Iefile GRAPHIC print - DO NOT PROCESS IAs Filed Data - Form990 Department of the Treasury Internal Revenue Seniice Check if applicable '7 Address change Name change Initial return Terminated Amended return Application pending Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation) fy Open to PUblic organiza ion may ave 0 use a copy repor ing reqUIremen 5 Inspection A For the 2012 calendar year, or tax year beginning 01-01-2012 2012, and ending 12-31-2012 OMB No 1545-0047 2012 Name of organization COM MUNITY HEALTH GROUP Employer identification number 95-3766170 D0ing Business As Number and street (or 0 box if mail is not delivered to street address) 2420 FENTON STREET NO 100 Room/swte Telephone number (619)422-0422 City or town, state or country, and ZIP 4 CHULA VISTA, CA 91914 Name and address of prinCIpal officer WILLIAM RICE 2420 FENTON STREET NO 100 CHULA 91914 Gross receipts 52,309,404 H(a) Is this a group return for affiliates? H(b) Are all affiliates included? _ Yes No If"No," attach a list (see instructions) I Tax?exem pt status 501(c)(3) l7 501(c) 4) I (insert no) 4947(a)(1) or 527 Website:ll- COM H(c) Group exemption number Ir Form of organization '7 Corporation Trust Assooation Other Year of formation 1982 State of legal domICIIe CA 1 Briefly describe the organization's missmn or most Significant actIVIties COMMUNITY HEALTH GROUP IS A HEALTH PLAN THAT IS DEDICATED TO IMPROVEMENT AND MAINTENANCE OF HEALTH FOR OUR MEMBERS TO HELP THEM ACHIEVE OPTIMUM HEALTH WHILE DEMONSTRATING EXCEPTIONAL SERVICE AND COMPETENCY IN SERVING DIVERSE POPULATION I 2 Check this box ifthe organization discontinued its operations or disposed of more than 25% ofits net assets 35 3 Number ofvoting members ofthe governing body (Part VI, line 1a) 3 9 4 Number ofindependent voting members of the governing body (Part VI, line 1b) 4 9 5 Total number ofindIVIduals employed in calendar year 2012 (Part V, line 2a) 5 196 I: 6 Total number ofvolunteers (estimate if necessary) 6 0 7aTota unrelated busmess revenue from Part column (C), line 12 7a 74,733 Net unrelated busmess taxableincome from Form 34 7b -195,752 Prior Year Current Year 8 Contributions and grants (Part line 1h) 0 0 9 Program serVIce revenue (Part 29) 37,485,887 39,629,719 10 Investmentincome (Part 3,4,and 7d 53,501 -23,395 11 5,6d,8c,9c,10c,and11e) 11,580,556 12,550,021 12 Total revenue?add lines 8 through 11 (must equal Part column (A), line 12) 49,119,944 52,156,345 13 Grants and Similar amounts paid (Part IX, column (A), lines 1?3) 0 0 14 Benefits paid to orfor members (Part IX, column (A), line 4) 0 0 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) 8,385,841 8,895,930 16a Professmnalfundraismg fees (PartIX,co umn 11e) 0 0 Total fundraising expenses (Part column (D), line 25) F0 17 39,134,893 38,963,775 18 Totalexpenses Add lines 47,520,734 47,859,705 19 Revenue less expenses Subtract line 18 from line 12 1,599,210 4,296,640 3E Beginning of Current End of Year ?g Year 33 20 Totalassets (PartX, ine 16) 49,323,885 36,869,545 5E 21 27,574,708 10,774,654 HE 22 Net assets orfund balances Subtract line 21 from line 20 21,749,177 26,094,891 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 (other than officer) is based on all information of which preparer has any knowledge l2013?11?11 Sign Signature of officer Date Here WILLIAM RICE CFO Type or print name and title Print/Type preparer's name Preparer?s Signature Date Check PTIN Id RENIE BURBANK self?employed P00159653 al Finn's name F- MOSS ADAMS LLP Finn's EIN 91?0189318 Preparer Use only Firrn's address II- 101 SECOND STREET 9TH FLOOR Phone no (415) 956?1500 SAN FRANCISCO, CA 94105 May the IRS discuss this return With the preparer shown above? (see instructions) For Paperwork Reduction Act Notice, see the separate instructions. Cat No 11282Y I7Yes Form 990 (2012) Form 990(2012) Page2 Statement of Program Service Accomplishments . . . . . . . . . . . . . . 