PIH HEALTH GOOD SAMARITAN HOSPITAL: Form 990, tax year 2018
View the entire original 990 at ProPublica ↗
- Organization
- PIH HEALTH GOOD SAMARITAN HOSPITAL (EIN 95-1656366)
- Tax period
- 2018-09-01 to 2019-08-31
- Filed
- 2020-07-15
- IRS object ID
- 202011979349307751
- Schema version
- 2018v3.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule I
- Schedule J
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-07-15T17:43:05-05:00 | ReturnTs |
| Tax Period End | 2019-08-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 420714325 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RSM US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 S Wacker Drive Ste 800 | AddressLine1Txt |
| City | Chicago | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60606 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2018-09-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 951656366 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Good Samaritan Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GOOD | BusinessNameControlTxt |
| Phone | 2139772121 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1225 WIlshire Blvd | AddressLine1Txt |
| City | Los Angeles | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 900172395 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Anita Chou | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 2139772121 | PhoneNum |
| Signature | 2020-07-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Rebekuh Eley | PreparerPersonNm |
| PTIN | P01247672 | PTIN |
| Phone | 3126343400 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 104.181.213.116 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-07-15 | IPDt |
| IP Tm | 14:41:53 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 2A28FA2E2A09A40AF4F0A751499BE74D16D20E85 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 2A28FA2E2A09A40AF4F0A751499BE74D16D20E85 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2018 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PIH Health Good Samaritan Hosp | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Anita Chou | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1225 WIlshire Blvd | AddressLine1Txt |
| City | Los Angeles | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 900172395 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $393,632,975 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.goodsam.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1885 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | Provide accessible, quality, cost-effective healthcare services at 408-bed hospital in LA. | ActivityOrMissionDesc |
| Voting Members Governing Body | 24 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 23 | VotingMembersIndependentCnt |
| Total Employee | 1679 | TotalEmployeeCnt |
| Total Volunteers | 327 | TotalVolunteersCnt |
| Total Gross UBI | $584,216 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $24,995,391 | PYContributionsGrantsAmt |
| CY Contributions Grants | $5,646,258 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $366,837,230 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $360,346,227 | CYProgramServiceRevenueAmt |
| PY Investment Income | $6,686,784 | PYInvestmentIncomeAmt |
| CY Investment Income | $8,450,513 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,603,456 | PYOtherRevenueAmt |
| CY Other Revenue | $2,790,362 | CYOtherRevenueAmt |
| PY Total Revenue | $400,122,861 | PYTotalRevenueAmt |
| CY Total Revenue | $377,233,360 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $693,029 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $552,231 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $156,088,633 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $170,456,156 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $1,547,857 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $194,328,241 | PYOtherExpensesAmt |
| CY Other Expenses | $221,196,301 | CYOtherExpensesAmt |
| PY Total Expenses | $351,109,903 | PYTotalExpensesAmt |
| CY Total Expenses | $392,204,688 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $49,012,958 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$14,971,328 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $498,043,556 | TotalAssetsBOYAmt |
| Total Assets EOY | $485,500,294 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $176,929,852 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $173,737,014 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $321,113,704 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $311,763,280 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | To provide accessible, quality, cost-effective community healthcare. The Hospital operates a 408-bed facility in inner-city Los Angeles. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $205,126,259 | ExpenseAmt |
| Grant | $552,231 | GrantAmt |
| Revenue | $260,783,842 | RevenueAmt |
| Desc | Patient Care: Good Samaritan Hospital was established in 1885 by Sister Mary Wood and has been helping the community for 130 years. As a 501(c)(3) nonprofit, 408-bed hospital, along with 32 Surgical Suites, Good Samarian Hospital is offering a multitude of services. The hospital's mission is to provide accessible, quality, cost-effective, and compassionate health care services that meet the needs of the patients, their families, the community, physicians and employees.Patient Care in Fiscal Year 2018-2019Employees ....... 1,601Volunteers ....... 304Number of Emergency Department (ED) visits ....... 44,054Number of Births ....... 2,667Medical Staff ....... 456 | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $134,362,003 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $99,516,874 | RevenueAmt |
| Desc | 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. Good Samaritan Hospital offers a generous Financial Assistance Program, providing charity care to those with family income(s) at or below 350% 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, 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: 32,735 | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $668,255 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $45,511 | RevenueAmt |
