2011-08-09T11:22:06-05:00 2010-09-30 DELOITTE TAX LLP 655 WEST BROADWAY SUITE 700 SAN DIEGO CA 921018590 990 2009-10-01 951934652 PRESBYTERIAN INTERCOMMUNITY HOSPITAL INC PRES 5626980811 12401 WASHINGTON BOULEVARD WHITTIER CA 90602 MITCHELL THOMAS 5626980811 2011-08-09 1 6192326500 2009 2016-02-24 21:20:13Z MITCHELL THOMAS 12401 WASHINGTON BOULEVARD WHITTIER CA 90602 532114438 0 X www.PIH.net X 1954 CA To provide quality healthcare and contribute to the community's health and well-being. 15 12 3150 905 154688 47819 2606395 1595087 380632625 392575409 -935983 13580533 834717 2138979 383137754 409890008 616501 739812 0 184625584 193119748 0 0 169672253 181162804 354914338 375022364 28223416 34867644 806597203 848581314 395654408 409434369 410942795 439146945 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. VISION: Where We Want To Be: We will achieve excellence in everything we do. VALUES: Our Promise: Our patient's safety, well-being, and medical condition will be our primary concern at all times. We will consistently demonstrate respect and compassion for the beliefs, situation, and needs of our patients and co-workers. We will strive to anticipate needs and respond in a timely way to meet or exceed the expectations of others. Our attitude and actions will reflect the highest ethical and moral standards. We will work together within and outside the organization to solve problems and pursue opportunities in creative ways. We will serve the community wisely through the efficient and prudent use of our financial resources. 0 0 252358596 739812 372090549 Patient Care. Presbyterian Intercommunity Hospital (PIH) is a 444-bed facility situated in the southeast portion of los angeles county within an area referred to as service planning area 7 (spa 7). Approximately 73% of admissions came from nine cities, which comprise its primary service area. PIH's secondary services area includes additional cities in san gabriel valley and north orange county. In addition, through PIH home health, arcadia home nursing & health services, hospice of presbyterian and hospice of pasadena, PIH's reach extends up the 605 freeway corridor into arcadia-pasadena, bringing the total service area well beyond 1.5 million residents.The following is a list of programs that PIH had during the year:24/7 IntensivistsA day away adhcBlood donor centerBreast health educationCancer helplineCar seat programCardiac lecturesCare force oneChaplaincy programChildbirth educationCommunity benefit managementCommunity building by senior leadership & managementCommunity clinicsCommunity education outreach Diabetes educationDonation of spaceDonations to community organizationsED physician on call expenses/ea programExercise classes / Balance and mobility fall preventionFamily practice residency programFlu and pneumonia clinicsHealth fairsHealth screeningsHigh-risk infant follow-up clinicHospice and Home HealthMariposa boutiqueMedi-Cal eligibility workersNotary serviceParamedic base stationParamedic base station trainingPhysician/medical professional educationPurchased services &/or donation of equipment/suppliesResearchSenior servicesSexual assualt response team (sart)Social services helplineStudent trainingSupport groupsTransportation for underserved patients & familiesWhittier first day clinic 54756467 15076121 Charity care refers to dollars expended to the provision of free or discounted care provided to those lacking insurance or financial resources to pay for needed healthcare services. Recognizing our charitable mission, PIH offers a generous Uncompensated Care Program providing charity care to all patients with family income(s) within 400% of the federal poverty guidelines. Additionally, under the PIH Cash Discount Program, all cash-pay patients (all patients lacking health insurance) are offered a bill reduction commensurate with the discounted reimbursement rate extended through the government-sponsored means-tested Healthy Families program; no pre-qualification is necessary. Each Fiscal Year, PIH realizes a net loss due to offering cash discounts off of actual hospital costs of providing this care. The discounts provided by the cash payment program are especially of benefit to those in the process of applying for PIH's charity care or other government means-tested program and awaiting eligibility determination. Number of persons served: 36,052. 23449891 6799166 Subsidized health services, community health improvement services and community benefit operations, contributions to community groups, research: In providing services to those patients participating in government-sponsored means-tested health programs, such as Medi-Cal, Medi-Cal HMO and Healthy Families, PIH realizes a collective net loss each fiscal year. Number of persons served: 34,766.For additional information, please refer to PIH's community benefit report at www.PIH.net. 330564954 1 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 270 0 3150 1 1 1 0 0 0 0 0 0 0 0 15 12 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X Ronald Yoshihara 5626980811 12102 Washington Blvd Whittier CA 90606 Efrain Aceves 1.50 X 0 0 0 Donald Alvarado 1.50 X X 0 0 0 Richard Atwood 1.50 X 0 0 0 Jane Dicus 1.50 X X 0 0 0 Leon MN Garcia 