2018-08-15T13:09:13-05:00 2017-09-30 420714325 RSM US LLP 1 S WACKER DRIVE STE 800 CHICAGO IL 60606 990 2016-10-01 951903935 PIH HEALTH HOSPITAL - DOWNEY PIHH 5629045000 11500 BROOKSHIRE AVENUE DOWNEY CA 90241 GREG WILLIAMS CFO 5626980811 2018-08-13 1 WAYNE HARDER P00294296 3126343400 2016 2022-09-23 18:48:47Z GREG WILLIAMS 11500 BROOKSHIRE AVENUE DOWNEY CA 90241 154452568 0 X WWW.PIHHEALTH.ORG X 1956 CA TO PROVIDE QUALITY HEALTHCARE AND CONTRIBUTE TO THE COMMUNITY'S HEALTH AND WELL-BEING. 16 14 1322 254 0 0 329155 919551 151501564 152308618 -246838 10800 108080 1213599 151691961 154452568 0 1031545 0 0 87896520 86303855 0 0 0 67270593 69995761 155167113 157331161 -3475152 -2878593 128224893 156652786 195490068 223935623 -67265175 -67282837 X MISSION: WHY WE ARE HERE: 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 75630219 111727714 PATIENT CARE: PIH HEALTH HOSPITAL - DOWNEY IS A NONPROFIT HOSPITAL WITH A RICH NEARLY 100 YEAR HISTORY OF MEETING THE HEALTHCARE NEEDS OF ITS COMMUNITY. THE 199-BED FACILITY SERVES RESIDENTS IN LOS ANGELES AND ORANGE COUNTIES AND THE SAN GABRIEL VALLEY AREA. THE DOWNEY CAMPUS IS A PART OF PIH HEALTH, A COMPREHENSIVE HEALTH SYSTEM CONSISTING OF TWO HOSPITALS, 22 MEDICAL OFFICE LOCATIONS AND A HOST OF SPECIALTY SERVICES INCLUDING ACUTE CARE HOSPITAL SERVICES, CORONARY INTENSIVE CARE, MEDICAL-SURGICAL ACUTE CARE, MEDICAL-SURGICAL INTENSIVE CARE, NEONATAL INTENSIVE CARE, NEWBORN NURSERY CARE, OBSERVATION UNIT, OBSTETRICS CARE/LABOR AND DELIVERY, TELEMETRY UNIT, EMERGENCY SERVICES, AND A WIDE RANGE OF ANCILLARY AND OUTPATIENT SERVICES.PATIENT CARE IN FISCAL YEAR 2016-2017EMPLOYEES 1,064VOLUNTEERS 240NUMBER OF EMERGENCY DEPARTMENT (ED) VISITS 57,059NUMBER OF BIRTHS 1,000MEDICAL STAFF 419 57050880 1031545 39837909 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: 34,962 5478404 742995 OTHER COMMUNITY BENEFIT SERVICES: COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS, HEALTH PROFESSIONS EDUCATION, SUBSIDIZED HEALTH SERVICES, CASH AND IN-KIND CONTRIBUTIONS AND COMMUNITY BUILDING FOR COMMUNITY BENEFIT 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 COLLABORATIVE SUPPORT AND PARTICIPATION, COMMUNITY EDUCATION, COMMUNITY INFORMATION AND REFERRAL SUPPORT, ENROLLMENT ASSISTANCE, AND PREVENTATIVE HEALTH PROGRAMS AND SCREENINGS.SNAPSHOT OF OUTCOMES:MORE THAN 5,706 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:SOME 102 STUDENT NURSES 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 380 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, AND SUPPLIES. SNAPSHOT OF OUTCOMES:36 AT-RISK INDIVIDUALS WERE PROVIDED WITH IN-KIND DURABLE MEDICAL EQUIPMENT OR SERVICES, SUCH AS SKILLED NURSING OR MENTAL HEALTHCARE.TOTAL NUMBER OF PERSONS SERVED BY ALL CATEGORIES: 