2024-08-06T13:53:39-05:00 2023-09-30 135565207 KPMG LLP 301 MAIN STREET SUITE 2150 BATON ROUGE LA 70801 990 2022-10-01 953761274 PIH HEALTH FOUNDATION PIHH 5626980811 12401 WASHINGTON BOULEVARD WHITTIER CA 90602 VID SHIVARAMAN CFO 5626980811 2024-08-06 1 0 BRITTANY ELLISER P01284594 2253444000 2022 2024-08-08 14:25:15Z JAMES WEST 12401 WASHINGTON BOULEVARD WHITTIER CA 90602 4258429 0 X WWW.PIHHEALTH.ORG X 1982 CA TO RAISE FUNDS FOR PIH HEALTH HOSPITALS. 5 4 8 4 0 0 3136591 3498688 0 0 1213221 84472 -27674 -99282 4322138 3483878 891750 1241891 0 0 538409 507702 0 379652 1258011 845022 370657 2275181 2499902 2046957 983976 15488683 17941107 282617 480198 15206066 17460909 X TO RAISE FUNDS FOR PIH HEALTH HOSPITALS AND TO PROVIDE HEALTH EDUCATION SERVICES AND RELATED PROGRAMS TO THE COMMUNITY. 0 0 321179 321179 FUNDS RAISED BY THE PIH HEALTH FOUNDATION ARE RELEASED TO PIH HEALTH FOR VARIOUS PROGRAMS AND SERVICES WHICH ARE OPERATED IN ACCORDANCE WITH THE ORGANIZATION'S EXEMPT PURPOSE. DONATIONS ARE RECEIVED FROM INDIVIDUALS, CORPORATIONS, GRANTS, FOUNDATIONS AND GOVERNMENT ENTITIES. 669312 669312 FUNDS RAISED AND PROVIDED TO PIH HEALTH FOR CAPITAL ASSETS. 251400 251400 FUNDS RAISED AND PROVIDED TO PIH HEALTH HOSPITAL FOR OPERATION OF ITS DISASTER RESOURCE CENTER: PIH HEALTH IS ONE OF 13 LOS ANGELES COUNTY-DESIGNATED DISASTER RESOURCE CENTERS (DRC'S) ESTABLISHED BY THE COUNTY TO ENSURE AVAILABILITY OF KEY CAPACITIES IN THE EVENT OF A TERRORIST INCIDENT OR OTHER PUBLIC HEALTH EMERGENCY. PIH HEALTH'S TEAM PARTICIPATES IN PERIODIC PLANNING MEETINGS AND DRILLS IN ORDER TO FINE-TUNE PREPARATIONS. PIH HEALTH'S SERVICE AS A DRC ENSURES THAT THE COMMUNITY HAS ACCESS TO ENHANCED SURGE CAPACITY RESOURCES-SUCH AS VENTILATORS, PHARMACEUTICALS, MEDICAL/SURGICAL SUPPLIES, LARGE TENT SHELTERS, AND, MOST IMPORTANTLY, THE HIGHLY-SKILLED STAFF-NEEDED TO RESPOND TO LARGE-SCALE DISASTER. PIH HEALTH ALSO HOSTS FREE DISASTER PREPAREDNESS CLASSES FOR THE COMMUNITY IN PARTNERSHIP WITH LOCAL EMERGENCY RESPONDERS THROUGH ROLE PLAYING DISASTER SCENARIOS. KEY RESPONDERS INCLUDE POLICE, FIRE, AMBULANCE COMPANIES, CITY WORKERS, SCHOOLS, LOCAL MEDIA, AND INTERNAL HOSPITAL STAFF. THESE ACTIVITIES GIVE KEY RESPONDERS THE OPPORTUNITY TO FINE-TUNE COMMUNICATION AND RESPONSE PLANS TO ENSURE BEST-POSSIBLE OUTCOMES IN THE EVENT OF AN ACTUAL DISASTER. CONTRIBUTIONS FOR DISASTER RESOURCE ARE RECEIVED FROM LA COUNTY PER AGREEMENTS DATED JANUARY 21, 2003 AND SUBSEQUENT AMENDMENTS. 1241891 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 1 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 10 0 1 8 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 5 4 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 CA X MARK KAWAUCHI 5626980811 12102 WASHINGTON BLVD WHITTIER CA 90606 ANNETTE ATWOOD DIRECTOR & VICE CHAIR 1.50 0.00 X X 0 0 0 BEVERLY MATHIS DIRECTOR & CHAIR 1.50 0.00 X 0 0 0 RICHARD ATWOOD DIRECTOR & TREASURER 1.50 7.50 X X 0 0 0 RICHARD LUCIANO DIRECTOR & SECRETARY 1.50 0.00 X X 0 0 0 YONG PARK MD DIRECTOR & CHAIR 1.50 40.00 X X 0 159849 26737 JAMES WEST CEO 1.50 50.70 X 0 2046653 355723 BRIAN SMOLSKIS 9282023 SYSTEM COO 1.50 46.20 