2018-08-15T13:10:12-05:00 2017-09-30 420714325 RSM US LLP 1 S WACKER DRIVE STE 800 CHICAGO IL 60606 990 2016-10-01 953619388 PIH HEALTH INC PIHH 5626980811 12401 WASHINGTON BOULEVARD WHITTIER CA 90602 GREG WILLIAMS CHIEF FINANCIAL OFFICER 5626980811 2018-08-13 1 WAYNE HARDER P00294296 3126343400 2016 2022-09-23 18:48:47Z GREG WILLIAMS 12401 WASHINGTON BOULEVARD WHITTIER CA 90602 16481517 0 X N/A X 1981 CA TO SUPPORT AND TO OPERATE FOR THE BENEFIT OF ITS TAX-EXEMPT AFFILIATES. 14 14 0 14 31926 30926 0 0 12522644 16389871 915275 0 4118242 55562 17556161 16445433 0 0 0 0 1639274 1691301 0 0 0 10959836 11172108 12599110 12863409 4957051 3582024 138176544 146777389 114564083 119709424 23612461 27067965 X PIH HEALTH, INC.'S PRIMARY EXEMPT PURPOSE IS TO SUPPORT AND TOOPERATE FOR THE BENEFIT OF ITS TAX-EXEMPT AFFILILATES: 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 10423304 16389871 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. 10423304 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 0 0 0 1 7 0 1 0 1 1 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 CA X GREG WILLIAMS 5626980811 12401 WASHINGTON BOULEVARD WHITTIER CA 90602 JANE DICUS DIRECTOR & CHAIR 1.50 4.50 X X 0 0 0 EFRAIN ACEVES DIRECTOR & VICE CHAIR 1.50 6.00 X X 0 0 0 THOMAS KING DIRECTOR & SECRETARY 1.50 4.50 X X 0 0 0 KENTON WOODS DIRECTOR & TREASURER 1.50 4.50 X X 0 0 0 RICHARD ATWOOD DIRECTOR 1.50 6.00 X 0 0 0 JAMES BALL DIRECTOR 1.50 4.50 X 0 0 0 PAULA COWAN DIRECTOR 1.50 4.50 X 0 0 0 ED DUNLAP DIRECTOR 1.50 4.50 X 0 0 0 FRANK GOMEZ PHD DIRECTOR 1.50 4.50 X 0 0 0 ROBERT PETRINA DIRECTOR 1.50 4.50 X 0 0 0 HUEY-MIN YU DIRECTOR 1.50 4.50 X 0 0 0 JEFF HAMAR DIRECTOR 1.50 3.00 X 0 0 0 PATRICK MONROE DIRECTOR 1.50 3.00 X 0 0 0 CHARLOTTE WEAVER DIRECTOR 1.50 3.00 X 0 0 0 JAMES WEST PRESIDENT & CEO 1.50 44.70 X 0 1311324 234548 PEGGY CHULACK CAO & ASSISTANT SECRETARY 1.50 44.70 X 0 709623 109060 GREG WILLIAMS CFO & ASSISTANT TREASURER 1.50 43.20 X 0 572298 175957 ROSALIO LOPEZ MD CSO/CMO 1.50 43.00 X 0 1054869 110446 MITCHELL THOMAS FORMER CFO FORMER CFO/SR VP OF FINANCE 0.00 X 0 165452 19754 0 3813566 649765 0 1 1 0 R J CONSTRUCTION 12107 PHILADELPHIA STREET WHITTIER CA 90601 CONSTRUCTION 1831224 DELOITTE & TOUCHE LLP 555 W 5TH STREET SUITE 2700 LOS ANGELES CA 90013 PROFESSIONAL SERVICES 583195 SERVI-TEK INC 3970 SORRENTO VALLEY BOULEVARD SUI SAN DIEGO CA 92121 JANITORIAL SERVICES 285784 ENCORE MAINTENANCE SERVICE INC 580-B W CENTRAL AVENUE BREA CA 92821 MAINTENANCE SERVICES 207189 BEACON SECURITY INC 2970 E LA PALMA AVENUE SUITE F ANAHEIM CA 92806 SECURITY SERVICES 177602 9 RELATED RENTAL 900099 16084843 16084843 CAFE REVENUE 900099 305028 305028 16389871 91646 36084 55562 55562 