6,234FOR ADDITIONAL INFORMATION, PLEASE REFER TO PIH HEALTH'S COMMUNITY BENEFIT REPORT AT PIHHEALTH.ORG/CBANNUALREPORT 138159503 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 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 74 0 1 1322 1 0 0 0 0 0 0 0 0 X 16 14 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 CA X GREG WILLIAMS 5626980811 12401 WASHINGTON BLVD WHITTIER CA 90602 THOMAS KING DIRECTOR & SECRETARY 1.50 4.50 X X 0 0 0 EFRAIN ACEVES DIRECTOR & VICE CHAIR 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 JANE DICUS DIRECTOR & CHAIR 1.50 4.50 X X 0 0 0 ED DUNLAP DIRECTOR 1.50 4.50 X 0 0 0 MARK MINKES MD DIRECTOR 10.00 0.00 X 72450 0 0 FRANK GOMEZ PHD DIRECTOR 1.50 4.50 X 0 0 0 JEFF HAMAR DIRECTOR (AS OF 10/10/16) 1.50 3.00 X 0 0 0 KENTON WOODS DIRECTOR & TREASURER 1.50 4.50 X X 0 0 0 HUEY-MIN YU DIRECTOR 1.50 4.50 X 0 0 0 BILL KIM MD DIRECTOR 11.00 0.00 X 95000 0 0 PATRICK MONROE DIRECTOR (AS OF 10/10/16) 1.50 3.00 X 0 0 0 SANATKUMAR PATEL MD DIRECTOR (UNTIL 9/12/17) 1.50 X 0 0 0 ROBERT PETRINA DIRECTOR 1.50 4.50 X 0 0 0 CHARLOTTE WEAVER DIRECTOR (AS OF 10/10/16) 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 44.70 X 0 572298 175957 ROSALIO LOPEZ MD CMO & SENIOR VP 1.50 43.00 X 0 1054869 110446 RAMONA PRATT COO 40.00 X 0 365339 84257 JUDY PUGACH CNO 40.00 X 0 346892 56733 LINDA BUDDINE RN CHARGE NURSE 40.00 X 192450 0 33382 GREGG KINNE RN CHARGE NURSE 40.00 X 210076 0 12642 JOSEPHINA VELARDE RN CHARGE NURSE 40.00 X 207445 0 26719 LELA ROSALES RN CHARGE NURSE 40.00 X 225052 0 32688 ROSALIE MADDEN RN CHARGE NURSE 40.00 X 171233 0 30491 MITCHELL THOMAS FORMER CFO / SENIOR VP FINANCE 0.00 X 0 165452 19754 1173706 4525797 926677 147 1 1 0 RIGHTSOURCING INC 999 STEWART AVENUE SUITE 100 BETHPAGE NY 11714 PROFESSIONAL SERVICES 4614755 MILLIE AND SEVERSON INC 3601 SERPENTINE DR LOS ALAMITOS CA 907200399 CONSTRUCTION 3285508 EMERGENCY ASSOCIATES CORP PO BOX 9350 RANCHO SANTA FE CA 92067 MEDICAL SERVICES 2340724 ALLIEDBARTON SECURITY SERVICES 1900 W GARVEY AVENUE SOUTH WEST COVINA CA 91790 SECURITY SERVICES 709193 ACUTE DIALYSIS SERVICE 12291 E WASHINGTON BLVD WHITTIER CA 90602 DIALYSIS SERVICES 592364 18 919551 919551 NET PATIENT REVENUE 621110 131949019 131949019 HOSPITAL FEE PROGRAM 900099 20134125 20134125 FOOD SERVICES 900099 197994 197994 COMMUNITY ED REVENUE 624100 27480 27480 152308618 10800 0 10800 10800 10800 VENDOR SETTLEMENTS 900099 63336 63336 1150263 1150263 1213599 154452568 152308618 0 1224399 X 1031545 1031545 707423 481582 225841 66303802 56358232 9945570 2994160 2545036 449124 11496907 9772371 1724536 4801563 4081329 720234 24000 24000 23700 23700 17435601 15361143 2074458 2410972 2177909 233063 6314 5178 1136 2309136 1496277 812859 14120 11927 2193 414 414 