PIH HEALTH GOOD SAMARITAN HOSPITAL: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- PIH HEALTH GOOD SAMARITAN HOSPITAL (EIN 95-1656366)
- Tax period
- 2016-09-01 to 2017-08-31
- Filed
- 2018-07-16
- IRS object ID
- 201811989349300761
- Schema version
- 2016v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-07-16T09:29:11-05:00 | ReturnTs |
| Tax Period End | 2017-08-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 861065772 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Deloitte Tax LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 East Fifth Street Suite 1900 | AddressLine1Txt |
| City | Cincinnati | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45202 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-09-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 951656366 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Good Samaritan Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GOOD | BusinessNameControlTxt |
| Phone | 2139772121 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1225 Wilshire Blvd | AddressLine1Txt |
| City | Los Angeles | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 900172395 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ALAN M INO | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 2139772121 | PhoneNum |
| Signature | 2018-07-16 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Rebecca Lyons | PreparerPersonNm |
| PTIN | P01487105 | PTIN |
| Phone | 5137847100 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Andrew B Leeka | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1225 Wilshire Blvd | AddressLine1Txt |
| City | Los Angeles | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 900172395 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $356,388,668 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.goodsam.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1885 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | Provide accessible, quality, cost-effective healthcare services at 408-bed hospital in LA. | ActivityOrMissionDesc |
| Voting Members Governing Body | 28 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 27 | VotingMembersIndependentCnt |
| Total Employee | 1609 | TotalEmployeeCnt |
| Total Volunteers | 368 | TotalVolunteersCnt |
| Total Gross UBI | $490,522 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$160,523 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $5,667,448 | PYContributionsGrantsAmt |
| CY Contributions Grants | $8,588,338 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $295,495,236 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $259,246,655 | CYProgramServiceRevenueAmt |
| PY Investment Income | $33,477,736 | PYInvestmentIncomeAmt |
| CY Investment Income | $23,089,563 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,683,367 | PYOtherRevenueAmt |
| CY Other Revenue | $1,791,134 | CYOtherRevenueAmt |
| PY Total Revenue | $336,323,787 | PYTotalRevenueAmt |
| CY Total Revenue | $292,715,690 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $931,177 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $582,229 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $148,748,671 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $151,825,748 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $1,490,100 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $165,886,266 | PYOtherExpensesAmt |
| CY Other Expenses | $156,323,744 | CYOtherExpensesAmt |
| PY Total Expenses | $315,566,114 | PYTotalExpensesAmt |
| CY Total Expenses | $308,731,721 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $20,757,673 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$16,016,031 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $488,758,576 | TotalAssetsBOYAmt |
| Total Assets EOY | $452,162,854 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $194,906,990 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $178,611,401 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $293,851,586 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $273,551,453 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | To provide accessible, quality, cost-effective community healthcare. The Hospital operates a 408-bed facility in inner-city Los Angeles. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $267,839,663 | ExpenseAmt |
| Grant | $582,229 | GrantAmt |
| Revenue | $258,955,320 | RevenueAmt |
| Desc | The Hospital is primarily engaged in providing inpatient and outpatient medical care for the general community regardless of ability to pay. Fiscal year August 31, 2017 patient days totaled 56,205 and outpatient visits totaled 80,071.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 cannot 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. | Desc |
| Total Program Service Expenses | $267,839,663 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 467 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 1609 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 28 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 27 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Ernalyn Baysac | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2139772003 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 637 South Lucas Ave 3rd Floor | AddressLine1Txt |
