STRATEGY STUDIO / NONPROFIT PEOPLE SEARCH

PIH HEALTH GOOD SAMARITAN HOSPITAL: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
PIH HEALTH GOOD SAMARITAN HOSPITAL (EIN 95-1656366)
Tax period
2012-09-01 to 2013-08-31
Filed
2014-04-25
IRS object ID
201401159349300000
Schema version
2012v2.1
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-04-25T05:12:38-05:00Timestamp
Tax Period End Date2013-08-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN861065772EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DELOITTE TAX LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1695 TOWN CENTER DRIVE SUITE 1200AddressLine1
CityCOSTA MESACity
StateCAState
ZIP Code92626ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-09-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN951656366EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Good Samaritan HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlGOODNameControl
Phone2139772010Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1616 South Witmer StreetAddressLine1
CityLos AngelesCity
StateCAState
ZIP Code900171912ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameALAN M INOName
TitleCFOTitle
Phone2139772010Phone
Date Signed2014-04-24DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameDIANA J McCUTCHENName
PTINP00545657PTIN
Phone7144367100Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonAndrew B LeekaNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1616 South Witmer StreetAddressLine1
CityLos AngelesCity
StateCAState
ZIP Code900171912ZIPCode
FieldValueIRS element (for citing)
Gross Receipts318699196GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.GOODSAM.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1885YearFormation
State Legal DomicileCAStateLegalDomicile
Activity Or Mission DescriptionProvide accessible, quality cost-effective, healthcare services at 408-bed hospital in LA.ActivityOrMissionDescription
Nbr Voting Members Governing Body29NbrVotingMembersGoverningBody
Nbr Independent Voting Members28NbrIndependentVotingMembers
Total Nbr Employees1693TotalNbrEmployees
Total Nbr Volunteers28TotalNbrVolunteers
Total Gross UBI303449TotalGrossUBI
Net Unrelated Business Txbl Income4863NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year7368138ContributionsGrantsPriorYear
Contributions Grants Current Year10544837ContributionsGrantsCurrentYear
Program Service Revenue Prior Year299502103ProgramServiceRevenuePriorYear
Program Service Revenue CY288044816ProgramServiceRevenueCY
Investment Income Prior Year10081490InvestmentIncomePriorYear
Investment Income Current Year9180007InvestmentIncomeCurrentYear
Other Revenue Prior Year3925129OtherRevenuePriorYear
Other Revenue Current Year1855627OtherRevenueCurrentYear
Total Revenue Prior Year320876860TotalRevenuePriorYear
Total Revenue Current Year309625287TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year3457353GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY2843407GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year137412341SalariesEtcPriorYear
Salaries Etc Current Year136802058SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year1524786TotalFundrsngExpCurrentYear
Other Expense Prior Year163816070OtherExpensePriorYear
Other Expenses Current Year152542424OtherExpensesCurrentYear
Total Expenses Prior Year304685764TotalExpensesPriorYear
Total Expenses Current Year292187889TotalExpensesCurrentYear
Revenues Less Expenses Prior Year16191096RevenuesLessExpensesPriorYear
Revenues Less Expenses CY17437398RevenuesLessExpensesCY
Total Assets BOY452867218TotalAssetsBOY
Total Assets EOY461254761TotalAssetsEOY
Total Liabilities BOY161280204TotalLiabilitiesBOY
Total Liabilities EOY158105850TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY291587014NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY303148911NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTo provide accessible, quality, cost-effective community healthcare. The hospital operates a 408-bed facility in inner-city Los Angeles.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense256925676Expense
Grants2843407Grants
Revenue288044816Revenue
DescriptionThe Hospital is primarily engaged in providing inpatient and outpatient medical care for the general community regardless of ability to pay. Fiscal year August 31, 2013 patient days totaled 59,882 and outpatient visits totaled 81,112.The Hospital has a policy to treat emergency and certain other patients regardless of their ability to pay. Consistent with the Hospital's tax-exempt status and community service responsibilities, the Hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Under the Hospital's policy, charity care may be provided to people who are uninsured or under-insured and can not afford to pay for their own medical care. Because the Hospital does not pursue collection or amounts determined to qualify as charity care, these are not included in net patient revenues. In some instances, charity care cases are identified subsequent to the occurrence of collection activities and may be classified as bad debts.Therefore, the Hospital is unable to determine actual total charity activity. Charitable care not included in net patient revenue was approximately $8,368,962 for fiscal year 2013.The Hospital also provides services to patients under Medi-Cal and other publicly sponsored programs which reimburse the Hospital at amounts less than the cost of the services provided to patients. In addition, health screenings and other benefits were provided for its community. The unreimbursed cost of these benefits and services were approximately $34,971,673 for fiscal year 2013.Description
Total Program Service Expense256925676TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096441NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees1693NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members29NbrVotingGoverningBodyMembers
