lefile GRAPHIC print - DO NOT PROCESS IAs Filed Data - Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private M990 ?5 Department of the Treasury Internal Revenue Servrce foundations) II- Do not enter Socral Securrty numbers on form as It may be made publrc By law, the IRS generally cannot redact the rnformatron on the form II- Informatron about Form 990 and Its rs at OMB No 1545-0047 A For the 2013 calendar year, or tax year beginning 01-01-2013 Check If applicable Address change Name change Inrtral return Terminated Amended return 2013, and ending 12-31-2013 2013 Open to Public Inspection Name of organrzatron COMMUNITY HEALTH GROUP Dorng Busrness As 95-3766170 Employer identification number Number and street (or 0 box If marl rs not delivered to street address) 2420 FENTON STREET NO 100 Room/surte City or town, state or provrnce, country, and ZIP or foreign postal code CHULA VISTA, CA 91914 Name and address of offrcer SCOTT CARROLL 2420 FENTON STREET NO 100 CHULA 91914 I Tax?exem pt status 501(c)(3) l7 501(c) 4) 1 (Insert no) 4947(a)(1) or 527 Website:ll- COM Telephone number (619)422-0422 Gross receipts 49,680,193 H(a) Is a group return for subordrnates? H(b) Are all subordrnates Included? If"No," attach a (see H(c) Group exemptron number Ir Form of organrzatron '7 Corporation Trust Assocratron Other Summary 1 Brrefly the organrzatron's or most COMMUNITY HEALTH GROUP IS DEDICATED TO MAINTAINING AND IMPROVING THE HEALTH OF OUR MEMBERS BY PROVIDING ACCESS TO QUALITY CARE AND OFFERING EXCEPTIONAL SERVICE TO DIVERSE POPULATIONS I Year of fonnatron 1982 State of legal CA i 2 Check box rfthe organrzatron drscontrnued Its operatrons or drsposed of more than 25% ofrts net assets 3 Number ofvotrng members ofthe body (Part VI, lrne 1a) 3 9 4 Number ofrndependent votrng members of the body (Part VI, lrne 1b) 4 9 5 Total number employed In calendar year 2013 (Part V, lrne 2a) 5 224 6 Total number ofvolunteers (estrmate If necessary) 6 0 7aTotal unrelated busrness revenue from Part column (C), lrne 12 7a 71,328 Net unrelated busrness taxablerncome from Form 990-T,lrne 34 7b 488,582 Prior Year Current Year 8 and grants (Part lrne 1h) 0 0 9 Program servrce revenue (Part 29) 39,629,719 19,162,283 10 (Part 3,4,and 7d -23,395 320,691 11 5,6d,8c,9c,10c,and11e) 12,550,021 13,425,663 12 Total revenue?add lrnes 8 through 11 (must equal Part column (A), lrne 12) 52,156,345 32,908,637 13 Grants and amounts pard (Part IX, column (A), lrnes 1?3) 0 0 14 Bene?ts pard to orfor members (Part IX, column (A), lrne 4) 0 0 15 Salarres, other compensatron, employee benefrts (Part IX, column (A), lrnes 5-10) 8,895,930 9,235,734 16a fees (PartIX,column lie) 0 0 Total expenses (Part column (D), lrne 25) F0 17 38,963,775 23,868,186 18 Totalexpenses Add lrnes 47,859,705 33,103,920 19 Revenue less expenses Subtract lrne 18 from lrne 12 4,296,640 -195,283 3% Beginnianeca): Current End of Year ?g 20 Totalassets (PartX,lrne 16) 36,869,545 32,206,974 5E 21 10,774,654 6,539,729 3IE 22 Net assets orfund balances Subtract lrne 21 from lrne 20 26,094,891 25,667,245 Signature Block Under penaltres of perjury, I declare that I have examrned return, rncludrng schedules and statements, and to the best of my knowledge and belref, rt rs true, correct, and complete Declaratron of preparer (other than of?cer) rs based on all rnformatron of preparer has any knowledge I 2014-11-07 Sign Signature of of?cer Date Here scorr CARROLL CFO Type or name and trtle Print/Type preparer's name Preparer?s srgnature Date Check If PTIN 'd RENIE BURBANK self?employed P00159653 al Frrm's name MOSS ADAMS LLP Frrm's EIN 91?0189318 Preparer Use only Frrm's address II- 101 SECOND STREET 9TH FLOOR Phone no (415) 956?1500 SAN FRANCISCO, CA 94105 May the IRS drscuss return the preparer shown above? (see For Paperwork Reduction Act Notice, see the separate instructions. Cat No 11282Y I7Yes Form 990 (2013) Form 990(2013) Page2 Statement of Program Service Accomplishments . . . . . . . . . . . . . 1 Briefly describe the organization?s missmn COMMUNITY HEALTH GROUP IS DEDICATED TO MAINTAINING AND IMPROVING THE HEALTH OF OUR MEMBERS BY PROVIDING ACCESS TO QUALITY CARE AND OFFERING EXCEPTIONAL SERVICE TO DIVERSE POPULATIONS 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 of its three largest program serVIces, as measured by expenses Section 501(c)(3)and 501(c)(4) organizations are reqUIred to report the amount ofgrants and allocations to others, the total expenses, and revenue, ifany, for each program serVIce reported 4a (Code (Expenses 16,397,626 including grants of (Revenue 32,516,618 TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES TO MEMBERS UNDER THE HEALTHY FAMILIES PROGRAM IN THE COUNTY OF SAN DIEGO AND PORTIONS OF THE COUNTY OF RIVERSIDE UNDER CONTRACT WITH THE STATE OF CALIFORNIA ALSO TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES TO MEMBERS UNDER A MEDICARE ADVANTAGE SPECIAL NEEDS PLAN OPEN TO PEOPLE ELIGIBLE FOR AND MEDICARE UNDER CONTRACT WITH THE CENTERS FOR MEDICARE AND MEDICAID SERVICES 4b (Code (Expenses including grants of (Revenue 44; (Code (Expenses including grants of (Revenue 4d Other program serVIces (Describe in Schedule 0 (Expenses including grants of$ (Revenue 4e Total program service expenseslr 16,397,626 Form 990 (2013) Form 990 (201320a Part Page 3 Part IV Checklist of Required Schedules Yes No Is the organization described In section 501(c)(3) or 4947(a)(1) (other than a prIvate foundatIon)?? If "Yes," No completeScheduleA 1 Is the organization reqUIred to complete Schedule 3, Schedule of Contributors (see instructions)? 2 No Did the organization engage in direct or indirect political campaign actIVItIes on behalf ofor In opp05Ition to No candidates for public of?ce? If "Yes," complete Schedule C, Part I 3 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 4 Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or SImilar amounts as defined In Revenue Procedure 98-197 If "Yes,?complete Schedule C, 5 No Did the organization maintaIn any donor adVIsed funds or any SimIIarfunds or accounts for donors have the right to prOVIde adVIce on the distribution or investment ofamounts In such funds or accounts? If "Yes,? complete Schedule D, Part IE 6 0 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 7 0 Did the organization maintaIn collections ofworks ofart, historical treasures, or other assets? If "Yes," complete Schedule D, Part . 3 0 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, PartI 9 0 Did the organization, dIrectly or through a related organization, hold assets in temporarily restricted endowments, 10 No permanent endowments, or quaSI-endowments? If "Yes," complete Schedule D, Part Ifthe organIzatIon?s answerto any ofthe followmg questions Is "Yes," then complete Schedule D, Parts VI, VII, IX, or as appIIcable Did the organIzatIon report an amount for land, and eqUIpment In Part X, line 10? If "Yes," complete Schedule D, Part VI 11a es Did the organization report an amount for investments?other securities in Part X, Me 12 that Is 5% or more of its total assets reported in Part X, Ine 16? If "Yes,? complete Schedule D, Part . 11b 0 Did the organization report an amount for investments?program related in Part X, Me 13 that Is 5% or more of its total assets reported in Part X, Ine 16? If "Yes,"complete Schedule D, Part . 