| City | Los Angeles | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 90017 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (41 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| Andrew B Leeka | |||||||||
| President & CEO | 50.00 | 8.00 | Yes (X) | Yes (X) | $638,801 | $0 | $29,308 | ||
| Charles T Munger | |||||||||
| Chairman | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | |||
| Sushma Adarkar MD | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Margaret Bates MD | |||||||||
| Trustee | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | |||
| George A Bender | |||||||||
| Trustee | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | |||
| Bruce Bennett | |||||||||
| Trustee | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | |||
| William M Bitting | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Mrs Jack L Blumenthal | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Mrs Maribeth A Borthwick | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| The Rt Rev Joseph Jon Bruno | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Arthur L Crowe Jr | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Victoria Seaver Dean | |||||||||
| Trustee | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | |||
| Robert E Denham | |||||||||
| Trustee | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | |||
| John B Frank | |||||||||
| Trustee | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | |||
| James H Gipson | |||||||||
| Trustee | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | |||
| Mimi Grant | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Robert K Maloney MD | |||||||||
| Trustee | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | |||
| Mrs Angus M McLeod | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Charles P Meister | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Glen H Mitchel Jr | |||||||||
| Trustee | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | |||
| Peter W Mullin | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Bruce E Pherson Jr | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Clark W Porter | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Helen Lho Ryu | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Thomas L Shook MD | |||||||||
| Trustee | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | |||
| Stephen L Smith | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Warren B Williamson | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Edward A Wopschall | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Alan M Ino | |||||||||
| CFO | 50.00 | 8.00 | Yes (X) | $489,850 | $0 | $27,444 | |||
| Michael Gomez | |||||||||
| VP Business Development | 40.00 | 0.00 | $181,581 | $0 | $14,764 | Yes (X) | |||
| Sammy Feuerlicht | |||||||||
| VP, Business Development | 24.00 | 0.00 | $246,288 | $0 | $23,086 | Yes (X) | |||
| Dan McLaughlin | |||||||||
| VP General Services | 20.00 | 0.00 | $163,153 | $0 | $8,657 | Yes (X) | |||
| Margaret Pfeiffer | |||||||||
| VP Nursing Services | 40.00 | 0.00 | $276,808 | $0 | $13,484 | Yes (X) | |||
| Lexis Schuster | |||||||||
| VP Human Resources | 40.00 | 0.00 | $293,650 | $0 | $14,240 | Yes (X) | |||
| Brian Thorne | |||||||||
| VP Fund Development | 40.00 | 0.00 | $265,145 | $0 | $26,885 | Yes (X) | |||
| Dean Campbell | |||||||||
| VP Info. Tech. Services | 40.00 | 0.00 | $299,600 | $0 | $10,950 | Yes (X) | |||
| Hilarion Castillo | |||||||||
| Controller | 40.00 | 0.00 | $252,164 | $0 | $14,848 | Yes (X) | |||
| Ching Chen | |||||||||
| Chief Radiation Physicst | 40.00 | 0.00 | $297,751 | $0 | $21,034 | Yes (X) | |||
| Samir Nabulsi | |||||||||
| Director Worker's Comp | 40.00 | 0.00 | $257,227 | $0 | $16,612 | Yes (X) | |||
| Ira Meiselman | |||||||||
| Director Managed Care | 40.00 | 0.00 | $253,125 | $0 | $29,132 | Yes (X) | |||
| Rolando Demafelix | |||||||||
| Coordinator Cardiothoracic | 40.00 | 0.00 | $232,584 | $0 | $30,308 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,147,727 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $280,752 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 530 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Millie and Severson Inc | |||||
| 3601 Serpentine Drive | Los Alamitos | CA | 90720 | Construction Services | $14,217,378 |
| Crothall Healthcare Inc | |||||
| 955 Chesterbrook Blvd Suite 300 | Wayne | PA | 19087 | Environmental Services | $5,049,916 |
| Sodexho Marriott Services | |||||
| 711 Kimberly Avenue Suite 250 | Placentia | CA | 92870 | Dietary Services | $3,330,560 |
| Smith and Severson Builders | |||||
| 21072 Bake Parkway Suite 106 | Lake Forest | CA | 92630 | Construction Services | $2,534,954 |
| California Commercial RE Svcs | |||||
| 1800 Quail St Ste 100 | Newport Beach | CA | 92660 | Real Estate Services | $1,572,577 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 99 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $150,200 | FundraisingAmt |
| Related Organizations | $895,245 | RelatedOrganizationsAmt |
| Government Grants | $642,925 | GovernmentGrantsAmt |
| All Other Contributions | $6,899,968 | AllOtherContributionsAmt |
