2024-08-06T13:53:39-05:00 2023-09-30 135565207 KPMG LLP 301 MAIN STREET SUITE 2150 BATON ROUGE LA 70801 990 2022-10-01 953619388 PIH HEALTH INC PIHH 5626980811 12401 WASHINGTON BOULEVARD WHITTIER CA 90602 VID SHIVARAMAN CFO 5626980811 2024-07-31 1 0 BRITTANY ELLISER P01284594 2253444000 2022 2024-08-08 14:25:15Z JAMES WEST 12401 WASHINGTON BOULEVARD WHITTIER CA 90602 20428879 0 X WWW.PIHHEALTH.ORG X 1981 CA TO SUPPORT AND TO OPERATE FOR THE BENEFIT OF ITS TAX-EXEMPT AFFILIATES. 16 15 0 15 0 0 0 0 20355190 20425162 0 0 0 3717 20355190 20428879 0 0 0 0 1624071 1638264 0 0 0 13998900 13387452 15622971 15025716 4732219 5403163 134148676 132342452 182947392 175738005 -48798716 -43395553 X PIH HEALTH, INC.'S PRIMARY EXEMPT PURPOSE IS TO SUPPORT AND OPERATE FOR THE BENEFIT OF ITS TAX-EXEMPT AFFILIATES: PIH HEALTH WHITTIER HOSPITAL, PIH HEALTH FOUNDATION, PIH HEALTH PHYSICIANS, PIH HEALTH MANAGEMENT CORP., PIH HEALTH ADULT DAY HEALTHCARE, PIH HEALTH HOME HEALTHCARE, PIH HEALTH DOWNEY HOSPITAL, AND PIH HEALTH GOOD SAMARITAN HOSPITAL. PIH HEALTH, INC. IS THE SOLE CORPORATE MEMBER OF THE ABOVE LISTED ENTITIES. 0 0 13051839 20157167 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. 13051839 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 7 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 16 15 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 1 0 CA X MARK KAWAUCHI 5626980811 12102 WASHINGTON BOULEVARD WHITTIER CA 90606 ALEX ALVAREZ DIRECTOR & TREASURER 1.50 6.00 X X 0 0 0 BLAYNE CUTLER MD PHD DIRECTOR 1.50 6.00 X 0 0 0 CHARLOTTE WEAVER PHD DIRECTOR & VICE CHAIR 1.50 6.00 X X 0 0 0 JANE DICUS DIRECTOR 1.50 6.00 X 0 0 0 JAY BROWN AS OF 3123 DIRECTOR 1.50 6.00 X 0 0 0 JEFF HAMAR DIRECTOR 1.50 6.00 X 0 0 0 KENTON WOODS DIRECTOR 1.50 6.00 X 0 0 0 MARISSA GOLDBERG DIRECTOR 1.50 6.00 X 0 0 0 MELANIE BATISTE DIRECTOR 1.50 6.00 X 0 0 0 PATRICK MONROE DIRECTOR & CHAIR 1.50 6.00 X X 0 0 0 PAUL TREINEN DIRECTOR 1.50 6.00 X 0 0 0 PAULA COWAN UNTIL 9222023 DIRECTOR 1.50 6.00 X 0 0 0 PETER GREANEY MD DIRECTOR & SECRETARY 1.50 6.00 X X 0 0 0 RICHARD ATWOOD DIRECTOR 1.50 7.50 X 0 0 0 ROBERT MALONEY MD DIRECTOR 1.50 6.00 X 0 0 0 WILLIAM ROTH AS OF 3123 DIRECTOR 1.50 6.00 X 0 0 0 ROSALIO LOPEZ MD SYSTEM CSO/CMO 1.50 44.70 X 0 1114134 46447 JAMES WEST SYSTEM PRESIDENT & CEO 1.50 50.70 X 0 2046653 355723 BRIAN SMOLSKIS UNTIL 9282023 SYSTEM COO 1.50 46.20 X 0 1034811 219042 PEGGY CHULACK SYSTEM CAO & ASST SECRETARY 1.50 50.70 X 0 995412 192712 VID SHIVARAMAN SYSTEM CFO & ASST TREASURER 1.50 50.70 X 0 749812 150468 ANITA CHOU FORMER CFO & ASST TREASURER 0.00 0.00 X 0 119014 14 0 6059836 964406 0 1 1 0 RSM US LLP 5155 PAYSHERE CIRCLE CHICAGO IL 60674 PROFESSIONAL SERVICES 572594 ENCORE MAINTENANCE SERVICE INC 580-B W CENTRAL AVENUE BREA CA 92821 MAINTENANCE SERVICES 490820 SERVI-TEK INC 3970 SORRENTO VALLEY BLVD SUITE 4 SAN DIEGO CA 92121 JANITORIAL SERVICES 253579 BEACON SECURITY INC 2970 E LA PALMA AVE STE F ANAHEIM CA 92806 SECURITY SERVICES 230794 VINCOR CONSTRUCTION INC 2651 SATURN STREET BREA CA 92821 CONSTRUCTION SERVICES 155690 7 RELATED RENTAL INCOME 531120 20157167 20157167 CAFE REVENUE 722515 267995 