Number Independent Voting Members28NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledCAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Reuben V BarbozaBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number2134822725TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1637 S Lucas Ave 3rd FloorAddressLine1
CityLos AngelesCity
StateCAState
ZIP Code90017ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (41 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
Andrew Leeka
CEO50.008.40XX534465010680
Sushma Adarkar MD
Trustee1.000.00X000
George A Bender
Trustee1.004.20X000
Bruce Bennett
Trustee1.004.20X000
William M Bitting
Trustee1.000.00X000
Mrs Jack L Blumenthal
Trustee1.000.00X000
Mrs Maribeth H Borthwick
Trustee1.000.00X000
Rt Rev Joseph Jon Bruno
Trustee1.000.00X000
Arthur L Crowe Jr
Trustee1.000.00X000
Mrs Victoria Seaver Dean
Trustee1.004.20X000
Robert E Denham
Trustee1.004.20X000
Andrew Fishmann MD
Trustee1.000.00X000
John B Frank
Trustee1.004.20X000
James H Gipson
Trustee1.004.20X000
Ms Mimi Grant
Trustee1.000.00X000
Robert K Maloney
Trustee1.004.20X000
Mrs Angus M McLeod
Trustee1.000.00X000
Charles P Meister
Trustee1.000.00X000
Glen H Mitchel Jr
Trustee1.004.20X000
Peter W Mullin
Trustee1.000.00X000
Charles T Munger
Chairman1.004.20X000
Todd G Owens
Trustee1.000.00X000
Clark Willard Porter
Trustee1.000.00X000
Mrs Helen Lho Ryu
Trustee1.000.00X000
Thomas L Shook MD
Trustee1.004.20X000
Stephen L Smith
Trustee1.000.00X000
Norman F Sprague III MD
Trustee1.000.00X000
Warren B Williamson
Trustee1.000.00X000
Edward A Wopschall
Trustee1.000.00X000
Alan M Ino
CFO50.008.20X433811010016
Susan Harlow
VP, Development40.000.003055400345X
Lexie Schuster
VP, Human Resources40.000.0026385707500X
Sammy Feuerlicht
VP, Bus. Development40.000.0024161008879X
Dan McLaughlin
VP, Professional Services20.0020.0024825608718X
Margaret Pfeiffer
VP, Nursing Services40.000.0024980801059X
Dean Campbell
VP, Information Services40.000.0026922907938X
Ching Chen
Chief Radiation Physicst40.000.0026307908316X
Ira Meiselman
Director, Managed Care40.000.00232491011541X
Hilarion Castillo
Controller40.000.0022435709123X
Rolando Demafelix
Coord. - Cardiothoracic40.000.0022354809966X
Elizabeth Pabros
Staff RN40.000.00212296010612X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3702347TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation104693TotalOtherCompensation
Number Individuals GT100 K384NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Crothall Healthcare Inc
955 Chesterbrook Blvd Suite 300WaynePA19087Environmental Services4529429
Sodexho Marriott Services
711 Kimberly Avenue Suite 250PlacentiaCA92870Dietary Services2989137
Management Solution
4401 Atlantic Ave 405Long BeachCA90807Temporary Registry2316147
Advanced Medical Management
5000 Airport Plaza Drive Suite 150Long BeachCA90815Capitated Program Intermediary1544898
DVA Renal Healthcare Inc
PO BOX 403008AtlantaGA30384Dialysis956692
FieldValueIRS element (for citing)
Number Of Contractors GT100 K89NumberOfContractorsGT100K
Fundraising Events74460FundraisingEvents
Related Organizations5785623RelatedOrganizations
All Other Contributions4684754AllOtherContributions
Total Contributions10544837TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Net Patient Revenue900099283531460283531460
EHR Meaningful Use90009933737993373799
Rental Income532000706440706440
Child Care Center624410424657424657
Symposium Revenue90009984608460
FieldValueIRS element (for citing)
Total Program Service Revenue288044816TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column8532561TotalRevenueColumn
Exclusion$8,532,561ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities9648168Securities
Other12573Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities9013295Securities
Other0Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities634873Securities
Other12573Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column647446TotalRevenueColumn
Exclusion$647,446ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events38465GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events74460CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses60614FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-22149TotalRevenueColumn
Exclusion-$22,149ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnUnrelated Business RevenueUnrelatedBusinessRevenueExclusionExclusionAmount
Parking Lot81293045511131884$423,227
Physician Mgmt Services621110156493156493
Non-patient Lab621500115072115072

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column1151100TotalRevenueColumn
Exclusion$1,151,100ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue1877776TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column309625287TotalRevenueColumn
Related Or Exempt Function Income288044816RelatedOrExemptFunctionIncome
Unrelated Business Revenue303449UnrelatedBusinessRevenue
Exclusion$10,732,185ExclusionAmount
FieldValueIRS element (for citing)
Info In Schedule O Part IXXInfoInScheduleOPartIX

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total2843407Total
Program Services2843407ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total2601710Total
Program Services507841ProgramServices
Management And General1787985ManagementAndGeneral
Fundraising305884Fundraising

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total96848335Total
Program Services87845671ProgramServices
Management And General8854278ManagementAndGeneral
Fundraising148386Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total5827183Total
Program Services5200748ProgramServices
Management And General626435ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total23199411Total
Program Services20751785ProgramServices
Management And General2390513ManagementAndGeneral
Fundraising57113Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total8325419Total
Program Services7506675ProgramServices
Management And General781976ManagementAndGeneral
Fundraising36768Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total1449659Total
