2022-08-10T16:42:06-05:00 2021-09-30 420714325 RSM US LLP 210 Park Ave Suite 1725 Oklahoma City OK 73102 990 2020-10-01 953619388 PIH Health Inc PIHH 5626980811 12401 Washington Boulevard Whittier CA 90602 Vid Shivaraman CFO 5626980811 2022-08-08 1 Vid Shivaraman 999009999 Lauren Nowakowski P01796934 4052397961 2022-08-09 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z James West 12401 Washington Boulevard Whittier CA 90602 19647393 0 X www.pihhealth.org X 1981 CA To support and to operate for the benefit of its tax-exempt affiliates. 11 11 0 11 0 0 0 0 19534886 19647393 0 0 0 0 19534886 19647393 0 0 0 0 1426058 1555974 0 0 0 12764699 12645976 14190757 14201950 5344129 5445443 144594182 139222706 163922341 192753641 -19328159 -53530935 X PIH Health, Inc.'s primary exempt purpose is to support and operate for the benefit of its tax-exempt affiliates: PIH Health Whittier Hospital, PIH Health Foundation, PIH Health Physicians, PIH Health Management Corp., PIH Health Adult Day Healthcare, PIH Health Home Healthcare, PIH Health Downey Hospital, and PIH Health Good Samaritan Hospital. PIH Health, Inc. is the sole corporate member of the above listed entities. 0 0 12239069 0 19647393 Providing technical, facility and support services for tax-exempt affiliates whose charitable purpose is to provide a broad range of health care services to their community by way of an integrated health care delivery system. 12239069 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 4 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 1 0 CA X Mark Kawauchi 5626980811 12102 Washington Boulevard Whittier CA 90606 James West President & CEO 1.50 51.70 X 0 2804484 309663 Rosalio Lopez MD CSO/CMO 1.50 41.50 X 0 1635578 205137 Peggy Chulack CAO & Assistant Secretary 1.50 51.70 X 0 911398 150543 Anita Chou CFO & Asst Treas. (until 2/3/21) 1.50 51.60 X 0 732572 21929 Vid Shivaraman CFO & Asst Treasurer 1.50 51.60 X 0 360336 70274 Jeff Hamar Director & Chair 1.50 6.00 X X 0 0 0 Patrick Monroe Director & Vice Chair 1.50 6.00 X X 0 0 0 Charlotte Weaver Director & Secretary 1.50 6.00 X X 0 0 0 Alex Alvarez Director & Treasurer 1.50 6.00 X X 0 0 0 Richard Atwood Director 1.50 7.50 X 0 0 0 Paula Cowan Director 1.50 6.00 X 0 0 0 Blayne Cutler MD PhD Director 1.50 6.00 X 0 0 0 Jane Dicus Director 1.50 6.00 X 0 0 0 Paul Trienen Director 1.50 6.00 X 0 0 0 Kenton Woods Director 1.50 6.00 X 0 0 0 Peter Greaney MD Director 1.50 6.00 X 0 0 0 0 6444368 757546 0 0 1 0 RSM US LLP 5155 Payshere Circle Chicago IL 60674 Professional Services 666898 Encore Maintenance Service Inc 580-B W Central Avenue Brea CA 92821 Maintenance Services 436308 Servi-Tek Inc 3970 Sorrento Valley Blvd Suite 4 San Diego CA 92121 Janitorial Services 378921 Beacon Security Inc 2970 E La Palma Ave Ste F Anaheim CA 92806 Security Services 188531 4 Related Rental 531120 19417070 19417070 Cafe Revenue 722515 230323 230323 19647393 19647393 19647393 0 0 X 1291155 1097482 193673 160928 136789 24139 103891 88307 15584 583956 583956 2078715 2037279 41436 76020 37885 38135 3683009 3497457 185552 42215 42215 2677 2677 87205 87205 5353877 4550795 803082 Bad Debt 584766 584766 Equipment R&M 15585 591 14994 Licenses & Fees 12372 7070 5302 Education 1705 1705 123874 113443 10431 14201950 12239069 1962881 0 130047 0 764650 425774 117606 7085 198366523 59576676 142535350 138789847 1046529 0 144594182 139222706 1572630 1395736 1369040 1294024 6086306 154894365 190063881 163922341 192753641 X -19328159 -53530935 -19328159 -53530935 144594182 139222706 X 5445443 -39648219 X 0 1 X 1 0 X X 5 PIH Health Whittier Hospital 951934652 3 0 0 0 PIH Health Foundation 