1.50 X 0 0 0 JC McFarland 1.50 X 0 0 0 Edward Miller 1.50 X 0 0 0 Angel Munoz 1.50 X 0 0 0 Gregory Polito MD 1.50 X 0 0 0 Norma Provencio 1.50 X 0 0 0 William Shanahan MD 1.50 X 60000 0 0 Neal Shindel MD 1.50 X 0 39427 0 Drew Sones 1.50 X X 0 0 0 Kenton Woods 1.50 X X 0 0 0 Huey-Min Yu 1.50 X 0 0 0 James West 40.00 X 814564 0 174331 Mitchell Thomas 40.00 X 442205 0 159079 Peggy Chulack 40.00 X 359383 0 62700 Rosalio Lopez MD 40.00 X 490887 0 90624 Reanna Thompson 40.00 X 287097 0 51977 Dave Klinger 40.00 X 265238 0 43640 Ronald Yoshihara 40.00 X 205341 0 42909 Patricia Bray 40.00 X 183604 0 27946 Judy Pugach 40.00 X 167342 0 32214 Lon Orey 40.00 X 273758 0 45881 Ramona Pratt 40.00 X 187700 0 36283 Margo Kaatz 40.00 X 165401 0 23816 Rowena Stajer 40.00 X 163662 0 35601 Suzanne Carlson 40.00 X 201118 0 41388 Perry Ebeltoft 40.00 X 176520 0 18291 Joan Rolland 40.00 X 164105 0 33045 Julie Reback 40.00 X 302269 0 5036 Todd Salnas 40.00 X 284953 0 14549 Jung Ho 40.00 X 218045 0 8179 Joanna Libiez 40.00 X 179836 0 6901 Lillian Bell 40.00 X 185591 0 16488 Alan Endo 40.00 X 177095 0 16632 Philip B Chon 40.00 X 174590 0 6621 6130304 39427 994131 235 0 1 0 Millie and Severson Inc PO Box 3601 Los Alamitos CA 90720 Construction 16935289 Eclypsis Solution Corp Three Ravinia Drive Atlanta GA 30346 IT Services 11922324 Whittier Pulm and Critc Care 6905 Alta Vista Drive Rancho Palos Verdes CA 90275 Medical Services 4936340 Lambert Radiol Med Grp Inc 11721 Whittier Blvd 509 Whittier CA 90601 Medical Services 4700967 Family Practice Residency Prog 12291 Washington Blvd Whittier CA 90606 Medical Services 3015720 81 1595087 1595087 NET PATIENT Service Re 621610 380365611 380365611 Other Patient Revenue 621610 12209798 12209798 392575409 11587053 11587053 124211820 6090 122008656 215774 2203164 -209684 1993480 1993480 Community Pharmacy 624110 1406473 1390427 16046 Purchase Discounts 900099 744990 744990 Non-Patient Lab 621500 138642 138642 -151126 -151126 2138979 409890008 393965836 154688 14174397 484412 484412 255400 255400 5591608 3967414 1624194 136235050 124143156 12091894 10361039 8806883 1554156 29517814 26457295 3060519 11414237 10025058 1389179 230767 230767 2696474 302 2696172 121061 121061 38276 38276 48701565 42414901 6286664 5719525 3257552 2461973 17345120 13199495 4145625 8206820 6864954 1341866 459056 337312 121744 176275 34544 141731 10669848 9360073 1309775 16207535 14189792 2017743 3437286 1047708 2389578 Medical Supplies 45369925 45043914 326011 0 Bad Debt 14941438 14941438 0 0 Equipment R&M 3738935 3588559 150376 0 Equipment Leases 673129 664384 8745 0 Dues & Subscriptions 553180 126587 426593 0 1876589 1353821 522768 375022364 330564954 44457410 0 1606745 2269947 7507156 6521483 64439263 69675419 36498 42000 3116493 3431697 13987703 10649826 362936022 106503646 237473046 256432376 321769904 351404186 1108958 594192 155509437 147602188 806597203 848581314 36755543 34496454 280304830 273946465 78594035 100991450 395654408 409434369 X 410942795 439146945 410942795 439146945 806597203 848581314 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 38276 38276 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: A portion of dues paid to Hospital Association of Southern California and American Hospital Association are related to lobbying. 214611 214611 186232390 39100637 147131753 103642347 65029233 38613114 72846674 2373776 70472898 256432376 Deferred Financing Costs 2843699 Due from Affiliates 138279513 Other Receivables 5174703 Investment in Affiliates 1132673 Other Receivables - Comm Pharmacy 171600 147602188 Deferred compensation 13778078 Self insurance trust 16458031 Accrued bond interest payable 842018 Pension liability 29447956 Interest rate swap 39631919 Intercompany payable - Comm Pharmacy 694650 Other liabilities 138798 100991450 409890008 375022364 34867644 16879375 -23542869 -6663494 28204150 Part X: Description of Uncertain Tax Positions Under FIN 48: The company measures liabilities for unrecognized tax uncertainties in accordance with ASC 740, Income taxes (formerly FASB Interpretation no. 48, Accounting for uncertainty in Income Taxes - an interpretation of FASB Statement no. 109) which prescribes a comprehensive model for how a company should recognize, measure, present, and disclosein its financial statements uncertain tax positions that a company has taken or expects to take on a tax return. The company has not recorded a liability for unrecognized tax uncertainties in 2010 or 2009. Part XI, Line 8 - Other Adjustments: Pension Adjustments: -6460111. Net unrealized losses on interest rate swap: -13582758. Loss on Litigation Settlement: -3500000. 1 1 X 1 X 1 X 1 1 0 1 1 10198 14745514 878968 13866546 0.03700 25811 38742078 14124115 24617963 0.06560 43 249078 73038 176040 0.00050 36052 53736670 15076121 38660549 0.10310 20 32223 4299481 19019 4280462 0.01140 5 579 4017068 751259 3265809 0.00870 5 1326 14159538 6023756 8135782 0.02170 1 15 86369 86369 0.00020 8 623 887435 5132 882303 0.00240 39 34766 23449891 6799166 16650725 0.04440 39 70818 77186561 21875287 55311274 0.14750 1 7 1 15 36000 36000 0.00000 1 13 45175 45175 0.00000 3 35 81175 81175 0 14941438 62321306 73615105 -11293799 X 1 1 Presbyterian Intercommunity Hospital

