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, Vid Shivaraman, Rosalio Lopez, Marissa Goldberg, Melanie Batiste, Robert Maloney, and Brian Smolskis.”

“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.”

“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 9.8% 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 - $72,736 Other Compensation - $0”

“Physician Fees: Program service expenses 13,961,854. Management and general expenses 0. Fundraising expenses 0. Total expenses 13,961,854. Consulting and Management Fees: Program service expenses 0. Management and general expenses 9,687. Fundraising expenses -90,000. Total expenses -80,313. Other Contracted Services: Program service expenses 3,814,794. Management and general expenses 8,468. Fundraising expenses 0. Total expenses 3,823,262. Other Professional Fees: Program service expenses 17,494. Management and general expenses 16,970. Fundraising expenses 0. Total expenses 34,464. Medical Purchased Services: Program service expenses 4,062,978. Management and general expenses 94,800. Fundraising expenses 0. Total expenses 4,157,778. Repairs and Maintenance: Program service expenses 4,388,384. Management and general expenses 239,808. Fundraising expenses 0. Total expenses 4,628,192. Software Maintenance : Program service expenses 3,676,318. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,676,318. Collection Fees: Program service expenses 0. Management and general expenses 71,020. Fundraising expenses 0. Total expenses 71,020. Other Purchased Services: Program service expenses 22,711,806. Management and general expenses 6,245,632. Fundraising expenses 5,729. Total expenses 28,963,167. Outside Provider Cost : Program service expenses 18,708,276. Management and general expenses 0. Fundraising expenses 0. Total expenses 18,708,276. Purchased Labor: Program service expenses 22,689,441. Management and general expenses 0. Fundraising expenses 0. Total expenses 22,689,441.”

“The FY21 amount in line 7 of $176,172,569 was moved to line 15 to match the FY22 presentation. The amounts in line 7 were all moved to line 15 as other assets with the detail being shown on Form 990, Schedule D, Part IX.”

“Accrued Minimum Pension Liability 659,617. Intercompany Transfer 185,388. Grant Refund 41,442. Net Assets Released from Restrictions 6,826.”