2023-07-07T16:52:57-05:00 2022-09-30 420714325 RSM US LLP 30 South Wacker Dr Suite 3300 Chicago IL 606063392 990 2021-10-01 953619388 PIH Health Inc PIHH 5626980811 12401 Washington Boulevard Whittier CA 90602 Vid Shivaraman CFO 5626980811 2023-06-29 1 Vid Shivaraman 999009999 Rebekuh Eley P01247672 3126343400 2023-06-29 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z James West 12401 Washington Boulevard Whittier CA 90602 20355190 0 X www.pihhealth.org X 1981 CA To support and to operate for the benefit of its tax-exempt affiliates. 14 14 0 14 0 0 0 0 19647393 20355190 0 0 0 0 19647393 20355190 0 0 0 0 1555974 1624071 0 0 0 12645976 13998900 14201950 15622971 5445443 4732219 139222706 134148676 192753641 182947392 -53530935 -48798716 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 13581381 0 20355190 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. 13581381 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 5 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 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 James West System President & CEO 1.50 51.70 X 0 2763938 340079 Rosalio Lopez MD System CSO/CMO 1.50 44.70 X 0 1573688 212248 Peggy Chulack System CAO & Assistant Secretary 1.50 51.70 X 0 1058662 164469 Brian Smolskis System COO 1.50 46.20 X 0 1029190 176975 Anita Chou Former CFO & Asst. Treasurer 0.00 0.00 X 0 1100156 21568 Vid Shivaraman System CFO & Asst Treasurer 1.50 51.70 X 0 702914 118060 Greg Williams Former CFO & Asst. Treasurer 0.00 0.00 X 0 613536 0 Patrick Monroe Director & Chair 1.50 6.00 X X 0 0 0 Charlotte Weaver Director & Vice Chair 1.50 6.00 X X 0 0 0 Peter Greaney MD Director & Secretary 1.50 6.00 X X 0 0 0 Jeff Hamar Director & Treasurer 1.50 6.00 X X 0 0 0 Alex Alvarez Director 1.50 6.00 X 0 0 0 Richard Atwood Director 1.50 7.50 X 0 0 0 Melanie Batiste Director 1.50 6.00 X 0 0 0 Paula Cowan 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 Marissa Goldberg Director 1.50 6.00 X 0 0 0 Robert Maloney MD Director 1.50 6.00 X 0 0 0 Paul Trienen Director 1.50 6.00 X 0 0 0 Kenton Woods Director 1.50 6.00 X 0 0 0 0 8842084 1033399 0 1 1 0 RSM US LLP 5155 Payshere Circle Chicago IL 60674 Professional Services 498890 Encore Maintenance Service Inc 580-B W Central Avenue Brea CA 92821 Maintenance Services 469880 Servi-Tek Inc 3970 Sorrento Valley Blvd Suite 4 San Diego CA 92121 Janitorial Services 380946 Beacon Security Inc 2970 E La Palma Ave Ste F Anaheim CA 92806 Security Services 162343 Coastal Landscape Services Inc 12610 Homepark Drive Whittier CA 90606 Landscaping services 104979 5 Related Rental 531120 20108178 20108178 Cafe Revenue 722515 247012 247012 20355190 20355190 20355190 0 0 X 1325644 1153310 172334 186755 162477 24278 111672 97155 14517 586371 586371 2786959 2544596 242363 87827 67543 20284 4668698 4479919 188779 47211 47211 3691 2526 1165 5438537 4731527 707010 Bad Debt 198913 198913 Equipment R&M 33838 10622 23216 Licenses & Fees 14475 8570 5905 Education 780 780 131600 124223 7377 15622971 13581381 2041590 0 0 4225 425774 473773 7085 7546 198678343 65015211 138789847 133663132 139222706 134148676 1395736 1720575 1294024 1219008 190063881 180007809 192753641 182947392 X -53530935 -48798716 -53530935 -48798716 139222706 134148676 4732219 0 X 0 1 X 1 0 X X 5 PIH Health Whittier Hospital 951934652 3 0 0 0 PIH Health Foundation 953761274 7 0 0 0 PIH Health Physicians 953942828 10 0 0 0 PIH Health Downey Hospital 951903935 3 0 0 0 PIH Health Good Samaritan Hospital 951656366 3 0 0 0 5 0 0 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. 44344808 44344808 92131364 34825449 57305915 58152294 26974108 31178186 4042946 3215654 827292 6931 6931 133663132 Intercompany Payables 180007809 180007809 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, 2022 or 2021. 