, check this box and stop here Section C. Com p utation of Public Su pp ort Percenta g e 15 Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f)) 15 16 Public support percentage from 2009 Schedule A, Part III, line 15 16 Section D . Computation of Investment Income Percentage 17 Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f)) 17 18 Investment income percentage from 2009 Schedule A, Part III, line 17 18 19a 33 1/3%support tests-2010 . 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 33 1 / 3% support tests- 2009 . If the organization did not check a box on line 14 or line 19a, 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 Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions b 20 Schedule A (Form 990 or 990-EZ) 2010 Schedule A (Form 990 or 990-EZ) 2010 Page 4 Supplemental Information . Supplemental Information. Complete this part to 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). Schedule A (Form 990 or 990-EZ) 2010 lefile GRAPHIC print - DO NOT PROCESS DLN: 934933250112031 OMB No 1545-0047 SCHEDULE D (Form 990) Department of the Treasury Internal Revenue Service I As Filed Data - I 2010 Supplemental Financial Statements 1- Complete if the organization answered "Yes," to Form 990, Part IV , line 6, 7, 8, 9, 10, 11, or 12. 1- Attach to Form 990. 1- See separate instructions. Name of the organization CLINTON HEALTH ACCESS INITIATIVE INC bafffim Employer identification number 27-1414646 Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts . Complete if the or g anization answered "Yes" to Form 990 Part IV , line 6. (a) Donor advised funds 1 Total number at end of year 2 Aggregate contributions to (during year) ( b) Funds and other accounts 3 Aggregate grants from ( during year) 4 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 organization ' s property , subject to the organization ' s exclusive legal control? F Yes I Did the organization inform all grantees , donors, and donor advisors in writing that grant funds may be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit fl Yes fl No 6 No MRSTIConservation 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) 1 Preservation of land for public use ( e g , recreation or pleasure ) 1 Preservation of an historically importantly land area 1 Protection of natural habitat fl Preservation of open space 1 Preservation of a certified historic structure Complete lines 2a-2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year Held at the End of the Year a Total number of conservation easements 2a b Total acreage restricted by conservation easements 2b c Number of conservation easements on a certified historic structure included in (a) 2c d Number of conservation easements included in (c) acquired after 8/17/06 2d N umber of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the taxable year 04 N umber of states where property subject to conservation easement is located 0- 5 Does the organization have a written policy regarding the periodic monitoring , inspection , handling of violations, and enforcement of the conservation easements it holds? fl Yes fl No fl Yes l No Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year 1Amount of expenses incurred in monitoring , inspecting , and enforcing conservation easements during the year - $ Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)( 4)(B)(i) and 170 ( h)(4)(B)(ii)? 9 In Part XIV, 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 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 b 2 If the organization elected, as permitted under SFAS 116, 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 XIV, the text of the footnote to its financial statements that describes these items If the organization elected, as permitted under SFAS 116, 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 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 -$ 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 relating to these items a Revenues included in Form 990, Part VIII, line 1 b Assets included in Form 990, Part X For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990 - $ - $ Cat No 52283D Schedule D ( Form 990) 2010 Schedule D (Form 990) 2010 r:FTnFW 3 Page 2 Organizations Maintaining Collections of Art, Historical Treasures , or Other Similar Assets (continued) Using the organization's accession and other records, check any of the following that are a significant use of its collection items (check all that apply) a F_ Public exhibition d fl Loan or exchange programs b 1 Scholarly research e (- Other c F 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 XIV 5 During the year, did the organization solicit or receive donations of art, historical treasures or other similar 1 Yes assets to be sold to raise funds rather than to be maintained as part of the organization's collection? 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 on Form 990, Part X7 b If "Yes," explain the arrangement in Part XIV and complete the following table c Beginning balance 1c d Additions during the year ld e Distributions during the year le f Ending balance if 1 Yes 1 No F No Amount 2a b Did the organization include an amount on Form 990, Part X, line 21? fl Yes fl No If"Yes," explain the arrangement in Part XIV MITIT-Endowment Funds . Com p lete If the or g anization answered "Yes" to Form 990, Part IV , line 10. (a)Current Year la Contributions c Investment earnings or losses d Grants or scholarships e Other expenditures for facilities and programs f Administrative expenses g End of year balance (d)Three Years Back (e)Four Years Back . . . . Provide the estimated percentage of the yearend balance held as a Board designated or quasi-endowment 0- b Permanent endowment 0- c 3a Term endowment 0Are there endowment funds not in the possession of the organization that are held and administered for the organization by (i) unrelated organizations b 4 (c)Two Years Back Beginning of year balance b 2 (b)Prior Year . . . . . . . . . . . . . . . . (ii) related organizations . . . . . . . . . . . . . . . . . If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? . . . . . . . . . . Yes . . . No 3a(i) 3a(ii) . . I 3b Describe in Part XIV the intended uses of the organization's endowment funds I Investments - Land . Buildinas. and Eauioment . See Form 990. Part X. line 10. (a) Cost or other basis (investment) Description of investment (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value la Land b Buildings c Leasehold improvements . . . . . . . . . . . d Equipment 88,781 88,781 0 2,537,469 1,444,911 1,092,558 e Other Total . Add lines la-le (Column (d) should equal Form 990, Part X, column (B), line 10(c).) . . 