| Desc | Other Community Benefit Services: Community health improvement services and community benefit operations, Health professions education, Research 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. The annual Korean Health Fair is included in this category.Snapshot of Outcomes:- 780 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. Good Samaritan Hospital's programs include the volunteer jobs training and lab student internship programs. Snapshot of Outcomes:- 306 volunteers and lab students were provided with mentorship, internship and training opportunities.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. Good Samaritan Hospital has been offering clinical trials and research studies aimed at improving health. Snapshot of Outcomes:- Over $390,000 expenses have been incurred in research in Fiscal Year 2018-2019.CASH & IN-KIND CONTRIBUTIONS: This category includes funds and in-kind services donated by Good Samaritan Hospital to community organizations or to the community-at-large for a community benefit purpose. Snapshot of Outcomes:- $5,000 in cash donations was given to an organization to address the significant health needs in our service area communities.Total number of persons served by all categories: 33,822For additional information, please refer to PIH Health's community benefit report at https://www.goodsam.org/About-Us/Community-Benefit-Plan.aspx | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $340,156,517 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 455 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 1679 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 24 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 23 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | 0 | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Ernalyn Baysac | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2139772003 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 637 South Lucas Avenue 3rd Floor | AddressLine1Txt |
| City | Los Angeles | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 90017 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (36 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| Andrew B Leeka | |||||||||
| President & CEO | 50.00 | 8.00 | Yes (X) | Yes (X) | $664,710 | $0 | $29,840 | ||
| Charles T Munger | |||||||||
| Chairman | 1.00 | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Robert E Denham | |||||||||
| Vice President | 1.00 | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| George A Bender | |||||||||
| Secretary | 1.00 | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Sushma Adarkar MD | |||||||||
| Trustee | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | |||
| Bruce Bennett | |||||||||
| Trustee | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | |||
| William M Bitting | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Mrs Jack L Blumenthal | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Mrs Maribeth A Borthwick | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Victoria Seaver Dean | |||||||||
| Trustee | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | |||
| John B Frank | |||||||||
| Trustee | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | |||
| James H Gipson | |||||||||
| Trustee | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | |||
| Mimi Grant | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Allison A Hill MD | |||||||||
| Trustee | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | |||
| Robert K Maloney MD | |||||||||
| Trustee | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | |||
| Charles P Meister | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Glen H Mitchel Jr | |||||||||
| Trustee | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | |||
| Peter W Mullin | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Bruce E Pherson Jr | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Clark W Porter | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Helen Lho Ryu | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Stephen L Smith | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| The Rt Rev John Harvey Taylor | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Edward A Wopschall | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Alan M Ino | |||||||||
| CFO | 50.00 | 8.00 | Yes (X) | $520,377 | $0 | $22,630 | |||
| Dean Campbell | |||||||||
| VP Info. Tech. Services | 40.00 | 0.00 | $278,753 | $0 | $0 | Yes (X) | |||
| Todd Goodall | |||||||||
| VP Business Development | 40.00 | 0.00 | $290,975 | $0 | $14,559 | Yes (X) | |||
| Lexie Schuster | |||||||||
| VP Human Resources | 40.00 | 0.00 | $253,451 | $0 | $329 | Yes (X) | |||
| Brian Thorne | |||||||||
| VP Fund Development | 40.00 | 0.00 | $281,255 | $0 | $28,517 | Yes (X) | |||
| Philip Wolfe | |||||||||
| VP Professional Services | 40.00 | 0.00 | $283,522 | $0 | $8,574 | Yes (X) | |||
| Shauna Pearce | |||||||||
| VP Nursing Services | 40.00 | 0.00 | $187,230 | $0 | $22,110 | Yes (X) | |||
| Ching Chen | |||||||||
| Chief Radiation Physicist | 40.00 | 0.00 | $330,589 | $0 | $22,630 | Yes (X) | |||
| Elena Bochove | |||||||||
| Staff R.N. | 40.00 | 0.00 | $267,848 | $0 | $22,769 | Yes (X) | |||
| Samir Nabulsi | |||||||||
| Director Worker's Comp | 40.00 | 0.00 | $270,818 | $0 | $17,658 | Yes (X) | |||
| Ira Meiselman | |||||||||
| Director Managed Care | 40.00 | 0.00 | $266,967 | $0 | $31,999 | Yes (X) | |||
| James Whitcomb | |||||||||
| Director Revenue Cycle | 40.00 | 0.00 | $269,150 | $0 | $26,833 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,165,645 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $248,448 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 572 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Crothall Healthcare Inc | |||||
| 955 Chesterbrook Blvd 300 | Wayne | PA | 19087 | Environmental Services | $6,087,515 |
| Orange Commercial Credit Ref SecureNurs | |||||
| PO Box 25229 | Anaheim | CA | 92825 | Nursing Registry Services | $4,299,521 |
| Morrison Management Specialists Inc | |||||
| 5801 Peachtree Dunwoody Rd | Atlanta | GA | 30342 | Dietary Services | $3,555,806 |
| Millie and Severson Inc | |||||
| 3601 Serpentine Drive | Los Alamitos | CA | 90720 | Construction Services | $3,073,711 |
| Samaritan Hospitalists Medical Group In | |||||
| 898 N Pacific Coast Hwy Ste 600 | El Segundo | CA | 90245 | Professional Medical Services | $2,237,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 109 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $146,201 | FundraisingAmt |
| Related Organizations | $196,902 | RelatedOrganizationsAmt |
| Government Grants | $57,999 | GovernmentGrantsAmt |
| All Other Contributions | $5,245,156 | AllOtherContributionsAmt |