953761274 7 0 0 0 PIH Health Physicians 953942828 10 0 0 0 PIH Health Downey Hospital 951903935 3 0 0 0 PIH Health Good Samaritan Hospital 951656366 3 0 0 0 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 Schedule A, Part IV, Section A, Line 1: PIH Health Inc.'s governing documents provide that the organization will support the existence, activities, and operations of its related charitable, tax-exempt organizations. The supported organizations are designated by class or purpose within the meaning of Section 501(c)(3) of the Internal Revenue Code of 1986 ("the Code") by conducting or supporting activities for the benefit of, performing the functions of, or carrying out the purposes of qualified organizations promoting the health of the community within the meaning of Section 501(c)(3) of the Code. 44344806 44344806 89455352 32487395 56967957 58125628 24168768 33956860 4042947 2920513 1122434 2397790 2397790 138789847 Intercompany Payables 190063881 190063881 X Part X, Line 2: The principal operations of the Company are exempt from income taxes pursuant to Internal Revenue Code (IRC) Section 501(c)(3) and the laws of the states in which it operates and, as such, is generally not subject to federal or state income taxes. However, the Company is subject to income taxes on net income derived from a trade or business regularly carried on that does not further the organization's exempt purpose. Further, the Company is also subject to federal excise taxes pursuant to the Tax Cuts and Jobs Act. No significant income tax provision has been recorded in the accompanying consolidated financial statements for net income derived from unrelated trade or business and excise taxes. The Company measures liabilities for unrecognized tax uncertainties in accordance with ASC 740, Income Taxes, which prescribes a comprehensive model for how a company should recognize, measure, present and disclose in its financial statements uncertain tax positions that a company has taken or expects to take on a tax return. The guidance is applicable to profit-oriented entities, pass-through entities and tax-exempt organizations. Management believes it has no significant uncertain tax positions and, as such, no tax liability, benefits, interest or penalties were accrued at September 30, 2021 or 2020. The Company is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. The Company believes it is no longer subject to income tax examinations for years prior to 2017 for federal purposes and 2015 for California purposes. 0 1 0 0 0 0 0 0 0 James West President & CEO 0 1347488 0 275638 0 1181358 0 290280 0 19383 0 3114147 0 1168584 Rosalio Lopez MD CSO/CMO 0 837160 0 107647 0 690771 0 195921 0 9216 0 1840715 0 397219 Peggy Chulack CAO & Assistant Secretary 0 698611 0 82933 0 129854 0 136456 0 14087 0 1061941 0 122666 Anita Chou CFO & Asst Treas. (until 2/3/21) 0 675702 0 50000 0 6870 0 7800 0 14129 0 754501 0 0 Vid Shivaraman CFO & Asst Treasurer 0 354174 0 0 0 6162 0 64019 0 6255 0 430610 0 0 Part I, Line 3 Compensation for the CEO was established and paid by PIH Health Whittier Hospital, a related organization. PIH used the following to establish the CEO's compensation (1) compensation committee, (2) independent compensation consultant, (3) Form 990 of other organizations, (4) compensation survey or study, (5) approval by the board. Part I, Line 4b PIH Health Inc. and its affiliates provides a Supplemental Executive Retirement Plan for certain executives. The following individuals participate in the plan: Peggy Chulack James West Anita Chou Vid Shivaraman Rosalio Lopez The following amounts became vested or were paid-out