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 953942828 PIH HEALTH PHYSICIANS PIHH 5626980811 6557 GREENLEAF AVE WHITTIER CA 90601 VID SHIVARAMAN CFO 5626980811 2024-07-31 1 0 BRITTANY ELLISER P01284594 2253444000 2024-07-22 2022 2024-08-08 14:25:15Z JAMES WEST 12401 WASHINGTON BLVD WHITTIER CA 90602 334068272 0 X WWW.PIHHEALTH.ORG X 1982 CA PROVIDE HIGH-QUALITY HEALTH CARE SERVICES TO THE COMMUNITY WITHOUT DISCRIMINATION. 20 16 1533 16 -11354 0 0 0 289826250 331356635 -40854 -11246 2587745 1866955 292373141 333212344 0 0 0 0 63018523 75083005 0 0 0 232352008 268428595 295370531 343511600 -2997390 -10299256 63687507 73263378 48108639 67983766 15578868 5279612 X SEE SCHEDULE O 0 0 304238356 322664546 PATIENT CARE: A 501(C)(3) NONPROFIT MEDICAL GROUP THAT IS EXCLUSIVELY AFFILIATED WITH PIH HEALTH. THE GROUP IS COMPRISED OF MORE THAN 270 PRIMARY CARE PHYSICIANS AND SPECIALISTS WHO COORDINATE CARE FROM DIAGNOSIS TO RECOVERY.PATIENT CARE IN FISCAL YEAR 2022-2023EMPLOYEES: 1,245PIH HEALTH PHYSICIAN LOCATIONS: 31 MEDICAL OFFICES; 7 URGENT CARE CENTERSTOTAL MEDICAL OFFICE VISITS: 850,349 13352482 9594968 SEE SCHEDULE O 4389685 964076 FINANCIAL ASSISTANCE AND MEANS-TESTED GOVERNMENT PROGRAMS:FINANCIAL ASSISTANCE, ALSO KNOWN AS CHARITY CARE, IS DEFINED AS FREE OR DISCOUNTED HEALTH SERVICES PROVIDED TO INDIVIDUALS WHO CANNOT AFFORD TO PAY AND WHO MEET THE ELIGIBILITY CRITERIA OF THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. IN PROVIDING SERVICES TO THOSE PATIENTS PARTICIPATING IN MEANS-TESTED GOVERNMENT HEALTH PROGRAMS, SUCH AS MEDI-CAL, PIH HEALTH PHYSICIANS REALIZES A COLLECTIVE NET LOSS EACH FISCAL YEAR DUE TO THE SHORTFALL CREATED WHEN THE PAYMENTS RECEIVED FROM THESE PROGRAMS ARE LESS THAN THE COST OF CARING FOR PUBLIC PROGRAM BENEFICIARIES. (CONTINUED ON SCHEDULE O)NUMBER OF PERSONS SERVED BY FINANCIAL ASSISTANCE AND MEANS-TESTED GOVERNMENT PROGRAMS: 12,720 321980523 1 0 0 0 0 0 0 0 0 0 1 0 0 1 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 0 1 1 1 0 0 1 964 0 1 1533 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 20 16 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 X ALEX ALVAREZ DIRECTOR & TREASURER 1.50 6.00 X X 0 0 0 BLAYNE CUTLER MD PHD DIRECTOR 1.50 6.00 X 0 0 0 BRENT GRAY MD DIRECTOR 1.50 12.50 X 0 103480 0 CHARLOTTE WEAVER PHD DIRECTOR & VICE CHAIR 1.50 6.00 X X 0 0 0 JANE DICUS DIRECTOR 1.50 6.00 X 0 0 0 JAY BROWN DIRECTOR 1.50 6.00 X 0 0 0 JEFF HAMAR DIRECTOR 1.50 6.00 X 0 0 0 JERRY FLORO MD DIRECTOR 9.50 0.00 X 81600 0 0 KENTON WOODS DIRECTOR 1.50 6.00 X 0 0 0 MARISSA GOLDBERG DIRECTOR 1.50 6.00 X 0 0 0 MARK MAGGED MD DIRECTOR 1.50 0.00 X 0 0 0 MELANIE BATISTE DIRECTOR 1.50 6.00 X 0 0 0 PATRICK MONROE DIRECTOR & CHAIR 1.50 6.00 X X 0 0 0 PAUL TREINEN DIRECTOR 1.50 6.00 X 0 0 0 PAULA COWAN THRU 09222023 DIRECTOR 1.50 6.00 X 0 0 0 PETER GREANEY MD