11C 0 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 I 11d 0 Did the organIzatIon report an amount for other IabI itIes In Part X, line 25? If "Yes," complete Schedule D, PartX'E 11e Yes Did the organIzatIon's separate or consolldated fInanCIal statements for the tax year include a footnote that 11f Yes addresses the organIzatIon's IabI Ity for uncertaIn tax pOSItIons under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part Did the organIzatIon obtaIn separate, Independent audIted fInanCIal statements for the tax year? If "Yes," complete Schedule D, Parts XI and XII 123 N0 Was the organIzatIon Included in consolldated, independent audIted fInanCIal statements for the tax year? If 12b Yes "Yes," and If the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII IS optional Is the organIzatIon a school descrIbed in sectIon If "Yes,?complete ScheduleE 13 No Did the organIzatIon maintaIn an office, employees, or agents outSIde ofthe United States? 14a No Did the organIzatIon have aggregate revenues or expenses of more than $10,000 from grantmakIng, fundraIsmg, busmess, investment, and program serVIce actIVItIes outSIde the UnIted States, or aggregate foreign investments valued at $100,000 or more? If "Yes,"complete Schedule F, Parts I and IV . 14b NO Did the organIzatIon report on Part IX, column (A), line 3, more than $5,000 ofgrants or other aSSIstance to or for any foreIgn organization? If ?Yes,? complete Schedule F, Parts II and IV 15 0 Did the organIzatIon report on Part IX, column (A), line 3, more than $5,000 ofaggregate grants or other aSSIstance to orforforeign IndIVIduals? If ?Yes,?complete ScheduleF, Parts and IV . 16 0 Did the organIzatIon report a total of more than $15,000 ofexpenses for profeSSIonal fundraISIng serVIces on Part 17 No IX, column (A), Ines 6 and 11e? If "Yes,? complete Schedule G, Part I (see Instructions) . Did the organIzatIon report more than $15,000 total offundraismg event gross income and contrIbutions on Part Ines 1c and 8a? If "Yes,"complete Schedule G, Part II 13 0 Did the organIzatIon report more than $15,000 ofgross Income from gamIng actIVItIes on Part Ine 9a? If 19 No "Yes, complete Schedule G, Part Did the organIzatIon operate one or more hospItal If "Yes,"complete ScheduleH 20a No If "Yes" to line 20a, did the organIzatIon attach a copy of Its audited fInanCIal statements to this return? 20b Form 990 (2013) Form 990 (2013Part I Page 4 Part IV Checklist of Required Schedules (continued) Did the organization report more than $5,000 ofgrants or other a55istance to any domestic organization or 21 No government on Part IX, column (A), line 1? If ?Yes,?complete Schedule I, Parts I and II Did the organization report more than $5,000 ofgrants or other a55istance to indIVIduals in the United States on 22 Part IX, column (A), line 2? If ?Yes,? complete Schedule I, Parts I and 0 Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization's current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes,? 23 es complete Schedule] . Did the organization have a tax-exempt bond issue With an outstanding prinCIpaI 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 K. If ?No, go to line 25a . . . . . . . . 24a 0 Did the organization invest any proceeds oftax-exempt bonds beyond a temporary period exception? 24b Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease any tax-exempt bonds? 24C Did the organization act as an "on behalfof" issuerfor bonds outstanding at any time during the year? 24d Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction With a disqualified person during the year? If "Yes,? complete Schedule L, Part I 25a N0 Is the organization aware that it engaged in an excess benefit transaction With a disqualified person in a prior year, and that the transaction has not been reported on any ofthe organization?s prior Forms 990 or If 25b No "Yes, complete Schedule L, Part I Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? 26 No If so, complete Schedule L, Part II Did the organization prowde a grant or other a55istance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family 27 NO member of any ofthese persons? If "Yes," complete Schedule L, Part Was the organization a party to a busmess transaction With one of the fo 0Wing parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions) A current or former officer, director, trustee, or key employee? If "Yes,? complete Schedule L, Part 28a Yes A family member ofa current or former officer, director, trustee, or key employee? If "Yes,? completeScheduleL,PartIV . . . . . . . . . . . . . . . . . . . . . 23'? es An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV . 23C 0 Did the organization receive more than $25,000 in non-cash contributions? If "Yes,"complete ScheduleM 29 No Did the organization receive contributions of art, historical treasures, or other Similar assets, or qualified conservation contributions? If "Yes," complete ScheduleM 30 No Did the organization liqUIdate, terminate, or dissolve and cease operations? If "Yes,? complete Schedule N, No 31 Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes,? complete Schedule N, Part II 32 0 Did 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, PartI 33 0 Was the organization related to any tax-exempt or taxable entity? If "Yes,"complete Schedule R, Part II, orIV, Yes and Part V, line 1 . . 34 Did 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 5 12(b)(13)? If "Yes," complete Schedule R, Part V, line2 es Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes,? complete Schedule R, Part V, line 2 35 Did 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 Did the organization complete Schedule 0 and prowde explanations in Schedule 0 for Part VI, lines 11b and 19? Note. Form 990 filers are reqUIred to complete Schedule 0 38 Yes Form 990 (2013) Form 990(2013) Page5 Statements Regarding Other IRS Filings and Tax Compliance . . . . . . . . . . . . . Yes No 1a Enter the number reported In Box 3 of Form 1096 Enter-0- If not appIIcable . . 1a 1,927 Enter the number of Forms W-ZG Included In Me 1a Enter-0- If not appIIcable 1b 0 the organIzatIon comply WIth backup WIthholdIng rules for reportable payments to vendors and reportable gamIng (gambIIng)WInnIngs to prlze WInnersEnter the number ofemployees reported on Form W-3, TransmIttal ofWage and Tax Statements, ?led for the calendar year endIng WIth or WIthIn the year covered 28 224 Ifat least one Is reported on Me 2a, dId the organIzatIon ?le all reqUIred federal employment tax returns? 2b Note. Ifthe sum ofIInes 1a and 2a Is greater than 250, you may be reqUIred to e-fIIe (see InstructIons) es 3a the organIzatIon have unrelated busmess gross Income of$1,000 or more durIng the year? . . . 3a Yes If?Yes,? has It ?led a Form 990-T forthIs year? If ?No? to [me 3b, prowde an explanation 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 otherfInanCIal 4a No If"Yes," enter the name ofthe foreIgn country Ir See InstructIons for fIlIng reqUIrements for Form TD 90-22 1, Report of ForeIgn Bank and FInanCIal Accounts 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 prothIted 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 deducthle as charItable contrIbutIons'P If"Yes," dId the organlzatIon Include WIth every so ICItatIon an express statement that such contrIbutIons or 6b 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 No serVIces prOVIded to the payor? If"Yes," dId the organIzatIon notIfy the donor ofthe value of the goods or serVIces prowdedthe organIzatIon sell, exchange, or otherWIse dIspose oftangIble personal property for It was reqUIred to No If"Yes,"IndIcate the numberofForm58282fI ed durIng the year . . . . I 7d I the organIzatIon recere any funds, dIrectly or IndIrectly, to pay prequms on a personal bene?t N0 the organIzatIon, durIng the year, pay prequms, dIrectly or IndIrectly, on a personal bene?t contract? . . 