2024-08-06T13:53:39-05:00 2023-09-30 135565207 KPMG LLP 301 MAIN STREET SUITE 2150 BATON ROUGE LA 70801 990 2022-10-01 951656366 PIH HEALTH GOOD SAMARITAN HOSPITAL PIHH 2139772121 1225 WILSHIRE BLVD LOS ANGELES CA 900172395 VID SHIVARAMAN CFO 5626980811 2024-07-31 1 0 BRITTANY ELLISER P01284594 2253444000 2024-07-22 2022 2024-08-08 14:25:15Z JAMES WEST 12401 WASHINGTON BLVD WHITTIER CA 90602 390117862 0 X WWW.PIHHEALTH.ORG X 1885 CA PROVIDE HIGH-QUALITY HEALTHCARE, WITHOUT DISCRIMINATION, AND CONTRIBUTE TO THE HEALTH AND WELL-BEING 17 17 1976 295 173402 0 5256557 3322305 394173438 361265554 30119687 8797284 6371765 5753362 435921447 379138505 238180 300100 0 0 181281254 171842791 0 0 176067 254205924 239274805 435725358 411417696 196089 -32279191 607219911 566649349 171956806 155809140 435263105 410840209 X WE PROVIDE HIGH-QUALITY HEALTHCARE, WITHOUT DISCRIMINATION, AND CONTRIBUTE TO THE HEALTH AND WELL-BEING OF OUR COMMUNITIES IN AN ETHICAL, SAFE AND FISCALLY PRUDENT MANNER, IN RECOGNITION OF OUR CHARITABLE PURPOSE. 0 0 212201369 300100 262968147 PATIENT CARE: FOUNDED IN 1885, PIH HEALTH GOOD SAMARITAN HOSPITAL BECAME PART OF PIH HEALTH IN DECEMBER 2019. AS A 501(C) (3) NONPROFIT, 408-BED ACUTE CARE HOSPITAL, THE DOWNTOWN LOS ANGELES CAMPUS SERVES THE HEALTHCARE NEEDS OF A GROWING AND DIVERSE COMMUNITY. PATIENT CARE IN FISCAL YEAR 2022-2023EMPLOYEES 1,389VOLUNTEERS 295NUMBER OF EMERGENCY DEPARTMENT (ED) VISITS 47,812NUMBER OF BIRTHS 1,471MEDICAL STAFF 669 158289209 98230080 FINANCIAL ASSISTANCE AND MEANS-TESTED GOVERNMENT PROGRAMS: FINANCIAL ASSISTANCE, ALSO KNOWN AS CHARITY CARE, IS DEFINED AS FREE OR DISCOUNTED HEALTH SERVICES PROVIDED TO INDIVIDUALS WHO CANNOT AFFORD TO PAY AND WHO MEET THE ELIGIBILITY CRITERIA OF THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. PIH HEALTH GOOD SAMARITAN HOSPITAL OFFERS A GENEROUS FINANCIAL ASSISTANCE PROGRAM, PROVIDING CHARITY CARE TO THOSE WITH FAMILY INCOME(S) AT OR BELOW 400% OF FEDERAL POVERTY LEVEL GUIDELINES. THE HOSPITAL HAS A POLICY TO TREAT EMERGENCY AND CERTAIN OTHER PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. UNDER THE CHARITY CARE POLICY, CHARITY CARE MAY BE PROVIDED TO PEOPLE WHO ARE UNINSURED OR UNDERINSURED AND CANNOT AFFORD TO PAY FOR THEIR OWN MEDICAL CARE.IN PROVIDING SERVICES TO THOSE PATIENTS PARTICIPATING IN MEANS-TESTED GOVERNMENT HEALTH PROGRAMS, SUCH AS MEDI-CAL, PIH HEALTH GOOD SAMARITAN HOSPITAL REALIZES A COLLECTIVE NET LOSS EACH FISCAL YEAR DUE TO THE SHORTFALL CREATED WHEN THE PAYMENTS RECEIVED FROM THESE PROGRAMS ARE LESS THAN THE COST OF CARING FOR PUBLIC PROGRAM BENEFICIARIES. NUMBER OF PERSONS SERVED BY FINANCIAL ASSISTANCE AND MEANS-TESTED GOVERNMENT PROGRAMS: 37,994 9356117 67327 "OTHER COMMUNITY BENEFIT SERVICES: COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS, HEALTH PROFESSIONS EDUCATION, SUBSIDIZED SERVICES, RESEARCH, COMMUNITY BUILDING AND CASH AND IN-KIND CONTRIBUTIONS FOR COMMUNITY BENEFIT ARE COMPRISED OF THE FOLLOWING: COMMUNITY HEALTH IMPROVEMENT SERVICES: DEFINED AS COMMUNITY HEALTH IMPROVEMENT ACTIVITIES, WHICH EXTEND BEYOND PATIENT CARE ACTIVITIES. THIS CATEGORY INCLUDES COMMUNITY HEALTH EDUCATION, COMMUNITY SOCIAL SERVICE HELPLINE, FLU AND COVID-19 VACCINATION CLINICS, MEDI-CAL ELIGIBILITY WORKERS AND TRANSPORTATION SERVICES.SNAPSHOT OF OUTCOMES: 17,608 COMMUNITY MEMBERS WERE REACHED THROUGH A VARIETY OF COMMUNITY HEALTH IMPROVEMENT ACTIVITIES.HEALTH PROFESSIONS EDUCATION: THIS CATEGORY INCLUDES EDUCATIONAL PROGRAMS FOR PHYSICIANS, NURSES, CHAPLAIN AND OTHER HEALTH PROFESSIONAL STUDENTS WHEN EDUCATION IS NECESSARY OR REQUIRED BY STATE LAW, ACCREDITING BODY OR HEALTH PROFESSION SOCIETY. SNAPSHOT OF OUTCOMES: 68 MEDICAL RESIDENTS AND ANCILLARY PROFESSIONS STUDENTS WERE PROVIDED WITH MENTORSHIP, INTERNSHIP AND TRAINING OPPORTUNITIES.SUBSIDIZED HEALTH SERVICES: SUBSIDIZED SERVICES ARE CLINICAL PROGRAMS, WHICH ARE PROVIDED DESPITE A FINANCIAL LOSS SO SIGNIFICANT THAT NEGATIVE MARGINS REMAIN AFTER REMOVING THE EFFECTS OF FINANCIAL ASSISTANCE, BAD DEBT AND MEDI-CAL SHORTFALLS. NEVERTHELESS, THE SERVICE IS PROVIDED BECAUSE IT MEETS AN IDENTIFIED COMMUNITY NEED AND, IF NO LONGER OFFERED, WOULD EITHER BE UNAVAILABLE IN THE AREA OR FALL TO THE RESPONSIBILITY OF GOVERNMENT OR ANOTHER NONPROFIT ORGANIZATION TO PROVIDE. PIH HEALTH GOOD SAMARITAN HOSPITAL SUBSIDIZED EMERGENCY DEPARTMENT ON-CALL PHYSICIANS AND THE NEONATAL INTENSIVE CARE UNIT (NICU).SNAPSHOT OF OUTCOMES: $843,068 IN EXPENSES WERE INCURRED IN SUBSIDIZED SERVICES IN FISCAL YEAR 2022-2023RESEARCH: RESEARCH THAT MAY BE REPORTED AS COMMUNITY BENEFIT INCLUDES CLINICAL AND COMMUNITY HEALTH RESEARCH AS WELL AS STUDIES ON HEALTHCARE DELIVERY THAT ARE GENERALIZABLE AND