2017-08-11T16:14:28-05:00 2016-09-30 420714325 RSM US LLP 1 S WACKER DRIVE STE 800 CHICAGO IL 60606 990 2015-10-01 953619388 PIH HEALTH INC PIHH 5626980811 12401 WASHINGTON BOULEVARD WHITTIER CA 90602 GREG WILLIAMS CHIEF FINANCIAL OFFICER 5626980811 2017-08-03 1 WAYNE HARDER P00294296 3126343400 2015 2021-01-29 14:40:06Z GREG WILLIAMS 12401 WASHINGTON BOULEVARD WHITTIER CA 90602 20938600 0 X N/A X 1981 CA TO SUPPORT AND TO OPERATE FOR THE BENEFIT OF ITS TAX-EXEMPT AFFILIATES. 13 13 0 16 0 0 0 0 16792491 12522644 10928054 915275 0 4118242 27720545 17556161 0 0 0 0 1466283 1639274 0 0 0 11688051 10959836 13154334 12599110 14566211 4957051 135994634 138176544 117339224 114564083 18655410 23612461 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, PIH HEALTH HOSPITAL-DOWNEY, AND MEMORIAL TRUST FOUNDATION OF DOWNEY REGIONAL. PIH HEALTH, INC. IS THE SOLE CORPORATE MEMBER OF THE ABOVE LISTED ENTITIES. 0 0 10390424 12522644 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. 10390424 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 6 0 1 0 0 0 0 0 0 0 0 0 X 13 13 1 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 RICHARD ATWOOD DIRECTOR & VICE CHAIR 1.50 6.00 X X 0 0 0 EFRAIN ACEVES DIRECTOR & SECRETARY 1.50 4.50 X X 0 0 0 KENTON WOODS DIRECTOR & TREASURER 1.50 4.50 X X 0 0 0 DONALD ALVARADO DIRECTOR 1.50 4.50 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 (AS OF 10/12/15) 1.50 4.50 X 0 0 0 LEON MN GARCIA DIRECTOR 1.50 4.50 X 0 0 0 FRANK GOMEZ PHD DIRECTOR 1.50 4.50 X 0 0 0 THOMAS KING DIRECTOR 1.50 4.50 X 0 0 0 ROBERT PETRINA DIRECTOR (AS OF 10/12/15) 1.50 4.50 X 0 0 0 HUEY-MIN YU DIRECTOR 1.50 4.50 X 0 0 0 JAMES WEST PRESIDENT & CEO 1.50 44.70 X 0 1433084 211867 PEGGY CHULACK CAO & ASSISTANT SECRETARY 1.50 44.70 X 0 584466 90482 GREG WILLIAMS CFO & ASSISTANT TREASURER 1.50 44.70 X 0 206935 40431 ROSALIO LOPEZ MD CMO/SR VICE PRESIDENT 1.50 43.00 X 0 740229 96364 MITCHELL THOMAS FORMER CFO FORMER CFO/SR VP OF FINANCE 0.00 0.00 X 0 447624 36747 0 3412338 475891 0 1 1 0 R J CONSTRUCTION 12107 PHILADELPHIA STREET WHITTIER CA 90601 CONSTRUCTION 2542100 MILLE AND SEVERSON INC 3601 SERPENTINE DRIVE LOS ALAMITOS CA 90720 CONSTRUCTION 1282055 BURGHARD DESIGN GROUP INC 29798 HAUN ROAD SUITE 200 SUN CITY CA 92586 CONSTRUCTION 595119 DELOITTE & TOUCHE LLP 555 W 5TH STREET 2700 LOS ANGELES CA 90013 PROFESSIONAL SERVICES 585773 COASTAL LANDSCAPE SERVICES INC 12610 HOMEPARK DRIVE WHITTIER CA 90606 LANDSCAPING 415346 9 RENTAL - TAX EXEMPT AFFILIATES 900099 12226047 12226047 CAFE REVENUE 900099 296597 296597 12522644 4108245 0 4108245 4108245 4108245 4297714 3382439 915275 915275 915275 9997 9997 9997 17556161 12522644 0 5033517 X 1401478 188326 1213152 140468 18876 121592 97328 13079 84249 31435 31435 343455 343455 2316817 2163052 153765 53301 31243 22058 3175529 3037448 138081 20886 451 20435 1634 1634 387930 387930 4439906 4357947 81959 MEDICAL SUPPLIES 155910 148758 7152 LICENSES & FEES 12912 9932 2980 REPAIRS & MAINTENANCE 9847 1947 7900 EDUCATION EXPENSES 2014 2014 8260 8260 12599110 10390424 2208686 0 123806 964945 438879 815672 1134900 666455 169098232 33818275 133870166 135279957 426883 449515 135994634 138176544 4035086 5254193 114513 122370 7052218 6498489 106137407 102689031 117339224 114564083 X 18655410 23612461 18655410 23612461 135994634 138176544 4957051 0 X 0 1 X 1 0 X X 6 PIH HEALTH HOSPITAL - WHITTIER 951934652 3 1 0 0 PIH HEALTH HOME HEALTHCARE 953036281 9 1 0 0 PIH HEALTH FOUNDATION 953761274 7 1 0 0 PIH HEALTH ADULT DAY HEALTHCARE 953643829 9 1 0 0 PIH HEALTH PHYSICIANS 953942828 9 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 75388454 21794289 53594165 38632337 10558101 28074236 2730085 1465885 1264200 15639946 15639946 135279957 INTERCOMPANY PAYABLES 102689031 102689031 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, REGULAR 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 2016 OR 2015. 