7f No Ifthe organIzatIon recered a contrIbutIon Intellectual property, dId the organlzatIon ?le Form 8899 as Ifthe organIzatIon recered a contrIbutIon ofcars, boats, aIrplanes, or other vehIcles, dId the organIzatIon ?le a 7h 8 Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. the supportIng organIzatIon, or a donor adVIsed fund maIntaIned by a sponsorIng organIzatIon, have excess busmess holdIngs at any tIme durIng the yearSponsoring organizations maintaining donor advised funds. a the organIzatIon make any taxable dIstrIbutIons under sectIon 4966the organIzatIon make a dIstrIbutIon to a donor, donor adVIsor, or related personSection 501(c)(7) organizations. Enter InItIatIon fees and capItal contrIbutIons Included on Part Me 12 . . . 10a Gross receIpts,Included on Form 12,forpub Ic use ofclub 10b 11 Section 501(c)(12) organizations. Enter a 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 recered from them11b 12a Section 4947(a)(1) non-exempt charitable trusts. Is the organIzatIon fIlIng Form 990 In lIeu of Form 1041? 12a If "Yes," enter the amount of tax-exempt Interest recered or accrued durIng the 12b 13 Section 501(c)(29) qualified nonprofit health insurance issuers. a Is the organIzatIon lIcensed 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 lIcensed to Issue health plans 13?" Enterthe amount of reserves on hand . . . . . . . . . . . . 13c 14a the organIzatIon recere any payments for IndoortannIng 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 (2013) Form 990(2013) Pages Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule 0. See instructions. Check IfSchedule contaIns a response or note to any Me In thIs Part .I7 Section A. Governing Body and Management 1a 7a 9 Yes No Enter the number ofvotIng members ofthe governIng body at the end ofthe tax 1a 9 year Ifthere are materIaI dIfferences In votIng rIghts among members ofthe governIng body, or Ifthe governIng body delegated broad authorIty to an executIve commIttee or commIttee, epraIn In Schedule 0 Enter the number ofvotIng members Included In Me 1a, above, who are 9 any of?cer, dIrector, trustee, or key employee have a famIIy relatIonshIp or a busIness relatIonshIp WIth any other of?cer, dIrector, trustee, or key employeethe organIzatIon delegate control over management dutIes customarIIy performed by or under the dIrect 3 No superVISIon of of?cers, dIrectors or trustees, or key employees to a management company or other person? the organIzatIon make any SIgnIfIcant changes to Its governIng documents smce the prIor Form 990 was 4 N0 the organIzatIon become aware durIng the year ofa SIgnIfIcant dIversIon of the organIzatIon's assets? . 5 No the organIzatIon have members or stockholdersthe organIzatIon have members, stockholders, or other persons who had the power to elect or app0Int one or more members ofthe governIng bodyAre any governance deCISIons ofthe organIzatIon reserved to (or subject to approval by) members, stockholders, 7b No or persons other than the governIng body? the organIzatIon contemporaneously document the meetIngs held or ertten actIons undertaken durIng the year by the followmg 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 Section B. Policies (This Section requests information about policies not required by the Internal Revenue CodeIf"Yes," dId the organIzatIon have ertten poIICIes and procedures governIng the actIVItIes ofsuch chapters, and branches to ensure theIr operatIons are conSIstent WIth the organIzatIon's exempt purposes? 10" Has the organIzatIon prOVIded a complete copy ofthIs Form 990 to all members ofIts governIng body before N0 DescrIbe In Schedule 0 the process, Ifany, used by the organIzatIon to reVIew thIs Form 990 the organIzatIon have a ertten coanIct of Interest poIIcy? If "No,"12a Yes Were offIcers, dIrectors, or trustees, and key employees reqUIred to dIsclose annually Interests that could gIve rIse to coanIcts12b Yes the organIzatIon regularly and conSIstently monItor and enforce compIIance WIth the poIIcy? If "Yes,"descrIbe In Schedule 0 how M5 was done . . . . . . . . . . . . . . . . . . . . . . . 12C Yes the organIzatIon have a ertten thstIeblower poIIcyYes the organIzatIon have a ertten document retentIon and destructIon poIIcythe process for determInIng compensatIon ofthe followmg persons Include a reVIew and approval by Independent persons, data, and contemporaneous substantIatIon of the deIIberatIon and deCISIon15b Yes If"Yes" to Me 15a or 15b, descrIbe the process In Schedule 0 (see InstructIons) the organIzatIon Invest In, contrIbute assets to, or partICIpate In a Jomt venture or arrangement WIth a taxableentItydurIngtheyear"Yes," dId the organIzatIon follow a ertten poIIcy or procedure reqUIrIng the organIzatIon to evaluate Its partICIpatIon In venture arrangements under appIIcabIe federal tax law, and take steps to safeguard the organIzatIon?s exempt status WIth respect to such arrangements16b Section C. Disclosure 17 18 19 20 LIst the States WIth a copy ofthIs Form 990 Is reqUIred to be SectIon 6104 reqUIres an organIzatIon to make Its Form 1023 (or 1024 IfappIIcabIe), 990, and 990-T (501(c) (3)s only) avaIIabIe for pubIIc InspectIon IndIcate how you made these avaIIabIe Check all that apply Own webSIte Another's webSIte I7 Upon request Other (epraIn In Schedule 0) DescrIbe In Schedule 0 whether (and Ifso, how) the organIzatIon made Its governIng documents, coanIct of Interest poIIcy, and fInanCIaI statements avaIIable to the pubIIc durIng the tax year State the name, phySIcal address, and telephone number ofthe person who possesses the books and records of the organIzatIon FDIANE ERK 2420 FENTON STREET CHULA 91914 (619)498-6427 Form 990 (2013) Form 990 (2013) Page 7 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 reqUIred to be listed Report compensation for the calendar year ending With or Within the organization?s tax year I List all ofthe organization?s current officers, directors, trustees (whether indIVIduals or organizations), regardless ofamount ofcompensation Enter-O- in columns (D), (E), and (F) if no compensation was paid I List all ofthe organization?s current key employees, ifany See instructions for definition of "key employee I List the organization?s five current highest compensated employees (other than an officer, director, trustee or key employee) who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the organization and any related organizations I 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 I List all ofthe organization?s former directors or trustees that received, in the capaCIty 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 indIVIduaI trustees or directors, institutional trustees, officers, key employees, highest compensated employees, and former such persons Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee (A) (B) (C) (D) (E) (F) Name and Title Average P05ition (do not check Reportable Reportable Estimated hours per more than one box, unless compensation compensation amount of week (list person is both an officer from the from related other any hours and a director/trustee) organization organizations compensation for related C, 3 3 I. I _n (W- 2/1099- (W- 2/1099- from the organizations a; 3.1: MISC) MISC) organization below 2'11 a; 1,31% and related dotted line) i: Ei 3 organizations E- -Ii '3 l?l- til Hrl(1) ALBERT 2 00 12,470 0 CHAIRMAN OF THE BOARD 2 00 (2) PAUL DATO 2 00 7,610 0 VICE CHAIRMAN OF THE BOARD 2 00 (3) CARLOTA SALAS 2 00 8,550 0 SECRETARY OF THE BOARD 2 00 (4) CARLOS CESENA 2 00 9,230 0 BOARD MEMBER 2 00 (5) JOSE LUIS VALDIVIA 2 00 8,880 0 BOARD MEMBER 2 00 (6) GRACE KOJIMA 2 00 8,110 0 BOARD MEMBER 2 00 (7) TITO CALSADA 2 00 9,500 0 BOARD MEMBER 2 00 (8) ANITA HOLT 2 00 8,030 0 BOARD MEMBER 2 00 (9) WILLIAM MACFARLAND 2 00 100 0 BOARD MEMBER 2 00 (10) NORMA DIAZ 20 00 520,480 20,001 CHIEF EXECUTIVE OFFICER 20 00 (11) EDWARD 20 00 422,477 20,029 CHIEF MEDICAL OFFICER 20 00 (12) WILLIAM RICE 20 00 315,247 19,518 CHIEF FINANCIAL OFFICER 20 00 (13) JONATHAN TAMAYO 20 00 220,867 22,786 VP INFORMATION SYSTEMS 20 00 (14) ANN WARREN 20 00 195,985 20,214 CHIEF RELATIONS 20 00 (15) MICHAEL MCGARRIGLE 20 00 232,351 18,455 CHIEF OPERATING OFFICER 20 00 (16) DIANE ERK 20 00 170,064 16,161 DIRECTOR OF FINANCE 20 00 (17) NORA PINTADO 20 00 158,833 14,421 DIRECTOR OF HEALTH PLAN OPERATIONS 20 00 Form 990 (2013) Form 990 (2013) Page 8 Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued) (A) (B) (C) (D) (E) (F) Name and Average P05It 0n (do not check Reportable Reportable Estlmated hours per more than one box, unless compensatlon compensatlon amount of other week (IIst person IS both an of?cer from the from related compensatlon any hours and a dlrector/trustee) organlzatlon organlzatlons from the for related .5, 3 Q, I I -n (W- 2/1099- (W- 2/1099- organlzatlon organlzatlons a E. 3.1: 9 MISC) MISC) and related below c: 1,315 3 organlzatlons ll 3 dotted Me(18) DAVID RITCHIE 20 00 133,302 16,782 DIRECTOR OF CONTRACTING 20 00 (19) NOREEN KOIZUMI 20 00 143,072 19,004 DIRECTOR OF HEALTHCARE OPERATIONS 20 00 (20) CAROLE ANDERSON 20 00 113,204 15,747 DIRECTOR OF CORPORATE QUALITY 20 00 1b Sub-Total Total from continuation sheets to Part VII, Section A Total (add lines 1b and 1c) 2,698,362 0 203,118 2 Total number of IndIVIduals (Includlng but not IImIted to those Ilsted above) who recelved more than $100,000 of reportable compensatlon from the organlzatlonlr19 Yes No 3 the organlzatlon IIst any former of?cer, dlrector or trustee, key employee, or hlghest compensated employee on Me 1a? If "Yes,? complete Schedulleor such . . . . . . . No 4 For any IndIVIduaI Ilsted reportable compensatlon and other compensatlon from the organlzatlon and related organlzatlons greater than $150,000? If "Yes," complete Schedulleorsuch Individual any person Ilsted on Me 1a recelve or accrue compensatlon from any unrelated organlzatlon or IndIVIduaI for serVIces rendered to the organlzatlon? If "Yes,"complete Schedulleorsuch person . . . . . . . . No Section B. Independent Contractors 1 Complete table for yourflve hlghest compensated Independent contractors that recelved more than $100,000 of compensatlon from the organlzatlon Report compensatlon for the calendar year WIth or WIthIn the organlzatlon?s tax year (A) (B) (C) Name and busmess address of serVIces Compensatlon JAG CONSULTING LLC 4364 BONITA RD SUITE 322 BONITA CA 91902 CONSULTING SERVICES 417,662 FOLEY LARDNER LLP 402 WEST BROADWAY SUITE 2100 SAN DIEGO CA 92101 LEGAL SERVICES 167,561 MOSS ADAMS LLP 2030 MAIN STREET SUITE 1400 IRVINE CA 92614 AND AUDITING 127,830 AXENE HEALTH PARTNERS LLC 38975 SKY CANYON DR SUITE 105 MURRIETA CA 92563 ACTUARIAL SERVICES 126,569 VERISK HEALTH INC PO BOX 5992 NEW YORK NY 10087 CONSULTING SERVICES 112,720 2 Total number of Independent contractors (Includlng but not IImIted to those Ilsted above) who recelved more than $100,000 ofcompensatlon from the organlzatlon II-5 Form 990 (2013) Form 990 (2013) Page 9 Statement of Revenue CheckifScheduleO contains a response ornote to any lineinthis . . . . . (A) (B) (C) (D) Total revenue Related or Unrelated Revenue exempt busmess excluded from function revenue tax under revenue sections 512-514 1a Federated campaigns . . 1a 3 Membership dues 1b El Fundraismg events . . . . 1c Related organizations . . . 1d I'll; Government grants (contributions) 1e 16 .E All other contributions, gifts, grants, and 1f Similar amounts not included above 3 Noncash contributions included in lines 1a?1f$ 3 Total.Add lines la-lf in Ir Busmess Code 2a MEDICARE REVENUE 524114 18,019,169 18,019,169 HEALTHY FAMILY REVENUE 524114 1,143,114 1,143,114 qa 5 p? a All other program serVIce revenue Total. Add lines 2a?2f Ir 19,162,283 3 Investment income (including diVidends, interest, 469 981 469 981 and otherSImilar amounts) Income from investment of tax?exempt bond proceeds F- 5 Royalties 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 16,622,266 assets other than inventory Less cost or other ba5is and 16,771,556 sales expenses Gain or (loss) ?149,290 Net gain or (loss) .p -149.290 -149,290 8a Gross income from fundraismg events (not including 3 5 3, ofcontributions reported on line 1c) See PartIV,line 18 II a 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 . . 10a Gross sales of inventory, less returns and allowances a Less cost ofgoods sold . . Net income or (loss) from sales ofinventory . . Miscellaneous Revenue Busmess Code TPA ADMIN INCOME 900099 71,328 71,328 OTHER OPER REVENUE 900099 44,734 44,734 All other revenue Total.Addlines 11a?11d Ir 13,425,663 12 Total revenue. See Instructions 32,908,637 32,516,618 71,328 320,691 Form 990 (2013) Form 990 (2013) Statement of Functional Expenses Section 501(c)(3)and 501(c)(4) organizations must complete all columns All other organizations must complete column (A) Page 10 CheckifScheduleO containsa response or note to anyline in this PartIX . . . . . . Do not include amounts reported on lines 6b, (A) Progragrlisiemce and 7b! 8b! 9b! and 10b Of Part Total expenses expenses general expenses expenses 1 Grants and other a55istance to governments and organizations in the United States See Part IV, line 21 2 Grants and other a55istance to indIVIduals in the United States See Part IV, line 22 3 Grants and other a55istance to governments, organizations, and indIVIduals outSIde the United States See Part IV, lines 15 and 16 Benefits paid to or for members 5 Compensation of current officers, directors, trustees, and key employees 2,100,890 2,100,890 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 5,573,599 202,615 5,370,984 8 Pen5ion plan accruals and contributions (include section 401(k) and 403(b) employer contributions) 228,428 228,428 9 Other employee benefits 726,200 24,465 701,735 10 Payroll taxes 606,617 13,173 593,444 11 Fees for serVIces (non-employees) a Management Legal 250,780 250,780 Accounting 131,400 131,400 Lobbying Professmnal fundraismg serVIces See Part IV, line 17 Investment management fees 9 Other (Ifline amount exceeds 10% ofline 25, column (A) amount, list line expenses on Schedule O) 1,422,150 1,422,150 12 Advertismg and promotion 77,893 77,893 13 Office expenses 1,381,046 1,381,046 14 Information technology 1,440,772 1,440,772 15 Royalties 16 Occupancy 666,344 666,344 17 Travel 66,561 66,561 18 Payments of travel or entertainment expenses for any federal, state, or local public offICIals 19 Conferences, conventions, and meetings 7,761 7,761 20 Interest 14,497 14,497 21 Payments to affiliates 22 DepreCIation, depletion, and amortization 915,988 915,988 23 Insurance 221,901 221,901 24 Other expenses Itemize expenses not covered above (List miscellaneous expenses in line 24e Ifline 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule 0) a HEALTH FACILITY 5,413,944 5,413,944 PHARMACY MED 4,976,362 4,976,362 PROVIDER PROF FEES 3,506,215 3,506,215 CAPITATION 1,696,210 1,696,210 All other expenses 1,678,362 550,145 1,128,217 25 Total functional expenses. Add lines 1 through 24e 33,103,920 16,397,626 16,706,294 0 26 Joint costs. Complete this line only ifthe organization reported in column (B)JOint costs from a combined educational campaign and fundraismg SOIICItation Check here It iffollowmg SOP 98-2 (ASC 958-720) Form 990 (2013) Form 990 (2013) Balance Sheet Page 11 Check ifSchedule 0 contains a response or note to any line In this Part . . (A) (B) Beginning ofyear End ofyear 1 Cash?non-interest-bearing 3,753,756 1 14,739,442 2 Sayings and temporary