PIH HEALTH GOOD SAMARITAN HOSPITAL: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- PIH HEALTH GOOD SAMARITAN HOSPITAL (EIN 95-1656366)
- Tax period
- 2010-09-01 to 2011-08-31
- Filed
- 2012-07-12
- IRS object ID
- 201201949349300860
- Schema version
- 2010v3.4
- 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) |
|---|---|---|
| Timestamp | 2012-07-12T11:57:06-05:00 | Timestamp |
| Tax Period End Date | 2011-08-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELOITTE TAX LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| 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 | ReturnType |
| Tax Period Begin Date | 2010-09-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 951656366 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Good Samaritan Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | GOOD | NameControl |
| Phone | 2139772010 | Phone |
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 |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ALAN M INO | Name |
| Title | CFO | Title |
| Phone | 2139772010 | Phone |
| Date Signed | 2012-07-12 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DIANA J McCUTCHEN | Name |
| Phone | 7144367100 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Andrew B Leeka | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| 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 | 328280480 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.GOODSAM.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1885 | YearFormation |
| State Legal Domicile | CA | StateLegalDomicile |
| Activity Or Mission Description | Provide accessible, quality cost-effective, healthcare services at 408-bed hospital in LA. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 31 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 30 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1756 | TotalNbrEmployees |
| Total Nbr Volunteers | 30 | TotalNbrVolunteers |
| Total Gross UBI | 374626 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -13912 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 5705168 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 8735356 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 280801581 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 304535116 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 9024949 | InvestmentIncomePriorYear |
| Investment Income Current Year | 9273290 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1672043 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1769308 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 297203741 | TotalRevenuePriorYear |
| Total Revenue Current Year | 324313070 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 1830644 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 2757061 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 132452606 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 140588254 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 1198272 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 156836266 | OtherExpensePriorYear |
| Other Expenses Current Year | 157888340 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 291119516 | TotalExpensesPriorYear |
| Total Expenses Current Year | 301233655 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 6084225 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 23079415 | RevenuesLessExpensesCY |
| Total Assets BOY | 388901723 | TotalAssetsBOY |
| Total Assets EOY | 413688317 | TotalAssetsEOY |
| Total Liabilities BOY | 166869460 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 158646027 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 222032263 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 255042290 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | To provide accessible, quality, cost-effective community healthcare. The hospital operates a 408-bed facility in inner-city Los Angeles. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 269504270 | Expense |
| Grants | 2757061 | Grants |
| Revenue | 304535116 | Revenue |
| Description | 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, 2011 patient days totaled 76,220 and outpatient visits totaled 92,325.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 $10,507,560 for fiscal year 2011.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 $23,999,466 for fiscal year 2011. | Description |
| Total Program Service Expense | 269504270 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 473 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1756 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 31 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 30 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | CA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Reuben V Barboza | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2134822725 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 637 S LUCAS AVENUE 3RD FLOOR | AddressLine1 |
| City | Los Angeles | City |
| State | CA | State |
| ZIP Code | 90017 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (43 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| Andrew Leeka | ||||||||
| CEO | 55.00 | X | X | 556235 | 0 | 10530 | ||
