Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2010
Open to Public Inspection
A For the calendar year, or tax year beginning 10-01-2010 and ending 09-30-2011
BCheck if applicable:
CName of organization
PRESBYTERIAN INTERCOMMUNITY HOSPITAL INC
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
12401 WASHINGTON BOULEVARD
 
Room/suite
City or town, state or country, and ZIP + 4
WHITTIER, CA90602
D Employer identification number

95-1934652
E Telephone number

G Gross receipts $ 535,072,562
F Name and address of principal officer:
MITCHELL THOMAS
12401 WASHINGTON BOULEVARD
WHITTIER,CA90602
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
N/A
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1954
M State of legal domicile: CA
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: TO PROVIDE QUALITY HEALTHCARE AND CONTRIBUTE TO THE COMMUNITY'S HEALTH AND WELL-BEING.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 15
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 12
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 3,082
6 Total number of volunteers (estimate if necessary) .... 6 830
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 139,234
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 52,047
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 1,595,087 2,204,568
9 Program service revenue (Part VIII, line 2g) ......... 392,575,409 444,974,620
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 13,580,533 15,084,659
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 2,138,979 3,235,462
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 409,890,008 465,499,309
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 739,812 852,252
14 Benefits paid to or for members (Part IX, column (A), line 4) .... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 193,119,748 212,682,689
16a Professional fundraising fees (Part IX, column (A), line 11e).... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 181,162,804 202,598,224
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 375,022,364 416,133,165
19 Revenue less expenses. Subtract line 18 from line 12...... 34,867,644 49,366,144
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 848,581,314 905,350,088
21 Total liabilities (Part X, line 26)............ 409,434,369 493,712,181
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 439,146,945 411,637,907
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid Preparer's Use Only Preparer's
signature
Big Right Arrow
Date
right pointing bullet image Preparer’s taxpayer identification number
(see instructions)
Firm’s name (or yours
if self-employed),
address, and ZIP + 4
Big Right Arrow




EIN right pointing bullet image
Phone no. right pointing bullet image
May the IRS discuss this return with the preparer shown above? (see instructions) .........
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2010)
Form 990 (2010)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III . . . . . . . . . .
1
Briefly describe the organization’s mission: 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.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the exempt purpose achievements for each of the organization’s three largest program services by expenses.
Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 257,888,806 including grants of $ 376,715 ) (Revenue $ 385,268,841 )
PATIENT CARE: PRESBYTERIAN INTERCOMMUNITY HOSPITAL (PIH) IS A 444-BED MEDICAL CENTER AND INTEGRATED HEALTHCARE DELIVERY SYSTEM WHICH SERVES MORE THAN 1.5 MILLION RESIDENTS IN LOS ANGELES, SAN BERNARDINO, AND ORANGE COUNTIES, AND INCLUDES A NETWORK OF PRIMARY CARE CLINICS, MOBILE HEALTH SERVICES, A RESIDENTIAL HOSPICE PROGRAM, AS WELL AS AN ADULT DAY HEALTH CARE CENTER. PIH IS 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 PIH'S PRIMARY SERVICE AREA. PIH'S SECONDARY SERVICE AREAS INCLUDE ADDITIONAL CITIES IN SAN GABRIEL VALLEY AND NORTH ORANGE COUNTY. THE FOLLOWING IS A LIST OF PROGRAMS OFFERED THROUGH PIH DURING THE YEAR:A DAY AWAY ADULT DAY HEALTH CARE CENTERBLOOD DONOR CENTERCOMPREHENSIVE CANCER PROGRAMCAR SEAT PROGRAM (LOW-COST CAR SEATS)CARE FORCE ONE MOBILE HEALTH SERVICESCHAPLAINCY PROGRAMCOMMUNITY-BUILDING BY SENIOR LEADERSHIP & MANAGEMENTCOMMUNITY EDUCATION OUTREACH (BREAST HEALTH/CHILDBIRTH/DIABETES/HEART HEALTH)COMMUNITY HELPLINES (CANCER HELPLINE, COMMUNITY ADVICE NURSE, SOCIAL SERVICES HELPLINE) DISASTER READINESSDONATIONS TO COMMUNITY ORGANIZATIONS (FINANCIAL & IN-KIND)ED PHYSICIAN ON-CALL PROGRAM (EA PROGRAM)ENROLLMENT ASSISTANCE (MEDI-CAL ELIGIBILITY WORKERS & ENROLLMENT COORDINATORS)EXERCISE CLASSES / FALL PREVENTION PROGRAMFAMILY PRACTICE RESIDENCY PROGRAMFLU AND PNEUMONIA VACCINATION CLINICSHEALTH SCREENINGSHIGH-RISK INFANT FOLLOW-UP CLINICHOSPICE AND HOME HEALTHHOSPITALISTS / INTENSIVISTS (24/7)NOTARY SERVICESPARAMEDIC BASE STATION (INCLUDING STAFF TRAINING)PHYSICIAN/MEDICAL PROFESSIONAL EDUCATIONPURCHASED SERVICES & TRANSPORTATION FOR UNDERSERVED PATIENTS/FAMILIESRESEARCHSENIOR SERVICESSEXUAL ASSUALT RESPONSE TEAM (SART)STUDENT TRAINING (NURSING & ANCILLARY)SUPPORT GROUPSWHITTIER FIRST DAY CLINIC (LOCAL HOMELESS SHELTER)CHARITY CARE REFERS TO DOLLARS EXPENDED FOR THE PROVISION OF FREE OR DISCOUNTED CARE PROVIDED TO BOTH THE UNINSURED AND THE INSURED WHO LACK FINANCIAL RESOURCES AND MEET THE UNCOMPENSATED CARE PROGRAMS CRITERIA TO PAY FOR NEEDED HEALTHCARE SERVICES. RECOGNIZING ITS CHARITABLE MISSION, PIH OFFERS A GENEROUS UNCOMPENSATED CARE PROGRAM THAT EXCEEDS RECOMMENDED STANDARDS, PROVIDING CHARITY CARE TO ALL PATIENTS WHO APPLY AND QUALIFY WITH FAMILY INCOME(S) WITHIN 400% OF THE FEDERAL POVERTY GUIDELINES. ADDITIONALLY, UNDER THE PIH SELF-PAY PAYMENT PROGRAM, ALL CASH-PAY PATIENTS AND THOSE THAT HAVE LIMITED BENEFIT PLANS (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. 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 SELF-PAY PAYMENT PROGRAM ARE ESPECIALLY OF BENEFIT TO THOSE IN THE PROCESS OF APPLYING FOR PIHS CHARITY CARE OR OTHER GOVERNMENT MEANS-TESTED PROGRAMS AND AWAITING ELIGIBILITY DETERMINATION. PIH ALSO REALIZES A NET LOSS EACH FISCAL YEAR IN PROVIDING SERVICES TO THOSE PATIENTS PARTICIPATING IN GOVERNMENT-SPONSORED MEANS-TESTED HEALTH PROGRAMS, SUCH AS MEDI-CAL, MEDI-CAL HMO, CCS, AND HEALTHY WAY LA. NUMBER OF PERSONS SERVED THROUGH CHARITY CARE & MEANS-TESTED PROGRAMS: 35,529.NUMBER OF PERSONS SERVED THROUGH COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS, HEALTH PROFESSIONS EDUCATION, SUBSIDIZED HEALTH SERVICES, RESEARCH, CASH & IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS: 53,229. FOR ADDITIONAL INFORMATION, PLEASE REFER TO PIH'S ANNUAL REPORT & PLAN FOR COMMUNITY BENEFIT REPORT AT WWW.PIH.NET.
4b (Code:   ) (Expenses $ 91,808,996 including grants of $   ) (Revenue $ 58,282,832 )
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: 35,529.
4c (Code:   ) (Expenses $ 20,057,068 including grants of $ 475,537 ) (Revenue $ 3,999,883 )
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: 53,229.FOR ADDITIONAL INFORMATION, PLEASE REFER TO PIH'S COMMUNITY BENEFIT REPORT AT WWW.PIH.NET.
4d Other program services. (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 369,754,870
Form 990 (2010)
Form 990 (2010)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part II
Click to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete
Schedule D, Part I
Click to see attachment
.......................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment
...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IV
Click to see attachment
...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in term, permanent,or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
 
No
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, and program service activities outside the United States? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
Form 990 (2010)
Form 990 (2010)
Page 4
Part IV
Checklist of Required Schedules (continued)
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
Did the organization attach its audited financial statement to this return? Note: All Form 990 filers that operate one or more hospitals must attach audited financial statements. ..... Click to see attachment
20b
Yes
 
