Form 990 for tax year 2022
Filed by PIH HEALTH GOOD SAMARITAN HOSPITAL.
Totals
- Total revenue
- $379,138,505
- Total expenses
- $411,417,696
- Contributions and grants received
- $3,322,305
- Grants paid
- $300,100
- Program services expenses (Part IX)
- $379,846,695
- Management and general expenses
- $31,394,934
- Fundraising expenses
- $176,067
- Program service expenses (Part III)
- $379,846,695
Program services were 92.3% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.
Listed in Part VII
-
ALEX ALVAREZ
DIRECTOR & TREASURER
- Total calculated
- $0
- Hours/week
- 1.5 + 6 related
-
BLAYNE CUTLER MD PHD
DIRECTOR
- Total calculated
- $0
- Hours/week
- 1.5 + 6 related
-
CHARLOTTE WEAVER PHD
DIRECTOR & VICE CHAIR
- Total calculated
- $0
- Hours/week
- 1.5 + 6 related
-
JANE DICUS
DIRECTOR
- Total calculated
- $0
- Hours/week
- 1.5 + 6 related
-
JAY BROWN AS OF 3123
DIRECTOR
- Total calculated
- $0
- Hours/week
- 1.5 + 6 related
-
JEFF HAMAR
DIRECTOR
- Total calculated
- $0
- Hours/week
- 1.5 + 6 related
-
KENTON WOODS
DIRECTOR
- Total calculated
- $0
- Hours/week
- 1.5 + 6 related
-
MARISSA GOLDBERG
DIRECTOR
- Total calculated
- $0
- Hours/week
- 1.5 + 6 related
-
MELANIE BATISTE
DIRECTOR
- Total calculated
- $0
- Hours/week
- 1.5 + 6 related
-
PATRICK MONROE
DIRECTOR & CHAIR
- Total calculated
- $0
- Hours/week
- 1.5 + 6 related
-
PAUL TREINEN
DIRECTOR
- Total calculated
- $0
- Hours/week
- 1.5 + 6 related
-
PAULA COWAN UNTIL 9222023
DIRECTOR
- Total calculated
- $0
- Hours/week
- 1.5 + 6 related
-
PETER GREANEY MD
DIRECTOR & SECRETARY
- Total calculated
- $0
- Hours/week
- 1.5 + 6 related
-
RICHARD ATWOOD
DIRECTOR
- Total calculated
- $0
- Hours/week
- 1.5 + 7.5 related
-
ROBERT MALONEY MD
DIRECTOR
- Total calculated
- $0
- Hours/week
- 1.5 + 6 related
-
WESLEY HEARTFIELD MD
DIRECTOR
- Total calculated
- $0
- Hours/week
- 1.5
-
WILLIAM ROTH AS OF 3123
DIRECTOR
- Total calculated
- $0
- Hours/week
- 1.5 + 6 related
-
JAMES WEST
SYSTEM PRESIDENT & CEO
- Total calculated
- $2,402,376
- From this org
- $0
- From related orgs
- $2,046,653
- Other
- $355,723
- Hours/week
- 10 + 42.2 related
Schedule J breakdown matched by us
- Base
- $0 + $1,506,821 related
- Bonus
- $0
- Other
- $0 + $539,832 related
- Deferred
- $0 + $335,520 related
- Nontaxable benefits
- $0 + $20,325 related
- Filer's total
- $0 + $2,402,498 related
-
ROSALIO LOPEZ MD
SYSTEM CSO/CMO
- Total calculated
- $1,160,581
- From this org
- $0
- From related orgs
- $1,114,134
- Other
- $46,447
- Hours/week
- 10 + 36.2 related
Schedule J breakdown matched by us
- Base
- $0 + $907,438 related
- Bonus
- $0
- Other
- $0 + $206,696 related
- Deferred
- $0 + $36,700 related
- Nontaxable benefits
- $0 + $9,869 related
- Filer's total
- $0 + $1,160,703 related
-
BRIAN SMOLSKIS UNTIL 9282023
SYSTEM COO
- Total calculated
- $1,253,853
- From this org
- $0
- From related orgs
- $1,034,811
- Other
- $219,042
- Hours/week
- 10 + 37.7 related
Schedule J breakdown matched by us
- Base
- $0 + $838,304 related
- Bonus
- $0
- Other
- $0 + $196,507 related
- Deferred
- $0 + $196,657 related
- Nontaxable benefits
- $0 + $22,507 related
- Filer's total
- $0 + $1,253,975 related
-
PEGGY CHULACK
SYSTEM CAO & ASST SECRETARY
- Total calculated
- $1,188,124
- From this org
- $0
- From related orgs
- $995,412
- Other
- $192,712
- Hours/week
- 10 + 42.2 related
Schedule J breakdown matched by us
- Base
- $0 + $826,709 related
- Bonus
- $0
- Other
- $0 + $168,703 related
- Deferred
- $0 + $178,274 related
- Nontaxable benefits
- $0 + $14,760 related
- Filer's total
- $0 + $1,188,446 related
-
VID SHIVARAMAN
SYSTEM CFO & ASST TREASURER
- Total calculated
- $900,280
- From this org
- $0
- From related orgs
- $749,812