12401 Washington Blvd Whittier CA 90602

X X X X Skilled nursing facility Same Day Surgery

12415 Washington Blvd Whittier CA 90602

Outpatient surgical services Intercommunity Magnetic Resonance Imagin

12455 Washington Blvd Whittier CA 90602

MRI services Ernest D Wells Medical Office Bldg

12462 Putnam St Whittier CA 90602

Outpatient services Patricia L Scheiffly Breast Health Ctr

12393 Washington Blvd Whittier CA 90602

SVCS Presbyterian Health Medical Plaza

12291 Washington Blvd Whittier CA 90602

wound healing, lab draw station Arcadia Home Nursing

351 E Foothill Blvd suite 100 Arcadia CA 91006

Visiting nurses association Hospice Homes - Dove

10736 Valley View Ave Whittier CA 90604

Hospice care Hospice Homes - Rose

10742 Valley View Ave Whittier CA 90604

Hospice care PIH Home Health

15050 Imperial Hwy La Mirada CA 90638

Home Health Agency Presbyterian Health Medical Plaza

15088 Imperial Hwy La Mirada CA 90638

Outpatient therapy BHP - La Mirada

12675 S La Mirada Blvd Suite 219 La Mirada CA 90638

Radiology Part I, Line 6a: PIH files its Community Benefit Report with the State of California in fulfillment of its mandated reporting requirement, as stipulated by California Senate Bill 697 (SB 697). This Annual Report & Plan for Community Benefit is submitted to Office of Statewide Health Planning & Development (OSHPD), Healthcare Information Division, and is also widely distributed throughout the community, as well as being posted to PIH's website: www.pih.net. Part I, Line 7: The cost system is based on the cost-to-charge ("C2C") methodology, 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 departments based on their relative gross charges. The sum of the direct and allocated indirect costs of each departement are divided by the total department gross procedure charges. The resulting department-specific percentage, e.g. 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. All cost information reflected in PIH's regulatory reporting and financial analysis is based on this department-level C2C methodology.Part I, Line 7F: $14,941,438. Part I, Line 7g: 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. Reserves for charity and uncollectible amounts have been established and are netted against patient accounts receivable in the consolidated balance sheet. 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: Uninsured patients will be encouraged to apply for government programs or uncompensated care. If PIH's collection agency identifies a patient that qualifies for PIH's uncompensated care program but that failed to apply, it will return the account to PIH and recommend an uncompensated care write-off. In addition it will remove delinquencies from the patient's credit report. Part VI, Line 2: To assess the health care needs of the communities we serve, PIH conducts a community health needs assessment every three years, in accordance with California State law and the new Patient Protection and Affordable Care Act (PPACA), is federal statute that was signed into law on March 23, 2010. The triennial assessment serves as a primary tool for the hospital to determine its community benefit plan, which outlines how the hospital will give back to the community in the form of health care and other community services to address unmet community health needs. 2010 Community Health Needs AssessmentDriven by a new and significantly innovative approach to assessing community health needs, the PIH 2010 Community Health Needs Assessment took a focused approach that included gaining a deeper understanding of the health access experience of our community's most vulnerable. As such, in planning for the 2010 Community Health Needs Assessment strategy, PIHs Community Benefit Oversight Committee (CBOC) identified an opportunity to obtain baseline data on our three community benefit priority health areas (identified below). As a result, these priority health areas were examined during primary data collection through stakeholder interviews and community focus groups. The resulting community input will greatly assist the hospital and CBOC sub-committees with designing meaningful initiatives that will provide a substantial return on investment of PIH's charitable resources.Secondary data were collected by obtaining and analyzing a variety of objective data from local, County, and State sources to present a community profile, birth and death characteristics, access to health care, chronic diseases, social issues, and school and student characteristics. When pertinent, these data sets were presented in the context of Los Angeles County and the State, which served to frame the scope of an issue as it related to the broader community. Additionally, findings were compared to accepted benchmarks that reference recognizable state and national resources (e.g., Healthy People 2020 objectives). Enhanced GIS mapping related to the priority areas was included, as well. Primary data collection included some 27 stakeholder interviews held with community partners and area physicians. In addition, ten focus groups were conducted to gather information and perceptions from PIH Primary Service Area residents; groups were conducted in both English and Spanish.Priority Health AreasUpon completion of the 2007 Community Health Needs Assessment, PIH's Community Benefit Oversight Committee (CBOC) undertook an extensive priority setting process, reaching consensus on three priority health areas on which to focus community benefit and community capacity-building efforts:1. Short-term priority: Adult Pneumonia; 2. Long-term priority: Overweight & Obesity; and3. Hospital Priority: Preventable Emergency Department Visits / Avoidable Hospitalizations The CBOC will again engage in a priority setting process, based on results of the 2010 Community Health Needs Assessment, to determine the hospitals areas of focus for 2011 through 2013. This process will include consideration of data findings and current priority health areas, as well as consideration of significant health indicators from the 2010 Assessment. Part VI, Line 3: Charity Care refers to dollars expended for the provision