4174951 4174908 43 5769908 4904422 865486 1291486 1291486 QUALITY ASSURANCE FEE ( 15872772 15872772 MEDICAL SUPPLIES 15038236 14689318 348918 BAD DEBT EXPENSE 2840085 2840085 EQUIPMENT R&M 1118199 1112437 5762 1665867 1218618 447249 157331161 138159503 19171658 0 220412 911232 15738418 16110925 2078595 2072761 2114483 1538878 126879637 20498396 88559000 106381241 19513985 29637749 128224893 156652786 15361437 19085975 180128631 204849648 195490068 223935623 X -67265175 -67282837 -67265175 -67282837 128224893 156652786 X -2878593 -219701 3080632 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 23700 23700 0 PART II-B, LINE 1, LOBBYING ACTIVITIES: EXPLANATION: A PORTION OF DUES PAID TO HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA IS RELATED TO LOBBYING. 14497365 14497365 30054219 2950195 27104024 16111002 3237047 12873955 34578489 14292613 20285876 31638562 18541 31620021 106381241 HOSPITAL FEE PROGRAM RECEIVABLE 26877065 OTHER RECEIVABLES 2760684 29637749 HOSPITAL FEE PROGRAM PAYABLE 17014576 SELF-INSURANCE RESERVES 6573951 BANKRUPTCY PAYABLE 3782206 INTERCOMPANY PAYABLE 177478915 204849648 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 X 1 X 1 X 1 1 1 0 1 1 0 500 701436 149106 552330 0.00360 0 34429 56318872 39681053 16637819 0.10770 0 33 30572 7750 22822 0.00010 34962 57050880 39837909 17212971 0.11140 7 5706 327058 6370 320688 0.00210 3 102 3017123 736625 2280498 0.01480 1 380 2056045 2056045 0.01330 0 0 2 36 78178 78178 0.00050 13 6224 5478404 742995 4735409 0.03070 13 41186 62529284 40580904 21948380 0.14210 1 2 1965 1965 0.00000 1 7 2698 2698 0.00000 1 1 818 818 0.00000 3 10 5481 5481 0.00000 1 2840085 27627774 30336708 -2708934 X 1 1 1 1 PIH HEALTH HOSPITAL - DOWNEY 11500 BROOKSHIRE AVE DOWNEY CA 90241 WWW.PIHHEALTH.ORG 930000048 X X X X PIH HEALTH HOSPITAL - DOWNEY 1 0 0 1 X X X X X X X X X X 15 1 1 0 1 X HTTPS://WWW.PIHHEALTH.ORG/WELLNESS/COMMUNITY-BENEFIT/ X HTTPS://HEALTHACTIONLAB.SHUTTERFLY.COM X X 1 15 1 PIHHEALTH.ORG/CHIP 0 1 X 100.000000000000 400.000000000000 X X X X X X 1 1 X X X X 1 X HTTPS://WWW.PIHHEALTH.ORG/PATIENTS-VISITORS/BILLING-FINANCIAL-ASSISTANCE/PR X HTTPS://WWW.PIHHEALTH.ORG/PATIENTS-VISITORS/BILLING-FINANCIAL-ASSISTANCE/PR X HTTPS://WWW.PIHHEALTH.ORG/PATIENTS-VISITORS/BILLING-FINANCIAL-ASSISTANCE/PR X X X X X X 1 X 0 X X X X 1 X 0 0 PIH HEALTH HOSPITAL - DOWNEY PART V, SECTION B, LINE 3J: THE COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDES DATA AND INFORMATION REGARDING DEMOGRAPHIC PROFILE, SOCIAL DETERMINANTS OF HEALTH, GENERAL HEALTHCARE ACCESS, MATERNAL AND INFANT HEALTH, ORAL HEALTH, MENTAL HEALTH, HEALTH BEHAVIORS, WEIGHT STATUS, NUTRITION AND PHYSICAL ACTIVITY, CHRONIC DISEASES, LEADING CAUSES OF DEATH AND COMMUNITY PERSPECTIVES GATHERED