Pih Health Good Samaritan Hospital

“The Organization is a member of an integrated healthcare system controlled by PIH Health, Inc. The following individuals have a business relationship by virtue of their positions as officers or directors of related entities within the system: J. Richard Atwood, Jeffrey Hamar, Paula Cowan, Alex Alvarez, Blayne Cutler, Jane Dicus, Patrick Monroe, Charlotte Weaver, Kenton Woods, Peter Greaney, Paul Treinen, James West, Peggy Chulack, Anita Chou, Vid Shivaraman and Rosalio Lopez.”

“On May 6, 2021, Good Samaritan Hospital changed its name to PIH Health Good Samaritan Hospital.”

“PIH Health, Inc. is the sole member of PIH Health Good Samaritan Hospital.”

“PIH Health, Inc. has authority to elect all the members of the board of directors of PIH Health Good Samaritan Hospital.”

“PIH Health, Inc. has all voting rights and the power to elect the board of directors of PIH Health Good Samaritan Hospital.”

“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 VP of Finance. Form 990 is then reviewed by the Audit Committee of PIH Health, Inc., which is made up of independent directors. RSM US LLP makes all changes necessary. The final Form 990 is provided to the board prior to filing.”

“Each year, all management and board of directors members are required to complete a conflict of interest disclosure form. All positive responses are reviewed by the General Counsel and Chief Administrative Officer of PIH Health, Inc. Each positive response is considered in light of magnitude of ownership interest, financial transaction(s), etc. If deemed necessary, conflicts of interest could be resolved by insisting that the incumbent either divest their ownership interest, that the organization terminate the business relationship, or even that the director resign. Directors with potential conflicts of interest may recuse themselves from voting on certain matters and/or may excuse themselves from meetings during the discussion, deliberation, and voting on of matters.”

“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.”

“PIH Health 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.”

“PIH Health 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. PIH Health Good Samaritan Hospital annually evaluates its participation in joint venture arrangements.”

“One of the filing organization's officers, Rosalio Lopez, is an employee of PIH Health Downey Medical Group, Inc. (DMG), which has a professional service agreement with PIH Health Physicians, an affiliate of the filing organization, to provide physician services. The individuals received compensation from DMG, as follows: Rosalio Lopez: Reportable Base Compensation - $63,985 Other Compensation - $0”

“Physician Fees: Program service expenses 15,550,839. Management and general expenses 0. Fundraising expenses 0. Total expenses 15,550,839. Consulting and Management Fees: Program service expenses 786,881. Management and general expenses 1,169,542. Fundraising expenses 119,996. Total expenses 2,076,419. Medical Purchased Services: Program service expenses 3,375,404. Management and general expenses 94,800. Fundraising expenses 0. Total expenses 3,470,204. Repairs and Maintenance: Program service expenses 7,628,844. Management and general expenses 181,863. Fundraising expenses 0. Total expenses 7,810,707. Software Maintenance: Program service expenses 4,193,384. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,193,384. Other Purchased Services: Program service expenses 24,845,483. Management and general expenses 6,267,495. Fundraising expenses 40,257. Total expenses 31,153,235. Outside Provider Cost: Program service expenses 14,987,722. Management and general expenses 0. Fundraising expenses 0. Total expenses 14,987,722. Purchased Labor: Program service expenses 30,679,773. Management and general expenses 43,236. Fundraising expenses 0. Total expenses 30,723,009. Other Contracted Services: Program service expenses 3,766,471. Management and general expenses 14,449. Fundraising expenses 0. Total expenses 3,780,920. Other Professional Services: Program service expenses 18,988. Management and general expenses 0. Fundraising expenses 0. Total expenses 18,988. Collection Fees: Program service expenses 0. Management and general expenses 199,315. Fundraising expenses 0. Total expenses 199,315.”

“Pension related changes 3,485,035. Net assets released from restrictions 41,226. Intercompany transfer 50,575. Grant Refund 2,508.”