- Other
- $150,468
- Hours/week
- 10 + 42.2 related
Schedule J breakdown matched by us
- Base
- $0 + $681,460 related
- Bonus
- $0
- Other
- $0 + $68,352 related
- Deferred
- $0 + $141,186 related
- Nontaxable benefits
- $0 + $9,404 related
- Filer's total
- $0 + $900,402 related
-
IRENA ZUANIC
CNO & CO-SITE ADMIN
- Total calculated
- $487,335
- From this org
- $0
- From related orgs
- $384,178
- Other
- $103,157
- Hours/week
- 40
Schedule J breakdown matched by us
- Base
- $0 + $376,622 related
- Bonus
- $0
- Other
- $0 + $7,556 related
- Deferred
- $0 + $87,395 related
- Nontaxable benefits
- $0 + $15,884 related
- Filer's total
- $0 + $487,457 related
-
MOHAMMED GHONIM
REGIONAL VP
- Total calculated
- $436,855
- From this org
- $0
- From related orgs
- $365,787
- Other
- $71,068
- Hours/week
- 15 + 25 related
Schedule J breakdown matched by us
- Base
- $0 + $357,516 related
- Bonus
- $0
- Other
- $0 + $8,271 related
- Deferred
- $0 + $69,038 related
- Nontaxable benefits
- $0 + $2,151 related
- Filer's total
- $0 + $436,976 related
-
KEVIN BROWN UNTIL 542023
VP, CARDIOLOGY SERVICES
- Total calculated
- $306,888
- From this org
- $0
- From related orgs
- $262,193
- Other
- $44,695
- Hours/week
- 30 + 10 related
Schedule J breakdown matched by us
- Base
- $0 + $255,779 related
- Bonus
- $0
- Other
- $0 + $6,414 related
- Deferred
- $0 + $36,142 related
- Nontaxable benefits
- $0 + $8,675 related
- Filer's total
- $0 + $307,010 related
-
JING CHEUNG
RN
- Total calculated
- $384,392
- From this org
- $362,626
- From related orgs
- $0
- Other
- $21,766
- Hours/week
- 40
Schedule J breakdown matched by us
- Base
- $350,803
- Bonus
- $0
- Other
- $11,823
- Deferred
- $15,250
- Nontaxable benefits
- $6,560
- Filer's total
- $384,436
-
IRA MEISELMAN
DIRECTOR MANAGED CARE
- Total calculated
- $360,039
- From this org
- $335,127
- From related orgs
- $0
- Other
- $24,912
- Hours/week
- 40
Schedule J breakdown matched by us
- Base
- $335,127
- Bonus
- $0
- Other
- $0
- Deferred
- $9,150
- Nontaxable benefits
- $15,884
- Filer's total
- $360,161
-
REDENTOR CERVANTES
RN
- Total calculated
- $346,722
- From this org
- $334,639
- From related orgs
- $0
- Other
- $12,083
- Hours/week
- 40
Schedule J breakdown matched by us
- Base
- $319,318
- Bonus
- $0
- Other
- $15,321
- Deferred
- $0
- Nontaxable benefits
- $12,128
- Filer's total
- $346,767
-
DALE MCCREE
SUPERVISOR, SURGERY
- Total calculated
- $321,661
- From this org
- $295,310
- From related orgs
- $0
- Other
- $26,351
- Hours/week
- 40
Schedule J breakdown matched by us
- Base
- $295,310
- Bonus
- $0
- Other
- $0
- Deferred
- $5,966
- Nontaxable benefits
- $20,429
- Filer's total
- $321,705
-
MATILDA HERNANDEZ
RN
- Total calculated
- $324,216
- From this org
- $288,726
- From related orgs
- $0
- Other
- $35,490
- Hours/week
- 40
Schedule J breakdown matched by us
- Base
- $280,712
- Bonus
- $0
- Other
- $8,014
- Deferred
- $20,526
- Nontaxable benefits
- $15,008
- Filer's total
- $324,260
-
ANITA CHOU
FORMER CFO & ASST. TREASURER
- Total calculated
- $119,028
- From this org
- $0
- From related orgs
- $119,014
- Other
- $14
- Hours/week
- 0
Schedule J breakdown matched by us
- Base
- $0 + -$14 related
- Bonus
- $0
- Other
- $0 + $119,028 related
- Deferred
- $0
- Nontaxable benefits
- $0 + $14 related
- Filer's total
- $0 + $119,028 related
-
JAIME DIAZ MD
FORMER CMO & CO-SITE ADMIN
- Total calculated
- $564,352
- From this org
- $546,097
- From related orgs
- $0
- Other
- $18,255
- Hours/week
- 0
Schedule J breakdown matched by us
- Base
- $546,097
- Bonus
- $0
- Other
- $0
- Deferred
- $0
- Nontaxable benefits
- $18,358
- Filer's total
- $564,455
Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.
