PIH HEALTH GOOD SAMARITAN HOSPITAL: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- PIH HEALTH GOOD SAMARITAN HOSPITAL (EIN 95-1656366)
- Tax period
- 2013-09-01 to 2014-08-31
- Filed
- 2015-07-08
- IRS object ID
- 201521899349300832
- Schema version
- 2013v4.0
- 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 | 2015-07-08T13:27:00-05:00 | ReturnTs |
| Tax Period End | 2014-08-31 | 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 | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 695 TOWN CENTER DRIVE SUITE 1200 | AddressLine1 |
| City | COSTA MESA | City |
| State | CA | State |
| ZIP Code | 92626 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-09-01 | 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 | BusinessNameLine1 |
| 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 | 616 South Witmer Street | AddressLine1 |
| City | Los Angeles | City |
| State | CA | State |
| ZIP Code | 900171912 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ALAN M INO | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 2139772121 | PhoneNum |
| Signature | 2015-07-08 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DIANA J McCUTCHEN | PreparerPersonNm |
| PTIN | P00545657 | PTIN |
| Phone | 7144367100 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | 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 | 616 South Witmer Street | AddressLine1 |
| City | Los Angeles | City |
| State | CA | State |
| ZIP Code | 900171912 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $316,229,454 | 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 | 1595 | TotalEmployeeCnt |
| Total Volunteers | 27 | TotalVolunteersCnt |
| Total Gross UBI | $192,950 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $25,849 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $10,544,837 | PYContributionsGrantsAmt |
| CY Contributions Grants | $5,983,947 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $288,044,816 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $245,949,155 | CYProgramServiceRevenueAmt |
| PY Investment Income | $9,180,007 | PYInvestmentIncomeAmt |
| CY Investment Income | $25,803,563 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,855,627 | PYOtherRevenueAmt |
| CY Other Revenue | $1,847,487 | CYOtherRevenueAmt |
| PY Total Revenue | $309,625,287 | PYTotalRevenueAmt |
| CY Total Revenue | $279,584,152 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $2,843,407 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,919,585 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $136,802,058 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $143,832,862 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $1,828,296 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $152,542,424 | PYOtherExpensesAmt |
| CY Other Expenses | $136,656,144 | CYOtherExpensesAmt |
| PY Total Expenses | $292,187,889 | PYTotalExpensesAmt |
| CY Total Expenses | $282,408,591 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $17,437,398 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$2,824,439 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $461,254,761 | TotalAssetsBOYAmt |
| Total Assets EOY | $445,014,747 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $158,105,850 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $146,760,088 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $303,148,911 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $298,254,659 | 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 | $244,583,695 | ExpenseAmt |
| Grant | $1,919,585 | GrantAmt |
| Revenue | $245,949,155 | 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, 2014 patient days totaled 56,625 and outpatient visits totaled 79,577.The Hospital has a policy to treat emergency and certain other patients regardless of their ability to pay. Consistent with the Hospital's tax-exempt status and community service responsibilities, the Hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Under the Hospital's policy, charity care may be provided to people who are uninsured or under-insured and can not afford to pay for their own medical care. Because the Hospital does not pursue collection or amounts determined to qualify as charity care, these are not included in net patient revenues. In some instances, charity care cases are identified subsequent to the occurrence of collection activities and may be classified as bad debts.Therefore, the Hospital is unable to determine actual total charity activity. Charitable care not included in net patient revenue was approximately $8,664,471 for fiscal year 2014.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 $41,663,913 for fiscal year 2014. | Desc |
| Total Program Service Expenses | $244,583,695 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 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 | 446 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 1595 | 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 |
