2019-08-02T13:17:34-05:00 2018-09-30 420714325 RSM US LLP 1 S WACKER DRIVE STE 800 CHICAGO IL 60606 990 2017-10-01 953619388 PIH HEALTH INC PIHH 5626980811 12401 WASHINGTON BOULEVARD WHITTIER CA 90602 RICHARD WANG VP OF FINANCE 5626980811 2019-08-01 1 REBEKUH ELEY P01247672 3126343400 66.98.98.130 2019-08-01 12:03:18 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 64E34636FEC2DFD844E3D394C3B342543AC68841 2017 2019-02-21 02:37:17Z RICHARD WANG 12401 WASHINGTON BOULEVARD WHITTIER CA 90602 18188766 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 16389871 18188766 0 0 55562 0 16445433 18188766 0 0 0 0 1691301 1661944 0 0 0 11172108 11853292 12863409 13515236 3582024 4673530 146777389 154130725 119709424 122226622 27067965 31904103 X PIH HEALTH, INC.'S PRIMARY EXEMPT PURPOSE IS TO SUPPORT AND TOOPERATE 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 12561210 18188766 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. 12561210 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 8 0 1 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 CA X RICHARD WANG 5626980811 12401 WASHINGTON BOULEVARD WHITTIER CA 90602 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 HUEY-MIN YU 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 JAMES WEST PRESIDENT & CEO 1.50 44.70 X 0 1373355 269389 PEGGY CHULACK CAO & ASSISTANT SECRETARY 1.50 44.70 X 0 668472 124860 GREG WILLIAMS CFO & ASSISTANT TREASURER 1.50 44.70 X 0 658252 177226 ROSALIO LOPEZ MD CSO/CMO 1.50 43.00 X 0 820505 138561 0 3520584 710036 0 0 1 0 OLTMANS CONSTRUCTION CO 10005 MISSION MILL ROAD WHITTIER CA 90601 CONSTRUCTION 7276586 R J CONSTRUCTION 12107 PHILADELPHIA STREET WHITTIER CA 90601 CONSTRUCTION 1976516 RSM US LLP 5155 PAYSHERE CIRCLE CHICAGO IL 60674 PROFESSIONAL SERVICES 609579 BEACON SECURITY INC 2970 E LA PALMA AVENUE SUITE F ANAHEIM CA 92806 SECURITY SERVICES 471635 SERVI-TEK INC 3970 SORRENTO VALLEY BOULEVARD SUI SAN DIEGO CA 92121 JANITORIAL SERVICES 267357 8 RELATED RENTAL 900099 17875463 17875463 CAFE REVENUE 900099 313303 313303 18188766 18188766 18188766 0 0 X 1412533 1243029 169504 150904 132796 18108 98507 86686 11821 4245 4245 279996 279996 1987718 1833501 154217 96356 80807 15549 3274639 3130932 143707 33727 8188 25539 2617 2617 370766 370766 5600170 5517195 82975 LICENSES & FEES 29617 8030 21587 REPAIRS & MAINTENANCE 10999 377 10622 EDUCATION EXPENSES 6200 6200 156242 148903 7339 13515236 12561210 954026 0 112714 127817 12416 139797 555308 9410 197424701 44529083 145386611 152895618 710340 958083 146777389 154130725 2952774 1438916 129606 137270 6367960 6230690 110259084 114419746 119709424 122226622 X 27067965 31904103 27067965 31904103 146777389 154130725 4673530 162608 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 45122410 45122410 91430173 26562867 64867306 56745332 15900363 40844969 3992136 2065853 1926283 134650 134650 152895618 INTERCOMPANY PAYABLES 114419746 114419746 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 2018 OR 2017. 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 2014 FOR FEDERAL PURPOSES AND 2012 FOR CALIFORNIA PURPOSES. 0 1 0 0 0 0 0 0 0 JAMES WEST PRESIDENT & CEO 0 1137303 0 47927 0 188125 0 247002 0 22387 0 1642744 0 172284 PEGGY CHULACK CAO & ASSISTANT SECRETARY 0 537083 0 39460 0 91929 0 115228 0 9632 0 793332 0 64439 GREG WILLIAMS CFO & ASSISTANT TREASURER 0 585710 0 38202 0 34340 0 156339 0 20887 0 835478 0 0 ROSALIO LOPEZ MD CSO/CMO 0 666564 0 30938 0 123003 0 123371 0 15190 0 959066 0 109510 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 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 2017 AND ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III): ROSALIO LOPEZ $109,510 PEGGY CHULACK $64,439 JAMES WEST $172,284 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 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 IX, LINE 11G R&M BUILDING: PROGRAM SERVICE EXPENSES 677,855. MANAGEMENT AND GENERAL EXPENSES 75,778. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 753,633. GROUND MAINTENANCE: PROGRAM SERVICE EXPENSES 205,605. MANAGEMENT AND GENERAL EXPENSES 6,268. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 211,873. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 25,639. MANAGEMENT AND GENERAL EXPENSES 66,996. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 92,635. OTHER FEES: PROGRAM SERVICE EXPENSES 924,402. MANAGEMENT AND GENERAL EXPENSES 5,175. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 929,577. PIH HEALTH REAL ESTATE SERVICES LLC 12401 WASHINGTON BOULEVARD WHITTIER CA 90602 464560794 REAL ESTATE CA 1969316 16423061 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 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 12B, II 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 -110098 21443396 1.00000 1 PIH HEALTH CARE SOLUTIONS 6557 GREENLEAF AVENUE WHITTIER CA 90601 462072342 HEALTHCARE CA PIH HEALTH INC C 4759 2959534 1.00000 1 DOWNEY REGIONAL MEDICAL CENTER PROPERTIES INC 11500 BROOKSHIRE AVENUE DOWNEY CA 90241 954769768 REAL ESTATE CA PIH HEALTH INC C 2409610 13773022 1.00000 1 PIH HEALTH RE 1003 BISHOP STREET HONOLULU HI 96813 472501390 CAPTIVE INSURANCE HI PIH HEALTH INC T -9880 2004631 1.00000 1 HEALTHMED SERVICES INC 12401 WASHINGTON BOULEVARD WHITTIER CA 90602 300831225 HEALTHCARE CA PIH HEALTH INC C 1325912 100 1.00000 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 1 0 PIH HEALTH HOSPITAL - WHITTIER J 4050633 FMV PIH HEALTH HOSPITAL - DOWNEY J 143249 FMV PIH HEALTH FOUNDATION J 78137 FMV PIH HEALTH PHYSICIANS J 9699669 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.