2022-11-15T19:47:48-06:00 2021-12-31 910189318 MOSS ADAMS LLP 21700 OXNARD ST STE 300 WOODLAND HILLS CA 91367 990 2021-01-01 330586911 CHG FOUNDATION CHGF 6194220422 2420 FENTON STREET 100 CHULA VISTA CA 91914 SCOTT CARROLL CHIEF FINANCIAL OFFICER 6194220422 2022-11-15 1 SCOTT CARROLL 999009999 LAUREN HAVERLOCK P00545829 8185771900 2022-11-15 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z COMMUNITY HEALTH GROUP PARTNERSHIP PLAN NORMA DIAZ 2420 FENTON STREET 100 CHULA VISTA CA 91914 1200137221 0 X WWW.CHGSD.COM X 1994 CA CHG FOUNDATION IS DEDICATED TO MAINTAINING AND IMPROVING THE HEALTH OF OUR MEMBERS BY PROVIDING ACCESS TO QUALITY CARE AND OFFERING EXCEPTIONAL SERVICE TO DIVERSE POPULATIONS. 9 9 419 0 0 0 5000 0 974217788 1195859294 2960118 1153404 909904 2976267 978092810 1199988965 12360 1266330 0 0 23049630 23170549 0 0 0 968699912 1242324053 991761902 1266760932 -13669092 -66771967 637171330 603263204 211816569 244680410 425354761 358582794 CHG FOUNDATION IS DEDICATED TO MAINTAINING AND IMPROVING THE HEALTH OF OUR MEMBERS BY PROVIDING ACCESS TO QUALITY CARE AND OFFERING EXCEPTIONAL SERVICE TO DIVERSE POPULATIONS. 0 0 1218870592 1266330 1195859294 TO ARRANGE FOR, MAKE AVAILABLE, AND ASSUME FINANCIAL RISK FOR THE PROVISION OF HEALTH CARE SERVICES TO ENROLLED MEMBERS ELIGIBLE FOR MEDI-CAL IN SAN DIEGO COUNTY UNDER THE CALIFORNIA MEDI-CAL PREPAID HEALTH PLAN PROGRAM. 1218870592 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 1 0 1 2100 0 1 419 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 1 1 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 CA X SCOTT CARROLL 6194986591 2420 FENTON STREET SUITE 100 CHULA VISTA CA 91914 ALBERT VITELA CHAIR OF THE BOARD OF DIRECTORS 3.00 1.00 X X 0 36955 0 CARLOS CESENA VICE CHAIRMAN OF THE BOARD 3.00 1.00 X X 0 28150 0 TITO CALSADA BOARD MEMBER 3.00 1.00 X 0 24450 0 GRACE KOJIMA BOARD MEMBER 3.00 1.00 X 0 22300 0 DOMENIC D'ALESSIO BOARD MEMBER 3.00 1.00 X 0 24550 0 JOSE LUIS VALDIVIA BOARD MEMBER 3.00 1.00 X 0 28150 0 CARLOTA SALAS SECRETARY OF THE BOARD OF DIRECTORS 3.00 1.00 X X 0 26850 0 JONATHAN BALL BOARD MEMBER 3.00 1.00 X 0 22750 0 ANITA HOLT BOARD MEMBER 3.00 1.00 X 0 3625 0 NORMA DIAZ CHIEF EXECUTIVE OFFICER 38.00 2.00 X 0 859748 33361 JOSEPH A GARCIA CHIEF OPERATING OFFICER 38.00 2.00 X 0 667333 0 SCOTT CARROLL CHIEF FINANCIAL OFFICER 37.00 3.00 X 0 334498 21575 PATRICK TELLEZ CHIEF MEDICAL OFFICER 20.00 20.00 X 0 428794 25803 ANN WARREN ASSOCIATE CHIEF EXECUTIVE 16.00 24.00 X 0 379269 23763 ALLAN SOMBILLO CHIEF INFORMATION OFFICER 20.00 20.00 X 0 303091 20941 ALEJANDRO HINOJOSA-VALENCIA IHA PHYSICIAN 20.00 20.00 X 0 546246 46092 MANISHA SHARMA MEDICAL DIRECTOR 20.00 20.00 X 0 292329 37542 YOUSAF FAROOK SENIOR DIRECTOR OF HEALTH 20.00 20.00 X 0 213627 44922 