| Sushma Adarkar MD | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| George A Bender | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| Bruce Bennett | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| William M Bitting | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| Mrs Jack L Blumenthal | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| Mrs William H Borthwick | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| Rt Rev Joseph Jon Bruno | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| Mrs Richard W Call | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| Arthur L Crowe Jr | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| Mrs Victoria Seaver Dean | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| Robert E Denham | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| Eben Feinstein MD | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| John B Frank | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| James H Gipson | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| Ms Mimi Grant | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| Robert K Maloney | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| Mrs Angus M McLeod | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| Charles P Meister | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| Glen H Mitchel Jr | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| Peter W Mullin | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| Charles T Munger | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| Todd G Owens | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| Clark Willard Porter | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| Mrs Helen Lho Ryu | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| Thomas L Shook MD | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| Stephen L Smith | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| Norman F Sprague III MD | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| Joseph P Van der Meulen | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| Warren B Williamson | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| Edward A Wopschall | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| Alan M Ino | ||||||||
| CFO | 55.00 | X | 388693 | 0 | 9866 | |||
| Susan Harlow | ||||||||
| VP, Development | 40.00 | 248306 | 0 | 7695 | X | |||
| Lexie Schuster | ||||||||
| VP, Human Resources | 40.00 | 246425 | 0 | 7350 | X | |||
| Sammy Feuerlicht | ||||||||
| VP, Bus Development | 40.00 | 234717 | 0 | 9393 | X | |||
| Dan McLaughlin | ||||||||
| VP, General Services | 40.00 | 239191 | 0 | 5427 | X | |||
| Patricia Rives | ||||||||
| VP, Nursing/Clinical Services | 40.00 | 239294 | 0 | 712 | X | |||
| Berniece Deol | ||||||||
| VP, Nursing Services | 40.00 | 218636 | 0 | 239 | X | |||
| Ching Chen | ||||||||
| Chief Radiation.Physicist | 40.00 | 247840 | 0 | 9666 | X | |||
| Ira Meiselman | ||||||||
| Director, Managed Care | 40.00 | 220003 | 0 | 11166 | X | |||
| Hilarion Castillo | ||||||||
| Controller | 40.00 | 211348 | 0 | 8733 | X | |||
| Daniel Moreno | ||||||||
| Director Cardiology | 40.00 | 209577 | 0 | 7347 | X | |||
| Steve Garcia | ||||||||
| Dir. Pat. Financial svcs. | 40.00 | 176370 | 0 | 10664 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3436635 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 98788 | TotalOtherCompensation |
| Number Individuals GT100 K | 320 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Crothall Healthcare Inc | |||||
| 955 Chesterbrook Blvd Suite 300 | Wayne | PA | 19087 | Environmental Services | 4886090 |
| Sodexho Marriott Services | |||||
| 711 Kimberly Avenue Suite 250 | Placentia | CA | 92870 | Dietary Services | 3323517 |
| Wellspring Partners | |||||
| 123 N Wacker Suite 900 | Chicago | IL | 60606 | Consulting | 1912531 |
| Universal Hospital Services Inc | |||||
| PO Box 86 | Minneapolis | MN | 554860940 | Equipment Maintenance | 1449130 |
| Total Renal CareDavita | |||||
| PO Box 403008 | Atlanta | GA | 30384 | Dialysis Service | 1243865 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 80 | NumberOfContractorsGT100K |
| Fundraising Events | 77050 | FundraisingEvents |
| Related Organizations | 2879523 | RelatedOrganizations |
| All Other Contributions | 5778783 | AllOtherContributions |
| Total Contributions | 8735356 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Net Patient Revenue | 900099 | 303402532 | 303402532 |
| Rental Income | 532000 | 714315 | 714315 |
| Child Care Center | 624410 | 406748 | 406748 |
| Symposium Revenue | 900099 | 11521 | 11521 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 304535116 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 9100344 | TotalRevenueColumn |
| Exclusion | $9,100,344 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 4063189 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 3890243 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 172946 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 172946 | TotalRevenueColumn |
| Exclusion | $172,946 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 64565 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 77050 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 77167 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -12602 | TotalRevenueColumn |
| Exclusion | -$12,602 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|
| Parking Lot | 812930 | 595863 | 29485 | $566,378 |
| Physician Mgmt Service | 621110 | 246034 | 246034 | |
| Non-patient Lab | 621500 | 99107 | 99107 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 840906 | TotalRevenueColumn |