X 0 1034811 219042 PEGGY CHULACK ASST SECRETARY 1.50 50.70 X 0 995412 192712 VID SHIVARAMAN CFO & ASST TREASURER 1.50 50.70 X 0 749812 150468 AMY FITZGERALD VICE PRESIDENT 40.00 0.00 X 0 367557 76779 GINA ADAMS MAJOR GIFTS OFFICER 40.00 0.00 X 112363 0 22692 ANITA CHOU FORMER ASST. TREASURER 0.00 0.00 X 0 119014 14 112363 5473108 1044167 1 1 1 0 DIGITAL HEALTH STRATEGIES 7310 PINEY BRANCH ROAD TAKOMA PARK MD 20912 CONSULTING SERVICES 201500 POWERS PYLES SUTTER & VERVILLE 1501 M STREET NW SEVENTH FLOOR WASHINGTON DC 20005 CONSULTING SERVICES 110006 2 1052495 446085 2000108 1264 3498688 170567 170567 164784 250879 -86095 -86095 -86095 424390 1052495 523672 -99282 -99282 3483878 0 0 -14810 1241891 1241891 399144 399144 15171 15171 60356 60356 33031 33031 379652 379652 27290 27290 184813 184813 46745 46745 95859 95859 1216 1216 8600 8600 LICENSES & FEES 5574 5574 560 560 2499902 1241891 0 1258011 11915593 12867881 11715 11715 0 0 3573090 5073226 15488683 17941107 168934 360594 113683 119604 282617 480198 X 7883198 8022172 7322868 9438737 15206066 17460909 15488683 17941107 X 983976 -56976 1327843 X 0 1 X 1 0 X 6407927 2549325 2943539 3136591 3498688 18536070 6407927 2549325 2943539 3136591 3498688 18536070 7410419 11125651 152794 235720 204700 268436 170567 1032217 19568287 0.56860 0.57310 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 970440 474201 -39644 6108 1478177 970440 -269899 -276989 7090 970440 970440 71541 66047 5494 970440 970440 118477 110036 8441 970440 970440 61537 48624 12913 970440 1.00000 0 0 11715 11715 0 0 INTERCOMPANY RECEIVABLES 4798257 SPLIT-INTEREST AGREEMENT ASSET 239745 GIFT ANNUITY ASSETS DONATED 35224 5073226 SPLIT-INTEREST AGREEMENT LIABILITY 119604 119604 X PART V, LINE 4: INCOME FROM THE CARMEL LING ENDOWMENT IS INTENDED TO COVER SELECTED EXPENSES OF THE CHAPLAINCY PROGRAM. PART X, LINE 2: THE PRINCIPAL OPERATIONS OF THE COMPANY ARE EXEMPT FROM INCOME TAXES PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3) AND THE LAWS OF THE STATES IN WHICH IT OPERATES AND, AS SUCH, IS GENERALLY NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES. HOWEVER, THE COMPANY IS SUBJECT TO INCOME TAXES ON NET INCOME DERIVED FROM A TRADE OR BUSINESS REGULARLY CARRIED ON THAT DOES NOT FURTHER THE ORGANIZATION'S EXEMPT PURPOSE. FURTHER, THE COMPANY IS ALSO SUBJECT TO FEDERAL EXCISE TAXES PURSUANT TO THE TAX CUTS AND JOBS ACT. NO SIGNIFICANT INCOME TAX PROVISION HAS BEEN RECORDED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS FOR NET INCOME DERIVED FROM UNRELATED TRADE OR BUSINESS AND EXCISE TAXES. THE COMPANY MEASURES LIABILITIES FOR UNRECOGNIZED TAX UNCERTAINTIES IN ACCORDANCE WITH ASC 740, INCOME TAXES, WHICH PRESCRIBES A COMPREHENSIVE MODEL FOR HOW A COMPANY SHOULD RECOGNIZE, MEASURE, PRESENT AND DISCLOSE IN ITS FINANCIAL STATEMENTS UNCERTAIN TAX POSITIONS THAT A COMPANY HAS TAKEN OR EXPECTS TO TAKE ON A TAX RETURN. THE GUIDANCE IS APPLICABLE TO PROFIT-ORIENTED ENTITIES, PASS-THROUGH ENTITIES AND TAX-EXEMPT ORGANIZATIONS. MANAGEMENT BELIEVES IT HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS AND, AS SUCH, NO TAX LIABILITY, BENEFITS, INTEREST OR PENALTIES WERE