| Total Contributions | $8,588,338 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| Net Patient Revenue | 900000 | $258,262,009 | $258,262,009 | |
| Child Care Center | 624410 | $539,509 | $248,174 | $291,335 |
| Rental Income | 532000 | $440,497 | $440,497 | |
| Symposium Revenue | 900000 | $4,640 | $4,640 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $259,246,655 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,785,024 | TotalRevenueColumnAmt |
| Exclusion | $7,785,024 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $78,835,137 | SecuritiesAmt |
| Other | $12,031 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $63,542,629 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $15,292,508 | SecuritiesAmt |
| Other | $12,031 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,304,539 | TotalRevenueColumnAmt |
| Exclusion | $15,304,539 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $75,395 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $150,200 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $130,349 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$54,954 | TotalRevenueColumnAmt |
| Exclusion | -$54,954 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| Parking Lot | 812930 | $518,912 | $36,211 | $482,701 |
| Non-Patient Lab | 621500 | $107,376 | $107,376 | |
| Physician Mgmt Svcs | 621110 | $55,600 | $55,600 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,164,200 | TotalRevenueColumnAmt |
| Exclusion | $1,164,200 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,846,088 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $292,715,690 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $258,955,320 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $490,522 | UnrelatedBusinessRevenueAmt |
| Exclusion | $24,681,510 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $582,229 | TotalAmt |
| Program Services | $582,229 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,921,407 | TotalAmt |
| Program Services | $442,434 | ProgramServicesAmt |
| Management And General | $2,204,122 | ManagementAndGeneralAmt |
| Fundraising | $274,851 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $103,388,193 | TotalAmt |
| Program Services | $93,980,291 | ProgramServicesAmt |
| Management And General | $9,265,321 | ManagementAndGeneralAmt |
| Fundraising | $142,581 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,854,062 | TotalAmt |
| Program Services | $8,786,951 | ProgramServicesAmt |
| Management And General | $1,067,111 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,968,926 | TotalAmt |
| Program Services | $24,131,943 | ProgramServicesAmt |
| Management And General | $2,787,648 | ManagementAndGeneralAmt |
| Fundraising | $49,335 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,693,160 | TotalAmt |
| Program Services | $7,758,428 | ProgramServicesAmt |
| Management And General | $899,597 | ManagementAndGeneralAmt |
| Fundraising | $35,135 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,381,873 | TotalAmt |
| Program Services | -$25 | ProgramServicesAmt |
| Management And General | $2,279,048 | ManagementAndGeneralAmt |
| Fundraising | $102,850 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $468,644 | TotalAmt |
| Management And General | $468,644 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,024 | TotalAmt |
| Management And General | $22,024 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,720,337 | TotalAmt |
| Program Services | $48,541,943 | ProgramServicesAmt |
| Management And General | $9,154,096 | ManagementAndGeneralAmt |
| Fundraising | $24,298 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,318,372 | TotalAmt |
| Program Services | $133,777 | ProgramServicesAmt |
| Management And General | $1,183,737 | ManagementAndGeneralAmt |
| Fundraising | $858 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $305,718 | TotalAmt |
| Program Services | $256,282 | ProgramServicesAmt |
| Management And General | $49,436 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,979 | TotalAmt |
| Program Services | $24,062 | ProgramServicesAmt |
| Management And General | $31,254 | ManagementAndGeneralAmt |
| Fundraising | $4,663 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,579 | TotalAmt |
| Program Services | $65,579 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,307,297 | TotalAmt |
| Program Services | $6,004,118 | ProgramServicesAmt |
| Management And General | $5,303,179 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,680,461 | TotalAmt |
| Program Services | $2,680,517 | ProgramServicesAmt |
| Management And General | $999,944 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Supplies | $57,863,836 | $57,553,878 | $297,888 | $12,070 |
| Hospital Fee Program | $10,903,888 | $10,903,888 | ||
| Utilities | $4,133,777 | $4,001,392 | $132,385 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,091,959 | TotalAmt |
| Program Services | $1,991,976 | ProgramServicesAmt |
| Management And General | $3,256,524 | ManagementAndGeneralAmt |
| Fundraising | $843,459 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $308,731,721 | TotalAmt |
| Program Services | $267,839,663 | ProgramServicesAmt |