1 Briefly describe the organization?s missmn COMMUNITY HEALTH GROUP IS A HEALTH PLAN THAT IS DEDICATED TO IMPROVEMENT AND MAINTENANCE OF HEALTH FOR OUR MEMBERS TO HELP THEM ACHIEVE OPTIMUM HEALTH WHILE DEMONSTRATING EXCEPTIONAL SERVICE AND COMPETENCY IN SERVING DIVERSE POPULATION 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 33,015,850 including grants of (Revenue 52,105,007 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 33,015,850 Form 990 (2012) Form 990 (201220a 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, Part I 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 aSSIstance to any organIzatIon or entity located outSIde the nited States? If ?Yes,? complete ScheduleF, Parts II and IV 15 0 Did the organIzatIon report on Part IX, column (A), line 3, more than $5,000 ofaggregate grants or a55istance to IndIVIduals located outSIde the United States? If ?Yes,?complete Schedule/i 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 (2012) Form 990 (2012Part II IV Part I Page 4 Part IV Checklist of Required Schedules (continued) Did the organization report more than $5,000 ofgrants and other a55istance to any government or organization In 21 No the United States 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 and other a55istance to indIVIduals in the United States 22 on 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 ofthe 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 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 K. If ?No, go to line 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 behalf of? 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 Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified person outstanding as ofthe end ofthe organization?s tax year? If ?Yes,?complete Schedule L, 26 No 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 fol 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, or IV, 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. All Form 990 filers are reqUIred to complete Schedule 0 38 Yes Form 990 (2012) Form 990(2012) 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 1,254 Enter the number of Forms W-ZG Included In Me 1a Enter-O- 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 28 196 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,?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 Me Be 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 organIzatIon 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 ofthe goods or serVIces prOVIdedthe organIzatIon sell, exchange, or otherWIse dIspose oftangIble personal property for It was reqUIred to No If?Yes,?IndIcate the number of Forms 8282 ?led 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 (2012) Form 990(2012) 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 to any questIon 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 busmess 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 ScheduleO . . . . . 9 N0 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 taxableentItydurIngtheyearIf?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 organlzatIon to make Its Form 1023 (or 1024 IfappIIcabIe), 990, and 990-T (501(c) (3)5 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 VISTA, CA (619)498-6427 Form 990 (2012) Form 990 (2012) Page 7 Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors Check ifSchedule 0 contains a response to any question 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 a 2 ri(1) ALBERT 2 00 12,680 0 CHAIRMAN OF THE BOARD 2 00 (2) PAUL DATO 2 00 8,970 0 VICE CHAIRMAN OF THE BOARD 2 00 (3) CARLOTA SALAS 2 00 10,070 0 SECRETARY OF THE BOARD 2 00 (4) CARLOS CESENA 2 00 10,750 0 BOARD MEMBER 2 00 (5) JOSE LUIS VALDIVIA 2 00 8,780 0 BOARD MEMBER 2 00 (6) GRACE KOJIMA 2 00 9,700 0 BOARD MEMBER 2 00 (7) TITO CALSADA 2 00 10,960 0 BOARD MEMBER 2 00 (8) ANITA HOLT 2 00 9,330 0 BOARD MEMBER 2 00 (9) WILLIAM MACFARLAND 2 00 4,355 0 BOARD MEMBER 2 00 (10) NORMA DIAZ 20 00 495,195 20,577 CHIEF EXECUTIVE OFFICER 20 00 (11) EDWARD 20 00 411,068 17,510 CHIEF MEDICAL OFFICER 20 00 (12) WILLIAM RICE 20 00 304,623 19,498 CHIEF FINANCIAL OFFICER 20 00 (13) JONATHAN TAMAYO 20 00 211,855 