Management And General1449659ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total430420Total
Management And General430420ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total24764Total
Management And General24764ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total32657274Total
Program Services28298860ProgramServices
Management And General4331747ManagementAndGeneral
Fundraising26667Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total1687192Total
Program Services234640ProgramServices
Management And General1452552ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total277143Total
Program Services276884ProgramServices
Management And General259ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total111182Total
Program Services53249ProgramServices
Management And General52556ManagementAndGeneral
Fundraising5377Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total4088837Total
Program Services4088837ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total9767999Total
Program Services6507806ProgramServices
Management And General3260193ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1897077Total
Program Services1183152ProgramServices
Management And General713925ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
Supplies48102383471822469112728865
Hospital Fee Program220970622209706200
Bad Debts124965401249654000
Repairs and Maintenance854278048004493742331

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total8912112Total
Program Services5049824ProgramServices
Management And General2926562ManagementAndGeneral
Fundraising935726Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total292187889Total
Program Services256925676ProgramServices
Management And General33737427ManagementAndGeneral
Fundraising1524786Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY9451527BOY
EOY5649105EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY6586025BOY
EOY6740626EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY13618930BOY
EOY11988869EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY34511383BOY
EOY37688365EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY37668074BOY
EOY33978929EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1288607BOY
EOY1413111EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY13240813BOY
EOY11080538EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis408862884LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec292946688LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY95874918BOY
EOY115916196EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY237981498BOY
EOY233124539EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY2645443BOY
EOY3674483EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY452867218BOY
EOY461254761EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY49742594BOY
EOY58253430EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY56472177BOY
EOY51755688EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY55065433BOY
EOY48096732EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY161280204BOY
EOY158105850EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY191733033BOY
EOY206250896EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY42520333BOY
EOY39564367EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY57333648BOY
EOY57333648EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY291587014BOY
EOY303148911EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY452867218BOY
EOY461254761EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses17437398ReconcilationRevenueExpenses
Reconciliation Unrealized Invest-7494650ReconciliationUnrealizedInvest
Reconcilation Other Changes1619149ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$24,764OtherActivitiesAmount
Total Lobbying Expenditures IIB24764TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierExplanation of Lobbying Activities:Identifier
Return ReferencePart II-B, Line 1:ReturnReference
ExplanationLobbying represents a portion of the dues Good Samaritan Hospital pays to the Hospital Association of Southern California.Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance57333648BeginningOfYearBalance
End Of Year Balance57333648EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance57333648BeginningOfYearBalance
End Of Year Balance57333648EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance57333648BeginningOfYearBalance
End Of Year Balance57333648EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance57316151BeginningOfYearBalance
Contributions17497Contributions
End Of Year Balance57333648EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Beginning Of Year Balance57313907BeginningOfYearBalance
Contributions2244Contributions
End Of Year Balance57316151EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance1.00000PermanentEndowmentEOYBalance
Endowments Held By Unrelated Orgs1EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis11395670OtherCostOrOtherBasis
Book Value11395670BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis129462839OtherCostOrOtherBasis
Depreciation101477453Depreciation
Book Value27985386BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis220136810OtherCostOrOtherBasis
Depreciation188486015Depreciation
Book Value31650795BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis47867565OtherCostOrOtherBasis
Depreciation2983220Depreciation
Book Value44884345BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings115916196TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (6 entries)

DescriptionDescriptionAmountAmount
Reserve For Self-Insured Programs$7,860,320
Pension Plan$18,213,604
Advances From Third Party Payors$553,210
Reserve For Asset Retirement Obligation$8,147,659
Other Long Term Reserves/Liabilities$12,170,000
Other Annuity Payment Liability$1,151,939
FieldValueIRS element (for citing)
Total Of Amounts48096732TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Description of Intended Use of Endowment Funds:Part V, Line 4:For Specific purposes listed by the donors.