21
Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
Yes
 
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?
......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II
........................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III............... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV
................... Click to see attachment
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I
...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35
Is any related organization a controlled entity within the meaning of section 512(b)(13)? .....
35
Yes
 
a
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2010)
Form 990 (2010)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V . . . . . . . . . .
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
244
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
3,082
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note.
All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2010)
Form 990 (2010)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI . . . . . . . . . .
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year ..............
1a
15
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
12
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? ..
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Does the organization have members or stockholders? ................
6
Yes
 
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
Yes
 
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Does the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? ....
10b
 
 
11a
Has the organization provided a copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Does the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ...........................
12b
Yes
 
c
Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this is done ....................
12c
Yes
 
13
Does the organization have a written whistleblower policy? ...............
13
Yes
 
14
Does the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line a or b, describe the process in Schedule O. (See instructions.)
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
CA
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you make these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and financial statements available to the public.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
RONALD YOSHIHARA
12102 WASHINGTON BLVD
WHITTIER,CA90606
(562) 698-0811
Form 990 (2010)
Form 990 (2010)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII . . . . . . . . . .
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title
(B)
Average hours per week (describe hours for related organizations in Schedule O)
(C)
Position (check all that apply)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) EFRAIN ACEVES
DIRECTOR
1.50 X           0 0 0
(2) DONALD ALVARADO
DIRECTOR & VICE CHAIRMAN
1.50 X   X       0 0 0
(3) RICHARD ATWOOD
DIRECTOR
1.50 X           0 0 0
(4) PAULA COWAN
DIRECTOR
1.50 X           0 0 0
(5) JANE DICUS
DIRECTOR & SECRETARY
1.50 X   X       0 0 0
(6) LEON MN GARCIA
DIRECTOR
1.50 X           0 0 0
(7) THOMAS KING
DIRECTOR
1.50 X           0 0 0
(8) ANGEL MUNOZ
DIRECTOR
1.50 X           0 0 0
(9) SUDHAKER NAYAK MD
DIRECTOR
1.50 X           191,106 0 0
(10) NORMA PROVENCIO
DIRECTOR
1.50 X           0 0 0
(11) WILLIAM SHANAHAN MD
DIRECTOR
1.50 X           55,000 0 0
(12) NEAL SHINDEL MD
DIRECTOR
1.50 X           42,012 24,194 0
(13) DREW SONES
DIRECTOR & CHAIRMAN
1.50 X   X       0 0 0
(14) KENTON WOODS
DIRECTOR & TREASURER
1.50 X   X       0 0 0
(15) HUEY-MIN YU
DIRECTOR
1.50 X           0 0 0
(16) JAMES WEST
PRESIDENT & CEO
40.00     X       885,023 0 184,410
(17) MITCHELL THOMAS
CFO, ASST TREAS & SR VP
40.00     X       520,452 0 112,615
Form 990 (2010)
Form 990 (2010)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title
(B)
Average hours per week (describe hours for related organizations in Schedule O)
(C)
Position (check all that apply)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) PEGGY CHULACK
CAO & ASST SECRETARY
40.00     X       440,143 0 66,885
(19) ROSALIO LOPEZ MD
CHIEF MED OFF & SR VP
40.00     X       530,978 0 95,031
(20) REANNA THOMPSON
CHIEF NURSING OFFICER
40.00     X       394,473 0 59,756
(21) DAVE KLINGER
VP, FACILITIES
40.00       X     366,152 0 59,920
(22) JOAN ROLLAND
ADMIN ED/DISASTER SERV
40.00       X     170,885 0 48,212
(23) JUDY PUGACH
VP OF QUALITY RISK MGMT.
40.00       X     183,151 0 35,497
(24) LON OREY
VP OF HUMAN RESOURCES
40.00       X     348,567 0 44,720
(25) PATRICIA BRAY
VP OF CONTINUING CARE
40.00       X     184,012 0 32,815
(26) PERRY EBELTOFT
ANCILLARY SERVICES ADMIN
40.00       X     197,719 0 42,062
(27) RAMONA PRATT
VP, NURSING OPERATIONS
40.00       X     220,667 0 39,345
(28) RONALD YOSHIHARA
VP, FINANCE & CONTROLLER
40.00       X     266,127 0 63,988
(29) ROWENA STAJER
ADMINISTRATIVE DIRECTOR
40.00       X     217,114 0 31,094
(30) SUSANNE CARLSON
ADMINISTRATIVE DIRECTOR
40.00       X     253,613 0 43,481
(31) MARVIN RICE
VP, NETWORK SERVICES
40.00       X     440,960 0 99,994
(32) JUNG HO
MEDICAL PHYSICIST
40.00         X   225,439 0 2,430
(33) CARMEN A CHANG
PHARMACIST
40.00         X   187,710 0 1,561
(34) PHILIP B CHON
PHARMACIST
40.00         X   184,110 0 2,010
(35) ALAN Y ENDO
DIRECTOR - PHARMACY
40.00         X   182,580 0 3,011
(36) ANNA KRUGER
RN
40.00         X   173,075 0 561
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 6,861,068 24,194 1,069,398
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet267
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
MILLIE AND SEVERSON INC
PO BOX 3601
LOS ALAMITOS,CA90720
CONSTRUCTION 24,728,560
ALLSCRIPTS (FORMERLY ECLIPSYS)
3 RAVINIA DRIVE SUITE B-150
ATLANTA,GA30346
IT SERVICES 10,762,498
WHITTIER PULM AND CRITC CARE
6905 ALTA VISTA DRIVE
RANCHO PALOS VERDES,CA90275
MEDICAL SERVICES 5,311,065
LAMBERT RADIOL MED GRP INC
11721 WHITTIER BLVD 509
WHITTIER,CA90601
MEDICAL SERVICES 4,635,071
FAMILY PRACTICE RESIDENCY PROGRAM
12291 WASHINGTON BLVD
WHITTIER,CA90606
MEDICAL SERVICES 3,164,360
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet75
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 2,204,568
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above
1f
 
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 2,204,568
 Program Service Revenue Business Code
2a NET PATIENT SERVICE RE 621,610 405,297,234 405,297,234    
b HOSPITAL FEE PROGRAM 900,099 27,601,129 27,601,129    
c OTHER PATIENT REVENUE 621,610 12,076,257 12,076,257    
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 444,974,620
 Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 9,004,803     9,004,803
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties............MediumBullet        
(i) Real (ii) Personal
6a Gross Rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 75,635,109 18,000
b Less: cost or other basis and sales expenses 69,555,870 17,383
c Gain or (loss) 6,079,239 617
d Net gain or (loss)..........MediumBullet 6,079,856     6,079,856
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Miscellaneous Revenue Business Code
11a COMMUNITY PHARMACY 624,110 2,586,771 2,576,936 9,835  
b PURCHASE DISCOUNTS 900,099 537,291     537,291
c NON-PATIENT LAB 621,500 125,323   125,323  
d All other revenue .... -13,923   4,076 -17,999
e Total. Add lines 11a–11d ......MediumBullet 3,235,462
12 Total revenue. See Instructions....MediumBullet 465,499,309 447,551,556 139,234 15,603,951
Form 990 (2010)
Form 990 (2010)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII.
(A)
Total expenses
(B)
Program service expenses
(C)
Management and general expenses
(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21 601,102 601,102
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22 251,150 251,150
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 5,427,058 3,934,941 1,492,117  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 144,966,239 129,681,194 15,285,045  
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 11,796,843 10,026,637 1,770,206  
9 Other employee benefits ....... 38,750,932 36,389,574 2,361,358  
10 Payroll taxes ........... 11,741,617 10,432,372 1,309,245  
11 Fees for services (non-employees):        
a Management ...... 370,219   370,219  
b Legal ......... 1,502,114 4,287 1,497,827  
c Accounting ........... 53,850   53,850  
d Lobbying ........... 50,318   50,318  
e Professional fundraising. See Part IV, line 17..    
f Investment management fees ......        
g Other .......... 48,997,600 42,779,593 6,218,007  
12 Advertising and promotion ....        
13 Office expenses ....... 5,219,496 3,387,479 1,832,017  
14 Information technology ...... 19,673,508 15,967,976 3,705,532  
15 Royalties ..        
16 Occupancy ........... 7,783,111 6,476,465 1,306,646  
17 Travel ............ 475,004 349,350 125,654  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 187,623 30,295 157,328  
20 Interest ........... 10,664,380 8,885,149 1,779,231  
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 16,502,054 13,750,287 2,751,767  
23 Insurance .............. 3,780,695 998,994 2,781,701  
24 Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a MEDICAL SUPPLIES 47,358,556 47,036,965 321,591 0
b HOSPITAL FEE PROGRAM 18,574,513 18,574,513 0 0
c BAD DEBT 14,195,019 14,195,019 0 0
d EQUIPMENT R&M 3,966,211 3,792,882 173,329 0
e EQUIPMENT LEASES 728,967 720,282 8,685 0
f All other expenses 2,514,986 1,488,364 1,026,622  
25 Total functional expenses. Add lines 1 through 24f 416,133,165 369,754,870 46,378,295 0
26 Joint costs. Check here MediumBullet if following
SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation
       
