2022-08-12T16:47:24-05:00 2021-09-30 420714325 RSM US LLP 30 S Wacker Drive Ste 3300 Chicago IL 606063392 990 2020-10-01 951903935 PIH Health Downey Hospital PIHH 5629045000 11500 Brookshire Avenue Downey CA 90241 Vid Shivaraman CFO 5626980811 2022-08-12 1 Vid Shivaraman XXX-XX-XXXX Rebekuh Eley P01247672 3126343400 2022-08-12 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z X X James West 12401 Washington Blvd Whittier CA 90602 190107791 0 X www.PIHHealth.org X 1956 CA To provide quality healthcare and contribute to the community's health and well-being. 14 12 1551 287 0 0 13928066 5870397 173080155 183463593 0 0 120746 543682 187128967 189877672 515553 0 0 0 107400801 115711771 0 0 0 76192182 82502122 184108536 198213893 3020431 -8336221 167862077 167649888 247295300 255419332 -79433223 -87769444 X Mission: We provide high quality healthcare without discrimination, and contribute to the health and well-being of our communities in an ethical, safe, and fiscally prudent manner in recognition of our charitable purpose. 0 0 99006606 0 131138390 Patient Care: PIH Health Downey Hospital officially became part of PIH Health in October 2013. As a 501 (c)(3) nonprofit, 199-bed hospital, the Downey campus has provided quality care in a welcoming environment for almost 100 years.Patient Care in Fiscal Year 2020-2021Employees 1,146Volunteers 270Number of Emergency Department (ED) Visits 45,817Medical Staff 420 70217972 0 51150163 Financial Assistance and Means-Tested Government Programs: Financial Assistance, also known as charity care, is defined as free or discounted health services provided to individuals who cannot afford to pay and who meet the eligibility criteria of the organization's financial assistance policy. PIH Health offers a generous Financial Assistance Program, providing charity care to those with family income(s) at or below 400% of Federal Poverty Level guidelines.In providing services to those patients participating in means-tested government health programs, such as Medi-Cal, PIH Health realizes a collective net loss each fiscal year due to the shortfall created when the payments received from these programs are less than the cost of caring for public program beneficiaries. Number of persons served by financial assistance and means-tested government programs: 28,855 5946297 0 1175040 See Schedule OOther Community Benefit Services: Community health improvement services and community benefit operations, Health professions education, Subsidized health services, cash and in-kind contributions are comprised of the following: COMMUNITY HEALTH IMPROVEMENT SERVICES: Defined as community health improvement activities, which extend beyond patient care activities. These programs include: Community Helpline and Enrollment Assistance.Snapshot of Outcomes:1,244 community members were reached through a variety of community health improvement activities.HEALTH PROFESSIONS EDUCATION: This category includes educational programs for physicians, nurses, students and other health professionals when education is necessary or required by state law, accrediting body or health profession society. PIH Health programs include the Family Medicine Residency Program, and Student Education (internship, externship, preceptorship and mentoring programs).Snapshot of Outcomes:66 student nurses, physician residents and other individuals studying to become healthcare professionals were provided with mentorship, preceptorship and training opportunities.SUBSIDIZED HEALTH SERVICES: Subsidized services are clinical programs, which are provided despite a financial loss so significant that negative margins remain after removing the effects of financial assistance, bad debt and Medi-Cal shortfalls. Nevertheless, the service is provided because it meets an identified community need and, if no longer offered, would either be unavailable in the area or fall to the responsibility of government or another nonprofit organization to provide. PIH Health services provided include Emergency Department On-Call Physicians.Snapshot of Outcomes:Some 87 individuals were served by subsidized health services. CASH & IN-KIND CONTRIBUTIONS: This category includes funds and in-kind services donated by PIH Health to community organizations or to the community-at-large for a community benefit purpose. These donations include cash donations to community organizations, hours contributed by staff to the community while on PIH Health work time, the cost of meeting space provided to community