| Noncash Contributions | $200,660 | NoncashContributionsAmt |
| Total Contributions | $5,646,258 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|---|
| Patient Revenue | 621990 | $359,284,320 | $359,284,320 | ||
| Child Care Center | 624410 | $738,178 | $398,616 | $339,562 | |
| Rental Income | 532000 | $323,729 | $323,729 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $360,346,227 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,228,882 | TotalRevenueColumnAmt |
| Exclusion | $8,228,882 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $16,490,091 | SecuritiesAmt |
| Other | $1,030 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $16,269,490 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $220,601 | SecuritiesAmt |
| Other | $1,030 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $221,631 | TotalRevenueColumnAmt |
| Exclusion | $221,631 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $98,915 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $146,201 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $130,125 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$31,210 | TotalRevenueColumnAmt |
| Exclusion | -$31,210 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| Parking Lot | 812930 | $1,065,238 | $68,803 | $996,435 |
| Non-Patient Lab Svcs | 621500 | $60,997 | $60,997 | |
| Physician Mngmt Svcs | 621110 | $55,800 | $55,800 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,639,537 | TotalRevenueColumnAmt |
| Exclusion | $1,639,537 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $2,821,572 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $377,233,360 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $359,608,049 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $584,216 | UnrelatedBusinessRevenueAmt |
| Exclusion | $11,394,837 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $552,231 | TotalAmt |
| Program Services | $552,231 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,044,107 | TotalAmt |
| Program Services | $484,699 | ProgramServicesAmt |
| Management And General | $2,269,903 | ManagementAndGeneralAmt |
| Fundraising | $289,505 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $121,386,474 | TotalAmt |
| Program Services | $112,000,273 | ProgramServicesAmt |
| Management And General | $9,137,968 | ManagementAndGeneralAmt |
| Fundraising | $248,233 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,088,508 | TotalAmt |
| Program Services | $6,350,906 | ProgramServicesAmt |
| Management And General | $737,602 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,954,770 | TotalAmt |
| Program Services | $25,218,916 | ProgramServicesAmt |
| Management And General | $3,670,351 | ManagementAndGeneralAmt |
| Fundraising | $65,503 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,982,297 | TotalAmt |
| Program Services | $9,013,765 | ProgramServicesAmt |
| Management And General | $925,984 | ManagementAndGeneralAmt |
| Fundraising | $42,548 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,675,620 | TotalAmt |
| Management And General | $1,542,429 | ManagementAndGeneralAmt |
| Fundraising | $133,191 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $410,000 | TotalAmt |
| Management And General | $410,000 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,424 | TotalAmt |
| Management And General | $27,424 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $80,426,759 | TotalAmt |
| Program Services | $70,671,837 | ProgramServicesAmt |
| Management And General | $9,707,838 | ManagementAndGeneralAmt |
| Fundraising | $47,084 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $899,603 | TotalAmt |
| Program Services | $143,138 | ProgramServicesAmt |
| Management And General | $756,465 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,476,902 | TotalAmt |
| Program Services | $2,429,112 | ProgramServicesAmt |
| Management And General | $43,970 | ManagementAndGeneralAmt |
| Fundraising | $3,820 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,426 | TotalAmt |
| Program Services | $21,373 | ProgramServicesAmt |
| Management And General | $21,951 | ManagementAndGeneralAmt |
| Fundraising | $1,102 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,105,845 | TotalAmt |
| Program Services | $2,105,845 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,117,218 | TotalAmt |
| Program Services | $6,506,479 | ProgramServicesAmt |
| Management And General | $5,610,739 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,665,673 | TotalAmt |
| Program Services | $516,318 | ProgramServicesAmt |
| Management And General | $2,149,223 | ManagementAndGeneralAmt |
| Fundraising | $132 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Supplies | $75,259,589 | $74,689,823 | $558,119 | $11,647 |
| Hospital Fee Program | $20,713,890 | $20,713,890 | ||
| Bad Debt Expense | $8,699,488 | $8,699,488 | ||
| Utilities | $5,323,967 | $4,956,788 | $366,984 | $195 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,349,897 | TotalAmt |
| Program Services | $3,781,124 | ProgramServicesAmt |
| Management And General | $3,863,876 | ManagementAndGeneralAmt |
| Fundraising | $704,897 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $392,204,688 | TotalAmt |
| Program Services | $340,156,517 | ProgramServicesAmt |
| Management And General | $50,500,314 | ManagementAndGeneralAmt |
| Fundraising | $1,547,857 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,249,311 | BOYAmt |
| EOY | $29,991,092 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $939,598 | BOYAmt |
| EOY | $957,000 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $53,524,004 | BOYAmt |
| EOY | $57,919,039 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $194,346,404 | BOYAmt |
| EOY | $177,697,339 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,690,024 | BOYAmt |
| EOY | $1,937,434 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,463,369 | BOYAmt |
| EOY | $5,148,279 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $470,206,390 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $358,783,965 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $109,626,924 | BOYAmt |
| EOY | $111,422,425 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $105,340,234 | BOYAmt |
| EOY | $95,171,348 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,863,688 | BOYAmt |
| EOY | $5,256,338 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $498,043,556 | BOYAmt |
