Iefile GRAPHIC print - DO NOT PROCESS IAs Filed Data - Form990 Department of the Treasury Internal Revenue Serwce foundations) Do not enter somal security numbers on this form as it may Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private Information about Form 990 and Its Instructions is at IRS g0vgform990 OMB NO 1545-0047 2015 Open to Public be made public Inspection A For the 2015 calendar year, or tax year beginning 01-01-2015 and ending 12-31-2015 Name of organization Check If applicable Community Health Group Address cha nge Employer identification number 95-3766170 Name change Initial return Final Domg business as Community Health Group Telephone number Number and street (or 0 box if mail is not delivered to street address) Room/swte return/terminated 2420 Fenton Street No 100 I?Amended retu rn (619)422?0422 City or town, state or provmce, country, and ZIP or foreign postal code I?Application pending Chula Vista, CA 91914 Gross receipts 156,054,993 Name and address of prinCIpal officer ScottCarroll 2420 Fenton Street No 100 ChulaVista,CA 91914 501(c)(3) I Tax-exempt status I7 501(c)(4) 4(inseitno) 4947(a)(1) or 527 Website:P com Is this a group return for subordinates? Yes I7 No H(b) Are all subordinates included? I?Yes attach a list (see instructions) Group exemption number Form of organization '7 Corporation Trust Assouation Other Year of formation 1982 State of legal domICIle CA Summary lBriefly describe the organization?s missmn or most Significant actIVIties and offering exceptional serVIce to diverse populations Community Health Group is dedicated to maintaining and improvmg the health ofour members by prowding access to quality care Activmes Bi Govemance 2 Check this box ifthe organization discontinued its operations or disposed ofmore than 25% ofits net assets 3 Number ofvoting members ofthe governing body (Part VI, line 1a) 3 9 4 Number ofindependent voting members ofthe governing body (Part VI, line 1b) 4 5 Total number ofindIVIduals employed in calendar year 2015 (Part V, line 2a) 5 304 6 Total number ofvolunteers (estimate if necessary) 6 7a Total unrelated busmess revenue from Part column (C), line 12 7a 0 Net unrelated busmess taxable income from Form line 34 7b 0 Prior Year Current Year Contributions and grants (Part line 1h) 0 0 9 Program serVIce revenue 2g) 61,414,328 132,380,982 :5 10 3,4,and 7d) 4,253 549,002 D: 11 5,6d,8c,9c,10c,and11e) 18,658,004 19,047,613 12 'll'gt)al revenue?add lines 8 through 11 (must equal Part column (A), line 80,076,585 151,977,597 13 Grants and Similar amounts paid (Part IX, column (A), lines 1?3) 0 0 14 Benefits paid to or for members (Part IX, column (A), line 4) 0 0 X3 15 galfgifs, other compensation, employee benefits (Part IX, column (A), lines 10,368,027 1 1,862,822 in 5 16a Professmnalfundraismg fees lie) 0 0 5 Total fundraismg expenses (Part IX, column (D), line 25) P0 17 Otherexpenses (Part 11a?11d,11f?24e) 68,682,694 108,453,370 18 Totalexpenses Addlines 79,050,721 120,316,192 19 Revenue less expenses Subtract line 18 from line 12 1,025,864 31,661,405 3; Beginning of Current Year End of Year 5 of? 20 Totalassets (PartX,line 16) 52,876,582 96,979,288 :2 21 Totalliabilities (Part X, ine 26) 26,137,741 41,277,961 22 Net assets orfund balances Subtract line 21 from line 20 26,738,841 55,701,327 Signature Block Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete Declaration of preparer (otherthan officer) is based on all information of which preparer has any knowledge 2016-11-15 . Si nature of officer Date Sign 9 Here Scott Carroll CFO Type or print name and title Print/Type preparer's name Preparer's Signature Date PTIN Renie Burbank Renie Burbank Check l? "c P00159653 se -emp Pald If i Firm's name Moss Adams LLP Firm's EIN 91?0189318 Preparer Firm's address 101 Second Street 900 Phone no (415) 956-1500 Use Only San FranCIsco, CA 94105 May the IRS discuss this return With the preparer shown above? (see instructions) . For Reduction Act Notice, see the separate instructions. Cat No 11282Y Form990(2015) Form 990(2015) Page2 Statement of Program Service Accomplishments 1 Check ifSchedule 0 contains a response or note to any line In this . . . . . . . . . . . . . Briefly describe the organization's mi55i0n Community Health Group is dedicated to maintaining and improvmg the health ofour members by prowding access to quality care and offering exceptional serVIce to diverse populations 2 Did the organization undertake any Significant program serVIces during the year which were not listed on thepriorForm990 or990?EZI?Yes 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 If"Yes," describe these changes on Schedule 0 4 Describe the organization?s program serVIce accomplishments for each ofits three largest program serVIces, as measured by expenses Section 501(c)(3) and 501(c)(4) organizations are reqUIred to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program serVIce reported 4a (Code (Expenses 97,185,544 including grants of 0 (Revenue 132,380,982 TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES TO MEMBERS UNDER A MEDICARE ADVANTAGE SPECIAL NEEDS PLAN AND A DUAL DEMONSTRATION PLAN (MMP) OPEN TO PEOPLE ELIGIBLE FOR MEDI-CAL AND MEDICARE UNDER CONTRACT WITH THE CENTERS FOR MEDICARE AND MEDICAID SERVICES 4b (Code (Expenses including grants of (Revenue 4c (Code (Expenses including grants of (Revenue 4d Other program serVIces (Describe in Schedule 0 (Expenses including grants of$ (Revenue 4e Total program service expenses? 97,185,544 Form 990 (2015) Fonn990(2015) Checklist of Required Schedules 20a Page 3 Is the organization described In section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," completeScheduleA Is the organization reqUIred to complete Schedule B, Schedule of Contributors (see instructions)? Did the organization engage in direct or indirect political campaign actIVIties on behalfofor in opposition to candidates for public office? If "Yes," complete Schedule C, Part I 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 Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, orSImilar amounts as defined in Revenue Procedure 98?19? If "Yes, complete Schedule C, Part Did the organization maintain any donor adVIsed funds or any Similar funds or accounts for which donors have the right to prowde adVIce on the distribution or investment ofamounts in such funds or accounts? If "Yes," complete Schedule D, Part I 911 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," complete Schedule D, Part II Did the organization maintain collections of works ofart, historical treasures, or other Similar assets? If "Yes," complete Schedule D, Part ?3 Did the organization report an amount in Part X, line 21 for escrow or custodial account liability, serve as a custodian for amounts not listed in Part X, or prowde credit counseling, debt management, credit repair, or debt negotiation serVIces?If ?Yes," complete Schedule D, Part IV 93' Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quaSI?endowments? If "Yes," complete Schedule D, Part SJ Ifthe organization's answerto any ofthe followmg questions is "Yes,? then complete Schedule D, Parts VI, VII, IX, orX as applicable Did the organization report an amount for land, and eqUIpment in Part X, line 10? If "Yes," complete Schedule D, Part VI 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," complete Schedule D, Part VII 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 2:1 Did the organization report an amount for other assets in Part X, line 15 that is 5% or more ofits total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IX SJ Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, PartX w- 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 p05itions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part 911 Did the organization obtain separate, independent audited finanCIal statements forthe tax year? If "Yes," complete Schedule D, Parts XI and XII 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 and XII is optional ?3 Is the organization a school described in section 170(b)(1)(A If ?Yes," complete Schedule Did the organization maintain an office, employees, or agents outSIde ofthe United States? Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraismg, busmess, investment, and program serVIce actIVIties outSIde the nited States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete ScheduleF, Parts I and IV . Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other a55istance to or for any foreign organization? If ?Yes,?complete Schedule F, Parts II and IV . Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other as5istance to or for foreign indIVIduals? If "Yes,?complete Schedule F, Parts and IV . Did the organization report a total of more than $15,000 of expenses for professmnal fundraismg serVIces on Part IX, column (A), lines 6 and lie? If "Yes," complete Schedule 6, Part I (see instructions) Did the organization report more than $15,000 total of fundraismg event gross income and contributions on Part lines 1c and 8a? If ?Yes," complete Schedule G, Part II Did the organization report more than $15,000 ofgross income from gaming actIVIties on Part line 9a? If "Yes, complete Schedule G, Part Did the organization operate one or more hospital faCIlities? If "Yes," complete Schedulel-l If"Yes" to line 20a, did the organization attach a copy ofits audited finanCIal statements to this return20b Forn1990(2015) Form 990(2015) Page4 Checklist of Required Schedules (contlnued) 21 the organization report more than $5,000 ofgrants or other a55istance to any domestIc organization or 21 No domestic government on Part IX, column (A), ?ne 1 If "Yes,?complete Schedule I, Parts I and II 22 the organization report more than $5,000 ofgrants or other a55istance to or for domestIc indIVIduals on Part 22 IX, column (A), ?ne 27 If "Yes,?complete Schedule I, Parts I and 0 23 the organization answer ?Yes" to Part VII, SectIon A, ?ne 3, 4, or 5 about compensation of the organIzatIon?s current and former of?cers, directors, trustees, key employees, and highest compensated employees? If "Yes," 23 es complete Schedule 24a the organIzation have a tax?exempt bond issue WIth an outstandIng prInCIpal amount of more than $100,000 as ofthe last day ofthe year, that was issued after December 31, 2002? If "Yes,?answer lines 24b through 24d and complete Schedule If "No,?go to lme 25a 24a 0 the organization invest any proceeds oftax-exempt bonds beyond a temporary perIod exception? 24 the organization maintain an escrow account other than a refundIng escrow at any tIme during the year to defease any tax?exempt bonds? 24C the organization act as an "on behalfof" Issuer for bonds outstandIng at any tIme durIng the year? 24d 25a Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. the organIzation engage In an excess bene?t transaction With a disqualified person durIng the year? If ?Yes," 25 complete Schedule L, Part I a 0 Is the organization aware that it engaged In an excess bene?t transaction With a dIsqualI?ed person In a prIor year, and that the transactIon has not been reported on any ofthe organIzation's prior Forms 990 or 25b N0 If "Yes," complete Schedule L, Part I 26 the organIzation report any amount on Part X, line 5, 6, or 22 for recerables from or payables to any current orformer of?cers,dIrectors,trustees,key employees,highestcompensated employees,ordisqualIfied persons? 26 No If "Yes, complete Schedule L, Part II 27 the organIzation prowde a grant or other aSSIstance to an of?cer, director, trustee, key employee, substantial contributor or employee thereof, a grant selectIon commIttee member, orto a 35% controlled entity orfamIly 27 No member ofany ofthese persons? If ?Yes," complete Schedule L, Part . 28 Was the organizatIon a party to a busmess transactIon WIth one ofthe followmg partIes (see Schedule L, Part IV InstructIons for applIcable ?lIng thresholds, conditIons, and exceptIons) a A current or former of?cer, dIrector, trustee, or key employee? If ?Yes," complete Schedule L, Part IV 233 No A family member ofa current orformer of?cer, dIrector, trustee, or key employee? If ?Yes," complete Schedule L, PartIV . 28b No A entIty of a current or former of?cer, dIrector, trustee, or key employee (or a famIly member thereof) was an of?cer, dIrector, trustee, or dIrect or Indirect owner? If "Yes," complete Schedule L, Part IV 28C 0 29 the organIzation recere more than $25,000 in non?cash contrIbutions? If ?Yes,? complete ScheduleM 29 No 30 the organIzation recere contributIons of art, hIstorIcal treasures, or other SimIlar assets, or quali?ed conservatIon contributIons? If ?Yes," complete Schedule 30 0 31 the organIzation quUIdate, termInate, or dIssolve and cease operatIons? If ?Yes,? complete Schedule N, Part I No 31 32 the organIzation sell, exchange, dispose of, or transfer more than 25% ofits net assets? If "Yes," complete Schedule N, Part II 32 0 33 the organIzation own 100% ofan entity dIsregarded as separate from the organIzatIon under Regulations sectIons 301 7701?2 and 301 7701?3? If "Yes," complete Schedule R, 6' 33 0 34 Was the organizatIon related to any tax-exempt or taxable entity? If ?Yes,? complete Schedule R, PaIt II, or IV, 34 Yes and Part V, lme 1 35a the organIzation have a controlled entIty WIthin the meaning ofsection 512(b)(13)? 35a Yes If?Yes'to line 35a, did the organizatIon receive any payment from or engage In any transactIon WIth a controlled 35b entIty WIthin the meaning of section 512(b)(13)7 If ?Yes," complete Schedule R, Part V, lIneZ 36 Section 501(c)(3) organizations. the organIzatIon make any transfers to an exempt non?charItable related organization? If ?Yes," complete Schedule R, Part V, lrne 2 36 37 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 0 38 the organIzation complete Schedule 0 and prowde explanatIons In Schedule 0 for Part VI, lines 1 1b and 197 Note. All Form 990 ?lers are reqUIred to complete Schedule 0 38 es Form 990 (2015) Form 990(2015) Page5 Statements Regarding Other IRS Filings and Tax Compliance Check If Schedule 0 contaIns a response or note to any lIne In thIs Part . . . . . . . . . . . Yes No 1a Enterthe number reported In Box 3 of Form 1096 Enter Ifnot applicable . . 1a 1,966 Enterthe number of Forms W-ZG Included In line 1a Enter If not applicable 1b 0 the organIzation comply WIth backup Withholding rules for reportable payments to vendors and reportable to prIze WinnersEnter the number ofemployees reported on Form Transmittal of Wage and Tax Statements, ?led for the calendar year ending With or WIthIn the year covered 23 304 Ifat least one Is reported on IIne 2a, dId the organization We all reqUIred federal employment tax returns? Yes Note.Ifthe sum of lines 1a and 2a IS greater than 250, you may be reqUIred to e?fIle (see Instructions) 3a the organIzation have unrelated busmess gross Income of $1,000 or more durIng the year? . . . 3a No If?Yes," has It filed a Form for thIs year?If "No?to lme 3b, prowde an exp/anatIon In Schedule 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)? . . 4a N0 If"Yes," enter the name ofthe foreIgn country See Instructions for filing reqUIrements for Form 114, Report of Foreign Bank and FinanCIal Accounts (FBA R) 5a Was the organizatIon a party to a prothIted tax shelter transaction at any tIme during the tax year? . . 5a No any taxable party notify the organIzatIon that It was or Is a party to a prohibited tax shelter transactIon? 5b No If"Yes," to line 5a or 5b, did the organization ?le Form 5c 6a Does the organization have annual gross receipts that are normally greater than $100,000, and did the Ga No organization so ICIt any contributIons that were not tax deductible as charItable contrIbutIons? If"Yes," did the organization Include With every solICItatIon an express statement that such contributIons or 5b 7 Organizations that may receive deductible contributions under section 170(c). a the organIzation recere a payment In excess of$75 made partly as a contrIbutIon and partly for goods and 7a serVIces prowded to the payorIf"Yes," did the organization notIfy the donor ofthe value ofthe goods or serVIces prowdedthe organIzation sell, exchange, or otherWIse dispose of tangible personal property for which It was reqUIred to 7C If"Yes," Indicate the number of Forms 8282 filed durIng the year . . . . I 7d I the organIzation recere any funds, directly or IndIrectly, to pay prequms on a personal benefit contract? 