| Form8282 Filed | 0 | Form8282FiledCnt |
| 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 | Reuben V Barboza | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2134822725 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 637 S Lucas Ave 3rd Floor | AddressLine1 |
| City | Los Angeles | City |
| State | CA | State |
| ZIP Code | 90017 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (39 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 Leeka | |||||||||
| President & CEO | 50.00 | 8.40 | Yes (X) | Yes (X) | $624,792 | $0 | $10,680 | ||
| Sushma Adarkar MD | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| George A Bender | |||||||||
| Trustee | 1.00 | 4.20 | Yes (X) | $0 | $0 | $0 | |||
| Bruce Bennett | |||||||||
| Trustee | 1.00 | 4.20 | 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 William H Borthwick | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Rt Rev Joseph Jon Bruno | |||||||||
| Honorary Chairman | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Arthur L Crowe Jr | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Mrs Victoria Seaver Dean | |||||||||
| Trustee | 1.00 | 4.20 | Yes (X) | $0 | $0 | $0 | |||
| Robert E Denham | |||||||||
| Vice Chairman 1 | 1.00 | 4.20 | Yes (X) | $0 | $0 | $0 | |||
| Andrew Fishmann MD | |||||||||
| Trustee | 1.00 | 4.20 | Yes (X) | $0 | $0 | $0 | |||
| John B Frank | |||||||||
| Trustee | 1.00 | 4.20 | Yes (X) | $0 | $0 | $0 | |||
| James H Gipson | |||||||||
| Trustee | 1.00 | 4.20 | Yes (X) | $0 | $0 | $0 | |||
| Ms Mimi Grant | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Robert K Maloney | |||||||||
| Trustee | 1.00 | 4.20 | 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 | |||||||||
| Vice Chairman 2 | 1.00 | 4.20 | Yes (X) | $0 | $0 | $0 | |||
| Peter W Mullin | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Charles T Munger | |||||||||
| Chairman | 1.00 | 4.20 | Yes (X) | $0 | $0 | $0 | |||
| Todd G Owens | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Clark Willard Porter | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Mrs Helen Lho Ryu | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Thomas L Shook MD | |||||||||
| Trustee | 1.00 | 4.20 | 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 | 8.20 | Yes (X) | $465,648 | $0 | $9,816 | |||
| Michael Gomez | |||||||||
| VP, Business Development | 40.00 | 0.00 | $227,911 | $0 | $2,089 | Yes (X) | |||
| Lexie Schuster | |||||||||
| VP, Human Resources | 40.00 | 0.00 | $287,478 | $0 | $7,500 | Yes (X) | |||
| Margaret Pfeiffer | |||||||||
| VP, Nursing Svcs | 40.00 | 0.00 | $267,241 | $0 | $1,059 | Yes (X) | |||
| Dan McLaughlin | |||||||||
| VP, Professional Services | 20.00 | 20.00 | $265,345 | $0 | $8,518 | Yes (X) | |||
| Dean Campbell | |||||||||
| VP, Info. Tech. Services | 40.00 | 0.00 | $288,308 | $0 | $7,338 | Yes (X) | |||
| Ching Chen | |||||||||
| Chief Radiation Physicst | 40.00 | 0.00 | $271,360 | $0 | $9,498 | Yes (X) | |||
| Ira Meiselman | |||||||||
| Director, Managed Care | 40.00 | 0.00 | $248,070 | $0 | $11,341 | Yes (X) | |||
| Hilarion Castillo | |||||||||
| Controller | 40.00 | 0.00 | $240,772 | $0 | $8,733 | Yes (X) | |||
| Samir Nabulsi | |||||||||
| Director, Worker's Comp | 40.00 | 0.00 | $249,520 | $0 | $8,160 | Yes (X) | |||
| Kevin Brown | |||||||||
| Director, Cardiology | 40.00 | 0.00 | $215,979 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,652,424 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $84,732 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 426 | 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/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Millie and Severson Inc | |||||
| 3601 Serpentine Drive | Los Almitos | CA | 90720 | Construction Services | $7,200,890 |
| Crothall Healthcare Inc | |||||
| 955 Chesterbrook Blvd St 300 | Wayne | PA | 19087 | Environmental Services | $4,574,194 |
| Sodexho Marriott Services | |||||
| 711 Kimberly Avenue Suite 250 | Placentia | CA | 92870 | Dietary Services | $3,373,888 |
| Questar Construction | |||||
| 17841 Mitchell North | Irvine | CA | 92614 | Engineering Services | $2,970,287 |
| Coast Healthcare Management | |||||
| 4909 Lakewood Blvd Ste 200 | Lakewood | CA | 90712 | Mgmt Services to Physicians | $1,802,892 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 82 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $143,375 | FundraisingAmt |
| Related Organizations | $1,798,248 | RelatedOrganizationsAmt |
| Government Grants | $145,641 | GovernmentGrantsAmt |
| All Other Contributions | $3,896,683 | AllOtherContributionsAmt |
| Total Contributions | $5,983,947 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Net Patient Revenue | 900099 | $243,355,246 | $243,355,246 |
