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PIH HEALTH GOOD SAMARITAN HOSPITAL: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
PIH HEALTH GOOD SAMARITAN HOSPITAL (EIN 95-1656366)
Tax period
2011-09-01 to 2012-08-31
Filed
2013-07-08
IRS object ID
201331899349300938
Schema version
2011v1.5
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)
Timestamp2013-07-08T17:03:03-05:00Timestamp
Tax Period End Date2012-08-31TaxPeriodEndDate

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 Date2011-09-01TaxPeriodBeginDate

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 Signed2013-07-08DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameDIANA J McCUTCHENName
PTINP00545657PTIN
Phone7144367100Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

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 Receipts387096828GrossReceipts
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 Body31NbrVotingMembersGoverningBody
Nbr Independent Voting Members30NbrIndependentVotingMembers
Total Nbr Employees1754TotalNbrEmployees
Total Nbr Volunteers30TotalNbrVolunteers
Total Gross UBI380392TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year8735356ContributionsGrantsPriorYear
Contributions Grants Current Year7368138ContributionsGrantsCurrentYear
Program Service Revenue Prior Year304535116ProgramServiceRevenuePriorYear
Program Service Revenue CY299502103ProgramServiceRevenueCY
Investment Income Prior Year9273290InvestmentIncomePriorYear
Investment Income Current Year10081490InvestmentIncomeCurrentYear
Other Revenue Prior Year1769308OtherRevenuePriorYear
Other Revenue Current Year3925129OtherRevenueCurrentYear
Total Revenue Prior Year324313070TotalRevenuePriorYear
Total Revenue Current Year320876860TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year2757061GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY3457353GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year140588254SalariesEtcPriorYear
Salaries Etc Current Year137412341SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year1511296TotalFundrsngExpCurrentYear
Other Expense Prior Year157888340OtherExpensePriorYear
Other Expenses Current Year163816070OtherExpensesCurrentYear
Total Expenses Prior Year301233655TotalExpensesPriorYear
Total Expenses Current Year304685764TotalExpensesCurrentYear
Revenues Less Expenses Prior Year23079415RevenuesLessExpensesPriorYear
Revenues Less Expenses CY16191096RevenuesLessExpensesCY
Total Assets BOY413688317TotalAssetsBOY
Total Assets EOY452867218TotalAssetsEOY
Total Liabilities BOY158646027TotalLiabilitiesBOY
Total Liabilities EOY161280204TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY255042290NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY291587014NetAssetsOrFundBalancesEOY
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
Expense271457583Expense
Grants2758720Grants
Revenue299502103Revenue
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, 2012 patient days totaled 61,444 and outpatient visits totaled 88,622.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 $11,334,214 for fiscal year 2012.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 $32,421,628 for fiscal year 2012.Description
Total Program Service Expense271457583TotalProgramServiceExpense
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 With1096471NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees1754NumberOfEmployees
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 Members31NbrVotingGoverningBodyMembers
Number Independent Voting Members30NumberIndependentVotingMembers
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
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (42 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
Andrew Leeka
CEO55.00XX519335010530
Sushma Adarkar MD
Trustee1.00X000
George A Bender
Trustee1.00X000
Bruce Bennett
Trustee1.00X000
William M Bitting
Trustee1.00X000
Mrs Jack L Blumenthal
Trustee1.00X000
Mrs William H Borthwick
Trustee1.00X000
Rt Rev Joseph Jon Bruno
Trustee1.00X000
Mrs Richard W Call
Trustee1.00X000
Arthur L Crowe Jr
Trustee1.00X000
Mrs Victoria Seaver Dean
Trustee1.00X000
Robert E Denham
Trustee1.00X000
Andrew Fishmann MD
Trustee1.00X000
John B Frank
Trustee1.00X000
James H Gipson
Trustee1.00X000
Ms Mimi Grant
Trustee1.00X000
Robert K Maloney
Trustee1.00X000
Mrs Angus M McLeod
Trustee1.00X000
Charles P Meister
Trustee1.00X000
Glen H Mitchel Jr
Trustee1.00X000
Peter W Mullin
Trustee1.00X000
Charles T Munger
Chairman1.00X000
Todd G Owens
Trustee1.00X000
Clark Willard Porter
Trustee1.00X000
Mrs Helen Lho Ryu
Trustee1.00X000
Thomas L Shook MD
Trustee1.00X000
Stephen L Smith
Trustee1.00X000
Norman F Sprague III MD
Trustee1.00X000
Joseph P Van der Meulen
Trustee1.00X000
Warren B Williamson
Trustee1.00X000
Edward A Wopschall
Trustee1.00X000
Alan M Ino
CFO55.00X42309609866
Susan Harlow
VP, Development40.0025785707695X
Lexie Schuster
VP, Human Resources40.0026131307350X
Sammy Feuerlicht
VP, Bus Development40.0023511708993X
Dan McLaughlin
VP, General Services40.0024533503730X
Berniece Deol
VP, Nursing Services40.002946090305X
Ching Chen
Chief Radiation Physicst40.0024783908166X
Ira Meiselman
Director, Managed Care40.00232154011351X
Hilarion Castillo
Controller40.0022374908925X
Elizabeth Pabros
Staff RN40.0019322609659X
Steve Garcia
Dir.,Pt.Financial Svcs.40.00186511010827X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3320141TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation97397TotalOtherCompensation
Number Individuals GT100 K205NumberIndividualsGT100K
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 Services4488222
Sodexho Marriott Services
711 Kimberly Avenue Suite 250PlacentiaCA92870Dietary Services3701273
Cross Country StaffFlex Staff
P O Box 404674AtlantaGA30384Employment Registry1511431
Dell Marketing
120 Royall StreetCantonMA02021Health Insurance Management1395815
DVA Renal Healthcare Inc
P O Box 403008AtlantaGA30384Dialysis Services1022394
FieldValueIRS element (for citing)
Number Of Contractors GT100 K88NumberOfContractorsGT100K
Fundraising Events78050FundraisingEvents
Related Organizations1193705RelatedOrganizations
All Other Contributions6096383AllOtherContributions
Total Contributions7368138TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Net Patient Revenue900099298263927298263927
Rental Income532000733547733547
Child Care Center624410468350468350
Symposium Revenue9000993627936279
FieldValueIRS element (for citing)
Total Program Service Revenue299502103TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column9058022TotalRevenueColumn
Exclusion$9,058,022ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities67105472Securities
Other48118Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities66130122Securities
Other0Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities975350Securities
Other48118Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column1023468TotalRevenueColumn
Exclusion$1,023,468ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events65165GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events78050CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses89846FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-24681TotalRevenueColumn
Exclusion-$24,681ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnUnrelated Business RevenueUnrelatedBusinessRevenueExclusionExclusionAmount
Parking Lot81293048011629485$450,631
Physician Mgmt Service621110242331242331
Non-patient Lab621500108576108576