in 2020 and are included in Schedule J, Part II, Column (b)(iii): James West $1,168,584 Peggy Chulack $122,666 Rosalio Lopez $397,219 Form 990, Part VI, Section A, line 2 PIH Health, Inc. is a member of an integrated healthcare system. The following individuals have a business relationship by virtue of their positions as officer or directors of related entities within the system: Richard Atwood, Jeff Hamar, Paula Cowan, Alex Alvarez, Blayne Cutler, Jane Dicus, Patrick Monroe, Charlotte Weaver, Kenton Woods, Peter Greaney, Paul Treinen, James West, Peggy Chulack, Anita Chou, Rosalio Lopez, Vid Shivaraman Form 990, Part VI, Section B, line 11b The Organization works with an independent accountant, RSM US LLP, to prepare the Form 990. Once the return is prepared, the return is reviewed by the Chief Financial Officer and VP of Finance. Form 990 is then reviewed by the Audit Committee of PIH Health, Inc., which is made up of independent directors. RSM US LLP makes all changes necessary. The final Form 990 is provided to the board prior to filing. Form 990, Part VI, Section B, line 12c Each year, all management and board of directors members are required to complete a conflict of interest disclosure form. All positive responses are reviewed by the General Counsel and Chief Administrative Officer of PIH Health, Inc. Each positive response is considered in light of magnitude of ownership interest, financial transaction(s), etc. If deemed necessary, conflicts of interest could be resolved by insisting that the incumbent either divest their ownership interest, that the organization terminate the business relationship, or even that the director resign. Directors with potential conflicts of interest may recuse themselves from voting on certain matters and/or may excuse themselves from meetings during the discussion, deliberation, and voting on of matters. Form 990, Part VI, Section C, line 19 The organization does not make its governing documents, conflict of interest policy, and financial statements available to the public. Form 990 and Form 990-T are available upon request. The organization is not required to make Form 1023 available for public inspection as it received its tax exemption prior to July 15, 1987. Form 990, Part IX, line 11g R&M Building: Program service expenses 675,438. Management and general expenses 26,246. Fundraising expenses 0. Total expenses 701,684. Ground Maintenance: Program service expenses 186,036. Management and general expenses 6,095. Fundraising expenses 0. Total expenses 192,131. Other Fees: Program service expenses 1,175,805. Management and general expenses 9,095. Fundraising expenses 0. Total expenses 1,184,900. Form 990, Part XI, line 9: Equity Transfer to Affiliates -39,648,219. Form 990, Part XI, Line 9, Changes in Net Assets In order to meet the requirements of Title 28 of the California Code of Regulations Section 1300.76, in fiscal year 2021 PIH made an equity transfer of $24.6 million to PHP. In fiscal year 2021, PIH also made equity transfers to PIH Health Management Corp, PIH Health Whittier Hospital, and Healthmed Services for $12.7 million, $1.2 million, and $1.1 million, respectively. Form 990, Part VI, Section B, Line 16b: PIH Health Inc. holds a 12.5% interest in a joint venture arrangement that exists to further the charitable and community-based health care purposes, mission, vision, and values of its controlling tax exempt members. PIH Health Inc. annually evaluates its participation in joint venture arrangements. PIH Health Real Estate Services LLC 12401 Washington Boulevard Whittier CA 90602 464560794 Real Estate CA 1542780 15521557 PIH