FROM FOCUS GROUPS AND INTERVIEWS. PIH HEALTH HOSPITAL - DOWNEY PART V, SECTION B, LINE 5: PRIMARY DATA COLLECTION CONSISTED OF 22 KEY STAKEHOLDER INTERVIEWS AND SEVEN COMMUNITY FOCUS GROUPS (57 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.KEY STAKEHOLDER INTERVIEWEES1. MARCOS ALAMILLO, FIELD REPRESENTATIVE, OFFICE OF ASSEMBLY MEMBER CRISTINA GARCIA2. CHRISTINE PADILLA BIRKEY, EXECUTIVE DIRECTOR, KINGDOM CAUSES3. VICTOR DOMINGUEZ, CHIEF MISSION ADVANCEMENT OFFICER, YMCA OF METROPOLITAN LOS ANGELES4. RICHARD ESPINOSA, HEALTH DEPUTY, OFFICE OF LA COUNTY SUPERVISOR DON KNABE5. JEFF FARBER, EXECUTIVE DIRECTOR, HELPLINE YOUTH COUNSELING6. BILL KIM MD, GASTROENTEROLOGIST, PIH HEALTH7. EDITH MARCEL, PROMOTORA PRESIDENT, HEALTHY LOS NIETOS8. MARIE MCAFEE, LEAD CLINIC ADMINISTRATOR, WESLEY HEALTH CENTERS9. CLARE MCCLAFFERTY, SOCIAL WORKER, PIH HEALTH10. RICARDO MENDOZA, DEPUTY DIRECTOR, OFFICE OF CONGRESSWOMAN LINDA SANCHEZ11. HILLARY MENNELLA, ASSOCIATE DEAN OF STUDENT HEALTH & WELLNESS, CERRITOS COLLEGE12. MARIA OCHOA RN BSN PHN, SPA 7 COMMUNITY LIAISON PUBLIC HEALTH NURSE, LA COUNTY DEPARTMENT OF PUBLIC HEALTH13. LIZET OLMOS, RECREATION COORDINATOR, PICO RIVERA SENIOR CENTER14. GEORGE SAADE MD, PEDIATRICIAN, PIH HEALTH15. ARLENE SALAZAR, DIRECTOR PARKS & RECREATION DEPT., CITY OF DOWNEY16. SCOTT SMITH, EXECUTIVE DIRECTOR, CERRITOS REGIONAL CHAMBER OF COMMERCE17. ANA SUAREZ LCSW, DISTRICT CHIEF, LA COUNTY DEPARTMENT OF MENTAL HEALTH SPA 718. ANNE ULLSTROM, EXECUTIVE DIRECTOR, DOWNEY FAMILY YMCA19. CAROLINA VASQUEZ MD, FAMILY MEDICINE, PHYSICIAN PIH HEALTH20. FERNANDO VASQUEZ, COUNCILMEMBER, CITY OF DOWNEY21. GUYLENE VELEZ, SOCIAL WORKER, PIH HEALTH22. NORMA YOGUEZ, PROGRAM DIRECTOR SPIRITT FAMILY SERVICES FOCUS GROUPS 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.COMMUNITY FOCUS GROUPS1. PARTNERSHIP FOR HEALTHIER COMMUNITIES COLLABORATIVE, SIX COMMUNITY-BASED ORGANIZATIONS2. LEADERS IN ACTION, 10 COMMUNITY RESIDENTS OF SOUTHEAST LOS ANGELES3. PLAZA DE LA RAZA, FIVE PARENTS OF PRESCHOOL-AGED CHILDREN4. ERNIE PYLE ELEMENTARY SCHOOL IN BELLFLOWER, 10 PARENTS OF SCHOOL CHILDREN5. CERRITOS COLLEGE, SIX STUDENT HEALTH CENTER CLIENTS6. TLC COLLABORATIVE IN DOWNEY, 10 COMMUNITY-BASED ORGANIZATIONS7. KAISER PERMANENTE WATTS COUNSELING AND LEARNING CENTER, 10 COMMUNITY RESIDENTS OF WATTS PIH HEALTH HOSPITAL - DOWNEY PART V, SECTION B, LINE 6A: PIH HEALTH HOSPITAL - DOWNEY'S CHNA WAS CONDUCTED WITH PIH HEALTH HOSPITAL - WHITTIER AND KAISER FOUNDATION HOSPITAL - DOWNEY MEDICAL CENTER. SHARED SERVICE AREAS AND COMMUNITY PARTNERS ALLOWED FOR COORDINATED INTERVIEWS AND FOCUS GROUPS AND SHARING OF DATA/RESULTS. PIH HEALTH HOSPITAL - DOWNEY 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, AND SPARING