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column3118787TotalRevenueColumn
Exclusion$3,118,787ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue3949810TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column320876860TotalRevenueColumn
Related Or Exempt Function Income299502103RelatedOrExemptFunctionIncome
Unrelated Business Revenue380392UnrelatedBusinessRevenue
Exclusion$13,626,227ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total3457353Total
Program Services3457353ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total2285131Total
Program Services294914ProgramServices
Management And General1724665ManagementAndGeneral
Fundraising265552Fundraising

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total96308210Total
Program Services87719882ProgramServices
Management And General8281687ManagementAndGeneral
Fundraising306641Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total5737654Total
Program Services5151382ProgramServices
Management And General586272ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total24598636Total
Program Services22203274ProgramServices
Management And General2324320ManagementAndGeneral
Fundraising71042Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total8482710Total
Program Services7667436ProgramServices
Management And General770329ManagementAndGeneral
Fundraising44945Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total861780Total
Management And General861780ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total382446Total
Management And General382446ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total25347Total
Management And General25347ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total42274267Total
Program Services33719771ProgramServices
Management And General8498657ManagementAndGeneral
Fundraising55839Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total1128764Total
Program Services139580ProgramServices
Management And General988884ManagementAndGeneral
Fundraising300Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total455407Total
Program Services454407ProgramServices
Management And General1000ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total156502Total
Program Services42638ProgramServices
Management And General106449ManagementAndGeneral
Fundraising7415Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total4395038Total
Program Services4395038ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total9496239Total
Program Services6609971ProgramServices
Management And General2886268ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1215388Total
Program Services601051ProgramServices
Management And General614337ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
Supplies483769564766090170285713198
Hospital Fee Program335338793353387900
Bad Debts126720081267200800
Utilities3237860314554392317