Health Inc KDW Real Estate Investments LLC 12401 Washington Boulevard Whittier CA 90602 472604215 Real Estate CA 0 0 PIH Health Inc Putnam Real Estate Properties LLC 12401 Washington Boulevard Whittier CA 90602 472596628 Real Estate CA 0 0 PIH Health Inc PIH Health Physicians 6557 Greenleaf Ave Whittier CA 90601 953942828 Healthcare CA 501(c)(3) Line 10 PIH Health Inc 1 PIH Health Downey Hospital 11500 Brookshire Avenue Downey CA 90241 951903935 Healthcare CA 501(c)(3) Line 3 PIH Health Inc 1 PIH Health Management Corp 12401 Washington Boulevard Whittier CA 90602 954016278 Support of Tax-Exempt Affiliates CA 501(c)(3) Line 12b, II PIH Health Inc 1 PIH Health Home Healthcare 12401 Washington Boulevard Whittier CA 90602 953036281 Support of Tax-Exempt Affiliates CA 501(c)(3) Line 12b, II PIH Health Inc 1 PIH Health Adult Day Healthcare 12401 Washington Boulevard Whittier CA 90602 953643829 Support of Tax-Exempt Affiliates CA 501(c)(3) Line 12b, II PIH Health Inc 1 PIH Health Foundation 12401 Washington Boulevard Whittier CA 90602 953761274 Fundraising CA 501(c)(3) Line 7 PIH Health Inc 1 PIH Health Whittier Hospital 12401 Washington Boulevard Whittier CA 90602 951934652 Healthcare CA 501(c)(3) Line 3 PIH Health Inc 1 PIH Health Good Samaritan Hospital 1225 Wilshire Blvd Los Angeles CA 90017 951656366 Hospital CA 501(c)(3) Line 3 PIH Health Inc 1 Good Samaritan Institute of Research and Education 1225 Wilshire Blvd Los Angeles CA 90017 954077161 Heart Research CA 501(c)(3) Line 4 PIH Health Good Samaritan Hospital 1 Orthopedic Institute of Good Samaritan Hospital 1225 Wilshire Blvd Los Angeles CA 90017 954346048 Orthopedic Research CA 501(c)(3) Line 12a, I PIH Health Good Samaritan Hospital 1 Samaritan Imaging Center 1225 Wilshire Blvd Los Angeles CA 90017 954252321 Outpatient Imaging Services CA 501(c)(3) Line 10 PIH Health Good Samaritan Hospital 1 Good Samaritan Medical Office Building Inc 1225 Wilshire Blvd Los Angeles CA 90017 953244046 Physicians Medical Offices CA 501(c)(3) Line 12a, I PIH Health Good Samaritan Hospital 1 Kate Van Nuys Page Foundation 1225 Wilshire Blvd Los Angeles CA 90017 956028032 Grants income to PIH Health Good Samaritan Hospital CA 501(c)(3) Line 12a, I PIH Health Good Samaritan Hospital 1 PIH Health Insurance Company 1003 Bishop Street Honolulu HI 96813 263760243 Captive Insurance HI PIH Health Inc T 34118445 1.00000 1 PIH Health Care Solutions 6557 Greenleaf Avenue Whittier CA 90601 462072342 Healthcare CA PIH Health Inc C 33425946 3329143 1.00000 1 DRMC Properties Inc 11500 Brookshire Avenue Downey CA 90241 954769768 Real Estate CA PIH Health Inc C 2385057 13072580 1.00000 1 PIH Health RE 1003 Bishop Street Honolulu HI 96813 472501390 Captive Insurance HI PIH Health Inc T -952 1447769 1.00000 1 HealthMed Services Inc 12401 Washington Boulevard Whittier CA 90602 300831225 Healthcare CA PIH Health Inc C 8944490 131748 1.00000 1 Pioneer Medical Group Inc 12401 Washington Boulevard Whittier CA 90602 330927283 Medical Services CA N/A C 1 Pioneer Provider Network A Medical Group Inc 12401 Washington Boulevard Whittier CA 90602 330922631 Management Services CA N/A C 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 PIH Health Physicians J 11135576 FMV PIH Health Whittier Hospital J 3045927 FMV PIH Health Downey Hospital J 919434 FMV PIH Health Physicians R 24637811 FMV PIH Health Management Corp R 12650306 FMV PIH Health Whittier Hospital R 1231717 FMV Healthmed Services R 1128385 FMV Part IV, Column (E): PIH Insurance Company is an unincorporated risk retention group. Part IV, Column (E): PIH Health Care Solutions is a nonprofit mutual benefit corporation.