| Management And General | $39,401,958 | ManagementAndGeneralAmt |
| Fundraising | $1,490,100 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,935,913 | BOYAmt |
| EOY | $11,801,346 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9 | BOYAmt |
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,399,987 | BOYAmt |
| EOY | $1,069,119 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $42,214,389 | BOYAmt |
| EOY | $44,009,592 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $54,505,792 | BOYAmt |
| EOY | $141,755,448 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,561,511 | BOYAmt |
| EOY | $1,418,756 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,895,959 | BOYAmt |
| EOY | $4,833,469 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $463,606,436 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $335,497,507 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $198,359,156 | BOYAmt |
| EOY | $128,108,929 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $178,885,860 | BOYAmt |
| EOY | $114,731,569 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $4,434,626 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $488,758,576 | BOYAmt |
| EOY | $452,162,854 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $82,771,575 | BOYAmt |
| EOY | $76,610,751 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $50,000,000 | BOYAmt |
| EOY | $49,775,939 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $62,135,415 | BOYAmt |
| EOY | $52,224,711 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $194,906,990 | BOYAmt |
| EOY | $178,611,401 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $207,508,211 | BOYAmt |
| EOY | $203,659,615 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,796,727 | BOYAmt |
| EOY | $12,343,190 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $57,546,648 | BOYAmt |
| EOY | $57,548,648 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $293,851,586 | BOYAmt |
| EOY | $273,551,453 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $488,758,576 | BOYAmt |
| EOY | $452,162,854 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$16,016,031 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$17,592,763 | NetUnrlzdGainsLossesInvstAmt |
| Prior Period Adjustments | $8,052,549 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $5,256,112 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $22,024 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $22,024 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | Lobbying expenses represent a portion of the dues Good Samaritan Hospital pays to the Hospital Association of Southern California. Good Samaritan Hospital does not participate in or intervene in (including the publishing or distributing of statements), any political on behalf or (or in opposition to) any candidate for public office. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $57,546,648 | BeginningYearBalanceAmt |
| Contributions | $2,000 | ContributionsAmt |
| End Year Balance | $57,548,648 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $57,435,648 | BeginningYearBalanceAmt |
| Contributions | $111,000 | ContributionsAmt |
| End Year Balance | $57,546,648 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $57,434,648 | BeginningYearBalanceAmt |
| Contributions | $1,000 | ContributionsAmt |
| End Year Balance | $57,435,648 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $57,333,648 | BeginningYearBalanceAmt |
| Contributions | $101,000 | ContributionsAmt |
| End Year Balance | $57,434,648 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $57,433,648 | BeginningYearBalanceAmt |
| End Year Balance | $57,433,648 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $17,195,670 | OtherCostOrOtherBasisAmt |
| Book Value | $17,195,670 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $141,027,924 | OtherCostOrOtherBasisAmt |
| Depreciation | $112,980,415 | DepreciationAmt |
| Book Value | $28,047,509 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $255,979,187 | OtherCostOrOtherBasisAmt |
| Depreciation | $219,362,729 | DepreciationAmt |
| Book Value | $36,616,458 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $49,403,655 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,154,363 | DepreciationAmt |
| Book Value | $46,249,292 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $128,108,929 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (6 entries)
| DescDesc | AmtAmt |
|---|---|
| Reserve For Self-Insured Programs | $5,980,590 |
| Pension Plan | $17,173,656 |
| Advances from Third Party Payors | $2,611,643 |
| Reserve for Asset Retirement Obligation | $10,237,730 |
| Other Annuity Payment Liability | $1,799,092 |
| Other Long Term Reserves | $14,422,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $52,224,711 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | For specific purposes listed by the donors. |
| Part X, Line 2: | The Hospital, SIC, and MOB are not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code (the "Code") and are exempt from federal income taxes pursuant to Section 501(a) of the Code. They are exempt from state franchise taxes under similar statutes. Accordingly, no provision for income taxes has been recorded in the accompanying consolidated financial statements. During the years ended August 31, 2017 and 2016, the Hospital did not record any liability for unrecognized tax contingencies. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | Golf Tournament | Event1Nm |
