2021-08-05T14:27:48-05:00 2020-09-30 420714325 RSM US LLP 30 S Wacker Drive Ste 3300 Chicago IL 60606 990 2019-10-01 953619388 PIH Health Inc PIHH 5626980811 12401 Washington Boulevard Whittier CA 90602 Vid Shivaraman Chief Financial Officer 5626980811 2021-07-12 1 Rebekuh Eley P01247672 3126343400 2019 2022-09-23 18:48:47Z Vid Shivaraman 12401 Washington Boulevard Whittier CA 90602 19534886 0 X www.pihhealth.org X 1981 CA To support and to operate for the benefit of its tax-exempt affiliates. 11 11 0 13 0 0 0 0 19652080 19534886 1723662 0 342950 0 21718692 19534886 0 0 0 0 1623828 1426058 0 0 0 12505169 12764699 14128997 14190757 7589695 5344129 148487514 144594182 108993716 163922341 39493798 -19328159 X PIH Health, Inc.'s primary exempt purpose is to support and operate for the benefit of its tax-exempt affiliates: PIH Health Hospital-Whittier, PIH Health Foundation, PIH Health Physicians, PIH Health Management Corp., PIH Health Adult Day Healthcare, PIH Health Home Healthcare, PIH Health Hospital-Downey, and Good Samaritan Hospital. PIH Health, Inc. is the sole corporate member of the above listed entities. 0 0 12654747 0 19534886 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. 12654747 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 10 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 Vid Shivaraman 5626980811 12102 Washington Boulevard Whittier CA 90606 James West President & CEO 1.50 51.70 X 0 1789200 290278 Rosalio Lopez MD CSO/CMO 1.50 41.50 X 0 1118285 11067 Peggy Chulack CAO & Assistant Secretary 1.50 51.70 X 0 833977 137822 Greg Williams CFO & Asst. Treasurer (until 6/1/19) 1.50 43.20 X 0 529914 66903 Anita Chou CFO & Asst Treas. (As of 11/18/19) 1.50 51.60 X 0 117808 8 Richard Atwood Director & Chair 1.50 7.50 X X 0 0 0 Ed Dunlap Director & Treasurer (Until 9/11/20) 1.50 6.00 X X 0 0 0 Jeff Hamar 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 Paula Cowan Director 1.50 6.00 X 0 0 0 Alex Alvarez 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 Patrick Monroe Director 1.50 6.00 X 0 0 0 Robert Petrina Director (Until 10/23/19) 1.50 4.50 X 0 0 0 Paul Trienen Director (As of 11/12/19) 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 4389184 506078 0 0 1 0 RJ Construction 12107 Philadelphia Street Whittier CA 90601 Construction 713976 Beacon Security Inc 2970 E La Palma Ave Ste F Anaheim CA 92806 Security Services 377391 Encore Maintenance Service Inc 580-B W Central Avenue Brea CA 92821 Maintenance Services 341858 RSM US LLP 5155 Payshere Circle Chicago IL 60674 Professional Services 338994 Servi-Tek Inc 3970 Sorrento Valley Blvd Suite 4 San Diego CA 92121 Janitorial Services 312892 6 Related Rental 531120 19348611 19348611 Cafe Revenue 722515 186275 186275 19534886 19534886 19534886 0 0 X 1185886 1043580 142306 145902 128394 17508 94270 82958 11312 1067 1067 410167 410167 2463988 2422516 41472 47500 32050 15450 3852990 3676673 176317 32266 32266 312 312 355987 355987 5464645 4808888 655757 Equipment R&M 17233 962 16271 Licenses & Fees 13607 8229 5378 Education 3485 3485 101452 94510 6942 14190757 12654747 1536010 0 107916 130047 473213 764650 85338 117606 196758148 54222798 146817306 142535350 1003741 1046529 148487514 144594182 1515715 1572630 1444055 1369040 144385 0 6086306 6086306 99803255 154894365 108993716 163922341 X 39493798 -19328159 39493798 -19328159 148487514 144594182 X 5344129 -64166086 X 0 1 X 1 0 X X 5 PIH Health Hospital - Whittier 951934652 3 1 0 0 PIH Health Foundation 953761274 7 1 0 0 PIH Health Physicians 953942828 10 1 0 0 PIH Health Hospital - Downey 951903935 3 1 0 0 Good Samaritan Hospital 951656366 3 0 0 0 5 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 Schedule A, Part IV, Section A, Line 1: 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. Part IV, Section A, Line 5a: During the tax year ended September 30, 2020, PIH Health Inc. added a new supported organization, Good Samaritan Hospital. On December 18, 2019, the State of California Attorney General provided consent to a proposed change in control and governance of Good Samaritan Hospital (GSH), a 408-bed facility based in Los Angeles, whereby PIH Health Inc. (PIH) would effect a membership transfer of GSH to PIH. On December 23, 2019, the amended articles of incorporation for GSH were successfully filed with the California Secretary of State, and PIH became the sole corporate member of GSH. On December 31, 2019, all of the members of GSH's board of directors were removed and replaced with the same individuals comprising PIH's board of directors. Amended articles of incorporation for PIH were subsequently filed during the organization's 2020 tax year ended September 30, 2021. The purpose of the affiliation of PIH and GSH is to further the goal of expanding the integrated healthcare delivery system to improve the quality of healthcare within their communities and to further their mission of advancing the quality of care and furthering charitable services. 