ACCRUED AT SEPTEMBER 30, 2023 OR 2022. THE COMPANY IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE COMPANY BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2019 FOR FEDERAL PURPOSES AND 2017 FOR CALIFORNIA PURPOSES. X X X X X X X 1 POWERS PYLES SUTTER & VERVILLE 1501 M STREET NW 7TH FLOOR WASHINGTON DC 20005 CONSULT ON RESEARCH & COMPLIANCE FOR FEDERAL FUNDINGS 0 315833 120000 195833 DIGITAL HEALTH STRATEGIES 7310 PINEY BRANCH ROAD TAKOMA MD 20912 CONSULT ON FUNDRAISING CAMPAIGNS, EMAIL & DIRECT MAIL PROGRA 0 200751 170500 30251 CI PARTNERS DIRECT 1601 EASTMAN AVE STE 202 VENTURA CA 93003 CONSULT ON DIRECT MAIL FUNDRAISING 0 116137 89152 26985 632721 379652 253069 CA GOLF TOURNAMENT 477653 346255 131398 12700 3730 26113 22386 750 13966 GALA 999232 706240 292992 9147 71997 159852 158028 45003 1476885 1052495 424390 12700 12877 98110 182238 158778 58969 523672 -99282 1 PIH HEALTH WHITTIER HOSPITAL 12401 WASHINGTON BLVD WHITTIER CA 90602 951934652 501(C)(3) 1184872 0 HEALTHCARE PIH HEALTH DOWNEY HOSPITAL 11500 BROOKSHIRE AVE DOWNEY CA 90241 951903935 501(C)(3) 54190 0 HEALTHCARE 2 PART I, LINE 2: GRANTS ARE MADE ONLY TO RELATED ENTITIES. THESE ENTITIES ARE GOVERNED BY THE SAME OFFICERS WHO ARE ABLE TO MONITOR THE USE OF GRANT FUNDS. 1 1 0 0 0 0 0 0 0 JAMES WEST CEO 0 1506821 0 0 0 539832 0 335520 0 20325 0 2402498 0 517243 BRIAN SMOLSKIS 9282023 SYSTEM COO 0 838304 0 0 0 196507 0 196657 0 22507 0 1253975 0 188312 PEGGY CHULACK ASST SECRETARY 0 826709 0 0 0 168703 0 178274 0 14760 0 1188446 0 120897 VID SHIVARAMAN CFO & ASST TREASURER 0 681460 0 0 0 68352 0 141186 0 9404 0 900402 0 61131 AMY FITZGERALD VICE PRESIDENT 0 318282 0 0 0 49275 0 56244 0 20657 0 444458 0 43861 YONG PARK MD DIRECTOR & CHAIR 0 159849 0 0 0 0 0 9935 0 16847 0 186631 0 0 ANITA CHOU FORMER ASST. TREASURER 0 -14 0 0 0 119028 0 0 0 14 0 119028 0 0 PART I, LINE 3 COMPENSATION FOR THE CEO WAS ESTABLISHED AND PAID BY PIH HEALTH WHITTIER HOSPITAL, ("PHWH"), A RELATED ORGANIZATION. PHWH USED THE FOLLOWING TO ESTABLISH THE CEO'S COMPENSATION: (1) COMPENSATION COMMITTEE; (2) INDEPENDENT COMPENSATION CONSULTANT; (3) FORM 990 OF OTHER ORGANIZATIONS; (4) COMPENSATION SURVEY OR STUDY; (5) APPROVAL BY THE BOARD. PART I, LINES 4A-B: PART I, LINE 4A: ANITA CHOU RECEIVED SEVERANCE PAYMENTS DURING THE CALENDAR YEAR. THE PAYMENTS ARE INCLUDED IN PART VII, COLUMN D (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 AMY FITZGERALD VID SHIVARAMAN BRIAN SMOLSKIS SCHEDULE J, PART II, COLUMN (B)(III): THE FOLLOWING AMOUNTS BECAME VESTED OR WERE PAID-OUT IN 2022 AND ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III): JAMES WEST $517,243 BRIAN SMOLSKIS $188,312 PEGGY CHULACK $120,897 VID SHIVARAMAN $61,131 AMY FITZGERALD $43,861 X 1 1264 FMV 0 0 1 0 PART I, COLUMN (B): IS THE NUMBER OF CONTRIBUTIONS. FORM 990, PART VI, SECTION A, LINE 2 THE FOLLOWING DIRECTORS HAVE A FAMILIAL RELATIONSHIP: ANNETTE AND RICHARD ATWOOD. PIH HEALTH FOUNDATION IS A MEMBER OF AN INTEGRATED HEALTHCARE SYSTEM CONTROLLED BY PIH HEALTH, INC. THE FOLLOWING INDIVIDUALS HAVE A BUSINESS RELATIONSHIP BY VIRTUE OF THEIR POSITIONS AS OFFICER OR DIRECTORS OF RELATED