22,853 VP INFORMATION SYSTEMS 20 00 (14) ANN WARREN 20 00 206,031 19,620 CHIEF RELATIONS 20 00 (15) MICHAEL MCGARRIGLE 20 00 192,374 9,453 CHIEF OPERATING OFFICER 20 00 (16) DIANE ERK 20 00 162,756 16,060 DIRECTOR OF FINANCE 20 00 (17) NORA PINTADO 20 00 158,778 14,437 DIRECTOR OF HEALTH PLAN OPERATIONS 20 00 Form 990 (2012) Form 990 (2012) Page 8 Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued) (A) (B) (C) (D) (E) (F) Name and Average (do not check Reportable Reportable Estlmated hours per more than one box, unless compensatlon compensatlon amount of other week (Ilst person IS both an of?cer from the from related compensatlon any hours and a dlrector/trustee) organlzatlon organlzatlons from the for related C, 3 Q, I I ?n (W- 2/1099- (W- 2/1099- organlzatlon organlzatlons a =l E. 3.1: MISC) MISC) and related below a; 1,313 3 organlzatlons ll 3 II-I dotted Me(18) DAVID RITCHIE 20 00 134,279 0 16,489 DIRECTOR OF CONTRACTING 20 00 (19) NOREEN KOIZUMI 20 00 134,274 0 21,425 DIRECTOR OF HEALTHCARE OPERATIONS 20 00 (20) CAROLE ANDERSON 20 00 116,379 0 15,955 DIRECTOR OF CORPORATE QUALITY 20 00 Total from continuation sheets to Part VII, Section A . . . . Total (add lines 2,513,207 0 193,877 2 Total number of IndIVIduals (Includlng but not IImIted to those Ilsted above) who recelved more than $100,000 of reportable compensatlon from the organlzatlonhr14 Yes No 3 the organlzatlon Ilst any former of?cer, dlrector or trustee, key employee, or hlghest compensated employee on Me 1a? If ?Yes,?complete Schedulleorsuch . . . . . . . . . . . . . . 3 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 5 any person Ilsted on Me 1a recelve or accrue compensatlon from any unrelated organlzatlon or IndIVIdual for serVIces rendered to the organlzatlon? If ?Yes,?complete Schedulleorsuch person . . . . . . . . 5 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 393,092 KP ON CALL 5855 COPLEY DR SUITE 250 SAN DIEGO CA 92111 TELEPHONE ADVICE NURSE 207,416 FOLEY LARDNER LLP 402 WEST BROADWAY SUITE 2100 SAN DIEGO CA 92101 LEGAL SERVICES 155,496 DATIFIED 1210 JEFFERSON ST SUITE PANAHEIM CA 92807 MEDICAL RECORDS RETRIEVAL 128,200 AXENE HEALTH PARTNERS LLC 38975 SKY CANYON DR SUITE 105 MURRIETA CA 92563 ACTUARIAL SERVICES 114,813 2 Total number of Independent contractors (Includlng but not IImIted to those Ilsted above) who recelved more than $100,000 ofcompensatlon from the organlzatlon II-7 Form 990 (2012) Form 990 (2012) Page 9 Statement of Revenue Check ifSchedule 0 contains a response to any question In this Part . . . . . . (A) (B) (C) (D) Total revenue Related or Unrelated Revenue exempt busmess excluded from function revenue tax under revenue sections 512, 513, or 514 1a Federated campaigns . . 1a 3 Membership dues . . . . 1b El Fundraismg events . . . . 1c Related organizations . . . 1d ., Government grants (contributions) 1e I- .E All other contributions, gifts, grants, and 1f Similar amounts not included above 3 Noncash contributions included in lines 1a?1f$ 3 Total.Add lines 1a-1f Ir Busmess Code 2a HEALTHY FAMILY REVENUE 524114 22,311,114 22,311,114 MEDICARE REVENUE 524114 17,318,605 17,318,605 qa p? a All other program serVIce revenue Total. Add lines 2a?2f Ir 39,629,719 3 Investment income (including diVidends, interest, 22 522 22 522 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 107,142 assets other than inventory Less cost or other ba5is and 153,059 sales expenses Gain or (loss) ?45,917 Net gain or (loss) .p -45.917 -45,917 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 74,733 74,733 OTHER OPER REVENUE 900099 44,564 44,564 All other revenue Total.Addlines 11a?11d Ir 12,550,021 12 Total revenue. See Instructions 52,156,345 52,105,007 74,733 -23,395 Form 990 (2012) Form 990 (2012) 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 Check ifSchedule 0 contains a response to any question in this Part IX . . . . 