FRANCISCA CHAVEZ SENIOR DIRECTOR OF OPERATIONS 38.00 2.00 X 0 270875 42544 ANDREW GREGOR CHIEF CORPORATE COUNSEL 38.00 2.00 X 0 211455 19151 HEIDI ARNDT SENIOR COMPLIANCE OFFICER 16.00 24.00 X 0 247754 29701 0 4972799 345395 0 1 1 0 MEDIMPACT HEALTHCARE SYSTEMS INC 10181 SCRIPPS GATEWAY CT SAN DIEGO CA 92131 PHARMACY SERVICES 255699282 UCSD MEDICAL CENTER 200 W ARBOR DR SAN DIEGO CA 92103 MEDICAL/HEALTHCARE SERVICES 102260774 SCRIPPS HEALTH 4077 FIFTH AVE SAN DIEGO CA 92103 MEDICAL/HEALTHCARE SERVICES 54879559 GROSSMONT HOSPITAL CORPORATION 5555 GROSSMONT CENTER DR LA MESA CA 91942 MEDICAL/HEALTHCARE SERVICES 53688113 PALOMAR HEALTH 2185 CITRICADO PKWY SAN DIEGO CA 92029 MEDICAL/HEALTHCARE SERVICES 42284015 518 MEDI-CAL PREMIUMS 524114 1195859294 1195859294 1195859294 1153404 1153404 101900 148256 -46356 -46356 -46356 DIRECTED PAYMENT ADMIN FEE 524114 3003311 3003311 STATE RESTITUTION 561000 19312 19312 3022623 1199988965 1195859294 0 4129671 X 1263330 1263330 3000 3000 2606549 113649 2492900 110982 110982 15109675 3342224 11767451 493961 147677 346284 3535250 940003 2595247 1314132 392878 921254 12695742 12695742 194968 194968 613793 613793 1209644991 1207337936 2307055 18330 18330 3230458 3230458 4558984 4558984 1012129 1012129 229766 229766 23070 23070 1811959 1811959 688805 688805 REINSURANCE 5329895 5329895 EMPLOYEE TRAINING AND P 586515 586515 TAXES, LICENSES, & FEES 543627 543627 DUES & SUBSCRIPTIONS 251291 251291 889730 889730 1266760932 1218870592 47890340 0 2280503 2328966 463105285 434737407 140755665 140990652 373284 376719 18867297 6598974 13118326 12268323 17538267 12561137 637171330 603263204 146618095 166028339 15130 0 65183344 78652071 211816569 244680410 X 425354761 358582794 425354761 358582794 637171330 603263204 -66771967 0 X 0 1 X 1 0 X 5000 5000 1065895336 832392078 930690690 974217788 1195859294 4999055186 1065895336 832392078 930690690 974222788 1195859294 4999060186 0 0 0 4999060186 711008 5275891 11744375 3199838 1255304 22186416 711008 5275891 11744375 3199838 1255304 22186416 694174 702041 1030401 856173 3022623 6305412 1067300518 838370010 943465466 978278799 1200137221 5027552014 0.99430 0.99500 0.00440 0.00430 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2017 AMOUNT: $ 694,174. 2018 AMOUNT: $ 702,041. 2019 AMOUNT: $ 1,030,401. 2020 AMOUNT: $ 856,173. 2021 AMOUNT: $ 3,022,623. 2176530 100081 4584 67791 39561 2173843 2119104 206540 4986 154100 2176530 1986730 290990 12012 131891 38736 2119104 1630775 355955 1986730 1630775 1630775 1.00000 0.00000 0.00000 0 0 3500000 3500000 15166856 6404493 8762363 130907 130907 0 69534 63574 5960 12268323 ACCRUED MEDICAL LOSS RATIO (MLR) RISK CORRIDOR LIABILITIES 37913729 HOSPITAL DIRECTED PAYMENTS PAYABLE 2526315 MANAGED CARE ORGANIZATION TAX PAYABLE 33467075 