ORGANIZATIONS THE EXPENSE OF DUPLICATIVE DATA COLLECTION EFFORTS. ASSESSMENT FINDINGS ARE ALSO SHARED ON AN ON-GOING BASIS AT COMMUNITY EVENTS AND COMMUNITY COLLABORATIVE MEETINGS. PIH HEALTH HOSPITAL - DOWNEY 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 2017-2019 CHIP AND THE INITIATIVES IDENTIFIED TO ADDRESS AREAS OF FOCUS (DIABETES, HEART DISEASE, OVERWEIGHT/OBESITY, PREVENTATIVE SCREENINGS AND IMMUNIZATIONS, FOOD INSECURITY, HOMELESSNESS AND EDUCATION), VISIT PIHHEALTH.ORG/CHIP. FOR THE HEALTH NEEDS THAT WERE NOT PRIORITIZED AS AREAS OF FOCUS (ASTHMA, CANCER DEATHS, DENTAL CARE ACCESS, HEALTH INSURANCE COVERAGE/AFFORDABILITY, LUNG DISEASE DEATHS, MENTAL HEALTHCARE, AND SUBSTANCE ABUSE), PIH HEALTH HAS NEITHER THE EXPERTISE NOR THE INFRASTRUCTURE TO SERVE AS LEAD IN THESE AREAS. AS THESE HEALTH NEEDS ARE STILL VERY IMPORTANT TO PIH HEALTH AND THE COMMUNITY WE SERVE, WORK WILL CONTINUE IN THESE AREAS WHERE APPLICABLE, AND REFERRAL AND FUNDING RELATIONSHIPS WITH COMMUNITY-BASED AGENCIES ALREADY WORKING IN THESE AREAS MAY BE STRENGTHENED. PIH HEALTH HOSPITAL - DOWNEY 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. THESE ARE ALSO CONSIDERATIONS FOR PATIENTS WHERE THE FPG IS NOT APPLICABLE AND THE PATIENT IS INSURED WITH INADEQUATE COVERAGE OR EXCESSIVE LIABILITY. PART I, LINE 6A PIH HEALTH'S COMMUNITY BENEFIT REPORT FOR FISCAL YEAR 2015-2016 ACCOUNTS FOR BOTH PIH HEALTH HOSPITAL WHITTIER AND PIH HEALTH HOSPITAL DOWNEY'S PROGRAMS AND SERVICES THAT PROMOTE THE HEALTH OF THE COMMUNITY.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 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 LOCAL CHAMBER OF COMMERCE BY SERVING ON THEIR BOARD. CHAMBERS OF COMMERCE AIM TO IMPROVE THE ECONOMIC, 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 THE COMPANY PROVIDES CARE TO PATIENTS EVEN THOUGH THEY MAY LACK ADEQUATE INSURANCE OR MAY PARTICIPATE IN PROGRAMS WITH NEGOTIATED OR REGULATED AMOUNTS. 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.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, THROUGH 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 PATIENTS HAVE BEEN EXHAUSTED, THE COMPANY FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCE WITH COLLECTION AGENCIES, SUBJECT TO CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY THE COMPANY.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 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 SCHEDULE H METHOD. HOWEVER, THE PIH 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 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, IE. DEPARTMENT C2C %, IS LOADED INTO PIH'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'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 PROGRAM7. 