2018-11-15T16:50:57-06:00 2017-12-31 910189318 MOSS ADAMS LLP 10960 WILSHIRE BOULEVARD SUITE 1100 LOS ANGELES CA 90024 990 2017-01-01 953766170 COMMUNITY HEALTH GROUP COMM 6194220422 2420 FENTON STREET NO 100 CHULA VISTA CA 91914 SCOTT CARROLL CHIEF FINANCIAL OFFICER 6194220422 2018-11-15 1 LAUREN HAVERLOCK P00545829 3104770450 2018-11-15 172.90.17.200 2018-11-15 11:26:32 PS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 41F3D51277C721D7E64869098416E4BAA04E310D 2017 2019-02-21 02:37:17Z NORMA DIAZ 2420 FENTON STREET NO 100 CHULA VISTA CA 91914 162939055 0 X WWW.CHGSD.COM X 1982 CA COMMUNITY HEALTH GROUP 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 9 367 5 0 0 0 0 85991432 112253859 669543 417416 29068114 33868831 115729089 146540106 0 0 0 0 15688595 20768168 0 0 0 108902563 109602353 124591158 130370521 -8862069 16169585 80042684 85369534 80748084 70010041 -705400 15359493 COMMUNITY HEALTH GROUP 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 93019299 112253859 TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES TO MEMBERS UNDER A DUAL DEMONSTRATION MEDI-CAL/MEDICARE PLAN (MMP) OPEN TO PEOPLE ELIGIBLE FOR MEDI-CAL AND MEDICARE UNDER CONTRACT WITH THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. 93019299 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 2137 0 1 367 1 0 0 0 0 0 0 X 9 9 1 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 CA X SCOTT CARROLL 6194986591 2420 FENTON STREET SUITE 100 CHULA VISTA CA 91914 ALBERT VITELA CHAIRMAN OF THE BOARD 2.00 2.00 X X 32550 0 0 CARLOS CESENA VICE CHAIRMAN OF THE BOARD 2.00 2.00 X X 22599 0 0 CARLOTA SALAS SECRETARY OF THE BOARD 2.00 2.00 X X 21502 0 0 JONATHAN BALL BOARD MEMBER 2.00 2.00 X 20075 0 0 TITO CALSADA BOARD MEMBER 2.00 2.00 X 19850 0 0 DOMENIC D'ALESSIO BOARD MEMBER 2.00 2.00 X 17823 0 0 ANITA HOLT BOARD MEMBER 2.00 2.00 X 15904 0 0 GRACE KOJIMA BOARD MEMBER 2.00 2.00 X 19887 0 0 JOSE LUIS VALDIVIA BOARD MEMBER 2.00 2.00 X 20877 0 0 NORMA DIAZ CHEIF EXECUTIVE OFFICER 20.00 20.00 X 671451 0 51489 SCOTT CARROLL CHIEF FINANCIAL OFFICER 20.00 20.00 X 312265 0 15612 JOSEPH GARCIA CHIEF OPERATING OFFICER 20.00 20.00 X 656055 0 0 ANN WARREN ASSOCIATE CHIEF EXECUTIVE OFFICER 20.00 20.00 X 272827 0 35896 EDWARD HUTT CHEIF MEDICAL OFFICER 20.00 20.00 X 503077 0 32372 ALLAN SOMBILLO CHIEF INFORMATION OFFICER 20.00 20.00 X 247934 0 19205 IGNACIO RAMIREZ-OCHOA IHA PHYSICIAN 20.00 20.00 X 302369 0 23393 ANDREW ROBERTSON MEDICAL DIRECTOR 20.00 20.00 X 261662 0 1110 ANDREW GREGOR CHIEF CORPORATE COUNSEL 20.00 20.00 X 196387 0 23530 MARCO CASTILLO MANAGER - QNXT CONFIGURATION 20.00 20.00 X 181340 0 0 NOREEN KOIZUMI DIRECTOR OF CORPORATE QUALITY 20.00 20.00 X 175826 0 45711 HEIDI ARNDT MEDICARE COMPLIANCE/FORMER CIO 20.00 20.00 X 178845 0 19760 4151105 0 268078 32 1 1 0 MEDIMPACT HEALTHCARE SYSTEMS INC 10680 TREENA STREET SAN DIEGO CA 92131 PHARMACY SERVICES 25749050 COUNTY OF SAN DIEGO 1700 PACIFIC HWY SAN DIEGO CA 921012147 MEDICAL SERVICES 6258292 REGENTS OF THE UNIVERSITY OF CALIFORNIA 200 WEST ARBOR DRIVE SAN DIEGO CA 92103 MEDICAL SERVICES 5237109 SCRIPPS HEALTH 4077 FIFTH AVE SAN DIEGO CA 92103 MEDICAL SERVICES 5108334 GROSSMONT HOSPITAL CORPORATION 5555 GROSSMONT CENTER DRIVE LA MESA CA 91942 MEDICAL SERVICES 3752873 100 CAL MEDICONNECT REVENUE 524114 112253859 112253859 112253859 422107 422107 16394258 16398949 -4691 -4691 -4691 ADMIN FEE FROM CHGF 900099 33816053 33816053 OTHER REVENUE 900099 52778 52778 33868831 146540106 