groups, and the donations of equipment, medications, supplies and services. Snapshot of Outcomes:656 at-risk individuals were provided with in-kind durable medical equipment, clothing or services, such as skilled nursing or mental healthcare.For additional information, please refer to PIH Health's community benefit report at: PIHHealth.org/CBAnnualReport 175170875 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 51 0 1 1551 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 12 1 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 CA X Mark Kawauchi 5626980811 12102 Washington Blvd Whittier CA 90606 X Jung Yong Park MD Medical Director 5.00 1.50 X 62655 0 0 Mark Minkes MD Director 6.50 0.00 X 47250 0 0 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 PhD 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 Peter Greaney MD Director 1.50 6.00 X 0 0 0 Sushil Ojha MD Director 1.50 0.00 X 0 0 0 Paul Treinen Director 1.50 6.00 X 0 0 0 Kenton Woods Director 1.50 6.00 X 0 0 0 James West President and CEO 10.00 43.20 X 0 2804484 309663 Rosalio Lopez MD CSO/CMO 10.00 33.00 X 0 1635578 205137 Peggy Chulack CAO & Asst. Secretary 10.00 43.20 X 0 911398 150543 Anita Chou CFO & Asst. Treasurer (Until 2/3/21) 10.00 43.10 X 0 732572 21929 Richard Trogman President & Sys. COO (Until 10/23/20) 40.00 0.00 X 0 607420 128293 Vid Shivaraman CFO & Asst. Treasurer 10.00 43.10 X 0 360336 70274 Ceonne Houston-Rassikh CNO 40.00 0.00 X 0 284308 86685 Jaime Diaz MD CMO (until 6/8/20) 20.00 20.00 X 476480 0 28770 Lela Rosales RN Charge Nurse 40.00 0.00 X 273581 0 23823 Linda Buddine RN Charge Nurse 40.00 0.00 X 252495 0 36457 Rosalie Madden RN Charge Nurse 40.00 0.00 X 227271 0 27927 Sandra Torres RN Charge Nurse 40.00 0.00 X 200664 0 5618 Muriel Moyo RN Clinical Dir. (Until 8/27/21) 40.00 0.00 X 195092 0 7452 Ramona Pratt Former CNO 0.00 40.00 X 0 406749 99542 1735488 7742845 1202113 279 1 1 0 Sodexo Inc & Affiliates PO Box 360170 Pittsburgh PA 15251 Dietary Services 1963745 Emergency Associates Corp PO Box 9350 Rancho Santa Fe CA 92067 Professional Services 1523013 Cross Country Staffing PO Box 404689 Atlanta GA 30384 Staffing Services 1477743 DLS Builders Inc 1975 N Batavia Street Orange CA 92665 Construction Services 1213428 Allied Universal 161 Washington Street Ste 600 Conshohocken PA 19428 Security Services 1075481 13 121033 5749364 5870397 Net Patient Revenue 622110 161951952 161951952 Hospital Fee Program 900099 21425433 21425433 Food Services 722514 86208 86208 183463593 230070 230119 -49 -49 -49 Medical Training 900099 18500 18500 Settlements, Purch. Discounts 900099 4713 4713 520518 520518 543731 189877672 183463593 0 543682 1603153 1018404 584749 86489054 73515696 12973358 2471953 2101160 370793 18594172 15805046 2789126 6553439 5570423 983016 24000 24000 25714 25714 19571664 18202857 1368807 9344 9218 126 3297183 2981844 315339 54261 54261 3319778 3146470 173308 4029 4029 15259 15204 55 4250946 4250946 6887377 5854270 1033107 1367674 1367674 Medical Supplies 22919452 22688250 231202 Quality Assurance Fee 11132634 11132634 Bad Debt Expense 5768007 5768007 Equipment R&M and Lease 2484546 2212849 271697 1370254 893568 476686 198213893 175170875 23043018 0 2097345 33503 22067159 23401792 3399618 2930420 421120 531249 169468853 48391367 118361383 121077486 21515452 19675438 167862077 167649888 19022794 19540998 228272506 235878334 247295300 255419332 X -79433223 -87769444 -79433223 -87769444 167862077 167649888 -8336221 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 25714 25714 0 Part II-B, Line 1, Lobbying Activities: Explanation: A portion of dues paid to Hospital Association of Southern California and American Hospital Association is related to lobbying. PIH Health Downey Hospital does not participate in or intervene in (including the publishing or distributing of statements), any political campaign on behalf of (or in opposition to) any candidate for public office. 14497365 14497365 57638020 7854405 49783615 25158406 10389392 14769014 45675421 29918306 15757115 26499641 229264 26270377 121077486 Hospital Fee Program Receivable 19088767 Other Receivables 586671 19675438 Intercompany Payable 206655758 Hospital Fee Payable 10135693 Self-Insurance Reserves 6289252 Estimated Third Party Payor Settlement 541283 Government Advances 12256348 235878334 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. 