31926 23636 16445433 16389871 31926 23636 X 1431552 365939 1065613 158024 37794 120230 101725 14266 87459 5850 5850 447320 447320 2026635 1865830 160805 65387 42541 22846 2858603 2718001 140602 18241 18241 378002 378002 4936672 4852396 84276 LICENSES & FEES 10894 7710 3184 REPAIRS & MAINTENANCE 8836 1309 7527 MEDICAL SUPPLIES 4272 4272 EDUCATION EXPENSES 3703 3703 407693 133666 274027 12863409 10423304 2440105 0 964945 112714 815672 12416 666455 555308 184520237 39133626 135279957 145386611 449515 710340 138176544 146777389 5254193 2952774 122370 129606 6498489 6367960 102689031 110259084 114564083 119709424 X 23612461 27067965 23612461 27067965 138176544 146777389 3582024 -126520 0 X 0 1 X 1 0 X X 6 PIH HEALTH HOSPITAL - WHITTIER 951934652 3 1 0 0 PIH HEALTH HOME HEALTHCARE 953036281 10 1 0 0 PIH HEALTH FOUNDATION 953761274 7 1 0 0 PIH HEALTH ADULT DAY HEALTHCARE 953643829 10 1 0 0 PIH HEALTH PHYSICIANS 953942828 10 1 0 0 PIH HEALTH HOSPITAL - DOWNEY 951903935 3 1 0 0 6 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 36707410 36707410 89953705 24008559 65945146 43770996 10930448 32840548 3795544 1700773 2094771 10292582 2493846 7798736 145386611 INTERCOMPANY PAYABLES 110259084 110259084 X PART X, LINE 2: THE COMPANY HAS ESTABLISHED ITS STATUS AS AN ORGANIZATION EXEMPT FROM INCOME TAXES UNDER THE INTERNAL REVENUE CODE (THE CODE) 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, WHICH DOES NOT FURTHER THE ORGANIZATION'S EXEMPT PURPOSE. NO SIGNIFICANT INCOME TAX PROVISION HAS BEEN RECORDED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS FOR NET INCOME DERIVED FROM UNRELATED TRADE OR BUSINESS. 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 BE TAKEN ON A TAX RETURN. THE COMPANY HAS NOT RECORDED A LIABILITY FOR UNRECOGNIZED TAX UNCERTAINTIES IN 2017 OR 2016. 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 2013 FOR FEDERAL PURPOSES AND 2011 FOR CALIFORNIA PURPOSES. 1 1 0 0 0 0 0 0 0 JAMES WEST PRESIDENT & CEO 0 981202 0 314603 0 15519 0 215373 0 19175 0 1545872 0 0 PEGGY CHULACK CAO & ASSISTANT SECRETARY 0 508559 0 116344 0 84720 0 102618 0 6442 0 818683 0 68461 GREG WILLIAMS CFO & ASSISTANT TREASURER 0 515986 0 50000 0 6312 0 156501 0 19456 0 748255 0 0 ROSALIO LOPEZ MD CSO/CMO 0 606781 0 109813 0 338275 0 97231 0 13215 0 1165315 0 326454 MITCHELL THOMAS FORMER CFO FORMER CFO/SR VP OF FINANCE 0 0 0 0 0 165452 0 18000 0 1754 0 185206 0 58710 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, LINES 4A-B PART I, LINE 4A: IN 2016, SEVERANCE PAYMENTS WERE MADE IN ACCORDANCE WITH THE WRITTEN SEVERANCE PLAN TO MITCHELL THOMAS FOR $165,452. 