cash investments 25,242,288 2 12,294,289 3 Pledges and grants receivable, net 3 4 Accounts receivable, net 4,032,824 4 870,109 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 disqualified persons (as de?ned 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 II ofSchedule 6 7 Notes and loans receivable, net 7 8 Inventories for sale or use 8 Prepaid expenses and deferred charges 556,857 9 592.090 10a Land, bUIldings, and eqUIpment cost or other ba5is Complete Part VI of Schedule 103 4'718'049 Less accumulated depreCIation 10b 1,025,129 3,083,783 10c 3,692,920 11 Investments?publicly traded securities 11 12 Investments?other securities See Part IV, line 11 12 13 Investments?program-related See Part IV, line 11 13 14 Intangible assets 181,913 14 0 15 Other assets See Part IV, line 11 18,124 15 18,124 16 Total assets. Add lines 1 through 15 (must equal line 34) 36,869,545 16 32,206,974 17 Accounts payable and accrued expenses 9,014,292 17 5,503,472 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 :2 22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified 7% persons Complete Part II ofSchedule 22 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 1,760,362 25 1,036,257 26 Total liabilities. Add lines 17 through 25 10.774.654 26 6.539.729 Organizations that follow SFAS 117 (ASC 958), check here It 7 and complete 3 lines 27 through 29, and lines 33 and 34. 27 Unrestricted net assets 25,794,891 27 25,367,245 28 Temporarily restricted net assets 300,000 23 300,000 29 Permanently restricted net assets 29 If Organizations that do not follow SFAS 117 (ASC 958), check here It and complete lines 30 through 34. 3 30 Capital stock or trust prinCIpal, or current funds 30 Iii-1,, 31 Paid-in or capital surplus,or and, bUIIdlng or eqUIpment fund 31 32 Retained earnings, endowment, accumulated income, or otherfunds 32 ii; 33 Total net assets or fund balances 26,094,891 33 25,667,245 2 34 Total liabilities and net assets/fund balances 36,869,545 34 32,206,974 Form 990 (2013) Form 990(2013) Page 12 Reconcilliation of Net Assets Check IfSchedule contaIns a response or note to any Me In thIs Part XI . 1 Total revenue (must equal Part column (A), Me 12) 1 32,908,637 2 Total expenses (must equal Part IX, column (A), Me 25) 2 33,103,920 3 Revenue less expenses Subtract Me 2 from Me 1 3 -195,283 4 Net assets orfund balances at begInnIng ofyear (must equal Part X, Me 33, column 4 26,094,891 5 Net unrealized gaIns (losses) on Investments 5 -232,363 6 Donated serVIces and use of 6 7 Investment expenses 7 8 WIN perIod adjustments 8 9 Other changes In net assets orfund balances (explaIn In Schedule 0) 9 0 10 Net assets orfund balances at end ofyear CombIne lInes 3 through 9 (must equal Part X, Me 33, column 10 25,667,245 Financial Statements and Reporting Check IfSchedule contaIns a response or note to any Me In thIs Part XII . I7 Yes No 1 AccountIng method used to prepare the Form 990 Cash I7 Accrual ther Ifthe organIzatIon changed Its method ofaccountIng from a prIor year or checked "Other," explaIn In Schedule 0 2a Were the organIzatIon?s fInanCIal statements compIIed 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 consolldated and separate Were the organlzatIon?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 baSIs, consolldated baSIs, or both Separate I7 Consolldated Both consolldated and separate 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 AudItAct and OMB CIrcularA-133? 3a N0 If "Yes," dId the organIzatIon undergo the reqUIred audIt or audIts'? Ifthe organIzatIon dId not undergo the 3b reqUIred audIt or audIts, explaIn why In Schedule 0 and descrIbe any steps taken to undergo such audIts Form 990 (2013) Iefile GRAPHIC print - DO NOT PROCESS IAS Filed Data - DLN: 93493318066454I SCHEDULE (Form 990) Department ofthe Treasury Ir Attach to Form 990. hr See separate instructions. Ir Information about Schedule (Form 990) lniemal Revenue Sewice and its instructions is at OMB No 1545-0047 Supplemental Financial Statements Ir Complete if the organization answered "Yes," to Form 990, 20 1 3 Part Iv, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b Open to Public Inspection Name of the organization Employer identification number COM HEALTH GROUP 95-3766170 Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990 Part IV, line 6. 1 2 3 4 5 Donor adVIsed funds Funds and other accounts Total number at end of year Aggregate contributions to (during year) Aggregate grants from (during year) Aggregate value at end ofyear Did the organization inform all donors and donor adVIsorS in writing that the assets held in donor adVIsed funds are the organization's property, subject to the organization's excluswe legal control? Yes No Did the organization inform all grantees, donors, and donor adVIsorS in writing that grant funds can be used only for charitable purposes and not for the benefit ofthe donor or donor adVIsor, or for any other purpose conferring impermiSSible private benefit? Yes N0 Conservation Easements. Complete if the organization answered ?Yes? to Form 990, Part IV, line 7. 1 Purpose(s) ofconservation easements held by the organization (check all that apply) Preservation ofland for public use (e recreation or education) Preservation ofan historically important land area Protection of natural habitat Preservation ofa certified historic structure Preservation ofopen space Complete lines 2a through 2d ifthe organization held a qualified conservation contribution in the form ofa conservation easement on the last day ofthe tax year Held at the End of the Year Total number ofconservation easements 2a Total acreage restricted by conservation easements 2b Number ofconservation easements on a certified historic structure included in 2c Number ofconservation easements included in achIred after 8/17/06, and not on a historic structure listed in the National Register 2d Number ofconservation easements modified, transferred, released, extingUIShed, or terminated by the organization during the tax year Ir Number ofstates where property subject to conservation easement IS located II- Does the organization have a written policy regarding the periodic monitoring, inspection, handling ofviolations, and enforcement ofthe conservation easements it holds? Yes No Staff and volunteer hours devoted to monitoring, inspecting, and enforcmg conservation easements during the year II- Amount ofexpenses incurred in monitoring, inspecting, and enforcmg conservation easements during the year Does each conservation easement reported on line 2(d) above satisfy the reqUIrementS ofsection and section Yes No In Part describe how the organization reports conservation easements in its revenue and expense statement, and balance sheet, and include, ifapplicable, the text of the footnote to the organization?s finanCIal statements that describes the organization?s accounting for conservation easements Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets. 1a Complete if the organization answered ?Yes" to Form 990, Part IV, line 8. Ifthe organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works ofart, historical treasures, or other Similar assets held for public exhibition, education, or research in furtherance of public serVIce, provide, in Part the text ofthe footnote to its finanCIal statements that describes these items Ifthe organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance Sheet works ofart, historical treasures, or other Similar assets held for public exhibition, education, or research in furtherance of public serVIce, prowde the followmg amounts relating to these items Revenues included in Form 990, Part line 1 Ir (ii)AssetS includedin Form 990,PartX