7e No the organIzatIon, durIng the year, pay prequms, directly or IndIrectly, on a personal bene?t contract? . . 7f No 9 Ifthe organIzation recered a contrIbutIon of qualified Intellectual property, dId the organIzation ?le Form 8899 as 7g Ifthe organIzation recered a contrIbutIon of cars, boats, aIrplanes, or other vehIcles, did the organization ?le a 8 Sponsoring organizations maintaining donor advised funds. a donor adVIsed fund maIntaIned by the sponsorIng organizatIon have excess busmess holdIngs at any time 3 9a the sponsoring organIzation make any taxable dIstrIbutIons under section 4966? . . . 9a the sponsoring organIzation make a dIstrIbutIon to a donor, donor adVIsor, or related person? . . . 9b 10 Section 501(c)(7) organizations. Enter InitiatIon fees and capital contrIbutIons Included on Part Me 12 . . . 10a Gross rECEIpts, Included on Form 990, Part line 12, for public use ofclub 10b faCIlities 11 Section 501(c)(12) organizations. Enter Gross Income from members or shareholders . . . . . . . . . 11a Gross Income from other sources (Do not net amounts due or paid to other sources against amounts due or recewed from them11b 12a Section 4947(a)(1) non-exempt charitable trusts.Is the organization fIlIng Form 990 In of Form 1041? 12a If "Yes," enter the amount of tax-exempt Interest received or accrued durIng the year 12b 13 Section 501(c)(29) qualified nonprofit health insurance issuers. a Is the organization Icensed to Issue health plans In more than one state?Note. See the InstructIons for addItIonal Information the organIzation must report on Schedule 0 13a Enter the amount of reserves the organizatIon IS reqUIred to maIntaIn by the states In the organIzatIon Is Icensed to Issue health plans . . . . 13b Enterthe amount of reserves on hand . . . . . . . . . . . . 13c 14a the organIzation recewe any payments for Indoor tannIng serVIces during the tax year"Yes," has It ?led a Form 720 to report these payments?If ?No,"prowde an explanation In Schedule 0 . . 14b Form 990 (2015) Form 990(2015) Pages Governance, Management, and Disclosure For each ?Yes" response to lines 2 through 7b below, and for a "No" response to ?nes 8a, 8b, or 10b below, describe the Circumstances, processes, or changes In Schedule 0. See Instructlons. Check IfSchedule contaIns a response or note to any IIne In thIs PartVI . . . . . . . . . . . . . .I7 Section A. Governing Body and Management Yes No 1a Enter the number ofvotIng members of the governIng body at the end ofthe tax 1a 9 year Ifthere are materIal dIfferences In votIng rIghts among members ofthe governIng body, or Ifthe governIng body delegated broad authorIty to an exec utIve committee or SImIlar commIttee, explaIn In Schedule 0 Enter the number ofvotIng members Included In Ine la, above, who are Independent 1b 7 2 any of?cer, dIrector, trustee, or key employee have a famIly relatIonshIp or a busmess relatIonshIp WIth any other of?cer, dIrector, trustee, or key employeethe organIzatIon delegate control over management dutIes customarlly performed by or underthe dIrect 3 No superVISIon ofoffIcers, dIrectors or trustees, or key employees to a management company or other person? 4 the organIzatIon make any SIgnIfIcant changes to Its governIng documents smce the prIor Form 990 was 4 N0 5 the organIzatIon become aware durIng the year ofa SIgnIfIcant dIverSIon of the organIzatIon's assets? . 5 No 6 the organIzatIon have members or stockholdersthe organIzatIon have members, stockholders, or other persons who had the power to elect or appomt one or more members ofthe governIng bodyAre any governance deCISlonS of the organIzatIon reserved to (or subject to approval by) members, stockholders, 7b No or persons other than the governIng body? 8 the organIzatIon contemporaneously document the meetIngs held or ertten actIons undertaken durIng the year by the followmg 8aYes Each commIttee WIth authorIty to act on behalfofthe governIng bodythere any of?cer, dIrector, trustee, or key employee Isted In Part VII, SectIon A, who cannot be reached at the organIzatIon? address? If' Yes, prowde the names and addresses In Schedule 0 . . . 9 N0 Section B. Policies (Thls Sectlon requests Informatron about polICIes not requrred by the Internal Revenue Code.) Yes No 10a the organIzatIon have local chapters, branchesIf"Yes," dId the organIzatIon have ertten polICIes and procedures governIng the actIVItIes ofsuch chapters, and branches to ensure theIr operatIons are conSIstent WIth the organIzatIon's exempt purposes? 10b 11a Has the organIzatIon prOVIded a complete copy ofthIs Form 990 to all members ofIts governIng body before fIlIng N0 DescrIbe In Schedule 0 the process, Ifany, used by the organIzatIon to reVIew thIs Form 990 12a the organIzatIon have a ertten conflIct ofInterest polIcy? If go to llne 12a Yes Were offIcers, dIrectors, or trustees, and key employees reqUIred to dIsclose annually Interests that could gIve me to conflIcts12b Yes the organIzatIon regularly and conSIstently monItor and enforce compIIance WIth the polIcy? If ln ScheduleOhow this was done . . . . . . . . . . . . . . . . . . . 12C Yes 13 the organIzatIon have a ertten polIcythe organIzatIon have a ertten document retentIon and destructIon polIcythe process for determInIng compensatIon of the followmg persons Include a reVIew and approval by Independent persons, data, and contemporaneous substantIatIon ofthe deIIberatIon and . . . . . . . . . . . 15a Yes . . . . . . . . . . . . . . . . 15b Yes If"Yes" to lIne 15a or 15b, descrIbe the process In Schedule 0 (see InstructIons) 16a the organIzatIon Invest In, contrIbute assets to, or partICIpate In a JOlnt venture or SImIlar arrangement WIth a taxableentItydurIngtheyearIf"Yes," dId the organIzatIon follow a ertten polIcy or procedure reqUIrIng the organIzatIon to evaluate Its partICIpatIon In Jomt venture arrangements under appIIcable federal tax law, and take steps to safeguard the organIzatIon?s exempt status WIth respect to such arrangements16b Section C. Disclosure 17 LIst the States WIth a copy ofthIs Form 990 IS reqUIred to be ?led? CA 18 SectIon 6104 reqUIres an organIzatIon to make Its Form 1023 (or 1024 IfapplIcable), 990, and (501(c) (3)5 only) avaIIable for publIc InspectIon IndIcate how you made these avaIlable Check all that apply Own webSIte I?Another's webSIte I7 Upon request Other (explaIn In Schedule 0) 19 DescrIbe In Schedule 0 whether (and If so, how) the organIzatIon made Its governIng documents, conflIct of Interest polIcy, and fInanCIal statements avaIlable to the publIc durIng the tax year 20 State the name, address, and telephone number ofthe person who possesses the organIzatIon's books and records PScott Carroll 2420 Fenton Street CHULA VISTA, CA 91914 (619) 498?6591 Form 990 (2015) Form 990(2015) Page7 Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors Check ifSchedule 0 contains a response or note to any line In thIs Part VII . . . . . . . Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees 1a Complete this table for all persons requ1red to be listed Report compensation for the calendar year ending With or the organization's tax year a LIst all of the organization's current officers, directors, trustees (whether or organizations), regardless of amount ofcompensation Enter In columns (D), (E), and (F) if no compensation was paid 0 List all ofthe organization?s current key employees, Ifany See instructions for definition of "key employee 0 List the organization's fIve current highest compensated employees (otherthan an officer, director, trustee or key employee) who received reportable compensation (Box 5 of Form and/or Box 7 ofForm of more than $100,000 from the organization and any related organizations 0 List all ofthe organization?s former officers, key employees, or highest compensated employees who received more than $100,000 of reportable compensation from the organization and any related organizations 0 List all ofthe organization?s former directors or trustees that received, in the capac1ty as a former director or trustee ofthe organization, more than 10,000 of reportable compensation from the organization and any related organizations List persons in the followmg order indiVidual trustees or directors, institutional trustees, officers, key employees, highest compensated employees, and former such persons Check this box If neitherthe organization nor any related organization compensated any current officer, director, ortrustee (A) (B) (C) (D) (E) (F) Name and Title Average Pos1tlon (do not check Reportable Reportable Estimated hours per more than one box, compensation compensation amount of week (list unless person is both an from the from related other any hours officer and a organization organizations compensation for related director/trustee) 2/1099- (W- 2/1099? from the organizations 0 5. 3. I 'n MISC) MISC) organization below a; :3 and related dotted line) .p .173. organizations (1) Albert Vitela 2 00 13,795 0 0 Chairman of the Board 2 00 (2) Paul Date 2 00 7,935 0 0 Vice Chairman of the Board 2 00 (3) Carlota Salas 2 00 9,815 0 0 Secretary of the Board 2 00 (4) Carlos Cesena 2 00 9,865 0 0 Board Member 2 00 (5) Jose LUIS Valdivia 2 00 9,645 0 Board Member 2 00 (6) Grace KOJlma 2 00 9,035 0 0 Board Member 2 00 (7) Tito Calsada 2 00 10,285 0 0 Board Member 2 00 (8) Anita Holt 2 00 8,895 0 0 Board Member 2 00 (9) Jonathan Ball 2 00 8,365 0 0 Board Member 2 00 (10) Norma Diaz 20 00 595,397 0 18,723 Chief Executive Officer 20 00 (11) Edward Hutt 20 00 483,833 0 16,980 Assooate Chief Executive Officer 20 00 (12) Scott Carroll 20 00 259,374 0 0 Chief FinanCIal Officer 20 00 (13) Jonathan Tamayo 20 00 98,009 0 13,165 VP Info Systems (Thru 05/2015) 20 00 (14) Ann Warren 20 00 268,958 0 14,912 Chief Gov't 81 Relations 20 00 Form 990 (2015) Form 990 (2015) Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued) Page 8 (A) (B) (C) (D) (E) (F) Name and Title Average P05ition (do not check Reportable Reportable Estimated hours per more than one box, compensation compensation amount of week (list unless person is both an from the from related other any hours officer and a organization organizations compensation for related director/trustee) 2/1099? 2/1099? from the organizations 2 3 g, g, 3.1: 1" MISC) MISC) organlzation below g. :3 ., and related dotted line) (3 '5 organizations (15) Rene Vega 20 00 29,930 0 Chief Medical Officer 20 00 (16) Heidi Arndt 20 00 279,740 6,849 Chief Information Officer 20 00 (17) Adla 20 00 247,491 12,344 Medical Director 20 00 (18) Noreen K0izumi 20 00 169,750 14,231 Director of Healthcare Operations 20 00 (19) Nora Pintado 20 00 164,975 11,665 Director of Health Plan Operations 20 00 (20) Ritchie 20 00 150,079 12,014 Director of Contracting 20 00 (21) Diane Erk 20 00 148,181 16,496 Director of Finance (Thru 8/2015) 20 00 Total from continuation sheets to Part VII, Section A . . . . Total (add lines 2,983,352 0 137,379 2 Total number of IndIVIdualS (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization 14 Yes No 3 Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedu/leor such Ind/Vldual . . . . . . . . . . . . . . No 4 For any indiVidual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If ?Yes," complete Schedu/leor such Yes 5 Did any person listed on line 1a receive or accrue compensation from any unrelated organization or indiVidual for serVIces rendered to the organizationnf "Yes," complete Schedu/leor such person . . . . . . . . No 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 Report compensation for the calendar year ending With or Within the organization's tax year (A) (B) (C) Name and busmess address Description of serwces Compensation Corporate Health Strategies LLC Disease 81 product 8,274,821 development PO Box 225 Bonita, CA 91908 Elm Holdings LLC A55isted Living for Insured 1,169,126 Member 3780 Massachusetts Avenue La Mesa, CA 91941 ATI Staffing Solutions LLC Temporary Staff for Operations 1,155,049 5455 Garden Grove Boulevard Westminster, CA 92683 WEIserMazars LLP General Busmess Serwces 535,283 2151 River Place Drive 205 Sacramento, CA 95833 Managerial/ Ops/Busmess 500,000 JAG Consulting LLC 4364 Bonita Road 322 Bonita, CA 91902 2 Total number ofindependent contractors (including but not limited to those listed above) who received more than $100,000 ofcompensation from the organization 29 Form 990 (2015) Form 990 (2015) Page 9 Statement of Revenue Check ifSchedule 0 contains a response or note to any line in this Part (A) (B) (C) (D) Total revenue Related or Unrelated Revenue exempt busmess excluded from function revenue tax under revenue sections 512-514 1a Federated campaigns . . 1a 9 2! Membership dues . . . . 1b (D Fundraismg events . . . . 1c <12 :35 '5 Related organizations . . . 1d (3 Government grants (contributions) 13 All other contributions, gifts, grants, and 1f 1: OJ Similar amounts not included above .1: :2 Noncash contributions included in lines .9 1a-1f '5 8 Total.Add lines 1a?1f a? Busmess Code 2a Cal Medi Connect Rev 524114 132,380,982 132,380,982 on: 3 51 All other program serVIce revenue 0 I: Total. Add lines 2a?2f 132,380,982 3 Investment income (including diVidends, interest, and other Similar amounts) . 658'243 658?243 Income from investment of tax-exempt bond proceeds 5 Royalties (i)Real (ii)Personal 6a Gross rents Less rental expenses Rental income or(loss) Net rental income or(loss) Securities (ii) Other 7a Gross amount from sales of 3,968,155 assets other than inventory Less cost or other ba5is and 4,077,396 sales expenses Gain or (loss) ?109,241 Net gain or (loss) .p '1091241 409,241 '0 83 Gross income from fundraismg 3 events (not including 5 ofcontributions reported on line 1c) a See PartIV,line 18 a; a .C 5 Less direct expenses . . . Net income or (loss) from fundraismg events . . 9a Gross income from gaming actIVIties See Part IV, line 19 a Less direct expenses . . . Net income or (loss) from gaming actIVIties . 103 Gross sales ofinventory, less returns and allowances a Less cost ofgoods sold . . Net income or (loss) from sales of inventory . . Miscellaneous Revenue Busmess Code 113 Adm,? Fee from 900099 18,980,262 18,980,262 Other oper revenue 900099 67,351 67,351 All other revenue Total.Addlines 11a?11d 19,047,613 12 Total revenue. See Instructions 151,977,597 132,380,982 0 19,596,615 Form 990 (2015) Form 990(2015) 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) Check if Schedule 0 contains a response or note to any line in this Part IX I7 Do not include amounts reported on lines 6b, (A) Progragiemce and Fm?gsmg 7b! 8b! 9b! and 10b 0f Part Total expenses expenses general expenses expenses 1 Grants and other aSSIstance to domestic organizations and domestic governments See Part IV, line 21 2 Grants and other a55istance to domestic lnleIduaIS See Part IV, line 22 3 Grants and other aSSIstance to foreign organizations, foreign governments, and foreign indiViduals See Part IV, lines 15 and 16 Benefits paid to or for members 5 Compensation of current officers, directors, trustees, and key employees 2,173,508 2,173,508 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 7,281,106 514,774 6,766,332 8 Pen5ion plan accruals and contributions (include section 401(k) and 403(b) employer contributions) 385,742 385,742 9 Other employee benefits 862,307 32,854 829,453 10 Payroll taxes 1,150,159 44,202 1,115,957 11 Fees for serVIces (non?employees) a Management Legal 390,814 390,814 Accounting 128,250 128,250 Lobbying Profe55ional fundraismg serVIces See Part IV, line 17 Investment management