0- 1,092,558 Schedule D (Form 990) 2010 Schedule D (Form 990) 2010 Page 3 Investments - Other Securities . See Form 990 , Part X , line 12. (a) Description of security or category (b)Book value (including name of security) (c) Method of valuation Cost or end-of-year market value (1 )Financial derivatives (2)Closely-held equity interests Other Total . (Column (b) should equal Form 990, Part X, col (B) line 12 ) 01 1 Investments - Pro ram Related . See Form 990 , Part X , line 13. (a) Description of investment type (b) Book value I I (c) Method of valuation Cost or end-of-vear market value Total . (Column (b) should equa l Form 990, Part X, col (B) line 13 ) 01 1 Other Assets . See Form 990 , Part X line 15. (a) Description ( b) Book value (1) ASSETS LIMITED AS TO USE 86, 304,698 (2) ASSETS HELD BY AFFILIATE 11.511.474 Total . (Column (b) should equal Form 990, Part X, co/.(8) line 15.) 97.816.172 1 Other Liabilities . See Form 990 , Part X (a) Description of Liability line 25. (b) Amount Federal Income Taxes DUE TO AFFILIATE Total . (Column (b) should equal Form 990, Part X, col (B) line 25) 6,694,455 N. I 6,694,455 2. Fin 48 (ASC 740) Footnote In Part XIV, 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 (ASC740) Schedule D ( Form 990) 2010 Schedule D (Form 990) 2010 Page 4 171174W Reconciliation of Chan g e in Net Assets from Form 990 to Financial Statements 1 Total revenue (Form 990, Part VIII, column (A), line 12) 1 67,060,090 2 Total expenses (Form 990, Part IX, column (A), line 25) 2 69,565,835 3 Excess or (deficit) for the year Subtract line 2 from line 1 3 -2,505,745 4 Net unrealized gains (losses) on investments 4 5 Donated services and use of facilities 5 6 Investment expenses 6 7 Prior period adjustments 7 8 Other (Describe in Part XIV) 8 17,728,060 9 Total adjustments (net) Add lines 4 - 8 9 17,728,060 Excess or (deficit) for the year per financial statements Combine lines 3 and 9 10 15,222,315 10 « 1 Reconciliation of Revenue p er Audited Financial Statements With Revenue p er Return Total revenue, gains, and other support per audited financial statements 2 1 194,314,174 2e 127,254,084 Amounts included on line 1 but not on Form 990, Part VIII, line 12 a Net unrealized gains on investments . b Donated services and use of facilities c Recoveries of prior year grants d Other (Describe in Part XIV) e Add lines 2a through 2d 3 2a . 2b 536,763 2c . . . . Subtract line 2e from line 1 . 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . 2d . . . . . 126,717,321 . . . . . . . . . . . . . . 3 . . . . . . 4c . . . . . 5 67,060,090 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 XIV) . . . . . . . . . . 4b Add lines 4a and 4b . . . . . . . . . . . c 5 . . . . . Total Revenue Add lines 3 and 4c. (This should equal Form 990, Part I, line 12 « 1 0 67,060,090 Reconciliation of Expenses per Audited Financial Statements With Expenses per Return Total expenses and losses per audited financial statements . 2 179,091,859 1 Amounts included on line 1 but not on Form 990, Part IX, line 25 a Donated services and use of facilities b Prior year adjustments c Other losses . . . 2a . . d Other (Describe in Part XIV) e Add lines 2a through 2d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2c . . 3 Subtract line 2e from line 1 . Amounts included on Form 990, Part IX, line 25, but not on line 1: a 536,763 2b . 4 5 . . 2d . . . . . . Investment expenses not included on Form 990, Part VIII, line 7b b Other (Describe in Part XIV) . . . . . . . . . . . Add lines 4a and 4b . . . . . . . . . . . . . . Su . . . . 2e 109,526,024 . . . . . 3 69,565,835 . . . . . 4c 0 4b . . . Total expenses Add lines 3 and 4c. (This should equal Form 990, Part I, line 18 « . 4a c . 108,989,261 . . . . . . 5 69,565,835 lementalInformation Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9, Part III, lines la and 4, Part IV, lines lb and 2b, Part V, line 4, Part X, Part XI, line 8, Part XII, lines 2d and 4b, and Part XIII, lines 2d and 4b Also complete this part to provide any additional information Identifier Return Reference Explanation PART XI, LINE 8 - OTHER ADJUSTMENTS TRANSFER OF FUNDS RESTRICTED FOR CHAI PURPOSES FROM THE CLINTON FOUNDATION 17,728,060 PART XII, LINE 2D - OTHER ADJUSTMENTS UNITAID COMMODITIES NOT RECOGNIZED AS FORM 990 REVENUE (SEE SCH O) 108,989,261 TRANSFER OF FUNDS RESTRICTED FOR CHAI PURPOSES FROM THE CLINTON FOUNDATION 17,728,060 PART XIII, LINE 2D - OTHER ADJUSTMENTS UNITAID COMMODITIES NOT RECOGNIZED AS FORM 990 REVENUE (SEE SCH O) 108,989,261 Schedule D (Form 990) 2010 l efile GRAPHIC p rint - DO NOT PROCESS SCHEDULE F (Form 990) As Filed Data - DLN: 93493325011203 OMB No 1545-0047 Statement of Activities Outside the United States Department of the Treasury ■ Complete if the organization answered " Yes" to Form 990, Part IV, line 14b, 15, or 16. ■ Attach to Form 990 . ^ See separate instructions. 2010 Open to Public Internal Revenue Service Inspection ivame ortne organization CLINTON HEALTH ACCESS INITIATIVE INC Employer identification number 27-1414646 General Information on Activities Outside the United States . Complete if the organization answered "Yes" to Form 990, Part IV, line 14b. 1 For grantmakers . 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F 2 For grantmakers . Describe in Part V the organization's procedures for monitoring the use of grant funds outside the United States 3 Activites per Region (Use Part V if additional space is needed ) (a) Region CENTRAL AMERICA AND THE CARIBBEAN SUB-SAHARAN AFRICA ( b) Number of offices in the region ( c) Number of ( d) Activities conducted in (e) If activity listed in (d) is employees or region (by type) ( e g , a program service, describe agents in region or fundraising , program services, specific type of independent investments , grants to service( s) in region contractors recipients located in the region) fl No (f) Total expenditures for region/ investments in region 4 25 PROGRAM SERVICES HEALTH 4,484,945 20 358 PROGRAM SERVICES HEALTH 34,551,866 692,029 EUROPE (INCLUDING ICELAND & GREENLAND) MIDDLE EAST AND NORTH AFRICA SOUTH AMERICA 1 3 PROGRAM SERVICES HEALTH 0 N/A 1 1 MAINTAINING OFFICES 1 PROGRAM SERVICES SOUTH ASIA 1 RUSSIA &THE NEWLY INDEPENDENT STATES EAST ASIA AND THE PACIFIC 3a Sub-total b Total from continuation sheets to Part I c Totals ( add lines 3a and 3b ) Yes HEALTH 54,082 55 PROGRAM SERVICES HEALTH 3,467,196 1 7 PROGRAM SERVICES HEALTH 692,029 7 70 PROGRAM SERVICES HEALTH 7,836,944 35 0 35 520 51 , 779 , 091 0 0 520 For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990 . 