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 MITCHELL THOMAS ROSALIO LOPEZ THE FOLLOWING AMOUNTS BECAME VESTED OR WERE PAID-OUT IN 2016 AND ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III): ROSALIO LOPEZ $326,454 PEGGY CHULACK $68,461 MITCHELL THOMAS $58,710 FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED BY THE AUDIT COMMITTEE OF THE PARENT ORGANIZATION, WHICH IS MADE UP OF INDEPENDENT DIRECTORS. THE FORM 990 IS THEN PROVIDED TO THE BOARD FOR ITS INFORMATION AND APPROVAL. 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 CHIEF ADMINISTRATIVE OFFICER AND GENERAL COUNSEL. 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 B, LINE 15 THE ORGANIZATION'S EXECUTIVE COMPENSATION COMMITTEE ENGAGES AN INDEPENDENT, THIRD-PARTY, EXPERT COMPENSATION CONSULTANT TO REVIEW ITS EXECUTIVE SALARIES. THE CONSULTANT OBTAINS SPECIFIC ORGANIZATIONAL DATA FROM WHICH TO BASE ITS ANALYSIS (REVENUES, EXPENSES, EMPLOYEES, SERVICE AREA, JOB DESCRIPTIONS, ETC.). THE CONSULTANT'S ANALYSIS INCLUDES A REVIEW OF COMPENSATION TRENDS, REGULATORY ISSUES, THE ORGANIZATION'S EXECUTIVE COMPENSATION PHILOSOPHY, THE METHODOLOGY USED FOR THE ASSESSMENT, THE BASE SALARY ANALYSIS, THE INCENTIVE COMPENSATION ANALYSIS, THE TOTAL CASH COMPENSATION ANALYSIS, AND THE TOTAL COMPENSATION ANALYSIS. SALARY MOVEMENT, INCENTIVE COMPENSATION, MARKET BENEFIT, AND RECRUITMENT AND RETENTION TRENDS ARE REVIEWED. THIS ANALYSIS IS PROVIDED TO THE ORGANIZATION'S EXECUTIVE COMPENSATION COMMITTEE, WHICH IS COMPRISED OF INDEPENDENT DIRECTORS. THE EXECUTIVE COMPENSATION COMMITTEE HAS APPROVED A REGIONAL PEER GROUP THAT INCLUDES HIGH-PERFORMING, COMPARABLY-SIZED CALIFORNIA HOSPITALS AND HEALTH SYSTEMS. THE CONSULTANT COMPILES COMPARABILITY DATA FROM NATIONAL AND REGIONAL PEERS; COMPARES THE ORGANIZATION'S EXECUTIVE COMPENSATION WITH PEER GROUP COMPENSATION LEVELS; AND PREPARES A REPORT THAT INCLUDES ALL OF THE BACK-UP DATA ON COMPARABILITY, PEER GROUPS, AND JOB MATCHES. THE METHODOLOGY USED BY THE CONSULTANT WAS TWO PEER GROUPS-A NATIONAL PEER GROUP OF COMPARABLY-SIZED HOSPITALS AND SINGLE HOSPITAL SYSTEMS AND A REGIONAL PEER GROUP OF HOSPITALS AND SYSTEMS IN SOUTHERN CALIFORNIA, THE DATA OF WHICH IS PROVIDED TO THE COMMITTEE IN ITS REPORT. THE NATIONAL DATA IS USED AS THE PRIMARY COMPARATOR FOR THE ANALYSIS. THE COMMITTEE IS PRESENTED WITH CHARTS THAT COMPARE ORGANIZATION SALARIES TO THE LEVEL TARGETED IN THE COMPENSATION PHILOSOPHY. NEITHER PERFORMANCE NOR QUALIFICATIONS OF THE INCUMBENT IS CONSIDERED WHEN PROVIDING THE MARKET DATA. THE COMMITTEE IS PROVIDED WITH A REVIEW OF THE BASE SALARY ANALYSIS, A REVIEW OF THE INCENTIVE COMPENSATION ANALYSIS, A REVIEW OF THE TOTAL CASH COMPENSATION ANALYSIS (BASE SALARY PLUS INCENTIVE), AND A REVIEW OF THE TOTAL COMPENSATION ANALYSIS (BASE SALARY PLUS