1 1 X 1 X 1 X 1 1 1 0 1 1 0 304 1115692 339327 776365 0.00400 0 28551 69102280 50810836 18291444 0.09500 0 0 28855 70217972 51150163 19067809 0.09900 2 1244 256394 256394 0.00130 3 66 3639692 1175040 2464652 0.01280 1 87 1819789 1819789 0.00950 0 0 2 658 230422 230422 0.00120 8 2055 5946297 1175040 4771257 0.02480 8 30910 76164269 52325203 23839066 0.12380 1 1 168 168 0.00000 1 2 1117 1117 0.00000 2 3 1285 1285 0.00000 1 5768007 26520203 24689983 1830220 X 1 1 1 1 PIH Health Downey Hospital 11500 Brookshire Ave Downey CA 90241 www.pihhealth.org License #930000048 X X X X PIH Health Downey Hospital 1 0 0 1 X X X X X X X X X X 18 1 1 0 1 X https://www.pihhealth.org/about-us/community-benefit/ X X 1 19 1 https://www.pihhealth.org/about-us/community-benefit/ 0 1 X 100.000000000000 400.000000000000 X X X X X X 1 1 X X X X 1 X See Part V, Page 8 X See Part V, Page 8 X See Part V, Page 8 X X X X X X 1 X 0 X X X X 1 X 0 0 PIH Health Downey Hospital Part V, Section B, Line 3j: The community health needs assessment includes data, maps and information regarding social determinants of health, health status and life expectancy, access to healthcare, mental health, alcohol, substance and tobacco use, physical activity, nutrition and weight status, reproductive health, acute and chronic disease, leading causes of death, community perspectives gathered from focus groups and interviews, and progress on the implementation strategy. PIH Health Downey Hospital Part V, Section B, Line 5: Primary data collection consisted of 23 key stakeholder interviews and 14 community focus groups (138 participants) regarding perceptions and opinions of those representing the broad interests of the communities in our primary service area. Interview participants included agencies representing a broad range of health and social services, including leaders and representatives of medically underserved, low-income and minority populations as well the local health department that have current information relevant to the health needs of the communities we serve. Focus group participants included members of medically underserved, low-income and minority populations, individuals or organizations serving the interests of these populations, and persons representing the broad interest of the community. Focus groups were conducted in both English and Spanish.The full listing of interview and focus groups can be found in Appendix B of the assessment found here: https://www.pihhealth.org/app/files/public/5021/2019-CHNA-Downey.pdf PIH Health Downey Hospital Part V, Section B, Line 6a: PIH Health Downey Hospital's CHNA was conducted with PIH Health Whittier Hospital, St. Francis Medical Center and Kaiser Permanente Downey Medical Center. Shared service areas and community partners allowed for coordinated interviews and focus groups and sharing of data/results. PIH Health Downey Hospital Part V, Section B, Line 7d: Assessment findings were also distributed to key stakeholders via email with emphasis on supporting program planning and fund-development endeavors, sharing organizations the expense of duplicative data collection efforts. Assessment findings are also shared on an on-going basis via presentations at community events and community collaborative meetings, through social media channels and via our organization's e-newsletter and mailed magazine that reaches over 350,000 residents collectively. PIH Health Downey Hospital Part V, Section B, Line 11: PIH Health's Community Health Improvement Plan (CHIP) ensures alignment of CHNA findings, our community health improvement programs and PIH Health's organizational strategy. To view the 2020-2022 CHIP and the initiatives identified to address areas of focus (cancer incidence/mortality, diabetes incidence/mortality, heart disease/stroke incidence/mortality, overweight/obesity, substance use and misuse, preventative screenings and immunizations with emphasis on flu and pneumonia vaccines and cancer screenings, food insecurity, housing/homelessness, dental care and mental health), visit https://www.pihhealth.org/about-us/community-benefit/. For the health needs not prioritized as areas of focus - access to healthcare, asthma incidence, birth indicators, economic insecurity, education, kidney disease mortality, liver disease mortality, sexually transmitted infections, violence and injury - it was determined that PIH Health has neither the expertise nor the infrastructure to lead efforts in these areas. As these health needs are still very important to PIH Health and the community it serves, emphasis will be placed on referral relationships with community-based agencies already