SHARED WITH THE PUBLIC. PIH HEALTH GOOD SAMARITAN HOSPITAL HAS BEEN OFFERING CLINICAL TRIALS AND RESEARCH STUDIES AIMED AT IMPROVING HEALTH. SNAPSHOT OF OUTCOMES: OVER $307,016 IN EXPENSES HAVE BEEN INCURRED IN RESEARCH IN FISCAL YEAR 2022-2023CASH & IN-KIND CONTRIBUTIONS: THIS CATEGORY INCLUDES FUNDS AND IN-KIND SERVICES DONATED BY PIH HEALTH GOOD SAMARITAN HOSPITAL TO COMMUNITY ORGANIZATIONS OR TO THE COMMUNITY-AT-LARGE FOR A COMMUNITY BENEFIT PURPOSE. THESE DONATIONS INCLUDE CASH DONATIONS TO COMMUNITY ORGANIZATIONS, IN-KIND HOURS CONTRIBUTED BY STAFF TO THE COMMUNITY WHILE ON PIH HEALTH WORK TIME, THE COST OF OFFICE AND MEETING SPACE PROVIDED TO COMMUNITY GROUPS, AND THE DONATIONS OF EQUIPMENT, MEDICATIONS, SUPPLIES AND SERVICES. SNAPSHOT OF OUTCOMES:4,102 AT-RISK INDIVIDUALS WERE PROVIDED WITH IN-KIND DURABLE MEDICAL EQUIPMENT OR SERVICES, SUCH AS SKILLED NURSING OR MENTAL HEALTHCARE.TOTAL NUMBER OF PERSONS SERVED BY OTHER COMMUNITY BENEFIT SERVICES: 18,036 FOR ADDITIONAL INFORMATION, PLEASE REFER TO PIH HEALTH'S COMMUNITY BENEFIT REPORT AT PIHHEALTH.ORG/CBA ANNUALREPORT 379846695 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 285 0 1 1976 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 17 17 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 0 CA X MARK KAWAUCHI 5626980811 12102 WASHINGTON BLVD WHITTIER CA 90606 X ALEX ALVAREZ DIRECTOR & TREASURER 1.50 6.00 X X 0 0 0 BLAYNE CUTLER MD PHD DIRECTOR 1.50 6.00 X 0 0 0 CHARLOTTE WEAVER PHD DIRECTOR & VICE CHAIR 1.50 6.00 X X 0 0 0 JANE DICUS DIRECTOR 1.50 6.00 X 0 0 0 JAY BROWN AS OF 3123 DIRECTOR 1.50 6.00 X 0 0 0 JEFF HAMAR DIRECTOR 1.50 6.00 X 0 0 0 KENTON WOODS DIRECTOR 1.50 6.00 X 0 0 0 MARISSA GOLDBERG DIRECTOR 1.50 6.00 X 0 0 0 MELANIE BATISTE DIRECTOR 1.50 6.00 X 0 0 0 PATRICK MONROE DIRECTOR & CHAIR 1.50 6.00 X X 0 0 0 PAUL TREINEN DIRECTOR 1.50 6.00 X 0 0 0 PAULA COWAN UNTIL 9222023 DIRECTOR 1.50 6.00 X 0 0 0 PETER GREANEY MD DIRECTOR & SECRETARY 1.50 6.00 X X 0 0 0 RICHARD ATWOOD DIRECTOR 1.50 7.50 X 0 0 0 ROBERT MALONEY MD DIRECTOR 1.50 6.00 X 0 0 0 WESLEY HEARTFIELD MD DIRECTOR 1.50 0.00 X 0 0 0 WILLIAM ROTH AS OF 3123 DIRECTOR 1.50 6.00 X 0 0 0 JAMES WEST SYSTEM PRESIDENT & CEO 10.00 42.20 X 0 2046653 355723 ROSALIO LOPEZ MD SYSTEM CSO/CMO 10.00 36.20 X 0 1114134 46447 BRIAN SMOLSKIS UNTIL 9282023 SYSTEM COO 10.00 37.70 X 0 1034811 219042 PEGGY CHULACK SYSTEM CAO & ASST SECRETARY 10.00 42.20 X 0 995412 192712 VID SHIVARAMAN SYSTEM CFO & ASST TREASURER 10.00 42.20 X 0 749812 150468 IRENA ZUANIC CNO & CO-SITE ADMIN 40.00 0.00 X 0 384178 103157 MOHAMMED GHONIM REGIONAL VP 15.00 25.00 X 0 365787 71068 KEVIN BROWN UNTIL 542023 VP, CARDIOLOGY SERVICES 30.00 10.00 X 0 262193 44695 JING CHEUNG RN 40.00 0.00 X 362626 0 21766 IRA MEISELMAN DIRECTOR MANAGED CARE 40.00 0.00 X 335127 0 24912 REDENTOR CERVANTES RN 40.00 0.00 X 334639 0 12083 DALE MCCREE SUPERVISOR, SURGERY 40.00 0.00 X 295310 0 26351 MATILDA HERNANDEZ RN 40.00 0.00 X 288726 0 35490 ANITA CHOU FORMER CFO & ASST. TREASURER 0.00 0.00 X 0 119014 14 JAIME DIAZ MD FORMER CMO & CO-SITE ADMIN 0.00 0.00 X 546097 0 18255 2162525 7071994 1322183 590 1 1 0 CROSS COUNTRY STAFFING P O BOX 404674 ATLANTA GA 30384 NURSING REGISTRY SERVICES 21107964 SODEXO AMERICA LLC 9801 WASHINGTON BLVD GAITHERSBURG MD 20878 DIETARY SERVICES 10349533 REHABCARE GROUP OF CALIFORNIA LLC P O BOX 502096 ST LOUIS MO 63150 REHABILITATION SERVICES 4080153 MILES & KELLY CONSTRUCTION COMPANY INC 23691 VIA DEL RIO YORBA LINDA CA 92887 CONSTRUCTION SERVICES 2829694 AYA HEALTHCARE INC 5930 CORNERSTONE CT W SUITE 300 SAN DIEGO CA 92121 NURSING REGISTRY SERVICES 2769195 65 169477 1552583 1600245 10575 3322305 PATIENT REVENUE 622110 311865542 311865542 HOSPITAL FEE PROGRAM 900099 46809431 46809431 LAMBERT RADIOLOGY 622110 2466070 2466070 RENTAL INCOME 532000 124511 124511 361265554 8635379 8635379 11127104 14158 10979357 0 147747 14158 161905 161905 PARKING LOT 812930 2476510 76511 2399999 VIVITY EARNINGS DISTRI 900099 1071055 1071055 PHYSICIAN MANAGEMENT S 621110 52200 52200 2153597 44691 2108906 5753362 379138505 361265554 173402 14377244 X 300100 300100 420957 294670 126287 123036659 117433120 5603539 5358488 5139317 219171 32735868 31002288 1733580 10290819 10189550 101269 66065 66065 1911 1911 80229 80229 202178 202178 95992186 88614602 7377584 299659 2000 297659 2748258 2706346 41912 223 223 6271567 5388403 883164 3741230 433937 3307293 SUPPLIES 60689423 60472655 216768 HOSPITAL FEE PROGRAM 21756365 21756365 BAD DEBT EXPENSE 21002300 21002300 UTILITIES 6683851 6668408 15443 19739360 8442411 11120882 176067 411417696 379846695 31394934 176067 2406617 1974969 1367000 1528905 92194351 102437233 5549268 5692298 6115499 2545308 345749151 31238956 