INCENTIVE PLUS BENEFITS/PERQUISITES). BASED UPON ALL OF THE ABOVE INFORMATION, THE CONSULTANT PROVIDES THE COMMITTEE WITH RECOMMENDED SALARY RANGES FOR THE PERIOD ASSESSED. THE EXECUTIVE COMPENSATION COMMITTEE DELIBERATES ON THE COMPARABILITY DATA TO ENSURE THAT IT IS APPROPRIATE IN REPRESENTING LIKE ORGANIZATIONS, LIKE POSITIONS, AND LIKE CIRCUMSTANCES, AND THAT IT COULD REALISTICALLY RELY ON THE COMPARABILITY DATA IN REACHING ITS DECISION THAT THE COMPENSATION IS REASONABLE AND REPRESENTS FAIR MARKET VALUE FOR SERVICES RENDERED. THE EXECUTIVE COMPENSATION COMMITTEE AFFIRMS THIS PROCESS TO THE BOARD OF DIRECTORS. 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 IX, LINE 11G R&M BUILDING: PROGRAM SERVICE EXPENSES 576,963. MANAGEMENT AND GENERAL EXPENSES 26,832. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 603,795. GROUND MAINTENANCE: PROGRAM SERVICE EXPENSES 373,007. MANAGEMENT AND GENERAL EXPENSES 5,801. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 378,808. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 123,137. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 123,137. OTHER FEES: PROGRAM SERVICE EXPENSES 915,860. MANAGEMENT AND GENERAL EXPENSES 5,035. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 920,895. PIH HEALTH REAL ESTATE SERVICES LLC 12401 WASHINGTON BOULEVARD WHITTIER CA 90602 REAL ESTATE CA 1317108 16551670 PIH HEALTH INC KDW REAL ESTATE INVESTMENTS LLC 12401 WASHINGTON BOULEVARD WHITTIER CA 90602 REAL ESTATE CA 0 0 PIH HEALTH INC PUTNAM REAL ESTATE PROPERTIES LLC 12401 WASHINGTON BOULEVARD WHITTIER CA 90602 REAL ESTATE CA 0 0 PIH HEALTH INC PIH HEALTH PHYSICIANS 12401 WASHINGTON BOULEVARD WHITTIER CA 90602 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 12A, I PIH HEALTH INC 1 PIH HEALTH HOME HEALTHCARE 12401 WASHINGTON BOULEVARD WHITTIER CA 90602 953036281 HEALTHCARE CA 501(C)(3) LINE 10 PIH HEALTH INC 1 PIH HEALTH ADULT DAY HEALTHCARE 12401 WASHINGTON BOULEVARD WHITTIER CA 90602 953643829 HEALTHCARE CA 501(C)(3) LINE 10 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 1 PIH HEALTH CARE SOLUTIONS 6557 GREENLEAF AVENUE WHITTIER CA 90601 462072342 HEALTHCARE CA PIH HEALTH INC C 1 DOWNEY REGIONAL MEDICAL CENTER PROPERTIES INC 11500 BROOKSHIRE AVENUE DOWNEY CA 90241 954769768 REAL ESTATE CA PIH HEALTH INC C 1 PIH HEALTH RE 1003 BISHOP STREET HONOLULU HI 96813 472501390 CAPTIVE INSURANCE HI PIH HEALTH INC T 1 HEALTHMED SERVICES INC 12401 WASHINGTON BOULEVARD WHITTIER CA 90602 300831225 HEALTHCARE CA PIH HEALTH INC C 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 1 0 PIH HEALTH HOSPITAL - WHITTIER A 4210334 FMV PIH HEALTH PHYSICIANS A 8295639 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.