Form 990 (2010)
Form 990 (2010)
Page 11
Part X Balance Sheet
(A)
Beginning of year
(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 2,269,947 1 8,522,455
2 Savings and temporary cash investments ....... 6,521,483 2 6,038
3 Pledges and grants receivable, net .........   3  
4 Accounts receivable, net ......... 69,675,419 4 63,298,558
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..........   5  
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L ..........   6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use .............. 3,431,697 8 3,307,679
9 Prepaid expenses and deferred charges ............ 10,649,826 9 8,710,475
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 405,509,298
b Less: accumulated depreciation. ..... 10b 116,205,653 256,432,376 10c 289,303,645
11 Investments—publicly traded securities .......... 351,404,186 11 352,866,582
12 Investments—other securities. See Part IV, line 11 ......   12  
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets ......... 594,192 14 594,192
15 Other assets. See Part IV, line 11 ........... 147,602,188 15 178,740,464
16 Total assets. Add lines 1 through 15 (must equal line 34)... 848,581,314 16 905,350,088
Liabilities 17 Accounts payable and accrued expenses . 34,496,454 17 38,628,321
18 Grants payable ..........   18  
19 Deferred revenue ..........   19  
20 Tax-exempt bond liabilities .......... 273,946,465 20 308,097,102
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities. Complete Part X of Schedule D..... 100,991,450 25 146,986,758
26 Total liabilities. Add lines 17 through 25..... 409,434,369 26 493,712,181
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 439,146,945 27 411,637,907
28 Temporarily restricted net assets .....   28  
29 Permanently restricted net assets .....   29  
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 439,146,945 33 411,637,907
34 Total liabilities and net assets/fund balances ..... 848,581,314 34 905,350,088
Form 990 (2010)
Form 990 (2010)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI . . . . . . . . . .
1
Total revenue (must equal Part VIII, column (A), line 12) . . .
1
465,499,309
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
416,133,165
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
49,366,144
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
439,146,945
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
-76,875,182
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) . . . . . .
6
411,637,907
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII . . . . . . . . . .
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?..
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
...........................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2010)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
PRESBYTERIAN INTERCOMMUNITY HOSPITAL INC
 
Employer identification number

95-1934652
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization
(ii)
EIN
(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv)
Is the organization in col. (i) listed in your governing document?
(v)
Did you notify the organization in col. (i) of your support?
(vi)
Is the organization in col. (i) organized in the U.S.?
(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2010
Name of organization
PRESBYTERIAN INTERCOMMUNITY HOSPITAL INC
 
Employer identification number

95-1934652
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule—
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part I
Name of organization
PRESBYTERIAN INTERCOMMUNITY HOSPITAL INC
 
Employer identification number

95-1934652
Part I
Contributors (see Instructions)
     
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Aggregate contributions
(d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is
a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Aggregate contributions
(d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Aggregate contributions
(d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Aggregate contributions
(d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Aggregate contributions
(d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Aggregate contributions
(d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part II
Name of organization
PRESBYTERIAN INTERCOMMUNITY HOSPITAL INC
 
Employer identification number

95-1934652
Part II
Noncash Property (see Instructions)
     
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part III
Name of organization
PRESBYTERIAN INTERCOMMUNITY HOSPITAL INC
 
Employer identification number

95-1934652
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
(a) No.
from
Part I
(b)
Purpose of gift
(c)
Use of gift
(d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I
(b)
Purpose of gift
(c)
Use of gift
(d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I
(b)
Purpose of gift
(c)
Use of gift
(d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I
(b)
Purpose of gift
(c)
Use of gift
(d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
If the organization answered “Yes,” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes,” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
PRESBYTERIAN INTERCOMMUNITY HOSPITAL INC
 
Employer identification number

95-1934652
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities ....................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2010

Schedule C (Form 990 or 990-EZ) 2010
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.)
(a) Filing
Organization's
Totals
(b) Affiliated Group
Totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.
   
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in)
(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e))
         
             
c Total lobbying expenditures          
             
d Grassroots non-taxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))
         
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2010


Schedule C (Form 990 or 990-EZ) 2010
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? If "Yes," describe in Part IV ..........................
Yes
 
50,318
j
Total. lines 1c through 1i ...................................
50,318
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: A PORTION OF DUES PAID TO HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA AND AMERICAN HOSPITAL ASSOCIATION ARE RELATED TO LOBBYING.
Schedule C (Form 990 or 990EZ) 2010

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
PRESBYTERIAN INTERCOMMUNITY HOSPITAL INC
 
Employer identification number

95-1934652
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06 ........ 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance ....      
b Contributions ........      
c Investment earnings or losses ...      
d Grants or scholarships .....      
e Other expenditures for facilities
and programs ........
     
f Administrative expenses ....      
g End of year balance ......      
2
Provide the estimated percentage of the year end balance held as:
a
Board designated or quasi-endowment: SchDMd Bullet  
b
Permanent endowment: SchDMd Bullet  
c
Term endowment: SchDMd Bullet  
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Investments—Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of investment (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   214,611 214,611
b Buildings ................   187,032,997 44,555,746 142,477,251
c Leasehold improvements ............        
d Equipment ................   98,134,089 66,760,589 31,373,500
e Other .................   120,127,601 4,889,318 115,238,283
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 289,303,645
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)
(b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) DEFERRED FINANCING COSTS 3,544,563
(2) DUE FROM AFFILIATES 164,049,712
(3) OTHER RECEIVABLES 3,729,110
(4) INVESTMENTS IN AFFILIATES 1,113,445
(5) OTHER ASSET-HOSPITAL FEE PROGRAM 6,303,634




Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 178,740,464
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes  
DEFERRED COMPENSATION 14,047,633
SELF INSURANCE TRUST 19,697,205
ACCRUED BOND INTEREST PAYABLE 1,496,675
DEFERRED INCOME-HOSP FEE PROGRAM 10,011,739
INTEREST RATE SWAP 49,557,301
INTERCO PAYABLE 840,002
PENSION LIABILITY 51,336,203


Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 146,986,758
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1 465,499,309
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2 416,133,165
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3 49,366,144
4 Net unrealized gains (losses) on investments .......................... 4 -20,815,448
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV) ................................. 8 -56,059,734
9 Total adjustments (net). Add lines 4 - 8 ............................. 9 -76,875,182
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10 -27,509,038
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV): ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ...... 5  
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV): ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ...... 5  
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 COMPANY HAS NOT RECORDED A LIABILITY FOR UNRECOGNIZED TAX UNCERTAINTIES IN 2011 OR 2010.
PART XI, LINE 8 - OTHER ADJUSTMENTS:   PENSION ADJUSTMENTS -16,444,669. NET UNREALIZED LOSSES ON INTEREST RATE SWAP -9,925,385. LOSS ON INSURANCE LITIGATION SETTLEMENT -650,000. EQUITY TRANSFER TO IHMC -29,039,680.
Schedule D (Form 990) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
PRESBYTERIAN INTERCOMMUNITY HOSPITAL INC
 
Employer identification number

95-1934652
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Does the organization have a charity care policy? If "No," skip to question 6a...........
1a
Yes
 
b
If "Yes," is it a written policy? .......................
1b
Yes
 
2
If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.
3
Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.
a
Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low
income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If
"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....
3b
Yes
 
c
If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Does the organization's policy provide free or discounted care to the "medically indigent"? ......
4
Yes
 
5a
Does the organization budget amounts for free or discounted care provided under its charity care policy? ...
5a
Yes
 
b
If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?...............
5c
 
No
6a
Does the organization prepare an annual community benefit report?.............
6a
Yes
 