fees 9 Other (If line 1 lg amount exceeds 10% ofline 25, column (A) amount, list line 1 lg expenses on Schedule 0) 41,324,692 41,324,692 12 Advertismg and promotion 33,796 33,796 13 Office expenses 14 Information technology 2,054,376 2,054,376 15 Royalties 16 Occupancy 3,954,934 3,954,934 17 Travel 201,972 201,972 18 Payments of travel or entertainment expenses for any federal, state, or local public offICIals 19 Conferences, conventions, and meetings 345,177 345,177 20 Interest 21 Payments to affiliates 22 DepreCIation, depletion, and amortization 1,324,060 1,324,060 23 Insurance 301,540 301,540 24 Other expenses Itemize expenses not covered above (List miscellaneous expenses in line 24e If line 24e amount exceeds 10% ofline 25, column (A) amount, list line 24e expenses on Schedule 0 a pharmacy 81 Med 55,269,022 55,269,022 Temporary Labor 2,102,325 2,102,325 All other expenses 1,022,412 1,022,412 25 Total functional expenses. Add lines 1 through 24e 120,316,192 97,185,544 23,130,648 0 26 Joint costs.Complete this line only if the organization reported in column (B) J0 nt costs from a combined educational campaign and fundraismg soliutation Check here ?iffollowmg SOP 98?2 (ASC 958-720) Form 990 (2015) Form 990(2015) Page 11 Balance Sheet CheckifScheduleO contains a response or note to any linein this PartX . . (A) (B) Beginning ofyear End ofyear 1 Cash?non-interest?bearing 13,230,820 1 12,498,761 2 Savmgs and temporary cash Investments 32,052,943 2 32,116,956 3 Pledges and grants receivable, net 3 4 Accounts receivable, net 3,145,788 4 48,011,363 5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees Complete Part II of Schedule 5 6 Loans and other receivables from other disquali?ed persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations ofsection 501(c)(9) voluntary employees? benefICIary organizations (see instructions) Complete Part V) II ofSchedule 6 2 Notes and loans recewable, net 7 Inventories for sale or use 8 Prepaid expenses and deferred charges 1,311,931 9 1,377,311 10a Land, and eqUIpment cost or other ba5is Complete Part VI ofSchedule 103 51385392 Less accumulated depreCIation 10b 2,654,219 3,116,976 10c 2,731,773 11 Investments?publicly traded securities 11 12 Investments?other securities See Part IV, line 1 1 12 13 Investments?program?related See Part IV, line 1 1 13 14 Intangible assets 14 15 Other assets See Part IV, line 1 1 18,124 15 243,124 16 Total assets.A dd lines 1 through 15 (must equal line 34) 52,876,582 16 96,979,288 17 Accounts payable and accrued expenses 15,470,013 17 38,571,602 18 Grants payable 18 19 Deferred revenue 19 20 Tax?exempt bond liabilities 20 21 Escrow or custodial account liability Complete Part IV ofSchedule 21 Q) 22 Loans and other payables to currentand former officers,directors,trustees, r: key employees, highest compensated employees, and disqualified 5 persons Complete Part II ofSchedule 22 G: :1 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 (including federal income tax, payables to related third parties, and other liabilities not included on lines 17?24) Complete Part ofSchedule . . . . . . . . . . 10,667,728 25 2,706,359 26 Total liabilities.A dd lines 17 through 25 28,137,741 26 41,277,961 Organizations that follow SFAS 117 (ASC 958), check here '7 and complete :3 lines 27 through 29, and lines 33 and 34. 27 Unrestricted net assets 26,438,841 27 55,401,327 r3 CD 28 Temporarily restricted net assets 300,000 28 300,000 29 Permanently restricted net assets 29 Organizations that do not follow SFAS 117 (ASC 958), check here and 5 complete lines 30 through 34. 73 30 Capital stock ortrust prinCIpa ,or current funds 30 31 Paid?in or capitalsurplus,0r and,bUI ding or eqUIpment fund 31 32 Retained earnings,endowment,accumu ated income,or otherfunds 32 33 Total net assets or fund balances 26,738,841 33 55,701,327 34 Total liabilities and net assets/fund balances 52,876,582 34 96,979,288 Form 990 (2015) Form 990 (2015) Reconcilliation of Net Assets Page 12 Check IfSchedule contaIns a response or note to any lIne In thIs Part XI . 1 Total revenue (must equal Part column (A), lIne 12) 1 151,977,597 2 Total expenses (must equal Part IX, column (A), Me 25) 2 120,316,192 3 Revenue less expenses Subtract lIne 2 from lIne 1 3 31,661,405 4 Net assets or fund balances at begInnIng ofyear (must equal Part X, lIne 33, column 4 26,738,841 5 Net unrealized gaIns (losses) on Investments 5 -368,253 6 Donated serVIces and use of 6 7 Investment expenses 7 8 PrIor perIod adjustments 8 ?2,330,666 9 Other changes In net assets orfund balances (explaIn In Schedule 0) 9 0 10 Net assets or fund balances at end ofyear CombIne lInes 3 through 9 (must equal Part X, Me 33, column 10 55,701,327 Financial Statements and Reporting Check IfSchedule contaIns a response or note to any Me In thIs Part XII Yes No 1 AccountIng method used to prepare the Form 990 I?Cash WAccrual I?Other Ifthe organIzatIon changed Its method ofaccountIng from a prIor year or checked "Other," explaIn In Schedule 0 2a Were the organIzatIon's fInanCIal statements complied or reVIewed by an Independent accountant? 2a No If?Yes,?check a box below to IndIcate whether the fInanCIal statements for the year were compIIed or reVIewed on a separate consolldated or both Separate Consolldated Both consolIdated and separate Were the organIzatIon's fInanCIal statements audIted by an Independent accountant? 2b Yes If?Yes,?check a box below to IndIcate whether the fInanCIal statements for the year were audIted on a separate consolldated or both Separate I7 Consolldated Both consolIdated and separate basIs If"Yes," to Me 2a or 2b, does the organIzatIon have a commIttee that assumes for overSIght ofthe audIt, reVIew, or compIIatIon ofIts fInanCIal statements and selectIon ofan Independent accountant? 2C Yes Ifthe organIzatIon changed eIther Its overSIght process or selectIon process durIng the tax year, explaIn In Schedule 0 3a As a result ofa federal award, was the organIzatIon reqUIred to undergo an audIt or audIts as set forth In the SIngle AudItActand OMB CIrcularA-133? 3a N0 If"Yes," dId the organIzatIon undergo the reqUIred audIt or audIts? Ifthe organIzatIon dId not undergo the reqUIred audIt or audIts, explaIn why In Schedule 0 and descrIbe any steps taken to undergo such audIts 3b Form 990 (2015) Iefile GRAPHIC print - DO NOT PROCESS As Filed Data - DLN: 93493320154356I SCHEDULE . . OMB No 1545-0047 Supplemental FInanCIal Statements (Form 990) Complete if the organization answered "Yes," on Form 990, 2 1 5 Part IV, line 6, 7, B, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b. Department of the Attach to Form 990. Open to Public Treasury Information about Schedule (Form 990) and its instructions is at Inspection Internal Revenue SerVIce Name of the organization Employer identification number Communlty Health Group 95-3766170 Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete If the organIzatIon answered ?Yes" on Form 990, Part IV, Me 6. a Donor adVIsed funds Funds and other accounts Total number at end of year Aggregate value ofcontrIbutIons to (durIng year) Aggregate value ofgrants from (durIng year) Aggregate value at end ofyear the organization Inform all donors and donor adVIsors In ertIng that the assets held In donor adVIsed funds are the organIzatIon's property, subject to the organIzatIon's excluswe legal control? Yes No the organIzatIon Inform all grantees, donors, and donor adVIsors In ertIng that grant funds can be used only for charItable purposes and not for the bene?t of the donor or donor adVIsor, or for any other purpose conferrIng ImpermISSIble prIvate bene?t? I?Yes No Conservation Easements. Complete If the organIzatIon answered "Yes" on Form 990, Part IV, lIne 7. 1 Purpose(s) of conservatlon easements held by the organlzatIon (check all that apply) PreservatIon ofland for pubIIc use (e recreatIon or educatIon) Preservatlon ofan hIstorIcally Important land area ProtectIon of natural habItat Preservatlon ofa certIerd hIstorIc structure PreservatIon ofopen space Complete IInes 2a through 2d Ifthe organlzatIon held a qualIerd conservatlon contrIbutIon In the form ofa conservatlon easement on the last day of the tax year Held at the End of the Year Total number ofconservatlon easements 2a Total acreage restrIcted by conservatIon easements 2b Number ofconservatlon easements on a certIerd hIstorIc structure Included In 2c Number ofconservatlon easements Included In achIred after 8/17/06, and not on a hIstorIc structure Isted In the NatIonal RegIster 2d umber ofconservatlon easements modIerd, transferred, released, or termInated by the organIzatIon durIng the tax year Number ofstates where property subject to conservatlon easement Is located Does the organIzatIon have a ertten poIIcy regardIng the perIodIc monItorIng, InspectIon, handlIng of VIolatIons, and enforcement ofthe conservatIon easements It holds? Yes No Staffand volunteer hours devoted to monItorIng, handIIng ofVIolatIons, and enforcmg conservatlon easements durIng the year Amount of expenses Incurred In monItorIng, ofVIolatIons, and enforCIng conservatlon easements durIng the year Does each conservatlon easement reported on We 2(d) above satIsfy the reqUIrements ofsectIon 170(h)(4) (B)(I)and sectIon I?Yes In Part descrIbe how the organlzatIon reports conservatlon easements In Its revenue and expense statement, and balance sheet, and Include, IfappIIcable, the text ofthe footnote to the organlzatIon's fInanCIal statements that the organIzatIon?s for conservatIon easements Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets. Complete If the organIzatIon answered ?Yes" on Form 990, Part IV, lIne 8. 1a Ifthe organlzatlon elected, as permItted under SFAS 1 16 (ASC 958), not to report In Its revenue statement and balance sheet works of art, hIstorIcal treasures, or other assets held for pubIIc ethbItIon, educatIon, or research In furtherance of publIc serVIce, prOVIde, In Part the text ofthe footnote to Its fInanCIal statements that descrIbes these Items Ifthe organlzatlon elected, as permItted under SFAS 1 16 (ASC 958), to report In Its revenue statement and balance sheet works of art, hIstorIcal treasures, or other assets held for pubIIc ethbItIon, educatlon, or research In furtherance of publIc serVIce, prOVIde the followmg amounts relatIng to these Items Revenue Included on Form 990, Part lIne 1 (ii)Assets IncludedIn Form 990,PartX 2 Ifthe organlzatlon recered or held works ofart, hIstorIcal treasures, or otherSImIIar assets forfInanCIal gaIn, prOVIde the followmg amounts reqUIred to be reported under SFAS 1 16 (A SC 958) relatIng to these Items a RevenueIncluded on Form '3 Assets Included In Form 990,PartX For Paperwork Reduction Act Notice, see the Instructions for Form 990. at 5 2 2 83 Schedule (Form 990) 2015 ScheduleD (Form 990)2015 Page2 Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (contmued) 3 the organIzatIon?s achISItIon, acceSSIon, and other records, check any ofthe followmg that are a 5IgnIfIcant use of Its collectIon Items (check all that apply) a PublIc ethbItIon Loan or exchange programs '3 Other Scholarly research PreservatIon forfuture generatIons 4 a descrIptlon 0f the organIzatIon?s collectIons and explaIn how they furtherthe organIzatIon's exempt purpose In Part 5 DurIng the year, dId the organIzatIon so ICIt or recere donatlons ofart, hIstorIcal treasures or other assets to be sold to raIse funds rather than to be maIntaIned as part ofthe organIzatIon?s collectIon? Yes No Escrow and Custodial Arrangements. Complete If the organIzatIon answered ?Yes" on Form 990, Part IV, ?me 9, or reported an amount on Form 990, Part X, Ine 21. 1a Is the organIzatIon an agent, trustee, custodIan or other IntermedIary for contrIbutIons or other assets not Included on Form 990,Part X7 I?Yes If "Yes," explaIn the arrangement In Part and complete the followmg table Amount BegInnIng balance 1c AddItIons durIng the year 1d DIstrIbutIons durIng the year 1e EndIng balance 1f 2a the organIzatIon Include an amount on Form 990, Part X, lIne 21, for escrow orcustodlal account Yes No If"Yes," explaIn the arrangement In Part Check here Ifthe explanatlon has been prOVIded In Part . . . . . . . . Endowment Funds. Complete If the organIzatIon answered ?Yes" to Form 990, Part IV, IIne 10. (a)Current year (b)PrIor year (c)Two years back (d)Three years back (e)Four years back 1a BegInnIng ofyear balance ontrIbutIons Net Investment earnIngs, gaIns, and losses Grants or scholarshIps Other expendItures for and programs AdmInIstratIve expenses 9 End ofyear balance 2 ProvIde the estImated percentage ofthe current year end balance (IIne lg, column held as Board deSIgnated or quasI?endowment Permanent endowment TemporarIIy restrIcted endowment The percentages on lInes 2a, 2b, and 2c should equal 100% 3a Are there endowment funds not In the posseSSIon ofthe organIzatIon that are held and admInIstered forthe organIzatIon by Yes No (i)unre atedorganIzatIons . . . . . . . . . . . . . . . . . 3a(i) 3a(ii) (ii) related organIzatIons . . . . . . . . . . . . . . If"Yes" on are the related organIzatIons Isted as reqUIred on Schedule . . . . . . . . . 3b 4 DescrIbe In Part the Intended uses ofthe organIzatIon's endowment funds Land, Buildings, and Equipment. Complete If the organIzatIon answered 'Yes' to Form 990, Part IV, IIne 11a.See Form 990, Part X, IIne 10. DescrIptIon of property Accumulated (d)Book value Cost or other baSIs Cost or other baSIs (c)depreCIatIon (Investment) (other) 1a Land BUIldIngs Leasehold Improvements quUIpment1,895,556 857,167 1,038,389 eOther3,490,436 1,797,052 1,693,384 Total.Add Ines . . . . . .P 2,731,773 Schedule (Form 990) 2015 ScheduleD (Form 990)2015 Page3 Investments?Other Securities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11b. See Form 990, Part X, line 12. Description of security or category (b)Book value (c)Method of valuation (including name ofsecurity) Cost or end-of-year market value (1)FinanCIa derivatives (2)Closely?held eqmty interests (3)Other Total. (Column must equal Form 990, Part X, col (B) line 12) Investments?Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line llc-See Form 990 Part line 13_ Description ofinvestment Book value Method ofvaluation Cost or end-of- ear market value Total. (Column must equal Form 990, Part X, col (B) line 13) Other Assets. Corn lete ifthe or anization answered 'Yes' on Form 990 Part IV line 11d See Form 990 Part line 15 a Descri tion Book value Total. Columnbmust ualF0im990,PaitX,colBline15 . . . . . . . . . . .b Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line He or 111?. See Form 990, Part X, line 25. 1_ Description ofliability Book value Federal income taxes Due to CH6 Foundation 2,706,359 Total. (Column must equal Form 990, PartX, col (B) line 25) 2,706,359 2. Liability for uncertain tax pOSItions In Part provide the text of the footnote to the organization's finanCIal statements that reports the organization's liability for uncertain tax p05itions under FIN 48 (ASC 740) Check here ifthe text ofthe footnote has been provided in Part Schedule (Form 990) 2015 ScheduleD (Form 990)2015 Page4 Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete If the organization answered 'Yes' on Form 990, Part IV, IIne 12a. 1 Total revenue, gaIns, and other support per audlted fInanCIal statements 1 1,039,060,471 Amounts Included on IIne 1 but not on Form 990, Part MM 12 a Net unrealized gaIns (losses) on Investments 2a ?368,253 Donated serVIces and use 2b Recoverles ofprIor year grants 2c Other In Part 2d 887,451,127 AddlInes 2a through 2d 2e 887,082,874 3 2e fromIInel 3 151,977,597 Amounts Included on Form 990, Part Ine 12, but not on Ine 1 Investment expenses not Included on Form 990, Part IIne 7b 4a Other In Part 4b AddlInes 4a and 4b 4c 0 5 Total revenue AddlInes 3and 4c.(ThIs mustequalForm 990 PartI, Me 12 . . 