51,779,091 Cat No 50082W Schedule F (Form 990) 2010 Schedule F (Form 990) 2010 Page 2 Grants and Other Assistance to Organizations or Entities Outside the United States . Complete if the organization answered "Yes" to Form 990, Part IV, line 15, for any recipient who received more than $5,000. Check this box if no one recipient received more than $5,000 . . . . . . . . ^ F Use Part V if additional space is needed. 1 (a) Name of organization (b) IRS code section and EIN (if applicable) ( c) Region ( d) Purpose of grant (e) Amount of cash grant (f) Manner of cash disbursement (g) Amount of of non-cash assistance (h) Description of non-cash assistance (i) Method of valuation (book, FMV, appraisal, other) See Add'I Data 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(c)(3) equivalency letter . . . . . Enter total number of other organizations or entities . 59 Schedule F (Form 990) 2010 Schedule F (Form 990) 2010 Page 3 Grants and Other Assistance to Individuals Outside the United States . Complete if the organization answered "Yes" to Form 990, Part IV, line 16. Use Part V if additional space is needed. (a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of cash grant ( e) Manner of cash disbursement ( f) Amount of non-cash assistance (g) Description of non-cash assistance (h) Method of valuation (book, FMV, a pp raisal , other ) Schedule F (Form 990) 2010 Schedule F (Form 990) 2010 Page 4 Foreign Forms 1 2 3 4 5 6 Was the organization a U S transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926 (see instructions for Form 926) F- Yes F 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 and/or Form 3520-A. (see instructions for Forms 3520 and 3520-A) F- Yes F No Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with respect to Certain Foreign Corporations. (see instructions for Form 5471) F- Yes F No 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, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see instructions for Form 8621) F- Yes F No Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with respect to Certain Foreign Partnerships. (see instructions for Form 8865) F- Yes F No Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see instructions for Form 5713). F- Yes F No Schedule F (Form 990) 2010 Schedule F (Form 990) 2010 Page 5 Supplemental Information Complete this part to provide the information (see instructions) required in Part I, line 2, and any additional information. Identifier PROCEDURE FOR MONITORING GRANTS OUTSIDE THE U S Return Reference Explanation SCHEDULE F, PART I, LINE 2 MOST GRANT FUNDS ARE MAINTAINED AT HEADQUARTERS CHAI DOES HAVE SOME IN COUNTRY, AND THEY ARE MONITORED BY THE CASH REPORTS RECEIVED AT HEADQUARTERS EACH MONTH FOR GRANTS OUTSIDE OF THE US, EACH COUNTRY OR PROGRAM TEAM REQUESTS THEIR CASH NEEDS EACH MONTH AFTER THE AMOUNTS ARE VERIFIED, THE HEADQUARTER'S TEAM DISBURSES THE FUNDS TO THE COUNTRY/PROGRAM TEAMS Identifier OTHER INFORMATION Return Reference SCHEDULE F, PART V Explanation SCHEDULE F, PART II, LINE 3 THE GRANTEES COUNTED ON LINE 3 CONSIST OF GOVERNMENT MINISTRIES OF HEALTH, HOSPITALS, AND OTHER ORGANIZATIONS IN FURTHERANCE OF OUR MISSION Schedule F (Form 990) 2010 Additional Data Software ID: Software Version: EIN: Name : 27 -1414646 CLINTON HEALTH ACCESS INITIATIVE INC Form 990 Schedule F Part II - Grants or Entities Outside The United States (a) Name of organization (b) IRS code section and EIN ( if applicable ) (c) Region ( d) Purpose of grant ( e) Amount of cash grant ( f) Manner of cash disbursement (g) Amount of noncash assistance (h) Description of non-cash assistance (i) Method of valuation (book, FMV, appraisal, other) SUB-SAHARAN AFRICA HEALTH 1,042,218 WIRE TRANSFER N/A N/A SUB-SAHARAN AFRICA HEALTH 614,589 WIRE TRANSFER N/A N/A Form 990 Schedule F Part II - Grants or Entities Outside The United States (a) Name of organization (b) IRS code section and EIN ( if applicable ) ( c) Region ( d) Purpose of grant ( e) Amount of cash grant (f) Manner of cash disbursement (g) Amount of noncash assistance (h) Description of non-cash assistance (i) Method of valuation (book, FMV, appraisal, other) SOUTH ASIA HEALTH 489,457 WIRE TRANSFER N/A N/A SUB-SAHARAN AFRICA HEALTH 465,328 WIRE TRANSFER N/A N/A Form 990 Schedule F Part II - Grants or Entities Outside The United States (a) Name of organization (b) IRS code section and EIN ( if applicable) ( c) Region ( d) Purpose of grant ( e) Amount of cash grant ( f) Manner of cash disbursement (g) Amount of noncash assistance (h) Description of non-cash assistance (i) Method of valuation (book, FMV, appraisal, other) SOUTH ASIA HEALTH 399,529 WIRE TRANSFER N/A N/A SUB-SAHARAN AFRICA HEALTH 390,474 WIRE TRANSFER N/A N/A Form 990 Schedule F Part II - Grants or Entities Outside The United States (a) Name of organization (b) IRS code section and EIN ( if applicable) ( c) Region ( d) Purpose of grant (e) Amount of cash grant (f) Manner of cash disbursement (g) Amount of noncash assistance (h) Description of non-cash assistance ( i) Method of valuation (book, FMV, appraisal, other) SUB-SAHARAN AFRICA HEALTH 312,800 WIRE TRANSFER N/A N/A SUB-SAHARAN AFRICA HEALTH 203,418 WIRE TRANSFER N/A N/A Form 990 Schedule F Part II - Grants or Entities Outside The United States (a) Name of organization (b) IRS code section and EIN ( if applicable) (c) Region (d) Purpose of grant (e) Amount of cash grant (f) Manner of cash disbursement (g) Amount of noncash assistance (h) Description of non-cash assistance (i) Method of valuation (book, FMV, appraisal, other) SOUTH ASIA HEALTH 172,534 WIRE TRANSFER N/A N/A SUB-SAHARAN AFRICA HEALTH 166,501 WIRE TRANSFER N/A N/A Form 990 Schedule F Part II - Grants or Entities Outside The United States (a) Name of organization (b) IRS code section and EIN(if applicable) (c) Region (d) Purpose of grant (e) Amount of cash grant (f) Manner of cash disbursement (g) Amount of noncash assistance (h) Description of non-cash assistance (i) Method of valuation (book, FMV, appraisal, other) SOUTH ASIA HEALTH 163,388 WIRE TRANSFER N/A N/A SOUTH ASIA HEALTH 158,784 WIRE TRANSFER N/A N/A Form 990 Schedule F Part II - Grants or Entities Outside The United States (a) Name of organization (b) IRS code section and EIN ( if applicable) ( c) Region ( d) Purpose of grant ( e) Amount of cash grant (f) Manner of cash disbursement (g) Amount of noncash assistance (h) Description of non-cash assistance (i) Method of valuation (book, FMV, appraisal, other) SOUTH ASIA HEALTH 139,523 WIRE TRANSFER N/A N/A SUB-SAHARAN AFRICA HEALTH 139,485 WIRE TRANSFER N/A N/A Form 990 Schedule F Part II - Grants or Entities Outside The United States (a) Name of organization (b) IRS code section and EIN ( if applicable) ( c) Region ( d) Purpose of grant (e) Amount of cash grant (f) Manner of cash disbursement (g) Amount of noncash assistance (h) Description of non-cash assistance (i) Method of valuation (book, FMV, appraisal, other) EUROPE (INCLUDING ICELAND & GREENLAND) HEALTH 125,754 WIRE TRANSFER N/A N/A SOUTH ASIA HEALTH 114,532 WIRE TRANSFER N/A N/A Form 990 Schedule F Part II - Grants or Entities Outside The United States (a) Name of organization (b) IRS code section and EIN ( if applicable) ( c) Region ( d) Purpose of grant ( e) Amount of cash grant (f) Manner of cash disbursement (g) Amount of noncash assistance (h) Description of non-cash assistance (i) Method of valuation (book, FMV, appraisal, other) CENTRAL AMERICA AND THE CARIBBEAN HEALTH 111,275 WIRE TRANSFER N/A N/A SUB-SAHARAN AFRICA HEALTH 102,111 WIRE TRANSFER N/A N/A Form 990 Schedule F Part II - Grants or Entities Outside The United States (a) Name of organization (b) IRS code section and EIN ( if applicable) (c) Region (d) Purpose of grant SUB-SAHARAN AFRICA HEALTH SOUTH ASIA HEALTH ( e) Amount of cash grant 100,801 ( f) Manner of cash disbursement (g) Amount of noncash assistance (h) Description of non-cash assistance (i) Method of valuation (book, FMV, appraisal, other) WIRE TRANSFER N/A N/A 95,304 WIRE TRANSFER N/A N/A Form 990 Schedule F Part II - Grants or Entities Outside The United States (a) Name of organization (b) IRS code section and EIN ( if applicable) ( c) Region ( d) Purpose of grant (e) Amount of cash grant (f) Manner of cash disbursement (g) Amount of noncash assistance (h) Description of non-cash assistance (i) Method of valuation (book, FMV, appraisal, other) SOUTH ASIA HEALTH 93,463 WIRE TRANSFER N/A N/A SUB-SAHARAN AFRICA HEALTH 87,550 WIRE TRANSFER N/A N/A Form 990 Schedule F Part II - Grants or Entities Outside The United States (a) Name of organization (b) IRS code section and EIN ( if applicable) ( c) Region (d) Purpose of grant (e) Amount of cash grant ( f) Manner of cash disbursement (g) Amount of noncash assistance (h) Description of non-cash assistance (i) Method of valuation (book, FMV, appraisal, other) SUB-SAHARAN AFRICA HEALTH 84,635 WIRE TRANSFER N/A N/A SUB-SAHARAN AFRICA HEALTH 82,773 WIRE TRANSFER N/A N/A Form 990 Schedule F Part II - Grants or Entities Outside The United States (a) Name of organization (b) IRS code section and EIN ( if applicable) ( c) Region ( d) Purpose of grant ( e) Amount of cash grant ( f) Manner of cash disbursement (g) Amount of noncash assistance (h) Description of non-cash assistance (i) Method of valuation (book, FMV, appraisal, other) EUROPE (INCLUDING ICELAND & GREENLAND) HEALTH 62,418 WIRE TRANSFER N/A N/A SOUTH ASIA HEALTH 60,604 WIRE TRANSFER N/A N/A Form 990 Schedule F Part II - Grants or Entities Outside The United States (a) Name of organization (b) IRS code section and EIN ( if applicable) (c) Region (d) Purpose of grant ( e) Amount of cash grant ( f) Manner of cash disbursement (g) Amount of noncash assistance (h) Description of non-cash assistance (i) Method of valuation (book, FMV, appraisal, other) SOUTH ASIA HEALTH 57,489 WIRE TRANSFER N/A N/A SOUTH ASIA HEALTH 53,211 N/A N/A WIRE TRANSFER Form 990 Schedule F Part II - Grants or Entities Outside The United States (a) Name of organization (b) IRS code section and EIN ( if applicable) ( c) Region ( d) Purpose of grant ( e) Amount of cash grant (f) Manner of cash disbursement (g) Amount of noncash assistance (h) Description of non-cash assistance (i) Method of valuation (book, FMV, appraisal, other) CENTRAL AMERICA AND THE CARIBBEAN HEALTH 48,581 WIRE TRANSFER N/A N/A SUB-SAHARAN AFRICA HEALTH 43,456 WIRE TRANSFER N/A N/A Form 990 Schedule F Part II - Grants or Entities Outside The United States (a) Name of organization (b) IRS code section and EIN(if applicable) ( c) Region ( d) Purpose of grant (e) Amount of cash grant ( f) Manner of cash disbursement (g) Amount of noncash assistance (h ) Description of non-cash assistance (i) Method of valuation (book, FMV, appraisal, other) SOUTH ASIA HEALTH 40,249 WIRE TRANSFER N/A N/A SUB-SAHARAN AFRICA HEALTH 37,260 WIRE TRANSFER N/A N/A Form 990 Schedule F Part II - Grants or Entities Outside The United States (a) Name of organization (b) IRS code section and EIN(if applicable) ( c) Region ( d) Purpose of grant (e) Amount of cash grant ( f) Manner of cash disbursement (g) Amount of noncash assistance (h ) Description of non-cash assistance (i) Method of valuation (book, FMV, appraisal, other) SOUTH ASIA HEALTH 37,252 WIRE TRANSFER N/A N/A SOUTH ASIA HEALTH 36,922 WIRE TRANSFER N/A N/A Form 990 Schedule F Part II - Grants or Entities Outside The United States (a) Name of organization (b) IRS code section and EIN(if applicable) (c) Region (d) Purpose of grant (e) Amount of cash grant (f) Manner of cash disbursement (g) Amount of noncash assistance (h) Description of non-cash assistance (i) Method of valuation (book, FMV, appraisal, other) CENTRAL AMERICA AND THE CARIBBEAN HEALTH 33,985 WIRE TRANSFER N/A N/A SOUTH ASIA HEALTH 31,948 WIRE TRANSFER N/A N/A Form 990 Schedule F Part II - Grants or Entities Outside The United States (a) Name of organization (b) IRS code section and EIN ( if applicable) (c) Region (d) Purpose of grant (e) Amount of cash grant (f) Manner of cash disbursement (g) Amount of noncash assistance (h) Description of non-cash assistance (i) Method of valuation (book, FMV, appraisal, other) SOUTH ASIA HEALTH 30,173 WIRE TRANSFER N/A N/A SUB-SAHARAN AFRICA HEALTH 28,774 WIRE TRANSFER N/A N/A Form 990 Schedule F Part II - Grants or Entities Outside The United States (a) Name of organization (b) IRS code section and EIN(if applicable) ( c) Region (d) Purpose of grant (e) Amount of cash grant (f) Manner of cash disbursement (g) Amount of noncash assistance (h) Description of non-cash assistance (i) Method of valuation (book, FMV, appraisal, other) SUB-SAHARAN AFRICA HEALTH 27,893 WIRE TRANSFER N/A N/A SOUTH ASIA HEALTH 27,498 WIRE TRANSFER N/A N/A Form 990 Schedule F Part II - Grants or Entities Outside The United States (a) Name of organization (b) IRS code section and EIN(if applicable) (c) Region (d) Purpose of grant (e) Amount of cash grant (f) Manner of cash disbursement (g) Amount of noncash assistance (h) Description of non-cash assistance (i) Method of valuation (book, FMV, appraisal, other) SOUTH ASIA HEALTH 27,256 WIRE TRANSFER N/A N/A SOUTH ASIA HEALTH 25,504 WIRE TRANSFER N/A N/A Form 990 Schedule F Part II - Grants or Entities Outside The United States (a) Name of organization (b) IRS code section and EIN(if applicable) ( c) Region (d) Purpose of grant (e) Amount of cash grant (f) Manner of cash disbursement (g) Amount of noncash assistance (h) Description of non-cash assistance (i) Method of valuation (book, FMV, appraisal, other) SUB-SAHARAN AFRICA