6b
If "Yes," does the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Charity Care and Certain Other Community Benefits at Cost
Charity Care and
Means-Tested Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Charity care at cost (from
Worksheets 1 and 2) ..
  8,107 23,198,308 7,008,980 16,189,328 4.030 %
b Unreimbursed Medicaid (from
Worksheet 3, column a) .
  27,159 66,704,942 50,753,201 15,951,741 3.970 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....   263 954,672 520,651 434,021 0.110 %
dTotal Charity Care and
Means-Tested Government Programs .....
  35,529 90,857,922 58,282,832 32,575,090 8.110 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) ....
21 39,459 4,569,321 66,008 4,503,313 1.120 %
f Health professions education
(from Worksheet 5) ..
5 624 3,519,378 816,145 2,703,233 0.670 %
g Subsidized health services
(from Worksheet 6) ..
5 11,766 10,857,432 2,977,663 7,879,769 1.960 %
h Research (from Worksheet 7) 1 20 86,332   86,332 0.020 %
i Cash and in-kind contributions
to community groups
(from Worksheet 8) ..
6 1,360 1,024,605 140,067 884,538 0.220 %
jTotal Other Benefits ... 38 53,229 20,057,068 3,999,883 16,057,185 3.990 %
kTotal. Add lines 7d and 7j. .. 38 88,758 110,914,990 62,282,715 48,632,275 12.100 %
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 2
Part II
Community Building Activities Complete this table if the organization conducted any community building activities.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue
(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support 1   8,532   8,532 0 %
4 Environmental improvements 1 15 36,000   36,000 0.010 %
5 Leadership development and training for community members            
6 Coalition building 1 15 48,781   48,781 0.010 %
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total 3 30 93,313   93,313 0.020 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense (at cost).....
2
14,195,019
3
Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..
3
 
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
66,236,883
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
76,706,202
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-10,469,319
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:
Section C. Collection Practices
9a
Does the organization have a written debt collection policy? ...............
9a
Yes
 