hr$ Ifthe organization received or held works ofart, historical treasures, or other Similar assets for finanCIal gain, prowde the followmg amounts reqUIred to be reported under SFAS 116 (ASC 958) relating to these items Revenues included in Form 990, Part line 1 Ir$ Assets includedin Form 990,PartX For Paperwork Reduction Act Notice, see the Instructions for Form 990Schedule (Form 990) 2013 Schedule (Form 990) 2013 Manizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued) Page 2 3 Usmg the organization's achISItion, accessmn, and other records, check any ofthe followmg that are a Significant use of Its collection Items (check all that apply) a Public exhibition Loan or exchange programs Scholarly research Other Preservation for future generations 4 Prowde a description of the organization's collections and explain how they further the organization?s exempt purpose in Part 5 During the year, did the organization or receive donations ofart, historical treasures or other Similar assets to be sold to raise funds ratherthan to be maintained as part ofthe organization?s collection? Yes NO Part IV Escrow and Custodial Arrangements. Complete if the organization answered ?Yes" to Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21. 1a Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not included on Form 990,Part FY85 If "Yes," explain the arrangement in Part and complete the followmg table Amount Beginning balance Additions during the year Distributions during the year Ending balance 2a Did the organization include an amount on Form 990,Part X,line 21? I_Yes If"Yes," explain the arrangement in Part Check here ifthe explanation has been prowded in Part Part Endowment Funds. Complete if the organization answered ?Yes" to Form 990, Part IV, line 10. (a)Current year (b)Prior year (c)Two years back (d)Three years back (e)Four years back 1a Beginning ofyear balance Contributions Net investment earnings, gains, and losses Grants or scholarships Other expenditures forfaCIlities and programs Administrative expenses 9 End ofyear balance 2 Prowde the estimated percentage ofthe current year end balance (line lg, column held as a Board de5ignated or quaSI-endowment II- Permanent endowment II- Temporarily restricted endowment hr The percentages in lines 2a, 2b, and 2c should equal 100% 3a Are there endowment funds not in the possessmn ofthe organization that are held and administered for the organization by Yes No unrelated organizations 3a(i) (ii) related organizations . . . . . . . . . . . . . . 3a(ii) If"Yes" to 3a(ii), are the related organizations listed 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, line 11a. See Form 990, Part X, line 10. Description of property Cost or other (b)Cost or other Accum lated Book value ba5is (investment) ba5is (other) depreCIation 1a Land Leasehold improvements EqUIpment 1,277,653 438,425 839,228 Other . . . . . . . . . . . . . . . 3,440,396 586,704 2,853,692 Total. Add lines 1a through 1e (Column must equal Form 990, Part X, column (3), line Ir 3,692,920 Schedule (Form 990) 2013 Schedule (Form 990)2013 Page3 Investments?Other Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. See Form 990, Part X, line 12. Description ofsecurity or category (b)Book value Method ofvaluation (including name ofsecurity) Cost or end-of?year market value (1 )FinanCIal derivatives (2 losely-held equity interests Other Total. (Column must equal Form 990, PartX, col (B) line 12) Investments?Program Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13. Description of investment Book value Method ofvaluation Cost or end-of?year market value Total. (Column must equal Form 990, PartX, col (B) line 13) Other Assets. Complete ifthe organization answered 'Yes' to Form 990, Part IV, line 11d See Form 990, Part X, line 15 Description Book value . . . . . . . . . . . II- Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25. 1 Description of liability Book value Federal income taxes DUE TO CHG FOUNDATION 1,036,257 Total. (Column must equal Form 990, PartX, col (B) line 25) p. 1,036,257 2. Liability for uncertain tax pOSItions In Part prowde the text of the footnote to the organization's finanCIal statements that reports the organization's liability for uncertain tax pOSItions under FIN 48 (ASC 740) Check here if the text of the footnote has been provided in Part 7 Schedule (Form 990) 2013 Schedule (Form 990) 2013 Page 4 Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete If the organization answered 'Yes' to Form 990, Part IV, lIne 12a. Total revenue, gaIns, and other support per audIted fInanCIal statements . . . . . . . 1 341,171,482 2 Amounts Included on Me 1 but not on Form 990, Part Me 12 a Net unreaIIzed gaIns on Investments . . . . . . . . . . 2a -232,363 Donated serVIces and use RecoverIes of prIor year grants 2c Other(DescrIbeIn Part 2d 308,495,208 Add lInes 2a through 2d 2e 308,262,845 3 Subtract lIne 2e from Me 1 3 32,908,637 4 Amounts Included on Form 990, Part Investment expenses notIncluded on Form 990,Part 7b . 4a Other (DescrIbe In Part 4b AddlInes4aand 4b 4c 0 5 Total revenue Add ?ms 3 and 4c. (ThIs must equal Form 990, PartI,908 ,637 Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete If the organIzatIon answered 'Yes' to Form 990, Part IV, IIne 12a. Total expenses and losses per audIted fInanCIal statements . . . . . . . . . . . 1 353,066,026 2 Amounts Included on Me 1 but not on Form 990, Part IX, Me 25 a Donated serVIces and use . . . . . . . . . . 2a PrIor year adjustments 2b Otherlosses 2c Other(DescrIbe In Part 2d 319,962,106 Add lInes 2a through 2d 2e 319,962,106 3 2e fromIIne 1 3 33,103,920 4 Amounts Included on Form 990, Part IXInvestment expenses notIncluded on Form 7b . . 4a Other (DescrIbe In Part 4b AddlInes4aand 4b 4c 0 Total expenses Add lInes 3and 4c. (ThIs must equal Form 990, PartI33,103,920 Supplemental Information the descrIptIons requIred for Part II, lInes 3, 5, and 9, Part lInes 1a and 4, Part IV, lInes 1b and 2b, Part V, Me 4, Part X, Me 2, Part XI, lInes 2d and 4b, and Part XII, lInes 2d and 4b Also complete thIs part to prowde any addItIonal InformatIon Return Reference ExplanatIon PART X, LINE 2 PART XI, LINE 2D - OTHER ADJUSTMENTS 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 AND CHG CONTINUED QUALIFICATION 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 WILL BE SUSTAINED UPON POTENTIAL AUDIT OR EXAMINATION, THEREFORE, NO DISCLOSURES OF UNCERTAIN INCOME TAX POSITIONS ARE REQUIRED TOTAL REVENUE ATTRIBUTABLE TO CHG FOUNDATION 323,906,125 MANAGEMENT FEE FROM FOUNDATION (ELIMINATED IN CONSOLIDATION) -13,309,601 CHG FOUNDATION GAIN FROM SALE OF PROPERTY -2,101,316 PART XII, LINE 2D - OTHER ADJUSTMENTS TOTAL EXPENSES ATTRIBUTABLE TO CHG FOUNDATION 335,373,023 MANAGEMENT FEE FROM FOUNDATION (ELIMINATED IN CONSOLIDATION) -13,309,601 CHG FOUNDATION GAIN FROM SALE OF PROPERTY -2,101,316 Schedule (Form 990) 2013 Schedule (Form 990)2013 Pages Su lemental Information continued Return Reference Explanation Schedule (Form 990) 2013 lefile GRAPHIC print - DO NOT PROCESS IAs Filed Data - Schedule Compensation Information 0MB No 1545-0047 (Form 990) For certain Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees 2013 IF Complete if the organization answered "Yes" to Form 990, Part IV, line 23. Depariment ofthe Treasury Ir Attach to Form 990. hr See separate instruct ions. Open to P_Ubllc Internal Revenue Sewice II- Information about Schedule (Form 990) and its instructions is at InSPeCtlon Name ofthe organization COMMUNITY HEALTH GROUP 95-3766170 Questions Regarding Compensation 1a 9 Employer identification number Check the appropiate box(es) ifthe organization prowded any ofthe