of free or discounted care provided to both the insured and uninsured who lack financial resources and meet the uncompensated care program's criteria to pay for needed healthcare services. During FY 2009-2010, PIH incurred un-reimbursed costs for this provision of charity care to the under-served in the amount of $ 13,866,546.PIH's Charity Care policy includes the following two programs: Uncompensated Care Program PIH offers a generous Uncompensated Care Program that exceeds recommended standards providing charity care to all patients with family income(s) within 400% of the federal poverty guidelines. Patients who would qualify under this program are: Uninsured patients who do not have the ability to pay as determined by the financial guidelines in the Charity Care policy;Patients who have Restricted Medi-Cal Emergency & Pregnancy services Coverage (and share no cost) and are receiving services not paid for by Medi-Cal;Insured patients whose coverage is inadequate to cover a catastrophic situation;Persons whose income is sufficient to pay for basic living costs, but not medical care; andPatients who demonstrate ability to pay part, but not all of their liability.Self-Pay Payment ProgramAdditionally, under the PIH Self-Pay Payment Program, all cash-pay patients (all patients lacking health insurance) are automatically given a bill reduction commensurate with or less than the negotiated reimbursement rates with a contracted Healthy Families program plan; no pre-qualification is necessary. If a patient cannot pay the entire discounted obligation and does not qualify for government or hospital programs, PIH will extend reasonable no-interest payments. The discounts provided by the Self-Pay Payment program are especially of benefit to those in the process of applying for PIH's charity care or other government means-tested program and awaiting eligibility determination. Uninsured patients are educated about the Self-Pay Payment program prior to or at registration/admission (or after an Emergency Department patient has been medically screened and stabilized).Both of these programs are designed to alleviate the burdensome costs of healthcare for those with limited financial resources and for those who may be on the brink of poverty. The discounts provided by the self-pay payment program are especially of benefit to those in the process of applying for PIH's Charity Care or other government means-tested programs and awaiting eligibility determination. Additional Patient Education Regarding PIH's Charity Care:It is important to note that, regardless of ability to pay, appropriate clinical staff establish a plan of care, order medically necessary treatment, services and medications, in order to stabilize all patients. Once stabilized, bilingual (English and Spanish) Financial Counselors or other appropriate staff work with eligible patients in applying for assistance. In accordance with California's Fair Pricing Law for low-income, uninsured individuals, PIH posts notices in both English and/or Spanish with information regarding its Uncompensated Care and Self-Pay Payment programs policies in settings that are highly visible to the public, such as the Emergency Department, Billing/Cashier Office, Patient Registration, as well as various ancillary departments and outpatient facilities. Patients also receive a Letter to the Uninsured in English and/or Spanish, which details the various programs for which they may be eligible and the below statement appears on all patient billing statements in English and Spanish:Please pay the balance due. If you cannot pay the entire balance, please call to set up installment payments. If you are unable to pay all or part of your balance and your family income is within 400% of federal poverty limits, please call and request an uncompensated care application. PIH accepts all major credit cards. You may also pay on-line at http://www.pih.net. Note: checks will be processed electronically and will immediately take funds from your account. Thank you. Part VI, Line 4: Presbyterian Intercommunity Hospital (PIH) is situated in the southeast portion of Los Angeles County, California within an area referred to as Service Planning Area 7 (SPA 7). Approximately 73% of admissions come from nine cities, which comprise its primary service area. PIH's secondary service area includes additional cities in San Gabriel Valley and North Orange County. In addition, through PIH Home Health, Arcadia Home Nursing & Health Services, Hospice of Presbyterian and Hospice of Pasadena, PIHs reach extends up the 605 Freeway Corridor into Arcadia-Pasadena, bringing the total estimated hospital service area well beyond 1.5 million residents. Below are PIH's Primary and Secondary Service Areas, based upon OSHPD Discharge Data (2009):Primary Service Area(Encompasses 9 cities/13 zip codes)Hacienda Heights 91745La Habra 90631La Habra Heights 90631La Mirada 90638Montebello 90640Norwalk 90650Pico Rivera 90660Santa Fe Springs 90670Whittier 90601-90606Secondary Service Area - WestBell 90201Bellflower 90706Downey 90240-90242Los Angeles 90022Los Angeles 90040South Gate 90280Secondary Service Area - EastChino Hills 91709Diamond Bar 91765La Puente 91744La Puente 91746Rowland Heights 91748Walnut 91789West Covina 91792Primary Service Area ProfileThe population for the PIH Primary Service Area is approximately 600,000. Children and youth, ages 0-17 make up 29.4% of the population; 32.9% are 18-39 years of age; 26.6% are 40-64; and 11.2% of the population are seniors, 65 years of age and older. The area has slightly higher percentages of children ages 5-17 and seniors than found in Los Angeles County and the State. The Primary Service Area consists primarily of Latinos (60.7%) and Whites (25.6%). Asian/Pacific Islanders comprise 9.7% of the population, and African Americans, Native Americans, and other races combined total only 4.0% of the population. The area has a notably larger percentage of Latinos, and a smaller percentage of all other races and ethnicities when compared to Los Angeles County. On average, the PIH Primary Service Area has a lower unemployment rate than