ENTITIES WITHIN THE SYSTEM: RICHARD ATWOOD, JAMES WEST, PEGGY CHULACK, VID SHIVARAMAN, AND BRIAN SMOLSKIS. FORM 990, PART VI, SECTION A, LINE 6 PIH HEALTH, INC. IS THE SOLE MEMBER OF PIH HEALTH FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A PIH HEALTH, INC. HAS AUTHORITY TO ELECT ALL THE MEMBERS OF THE BOARD OF DIRECTORS OF PIH HEALTH FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7B PIH HEALTH, INC. HAS ALL VOTING RIGHTS AND THE POWER TO ELECT THE BOARD OF DIRECTORS OF PIH HEALTH FOUNDATION. 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 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 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 XI, LINE 9: OTHER CHANGES IN NET ASSETS OR FUND BALANCES 1,327,843. PIH HEALTH MANAGEMENT CORP 12401 WASHINGTON BLVD WHITTIER CA 90602 954016278 SUPPORT OF TAX-EXEMPT AFFILIATES CA 501(C)(3) LINE 12B, II PIH HEALTH INC 1 PIH HEALTH INC 12401 WASHINGTON BLVD WHITTIER CA 90602 953619388 SUPPORT OF TAX-EXEMPT AFFILIATES CA 501(C)(3) LINE 12B, II N/A 0 PIH HEALTH HOME HEALTHCARE 12401 WASHINGTON BLVD WHITTIER CA 90602 953036281 HEALTHCARE CA 501(C)(3) LINE 12B, II PIH HEALTH INC 1 PIH HEALTH WHITTIER HOSPITAL 12401 WASHINGTON BLVD WHITTIER CA 90602 951934652 HEALTHCARE CA 501(C)(3) LINE 3 PIH HEALTH INC 1 PIH HEALTH ADULT DAY HEALTHCARE 12401 WASHINGTON BLVD WHITTIER CA 90602 953643829 SUPPORT OF TAX-EXEMPT AFFILIATES CA 501(C)(3) LINE 12B, II PIH HEALTH INC 1 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 AVE DOWNEY CA 90241 951903935 HEALTHCARE CA 501(C)(3) LINE 3 PIH HEALTH INC 1 PIH HEALH GOOD SAMARITAN HOSPITAL 1225 WILSHIRE BLVD LOS ANGELES CA 90017 951656366 HEALTHCARE CA 501(C)(3) LINE 3 PIH HEALTH INC 1 GOOD SAMARITAN INSTITUTE FOR RESEARCH AND EDUCATION 1225 WILSHIRE BLVD LOS ANGELES CA 90017 954077161 HEART RESEARCH CA 501(C)(3) LINE 4 PIH HEALTH GOOD SAMARITAN HOSPITAL 1 ORTHOPEDIC INSTITUTE OF THE GOOD SAMARITAN HOSPITAL 1225 WILSHIRE BLVD LOS ANGELES CA 90017 954346048 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 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 12401 WASHINGTON BLVD WHITTIER CA 90602 956028032 GRANTS INCOME TO GOOD SAMARITAN HOSPITAL CA 501(C)(3) LINE 12A, I PIH HEALTH GOOD SAMARITAN HOSPITAL 1 PIH HEALTH INSURANCE COMPANY 733 BISHOP STREET STE 1555 HONOLULU HI 96813 263760243 CAPTIVE INSURANCE HI N/A T 1 PIH HEALTH CARE SOLUTIONS 6557 GREENLEAF AVENUE WHITTIER CA 90601 462072342 HEALTHCARE CA N/A C 1 DRMC PROPERTIES INC 12401 WASHINGTON BLVD WHITTIER CA 90602 954769768 REAL ESTATE CA N/A C 1 PIH HEALTH RE 733 BISHOP STREET STE 1555 HONOLULU HI 96813 472501390 CAPTIVE INSURANCE HI N/A T 1 HEALTHMED SERVICES INC 12401 WASHINGTON BLVD WHITTIER CA 90602 300831225 HEALTHCARE CA N/A C 1 PIONEER MEDICAL GROUP INC 12401 WASHINGTON BLVD WHITTIER CA 90602 330927283 MEDICAL SERVICES CA N/A C 1 PIONEER PROVIDER NETWORK A MEDICAL GROUP INC 12401 WASHINGTON BLVD WHITTIER CA 90602 330922631 MANAGEMENT SERVICES CA N/A C 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 PIH HEALTH WHITTIER HOSPITAL B 1184872 FMV PIH HEALTH DOWNEY HOSPITAL B 54190 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.