| Exclusion | $840,906 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1781910 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 324313070 | TotalRevenueColumn |
| Related Or Exempt Function Income | 304535116 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 374626 | UnrelatedBusinessRevenue |
| Exclusion | $10,667,972 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2757061 | Total |
| Program Services | 2757061 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2573207 | Total |
| Program Services | 458880 | ProgramServices |
| Management And General | 1858326 | ManagementAndGeneral |
| Fundraising | 256001 | Fundraising |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 98539564 | Total |
| Program Services | 89731365 | ProgramServices |
| Management And General | 8503839 | ManagementAndGeneral |
| Fundraising | 304360 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6581046 | Total |
| Program Services | 5902895 | ProgramServices |
| Management And General | 678151 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24401878 | Total |
| Program Services | 21844398 | ProgramServices |
| Management And General | 2489771 | ManagementAndGeneral |
| Fundraising | 67709 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8492559 | Total |
| Program Services | 7682686 | ProgramServices |
| Management And General | 765831 | ManagementAndGeneral |
| Fundraising | 44042 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 966182 | Total |
| Management And General | 966182 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 376308 | Total |
| Program Services | 9940 | ProgramServices |
| Management And General | 366368 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 68452 | Total |
| Management And General | 68452 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 32606294 | Total |
| Program Services | 26932716 | ProgramServices |
| Management And General | 5523436 | ManagementAndGeneral |
| Fundraising | 150142 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 970632 | Total |
| Program Services | 133090 | ProgramServices |
| Management And General | 837542 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 477203 | Total |
| Program Services | 476649 | ProgramServices |
| Management And General | 554 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 111052 | Total |
| Program Services | 57373 | ProgramServices |
| Management And General | 48783 | ManagementAndGeneral |
| Fundraising | 4896 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4682472 | Total |
| Program Services | 4682472 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9643947 | Total |
| Program Services | 6777564 | ProgramServices |
| Management And General | 2866383 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2338189 | Total |
| Program Services | 1512446 | ProgramServices |
| Management And General | 825743 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| Supplies | 51171380 | 50986298 | 157091 | 27991 |
| Hospital Fee Program | 22985172 | 22985172 | ||
| Bad Debts | 13383200 | 13383200 | 0 | 0 |
| Repairs & Maintenance | 7287692 | 4542722 | 2744586 | 384 |
| Utilities | 3355968 | 3343235 | 12733 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7464197 | Total |
| Program Services | 5304108 | ProgramServices |
| Management And General | 1817342 | ManagementAndGeneral |
| Fundraising | 342747 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 301233655 | Total |
| Program Services | 269504270 | ProgramServices |
| Management And General | 30531113 | ManagementAndGeneral |
| Fundraising | 1198272 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5990871 | BOY |
| EOY | 13112844 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6301901 | BOY |
| EOY | 6559400 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13415384 | BOY |
| EOY | 14111669 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37448400 | BOY |
| EOY | 35763304 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14539197 | BOY |
| EOY | 16034956 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1412209 | BOY |
| EOY | 1399114 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14711289 | BOY |
| EOY | 13918132 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 366676945 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 274042236 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 90042237 | BOY |
| EOY | 92634709 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 202818058 | BOY |
| EOY | 217975854 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2222177 | BOY |
| EOY | 2178335 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 388901723 | BOY |
| EOY | 413688317 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 43712620 | BOY |
| EOY | 42837100 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 65001657 | BOY |
| EOY | 60880882 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 58155183 | BOY |
| EOY | 54928045 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 166869460 | BOY |
| EOY | 158646027 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 127198187 | BOY |
| EOY | 157290065 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37500428 | BOY |
| EOY | 40418577 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 57333648 | BOY |
| EOY | 57333648 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 222032263 | BOY |