when compared to the County and the State. In all Primary Service Area cities, unemployment has risen in 2010 compared to 2009.Poverty rates paint an important picture of the population within the PIH Primary Service Area. At the time of the 2000 census, from 5.5% to 16.6% of the population lived at or below 100% of the Federal Poverty Level. It can be assumed with the increase in unemployment in the area, that poverty rates have also increased. Importantly, the data indicate that within the PIH service area poverty increases markedly for the population at or below 200% of the Federal Poverty Level (FPL). In the PIH service area almost one-third (31.3%) of the residents exist at 200% of FPL. In the overall PIH Service Area, Spanish is spoken in 44.3% of the homes; this is higher than the number of Spanish speaking households in the county (37.9%) and the state (25.8%). Comparatively, the service area has noticeably fewer households that speak other Indo-European (2.6%) or Asian/Pacific Island languages (8.0%). Of the population age 25 and over, 30.0% have less than a high school diploma; this is consistent with county completion rates. By comparison, the area has higher high school graduation rates than the county or state, with almost one-quarter of the population (24.8%) having a high school diploma. In comparison, the residents show equivalent Associate degree college attainment, but lower rates of residents with Bachelors degrees, graduate or professional degrees than in the county or state.The population served by PIH experiences high rates of overweight and obesity, chronic diseases and poor birth outcomes. The concerns and barriers faced by vulnerable populations in Whittier and the surrounding environs include a lack of affordable housing, resources that are outstripped by needs, difficulty accessing services, and a general lack of awareness of the services that are available. Part VI, Line 5: PIH works with a variety of community stakeholders to enhance our collective capacity to improve the health of the communities we serve. Members of PIH's management team, in addition to designated community benefit staff, actively engage key community stakeholders through service on the hospital's Community Benefit Oversight Committee (CBOC). The CBOC is accountable to the hospitals Board of Directors and is responsible for Community Benefit Oversight, implementation and evaluation.To further support community-building, many hospital staff members serve on boards of a variety of community-based organizations which serve the health and social service needs of local communities, including the Whole Child, a local agency with a mission to strengthen vital parent-child relationships. PIH's Director of Marketing & Planning Department serves on a community coalition, which is advocating for bringing vital public transportation services to Whittier. Other members of this coalition include Whittier City Councilmembers, a City of Whittier Planning Commissioner, Whittier College professors, the Executive Director of the Whittier Chamber of Commerce, as well as Whittier residents. Furthermore, PIH offers a free shuttle service from a local train station during morning and afternoon hours to provide employees living a significant distance from the hospital with an incentive to commute via train rather than by car. Launched initially as a pilot in FY 2005-2006, the shuttle service now has many participants using public transportation on a regular basis, supporting PIH's efforts to improve the environment.Additionally, PIH mobilizes assets and invests resources through other carefully prioritized community-building activities. Examples of these activities include:Activate Whittier - a collaborative community initiative to motivate and support a healthy community through wellness education, advocacy and policy-related efforts, and promotion of healthy eating and physical activity. PIH is an active member and joins the City of Whittier, YMCA of Greater Whittier, LA County Public Health Department (SPA 7), Whittier College, Whittier First Day, and the Boys and Girls Club of Whittier to serve on Activate Whittier.La Mirada ACHIEVE - An initiative led by the City of La Mirada, which engages key stakeholders in all community sectors to identify and implement policies and environmental strategies to 1) Facilitate an increase in physical activity in public spaces; 2) Facilitate development and implementation of worksite wellness policies; and 3) To establish La Mirada as a smoke-free environment; PIH is a supporting partner in implementation of this initiative.Whittier Unified School District - PIH has contributed to the increased effectiveness and improved capacity of a local school district through Reach for the Stars childhood obesity prevention program. As a key program partner, PIH has contributed staff time, in-kind resources, direct primary care for school children through the Care Force One mobile clinic, and a variety of health promotion education efforts; effective FY 2010-2011, PIH is facilitating expansion of this program into a district-wide effort that includes the implementation of CATCH (Coordinated Approach to Childrens Health) - an evidence-based curriculum.Whittier Area First Day Coalition - PIH provides direct support for Whittier First Day, an agency that offers short-term transitional housing and supportive social services for homeless adults. A PIH Board member also serves on the Board of First Day. In addition, PIH and First Day actively collaborate in many ways to assist homeless residents and, ultimately, benefit the entire community through many positive outcomes. For example, PIH provides a licensed Nurse Practitioner to staff an on-site health and wellness clinic at First Day, as well as donating medications and medical supplies. Through this provision of preventive primary care services to First Day residents, the residents experienced a measurable reduction in sick care visits to local clinics and the emergency room. Additionally, PIH provided First Day with a grant to assist with the purchase of a tri-plex property to be used by families for