| EOY | $485,500,294 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $74,510,263 | BOYAmt |
| EOY | $74,613,845 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,892,925 | BOYAmt |
| EOY | $52,397,957 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $49,526,664 | BOYAmt |
| EOY | $46,725,212 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $176,929,852 | BOYAmt |
| EOY | $173,737,014 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $253,732,359 | BOYAmt |
| EOY | $246,334,946 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,825,997 | BOYAmt |
| EOY | $10,850,409 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $57,555,348 | BOYAmt |
| EOY | $54,577,925 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $321,113,704 | BOYAmt |
| EOY | $311,763,280 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $498,043,556 | BOYAmt |
| EOY | $485,500,294 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$14,971,328 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $5,704,697 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$83,793 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $27,424 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $27,424 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | Lobbying expenses represent a portion of the dues Good Samaritan Hospital pays to the Hospital Association of Southern California. 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. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $73,767,150 | BeginningYearBalanceAmt |
| Contributions | $108,951 | ContributionsAmt |
| Investment Earnings Or Losses | $4,068,889 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $5,875,119 | OtherExpendituresAmt |
| Administrative Expenses | $36,579 | AdministrativeExpensesAmt |
| End Year Balance | $72,033,292 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $74,567,557 | BeginningYearBalanceAmt |
| Contributions | $16,756 | ContributionsAmt |
| Investment Earnings Or Losses | $5,368,619 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $6,185,782 | OtherExpendituresAmt |
| End Year Balance | $73,767,150 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $72,393,290 | BeginningYearBalanceAmt |
| Contributions | $1,202,722 | ContributionsAmt |
| Investment Earnings Or Losses | $8,424,663 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $7,426,842 | OtherExpendituresAmt |
| Administrative Expenses | $26,276 | AdministrativeExpensesAmt |
| End Year Balance | $74,567,557 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $71,589,573 | BeginningYearBalanceAmt |
| Contributions | $164,742 | ContributionsAmt |
| Investment Earnings Or Losses | $4,279,465 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $3,979,499 | OtherExpendituresAmt |
| Administrative Expenses | -$339,009 | AdministrativeExpensesAmt |
| End Year Balance | $72,393,290 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $63,269,200 | BeginningYearBalanceAmt |
| Contributions | $10,395,868 | ContributionsAmt |
| Investment Earnings Or Losses | $2,792,152 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $4,867,647 | OtherExpendituresAmt |
| End Year Balance | $71,589,573 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.15780 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.75770 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.08450 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $17,195,670 | OtherCostOrOtherBasisAmt |
| Book Value | $17,195,670 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $151,460,317 | OtherCostOrOtherBasisAmt |
| Depreciation | $119,073,924 | DepreciationAmt |
| Book Value | $32,386,393 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $284,927,249 | OtherCostOrOtherBasisAmt |
| Depreciation | $236,464,985 | DepreciationAmt |
| Book Value | $48,462,264 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $16,623,154 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,245,056 | DepreciationAmt |
| Book Value | $13,378,098 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $111,422,425 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (6 entries)
| DescDesc | AmtAmt |
|---|---|
| Reserve for Self-Insured Programs | $4,121,772 |
| Pension Plan | $17,168,043 |
| Advances from Third Party Payors | $2,437,810 |
| Reserve for Asset Retirement Obligation | $11,509,109 |
| Other Annuity Payment Liability | $1,738,583 |
| Other Long Term Reserves | $9,749,895 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $46,725,212 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | For specific purposes listed by the donors. |
| Part X, Line 2: | The Hospital, SIC, and MOB are not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code (the "Code") and are exempt from federal income taxes pursuant to Section 501(a) of the Code. They are exempt from state franchise taxes under similar statutes. Accordingly, no provision for income taxes has been recorded in the accompanying consolidated financial statements. During the years ended August 31, 2019 and 2018, the Company did not record any liability for unrecognized tax contingencies. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | Golf Tournament | Event1Nm |
| Gross Receipts Event1 | $245,116 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $146,201 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $98,915 | GrossRevenueEvent1Amt |
| Rent Facility Costs Event1 | $71,875 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $22,534 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $35,716 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $245,116 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $146,201 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $98,915 | GrossRevenueTotalEventsAmt |
| Rent Fclty Costs Total Events | $71,875 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $22,534 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $35,716 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $130,125 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$31,210 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent350 | Yes (X) | Percent350Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 7101 | PersonsServedCnt |
| Total Community Benefit Expns | $8,615,861 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $8,615,861 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02200 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 25634 | PersonsServedCnt |