ACCRUED PROVIDER INCENTIVES 4744952 78652071 X 1200137221 0 1200137221 -148256 -148256 1199988965 1266909188 148256 148256 1266760932 0 1266760932 PART X, LINE 2: COMMUNITY HEALTH GROUP AND CHG FOUNDATION ARE NOT-FOR-PROFIT PUBLIC BENEFIT CORPORATIONS, ORGANIZED UNDER THE NOT-FOR-PROFIT PUBLIC BENEFIT LAWS OF CALIFORNIA, AND EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE (THE "CODE") SECTION 501(A) AS ORGANIZATIONS DESCRIBED IN SECTIONS 501(C)(4) AND 501(C)(3), RESPECTIVELY, OF THE CODE. BOTH ORGANIZATIONS ARE EXEMPT FROM STATE TAXES UNDER THE CALIFORNIA REVENUE AND TAXATION CODE SECTION 23701(D). ACCORDINGLY, NO PROVISION HAS BEEN MADE FOR INCOME TAXES. MANAGEMENT HAS EVALUATED THE TAX POSITIONS OF COMMUNITY HEALTH GROUP AND CHG FOUNDATION AND THE CERTAINTY AS TO WHETHER THOSE POSITIONS WILL BE SUSTAINED IN THE EVENT OF AN AUDIT BY TAXING AUTHORITIES AT THE FEDERAL AND STATE LEVELS. THE PRIMARY TAX POSITIONS EVALUATED ARE RELATED TO COMMUNITY HEALTH GROUP'S AND CHG FOUNDATION'S CONTINUED QUALIFICATION AS TAX-EXEMPT ORGANIZATIONS AND WHETHER THERE ARE UNRELATED BUSINESS INCOME ACTIVITIES CONDUCTED THAT WOULD BE TAXABLE. MANAGEMENT BELIEVES THAT IT IS MORE LIKELY THAN NOT THAT ALL INCOME TAX POSITIONS WILL BE SUSTAINED UPON POTENTIAL AUDIT OR EXAMINATION. THE ORGANIZATION HAS NO UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2021 OR 2020. COMMUNITY HEALTH GROUP AND CHG FOUNDATION FILE INFORMATION RETURNS IN THE U.S. FEDERAL JURISDICTION AND THE STATE OF CALIFORNIA. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -148,256. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 148,256. 1 HUMBLE DESIGN CPS REMITTANCE PROCESSING - SUITE A CARSON CA 90746 270410088 501(C)(3) 6010 0 GENERAL DONATION ABEL CESAR TOLEDO MD INC 330 OXFORD STREET CHULA VISTA CA 91911 263596648 5779 0 PPE GRANT FOR PROVIDERS CARLOS GARCIA MD 1392 EAST PALOMAR CHULA VISTA CA 91913 760703628 7160 0 PPE GRANT FOR PROVIDERS COMMUNITY HEALTH SYSTEMS INC 22675 ALESSANDRO BLVD MORENO VALLEY CA 92553 330056551 501(C)(3) 9670 0 PPE GRANT FOR PROVIDERS FAMILY HEALTH CENTERS OF SD 823 GATEWAY CENTER WAY SAN DIEGO CA 92102 952833205 501(C)(3) 198200 0 PPE GRANT FOR PROVIDERS HUONG T NGUYEN MD 4444 EL CAJON BLVD SAN DIEGO CA 921154312 832227311 6993 0 PPE GRANT FOR PROVIDERS IMPERIAL BEACH COMMUNITY CLINIC PO BOX 459 IMPERIAL BEACH CA 91933 237209592 501(C)(3) 32177 0 PPE GRANT FOR PROVIDERS LA MAESTRA FAMILY CLINIC 4060 FAIRMOUNT AVENUE SAN DIEGO CA 92105 330473171 501(C)(3) 45019 0 PPE GRANT FOR PROVIDERS NEIGHBORHOOD HEALTHCARE 425 N DATE STREET ESCONDIDO CA 92025 952796316 501(C)(3) 119365 0 PPE GRANT FOR PROVIDERS NORTH COUNTY HEALTH PROJECT 150 VALPREDA ROAD SAN MARCOS CA 920692973 952847102 501(C)(3) 98442 0 PPE GRANT FOR PROVIDERS OPERATION