DIRECTOR & SECRETARY 1.50 6.00 X X 0 0 0 RICHARD ATWOOD DIRECTOR 1.50 7.50 X 0 0 0 ROBERT MALONEY MD DIRECTOR 1.50 6.00 X 0 0 0 SANATKUMAR PATEL MD DIRECTOR 7.50 0.00 X 56220 0 0 WILLIAM ROTH DIRECTOR 1.50 6.00 X 0 0 0 ROSALIO LOPEZ MD SYSTEM CSO/CMO 1.50 44.70 X 0 1114134 46447 JAMES WEST SYSTEM PRESIDENT & CEO 1.50 50.70 X 0 2046653 355723 BRIAN SMOLSKIS THRU 09282023 SYSTEM COO 1.50 46.70 X 0 1034811 219042 PEGGY CHULACK SYSTEM CAO & ASST SECRETARY 1.50 50.70 X 0 995412 192712 ANDREW ZWERS PRESIDENT, PHP, HMS, & PHCS 40.00 0.00 X 0 638016 150624 VID SHIVARAMAN SYSTEM CFO & ASST TREASURER 1.50 50.70 X 0 749812 150468 ROBERTO MADRID MD VP MEDICAL GRP OPS 40.00 0.00 X 0 636230 145185 ROLAND FARGO REGIONAL VP 10.00 0.00 X 0 461515 97325 YAJAIRA GARCIA VP GROUP OPS 40.00 0.00 X 254333 0 9720 MUTHUKUMAR VAIDYARAMAN MED DIR MSO/IPA 40.00 0.00 X 375995 0 29657 ELIZABETH BROGAN-SHIVARMAN SR DIR MANAGED CARE 40.00 0.00 X 240224 0 23020 CHING HUEI LIN DIRECTOR DECISION SUPPORT 40.00 0.00 X 223479 0 22308 LINDA CAMPBELL RN ADMIN DIR 40.00 0.00 X 210721 0 26842 DAWN ROTH ADM DIR COMM RES 40.00 0.00 X 198826 0 24231 ANITA CHOU FORMER CFO & ASST. TREASURER 0.00 0.00 X 0 119014 14 1641398 7899077 1493318 60 1 1 0 INTERCOMMUNITY HEALTH ASSOCIATES 6557 GREENLEAF AVENUE WHITTIER CA 90601 MEDICAL SERVICES 89869962 PIH HEALTH DOWNEY MEDICAL GROUP 11500 BROOKSHIRE AVENUE DOWNEY CA 90241 MEDICAL SERVICES 36526675 LOS ANGELES CARDIOLOGY ASSOC 1245 WILSHIRE BLVD STE 703 LOS ANGELES CA 90017 MEDICAL SERVICES 17637218 PIONEER HEALTH ASSOCIATES INC 6557 GREENLEAF AVENUE WHITTIER CA 90601 MEDICAL SERVICES 10456669 HOUSE CLINIC ASSOCIATES INC 12102 WASHINGTON BLVD WHITTIER CA 90606 MEDICAL SERVICES 5766339 51 CAPITATION REVENUE 621999 182109529 182109529 PATIENT REVENUE 621111 125773836 125773836 PHYSICIAN OFFICES 621110 9435634 9435634 14037636 14037636 331356635 -11246 -11354 108 2722883 855928 1866955 1866955 333212344 333223590 -11354 108 X 1845740 1148740 697000 53338652 45096965 8241687 2469197 2123509 345688 11920452 10155446 1765006 5508964 4672150 836814 1794 1794 196821091 190589137 6231954 11540 11540 1389205 1253772 135433 110472 110472 14789498 12954624 1834874 24645 12828 11817 18535 6153 12382 55616 55616 3177556 2719710 457846 4530620 4165707 364913 CLAIMS 26428969 26428969 MEDICAL SUPPLIES 14079320 14075750 3570 BAD DEBT EXPENSE 4554795 4554795 EQUIPMENT R&M 1736060 1668076 67984 698879 340858 358021 343511600 321980523 21531077 0 19007853 16795906 16456169 30984443 2073110 1722644 437948 293051 50719974 37985166 9542919 12734808 24790 24790 16144718 10707736 63687507 73263378 12887735 24999087 35220904 42984679 48108639 67983766 X 15578868 5279612 15578868 5279612 63687507 73263378 X -10299256 0 X 0 1 X 1 0 X 1224603 3666897 1303739 6195239 168471580 204948033 240536596 292822207 334079518 1240857934 