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.COMMUNITY HEALTH IMPROVEMENT TEAM- THIS INTERNAL WORK GROUP OF HOSPITAL STAFF THAT MANAGES THE HOSPITAL'S VARIOUS COMMUNITY-BASED PROGRAMS MEET REGULARLY TO SHARE RESOURCES THAT BENEFIT COMMUNITY MEMBERS AND TO DISCUSS ANY CHALLENGES / NEEDS AS A WAY TO ENHANCE THE PROVISION OF SERVICES.PROGRAM OUTCOMES - DATA ANALYSIS - EXTENSIVE DATA COLLECTION IS DONE FOR PIH HEALTH'S KEY COMMUNITY-BASED PROGRAMS. THIS DATA IS SUMMARIZED AND EVALUATED REGULARLY BY PROGRAM MANAGEMENT, CBOC MEMBERS, AND HOSPITAL LEADERSHIP. CHNA DATA DRIVES PROGRAM IMPROVEMENTS TO MAXIMIZE IMPACT AND MORE DIRECTLY MEET COMMUNITY NEEDS. FEEDBACK FROM COMMUNITY ORGANIZATIONS / COLLABORATIVESTHROUGH PARTICIPATION IN VARIOUS COMMUNITY COLLABORATIVES 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. PATIENTS 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 ARE 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 EACH PATIENT STATEMENT THAT IS SENT OUT, THE FAP PROGRAM IS PRINTED ON THE BACK OF THE STATEMENT. PIH'S FAP IS ALSO PUBLISHED ON OUR WEBSITE. PART VI, LINE 4: PIH HEALTH HOSPITAL - DOWNEY SERVES AN URBAN GEOGRAPHY IN THE SOUTHEAST PORTION OF LOS ANGELES COUNTY, CALIFORNIA, PRIMARILY WITHIN SERVICE PLANNING AREA 7 (SPA 7). PRIMARY SERVICE AREA CITIES INCLUDE:BELL 90202BELLFLOWER 90706BELL GARDENS 90201CERRITOS 90703COMMERCE 90040COMPTON 90221DOWNEY 90240-90242HUNTINGTON PARK 90255LONG BEACH 90805LYNWOOD 90262MAYWOOD 90270NORWALK 90650PARAMOUNT 90723PICO RIVERA 90660SOUTH GATE 90280SOUTH LOS ANGELES 90001PRIMARY SERVICE AREA PROFILETHE POPULATION FOR PIH HEALTH HOSPITAL - DOWNEY'S PRIMARY SERVICE AREA IS 1,045,078. POPULATION DEMOGRAPHICS: CHILDREN AND YOUTH (AGES 0-19) MAKE UP 32.7% OF THE POPULATION; OLDER ADULTS (AGES 65+) MAKE UP 8.6% OF THE POPULATION. THE LARGEST POPULATION BY RACE AND ETHNICITY IN THE SERVICE AREA IS HISPANIC OR LATINO (77.1%). WHITE/CAUCASIANS MAKE UP 7.6% OF THE POPULATION. ASIANS COMPRISE 7.2% OF THE POPULATION, AND AFRICAN AMERICANS, NATIVE AMERICANS, HAWAIIANS, AND OTHER RACES COMBINED TOTAL 8.1% OF THE POPULATION. INCOME & POVERTY: THE MEDIAN HOUSEHOLD INCOME IN THE SERVICE AREA RANGES FROM $34,697 IN SOUTH LOS ANGELES TO $98,004 IN CERRITOS. SOME 20% OF THE SERVICE AREA POPULATION LIVES BELOW 100% OF THE FEDERAL POVERTY LEVEL AND 47.7% LIVE BELOW 200%. HEALTH INSURANCE: 72% OF THE SERVICE AREA IS INSURED, 88.2% OF CHILDREN UNDER 18 ARE INSURED AND 61% OF ADULTS AGES 18-64 ARE INSURED. IN SPA 7, 30.7% ARE MEDI-CAL RECIPIENTS.THERE ARE SIX OTHER HOSPITALS PROVIDING CARE IN THE SERVICE AREA POPULATION AND EIGHT FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS PRESENT IN THE SERVICE AREA. FOR ADDITIONAL DATA REGARDING THE SERVICE AREA, PLEASE SEE THE CHNA AT PIHHEALTH.ORG/CHNA