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total5604189Total
Program Services1988555ProgramServices
Management And General2869270ManagementAndGeneral
Fundraising746364Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total304685764Total
Program Services271457583ProgramServices
Management And General31716885ManagementAndGeneral
Fundraising1511296Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY13112844BOY
EOY9451527EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY6559400BOY
EOY6586025EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY14111669BOY
EOY13618930EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY35763304BOY
EOY34511383EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY16034956BOY
EOY37668074EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1399114BOY
EOY1288607EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY13918132BOY
EOY13240813EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis379364372LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec283489454LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY92634709BOY
EOY95874918EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY217975854BOY
EOY237981498EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY2178335BOY
EOY2645443EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY413688317BOY
EOY452867218EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY42837100BOY
EOY49742594EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY60880882BOY
EOY56472177EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY54928045BOY
EOY55065433EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY158646027BOY
EOY161280204EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY157290065BOY
EOY191733033EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY40418577BOY
EOY42520333EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY57333648BOY
EOY57333648EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY255042290BOY
EOY291587014EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY413688317BOY
EOY452867218EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses16191096ReconcilationRevenueExpenses
Reconcilation Other Changes20353628ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
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)
Org Belongs To Affiliated GroupXOrgBelongsToAffiliatedGroup
Limited Control Provisions ApplyXLimitedControlProvisionsApply
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$25,347OtherActivitiesAmount
Total Lobbying Expenditures IIB25347TotalLobbyingExpendituresIIB
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

FieldValueIRS element (for citing)
Beginning Balance0BeginningBalance
Ending Balance0EndingBalance

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 Balance57316151BeginningOfYearBalance
Contributions17497Contributions
End Of Year Balance57333648EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

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 Basis128932121OtherCostOrOtherBasis
Depreciation98306726Depreciation
Book Value30625395BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis213299598OtherCostOrOtherBasis
Depreciation182241237Depreciation
Book Value31058361BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis25736983OtherCostOrOtherBasis
Depreciation2941491Depreciation
Book Value22795492BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings95874918TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (6 entries)

DescriptionDescriptionAmountAmount
Reserve For Self-Insured Programs$7,613,831
Pension Plan$21,762,129
Advances From Third Party Payors$4,076,311
Reserve For Asset Retirement Obligation$7,686,472
Other Long term Reserves/Liabilities$12,735,188
Other Annuity Payment Liability$1,191,502
FieldValueIRS element (for citing)
Total Of Amounts55065433TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (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: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, 2012 and 2011, 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 Event1143215GrossReceiptsEvent1
Charitable Contributions Event178050CharitableContributionsEvent1
Gross Revenue Event165165GrossRevenueEvent1
Rent Facility Costs Event161841RentFacilityCostsEvent1
Other Direct Expenses Event128005OtherDirectExpensesEvent1
Gross Receipts Total143215GrossReceiptsTotal
Charitable Contributions Total78050CharitableContributionsTotal
Gross Revenue Total Events65165GrossRevenueTotalEvents
Rent Facility Costs Total Events61841RentFacilityCostsTotalEvents
Other Direct Expenses Total Events28005OtherDirectExpensesTotalEvents
Direct Expense Summary Events89846DirectExpenseSummaryEvents
Net Income Summary-24681NetIncomeSummary

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 Available0ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense12271220TotalCommunityBenefitExpense
Direct Offsetting Revenue1500291DirectOffsettingRevenue
Net Community Benefit Expense10770929NetCommunityBenefitExpense
Percent Of Total Expense0.03690PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense92506663TotalCommunityBenefitExpense
Direct Offsetting Revenue85671161DirectOffsettingRevenue
Net Community Benefit Expense6835502NetCommunityBenefitExpense
Percent Of Total Expense0.02340PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense104777883TotalCommunityBenefitExpense
Direct Offsetting Revenue87171452DirectOffsettingRevenue
Net Community Benefit Expense17606431NetCommunityBenefitExpense
Percent Of Total Expense0.06030PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense140504TotalCommunityBenefitExpense
Net Community Benefit Expense140504NetCommunityBenefitExpense
Percent Of Total Expense0.00050PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Percent Of Total Expense0.00000PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Percent Of Total Expense0.00000PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Total Community Benefit Expense2026741TotalCommunityBenefitExpense
Direct Offsetting Revenue682912DirectOffsettingRevenue
Net Community Benefit Expense1343829NetCommunityBenefitExpense
Percent Of Total Expense0.00460PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense1256688TotalCommunityBenefitExpense
Net Community Benefit Expense1256688NetCommunityBenefitExpense
Percent Of Total Expense0.00430PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense3423933TotalCommunityBenefitExpense
Direct Offsetting Revenue682912DirectOffsettingRevenue
Net Community Benefit Expense2741021NetCommunityBenefitExpense
Percent Of Total Expense0.00940PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense108201816TotalCommunityBenefitExpense
Direct Offsetting Revenue87854364DirectOffsettingRevenue
Net Community Benefit Expense20347452NetCommunityBenefitExpense
Percent Of Total Expense0.06970PercentOfTotalExpense

Physical Improvements And Housing PhysicalImprovementsAndHousing

FieldValueIRS element (for citing)
Percent Of Total Expense0.00000PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Percent Of Total Expense0.00000PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Percent Of Total Expense0.00000PercentOfTotalExpense