SAMAHAN 1428 HIGHLAND AVENUE NATIONAL CITY CA 91950 953008798 501(C)(3) 23392 0 PPE GRANT FOR PROVIDERS SAN DIEGO FAMILY CARE 6973 LINDA VISTA ROAD SAN DIEGO CA 921116339 952700856 501(C)(3) 47023 0 PPE GRANT FOR PROVIDERS SAN YSIDRO HEALTH CENTER 1275 30TH STREET SAN DIEGO CA 92154 952801772 501(C)(3) 175658 0 PPE GRANT FOR PROVIDERS VIET TRONG DAO MD INC 4616 EL CAJON BLVD SAN DIEGO CA 92115 454184500 8789 0 PPE GRANT FOR PROVIDERS VISTA COMMUNITY CLINIC 1000 VALE TERRACE DRIVE VISTA CA 920845218 952815615 501(C)(3) 79128 0 PPE GRANT FOR PROVIDERS ABACUS 4204A ADAMS AVE SAN DIEGO CA 92116 454904064 7000 0 PPE GRANT FOR PROVIDERS KAB MEDICAL GROUP INC 15144 BAROLO CT SAN DIEGO CA 92127 814236980 7000 0 PPE GRANT FOR PROVIDERS BEHAVIOR HEALTH & WELLNESS LLC 3024 CONE MANOR LANE RALEIGH NC 27613 272992358 7000 0 PPE GRANT FOR PROVIDERS EASTLAKE SLEEP CENTER 841 KUHN DRIVE CHULA VISTA CA 919143552 203015013 7000 0 PPE GRANT FOR PROVIDERS GELEN R DEL ROSARIO MD 502 EUCLID AVENUE NATIONAL CITY CA 91950 472387000 7000 0 PPE GRANT FOR PROVIDERS HENRY J SHIN DPM 2340 EAST 8TH STREET NATIONAL CITY CA 919502873 380727550 7000 0 PPE GRANT FOR PROVIDERS INLAND PAIN SPECIALISTS 29911 NIGUEL RD SUITE 6429 LAGUNA NIGUEL CA 926779998 811507345 7000 0 PPE GRANT FOR PROVIDERS SOUTH BAY PULMONARY MEDICAL GROUP 841 KUHN DRIVE CHULA VISTA CA 91914 330513208 7000 0 PPE GRANT FOR PROVIDERS UNIQUE HEALTHCARE FOR WOMEN MED CORP 502 SO EUCLID AVE NATIONAL CITY CA 91950 200461497 7000 0 PPE GRANT FOR PROVIDERS RETINA CENTER OF SAN DIEGO 6259 CAMINITO LUISITO SAN DIEGO CA 92111 834516271 7000 0 PPE GRANT FOR PROVIDERS MEHRDAD MARK MOFID MD APC 4150 REGENTS PARK ROW 300 LA JOLLA CA 92037 200549153 7000 0 PPE GRANT FOR PROVIDERS ADVANCED PHYSIOTHERAPY PO BOX 2736 SPRING VALLEY CA 91978 462048156 7000 0 PPE GRANT FOR PROVIDERS MOTIVA ASSOCIATES PO BOX 122279 CHULA VISTA CA 91912 330943756 7000 0 PPE GRANT FOR PROVIDERS BEST SERVICES 111 CURRITUCK COMMERCIAL DR MOYOCK NC 27958 330979097 7000 0 PPE GRANT FOR PROVIDERS RETINA CONSULTANTS SAN DIEGO 12630 MONTE VISTA ROAD POWAY CA 920642526 953511595 7000 0 PPE GRANT FOR PROVIDERS MISSION INFECTIOUS DIS INFUS CNSLTS INC PO BOX 28849 SAN DIEGO CA 92198 274694772 7000 0 PPE GRANT FOR PROVIDERS FAMILY EYE HEALTH OPTOMETRY CENTER 181 S RANCHO SANTE FE RD SAN MARCOS CA 92078 205433458 7000 0 PPE GRANT FOR PROVIDERS THERAPY SPECIALISTS 3760 CONVOY STREET SAN DIEGO CA 92111 330209580 7000 0 PPE GRANT FOR PROVIDERS TORY PRESTERA 100 NORTH RANCHO SANTA FE ROAD SAN MARCOS CA 920691294 810943162 7000 0 PPE GRANT FOR PROVIDERS CROWNVIEW MEDICAL GROUP INC 158 C AVENUE CORONADO CA 92118 800196377 7000 0 PPE GRANT FOR PROVIDERS MANA DE SAN DIEGO 2515 CAMINO DEL RIO SOUTH 228 SAN DIEGO CA 92108 330821060 25000 0 SCHOLARSHIP PROGRAM- 