| Total Community Benefit Expns | $125,746,142 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $99,516,874 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $26,229,268 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06690 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 32735 | PersonsServedCnt |
| Total Community Benefit Expns | $134,362,003 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $99,516,874 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $34,845,129 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08890 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 780 | PersonsServedCnt |
| Total Community Benefit Expns | $44,800 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,000 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $38,800 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 306 | PersonsServedCnt |
| Total Community Benefit Expns | $186,312 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $186,312 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $432,143 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $38,511 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $393,632 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1 | PersonsServedCnt |
| Total Community Benefit Expns | $5,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1087 | PersonsServedCnt |
| Total Community Benefit Expns | $668,255 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $44,511 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $623,744 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00160 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 33822 | PersonsServedCnt |
| Total Community Benefit Expns | $135,030,258 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $99,561,385 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $35,468,873 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09050 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,126,130 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $92,340,980 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $100,292,060 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$7,951,080 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Good Samaritan Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1225 Wilshire Blvd | AddressLine1Txt |
| City | Los Angeles | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 90017 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.goodsam.org | WebsiteAddressTxt |
| State License | 930000071 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Teaching Hospital | Yes (X) | TeachingHospitalInd |
| Research Facility | Yes (X) | ResearchFacilityInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Good Samaritan Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 18 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | See Part V, Page 8 | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 18 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | See Part V, Page 8 | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 350.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | www.goodsam.org/About-Us/Charity-Care-Discount-Policy/Policy.aspx | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | www.goodsam.org/documents/Financial-Assistance-Request-Form-English_Spanish | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | www.goodsam.org/About-Us/Charity-Care-Discount-Policy/Policy.aspx | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Good Samaritan Hospital | Part V, Section B, Line 5: 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.Twenty-nine (29) interviews were completed from November 2018 to January 2019. Community stakeholders identified by the Metro Los Angeles Collaborative were contacted and asked to participate in the needs assessment. Interviewees included individuals who are leaders and/or representatives of medically underserved, low-income, and minority populations, local health or other departments or agencies that have current data or other information relevant to the health needs of the community. Input was obtained from the Los Angeles County Department of Public Health.The identified stakeholders were invited by email to participate in a 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 needs 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: - Health issues in the community - Challenges and barriers people face in addressing these issues - Socioeconomic, behavioral, or environmental factors contributing to poor health in the community - Potential resources to address the identified health needs, such as services, programs and/or community efforts - Additional comments and concerns A list of the stakeholder interview respondents, their titles and organizations can be found in Attachment 2. |
| Good Samaritan Hospital | Part V, Section B, Line 6a: Good Samaritan Hospital participated in a collaborative process for the Community Health Needs Assessment, in partnership with St. Vincent Medical Center and California Hospital Medical Center. |
| Good Samaritan Hospital | Part V, Section B, Line 11: The Needs Assessment for Good Samaritan Hospital was conducted in collaboration with California Hospital Medical Center and St. Vincent Medical Center.The Community Needs Assessment process identified the top broad health issues as:- Access to Care (health insurance, regular source of care, inappropriate use of the ER)- Care for Chronic Conditions (diabetes, heart disease)- Cancer Care- Disease Management and Preventative Care (patient education, cardiovascular disease, including stroke, breastfeeding, screenings, and vaccinations)- Community Social IssuesFor needs that are not addressed such as mental health services, education on sexually transmitted infections including HIV, alcohol and substance abuse, and Alzheimer's disease, Good Samaritan Hospital has partnered with several organizations that have this expertise.The initiatives included in this year's Community Benefit Implementation Plan will require collaboration with many public and private organizations including philanthropic foundations, disease support groups, and governmental programs for the uninsured, community service agencies, local elected officials, security agencies and schools. |
| Part V, Section B, Line 7, CHNA Policy Website: | https://www.goodsam.org/documents/Good-Samaritan-2019-CHNA-FINAL.pdf |
| Part V, Section B, Line 10, Implementation Strategy Website: | https://www.goodsam.org/About-Us/Community-Benefit-Plan.aspx |