working in these areas. PIH Health Downey Hospital Part V, Section B, Line 13b: Assistance is provided free or discounted for those patients eligible for FAP. The criteria for FAP is if the patient is uninsured and does not have the ability to pay, has restricted Medi-Cal benefits, or is underinsured. This is also considerations for patients where the FPG is not applicable and the patient is insured with inadequate coverage or excessive liability. PIH Health Downey Hospital Part V, line 16a, FAP website: https://www.pihhealth.org/patients-visitors/billing-financial-assistance/financial-assistance/ PIH Health Downey Hospital Part V, line 16b, FAP Application Website: https://www.pihhealth.org/patients-visitors/billing-financial-assistance/financial-assistance/ PIH Health Downey Hospital Part V, line 16c, FAP Plain Language Summary Website: https://www.pihhealth.org/patients-visitors/billing-financial-assistance/financial-assistance/ 1 1 - PIH Health Downey Hosp Rehabilitation 11420 Brookshire Ave Downey CA 90241 Outpatient Therapy Part I, Line 6a: PIH Health's Community Benefit Report, prepared annually, accounts for the organization's programs and services that promote the health of the community. The report separates out community benefit investment figures for each hospital. The report was made widely available to the public via social media, our organization's website and a community e-newsletter. It will also be shared with certain internal and community stakeholders via presentation.To view the full report, visit PIHHealth.org/cbannualreport Part I, Line 7: Patient care cost-to-charges ratio derived from worksheet 2 was used to calculate the financial assistance. For all others, we utilized internal costing system and accounts for the various payer mix. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 5,768,007. Part II, Community Building Activities: PIH Health works with a variety of community stakeholders to enhance the collective capacity for addressing the root causes of health problems. PIH Health staff supported a local community service club by participating in their meetings/activities. Civic clubs improve the civic and cultural wellbeing of the community. PIH Health also undertakes disaster preparedness training above and beyond licensure requirements to ensure we are effectively prepared to serve the community in a disaster. Part III, Line 2: The provision for bad debts is based upon management's assessment of historical and expected net collections, taking into consideration historical business and economic conditions, trends in health care coverage, and other collection indicators. Management routinely assesses the adequacy of the allowances for uncollectible accounts based upon historical write-off experience by payor category. The company follows established guidelines for placing certain patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by each facility. The provision for bad debts is presented on the consolidated statements of operations as a deduction from patient services revenues (net of contractual allowances and discounts) since the company accepts and treats all patients without regard to the ability to pay. Part III, Line 4: As part of the Company's mission to serve the community, the Company provides care to patients even though they may lack adequate insurance or may participate in programs with negotiated or regulated payment amounts. The Company makes every effort to determine if a patient qualifies for charity care upon admission, though determination may also be made at a later time. After satisfaction of amounts due from insurance, the application of any financial, uninsured or other discounts or payments received on the account, and reasonable efforts to collect from the patient have been exhausted, the Company follows established guidelines for placing certain past-due patient balances with collection agencies, subject to certain restrictions on collection efforts as determined by the Company. The Company manages its collection risk by regularly reviewing its accounts and contracts, and by providing appropriate allowances that are netted against patient accounts receivable in the consolidated balance sheets.Implicit price concessions is based upon management's assessment of historical and expected net collections, taking into consideration historical business and economic conditions, trends in healthcare coverage and other collection indicators. Management routinely assesses the adequacy