2021 COMMUNITY PARTNERSHIP SAN YSIDRO HEALTH CENTER 1275 30TH STREET SAN DIEGO CA 92154 952801772 10000 0 15TH ANNUAL CLSICO DE GOLF (CHARITY GOLF TOURNAMENT) NEIGHBORHOOD HEALTHCARE 425 N DATE STREET ESCONDIDO CA 92025 952796316 10000 0 BACK TO THE 80S GALA SILVER SPONSOR SEPT 18 2021 SOUTHWESTERN COLLEGE FOUNDATION 900 OTAY LAKES RD CHULA VISTA CA 91910 953794927 20000 0 CHG DIVERSITY & INCLUSION SCHOLARSHIPS TRUECARE 150 VALPREDA ROAD SAN MARCOS CA 920692973 952847102 30000 0 2022 MAGICAL MASQUERADE GRAND GALA -MARCH 26 2022 SAN DIEGO FAMILY CIRCLE ADULT DAY HEALTH CARE 5770 BELLEVUE AVE LA JOLLA CA 92037 364912524 15000 0 MONTHLY DONATION SAN DIEGO PRINTERS 10025 HUENNEKENS ST SAN DIEGO CA 92121 330867407 12392 0 1,000 BACKPACK ANNUAL DONATION ASSOCIATION FOR COMMUNITY AFFILIATED PLANS 1155 15TH STREET NW WASHINGTON DC 22172 050509791 10000 0 ACAP SDOH INNOVATION CENTER -FOUNDER'S CIRCLE 2022 11 32 SCHOLARSHIPS 1 3000 PART I, LINE 2: CHG FOUNDATION AWARDS GRANTS AND SCHOLARSHIPS FOR HEALTH AND EDUCATIONAL RELATED PURPOSES TO INDIVIDUALS RESIDING IN SAN DIEGO COUNTY WHO ARE NOT RELATED TO THE ORGANIZATION. 0 0 0 0 0 0 0 0 0 NORMA DIAZ CHIEF EXECUTIVE OFFICER 0 738406 0 17700 0 103642 0 8550 0 24811 0 893109 0 0 JOSEPH A GARCIA CHIEF OPERATING OFFICER 0 667333 0 0 0 0 0 0 0 0 0 667333 0 0 ALEJANDRO HINOJOSA-VALENCIA IHA PHYSICIAN 0 66488 0 469820 0 9938 0 8550 0 37542 0 592338 0 0 PATRICK TELLEZ CHIEF MEDICAL OFFICER 0 411757 0 3557 0 13480 0 0 0 25803 0 454597 0 0 ANN WARREN ASSOCIATE CHIEF EXECUTIVE 0 302260 0 8686 0 68323 0 8550 0 15213 0 403032 0 0 SCOTT CARROLL CHIEF FINANCIAL OFFICER 0 329708 0 500 0 4290 0 8550 0 13025 0 356073 0 0 MANISHA SHARMA MEDICAL DIRECTOR 0 291279 0 500 0 550 0 0 0 37542 0 329871 0 0 ALLAN SOMBILLO CHIEF INFORMATION OFFICER 0 292517 0 6524 0 4050 0 7916 0 13025 0 324032 0 0 FRANCISCA CHAVEZ SENIOR DIRECTOR OF OPERATIONS 0 202827 0 7058 0 60990 0 5002 0 37542 0 313419 0 0 HEIDI ARNDT SENIOR COMPLIANCE OFFICER 0 245064 0 2000 0 690 0 6815 0 22886 0 277455 0 0 YOUSAF FAROOK SENIOR DIRECTOR OF HEALTH 0 207719 0 5558 0 350 0 6287 0 38635 0 258549 0 0 ANDREW GREGOR CHIEF CORPORATE COUNSEL 0 210655 0 500 0 300 0 6353 0 12798 0 230606 0 0 PART I, LINE 3 CHG FOUNDATION RELIES ON COMMUNITY HEALTH GROUP (PARENT), A RELATED ORGANIZATION, TO ESTABLISH THE COMPENSATION AND BENEFITS OF THE ORGANIZATION'S CEO. CHG FOUNDATION'S CEO IS ALSO THE CEO OF COMMUNITY HEALTH GROUP; CHG FOUNDATION'S CEO RECEIVES ONE HUNDRED PERCENT OF HER COMPENSATION FROM COMMUNITY HEALTH GROUP. COMMUNITY HEALTH GROUP UTILIZES THE FOLLOWING METHODS TO DETERMINE THE COMPENSATION OF THE CEO: 1) COMPENSATION COMMITTEE; 2) INDEPENDENT COMPENSATION CONSULTANT; 3) COMPENSATION SURVEY AND/OR STUDY; AND 4) APPROVAL BY THE BOARD OF DIRECTORS. JOSEPH