2025-08-13T11:41:20+00:00 2024-09-30 135565207 KPMG LLP 301 Main Street Suite 2150 Baton Rouge LA 70801 990 2023-10-01 951656366 PIH Health Good Samaritan Hospital PIHH 2139772121 1225 Wilshire Blvd Los Angeles CA 900172395 Vid Shivaraman CFO 2025-08-13 true BRITTANY ELLISER P01284594 2253444000 2025-08-13 2023 2025-03-06 01:10:19Z James West 12401 Washington Blvd Whittier CA 90602 411992669 false X www.pihhealth.org X 1885 CA Provide high-quality healthcare, without discrimination, and contribute to the health and well-being. 15 15 1824 271 176896 0 3322305 7694857 361265554 368107801 8797284 8917861 5753362 6506734 379138505 391227253 300100 5169509 0 0 171842791 176197164 0 0 225426 239274805 230694278 411417696 412060951 -32279191 -20833698 566649349 602884520 155809140 196891669 410840209 405992851 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. false false 198364179 0 137341570 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 Good Samaritan Hospital offers a generous Financial Assistance Program, providing charity care to those with family income(s) at or below 400% of Federal Poverty Level guidelines. The hospital has a policy to treat emergency and certain other patients regardless of their ability to pay. Under the charity care policy, charity care may be provided to people who are uninsured or underinsured and cannot afford to pay for their own medical care. In providing services to those patients participating in means-tested government health programs, such as Medi-Cal, PIH Health Good Samaritan Hospital 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: 40,696 183416656 5169509 230082698 Patient Care: Founded in 1885, PIH Health Good Samaritan Hospital 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. Patient Care in Fiscal Year 2023-2024 Employees: 1,412 Volunteers: 271 Number of Emergency Department (ED) visits: 48,063 Number of Births: 1,457 Medical Staff: 615 8995875 0 683533 Other Community Benefit Services: Community health improvement services and community benefit operations, health professions education, subsidized services, research, community building and cash and in-kind contributions for community benefit are comprised of the following: COMMUNITY HEALTH IMPROVEMENT SERVICES: Defined as community health improvement activities, which extend beyond patient care activities. This category includes community health education, community social service helpline, flu and vaccination clinics, Medi-Cal eligibility workers and transportation services. Snapshot of Outcomes: * 22,789 community members were reached through a variety of community health improvement activities. HEALTH PROFESSIONS EDUCATION: This category includes educational programs for physicians, nurses, chaplain and other health professional students when education is necessary or required by state law, accrediting body or health profession society. Snapshot of Outcomes: * 68 medical residents, nursing, and ancillary professions students were provided with mentorship, internship, 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 Good Samaritan Hospital subsidized Emergency Department On-Call Physicians and the Neonatal Intensive Care Unit (NICU). Snapshot of Outcomes: * $1,068,936 in expenses were incurred in subsidized services in Fiscal Year 2023-2024. RESEARCH: Research that may be reported as community benefit includes clinical and community health research as well as studies on healthcare delivery that are generalizable and shared with the public. PIH Health Good Samaritan Hospital has been offering clinical trials and research studies aimed at improving health. Snapshot of Outcomes: * Over $378,083 in expenses have been incurred in research in Fiscal Year 2023-2024. CASH & IN-KIND CONTRIBUTIONS: This category includes funds and in-kind services donated by PIH Health Good Samaritan Hospital to community organizations or to the community-at-large for a community benefit purpose. These donations include cash donations to community organizations, in-kind hours contributed by staff to the community while on PIH Health work time, the cost of office and meeting space provided to community groups, and the donations of equipment, medications, supplies and services. Snapshot of Outcomes: *8,985 at-risk individuals were provided with in-kind durable medical equipment, transportation, or other healthcare support services, such as skilled nursing or mental healthcare. Total number of persons served by other community benefit services: 23,364 For additional information, please refer to PIH Health's community benefit report at: PIHHealth.org/CBAAnnualReport 390776710 true true false true false false false false true true false false true true true false true false false false false false false false false true true true false true false false false false