PART VI, LINE 5: IN 2006, PIH HEALTH'S BOARD OF DIRECTORS ESTABLISHED THE COMMUNITY BENEFIT OVERSIGHT COMMITTEE (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. PART VI, LINE 6: HOSPITAL AFFILIATES INCLUDE: 1) PIH HEALTH, INC., PIH HEALTH'S PARENT COMPANY; 2) PIH HEALTH HOSPITAL - WHITTIER; 3) PIH HEALTH PHYSICIANS (PHP), A NONPROFIT MEDICAL FOUNDATION; AND 4) THE PIH HEALTH FOUNDATION, A NONPROFIT ORGANIZATION THAT EXISTS TO RAISE PHILANTHROPIC FUNDS IN SUPPORT OF PIH'S CHARITABLE MISSION 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.PIH HEALTH HOSPITAL - WHITTIER BEGAN AS A COMMUNITY HOSPITAL IN 1959. AS A 501 (C) (3) NONPROFIT, 547-BED HOSPITAL, THE WHITTIER CAMPUS HAS DEVELOPED INTO A HEALTH SYSTEM OFFERING A MULTITUDE OF SERVICES.PIH HEALTH PHYSICIANS 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. 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. 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 PIH HEALTH PHYSICIANS 12401 WASHINGTON BOULEVARD WHITTIER CA 90602 953942828 501(C)(3) 1031545 GENERAL SUPPORT 1 0 1 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 68451 GREG WILLIAMS CFO & ASSISTANT TREASURER 0 515986 0 50000 0 6312 0 156501 0 19456 0 748255 0 0 ROSALIO LOPEZ MD CMO & SENIOR VP 0 606781 0 109813 0 338275 0 97231 0 13215 0 1165315 0 326454 RAMONA PRATT COO 0 307576 0 49542 0 8221 0 65180 0 19077 0 449596 0 0 JUDY PUGACH CNO 0 259064 0 35855 0 51973 0 50650 0 6083 0 403625 0 43923 LINDA BUDDINE RN CHARGE NURSE 190297 0 0 0 2153 0 11945 0 21437 0 225832 0 0 0 GREGG KINNE RN CHARGE NURSE 207931 0 0 0 2145 0 12605 0 37 0 222718 0 0 0 JOSEPHINA VELARDE RN CHARGE NURSE 205293 0 0 0 2152 0 12673 0 14046 0 234164 0 0 0 LELA ROSALES RN CHARGE NURSE 222735 0 0 0 2317 0 13751 0 18937 0 257740 0 0 0 ROSALIE MADDEN RN CHARGE NURSE 169268 0 0 0 1965 0 10552 0 19939 0 201724 0 0 0 MITCHELL THOMAS FORMER CFO / SENIOR VP 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 (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: 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 RAMONA PRATT JUDY PUGACH 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 JUDY PUGACH $43,923 MITCHELL THOMAS $58,710 FORM 990, PART VI, SECTION A, LINE 6 PIH HEALTH, INC. IS THE SOLE MEMBER OF PIH HEALTH HOSPITAL - DOWNEY. FORM 990, PART VI, SECTION A, LINE 7A PIH HEALTH, INC. HAS AUTHORITY TO ELECT ALL THE MEMBER OF THE BOARD OF DIRECTORS OF PIH HEALTH HOSPITAL - DOWNEY. 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 HOSPITAL - DOWNEY. 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. 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 COMPLIANCE OFFICER. 