of the implicit price concessions based upon historical write-off experience by payor category. The Company follows established guidelines for placing certain patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by each facility. Implicit price concessions is included as a deduction from patient services revenues since the Company generally accepts and treats all patients without regard to the ability to pay. Part III, Line 8: The Company does not take the position that Medicare shortfall should be treated as community benefit. The State has specifically asked us to report this separately from our community benefit totals. The Company uses a cost-to-charge (C2C) ratio to determine Medicare allowable costs of care relating to payment received from Medicare, which is similar to the IRS Form 990, Schedule H method. However, the PIH Health system is more refined and exacting, since it is generated at the department level and includes both direct costs and allocated company-wide indirect costs. All period indirect costs are allocated between PIH Health departments based on their relative gross charges. The sum of the direct and allocated indirect costs of each department are divided by the total department gross procedure charges. The resulting department specific percentage, i.e., department C2C %, is loaded into PIH Health's ERP software each quarter. The cost system applies the department's C2C % to all procedure charges originating within the department in order to compute the related procedure costs. As such, all cost information reflected in PIH Health's regulatory reporting and financial analysis is based on the above department C2C methodology. Part III, Line 9b: The hospital encourages all self-pay patients to apply for financial assistance or other programs. 1. All uninsured patients are assumed to need financial assistance and automatically receive discounted bills that reflect the contract rate or less of a Medicare Advantage contract.2. All uninsured patients are provided with a financial assistance and Medicaid application at the time of registration thereby giving them the opportunity to apply for assistance.3. There are signs through the facility that educate patients and visitors about the availability of financial assistance.4. The hospital's website publishes the financial assistance policy and applications.5. Self-pay inpatients also may be contacted by a vendor to offer assistance in applying for Medicaid, if eligible.6. Statements (which reflect a reduction in charges to the rates at or lower than contracted rates for Medicare Advantage members) promote the hospital's financial assistance program.7. Only patients who do not qualify for further financial assistance (after discounts) or who do not apply for programs and do not pay are referred to collection. In addition, if a patient is referred to collection and later applies for charity and qualifies, the patient's account is returned to the hospital and financial assistance is extended. Part VI, Line 2: In addition to the hospital's CHNA, PIH Health utilizes the following methods to assess the health care needs of the communities it serves: Community Benefit Oversight Committee- In 2006, PIH Health's Board of Directors established the Community Benefit Oversight Committee (CBOC), which is comprised of community stakeholders and key public health and legislative representatives. This committee meets regularly and its members share healthcare-related needs/concerns experienced by the community members they represent as well as assets or potential partners for the hospital to engage in addressing the identified needs.Feedback from Community Organizations / Collaborative- Through participation in various community collaborative and networking meetings, PIH Health is able to assess the healthcare needs of the community and identify partnership opportunities. Part VI, Line 3: There are many avenues PIH Health takes in educating patients and family members about the various financial assistance programs. Patient are advised at the time of service, during in-house care and post discharges. Free handouts of the FAP application are provided in both english and spanish. There ae postings throughout the hospital in both english and spanish with information about our FAP program. We have an eligibility vendor that is conveniently available to assist our patients in the emergency room or in-house patients with determining eligibility for various governmental programs, as well