false false false false false false false false false true true true false false true 530 0 true 1824 true true true false false false false true true false false false false false false X 15 15 true false false false true true true true true false false true true true true true true false false true false CA X Mark Kawauchi 5626980811 12401 Washington Blvd Whittier CA 90602 ALEX ALVAREZ DIRECTOR & TREASURER 1.5 6.0 X X 0 0 0 CHARLOTTE WEAVER PhD DIRECTOR & CHAIR 1.5 6.0 X X 0 0 0 PATRICK MONROE DIRECTOR & VICE CHAIR 1.5 6.0 X X 0 0 0 PAUL TREINEN DIRECTOR & SECRETARY 1.5 6.0 X X 0 0 0 BLAYNE CUTLER MD PhD THRU 92724 DIRECTOR 1.5 6.0 X 0 0 0 JANE DICUS THRU 92724 DIRECTOR 1.5 6.0 X 0 0 0 JAY BROWN THRU 92724 DIRECTOR 1.5 6.0 X 0 0 0 JEFF HAMAR DIRECTOR 1.5 6.0 X 0 0 0 KENTON WOODS DIRECTOR 1.5 6.0 X 0 0 0 MARISSA GOLDBERG DIRECTOR 1.5 6.0 X 0 0 0 MELANIE BATISTE DIRECTOR 1.5 6.0 X 0 0 0 MOEZ KHORSANDI DO DIRECTOR 1.5 0 X 0 0 0 PETER GREANEY MD DIRECTOR 1.5 6.0 X 0 0 0 RICHARD ATWOOD DIRECTOR 1.5 7.5 X 0 0 0 ROBERT MALONEY MD THRU 111623 DIRECTOR 1.5 6.0 X 0 0 0 THURSO BARENDSE START 2824 DIRECTOR 1.5 6.0 X 0 0 0 TRACEA SARALIEV START 2824 DIRECTOR 1.5 6.0 X 0 0 0 WESLEY HEARTFIELD MD DIRECTOR 1.5 0 X 0 0 0 WILLIAM ROTH DIRECTOR 1.5 6.0 X 0 0 0 IRENA ZUANIC CNO & CO-SITE ADMIN 40.0 0.0 X 0 526078 128603 JAMES WEST SYSTEM PRESIDENT & CEO 10.0 42.2 X 0 2523533 38737 PEGGY CHULACK SYSTEM CAO & ASST SECRETARY 10.0 42.2 X 0 1619441 32543 ROSALIO LOPEZ MD CSO 10.0 36.2 X 0 1366325 48338 VID SHIVARAMAN SYSTEM CFO & ASST TREASURER 10.0 42.2 X 0 884098 197076 MOHAMMED GHONIM REGIONAL VP 15.0 25.0 X 0 480593 78065 BENJAMIN LY Supervisor, Inpatient Pharmacy 40.0 0 X 253766 0 26376 DAVID WON-SUK CHOI DIR INPATIENT PHARMACY 40.0 0 X 225612 0 32177 IRA MEISELMAN DIRECTOR MANAGED CARE 40.0 0 X 307856 0 36087 JORGE GAMEZ DIR PREOPERATIVE SVCS 40.0 0 X 258196 0 15649 KELVIN MATUTE DIR CARE MGMT 40.0 0 X 266906 0 9198 BRIAN SMOLSKIS FORMER - SYSTEM COO 0.0 X 0 1928328 264451 KEVIN BROWN FORMER -VP, CARDIOLOGY SERVICES (THRU 5/23) 0.0 X 0 434841 61389 1312336 9763237 968689 578 true true false SODEXO AMERICA LLC 9801 Washington Blvd GAITHERSBURG MD 20878 DIETARY SERVICES 12158245 AYA HEALTHCARE INC 5930 Cornerstone Ct W Suite 300 SAN DIEGO CA 92121 Nursing Registry Services 10829344 REHABCARE GROUP OF CALIFORNIA LLC P O Box 502096 ST LOUIS MO 63150 Rehabilitation Services 3482288 MILES & KELLY CONSTRUCTION COMPANY INC 23691 Via Del Rio YORBA LINDA CA 92887 Construction Services 2659373 INNOVATIVE HEALTH ASSOCIATES 13886 Plumrose Place CHINO HILLS CA 91709 Healthcare Professionals 1913600 97 226634 5956587 1511636 7694857 PATIENT REVENUE 622110 294825780 294825780 HOSPITAL FEE PROGRAM 900099 70553811 70553811 LAMBERT RADIOLOGY 622110 2606258 2606258 RENTAL INCOME 532000 121952 121952 0 0 0 0 368107801 9357885 9357885 0 0 20274699 50693 20765416 -490717 50693 -440024 -440024 PARKING LOT 812930 2288363 80010 2208353 VIVITY EARNING DISTRIBUTIONS 900099 1688158 1688158 PHYSICIAN MANAGEMENT SERVICES 621110 47625 47625 2482588 0 49261 2433327 6506734 391227253 368107801 176896 15247699 X 5169509 5169509 0 0 401805 281264 120541 122445607 117637669 4807938 4484980 4326757 158223 38665303 36836055 1829248 10199469 9998014 201455 103917 103917 67168 67168 159407 159407 84665691 79317987 5347704 0 269422 5772 263650 2809679 2790200 19479 23441 23441 7432030 5808707 1623323 4802462 1499373 3303089 Supplies 58086724 57899724 187000 Hospital Fee Program 41860503 41860503 Bad Debt Expense 12896382 12896382 Utilities 5923400 5905095 18305 11594052 8520258 2848368 225426 412060951 390776710 21058815 225426 1974969 4268938 1528905 1643091 102437233 95411919 0 0 5692298 5331206 2545308 2904864 360946016 38671148 314510195 322274868 87141966 103061276 0 0 50818475 67988358 566649349 602884520 83892137 76420683 0 71917003 120470986 155809140 196891669 X 336324802 329457526 74515407 76535325 410840209 405992851 566649349 602884520 X -20833698 15039613 946727 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 67168 67168 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Lobbying expenses represent a portion of the dues PIH Health Good Samaritan Hospital pays to the Hospital Association of Southern California and to American Hospital Association. PIH Health Good Samaritan Hospital does not participate in or intervene in (including the publishing or distributing of statements) any political campaign on behalf of (or in opposition to) any candidate for public office. 