| EOY | 255042290 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 388901723 | BOY |
| EOY | 413688317 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 23079415 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 9930612 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $68,452 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 68452 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Explanation of Other Lobbying Activities: | Identifier |
| Return Reference | Part II-B, Line 1i: | ReturnReference |
| Explanation | Lobbying represents a portion of the dues Good Samaritan Hospital pays to the Hospital Association of Southern California and payments to Griffin & Associates. | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 57333648 | BeginningOfYearBalance |
| End Of Year Balance | 57333648 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 57316151 | BeginningOfYearBalance |
| Contributions | 17497 | Contributions |
| End Of Year Balance | 57333648 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 57313907 | BeginningOfYearBalance |
| Contributions | 2244 | Contributions |
| End Of Year Balance | 57316151 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 1.00000 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 1 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 11395670 | OtherCostOrOtherBasis |
| Book Value | 11395670 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 128512086 | OtherCostOrOtherBasis |
| Depreciation | 95000857 | Depreciation |
| Book Value | 33511229 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 210156880 | OtherCostOrOtherBasis |
| Depreciation | 176144821 | Depreciation |
| Book Value | 34012059 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 16612309 | OtherCostOrOtherBasis |
| Depreciation | 2896558 | Depreciation |
| Book Value | 13715751 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 92634709 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (6 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Reserve For Self-Insured Programs | $6,233,552 |
| Pension Plan | $19,091,298 |
| Advances From Third Party Payors | $9,211,818 |
| Reserve For Asset Retirement Obligation | $7,251,390 |
| Other Long Term Reserves/Liabilities | $12,422,270 |
| Intercompany Payable | $717,717 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 54928045 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Description of Intended Use of Endowment Funds: | Part V, Line 4: | For Specific purposes listed by the donors. |
| Description of Uncertain Tax Positions Under FIN 48: | Part X: | THE HOSPITAL, SIC, AND MOB ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND ARE EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE CODE. THEY ARE EXEMPT FROM STATE FRANCHISE TAXES UNDER SIMILAR STATUTES. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN RECORDED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. DURING THE YEARS ENDED AUGUST 31, 2011 AND 2010, THE HOSPITAL DID NOT RECORD ANY LIABILITY FOR UNRECOGNIZED TAX CONTINGENCIES. |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | Golf Tournament | NameOfEvent1 |
| Gross Receipts Event1 | 141615 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 77050 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 64565 | GrossRevenueEvent1 |
| Rent Facility Costs Event1 | 48838 | RentFacilityCostsEvent1 |
| Other Direct Expenses Event1 | 28329 | OtherDirectExpensesEvent1 |
| Gross Receipts Total | 141615 | GrossReceiptsTotal |
| Charitable Contributions Total | 77050 | CharitableContributionsTotal |
| Gross Revenue Total Events | 64565 | GrossRevenueTotalEvents |
| Rent Facility Costs Total Events | 48838 | RentFacilityCostsTotalEvents |
| Other Direct Expenses Total Events | 28329 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 77167 | DirectExpenseSummaryEvents |
| Net Income Summary | -12602 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent350 | X | Pcent350 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 0 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5658169 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 5658169 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01970 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 19752 | PersonsServed |
| Total Community Benefit Expense | 76922659 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 74531838 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2390821 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00830 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 19752 | PersonsServed |
| Total Community Benefit Expense | 82580828 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 74531838 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 8048990 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02800 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 132861 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 132861 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
Research Research
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1148328 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1148328 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00400 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1076788 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1076788 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00370 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2357977 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2357977 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00820 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 19752 | PersonsServed |
