Civic Intelligence

Samaritan Imaging Center

990 • Fiscal year 2021 • EIN 95-4252321

Oct 01, 2020 to Sep 30, 2021 • Filed on Aug 25, 2022

1225 Wilshire BlvdLos Angeles, CA 90017-2395

(213) 977-2121

Siviq Scores

Precomputed percentiles for this filing year versus similar nonprofits in the same peer cohort.

Liabilities / Assets

Score unavailable

No value available

Liabilities-to-assets requires both liabilities and assets on this filing.

Source year 2021

Liabilities / Revenue

Score unavailable

No value available

Liabilities-to-revenue requires both liabilities and revenue on this filing.

Source year 2021

Net Margin

Score unavailable

No value available

Net margin requires both revenue and expenses on this filing.

Source year 2021

Top Officer Pay

100th percentile

$3,114,147

Higher top officer pay than 100% of similar nonprofits.

2021 filings • 501(c)3 • <$500k nonprofits • Source year 2021

Asset Growth

2nd percentile

-100%

Faster asset growth than 2% of similar nonprofits.

2021 filings • 501(c)3 • <$500k nonprofits • Annualized from 2020 to 2021

Revenue Growth

2nd percentile

-100%

Faster revenue growth than 2% of similar nonprofits.

2021 filings • 501(c)3 • <$500k nonprofits • Annualized from 2020 to 2021

Assets

Down

$0

Down $697,936 (-100%) from 2020

Net Assets

Down

-$12,521,142

Down $24,232 (-0.2%) from 2020

Liabilities

Down

$12,521,142

Down $673,704 (-5.1%) from 2020

Revenue

Down

$0

Down $89,868 (-100%) from 2020

Expenses

Down

$0

Down $205,009 (-100%) from 2020

Net Income

Up

$0

Up $115,141 (+100%) from 2020

Historical Trend

Balance Sheet Trend

The highlighted filing sits inside the broader history for assets, liabilities, and net assets.

$20M$10M$0-$10M-$20MAssets 2011: $3,190,309Liabilities 2011: $12,252,840Net Assets 2011: -$9,062,5312011Assets 2012: $1,982,078Liabilities 2012: $12,397,901Net Assets 2012: -$10,415,8232012Assets 2013: $1,435,112Liabilities 2013: $12,784,036Net Assets 2013: -$11,348,9242013Assets 2014: $1,260,319Liabilities 2014: $12,904,173Net Assets 2014: -$11,643,8542014Assets 2015: $1,050,966Liabilities 2015: $13,180,902Net Assets 2015: -$12,129,9362015Assets 2016: $811,487Liabilities 2016: $13,520,367Net Assets 2016: -$12,708,8802016Assets 2017: $3,808,086Liabilities 2017: $17,204,574Net Assets 2017: -$13,396,4882017Assets 2018: $3,981,831Liabilities 2018: $17,173,810Net Assets 2018: -$13,191,9792018Assets 2019: $4,072,388Liabilities 2019: $17,203,608Net Assets 2019: -$13,131,2202019Assets 2020: $697,936Liabilities 2020: $13,194,846Net Assets 2020: -$12,496,9102020Assets 2021: $0Liabilities 2021: $12,521,142Net Assets 2021: -$12,521,1422021Assets 2022: $0Liabilities 2022: $12,521,142Net Assets 2022: -$12,521,1422022Assets 2023: $0Liabilities 2023: $12,521,142Net Assets 2023: -$12,521,1422023Assets 2024: $0Liabilities 2024: $12,521,142Net Assets 2024: -$12,521,1422024

Highlighted filing

2021

Assets$0
Liabilities$12,521,142
Net Assets-$12,521,142

Operations Trend

Revenue, expenses, and net income across loaded years, with this filing highlighted.