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 2012 FOR FEDERAL PURPOSES AND 2010 FOR CALIFORNIA PURPOSES. 1 1 0 0 0 0 0 0 0 JAMES WEST PRESIDENT & CEO 0 979845 0 0 0 453239 0 189956 0 21911 0 1644951 0 0 PEGGY CHULACK CAO & ASSISTANT SECRETARY 0 500906 0 0 0 83560 0 83031 0 7451 0 674948 0 0 GREG WILLIAMS CFO & ASSISTANT TREASURER 0 204385 0 0 0 2550 0 33208 0 7223 0 247366 0 0 ROSALIO LOPEZ MD CMO/SR VICE PRESIDENT 0 555660 0 0 0 184569 0 81662 0 14702 0 836593 0 0 MITCHELL THOMAS FORMER CFO FORMER CFO/SR VP OF FINANCE 0 0 0 0 0 447624 0 13379 0 23368 0 484371 0 0 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 ORSTUDY, (5) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINES 4A-B PART I, LINE 4A: IN 2015, SEVERANCE PAYMENT OF $440,436 WAS MADE TO MITCHELL THOMAS. 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: JAMES WEST PEGGY CHULACK GREGORY WILLIAMS ROSALIO LOPEZ THE FOLLOWING AMOUNTS BECAME VESTED OR WERE PAID-OUT IN 2015 AND ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III): PEGGY CHULACK $76,508 JAMES WEST $437,922 ROSALIO LOPEZ $173,064 FORM 990, PART VI, SECTION A, LINE 2 JANE DICUS HAS A BUSINESS RELATIONSHIP WITH ROSALIO LOPEZ, MD. FORM 990, PART VI, SECTION B, LINE 11 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. IN ADDITION, THE EXECUTIVE COMPENSATION COMMITTEE REVIEWS THE SPECIFIC SALARY OF THE PRESIDENT AND THE CHIEF EXECUTIVE OFFICER AND THE SENIOR VICE PRESIDENT OF FINANCE AND CHIEF FINANCIAL OFFICER. 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 877,769. MANAGEMENT AND GENERAL EXPENSES 32,868. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 910,637. GROUND MAINTENANCE: PROGRAM SERVICE EXPENSES 117,978. MANAGEMENT AND GENERAL EXPENSES 7,407. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 125,385. CONSULTANTS: PROGRAM SERVICE EXPENSES 311,974. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 311,974. OTHER FEES: PROGRAM SERVICE EXPENSES 855,331. MANAGEMENT AND GENERAL EXPENSES 113,490. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 968,821. PIH HEALTH REAL ESTATE SERVICES LLC 12401 WASHINGTON BOULEVARD WHITTIER CA 90602 REAL ESTATE CA 1437837 14544248 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 9 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 11A, I PIH HEALTH INC 1 PIH HEALTH HOME HEALTHCARE 12401 WASHINGTON BOULEVARD WHITTIER CA 90602 953036281 HEALTHCARE CA 501(C)(3) LINE 9 PIH HEALTH INC 1 PIH HEALTH ADULT DAY HEALTHCARE 12401 WASHINGTON BOULEVARD WHITTIER CA 90602 953643829 HEALTHCARE CA 501(C)(3) LINE 9 PIH HEALTH INC 1 MEMORIAL TRUST FOUNDATION OF DOWNEY REGIONAL MEDICAL CENTER 11500 BROOKSHIRE AVENUE DOWNEY CA 90241 203883428 FUNDRAISING CA 501(C)(3) LINE 11A, I 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 DOWNEY REGIONAL MEDICAL CENTER INC 11500 BROOKSHIRE AVENUE DOWNEY CA 90241 954504845 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 DRMC 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 0 0 0 1 0 PIH HEALTH HOSPITAL - WHITTIER A 4119504 FMV PIH HEALTH PHYSICIANS A 7957055 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.