| EHR Meaningful Use | 900099 | $1,489,434 | $1,489,434 |
| Rental Income | 532000 | $628,000 | $628,000 |
| Child Care Center | 624410 | $476,475 | $476,475 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $245,949,155 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,251,395 | TotalRevenueColumnAmt |
| Exclusion | $6,251,395 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $56,069,849 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $36,299,539 | SecuritiesAmt |
| Other | $218,142 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $19,770,310 | SecuritiesAmt |
| Other | -$218,142 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $19,552,168 | TotalRevenueColumnAmt |
| Exclusion | $19,552,168 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $52,125 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $143,375 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $127,621 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$75,496 | TotalRevenueColumnAmt |
| Exclusion | -$75,496 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| Parking Lot | 812930 | $488,152 | $31,884 | $456,268 |
| Non-patient Lab | 621500 | $101,966 | $101,966 | |
| Physician Mgmt Services | 621110 | $59,100 | $59,100 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,273,765 | TotalRevenueColumnAmt |
| Exclusion | $1,273,765 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,922,983 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $279,584,152 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $245,949,155 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $192,950 | UnrelatedBusinessRevenueAmt |
| Exclusion | $27,458,100 | 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 | $1,919,585 | TotalAmt |
| Program Services | $1,919,585 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,473,723 | TotalAmt |
| Program Services | $542,163 | ProgramServicesAmt |
| Management And General | $1,931,560 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $101,392,804 | TotalAmt |
| Program Services | $91,364,341 | ProgramServicesAmt |
| Management And General | $9,247,154 | ManagementAndGeneralAmt |
| Fundraising | $781,309 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,698,868 | TotalAmt |
| Program Services | $5,080,613 | ProgramServicesAmt |
| Management And General | $618,255 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,292,914 | TotalAmt |
| Program Services | $22,590,908 | ProgramServicesAmt |
| Management And General | $2,640,774 | ManagementAndGeneralAmt |
| Fundraising | $61,232 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,974,553 | TotalAmt |
| Program Services | $7,934,031 | ProgramServicesAmt |
| Management And General | $978,410 | ManagementAndGeneralAmt |
| Fundraising | $62,112 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,349,113 | TotalAmt |
| Management And General | $1,343,613 | ManagementAndGeneralAmt |
| Fundraising | $5,500 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $361,710 | TotalAmt |
| Management And General | $361,710 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,619 | TotalAmt |
| Management And General | $21,619 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,251,903 | TotalAmt |
| Program Services | $31,297,514 | ProgramServicesAmt |
| Management And General | $8,915,839 | ManagementAndGeneralAmt |
| Fundraising | $38,550 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $654,719 | TotalAmt |
| Program Services | $162,078 | ProgramServicesAmt |
| Management And General | $492,641 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $269,626 | TotalAmt |
| Program Services | $251,255 | ProgramServicesAmt |
| Management And General | $18,371 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $203,889 | TotalAmt |
| Program Services | $35,451 | ProgramServicesAmt |
| Management And General | $157,591 | ManagementAndGeneralAmt |
| Fundraising | $10,847 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,761,497 | TotalAmt |
| Program Services | $3,761,497 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,081,613 | TotalAmt |
| Program Services | $6,394,366 | ProgramServicesAmt |
| Management And General | $3,687,247 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,283,614 | TotalAmt |
| Program Services | $1,481,610 | ProgramServicesAmt |
| Management And General | $802,004 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Supplies | $49,952,072 | $49,215,374 | $713,988 | $22,710 |
| Bad Debts | $11,019,228 | $11,019,228 | $0 | $0 |
| Hospital Fee Program | $5,916,501 | $5,916,501 | $0 | $0 |
| Utilities | $3,934,190 | $3,833,629 | $100,561 | $0 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,594,850 | TotalAmt |
| Program Services | $1,783,551 | ProgramServicesAmt |
| Management And General | $3,965,263 | ManagementAndGeneralAmt |
