Pih Health Good Samaritan Hospital

“Mrs. Maribeth Borthwick, a Board Member of Good Samaritan Hospital, has a family relationship with Mr. Charles Munger, Chairman of the Board. Mr. Clark W. Porter has a family relationship with Mr. Glen H. Mitchel, Jr., who are both board members.”

“The organization works with an independent accountant, RSM US LLP, to prepare the Form 990. Once the return is prepared, the return is reviewed by the Chief Financial Officer and the Controller, who will provide any final comments to RSM US LLP. RSM US LLP makes all changes necessary and a final Form 990 is made available to all Board Members prior to filing.”

“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.”

“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 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.”

“Good Samaritan Hospital's organizing documents and the Conflict of Interest Policy are not made available to the public. The financial information from the financial statements is included in the Organization's Form 990, which is available for public inspection upon request.”

“Good Samaritan Hospital holds a 12.5% interest a joint venture arrangement that exists to further the charitable and community-based health care purposes, mission, vision, and values of its controlling tax exempt members. Good Samaritan Hospital annually evaluates its participation in joint venture arrangements.”

“Physician Fees: Program service expenses 9,208,225. Management and general expenses 0. Fundraising expenses 0. Total expenses 9,208,225. Consulting and Management Fees: Program service expenses 2,311,069. Management and general expenses 2,425,365. Fundraising expenses 15,074. Total expenses 4,751,508. Medical Purchased Services: Program service expenses 2,276,030. Management and general expenses 350. Fundraising expenses 0. Total expenses 2,276,380. Repairs and Maintenance: Program service expenses 6,454,595. Management and general expenses 888,341. Fundraising expenses 0. Total expenses 7,342,936. Software Maintenance: Program service expenses 1,833,675. Management and general expenses 1,762,426. Fundraising expenses 3,540. Total expenses 3,599,641. Other Purchased Services: Program service expenses 16,207,338. Management and general expenses 4,213,072. Fundraising expenses 28,470. Total expenses 20,448,880. Outside Provider Cost: Program service expenses 7,840,835. Management and general expenses 0. Fundraising expenses 0. Total expenses 7,840,835. Purchased Labor: Program service expenses 24,540,070. Management and general expenses 418,284. Fundraising expenses 0. Total expenses 24,958,354.”

“Net assets released from restrictions -78,716. Pension related changes -8,456. Change in value of split-interest agreements -132,598. TRF Transfer 135,977.”