169696183 208614930 241840335 292822207 334079518 1247053173 0 0 0 1247053173 4340 1464 389 108 6301 97933 20093 118026 102273 21557 389 108 124327 194616 10510841 364209 11069666 169696183 208911819 252372733 293186805 334079626 1258247166 0.99110 0.98960 0.00010 0.00010 X 172866 47674 125192 6002615 3897535 2105080 34820013 25381311 9438702 9724480 8658646 1065834 12734808 ROU ASSET 10399296 DEPOSITS AND OTHER ASSETS 308440 10707736 INTERCOMPANY PAYABLE 17873258 ROU LIABILITIES 10878799 IBNR AND CAP LIABILITY 9206000 SELF-INSURANCE RESERVES 4686465 OTHER LIABILITIES 340157 42984679 X PART X, LINE 2: THE PRINCIPAL OPERATIONS OF THE COMPANY ARE EXEMPT FROM INCOME TAXES PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3) AND THE LAWS OF THE STATES IN WHICH IT OPERATES AND, AS SUCH, IS GENERALLY NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES. HOWEVER, THE COMPANY IS SUBJECT TO INCOME TAXES ON NET INCOME DERIVED FROM A TRADE OR BUSINESS REGULARLY CARRIED ON THAT DOES NOT FURTHER THE ORGANIZATION'S EXEMPT PURPOSE. FURTHER, THE COMPANY IS ALSO SUBJECT TO FEDERAL EXCISE TAXES PURSUANT TO THE TAX CUTS AND JOBS ACT. NO SIGNIFICANT INCOME TAX PROVISION HAS BEEN RECORDED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS FOR NET INCOME DERIVED FROM UNRELATED TRADE OR BUSINESS AND EXCISE TAXES. THE COMPANY MEASURES LIABILITIES FOR UNRECOGNIZED TAX UNCERTAINTIES IN ACCORDANCE WITH ASC 740, INCOME TAXES, WHICH PRESCRIBES A COMPREHENSIVE MODEL FOR HOW A COMPANY SHOULD RECOGNIZE, MEASURE, PRESENT AND DISCLOSE IN ITS FINANCIAL STATEMENTS UNCERTAIN TAX POSITIONS THAT A COMPANY HAS TAKEN OR EXPECTS TO TAKE ON A TAX RETURN. THE GUIDANCE IS APPLICABLE TO PROFIT-ORIENTED ENTITIES, PASS-THROUGH ENTITIES AND TAX-EXEMPT ORGANIZATIONS. MANAGEMENT BELIEVES IT HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS AND, AS SUCH, NO TAX LIABILITY, BENEFITS, INTEREST OR PENALTIES WERE ACCRUED AT SEPTEMBER 30, 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. 1 1 0 0 0 0 0 0 0 JAMES WEST SYSTEM PRESIDENT & CEO 0 1506821 0 0 0 539832 0 335520 0 20325 0 2402498 0 517243 BRIAN SMOLSKIS THRU 09282023 SYSTEM COO 0 838304 0 0 0 196507 0 196657 0 22507 0 1253975 0 188312 PEGGY CHULACK SYSTEM CAO & ASST SECRETARY 0 826709 0 0 0 168703 0 178274 0 14760 0 1188446 0 120897 ROSALIO LOPEZ MD SYSTEM CSO/CMO 0 907438 0 0 0 206696 0 36700 0 9869 0 1160703 0 0 VID SHIVARAMAN SYSTEM CFO & ASST TREASURER 0 681460 0 0 0 68352 0 141186 0 9404 0 900402 0 61131 ANDREW ZWERS PRESIDENT, PHP, HMS, & PHCS 0 530059 0 0 0 107957 0 130240 0 20507 0 788763 0 101795 ROBERTO MADRID MD VP MEDICAL GRP OPS 0 492647 0 0 0 143583 0 124800 0 20507 0 781537 0 134527 ROLAND FARGO REGIONAL VP 0 389307 0 0 0 72208 0 76941 0 20507 0 558963 0 65794 MUTHUKUMAR VAIDYARAMAN MED DIR MSO/IPA 375581 0 0 0 414 0 10800 0 18979 0 405774 0 0 0 YAJAIRA GARCIA