| Fundraising | $846,036 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $282,408,591 | TotalAmt |
| Program Services | $244,583,695 | ProgramServicesAmt |
| Management And General | $35,996,600 | ManagementAndGeneralAmt |
| Fundraising | $1,828,296 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,649,105 | BOYAmt |
| EOY | $2,088,508 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,740,626 | BOYAmt |
| EOY | $6,904,376 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,988,869 | BOYAmt |
| EOY | $11,508,716 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,688,365 | BOYAmt |
| EOY | $39,694,369 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,978,929 | BOYAmt |
| EOY | $21,147,532 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,413,111 | BOYAmt |
| EOY | $1,597,819 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,080,538 | BOYAmt |
| EOY | $9,228,651 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $448,335,283 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $300,937,808 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $115,916,196 | BOYAmt |
| EOY | $147,397,475 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $233,124,539 | BOYAmt |
| EOY | $201,794,860 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,674,483 | BOYAmt |
| EOY | $3,652,441 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $461,254,761 | BOYAmt |
| EOY | $445,014,747 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $58,253,430 | BOYAmt |
| EOY | $52,093,280 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,755,688 | BOYAmt |
| EOY | $46,711,572 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,096,732 | BOYAmt |
| EOY | $47,955,236 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $158,105,850 | BOYAmt |
| EOY | $146,760,088 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $206,250,896 | BOYAmt |
| EOY | $200,348,339 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,564,367 | BOYAmt |
| EOY | $40,471,672 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $57,333,648 | BOYAmt |
| EOY | $57,434,648 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $303,148,911 | BOYAmt |
| EOY | $298,254,659 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $461,254,761 | BOYAmt |
| EOY | $445,014,747 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$2,824,439 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $3,673,731 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$5,743,544 | 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 | $21,619 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $21,619 | 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 represents a portion of the dues Good Samaritan Hospital pays to the Hospital Association of Southern California. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| 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 Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $57,333,648 | BeginningYearBalanceAmt |
| End Year Balance | $57,333,648 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $57,333,648 | BeginningYearBalanceAmt |
| End Year Balance | $57,333,648 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $57,333,648 | BeginningYearBalanceAmt |
| End Year Balance | $57,333,648 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $57,316,151 | BeginningYearBalanceAmt |
| Contributions | $17,497 | ContributionsAmt |
| End Year Balance | $57,333,648 | 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 | $11,395,670 | OtherCostOrOtherBasisAmt |
| Book Value | $11,395,670 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $134,321,614 | OtherCostOrOtherBasisAmt |
| Depreciation | $104,495,730 | DepreciationAmt |
| Book Value | $29,825,884 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $226,550,971 | OtherCostOrOtherBasisAmt |
| Depreciation | $193,418,295 | DepreciationAmt |
| Book Value | $33,132,676 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $76,067,028 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,023,783 | DepreciationAmt |
| Book Value | $73,043,245 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $147,397,475 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (6 entries)
| DescDesc | AmtAmt |
|---|---|
| Reserve For Self-Insured Programs | $6,365,633 |
| Pension Plan | $17,523,744 |
| Advances From Third Party Payors | $1,559,657 |
| Reserve For Asset Retirement Obligation | $8,636,519 |
| Other Long Term Reserves/Liabilities | $12,479,000 |
| Other Annuity Payment Liability | $1,390,683 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $47,955,236 | 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, 2014 and 2013, the hospital did not record any liability for unrecognized tax contingencies. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | Golf Tournament | NameOfEvent1Amt |
