Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 1,031,545 | 467,702 | 1,224,603 | 3,666,897 | 6,390,747 | |
| 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 | 137,318,935 | 138,788,062 | 152,267,751 | 168,471,580 | 204,948,033 | 801,794,361 |
| 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 | 137,318,935 | 139,819,607 | 152,735,453 | 169,696,183 | 208,614,930 | 808,185,108 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 0 | |||||
| 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. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support. (Subtract line 7c from line 6.) | 808,185,108 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 137,318,935 | 139,819,607 | 152,735,453 | 169,696,183 | 208,614,930 | 808,185,108 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 4,340 | 4,340 | ||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 98,704 | 98,704 | ||||
| c | Add lines 10a and 10b. | 103,044 | 103,044 | ||||
| 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 VI.) .. | 194,616 | 194,616 | ||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 137,318,935 | 139,819,607 | 152,735,453 | 169,696,183 | 208,912,590 | 808,482,768 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
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| 9 Distributable amount for 2019 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2019 |
(iii) Distributable Amount for 2019 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2019 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2019: | ||||
| a From 2014....... | ||||
| b From 2015....... | ||||
| c From 2016....... | ||||
| d From 2017....... | ||||
| e From 2018....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2019 distributable amount | ||||
|
i
Carryover from 2014 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2019 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2019 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2020. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2015..... | ||||
| b Excess from 2016..... | ||||
| c Excess from 2017..... | ||||
| d Excess from 2018..... | ||||
| e Excess from 2019..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Form 990, Part VI, Section A, line 2 | PIH Health Physicians is a member of an integrated healthcare system controlled by PIH Health, Inc. The following individuals have a business relationship by virtue of their positions as officer or directors of related entities within the system: Richard Atwood, Paula Cowan, Jeff Hamar, Alex Alvarez, Blayne Cutler, Jane Dicus, Rosalio Lopez, Patrick Monroe, Paul Treinen, Charlotte Weaver, Kenton Woods, Peter Greaney, Mark Magged, Ed Dunlap, Robert Petrina, James West, Peggy Chulack, Brian Smolskis, Anita Chou |
| Form 990, Part VI, Section A, line 6 | PIH Health, Inc. is the sole member of PIH Health Physicians ("PHP"). |
| Form 990, Part VI, Section A, line 7a | PIH Health, Inc. has authority to elect all the members of the board of directors of PIH Health Physicians ("PHP"). |
| Form 990, Part VI, Section A, line 7b | PIH Health, Inc. has all voting rights and the power to elect the board of directors of PIH Health Physicians ("PHP"). |
| Form 990, Part VI, Section B, line 11b | Form 990 is reviewed by the Audit Committee of PIH Health, Inc., which is made up of independent directors. The Form 990 is then provided to the Board for its information. |
| Form 990, Part VI, Section B, line 12c | Each year, all management and board of directors members are required to complete a conflict of interest disclosure form. All positive responses are reviewed by the General Counsel Chief Administrator Officer of PIH Health, Inc. Each positive response is considered in light of magnitude of ownership interest, financial transaction(s), etc. If deemed necessary, conflicts of interest could be resolved by insisting that the incumbent either divest their ownership interest, that the organization terminate the business relationship, or even that the director resign. Directors with potential conflicts of interest may recuse themselves from voting on certain matters and/or may excuse themselves from meetings during the discussion, deliberation, and voting on of matters. |
| Form 990, Part VI, Section C, line 19 | The organization does not make its governing documents, conflict of interest policy, and financial statements available to the public. Form 990 and Form 990-T are available upon request. The organization is not required to make form 1023 available for public inspection as it received its tax exemption prior to July 15, 1987. |
| Part VII, Section A, Line 1: | Two of the filing organization's directors, Brent Gray and Mark Magged, are employees of Intercommunity Health Associates (IHA), which has a professional service agreement with the filing organization, to provide physician services. The individuals received compensation from IHA, as follows: Brent Gray: Reportable Base Compensation - $573,024 Other Compensation - $36,011 Mark Magged: Reportable Base Compensation - $370,486 Other Compensation - $34,080 Two of the filing organization's directors, Jerry Floro and Sanatkumar Patel, are employees of Pioneer Health Associates, Inc. (PHA), which has a professional service agreement with the filing organization, to provide physician services. The individuals received compensation from PHA, as follows: Jerry Floro: Reportable Base Compensation - $301,028 Other Compensation - $19,414 Sanatkumar Patel: Reportable Base Compensation - $173,635 Other Compensation - $13,276 One of the filing organization's Directors. Rosalio Lopez , is an employee of PIH Health Downey Medical Group, Inc. (DMG) , which has a professional service agreement with PIH Health Physicians, an affiliate of the filing organization, to provide physician services. The individuals received compensation from DMG, as follows: Roalio Lopez: Reportable Base Compensation - $72,576 Other Compensation - $0 |
| Form 990, Part VII, Section A, Column B | Vidhyashankaran Mahalingamshiva devoted 40 hours per week to PIH Health Hospital - Downey through March 31, 2019 while serving as Controller. For the remainder of 2019, Vidhyashankaran Mahalingamshiva devoted 40 hours per week to PIH Health Physicians while serving as VP Managed Care Operations. |
| Form 990, Part IX, line 11g | Professional Fees - Physicians: Program service expenses 76,570,611. Management and general expenses 0. Fundraising expenses 0. Total expenses 76,570,611. Capitation Expense: Program service expenses 14,973,075. Management and general expenses 0. Fundraising expenses 0. Total expenses 14,973,075. Professional Fees - Consultants/Other: Program service expenses 1,229,724. Management and general expenses 2,374,932. Fundraising expenses 0. Total expenses 3,604,656. |
| Form 990, Part XI, line 9: | Equity Transfer From PIH Health, Inc. 38,399,025. Goodwill Impairment -34,087,082. |
| Form 990, Part XI, Line 9, Changes in Net Assets: | In accordance with the requirements of California Health and Safety Code Section 1375.4(b)(1)(B) in December 2005, PIH Health, Inc. ("PIH") and PIH Health Physicians ("PHP") signed a guaranty agreement (the Guaranty). Under the terms of the Guaranty, PIH has unconditionally guaranteed all liabilities of PHP not to exceed $30 million. In fiscal year 2020, PIH made an equity transfer of $38 million to PHP. The Guaranty expires 10/1/2020. |
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