HEALTH 20,000 WIRE TRANSFER N/A N/A SUB-SAHARAN AFRICA HEALTH 19,076 WIRE TRANSFER N/A N/A Form 990 Schedule F Part II - Grants or Entities Outside The United States (a) Name of organization (b) IRS code section and EIN(if applicable) (c) Region (d) Purpose of grant (e) Amount of cash grant (f) Manner of cash disbursement (g) Amount of noncash assistance (h) Description of non-cash assistance (i) Method of valuation (book, FMV, appraisal, other) SUB-SAHARAN AFRICA HEALTH 18,840 WIRE TRANSFER N/A N/A EUROPE (INCLUDING ICELAND & GREENLAND) HEALTH 15,016 WIRE TRANSFER N/A N/A Form 990 Schedule F Part II - Grants or Entities Outside The United States (a) Name of organization (b) IRS code section and EIN(if applicable) ( c) Region (d) Purpose of grant (e) Amount of cash grant (f) Manner of cash disbursement (g) Amount of noncash assistance (h) Description of non-cash assistance (i) Method of valuation (book, FMV, appraisal, other) SOUTH ASIA HEALTH 13,473 WIRE TRANSFER N/A N/A SUB-SAHARAN AFRICA HEALTH 12,078 WIRE TRANSFER N/A N/A Form 990 Schedule F Part II - Grants or Entities Outside The United States (a) Name of organization (b) IRS code section and EIN ( if applicable) (c) Region (d) Purpose of grant SOUTH ASIA HEALTH EUROPE (INCLUDING ICELAND & GREENLAND) HEALTH (e) Amount of cash grant 10,831 (f) Manner of cash disbursement (g) Amount of noncash assistance (h) Description of non-cash assistance (i) Method of valuation (book, FMV, appraisal, other) WIRE TRANSFER N/A N/A 9,740 WIRE TRANSFER N/A N/A Form 990 Schedule F Part II - Grants or Entities Outside The United States (a) Name of organization (b) IRS code section and EIN(if applicable) ( c) Region (d) Purpose of grant (e) Amount of cash grant (f) Manner of cash disbursement (g) Amount of noncash assistance (h) Description of non-cash assistance (i) Method of valuation (book, FMV, appraisal, other) SUB-SAHARAN AFRICA HEALTH 9,269 WIRE TRANSFER N/A N/A SOUTH ASIA HEALTH 9,019 WIRE TRANSFER N/A N/A Form 990 Schedule F Part II - Grants or Entities Outside The United States (a) Name of organization (b) IRS code section and EIN ( if applicable) ( c) Region (d) Purpose of grant (e) Amount of cash grant (f) Manner of cash disbursement (g) Amount of noncash assistance (h) Description of non-cash assistance (i) Method of valuation (book, FMV, appraisal, other) SUB-SAHARAN AFRICA HEALTH 8,482 WIRE TRANSFER N/A N/A SOUTH ASIA HEALTH 7,490 WIRE TRANSFER N/A N/A Form 990 Schedule F Part II - Grants or Entities Outside The United States (a) Name of organization (b) IRS code section and EIN(if applicable) (c) Region (d) Purpose of grant SUB-SAHARAN AFRICA HEALTH SOUTH ASIA HEALTH (e) Amount of cash grant 5,964 (f) Manner of cash disbursement (g) Amount of noncash assistance (h) Description of non-cash assistance (i) Method of valuation (book, FMV, appraisal, other) WIRE TRANSFER N/A N/A 22,000 WIRE TRANSFER N/A N/A Form 990 Schedule F Part II - Grants or Entities Outside The United States (a) Name of organization (b) IRS code section and EIN(if applicable) (c) Region (d) Purpose of grant (e) Amount of cash grant (f) Manner of cash disbursement (g) Amount of noncash assistance (h) Description of non-cash assistance (i) Method of valuation (book, FMV, appraisal, other) EUROPE (INCLUDING ICELAND & GREENLAND) HEALTH 166,674 WIRE TRANSFER N/A N/A SUB-SAHARAN AFRICA HEALTH 11,211 WIRE TRANSFER N/A N/A Form 990 Schedule F Part II - Grants or Entities Outside The United States (a) Name of organization (b) IRS code section and EIN ( if applicable) ( c) Region SUB-SAHARAN AFRICA (d) Purpose of grant HEALTH (e) Amount of cash grant (f) Manner of cash disbursement 16,133 WIRE TRANSFER (g) Amount of noncash assistance (h) Description of non-cash assistance N/A (i) Method of valuation (book, FMV, appraisal, other) N/A efile GRAPHIC print - DO NOT PROCESS I As Filed Data - I DLN: 93493325011203 OMB No 1545-0047 Schedule I (Form 990 ) Grants and Other Assistance to Organizations, 20 Governments and Individuals in the United States Department of the Treasury Internal Revenue Service Name of the organization CLINTON HEALTH ACCESS INITIATIVE INC 1 O Complete if the organization answered " Yes," to Form 990, Part IV, line 21 or 22. l Attach to Form 990 Employer identification number 27-1414646 JE^ll 1 General Information on Grants and Assistance 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States 2 . . F Yes . 1 No 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 recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Part II can be duplicated if additional space is needed. . . . . . . . . . . . . . . . . . . . . . . . . . llii^ F 1 (a) Name and address of organization or government (b) EIN (c) IRC Code section if applicable (d) Amount of cash grant (e) Amount of noncash assistance (f) Method of (g) Description of valuation non-cash assistance (book, FMV, appraisal, other) (h) Purpose of grant or assistance (1) PARTNERS IN HEALTH 888 COMMONWEALTH AVENUE BOSTON,MA 022415026 04-3567502 501(C)(3) 1,468,968 N/A N/A HEALTH (2) NEW YORK UNIVERSITY SCHOOL OF MEDICINEPO BOX 45026 BOSTON,MA 022415026 11-3556309 501(C)(3) 301,531 N/A N/A HEALTH (3) PANGAEA GLOBAL AIDS FOUNDATION472 9TH STREET OAKLAND,CA 94607 91-2167423 501(C)(3) 82,516 N/A N/A HEALTH (4)JOHNS HOPKINS UNIVERSITY12529 COLLECTIONS CTR DRIVE CHICAGO,IL 60693 52-0595110 501(C)(3) 46,400 N/A N/A HEALTH (5) ACCESS BIO INC2033 ROUTE 13D UNIT H MONMOUTH JCT,NJ 08852 30-0396368 32,880 N/A N/A HEALTH (6) RHEAULT & WILLIAMS1 OAK MEADOW ROAD LINCOLN,MA 01773 06-6405716 8,400 N/A N/A HEALTH (7) HOWARD UNIVERSITY 525 BRYANT STREET NW SUITE 137 WASHINGTON,DC 20059 53-0204717 8,001 N/A N/A HEALTH 501(C)(3) 2 Enter total number of section 501 (c)(3) and government organizations. 3 Enter total number of other organizations . . . . . . . . . . . For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990 . . . . . . . . . . . . . . . . . . . . . Cat No 50055P . . . . . . . . . . . . . . . . . . . . . . . . . . ^ . 