2018-11-15T16:44:46-06:00 2017-12-31 910189318 MOSS ADAMS LLP 10960 WILSHIRE BOULEVARD SUITE 1100 LOS ANGELES CA 90024 990 2017-01-01 330586911 CHG FOUNDATION CHGF 6194220422 2420 FENTON STREET NO 100 CHULA VISTA CA 91914 SCOTT CARROLL CFO 6194220422 2018-11-15 1 LAUREN HAVERLOCK P00545829 3104770450 2018-11-15 172.90.17.200 2018-11-15 11:40:53 PS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 41F3D51277C721D7E64869098416E4BAA04E310D 2017 2019-02-21 02:37:17Z COMMUNITY HEALTH GROUP PARTNERSHIP PLAN NORMA DIAZ 2420 FENTON STREET NO 100 CHULA VISTA CA 91914 1067300518 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 9 367 5 0 0 0 0 1098483346 1065895336 0 206481 197732 1007994 1098681078 1067109811 0 0 0 0 7172914 24492820 0 0 0 885083796 897634234 892256710 922127054 206424368 144982757 736586696 749059796 351345852 218836195 385240844 530223601 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 887678014 1066589510 TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES TO MEMBERS UNDER THE MEDI-CAL PROGRAM IN SAN DIEGO COUNTY UNDER CONTRACT WITH THE STATE OF CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES. 887678014 1 0 0 0 0 0 0 0 0 0 1 0 0 1 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 0 1 0 1 2137 0 1 367 1 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 CHAIRMAN OF THE BOARD 2.00 2.00 X X 0 32550 0 CARLOS CESENA VICE CHAIRMAN OF THE BOARD 2.00 2.00 X X 0 22599 0 CARLOTA SALAS SECRETARY OF THE BOARD 2.00 2.00 X X 0 21502 0 JONATHAN BALL BOARD MEMBER 2.00 2.00 X 0 20075 0 TITO CALSADA BOARD MEMBER 2.00 2.00 X 0 19850 0 DOMENIC D'ALESSIO BOARD MEMBER 2.00 2.00 X 0 17823 0 ANITA HOLT BOARD MEMBER 2.00 2.00 X 0 15904 0 GRACE KOJIMA BOARD MEMBER 2.00 2.00 X 0 19887 0 JOSE LUIS VALDIVIA BOARD MEMBER 2.00 2.00 X 0 20877 0 NORMA DIAZ CHIEF EXECUTIVE OFFICER 20.00 20.00 X 0 671451 51489 SCOTT CARROLL CHIEF FINANCIAL OFFICER 20.00 20.00 X 0 312265 15612 JOSEPH GARCIA CHIEF OPERATING OFFICER 20.00 20.00 X 0 656055 0 ANN WARREN ASSOCIATE CHIEF EXECUTIVE OFFICER 20.00 20.00 X 0 272827 35896 EDWARD HUTT CHIEF MED OFFICER 20.00 20.00 X 0 503077 32372 ALLAN SOMBILLO CHIEF INFO OFFICER 20.00 20.00 X 0 247934 19205 IGNACIO RAMIREZ-OCHOA IHA PHYSICIAN 20.00 20.00 X 0 302369 23393 ANDREW ROBERTSON MEDICAL DIRECTOR 20.00 20.00 X 0 261662 1110 ANDREW GREGOR CHIEF CORPORATE COUNCIL 20.00 20.00 X 0 196387 23530 MARCO CASTILLO MANAGER - QNXT CONFIGURATION 20.00 20.00 X 0 181340 0 NOREEN KOIZUMI DIRECTOR OF CORPORATE QUALITY 20.00 20.00 X 0 175826 45711 HEIDI ARNDT MEDICARE COMPLIANCE/FORMER CIO 20.00 20.00 X 0 178845 19760 0 4151105 268078 0 1 1 0 MEDIMPACT HEALTHCARE SYSTEMS INC 10680 TREENA STREET SAN DIEGO CA 92131 PHARMACY SERVICES 173511544 PALOMAR HEALTH 555 EAST VALLEY PARKWAY ESCONDIDO CA 92025 MEDICAL SERVICES 87875761 SCRIPPS HEALTH 4077 FIFTH AVENUE SAN DIEGO CA 92103 MEDICAL SERVICES 78734965 GROSSMONT HOSPITAL CORPORATION 5555 GROSSMONT CENTER DRIVE LA MESA CA 91942 MEDICAL SERVICES 66006791 RADY CHILDREN'S HOSPITAL - SAN DIEGO 3020 CHILDRENS WAY SAN DIEGO CA 92123 MEDICAL SERVICES 64800469 481 MEDI-CAL PREMIUMS 524114 1065895336 1065895336 1065895336 206481 206481 504527 190707 313820 313820 313820 IGT ADMINISTRATION FEES 524114 694174 694174 694174 1067109811 1066589510 0 520301 X 1888280 513271 1375009 17226488 4950591 12275897 1515564 344238 1171326 2374802 639300 1735502 1487686 418662 1069024 373972 373972 417098 417098 879849953 879849953 228403 228403 3840030 3840030 2256778 2256778 611765 611765 137064 137064 335857 335857 2304023 2304023 724426 724426 CONSULTING EXPENSES 2707521 24415 2683106 TEMP STAFFING SERVICES 1212809 1212809 TAXES, LICENSES, & FEES 973810 973810 REINSURANCE EXPENSE 937584 937584 723141 723141 922127054 887678014 34449040 0 659780757 506144816 70206481 21857430 106340316 18320577 3206576 14328738 15114001 40619771 51254182 736586696 749059796 351318423 92689539 27429 28252 0 126118404 351345852 218836195 X 385240844 530223601 385240844 530223601 736586696 749059796 144982757 0 X X 0 1 X 1 0 X 5860 8036 0 0 0 13896 321502780 622207475 947850148 1098483346 1065895336 4055939085 321508640 622215511 947850148 1098483346 1065895336 4055952981 0 0 0 4055952981 302031 311088 320424 323307 711008 1967858 302031 311088 320424 323307 711008 1967858 694174 694174 321810671 622526599 948170572 1098806653 1067300518 4058615013 0.99930 0.99960 0.00050 0.00040 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2017 AMOUNT: $ 694,174. 3500000 3500000 14626095 3031967 11594128 130908 118452 12456 63574 56157 7417 15114001 DUE FROM COMMUNITY HEALTH GROUP 40401953 REINSURANCE RECEIVABLES 7364436 PHARMACY REBATE RECEIVABLES 3487793 51254182 ACCRUED MEDICAL LOSS RATIO (MLR) REBATES 112908231 PAYABLE TO THE STATE OF CALIFORNIA 13210173 126118404 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. 0 0 0 0 0 0 0 0 0 NORMA DIAZ CHIEF EXECUTIVE OFFICER 0 607321 0 3490 0 60640 0 11925 0 39564 0 722940 0 0 SCOTT CARROLL CHIEF FINANCIAL OFFICER 0 303548 0 1027 0 7690 0 11925 0 3687 0 327877 0 0 JOSEPH GARCIA CHIEF OPERATING OFFICER 0 656055 0 0 0 0 0 0 0 0 0 656055 0 0 ANN WARREN ASSOCIATE CHIEF EXECUTIVE OFFICER 0 257867 0 2792 0 12168 0 11205 0 24691 0 308723 0 0 EDWARD HUTT CHIEF MED OFFICER 0 471452 0 1024 0 30601 0 11925 0 20447 0 535449 0 0 ALLAN SOMBILLO CHIEF INFO OFFICER 0 247084 0 0 0 850 0 7958 0 11247 0 267139 0 0 IGNACIO RAMIREZ-OCHOA IHA PHYSICIAN 0 64783 0 1040 0 236546 0 9364 0 14029 0 325762 0 0 ANDREW ROBERTSON MEDICAL DIRECTOR 0 242154 0 0 0 19508 0 0 0 1110 0 262772 0 0 ANDREW GREGOR CHIEF CORPORATE COUNCIL 0 195368 0 349 0 670 0 8653 0 14877 0 219917 0 0 MARCO CASTILLO MANAGER - QNXT CONFIGURATION 0 180250 0 0 0 1090 0 0 0 0 0 181340 0 0 NOREEN KOIZUMI DIRECTOR OF CORPORATE QUALITY 0 172042 0 2094 0 1690 0 8700 0 37011 0 221537 0 0 HEIDI ARNDT MEDICARE COMPLIANCE/FORMER CIO 0 78788 0 0 0 100057 0 11925 0 7835 0 198605 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. 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 2017 IN RELATION TO THESE DUTIES WAS $656,055. 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. FORM 990, PART VI, SECTION B, LINE 15 CHG FOUNDATION ANSWERED EACH OF THESE QUESTTIONS AS "NO" BECAUSE ALL COMPENSATION PAID TO THOSE PERSONS REPORTED IN PART VII OR SCHEDULE J IS PAID BY COMMUNITY HEALTH GROUP (CHG'S 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 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 703,256,831. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 703,256,831. PHARMACY EXPENSES: PROGRAM SERVICE EXPENSES 176,593,122. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 176,593,122. FORM 990, PART IX, LINES 5 THROUGH 10 CHG FOUNDATION HAS NO EMPLOYEES. 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, 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), A RELATED ORGANIZATION 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. 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. 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 0 1 1 1 0 0 0 COMMUNITY HEALTH GROUP O 24492820 BOOK VALUE COMMUNITY HEALTH GROUP P 921469651 BOOK VALUE PART V, SECTION 2, LINE 1 CHG FOUNDATION SHARES OFFICE SPACE WITH COMMUNITY HEALTH GROUP. 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 PERFOMRING 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 OF THE AFOREMENTIONED ADMINISTRATIVE SERVICES AGREEMENTS.