267995 20425162 MISC REVENUE 900099 3717 3717 3717 20428879 20157167 0 271712 X 1326204 1140535 185669 199895 171910 27985 112165 96462 15703 493305 493305 2554244 2342504 211740 100570 82702 17868 4507825 4324928 182897 43745 43745 1174 1174 5436859 4675699 761160 BAD DEBT 25636 25636 EQUIPMENT R&M 17353 505 16848 LICENSES & FEES 13337 7280 6057 EDUCATION 1920 1920 191484 183678 7806 15025716 13051839 1973877 0 4225 473773 518583 7546 7731 202268208 70452070 133663132 131816138 134148676 132342452 1720575 1441309 1219008 1143992 180007809 173152704 182947392 175738005 X -48798716 -43395553 -48798716 -43395553 134148676 132342452 5403163 0 X 0 1 X 1 0 X X 5 PIH HEALTH WHITTIER HOSPITAL 951934652 3 0 0 4895439 PIH HEALTH FOUNDATION 953761274 7 0 0 95859 PIH HEALTH PHYSICIANS 953942828 10 0 0 13688336 PIH HEALTH DOWNEY HOSPITAL 951903935 3 0 0 0 PIH HEALTH GOOD SAMARITAN HOSPITAL 951656366 3 0 0 0 5 0 18679634 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 SCHEDULE A, PART IV, SECTION A, LINE 1: PIH HEALTH INC.'S GOVERNING DOCUMENTS PROVIDE THAT THE ORGANIZATION WILL SUPPORT THE EXISTENCE, ACTIVITIES, AND OPERATIONS OF ITS RELATED CHARITABLE, TAX-EXEMPT ORGANIZATIONS. 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. 45115362 45115362 94923105 37178753 57744352 58152294 29770825 28381469 4077447 3502492 574955 131816138 INTERCOMPANY PAYABLES 173152704 173152704 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, 2023 OR 2022. 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 2019 FOR FEDERAL PURPOSES AND 2017 FOR CALIFORNIA PURPOSES. 1 1 0 0 0 0 0 0 0 JAMES WEST SYSTEM PRESIDENT & CEO 0 1506821 0 0 0 539832 0 335520 0 20325 0 2402498 0 517243 BRIAN SMOLSKIS UNTIL 9282023 SYSTEM COO 0 838304 0 0 0 196507 0 196657 0 22507 0 1253975 0 188312 PEGGY CHULACK SYSTEM CAO & ASST SECRETARY 0 826709 0 0 0 168703 0 178274 0 14760 0 1188446 0 120897 ROSALIO LOPEZ MD SYSTEM CSO/CMO 0 907438 0 0 0 206696 0 36700 0 9869 0 1160703 0 0 VID SHIVARAMAN SYSTEM CFO & ASST TREASURER 0 681460 0 0 0 68352 0 141186 0 9404 0 900402 0 61131 ANITA CHOU FORMER CFO & ASST TREASURER 0 -14 0 0 0 119028 0 0 0 14 0 119028 0 0 PART I, LINE 3 COMPENSATION FOR THE CEO WAS ESTABLISHED AND PAID BY PIH HEALTH WHITTIER HOSPITAL (PHWH), A RELATED ORGANIZATION. PHWH 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 ANITA CHOU RECEIVED A SEVERANCE PAYMENT DURING THE CALENDAR YEAR. THE PAYMENT IS INCLUDED IN PART VII, COLUMN 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. PIH HEALTH INC. AND ITS AFFILIATES PROVIDES A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN FOR CERTAIN EXECUTIVES. THE FOLLOWING INDIVIDUALS PARTICIPATE IN THE PLAN: JAMES WEST BRIAN SMOLSKIS PEGGY CHULACK ROSALIO LOPEZ VID SHIVARAMAN THE FOLLOWING AMOUNTS BECAME VESTED OR WERE PAID-OUT IN 2022 AND ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III): JAMES WEST $517,243 BRIAN SMOLSKIS $188,312 PEGGY CHULACK $120,897 VID SHIVARAMAN $61,131 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, JEFF HAMAR, PAULA COWAN, ALEX ALVAREZ, BLAYNE CUTLER, JANE DICUS, PATRICK MONROE, PAUL TREINEN, CHARLOTTE WEAVER, KENTON WOODS, PETER GREANEY, MARISSA GOLDBERG, MELANIE BATISTE, ROBERT MALONEY, JAMES WEST, PEGGY CHULACK, VID SHIVARAMAN, ROSALIO LOPEZ, AND BRIAN SMOLSKIS. 