112253859 0 34286247 X 2699975 54055 2645920 13682824 521367 13161457 1290277 36253 1254024 1906501 67328 1839173 1188591 44091 1144500 400375 400375 446546 446546 93034809 93034809 244528 244528 4111142 4111142 2416111 2416111 841837 841837 146741 146741 359568 359568 1575994 1575994 775572 775572 CONSULTING EXPENSES 2898677 26139 2872538 TEMP STAFFING SERVICES 1298435 1298435 TAXES, LICENSES, & FEES 1042563 1042563 STAFF RECRUITING 280346 280346 -270891 -764743 493852 130370521 93019299 37351222 0 20202701 19350509 300304 20319971 2944339 4246391 1314289 1539580 8077536 4572852 2529194 3504684 52508733 32760484 243124 3647915 80042684 85369534 40128313 12311410 40619771 57698631 80748084 70010041 X -1005400 15059129 300000 300364 -705400 15359493 80042684 85369534 16169585 -104692 0 X X 0 1 X 1 0 3146883 1039669 2107214 4930653 3533183 1397470 3504684 DUE TO SUBSIDIARY (CHG FOUNDATION) 40401953 PAYABLE TO THE STATE OF CALIFORNIA 17296678 57698631 X PART X, LINE 2: CHG AND CHG FOUNDATION ARE NOT-FOR-PROFIT PUBLIC BENEFIT CORPORATIONS, ORGANIZED UNDER THE NOT-FOR-PROFIT PUBLIC BENEFIT LAWS OF CALIFORNIA. CHG IS EXEMPT FROM FEDERAL TAXES UNDER SECTION 501(C)(4) OF THE INTERNAL REVENUE CODE (THE "CODE") AND CHG FOUNDATION IS TAX-EXEMPT UNDER SECTION 501(C)(3) 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. CHG AND CHG FOUNDATION HAVE EVALUATED THEIR TAX POSITIONS 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 CHG'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 AT DECEMBER 31, 2017 OR 2016. CHG AND CHG FOUNDATION FILE INFORMATION RETURNS IN THE U.S. FEDERAL JURISDICTION AND THE STATE OF CALIFORNIA. X X X X 0 0 0 0 0 0 0 1 0 NORMA DIAZ CHEIF EXECUTIVE OFFICER 607321 0 3490 0 60640 0 11925 0 39564 0 722940 0 0 0 SCOTT CARROLL CHIEF FINANCIAL OFFICER 303548 0 1027 0 7690 0 11925 0 3687 0 327877 0 0 0 JOSEPH GARCIA CHIEF OPERATING OFFICER 656055 0 0 0 0 0 0 0 0 0 656055 0 0 0 ANN WARREN ASSOCIATE CHIEF EXECUTIVE OFFICER 257867 0 2792 0 12168 0 11205 0 24691 0 308723 0 0 0 EDWARD HUTT CHEIF MEDICAL OFFICER 471452 0 1024 0 30601 0 11925 0 20447 0 535449 0 0 0 ALLAN SOMBILLO CHIEF INFORMATION OFFICER 247084 0 0 0 850 0 7958 0 11247 0 267139 0 0 0 IGNACIO RAMIREZ-OCHOA IHA PHYSICIAN 64783 0 1040 0 236546 0 9364 0 14029 0 325762 0 0 0 ANDREW ROBERTSON MEDICAL DIRECTOR 242154 0 0 0 19508 0 0 0 1110 0 262772 0 0 0 ANDREW GREGOR CHIEF CORPORATE COUNSEL 195368 0 349 0 670 0 8653 0 14877 0 219917 0 0 0 MARCO CASTILLO MANAGER - QNXT CONFIGURATION 180250 0 0 0 1090 0 0 0 0 0 181340 0 0 0 NOREEN KOIZUMI DIRECTOR OF CORPORATE QUALITY 172042 0 2094 0 1690 0 8700 0 37011 0 221537 0 0 0 HEIDI ARNDT MEDICARE COMPLIANCE/FORMER CIO 78788 0 0 0 100057 0 11925 0 7835 0 198605 0 0 0 PART I, LINE 7 THE ORGANIZATION PROVIDED THE FOLLOWING TYPES OF NONFIXED PAYMENTS IN 2017: VACATION CASHOUT PAYMENTS, DISCRETIONARY BONUSES (GENERALLY LESS THAN $5,000), GIFT CARDS (GENERALLY LESS THAN $1,000), AND SERVICE AWARDS (BASED ON EMPLOYEE TENURE). FORM 990, PART VI, SECTION A, LINE 2 NORMA DIAZ AND JOSEPH GARCIA HAVE A FAMILY RELATIONSHIP (SPOUSES). FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION 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. COMPENSATION PAID TO J.A.G CONSULTING, LLC IN 2017 IN RELATION TO THESE DUTIES WAS $656,055. FORM 990, PART VI, SECTION B, LINE 11B MOSS ADAMS, LLP IS ENGAGED TO PREPARE AND COMPLETE THE FORM 990 ON BEHALF OF COMMUNITY HEALTH GROUP. THE FORM 990 IS PREPARED UNDER THE