| Gross Receipts Event1 | $195,500 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $143,375 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $52,125 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $4,633 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $86,883 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $23,304 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $12,801 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $195,500 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $143,375 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $52,125 | GrossRevenueTotalEventsAmt |
| Non Cash Prizes Total Events | $4,633 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $86,883 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $23,304 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $12,801 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $127,621 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$75,496 | 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 | $10,796,481 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,996,689 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,799,792 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03240 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $38,079,076 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,779,739 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $28,299,337 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10430 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $48,875,557 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $11,776,428 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $37,099,129 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13670 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $158,427 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $158,427 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,596,176 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,053,060 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $543,116 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00200 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $323,413 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $323,413 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00120 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,078,016 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,053,060 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,024,956 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00380 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $50,953,573 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,829,488 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $38,124,085 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.14050 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,709,215 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $77,692,994 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $81,734,690 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$4,041,696 | 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 | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 616 South Witmer Street | AddressLine1 |
| City | Los Angeles | City |
| State | CA | State |
| ZIP Code | 90071 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 |
| Other | Hospital Research by Institutes | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GOOD SAMARITAN HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| 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 |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| All Needs Addressed | 0 | AllNeedsAddressedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (1) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (1) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 350.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| Medical Indigency | Yes (X) | MedicalIndigencyInd |
| Insurance Status | Yes (X) | InsuranceStatusInd |
| Uninsured Discount | Yes (X) | UninsuredDiscountInd |
| Medicaid Medicare | Yes (X) | MedicaidMedicareInd |
| State Regulation | Yes (X) | StateRegulationInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| Attached To Invoice | Yes (X) | AttachedToInvoiceInd |
| Posted In Emergency Room | Yes (X) | PostedInEmergencyRoomInd |