311993507 314510195 84859495 87141966 102734174 50818475 607219911 566649349 95666268 83892137 76290538 71917003 171956806 155809140 X 361127939 336324802 74135166 74515407 435263105 410840209 607219911 566649349 X -32279191 5502272 2354023 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 80229 80229 0 PART II-B, LINE 1: LOBBYING EXPENSES REPRESENT A PORTION OF THE DUES PIH HEALTH GOOD SAMARITAN HOSPITAL PAYS TO THE HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA AND TO AMERICAN HOSPITAL ASSOCIATION. PIH HEALTH GOOD SAMARITAN HOSPITAL DOES NOT PARTICIPATE IN OR INTERVENE IN (INCLUDING THE PUBLISHING OR DISTRIBUTING OF STATEMENTS), ANY POLITICAL CAMPAIGN ON BEHALF OF (OR IN OPPOSITION TO) ANY CANDIDATE FOR PUBLIC OFFICE. 69931515 593 3371694 2575117 721634 70007051 70136970 18931 3493226 2963822 753790 69931515 68288340 35438 5607660 3656122 138346 70136970 68269283 20070 1013 68288340 72033292 9678 -1950120 1648396 175171 68269283 0.16234 0.77734 0.06032 0 0 204149473 204149473 61473866 5515856 55958010 65346343 23339975 42006368 14779469 2383125 12396344 314510195 RIGHT-OF-USE ASSETS 57513 HOSPITAL FEE PROGRAM RECEIVABLE 47166847 SELF-INSURANCE RECEIVABLE - CURRENT PORTION 1568000 OTHER NOTES AND LOAN RECEIVABLE 2026115 50818475 ADVANCES FROM THIRD PARTY PAYORS 7776212 CARES ACT PROVIDER RELIEF FUNDS 3998463 OTHER ANNUITY PAYMENT LIABILITY 1362618 HOSPITAL FEE PROGRAM PAYABLE 26740358 OTHER LIABILITIES 450413 OTHER LONG TERM RESERVES 6869839 PENSION PLAN 6469235 RESERVE FOR ASSET RETIREMENT OBLIGATION 13351873 RESERVE FOR SELF-INSURED PROGRAMS 2195590 INTERCOMPANY PAYABLE 2702402 71917003 X PART V, LINE 4: THE ORGANIZATION'S ENDOWMENT CONSISTS OF FUNDS ESTABLISHED FOR HEALTH CARE SERVICES, AS SPECIFIED BY DONORS OR THE ORGANIZATION'S BOARD OF DIRECTORS. 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, 2023 OR 2022. 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 2019 FOR FEDERAL PURPOSES AND 2017 FOR CALIFORNIA PURPOSES. 1 1 X 1 X 1 X 1 1 1 0 1 1 7327 5133470 5133470 0.01320 30667 151606430 98230080 53376350 0.13920 37994 156739900 98230080 58509820 0.15240 11 17608 6382307 6382307 0.01620 2 68 1755341 67328 1688013 0.00430 2 37 843068 843068 0.00210 1 251 307016 307016 0.00080 2 72 68385 68385 0.00020 18 18036 9356117 67328 9288789 0.02360 18 56030 166096017 98297408 67798609 0.17600 1 430382 0 87708662 91108973 -3400311 X 1 0 1 1 PIH HEALTH GOOD SAMARITAN HOSPITAL 1225 WILSHIRE BLVD LOS ANGELES CA 90017 WWW.PIHHEALTH.ORG 930000071 X X X X X PIH HEALTH GOOD SAMARITAN HOSPITAL 1 0 0 1 X X X X X X X X X X 22 1 1 0 1 X HTTPS://WWW.PIHHEALTH.ORG/ABOUT-US/COMMUNITY-BENEFIT/ X 1 22 1 HTTPS://WWW.PIHHEALTH.ORG/WELLNESS/COMMUNITY-BENEFIT/ 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X 1 X HTTPS://WWW.PIHHEALTH.ORG/PATIENTS-VISITORS/BILLING-FINANCIAL-ASSISTANCE X HTTPS://WWW.PIHHEALTH.ORG/PATIENTS-VISITORS/BILLING-FINANCIAL-ASSISTANCE X HTTPS://WWW.PIHHEALTH.ORG/PATIENTS-VISITORS/BILLING-FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 PIH HEALTH GOOD SAMARITAN HOSPITAL PART V, SECTION B, LINE 3J: THE COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDES DATA, MAPS AND INFORMATION REGARDING SOCIAL DETERMINANTS OF HEALTH, HEALTH STATUS AND LIFE EXPECTANCY, ACCESS TO HEALTHCARE, MENTAL HEALTH, ALCOHOL, SUBSTANCE AND TOBACCO USE, PHYSICAL ACTIVITY, NUTRITION AND WEIGHT STATUS, REPRODUCTIVE HEALTH, ACUTE AND CHRONIC DISEASE, LEADING CAUSES OF DEATH, COMMUNITY PERSPECTIVES GATHERED FROM FOCUS GROUPS AND INTERVIEWS, AND PROGRESS ON THE IMPLEMENTATION STRATEGY. PIH HEALTH GOOD SAMARITAN HOSPITAL PART V, SECTION B, LINE 5: PIH HEALTH GOOD SAMARITAN HOSPITAL CONDUCTED TARGETED INTERVIEWS TO GATHER INFORMATION AND OPINIONS FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE MEDICAL CENTER.FORTY-THREE (43) TELEPHONE INTERVIEWS WERE CONDUCTED DURING DECEMBER 2021 AND JANUARY 2022. INTERVIEW PARTICIPANTS INCLUDED A BROAD RANGE OF STAKEHOLDERS CONCERNED WITH HEALTH AND WELLBEING IN THE LOS ANGELES SERVICE AREA WHO SPOKE TO ISSUES AND NEEDS IN THE COMMUNITIES SERVED BY THE HOSPITAL. THE IDENTIFIED STAKEHOLDERS WERE INVITED BY EMAIL TO PARTICIPATE IN THE PHONE INTERVIEW. APPOINTMENTS FOR THE INTERVIEWS WERE MADE ON DATES AND TIMES CONVENIENT TO THE STAKEHOLDERS. AT THE BEGINNING OF EACH INTERVIEW, THE PURPOSE OF THE INTERVIEW IN THE CONTEXT OF THE ASSESSMENT WAS EXPLAINED, THE STAKEHOLDERS WERE ASSURED THEIR RESPONSES WOULD REMAIN CONFIDENTIAL, AND CONSENT TO PROCEED WAS GIVEN. INTERVIEW QUESTIONS FOCUSED ON THE FOLLOWING TOPICS: - BIGGEST HEALTH ISSUES IN THE COMMUNITY- GROUPS MOST IMPACTED BY COMMUNITY ISSUES- WHERE PEOPLE ACCESS ROUTINE HEALTHCARE SERVICES- REASONS FOR NOT HAVING HEALTH