Samaritan Imaging Center

“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: James West, Peggy Chulack, and Anita Chou.”

“The sole member of the Organization is Good Samaritan Hospital, a California nonprofit organization.”

“The sole member has the power to appoint, replace or remove the members of the Board of Directors.”

“The Organization's corporate member is Good Samaritan Hospital ("GSH"). Pursuant to Section 3.2 of the Organization's bylaws, the following decisions require approval by GSH: - Amendment of the Articles of Incorporation or Bylaws - Removal of Director for a cause - Sale of disposal of all or substantially all of the Organization's assets - Dissolution or winding up of the Organization - Approval of a merger - Contracts resulting in expenditures of the Organization's assets in excess of an amount as shall be determined, from time to time, by resolution of the Board of Directors of GSH - Contracts for the purchase, sale, exchange, or other disposition or gift of any real estate owned or partially owned by the organization - Short-term or long-term borrowings, mortgages, pledges of, or leases entailing cumulative payments by the organization in excess of such amount (s) respecting specific types of transactions as shall be determined, from time to time, by resolution of the Board of Directors of GSH - Hiring or firing of the Organization's senior executives, as such term shall be defined by resolution of the Board of Directors of GSH - Final approval of the annual operating budget of the Organization - Acceptance of a legacy or gift imposing a permanent or continuing obligation on the Organization - Establish and/or acknowledgement of any auxiliary and/or auxiliary corporation to be association with the organization.”

“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.”

“The organization is included in the Conflict of Interest Policy for Good Samaritan Hospital, the Organization's sole member. According to the Policy, 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.”

“During the tax year ended August 31, 2020, no officers, directors, or trustees received compensation from this Organization. The compensation reported is paid by a related organization and is determined based on the compensation review practices and policies of Good Samaritan Hospital, a controlling related entity.”

“Samaritan Imaging Center'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.”

“This line reflects a prior period adjustment for the organization's fair market valuation of assets, primarily fixed assets. This adjustment was identified during the opening balance sheet audit conducted during the tax year in connection with the acquisition of Good Samaritan Hospital and its affiliates by PIH Health, Inc. Schedule D Part VI similarly reflects changes resulting from this revaluation.”