$10M$5.0M$0-$5.0MRevenue 2011: $5,118,393Expenses 2011: $6,581,376Net Income 2011: -$1,462,9832011Revenue 2012: $4,677,150Expenses 2012: $6,030,442Net Income 2012: -$1,353,2922012Expenses 2013: $5,273,8412013Revenue 2014: $4,343,281Expenses 2014: $4,638,211Net Income 2014: -$294,9302014Revenue 2015: $4,128,966Expenses 2015: $4,615,048Net Income 2015: -$486,0822015Revenue 2016: $3,892,611Expenses 2016: $4,471,555Net Income 2016: -$578,9442016Revenue 2017: $3,777,614Expenses 2017: $4,465,222Net Income 2017: -$687,6082017Revenue 2018: $280,549Expenses 2018: $76,040Net Income 2018: $204,5092018Revenue 2019: $98,593Expenses 2019: $37,834Net Income 2019: $60,7592019Revenue 2020: $89,868Expenses 2020: $205,009Net Income 2020: -$115,1412020Revenue 2021: $0Expenses 2021: $0Net Income 2021: $02021Revenue 2022: $0Expenses 2022: $0Net Income 2022: $02022Revenue 2023: $0Expenses 2023: $0Net Income 2023: $02023Revenue 2024: $0Expenses 2024: $0Net Income 2024: $02024

Highlighted filing

2021

Revenue$0
Expenses$0
Net Income$0
Jump To
Filing Snapshot
Filing Period
Oct 1, 2020 to Sep 30, 2021
Signed
Aug 25, 2022
Return Version
2020v4.2
Gross Receipts
$0
Mission and Program Overview

Mission

The primary exempt purpose of the Samaritan Imaging Center is to operate an outpatient radiology imaging center which provides radiological diagnostic services and a medical facility dedicated to the advancement of the care of sick, injured or disabled individuals requiring radiological imaging services. The Center also provides advanced education and training of members of the medical community in the area of radiological imaging technology, procedures and safety. In addition, the Center educates the public with respect to advances in radiological imaging medicine, the benefits and risks of the latest available radiological imaging procedures as well as the contributions such procedures make to the prevention and treatment of disease and injury.

Operate an outpatient radiology imaging Center which provides radiological diagnostic services.

Balance Sheet Detail
LineBeginningEndChange
Assets
Land, Buildings, and Equipment, Net$624,824$0▼ $624,824
Accounts Receivable$24,249$0▼ $24,249
Cash and Non-Interest-Bearing Accounts$0$0→ $0
Total Assets$649,073$0▼ $649,073
Liabilities
Other Liabilities$12,989,648$12,521,142▼ $468,506
Accounts Payable and Accrued Expenses$180,567$0▼ $180,567
Total Liabilities$13,170,215$12,521,142▼ $649,073
Net Assets / Fund Balance
Net Assets Without Donor Restrictions$-12,521,142$-12,521,142→ $0
Total Net Assets Fund Balance$-12,521,142$-12,521,142→ $0
Total Liabilities and Net Assets / Fund Balance$649,073$0▼ $649,073
Compensation and Service Providers

Board Members and Trustees

NameTitle
James WestPresident & CEO
Vid ShivaramanCFO & Assistant Treasurer
Anita ChouCFO & Asst. Treasurer (until 2/2021)
Peggy ChulackCOO & Asst. Secretary
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$0
Investment Income
$0
Other Revenue
$0
Change in Net Assets
$0
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Grants and Similar Amounts Paid$0
Other Expenses$0
Professional Fundraising Fees$0
Salaries, Compensation, and Employee Benefits$0
Total Fundraising Expense$0
Fundraising, Events, and Gaming
Fundraising activities
No
Gaming activities
No
Professional fundraiser used
No

Fundraising and Gaming Totals

Line ItemAmount
Professional Fundraising Fees$0
Political and Lobbying Activity
Political campaign activity
No
Lobbying activity
No
Subject to proxy tax
No
Debt and Bond Financing

Other Reported Liabilities

LiabilityAmount
Due to Affiliates$12,521,142
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Annual disclosure for covered persons
Yes
Audit committee
Yes
Business relationship with 35% controlled entity
No
Business relationship with family members
No
Business relationship with organization members
No
Material changes to governing documents
No
Compensation from other sources disclosed
No
CEO compensation reviewed
No
Other officer compensation reviewed
No
Conflict-of-interest policy
Yes
Audited financial statements prepared
Yes
Key decisions subject to board approval
Yes
Management duties delegated
No

Governance Explanations

Form 990, Part VI, Section A, line 2

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, Anita Chou, and Vid Shivaraman.

Form 990, Part VI, Section A, line 6

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

Form 990, Part VI, Section A, line 7A

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

Form 990, Part VI, Section A, line 7B

The Organization's corporate member is PIH Health Good Samaritan Hospital ("PHGSH"). Pursuant to Section 3.2 of the Organization's bylaws, the following decisions require approval by PHGSH: - 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 PHGSH - 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 PHGSH - Hiring or firing of the Organization's senior executives, as such term shall be defined by resolution of the Board of Directors of PHGSH - 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.

Form 990, Part VI, Section B, line 11B

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.

Form 990, Part VI, Section B, line 12C

The organization is included in the Conflict of Interest Policy for PIH Health 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 PIH Health Good Samaritan Hospital and are enforced by the Audit Committee Chairperson.

Form 990, Part VI, Section B, line 15

During the tax year ended September 30, 2021, 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.

Form 990, Part VI, Section C, line 19

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.

Filing and Contact Details

Filer

Filer Name
Samaritan Imaging Center
EIN
95-4252321
Phone
2139772121
Address
1225 Wilshire Blvd, Los Angeles, CA 90017-2395

Signing Officer

Name
Vid Shivaraman
Title
CFO
Phone
2139772121
Signed
2022-08-25
Discuss with paid preparer
Yes

Organization Details

Principal Officer
James West
Formed
2003
Legal Domicile
CA
Voting Board Members
3
Independent Board Members
0
Employees
0
Volunteers
0

Preparer

Firm
Rsm US Llp
Address
210 Park Ave Suite 1725, Oklahoma City, OK 73102
Preparer
Lauren Nowakowski
Phone
4052397961
Supplemental Narrative

Additional Explanations

Form 990, Part III, line 3

Samaritan Imaging Center previously provided outpatient radiological diagnostic services for patients. This activity was moved to PIH Health Good Samaritan Hospital in 2020. The organization is in the process of evaluating plans for future activities.

Financial Statement Notes

Part X, Line 2:

The principal operations of the Company are exempt from income taxes pursuant to Internal Revenue Code (IRC) Section 501(c)(3) and the laws of the states in which it operates and, as such, is generally not subject to federal or state income taxes. However, the Company is subject to income taxes on net income derived from a trade or business regularly carried on that does not further the organization's exempt purpose. Further, the Company is also subject to federal excise taxes pursuant to the Tax Cuts and Jobs Act. No significant income tax provision has been recorded in the accompanying consolidated financial statements for net income derived from unrelated trade or business and excise taxes. The Company measures liabilities for unrecognized tax uncertainties in accordance with ASC 740, Income Taxes, which prescribes a comprehensive model for how a company should recognize, measure, present and disclose in its financial statements uncertain tax positions that a company has taken or expects to take on a tax return. The guidance is applicable to profit-oriented entities, pass-through entities and tax-exempt organizations. Management believes it has no significant uncertain tax positions and, as such, no tax liability, benefits, interest or penalties were accrued at September 30, 2021 or 2020. The Company is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. The Company believes it is no longer subject to income tax examinations for years prior to 2017 for federal purposes and 2015 for California purposes.

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IRS990ScheduleD/SupplementalInformationDetail/ExplanationTxt0The principal operations of the Company are exempt from income taxes pursuant to Internal Revenue Code (IRC) Section 501(c)(3) and the laws of the states in which it operates and, as such, is generally not subject to federal or state income taxes. However, the Company is subject to income taxes on net income derived from a trade or business regularly carried on that does not further the organization's exempt purpose. Further, the Company is also subject to federal excise taxes pursuant to the Tax Cuts and Jobs Act. No significant income tax provision has been recorded in the accompanying consolidated financial statements for net income derived from unrelated trade or business and excise taxes. The Company measures liabilities for unrecognized tax uncertainties in accordance with ASC 740, Income Taxes, which prescribes a comprehensive model for how a company should recognize, measure, present and disclose in its financial statements uncertain tax positions that a company has taken or expects to take on a tax return. The guidance is applicable to profit-oriented entities, pass-through entities and tax-exempt organizations. Management believes it has no significant uncertain tax positions and, as such, no tax liability, benefits, interest or penalties were accrued at September 30, 2021 or 2020. The Company is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. The Company believes it is no longer subject to income tax examinations for years prior to 2017 for federal purposes and 2015 for California purposes.
IRS990ScheduleD/SupplementalInformationDetail/FormAndLineReferenceDesc0Part X, Line 2:
IRS990ScheduleD/TotalBookValueLandBuildingsAmt00
IRS990ScheduleD/TotalLiabilityAmt012521142
IRS990ScheduleJ/AnyNonFixedPaymentsInd00
IRS990ScheduleJ/CompBasedOnRevenueOfFlngOrgInd00
IRS990ScheduleJ/CompBsdNetEarnsFlngOrgInd00
IRS990ScheduleJ/CompBsdNetEarnsRltdOrgsInd00
IRS990ScheduleJ/CompBsdOnRevRelatedOrgsInd00
IRS990ScheduleJ/EquityBasedCompArrngmInd00
IRS990ScheduleJ/InitialContractExceptionInd00
IRS990/ScheduleJRequiredInd01
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BaseCompensationFilingOrgAmt00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BaseCompensationFilingOrgAmt10
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BaseCompensationFilingOrgAmt20
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BaseCompensationFilingOrgAmt30
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BonusFilingOrganizationAmount00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BonusFilingOrganizationAmount10
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BonusFilingOrganizationAmount20
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BonusFilingOrganizationAmount30
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BonusRelatedOrganizationsAmt0275638
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BonusRelatedOrganizationsAmt182933
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BonusRelatedOrganizationsAmt250000
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BonusRelatedOrganizationsAmt30
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/CompensationBasedOnRltdOrgsAmt01347488
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/CompensationBasedOnRltdOrgsAmt1698611
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/CompensationBasedOnRltdOrgsAmt2675702
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/CompensationBasedOnRltdOrgsAmt3354174
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/CompReportPrior990FilingOrgAmt00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/CompReportPrior990FilingOrgAmt10
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/CompReportPrior990FilingOrgAmt20
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/CompReportPrior990FilingOrgAmt30
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/CompReportPrior990RltdOrgsAmt01168584
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/CompReportPrior990RltdOrgsAmt1122666
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/CompReportPrior990RltdOrgsAmt20
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/CompReportPrior990RltdOrgsAmt30
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/DeferredCompensationFlngOrgAmt00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/DeferredCompensationFlngOrgAmt10
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/DeferredCompensationFlngOrgAmt20
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/DeferredCompensationFlngOrgAmt30
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/DeferredCompRltdOrgsAmt0290280
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/DeferredCompRltdOrgsAmt1136456
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/DeferredCompRltdOrgsAmt27800
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/DeferredCompRltdOrgsAmt364019
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/NontaxableBenefitsFilingOrgAmt00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/NontaxableBenefitsFilingOrgAmt10
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/NontaxableBenefitsFilingOrgAmt20
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/NontaxableBenefitsFilingOrgAmt30
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/NontaxableBenefitsRltdOrgsAmt019383
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/NontaxableBenefitsRltdOrgsAmt114087
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/NontaxableBenefitsRltdOrgsAmt214129
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/NontaxableBenefitsRltdOrgsAmt36255
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/OtherCompensationFilingOrgAmt00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/OtherCompensationFilingOrgAmt10
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/OtherCompensationFilingOrgAmt20
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/OtherCompensationFilingOrgAmt30
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/OtherCompensationRltdOrgsAmt01181358
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/OtherCompensationRltdOrgsAmt1129854
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/OtherCompensationRltdOrgsAmt26870
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/OtherCompensationRltdOrgsAmt36162
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm0James West
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm1Peggy Chulack
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm2Anita Chou
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm3Vid Shivaraman
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt0President & CEO
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt1COO & Asst. Secretary
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt2CFO & Asst. Treasurer (until 2/2021)
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt3CFO & Assistant Treasurer
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationFilingOrgAmt00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationFilingOrgAmt10
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationFilingOrgAmt20
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationFilingOrgAmt30
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationRltdOrgsAmt03114147
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationRltdOrgsAmt11061941
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationRltdOrgsAmt2754501
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationRltdOrgsAmt3430610
IRS990ScheduleJ/SeverancePaymentInd00
IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt0Compensation for the CEO was established and paid by PIH Health Whittier Hospital (PIH), a related organization. PIH used the following to establish the CEO's compensation: (1) Compensation Committee; (2) Independent Compensation Consultant; (3) Form 990 of other organizations;(4) Compensation Survey or Study; (5) Approval by the Board.
IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt1A related organization, PIH Health, Inc., provides a supplemental executive retirement plan for certain executives. The following individuals participate in the plan: James West Peggy Chulack Anita Chou Vid Shivaraman The following amounts became vested or were paid-out in 2020 and are included in Schedule J, Part II, Column (b) (iii): James West $1,168,584 Peggy Chulack $122,666
IRS990ScheduleJ/SupplementalInformationDetail/FormAndLineReferenceDesc0Part I, Line 3
IRS990ScheduleJ/SupplementalInformationDetail/FormAndLineReferenceDesc1Part I, Line 4b
IRS990ScheduleJ/SupplementalNonqualRtrPlanInd01
IRS990/ScheduleORequiredInd01