Schedule J
Answered yes
- 4a · Severance or change-of-control payment
- 4b · Supplemental nonqualified retirement plan
Answered no
- 4c · Equity-based compensation arrangement
- 5a · Pay contingent on this organization's revenues
- 5b · Pay contingent on a related organization's revenues
- 6a · Pay contingent on this organization's net earnings
- 6b · Pay contingent on a related organization's net earnings
- 7 · Other non-fixed payments
- 8 · Paid under the initial-contract exception
The filer's explanations (Part III)
- 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
Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.
Grants on this return
-
EXPENSES PAID BY THE ORGANIZATION
Related organizations on this return
Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.
-
GOOD SAMARITAN INSTITUTE FOR RESEARCH AND EDUCATION
501(C) (3) · HEART RESEARCH · CA · controlled entity
Directly controlled by PIH HEALTH GOOD SAMARITAN HOSPITAL
-
ORTHOPEDIC INSTITUTE OF THE GOOD SAMARITAN HOSPITAL
501(C) (3) · ORTHOPEDIC RESEARCH · CA · controlled entity
Directly controlled by PIH HEALTH GOOD SAMARITAN HOSPITAL
-
501(C) (3) · OUTPATIENT IMAGING · CA · controlled entity
Directly controlled by PIH HEALTH GOOD SAMARITAN HOSPITAL
-
GOOD SAMARITAN MEDICAL OFFICE BUILDING INC
501(C) (3) · PHYSICIANS MEDICAL OFFICES · CA · controlled entity
Directly controlled by PIH HEALTH GOOD SAMARITAN HOSPITAL
-
501(C) (3) · GRANTS INCOME TO GOOD SAMARITAN HOSPITAL · CA · controlled entity
Directly controlled by PIH HEALTH GOOD SAMARITAN HOSPITAL
-
PIH HEALTH ADULT DAY HEALTHCARE
501(C) (3) · SUPPORT OF TAX-EXEMPT AFFILIATES · CA · controlled entity
Directly controlled by PIH HEALTH INC
-
501(C) (3) · FUNDRAISING · CA · controlled entity
Directly controlled by PIH HEALTH INC
-
501(C) (3) · SUPPORT OF TAX-EXEMPT AFFILIATES · CA · controlled entity
Directly controlled by PIH HEALTH INC
-
501(C) (3) · HEALTHCARE · CA · controlled entity
Directly controlled by PIH HEALTH INC
-
501(C) (3) · HEALTHCARE · CA · controlled entity
Directly controlled by PIH HEALTH INC
-
501(C) (3) · SUPPORT OF TAX-EXEMPT AFFILIATES · CA · controlled entity
Directly controlled by PIH HEALTH INC
-
501(C) (3) · HEALTHCARE · CA · controlled entity
Directly controlled by PIH HEALTH INC
-
501(C) (3) · SUPPORT OF TAX-EXEMPT AFFILIATES · CA
-
AUXILIARY OF THE HOSPITAL OF THE GOOD SAMARITAN
501(C) (3) · WELFARE OF THE GOOD SAMARITAN HOSPITAL · CA
Provenance
- Return type
- form_990
- Tax year
- 2022
- Filed
- 31 July 2024
- IRS schema version
- 2022v5.0
- Source object
- 202412199349300831
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