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 2,016,252 2,016,252 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 5,465,009 408,735 5,056,274 8 Pen5i0n plan accruals and contributions (include section 401(k) and 403(b) employer contributions) 208,585 208,585 9 Other employee benefits 644,170 49,474 594,696 10 Payroll taxes 561,914 26,640 535,274 11 Fees for serVIces (non-employees) a Management Legal 230,000 230,000 Accounting 111,000 111,000 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) 1,249,045 1,249,045 12 Advertismg and promotion 51,776 51,776 13 Office expenses 1,355,217 1,355,217 14 Information technology 1,223,320 1,223,320 15 Royalties 16 Occupancy 402,068 402,068 17 Travel 118,636 118,636 18 Payments of travel or entertainment expenses for any federal, state, or local public offICIals 19 Conferences, conventions, and meetings 7,760 7,760 20 Interest 9,635 8,193 1,442 21 Payments to affiliates 22 DepreCIation, depletion, and amortization 460,994 460,994 23 Insurance 214,291 214,291 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 10,732,296 10,732,296 PHARMACY MED 6,630,489 6,630,489 CAPITATION 6,586,610 6,586,610 PROVIDER PRO FEES 5,936,298 5,936,298 All other expenses 3,644,340 2,637,115 1,007,225 25 Total functional expenses. Add lines 1 through 24e 47,859,705 33,015,850 14,843,855 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 (2012) Form 990 (2012) Balance Sheet Page 11 Check ifSchedule 0 contains a response to any question In this Part . . (A) (B) Beginning ofyear End ofyear 1 Cash?non-interest- bearing 9,634,520 1 3,753,756 2 Savmgs and temporary cash investments 34,355,234 2 25,242,288 3 Pledges and grants receivable, net 3 4 Accounts receivable, net 2,154,569 4 4,032,824 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 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 II ofSchedule 6 7 Notes and loans receivable, net 7 8 Inventories for sale or use 8 Prepaid expenses and deferred charges 476,789 9 556,857 10a Land, bUIldings, and eqUIpment cost or other ba5is Complete Part VI of Schedule 103 3596286 Less accumulated depreCIation 10b 512,503 2,218,386 10c 3,083,783 11 Investments?publicly traded securities 102,437 11 0 12 Investments?other securities See Part IV, line 11 12 13 Investments?program-related See Part IV, line 11 13 14 Intangible assets 363,826 14 181,913 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) 49,323,885 16 36,869,545 17 Accounts payable and accrued expenses 8,544,950 17 9.014.292 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 21.615 23 0 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 19,008,133 25 1,760,362 26 Total liabilities. Add lines 17 through 25 27.574.708 26 10.774.654 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 21,449,177 27 25,794,891 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, building or equipment fund 31 32 Retained earnings, endowment, accumulated income, or otherfunds 32 ii; 33 Total net assets or fund balances 21,749,177 33 26,094,891 2 34 Total liabilities and net assets/fund balances 49,323,885 34 36,869,545 Form 990 (2012) Form 990(2012) Page 12 Reconcilliation of Net Assets Check ifSchedule 0 contains a response to any question In this Part XI . 1 Total revenue (must equal Part column (A), line 12) 1 52,156,345 2 Total expenses (must equal Part IX, column (A), line 25) 2 47,859,705 3 Revenue less expenses Subtract line 2 from line 1 3 4,296,640 4 Net assets orfund balances at beginning ofyear (must equal Part X, line 33, column 4 21,749,177 5 Net unrealized gains (losses) on investments 5 49,074 6 Donated serVIces and use of faCIlities 6 7 Investment expenses 7 8 Prior 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, line 33, column 10 26,094,891 Financial Statements and Reporting Check ifSchedule 0 contains a response to any question 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 compiled or reVIewed by an independent accountant? 