70007051 1552 12254517 2761503 1126100 78375517 69931515 593 3371694 2575117 721634 70007051 70136969 18931 3493226 2963821 753790 69931515 68288340 35438 5607660 3656123 138346 70136969 68269283 20070 1013 68288340 0.145 0.6773 0.1777 false false 204149473 204149473 64852562 7781624 57070938 78012538 28506236 49506302 13931443 2383288 11548155 322274868 Hospital Fee Program Receivable 64002412 SELF-INSURANCE RECEIVABLE - CURRENT PORTION 1888085 Other notes and loan receivable 1587565 Right of use Assets 510296 67988358 Cares Act Provider Relief Funds 2195953 Hospital Fee Program Payable 40551927 Reserve for Self-Insured Programs 6246544 Pension Plan 5788931 Advances from Third Party Payors 8018540 Other Annuity Payment Liability 1327299 Other Long Term Reserves 7647881 Other Liabilities 314668 Right-of-Use Liability 519320 Intercompany Payable 33632577 Reserve for Asset Retirement Obligation 14227346 120470986 X Schedule D, Part V, Line 4 Intended uses of endowment funds The organization's endowment consists of funds established for health care services, as specified by donors or the organization's board of directors. Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote The principal operations of the Company are exempt from income taxes pursuant to Internal Revenue Code (IRC) Section 501(c)(3) and the laws of the states in which it operates and, as such, is generally not subject to federal or state income taxes. However, the Company is subject to income taxes on net income derived from a trade or business regularly carried on that does not further the organization's exempt purpose. Further, the Company is also subject to federal excise taxes pursuant to the Tax Cuts and Jobs Act. No significant income tax provision has been recorded in the accompanying consolidated financial statements for net income derived from unrelated trade or business and excise taxes. The Company measures liabilities for unrecognized tax uncertainties in accordance with ASC 740, Income Taxes, which prescribes a comprehensive model for how a company should recognize, measure, present and disclose in its financial statements uncertain tax positions that a company has taken or expects to take on a tax return. The guidance is applicable to profit-oriented entities, pass-through entities and tax-exempt organizations. Management believes it has no significant uncertain tax positions and, as such, no tax liability, benefits, interest or penalties were accrued at September 30, 2024 or 2023. The Company is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. The Company believes it is no longer subject to income tax examinations for years prior to 2020 for federal purposes and 2018 for California purposes. true true X true X true X true true true false true true 0 6457 6849649 0 6849649 0.0172 0 34239 188512246 137341570 51170676 0.1282 0 0 0 0 0 0.0 0 40696 195361895 137341570 58020325 0.1454 9 22789 4746448 0 4746448 0.0119 3 68 2759109 683533 2075576 0.0052 1 123 1068936 0 1068936 0.0027 1 271 378083 0 378083 0.0009 1 94 43299 0 43299 0.0001 15 23345 8995875 683533 8312342 0.0208 15 64041 204357770 138025103 66332667 0.1662 0 0 0 0 0 0.0 0 0 0 0 0 0.0 1 3 2338 0 2338 0.0000 0 0 0 0 0 0.0 0 0 0 0 0 0.0 0 0 0 0 0 0.0 0 0 0 0 0 0.0 1 16 1986 0 1986 0.0000 0 0 0 0 0 0.0 2 19 4324 0 4324 0.0000 true 3779567 0 85280361 85206841 73520 X true false 1 1 PIH HEALTH GOOD SAMARITAN HOSPITAL 1225 WILSHIRE BLVD LOS ANGELES CA 900172395 www.pihhealth.org/patients-visitors/welcome-to-pih-health-good-samaritan-hospital/ 930000071 X X X X X PIH HEALTH GOOD SAMARITAN HOSPITAL 1 false false true X X X X X X X X X X 22 true true false true X https://www.pihhealth.org/about-us/community-benefit/ X X true 22 true https://www.pihhealth.org/about-us/community-benefit/ false true X 200.0 400.0 X X X X true true X X X true X https://www.pihhealth.org/patients-visitors/billing-financial-assistance/financial-assistance/ X https://www.pihhealth.org/patients-visitors/billing-financial-assistance/financial-assistance/ X https://www.pihhealth.org/patients-visitors/billing-financial-assistance/financial-assistance/ X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 3 Facility , 1 Facility , 1 - PIH HEALTH GOOD SAMARITAN HOSPITAL. The Community Health Needs Assessment includes data 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. Infographics depict key data sets for the service area, and 10 heat maps further illustrate selected community health indicators. Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - PIH HEALTH GOOD SAMARITAN HOSPITAL. PIH Health Good Samaritan Hospital conducted targeted interviews to gather information and opinions from persons who represent the broad interests of the community served by the medical center. Forty-three (43) telephone interviews were conducted during December 2021 and January 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 questions focused on the following topics: * Biggest health issues in the community * Groups most impacted by community issues * Where people access routine healthcare services * Reasons for not having health coverage/insurance * Reasons for delaying needed healthcare * COVID-19 pandemic impact and the vaccine * Priority ranking of community needs * Whether they have received any cancer screenings and reasons for delaying * Barriers experienced while receiving cancer treatment * Additional comments and concerns A list of the stakeholder interview respondents, their titles and organizations can be found in Attachment 2. The full Community Health Needs Assessment, can be found at: https://www.pihhealth.org/about-us/community-benefit/ Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - PIH HEALTH GOOD SAMARITAN HOSPITAL. PIH Health Good Samaritan Hospital participated in a collaborative process for the 2022 Community Health Needs Assessment, in partnership with California Hospital Medical Center. Schedule H, Part V, Section B, Line 7 Facility , 1 Facility , 1 - PIH HEALTH GOOD SAMARITAN HOSPITAL. The 2022 Community Health Needs Assessment was shared with PIH Health's Community Benefit Oversight Committee, comprised of community partners, legislative representatives, and community-at-large representatives, as well as Los Angeles Department of Public Health staff. The report was also shared with area nonprofit partners to support their program planning and grant-writing efforts. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - PIH HEALTH GOOD SAMARITAN HOSPITAL. PIH Health's Implementation Strategy ensures alignment of CHNA findings, our community health improvement programs and PIH Health's organizational strategy. To view the 2023-2025 Implementation Strategy and the initiatives identified to address areas of focus (access to health care - primary care, dental care and mental health, 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/files/public/7fb79b0d-deb2-42e7-a1b6-da7400c7f211/Community%20Health%20Improvement%20Plan%202022_PHGSH.pdf Since PIH Health Good Samaritan 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 Good Samaritan 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 Good Samaritan Hospital will continue to deliver vaccines, testing, and acute medical care to address COVID-19. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - PIH HEALTH GOOD SAMARTIAN HOSPITAL. Assistance is provided free or discounted for those patients eligible under the 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 uninsured. There are also considerations for patients where the FPG is not applicable, and the patient is insured with inadequate coverage or excessive liability. 0 Schedule H, 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 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: PIHHealth.org/CBAnnualReport. Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation 12896382 Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance Patient care cost to charge ratio derived from Worksheet 2 was used to calculate the financial assistance and Medi-Cal cost. Actual costs from general ledger or departments were used for all other Costs. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount Bad debt expense is determined by subtracting Medicare bad debt reimbursement in the Medicare Cost Report from total bad debt transfers net of recoveries. This expense was not included in community benefit expense. Schedule H, Part III, Line 3 Bad Debt Expense Methodology PIH Health Good Samaritan Hospital actively provides all patients the option to apply for financial assistance, therefore, no estimate is made for bad debt attributable to patients eligible under the financial assistance policy. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote From the audited financial statements of PIH Health, Inc. and Subsidiaries for the year ended September 30, 2024: "Implicit price concessions are 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. Implicit price concessions are included as a deduction from patient services revenues since the Company generally accepts and treats all patients without regard to the ability to pay." The bad debt expense on line 2 is calculated by subtracting Medicare bad debt reimbursement in the Medicare Cost Report from total bad debt transfers net of recoveries, and none of the bad debt expense is included in community benefit expense. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs The amounts on lines 5 and 6 are from the FY 2024 Medicare cost report. Schedule H, Part V, Section B, Line 16a FAP website - PIH HEALTH GOOD SAMARITAN HOSPITAL: Line 16a URL: https://www.pihhealth.org/patients-visitors/billing-financial-assistance/financial-assistance/; Schedule H, Part V, Section B, Line 16b FAP Application website - PIH HEALTH GOOD SAMARITAN HOSPITAL: Line 16b URL: https://www.pihhealth.org/patients-visitors/billing-financial-assistance/financial-assistance/; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - PIH HEALTH GOOD SAMARITAN HOSPITAL: Line 16c URL: https://www.pihhealth.org/patients-visitors/billing-financial-assistance/financial-assistance/; Schedule H, Part VI, Line 2 Needs assessment 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. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance Uninsured patients are screened for Medi-Cal linkage and if they meet the criteria, the patient is referred to RISARC and COMSPEC to assist with the application and eligibility process. If the patient does not have Medi-Cal linkage, they are screened for Queens Care which is a program for uninsured patients that reside within specific zip codes in Los Angeles County and meet income qualification. Financial Assistance Applications are provided to all patients who are unisured, underinsured, financial hardship, have catastrophic illness or have excessive medical expenses. The following hospital policies are available on our website; Charity Care / Discount Policy, Financial Assistance Application and Cash Price Policy. The statements mailed to patients provides information regarding Financial Assistance, Covered California Health Benefits, Medi-Cal and Medicare. Schedule H, Part VI, Line 4 Community information PIH Health Good Samaritan Hospital (PHGSH) is located at 1225 Wilshire Blvd., Los Angeles, California 90017. The hospital service area includes 17 ZIP Codes in Los Angeles. The service area is served by the Los Angeles County 1st and 2nd Supervisorial Districts and falls within the Los Angeles County Service Planning Areas (SPAs) 4 and 6. *PIH Health Good Samaritan Hospital tracks ZIP codes of origin for patient admissions. The service area was determined from the ZIP codes that reflect a majority (59%) of patient admissions from the local geographic area. Based on the 2022 Community Health Needs Assessment, the population for the PHGSH service area is 930,016. Children and youth, ages 0-17, make up 22.8% of the population, 67.6% are 18-64 years of age, and 9.6% are seniors, 65 years and older. In the service area, 62.4% of the population are Hispanic/Latino, 13.3% are Asian, 13.2% Black/African American, 9.0% are White, and the remaining 2.1% are Native American residents, Hawaiian or Pacific Islander. Among the service area population, ages five and older, 58.1% speak Spanish, 27.9% speak only English, 11.6% speak an Asian or Pacific Islander language, 1.7% speak other Indo-European languages, and 0.7% speak other languages in their home. English is spoken in the home among 32.8% of the service area population. In the service area, 27.1% of the population is at or below 100% of the federal poverty level. Among service area adults, ages 25 and older, 22.3% have less than a 9th grade education. 36.8% of area adults are high school graduates, and 27.9% have an associate, bachelor's, or graduate/professional degree. Area residents have lower educational levels than adults in the county and state. Schedule H, Part VI, Line 5 Promotion of community health Community Board PIH Health's community Board of Directors works to advance the commitment to helping our communities get well and stay healthy. Open Medical Staff PIH Health extends medical staff privileges to all qualified physicians in its community for some or all of its departments or specialties. Donation of Time Many PIH Health providers and staff are living out their passion to serve people in need by donating their time and talents both in our community and overseas. Employee Giving Each year, PIH Health employees, physicians, and volunteers generously support various charitable giving initiatives. During Fiscal Year 2024, holiday wish lists were fulfilled for 175 families served by The Whole Child, over 250 duffle bags with essential items were donated for youth in the foster care system through a partnership with Foster Love, and over 300 backpacks filled with school supplies were collected for distribution by Helpline Youth Counseling to low-income students across our service area. Environmental and Recycling Projects PIH Health continues to implement "green" initiatives, including increased usage of LED lighting to decrease consumption of electricity, expansion of a project with the City of Whittier to convert methane gas into electricity, and purchase of reprocessed instruments through a vendor agreement that results in national forest restoration. In addition, eyeglasses and hearing aids are collected for recycling and redistribution by the East Whittier Lions Club to those in need. Volunteer Contributions Some 1,380 PIH Health volunteers collectively contributed 108,326 hours of service, supporting departments throughout the organization. Through the PIH Health Medical Careers Program, which gives student volunteers a head start in discovering productive and meaningful careers in healthcare, 42 individuals spent 828 hours shadowing