as, advise and assist the patient with the FAP. Post discharge, our Business Office staff takes the initiative to advise the patient of our FAP program. Also, with the initial statement sent to patients, an application is included. PIH Health's FAP is also published on our website. Part VI, Line 4: PIH Health Downey Hospital is located in a mostly suburban area of southeastern Los Angeles County. The hospital's primary service area includes 11 zip codes in 11 cities / communities. Primary service area cities include:Bell / Bell Gardens / Cudahy 90201Bellflower 90706Downey 90240, 90241, 90242Huntington Park 90255Lynwood 90262Norwalk 90650Paramount 90723Pico Rivera 90660South Gate 90280Primary Service Area ProfileThe population for PIH Health Downey Hospital's primary service area is 760,867.Population demographics: Children and youth (ages 0-17) make up 27.4% of the population; older adults (ages 65+) make up 9.5% of the population. The largest population by race and ethnicity in the service area is Hispanic or Latino (82.4%). White/Caucasians make up 7.5% of the population. Asians comprise 4.9% of the population, and African Americans, Native Americans, Hawaiians, and other races combined total 5.3% of the population.Income & Poverty: The median household income in the service area is $50,712. Some 19.4% of the service area population lives below 100% of the Federal Poverty Level and 47.8% live below 200%. Health Insurance: 82.6% of the service area is insured, 92.4% of children 0-18 are insured and 75.8% of adults ages 19-64 are insured. There are nine other hospitals providing care in the service area population and one federally-designated medically underserved areas present in the service area. For additional data regarding the service area, please see the CHNA at https://www.pihhealth.org/about-us/community-benefit/ Part VI, Line 5: Community BoardPIH Health's community Board of Directors works to advance PIH Health's commitment to helping our communities get well and stay healthy.Open Medical StaffPIH Health extends medical staff privileges to all qualified physicians in its community for some or all of its departments or specialties.Use of Surplus FundsPIH Health applies surplus funds toward improvements in patient care, technology, and medical education.Community Benefit Oversight Committee (CBOC)In 2006, PIH Health's Board of Directors established the CBOC, comprised of community stakeholders and a public health representative. The CBOC promotes the health of the community by 1) reviewing and validating legal and regulatory compliance with respect to community benefit mandates, 2) reviewing and validating that PIH Health's community benefit programs and services effectively meet identified community health needs, with emphasis on vulnerable populations, as an essential expression of PIH Health's charitable mission and 3) increasing public awareness of community benefit activities and community value.Donation of TimeMany PIH Health providers are living out their passion to serve people in need by donating their time and talents both in our community and overseas. Emergency and Disaster Preparedness/Disaster Resource Center (DRC) PIH Health Whittier Hospital is one of 13 Los Angeles County designated DRC's that ensure the community has access to resources and the highly skilled staff needed to respond to a large-scale disaster or other public health emergencies.Environmental and Recycling ProjectsPIH Health continues to implement "green" initiatives, including increased usage of LED lighting to decrease consumption of electricity and, expanding a methane gas project with the City of Whittier to convert methane gas into electricity. Eyeglasses and hearing aids are also collected and recycled for redistribution by the East Whittier Lions Club to those in need.Volunteer Contributions Some 1,282 PIH Health System volunteers collectively contributed 111,535 hours of service, supporting departments throughout the organization.Reach Out and Read Program Our Pediatrics Department partners with Reach Out and Read to promote early literacy and school readiness. Physicians provide patients with a children's book and discuss with parents the importance of reading aloud. Each year, over 4,912 new books are distributed. Part VI, Line 6: PIH Health Downey Hospital is a member of an integrated healthcare system controlled by PIH Health, Inc. As such, the hospital has several affiliates, as outlined in Schedule R, which conduct, support, and promote the