Description of Uncertain Tax Positions Under FIN 48: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, 2013 and 2012, the hospital did not record any liability for unrecognized tax contingencies.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1Golf TournamentNameOfEvent1
Gross Receipts Event1112925GrossReceiptsEvent1
Charitable Contributions Event174460CharitableContributionsEvent1
Gross Revenue Event138465GrossRevenueEvent1
Rent Facility Costs Event146882RentFacilityCostsEvent1
Food And Beverage Event18116FoodAndBeverageEvent1
Entertainment Event15616EntertainmentEvent1
Gross Receipts Total112925GrossReceiptsTotal
Charitable Contributions Total74460CharitableContributionsTotal
Gross Revenue Total Events38465GrossRevenueTotalEvents
Rent Facility Costs Total Events46882RentFacilityCostsTotalEvents
Food And Beverage Total Events8116FoodAndBeverageTotalEvents
Entertainment Total Events5616EntertainmentTotalEvents
Direct Expense Summary Events60614DirectExpenseSummaryEvents
Net Income Summary-22149NetIncomeSummary

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent350XPcent350
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense11580081TotalCommunityBenefitExpense
Direct Offsetting Revenue1585727DirectOffsettingRevenue
Net Community Benefit Expense9994354NetCommunityBenefitExpense
Percent Of Total Expense0.03570PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense76111275TotalCommunityBenefitExpense
Direct Offsetting Revenue72054558DirectOffsettingRevenue
Net Community Benefit Expense4056717NetCommunityBenefitExpense
Percent Of Total Expense0.01450PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense87691356TotalCommunityBenefitExpense
Direct Offsetting Revenue73640285DirectOffsettingRevenue
Net Community Benefit Expense14051071NetCommunityBenefitExpense
Percent Of Total Expense0.05020PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense138903TotalCommunityBenefitExpense
Net Community Benefit Expense138903NetCommunityBenefitExpense
Percent Of Total Expense0.00050PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Total Community Benefit Expense1683014TotalCommunityBenefitExpense
Direct Offsetting Revenue464273DirectOffsettingRevenue
Net Community Benefit Expense1218741NetCommunityBenefitExpense
Percent Of Total Expense0.00440PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense970240TotalCommunityBenefitExpense
Net Community Benefit Expense970240NetCommunityBenefitExpense
Percent Of Total Expense0.00350PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense2792157TotalCommunityBenefitExpense
Direct Offsetting Revenue464273DirectOffsettingRevenue
Net Community Benefit Expense2327884NetCommunityBenefitExpense
Percent Of Total Expense0.00840PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense90483513TotalCommunityBenefitExpense
Direct Offsetting Revenue74104558DirectOffsettingRevenue
Net Community Benefit Expense16378955NetCommunityBenefitExpense
Percent Of Total Expense0.05860PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$1,895,283BadDebtExpenseAmount
Amount Reimbursed By Medicare86814622AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare83871762CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall2942860MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Good Samaritan HospitalBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1616 South Witmer StreetAddressLine1
CityLos AngelesCity
StateCAState
ZIP Code90071ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Teaching HospitalXTeachingHospital
Research FacilityXResearchFacility
Er24 HoursXEr24Hours
OtherHospital research by InstitutesOther

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1GOOD SAMARITAN HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA Conducted1CHNAConducted
Community DefinitionXCommunityDefinition
Community DemographicsXCommunityDemographics
Existing ResourcesXExistingResources
How Data ObtainedXHowDataObtained
Community Health NeedsXCommunityHealthNeeds
Other Health IssuesXOtherHealthIssues
Identifying ProcessXIdentifyingProcess
Consulting ProcessXConsultingProcess
Information GapsXInformationGaps
Needs Assessment Conducted10NeedsAssessmentConducted
Take Into Account1TakeIntoAccount
Other Facilities1OtherFacilities
CHNA Widely Available1CHNAWidelyAvailable
On RequestXOnRequest
Adopt Implement StrategyXAdoptImplementStrategy
Execute Implement StrategyXExecuteImplementStrategy
Prioritize Health NeedsXPrioritizeHealthNeeds
Prioritize ServicesXPrioritizeServices
All Needs Addressed0AllNeedsAddressed
Organization Incur Excise Tax0OrganizationIncurExciseTax
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent200.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent350.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
State RegulationXStateRegulation
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Attached To InvoicesXAttachedToInvoices