b
If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......
9b
Yes
 
Part IV
Management Companies and Joint Ventures
(a) Name of entity (b) Description of primary
activity of entity
(c) Organization's
profit % or stock
ownership %
(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership%
(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 3
Part VFacility Information
Section A. Hospital Facilities
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many hospital facilities did the organization operate during the tax year?1
Name and address
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 PRESBYTERIAN INTERCOMMUNITY HOSPITAL
12401 WASHINGTON BLVD
WHITTER,CA90602
X X   X     X   SKILLED NURSING FACILITY
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:NOT REQUIRED
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 7
Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many non-hospital facilities did the organization operate during the tax year?11
Name and address Type of Facility (Describe)
1 SAME DAY SURGERY
12415 WASHINGTON BLVD
WHITTER,CA90602
OUTPATIENT SURGICAL SERVICES
2 SAME DAY SURGERY
12415 WASHINGTON BLVD
WHITTER,CA90602
OUTPATIENT SURGICAL SERVICES
3 SAME DAY SURGERY
12415 WASHINGTON BLVD
WHITTER,CA90602
OUTPATIENT SURGICAL SERVICES
4 SAME DAY SURGERY
12415 WASHINGTON BLVD
WHITTER,CA90602
OUTPATIENT SURGICAL SERVICES
5 SAME DAY SURGERY
12415 WASHINGTON BLVD
WHITTER,CA90602
OUTPATIENT SURGICAL SERVICES
6 SAME DAY SURGERY
12415 WASHINGTON BLVD
WHITTER,CA90602
OUTPATIENT SURGICAL SERVICES
7 SAME DAY SURGERY
12415 WASHINGTON BLVD
WHITTER,CA90602
OUTPATIENT SURGICAL SERVICES
8 SAME DAY SURGERY
12415 WASHINGTON BLVD
WHITTER,CA90602
OUTPATIENT SURGICAL SERVICES
9 SAME DAY SURGERY
12415 WASHINGTON BLVD
WHITTER,CA90602
OUTPATIENT SURGICAL SERVICES
10 SAME DAY SURGERY
12415 WASHINGTON BLVD
WHITTER,CA90602
OUTPATIENT SURGICAL SERVICES
11 SAME DAY SURGERY
12415 WASHINGTON BLVD
WHITTER,CA90602
OUTPATIENT SURGICAL SERVICES
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 8
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2 Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
    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 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 14195019.
    PART II: 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 HOSPITAL'S 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 COMMUNITY-BASED ORGANIZATIONS THAT SERVE THE HEALTH AND SOCIAL SERVICE NEEDS OF LOCAL COMMUNITIES, SUCH AS THE WHOLE CHILD, A LOCAL AGENCY WITH A MISSION TO STRENGTHEN VITAL PARENT-CHILD RELATIONSHIPS. PIH'S DIRECTOR OF MARKETING & PLANNING DEPARTMENT SERVED ON A COMMUNITY COALITION, ADVOCATING FOR BRINGING VITAL PUBLIC TRANSPORTATION SERVICES TO WHITTIER. OTHER MEMBERS OF THIS COALITION INCLUDE WHITTIER CITY COUNCIL MEMBERS, 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 WITH A VISION FOR A HEALTHY ACTIVE WHITTIER, WHICH IS COMMITTED TO MOTIVATING AND SUPPORTING A HEALTHY COMMUNITY THROUGH WELLNESS EDUCATION, ADVOCACY AND POLICY-RELATED EFFORTS, AND PROMOTION OF HEALTHY EATING AND PHYSICAL ACTIVITY. ACTIVATE WHITTIER SUPPORTS THE GRANT-FUNDED ACHIEVE INITIATIVE, DESIGNED TO FACILITATE ENVIRONMENTAL CHANGE. PIH IS AN ACTIVE MEMBER AND JOINS THE CITY OF WHITTIER, YMCA OF GREATER WHITTIER, LA COUNTY PUBLIC HEALTH DEPARTMENT, WHITTIER COLLEGE, WHITTIER FIRST DAY, AND THE BOYS AND GIRLS CLUB OF WHITTIER, ALL OF WHICH ARE SERVING AS ACTIVE PARTNERS IN THIS COLLABORATION.LA MIRADA ACHIEVE - A 3-YEAR INITIATIVE LED BY THE CITY OF LA MIRADA, WITH FY 2010-2011 BEING THE PROJECTS FINAL YEAR. THIS ACHIEVE INITIATIVE ENGAGED KEY STAKEHOLDERS IN ALL COMMUNITY SECTORS TO IDENTIFY AND IMPLEMENT POLICIES AND ENVIRONMENTAL STRATEGIES WHICH SOUGHT TO 1) FACILITATE AN INCREASE IN PHYSICAL ACTIVITY IN AFTER-SCHOOL PROGRAMS; 2) FACILITATE DEVELOPMENT AND IMPLEMENTATION OF WORKSITE WELLNESS POLICIES; AND 3) TO ESTABLISH LA MIRADA PARKS AS SMOKE-FREE ENVIRONMENTS. PIH SERVED AS A PARTNER IN IMPLEMENTATION OF THIS INITIATIVE.WHITTIER CITY SCHOOL DISTRICT - PIH HAS CONTRIBUTED TO THE INCREASED EFFECTIVENESS AND IMPROVED CAPACITY OF A LOCAL SCHOOL DISTRICT THROUGH THE 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 ITS CARE FORCE ONE MOBILE HEALTH SERVICES, 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. IN ADDITION, PIH PLAYED A KEY ROLE, THROUGH ITS PARTICIPATION IN ACTIVATE WHITTIER, IN FACILITATING THE FIRST-EVER SALAD BAR IN THE DISTRICT SPECIFICALLY AT AN ELEMENTARY SCHOOL LOCATED IN A LOW-INCOME AREA WITH HIGH NEED FOR ACCESS TO HEALTHY FOOD OPTIONS. 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 VISITS TO LOCAL CLINICS AND THE EMERGENCY ROOM. 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 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 I, LINE 7B:IN OCTOBER 2010, CMS APPROVED LEGISLATION ENACTED BY THE STATE OF CALIFORNIA THAT PROVIDED FOR SUPPLEMENTAL MEDI-CAL PAYMENTS TO BE PAID TO CERTAIN HOSPITALS FROM FUNDS COLLECTED FROM PARTICIPATING HOSPITALS UNDER THE STATE'S QUALITY ASSURANCE FEE PROGRAM. SUCH AMOUNTS WERE ALLOCATED AND PAID TO PRESBYTERIAN INTERCOMMUNITY HOSPITAL BASED ON PRIOR YEAR PATIENT DATA, WHICH INCLUDES MEDI-CAL PATIENTS. THE INCLUSION OF OUT-OF-PERIOD REVENUE IN FISCAL YEAR 2011 FINANCIAL RESULTS REDUCED THE NET UNREIMBURSED MEDICAID. IF THESE AMOUNTS HAD NOT BEEN INCLUDED, THE HOSPITAL WOULD HAVE REPORTED A TOTAL CHARITY CARE PERCENTAGE OF 14.23% INSTEAD OF THE 12.10% CURRENTLY BEING REPORTED.
    PART VI, LINE 2: TO ASSESS THE HEALTH NEEDS OF THE COMMUNITIES WE SERVE, PIH CONDUCTS A COMMUNITY HEALTH NEEDS ASSESSMENT EVERY THREE YEARS, IN ACCORDANCE WITH CALIFORNIA STATE LAW AND THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (PPACA). THE FINDINGS OF THESE ASSESSMENTS SERVES AS A PRIMARY TOOL FOR THE HOSPITAL TO DETERMINE ITS COMMUNITY BENEFIT PLAN, WHICH OUTLINES HOW THE HOSPITAL WILL ADDRESS UNMET COMMUNITY HEALTH NEEDS, AND ULTIMATELY, STRIVE TO IMPROVE THE OVERALL HEALTH AND QUALITY OF LIFE IN OUR LOCAL COMMUNITIES. 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 ENHANCED PRIMARY DATA COLLECTION IN ORDER TO GAIN A DEEPER UNDERSTANDING OF THE HEALTH ACCESS EXPERIENCE OF OUR COMMUNITY'S MOST VULNERABLE. AS A RESULT, PRIMARY DATA COLLECTION INCLUDED 27 STAKEHOLDER INTERVIEWS HELD WITH COMMUNITY STAKEHOLDERS, REPRESENTING LOCAL GOVERNMENT, AND HEALTH AND SOCIAL SERVICES IN PRIMARY SERVICE AREA COMMUNITIES. 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.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 PRIORITY HEALTH AREAS WAS INCLUDED, AS WELL. IN ADDITION TO BEING AVAILABLE ON PIH'S WEBSITE, THE 2010 COMMUNITY HEALTH NEEDS ASSESSMENT HAS BEEN WIDELY SHARED WITH CIVIC, BUSINESS AND COMMUNITY LEADERS, LOCAL COMMUNITY-BASED ORGANIZATIONS, AND KEY STAKEHOLDERS, AS WELL AS THE COMMUNITY AT-LARGE. EMPHASIS IS MADE ON SHARING ASSESSMENT RESULTS WITH AREA AGENCIES TO ASSIST THEM WITH THEIR PROGRAM PLANNING AND FUND-DEVELOPMENT ENDEAVORS, WHILE SPARING THE EXPENSE OF DUPLICATIVE DATA COLLECTION EFFORTS.
    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 PROGRAMS CRITERIA TO PAY FOR NEEDED HEALTHCARE SERVICES. DURING FY 2010-2011, PIH INCURRED UN-REIMBURSED COSTS FOR THIS PROVISION OF CHARITY CARE TO THE UNDER-SERVED IN THE AMOUNT OF $16,189,328.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 WHO APPLY AND QUALIFY 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 THIS POLICY;PATIENTS WHO HAVE RESTRICTED MEDI-CAL EMERGENCY AND PREGNANCY SERVICES COVERAGE (AND NO SHARE OF COST) AND WHOSE SERVICES ARE NOT COVERED FOR A PARTICULAR EPISODE OR PARTIAL EPISODE OF CARE. (AN UNCOMPENSATED CARE APPLICATION IS NOT REQUIRED SINCE THE PATIENT IS PRESUMED TO MEET THE CHARITY CARE ELIGIBILITY REQUIREMENTS);THERE ARE INSTANCES WHEN A PATIENT MAY APPEAR ELIGIBLE FOR CHARITY CARE DISCOUNTS, BUT THERE IS NO FINANCIAL ASSISTANCE FORM ON FILE DUE TO A LACK OF SUPPORTING DOCUMENTATION. PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE, BUT ARE NOT LIMITED TO: STATE-FUNDED PRESCRIPTION PROGRAMS; HOMELESS OR RECEIVED CARE FROM A HOMELESS CLINIC OR SHELTER PARTICIPATION IN WOMEN, INFANTS AND CHILDREN PROGRAMS (WIC); FOOD STAMP ELIGIBILITY; SUBSIDIZED SCHOOL LUNCH PROGRAM ELIGIBILITY; LOW INCOME/SUBSIDIZED HOUSING IS PROVIDED AS A VALID ADDRESS; AND PATIENT IS DECEASED WITH NO KNOWN ESTATE; AND PATIENTS WHO ARE CURRENTLY ELIGIBLE FOR MEDI-CAL, BUT WERE NOT ELIGIBLE IN ONE TO THREE MONTHS PRIOR TO ELIGIBILITY ARE PRESUMED TO BE ELIGIBLE FOR CHARITY AND DO NOT NEED TO FILL OUT THE APPLICATION.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, AND ALSO THOSE PERSONS WITH GENERALLY ADEQUATE INCOMES WHO ARE SUDDENLY FACED WITH CATASTROPHICALLY LARGE MEDICAL BILLS;PATIENTS WHO DEMONSTRATE ABILITY TO PAY PART BUT NOT ALL OF THEIR LIABILITY. FOR EXAMPLE, THOSE WHO HAVE AN OUT OF POCKET THAT EXCEEDS 10% OF THEIR ANNUAL NET FAMILY INCOME IN THE PRIOR TWELVE MONTHS.SELF-PAY PAYMENT PROGRAMADDITIONALLY, UNDER THE PIH SELF-PAY PAYMENT PROGRAM, ALL CASH-PAY PATIENTS AND THOSE THAT HAVE LIMITED BENEFIT PLANS (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 PROGRAMS 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).ADDITIONAL PATIENT EDUCATION REGARDING PIH'S CHARITY CAREIT 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 & SPANISH) FINANCIAL COUNSELORS OR OTHER APPROPRIATE STAFF WORK WITH ELIGIBLE PATIENTS IN APPLYING FOR PIH'S CHARITY CARE OR OTHER GOVERNMENT MEANS-TESTED PROGRAMS. IN ACCORDANCE WITH CALIFORNIA'S FAIR PRICING LAW FOR LOW-INCOME, UNINSURED INDIVIDUALS, PIH POSTS NOTICES IN BOTH ENGLISH AND SPANISH WITH INFORMATION REGARDING ITS UNCOMPENSATED CARE AND SELF-PAY PAYMENT 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. UN-INSURED PATIENTS ALSO RECEIVE A LETTER IN ENGLISH AND/OR SPANISH, WHICH DETAILS THE VARIOUS PROGRAMS FOR WHICH THEY MAY BE ELIGIBLE. IN ADDITION, 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."
    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, PIH'S 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. 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 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, MOBILE HEALTH SERVICES, A RESIDENTIAL HOSPICE PROGRAM, 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 AND OTHER FINANCIAL ASSISTANCE PROGRAMS, AS WELL AS A MULTITUDE OF COMMUNITY-BASED INITIATIVES TO IMPROVE AND PROMOTE OVERALL HEALTH AND WELL-BEING, REGARDLESS OF HEALTH OR ECONOMIC STATUS. IN ADDITION, PIH HAS A STRONG NETWORK OF COMMUNITY PARTNERSHIPS AND COLLABORATIONS, DEMONSTRATING OUR ACTIVE LEADERSHIP ROLE IN THE COMMUNITY.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 AND MEASURABLE OBJECTIVES, HAS RESULTED IN A MORE SOPHISTICATED LEVEL OF EVALUATION AND OVERSIGHT BY PIH'S CBOC AT ITS ANNUAL MEETINGS. EXAMPLES OF PIH'S COMMITMENT TO IMPROVEMENT OF OVERALL COMMUNITY HEALTH AND HEALTHCARE ACCESS ARE BELOW:ENROLLMENT ASSISTANCE PIH, 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 PIH PATIENTS IN APPLYING FOR PIH'S CHARITY CARE PROGRAM. THE ENROLLMENT COORDINATORS ALSO PROVIDE REFERRALS TO OTHER SOURCES OF HEALTH CARE AND SOCIAL SERVICES. THEY WORK IN CONJUNCTION WITH LOCAL SCHOOLS AND PIH'S BUSINESS OFFICE, EMERGENCY, MOBILE HEALTH SERVICES, SOCIAL WORK AND INFORMATION TECHNOLOGY DEPARTMENTS TO LOCATE FAMILIES IN NEED. THE RESULTS OF THEIR EFFORTS ARE ALSO REFLECTED IN PIH'S 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 HEALTH CAREPIH AND WHITTIER FIRST DAY, A LOCAL TRANSITIONAL 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 BASIC AND PREVENTIVE HEALTH CARE SERVICES; DURING FY 2011, 87% OF CLINIC PATIENTS EXPERIENCED IMPROVED HEALTH STATUS; 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. IN ADDITION, PIH'S CARE FORCE ONE MOBILE HEALTH SERVICES PROVIDES FREE AND LOW-COST PRIMARY HEALTHCARE SERVICES DIRECTLY TO THOSE IN THE COMMUNITY WHO HAVE DIFFICULTY ACCESSING CARE FOR A VARIETY OF REASONS, WITH OVER 9,100 PATIENT ENCOUNTERS DURING FY 2011.FAMILY PRACTICE RESIDENCY PROGRAMPIH IS COMMITTED TO EDUCATING THE NEXT GENERATION OF HEALTHCARE PROFESSIONALS VIA ITS FAMILY PRACTICE RESIDENCY PROGRAM, WHICH PLACES SPECIAL EMPHASIS ON TRAINING RESIDENT PHYSICIANS TO WORK WITH MEDICALLY AT-RISK COMMUNITY MEMBERS OF ALL AGES WHO RESIDE IN LOW-INCOME, UNDER-SERVED AREAS. RESIDENT PHYSICIANS PROVIDE COMMUNITY HEALTH SERVICES VIA PIH'S HOME-BASED PALLIATIVE CARE PROGRAM, AT HOSPITAL-SUPPORTED CLINICS AT WHITTIER COLLEGE AND A LOCAL HOMELESS SHELTER, AS WELL AS THROUGH COMMUNITY PARTNERSHIPS, SUCH AS WITH THE LOS NIETOS SCHOOL DISTRICT, IN WHICH RESIDENTS SUPPORT THIS LOW-INCOME COMMUNITY IN ITS EFFORTS TO ADDRESS THEIR SIGNIFICANT OBESITY RATES. 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 2010-2011, PIH'S EMERGENCY DEPARTMENT (ED) EXPERIENCED AN ESTIMATED 70,000 VISITS. PIH COMPLETED EXPANSION OF THE ED IN 2009, MAKING IT ONE OF THE LARGEST EMERGENCY ROOMS IN LOS ANGELES COUNTY WITH 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 AREAS 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, PARAMEDICS HAVE CRITICAL ACCESS TO LOCAL HOSPITAL-BASED EMERGENCY SERVICES. FURTHERMORE, PIH SUSTAINS A CONTRACT WITH AN ON-CALL PHYSICIAN PANEL SO THAT ALL ELIGIBLE PATIENTS, REGARDLESS OF HEALTH INSURANCE STATUS, ARE ASSURED ACCESS TO SPECIALTY CARE APPROPRIATE TO THEIR NEEDS. 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. THE PROGRAM HAS BEEN ENHANCED IN RECENT YEARS TO INCLUDE: A CANCER SURVIVORSHIP PROGRAM; LYMPHEDEMA WORKSHOPS; AND TWO NEW CLINICAL TRIALS FOR METASTATIC PROSTATE CANCER AND STAGE III COLON CANCER; AND COMPLEMENTARY MEDICINE OFFERINGS OPEN TO THE COMMUNITY, INCLUDING YOGA FOR HEALING AND REIKI HEALING HANDS THERAPY.VOLUNTEER CONTRIBUTIONSAPPROXIMATELY 800 PIH VOLUNTEERS COLLECTIVELY CONTRIBUTED 125,696 HOURS, TRANSLATING INTO MORE THAN $2,620,753 IN SAVINGS FOR THE HOSPITAL.
    PART VI, LINE 7: WHILE PIH IS NOT PART OF A HOSPITAL SYSTEM, THE HOSPITAL IS AFFILIATED WITH: 1) INTERHEALTH CORP, PIH'S PARENT COMPANY; 2) BRIGHT HEALTH PHYSICIANS (BHP), A NOT-FOR-PROFIT MEDICAL FOUNDATION; 3) THE PIH FOUNDATION, A NOT-FOR-PROFIT ORGANIZATION THAT EXISTS TO RAISE PHILANTHROPIC FUNDS IN SUPPORT OF PIH'S CHARITABLE MISSION; AND 4) MEDSITE, WHICH SUBSIDIZES THE S. MARK TAPER FOUNDATION A DAY AWAY ADULT DAY HEALTH CARE CENTER. INTERHEALTH CORP. PROVIDES TECHNICAL, FACILITY AND SUPPORT SERVICES FOR TAX-EXEMPT AFFILIATES WHOSE CHARITABLE PURPOSE IS TO PROVIDE A BROAD RANGE OF HEALTHCARE SERVICES TO THEIR COMMUNITY BY WAY OF AN INTEGRATED HEALTH CARE DELIVERY SYSTEM.BHP SUPPORTS THE LOCAL COMMUNITY THROUGH A NETWORK OF COMMUNITY-BASED HEALTH CLINICS, AND HEALTH PROMOTION AND HEALTH INSURANCE ENROLLMENT EFFORTS. DURING FY 2010-2011, PIH & BRIGHT HEALTH PHYSICIANS (BHP) WERE THE RECIPIENTS OF THE WHITTIER BEAUTIFUL AWARD, PRESENTED BY THE WHITTIER CHAMBER OF COMMERCE FOR ITS CORPORATE OFFICE IN UPTOWN WHITTIER, WHICH OPENED IN 2010, AFTER THE PURCHASE AND REFURBISHMENT OF THE VACANT FISHER BUILDING. THE NEW, 40,000 SQUARE FOOT OFFICE BUILDING HOUSES OVER 165 EMPLOYEES, WHO IN TURN SUPPORT AREA BUSINESSES. THE CITY OF WHITTIER'S ECONOMIC DEVELOPMENT NEWSLETTER "GROWING WHITTIER," (SPRING/SUMMER 2010, ISSUE 11), STATES THAT PROJECTS SUCH AS THIS UNDERSCORE PIH AS A "RESOURCE THAT PROTECTS THE HEALTH AND SAFETY OF THE COMMUNITY WHILE PROVIDING JOBS TO OUR CITY'S RESIDENTS." THE PIH FOUNDATION RAISES FUNDS IN SUPPORT OF PIH, AS WELL AS PROVIDING IN-KIND FUNDRAISING CONSULTATION TO LOCAL COMMUNITY-BASED ORGANIZATIONS. THE PIH FOUNDATIONS GALA, WHICH IS HELD ANNUALLY, BENEFITS A HOSPITAL PROGRAM, INITIATIVE, OR DEPARTMENT EACH YEAR. DURING FY 2010-2011, THE GALA DREW MORE THAN 700 PEOPLE AND RAISED A RECORD $642,740 IN SUPPORT OF THE CRITICAL CARE CENTER THAT WILL BE IN PIH'S NEW PLAZA TOWER; THE CRITICAL CARE CENTER RECENTLY CELEBRATED 50 YEARS OF SERVICE TO THE COMMUNITY. ALSO DURING FY 2010-2011, PIH FOUNDATION GOLF TOURNAMENT GENERATED OVER $205,000 IN SUPPORT OF PIH'S NURSING EDUCATION PROGRAM, WHICH PROVIDES FOR NURSING SCHOLARSHIPS SO THAT PIH NURSES ARE ABLE TO ADVANCE THEIR EDUCATION, AS WELL AS THE HOSPITALS CAPITAL CAMPAIGN FOR THE NEW PLAZA TOWER. 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 PROGRAMS 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 2010-2011, SOME 90 INDIVIDUALS WERE CARED FOR AT 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.
REPORTS FILED WITH STATES PART VI, LINE 7 CA
Schedule H (Form 990) 2010
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
PRESBYTERIAN INTERCOMMUNITY HOSPITAL INC
 