health of the community within the meaning of Section 501(c)(3) of the code. Key affiliates include: 1) PIH Health, Inc., PIH Health Downey Hospital's parent company; 2) PIH Health Good Samaritan Hospital; 3) PIH Health Whittier Hospital 4) PIH Health Physicians, a nonprofit medical foundation; 5) PIH Health Home Healthcare and 6) the PIH Health Foundation, a nonprofit organization that exists to raise philanthropic funds in support of PIH's charitable mission.1) PIH Health, Inc. provides technical, facility and support services for tax-exempt affiliates whose charitable purpose is to provide a broad range of healthcare services to their community by way of an integrated health care delivery system.2) PIH Health Good Samaritan Hospital founded in 1885, became part of PIH Health in December 2019. As a 501 (c)(3) nonprofit, 408-bed acute care hospital, the downtown Los Angeles campus serves the healthcare needs of a growing and diverse community. As a nonnprofit hospital with a charitable mission, PIH Health Good Samaritan Hospital is a dedicated community health and wellness partner. This commitment and leadership gives back to the community through charity care, medical research, donations, health professions education and more.3) PIH Health Whittier Hospital opened in 1959. As a 501 (c)(3) nonprofit, 523-bed hospital, the Whittier campus has developed into a health system offering a multitude of services. As a nonnprofit hospital with a charitable mission, PIH Health Whittier Hospital is a dedicated community health and wellness partner. This commitment and leadership gives back to the community through charity care, medical research, donations, health professions education and more.4) PIH Health Physicians (PHP) A 501(c)(3) nonprofit medical group that is exclusively affiliated with PIH Health, the group is comprised of more than 150 primary care physicians and over 245 specialists who coordinate care from diagnosis to recovery. PHP supports the local community through its financial assistance program, Whittier First Day Health & Wellness Center for the homeless and those at-risk for homelessness, health professions education, and other community health improvement services.5) PIH Health Home Healthcare provides around-the-clock, quality care for patients in their own home. PIH Health Home Healthcare is certified by the Centers for Medicare and Medicaid Services.6) The PIH Health Foundation raises funds in support of PIH Health to ensure the health and well-being of our communities for years to come through supporting programs that directly impact the community, including PIH Health's community benefit programs. Healthy Living Healthy Giving is an opportunity for everyone to play a role in the overall health of their friends, family, neighbors and everyone who lives, works, learns and plays in our community. Gifts big, small and all will support PIH Health's work to provide access to quality healthcare, screenings, preventative care, prevention-focused education and other important initiatives.For detailed information regarding these PIH Health affiliates' additional activities to support and promote community health, please see each respective organization's IRS Form 990. Part VI, Line 7, Reports Filed With States CA 1 1 0 0 0 0 0 0 0 James West President and 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 & Asst. Secretary 0 698611 0 82933 0 129854 0 136456 0 14087 0 1061941 0 122666 Anita Chou CFO & Asst. Treasurer (Until 2/3/21) 0 675702 0 50000 0 6870 0 7800 0 14129 0 754501 0 0 Richard Trogman President & Sys. COO (Until 10/23/20 0 453234 0 0 0 154186 0 128141 0 152 0 735713 0 19604 Ramona Pratt Former CNO 0 360192 0 39783 0 6774 0 80111 0 19431 0 506291 0 0 Jaime Diaz MD CMO (until 6/8/20) 419160 0 0 0 57320 0 7800 0 20970 0 505250 0 0 0 Vid Shivaraman CFO & Asst. Treasurer 0 354174 0 0 0 6162 0 64019 0 6255 0 430610 0 0 Ceonne Houston-Rassikh CNO 0 277340 0 0 0 6968 0 68654 0 18031 0 370993 0 0 Lela Rosales RN Charge Nurse 273581 0 0 0 0 0 10348 0 13475 0 297404 0 0 0 Linda Buddine RN Charge Nurse 248813 0 0 0 3682 0 12786 0 23671 0 288952 0 0 0 Rosalie Madden RN Charge Nurse 226221 0 0 0 1050 0 6764 0 21163 0 255198 0 0 0 Sandra Torres RN Charge Nurse 196717 0 1500 0 2447 0 1822 0 3796 0 206282 0 0 0 Muriel Moyo RN Clinical Dir. (Until 8/27/21) 184100 0 2500 0 8492 0 6032 0 1420 0 202544 0 0 0 Part I, Line 3 Compensation for the CEO was established and paid by PIH Health Whittier Hospital (PIH), 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, Lines 4a-b Part I, Line 4A: Richard Trogman received a severance payment during the calendar year. The payment is included in Part VII, Column D (E) and Schedule J, Part II, Column B(iii). The terms and conditions of the confidential severance agreement are available to the Internal Revenue Service upon request. 