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 PIH HEALTH HOSPITAL - WHITTIER'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, PIH HEALTH HOSPITAL - WHITTIER'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 PIH HEALTH HOSPITAL - WHITTIER'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 PIH HEALTH HOSPITAL - WHITTIER'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 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 PROFESSIONAL FEES - PHYSICIANS: PROGRAM SERVICE EXPENSES 8,316,132. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,316,132. PROFESSIONAL FEES - OTHERS: PROGRAM SERVICE EXPENSES 6,351,549. MANAGEMENT AND GENERAL EXPENSES 1,054,792. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,406,341. R&M BUILDING: PROGRAM SERVICE EXPENSES 693,462. MANAGEMENT AND GENERAL EXPENSES 302,463. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 995,925. COLLECTIONS AGENCY SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 717,203. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 717,203. FORM 990, PART XI, LINE 9: BANKRUPTCY/REORGANIZATION COSTS 3,080,632. PIH HEALTH FOUNDATION 12401 WASHINGTON BLVD WHITTIER CA 90602 953761274 FUNDRAISING CA SECTION 501(C)(3) LINE 7 PIH HEALTH INC 0 PIH HEALTH MANAGEMENT CORP 12401 WASHINGTON BLVD WHITTIER CA 90602 954016278 SUPPORT OF TAX-EXEMPT AFFILIATES CA SECTION 501(C)(3) LINE 12A, I PIH HEALTH INC 0 PIH HEALTH HOME HEALTHCARE 12401 WASHINGTON BLVD WHITTIER CA 90602 953036281 HEALTHCARE CA SECTION 501(C)(3) LINE 10 PIH HEALTH INC 0 PIH HEALTH INC 12401 WASHINGTON BLVD WHITTIER CA 90602 953619388 SUPPORT OF TAX-EXEMPT AFFILIATES CA SECTION 501(C)(3) LINE 12A, I 0 PIH HEALTH ADULT DAY HEALTHCARE 12401 WASHINGTON BLVD WHITTIER CA 90602 953643829 HEALTHCARE CA SECTION 501(C)(3) LINE 10 PIH HEALTH INC 0 PIH HEALTH HOSPITAL - WHITTIER 12401 WASHINGTON BLVD WHITTIER CA 90602 951934652 HEALTHCARE CA SECTION 501(C)(3) LINE 3 PIH HEALTH INC 0 PIH HEALTH PHYSICIANS 12401 WASHINGTON BLVD WHITTIER CA 90602 953942828 HEALTHCARE CA SECTION 501(C)(3) LINE 10 PIH HEALTH INC 0 DRMC PROPERTIES 11500 BROOKSHIRE AVENUE DOWNEY CA 90241 954769768 REAL ESTATE CA DRMC INC C 0 PIH HEALTH RE 1003 BISHOP STREET HONOLULU HI 96813 472501390 CAPTIVE INSURANCE HI INTERHEALTH CORP T 0 PIH INSURANCE CO A RECIPROCAL RISK RETENTION GROUP 1003 BISHOP STREET HONOLULU HI 96813 263760243 CAPTIVE INSURANCE HI INTERHEALTH CORP T 0 PIH HEALTH CARE SOLUTIONS 6557 GREENLEAF AVENUE WHITTIER CA 90601 462072342 HEALTHCARE CA INTERHEALTH CORP C 0 HEALTHMED SERVICES INC 12401 WASHINGTON BLVD WHITTIER CA 90602 300831225 HEALTHCARE CA INTERHEALTH CORP C 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 0 1 1 0 PART IV, COLUMN (E): PIH HEALTH CARE SOLUTIONS IS A NONPROFIT MUTUAL BENEFIT CORPORATION. PART IV, COLUMN (E): PIH INSURANCE COMPANY IS AN UNINCORPORATED RISK RETENTION GROUP.