VP GROUP OPS 253784 0 0 0 549 0 7653 0 2189 0 264175 0 0 0 ELIZABETH BROGAN-SHIVARMAN SR DIR MANAGED CARE 240224 0 0 0 0 0 13754 0 9310 0 263288 0 0 0 CHING HUEI LIN DIRECTOR DECISION SUPPORT 223065 0 0 0 414 0 8189 0 14241 0 245909 0 0 0 LINDA CAMPBELL RN ADMIN DIR 209533 0 0 0 1188 0 10721 0 16242 0 237684 0 0 0 DAWN ROTH ADM DIR COMM RES 198412 0 0 0 414 0 10948 0 13405 0 223179 0 0 0 ANITA CHOU FORMER CFO & ASST. TREASURER 0 -14 0 0 0 119028 0 0 0 14 0 119028 0 0 PART I, LINES 4A-B ANITA CHOU RECEIVED A SEVERANCE PAYMENT DURING THE CALENDAR YEAR. THE PAYMENT IS INCLUDED IN PART VII, COLUMN E, AND SCHEDULE J, PART II, COLUMN B(III). THE TERMS AND CONDITIONS OF THE CONFIDENTIAL SEVERANCE AGREEMENT ARE AVAILABLE TO THE INTERNAL REVENUE SERVICE UPON REQUEST. PART I, LINE 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 ORGAANIZATIONS; (4) COMPENSATION SURVEY OR STUDY; (5) APPROVAL BY THE BOARD. 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 ROSALIO LOPEZ BRIAN SMOLSKIS ROBERTO MADRID ANDREW ZWERS VID SHIVARAMAN ROLAND FARGO 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 PEGGY CHULACK $120,897 BRIAN SMOLSKIS $188,312 ROBERTO MADRID $134,527 ANDREW ZWERS $101,795 VID SHIVARAMAN $61,131 ROLAND FARGO $65,794 FORM 990, PART III, LINE 1, DESCRIPTION OF ORGANIZATION MISSION: PIH HEALTH PHYSICIANS ("PHP") IS PART OF AN INTEGRATED DELIVERY SYSTEM (IDS) TO PROVIDE HIGH-QUALITY HEALTHCARE WITHOUT DISCRIMINATION AND CONTRIBUTE TO THE HEALTH AND WELL-BEING OF OUR COMMUNITIES. IN ADDITION TO DIRECT CLINICAL CARE, PIH HEALTH PHYSICIANS ("PHP") ALSO SERVES THE COMMUNITY THROUGH RESEARCH ACTIVITIES, COMMUNITY HEALTH SCREENINGS AND EVENTS, AND HEALTH EDUCATION CLASSES PROVIDED AT NO COST TO PARTICIPANTS. IN ADDITION TO A SENIOR OUTREACH PROGRAM, PHP OFFERS A WIDE VARIETY OF HEALTH AND WELLNESS EDUCATION TO THE COMMUNITY FREE OF CHARGE OR AT A NOMINAL COST. FURTHERMORE, ALL PHP FACILITIES OFFER HEALTH CARE SERVICES HONORING A CHARITY CARE POLICY THAT PROVIDES SERVICES TO THE COMMUNITY REGARDLESS OF THEIR ABILITY TO PAY. FORM 990, PART III, LINE 4B, PROGRAM SERVICE ACCOMPLISHMENTS: OTHER COMMUNITY BENEFIT SERVICES: COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS, HEALTH PROFESSIONS EDUCATION, AND SUBSIDIZED HEALTH SERVICES ARE COMPRISED OF THE FOLLOWING: COMMUNITY HEALTH IMPROVEMENT SERVICES: DEFINED AS COMMUNITY HEALTH IMPROVEMENT ACTIVITIES, WHICH EXTEND BEYOND PATIENT CARE ACTIVITIES. THESE PROGRAMS INCLUDE: COMMUNITY EDUCATION, SUPPORT GROUPS, COVID-19 VACCINATION CLINIC AND THE HEALTH AND WELLNESS CENTER AT WHITTIER FIRST DAY. SNAPSHOT OF OUTCOMES: 248 COMMUNITY MEMBERS WERE REACHED THROUGH A VARIETY OF COMMUNITY HEALTH IMPROVEMENT ACTIVITIES. HEALTH PROFESSIONS EDUCATION: THIS CATEGORY INCLUDES EDUCATIONAL PROGRAMS FOR PHYSICIANS, NURSES, STUDENTS AND OTHER HEALTH PROFESSIONALS