| Gross Receipts Event1 | $225,595 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $150,200 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $75,395 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $2,178 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $94,705 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $24,021 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $9,445 | OtherDirectExpensesEvent1Amt |
| Event2 | Event 2 | Event2Nm |
| Gross Receipts Total | $225,595 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $150,200 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $75,395 | GrossRevenueTotalEventsAmt |
| Non Cash Prizes Total Events | $2,178 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $94,705 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $24,021 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $9,445 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $130,349 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$54,954 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent350 | Yes (X) | Percent350Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,005,382 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $7,005,382 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02270 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $34,537,956 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $34,537,956 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11190 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $41,543,338 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $41,543,338 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13460 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $172,116 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $172,116 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $421,197 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $57,038 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $364,159 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00120 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $593,313 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $57,038 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $536,275 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00180 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $42,136,651 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $57,038 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $42,079,613 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13640 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,062,748 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $77,255,880 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $84,406,336 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$7,150,456 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Good Samaritan Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1225 Wilshire Blvd | AddressLine1Txt |
| City | Los Angeles | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 90017 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.goodsam.org | WebsiteAddressTxt |
| State License | 930000071 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Teaching Hospital | Yes (X) | TeachingHospitalInd |
| Research Facility | Yes (X) | ResearchFacilityInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Good Samaritan Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | See Part V, Section C | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | See Part V, Section C | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 350.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | See Part V, Section C | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | See Part V, Section C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | See Part V, Section C | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Good Samaritan Hospital | Part V, Section B, Line 5: Primary Data-Community InputPrimary data were collected through interviews and focus groups with key stakeholders including patients, patient navigators, community liaisons and hospital administrators. Two community focus groups held on Tuesday August 16 and Tuesday August 30, 2016 were attended by a total of 21 people. Participants were invited by the Metro Hospital Collaborative. For a list of focus group questions please refer to Appendix B - Primary Data Gathering Tools and Appendix C - Stakeholders.Focus group participants identified a list of most important health needs (comprised of health drivers and health outcomes, per the County Health Rankings Model). To begin to gain a sense for the perceived severity of each health need in the community, each participant was given a total of ten sticker dots and asked to vote for the five most severe health outcomes and the five most severe health drivers on a grid created during the focus group. For the purpose of the voting activity, severity was defined as the level to which a health outcome or health driver affected the health and