2024-11-15T11:43:56-06:00 2023-12-31 910189318 MOSS ADAMS LLP 21700 OXNARD ST STE 300 WOODLAND HILLS CA 91367 990 2023-01-01 330586911 CHG FOUNDATION CHGF 6194220422 2420 FENTON STREET 100 CHULA VISTA CA 91914 SCOTT CARROLL CHIEF FINANCIAL OFFICER 6194220422 2024-11-15 1 0 LAUREN A HAVERLOCK P00545829 8185771900 2024-11-14 2023 2024-10-15 13:58:12Z COMMUNITY HEALTH GROUP PARTNERSHIP PLAN NORMA DIAZ 2420 FENTON STREET 100 CHULA VISTA CA 91914 1530362521 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. 8 8 521 0 0 0 0 0 1226812699 1500555965 7004224 29313041 13882146 493515 1247699069 1530362521 219478 592022 0 0 24980981 29344361 0 0 0 1017711261 1221691374 1042911720 1251627757 204787349 278734764 779485719 1446221312 216115576 603890653 563370143 842330659 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 1193240997 592022 1500555965 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. 1193240997 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 2388 0 1 521 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 8 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 OF DIRECTORS 3.00 1.00 X X 0 45035 0 CARLOS CESENA VICE CHAIRMAN OF THE BOARD OF DIRECTORS 3.00 1.00 X X 0 33850 0 CARLOTA SALAS SECRETARY OF THE BOARD OF DIRECTORS 3.00 1.00 X X 0 29600 0 JONATHAN BALL BOARD MEMBER 3.00 1.00 X 0 29550 0 TITO CALSADA BOARD MEMBER 3.00 1.00 X 0 30950 0 DOMENIC D'ALESSIO BOARD MEMBER 3.00 1.00 X 0 32075 0 JOSE LUIS VALDIVIA BOARD MEMBER 3.00 1.00 X 0 34350 0 RENEE L RAMOS BOARD MEMBER 3.00 1.00 X 0 27850 0 NORMA DIAZ CHIEF EXECUTIVE OFFICER 38.00 2.00 X 0 985802 49254 SCOTT CARROLL CHIEF FINANCIAL OFFICER 37.00 3.00 X 0 428410 31757 JOSEPH GARCIA CHIEF OPERATING OFFICER 38.00 2.00 X 0 828700 0 PATRICK TELLEZ CHIEF MEDICAL OFFICER 20.00 20.00 X 0 396835 1085 ANN WARREN ASSOCIATE CHIEF EXECUTIVE OFFICER 16.00 24.00 X 0 456476 38701 ALLAN SOMBILLO CHIEF INFORMATION OFFICER 20.00 20.00 X 0 339711 22110 ALAN CONRAD CHIEF MEDICAL OFFICER 20.00 20.00 X 0 355802 40592 ALEJANDRO HINOJOSA-VALENCIA IHA PHYSICIAN 20.00 20.00 X 0 496239 30483 YOUSAF FAROOK SENIOR DIRECTOR OF HEALTH CARE SERVICES 20.00 20.00 X 0 246247 35988 FRANCISCA CHAVEZ SENIOR DIRECTOR OF OPERATIONS 38.00 2.00 X 0 242924 18993 NOREEN KOIZUMI DIRECTOR OF CORPORATE QUALITY 20.00 20.00 X 0 242567 49836 HEIDI ARNDT SENIOR COMPLIANCE OFFICER 16.00 24.00 X 0 286074 34135 0 5569047 352934 0 0 1 0 UCSD MEDICAL CENTER 9300 CAMPUS POINT DR LA JOLLA CA 92037 PHARMACY SERVICES 148094087 GREEN HOSPITAL OF SCRIPPS CLINIC PO BOX 2469 LA JOLLA CA 92038 MEDICAL/HEALTHCARE SERVICES 95362326 GROSSMONT HOSPITAL CORPORATION FILE 55484 LOS ANGELES CA 90074 MEDICAL/HEALTHCARE SERVICES 85754291 PALOMAR HEALTH PO BOX 748698 LOS ANGELES CA 90074 MEDICAL/HEALTHCARE SERVICES 85421185 RADY