COVERAGE/INSURANCE- REASONS FOR DELAYING NEEDED HEALTHCARE- COVID-19 PANDEMIC IMPACT AND THE VACCINE- PRIORITY RANKING OF COMMUNITY NEEDS- WHETHER THEY HAVE RECEIVED ANY CANCER SCREENINGS AND REASONS FOR DELAYING- BARRIERS EXPERIENCED WHILE RECEIVING CANCER TREATMENT- ADDITIONAL COMMENTS AND CONCERNS A LIST OF THE STAKEHOLDER INTERVIEW RESPONDENTS, THEIR TITLES AND ORGANIZATIONS CAN BE FOUND IN ATTACHMENT 2.THE FULL COMMUNITY HEALTH NEEDS ASSESSMENT, CAN BE FOUND AT HTTPS://WWW.PIHHEALTH.ORG/APP/FILES/PUBLIC/7FB79B0D-DEB2-42E7-A1B6-DA7400C7F211/COMMUNITY%20HEALTH%20IMPROVEMENT%20PLAN%202022_PHGSH.PDF PIH HEALTH GOOD SAMARITAN HOSPITAL PART V, SECTION B, LINE 6A: PIH HEALTH GOOD SAMARITAN HOSPITAL PARTICIPATED IN A COLLABORATIVE PROCESS FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT, IN PARTNERSHIP WITH CALIFORNIA HOSPITAL MEDICAL CENTER. PIH HEALTH GOOD SAMARITAN HOSPITAL PART V, SECTION B, LINE 11: PIH HEALTH'S COMMUNITY HEALTH IMPLEMENTATION STRATEGY (CHIS) ENSURES ALIGNMENT OF CHNA FINDINGS, OUR COMMUNITY HEALTH IMPROVEMENT PROGRAMS AND PIH HEALTH'S ORGANIZATIONAL STRATEGY. TO VIEW THE 2023-2025 CHIS AND THE INITIATIVES IDENTIFIED TO ADDRESS AREAS OF FOCUS (ACCESS TO HEALTH CARE - PRIMARY CARE, DENTAL CARE AND MENTAL HEALTH, CANCER INCIDENCE/MORTALITY, DIABETES INCIDENCE/MORTALITY, HEART DISEASE/STROKE INCIDENCE/MORTALITY, OVERWEIGHT/OBESITY, SUBSTANCE USE AND MISUSE, PREVENTATIVE SCREENINGS AND IMMUNIZATIONS WITH EMPHASIS ON FLU AND PNEUMONIA VACCINES AND CANCER SCREENINGS, FOOD INSECURITY, HOUSING/HOMELESSNESS), VISIT HTTPS://WWW.PIHHEALTH.ORG/APP/FILES/PUBLIC/7FB79B0D-DEB2-42E7-A1B6-DA7400C7F211/COMMUNITY%20HEALTH%20IMPROVEMENT%20PLAN%202022_PHGSH.PDF.SINCE PIH HEALTH GOOD SAMARITAN HOSPITAL CANNOT DIRECTLY ADDRESS ALL THE HEALTH NEEDS PRESENT IN THE COMMUNITY, WE WILL CONCENTRATE ON THOSE HEALTH NEEDS THAT CAN MOST EFFECTIVELY BE ADDRESSED GIVEN OUR AREAS OF FOCUS AND EXPERTISE. TAKING EXISTING HOSPITAL AND COMMUNITY RESOURCES INTO CONSIDERATION, PIH HEALTH GOOD SAMARITAN HOSPITAL WILL NOT DIRECTLY ADDRESS THE REMAINING HEALTH NEEDS IDENTIFIED IN THE CHNA, INCLUDING: BIRTH INDICATORS, COVID-19, ECONOMIC INSECURITY, EDUCATION, AND VIOLENCE AND INJURY PREVENTION. WHILE THE HOSPITAL DOES NOT INTEND TO EMPHASIZE COMMUNITY COVID-19 INTERVENTIONS AT THIS POINT IN THE PANDEMIC, PIH HEALTH GOOD SAMARITAN HOSPITAL WILL CONTINUE TO DELIVER VACCINES, TESTING AND ACUTE MEDICAL CARE TO ADDRESS COVID-19. PIH HEALTH GOOD SAMARITAN HOSPITAL PART V, SECTION B, LINE 13B: ASSISTANCE IS PROVIDED FREE OR DISCOUNTED FOR THOSE PATIENTS ELIGIBLE FOR FAP. THE CRITERIA FOR FAP IS IF THE PATIENT IS UNINSURED AND DOES NOT HAVE THE ABILITY TO PAY, HAS RESTRICTED MEDI-CAL BENEFITS, OR IS UNINSURED. THERE ARE ALSO CONSIDERATIONS FOR PATIENTS WHERE THE FPG IS NOT APPLICABLE AND THE PATIENT IS INSURED WITH INADEQUATE COVERAGE OR EXCESSIVE LIABILITY. PART I, LINE 6A: PIH HEALTH'S COMMUNITY BENEFIT REPORT, PREPARED ANNUALLY, ACCOUNTS FOR THE ORGANIZATION'S PROGRAMS AND SERVICES THAT PROMOTE THE HEALTH OF THE COMMUNITY. THE REPORT SEPARATES OUT COMMUNITY BENEFIT INVESTMENT FIGURES FOR EACH HOSPITAL. THE REPORT WAS MADE WIDELY AVAILABLE TO THE PUBLIC VIA SOCIAL MEDIA, OUR ORGANIZATION'S WEBSITE AND A COMMUNITY E-NEWSLETTER. IT WILL ALSO BE SHARED WITH CERTAIN INTERNAL AND COMMUNITY STAKEHOLDERS VIA PRESENTATION. TO VIEW THE FULL REPORT, VISIT HTTPS://WWW.PIHHEALTH.ORG/APP/FILES/PUBLIC/2992BE3C-D8DA-4036-A2D3-C2D2AB0DC19E/PIH_HEALTH_GOOD_SAMARITAN_HOSPITAL_FY23_COMMUNITY_BENEFIT_ANNUAL_REPORT_AND_PLAN.PDF PART I, LINE 7: PATIENT CARE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 WAS USED TO CALCULATE THE FINANCIAL ASSISTANCE AND UNREIMBURSED MEDICAID COST. ACTUAL COSTS FROM GENERAL LEDGER OR DEPARTMENTS WERE USED FOR ALL OTHER COSTS. PART I, LN 7 COL(F): BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25(A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $21,002,300. PART III, LINE 2: BAD DEBT EXPENSE IS THE BAD DEBT TRANSFERS NET OF RECOVERIES. THIS EXPENSE WAS NOT INCLUDED IN COMMUNITY BENEFIT EXPENSE. PART III, LINE 3: PIH HEALTH GOOD SAMARITAN HOSPITAL ACTIVELY PROVIDES ALL PATIENTS THE OPTION TO APPLY FOR FINANCIAL ASSISTANCE, THEREFORE, NO ESTIMATE IS MADE FOR BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY. PART III, LINE 4: FROM THE AUDITED FINANCIAL STATEMENTS OF PIH HEALTH, INC. AND SUBSIDIARIES FOR THE YEAR ENDED SEPTEMBER 30, 2023: "IMPLICIT PRICE CONCESSIONS ARE BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, TAKING INTO CONSIDERATION HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE AND OTHER COLLECTION INDICATORS. MANAGEMENT ROUTINELY ASSESSES THE ADEQUACY OF THE IMPLICIT PRICE