GARCIA FAMILY MEMBER OF OFFICER 667333 COMPENSATION 0 SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: JOSEPH GARCIA IS COMPENSATED THROUGH COMMUNITY HEALTH GROUP, A RELATED ORGANIZATION, THAT PROVIDES ADMINISTRATIVE SERVICES AND SUPPORT TO CHG FOUNDATION AND ACTS AS THE COMMON PAYMASTER. FORM 990, PART VI, SECTION A, LINE 2 NORMA DIAZ AND JOSEPH A. GARCIA HAVE A FAMILY RELATIONSHIP (SPOUSES). FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION'S PARENT (COMMUNITY HEALTH GROUP, OR "CHG") ENGAGED WITH JOSEPH A. GARCIA, A CONSULTANT WITH J.A.G. CONSULTING, LLC (SINGLE-MEMBER LLC, WHERE JOSEPH A. GARCIA IS THE SOLE MANAGER) TO FULFILL THE DUTIES OF CHIEF OPERATING OFFICER FOR CHG. COMPENSATION PAID TO J.A.G. CONSULTING, LLC BY CHG IN 2021 IN RELATION TO THESE DUTIES WAS $667,333. FORM 990, PART VI, SECTION A, LINE 6 CHG FOUNDATION HAS ONE SOLE MEMBER, COMMUNITY HEALTH GROUP, A CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S SOLE MEMBER, COMMUNITY HEALTH GROUP, HAS THE POWER TO APPOINT ALL OF THE ORGANIZATION'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B AS THE SOLE MEMBER OF CHG FOUNDATION, COMMUNITY HEALTH GROUP HAS THE POWER TO APPROVE ANY AMENDMENT TO THE ARTICLES OF INCORPORATION OR BYLAWS OF CHG FOUNDATION. ADDITIONALLY, COMMUNITY HEALTH GROUP HAS THE POWER OR AUTHORITY GIVEN TO MEMBERS BY THE NONPROFIT PUBLIC BENEFIT CORPORATION LAW BY ITS WRITTEN CONSENT. FORM 990, PART VI, SECTION B, LINE 11B MOSS ADAMS, LLP IS ENGAGED TO PREPARE AND COMPLETE THE FORM 990 ON BEHALF OF CHG FOUNDATION. THE FORM 990 IS PREPARED UNDER THE DIRECTION, REVIEW, AND OVERSIGHT OF COMMUNITY HEALTH GROUP'S (CHG FOUNDATION'S PARENT) FINANCE DEPARTMENT, AND EXECUTIVE MANAGEMENT TEAM. THE FORM 990 IS REVIEWED IN DETAIL BY THE CHIEF FINANCIAL OFFICER OF CHG FOUNDATION WHO APPROVES THE FINAL VERSION FOR FILING WITH MOSS ADAMS, LLP. CHG FOUNDATION'S BOARD OF DIRECTORS RELIES ON THE EXPERTISE OF INTERNAL MANAGEMENT AND MOSS ADAMS, LLP FOR THE ACCURATE AND TIMELY FILING OF FORM 990. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, THE CHG FOUNDATION BOARD OF DIRECTORS AND EXECUTIVE MANAGEMENT TEAM RECEIVE A REFRESHER TRAINING (CONDUCTED BY OUTSIDE LEGAL COUNSEL) ON THE IMPORTANCE OF IDENTIFYING ANY CONFLICTS OF INTEREST; THE DISCLOSURE OF ANY ACTUAL OR POTENTIAL CONFLICTS OF INTEREST IS AN INTEGRAL PART OF THE CULTURE AT CHG FOUNDATION AND COMMUNITY HEALTH GROUP. ANY ACTUAL OR POTENTIAL CONFLICTS OF INTEREST ARE REPORTED TO COMMUNITY HEALTH GROUP'S COMPLIANCE OFFICER FOR INVESTIGATION AND FOLLOW-UP. IN THE EVENT OF ANY CONFLICTS OF INTEREST, THE BOARD OF DIRECTORS WILL DETERMINE WHAT RESTRICTIONS, IF ANY, WILL BE IMPOSED ON THE PERSON(S) WITH THE CONFLICT; AND SUCH PERSON(S) WILL RECUSE THEMSELVES FROM PARTICIPATING IN