transitional housing, therefore, reducing the burden of homelessness in the community. The PIH and First Day collaborative has been recognized by the Los Angeles Homeless Services Authority and the Hospital Association of Southern California as a model for effective community engagement to meet the needs of those most at-risk. During FY 2009-2010, PIH was recognized by VHA, Inc. with its national 2010 Community Benefit Excellence Leadership award, with special emphasis on this partnership between PIH and First Day. Part VI, Line 6: Since opening in 1959, Presbyterian Intercommunity Hospital (PIH) has grown from a 188-bed facility to a 444-bed medical center and integrated healthcare delivery system that today serves more than 1.5 million residents, and includes a network of primary care clinics, a mobile health clinic, hospice programs, as well as an adult day health care center. PIH's mission is to 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. We are guided by our belief that health care is a right and not a privilege. Today, as a not-for-profit hospital, community benefit continues to be an integral part of PIH's mission. We dedicate assets to charitable purposes, such as charity care, as well as a multitude of community-based initiatives to improve and promote overall health and well-being, regardless of health or economic status.Furthermore, PIH, along with our affiliated medical group, Bright Health Physicians, is forward-thinking in making plans to ensure our longevity and position us to continue our provision of outstanding healthcare which meets the needs of our communities. We are intuitively planning for the upcoming changes in healthcare and are committed to safeguarding our financial strength, which, in turn, allows for future growth and continued fulfillment of our community-based healthcare mission. This careful stewardship of PIH's charitable resources is of high priority for PIH's Board of Directors. As such, in 2006, the Board established a Community Benefit Oversight Committee (CBOC), comprised of community stakeholders and hospital senior management, which is dedicated to providing the strategic direction, oversight, and evaluation of the hospital's community benefit programs and initiatives. Measurement of outcomes for each of PIH's "flagship community benefit programs via development of aims & measurable goals, has resulted in a more sophisticated level of evaluation and oversight by PIH's CBOC at its annual meetings. This on-going review of program effectiveness and impact ensures that PIH continues to employ intelligent business approaches in evaluation of initiatives to inform overall decision-making. We realize that it is only through measurement and evaluation of impact that we can distinguish successes, highlight areas for improvement, and identify those programs that should be re-focused or discontinued to free-up vital resources for allocation to more effective interventions. For Fiscal Year 2009-2010, PIHs community benefit contributions totaled $55,392,449, including $38,660,549 related to Charity Care and programs such as Medi-Cal, $8,135,782 in Subsidized Health Services and $4,014,355 in Community Health Improvement Services, as well as dollars associated with other community benefit categories.Examples of PIH's commitment to improvement of overall community health and healthcare access are below:Enrollment AssistancePIH, through its Bright Health Physicians affiliate, established a team of bi-lingual Enrollment Coordinators to assist the un-insured in applying for health insurance coverage for children and to assist eligible patients in applying for PIHs charity care program. Since September 2006, they have enrolled over 1,100 families with health insurance programs, such as Healthy Families. The results of their efforts are also reflected in PIHs Charity Care reporting. In addition, PIH contracts with agencies specializing in Medi-Cal and Healthy Families enrollment, in an effort to ensure that all those eligible obtain health insurance coverage and, ultimately, have access to care.Community-Based HealthcarePIH and Whittier First Day, a local homeless shelter, collaborate in many ways to assist shelter residents and, ultimately, to benefit the entire community through many positive outcomes. As such, PIH provides a Nurse Practitioner (and supervising physician) to staff a health and wellness clinic on-site at Whittier First Day to ensure that homeless individuals have direct access to primary healthcare services. During FY 2009-2010, PIH was recognized by VHA, Inc. with its national 2010 Community Benefit Excellence Leadership award, with special emphasis on the partnership between PIH and First Day. Family Practice Residency ProgramAs an Accredited Continuing Medical Education Provider, PIH's Family Practice Residency Program places special emphasis upon training residents to work with medically at-risk populations in the community including teen mothers, homeless families, and community members of all ages who reside in low-income, under-served areas. Resident physicians provide community health services via the Care Force One mobile health unit, a County-sponsored Community Resource Center, PIH's home-based palliative care program, and at hospital-supported clinics at Whittier College and local homeless shelters. In addition, the PIH Residency program offers a Tropical Medicine track, which provides opportunities for residents to provide much needed care in countries as far away as Cameroon and Zambia.R. C. Baker Foundation Regional Emergency DepartmentDuring FY 2009-2010, PIH's Emergency Department (ED) experienced an estimated 70,000 visits, a slight increase from the prior fiscal year. PIH completed expansion of the ED in 2009, making it one of the largest emergency rooms in Los Angeles County. The expansion included an increase from 43 to 61 beds, allowing for decreased wait times, more triage rooms, and an area designed specifically for pediatric care. Additionally, the ED features the local area's Paramedic Base Station, providing both the equipment and resources for qualified staffing of the base