medical career professionals. Schedule H, Part VI, Line 6 Affiliated health care system Hospital affiliates include: 1) PIH Health, Inc., PIH Health's parent company; 2) PIH Health Downey Hospital; 3) PIH Health Good Samaritan Hospital; 4) PIH Health Whittier Hospital; 5) PIH Health Physicians, a nonprofit medical foundation; 6) PIH Health Home Healthcare and 7) 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 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 more than 100 years. As a non-profit hospital with a charitable mission, PIH Health Hospital Downey is a dedicated community health and wellness partner. This commitment and leadership gives back to the community through charity care, health professions education and more. 3) PIH Health Good Samaritan Hospital was founded in 1885, PIH Health Good Samaritan Hospital 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, giving back to the community through charity care, health professions education and more. 4) 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 nonprofit 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. 5) 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 270 primary care physicians and 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. 6) 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. 7) The PIH Health Foundation is a 501(c)(3) nonprofit organization with the sole mission to raise funds through philanthropy 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. Schedule H, Part VI, Line 7 State filing of community benefit report CA true GOOD SAMARITAN INSTITUTE FOR RESEARCH AND EDUCATION 1225 WILSHIRE BLVD LOS ANGELES CA 90017 954077161 501(c)(3) 323092 Expenses paid by the Organization PIH Health Physicians 6557 Greenleaf Ave Whittier CA 90601 953942828 501(c)(3) 4846417 Grant to related organization 2 0 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds PIH Health provides financial assistance to both not-for-profit organizations and individuals. PIH Health provides financial support to nonprofit organizations in our service area cities through its Community Support and Sponsorships Program, with emphasis on community health needs/areas of concern as identified by PIH Health's most recent Community Health Needs Assessment findings. Financial support may be provided if the requesting organization addresses one or more of these areas and is responsive to the health and wellness needs of the communities we serve, allowing PIH Health to build upon the impact of existing community health improvement efforts. For contributions made to charitable organizations, PIH Health has adopted a policy which guides the process to ensure good stewardship of PIH Health's charitable resources as a federally registered nonprofit entity. To ensure accurate community benefit reporting, this policy sets forth that direct financial contributions made to community organizations must be appropriately classified as either a) Community Benefit or b) a Sponsorship (a Marketing Communications Department expense not reportable as community benefit). In compliance with this policy, information is gathered from the grantee regarding the intended use of funds and a restriction letter is sent, noting the intended use of funds. Organizations receiving Community Support funding in the amount of $2,500 or more are required to submit a summary report of program or service impact, within 90 days after event or receipt of program funding, unless an alternate date is designated. For contributions made to individuals, PIH Health 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 Health discharge planners or social workers. true true false false false false false false false BRIAN SMOLSKIS FORMER - SYSTEM COO 0 833329 0 160594 0 934405 0 241053 0 23398 0 2192779 0 721922 JAMES WEST SYSTEM PRESIDENT & CEO 0 1565657 0 383472 0 574404 0 18000 0 20737 0 2562270 0 552201 ROSALIO LOPEZ MD CSO 0 1028860 0 104954 0 232511 0 40500 0 7838 0 1414663 0 215904 PEGGY CHULACK SYSTEM CAO & ASST SECRETARY 0 909522 0 151215 0 558704 0 18000 0 14543 0 1651984 0 545719 VID SHIVARAMAN SYSTEM CFO & ASST TREASURER 0 782967 0 93639 0 7492 0 176607 0 20469 0 1081174 0 0 IRENA ZUANIC CNO & CO-SITE ADMIN 0 413237 0 23596 0 89245 0 110933 0 17670 0 654681 0 81298 KEVIN BROWN FORMER -VP, CARDIOLOGY SERVICES (THRU 5/23) 0 144836 0 20600 0 269405 0 53308 0 8081 0 496230 0 132205 MOHAMMED GHONIM REGIONAL VP 0 361193 0 47607 0 71793 0 76020 0 2045 0 558658 0 63416 IRA MEISELMAN DIRECTOR MANAGED CARE 283542 0 8403 0 15911 0 17317 0 18770 0 343943 0 0 0 KELVIN MATUTE DIR CARE MGMT 134790 0 0 0 132116 0 8618 0 580 0 276104 0 0 0 JORGE GAMEZ DIR PREOPERATIVE SVCS 257196 0 1000 0 0 0 9000 0 6649 0 273845 0 0 0 BENJAMIN LY Supervisor, Inpatient Pharmacy 204576 0 0 0 49190 0 6202 0 20174 0 280142 0 0 0 DAVID WON-SUK CHOI DIR INPATIENT PHARMACY 225612 0 0 0 0 0 9000 0 23177 0 257789 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation COMPENSATION FOR THE CEO WAS ESTABLISHED AND PAID BY PIH HEALTH WHITTIER HOSPITAL (PHWH), A RELATED ORGANIZATION. PHWH USED THE FOLLOWING TO ESTABLISH THE CEO'S COMPENSATION: 1) COMPENSATION COMMITTEE; 2) INDEPENDENT COMPENSATION CONSULTANT; 3) FORM 990 OF OTHER ORGANIZATIONS; 4) COMPENSATION SURVEY OR STUDY; 5) APPROVAL BY THE BOARD. Schedule J, Part I, Line 4a Severance or change-of-control payment Brian Smolskis and Kevin Brown received a severance payment during the calendar year. The payment is included in Part VII, Column D (E) and Schedule J, Part II, Column B(iii). The terms and conditions of the confidential severance agreement are available to the Internal Revenue Service upon request. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan PIH Health Inc. and its affiliates provides a supplemental executive retirement plan for certain executives. The following individuals participate in the plan: JAMES WEST PEGGY CHULACK VID SHIVARAMAN IRENA ZUNIAC MOHAMMED GHONIM ROSALIO LOPEZ KEVIN BROWN The following amounts became vested or were paid-out in 2023 and are included in Schedule J, Part II, Column (b)(iii): James West: $552,201 Peggy Chulack: $545,719 Irena Zuanic: $81,298 Mohammed Ghonim: $63,416 KEVIN BROWN: $132,205 Rosalio Lopez: $215,904 Brian Smolskis: $721,922 Form 990, Part VI, Line 16b PIH Health Good Samaritan Hospital holds a 10.8% interest a joint venture arrangement that exists to further the charitable and community-based health care purposes, mission, vision, and values of its controlling tax exempt members. PIH Health Good Samaritan Hospital annually evaluates its participation in joint venture arrangements. Form 990, Part VI, Line 2 Family/business relationships amongst interested persons James West - Business relationship, Peggy Chulack - Business relationship, Vid Shivaraman - Business relationship, Rosalio Lopez - Business relationship, Alex Alvarez - Business relationship, Charlotte Weaver - Business relationship, Jeff Hamar - Business relationship, Kenton Woods - Business relationship, Marissa Goldberg - Business relationship, Melanie Batiste - Business relationship, Patrick Monroe - Business relationship, Paul Treinen - Business relationship, Peter Greaney - Business relationship, WIlliam Roth - Business relationship, Richard Atwood - Business relationship, Blayne Cutler - Business relationship, Jane Dicus - Business relationship, Jay Brown - Business relationship, Robert Maloney - Business relationship, THURSO BARENDSE - Business relationship, TRACEA SARALIEV - Business relationship Form 990, Part VI, Line 6 Classes of members or stockholders PIH Health, Inc. is the sole member of PIH Health Good Samaritan Hospital. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body PIH Health, Inc. has authority to elect all the members of the board of directors of PIH Health Good Samaritan Hospital. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders PIH Health, Inc. has all voting rights and the power to elect the board of directors of PIH Health Good Samaritan Hospital. Form 990, Part VI, Line 11b Review of form 990 by governing body The Organization works with an independent accountant, KPMG LLP, to prepare the Form 990. Once the return is prepared, the return is reviewed by the Chief Financial Officer and VP of Finance. Form 990 is then reviewed by the Audit Committee of PIH Health, Inc., which is made up of independent directors. KPMG LLP makes all changes necessary. The final Form 990 is provided to the board prior to filing. Form 990, Part VI, Line 12c Conflict of interest policy 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 and Chief Administrative 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, Line 19 Required documents available to the public PIH Health Good Samaritan Hospital's organizing and governing documents and the Conflict of Interest Policy are not made available to the public. The financial information from the financial statements is included in the Organization's Form 990, which is available for public inspection upon request. Form 990, Part VII, Section A, Line 1a One of the filing organization's officers, Rosalio Lopez, receives compensation for Directorship from 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: Rosalio Lopez: Reportable Base Compensation - $0 Other Compensation - $5,376 Form 990, Part VIII, Line 11d Other Miscellaneous Revenue ALL OTHER REVENUE - Total Revenue: 2482588, Related or Exempt Function Revenue: , Unrelated Business Revenue: 49261, Revenue Excluded from Tax Under Sections 512, 513, or 514: 2433327; Form 990, Part IX, Line 11g Other Fees Physician Fees - Total Expense: 12325218, Program Service Expense: 12325218, Management and