4A (Expenses $ 114217797 including grants of $ 0) (Revenue $ 163145863)
Patient Care: PIH Health Downey Hospital officially became part of PIH Health in October 2013. As a 501 (c)(3) nonprofit, 199-bed hospital, the Downey campus has provided quality care in a welcoming environment for almost 100 years.Patient Care in Fiscal Year 2021-2022Employees 1,631Volunteers 291Number of Emergency Department (ED) Visits 55,792Medical Staff 473

4B (Expenses $ 56349322 including grants of $ 0) (Revenue $ 37918779)
Financial Assistance and Means-Tested Government Programs: Financial Assistance, also known as charity care, is defined as free or discounted health services provided to individuals who cannot afford to pay and who meet the eligibility criteria of the organization's financial assistance policy. PIH Health offers a generous Financial Assistance Program, providing charity care to those with family income(s) at or below 400% of Federal Poverty Level guidelines.In providing services to those patients participating in means-tested government health programs, such as Medi-Cal, PIH Health realizes a collective net loss each fiscal year due to the shortfall created when the payments received from these programs are less than the cost of caring for public program beneficiaries. Number of persons served by financial assistance and means-tested government programs: 30,617

4C (Expenses $ 6490630 including grants of $ 0) (Revenue $ 1079060)
See Schedule OOther Community Benefit Services: Community health improvement services and community benefit operations, Health professions education, Subsidized health services, cash and in-kind contributions are comprised of the following: COMMUNITY HEALTH IMPROVEMENT SERVICES: Defined as community health improvement activities, which extend beyond patient care activities. These programs include: Community Helpline and Enrollment Assistance.Snapshot of Outcomes:1,904 community members were reached through a variety of community health improvement activities.HEALTH PROFESSIONS EDUCATION: This category includes educational programs for physicians, nurses, students and other health professionals when education is necessary or required by state law, accrediting body or health profession society. PIH Health programs include the Family Medicine Residency Program, and Student Education (internship, externship, preceptorship and mentoring programs).Snapshot of Outcomes:63 student nurses, physician residents and other individuals studying to become healthcare professionals were provided with mentorship, preceptorship and training opportunities.SUBSIDIZED HEALTH SERVICES: Subsidized services are clinical programs, which are provided despite a financial loss so significant that negative margins remain after removing the effects of financial assistance, bad debt and Medi-Cal shortfalls. Nevertheless, the service is provided because it meets an identified community need and, if no longer offered, would either be unavailable in the area or fall to the responsibility of government or another nonprofit organization to provide. PIH Health services provided include Emergency Department On-Call Physicians.Snapshot of Outcomes:Some 38 individuals were served by subsidized health services. CASH & IN-KIND CONTRIBUTIONS: This category includes funds and in-kind services donated by PIH Health to community organizations or to the community-at-large for a community benefit purpose. These donations include cash donations to community organizations, hours contributed by staff to the community while on PIH Health work time, the cost of meeting space provided to community groups, and the donations of equipment, medications, supplies and services. Snapshot of Outcomes:121 at-risk individuals were provided with in-kind durable medical equipment, clothing or services, such as skilled nursing or mental healthcare.For additional information, please refer to PIH Health's community benefit report at: https://www.pihhealth.org/CHNA

PIH Health Downey Hospital
Part V, Section B, Line 3j: The community health needs assessment includes data, maps and information regarding social determinants of health, health status and life expectancy, access to healthcare, mental health, alcohol, substance and tobacco use, physical activity, nutrition and weight status, reproductive health, acute and chronic disease, leading causes of death, community perspectives gathered from focus groups and interviews, and progress on the implementation strategy.

PIH Health Downey Hospital
Part V, Section B, Line 5: Primary Data-Community InputPIH Health Downey Hospital conducted targeted interviews to gather information and opinions from persons who represent the broad interests of the community served by the Hospital. Eighteen (18) telephone interviews were conducted during March and April 2022. Interview participants included a broad range of stakeholders concerned with health and wellbeing in the Los Angeles service area who spoke to issues and needs in the communities served by the hospital. The identified stakeholders were invited by email to participate in the phone interview. Appointments for the interviews were made on dates and times convenient to the stakeholders. At the beginning of each interview, the purpose of the interview in the context of the assessment was explained, the stakeholders were assured their responses would remain confidential, and consent to proceed was given. Interview participants included agencies representing a broad range of health and social services, including leaders and representatives of medically underserved, low-income and minority populations as well the local health department that have current information relevant to the health needs of the communities we serve. The full listing of interview and focus groups can be found in Attachment 2 of the assessment found here: https://www.pihhealth.org/app/files/public/cbe4c661-a9c5-476d-bc89-de447879855f/FINAL_CHNA%20Report%202022-Downey.9.23.22.pdf

PIH Health Downey Hospital
Part V, Section B, Line 6a: PIH Health Downey Hospital participated in a collaborative process for the Community Health Needs Assessment with PIH Health Whittier Hospital.