Employer identification number
95-1934652
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed
......................... lBullet
(a) Name and address of organization
or government
(b) EIN (c) IRC Code section
if applicable
(d) Amount of cash grant (e) Amount of non-cash
assistance
(f) Method of valuation
(book, FMV, appraisal,
other)
(g) Description of
non-cash assistance
(h) Purpose of grant
or assistance
(1) AMERICAN CANCER SOCIETY13230 PENN STREET
WHITTIER,CA90602
94-1170350 501(C)(3) 7,900       GENERAL SUPPORT
(2) PARTNERS IN CARE FOUNDATION732 MOTT STREET STE 150
SAN FERNANDO,CA91340
95-3954057 501(C)(3) 5,625       GENERAL SUPPORT
(3) RANCHO LOS AMIGOS FOUNDATION7601 E IMPERIAL HWY
DOWNEY,CA90242
95-3849600 501(C)(3) 6,800       GENERAL SUPPORT
(4) YMCA OF GREATER WHITTIER12510 E HADLEY ST STE 201
WHITTIER,CA90601
95-1684795 501(C)(3) 8,500       GENERAL SUPPORT
(5) SANTA FE SPRINGS CHAMBERS12016 E TELEGRAPH RD STE 100
SANTA FE SPRINGS,CA90670
95-2912042 501(C)(3) 6,000       GENERAL SUPPORT
(6) WHITTIER COMMUNITY FOUNDATION13230 PENN STREET
WHITTIER,CA90602
95-1918226 501(C)(3) 7,500       GENERAL SUPPORT
(7) CALIFORNIA HEALTH FOUNDATION AND TRUST1215 K STREET SUITE 800
SACRAMENTO,CA95814
94-1498687 501(C)(3) 475,537       SUPPORT CHARITABLE ACTIVITIES AT HOSPITALS & HEALTH SYSTEMS IN CALIFORNIA