ANY DELIBERATIONS AND DECISIONS OF THE BOARD OF DIRECTORS REGARDING MATTERS INVOLVING THE POTENTIAL CONFLICT OF INTEREST, UNLESS OTHERWISE PERMITTED OR AUTHORIZED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 CHG FOUNDATION ANSWERED EACH OF THESE QUESTIONS AS "NO" BECAUSE ALL COMPENSATION PAID TO THOSE PERSONS REPORTED IN PART VII OR SCHEDULE J IS PAID BY COMMUNITY HEALTH GROUP (CHG FOUNDATION'S PARENT). SEE THE COMMUNITY HEALTH GROUP FORM 990 SCHEDULE O FOR A DESCRIPTION OF THE PROCESSES BY WHICH IT DETERMINES EXECUTIVE COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS, AS WELL AS THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS (WHICH INCLUDE THE CONSOLIDATED RESULTS OF COMMUNITY HEALTH GROUP AND CHG FOUNDATION) ARE AVAILABLE TO THE GENERAL PUBLIC ON THE CALIFORNIA DEPARTMENT OF MANAGED HEALTH CARE WEBSITE (DMHC.CA.GOV). THE ORGANIZATION'S GOVERNING DOCUMENTS ARE ON FILE WITH THE CALIFORNIA DEPARTMENT OF MANAGED HEALTH CARE AND CAN BE OBTAINED VIA REQUEST UNDER THE CALIFORNIA PUBLIC RECORDS ACT. THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS NOT MADE AVAILABLE TO THE GENERAL PUBLIC. FORM 990, PART IX, LINE 11G PHARMACY EXPENSES: PROGRAM SERVICE EXPENSES 256,904,525. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 256,904,525. CONSULTING EXPENSES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 2,307,055. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,307,055. HEALTH CARE EXPENSES: PROGRAM SERVICE EXPENSES 950,433,411. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 950,433,411. FORM 990, PART IX, LINES 5 THROUGH 10: CHG FOUNDATION HAS NO EMPLOYEES. FOR A FEE, COMMUNITY HEALTH GROUP (PARENT) PROVIDES ADMINISTRATIVE SERVICES AND SUPPORT TO CHG FOUNDATION UNDER THE TERMS AND CONDITIONS OF AN ADMINISTRATIVE SERVICES AGREEMENT. THE SERVICES PROVIDED INCLUDE BUT ARE NOT LIMITED TO: MEDICAL MANAGEMENT, CLAIMS PROCESSING AND PAYMENT, INFORMATION SYSTEMS, LEGAL, PLANNING, INSURANCE, ACCOUNTING SERVICES, AND OTHER SERVICES AS DEFINED IN THE AGREEMENT. ALL EMPLOYEES PERFORMING WORK ON BEHALF OF CHG FOUNDATION IN ACCORDANCE WITH THE ADMINISTRATIVE SERVICES AGREEMENT ARE COMPENSATED AND PAID BY COMMUNITY HEALTH GROUP, A RELATED ORGANIZATION (PARENT) WHO ALSO ACTS AS THE COMMON PAYMASTER. COMPENSATION IS ALLOCATED TO CHG FOUNDATION FROM COMMUNITY HEALTH GROUP, AND THIS ALLOCATED COMPENSATION IS REPORTED ON CHG FOUNDATION'S FORM 990, PART IX, LINES 5-10. FORM 990, PART IX, LINES 11B THROUGH 11D; AND LINES 12 THROUGH 24E: A MAJORITY OF THE EXPENSES REPORTED IN THESE LINES REPRESENT AMOUNTS ALLOCATED TO CHG FOUNDATION FROM COMMUNITY HEALTH GROUP IN ACCORDANCE WITH THE TERMS OF THE ADMINISTRATIVE SERVICES AGREEMENT IN PLACE BETWEEN THE TWO ENTITIES. SUCH ALLOCATED EXPENSES ARE REPORTED AT THE FUNCTIONAL LEVEL ON CHG FOUNDATION'S FORM 990 PART IX. COMMUNITY HEALTH GROUP 2420 FENTON STREET SUITE 100 CHULA VISTA CA 91914 953766170 HEALTH CARE SERVICES CA 501(C)(4) N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 COMMUNITY HEALTH GROUP O 25182561 BOOK VALUE COMMUNITY HEALTH GROUP P 1266909188 BOOK VALUE COMMUNITY HEALTH GROUP S 18049187 BOOK VALUE COMMUNITY HEALTH GROUP M 12695742 BOOK VALUE PART V, SECTION 2, LINES 1 TO 4: FOR A FEE, COMMUNITY HEALTH GROUP PROVIDES ADMINISTRATIVE SERVICES AND SUPPORT TO CHG FOUNDATION UNDER THE TERMS OF AN ADMINISTRATIVE SERVICES AGREEMENT. THE SERVICES PROVIDED INCLUDE, BUT ARE NOT LIMITED TO: MEDICAL MANAGEMENT, CLAIMS PROCESSING AND PAYMENT, INFORMATION SYSTEMS, LEGAL, PLANNING, INSURANCE, ACCOUNTING SERVICES, AND OTHER SERVICES AS DEFINED IN THE AGREEMENT. ALL EMPLOYEES PERFORMING WORK ON BEHALF OF CHG FOUNDATION IN ACCORDANCE WITH THE ADMINISTRATIVE SERVICES AGREEMENT ARE COMPENSATED AND PAID BY COMMUNITY HEALTH GROUP (PARENT), WHO ALSO ACTS AS THE COMMON PAYMASTER. COMPENSATION IS ALLOCATED TO CHG FOUNDATION FROM COMMUNITY HEALTH GROUP, AND THIS ALLOCATED COMPENSATION IS REPORTED ON CHG FOUNDATION'S FORM 990, PART IX, LINES 5-10. SUCH AMOUNTS ARE REPORTED ON LINE 1 OF THIS SCHEDULE R, PART V, SECTION 2. LINE 2 OF THIS SCHEDULE R, PART V, SECTION 2 IS PRIMARILY COMPRISED OF REIMBURSEMENTS OF HEALTH CARE EXPENSES AND PHARMACY EXPENSES (CLAIMS PAYMENTS), PAID BY COMMUNITY HEALTH GROUP ON BEHALF OF CHG FOUNDATION, AS WELL AS REIMBURSEMENT OF COMPENSATION AND OTHER ADMINISTRATIVE EXPENSES ALLOCATED TO CHG FOUNDATION IN ACCORDANCE WITH THE TERMS AND CONDITIONS OF THE AFOREMENTIONED ADMINISTRATIVE SERVICES AGREEMENT. LINE 3 OF THIS SCHEDULE R, PART V, SECTION 2 REFLECTS THE NET AMOUNT OF $18,049,187 THAT WAS TRANSFERRED TO CHG FOUNDATION FROM COMMUNITY HEALTH GROUP AS A RETURN OF FUNDS TO CHG FOUNDATION THAT COMMUNITY HEALTH GROUP WAS HOLDING ON BEHALF OF CHG FOUNDATION. IN THE NORMAL COURSE OF BUSINESS, FUNDS ARE BEING HELD BY COMMUNITY HEALTH GROUP ON BEHALF OF CHG FOUNDATION ON A SHORT-TERM BASIS SO THAT SUCH FUNDS ARE AVAIALABLE FOR FUNDING CERTAIN OBLIGATIONS OF CHG FOUNDATION THAT WILL BE PAID BY COMMUNITY HEALTH GROUP IN ACCORDANCE WITH THE ADMINISTRATIVE SERVICES AGREEMENT. COMMUNITY HEALTH GROUP HOLDS THESE FUNDS IN CUSTODY OF CHG FOUNDATION AND MAINTAINS A SEPARATE ACCOUNTING OF THESE FUNDS (AS WELL AS ALL INTEREST EARNED ON SUCH FUNDS) WHILE THEY ARE IN POSSESSION OF COMMUNITY HEALTH GROUP. LINE 4 OF THIS SCHEDULE R, PART V, SECTION 2 REPRESENTS FEES FOR THE ADMINISTRATIVE SERVICES AND SUPPORT THAT COMMUNITY HEALTH GROUP PROVIDES TO CHG FOUNDATION IN ACCORDANCE WITH THE TERMS AND CONDITIONS OF THE ADMINISTRATIVE SERVICES AGREEMENT IN EFFECT BETWEEN THE TWO ORGANIZATIONS.