PIH Health Downey Hospital
Part V, Section B, Line 7d: Assessment findings were also distributed to key stakeholders via email with emphasis on supporting program planning and fund-development endeavors, sharing organizations the expense of duplicative data collection efforts. Assessment findings are also shared on an on-going basis via presentations at community events and community collaborative meetings, through social media channels and via our organization's e-newsletter and mailed magazine.

PIH Health Downey Hospital
Part V, Section B, Line 11: PIH Health's Community Health Improvement Strategy (CHIS) ensures alignment of CHNA findings, our community health improvement programs and PIH Health's organizational strategy. To view the 2023-2025 CHIS and the initiatives identified to address areas of focus (access to health care - primary care, dental care and mental heatlh, cancer incidence/mortality, diabetes incidence/mortality, heart disease/stroke incidence/mortality, overweight/obesity, substance use and misuse, preventative screenings and immunizations with emphasis on flu and pneumonia vaccines and cancer screenings, food insecurity, housing/homelessness), visit https://www.pihhealth.org/app/public//72cfb81b-4833-4bbd-90a1-bb00ea6c44f7/Community%20Health%20Improvement%20Plan%202022_PHDH.pdfSince PIH Health Downey Hospital cannot directly address all the health needs present in the community, we will concentrate on those health needs that can most effectively be addressed given our areas of focus and expertise. Taking existing hospital and community resources into consideration, PIH Health Downey Hospital will not directly address the remaining health needs identified in the CHNA, including: birth indicators, COVID-19, economic insecurity, education, and violence and injury prevention. While the hospital does not intend to emphasize community COVID-19 interventions at this point in the pandemic, PIH Health Downey Hospital will continue to deliver vaccines, testing and acute medical care to address COVID-19.

PIH Health Downey Hospital
Part V, Section B, Line 13b: Assistance is provided free or discounted for those patients eligible for FAP. The criteria for FAP is if the patient is uninsured and does not have the ability to pay, has restricted Medi-Cal benefits, or is underinsured. This is also considerations for patients where the FPG is not applicable and the patient is insured with inadequate coverage or excessive liability.

PIH Health Downey Hospital
Part V, line 16a, FAP website: https://www.pihhealth.org/patients-visitors/billing-financial-assistance/financial-assistance/

PIH Health Downey Hospital
Part V, line 16b, FAP Application Website: https://www.pihhealth.org/patients-visitors/billing-financial-assistance/financial-assistance/

PIH Health Downey Hospital
Part V, line 16c, FAP Plain Language Summary Website: https://www.pihhealth.org/patients-visitors/billing-financial-assistance/financial-assistance/

Part I, Line 6a:
PIH Health's Community Benefit Report, prepared annually, accounts for the organization's programs and services that promote the health of the community. The report separates out community benefit investment figures for each hospital. The report was made widely available to the public via social media, our organization's website and a community e-newsletter. It will also be shared with certain internal and community stakeholders via presentation.To view the full report, visit https://Pihhealth.org/app/files/public/32210790-3a65-49f2-be80-d54aab30ec48/PIH_Health_Downey_Hospital_FY22_Community_Benefit_Annual_Report_and_Plan.pdf

Part I, Line 7:
Patient care cost-to-charges ratio derived from worksheet 2 was used to calculate the financial assistance. For all others, we utilized internal costing system and accounts for the various payer mix.

Part I, Ln 7 Col(f):
The Bad Debt expense included on Form 990, Part IX, Line 25(A), but subtracted for purposes of calculating the percentage in this column is $8,532,666.

Part II, Community Building Activities:
PIH Health works with a variety of community stakeholders to enhance the collective capacity for addressing the root causes of health problems. PIH Health staff supported a local community service club by participating in their meetings/activities. Civic clubs improve the civic and cultural wellbeing of the community. PIH Health also undertakes disaster preparedness training above and beyond licensure requirements to ensure we are effectively prepared to serve the community in a disaster.

Part III, Line 2:
The provision for bad debts is based upon management's assessment of historical and expected net collections, taking into consideration historical business and economic conditions, trends in health care coverage, and other collection indicators. Management routinely assesses the adequacy of the allowances for uncollectible accounts based upon historical write-off experience by payor category. The company follows established guidelines for placing certain patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by each facility. The provision for bad debts is presented on the consolidated statements of operations as a deduction from patient services revenues (net of contractual allowances and discounts) since the company accepts and treats all patients without regard to the ability to pay. As a result of the adoption of ASC 606, PIH Health Downey Hospital is reporting implicit price concessions, which is established based on many factors, including payer mix, age of receivables, historical cash collection experience, other relevant information.

Part III, Line 4:
As part of the Company's mission to serve the community, the Company provides care to patients even though they may lack adequate insurance or may participate in programs with negotiated or regulated payment amounts. The Company makes every effort to determine if a patient qualifies for charity care upon admission, though determination may also be made at a later time. After satisfaction of amounts due from insurance, the application of any financial, uninsured or other discounts or payments received on the account, and reasonable efforts to collect from the patient have been exhausted, the Company follows established guidelines for placing certain past-due patient balances with collection agencies, subject to certain restrictions on collection efforts as determined by the Company. The Company manages its collection risk by regularly reviewing its accounts and contracts, and by providing appropriate allowances that are netted against patient accounts receivable in the consolidated balance sheets.Implicit price concessions is based upon management's assessment of historical and expected net collections, taking into consideration historical business and economic conditions, trends in healthcare coverage and other collection indicators. Management routinely assesses the adequacy of the implicit price concessions based upon historical write-off experience by payor category. The Company follows established guidelines for placing certain patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by each facility. Implicit price concessions is included as a deduction from patient services revenues since the Company generally accepts and treats all patients without regard to the ability to pay.

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 Form 990, Schedule H method. However, the PIH Health 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 Health 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, i.e., department C2C %, is loaded into PIH Health'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 Health's regulatory reporting and financial analysis is based on the above department C2C methodology.

Part VI, Line 7, Reports Filed With States
CA

Part III, Line 9b:
The hospital encourages all self-pay patients to apply for financial assistance or other programs. 1. All uninsured patients are assumed to need financial assistance and automatically receive discounted bills that reflect the contract rate or less of a Medicare Advantage contract.2. All uninsured patients are provided with a financial assistance and Medicaid application at the time of registration thereby giving them the opportunity to apply for assistance.3. There are signs through the facility that educate patients and visitors about the availability of financial assistance.4. The hospital's website publishes the financial assistance policy and applications.5. Self-pay inpatients also may be contacted by a vendor to offer assistance in applying for Medicaid, if eligible.6. Statements (which reflect a reduction in charges to the rates at or lower than contracted rates for Medicare Advantage members) promote the hospital's financial assistance program.7. Only patients who do not qualify for further financial assistance (after discounts) or who do not apply for programs and do not pay are referred to collection. In addition, if a patient is referred to collection and later applies for charity and qualifies, the patient's account is returned to the hospital and financial assistance is extended.

Part VI, Line 2:
In addition to the hospital's CHNA, PIH Health utilizes the following methods to assess the health care needs of the communities it serves: Community Benefit Oversight Committee- In 2006, PIH Health's Board of Directors established the Community Benefit Oversight Committee (CBOC), which is comprised of community stakeholders and key public health and legislative representatives. This committee meets regularly and its members share healthcare-related needs/concerns experienced by the community members they represent as well as assets or potential partners for the hospital to engage in addressing the identified needs.Feedback from Community Organizations / Collaborative- Through participation in various community collaborative and networking meetings, PIH Health is able to assess the healthcare needs of the community and identify partnership opportunities.

Part VI, Line 3:
There are many avenues PIH Health takes in educating patients and family members about the various financial assistance programs. Patient are advised at the time of service, during in-house care and post discharges. Free handouts of the FAP application are provided in both English and Spanish. There are postings throughout the hospital in both English and Spanish with information about our FAP program. We have an eligibility vendor that is conveniently available to assist our patients in the emergency room or in-house patients with determining eligibility for various governmental programs, as well as, advise and assist the patient with the FAP. Post discharge, our Business Office staff takes the initiative to advise the patient of our FAP program. Also, with the initial statement sent to patients, an application is included. PIH Health's FAP is also published on our website.

Part VI, Line 4:
PIH Health Downey Hospital is located at 11500 Brookshire Ave., Downey, CA 90241. The hospital's service area encompasses 10 ZIP codes in the cities of Bellflower, Bell Gardens, Downey, Huntington Park, Lynwood, Norwalk, Paramount, and South Gate. The service area is served by the Los Angeles County 1st, 2nd, and 4th Supervisorial Districts and the majority of the cities/communities fall within the Los Angeles County Service Planning Area (SPA) 7. PIH Health Downey Hospital tracks ZIP codes of origin for patient admissions. The service area was determined from the ZIP codes that reflect a majority of patient admissions from the local geographic area.The population for PIH Health Downey Hospital's service area is 691,496. Children and youth (ages 0-17) make up 26.5% of the population, 63.4% are adults, ages 18 to 64, and 10.1% are adults, ages 65 and older. In the service area, 81.9% of the population is Hispanic/Latino, 7.4% are White, 5.0% are Asian, 4.5% are Black/African American, 0.9% are Other/Multiple Races, 0.3% are Native Hawaiian/Pacific Islander, and 0.1% are Native American/Alaskan Native. Among the service area population, ages five and older, 72.3% speak Spanish in the home, 22.2% speak only English in the home, 3.9% speak an Asian or Pacific Islander language, 1.0% speak other Indo-European languages, and 0.6% speak other languages in their home. In the service area, 16.4% of the population is at or below 100% of the federal poverty level. Among service area adults, ages 25 and older, 35.0% have less than a high school diploma, 45% are high school graduates, and 19.9% have an associate, bachelor's, or graduate/professional degree. There are nine other hospitals providing care in the service area population and one federally-designated medically underserved areas present in the service area. For additional data regarding the service area, please see the CHNA at https://www.pihhealth.org/CHNA

Part VI, Line 5:
"Community BoardPIH Health's community Board of Directors works to advance PIH Health's commitment to helping our communities get well and stay healthy.Open Medical StaffPIH Health extends medical staff privileges to all qualified physicians in its community for some or all of its departments or specialties.Use of Surplus FundsPIH Health applies surplus funds toward improvements in patient care, technology, and medical education.Community Benefit Oversight Committee (CBOC)In 2006, PIH Health's Board of Directors established the CBOC, comprised of community stakeholders and a public health representative. The CBOC promotes the health of the community by 1) reviewing and validating legal and regulatory compliance with respect to community benefit mandates, 2) reviewing and validating that PIH Health's community benefit programs and services effectively meet identified community health needs, with emphasis on vulnerable populations, as an essential expression of PIH Health's charitable mission and 3) increasing public awareness of community benefit activities and community value.Donation of TimeMany PIH Health providers are living out their passion to serve people in need by donating their time and talents both in our community and overseas. Emergency and Disaster Preparedness/Disaster Resource Center (DRC) PIH Health Whittier Hospital is one of 13 Los Angeles County designated DRC's that ensure the community has access to resources and the highly skilled staff needed to respond to a large-scale disaster or other public health emergencies.Environmental and Recycling ProjectsPIH Health continues to implement ""green"" initiatives, including increased usage of LED lighting to decrease consumption of electricity and, expanding a methane gas project with the City of Whittier to convert methane gas into electricity. Eyeglasses and hearing aids are also collected and recycled for redistribution by the East Whittier Lions Club to those in need.Volunteer Contributions Some 1,459 PIH Health System volunteers collectively contributed 116,429 hours of service, supporting departments throughout the organization.Reach Out and Read Program Our Pediatrics Department partners with Reach Out and Read to promote early literacy and school readiness. Physicians provide patients with a children's book and discuss with parents the importance of reading aloud. Each year, over 4,912 new books are distributed."

Part VI, Line 6:
Hospital affiliates include: 1) PIH Health, Inc., PIH Health's parent company; 2) PIH Health Whittier Hospital; 3)PIH Health Good Samaritan Hospital; 4) PIH Health Physicians, a nonprofit medical foundation; 5) PIH Health Home Healthcare and 6) the PIH Health Foundation, a nonprofit organization that exists to raise philanthropic funds in support of PIH Health's charitable mission.1) PIH Health, Inc. 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.2) PIH Health Whittier Hospital opened in 1959. As a 501 (c)(3) nonprofit, 523-bed hospital, the Whittier campus has developed into a health system offering a multitude of services. As a nonnprofit hospital with a charitable mission, PIH Health Whittier Hospital is a dedicated community health and wellness partner. This commitment and leadership gives back to the community through charity care, medical research, donations, health professions education and more.3) PIH Health Good Samaritan Hospital founded in 1885, became part of PIH Health in December 2019. As a 501 (c)(3) nonprofit, 408-bed acute care hospital, the downtown Los Angeles campus serves the healthcare needs of a growing and diverse community. As a nonnprofit hospital with a charitable mission, PIH Health Good Samaritan Hospital is a dedicated community health and wellness partner. This commitment and leadership gives back to the community through charity care, medical research, donations, health professions education and more.4) PIH Health Physicians (PHP) A 501(c)(3) nonprofit medical group that is exclusively affiliated with PIH Health, the group is comprised of more than 150 primary care physicians and over 245 specialists who coordinate care from diagnosis to recovery. PHP supports the local community through its financial assistance program, Whittier First Day Health & Wellness Center for the homeless and those at-risk for homelessness, health professions education, and other community health improvement services.5) PIH Health Home Healthcare provides around-the-clock, quality care for patients in their own home. PIH Health Home Healthcare is certified by the Centers for Medicare and Medicaid Services.6) The PIH Health Foundation is a 501(c)(3) nonprofit organization with the sole mission to raise funds through philantrophy to benefit PIH Health and its affiliates. Dollars raised are reinvested into the communities we serve through quality healthcare, health-based programs and services offered through PIH Health.For detailed information regarding these PIH Health affiliates' additional activities to support and promote community health, please see each respective organization's IRS Form 990.