Environmental Improvements EnvironmentalImprovements

FieldValueIRS element (for citing)
Percent Of Total Expense0.00000PercentOfTotalExpense

Leadership Development LeadershipDevelopment

FieldValueIRS element (for citing)
Percent Of Total Expense0.00000PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Percent Of Total Expense0.00000PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Percent Of Total Expense0.00000PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Percent Of Total Expense0.00000PercentOfTotalExpense

Other Other

FieldValueIRS element (for citing)
Percent Of Total Expense0.00000PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$1,863,325BadDebtExpenseAmount
Amount Attributable To0AmountAttributableTo
Amount Reimbursed By Medicare90888067AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare83396579CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall7491488MedicareSurplusOrShortfall

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 Code90017ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Teaching HospitalXTeachingHospital
Critical Access HospitalXCriticalAccessHospital
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
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 Addressed1AllNeedsAddressed
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 (14 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 care cost: applied FY 2012 Medi-Cal RCC of 20.59% (total patient cost to charges excluding Hospital Fee expense) 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 $ 12672008.
Part III, Line 4: Bad debt cost determined by applying RCC from FY 2012 Medi-Cal cost report to bad debt transfers net of recoveries. These costs were not included in community benefit.
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 memebers 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, Childrens Hospital of Los Angeles, Kaiser Foundation Hospital - Los Angeles, St. Vincent Medical Center.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 13%.
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 lecures, 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)1876038Expenses paid by the Hospital
Orthopedic Institute of the Good Samaritan Hospital
616 South Witmer StreetLos AngelesCA90017954346048501(c)(3)324627Expenses paid by the Hospital
California Health Foundation and Trust
1215 K Street Suite 800SacramentoCA95814941498687501(c)(3)1256688Support 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 (12 entries)

Base 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
511436000789907350031800529865000
Alan M Ino
423096000007350025160432962000
Susan Harlow
25785700000735003450265552000
Lexie Schuster
2612580005507350000268663000
Sammy Feuerlicht
235117000007110018830244110000
Dan McLaughlin
245335000001214025160249065000
Berniece Deol
29460900000003050294914000
Ching Chen
24783900000735008160256005000
Ira Meiselman
232154000006335050160243505000
Hilarion Castillo
223749000006602023230232674000
Elizabeth Pabros
193226000009659000202885000
Steve Garcia
186511000005611052160197338000

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. who are board members.
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 VII:Compensation reported on Form 990, Part VII was paid to each of these individuals in exchange for the fulfillment of their duties as full-time, 40+ hour-per-week employees at Good Samaritan Hospital and 2 hours-per-week employees at related organizations.Avg hours devoted to related org(s) when related comp is reported:
Form 990, Part XI, line 5:Net unrealized gains on investments: 20,623,878. Minimum Pension Liability -2,745,557. Intercompany Adjustments 2,475,307. Total to Form 990, Part XI, Line 5: 20,353,628.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 StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrg
Heart Institute of the Good Samaritan Hospital
616 South Witmer StreetLos AngelesCA90017954077161Heart ResearchCAsection 501(c)(3)4N/A1
Orthopedic Institute of the Good Samaritan Hospital
616 South Witmer StreetLos AngelesCA90017954346048Orthopedic ResearchCAsection 501(c)(3)11, Type 1N/A1
Samaritan Imaging Center
616 South Witmer StreetLos AngelesCA90017954252321Outpatient Imaging ServicesCAsection 501(c)(3)9N/A1
Cancer Institute of the Good Samaritan Hospital
616 South Witmer StreetLos AngelesCA90017954271815Cancer ResearchCAsection 501(c)(3)4N/A1
Institute for reproductive research of the Hospital of the Good Samaritan
616 South Witmer StreetLos AngelesCA90017954252306Reproductive ResearchCAsection 501(c)(3)11, Type 1N/A1
Good Samaritan Hospital Medical Office Building Inc
616 South Witmer StreetLos AngelesCA90017953244046Physicians Medical OfficesCAsection 501(c)(3)11, Type 1N/A1
Auxiliary of the Hospital of the Good Samaritan
616 South Witmer StreetLos AngelesCA90017956051253Welfare of the Good Samaritan HospitalCAsection 501(c)(3)11, Type 3N/A1
Kate Van Nuys Page Foundation
616 South Witmer StreetLos AngelesCA90017956028032Grants income to Good Samaritan HospitalCAsection 501(c)(3)11, Type 1N/A1
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
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
A560615FMV
Good Samaritan Hospital Medical Office Bldg
J302245FMV
Heart Institute of the Good Samaritan Hosp
B1876038FMV
Heart Institute of the Good Samaritan Hosp
C652011FMV
Orthopedic Inst of the Good Samaritan Hosp
B324627FMV