CONCESSIONS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. IMPLICIT PRICE CONCESSIONS ARE INCLUDED AS A DEDUCTION FROM PATIENT SERVICES REVENUES SINCE THE COMPANY GENERALLY ACCEPTS AND TREATS ALL PATIENTS WITHOUT REGARD TO THE ABILITY TO PAY." THE BAD DEBT EXPENSE ON LINE 2 IS CALCULATED USING TOTAL COST TO CHARGE RATIO APPLYING TO TOTAL BAD DEBT TRANSFERS NET OF RECOVERIES AND NONE OF THE BAD DEBT EXPENSE IS INCLUDED IN COMMUNITY BENEFIT EXPENSE. PART III, LINE 8: THE AMOUNTS ON LINES 5 AND 6 ARE FROM THE FY 2023 MEDICARE COST REPORT AND WE BELIEVE DO NOT QUALIFY AS COMMUNITY BENEFIT. PART VI, LINE 2: IN ADDITION TO THE HOSPITAL'S CHNA, PIH HEALTH UTILIZES THE FOLLOWING METHODS TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES:COMMUNITY BENEFIT OVERSIGHT COMMITTEE- IN 2006, PIH HEALTH'S BOARD OF DIRECTORS ESTABLISHED THE COMMUNITY BENEFIT OVERSIGHT COMMITTEE (CBOC), WHICH IS COMPRISED OF COMMUNITY STAKEHOLDERS AND KEY PUBLIC HEALTH AND LEGISLATIVE REPRESENTATIVES. THIS COMMITTEE MEETS REGULARLY AND ITS MEMBERS SHARE HEALTHCARE-RELATED NEEDS/CONCERNS EXPERIENCED BY THE COMMUNITY MEMBERS THEY REPRESENT AS WELL AS ASSETS OR POTENTIAL PARTNERS FOR THE HOSPITAL TO ENGAGE IN ADDRESSING THE IDENTIFIED NEEDS.FEEDBACK FROM COMMUNITY ORGANIZATIONS / COLLABORATIVE- THROUGH PARTICIPATION IN VARIOUS COMMUNITY COLLABORATIVE AND NETWORKING MEETINGS, PIH HEALTH IS ABLE TO ASSESS THE HEALTHCARE NEEDS OF THE COMMUNITY AND IDENTIFY PARTNERSHIP OPPORTUNITIES. PART VI, LINE 3: UNINSURED PATIENTS ARE SCREENED FOR MEDI-CAL LINKAGE AND IF THEY MEET THE CRITERIA, THE PATIENT IS REFERRED TO RISARC AND COMSPEC TO ASSIST WITH THE APPLICATION AND ELIGIBILITY PROCESS. IF THE PATIENT DOES NOT HAVE MEDI-CAL LINKAGE, THEY ARE SCREENED FOR QUEENS CARE WHICH IS A PROGRAM FOR UNINSURED PATIENTS THAT RESIDE WITHIN SPECIFIC ZIP CODES IN LOS ANGELES COUNTY AND MEET INCOME QUALIFICATION. FINANCIAL ASSISTANCE APPLICATIONS ARE PROVIDED TO ALL PATIENTS WHO ARE UNISURED, UNDERINSURED, FINANCIAL HARDSHIP, HAVE CATASTROPHIC ILLNESS OR HAVE EXCESSIVE MEDICAL EXPENSES. THE FOLLOWING HOSPITAL POLICIES ARE AVAILABLE ON OUR WEBSITE; CHARITY CARE / DISCOUNT POLICY, FINANCIAL ASSISTANCE APPLICATION AND CASH PRICE POLICY. THE STATEMENTS MAILED TO PATIENTS PROVIDES INFORMATION REGARDING FINANCIAL ASSISTANCE, COVERED CALIFORNIA HEALTH BENEFITS, MEDI-CAL AND MEDICARE. PART VI, LINE 4: PIH HEALTH GOOD SAMARITAN HOSPITAL (PHGSH) IS LOCATED AT 1225 WILSHIRE BLVD., LOS ANGELES, CALIFORNIA 90017. THE HOSPITAL SERVICE AREA INCLUDES 17 ZIP CODES IN LOS ANGELES. THE SERVICE AREA IS SERVED BY THE LOS ANGELES COUNTY 1ST AND 2ND SUPERVISORIAL DISTRICTS AND FALLS WITHIN THE LOS ANGELES COUNTY SERVICE PLANNING AREAS (SPAS) 4 AND 6.*PIH HEALTH GOOD SAMARITAN HOSPITAL TRACKS ZIP CODES OF ORIGIN FOR PATIENT ADMISSIONS. THE SERVICE AREA WAS DETERMINED FROM THE ZIP CODES THAT REFLECT A MAJORITY (59%) OF PATIENT ADMISSIONS FROM THE LOCAL GEOGRAPHIC AREA.BASED ON THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT, THE POPULATION FOR THE PHGSH SERVICE AREA IS 930,016. CHILDREN AND YOUTH, AGES 0-17, MAKE UP 22.8% OF THE POPULATION, 67.6% ARE 18-64 YEARS OF AGE, AND 9.6% ARE SENIORS, 65 YEARS AND OLDER. IN THE SERVICE AREA, 62.4% OF THE POPULATION ARE HISPANIC/LATINO, 13.3% ARE ASIAN, 13.2% BLACK/AFRICAN AMERICAN, 9.0% ARE WHITE, AND THE REMAINING 2.1% ARE NATIVE AMERICAN RESIDENTS, HAWAIIAN OR PACIFIC ISLANDER. AMONG THE SERVICE AREA POPULATION, AGES FIVE AND OLDER, 58.1% SPEAK SPANISH, 27.9% SPEAK ONLY ENGLISH, 11.6%SPEAK AN ASIAN OR PACIFIC ISLANDER LANGUAGE, 1.7% SPEAK OTHER INDO-EUROPEAN LANGUAGES, AND 0.7% SPEAK OTHER LANGUAGES IN THEIR HOME ENGLISH IS SPOKEN IN THE HOME AMONG 32.8% OF THE SERVICE AREA POPULATION. IN THE SERVICE AREA, 27.1% OF THE POPULATION IS AT OR BELOW 100% OF THE FEDERAL POVERTY LEVEL. AMONG SERVICE AREA ADULTS, AGES 25 AND OLDER, 22.3% HAVE LESS THAN A 9TH GRADE EDUCATION. 36.8% OF AREA ADULTS ARE HIGH SCHOOL GRADUATES, AND 27.9% HAVE AN ASSOCIATE, BACHELOR'S, OR GRADUATE/PROFESSIONAL DEGREE. AREA RESIDENTS HAVE LOWER EDUCATIONAL LEVELS THAN ADULTS IN THE COUNTY AND STATE. PART VI, LINE 5: COMMUNITY BOARDPIH HEALTH'S COMMUNITY BOARD OF DIRECTORS WORKS TO ADVANCE THE COMMITMENT TO HELPING OUR COMMUNITIES GET WELL AND STAY HEALTHY.OPEN MEDICAL STAFFPIH HEALTH EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS OR SPECIALTIES.DONATION OF TIMEMANY PIH HEALTH PROVIDERS ARE LIVING OUT THEIR PASSION TO SERVE PEOPLE IN NEED BY DONATING THEIR TIME AND TALENTS BOTH IN OUR COMMUNITY AND OVERSEAS. ENVIRONMENTAL AND RECYCLING PROJECTSPIH HEALTH CONTINUES TO IMPLEMENT "GREEN" INITIATIVES, INCLUDING INCREASED USAGE OF LED LIGHTING TO DECREASE CONSUMPTION OF ELECTRICITY AND DEVELOPING ENERGY MANAGEMENT PROJECTS.VOLUNTEER CONTRIBUTIONS SOME 1,355 PIH HEALTH VOLUNTEERS COLLECTIVELY CONTRIBUTED 112,001 HOURS OF SERVICE, SUPPORTING DEPARTMENTS THROUGHOUT THE ORGANIZATION. THROUGH THE PIH HEALTH MEDICAL CAREERS PROGRAM, WHICH GIVES STUDENT VOLUNTEERS A HEAD START IN DISCOVERING PRODUCTIVE AND MEANINGFUL CAREERS IN HEALTHCARE, 30 INDIVIDUALS SPENT 184 HOURS SHADOWING MEDICAL CAREER PROFESSIONALS AND ATTENDING SIMULATION LABS. SOME 15 VOLUNTEERS AND COMMUNITY MEMBERS ATTENDED A 'MEET THE PROS' EDUCATIONAL CLASS, WHERE A HEALTHCARE PROFESSIONAL GAVE A PRESENTATION ON HIS CAREER PATH. PART VI, LINE 6: HOSPITAL AFFILIATES INCLUDE: 1) PIH HEALTH, INC., PIH HEALTH'S PARENT COMPANY; 2) PIH HEALTH DOWNEY HOSPITAL; 3) PIH HEALTH WHITTIER HOSPITAL 4) PIH HEALTH PHYSICIANS, A NONPROFIT MEDICAL FOUNDATION; 5) PIH HEALTH HOME HEALTHCARE AND 6) THE PIH HEALTH FOUNDATION, A NONPROFIT ORGANIZATION THAT EXISTS TO RAISE PHILANTHROPIC FUNDS IN SUPPORT OF PIH HEALTH'S CHARITABLE MISSION 1) PIH HEALTH, INC. PROVIDES TECHNICAL, FACILITY AND SUPPORT SERVICES FOR TAX-EXEMPT AFFILIATES WHOSE CHARITABLE PURPOSE IS TO PROVIDE A BROAD RANGE OF HEALTHCARE SERVICES TO THEIR COMMUNITY BY WAY OF AN INTEGRATED HEALTH CARE DELIVERY SYSTEM.2) PIH HEALTH DOWNEY HOSPITAL OFFICIALLY BECAME PART OF PIH HEALTH IN OCTOBER 2013. AS A 501 (C)(3) NONPROFIT, 199-BED HOSPITAL, THE DOWNEY CAMPUS HAS PROVIDED QUALITY CARE IN A WELCOMING ENVIRONMENT FOR MORE THAN 100 YEARS. AS A NONNPROFIT HOSPITAL WITH A CHARITABLE MISSION, PIH HEALTH HOSPITAL DOWNEY IS A DEDICATED COMMUNITY HEALTH AND WELLNESS PARTNER. THIS COMMITMENT AND LEADERSHIP GIVES BACK TO THE COMMUNITY THROUGH CHARITY CARE, HEALTH PROFESSIONS EDUCATION AND MORE.3) PIH HEALTH WHITTIER HOSPITAL OPENED IN 1959. AS A 501 (C)(3) NONPROFIT, 523-BED HOSPITAL, THE WHITTIER CAMPUS HAS DEVELOPED INTO A HEALTH SYSTEM OFFERING A MULTITUDE OF SERVICES. AS A NONPROFIT HOSPITAL WITH A CHARITABLE MISSION, PIH HEALTH HOSPITAL WHITTIER IS A DEDICATED COMMUNITY HEALTH AND WELLNESS PARTNER. THIS COMMITMENT AND LEADERSHIP GIVES BACK TO THE COMMUNITY THROUGH CHARITY CARE, MEDICAL RESEARCH, DONATIONS, HEALTH PROFESSIONS EDUCATION AND MORE.4) PIH HEALTH PHYSICIANS (PHP) A 501(C)(3) NONPROFIT MEDICAL GROUP THAT IS EXCLUSIVELY AFFILIATED WITH PIH HEALTH, THE GROUP IS COMPRISED OF MORE THAN 150 PRIMARY CARE PHYSICIANS AND OVER 250 SPECIALISTS WHO COORDINATE CARE FROM DIAGNOSIS TO RECOVERY. PHP SUPPORTS THE LOCAL COMMUNITY THROUGH ITS FINANCIAL ASSISTANCE PROGRAM, WHITTIER FIRST DAY HEALTH & WELLNESS CENTER FOR THE HOMELESS AND THOSE AT-RISK FOR HOMELESSNESS, HEALTH PROFESSIONS EDUCATION, AND OTHER COMMUNITY HEALTH IMPROVEMENT SERVICES.5) PIH HEALTH HOME HEALTHCARE PROVIDES AROUND-THE-CLOCK, QUALITY CARE FOR PATIENTS IN THEIR OWN HOME. PIH HEALTH HOME HEALTHCARE IS CERTIFIED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES.6) THE PIH HEALTH FOUNDATION IS A 501(C)(3) NONPROFIT ORGANIZATION WITH THE SOLE MISSION TO RAISE FUNDS THROUGH PHILANTHROPHY TO BENEFIT PIH HEALTH AND ITS AFFILIATES. DOLLARS RAISED ARE REINVESTED INTO THE COMMUNITIES WE SERVE THROUGH QUALITY HEALTHCARE, HEALTH-BASED PROGRAMS AND SERVICES OFFERED THROUGH PIH HEALTH.FOR DETAILED INFORMATION REGARDING THESE PIH HEALTH AFFILIATES' ADDITIONAL ACTIVITIES TO SUPPORT AND PROMOTE COMMUNITY HEALTH, PLEASE SEE EACH RESPECTIVE ORGANIZATION'S IRS FORM 990. PART VI, LINE 7, REPORTS FILED WITH STATES CA 1 GOOD SAMARITAN INSTITUTE FOR RESEARCH AND EDUCATION 1225 WILSHIRE BLVD LOS ANGELES CA 90017 954077161 501(C) (3) 300100 0 EXPENSES PAID BY THE ORGANIZATION 1 PART I, LINE 2: PIH HEALTH PROVIDES FINANCIAL ASSISTANCE TO BOTH NOT-FOR-PROFIT ORGANIZATIONS AND INDIVIDUALS. PIH HEALTH PROVIDES FINANCIAL SUPPORT TO NONPROFIT ORGANIZATIONS IN OUR SERVICE AREA CITIES THROUGH ITS COMMUNITY SUPPORT AND SPONSORSHIPS PROGRAM, WITH EMPHASIS ON COMMUNITY HEALTH NEEDS/AREAS OF CONCERN AS IDENTIFIED BY PIH HEALTH'S MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT FINDINGS. FINANCIAL SUPPORT MAY BE PROVIDED IF THE REQUESTING ORGANIZATION ADDRESSES ONE OR MORE OF THESE AREAS AND IS RESPONSIVE TO THE HEALTH AND WELLNESS NEEDS OF THE COMMUNITIES WE SERVE, ALLOWING PIH HEALTH TO BUILD UPON THE IMPACT OF EXISTING COMMUNITY HEALTH IMPROVEMENT EFFORTS. FOR CONTRIBUTIONS MADE TO CHARITABLE ORGANIZATIONS, PIH HEALTH HAS ADOPTED A POLICY WHICH GUIDES THE PROCESS TO ENSURE GOOD STEWARDSHIP OF PIH HEALTH'S CHARITABLE RESOURCES AS A FEDERALLY REGISTERED NONPROFIT ENTITY. TO ENSURE ACCURATE COMMUNITY BENEFIT REPORTING, THIS POLICY SETS FORTH THAT DIRECT FINANCIAL CONTRIBUTIONS MADE TO COMMUNITY ORGANIZATIONS MUST BE APPROPRIATELY CLASSIFIED AS EITHER A) COMMUNITY BENEFIT OR B) A SPONSORSHIP (A MARKETING