CHILDREN S HOSPITAL - SAN DIEGO PO BOX 843951 LOS ANGELES CA 90084 MEDICAL/HEALTHCARE SERVICES 71815827 725 MEDI-CAL PREMIUMS 524114 1500555965 1500555965 1500555965 29313041 29313041 DIRECTED PAYMENT ADMIN FEE 524114 493515 493515 493515 1530362521 1500555965 0 29806556 X 565022 565022 27000 27000 4043737 1239915 2803822 18539946 5684830 12855116 953710 292432 661278 4131869 1044461 3087408 1675099 513629 1161470 15262756 15262756 154071 154071 408042 408042 1180812080 1177053639 3758441 188242 188242 4476050 4476050 4646373 4646373 1307751 1307751 992383 992383 130888 130888 1903522 1903522 1139790 1139790 REINSURANCE 6820069 6820069 EMPLOYEE TRAINING AND P 1031539 1031539 TAXES, LICENSES, & FEES 1013433 1013433 DUES & SUBSCRIPTIONS 413806 413806 990579 990579 1251627757 1193240997 58386760 0 2274151 9568133 598263833 914894641 158707433 492988242 519394 7649660 20156933 8192800 11425017 11964133 8295891 9156503 779485719 1446221312 133370863 172375475 82744713 431515178 216115576 603890653 X 563370143 842330659 563370143 842330659 779485719 1446221312 X 278734764 71756 153996 X 0 1 X 1 0 X 5000 5000 930690690 974217788 1195859294 1226812699 1500555965 5828136436 930690690 974222788 1195859294 1226812699 1500555965 5828141436 0 0 0 5828141436 11744375 3199838 1255304 7004224 29313041 52516782 11744375 3199838 1255304 7004224 29313041 52516782 1030401 856173 3022623 13882146 493515 19284858 943465466 978278799 1200137221 1247699069 1530362521 5899943076 0.98780 0.99080 0.00890 0.00550 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2019 AMOUNT: $ 1,030,401. 2020 AMOUNT: $ 856,173. 2021 AMOUNT: $ 3,022,623. 2022 AMOUNT: $ 13,882,146. 2023 AMOUNT: $ 493,515. 2165153 91798 2256951 2173843 7800 16490 2165153 2176530 100081 4584 67791 39561 2173843 2119104 206540 4986 154100 2176530 1986730 290990 12012 131891 38736 2119104 1.00000 0.00000 0.00000 0 0 3500000 3500000 15198867 7998319 7200548 130907 130907 0 1327159 63574 1263585 11964133 ACCRUED MEDICAL LOSS RATIO (MLR) RISK CORRIDOR LIABILITIES 18942678 HOSPITAL DIRECTED PAYMENTS PAYABLE 9077923 MANAGED CARE ORGANIZATION TAX PAYABLE 375251305 ACCRUED PROVIDER INCENTIVES 5158191 RATE ADJUSTMENTS 23085081 431515178 X 1530362521 0 1530362521 0 1530362521 1251473761 0 1251473761 153996 153996 1251627757 PART X, LINE 2: THE ORGANIZATION IS A NOT-FOR-PROFIT PUBLIC BENEFIT CORPORATION, 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 AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE CODE. THE ORGANIZATION IS 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 THE ORGANIZATION 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 THE ORGANIZATION'S CONTINUED QUALIFICATION AS A TAX-EXEMPT ORGANIZATION 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, 2023 AND 2022. THE ORGANIZATION FILES INFORMATION RETURNS IN THE U.S. FEDERAL JURISDICTION AND THE STATE OF CALIFORNIA. PART XII, LINE 4B - OTHER ADJUSTMENTS: GRANTS RECORDED ON CHG BOOKS BUT REPORTED ON CHG FOUNDATION FORM 990 153,996. 1 THE CAMPANILE FOUNDATION 5500 CAMPANILE DRIVE SAN DIEGO CA 921821968 330868418 501(C)(3) 105000 0 DONATION TO SDSU CAMPANILE SAN YSIDRO WOMEN'S CLUB 1320 SEACOAST DRIVE IMPERIAL BEACH CA 91932 330771267 501(C)(3) 100000 0 SYWC SCHOLARSHIP ENDOWMENT CAMPAIGN 2023 MANA DE SAN DIEGO 2515 CAMINO DEL RIO SOUTH 228 SAN DIEGO CA 92108 330821060 501(C)(3) 85500 0 2023 ENDOWMENT SCHOLARSHIP FUND, NOCHE TROPICANA 10/21/23, &LEGACY LUNCHEON/WOMEN'S HISTORY MONTH -MAR 17 2023 SOUTHWESTERN COLLEGE FOUNDATION 900 OTAY LAKES RD CHULA VISTA CA 91910 953794927 501(C)(3) 50000 0 CHG ENDOWED SCHOLARSHIP FUND -INV 5470 ASSOCIATION FOR COMMUNITY AFFILIATED PLANS 1155 15TH STREET NW WASHINGTON DC 20005 050509791 501(C)(3) 10000 0 ACAP SDOH INOVATION CENTER FOUNDER'S CIRCLE 2023 INVOICE LA MAESTRA COMMUNITY HEALTH CENTER 4060 FAIRMONT AVENUE SAN DIEGO CA 92105 330473171 501(C)(3) 18000 0 ANNUAL FUNDRAISER "BLACK & WHITE CASINO NIGHT" -MAY 12 2023 & 2023 TOY & GIFT DRIVE & 20TH ANNUAL GOLF TOURNAMENT FUNDRAISER 9/22/23 FAMILY HEALTH CENTERS OF SD 823 GATEWAY CENTER WAY SAN DIEGO CA 92102 952833205 501(C)(3) 12500 0 2023 SPIRIT OF THE BARRIO -05/19, 08/25,10/27 & VIVE TU VIDA! GET UP! GET MOVING! -10/07/23 CHAMPIONS FOR HEALTH 4699 MURPHY CANYON ROAD SAN DIEGO CA 92123 952568714 501(C)(3) 10000 0 TOGETHER WE RISE" GALA W/ SDCMS -MAY 12 2023 CHULA VISTA POLICE FOUNDATION 315 FOURTH AVENUE CHULA VISTA CA 91910 300281686 501(C)(3) 10000 0 AWARDS & RECOGNITION 5/4/23 & EVENING W/ HEROES 9/23/23 EASTLAKE YOUTH FOOTBALL & CHEER PO BOX 212846 CHULA VISTA CA 91921 330953686 501(C)(3) 5500 0 2023 EASTLAKE PANTHERS 13UQ GIRL SCOUTS SAN DIEGO 1231 UPAS ST SAN DIEGO CA 92103 951644585 501(C)(3) 10000 0 2023 SD GIRL SCOUTS COOL WOMEN -MARCH 24 2023 KIM CENTER FOR SOCIAL BALANCE 5173 WARING RD SAN DIEGO CA 92120 814518651 501(C)(3) 7500 0 LEAPS INICIATIVE 2023 LEGAL AID SOCIETY OF SAN DIEGO 110 S EUCLID AVENUE SAN DIEGO CA 92114 951869806 501(C)(3) 6500 0 RETIREMENT CELEBRATION GALA FOR GREGORY E. KNOLL NAMI SAN DIEGO 5095 MURPHY CANYON ROAD SAN DIEGO CA 92123 330122462 501(C)(3) 7750 0 CASINO ROYALE FUNDRAISING GALA -09/09/23 NEIGHBORHOOD HEALTHCARE 425 N DATE STREET ESCONDIDO CA 920253413 952796316 501(C)(3) 10000 0 CASINO ROYALE FUNDRAISING GALA -09/09/23 REGIONAL TASK FORCE ON THE HOMELESS INC 4699 MURPHY CANYON RD SAN DIEGO CA 92123 113723093 501(C)(3) 5221 0 GOLD SPONSOR NAMIWALKS SD & IMPERIAL COUNTIES -APR 29 2023, SILVER SPONS 20TH ANNUAL NAMI SD & IMPER. COUNTIES -10/26/23 SAN YSIDRO HEALTH 1275 30TH STREET SAN DIEGO CA 92154 952801772 501(C)(3) 