station so that when an ambulance is dispatched to a local home, Los Angeles County Paramedics have critical access to local hospital-based emergency services. Furthermore, PIH sustains a contract with an on-call physician panel so that eligible patients, regardless of health insurance status, are assured access to specialty care appropriate to their needs. Research - Ruby L. Golleher Comprehensive Cancer ProgramPIH's award-winning comprehensive cancer program participates in clinical research trials through affiliations with two academic teaching centers: (1) Southwest Oncology Group [SWOG] in affiliation with the University of California at Irvine; and (2) Radiation Therapy Oncology Group (RTOG) in affiliation with the University of California at Davis. During FY 2009-2010, the comprehensive cancer program was enhanced to include: a cancer survivorship program; yoga for healing; meditation/relaxation therapy; Lymphedema workshops; and two new clinical trials for metastic prostate cancer and stage III colon cancer.Volunteer ContributionsOver 600 PIH volunteers contributed some 102,655 hours, translating into more than $2,140,265 in savings for the hospital. Part VI, Line 7: While PIH is not part of a hospital system, the hospital is affiliated with 1) Bright Health Physicians (BHP), a not-for-profit medical foundation; 2) the PIH Foundation, a not-for-profit organization that exists to raise philanthropic funds in support of PIHs charitable mission; and 3) MedSite, which subsidizes The S. Mark Taper Foundation "A Day Away" Adult Day Health Care Center. BHP supports the local community through a network of community-based health clinics, and health promotion and health insurance enrollment efforts. In addition, BHP opened a corporate office in 2010, after the purchase and refurbishment of the Fisher Building in Uptown Whittier. The new corporate office houses over 165 employees. The City of Whittier's Economic Development Newsletter states that projects such as this underscore PIH / BHP as a "resource that protects the health and safety of the community while providing jobs to our City's residents." During FY 2008-2009, PIH and BHP were jointly recognized as "Whittier Business of the Year" by the City's Chamber of Commerce for this Uptown project, an award only given when a local organization or business has exemplified exceptional benefit and service to the community. The PIH Foundation Gala, which is held annually, benefits a hospital program, initiative, or department each year. During FY 2009-2010, the Gala benefited the Ruby L. Golleher Comprehensive Cancer Program, generating over $268,000 to enhance its oncology services. The total dollars raised include a subsequent employee appeal, which resulted in an additional $10,000 for the Program. In addition to raising funds in support of PIH, the PIH Foundation also provides in-kind fundraising consultation to local community-based organizations. MedSite's S. Mark Taper Foundation "A Day Away" Adult Day Health Care Center has, since 1999, provided high quality care for individuals requiring continuous supervision and care and whose caregivers may need to work, care for others or are in desperate need of respite. The center offers both social & medical models depending upon individual need. Family members involved in their loved ones treatment have the opportunity to participate in on-going education and caregiver support groups, all designed to empower families to be more skilled and effective in their caregiving roles. During FY 2010, some 80 individuals were cared for at the "A Day Away". For detailed information regarding these PIH affiliates' additional activities to support and promote community health, please see each respective organization's IRS Form 990. CA 1 Arthritis Foundation 4311 Wilshire Blvd Ste 530 Los Angeles CA 90010 951885447 501(c)(3) 7000 General Support Rancho Los Amigos Foundation 7601 E Imperial hwy Downey CA 90242 953849600 501(c)(3) 10625 General Support Rio Hondo College Foundation 3600 Workman Mill RD Whittier CA 90601 954367487 501(c)(3) 291000 Degree Nursing Program and General Support American Cancer Society - Whittier 13230 Penn street Whittier CA 90602 941170350 501(c)(3) 8295 General Support Boys & Girls Club of Whittier 7905 Greenleaf Avenue Whittier CA 90602 956151763 501(c)(3) 7617 General Support YMCA of Greater Whittier 12510 E Hadley St Ste 201 Whittier CA 90601 951684795 501(c)(3) 6800 General Support COPE Health Solutions 2400 S Flower Street Los Angeles CA 90007 470864952 501(c)(3) 5025 General Support Los Angeles Centers for Alcohol and Drug Abuse - LACADA 11015 Bloomfield Avenue Santa Fe Springs CA 90670 237110152 501(c)(3) 15250 General Support National Health Foundation 515 S Figueroa Street Ste 1300 Los Angeles CA 90071 237314808 501(c)(3) 5000 General Support Partners in Care FoundE Goetz 732 Mott Street Suite 150 San Fernando CA 91340 953954057 501(c)(3) 6900 General Support Whittier Area First Day Coalition 12426 Whittier blvd Whittier CA 90602 931141844 501(c)(3) 18850 General Support Whittier Community Foundation 13230 Penn street Whittier CA 90602 830450823 501(c)(3) 8300 General Support Whittier Host Lions Club PO BOX 245 Whittier CA 90608 956094500 501(c)(3) 7275 General Support PIH FOUNDATION 12401 WASHINGTON BOULEVARD Whittier CA 90602 953761274 501(c)(3) 121052 General Support 14 Scholarships and medical education 37 159000 Psychiatric Care at independent facility for uninsured patients 54 96400 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: PIH provides financial assistance to both not-for-profit organizations and individuals based on 1) Charitable mission or purpose of the charitable organization and its alignment with PIH's mission, values and objectives and/or 2) Identified individual need for health-related services. For contributions made to charitable organizations, PIH adopted a policy which guides the process by which funds are granted to ensure that PIH is a good steward of its resources as a federally registered 501(c)(3) not-for-profit entity. To ensure accurate community benefit reporting, this policy also sets forth