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Available On RequestXAvailableOnRequest
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Medicare RateXMedicareRate
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (15 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
Part I, Line 3c: Discounted care is provided to patients that are uninsured and do not meet the charity care eligibility criteria.
Part I, Line 7: 7 a) Charity cost: applied RCC from hospital's FY 2013 internal financial statements of 19.5% to charity write-offs. 7 b) Unreimbursed Medi-Cal: cost for all Medi-Cal patients calculated from cost accounting system less payments received and estimated outstanding. 7 e) Community health improvement services: general ledger expenses for the hospital's volunteer program. 7 h) Research: expenses from Research general ledger account less funding received.7 i) Cash in-kind contributions: Amounts paid to California Health Fund & Trust.
Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 12496540.
Part III, Line 4: Bad debt cost determined by applying RCC from hospital financial statements to bad debt transfers net of recoveries. These costs were not included in community benefit cost.
Part III, Line 8: Filed Medicare cost report.
Part III, Line 9b: The debt collection policy indicates that patients that qualify for charity will be adjudicated under that policy. Charity patients receive a 100% discount. Patients whose family income is between 200% and 350% of the FPL will receive a 60% discount on the cash price for uninsured patients.
Part V, Section B, Line 3: Focus Groups - Two types of focus groups were conducted in order to collect information from both the community member perspective as well as the CBO perspective. CBOs included agencies that provide health, social, and other types of services. Information was gathered to identify areas of needs and services available or lacking to meet those needs. In addition, an online survey was made available to CBOs who were unable to attend a focus group. In total, there were ten focus groups conducted (5 with community members and 5 with CBOs) with a total of 158 participants. The focus group interviews were conducted in either English or Spanish, with a mixed age group, including both males and females. Groups included residents from major ethnic groups, geographic areas and service providers in the Collaborative's service areas. Seniors, community health promoters and service providers were gathered separately. Topics in the focus group included major areas from previous needs assessments and other issues anticipated to be important in health care. Areas covered were: health care utilization, preventative and primary care, health insurance, access and barriers to care, emergency room use, chronic disease management and community issues. Individual Interviews - Thirty interviews were conducted to gather information about the needs and challenges faced by the community in accessing and utilizing health care services, and to ensure reliable and representative information. Key informants included staff at collaborative hospitals and health care service organizations in the primary service areas. Interviews were conducted over the phone or in person and lasted approximately 45 minutes.GOOD SAMARITAN HOSPITAL
Part V, Section B, Line 4: Good Samaritan Hospital conducted the Community Needs Assessment in collaboration with California Hospital Medical Center, Children's Hospital of Los Angeles, Kaiser Foundation Hospital - Los Angeles, St. Vincent Medical Center.GOOD SAMARITAN HOSPITAL
Part V, Section B, Line 7: Good Samaritan Hospital identified 7 focus issues in the latest Community Health Needs Assessment. Of the 7 issues identified, the following 5 are currently being addressed: Primary Care, Health Behaviors, Chronic Disease, Cancer and Disease Prevention/Community/Social Issues. The 2 issues that have not been addressed and are not part of an implementation plan are HIV/AIDS/Communicable Diseases and Mental Health. The Hospital has determined that it currently does not have the capacity to address these issues. However, when applicable, the Hospital will refer patients with those needs to outside organizations that are capable of working with those patients.GOOD SAMARITAN HOSPITAL
Part I, line 7b:In October 2010, CMS approved legislation enacted by the State of California that provided for supplemental Medi-Cal payments to be paid to certain hospitals from funds collected from participating hospitals under the state's quality assurance fee program. Such amounts were allocated and paid to the Good Samaritan Hospital based on prior year patient data, which includes Medi-Cal patients. If these amounts had not been included, the Hospital would have reported a total Community Benefit percentage in excess of 12%.