lives of those in the community.In addition to focus group interviews, in-depth semi-structured interviews were conducted with 5 key stakeholders in August 2016. Qualitative feedback from both the focus groups and individual interviews are incorporated in the Stakeholder Feedback sections below each Health Outcome.The goal of the primary data collection component of the CHNA was to identify through the perceptions and knowledge of varied and multiple stakeholders health outcomes and drivers that are of particular concern to the service area community. Primary data collection also produced a list of community assets and information about gaps in resources. An inventory of existing community assets and resources was also compiled as a part of the CHNA process (Appendix E-Local Community Assets). |
| Good Samaritan Hospital | Part V, Section B, Line 6a: The CHNA was conducted in collaboration with California Hospital Medical Center and St. Vincent Medical Center. |
| Good Samaritan Hospital | Part V, Section B, Line 11: The Needs Assessment for Good Samaritan Hospital was conducted in collaboration with California Hospital Medical Center and St. Vincent Medical Center. The Community Needs Assessment process identified the top broad health issues as: - Access to Care (health insurance, regular source of care, inappropriate use of the ER) - Care for chronic conditions (diabetes, heart disease) - Cancer Care - Disease management and preventive care (patient education, cardiovascular disease, including stroke, breastfeeding, screenings, and vaccinations) - Community social issues For needs that are not addressed such as mental health services, education on sexually transmitted infections including HIV, alcohol and substance abuse, and Alzheimer's disease, Good Samaritan Hospital has partnered with several organizations that have this expertise. The initiatives included in this year's Community Benefit Implementation Plan will require collaboration with many public and private organizations including philanthropic foundations, disease support groups, and governmental programs for the uninsured, community service agencies, local elected officials, security agencies and schools. |
| Part V, Section B, Line 7a: | https://www.goodsam.org/documents/2016-Community-Health-Needs-Assessment.pdf |
| Part V, Section B, Line 10a: | https://www.goodsam.org/documents/2016-Community-Health-Needs-Assessment.pdf |
| Part V, Section B, Line 16a, FAP Website: | http://www.goodsam.org/About-Us/Charity-Care-Discount-Policy/Policy.aspx |
| Part V, Section B, Line 16b, FAP Application Website : | http://www.goodsam.org/documents/Financial-Assistance-Request-form-English_Spanish.pdf |
| Part V, Section B, Line 16c, FAP Plain Language Summary: | http://www.goodsam.org/About-Us/Charity-Care-Discount-Policy/Policy.aspx |
| Part V, Section B, Line 22: | Individuals at or below 200% of the FPL receive a full charity discount. Individuals between 200% and 350% of the FPL receive a price equal to 60% of the cash price per policy. |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | Charity cost: applied RCC from hospital's FY 2017 internal financial statements of 19.71% to charity write-offs. 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. |
| Part III, Line 2: | Bad debt expense determined by applying RCC from hospital financial statements to bad debt transfers net of recoveries. This expense was not included in community benefit expense. |
| Part III, Line 3: | Good Samaritan Hospital has a very robust financial assistance program, Therefore, no estimate is made for bad debt attributable to patients eligible under the financial assistance policy. |
| Part III, Line 4: | From the audited financial statements of Good Samaritan Hospital and its affiliates for the year ended August 31, 2017:The Company has agreements with third-party payors that provide for payments to the Company at amounts different from its established rates. Payment arrangements include prospectively determined rates per discharge, reimbursed costs, discounted charges, and per diem payments. Net patient service revenue is reported at the estimated net realizable amounts from patients, third-party payors, and others for services rendered, including estimated retroactive adjustments under reimbursement agreements with third-party payors. Retroactive adjustments are accrued on an estimated basis in the period the related services are rendered and adjusted in future periods as final settlements are determined. The Company presents its provision for bad debts as a reduction of patient service revenue on a separate line item in its consolidated statements of operations. |
| Part III, Line 8: | The amounts on lines 5 and 6 are from the FY 2017 Medicare cost report and we believe do not qualify as community benefit. |
| Part III, Line 9b: | Patients are advised that they have the opportunity to submit a charity application or apply for a discount under the hospital's Charity Care Policy or Cash Price Policy. |
| Part VI, Line 2: | Every 3 years as required Good Samaritan Hospital conducts the Community Health Needs Assessment as part of a metro collaborative. Every year Good Samaritan Hospital also submits the attached Community Benefit Plan where an ad hoc hospital team assess previous year's goals (see page 33 of the CBIP 2017 document) and plans for the next year (see page 48 of the CBIP 2017 document). |