that direct contributions made to community organizations must be appropriately classified as either a) Community Benefit or b) Community Relations/Marketing Contributions. In compliance with this policy, information is gathered from the grantee regarding the intended use of funds and the percent of granted funds that will go towards supporting the organization's mission. For contributions made to individuals, PIH has established a dedicated budget which subsidizes vital assistance such as purchase of durable medical equipment or non-acute care not covered by insurance upon hospital discharge, including paid placement in skilled nursing or mental health facilities. In these instances, a specific service is being purchased and receipt of proper service is ensured through follow-up by PIH discharge planners or social workers. X 1 1 X X X X X X 1 1 0 0 0 0 0 0 0 James West 679194 0 63000 0 72370 0 8012 0 166319 0 988895 0 0 0 Mitchell Thomas 403236 0 32753 0 6216 0 8012 0 151067 0 601284 0 0 0 Peggy Chulack 264671 0 68310 0 26402 0 8012 0 54688 0 422083 0 0 0 Rosalio Lopez MD 418779 0 40013 0 32095 0 8012 0 82612 0 581511 0 0 0 Reanna Thompson 201243 0 69300 0 16554 0 8012 0 43965 0 339074 0 0 0 Dave Klinger 209180 0 39520 0 16538 0 8012 0 35628 0 308878 0 0 0 Ronald Yoshihara 191691 0 0 0 13650 0 6246 0 36663 0 248250 0 0 0 Patricia Bray 176662 0 0 0 6942 0 5821 0 22125 0 211550 0 0 0 Judy Pugach 160808 0 0 0 6534 0 5265 0 26949 0 199556 0 0 0 Lon Orey 258291 0 0 0 15467 0 7456 0 38425 0 319639 0 0 0 Ramona Pratt 180856 0 0 0 6844 0 5951 0 30332 0 223983 0 0 0 Margo Kaatz 146395 0 8359 0 10647 0 5069 0 18747 0 189217 0 8359 0 Rowena Stajer 157662 0 0 0 6000 0 5199 0 30402 0 199263 0 0 0 Suzanne Carlson 190705 0 0 0 10413 0 6246 0 35142 0 242506 0 0 0 Perry Ebeltoft 170387 0 2369 0 3764 0 936 0 17355 0 194811 0 0 0 Joan Rolland 155571 0 0 0 8534 0 5116 0 27929 0 197150 0 0 0 Julie Reback 161638 0 53438 0 87193 0 0 0 5036 0 307305 0 53438 0 Todd Salnas 230575 0 28658 0 25720 0 0 0 14549 0 299502 0 28658 0 Jung Ho 217945 0 0 0 100 0 0 0 8179 0 226224 0 0 0 Joanna Libiez 148926 0 11661 0 19249 0 0 0 6901 0 186737 0 0 0 Lillian Bell 181744 0 1500 0 2347 0 0 0 16488 0 202079 0 0 0 Alan Endo 174726 0 2369 0 0 0 0 0 16632 0 193727 0 0 0 Philip B Chon 171976 0 0 0 2614 0 0 0 6621 0 181211 0 0 0 Part I, Line 1a All employees are eligible for Health Club reimbursement and any such reimbursements were included in taxable compensation, per 2010 plan year benefits summary. Part I, Lines 4a-b: Julie Reback received a total severance payment of $149,578. The first half of $74,789 was paid during calendar year 2009 and the second half of $74,789 was paid during calendar year 2010. Part I, Line 4b: IHC and its related affiliates sponsors a 457(F) plan. The Plan participants and amounts received (if applicable) were: James West, Mitchell Thomas, Peggy Chulack, Rosalio Lopez MD, Reanna Thompson, Dave Klinger, Ronald Yoshihara, Patricia Bray, Judy Pugach, Ramona Pratt, Margo Kaatz ($8,359), Rowena Stajer, Suzanne Carlson, Joan Rolland, Julie Reback ($53,438), and Todd Salnas ($28,658). City of whittier - Series 2009 956000812 966769DA6 2009-05-14 280328878 Hospital Facilities, refund 2007 Bonds 0 0 280328878 6278125 3155562 1337383 2012 1 0 1 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 1 1 Goldman Sachs Bank USA 29.500000000000 0 0 1 See Schedule O 0 Form 990, Part VI, Section A, line 2 1) Jane Dicus has a business relationship with J.C. McFarland 2) Jane Dicus has a business relationship with Drew Sones Form 990, Part VI, Section A, line 6 Interhealth corp. ("IHC") is the sole member of PIH. Form 990, Part VI, Section A, line 7a IHC has authority to elect all the members of the board of PIH. Form 990, Part VI, Section A, line 7b IHC has all voting rights and the power to elect the board of directors of PIH. 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 the independent directors. The Form 990s are then provided to the Board for its inforation. 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 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 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 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, Schedule L, Part IV: A. Lambert Radiology Medical Group, inc B. Shareholder, William Shanahan is a Director of PIH C. $ 4,587,040 D. Radiology services provided to PIH E. No A. Bewley, Lassleben & Miller B. Partner, Edward Miller is a Director of PIH C. $635,363 D. Legal services provided to PIH E. No FORM 990, PART VII, SECTION A: William Shanahan MD received $60,000 during calendar year 2009 for professional services as a medical director. Neal Shindel MD received $39,427 during calendar year 2009 for GI bonus payments. Schedule R, Part IV, column (e): PIH Insurance Company is an unincorporated risk retention group. PIH Community Pharmacy LLC 12401 Washington Blvd Whittier CA 90602 264390142 Pharmacy CA 1406473 545465 N/A PIH Foundation 12401 Washington Blvd Whittier CA 90602 953761274 Fundraising CA section 501(c)(3) 7 InterHealth Corp IHC Management Corp 12401 Washington Blvd Whittier CA 90602 954016278 Support of tax-exempt affiliates CA section 501(c)(3) 11, type 1 InterHealth Corp Interhealth Home Health Care 12401 Washington Blvd Whittier CA 90602 953036281 Healthcare CA section 501(c)(3) 9 InterHealth Corp InterHealth Corp 12401 Washington Blvd Whittier CA 90602 953619388 Support of tax-exempt affiliates CA section 501(c)(3) 11, type 1 InterHealth Corp Med Site - Hacienda Heights 12401 Washington Blvd Whittier CA 90602 953643829 Healthcare CA section 501(c)(3) 9 InterHealth Corp Bright Health Physicians of PIH 12401 Washington Blvd Whittier CA 90602 953942828 Healthcare CA section 501(c)(3) 9 InterHealth Corp PIH Insurance Company a reciprocal risk retention group 1003 Bishop Street Honolulu HI 96813 263760243 Captive Insurance HI Interhealth Corp T 0 1 1 0 0 0 0 0 0 1 0 1 0 0 1 1 1 0 InterHealth Corp J 2651656 IHC Management Corp L 230767 PIH Foundation C 1595087 Bright Health Physicians of PIH O 3976409 PIH Insurance Company A Reciprocal Risk Retention Group Q 1916391 PIH Foundation B 121052