Part VI, Line 2: Based on a community needs assessment conducted every three years in collaboration with neighboring hospitals and health care organizations, Good Samaritan Hospital develops a yearly community benefit plan that is submitted to the State. The plan includes proposed activities designed around disease prevention efforts and improvement of health status along a progress report on goals from the previous year. Seven major content areas were identified in previous needs assessments that is included in the community benefit plan: Access, Health Behaviors, Risk Behaviors, Chronic Disease, Communicable Diseases, Mental Health and Community and Social Issues.
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.
Part VI, Line 4: Good Samaritan Hospital's ("GSH") primary service area is defined by sixteen zip codes within a five mile radius. The zip codes in this area contain a population of one-half million residents, as described in the Year 2000 U.S. Census Report. The zip codes are as follows: 90004, 90005, 90006, 90007, 90010, 90012, 90013, 90014, 90015, 90017, 90018, 90020, 90021, 90026, 90057, 90071. Based on the last community needs assessment (2010), Latinos accounted for a majority of the population in the GSH service area (59.9%) and four out of five of its health districts (Central, Hollywood, Northeast and Southeast). The second largest ethnic group in the GSH service area is Asian/Pacific Islanders (32.1%).
Part VI, Line 5: Good Samaritan Hospital maintains an active presence in the community through the volunteer and advocacy efforts of its physicians, employees and Board of Trustees. The hospital provides support to community clinics by providing services such as transportation for patients to the hospital. The hospital also hosts conferences open to the public at no cost on topics related to various health issues prevalent in the community. Good Samaritan Hospital publishes Good Health, a community newsletter that goes out to 16,000 households to increase awareness and understanding of medical advances related to cardiovascular care, orthopedic services, transfusion-free medicine and surgery, urology, oncology and womens and newborn services. Good Samaritan Hospital also provides community building activities to promote health, wellness and safety through: health fairs, health lectures, hosting cancer support groups, community policy advisory meetings to discuss neighborhood safety, annual Blessing of the Bicycles to promote bike and road safety as well as the benefits of cycling.
CAReports Filed With StatesPart VI, Line 7

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
Heart Institute of the Good Samaritan Hospital
616 South Witmer StreetLos AngelesCA90017954077161501(c)(3)1845571Expenses paid by the Hospital
Orthopedic Institute of the Good Samaritan Hospital
616 South Witmer StreetLos AngelesCA90017954346048501(c)(3)27596Expenses paid by the Hospital
California Health Foundation and Trust
1215 K Street Suite 800SacramentoCA95814941498687501(c)(3)970240Support Charitable activities at hospitals & health systems in California
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants3TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierProcedure for Monitoring Grants in the U.S.:Identifier
Return ReferencePart I, Line 2:ReturnReference
ExplanationSchedule I, Part I, Line 2: The Institutes (Heart 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, thru 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.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (13 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Andrew Leeka
CEO526821000764407500031800545145000
Alan M Ino
CFO433811000007500025160443827000
Susan Harlow
VP, Development260093000454470003450305885000
Lexie Schuster
VP, Human Resources2638020005500075000271357000
Sammy Feuerlicht
VP, Bus. Development241610000007296015830250489000
Dan McLaughlin
VP, Professional Services248256000006202025160256974000
Margaret Pfeiffer
VP, Nursing Services249808000000010590250867000
Dean Campbell
VP, Information Services269229000005938020000277167000
Ching Chen
Chief Radiation Physicst26307900000750008160271395000
Ira Meiselman
Director, Managed Care232491000006525050160244032000
Hilarion Castillo
Controller224357000006800023230233480000
Rolando Demafelix
Coord. - Cardiothoracic22354800000898109850233514000
Elizabeth Pabros
Staff RN21224100055010612000222908000

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part VI, Section A, line 1The Executive Committee consists only of no less than five and no more than eleven members of the Board of Directors. Three of the members will be the Chairman of the Board, the President of the organization and the Chairman of the Medical Staff. The others will be appointed, after considering nominations by the Chairman. Between meetings of the Board of Directors, the Executive Committee will have and exercise all the authority of the Board in the management of the organization. At meetings of the board of Directors, the Executive Committee will report on actions taken between the meetings, and will propose actions to the Board of Directors. The Executive Committee will meet on the call of the Chairman of the Board or the President. Four members of the Committee shall constitute a quorum.
