Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet 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.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
ALTAMED HEALTH SERVICES CORPORATION
 
Employer identification number

95-2810095
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
(1) CASTULO DE LA ROCHA   SPLIT DOLLAR LIFE INSURANCE   X 3,697,478 3,799,702   No Yes   Yes  
(2) ZOILA D ESCOBAR   SPLIT DOLLAR LIFE INSURANCE   X 890,000 914,606   No Yes   Yes  
(3) JOSE U ESPARZA   SPLIT DOLLAR LIFE INSURANCE   X 890,600 915,222   No Yes   Yes  
(4) MARIA S TORRES   SPLIT DOLLAR LIFE INSURANCE   X 1,014,826 1,042,883   No Yes   Yes  
(5) MARTIN SEROTA   SPLIT DOLLAR LIFE INSURANCE   X 770,000 779,325   No Yes   Yes  
Total ......Small Bullet $ 7,451,738
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2012
Page 2
Schedule L (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.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
    IN 2011 ALTAMED ADOPTED A SPLIT DOLLAR RETENTION AND LOAN PLAN ( THE PLAN) DESIGNED TO ASSIST ALTAMED IN RECRUITING AND RETAINING KEY EXECUTIVES AND REWARD FUTURE SERVICE. THE PLAN IS DESIGNED TO SATISFY THE FINAL REGULATIONS DEALING WITH LOANS MADE TO EXECUTIVES TO PAY PREMIUMS ON LIFE INSURANCE POLICIES THEY OWN. REPAYMENT OF THE LOANS IS SECURED BY THE CASH VALUES AND DEATH BENEFITS IN ACCORDANCE WITH TAX AND CALIFORNIA LEGAL REQUIREMENTS. IN ADDITION, THE LOANS BEAR INTEREST AND BECAUSE OF THE PLAN'S DESIGN , ALTAMED IS EXPECTED TO BE REPAID FULLY WITH THE APPLICABLE FEDERAL RATE OF INTEREST . THE LOANS ARE REPORTED ON PART X AND SCHEDULE L.
Schedule L (Form 990 or 990-EZ) 2012

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