| Total Community Benefit Expense | 84938805 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 74531838 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 10406967 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03620 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $12,605,843 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 98393323 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 92215946 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 6177377 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Good Samaritan Hospital | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 616 South Witmer Street | AddressLine1 |
| City | Los Angeles | City |
| State | CA | State |
| ZIP Code | 90017 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Teaching Hospital | X | TeachingHospital |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
| Other | Hospital research by Institutes | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NOT REQUIRED | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| Part I, Line 3c: Discounted care is provided to patients that are uninsured and do not meet the charity care eligibility criteria. | ||
| Part I, Line 7: a) Charity care cost: applied cost-to-charge ratio (total patient cost to total charges from FY 2011 Medi-Cal cost report = 22.22%) to charity write offs.7 b) Unreimbursed Medi-Cal: cost from cost accounting system that calculated cost of care for all Medi-Cal patients net of payments received and estimated.7 h) Research: cost from Research general ledger accounts less funding received. | ||
| 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 $ 13383200. | ||
| Part III, Line 4: The Company recognizes patient service revenue on the basis of contractual rates for the services rendered for those patients who have third-party payor coverage. For uninsured patients who do not qualify for charity care, the Company recognizes revenue on the basis of its standard rates (or on the basis of discounted rates, if negotiated or provided by policy). Patients covered by insurance, but required to pay deductibles or copayments are considered to be uninsured for those portions. Based on historical experience, the Company believes that a significant portion of its patient accounts will be uncollectible. Thus, it records a significant provision for bad debts related to patient accounts in the period the services are provided.Bad debts are not included as community benefits and contain -0- charity cost. Bad debts are calculated based on uncollectible accounts net of contractuals. | ||
| Part III, Line 8: Filed Medicare cost report. | ||
| Part III, Line 9b: Account Balances for patients that qualify for charity care are written off. | ||
| Part I, line 7b:In October 2010, CMS approved legislation enacted by the State of California that provided for supplemental Medi-Cal payments to be paid to certain hospitals from funds collected from participating hospitals under the state's quality assurance fee program. Such amounts were allocated and paid to Good Samaritan Hospital based on prior year patient data, which includes Medi-Cal patients. The inclusion of out-of-period revenue in fiscal year 2011 financial results reduced the net unreimbursed Medicaid. If these amounts had not been included, the Hospital would have reported a total charity care percentage of 8.87% instead of the 3.62% currently being reported. | ||
| 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 (2007), Latinos accounted for a majority of the population in the GSH service area (58.7%) 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 (19.6%). | ||
| Part VI, Line 6: Good Samaritan Hospital provides community building activities to promote health, wellness and safety: health fairs, health lectures, hosting cancer support groups, community police advisory board 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: Good Samaritan Hospital maintains an active presence in the community through the volunteer and advocacy efforts of its physicians, employees and Board of Trustees. The hospital provides support to community clinics by providing services such as transportation for patients to the hospital. The hospital also hosts conferences open to the public at no cost on topics related to various health issues prevalent in the community. Good Samaritan Hospital publishes Good Health, a community newsletter that goes out to 16,000 households to increase awareness and understanding of medical advances related to cardiovascular care, orthopedic services, transfusion-free medicine and surgery, urology, oncology and womens and newborn services. | ||
| CA | Reports Filed With States | Part VI, Line 7 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Method Of ValuationMethodOfValuation | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|---|
| Heart Institute of the Good Samaritan Hospital | ||||||||
| 616 South Witmer Street | Los Angeles | CA | 90017 | 954077161 | 501(c)(3) | 1458756 | FMV | Expenses paid by the Hospital |
| Orthopedic Institute of the Good Samaritan Hospital | ||||||||
| 616 South Witmer Street | Los Angeles | CA | 90017 | 954346048 | 501(c)(3) | 221517 | FMV | Expenses paid by the Hospital |