5 2 Schedule I (Form 990) 2010 Schedule I (Form 990) 2010 Pa g e 2 Grants and Other Assistance to Individuals in the United States . Complete if the organization answered "Yes" to Form 990, Part IV, line 22. Use Schedule I-1 (Form 990) if additional space is needed. (a)Type of grant or assistance (b)N umber of recipients (c)Amount of cash grant (d)Amount of non-cash assistance (e)Method of valuation (book, FMV, appraisal, other) (f)Description of non-cash assistance Supplemental Information . Complete this part to provide the information required in Part I, line 2, and any other additional information. Identifier PROCEDURE FOR MONITORING GRANTS IN THE U S Return Reference PART I, LINE 2 Explanation SCHEDULE I, PART I, LINE 2 MOST GRANT FUNDS ARE MAINTAINED AT HEADQUARTERS CHAI DOES HAVE SOME IN COUNTY, AND THEY ARE MONITORED BY THE CASH REPORTS RECEIVED AT HEADQUARTERS EACH MONTH FOR GRANTS OUTSIDE THE US, EACH COUNTRY OR PROGRAM TEAM REQUESTS THEIR CASH NEEDS EACH MONTH AFTER THE AMOUNTS ARE VERIFIED, THE HEADQUARTER'S TEAM DISBURSES THE FUNDS TO THE COUNTRY/PROGRAM TEAMS Schedule I (Form 990) 2010 l efile GRAPHIC p rint - DO NOT PROCESS Department of the Treasury Internal Revenue Service DLN: 93493325011203 Compensation Information Schedule J (Form 990) As Filed Data - OMB No 1545-0047 For certain Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees 1- Complete if the organization answered "Yes" to Form 990, Part IV, question 23. 1- Attach to Form 990. 1- See separate instructions. Name of the organization 20 1 0 Open to Public Inspection Employer identification number CLINTON HEALTH ACCESS INITIATIVE INC 27-1414646 Questions Regarding Compensation Yes I No la b 2 3 Check the appropiate 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 1 First-class or charter travel 1 Housing allowance or residence for personal use 1 Travel for companions 1 Payments for business use of personal residence 1 Tax idemnification and gross - up payments 1 Health or social club dues or initiation fees 1 Discretionary spending account 1 Personal services (e g , maid, chauffeur, chef) If any of the boxes in line la are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain lb Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line la? 2 Indicate which , if any, of the following the organization uses to establish the compensation of the organization 's CEO/ Executive Director Check all that apply fl Compensation committee fl Written employment contract 4 1 Independent compensation consultant F Compensation survey or study fl Form 990 of other organizations F Approval by the board or compensation committee 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 from the organization or a related organization? 4a No b Participate in, or receive payment from, a supplemental nonqualified retirement plan? 4b No c Participate in, or receive payment from, an equity-based compensation arrangement? 4c No If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III Only 501 ( c)(3) and 501 ( c)(4) organizations only 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? 5a No b Any related organization? 5b No If "Yes," to line 5a or 5b, describe in Part III 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? 6a No b Any related organization? 6b No If "Yes," to line 6a or 6b, describe in Part III 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 III 7 No 8 Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was subject to the initial contract exception described in Regs section 53 4958-4(a)(3)? If "Yes," describe in Part III 8 No If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53 4958-6(c)? 9 9 For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990 Cat No 50053T Schedule 3 ( Form 990) 2010 Schedule J (Form 990) 2010 Page 2 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 (i) and from related organizations, described in the instructions on row (ii) Do not list any individuals that are not listed on Form 990, Part VII Note . The sum of columns ( B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line la (A) Name ( B) Breakdown of W-2 and / or 1099-MISC compensation (i) Base compensation (ii) Bonus & incentive compensation ( C) Retirement and (D) Nontaxable benefits other deferred compensation ( iii) Other reportable compensation ( E) Total of columns ( B)(i)-(D) (F) Compensation reported in prior Form 990 or Form 990-EZ (1) BRUCE LINDSEY (i1i) 276 , 290 0 0 0 0 0 16,799 0 15,446 0 308,543 0 0 (2) VISHAL BRIJLAL ( i) (^^) 175,376 0 0 0 0 0 0 0 0 0 175,376 0 0 0 (3) (4) (5) (6) (7) (8) (9) ( 10 ) ( 11 ) ( 12 ) ( 13 ) 14 ( 15 ) ( 16 ) Schedule 3 (Form 990) 2010 Schedule J (Form 990) 2010 Page 3 Supplemental Information Complete this part to provide the information, explanation, or descriptions required for Part I, lines la, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8 Also complete this part for any additional information Identifier Return Reference Explanation Schedule 3 (Form 990) 2010 l efile GRAPHIC p rint - DO NOT PROCESS Department of the Treasury DLN: 93493325011203 OMB No 1545-0047 Transactions with Interested Persons Schedule L (Form 990 or 990-EZ) As Filed Data - 0- Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a , 28b, or 28c, or Form 990-EZ, Part V lines 38a or 40b. 20 1 0 • . - 0- Attach to Form 990 or Form 990-EZ. 1-See separate instructions . Internal Revenue Service Name of the organization CLINTON HEALTH ACCESS INITIATIVE INC L^l Employer identification number 27-1414646 Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only). 2 Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958 . ^ $ 3 Enter the amount of tax, if any, on line 2, above, reimbursed by the organization . ^ $ Loans to and / or From Interested Persons. C'mmnlata iftha nrnannatinn ancwarari "Vac" nn Fnrm QQn (a) Name of interested person and purpose (b) Loan to or from the? organization To (c)Original principal amount From Total Part T\/ Iina 7A, (d)Balance due nr Fnrm QQn-F7 (e) In default? Yes Part \/ Iina '3Ra App o)ved by board or committee? No Yes No (g )Written agreement? Yes No $ IT.IIl Grants or Assistance Benefitting Interested Persons. Com p lete if the or g anization answered "Yes" on Form 990 , Part IV, line 27. (a) Name of interested person (b)Relationship between interested person and the organization For Privacy Act and Paperwork Reduction Act Noticee see the Instructions for Form 990 or 990-EZ. Cat No 50056A (c)Amount of grant or type of assistance Schedule L (Form 990 or 990-EZ) 2010 Schedule L (Form 990 or 990-EZ) 2010 Page 2 Business Transactions Involving Interested Persons. Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c. ( a) Name of interested person (1) SJS INC (b) Relationship between interested person and the organization CEO IS AN OFFICER OF CO ( e) Sharing of (c) Amount of transaction escription of transaction ( d) Description revenues? Yes 135,395 PROFESSIONAL FEES No No Supplemental Information Complete this part to provide additional information for responses to questions on Schedule L (see instructions) Identifier Return Reference Explanation Schedule L (Form 990 or 990-EZ) 2010 efile GRAPHIC p rint - DO NOT PROCESS SCHEDULE 0 (Form 990 or 990-EZ) As Filed Data - DLN: 93493325011203 OMB No 1545 0047 Supplemental Information to Form 990 or 990-EZ Complete to provide information for responses to specific questions on Form 990 or to provide any additional information . Department of the Treasury Internal Revenue Service 1- Attach to Form 990 or 990-EZ. Name of the organization CLINTON HEALTH ACCESS INITIATIVE INC Identifier FORM 990, PART VI, SECTION A, LINE 3 Return Reference O 201 Open Inspection Employer identification number Explanation CHAI HAS A CONSULTING AGREEMENT WITH SJS ADVISORS PURSUANT TO WHICH CHAI OBTAINS THE SERVICES OF IRA C MAGAZINER AS VICE CHAIR AND CHIEF EXECUTIVE OFFICER OF CHAT, INC Identifier FORM 990, PART VI, SECTION A, LINE 6 Return Reference Explanation UNDER CHAT'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 Identifier FORM 990, PART VI, SECTION A, LINE 7A Return Reference Explanation UNDER CHAT'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 Identifier FORM 990, PART VI, SECTION B, LINE 11 Return Reference Explanation THE SENIOR ACCOUNTANT COLLECTS AND CONSOLIDATES THE INFORMATION WHEN THE 2010 AUDIT IS COMPLETED THE DIRECTOR OF ACCOUNTING AND ADMINISTRATION AND CFO REVIEW THE FORM 990 THE BOARD WILL RECEIVE A COPY OF THE FINAL 990 AT A MEETING SUBSEQUENT TO FILING Identifier Return Reference FORM 990, PART VI, SECTION B, LINE 12C Explanation THIS APPLIES TO DIRECTORS, OFFICERS, OR COMMITTEE MEMBERS AND ALL OTHERS WHO ARE PERMITTED TO VOTE AT BOARD OF DIRECTOR MEETINGS INTERESTED PERSONS MUST DISCLOSE ANY TRANSACTION OR ARRANGEMENT WHICH RESULTS IN A CONFLICT OF INTEREST TO THE BOARD OR COMMITTEE OF WHICH THEY AREA 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 Identifier Return Reference FORM 990, PART VI, SECTION C, LINE 19 Explanation THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST Identifier Return Reference FORM 990, PART VII, COLUMN B - ESTIMATED AVERAGE PER WEEK Explanation NAME AND TITLE HOURS DEVOTED FOR RELATED ORGANIZATION BRUCE LINDSEY, DIRECTOR 50 Identifier CHANGES IN NET ASSETS OR FUND BALANCES Return Reference FORM 990, PART XI, LINE 5 Explanation TRANSFER OF FUNDS RESTRICTED FOR CHAI PURPOSES FROM THE CLINTON FOUNDATION 17,728,060 TOTAL TO FORM 990, PART XI, LINE 5 17,728,060 Identifier Return Reference Explanation REASONS FOR AMENDING RETURN CHAI IS AMENDING ITS PREVIOUSLY FILED FORM 990 IN ORDER TO 1) CHANGE ITS CHARACTERIZATION OF COMMODITIES RELATED SUPPORT RECEIVED FROM UNITAID, AND 2) T 0 PROPERLY REPORT SUPPORT FROM THE CLINTON FOUNDATION AS REVENUE FURTHER B(PLANATION IS A S FOLLOWS COMMODITIES RELATED SUPPORT FROM UNITAID CHAI IS ENGAGED IN A PARTNERSHIP WITH UNITAID, AN INTERNATIONAL ORGANIZATION AFFILIATED WITH THE WORLD HEALTH ORGANIZATION, THAT WORKS TO LEVERAGE PRICE REDUCTIONS FOR DIAGNOSTIC AND MEDICINES TO BETTER TREAT AIDS, MAL ARIA, AND TUBERCULOSIS IN THE DEVELOPING WORLD CHAI HAS AN AGREEMENT WITH UNITAID FOR THE PURCHASE AND DELIVERY OF ANTIRETROVIRAL DRUGS AND RELATED COMMODITIES TO SPECIFIC COUNTRI ES CHAI ACTS AS A GO-BETWEEN UNTIAID AND THE RESPECTIVE COUNTRY GOVERNMENTS CHAI ON BEHA LF OF UNITAID OVERSEES VARIOUS BUSINESS ASPECTS OF ENABLING EFFICIENT ADMINISTRATION OF TH E PROGRAM CHAI IS AMENDING ITS FORM 990 TO EXCLUDE THIS UNITAID SUPPORT ($108,989,261) FR OM REVENUE FOR FORM 990 PURPOSES SUPPORT FROM THE CLINTON FOUNDATION CHAI IS ALSO AMENDIN G ITS FORM 990 IN ORDER TO INCLUDE IN REVENUE, FOR FORM 990 PURPOSES, CONTRIBUTIONS AND GR ANTS IN THE AMOUNT OF $2,350,000 RECEIVED FROM THE CLINTON FOUNDATION FOLLOWING IS A SUMM ARY OF THE PARTS AND SCHEDULES OF THE FORM 990 THAT ARE BEING AMENDED TO EFFECT THE ABOVE DESCRIBED CHANGES, AS WELL AS VARIOUS MISCELLANEOUS OTHER CHANGES THESE CHANGES HAVE AFFECTED THE FOLLOWING SCHEDULES OF THE FORM 990 FORM 990, PART I LINE 8 - CONTRIBUTIONS AND GRANTS CHANGED FROM $173,513,413 TO $66,874,152 LINE 17 - OTHER BKPENSES CHANGED FROM $139,684,009 TO $30,886,751 FORM 990, PART III LINE 4A - REMOVED UNITAID OF $108,989,261 LINE 4A - RURAL BKP $12,114,902 GRANT $2,888,200 LINE 4B - PEDS EXP$8,293,808 GRANT $1,678,602 LINE 4C - PMTCT EXP$5,732,130 GRANT $1,088,089 LINE 4D - OTHER PROGRAM SERVICES (EXPENSES) CHANGED FROM $42,369,414 TO $36,520,348 LINE 4D - OTHER PROGRAM SERVICES (GRANTS) CHANG ED FROM $0 TO $3,059,441 LINE4E- TOTAL PROGRAM SERVICE(EXPENSES) CHANGED FROM $171,650, 449 TO $62,661,188 FORM 990, PART IV LINE 12A - CHANGED FROM YES TO NO LINE 35 - CHANGED F ROM NO TO YES FROM 990, PART VI LINE 6 - CHANGED FROM NO TO YES LINE 7A - CHANGED FROM NO TO YES LINE 1 OA - CHANGED FROM NO TO YES LINE 1 OB - CHANGED FROM NO TO YES FORM 990, PART VIII LINE 1 D - CHANGED FROM $0 TO $2,350,000 LINE 1 E - CHANGED FROM $137,972,620 TO $26,74 0,319 LINE 1 F - CHANGED FROM $35,540,793 TO $37,783,833 FORM 990, PART IX LINE 1, COLUMN B - CHANGED FROM $1,959,340 TO $1,767,337 LINE 24 - REMOVED UNITAID AS AN EXPENSE ITEM LINE 24A, COLUMN B - DIRECT PROGRAM EXPENDITURES CHANGED FROM $7,540,196 TO $10,300,329 LINE2 4F, COLUMN B - CHANGED FROM $1,357,087 TO $439,785 FORM 990, PART X LINE 2 - CHANGED FROM $5,757,920 TO $5,674,455 LINE 4 - CHANGED FROM $491,366 TO $574,831 FORM 990, PART XI LINE 1 - CHANGED FROM $173,699,351 TO $67,060,090 LINE 2 CHANGED FROM $178,555,096 TO $69,56 5,835 LINE 3 - CHANGED FROM ($4,855,745) TO ($2,505,745) LINE 5 CHANGED FROM $20,078,060 TO $17,728,060 FORM 990, PART XII LINE 2D CHANGED FROM BOTH CONSOLIDATED AND SEPARATE BAS IS TO CONSOLIDATED BASIS FORM 990, SCHEDULE A, PART II SECTION A, LINE 1, COLUMN (E) - CHA NGED FROM $64,645,004 TO $66,874,152 FORM 990, SCHEDULE A, PART IV REMOVED REFERENCES TO U NUSUAL GRANTS FOR PURPOSES OF SCHEDULE A, PART II, SECTION A, LINE 1 NO AMOUNTS ARE BEING CHARACTERIZED AS UNUSUAL GRANTS FORM 990, SCHEDULE B, PART I REMOVED CONTRIBUTOR PREVIOUS LY LISTED AS NO 4 FORM 990, SCHEDULED, PART XI LINE 1 - CHANGED FROM $173,699,351 TO $67,060,090 LINE 2 - CHANGED FROM $178,555,096 TO $69,565,835 LINE 3 - CHANGED FROM ($4,855,7 45) TO ($2,505,745) LINE 8 CHANGED FROM $20,078,060 TO $17,728,060 FORM 990, SCHEDULED, PART XII LINE 2D - CHANGED FROM $20,078,060 TO $126,717,321 FORM 990, SCHEDULE D, PART XI II LINE 2D - CHANGED FROM $0 TO $108,989,261 FORM 990, SCHEDULED, PART XIV REMOVED PREVIO US LANGUAGE OF RECONCILIATION OF CHANGE IN NET ASSETS (FROM 990, SCHEDULED, PART XI, LINE 8) REMOVED PREVIOUS LANGUAGE OF REVENUE RECONCILIATION (FORM 990, SCHEDULE D, PART XII, L INE 2D) ADDED PART XI, LINE 8 - OTHER ADJUSTMENTS TRANSFER OF FUNDS RESTRICTED FOR CHAI PURPOSES FROM THE CLINTON FOUNDATION $17,728,060 PART XII, LINE 2D - OTHER ADJUSTMENTS UN ITAID COMMODITIES NOT RECOGNIZED AS FORM 990 REVENUE (SEE SCH 0) $108,989,261 TRANSFER OF FUNDS RESTRICTED FOR CHAI PURPOSES FROM THE CLINTON FOUNDATION $17,728,060 TOTAL TO SCHED ULE D, PART XII, LINE 2D $126,717,321 PART XIII, LINE 2D - OTHER ADJUSTMENTS UNITAID COMM ODITIES NOT