followmg to or for a person listed in Form 990, Part VII, Section A, line 1a Complete Part to prowde any relevant information regarding these items First-class or charter travel Housmg allowance or reSIdence for personal use Travel for companions Payments for busmess use of personal reSIdence Tax idemnification and gross-up payments Health or club dues or initiation fees Discretionary spending account Personal serVIces (e maid, chauffeur, chef) Ifany of the boxes in line 1a are checked, did the organization followa written policy regarding payment or reimbursement or prowsmn ofall ofthe expenses described above? If"No," complete Part to explain Did the organization reqUIre substantiation priorto reimbursmg or allowmg expenses incurred by all directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? Indicate which, ifany, ofthe followmg the filing organization used to establish the compensation ofthe organization's CEO/Executive Director Check all that apply Do not check any boxes for methods used by a related organization to establish compensation ofthe CEO/Executive Director, but explain in Part Compensation committee I7 Written employment contract I7 Independent compensation consultant I7 Compensation survey or study Form 990 of other organizations I7 Approval by the board or compensation committee During the year, did any person listed in Form 990, Part VII, Section A, line 1a With respect to the filing organization or a related organization Receive a severance payment or change-of?control payment? PartICIpate in, or receive payment from, a supplemental nonqualified retirement plan? PartICIpate in, or receive payment from, an eqUIty-based compensation arrangement? If"Yes" to any oflines 4a-c, list the persons and prowde the applicable amounts for each item in Part Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9. For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any compensation contingent on the revenues of The organization? Any related organization? If"Yes," to line 5a or 5b, describe in Part For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any compensation contingent on the net earnings of The organization? Any related organization? If"Yes," to line 6a or 6b, describe in Part For persons listed in Form 990, Part VII, Section A, line 1a, did the organization prowde any non-fixed payments not described in lines 5 and 6? If"Yes," describe in Part Were any amounts reported in 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 If"Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section For Paperwork Reduction Act Notice, see the Instructions for Form 990. at 5 OO 5 3T Schedule (Form 990) 2013 Schedule] (Form 990)2013 Page 2 Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed. For each indIVIduaI whose compensation must be reported In 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 indIVIduaI must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that indIVIduaI (A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and (D) Nontaxable (E) Total of (F) Compensation Base (ii) Bonus Other other deferred benefits columns reported as deferred com ensatlon ??Cent've repo'iab'e compensation (Emu-(D) .n prior Form 990 compensation compensation See Additional Data Table Schedule (Form 990) 2013 Schedule] (Form 990)2013 Page3 Supplemental Information Prowde the Information, explanation, or descriptions reqUIred for Part I, lines 1aI 1band for Part II Also complete this part for any additional information Ret urn Reference Expla nation Schedule (Form 990) 2013 Additional Data Software ID: Software Version: EIN: Name: 95?3766170 COMMUNITY HEALTH GROUP Form 990, Schedule J, Part II - Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (A) Name (B) Breakdown ofW-2 and/0r 1099-MISC compensation (C) Deferred (D) Nontaxable (E) Total ofcolumns (F) Cgmpensatlion reporte In prIor orm Bonus compensation bene?ts (D) 990 (I) Base or orm Compensatlon IncentIve compensatlon compensatIon NORMA DIAZ CHIEF (I) 520,480 0 0 7,650 12,351 540,481 0 EXECUTIVE OFFICER (II) 0 0 0 0 0 EDWARD HUTT CHIEF (I) 422,477 0 0 7,650 12,379 442,506 0 MEDICAL OFFICER (IIWILLIAM RICE CHIEF (I) 315,247 0 0 7,650 11,868 334,765 0 FINANCIALOFFICER (II) 0 0 0 0 0 JONATHAN TAMAYO (I) 220,867 0 0 6,840 15,946 243,653 0 VP INFORMATION (II) 0 0 0 0 0 SYSTEMS I ANNIWARREN CHIEF (I) 195,985 0 0 6,042 14,172 216,199 0 GOV (II) 0 0 0 0? MICHAEL (I) 232351 0 0 7,113 11,342 250,806 0 MCGARRIGLE CHIEF (II) 0 0 0 0 OPERATING OFFICER DIANE ERK (I) 170,064 0 0 5,166 10,995 186,225 0 DIRECTOR OF (II) 0 0 0 0 0 FINANCE I NORA PINTADO (I) 158,833 0 0 41791 9,630 173,254 0 DIRECTOR OF (II) 0 0 0 0 HEALTH PLAN OPERATIONS DAVID RITCHIE (I) 133302 0 0 4,115 12,667 150,084 0 DIRECTOR OF (II) 0 0 0 0 0 CONTRACTING NOREEN KOIZUMI (I) 143,072 0 0 4,467 14,537 162,076 0 DIRECTOR OF (II) 0 0 0 0 HEALTHCARE OPERATIONS lefile GRAPHIC print - DO NOT PROCESS IAs Filed Data - DLN: 93493318066454I Schedule Transactions With Interested Persons OMB ?0 1545'0047 lForm 990 or 99042) Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b. Department ofthe Treasury hr Attach to Form 990 or Form 990-EZ. See separate instructions. Open to Public Iniemal Revenue Sewice FInformation about Schedule (Form 990 or 990-EZ) and its instructions is at Inspection ame of the organization Employer identification number COMMUNITY HEALTH GROUP 95-3766170 Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only). Complete ifthe organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b 1 Name ofdisqualified person Relationship between disqualified Description oftransaction Corrected? person and organization Yes No 2 Enter the amount oftax incurred by organization managers or disqualified persons during the year under section 4958lr$ 3 Enter the amount oftax, ifany, on line 2, above, reimbursed by the organization . . . . . . . It Loans to and/or From Interested Persons. Complete ifthe organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26, or ifthe organization reported an amount on Form 990, Part X, line 5, 6, or 22 Name of Loan to (e)Origina (f)Ba ance In (i)Written interested Relationship Purpose of or from the prinCIpal due default? Approved agreement? person With loan organization? amount by organization board or committeeTotal IF I Grants or Assistance Benefitting Interested Persons. Com lete if the or anization answered "Yes" on Form 990 Part IV line 27. Name of interested Relationship between Amount ofassmtance Type ofa55istance Purpose ofa55istance person interested person and the anization For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Cat No 50056A Schedule (Form 990 or 990-52) 2013 Schedule (Form 990 or 990-EZ) 2013 Page 2 Part IV Business Transactions Involving Interested Persons. Complete if the organization answered ?Yes" on Form 990, Part IV, line 28a, 28b, or 28c. Name of interested person Relationship Amount of Description oftransaction Sharing between interested transaction of person and the organization organization's revenues? Yes No CONSULTING LLC JOSEPHA GARCIA, 417,662 HEALTHCARE No FORMER COO AND ADMINISTRATIVE HUSBAND OF NORMA CONSULTING SERVICES DIAZ, CEO Supplemental Information Prowde additional information for responses to questions on Schedule (see instructions) Ret urn Reference Explanation Schedule (Form 990 or 990-EZ) 2013 lefile GRAPHIC print - DO NOT PROCESS As Filed Data - DLN: 93493318066454I OMB No 1545-0047 35:53:33; Supplemental Information to Form 990 or 990-EZ 201 3 Complete to provide information for responses to specific questions on Form 990 or to provide any additional information. Open to Ir Attach to Form 990 or 990-EZ. Inspection II- Information