2a No If?Yes,?check a box below to indicate whether the finanCIal statements for the year were compiled or reVIewed on a separate ba5is, consolidated ba5is, or both Separate ba5is Consolidated ba5is Both consolidated and separate ba5is 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 ba5is, consolidated ba5is, or both Separate I7 Consolidated Both consolidated and separate If?Yes,? to line 2a or 2b, does the organization have a committee that assumes responSIbility for overSIght of the audit, reVIew, or compilation 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 reqUIred 3b audit or audits, explain why in Schedule 0 and describe any steps taken to undergo such audits Form 990 (2012) Iefile GRAPHIC print - DO NOT PROCESS IAs Filed Data - DLN: 93493319042613I SCHEDULE OMB No 1545-0047 990? Supplemental Financial Statements 201 2 Complete if the organization answered "Yes," to Form 990, Department ofthe Treasury Part Iv, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b Open to lniemal Revenue hr Attach to Form 990. See separate instruct ions. 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) 2012 Schedule (Form 990) 2012 Manizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued) 3 a 4 5 Page 2 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) Public exhibition Scholarly research Preservation for future generations Loan or exchange programs Other Prowde a description of the organization's collections and explain how they further the organization?s exempt purpose in Part 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 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 X7 I?Yes 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 h- 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. See Form 990, Part X, line 10. Description of property Cost or other (b)Cost or other Accumulated Book value ba5is (investment) ba5is (other) depreCIation 1a Land Leasehold improvements EqUIpment 1,184,911 412,528 772,383 Other . . . . . . . . . . . . . . . 2,411,375 99,975 2,311,400 Total. Add lines 1a through 1e (Column must equal Form 990, Part X, column (3), line Ir 3,083,783 Schedule (Form 990) 2012 Schedule (Form 990) 2012 Investments?Other Securities. See Form 990, Part X, line 12. Description ofsecurity or category (b)Book value (including name ofsecurity) Page 3 Method ofvaluation Cost or end-of?year market value (1 )FinanCIal derivatives (2 losely-held eqUIty interests Other Total. (Column must equal Form 990, Part)(, col (B) line 12) Investments?Pro ram Related. See Form 990, Part X, line 13. Description of investment type Book value Method ofvaluation Cost or end-of?year market value Total. (Column must equal Form 990, PartX, col (B) line 13) Other Assets. See Form 990, Part X, line 15. Description Book value Total. (Column must equal Form 990, Part X, col.(B) line 15.) Other Liabilities. See Form 990, Part X, line 25. 1 Description of liability Book value Federal income taxes DUE TO CHG FOUNDATION 1,760,362 Total. (Column must equal Form 990, PartX, col (B) line 25) p. 1,760,362 2. Fin 48 (ASC 740) Footnote In Part prowde the text ofthe 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 prowded in Part 7 Schedule (Form 990) 2012 Schedule (Form 990)2012 Page4 Reconciliation of Revenue per Audited Financial Statements With Revenue er Return Total revenue, gaIns, and other support per audIted fInanCIal statements . . . . . . . 1 312,421,760 2 Amounts Included on Me 1 but not on Form 990, Part Me 12 a Net unreaIIzed gaIns on Investments . . . . . . . . . . 2a 49,074 Donated serVIces and use RecoverIes of prIor year grants . . . . . . . . . . . 2c Other(DescrIbeIn Part . . . . . . . . . . . . 2d 260,220,687 Add lInes 2a through 260,269,761 3 Subtract lIne 2e from 52,151,999 4 Amounts Included on Form 990, Part Me 12, but not on lIne 1 Investment expenses notIncluded on Form 990,Part 7b . 4a Other (DescrIbe In Part . . . . . . . . . . . 4b 4,346 AddlInes4aand 4,346 5 Total revenue Add lInes 3 and 4c. (ThIs must equal Form 990, PartI52,156,345 Reconciliation of Expenses per Audited Financial Statements With Expenses per Return Total expenses and losses per audIted fInanCIal statements . . . . . . . . . . . 