| Part V, Section B, Lines 9 and 12a: | During tax year 2018, Good Samaritan Hospital (GSH), a single facility hospital, conducted a community health needs assessment in accordance with Section 501(r)(3). The CHNA report was adopted by the board of directors in July 2019. On December 23, 2019, Good Samaritan Hospital was acquired by PIH Health Inc. (PIH Health), EIN 95-3619388, at which time the GSH board of directors was dissolved and replaced by the PIH Health board of directors. Immediately upon acquisition, PIH Health began its due diligence to ensure GSH was in compliance with the requirements of Section 501(r). As of the date of acquisition, GSH became subject to PIH Health's existing Community Health Improvement Plan (CHIP), which was approved by the PIH Health board of directors in December 2019. At this time, PIH Health also began assessing whether and to what extent adjustments to its existing CHIP were necessary to fully incorporate Good Samaritan Hospital's community needs based on the most recently conducted GSH CHNA. Due to the transition arising from the acquisition, there were administrative delays which prevented Good Samaritan Hospital's newly appointed Board of Directors from being able to convene and formally adopt a written implementation strategy by the statutory deadline of January 15, 2020, as required by Treas. Reg. Section 501(r)-3(a)(2). However, Good Samaritan Hospital had a revised, written implementation strategy in place in January 2020 and was acting upon the PIH Health CHIP, which already incorporated several needs identified by the GSH CHNA. PIH Health's revised 2020-2022 CHIP, which includes PIH Health Good Samaritan Hospital, was formally approved by the Board on April 8, 2020. PIH Health's Board meets on a quarterly basis.Except for the formal adoption of the written implementation strategy by the January 15, 2020 deadline, GSH acted in a manner to meet the needs of the community served by GSH based on the 2019 Community Health Needs Assessment (CHNA). Beginning in January 2020, the PIH Health Community Benefit department incorporated the GSH service areas into the work to support the 2019 CHNA, while the GSH CHNA IP was being developed. These programs have continued through the 2020 fiscal year. PIH Health Good Samaritan Hospital has implemented new policies and procedures to minimize the likelihood of further Section 501(r)(3) compliance errors and to facilitate the prompt identification and correction of any such future failures that do occur. Changes include hiring a consultant to assist with assessment of the organization's Section 501(r) compliance, appointing new employees to oversee the community benefit process, and subjecting Good Samaritan Hospital to the policies and procedures established by PIH Health Inc., the organization's newly controlling related entity. For these reasons, Good Samaritan Hospital's error with respect to the implementation policy is not considered a failure to meet a requirement of Section 501(r) because the error was minor and due to reasonable cause. However, Good Samaritan Hospital corrected the error promptly upon discovery and is including this disclosure pursuant to Revenue Procedure 2015-21 Sections 6 and 7. |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | Charity cost: Hospital RCC from internal financial statements applied to charity write offs. Medi-Cal cost: From hospital's Harris costing system. Health Fair: Cost provided by Public Relations Department. Job Training for Volunteers: From general ledger expense for Volunteer Department. Research Cost: Provided by Accounting Department. |
| Part III, Line 2: | Bad debt expense is determined by applying RCC from Hospital financial statements to bad debt transfers net of recoveries. This expense was not included in community benefit expense. |
| Part III, Line 3: | Good Samaritan Hospital has a very robust financial assistance program, therefore, no estimate is made for bad debt attributable to patients eligible under the financial assistance policy. |
| Part III, Line 4: | From the audited financial statements of Good Samaritan Hospital and its affiliates for the year ended August 31, 2019: The Company has agreements with third-party payors that provide for payments to the Company at amounts different from its established rates. Payment arrangements include prospectively determined rates per discharge, reimbursed costs, discounted charges, and per diem payments. Net patient service revenue is reported at the estimated net realizable amounts from patients, third-party payors, and others for services rendered, including estimated retroactive adjustments under reimbursement agreements with third-party payors. Retroactive adjustments are accrued on an estimated basis in the period the related services are rendered and adjusted in future periods as final settlements are determined. The Company presents its provision for bad debts as a reduction of patient service revenue on a separate line item in its consolidated statements of operations.The bad debt expense reported on Part III, Line 2 is calculated using total cost to charge ratio applying to total bad debt transfers net of recoveries and none of the bad debt expense is included in community benefit expense. |
| Part III, Line 8: | The amounts on lines 5 and 6 are from the FY 2019 Medicare cost report and we believe do not qualify as community benefit. |
| Part III, Line 9b: | Patients are advised that they have the opportunity to submit a charity application or apply for a discount under the Hospital's Charity Care Policy or Cash Price Policy. |
| Part VI, Line 2: | Good Samaritan Hospital addresses the healthcare needs of the communities it serves through participation in various community collaboratives and networking meetings, including it's annual Korean Health Fair. Good Samaritan Hospital is able to assess the healthcare needs of the community and identify partnership opportunities. |
| Part VI, Line 3: | Signage describing the Hospital's charity programs is posted at all points of registration in three languages. Also, all uninsured patients are sent a letter with their first bill informing them of the Hospital's available charity care programs and personnel to contact for information and application. Uninsured patients are screened for Medi-Cal linkage and if they meet the criteria, the patient is referred to RISARC 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 uninsured, 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. |
