2020-08-14T14:59:32-05:00 2019-09-30 420714325 RSM US LLP 1 S Wacker Drive Ste 800 Chicago IL 60606 990 2018-10-01 953619388 PIH Health Inc PIHH 5626980811 12401 Washington Boulevard Whittier CA 90602 Anita Chou Chief Financial Officer 5626980811 2020-08-14 1 Rebekuh Eley P01247672 3126343400 67.184.218.2 2020-08-14 14:37:07 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 64E34636FEC2DFD844E3D394C3B342543AC68841 2018 2020-11-06 18:47:13Z Anita Chou 12401 Washington Boulevard Whittier CA 90602 24175599 0 X www.pihhealth.org X 1981 CA To support and to operate for the benefit of its tax-exempt affiliates. 12 12 0 12 0 0 0 0 18188766 19652080 0 1723662 0 342950 18188766 21718692 0 0 0 0 1661944 1623828 0 0 0 11853292 12505169 13515236 14128997 4673530 7589695 154130725 148487514 122226622 108993716 31904103 39493798 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, and PIH Health Hospital-Downey. PIH Health, Inc. is the sole corporate member of the above listed entities. 0 0 12588733 0 19652080 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. 12588733 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 6 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 1 0 CA X Richard Wang 5626980811 12102 Washington Boulevard Whittier CA 90606 Richard Atwood Director & Chair 1.50 6.00 X X 0 0 0 Ed Dunlap Director & Vice Chair 1.50 4.50 X X 0 0 0 Paula Cowan Director & Secretary 1.50 4.50 X X 0 0 0 Jeff Hamar Director & Treasurer 1.50 4.50 X X 0 0 0 Alex Alvarez Director 1.50 4.50 X 0 0 0 Blayne Cutler MD PhD Director 1.50 4.50 X 0 0 0 Jane Dicus Director 1.50 4.50 X 0 0 0 Patrick Monroe Director 1.50 4.50 X 0 0 0 Robert Petrina Director 1.50 4.50 X 0 0 0 Charlotte Weaver Director 1.50 4.50 X 0 0 0 Kenton Woods Director 1.50 4.50 X 0 0 0 Peter Greaney MD Director (as of 11/13/18) 1.50 4.50 X 0 0 0 James West President & CEO 1.50 43.20 X 0 1576298 278696 Peggy Chulack CAO & Assistant Secretary 1.50 43.20 X 0 857401 130358 Greg Williams CFO & Asst Treasurer (until 6/1/19) 1.50 43.20 X 0 816748 184490 Rosalio Lopez MD CSO/CMO 1.50 43.00 X 0 989775 27062 0 4240222 620606 0 0 1 0 R J Construction 12107 Philadelphia Street Whittier CA 90601 Construction 2975141 RSM US LLP 5155 Payshere Circle Chicago IL 60674 Professional Services 372244 Encore Maintenance Service Inc 580-B W Central Avenue Brea CA 92821 Maintenance Services 360445 Servi-Tek Inc 3970 Sorrento Valley Blvd Suite 4 San Diego CA 92121 Janitorial Services 329603 Beacon Security Inc 2970 E La Palma Avenue Suite F Anaheim CA 92806 Security Services 218680 6 Related Rental 531120 19328045 19328045 Cafe Revenue 900099 324035 324035 19652080 4180569 2456907 1723662 1723662 1723662 Settlement Proceeds 900099 328500 328500 14450 14450 342950 21718692 19652080 0 2066612 X 1385741 1205595 180146 137620 119729 17891 100467 87406 13061 6095 6095 346992 346992 2555260 2516948 38312 77942 64645 13297 3286837 3145987 140850 24967 24967 1349 1349 363102 363102 5658207 4922640 735567 Licenses & Fees 12028 7535 4493 Repairs & Maintenance 6799 251 6548 Education Expenses 3485 3485 162106 154895 7211 14128997 12588733 1540264 0 127817 107916 139797 473213 9410 85338 195575455 48758149 152895618 146817306 958083 1003741 154130725 148487514 1438916 1515715 0 1444055 137270 144385 6230690 6086306 114419746 99803255 122226622 108993716 X 31904103 39493798 31904103 39493798 154130725 148487514 7589695 0 X 0 1 X 1 0 X X 4 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 4 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 44344806 44344806 89015872 27999005 61016867 56418771 18455267 37963504 3977872 2303877 1673995 1818134 1818134 146817306 Intercompany Payables 99803255 99803255 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, 2019 or 2018. 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 2015 for federal purposes and 2013 for California purposes. 0 1 0 0 0 0 0 0 0 James West President & CEO 0 1186038 0 374390 0 15870 0 256308 0 22388 0 1854994 0 0 Peggy Chulack CAO & Assistant Secretary 0 559924 0 134545 0 162932 0 114990 0 15368 0 987759 0 155437 Greg Williams CFO & Asst Treasurer (until 6/1/19) 0 630080 0 168090 0 18578 0 161705 0 22785 0 1001238 0 0 Rosalio Lopez MD CSO/CMO 0 688460 0 158159 0 143156 0 16770 0 10292 0 1016837 0 129656 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 Greg Williams Rosalio Lopez The following amounts became vested or were paid-out in 2018 and are included in Schedule J, Part II, Column (b)(iii): Rosalio Lopez $129,656 Peggy Chulack $155,437 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, James West, Peggy Chulack, Greg Williams, 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 996,410. Management and general expenses 27,710. Fundraising expenses 0. Total expenses 1,024,120. Ground Maintenance: Program service expenses 216,807. Management and general expenses 4,407. Fundraising expenses 0. Total expenses 221,214. Professional Fees: Program service expenses 3,200. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,200. Other Fees: Program service expenses 1,300,531. Management and general expenses 6,195. Fundraising expenses 0. Total expenses 1,306,726. 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 1904755 16226883 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 PIH Health Insurance Company 1003 Bishop Street Honolulu HI 96813 263760243 Captive Insurance HI PIH Health Inc T -121269 22747333 1.00000 1 PIH Health Care Solutions 6557 Greenleaf Avenue Whittier CA 90601 462072342 Healthcare CA PIH Health Inc C 4910 2949004 1.00000 1 DRMC Properties Inc 11500 Brookshire Avenue Downey CA 90241 954769768 Real Estate CA PIH Health Inc C 1864916 13627674 1.00000 1 PIH Health RE 1003 Bishop Street Honolulu HI 96813 472501390 Captive Insurance HI PIH Health Inc T 5185 2491591 1.00000 1 HealthMed Services Inc 12401 Washington Boulevard Whittier CA 90602 300831225 Healthcare CA PIH Health Inc C 1455526 100 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 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 PIH Health Hospital - Whittier J 4395593 FMV PIH Health Foundation J 96247 FMV PIH Health Physicians J 10503855 FMV PIH Health Hospital - Downey J 56127 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.