5 151 9,77 597 Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete If the organIzatIon answered 'Yes' on Form 990, Part IV, IIne 12a. Total expenses and losses per audlted fInanCIal statements 1 919,844,780 2 Amounts Included on We 1 but not on Form 990, Part IX, We 25 a Donated serVIces and use of 2a PrIor year adjustments 2b Otherlosses 2c Other(DescrIbeIn 2d 799,528,588 Add Ines 2a through 2d 2e 799,528,588 3 2efrom Ine 1 3 120,316,192 Amounts Included on Form 990, Part IX, IIne 25Investment expenses not Included on Form 990, Part IIne 7b 4a Other(DescrIbeIn Part 4b Add Ines 4a and 4b 4c 0 5 Total expenses Add Ines 3and 4c. (ThIs must equal Form 990, Part I, Ine 18120,316,192 Supplemental Information Prowde the descrIptIons reqUIred for Part II, IInes 3, 5, and 9, Part IInes 1a and 4, Part IV, IInes 1b and 2b, Part V, Ine 4, Part X, We 2, Part XI, IInes 2d and 4b, and Part XII, Ines 2d and 4b Also complete thIs part to prowde any addItIonal InformatIon Return Reference Explanatlon Part X, LIne 2 CH6 and CH6 FoundatIon have evaluated theIr tax pOSItIons and the certaInty as to whether those posItIons be sustaIned In the event ofan audIt by taxmg authorItIes at the federal and state levels The prImary tax pOSItIons evaluated are related to and CH6 FoundatIon's contInued quaIIfIcatIon as a tax-exempt organIzatIon and whether there Is unrelated busIness Income actIVItIes conducted that would be taxable Management has determIned that all Income tax pOSItIons be sustaIned upon potentIal audIt or examInatIon, therefore, no dIsclosures of uncertaIn Income tax posmons are reqUIred Schedule (Form 990) 2015 ScheduleD (Form 990)2015 Page5 Supplemental Information (continued) Return Reference Explanation Part XII, Line 2d Other otal Expenses Attributable to CH6 Foundation 818,508,850 MANAGEMENT FEE FROM Adjustments FOUNDATION (ELIMINATED IN CONSOLIDATION) -18,980,262 Schedule (Form 990) 2015 Iefile GRAPHIC print - DO NOT PROCESS IAS Filed Data - DLN: 93493320154356I Schedule Compensation Information 0MB No 1545-0047 (Form 990) For certain Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees Complete if the organization answered "Yes" on Form 990, Pait IV, line 23. Attach to Form 990. Department of the Information about Schedule (Form 990) and its instructions is at Open to PUbliC Treasurv Ins - ection Internal Revenue Serwce Name of the organization Employer identification number Community Health Group 95-3766170 Questions Regarding Compensation Yes No 990, Part VII, Section A, line 1a Complete Part to prowde any relevant Information regarding these items 1a Check the appropiate box(es) ifthe organization prowded any of the followmg to orfor a person listed on Form First?class orchartertravel Housmg allowance or re5idence for personal use Travel for companions Payments for busmess use of personal reSIdence I Tax idemnification and gross-up payments Health or club dues or initiation fees I Discretionary spending account Personal serVIces (e maid, chauffeur, chef) Ifany ofthe boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or prOVI5ion ofall ofthe expenses described above? If"No," complete Part to explain 1b 2 Did the organization reqUIre substantiation prior to reimburSIng or allowmg expenses incurred by all directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? 2 3 Indicate which, if any, of the followmg the filing organization used to establish the compensation of the organization's CEO/Executive Director Check all that apply Do not check any boxes for methods used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part I7 Compensation committee Written employment contract I7 Independent compensation consultant I7 Compensation survey or study I I I Form 990 of other organizations I7 Approval by the board or compensation committee I I I 4 During the year, did any person listed on Form 990, Part VII, Section A, line la With respect to the filing organization or a related organization a Recewe a severance payment or change?of?control payment? 4a No PartICIpate in, or recewe payment from, a supplemental nonqualified retirement plan? 4b No 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 prowde the applicable amounts for each item in Part Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9. 5 For persons listed on 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 Any related organization? 5b No If"Yes," on line 5a or 5b, describe in Part 6 For persons listed on 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 Any related organization? 6b No If"Yes," on line 6a or 6b, describe in Part 7 For persons listed on Form 990, Part VII, Section A, line la, did the organization prowde any non-fixed payments not described in lines 5 and 6? If"Yes," describe in Part 7 Yes 8 Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was subject to the initial contract exception described in Regulations section 53 If"Yes," describe in Part 8 No 9 If"Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53 9 For Paperwork Reduction Act Notice, see the Instructions for Form 990. at 50 0 5 3T Schedule (Form 990) 2015 ScheduleJ (Form 990) 2015 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 on Schedule J, report compensation from the organization on row 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 ofcolumns for each listed IndIVIdual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that ihdiVidual (A) Name and Title (B) Breakdown ofW?Z and/or compensation Base compensation (Ii) Bonus incentive compensation Other re porta ble conwpensabon (C) Retirement and other deferred compensation (D) Nontaxable benefits (E) Total of columns (F) Compensation in column(B) reported as deferred on prior Form 990 See Additional Data Table Schedule (Form 990) 2015 ScheduleJ(Form990)2015 Page3 Supplemental Information Prowde the Information, explanation, or descriptions reqUIred for Part 1, lines 1aand for Part II Also complete thIS part for any additional information Explanation OFFICERS RECEIVE PERFORMANCE BONUSES AS PART OF THEIR COMPENSATION there were Signing bonuses based on length ofstay, and monetary serVIce awards based on years ofserVice Ret urn Reference Part I, Line 7 Schedule (Form 990) 2015 Additional Data Form 990, Schedule J, Part II - Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees Software ID: Softwa re Ve rsion: EIN: Name: 95-3766170 Community Health Group (A) Name and Title (B) Breakdown of and/or 1099-MISC compensation (C) Retirement and (D) Nontaxable (E) Total of columns (F) Compensation In - -- 0 er erre ene i? co umn (I) (II) th ft I Base Bonus 81 Other compensation reported as deferred Compensation incentive reportable 0? prior Form 990 compensation compensation 1Norma Diaz I 582,847 ChiefExecutwe Of?cer 1,750 10,800 11,700 7,023 614,120 0 (IIEdward (I) 476,133 500 7,200 11,700 5,280 500,813 0 Assomate Chief Executive Officer (IIZScott Carroll I 233,654 Chief Financial Officer 2211 20 3:600 0 0 259,374 3Ann Warren I 264,108 ChiefGov,t& Relations 1,250 3,600 9,573 5,339 283,870 4Heidi Arndt I 262,390 Chief Information Officer 1 51250 2:100 0 6,849 286,589 5Ad a TeSSIerMedical Director (I) 247241 250 0 7,194 5,150 259,835 0 (II?we? (I) 163,800 1,750 4,200 7,151 7,080 183,981 0 Director of Healthcare erations 7Nora Pintado I 163,475 BMW, Heath PIan (l 1 ,500 7.126 4,539 176,640 0 erations R'tCh'e 0) 1491579 500 0 6,280 5,734 162,093 0 Director of Contracting 9Diane Erk I 148,181 mam, Fmance (Tm 0 8,875 7,621 164,677 0 8/2015 Iefile GRAPHIC print - DO NOT PROCESS As Filed Data - DLN: 93493320154356] SCHEDULE 0 Supplemental Information to Form 990 or 990-EZ (Form 990 or 2 1 990_ E2) Complete to provide information for responses to specific questions on Form 990 or 990-EZ or to provide any additional information. Attach to Form 990 or 990-EZ. Open to Public Department ofthe Information about Schedule 0 (Form 990 or 990-EZ) and its instructions is at Inspection Treasury Internal Revenue SerVIce Name ofthe organization Employer identification number Community Health Group 95-3766170 Return Explanation Reference Form 990, Part THE BOARD OF DIRECTORS ENGAGES