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 2018 for federal purposes and 2016 for California purposes. 1 1 0 0 0 0 0 0 0 James West System President & CEO 0 1403776 0 1129582 0 230580 0 320688 0 19391 0 3104017 0 210464 Rosalio Lopez MD System CSO/CMO 0 848206 0 336481 0 389001 0 203006 0 9242 0 1785936 0 381303 Peggy Chulack System CAO & Assistant Secretary 0 701640 0 347513 0 9509 0 150342 0 14127 0 1223131 0 0 Brian Smolskis System COO 0 697337 0 323736 0 8117 0 155902 0 21073 0 1206165 0 0 Anita Chou Former CFO & Asst. Treasurer 0 113900 0 142450 0 843806 0 8041 0 13527 0 1121724 0 233343 Vid Shivaraman System CFO & Asst Treasurer 0 516146 0 180469 0 6299 0 111770 0 6290 0 820974 0 0 Greg Williams Former CFO & Asst. Treasurer 0 0 0 0 0 613536 0 0 0 0 0 613536 0 613536 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 Part I, Line 4a: 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. 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 Vid Shivaraman Anita Chou Rosalio Lopez Brian Smolskis Greg Williams The following amounts became vested or were paid-out in 2021 and are included in Schedule J, Part II, Column (b)(iii): James West $210,464 Rosalio Lopez $381,303 Greg Williams $613,536 Anita Chou $233,343 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 The Organization works with an independent accountant, RSM US LLP, to prepare the Form 990. Once the return is prepared, the return is reviewed by the Chief Financial Officer and VP of Finance. Form 990 is then reviewed by the Audit Committee of PIH Health, Inc., which is made up of independent directors. RSM US LLP makes all changes necessary. The final Form 990 is provided to the board prior to filing. 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 1,149,611. Management and general expenses 41,582. Fundraising expenses 0. Total expenses 1,191,193. Ground Maintenance: Program service expenses 164,774. Management and general expenses 11,605. Fundraising expenses 0. Total expenses 176,379. Other Fees: Program service expenses 1,230,211. Management and general expenses 189,176. Fundraising expenses 0. Total expenses 1,419,387. Form 990, Part VI, Section B, Line 16b: PIH Health Inc. holds a 9.8% 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 1913570 14872816 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 Downey Hospital 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 Whittier Hospital 12401 Washington Boulevard Whittier CA 90602 951934652 Healthcare CA 501(c)(3) Line 3 PIH Health Inc 1 PIH Health 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 PIH Health 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 PIH Health Good Samaritan Hospital 1 Samaritan Imaging Center 1225 Wilshire Blvd Los Angeles CA 90017 954252321 Outpatient Imaging Services 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 Physicians 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 PIH Health Good Samaritan Hospital CA 501(c)(3) Line 12a, I PIH Health Good Samaritan Hospital 1 PIH Health Insurance Company 1003 Bishop Street Honolulu HI 96813 263760243 Captive Insurance HI PIH Health Inc T -104517 42346483 1.00000 1 PIH Health Care Solutions 6557 Greenleaf Avenue Whittier CA 90601 462072342 Healthcare CA PIH Health Inc C 74046975 4010951 1.00000 1 DRMC Properties Inc 11500 Brookshire Avenue Downey CA 90241 954769768 Real Estate CA PIH Health Inc C 2545075 13158480 1.00000 1 PIH Health RE 1003 Bishop Street Honolulu HI 96813 472501390 Captive Insurance HI PIH Health Inc T 103641 5767705 1.00000 1 HealthMed Services Inc 12401 Washington Boulevard Whittier CA 90602 300831225 Healthcare CA PIH Health Inc C 10788965 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 0 0 0 0 0 0 0 0 0 0 PIH Health Physicians A 11212787 FMV PIH Health Whittier Hospital A 4804269 FMV PIH Health Foundation A 102921 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.