1 315,063,759 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 267,207,354 AddlInes 2a through 267,207,354 3 Subtract lIne 2e from 47,856,405 4 Amounts Included on Form 990, Part IXInvestment expenses notIncluded on Form 7b . . 4a Other (DescrIbe In Part . . . . . . . . . . . . 4b 3,300 Add lIneS 4aand 3,300 Total expenses Add lInes 3and 4c. (ThIs must equal Form 990, PartI47,859,705 Supplemental Information Complete thIs part to prOVIde 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 prOVIde any addItIonal InformatIon IdentIerr Return Reference ExplanatIon DESCRIPTION OF UNCERTAIN PART X, LINE2 CHG AND CHG FOUNDATION HAVE EVALUATED THEIR TAX POSITIONS UNDER FIN 48 TAX POSITIONS AND THE CERTAINTY AS TO WHETHER THOSE POSITIONS WILL BE SUSTAINED IN THE EVENT OF AN AUDIT BY TAXING AUTHORITIES AT THE FEDERALAND STATE LEVELS THE PRIMARY TAX POSITIONS EVALUATED ARE RELATED TO AND CHG CONTINUED QUALIFICATION AS A TAX- EXEMPT ORGANIZATION AND WHETHER THERE IS UNRELATED BUSINESSINCOME ACTIVITIES CONDUCTED THAT WOULD BE TAXABLE MANAGEMENT HAS DETERMINED THAT ALLINCOME TAX POSITIONS WILL BE SUSTAINED UPON POTENTIAL AUDIT OR EXAMINATION, DISCLOSURES OF UNCERTAIN INCOME TAX POSITIONS ARE REQUIRED PART x1, LINE 2D - OTHER TOTAL REVENUE ATTRIBUTABLE TO CHG FOUNDATION ADJUSTMENTS 272,651,411 LESS - MANAGEMENT FEE FROM FOUNDATION (ELIMINATED IN CONSOLIDATION) - 12,430,724 PART x1, LINE 4B - OTHER AMOUNTS ATTRIBUTABLE TO COMMUNITY CARE ADJUSTMENTS COMMITTEE PART x11, LINE 2D - OTHER TOTAL EXPENSES ATTRIBUTABLE TO CHG FOUNDATION ADJUSTMENTS 279,638,078 LESS - MANAGEMENT FEE FROM FOUNDATION (ELIMINATED IN CONSOLIDATION) - 12,430,724 PART XII, LINE 4B - OTHER AMOUNTS ATTRIBUTABLE TO COMMUNITY CARE ADJUSTMENTS COMMITTEE NOTINCLUDEDINAFS 3,300 Schedule (Form 990) 2012 Iefile GRAPHIC print - DO NOT PROCESS IAS Filed Data - Schedule Compensation Information 0MB No 1545-0047 (Form 990) Department of the Treasury Part IV, question 23. lniemal Revenue hr Attach to Form 990. See separate instruct ions. Name ofthe organization COMMUNITY HEALTH GROUP For certain Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees Complete if the organization answered "Yes" to Form 990, 95-3766170 Questions Regarding Compensation 1a 9 Open to Public Inspection Employer identification number Check the appropiate box(es) ifthe organization provrded any ofthe followrng to or for a person listed in Form 990, Part VII, Section A, line 1a Complete Part to provrde any relevant information regarding these items First-class or charter travel Housrng allowance or reSIdence for personal use Travel for companions Payments for busrneSS 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 provrsron ofall ofthe expenses described above? If"No," complete Part to explain Did the organization requrre substantiation priorto reimburSing or allowrng expenses incurred by all officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? Indicate which, ifany, ofthe followrng 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? in, or receive payment from, a supplemental nonqualified retirement plan? in, or receive payment from, an equrty-based compensation arrangement? If"Yes" to any oflines 4a-c, list the persons and provrde 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? 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? to line 6a or 6b, describe in Part For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provrde any non-fixed payments not described in lines 5 and 6? 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 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) 2012 Schedule] (Form 990)2012 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) 2012 Schedule (Form 990) 2012 Supplemental Information Complete this part to prowde the Information, explanation, or descriptions reqUIred for Part I, lines 1aI 1band for Part II Also complete this part for any additional information Page 3 Identifier Ret urn Reference Explanation Schedule (Form 990) 2012 Additional Data Form 990, Schedule J, Part II - Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees Software