RECOGNIZED AS FORM 990 REVENUE (SEE SCH 0) $108,989,261 FORM 990, SCHEDULE F, PART I, QUESTION 3 CENTRAL AMERICA/CARIBBEAN - CHANGED FROM $6,745,050 TO $4,484,845 SUB- SAHARAN AFRICA - CHANGED FROM $134,586,233 TO $34,551,866 MIDDLE EAST AND NORTH AFRICA - C HANGED FROM $1,048,967 TO $0 NORTH AMERICA - WAS REMOVED SOUTH ASIA - CHANGED FROM $15,946,373 TO $3,467,196 RUSSIA & THE NEWLY INDEPENDENT Identifier Return Reference Explanation STATES ADDED COLUMN B 1 COLUMN C 7 COLUMN D PROGRAM SERVICES COLUMN E. HEALTH COLUMN F $692,029 EAST ASIA AND THE PACIFIC ADDED COLUMN B 7 COLUMN C 70 COLUMN D PROGRAM SER VICES COLUMN E. HEALTH COLUMN F $7,836,944 FORM 990, SCHEDULE F, PART II LINE 2 - CHANGED FROM 59 TO 0 LINE 3 - CHANGED FROM 0 TO 59 FORM 990, SCHEDULE F, PART V ADDED LANGUAGE S CHEDULE F, PART II, LINE 3 THE GRANTEES COUNTED ON LINE 3 CONSIST OF GOVERNMENT MINISTRIES OF HEALTH, HOSPITALS, AND OTHER ORGANIZATIONS IN FURTHERANCE OF OUR MISSION FORM 990, S CHEDULE I, PART II LINE 1 1 COLUMN C - CHANGED FROM BLANK TO 501(C)(3) LINE 12 COLUMN C - CHANGED FROM BLANK TO 501(C)(3) LINE 1 3 COLUMN C - CHANGED FROM BLANK TO 501(C)(3) LINE 14 COLUMN C - CHANGED FROM BLANK TO 501 (C)(3) LINE 1 7 COLUMN C - CHANGED FROM BLANK TO 5 01(C)(3) LINE 2 - CHANGED FROM 0 TO 5 LINE 3 CHANGED FROM 7 TO 2 FORM 990, SCHEDULE L, P ART IV COLUMN (E) - CHANGED FROM YES TO NO REMOVED PARTNERS IN HEALTH TRANSACTION FORM 990, SCHEDULE R, PART II LINE 2, COLUMN G - CHANGED FROM NO TO YES LINE 3, COLUMN G - CHANGED FROM NO TO YES FORM 990, SCHEDULER, PART V LINE 1J - CHANGED FROM Y ES TO NO LINE 1 M - CHANGED FROM NO TO Y ES LINE 1 N - CHANGED FROM NO TO YES LINE 10 CHANGED FROM NO TO YES LINE 1 P- CHANGED FROM NO TO YES jefile GRAPHIC print - DO NOT PROCESS SCHEDULE R (Form 990) As Filed Data - DLN:93493325011203 OMB No 1545-0047 Related Organizations and Unrelated Partnerships 2010 1- Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37. 1- Attach to Form 990. 1- See separate instructions. Department of the Treasury Internal Revenue Service Name of the organization CLINTON HEALTH ACCESS INITIATIVE INC Employer identification number 27-1414646 Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.) (a) Name, address, and EIN of disregarded entity (b) Primary activity (c) Legal domicile (state or foreign country) (d ) Total income ( e) End-of-year assets (f) Direct controlling entity Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.) (a) Name, address, and EIN of related organization (b) Primary activity (c) Legal domicile (state or foreign country) (d ) Exempt Code section (e) Public charity status (if section 501(c)(3)) (f) Direct controlling entity (g) Section 512(b)(13) controlled organization Yes No (1) WILLIAM I CLINTON FOUNDATION 1200 PRESIDENT CLINTON AVENUE ECONOMIC DEVELOPMENT AR 501(C)(3) LINE 7 N/A No FUNDRAISING UK N/A N/A WILLIAM I CLINTON FOUNDATION Yes INITIATIVE AR 501(C)(3) LINE 11A, I WILLIAM I CLINTON FOUNDATION Yes LITTLE ROCK, AR 72201 31-1580204 (2) WILLIAM I CLINTON FOUNDATION UK 610 PRESIDENT CLINTION AVE 2ND LITTLE ROCK, AR 72201 (3) CLINTON GLOBAL INITIATIVE INC 1200 PRESIDENT CLINTON AVENUE LITTLE ROCK, AR 72201 27-1551550 For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat No 50135Y Schedule R (Form 990) 2010 Schedule R (Form 990) 2010 Page 2 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 (b) Primary activity (c) Legal domicile (state or foreign country) (h) ( d) Direct controlling entity (e) Predominant income (related,, unrelated, excluded from tax under sections 512 514) (f) of total income (g ) Share of end-of-year assets Disproprtionate allocations7 Yes (i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065) No U) General or managing part ner? Yes (k) Percentage ownership No Identification of Related 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 organizations treated as a corporation or trust during the tax year.) ( a) Name, address, and EIN of related organization (b) Primary activity (c) Legal domicile (state or foreign country) (d) Direct controlling entity (e) Type of entity (C corp, S corp, or trust) (f) Share of total income (g) Share of end-of-year assets (h) Percentage ownership Schedule R (Form 990) 2010 Schedule R (Form 990) 2010 ff^ Page 3 Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.) Yes Note . Complete line 1 if any entity is listed in Parts II, III or IV No 1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV? a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity la b Gift, grant, or capital contribution to other organization (s) lb c Gift, grant, or capital contribution from other organization (s) 1c d Loans or loan guarantees to or for other organization (s) ld e Loans or loan guarantees by other organization( s) le f Sale of assets to other organization( s) if No g Purchase of assets from other organization( s) 1g No h Exchange of assets 1h No ii No No Yes No Yes i Lease of facilities, equipment, or other assets to other organization (s) j Lease of facilities, equipment, or other assets from other organization( s) 1j No k Performance of services or membership or fundraising solicitations for other organization( s) 1k No 11 No I Performance of services or membership or fundraising solicitations by other organization( s) m Sharing of facilities, equipment, mailing lists, or other assets 1m Yes n Sharing of paid employees in o Reimbursement paid to other organization for expenses p Reimbursement paid by other organization for expenses q Other transfer of cash or property to other organization( s) 1q No Other transfer of cash or property from other organization( s) lr No r 2 No Yes If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds (a) Name of other organization (b) Transaction type(a-r) (^) Amount involved (d) Method of determining amount involved (1) (2) (3) (4) (5) (6) Schedule R (Form 990) 2010 Schedule R (Form 990) 2010 Page 4 Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.) Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization See instructions regarding exclusion for certain investment partnerships (a) Name, address, and EIN of entity (b) Primary activity (c) Legal domicile (state or foreign country) (d) Are all partners section 501(c)(3) organizations? Yes No (e) Share of end-of-year assets (f) Disproprtionate allocations? Yes No (g) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065) (h) General or managing part ner? Yes No Schedule R (Form 990) 2010 Schedule R (Form 990) 2010 Page 5 Supplemental Information Complete this part to provide additional information for responses to questions on Schedule R (see instructions) Identifier Return Reference Explanation Schedule R (Form 990) 2010