| Part VI, Line 4: | Good Samaritan Hospital is located at 1225 Wilshire Blvd., Los Angeles, California 90017. The hospital service area includes 18 ZIP Codes in Los Angeles City Council District 1. The service area is comprised of portions of Service Planning Areas (SPAs) 4 and 6. The hospital service area is detailed below by community and ZIP Code and was determined from the ZIP Codes that reflect a majority of patient admissions from the local geographic area.The population for the GSH service area is 516,340. Children and youth, ages 0-17, make up 15.6% of the population, 74% are 18-64 years of age, and 10.4% are seniors, 65 years and older. In the service area, 53.1% of the population are Hispanic/Latino, 22.5% are Asian, 13.2% are White, 8.9% are Black/African American; and the remaining 2.3% are American Indian/Alaskan Native, Native Hawaiian/Pacific Islander, other or multiple races. English is spoken in the home among 32.8% of the service area population. Spanish is spoken at home among 42.3% of the population, and 21.1% of the population speaks an Asian language in the home. In the service area, 30% of the population is at or below 100% of the federal poverty level. Among area adults, ages 25 and older, 30.2% lack a high school diploma, 19% are high school graduates and 35.6% are college graduates. |
| Part VI, Line 5: | Community BoardGood Samaritan Hospital's community Board of Directors works to advance the commitment to helping our communities get well and stay healthy.Open Medical StaffGood Samaritan Hospital extends medical staff privileges to all qualified physicians in its community for some or all of its departments or specialties.Use of Company Campaign FundsGood Samaritan Hospital's employees donate back to the hospital during Good Company Campaign each year and the money raised applies toward improvements in patient care, technology, medical education and areas with greatest needs.Donation of TimeMany Good Samaritan Hospital Health providers are living out their passion to serve people in need by donating their time and talents both in our community and overseas. Volunteer Contributions Some 304 Good Samaritan Hospital volunteers collectively contributed 36,886 hours of service, supporting departments throughout the organization. |
| Part VI, Line 6: | Good Samaritan Hospital (the "Hospital") is a not-for-profit and tax-exempt corporation that operates a 408-bed tertiary hospital in Los Angeles, California. The Hospital's mission is to provide accessible, quality, cost-effective, and compassionate health care services that meet the needs of the patients, their families, the community, physicians, and employees.Good Samaritan Medical Office Building, Inc. (MOB), a not-for-profit corporation consisting of a medical office building adjacent to the Hospital, was formed to provide and lease office space to physicians on staff at the Hospital.Samaritan Imaging Center (SIC), a not-for-profit corporation, was formed as an outpatient imaging center, dedicated to the advancement of the care of the sick, injured, and disabled individuals requiring radiological imaging services.The Hospital, MOB, and SIC are consolidated in these financial statements because the Hospital is the sole corporate member of MOB and SIC, and are referred to collectively as the "Company."As part of its clinical mission, the Company created Good Samaritan Institute for Research and Education and the Orthopedic Institute (collectively, the "Institutes"). The Institutes conduct clinical research in their specialized areas and provide education to the medical community and the general public. The Institutes are included in these consolidated financial statements. |
| Part VI, Line 7, Reports Filed With States | CA |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|
| Good Samaritan Institute for Research and Education | ||||||||
| 1225 Wilshire Blvd | Los Angeles | CA | 90017 | 954077161 | 501(c)(3) | $432,161 | $0 | Expenses paid by the Organization |
| California Health Foundation and Trust | ||||||||
| 1215 K Street Suite 800 | Sacramento | CA | 95814 | 941498687 | 501(c)(3) | $108,970 | $0 | Support charitable activities at Hospitals and Health Systems in California |
| Orthopedic Institute of the Good Samaritan Hospital | ||||||||
| 1225 Wilshire Blvd | Los Angeles | CA | 90017 | 954346048 | 501(c)(3) | $11,100 | $0 | Expenses paid by the Organization |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 3 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | The Institutes (Good Samaritan Institute for Research and Education and Ortho) do not have their own checking accounts, so all of their expenses (including salaries, wages and benefits) are paid for by the Hospital and are all recorded in each of the Institutes' accounts in the general ledger, through intercompany due to and from accounts on both sides (Institutes and Hospital's). Grants will only be made to 501(c)(3) organizations to ensure the funds will be used properly. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (13 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Andrew B Leeka | ||||||||||||||
| President & CEO | $664,710 | $0 | $0 | $0 | $0 | $0 | $8,250 | $0 | $21,590 | $0 | $694,550 | $0 | $0 | $0 |
| Alan M Ino | ||||||||||||||
| CFO | $520,377 | $0 | $0 | $0 | $0 | $0 | $8,250 | $0 | $14,380 | $0 | $543,007 | $0 | $0 | $0 |
| Dean Campbell | ||||||||||||||
| VP Info. Tech. Services | $278,753 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $278,753 | $0 | $0 | $0 |
| Todd Goodall | ||||||||||||||
| VP Business Development | $290,975 | $0 | $0 | $0 | $0 | $0 | $8,250 | $0 | $6,309 | $0 | $305,534 | $0 | $0 | $0 |
| Lexie Schuster | ||||||||||||||
| VP Human Resources | $253,451 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $329 | $0 | $253,780 | $0 | $0 | $0 |
| Brian Thorne | ||||||||||||||
| VP Fund Development | $281,255 | $0 | $0 | $0 | $0 | $0 | $8,250 | $0 | $20,267 | $0 | $309,772 | $0 | $0 | $0 |
| Philip Wolfe | ||||||||||||||
| VP Professional Services | $283,522 | $0 | $0 | $0 | $0 | $0 | $8,250 | $0 | $324 | $0 | $292,096 | $0 | $0 | $0 |
| Shauna Pearce | ||||||||||||||
| VP Nursing Services | $187,230 | $0 | $0 | $0 | $0 | $0 | $5,697 | $0 | $16,413 | $0 | $209,340 | $0 | $0 | $0 |
| Ching Chen | ||||||||||||||