ID: Software Version: EIN: Name: 95-3766170 COMMUNITY HEALTH GROUP Return to Form (A) Name (B) Breakdown ofW-Z and/0r 1099-MISC compensatlon (C) Deferred (D) Nontaxable (E) Total ofcolumns (F) CgmpensatlFon reporte In prIor own Base (.0 Bonus Other compensatlon bene?ts (D) 990 or Form Compensatlon Incentlve compensatlon compensatlon NORMA DIAZ (I) 495195 0 0 7,500 13,077 515,772 0 (IIEDWARD HUTT (I) 4111068 0 0 7,500 10,010 428,578 0 (IIWILLIAM RICE (I) 3041623 0 0 7,500 11,998 324,121 0 (IIJONATHAN TAMAYO (I) 211,855 0 0 6,576 16,277 234,708 0 (IIANN WARREN (I) 2061031 0 0 6,313 13,307 225,651 0 (IIMICHAEL (I) 192,374 0 0 0 9,453 201,827 0 MCGARRIGLE (IIDIANE ERK (I) 1621756 0 0 4,947 11,113 178,816 0 (IINORA PINTADO (I) 158,778 0 0 4,789 9,648 173,215 DAVID RITCHIE (I) 134,279 0 0 4,132 12,357 150,768 0 (IINOREEN KOIZUMI (I) 134,274 0 0 4,278 17,147 155,699 0 (II lefile GRAPHIC print - DO NOT PROCESS IAs Filed Data - DLN: 93493319042613I Schedule Transactions with Interested Persons OMB ?0 1545'0047 lForm 990 or 99042) It 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. Depaiimeni ofthe Treasury Ir Attach to Form 990 or Form 990-EZ. It See separate instructions. Open to Public Iniemal Revenue Sewice Inspection Name ofthe organization Employer identification number 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 3 Enter the amount oftax, ifany, on line 2, above, reimbursed by the organization . . . . . . . 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 Relationship Purpose Loan to (e)Origina (f)Ba ance In (i)Written interested With organization ofloan orfrom the prinCIpal due default? Approved agreement? person organization? amount by board or committee? To From Yes No Yes No Yes I No Total I Grants or Assistance Benefitting Interested Persons. Complete if the organization answered ?Yes" on Form 990, Part IV, line 27. Name of interested Relationship between Amount ofa55istance Type ofaSSIstance Purpose ofa55istance person interested person and the organization For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Cat No 50056A Schedule (Form 990 or 990-52) 2012 Schedule (Form 990 or 990-EZ) 2012 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, 393,092 HEALTHCARE No FORMER COO AND ADMINISTRATIVE HUSBAND OF NORMA CONSULTING SERVICES DIAZ, CEO Supplemental Information Complete this part to prowde additional information for responses to questions on Schedule (see instructions) Identifier Ret urn Reference Expla nation Schedule (Form 990 or 990-EZ) 2012 lefile GRAPHIC print - DO NOT PROCESS IAs Filed Data - SCHEDULE 0 (Form 990 or 990-EZ) Department of the Treasury Internal Revenue Senrlce Supplemental Information to Form 990 or 990-EZ Complete to provide information for responses to specific questions on OMB No 1545-0047 2012 Form 990 or to provide any additional information. Open to Public Attach to Form 990 or 990-EZ. Inspection Name of the organization COMMUNITY HEALTH GROUP Employer identification number 95-3766170 Identifier Return Explanation Reference FORM 990, THE BOARD OF DIRECTORS ENGAGES THE SERVICES OF AN INDEPENDENT PUBLIC ACCOUNTING FIRM PART VI, (MOSS ADA MS, LLP) AS OUTSIDE SERVICE PROVIDERS TO COMPLETE THE ANNUAL CERTIFIED AUDIT SECTION B, THE CERTIFIED FINANCIAL STATEMENTS ARE REVIEWED WITH AND APPROVED BY THE BOARD OF LINE DIRECTORS THE SERVICES OF MOSS ADA MS, 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 BOARD OF DIRECTORS RELIES ON THE EXPERTISE OF INTERNAL MANAGEMENT AND MOSS ADA MS, LLP FORM 990, ANNUALLY THE BOARD OF DIRECTORS AND KEY MANAGEMENT RECEIVE REFRESHER TRAINING, PART VI, CONDUCTED BY OUTSIDE LEGAL COUNSEL, ON THE IMPORTANCE OF IDENTIFYING ANY CONFLICT OF SECTION B, INTEREST AND THE DISCLOSURE OF ANY REAL OR POTENTIAL CONFLICTS OF INTEREST IS AN LINE 12C INTEGRAL PART OF THE CULTURE AT COMMUNITY HEALTH GROUP ANY POTENTIAL CONFLICTS ARE REPORTED TO THE COMPLIANCE OFFICER FOR INVESTIGATION AND FOLLOW-UP FORM 990, A SALARY ANALYSIS IS PREPARED BY THE HUMAN RESOURCES DEPARTMENT USING THE WARREN PART