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 Richard Trogman Ramona Pratt Ceonne Houston-Rassikh 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 Rosalio Lopez $397,219 Peggy Chulack $122,666 Richard Trogman $19,604 Explanation for filing Amended Form 990: PIH Health Downey Hospital is amending the Form 990 with year ended September 30, 2021 to attach a copy of the amendment to the articles of incorporation and proof of filing with the appropriate state authority as required for a legal name change that hasn't been reported to the Internal Revenue Service. The amended Form 990 is being filed before the extended due date of August 15, 2022. Form 990, Part VI, Section A, line 2 PIH Health Downey Hospital is a member of an integrated healthcare system controlled by PIH Health, Inc. 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, Paul Treinen, Charlotte Weaver, Kenton Woods, Peter Greaney, James West, Peggy Chulack, Anita Chou, Rosalio Lopez, Vid Shivaraman. Form 990, Part VI, Section A, line 4 On May 6, 2021, the organization changed its name to PIH Health Downey Hospital. Form 990, Part VI, Section A, line 6 PIH Health, Inc. Is the sole member of PIH Health Downey Hospital. Form 990, Part VI, Section A, line 7a PIH Health, Inc. has authority to elect all the members of the Board of Directors of PIH Health Downey Hospital. Form 990, Part VI, Section A, line 7b PIH Health, Inc. has all voting rights and the power to elect the Board of Directors of PIH Health Downey Hospital. 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 is 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 VII, Section A, Line 1: Three of the filing organization's directors, Mark Minkes, Jung Yong Park and Rosalio Lopez, are employees of PIH Health Downey Medical Group (DMG), Inc. which has a professional service agreement with PIH Health Physicians, an affiliate of the filing organization, to provide physician services. The individuals received compensation from DMG as follows: Mark Minkes: Reportable Base Compensation - $543,573 Other Compensation - $50,647 Jung Yong Park: Reportable Base Compensation - $569,577 Other Compensation - $29,331 Rosalio Lopez: Reportable Base Compensation - $63,985 Other Compensation - $0 PIH Health Foundation 12401 Washington Blvd Whittier CA 90602 953761274 Fundraising CA 501(c)(3) Line 7 PIH Health Inc 1 PIH Health Management Corp 12401 Washington Blvd 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 Blvd Whittier CA 90602 953036281 Support of Tax-Exempt Affiliates CA 501(c)(3) Line 12b, II PIH Health Inc 1 PIH Health Inc 12401 Washington Blvd Whittier CA 90602 953619388 Support of Tax-Exempt Affiliates CA 501(c)(3) Line 12b, II N/A 0 PIH Health Adult Day Healthcare 12401 Washington Blvd Whittier CA 90602 953643829 Support of Tax-Exempt Affiliates CA 501(c)(3) Line 12b, II PIH Health Inc 1 PIH Health Whittier Hospital 12401 Washington Blvd Whittier CA 90602 951934652 Healthcare CA 501(c)(3) Line 3 PIH Health Inc 1 PIH Health Physicians 6557 Greenleaf Ave Whittier CA 90601 953942828 Healthcare CA 501(c)(3) Line 10 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 for 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 the 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 Good Samaritan Hospital CA 501(c)(3) Line 12a, I PIH Health Good Samaritan Hospital 1 DRMC Properties Inc 11500 Brookshire Avenue Downey CA 90241 954769768 Real Estate CA N/A C 1 PIH Health RE 1003 Bishop Street Honolulu HI 96813 472501390 Captive Insurance HI N/A T 1 PIH Insurance Co A Reciprocal Risk Retention Group 1003 Bishop Street Honolulu HI 96813 263760243 Captive Insurance HI N/A T 1 PIH Health Care Solutions 6557 Greenleaf Avenue Whittier CA 90601 462072342 Healthcare CA N/A C 1 Healthmed Services Inc 12401 Washington Blvd Whittier CA 90602 300831225 Healthcare CA N/A C 1 Pioneer Medical Group Inc 12401 Washington Blvd Whittier CA 90602 330927283 Medical Services CA N/A C 1 Pioneer Provider Network A Medical GroupInc 12401 Washington Blvd Whittier CA 90602 330922631 Management Services CA N/A C 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 PIH Health Foundation C 121033 Cash