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 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 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 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. FORM 990, PART IX, LINE 11G R&M BUILDING: PROGRAM SERVICE EXPENSES 960,502. MANAGEMENT AND GENERAL EXPENSES 38,017. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 998,519. GROUND MAINTENANCE: PROGRAM SERVICE EXPENSES 178,679. MANAGEMENT AND GENERAL EXPENSES 5,295. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 183,974. OTHER: PROGRAM SERVICE EXPENSES 1,203,323. MANAGEMENT AND GENERAL EXPENSES 168,428. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,371,751. PIH HEALTH REAL ESTATE SERVICES LLC 12401 WASHINGTON BOULEVARD WHITTIER CA 90602 464560794 REAL ESTATE CA 1931154 14213324 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 FOUNDATION 12401 WASHINGTON BLVD WHITTIER CA 90602 953761274 FUNDRAISING CA 501(C)(3) LINE 7 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 12401 WASHINGTON BLVD WHITTIER CA 90602 953942828 HEALTHCARE CA 501(C)(3) LINE 10 PIH HEALTH INC 1 PIH HEALTH DOWNEY HOSPITAL 11500 BROOKSHIRE AVENUE DOWNEY CA 90241 951903935 HEALTHCARE CA 501(C)(3) LINE 12B, II 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 HEALTHCARE CA 501(C)(3) LINE 12B, II PIH HEALTH INC 1 PIH HEALTH ADULT DAY HEALTHCARE 12401 WASHINGTON BLVD WHITTIER CA 90602 953643829 HEALTHCARE CA 501(C)(3) LINE 12B, II PIH HEALTH INC 1 PIH HEALTH GOOD SAMARITAN HOSPITAL 1225 WILSHIRE BOULEVARD LOS ANGELES CA 90017 951656366 HEALTHCARE 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 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 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 HEALTHCARE 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 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 PIH INSURANCE CO A RECIPROCAL RISK RETENTION GROUP 1003 BISHOP STREET HONOLULU HI 96813 263760243 CAPTIVE INSURANCE HI PIH HEALTH INC T -71173 42240223 1.00000 1 PIH HEALTH CARE SOLUTIONS 6557 GREENLEAF AVENUE WHITTIER CA 90601 462072342 HEALTHCARE CA PIH HEALTH INC C 87110233 4897154 1.00000 1 DRMC PROPERTIES INC 11500 BROOKSHIRE AVE DOWNEY CA 90241 954769768 REAL ESTATE CA PIH HEALTH INC C 2502571 13316140 1.00000 1 PIH HEALTH RE 1003 BISHOP STREET 11500 BROOKSHIRE HONOLULU HI 96813 472501390 CAPTIVE INSURANCE HI PIH HEALTH INC T 1320241 10213387 1.00000 1 HEALTHMED SERVICES INC 12401 WASHINGTON BLVD WHITTIER CA 90602 300831225 HEALTHCARE CA PIH HEALTH INC C 11847379 100 1.00000 1 PIONEER MEDICAL GROUP INC 12401 WASHINGTON BLVD WHITTIER CA 90602 330927283 MEDICAL SERVICES CA N/A C 0 PIONEER PROVIDER NETWORK A MEDICAL GROUP INC 12401 WASHINGTON BLVD WHITTIER CA 90602 330922631 MANAGEMENT SERVICES CA N/A C 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 PIH HEALTH PHYSICIANS A 13688336 FMV PIH HEALTH WHITTIER HOSPITAL A 4895439 FMV PIH HEALTH FOUNDATION A 95859 FMV HEALTHMED SERVICES A 190214 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.