2
Enter total number of section 501(c)(3) and government organizations ......................... Bullet Image
7
3
Enter total number of other organizations ................................ . Bullet Image
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2010

Schedule I (Form 990) 2010
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients
(c)Amount of
cash grant
(d)Amount of
non-cash assistance
(e)Method of valuation (book,
FMV, appraisal, other)
(f)Description of non-cash assistance
(1) SCHOLARSHIPS AND MEDICAL EDUCATION 51 142,000      
(2) PSYCHIATRIC CARE AT INDEPENDENT FACILITY FOR UNINSURED 59 109,150      











Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
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.
Schedule I (Form 990) 2010


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
PRESBYTERIAN INTERCOMMUNITY HOSPITAL INC
 
Employer identification number

95-1934652
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
Yes
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits
(E) Total of columns
(B)(i)-(D)
(F) Compensation
reported in prior
Form 990 or
Form 990-EZ
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) SUDHAKER NAYAK MD (i)
(ii)
191,106
0
0
0
0
0
0
0
0
0
191,106
0
0
0
(2) JAMES WEST (i)
(ii)
769,831
0
63,000
0
52,192
0
8,012
0
176,398
0
1,069,433
0
63,000
0
(3) MITCHELL THOMAS (i)
(ii)
389,758
0
32,753
0
97,941
0
8,012
0
104,603
0
633,067
0
32,753
0
(4) PEGGY CHULACK (i)
(ii)
365,436
0
68,310
0
6,397
0
8,012
0
58,873
0
507,028
0
68,310
0
(5) ROSALIO LOPEZ MD (i)
(ii)
481,810
0
40,013
0
9,155
0
8,012
0
87,019
0
626,009
0
40,013
0
(6) REANNA THOMPSON (i)
(ii)
288,993
0
69,300
0
36,180
0
8,012
0
51,744
0
454,229
0
69,300
0
(7) DAVE KLINGER (i)
(ii)
291,800
0
39,520
0
34,832
0
8,012
0
51,908
0
426,072
0
39,520
0
(8) JOAN ROLLAND (i)
(ii)
160,215
0
3,755
0
6,915
0
21,769
0
26,443
0
219,097
0
0
0
(9) JUDY PUGACH (i)
(ii)
163,356
0
12,880
0
6,915
0
5,423
0
30,074
0
218,648
0
0
0
(10) LON OREY (i)
(ii)
238,982
0
13,680
0
95,905
0
7,679
0
37,041
0
393,287
0
0
0
(11) PATRICIA BRAY (i)
(ii)
177,056
0
0
0
6,956
0
5,821
0
26,994
0
216,827
0
0
0
(12) PERRY EBELTOFT (i)
(ii)
190,217
0
0
0
7,502
0
5,614
0
36,448
0
239,781
0
0
0
(13) RAMONA PRATT (i)
(ii)
184,667
0
29,266
0
6,734
0
6,130
0
33,215
0
260,012
0
0
0
(14) RONALD YOSHIHARA (i)
(ii)
215,339
0
18,366
0
32,422
0
23,236
0
40,752
0
330,115
0
0
0
(15) ROWENA STAJER (i)
(ii)
161,680
0
25,567
0
29,867
0
17,187
0
13,907
0
248,208
0
0
0
(16) SUSANNE CARLSON (i)
(ii)
196,219
0
32,088
0
25,306
0
6,433
0
37,048
0
297,094
0
0
0
(17) MARVIN RICE (i)
(ii)
338,925
0
29,621
0
72,414
0
30,012
0
69,982
0
540,954
0
0
0
(18) JUNG HO (i)
(ii)
225,439
0
0
0
0
0
0
0
2,430
0
227,869
0
0
0
(19) CARMEN A CHANG (i)
(ii)
187,710
0
0
0
0
0
0
0
1,561
0
189,271
0
0
0
(20) PHILIP B CHON (i)
(ii)
184,110
0
0
0
0
0
0
0
2,010
0
186,120
0
0
0
(21) ALAN Y ENDO (i)
(ii)
182,580
0
0
0
0
0
0
0
3,011
0
185,591
0
0
0
(22) ANNA KRUGER (i)
(ii)
173,075
0
0
0
0
0
0
0
561
0
173,636
0
0
0
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
  PART I, LINE 1A ALL EMPLOYEES ARE ELIGIBLE FOR HEALTH CLUB REIMBURSEMENT AND ANY SUCH REIMBURSEMENTS WERE INCLUDED IN TAXABLE COMPENSATION, PER 2011 PLAN YEAR BENEFITS SUMMARY.
  PART I, LINE 4B PART I, LINE 4B: IHC AND ITS AFFILIATES SPONSOR A 457(F) PLAN. THE PLAN PARTICIPANTS AND AMOUNTS RECEIVED (IF APPLICABLE) WERE: PATRICIA BRAY, SUSANNE CARLSON ($18,892), PEGGY CHULACK, DAVID KLINGER ($28,418), PERRY EBELTOFT, ROSALIO LOPEZ MD, LON OREY ($89,053), RAMONA PRATT, JUDY PUGACH, JOAN ROLLAND, ROWENA STAJER ($23,867), MARVIN RICE ($65,226), MITCHELL THOMAS ($75,441), REANNA THOMPSON ($29,394), JAMES WEST, AND RONALD YOSHIHARA ($25,368).
SUPPLEMENTAL INFORMATION PART III PART II, COLUMN F: THE ORGANIZATION INADVERTENTLY USED THE INCORRECT CALENDAR YEAR BONUS INFORMATION ON THE 2009 FORM 990. THE BONUS IS REPORTED CORRECTLY ON THE 2010 FORM 990 IN PART II, COLUMN B(II). BECAUSE THE BONUS AMOUNTS WERE PREVIOUSLY REPORTED IN THE PRIOR YEAR FORM 990, THE AMOUNTS ALSO APPEAR IN COLUMN F OF THE CURRENT YEAR FORM 990. ALL OTHER COMPENSATION INFORMATION REPORTED ON THE 2009 FORM 990 IS CORRECT.
Schedule J (Form 990) 2010

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Schedule O (Form 990).
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.

OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
PRESBYTERIAN INTERCOMMUNITY HOSPITAL INC
 
Employer identification number
95-1934652
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer
(i) Pool
financing
Yes No Yes No Yes No
A CITY OF WHITTIER - SERIES 2009
 
95-6000812 966769DA6 05-14-2009 280,328,878 HOSPITAL FACILITIES REFUND 2007 BONDS   X   X   X
B CITY OF WHITTIER - SERIES 2011
 
95-6000812 966769DH1 03-31-2011 40,828,054 CONSTRUCTION OF FACILITIES   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired. . . . .        
2 Amount of bonds defeased . . . .        
3 Total proceeds of issue . . . . 280,328,878 40,828,054    
4 Gross proceeds in reserve funds . . 5,800,000      
5 Capitalized interest from proceeds.        
6 Proceeds in refunding escrow. . . . .        
7 Issuance costs from proceeds . . . 2,416,738 939,373    
8 Credit enhancement from proceeds. 1,087,414      
9 Working capital expenditures from proceeds . .        
10 Capital expenditures from proceeds . . 1,337,283 40,011,493    
11 Other spent proceeds . .        
12 Other unspent proceeds. . .        
13 Year of substantial completion . . . 2012 2012
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? X     X        
15 Were the bonds issued as part of an advance refunding issue?   X   X        
16 Has the final allocation of proceeds been made? . . X   X          
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . X   X          
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . .   X   X        
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . .   X   X        
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2010
Schedule K (Form 990) 2010
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use?   X   X        
b Are there any research agreements that may result in private business use of bond-financed property? . .   X   X        
c Does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts or research agreements relating to the financed property? . X   X          
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . . . . . . . . . . . . SchKMediumBullet        
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . SchKMediumBullet        
6 Total of lines 4 and 5 . . .. . . . . .        
7 Has the organization adopted management practices and procedures to ensure the post-issuance compliance of its tax-exempt bond liabilities? X   X          
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .   X   X        
2 Is the bond issue a variable rate issue? X     X        
3a Has the organization or the governmental issuer entered into a hedge with respect to the bond issue? X     X        
b Name of provider . GOLDMAN SACHS BANK
USA
 
 
 
 
 
 
c Term of hedge . . 29.500000000000      
d Was the hedge superintegrated? .   X            
e Was a hedge terminated? .   X            
4a Were gross proceeds invested in a GIC? .   X   X        
b Name of provider .  
 
 
 
 
 
 
 
c Term of GIC . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? .                
5 Were any gross proceeds invested beyond an available temporary period? .   X   X        
6 Did the bond issue qualify for an exception to rebate? . . . X   X          
Schedule K (Form 990) 2010

Schedule K (Form 990) 2010
Page 3
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
Schedule K (Form 990) 2010

Additional Data


Software ID:  
Software Version:  

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
PRESBYTERIAN INTERCOMMUNITY HOSPITAL INC
 
Employer identification number

95-1934652
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2010
Schedule L (Form 990 or 990-EZ) 2010
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) SEE PART V
 
  4,635,071     No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
SCHEDULE L, PART IV:   A: LAMBERT RADIOLOGY MEDICAL GROUP, INC.B: SHAREHOLDER, WILLIAM SHANAHAN IS A DIRECTOR OF PIHC: $4,635,071D: RADIOLOGY SERVICES PROVIDED TO PIHE: NO
Schedule L (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
PRESBYTERIAN INTERCOMMUNITY HOSPITAL INC
 
Employer identification number

95-1934652
Identifier Return Reference Explanation
FORM 990, PART VI, SECTION A, LINE 2   1)DREW SONES HAS A BUSINESS RELATIONSHIP WITH LEON M.N. GARCIA. 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 INDEPENDENT DIRECTORS. THE FORM 990S ARE 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 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 INTEGRATED DELIVERY 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 HAS TWO PEER GROUPS-A NATIONAL PEER GROUP OF COMPARABLY-SIZED HOSPITALS AND INTEGRATED DELIVERY 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, PART VII, SECTION A: BOARD MEMBERS ARE NOT COMPENSATED FOR SERVICE AS A MEMBER OF THE BOARD. WILLIAM SHANAHAN MD RECEIVED $55,000 DURING CALENDAR YEAR 2010 FOR PROFESSIONAL SERVICES AS A MEDICAL DIRECTOR. NEAL SHINDEL MD RECEIVED $42,012 DURING CALENDAR YEAR 2010 FOR GI BONUS PAYMENTS. SUDHAKER NAYAK MD RECEIVED $191,106 DURING CALENDAR YEAR 2010 FOR PROFESSIONAL SERVICES AS ED ON CALL FOR PIH. THE HOURS REPORTED ON PART VII ONLY REFLECT TIME SPENT AS AN UNCOMPENSATED BOARD MEMBER AND DOES NOT INCLUDE TIME SPENT ON OTHER DUTIES.
CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -20,815,448. PENSION ADJUSTMENTS -16,444,669. NET UNREALIZED LOSSES ON INTEREST RATE SWAP -9,925,385. LOSS ON INSURANCE LITIGATION SETTLEMENT -650,000. EQUITY TRANSFER TO IHMC -29,039,680. TOTAL TO FORM 990, PART XI, LINE 5: -76,875,182.
  SCHEDULE R, PART IV, COLUMN (E): PIH INSURANCE COMPANY IS AN UNINCORPORATED RISK RETENTION GROUP.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
PRESBYTERIAN INTERCOMMUNITY HOSPITAL INC
 
Employer identification number

95-1934652
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Total income



(e)
End-of-year assets


(f)
Direct controlling
entity









(1) PIH COMMUNITY PHARMACY LLC
12401 WASHINGTON BLVD
WHITTIER,CA90602
26-4390142
PHARMACY CA 2,586,771 522,845 PRESBYTERIAN INTERCOMMUNITY HOSPITAL INC
 










Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Exempt Code section



(e)
Public charity status
(if section 501(c)(3))

(f)
Direct controlling
entity

(g)
Section 512(b)(13) controlled organization
Yes No
(1) PIH FOUNDATION

12401 WASHINGTON BLVD

WHITTIER,CA90602
95-3761274
FUNDRAISING CA SECTION 501(C)(3) 7 INTERHEALTH CORP
 
Yes
 
(2) IHC MANAGEMENT CORP

12401 WASHINGTON BLVD

WHITTIER,CA90602
95-4016278
SUPPORT OF TAX-EXEMPT AFFILIATES CA SECTION 501(C)(3) 11, TYPE 1 INTERHEALTH CORP
 
Yes
 
(3) INTERHEALTH HOME HEALTH CARE

12401 WASHINGTON BLVD

WHITTIER,CA90602
95-3036281
HEALTHCARE CA SECTION 501(C)(3) 9 INTERHEALTH CORP
 
Yes
 
(4) INTERHEALTH CORP

12401 WASHINGTON BLVD

WHITTIER,CA90602
95-3619388
SUPPORT OF TAX-EXEMPT AFFILIATES CA SECTION 501(C)(3) 11, TYPE 1 INTERHEALTH CORP
 
 
No
(5) MED SITE - HACIENDA HEIGHTS

12401 WASHINGTON BLVD

WHITTIER,CA90602
95-3643829
HEALTHCARE CA SECTION 501(C)(3) 9 INTERHEALTH CORP
 
Yes
 
(6) BRIGHT HEALTH PHYSICIANS OF PIH

12401 WASHINGTON BLVD

WHITTIER,CA90602
95-3942828
HEALTHCARE CA SECTION 501(C)(3) 9 INTERHEALTH CORP
 
Yes
 


For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



(b)
Primary activity




(c)
Legal
domicile
(state or foreign
country)


(d)
Direct controlling
entity



(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




(g)
Share of end-of-year
assets



(h)
Disproprtionate allocations?




(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?



(k)
Percentage
ownership


Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



(b)
Primary activity



(c)
Legal domicile
(state or
foreign
country)
(d)
Direct controlling
entity


(e)
Type of entity
(C corp, S corp,
or trust)

(f)
Share of total income



(g)
Share of
end-of-year
assets

(h)
Percentage
ownership


(1) PIH INSURANCE COMPANY A RECIPROCAL RISK RETENTION GROUP
1003 BISHOP STREET
HONOLULU,HI96813
26-3760243
CAPTIVE INSURANCE HI INTERHEALTH CORP
 
T      












Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization
(b)
Transaction
type(a-r)
(c)
Amount involved
(d)
Method of determining amount involved
(1) IHC MANAGEMENT CORP

L 370,219 FV BASED ON INTERCOMPANY BALANCE
(2) PIH FOUNDATION

C 2,204,568 FV BASED ON INTERCOMPANY BALANCE
(3) BRIGHT HEALTH PYSICIANS OF PIH

O 3,712,695 FV BASED ON INTERCOMPANY BALANCE
(4) PIH INSURANCE COMPANY A RECIPROCAL RISKRETENTION GROUP

Q 1,879,198 FV BASED ON INTERCOMPANY BALANCE
(5) PIH FOUNDATION

B 147,500 FV BASED ON INTERCOMPANY BALANCE
(6) IHC MANAGEMENT CORP

Q 29,039,680 SETTLEMENT OF INTERCO BAL AT FV
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Are all
partners
section
501(c)(3)
organizations?
(e)
Share of
end-of-year
assets
(f)
Disproprtionate allocations?
(g)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065)
(h)
General or
managing
partner?
Yes No Yes No Yes No






























Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


Software ID:  
Software Version: