2025-08-13T11:43:15+00:00 2024-09-30 135565207 KPMG LLP 301 Main Street Suite 2150 Baton Rouge LA 70801 990 2023-10-01 953244046 Good Samaritan Hospital Medical Office Building Inc GOOD 2139772121 1225 Wilshire Blvd Los Angeles CA 900172395 Vid Shivaraman CFO 2025-08-13 true BRITTANY ELLISER P01284594 2253444000 2025-08-13 2023 2025-03-06 01:10:19Z James West 12401 Washington Blvd Whittier CA 90602 8831604 false X N/A X N/A 1978 CA PROVIDES PROFESSIONAL MEDICAL OFFICE SPACE TO HOSPITAL STAFF PHYSICIANS IN AN ADJACENT BUILDING. 4 0 0 0 0 0 0 0 2711817 2784297 0 0 -2928674 -3142862 -216857 -358565 0 0 0 0 0 0 0 0 0 4235867 4231332 4235867 4231332 -4452724 -4589897 119584726 116553357 159727940 161286468 -40143214 -44733111 TO INCREASE HOSPITAL EFFICIENCY, ENCOURAGE HIGHER UTILIZATION OF HOSPITAL FACILITIES AND IMPROVE THE OVERALL QUALITY OF PATIENT CARE BY PROVIDING PROFESSIONAL MEDICAL OFFICE SPACE TO STAFF PHYSICIANS IN A BUILDING ADJACENT TO THE HOSPITAL. false false 4136500 2784297 MEDICAL OFFICE FACILITIES FOR THE BENEFIT OF THE HOSPITAL TO FURTHER THE QUALITY AND AVAILABILITY OF MEDICAL CARE TO THE PUBLIC. 4136500 true false false false false false false false false true false false false true true false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 0 0 0 false false false false false false false false false false false false X 4 0 true false false false false false false true true false false true true true true true true false false false CA X Mark Kawauchi 5626980811 12401 Washington Blvd Whittier CA 90602 JAMES WEST SYSTEM PRESIDENT & CEO 1.5 50.7 X X 0 2523533 38737 PEGGY CHULACK SYSTEM CAO & ASST SECRETARY 1.5 50.7 X X 0 1619441 32543 ROSALIO LOPEZ MD SYSTEM CSO/CMO 1.5 44.7 X X 0 1366325 48338 VID SHIVARAMAN SYSTEM CFO & ASST TREASURER 1.5 50.7 X X 0 884098 197076 BRIAN SMOLSKIS FORMER - SYSTEM COO 0.0 X 0 1928328 264451 0 8321725 581145 0 true true false 0 0 RENTAL INCOME 532000 2784297 2784297 0 0 0 0 2784297 6047306 9190169 -3142863 0 -3142862 -3142862 0 0 0 0 0 0 0 -358565 2784297 0 -3142862 X 461711 447860 13851 0 829359 804478 24881 1869996 1813896 56100 1070266 1070266 0 0 0 0 4231332 4136500 94832 0 0 213286 489218 0 0 19483 132200540 16199806 119288386 116000734 63571 63405 0 0 0 119584726 116553357 776021 1197130 0 158951919 160089338 159727940 161286468 X -40143214 -44733111 -40143214 -44733111 119584726 116553357 -4589897 0 X false true X true false X X 1 PIH HEALTH GOOD SAMARITAN HOSPITAL 951656366 3 true 0 2784297 1 0 2784297 true false false false false false false false false false false false false false false true false 4950527 4950527 112518720 16109868 96408852 99961 12408 87553 14631332 77530 14553802 116000734 RESERVE FOR ASSET RETIREMENT OBLIGATION 47722 DUE TO AFFILIATES 160041616 160089338 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote 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, 2024 OR 2023. 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 2020 FOR FEDERAL PURPOSES AND 2018 FOR CALIFORNIA PURPOSES. true true false false false false false false false JAMES WEST SYSTEM PRESIDENT & CEO 0 1565657 0 383472 0 574404 0 18000 0 20737 0 2562270 0 552201 ROSALIO LOPEZ MD SYSTEM CSO/CMO 0 1028860 0 104954 0 232511 0 40500 0 7838 0 1414663 0 215904 PEGGY CHULACK SYSTEM CAO & ASST SECRETARY 0 909522 0 151215 0 558704 0 18000 0 14543 0 1651984 0 545719 VID SHIVARAMAN SYSTEM CFO & ASST TREASURER 0 782967 0 93639 0 7492 0 176607 0 20469 0 1081174 0 0 BRIAN SMOLSKIS FORMER - SYSTEM COO 0 833329 0 160594 0 934405 0 241053 0 23398 0 2192779 0 721922 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation COMPENSATION FOR THE CEO WAS ESTABLISHED AND PAID BY PIH HEALTH WHITTIER HOSPITAL (PHWH), A RELATED ORGANIZATION. PHWH 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. Schedule J, Part I, Line 4a Severance or change-of-control payment Brian Smolskis received a severance payment in the amount of $205,694 during the calendar year. The payment is included in Part VII, Column (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. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan A 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 VID SHIVARAMAN ROSALIO LOPEZ, MD BRIAN SMOLSKIS THE FOLLOWING AMOUNTS BECAME VESTED OR WERE PAID-OUT IN 2023 AND ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III): Brian Smolskis - $721,922 James West - $552,201 Peggy Chulack - $545,719 Rosalio Lopez - $215,904 Form 990, Part VI, Line 15b During the tax year ended September 30, 2024, 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 PIH Health Good Samaritan Hospital, a controlling related entity. Form 990, Part VI, Line 2 Family/business relationships amongst interested persons JAMES WEST - Business relationship, PEGGY CHULACK - Business relationship, VID SHIVARAMAN - Business relationship, ROSALIO LOPEZ - Business relationship Form 990, Part VI, Line 11b Review of form 990 by governing body 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, Line 12c Conflict of interest policy 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 and enforced by the Audit Committee Chairperson. Form 990, Part VI, Line 19 Required documents available to the public Good Samaritan Hospital Medical Office Building, Inc.'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 IX, Line 11g Other Fees Repairs and Maintenance - Total Expense: 202901, Program Service Expense: 196814, Management and General Expenses: 6087, Fundraising Expenses: ; Other Purchased Services - Total Expense: 258810, Program Service Expense: 251046, Management and General Expenses: 7764, Fundraising Expenses: ; PIH Health Good Samaritan Hospital 1225 Wilshire Blvd LOS ANGELES CA 90017 951656366 Hospital CA 501(c)(3) 3 PIH Health Inc false Orthopedic Institute of the Good Samaritan Hospital 1225 Wilshire Blvd LOS ANGELES CA 90017 954346048 Orthopedic Research CA 501(c)(3) Type I PIH Health Good Samaritan Hospital false Good Samaritan Institute for Research and Education 1225 Wilshire Blvd LOS ANGELES CA 90017 954077161 Heart Research CA 501(c)(3) 4 PIH Health Good Samaritan Hospital false Samaritan Imaging Center 1225 Wilshire Blvd LOS ANGELES CA 90017 954252321 OUTPATIENT IMAGING SERVICES CA 501(c)(3) 10 PIH Health Good Samaritan Hospital false Kate Van Nuys Page Foundation 12401 Washington Blvd WHITTIER CA 90602 956028032 Grants Income to PIH Health Good Samaritan Hospital CA 501(c)(3) Type I PIH Health Good Samaritan Hospital false PIH Health Adult Day Healthcare 12401 Washington Blvd WHITTIER CA 90602 953643829 Support of Tax-Exempt Affiliates CA 501(c)(3) Type II PIH Health Inc false PIH Health Foundation 12401 Washington Blvd WHITTIER CA 90602 953761274 Fundraising CA 501(c)(3) 7 PIH Health Inc false PIH Health Home Healthcare 12401 Washington Blvd WHITTIER CA 90602 953036281 Support of Tax-Exempt Affiliates CA 501(c)(3) Type II PIH Health Inc false PIH Health Downey Hospital 11500 Brookshire Ave DOWNEY CA 90241 951903935 Healthcare CA 501(c)(3) 3 PIH Health Inc false PIH Health Whittier Hospital 12401 Washington Blvd WHITTIER CA 90602 951934652 Healthcare CA 501(c)(3) 3 PIH Health Inc false PIH Health Management Corp 12401 Washington Blvd WHITTIER CA 90602 954016278 Support of Tax-Exempt Affiliates CA 501(c)(3) Type II PIH Health Inc false PIH Health Physicians 6557 Greenleaf Ave WHITTIER CA 90601 953942828 Healthcare CA 501(c)(3) 10 PIH Health Inc false PIH Health Inc 12401 Washington Blvd WHITTIER CA 90602 953619388 Support of Tax-Exempt Affiliates CA 501(c)(3) Type II NA false DRMC Properties Inc 12401 Washington Blvd WHITTIER CA 90602 954769768 Real Estate CA NA C Corporation false HealthMed Services Inc 12401 Washington Blvd WHITTIER CA 90602 300831225 Healthcare CA NA C Corporation false PIH Health Care Solutions 6557 Greenleaf Ave WHITTIER CA 90601 462072342 Healthcare CA NA C Corporation false PIH Insurance Co A Reciprocal Risk Retention Group 733 Bishop Street Ste 1555 HONOLULU HI 96813 263760243 Captive Insurance HI NA Trust false PIH Health RE 733 Bishop Street Ste 1555 HONOLULU HI 96813 472501390 Captive Insurance HI NA Trust false Pioneer Medical Group Inc 6557 Greenleaf Ave WHITTIER CA 90601 330927283 Medical Services CA NA C Corporation false Pioneer Provider Network A Medical Group Inc 6557 Greenleaf Ave WHITTIER CA 90601 330922631 Management Services CA NA C Corporation false false false false false false false false false false true false false false false false false false false false