VI, SURVEY, WHICH IS THE ONLY SURVEY FOR THIS ANALYSIS IS THEN VALIDATED BY AN SECTION B, OUTSIDE CONSULTANT AN EVALUATION COMMITTEE CONSISTING OF THE CHAIRMAN OF THE LINE 15 BOARD AND FOUR ADDITIONAL BOARD MEMBERS, REVIEWS THIS ANALYSIS AND MAKES A RECOMMENDATION TO THE BOARD OF DIRECTORS, WHO 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 POSITIONS RESULTS ARE PRESENTED TO THE HUMAN RESOURCES DEPARTMENT RECOMMENDATIONS ARE THEN MADE TO THE CEO FOR APPROVAL FORM 990, CONSOLIDATED AUDITED FINANCIAL STATEMENTS, INCLUDING COMMUNITY HEALTH GROUP AND PART VI, COMMUNITY HEALTH GROUP FOUNDATION, ARE AVAILABLE TO THE PUBLIC ON THE DEPARTMENT SECTION C, OF MANAGED CARE WEBSITE THE DOCUMENTS ARE ON FILE WITH THE LINE 19 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 AUDIT COMMITTEE FORM 990, THERE HAVE BEEN NO CHANGES TO THIS PROCESS FROM PRIOR YEAR AND OVERSIGI-TT PART XII, LINE 2C AUDITED FORM 990, THE AUDITED FINANCIAL STATEMENTS ARE PREPARED ON A CONSOLIDATED FINANCIAL PART XII, LINE BASIS, HOWEVER, THE ORGANIZATION MAINTAINS SEPARATE FINANCIAL RECORDS FOR EACH STATEMENTS 2 PART IV, ENTITY THIS SEPARATE FINANCIAL INFORMATION HAS BEEN USED TO COMPLETE THE LINE 12 RECONCILIATION AT SCHEDULE D, PART XI CONSOLIDATED INFORMATION FROM THE AUDITED FINANCIAL STATEMENTS HAS BEEN USED IN PARTS XII EXCESS OR SCHEDULE D, THE AMOUNT AT SCHEDULE D, PART XI, LINE DOES NOT TIE TO THE AUDITED FINANCIAL (DEFICIT) FOR THE PART XI, LINE STATEMENTS AS THE AUDITED FINANCIAL STATEMENTS ARE PREPARED ON A CONSOLIDATED YEAR PER 10 BASIS THE AMOUNT AT SCHEDULE D, PART XI IS THE EXCESS FOR COMMUNITY HEALTH GROUP FINANCIAL ONLY AND DOES NOT INCLUDE THE EXCESS OR DEFICIT TO CHG FOUNDATION THIS STATEMENTS IS THE AMOUNT NECESSARY TO PROPERLY ROLL FORWARD NET ASSETS FOR CHG ONLY lefile GRAPHIC print - DO NOT PROCESS IAs Filed Data - DLN: 93493319042613 . . . OMBN 1545-0047 SCHEDULE Related Organizations and Unrelated Partnerships 0 (Form 990) Complete if the organization answered "Yes" to Form 990, Part IV, line 33Attach to Form 990. hr See separate instructions. Department of the Treasury Internal Revenue Servrce Open to Public Inspection Employer identification number Name of the organization COMMUNITY HEALTH GROUP 9 5-3766 170 Identification of Disregarded Entities (Complete if the organization answered ?Yes? to Form 990, Part IV, line 33.) (C) (0 Name, address, and EIN (if applicable) of disregarded entity Primary actIVIty Legal (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" to 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 domICIIe (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) 2012 Schedule (Form 990) 2012 Page 2 Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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" to 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) 2012 ScheduleR(Form990)2012 Page3 Transactions With Related Organizations (Complete if the organization answered "Yes" to 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 other organization Transaction Amount involved Method of determining amount involved type (1) CH6 FOUNDATION 1,760,362 VALUE (2) CH6 FOUNDATION 12,430,724 VALUE Schedule (Form 990) 2012 Schedule (Form 990) 2012 Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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 Primary actIVIty (C) Legal domICIle (state or foreign country) Predominant income (related, unrelated, excluded from tax under section 512? 514) Are all partners section 501(c)(3) organizations? Yes No (0 Share of total income (9) Share of end ?of? yea assets Disproprtionate allocations? Yes No Code amount in box 20 of Schedule (Form 1065) General or managing paitner7 00 Percentage ownership Yes Schedule (Form 990) 2012 Additional Data Software ID: Software Version: EIN: Name: Schedule (Form 990) 2012 Supplemental Information Complete part to prowde Informatlon for responses to questlons on Schedule (see Instructlons) 95-3766170 COMMUNITY HEALTH GROUP Return to Form Page 5 Identifier Return Reference Explanation