8500 0 RURAL HEALTH CELEBRATION LUNCHEON & BENEFIT -APR 18 2023 TRUECARE 150 VALPREDA ROAD SAN MARCOS CA 920692973 952847102 501(C)(3) 10000 0 2023 HAVANA NIGHTS GALA -MARCH 11 2023 18 0 SCHOLARSHIPS 27 27000 PART I, LINE 2: CHG FOUNDATION AWARDS GRANTS AND SCHOLARSHIPS FOR HEALTH AND EDUCATIONAL RELATED PURPOSES TO ORGANIZATIONS AND 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 855733 0 75874 0 54195 0 8400 0 40854 0 1035056 0 0 JOSEPH GARCIA CHIEF OPERATING OFFICER 0 828700 0 0 0 0 0 0 0 0 0 828700 0 0 ALEJANDRO HINOJOSA-VALENCIA IHA PHYSICIAN 0 486548 0 3129 0 6562 0 5252 0 25231 0 526722 0 0 ANN WARREN ASSOCIATE CHIEF EXECUTIVE OFFICER 0 383408 0 29139 0 43929 0 8400 0 30301 0 495177 0 0 SCOTT CARROLL CHIEF FINANCIAL OFFICER 0 349765 0 21828 0 56817 0 8400 0 23357 0 460167 0 0 PATRICK TELLEZ CHIEF MEDICAL OFFICER 0 322801 0 20002 0 54032 0 0 0 1085 0 397920 0 0 ALAN CONRAD CHIEF MEDICAL OFFICER 0 354538 0 1264 0 0 0 0 0 40592 0 396394 0 0 ALLAN SOMBILLO CHIEF INFORMATION OFFICER 0 314321 0 21100 0 4290 0 7716 0 14394 0 361821 0 0 HEIDI ARNDT SENIOR COMPLIANCE OFFICER 0 272698 0 12686 0 690 0 7605 0 26530 0 320209 0 0 NOREEN KOIZUMI DIRECTOR OF CORPORATE QUALITY 0 207584 0 25192 0 9791 0 6006 0 43830 0 292403 0 0 YOUSAF FAROOK SENIOR DIRECTOR OF HEALTH CARE SERVI 0 223205 0 22592 0 450 0 5480 0 30508 0 282235 0 0 FRANCISCA CHAVEZ SENIOR DIRECTOR OF OPERATIONS 0 219452 0 21492 0 1980 0 0 0 18993 0 261917 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 828700 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 2023 IN RELATION TO THESE DUTIES WAS $828,700. 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 -1,145,200. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES -1,145,200. CONSULTING EXPENSES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 3,758,441. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,758,441. HEALTH CARE EXPENSES: PROGRAM SERVICE EXPENSES 1,178,198,839. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,178,198,839. 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. FORM 990, PART XI, LINE 9: GRANTS RECORDED ON CHG BOOKS BUT REPORTED ON CHG FOUNDATION FORM 990 153,996. PART V, LINE 1A & 2A: COMMUNITY HEALTH GROUP AND CHG FOUNDATION SHARE JOINT COSTS FOR EMPLOYEES AND INDEPENDENT CONTRACTORS. AS SUCH, THE NUMBER OF EMPLOYEES AND INDEPENDENT CONTRACTORS REPORTED IS THE SAME FOR BOTH ORGANIZATIONS. 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 29344361 BOOK VALUE COMMUNITY HEALTH GROUP P 1251473761 BOOK VALUE COMMUNITY HEALTH GROUP S 1164210 BOOK VALUE COMMUNITY HEALTH GROUP M 15262756 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 $1,164,210 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 AVAILABLE 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.