about Schedule 0 (Form 990 or 990-EZ) and its instructions is at Name of the organization Employer identification number COMMUNITY HEALTH GROUP Department of the Treasury Internal Revenue Servrce 95-3766170 990 Schedule 0, Supplemental Information Return Reference Explanation FORM 990, PART VI, SECTION B, LINE 11 FORM 990, PART VI, SECTION B, LINE ANNUALLY THE BOARD OF DIRECTORS AND KEY MANAGEMENT RECEIVE REFRESHER TRAINING, 12C CONDUCTED OUTSIDE LEGAL COUNSEL, ON THE IMPORTANCE OF IDENTIFYING ANY CONFLICT OF INTEREST AND THE DISCLOSURE OF ANY REAL OR POTENTIAL CONFLICTS OF INTEREST IS AN INTEGRAL PART OF THE CULT URE AT COMMUNITY HEALTH GROUP ANY POTENTIAL CONFLICTS ARE REPORTED TO THE COMPLIANCE OFFI CER FOR INVESTIGATION AND FORM 990, PART VI, SECTION B, LINE 15 A SALARY ANALYSIS IS PREPARED BY THE HUMAN RESOURCES DEPARTMENT USING THE WARREN SURVEY, HICH IS THE ONLY SURVEY FOR THIS ANALYSIS IS THEN VALIDATED BY AN OUTSIDE CONSULTAN AN EVALUATION COMMITTEE CONSISTING OF THE CHAIRMAN OF THE BOARD AND FOUR ADDITIONAL BOA RD MEMBERS, REVIEWS THIS ANALYSIS AND MAKES A RECOMMENDATION TO THE BOARD OF DIRECTORS, WH MAKE THE FINAL DECISION THE ANALYSIS IS DONE ANNUALLY IN DECEMBER SALARY ANALYSIS ARE PREPARED BY AN OUTSIDE CONSULTANT FOR ALL EXECUTIVE POSITIONS AND SOME MANAGEMENT POSITION RESULTS ARE PRESENTED TO THE HUMAN RESOURCES DEPARTMENT RECOMMENDATIONS ARE THEN MADE TO THE CEO FOR APPROVAL FORM 990, PART VI, SECTION C, LINE 19 CONSOLIDATED AUDITED FINANCIAL STATEMENTS, INCLUDING COMMUNITY HEALTH GROUP AND COMMUNITY HEALTH GROUP FOUNDATION, ARE AVAILABLE TO THE PUBLIC ON THE DEPARTMENT OF MANAGED CARE WEB SITE THE DOCUMENTS ARE ON FILE WITH THE DEPARTMENT OF MANAGED HEALTH CARE AND CAN BE OBTAINED UNDER THE CALIFORNIA PUBLIC RECORDS ACT THE CONFLICT OF INTERES POLICY IS NOT MADE AVAILABLE TO THE PUBLIC FORM 990, PART XII, LINE 2C AUDIT COMMITTEE AND OVERSIGHT THERE HAVE BEEN NO CHANGES TO THIS PROCESS FROM PRIOR YEAR FORM 990, PART XII, LINE 2 PART IV, THE AUDITED FINANCIAL STATEMENTS ARE PREPARED ON A CONSOLIDATED LINE 12 BASIS, HOWE VER, THE ORGANIZATION MAINTAINS SEPARATE FINANCIAL RECORDS FOR EACH ENTITY THIS SEPARATE FINANCIAL INFORMATION HAS BEEN USED TO COMPLETE THE RECONCILIATION AT PART XI CONSOLIDATE INFORMATION FROM THE AUDITED FINANCIAL STATEMENTS HAS BEEN USED IN SCHEDULE D, PARTS XI XII FORM 990, PART XI, LINE 10 EXCESS OR (DEFICIT) FOR THE YEAR PER FINANCIAL STATEMENTS THE AMOUNT AT PART XI, LINE 1O DOES NOT TIE TO THE AUDITED FINANCIAL STATEMENTS AS THE AUDITED FINANCIAL STATEMENTS ARE REPARED ON A CONSOLIDATED BASIS THE AMOUNT AT PART XI IS THE EXCESS FOR COMMUNITY HEALTH GROUP ONLY AND DOES NOT INCLUDE THE EXCESS OR DEFICIT ATTRIBUTABLE TO CHG FOUNDATION THIS IS THE AMOUNT NECESSARY TO PROPERLY ROLL FORWARD NET ASSETS FOR CHG ONLY lefile GRAPHIC print - DO NOT PROCESS IAs Filed Data - DLN: 93493318066454 SCHEDULE Related Organizations and Unrelated Partnerships OMB 1545'0047 (Form 990) Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35bDepartment of the Treasury h- Attach to Form 990. h- See separate instructions. Open to Public Internal Revenue Servrce Inspection hr Information about Schedule (Form 990) and its instructions is at Name of the organization Employer identification number HEALTH GROUP 9 5-3766 170 Identification of Disregarded Entities Complete if the organization answered ?Yes" on Form 990, Part IV, line 33. (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 domICIle (state Exempt Code section Public charity status Direct controlling Section 512(b) or foreign country) (if section 501(c)(3)) entity (13) controlled entity? Yes No (1) CH6 FOUNDATION HEALTHCARE CA 9 COMMUNITY HEALTH Yes GROUP 2420 FENTON ST SUITE 100 CHULA VISTA, CA 91914 33-0586911 For Paperwork Reduction Act Notice, see the Instructions for Form 990. at 5 1 3 5 Schedule (Form 990) 2013 Schedule (Form 990) 2013 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. (C) (E) (9) 00 Name, address, and EIN of Primary actIVIty Legal Direct Predominant Share of Share of Disproprtionate Code General or Percentage related organization domICIle controlling income(related, total income end?of?year allocations? amount in box managing ownership (state or entity unrelated, assets 20 of partner? foreign excluded from Schedule K?l country) tax under (Fon'n 1065) sections 512? 514) Yes No Yes No Part IV 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. (C) (E) Name, address, and EIN of Primary actIVIty Legal Direct controlling Type of entity Share of total Share of end? Percentage Section 512 related organization domICIle entity (C corp, 5 income of?year ownership (state or foreign corp, assets controlled country) or trust) entity? Yes No Schedule (Form 990) 2013 ScheduleR(Form990)2013 Page3 Transactions With Related Organizations Complete if the organization answered "Yes? on Form 990, Part IV, line 34, 35b, or 36. Note. Complete line 1 ifany entity is listed In Parts II, or IV of this schedule Yes No 1 During the tax year, did the orgranization engage In any of the followmg transactions With one or more related organizations listed in Parts a Receipt of interest (ii) annUIties royalties or (iv) rent from a controlled entity 1a NO Gift, grant, or capital contribution to related organization(s) 1b No Gift, grant, or capital contribution from related organization(s) 1C N0 Loans or loan guarantees to or for related organization(s) 1d N0 Loans or loan guarantees by related organization(s) 19- Yes DIVldendS from related organization(s) 1f N0 9 Sale ofassets to related organization(s) 19 NO Purchase ofassets from related organization(s) 1" No i Exchange ofassets With related organization(s) 1i N0 Lease offaCIlities, eqUIpment, or other assets to related organization(s) 1i No Lease of faCIlities, eqUIpment, or other assets from related organization(s) 1k NO I Performance ofserVIces or membership orfundraismg SOIICItations for related organization(s) 1' N0 Performance ofserVIces or membership orfundraismg SOIICItations by related organization(s) 1m N0 Sharing offaCIlities, eqUIpment, mailing lists, or other assets With related organization(s) 1n N0 0 Sharing of paid employees With related organization(s) 10 N0 Reimbursement paid to related organization(s) for expenses 1P N0 Reimbursement paid by related organization(s) for expenses 1Cl Yes Othertransfer ofcash or property to related organization(s) 1r NO 5 Other transfer ofcash or property from related organization(s) 15 N0 2 Ifthe answerto any ofthe above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds (C) Name of related organization Transaction Amount involved Method of determining amount involved type (1) CH6 FOUNDATION 1,036,257 VALUE (2) CH6 FOUNDATION 13,309,601 VALUE Schedule (Form 990) 2013 Schedule (Form 990) 2013 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 of its actIVIties (measured by total assets or gross revenue) that was not a related organization See instructions regarding exc u5ion for certain investment partnerships Page 4 Name, address, and EIN of entity Prima ry activ ity (C) Legal domICIle (state or foreign country) Predominant income (related, unrelated, excluded from tax under sections 512? 514) Are all partners organizations? (6) 501(c)(3) Ya (0 Share of total income (9) Share of nd ?of? yea assets Dispropitio nate allocations? Yes Code V7UBI amount in box 20 of Schedule (Form 1065) General or managing partner? 00 Percentage ownership Yes No Schedule (Form 990) 2013 Schedule (Form 990) 2013 Page 5 Supplemental Information Prowde additional Information for responses to questions on Schedule (see Instructions) Ret urn Reference Explanation Schedule (Form 990) 2013