| Chief Radiation Physicist | $330,589 | $0 | $0 | $0 | $0 | $0 | $8,250 | $0 | $14,380 | $0 | $353,219 | $0 | $0 | $0 |
| Elena Bochove | ||||||||||||||
| Staff R.N. | $267,848 | $0 | $0 | $0 | $0 | $0 | $16,071 | $0 | $6,698 | $0 | $290,617 | $0 | $0 | $0 |
| Samir Nabulsi | ||||||||||||||
| Director Worker's Comp | $270,818 | $0 | $0 | $0 | $0 | $0 | $8,218 | $0 | $9,440 | $0 | $288,476 | $0 | $0 | $0 |
| Ira Meiselman | ||||||||||||||
| Director Managed Care | $246,967 | $0 | $20,000 | $0 | $0 | $0 | $8,173 | $0 | $23,826 | $0 | $298,966 | $0 | $0 | $0 |
| James Whitcomb | ||||||||||||||
| Director Revenue Cycle | $269,150 | $0 | $0 | $0 | $0 | $0 | $7,339 | $0 | $19,494 | $0 | $295,983 | $0 | $0 | $0 |
Schedule M IRS990ScheduleM
Securities Publicly Traded SecuritiesPubliclyTradedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $200,660 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8283 Received | 0 | Form8283ReceivedCnt |
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Column (b): | FormAndLineReferenceDesc |
| Explanation | Is the number of contributions. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 2 | Mrs. Maribeth Borthwick, a Board Member of Good Samaritan Hospital, has a family relationship with Mr. Charles Munger, Chairman of the Board. Mr. Clark W. Porter has a family relationship with Mr. Glen H. Mitchel, Jr., who are both board members. |
| Form 990, Part VI, Section B, line 11b | The organization works with an independent accountant, RSM US LLP, to prepare the Form 990. Once the return is prepared, the return is reviewed by the Chief Financial Officer and the Controller, who will provide any final comments to RSM US LLP. RSM US LLP makes all changes necessary and a final Form 990 is made available to all Board Members prior to filing. |
| Form 990, Part VI, Section B, line 12c | All Board Members and officers are required to complete a conflict of interest disclosure statement each year. The Policy requires each governing body member to disclose any conflict on a particular matter that may arise, and recuse him or herself from deliberations and votes on such matters. The Policies are monitored by the Director of Risk Management of the Good Samaritan Hospital and are enforced by the Audit Committee Chairperson. |
| Form 990, Part VI, Section B, line 15 | A subcommittee of the Governing Board's Executive Committee is responsible for determining the Chief Executive Officer's compensation. This Subcommittee is given comparison data on CEO salaries and benefits from comparable hospitals in the local area, prepared by human resources from 990s; and salary surveys completed by the local association. The decision of the Subcommittee on the CEO's salary is documented by the Subcommittee in writing. The compensation of the Organization's Vice Presidents are reviewed and approved by the Organization's CEO. Their salaries and benefits are determined using comparable hospitals in the local area, prepared by human resources from 990s; and salary surveys completed by the local hospital association. |
| Form 990, Part VI, Section C, line 19 | Good Samaritan Hospital's organizing 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 VI, Section B, Line 16b: | Good Samaritan Hospital holds a 12.5% 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. Good Samaritan Hospital annually evaluates its participation in joint venture arrangements. |
| Form 990, Part IX, line 11g | Physician Fees: Program service expenses 9,208,225. Management and general expenses 0. Fundraising expenses 0. Total expenses 9,208,225. Consulting and Management Fees: Program service expenses 2,311,069. Management and general expenses 2,425,365. Fundraising expenses 15,074. Total expenses 4,751,508. Medical Purchased Services: Program service expenses 2,276,030. Management and general expenses 350. Fundraising expenses 0. Total expenses 2,276,380. Repairs and Maintenance: Program service expenses 6,454,595. Management and general expenses 888,341. Fundraising expenses 0. Total expenses 7,342,936. Software Maintenance: Program service expenses 1,833,675. Management and general expenses 1,762,426. Fundraising expenses 3,540. Total expenses 3,599,641. Other Purchased Services: Program service expenses 16,207,338. Management and general expenses 4,213,072. Fundraising expenses 28,470. Total expenses 20,448,880. Outside Provider Cost: Program service expenses 7,840,835. Management and general expenses 0. Fundraising expenses 0. Total expenses 7,840,835. Purchased Labor: Program service expenses 24,540,070. Management and general expenses 418,284. Fundraising expenses 0. Total expenses 24,958,354. |
| Form 990, Part XI, line 9: | Net assets released from restrictions -78,716. Pension related changes -8,456. Change in value of split-interest agreements -132,598. TRF Transfer 135,977. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Good Samaritan Institute for Research and Education | |||||||||||
| 1225 Wilshire Blvd | Los Angeles | CA | 90017 | 954077161 | Heart Research | CA | 501(c)(3) | Line 4 | Good Samaritan Hospital | Yes (1) | |
| Orthopedic Institute of the Good Samaritan Hospital | |||||||||||
| 1225 Wilshire Blvd | Los Angeles | CA | 90017 | 954346048 | Orthopedic Research | CA | 501(c)(3) | Line 12a, I | Good Samaritan Hospital | Yes (1) | |
| Samaritan Imaging Center | |||||||||||
| 1225 Wilshire Blvd | Los Angeles | CA | 90017 | 954252321 | Outpatient Imaging Services | CA | 501(c)(3) | Line 10 | Good Samaritan Hospital | Yes (1) | |
| Good Samaritan Medical Office Building Inc | |||||||||||
| 1225 Wilshire Blvd | Los Angeles | CA | 90017 | 953244046 | Physicians Medical Offices | CA | 501(c)(3) | Line 12a, I | Good Samaritan Hospital | Yes (1) | |
| 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) | Line 12c, III-FI | 0 | N/A | |
| Kate Van Nuys Page Foundation | |||||||||||
| 1225 Wilshire Blvd | Los Angeles | CA | 90017 | 956028032 | Grants Income to Good Samaritan Hospital | CA | 501(c)(3) | Line 12a, I | Good Samaritan Hospital | Yes (1) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (1) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (4 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Good Samaritan Institute for Research and Education | ||
| B | $432,161 | FMV |
| Orthopedic Institute of the Good Samaritan Hospital | ||
| C | $120,121 | FMV |
| Good Samaritan Medical Office Building Inc | ||
| J | $2,422,427 | FMV |
| Good Samaritan Medical Office Building Inc | ||
| A | $4,750,631 | FMV |