WHEN EDUCATION IS NECESSARY OR REQUIRED BY STATE LAW, ACCREDITING BODY OR HEALTH PROFESSION SOCIETY. PIH HEALTH PHYSICIAN PROGRAMS INCLUDE THE STUDENT EDUCATION (ANCILLARY AND RESIDENT PRECEPTORSHIP). SNAPSHOT OF OUTCOMES: 70 STUDENT INTERNS AND PHYSICIAN RESIDENTS STUDYING TO BECOME HEALTHCARE PROFESSIONALS WERE PROVIDED WITH MENTORSHIP, PRECEPTORSHIP AND TRAINING OPPORTUNITIES. SUBSIDIZED HEALTH SERVICES: SUBSIDIZED SERVICES ARE CLINICAL PROGRAMS, WHICH ARE PROVIDED DESPITE A FINANCIAL LOSS SO SIGNIFICANT THAT NEGATIVE MARGINS REMAIN AFTER REMOVING THE EFFECTS OF FINANCIAL ASSISTANCE, BAD DEBT AND MEDI-CAL SHORTFALLS. NEVERTHELESS, THE SERVICE IS PROVIDED BECAUSE IT MEETS AN IDENTIFIED COMMUNITY NEED AND, IF NO LONGER OFFERED, WOULD EITHER BE UNAVAILABLE IN THE AREA OR FALL TO THE RESPONSIBILITY OF GOVERNMENT OR ANOTHER NONPROFIT ORGANIZATION TO PROVIDE. PIH HEALTH PHYSICIAN SERVICES PROVIDED INCLUDE PALLIATIVE CARE PROGRAM, AND URGENT CARES. SNAPSHOT OF OUTCOMES: 83,577 INDIVIDUALS WERE SERVED BY PIH HEALTH PHYSICIANS SUBSIDIZED HEALTH SERVICES. TOTAL NUMBER OF PERSONS SERVED BY ALL CATEGORIES: 84,496 FOR ADDITIONAL INFORMATION, PLEASE REFER TO PIH HEALTH'S COMMUNITY BENEFIT REPORT AT PIHHEALTH.ORG/CBANNUALREPORT FORM 990, PART VI, SECTION A, LINE 2 PIH HEALTH PHYSICIANS IS A MEMBER OF AN INTEGRATED HEALTHCARE SYSTEM. THE FOLLOWING INDIVIDUALS HAVE A BUSINESS RELATIONSHIP BY VIRTUE OF THEIR POSITIONS AS OFFICER OR DIRECTORS OF RELATED ENTITIES WITHIN THE SYSTEM: RICHARD ATWOOD, JEFF HAMAR, PAULA COWAN, ALEX ALVAREZ, BLAYNE CUTLER, JANE DICUS, PATRICK MONROE, PAUL TREINEN, CHARLOTTE WEAVER, KENTON WOODS, PETER GREANEY, MARISSA GOLDBERG, MELANIE BATISTE, ROBERT MALONEY, JAMES WEST, PEGGY CHULACK, VID SHIVARAMAN, ROSALIO LOPEZ, AND BRIAN SMOLSKIS. FORM 990, PART VI, SECTION A, LINE 6 PIH HEALTH, INC. IS THE SOLE MEMBER OF PIH HEALTH PHYSICIANS ("PHP"). 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 PHYSICIANS ("PHP"). 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 PHYSICIANS ("PHP"). 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. PART VII, SECTION A, LINE 1 TWO OF THE FILING ORGANIZATION'S DIRECTORS ARE EMPLOYEES OF INTERCOMMUNITY HEALTH ASSOCIATES (IHA), WHICH HAS A PROFESSIONAL SERVICE AGREEMENT WITH THE FILING ORGANIZATION, TO PROVIDE PHYSICIAN SERVICES. THE INDIVIDUALS RECEIVED COMPENSATION FROM IHA AS FOLLOWS: BRENT GRAY: REPORTABLE BASE COMPENSATION - $694,853 OTHER COMPENSATION - $36,187 MARK MAGGED: REPORTABLE BASE COMPENSATION - $411,582 OTHER COMPENSATION - $35,977 TWO OF THE FILING ORGANIZATION'S DIRECTORS ARE EMPLOYEES OF PIONEER HEALTH ASSOCIATES, INC. (PHA), WHICH HAS A PROFESSIONAL SERVICE AGREEMENT WITH THE FILING ORGANIZATION, TO PROVIDE PHYSICIAN SERVICES. THE INDIVIDUALS RECEIVED COMPENSATION FROM PHA AS FOLLOWS: JERRY FLORO: REPORTABLE BASE COMPENSATION - $619,871 OTHER COMPENSATION - $41,122 SANATKUMAR PATEL: REPORTABLE BASE COMPENSATION - $347,615 OTHER COMPENSATION - $40,406 ONE OF THE FILING ORGANIZATION'S DIRECTORS IS AN EMPLOYEE OF PIH HEALTH DOWNEY MEDICAL GROUP, INC. (DMG), WHICH HAS A PROFESSIONAL SERVICE AGREEMENT WITH THE FILING ORGANIZATION, TO PROVIDE PHYSICIAN SERVICES. THE INDIVIDUAL RECEIVED COMPENSATION FROM DMG AS FOLLOWS: ROSALIO LOPEZ: REPORTABLE BASE COMPENSATION - $70,464 OTHER COMPENSATION - $0 FORM 990, PART IX, LINE 11G PROFESSIONAL FEES - PHYSICIANS: PROGRAM SERVICE EXPENSES 162,979,551. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 162,979,551. CAPITATION EXPENSES: PROGRAM SERVICE EXPENSES 24,131,408. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 24,131,408. PROFESSIONAL FEES - CONSULTANTS/OTHER: PROGRAM SERVICE EXPENSES 3,478,178. MANAGEMENT AND GENERAL EXPENSES 6,231,954. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,710,132. PIH HEALTH FOUNDATION 12401 WASHINGTON BLVD WHITTIER CA 90602 953761274 FUNDRAISING CA 501(C)(3) LINE 7 PIH HEALTH INC 1 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 HOME HEALTHCARE 12401 WASHINGTON BLVD WHITTIER CA 90602 953036281 HEALTHCARE CA 501(C)(3) LINE 10 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 PIH HEALTH INC 0 PIH HEALTH ADULT DAY HEALTHCARE 12401 WASHINGTON BLVD WHITTIER CA 90602 953643829 HEALTHCARE CA 501(C)(3) LINE 10 PIH HEALTH INC 1 PIH HEALTH GOOD SAMARITAN HOSPITAL 1225 WILSHIRE BOULEVARD LOS ANGELES CA 90017 951656366 HEALTHCARE CA 501(C)(3) LINE 3 PIH HEALTH INC 1 PIH HEALTH DOWNEY HOSPITAL 11500 BROOKSHIRE AVENUE DOWNEY CA 90241 951903935 HEALTHCARE CA 501(C)(3) LINE 3 PIH HEALTH INC 1 PIH HEALTH WHITTIER HOSPITAL 12401 WASHINGTON BLVD WHITTIER CA 90602 951934652 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 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 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 HEALTHCARE 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 MEDICAL OFFICES CA 501(C)(3) LINE 12A, I PIH HEALTH GOOD SAMARITAN HOSPITAL 1 KATE VAN NUYS PAGE FOUNDATION 1225 WILSHIRE BLVD LOS ANGELES CA 90017 956028032 GRANTS INCOME TO GOOD SAMARITAN HOSPITAL CA 501(C)(3) LINE 12A, I PIH HEALTH GOOD SAMARITAN HOSPITAL 1 PIH HEALTH INSURANCE COMPANY 1003 BISHOP STREET HONOLULU HI 96813 263760243 CAPTIVE INSURANCE HI 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 1003 BISHOP STREET 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 PIH HEALTH PHYSICIANS C 54738531 4248695 1.00000 1 PIONEER PROVIDER NETWORK A MEDICAL GROUP INC 12401 WASHINGTON BLVD WHITTIER CA 90602 330922631 MANAGEMENT SERVICES CA PIH HEALTH PHYSICIANS C 51493710 503006 1.00000 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 1 0 0 0 PIONEER MEDICAL GROUP INC P 10372166 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.