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0Samaritan Imaging Center previously provided outpatient radiological diagnostic services for patients. This activity was moved to PIH Health Good Samaritan Hospital in 2020. The organization is in the process of evaluating plans for future activities.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1The 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, Anita Chou, and Vid Shivaraman.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt2The sole member of the Organization is PIH Health Good Samaritan Hospital, a California nonprofit organization.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt3The sole member has the power to appoint, replace or remove the members of the Board of Directors.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt4The Organization's corporate member is PIH Health Good Samaritan Hospital ("PHGSH"). Pursuant to Section 3.2 of the Organization's bylaws, the following decisions require approval by PHGSH: - 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 PHGSH - 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 PHGSH - Hiring or firing of the Organization's senior executives, as such term shall be defined by resolution of the Board of Directors of PHGSH - 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.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt5The 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.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt6The organization is included in the Conflict of Interest Policy for PIH Health 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 PIH Health Good Samaritan Hospital and are enforced by the Audit Committee Chairperson.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt7During the tax year ended September 30, 2021, 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.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt8Samaritan 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.
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc0Form 990, Part III, line 3
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc1Form 990, Part VI, Section A, line 2
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc2Form 990, Part VI, Section A, line 6
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc3Form 990, Part VI, Section A, line 7a
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc4Form 990, Part VI, Section A, line 7b
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc5Form 990, Part VI, Section B, line 11b
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc6Form 990, Part VI, Section B, line 12c
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc7Form 990, Part VI, Section B, line 15
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc8Form 990, Part VI, Section C, line 19
IRS990ScheduleR/AssetExchangeInd00
IRS990ScheduleR/AssetPurchaseFromOtherOrgInd00
IRS990ScheduleR/AssetSaleToOtherOrgInd00
IRS990ScheduleR/DivRelatedOrganizationInd00
IRS990ScheduleR/GiftGrntCapContriFromOthOrgInd00
IRS990ScheduleR/GiftGrntOrCapContriToOthOrgInd00
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/ControlledOrganizationInd00
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/ControlledOrganizationInd10
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/ControlledOrganizationInd20
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/ControlledOrganizationInd30
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/ControlledOrganizationInd40
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/ControlledOrganizationInd50
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/ControlledOrganizationInd60
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/DirectControllingNACd0N/A
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/DirectControllingNACd1N/A
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/DirectControllingNACd2N/A
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/DirectControllingNACd3N/A
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/DirectControllingNACd4N/A
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/DirectControllingNACd5N/A
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/DirectControllingNACd6N/A
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EIN0263760243
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EIN1462072342
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EIN2954769768
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EIN3472501390
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EIN4300831225
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EIN5330927283
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EIN6330922631
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EntityTypeTxt0T
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EntityTypeTxt1C
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EntityTypeTxt2C
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EntityTypeTxt3T
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EntityTypeTxt4C
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EntityTypeTxt5C
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EntityTypeTxt6C
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/LegalDomicileStateCd0HI
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/LegalDomicileStateCd1CA
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/LegalDomicileStateCd2CA
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/LegalDomicileStateCd3HI
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/LegalDomicileStateCd4CA
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/LegalDomicileStateCd5CA
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/LegalDomicileStateCd6CA
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt0Captive Insurance
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt1Healthcare
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt2Real Estate
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt3Captive Insurance
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt4Healthcare
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt5Medical Services
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt6Management Services
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/RelatedOrganizationName/BusinessNameLine1Txt0PIH Health Insurance Company
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/RelatedOrganizationName/BusinessNameLine1Txt1PIH Health Care Solutions
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/RelatedOrganizationName/BusinessNameLine1Txt2DRMC Properties Inc
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/RelatedOrganizationName/BusinessNameLine1Txt3PIH Health RE
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/RelatedOrganizationName/BusinessNameLine1Txt4HealthMed Services Inc
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/RelatedOrganizationName/BusinessNameLine1Txt5Pioneer Medical Group Inc
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/RelatedOrganizationName/BusinessNameLine1Txt6Pioneer Provider Network A Medical Group Inc
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/AddressLine1Txt01003 Bishop Street
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/AddressLine1Txt16557 Greenleaf Avenue
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/AddressLine1Txt211500 Brookshire Avenue
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/AddressLine1Txt31003 Bishop Street
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/AddressLine1Txt412401 Washington Boulevard
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/AddressLine1Txt512401 Washington Boulevard
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/AddressLine1Txt612401 Washington Boulevard
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/CityNm0Honolulu
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/CityNm1Whittier
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/CityNm2Downey
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/CityNm3Honolulu
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/CityNm4Whittier
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/CityNm5Whittier
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/CityNm6Whittier
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/StateAbbreviationCd0HI
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/StateAbbreviationCd1CA
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/StateAbbreviationCd2CA
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/StateAbbreviationCd3HI
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/StateAbbreviationCd4CA
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/StateAbbreviationCd5CA
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/StateAbbreviationCd6CA
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/ZIPCd096813
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/ZIPCd190601
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/ZIPCd290241