44344808 44344808 89045489 30268747 58776742 58059508 21335593 36723915 3992432 2618458 1373974 1315911 1315911 142535350 Intercompany Payables 154894365 154894365 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, 2020 or 2019. 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 2016 for federal purposes and 2014 for California purposes. 0 1 0 0 0 0 0 0 0 James West President & CEO 0 1257134 0 342262 0 189804 0 272003 0 18275 0 2079478 0 177030 Rosalio Lopez MD CSO/CMO 0 859313 0 160631 0 98341 0 2800 0 8267 0 1129352 0 90055 Peggy Chulack CAO & Assistant Secretary 0 599226 0 126276 0 108475 0 124412 0 13410 0 971799 0 101287 Greg Williams CFO & Asst. Treasurer (until 6/1/19) 0 388250 0 138581 0 3083 0 60011 0 6892 0 596817 0 0 Part I, Line 3 Compensation for the CEO was established and paid by PIH Health Hospital - Whittier, 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 Greg Williams Rosalio Lopez The following amounts became vested or were paid-out in 2019 and are included in Schedule J, Part II, Column (b)(iii): James West $177,030 Peggy Chulack $101,287 Rosalio Lopez $90,055 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, Ed Dunlap, Jeff Hamar, Paula Cowan, Alex Alvarez, Blayne Cutler, Jane Dicus, Patrick Monroe, Robert Petrina, Charlotte Weaver, Kenton Woods, Peter Greaney, Paul Treinen, James West, Peggy Chulack, Anita Chou, Rosalio Lopez Form 990, Part VI, Section B, line 11b Form 990 is reviewed by the Audit Committee of PIH Health, Inc., which is made up of independent directors. The Form 990 is then provided to the Board for its information. 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 1,109,123. Management and general expenses 27,672. Fundraising expenses 0. Total expenses 1,136,795. Ground Maintenance: Program service expenses 159,220. Management and general expenses 6,703. Fundraising expenses 0. Total expenses 165,923. Other Fees: Program service expenses 1,154,173. Management and general expenses 7,097. Fundraising expenses 0. Total expenses 1,161,270. Form 990, Part XI, line 9: Equity Transfer to Affiliates -64,166,086. Form 990, Part XI, Line 9, Changes in Net Assets In accordance with the requirements of California Health and Safety Code Section 1375.4(b)(1)(B) in December 2005, PIH Health, Inc. ("PIH") and PIH Health Physicians ("PHP")signed a guaranty agreement (the Guaranty). Under the terms of the Guaranty, PIH has unconditionally guaranteed all liabilities of PHP not to exceed $30 million. In fiscal year 2020, PIH made an equity transfer of $38 million to PHP. In fiscal year 2020, PIH also made equity transfers to PIH Health Hospital - Whittier and Healthmed Services for $6 million and $19 million, respectively. The Guaranty expires 10/1/2020. 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 1898252 16188440 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 Hospital - Downey 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 Hospital - Whittier 12401 Washington Boulevard Whittier CA 90602 951934652 Healthcare CA 501(c)(3) Line 3 PIH Health Inc 1 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 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 Good Samaritan Hospital 1 Samaritan Imaging Center 1225 Wilshire Blvd Los Angeles CA 90017 954252321 Outpatient Imaging Services CA 501(c)(3) Line 10 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 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 Good Samaritan Hospital 1 PIH Health Insurance Company 1003 Bishop Street Honolulu HI 96813 263760243 Captive Insurance HI PIH Health Inc T -57865 27662130 1.00000 1 PIH Health Care Solutions 6557 Greenleaf Avenue Whittier CA 90601 462072342 Healthcare CA PIH Health Inc C 1516 2932664 1.00000 1 DRMC Properties Inc 11500 Brookshire Avenue Downey CA 90241 954769768 Real Estate CA PIH Health Inc C 2312044 13475216 1.00000 1 PIH Health RE 1003 Bishop Street Honolulu HI 96813 472501390 Captive Insurance HI PIH Health Inc T -20762 1491394 1.00000 1 HealthMed Services Inc 12401 Washington Boulevard Whittier CA 90602 300831225 Healthcare CA PIH Health Inc C 3496044 20100 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 Hospital - Whittier J 4224963 FMV PIH Health Foundation J 95852 FMV PIH Health Physicians J 10917402 FMV PIH Health Physicians R 38399025 FMV PIH Health Hospital - Whittier R 6392229 FMV Healthmed Services R 19374832 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.