General Expenses: , Fundraising Expenses: ; Consulting and Management Fees - Total Expense: 39641, Program Service Expense: 103925, Management and General Expenses: -64284, Fundraising Expenses: ; Other Contracted Services - Total Expense: 3723401, Program Service Expense: 3634001, Management and General Expenses: 89400, Fundraising Expenses: ; Other Professional Services - Total Expense: 54758, Program Service Expense: 54758, Management and General Expenses: , Fundraising Expenses: ; Medical Purchased Services - Total Expense: 2113166, Program Service Expense: 2011781, Management and General Expenses: 101385, Fundraising Expenses: ; Repairs and Maintenance - Total Expense: 4988445, Program Service Expense: 4618706, Management and General Expenses: 369739, Fundraising Expenses: ; Software Maintenance - Total Expense: 2637167, Program Service Expense: 2637167, Management and General Expenses: , Fundraising Expenses: ; Other Purchased Services - Total Expense: 30672663, Program Service Expense: 25817699, Management and General Expenses: 4854964, Fundraising Expenses: ; Outside Provider Cost - Total Expense: 13455540, Program Service Expense: 13455540, Management and General Expenses: , Fundraising Expenses: ; Purchased Labor - Total Expense: 14655692, Program Service Expense: 14659192, Management and General Expenses: -3500, Fundraising Expenses: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances Accrued Minimum Pension Liability - 631132; Net Assets released from restrictions - operations - -7497; Other Intercompany transfers (expenses paid by GSH) - 323092; Good Samaritan Institute for Research and Education 1225 Wilshire Blvd Los Angeles CA 90017 954077161 Heart Research CA 501(c)(3) 4 PIH Health Good Samaritan Hospital true Orthopedic Institute of the Good Samaritan Hospital 1225 Wilshire Blvd Los Angeles CA 90017 954346048 Orthopedic Research CA 501(c)(3) Type I PIH Health Good Samaritan Hospital true Samaritan Imaging Center 1225 Wilshire Blvd Los Angeles CA 90017 954252321 Outpatient Imaging Services CA 501(c)(3) 10 PIH Health Good Samaritan Hospital true Good Samaritan Medical Office Building Inc 1225 Wilshire Blvd Los Angeles CA 90017 953244046 Physicians Medical Offices CA 501(c)(3) Type I PIH Health Good Samaritan Hospital true Kate Van Nuys Page Foundation 12401 Washington Blvd Whittier CA 90602 956028032 Grants Income to Good Samaritan Hospital CA 501(c)(3) Type I PIH Health Good Samaritan Hospital true PIH Health Adult Day Healthcare 12401 Washington Blvd Whittier CA 90602 953643829 Support of Tax-Exempt Affiliates CA 501(c)(3) Type II PIH Health Inc false PIH Health Foundation 12401 Washington Blvd Whittier CA 90602 953761274 Fundraising CA 501(c)(3) 7 PIH Health Inc false PIH Health Home Healthcare 12401 Washington Blvd Whittier CA 90602 953036281 Support of Tax-Exempt Affiliates CA 501(c)(3) Type II PIH Health Inc false PIH Health Downey Hospital 11500 Brookshire Ave Downey CA 90241 951903935 Healthcare CA 501(c)(3) 3 PIH Health Inc false PIH Health Whittier Hospital 12401 Washington Blvd Whittier CA 90602 951934652 Healthcare CA 501(c)(3) 3 PIH Health Inc false PIH Health Management Corp 12401 Washington Blvd Whittier CA 90602 954016278 Support of Tax-Exempt Affiliates CA 501(c)(3) Type II PIH Health Inc false PIH Health Physicians 6557 Greenleaf Ave Whittier CA 90601 953942828 Healthcare CA 501(c)(3) 10 PIH Health Inc false PIH Health Inc 12401 Washington Blvd Whittier CA 90602 953619388 Support of Tax-Exempt Affiliates CA 501(c)(3) Type II NA false Auxiliary of the Hospital of the Good Samaritan 1225 Wilshire Blvd Los Angeles CA 90017 956051253 Welfare of the Good Samaritan Hospital CA 501(c)(3) Type III-FI NA false DRMC Properties Inc 12401 Washington Blvd Whittier CA 90602 954769768 Real Estate CA NA C Corporation false HealthMed Services Inc 12401 Washington Blvd Whittier CA 90602 300831225 Healthcare CA NA C Corporation false PIH Health Care Solutions 6557 Greenleaf Ave Whittier CA 90601 462072342 Healthcare CA NA C Corporation false PIH Insurance Co A Reciprocal Risk Retention Group 733 Bishop Street Suite 1555 Honolulu HI 96813 263760243 Captive Insurance HI NA Trust false PIH Health RE 733 Bishop Street Ste 1555 Honolulu HI 96813 472501390 Captive Insurance HI NA Trust false Pioneer Medical Group Inc 6557 Greenleaf Ave Whittier CA 90601 330927283 Medical Services CA NA C Corporation false Pioneer Provider Network A Medical Group Inc 6557 Greenleaf Ave Whittier CA 90601 330922631 Management Services CA NA C Corporation false true true true false false false false false false false true false false false false false false false GOOD SAMARITAN HOSPITAL MEDICAL OFFICE BUILDING INC A 5931500 FMV Good Samaritan Hospital Medical Office Building Inc K 2784297 FMV Good Samaritan Institute for Research and Education B 323092 FMV