DIRECTION, REVIEW, AND OVERSIGHT OF COMMUNITY HEALTH GROUP'S FINANCE DEPARTMENT, AND EXECUTIVE MANAGEMENT TEAM. THE FORM 990 IS REVIEWED IN DETAIL BY THE CHIEF FINANCIAL OFFICER OF COMMUNITY HEALTH GROUP WHO APPROVES THE FINAL VERSION FOR FILING WITH MOSS ADAMS, LLP. COMMUNITY HEALTH GROUP'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 COMMUNITY HEALTH GROUP 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 COMMUNITY HEALTH GROUP. ANY ACTUAL OR POTENTIAL CONFLICTS OF INTEREST ARE REPORTED TO THE COMPANY'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. FORM 990, PART VI, SECTION B, LINE 15 A SALARY ANALYSIS IS PREPARED BY AN UNRELATED THIRD-PARTY COMPENSATION CONSULTANT. AN EVALUATION COMMITTEE, CONSISTING OF THE CHAIRMAN OF THE BOARD OF DIRECTORS AND FOUR ADDITIONAL BOARD MEMBERS REVIEWS THIS ANALYSIS AND MAKES A RECOMMENDATION TO THE BOARD OF DIRECTORS REGARDING THE CHIEF EXECUTIVE OFFICER'S COMPENSATION. THE BOARD OF DIRECTORS MAKES THE FINAL DECISIONS REGARDING COMPENSATION OF THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION. THIS ANALYSIS IS PERFORMED ANNUALLY IN DECEMBER. SALARY ANALYSES FOR ALL POSITIONS ON THE COMPANY'S EXECUTIVE MANAGEMENT TEAM (EXCEPT FOR THE CHIEF EXECUTIVE OFFICER POSITION, FOR WHICH THE PROCESS OF DETERMINING COMPENSATION IS PREVIOUSLY DESCRIBED HEREIN), AND CERTAIN OTHER MANAGERIAL POSITIONS ARE PREPARED BY AN UNRELATED THIRD-PARTY COMPENSATION CONSULTANT. RESULTS OF THESE ANALYSES ARE PRESENTED TO THE ORGANIZATION'S HUMAN RESOURCES DEPARTMENT, WHO THEN MAKES SALARY RECOMMENDATIONS TO THE CHIEF EXECUTIVE OFFICER FOR FINAL APPROVAL. THE CHIEF EXECUTIVE OFFICER MAKES THE FINAL DECISIONS REGARDING COMPENSATION OF THE PERSON FILLING THESE POSITIONS. THE CHIEF EXECUTIVE OFFICER DOES NOT PARTICIPATE NOR HAVE DECISION MAKING AUTHORITY REGARDING THE COMPENSATION ARRANGEMENT BETWEEN THE ORGANIZATION AND J.A.G. CONSULTING, LLC (SINGLE-MEMBER LLC, WHERE JOSEPH A. GARCIA IS THE SOLE MANAGER), DUE TO THE FAMILY RELATIONSHIP THAT EXISTS BETWEEN THE CHIEF EXECUTIVE OFFICER (NORMA DIAZ) AND JOSEPH GARCIA, AS PREVIOUSLY DESCRIBED IN SCHEDULE O. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S CONSOLIDATED AUDITED 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 HEALTH CARE EXPENSES: PROGRAM SERVICE EXPENSES 66,726,767. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 66,726,767. PHARMACY EXPENSES: PROGRAM SERVICE EXPENSES 26,308,042. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 26,308,042. FORM 990, PART XII, LINE 2C THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. CHG FOUNDATION 2420 FENTON STREET SUITE 100 CHULA VISTA CA 91914 330586911 HEALTH CARE SERVICES CA 501(C)(3) LINE 10 COMMUNITY HEALTH GROUP 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 CHG FOUNDATION O 24494820 BOOK VALUE CHG FOUNDATION Q 921469651 BOOK VALUE PART V, SECTION 2, LINE 1 COMMUNITY HEALTH GROUP SHARES OFFICE SPACE WITH CHG FOUNDATION. CHG FOUNDATION OWNS THE UNDERLYING REAL PROPERTY. CHG FOUNDATION DOES NOT CHARGE ANY AMOUNTS TO, NOR DOES IT COLLECT ANY REIMBURSEMENT FROM COMMUNITY HEALTH GROUP FOR COMMUNITY HEALTH GROUP'S USE OF OFFICE SPACE OWNED BY CHG FOUNDATION. PART V, SECTION 2, LINES 2 AND 3 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, ACCOUNTING SERVICES, AND OTHER SERVICES AS DEFINED. 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 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 OF THE AFOREMENTIONED ADMINISTRATIVE SERVICES AGREEMENT.