| 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 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 (2013), Latinos accounted for a majority of the population in the GSH service area (53.5%) 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 (22.9%). |
| 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 women's and newborn services. Good Samaritan Hospital also provides community building activities 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. |
| Part VI, Line 6: | Good Samaritan Hospital (the "Hospital") is a not-for-profit and tax-exempt corporation that operates a 408-bed tertiary hospital in Los Angeles, California. The Hospital's mission is to provide accessible, quality, cost-effective, and compassionate health care services that meet the needs of the patients, their families, the community, physicians, and employees.Good Samaritan Medical Office Building, Inc. (MOB), a not-for-profit corporation consisting of a medical office building adjacent to the Hospital, was formed to provide and lease office space to physicians on staff at the Hospital. Samaritan Imaging Center (SIC), a not-for-profit corporation, was formed as an outpatient imaging center, dedicated to the advancement of the care of the sick, injured, and disabled individuals requiring radiological imaging services. The Hospital, MOB, and SIC are consolidated in these financial statements because the Hospital is the sole corporate member of MOB and SIC, and are referred to collectively as the "Company."As part of its clinical mission, the Company created The Heart Institute, The Cancer Institute, The Institute of Reproductive Research, and the Orthopedic Institute (collectively, the "Institutes"). During 2016, The Heart Institute was renamed Good Samaritan Institute for Research and Education, and The Cancer Institute and The Institute of Reproductive Research were dissolved. The Institutes conduct clinical research in their specialized areas and provide education to the medical community and the general public. The Institutes are included in these consolidated financial statements. |
| Part VI, Line 7, Reports Filed With States | CA |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| Good Samaritan Institute for Research and Education | |||||||
| 1225 Wilshire Blvd | Los Angeles | CA | 90017 | 954077161 | 501(c)(3) | $441,949 | Expenses Paid by the Organization |
| California Health Foundation and Trust | |||||||
| 1215 K Street Suite 800 | Sacramento | CA | 95814 | 941498687 | 501(c)(3) | $140,280 | Support Charitable Activities at Hospitals and Health Systems in California |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | The Institutes (Good Samaritan Institute for Research and Education and Ortho) do not have their own checking accounts, so all of their expenses (including salaries, wages and benefits) are paid for by the Hospital and are all recorded in each of the Institutes' accounts in the general ledger, 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. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (14 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Andrew B Leeka | ||||||||||||||
| President & CEO | $606,436 | $0 | $0 | $0 | $32,365 | $0 | $7,950 | $0 | $21,358 | $0 | $668,109 | $0 | $0 | $0 |
| Alan M Ino | ||||||||||||||
| CFO | $465,850 | $0 | $0 | $0 | $24,000 | $0 | $7,950 | $0 | $19,494 | $0 | $517,294 | $0 | $0 | $0 |
| Michael Gomez | ||||||||||||||
| VP Business Development | $172,408 | $0 | $0 | $0 | $9,173 | $0 | $0 | $0 | $14,764 | $0 | $196,345 | $0 | $0 | $0 |
| Sammy Feuerlicht | ||||||||||||||
| VP, Business Development | $222,288 | $0 | $0 | $0 | $24,000 | $0 | $7,502 | $0 | $15,584 | $0 | $269,374 | $0 | $0 | $0 |
| Dan McLaughlin | ||||||||||||||
| VP General Services | $146,759 | $0 | $0 | $0 | $16,394 | $0 | $0 | $0 | $8,657 | $0 | $171,810 | $0 | $0 | $0 |
| Margaret Pfeiffer | ||||||||||||||
| VP Nursing Services | $276,808 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $13,484 | $0 | $290,292 | $0 | $0 | $0 |
| Lexis Schuster | ||||||||||||||
| VP Human Resources | $276,008 | $0 | $0 | $0 | $17,642 | $0 | $7,950 | $0 | $6,290 | $0 | $307,890 | $0 | $0 | $0 |
| Brian Thorne | ||||||||||||||
| VP Fund Development | $241,145 | $0 | $0 | $0 | $24,000 | $0 | $7,950 | $0 | $18,935 | $0 | $292,030 | $0 | $0 | $0 |
| Dean Campbell | ||||||||||||||
| VP Info. Tech. Services | $275,600 | $0 | $0 | $0 | $24,000 | $0 | $7,950 | $0 | $3,000 | $0 | $310,550 | $0 | $0 | $0 |
| Hilarion Castillo | ||||||||||||||
| Controller | $222,596 | $0 | $3,000 | $0 | $26,568 | $0 | $7,518 | $0 | $7,330 | $0 | $267,012 | $0 | $0 | $0 |
| Ching Chen | ||||||||||||||
| Chief Radiation Physicst | $273,828 | $0 | $0 | $0 | $23,923 | $0 | $7,950 | $0 | $13,084 | $0 | $318,785 | $0 | $0 | $0 |
| Samir Nabulsi | ||||||||||||||
| Director Worker's Comp | $231,707 | $0 | $0 | $0 | $25,520 | $0 | $7,747 | $0 | $8,865 | $0 | $273,839 | $0 | $0 | $0 |
| Ira Meiselman | ||||||||||||||