THE SERVICES OF AN INDEPENDENT PUBLIC ACCOUNTING FIRM (MOSS ADAMS, LLP) VI, Section B, AS OUTSIDE SERVICE PROVIDERS TO COMPLETE THE ANNUAL CERTIFIED AUDIT THE CERTIFIED FINANCIAL STATEIVIENTS line 11 ARE REVIEWED WITH AND APPROVED BY THE BOARD OF DIRECTORS THE SERVICES OF MOSS ADAMS, LLP ARE ALSO ENGAGED TO PREPARE AND COMPLETE FORM 990 THE FORM 990 IS PREPARED UNDER THE DIRECTION, REVIEW AND OVERSIGHT OF COMMUNITY HEALTH FINANCE DEPARTMENT THE BOA RD OF DIRECTORS RELIES ON THE EXPERTISE OF INTERNAL NIANAGEIVIENT AND MOSS ADA MS, LLP A con?plete copy of the Form 990 IS prowded to the rnerrbers of the board for their reVIew prior to filing With the Internal Revenue SerVIce EDNIIVIOANI SNOISIOEICI CINV CIEI V08 Vd INOEH CINV HO EIHJ. N0 88 :ll V08 EIHJ. NI d? GNV ANI 80: OJ. EIEIV ANV VEIH :l0 ithd NV SI HO 93L ANV EIHJ. CINV ANV EION EIHJ. N0 ?8 A8 EEIHSEEHEIH El)! CINV SHOLOEIHICI :l0 CIH V08 ATI 119d L066 UJJozl aouaJ may u1n1au Return Reference Explanation Form 990, Part VI, Section B, line 15 A salary analySIs is prepared by the Human Resources Department usmg the Warren Survey, hich is the only survey for HMO's This analy5is is then validated by an out5ide consultant An Evaluation Committee con5isting of the Chairman of the Board and four additional Board merrbers, reVIews this analySIs and makes a recommendation to the Board of Directors, he make the final deCI3ion The analySIS is done annually in Decen'ber Salary analySIS are prepared by an outSIde consultant for all Executive posmons and some management posmons Results are presented to the Human Resources Department Recommendations are then made to the CEO for approval Return Explanation Reference Form 990, Part VI, Consolidated Audited FinanCIal Statements, including Community Health Group and COMMUNITY HEALTH GROUP Section C, line 19 Foundation, are available to the public on the Department of Managed Care webSIte THE Governing/Organizmg documents are on file With the Department of Managed health Care and can be obtained under the California Public Records Act The conflict of interest policy is not made available to the public Return Reference Explanation Form 990, Part IX, line 119 Professmnal medical fees Program serVIce expenses 38,742,376 Total expenses 38,742,376 Consultants Program serVIce expenses 2,582,316 Total expenses 2,582,316 Return Reference Explanation FORM 990, PA RT XII, LINE 2 PART IV, LINE 12 THE ORGA AUDITED FINANCIAL STATEMENTS ARE PREPARED ON A CONSOLIDATED BASIS, HOWEVER, THE ORGANIZATION maintains SEPARATE FINANCIAL RECORDS FOR EACH ENTITY THIS SEPARATE FINANCIAL INFORMATION has been used to complete the at Part XI CONSOLIDATED INFORMATION FROM THE AUDITED FINANCIAL STATEMENTS HAS BEEN USED IN SCHEDULE D, PARTS XI XII Iefile GRAPHIC print - DO NOT PROCESS IAs Filed Data - SCHEDULE (Form 990) Department of the Treasury Internal Revenue Sen/ice Attach to Form 990. Related Organizations and Unrelated Partnerships Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37. Information about Schedule (Form 990) and its instructions is at OMB No 1545?0047 Open to Public Ins - ection Name ofthe organization Community Health Group 95-3766170 Identification of Disregarded Entities Complete if the organization answered ?Yes" on Form 990, Part IV, line 33. Employer identification number (C) (0 Name, address, and EIN (if applicable) of disregarded entity Primary actIVIty Legal domICIle (state Total income End?of?year assets Direct controlling or foreign country) 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. (C) (9) Name, address, and EIN of related organization Primary actIVIty Legal d0mlC le (state Exempt Code section Public charity status Direct controlling Section 512(b) or foreign country) (iic section 501(c)(3)) entity (13) controlled entity? Yes No HEALTHCARE CA 9 Community Health Group Yes Foundation 2420 Fenton St swte 100 CHULA VISTA, CA 91914 33-0586911 For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat No 50135Y Schedule (Form 990) 2015 Schedule (Form 990) 2015 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. Name, address, and EIN of related organization Primary actiVity (C) Legal domICIle (state or foreign country) Direct controlling entity income(related, Predominant unrelated, excluded from tax under sections 512- 514) Share of Share of Disproprtionate Code V-UBI total income end?of?year allocations? amount in box assets 20 of Schedule K-l (Form 1065) Yes No (J) (R) General or Percentage managing ownership partner? Yes 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. Name, address, and EIN of related organization Primary actIVIty (C) Legal domICIle (state or foreign country) Direct co ntrolling entity Type of entity (C corp, corp, or trust) Share of total income (9) Share of end- of-year assets (I) Percentage Section 512 ownership controlled entity? Yes No Schedule (Form 990) 2015 ScheduleR(Form990)2015 Page3 Transactions With Related Organizations Complete If the organIzatIon answered ?Yes? on Form 990, Part IV, IIne 34, 35b, or 36. Note. Complete lIne 1Ifany entIty Is lIsted In Parts II, or IV ofthIs schedule Yes N0 1 DurIng the tax year, dId the orgranIzatIon engage In any ofthe followmg transactIons WIth one or more related organIzatIons lIsted In Parts a ReceIpt of Interest, (ii)annUItIes, or(iv)rent from a controlled entIty . . . . . . . . . . . . . . . . . . . . . 1a N0 GIft, grant, or capItal contrIbutIon to related organIzatIon(GIft, grant, or capItal contrIbutIon from related organIzatIon(Loans or loan guarantees to or for related organIzatIon(Loans or loan guarantees by related organIzatIon(Yes DIVIdends from related organIzatIon(Sale ofassets to related organIzatIon(sPurchase ofassets from related organIzatIon(Exchange ofassets WIth related organIzatIon(Lease of eqUIpment, or other assets to related organIzatIon(Lease 0f eqUIpment, or other assets from related organIzatIon(Performance ofserVIces or membershIp orfundraIsmg so ICItatIons for related organIzatIon(s) 1' N0 Performance ofserVIces or membershIp orfundraIsmg so ICItatIons by related organIzatIon(SharIng eqUIpment, Ists, or other assets WIth related organIzatIon(SharIng of paId employees WIth related organIzatIon(ReImbursement paId to related organIzatIon(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1P N0 ReImbursement paId by related organIzatIon(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1?1 Yes Other transfer ofcash or property to related organIzatIon(Other transfer ofcash or property from related organIzatIon(Ifthe answer to any ofthe above Is "Yes," see the InstructIons for Informatlon on who must complete thIs lIne, IncludIng covered relatIonshIps and transactlon thresholds (C) (ID Name of related organIzatIon TransactIon Amount Involved Method of determInIng amount Involved type FOUNDATION 2,706,359 Book/Actual Value FOUNDATION 18,980,262 VALUE Schedule (Form 990) 2015 ScheduleR(Form990)2015 Page4 Unrelated Organizations Taxable as a Partnership Complete if the organization answered ?Yes" on Form 990, Part IV, line 37. Prowde the followmg Information for each entity taxed as a partnership through which the organization conducted more than five percent ofits actiVities (measured by total assets or gross revenue) that was not a related organization See instructions regarding exclu5ion for certain investment partnerships a (C) (9) (I) (J) ?0 Name, address, and EIN of entity Primary actiwty Legal Predominant Are all partners Share of Share of Disproprtionate Code General or Percentage domICIle income section total end-of-year allocations? amount in managing ownership (state or (related, 501(c)(3) income assets box 20 partner? foreign unrelated, organizations? of Schedule country) excluded from K-1 tax under (Form 1065) sections 512- 514Schedule (Form 990) 2015 ScheduleR(Form990)2015 Page5 Supplemental Information Prowde additional Information for responses to questions on Schedule (see instructions) Return Reference Explanation Schedule (Form 990) 2015