COMMUNICATIONS DEPARTMENT EXPENSE NOT REPORTABLE AS COMMUNITY BENEFIT). IN COMPLIANCE WITH THIS POLICY, INFORMATION IS GATHERED FROM THE GRANTEE REGARDING THE INTENDED USE OF FUNDS AND A RESTRICTION LETTER IS SENT, NOTING THE INTENDED USE OF FUNDS. ORGANIZATIONS RECEIVING COMMUNITY SUPPORT FUNDING IN THE AMOUNT OF $2,500 OR MORE ARE REQUIRED TO SUBMIT A SUMMARY REPORT OF PROGRAM OR SERVICE IMPACT, WITHIN 90 DAYS AFTER EVENT OR RECEIPT OF PROGRAM FUNDING, UNLESS AN ALTERNATE DATE IS DESIGNATED. FOR CONTRIBUTIONS MADE TO INDIVIDUALS, PIH HEALTH HAS ESTABLISHED A DEDICATED BUDGET WHICH SUBSIDIZES VITAL ASSISTANCE SUCH AS PURCHASE OF DURABLE MEDICAL EQUIPMENT OR NON-ACUTE CARE NOT COVERED BY INSURANCE UPON HOSPITAL DISCHARGE, INCLUDING PAID PLACEMENT IN SKILLED NURSING OR MENTAL HEALTH FACILITIES. IN THESE INSTANCES, A SPECIFIC SERVICE IS BEING PURCHASED AND RECEIPT OF PROPER SERVICE IS ENSURED THROUGH FOLLOW-UP BY PIH HEALTH DISCHARGE PLANNERS OR SOCIAL WORKERS. 1 1 0 0 0 0 0 0 0 JAMES WEST SYSTEM PRESIDENT & CEO 0 1506821 0 0 0 539832 0 335520 0 20325 0 2402498 0 517243 BRIAN SMOLSKIS UNTIL 9282023 SYSTEM COO 0 838304 0 0 0 196507 0 196657 0 22507 0 1253975 0 188312 PEGGY CHULACK SYSTEM CAO & ASST SECRETARY 0 826709 0 0 0 168703 0 178274 0 14760 0 1188446 0 120897 ROSALIO LOPEZ MD SYSTEM CSO/CMO 0 907438 0 0 0 206696 0 36700 0 9869 0 1160703 0 0 VID SHIVARAMAN SYSTEM CFO & ASST TREASURER 0 681460 0 0 0 68352 0 141186 0 9404 0 900402 0 61131 JAIME DIAZ MD FORMER CMO & CO-SITE ADMIN 546097 0 0 0 0 0 0 0 18358 0 564455 0 0 0 IRENA ZUANIC CNO & CO-SITE ADMIN 0 376622 0 0 0 7556 0 87395 0 15884 0 487457 0 0 MOHAMMED GHONIM REGIONAL VP 0 357516 0 0 0 8271 0 69038 0 2151 0 436976 0 0 JING CHEUNG RN 350803 0 0 0 11823 0 15250 0 6560 0 384436 0 0 0 IRA MEISELMAN DIRECTOR MANAGED CARE 335127 0 0 0 0 0 9150 0 15884 0 360161 0 0 0 REDENTOR CERVANTES RN 319318 0 0 0 15321 0 0 0 12128 0 346767 0 0 0 MATILDA HERNANDEZ RN 280712 0 0 0 8014 0 20526 0 15008 0 324260 0 0 0 DALE MCCREE SUPERVISOR, SURGERY 295310 0 0 0 0 0 5966 0 20429 0 321705 0 0 0 KEVIN BROWN UNTIL 542023 VP, CARDIOLOGY SERVICES 0 255779 0 0 0 6414 0 36142 0 8675 0 307010 0 0 ANITA CHOU FORMER CFO & ASST. TREASURER 0 -14 0 0 0 119028 0 0 0 14 0 119028 0 0 PART I, LINE 3 COMPENSATION 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. PART I, LINES 4A-B ANITA CHOU RECEIVED A SEVERANCE PAYMENT DURING THE CALENDAR YEAR. THE PAYMENT IS INCLUDED IN PART VII, COLUMN D (E) AND SCHEDULE J, PART II, COLUMN B(III). THE TERMS AND CONDITIONS OF THE CONFIDENTIAL SEVERANCE AGREEMENT ARE AVAILABLE TO THE INTERNAL REVENUE SERVICE UPON REQUEST. PIH HEALTH INC. AND ITS AFFILIATES PROVIDES A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN FOR CERTAIN EXECUTIVES. THE FOLLOWING INDIVIDUALS PARTICIPATE IN THE PLAN: JAMES WEST PEGGY CHULACK VID SHIVARAMAN BRIAN SMOLSKIS IRENA ZUANIC MOHAMMED GHONIM KEVIN BROWN THE FOLLOWING AMOUNTS BECAME VESTED OR WERE PAID-OUT IN 2022 AND ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III): JAMES WEST $517,243 PEGGY CHULACK $120,897 VID SHIVARAMAN $61,131 BRIAN SMOLSKIS $188,312 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: 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, BRIAN SMOLSKIS, JAY BROWN AND WILLIAM ROTH. FORM 990, PART VI, SECTION A, LINE 6 PIH HEALTH, INC. IS THE SOLE MEMBER OF PIH HEALTH GOOD SAMARITAN HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A PIH HEALTH, INC. HAS AUTHORITY TO ELECT ALL THE MEMBERS OF THE BOARD OF DIRECTORS OF PIH HEALTH GOOD SAMARITAN HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B PIH HEALTH, INC. HAS ALL VOTING RIGHTS AND THE POWER TO ELECT THE BOARD OF DIRECTORS OF PIH HEALTH GOOD SAMARITAN HOSPITAL. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION WORKS WITH AN INDEPENDENT ACCOUNTANT, KPMG 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. KPMG 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 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. FORM 990, PART VI, SECTION C, LINE 19 PIH HEALTH GOOD SAMARITAN HOSPITAL'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. FORM 990, PART VI, SECTION B, LINE 16B: PIH HEALTH GOOD SAMARITAN HOSPITAL HOLDS A 10.4% 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. FORM 990, PART VII, SECTION A, LINE 1: ONE OF THE FILING ORGANIZATION'S OFFICERS, ROSALIO LOPEZ, RECEIVES COMPENSATION FOR DIRECTORSHIP FROM 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 - $70,464 OTHER COMPENSATION - $0 FORM 990, PART IX, LINE 11G PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 11,143,515. MANAGEMENT AND GENERAL EXPENSES -13,882. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,129,633. CONSULTING & MANAGEMENT FEES: PROGRAM SERVICE EXPENSES 160,309. MANAGEMENT AND GENERAL EXPENSES 913,592. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,073,901. OTHER CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 3,976,247. MANAGEMENT AND GENERAL EXPENSES 32,335. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,008,582. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 10,500. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,500. MEDICAL PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 3,629,724. MANAGEMENT AND GENERAL EXPENSES 94,800. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,724,524. REPAIRS & MAINTENANCE: PROGRAM SERVICE EXPENSES 4,812,662. MANAGEMENT AND GENERAL EXPENSES 220,077. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,032,739. SOFTWARE MAINTENANCE: PROGRAM SERVICE EXPENSES 3,140,763. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,140,763. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 26,708,129. MANAGEMENT AND GENERAL EXPENSES 6,107,195. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 32,815,324. OUTSIDE PROVIDER COST: PROGRAM SERVICE EXPENSES 19,903,743. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,903,743. PURCHASED LABOR: PROGRAM SERVICE EXPENSES 15,139,510. MANAGEMENT AND GENERAL EXPENSES 12,967. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 15,152,477. FORM 990, PART XI, LINE 9: ACCRUED MINIMUM PENSION LIABILITY 2,041,649. NET ASSETS RELEASED FROM RESTRICTIONS - OPERATIONS 12,274. OTHER INTERCOMPANY TRANSFERS (EXPENSES PAID BY GSH) 300,100. GOOD SAMARITAN INSTITUTE FOR RESEARCH AND EDUCATION 1225 WILSHIRE BLVD LOS ANGELES CA 90017 954077161 HEART RESEARCH CA 501(C) (3) LINE 4 PIH HEALTH GOOD SAMARITAN HOSPITAL 1 ORTHOPEDIC INSTITUTE OF THE GOOD SAMARITAN HOSPITAL 1225 WILSHIRE BLVD LOS ANGELES CA 90017 954346048 ORTHOPEDIC RESEARCH CA 501(C) (3) LINE 12A, I PIH HEALTH GOOD SAMARITAN HOSPITAL 1 SAMARITAN IMAGING CENTER 1225 WILSHIRE BLVD LOS ANGELES CA 90017 954252321 OUTPATIENT IMAGING CA 501(C) (3) LINE 10 PIH HEALTH GOOD SAMARITAN HOSPITAL 1 GOOD SAMARITAN MEDICAL OFFICE BUILDING INC 1225 WILSHIRE BLVD LOS ANGELES CA 90017 953244046 PHYSICIANS MEDICAL OFFICES CA 501(C) (3) LINE 12A, I PIH HEALTH GOOD SAMARITAN HOSPITAL 1 KATE VAN NUYS PAGE FOUNDATION 12401 WASHINGTON BLVD LOS ANGELES CA 90602 956028032 GRANTS INCOME TO GOOD SAMARITAN HOSPITAL CA 501(C) (3) LINE 12A, I PIH HEALTH GOOD SAMARITAN HOSPITAL 1 PIH HEALTH ADULT DAY HEALTHCARE 12401 WASHINGTON BLVD LOS ANGELES CA 90602 953643829 SUPPORT OF TAX-EXEMPT AFFILIATES CA 501(C) (3) LINE 12B, II PIH HEALTH INC 1 PIH HEALTH FOUNDATION 12401 WASHINGTON BLVD LOS ANGELES CA 90602 953761274 FUNDRAISING CA 501(C) (3) LINE 7 PIH HEALTH INC 1 PIH HEALTH HOME HEALTHCARE 12401 WASHINGTON BLVD LOS ANGELES CA 90602 953036281 SUPPORT OF TAX-EXEMPT AFFILIATES CA 501(C) (3) LINE 12B, II PIH HEALTH INC 1 PIH HEALTH DOWNEY HOSPITAL 11500 BROOKSHIRE AVE LOS ANGELES CA 90017 951903935 HEALTHCARE CA 501(C) (3) LINE 3 PIH HEALTH INC 1 PIH HEALTH WHITTIER HOSPITAL 12401 WASHINGTON BLVD LOS ANGELES CA 90602 951934652 HEALTHCARE CA 501(C) (3) LINE 3 PIH HEALTH INC 1 PIH HEALTH MANAGEMENT CORP 12401 WASHINGTON BLVD LOS ANGELES CA 90602 954016278 SUPPORT OF TAX-EXEMPT AFFILIATES CA 501(C) (3) LINE 12B, II PIH HEALTH INC 1 PIH HEALTH PHYSICIANS 6557 GREENLEAF AVE LOS ANGELES CA 90601 953942828 HEALTHCARE CA 501(C) (3) LINE 10 PIH HEALTH INC 1 PIH HEALTH INC 12401 WASHINGTON BLVD LOS ANGELES CA 90602 953619388 SUPPORT OF TAX-EXEMPT AFFILIATES CA 501(C) (3) LINE 12B, II N/A 0 AUXILIARY OF THE HOSPITAL OF THE GOOD SAMARITAN 1225 WILSHIRE BLVD LOS ANGELES CA 90017 956051253 WELFARE OF THE GOOD SAMARITAN HOSPITAL CA 501(C) (3) LINE 12C, III-FI N/A 0 PIH HEALTH INSURANCE COMPANY 733 BISHOP STREET STE 1555 HONOLULU HI 96813 263760243 CAPTIVE INSURANCE HI N/A T 1 PIH HEALTH CARE SOLUTIONS 6557 GREENLEAF AVENUE WHITTIER CA 90601 462072342 HEALTHCARE CA N/A C 1 DRMC PROPERTIES INC 12401 WASHINGTON BLVD WHITTIER CA 90602 954769768 REAL ESTATE CA N/A C 1 PIH HEALTH RE 733 BISHOP STREET STE 1555 HONOLULU HI 96813 472501390 CAPTIVE INSURANCE HI N/A T 1 HEALTHMED SERVICES INC 12401 WASHINGTON BLVD WHITTIER CA 90602 300831225 HEALTHCARE CA N/A C 1 PIONEER MEDICAL GROUP INC 12401 WASHINGTON BLVD WHITTIER CA 90602 330927283 MEDICAL SERVICES CA N/A C 1 PIONEER PROVIDER NETWORK A MEDICAL GROUP INC 12401 WASHINGTON BLVD WHITTIER CA 90602 330922631 MANAGEMENT SERVICES CA N/A C 1 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 GOOD SAMARITAN HOSPITAL MEDICAL OFFICE BUILDING INC A 5642809 FMV GOOD SAMARITAN HOSPITAL MEDICAL OFFICE BUILDING INC K 2711817 FMV GOOD SAMARITAN INSTITUTE FOR RESEARCH AND EDUCATION B 300100 FMV KATE VAN NUYS PAGE FOUNDATION C 126162 FMV