| Posted In Admission Office | Yes (X) | PostedInAdmissionOfficeInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Medicare Rates | Yes (X) | MedicareRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| GOOD SAMARITAN HOSPITAL | 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 Community Based Organization ("CBO") perspective. CBOs included agencies that provide health, social, and other types of services. Information was gathered to identify areas of needs and services available or lacking to meet those needs. In addition, an online survey was made available to CBOs who were unable to attend a focus group. In total, there were ten focus groups conducted (5 with community members and 5 with CBOs) with a total of 158 participants. The focus group interviews were conducted in either English or Spanish, with a mixed age group, including both males and females. Groups included residents from major ethnic groups, geographic areas and service providers in the Collaborative's service areas. Seniors, community health promoters and service providers were gathered separately. Topics in the focus group included major areas from previous needs assessments and other issues anticipated to be important in health care. Areas covered were: health care utilization, preventative and primary care, health insurance, access and barriers to care, emergency room use, chronic disease management and community issues. Individual Interviews - Thirty interviews were conducted to gather information about the needs and challenges faced by the community in accessing and utilizing health care services, and to ensure reliable and representative information. Key informants included staff at collaborative hospitals and health care service organizations in the primary service areas. Interviews were conducted over the phone or in person and lasted approximately 45 minutes. |
| GOOD SAMARITAN HOSPITAL | Part V, Section B, Line 4: Good Samaritan Hospital conducted the CHNA in collaboration with California Hospital Medical Center and St. Vincent Medical Center. |
| GOOD SAMARITAN HOSPITAL | Part V, Section B, Line 7: Good Samaritan Hospital identified 7 focus issues in the latest Community Needs Assessment. Of the 7 issues identified, the following 5 are currently being addressed: Primary Care, Health Behaviors, Chronic Disease, Cancer and Disease Prevention/Community/Social Issues. The 2 issues that have not been addressed and are not part of an implementation plan are HIV/AIDS/Communicable Diseases and Mental Health. The hospital has determined that it currently does not have the capacity to address these issues. However, when applicable, the hospital will refer patients with those needs to outside organizations that are capable of working with those patients. |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | 7 a) Charity cost: applied RCC from hospital's FY 2014 internal financial statements of 19.92% 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.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 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 of 15%. |
| 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 $ 11,019,228. |
| Part III, Line 4: | Bad debt cost determined by applying RCC from hospital financial statements to bad debt transfers net of recoveries. These costs were not included in community benefit cost. |
| Part III, Line 8: | Filed Medicare cost report. |
| Part III, Line 9b: | The debt collection policy indicates that patients that qualify for charity will be adjudicated under that policy. Charity patients receive a 100% discount. Patients whose family income is between 200% and 350% of the FPL will receive a 60% discount on the cash price for uninsured patients. |
| Part 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 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 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. |
| 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/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| Heart Institute of the Good Samaritan Hospital | |||||||
| 616 South Witmer Street | Los Angeles | CA | 90017 | 954077161 | 501(c)(3) | $1,594,426 | Expenses paid by the organization |
| California Health Foundation and Trust | |||||||
| 1215 K Street Suite 800 | Sacramento | CA | 95814 | 941498687 | 501(c)(3) | $323,413 | 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 (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. | 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 (12 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 Leeka | ||||||||||||||
| President & CEO | $617,205 | $0 | $0 | $0 | $7,587 | $0 | $7,500 | $0 | $3,180 | $0 | $635,472 | $0 | $0 | $0 |
| Alan M Ino | ||||||||||||||
| CFO | $465,648 | $0 | $0 | $0 | $0 | $0 | $7,500 | $0 | $2,316 | $0 | $475,464 | $0 | $0 | $0 |
| Michael Gomez | ||||||||||||||
| VP, Business Development | $227,911 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $2,089 | $0 | $230,000 | $0 | $0 | $0 |
| Lexie Schuster | ||||||||||||||
| VP, Human Resources | $287,423 | $0 | $0 | $0 | $55 | $0 | $7,500 | $0 | $0 | $0 | $294,978 | $0 | $0 | $0 |
| Margaret Pfeiffer | ||||||||||||||
| VP, Nursing Svcs | $267,241 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $1,059 | $0 | $268,300 | $0 | $0 | $0 |
| Dan McLaughlin | ||||||||||||||
| VP, Professional Services | $265,345 | $0 | $0 | $0 | $0 | $0 | $6,202 | $0 | $2,316 | $0 | $273,863 | $0 | $0 | $0 |