Document Assets

No mirrored PDF or thumbnail assets are attached yet.

Filings

Balance SheetOperations
YearAssetsLiabilitiesNet AssetsRevenueExpensesNet Income
2024Detailed filing. Detailed filing data is available for this year.$0.00$12.5$12.5$0.00$0.00$0.00
2023Detailed filing. Detailed filing data is available for this year.$0.00$12.5$12.5$0.00$0.00$0.00
2022Detailed filing. Detailed filing data is available for this year.$0.00$12.5$12.5$0.00$0.00$0.00
2021Detailed filing. Detailed filing data is available for this year.$0.00$12.5$12.5$0.00$0.00$0.00
2020Detailed filing. Detailed filing data is available for this year.$0.70$13.2$12.5$0.09$0.21$0.12
2019Detailed filing. Detailed filing data is available for this year.$4.07$17.2$13.1$0.10$0.04$0.06
2018Detailed filing. Detailed filing data is available for this year.$3.98$17.2$13.2$0.28$0.08$0.20
2017Detailed filing. Detailed filing data is available for this year.$3.81$17.2$13.4$3.78$4.47$0.69
2016Detailed filing. Detailed filing data is available for this year.$0.81$13.5$12.7$3.89$4.47$0.58
2015Detailed filing. Detailed filing data is available for this year.$1.05$13.2$12.1$4.13$4.62$0.49
2014Detailed filing. Detailed filing data is available for this year.$1.26$12.9$11.6$4.34$4.64$0.29
2013Facts available. Structured filing facts are available, but richer extracted sections are limited.$1.44$12.8$11.3$5.27
2012Summary only. Only limited summary data is available for this year.$1.98$12.4$10.4$4.68$6.03$1.35
2011Summary only. Only limited summary data is available for this year.$3.19$12.3$9.06$5.12$6.58$1.46