Form 990, Part VI, Section A, line 2Mrs. Borthwick, a board member of Good Samaritan Hospital has a family relationship with Mr. Charles Munger, chairman of the board. Clark Willard Porter has a family relationship with Glen H. Mitchel, Jr.
Form 990, Part VI, Section B, line 11The organization works with an independent accountant, Deloitte Tax LLP, to prepare the Form 990. Once the return is prepared, the return is reviewed by the Chief Financial Officer and the Controller. The draft of the Form 990 is presented to the Audit Committee. Subsequent to review by the Audit Committee, the CFO and the Controller will provide any final comments to Deloitte Tax LLP. Deloitte Tax LLP makes all changes necessary and a final Form 990 is made available to all board members.
Form 990, Part VI, Section B, line 12cAll 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 15A 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 hospital 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 19Good 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. The organiztion's financial statements were audited by an independent accountant and are included in the consolidated audited financial statements for Good Samaritan Hospital and affiliates. Good Samaraitan Hospital's audit committee assumes responsibility for the oversight of the audit and its financial statements and the selection of an independent accountant.
Form 990, Part IX, line 11gPurchased Services: Program service expenses 22,535,385. Management and general expenses 4,178,936. Fundraising expenses 26,567. Total expenses 26,740,888. Purchased Labor: Program service expenses 5,763,475. Management and general expenses 152,811. Fundraising expenses 100. Total expenses 5,916,386.Other Fees
Form 990, Part XI, line 9:Minimum Pension Liability 3,548,525. Intercompany Adjustments -1,929,376.Changes in Net Assets or Fund Balances:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (8 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
Heart Institute of the Good Samaritan Hospital
616 South Witmer StreetLos AngelesCA90017954077161Heart ResearchCAsection 501(c)(3)4Good Samaritan Hospital1
Orthopedic Institute of the Good Samaritan Hospital
616 South Witmer StreetLos AngelesCA90017954346048Orthopedic ResearchCAsection 501(c)(3)11, Type 1Good Samaritan Hospital1
Samaritan Imaging Center
1245 Wilshire Blvd Suite 205Los AngelesCA90017954252321Outpatient Imaging ServicesCAsection 501(c)(3)9Good Samaritan Hospital1
Cancer Institute of the Good Samaritan Hospital
616 South Witmer StreetLos AngelesCA90017954271815Cancer ResearchCAsection 501(c)(3)4Good Samaritan Hospital1
Institute for Reproductive Research of the Hospital of the Good Samaritan
616 South Witmer StreetLos AngelesCA90017954252306Reproductive ResearchCAsection 501(c)(3)11, Type 1Good Samaritan Hospital1
Good Samaritan Hospital Medical Office Building Inc
1245 Wilshire Blvd Suite 205Los AngelesCA90017953244046Physicians Medical OfficesCAsection 501(c)(3)11, Type 1Good Samaritan Hospital1
Auxiliary of the Hospital of the Good Samaritan
616 South Witmer StreetLos AngelesCA90017956051253Welfare of the Good Samaritan HospitalCAsection 501(c)(3)11, Type 3Good Samaritan Hospital1
Kate Van Nuys Page Foundation
616 South Witmer StreetLos AngelesCA90017956028032Grants income to Good Samaritan HospitalCAsection 501(c)(3)11, Type 1Good Samaritan Hospital1
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties1ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (5 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
Good Samaritan Hospital Medical Office Bldg
A522375FMV
Good Samaritan Hospital Medical Office Bldg
K215615FMV
Heart Institute of the Good Samaritan Hosp
B1845571FMV
Heart Institute of the Good Samaritan Hosp
C5785623FMV
Orthopedic Inst of the Good Samaritan Hosp
B27596FMV