| Director Managed Care | $215,125 | $0 | $20,000 | $0 | $18,000 | $0 | $7,138 | $0 | $21,994 | $0 | $282,257 | $0 | $0 | $0 |
| Rolando Demafelix | ||||||||||||||
| Coordinator Cardiothoracic | $214,584 | $0 | $0 | $0 | $18,000 | $0 | $11,701 | $0 | $18,607 | $0 | $262,892 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 2 | Mrs. Maribeth Borthwick, a Board Member of Good Samaritan Hospital, has a family relationship with Mr. Charles Munger, Chairman of the Board. Mr. Clark W. Porter has a family relationship with Mr. Glen H. Mitchel, Jr., who are both board members. |
| Form 990, Part VI, Section B, line 11b | The Organization works with an independent accountant, 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 12c | All Board Members and officers are required to complete a conflict of interest disclosure statement each year. The Policy requires each governing body member to disclose any conflict on a particular matter that may arise, and recuse him or herself from deliberations and votes on such matters. The Policies are monitored by the director of risk management of the Good Samaritan Hospital and are enforced by the Audit Committee Chairperson. |
| Form 990, Part VI, Section B, line 15 | A subcommittee of the Governing Board's Executive Committee is responsible for determining the Chief Executive Officers' compensation. This subcommittee is given comparison data on CEO salaries and benefits from comparable hospitals in the local area, prepared by human resources from 990s; and salary surveys completed by the local association. The decision of the subcommittee on the CEO's salary is documented by the subcommittee in writing. The compensation of the Organization's Vice Presidents are reviewed and approved by the Organization's CEO. Their salaries and benefits are determined using comparable hospitals in the local area, prepared by human resources from 990s; and salary surveys completed by the local hospital association. |
| Form 990, Part VI, Section C, line 19 | Good Samaritan Hospital's organizing documents and the Conflict of Interest Policy are not made available to the public. The financial information from the financial statements is included in the Organization's Form 990, which is available for public inspection upon request. |
| Form 990, Part IX, line 11g | Professional Fees: Program service expenses 8,912,978. Management and general expenses 7,000. Fundraising expenses 0. Total expenses 8,919,978. Purchased Labor: Program service expenses 12,486,606. Management and general expenses 216,266. Fundraising expenses 0. Total expenses 12,702,872. Repairs and Maintenance: Program service expenses 4,885,889. Management and general expenses 932,908. Fundraising expenses 37. Total expenses 5,818,834. Outside Provider Cost: Program service expenses 6,917,914. Management and general expenses 0. Fundraising expenses 0. Total expenses 6,917,914. Other Purchased Services: Program service expenses 15,338,556. Management and general expenses 7,997,922. Fundraising expenses 24,261. Total expenses 23,360,739. |
| Form 990, Part XI, line 9: | Minimum Change in Pension Liability 8,508,337. Net Assets Released from Restriction-Capital 810,301. Net Assets Released from Restriction-Operations -4,714,935. Change in Value of Split-Interest Agreement -1,769,539. Gifts Received/Contributions 2,366,994. Net Loss from Fundraising Activities 54,954. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Good Samaritan Institute for Research and Education | |||||||||||
| 1225 Wilshire Blvd | Los Angeles | CA | 90017 | 954077161 | Heart Research | CA | 501(c)(3) | Line 4 | Good Samaritan Hospital | Yes (1) | |
| Orthopedic Institute of the Good Samaritan Hospital | |||||||||||
| 1225 Wilshire Blvd | Los Angeles | CA | 90017 | 954346048 | Orthopedic Research | CA | 501(c)(3) | Line 12a, Type I | Good Samaritan Hospital | Yes (1) | |
| Samaritan Imaging Center | |||||||||||
| 1225 Wilshire Blvd | Los Angeles | CA | 90017 | 954252321 | Outpatient Imaging Services | CA | 501(c)(3) | Line 10 | Good Samaritan Hospital | Yes (1) | |
| Good Samaritan Medical Office Building Inc | |||||||||||
| 1225 Wilshire Blvd | Los Angeles | CA | 90017 | 953244046 | Physicians Medical Offices | CA | 501(c)(3) | Line 12a, Type I | Good Samaritan Hospital | Yes (1) | |
| Auxiliary of the Hospital of the Good Samaritan | |||||||||||
| 1225 Wilshire Blvd | Los Angeles | CA | 90017 | 956051253 | Welfare of the Good Samaritan Hospital | CA | 501(c)(3) | Line 12c, Type III-F | 0 | N/A | |
| Kate Van Nuys Page Foundation | |||||||||||
| 1225 Wilshire Blvd | Los Angeles | CA | 90017 | 956028032 | Grants Income to Good Samaritan Hospital | CA | 501(c)(3) | Line 12a, Type I | Good Samaritan Hospital | Yes (1) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (1) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (5 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Good Samaritan Institute for Research and Education | ||
| B | $441,949 | FMV |
| Good Samaritan Institute for Research and Education | ||
| C | $859,245 | FMV |
| Good Samaritan Medical Office Building Inc | ||
| J | $240,346 | FMV |
| Samaritan Imaging Center | ||
| J | $198,912 | FMV |
| Good Samaritan Medical Office Building Inc | ||
| A | $1,402,788 | FMV |