| Dean Campbell | ||||||||||||||
| VP, Info. Tech. Services | $288,308 | $0 | $0 | $0 | $0 | $0 | $5,938 | $0 | $1,400 | $0 | $295,646 | $0 | $0 | $0 |
| Ching Chen | ||||||||||||||
| Chief Radiation Physicst | $271,360 | $0 | $0 | $0 | $0 | $0 | $7,500 | $0 | $1,998 | $0 | $280,858 | $0 | $0 | $0 |
| Ira Meiselman | ||||||||||||||
| Director, Managed Care | $248,070 | $0 | $0 | $0 | $0 | $0 | $6,525 | $0 | $4,816 | $0 | $259,411 | $0 | $0 | $0 |
| Hilarion Castillo | ||||||||||||||
| Controller | $240,772 | $0 | $0 | $0 | $0 | $0 | $6,800 | $0 | $1,933 | $0 | $249,505 | $0 | $0 | $0 |
| Samir Nabulsi | ||||||||||||||
| Director, Worker's Comp | $249,520 | $0 | $0 | $0 | $0 | $0 | $6,436 | $0 | $1,724 | $0 | $257,680 | $0 | $0 | $0 |
| Kevin Brown | ||||||||||||||
| Director, Cardiology | $215,839 | $0 | $0 | $0 | $140 | $0 | $0 | $0 | $0 | $0 | $215,979 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 1 | The 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 2 | Mrs. 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 11 | 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 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 19 | Good Samaritan Hospital's organizing and governing documents and the conflict of interest policy are not made available to the public. The financial information from the financial statements is included in the organization's Form 990, which is available for public inspection upon request. The organiztion's financial statements were audited by an independent accountant and are included in the consolidated audited financial statements for Good Samaritan Hospital and affiliates. Good Samaraitan Hospital's audit committee assumes responsibility for the oversight of the audit and its financial statements and the selection of an independent accountant. |
| Form 990, Part IX, line 11g | Purchased Services: Program service expenses 21,813,631. Management and general expenses 5,148,904. Fundraising expenses 38,550. Total expenses 27,001,085. Purchased Labor: Program service expenses 5,142,886. Management and general expenses 69,245. Fundraising expenses 0. Total expenses 5,212,131. Repairs and Maintenance: Program service expenses 4,340,997. Management and general expenses 3,697,690. Fundraising expenses 0. Total expenses 8,038,687. |
| Form 990, Part XI, line 9: | Minimum Change in Pension Liability 689,860. Intercompany adjustments -6,433,404. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (8 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Heart Institute of the Good Samaritan Hospital | |||||||||||
| 616 South Witmer Street | Los Angeles | CA | 90017 | 954077161 | Heart Research | CA | section 501(c)(3) | 4 | Good Samaritan Hospital | Yes (1) | |
| Orthopedic Institute of the Good Samaritan Hospital | |||||||||||
| 616 South Witmer Street | Los Angeles | CA | 90017 | 954346048 | Orthopedic Research | CA | section 501(c)(3) | 11, TYPE 1 | Good Samaritan Hospital | Yes (1) | |
| Samaritan Imaging Center | |||||||||||
| 1245 Wilshire Blvd Suite 205 | Los Angeles | CA | 90017 | 954252321 | Outpatient Imaging Services | CA | section 501(c)(3) | 9 | Good Samaritan Hospital | Yes (1) | |
| Cancer Institute of the Good Samaritan Hospital | |||||||||||
| 616 South Witmer Street | Los Angeles | CA | 90017 | 954271815 | Cancer Research | CA | section 501(c)(3) | 11, TYPE 1 | Good Samaritan Hospital | Yes (1) | |
| Institute for reproductive research of the Hospital of the Good Samaritan | |||||||||||
| 616 South Witmer Street | Los Angeles | CA | 90017 | 954252306 | Reproductive Research | CA | section 501(c)(3) | 11, TYPE 1 | Good Samaritan Hospital | Yes (1) | |
| Good Samaritan Hospital Medical Office Building Inc | |||||||||||
| 1245 Wilshire Blvd Suite 205 | Los Angeles | CA | 90017 | 953244046 | Physicians Medical Offices | CA | section 501(c)(3) | 11, TYPE 1 | Good Samaritan Hospital | Yes (1) | |
| Auxiliary of the Hospital of the Good Samaritan | |||||||||||
| 616 South Witmer Street | Los Angeles | CA | 90017 | 956051253 | Welfare of the Good Samaritan Hospital | CA | section 501(c)(3) | 11, TYPE 3 | 0 | N/A | |
| Kate Van Nuys Page Foundation | |||||||||||
| 616 South Witmer Street | Los Angeles | CA | 90017 | 956028032 | Grants income to Good Samaritan Hospital | CA | section 501(c)(3) | 11, TYPE 1 | 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 | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | 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 Hospital Medical Office Bldg | ||
| A | $480,403 | FMV |
| Good Samaritan Hospital Medical Office Bldg | ||
| K | $195,885 | FMV |
| Heart Institute of the Good Samaritan Hosp | ||
| B | $1,594,426 | FMV |
| Heart Institute of the Good Samaritan Hosp | ||
| C | $1,742,632 | FMV |
| Auxiliary of Good Samaritan Hospital | ||
| C | $55,616 | FMV |