| California Health Foundation and Trust | ||||||||
| 1215 K Street Suite 800 | Sacramento | CA | 95814 | 941498687 | 501(c)(3) | 1076788 | FMV | Support charitable activities at hospitals & health systems in California |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 3 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Procedure for Monitoring Grants in the U.S.: | Identifier |
| Return Reference | Part I, Line 2: | ReturnReference |
| Explanation | Schedule I, Part I, Line 2: The Institutes (Heart and Ortho) do not have their own checking accounts, so all of their expenses (including salaries, wages and benefits) are paid for by the hospital and are all recorded in each of the Institutes' accounts in the General Ledger, thru intercompany due to and from accounts on both sides (Institutes' and Hospital's). Grants will only be made to 501(c)(3) organizations to ensure the funds will be used properly. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (13 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Andrew Leeka | |||||||||||||
| 503791 | 0 | 0 | 0 | 52444 | 0 | 7350 | 0 | 3180 | 0 | 566765 | 0 | 0 | 0 |
| Alan M Ino | |||||||||||||
| 366693 | 0 | 0 | 0 | 22000 | 0 | 7350 | 0 | 2516 | 0 | 398559 | 0 | 0 | 0 |
| Susan Harlow | |||||||||||||
| 231806 | 0 | 0 | 0 | 16500 | 0 | 7350 | 0 | 345 | 0 | 256001 | 0 | 0 | 0 |
| Lexie Schuster | |||||||||||||
| 231588 | 0 | 0 | 0 | 14837 | 0 | 7350 | 0 | 0 | 0 | 253775 | 0 | 0 | 0 |
| Sammy Feuerlicht | |||||||||||||
| 234717 | 0 | 0 | 0 | 0 | 0 | 7110 | 0 | 2283 | 0 | 244110 | 0 | 0 | 0 |
| Dan McLaughlin | |||||||||||||
| 239191 | 0 | 0 | 0 | 0 | 0 | 2911 | 0 | 2516 | 0 | 244618 | 0 | 0 | 0 |
| Patricia Rives | |||||||||||||
| 239294 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 712 | 0 | 240006 | 0 | 0 | 0 |
| Berniece Deol | |||||||||||||
| 218636 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 239 | 0 | 218875 | 0 | 0 | 0 |
| Ching Chen | |||||||||||||
| 227827 | 0 | 0 | 0 | 20013 | 0 | 7350 | 0 | 2316 | 0 | 257506 | 0 | 0 | 0 |
| Ira Meiselman | |||||||||||||
| 178003 | 0 | 20000 | 0 | 22000 | 0 | 6150 | 0 | 5016 | 0 | 231169 | 0 | 0 | 0 |
| Hilarion Castillo | |||||||||||||
| 186588 | 0 | 0 | 0 | 24760 | 0 | 6410 | 0 | 2323 | 0 | 220081 | 0 | 0 | 0 |
| Daniel Moreno | |||||||||||||
| 190962 | 0 | 0 | 0 | 18615 | 0 | 2551 | 0 | 4796 | 0 | 216924 | 0 | 0 | 0 |
| Steve Garcia | |||||||||||||
| 165475 | 0 | 0 | 0 | 10895 | 0 | 5448 | 0 | 5216 | 0 | 187034 | 0 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| 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. | |
| 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 12c | |
| 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 B, line 15 | |
| 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 organizations Form 990, which is available for public inspection upon request. The organization'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 Samaritan 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 VI, Section C, line 19 | |
| Avg hours devoted to related org(s) when related comp is reported: | Compensation reported on Form 990, Part VII was paid to each of these individuals in exchange for the fulfillment of their duties as full-time, 40+ hour-per-week employees at Good Samaritan Hospital and 2 hours-per-week employees at related organizations. | Form 990, Part VII: |
| Changes in Net Assets or Fund Balances: | Net unrealized gains on investments: 2,911,522. Minimum Pension Liability 4,112,692. Intercompany Adjustments 2,906,398. Total to Form 990, Part XI, Line 5: 9,930,612. | Form 990, Part XI, line 5: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (8 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| Heart Institute of the Good Samaritan Hospital | ||||||||||
| 616 South Witmer Street | Los Angeles | CA | 90017 | 954077161 | Heart Research | CA | section 501(c)(3) | 4 | N/A | 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 | N/A | 1 |
| Samaritan Imaging Center | ||||||||||
| 616 South Witmer Street | Los Angeles | CA | 90017 | 954252321 | Outpatient Imaging Services | CA | section 501(c)(3) | 9 | N/A | 1 |
| Cancer Institute of the Good Samaritan Hospital | ||||||||||
| 616 South Witmer Street | Los Angeles | CA | 90017 | 954271815 | Cancer Research | CA | section 501(c)(3) | 4 | N/A | 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 | N/A | 1 |
| Good Samaritan Hospital Medical Office Building Inc | ||||||||||
| 616 South Witmer Street | Los Angeles | CA | 90017 | 953244046 | Physicians Medical Offices | CA | section 501(c)(3) | 11, Type 1 | N/A | 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 | N/A | 1 |
| 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 | N/A | 1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 1 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (6 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| Good Samaritan Hospital Medical Office Building Inc | ||
| A | 595201 | FMV |
| Good Samaritan Hospital Medical Office Building Inc | ||
| J | 305724 | FMV |
| Heart Institute of the Good Samaritan Hospital | ||
| B | 1458756 | FMV |
| Heart Institute of the Good Samaritan Hospital | ||
| C | 2031817 | FMV |
| Orthopedic Institute of the Good Samaritan Hospital | ||
| B | 221517 | FMV |
| Orthopedic Institute of the Good Samaritan Hospital | ||
| C | 821706 | FMV |