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← ORTHOPEDIC INSTITUTE OF THE HOSPITAL OF THE GOOD SAMARITAN

Form 990 for tax year 2022

Filed by ORTHOPEDIC INSTITUTE OF THE HOSPITAL OF THE GOOD SAMARITAN.

Totals

Total revenue
-$13,921
Total expenses
$4,116
Contributions and grants received
$100
Grants paid
$2,950
Program service revenue
$0
Investment income
-$14,021
Other revenue
$0
Total assets, end of year
$1,288,402
Total liabilities, end of year
$264,562
Net assets or fund balances, end of year
$1,023,840
Program services expenses (Part IX)
$4,116
Management and general expenses
$0
Fundraising expenses
$0
Program service expenses (Part III)
$4,116

Program services were 100.0% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 1f · All other contributions, gifts and grants

    $100

  • 3 · Investment income

    total $56,501 · excluded $56,501

  • 7b · Less cost or other basis and sales expenses

    securities $70,522

  • 7c · Gain or loss

    securities -$70,522

  • 7d · Net gain or loss

    total -$70,522 · excluded -$70,522

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $2,950 · program services $2,950

  • 22 · Depreciation, depletion and amortization

    total $1,166 · program services $1,166

Balance sheet

Part X, book values.

  • 10a · Land, buildings and equipment: cost or other basis

    $12,600

  • 10b · Land, buildings and equipment: accumulated depreciation

    $2,333

  • 10c · Land, buildings and equipment, net

    beginning of year $11,434 · end of year $10,267

  • 11 · Investments: publicly traded securities

    beginning of year $1,212,433 · end of year $1,278,135

  • 25 · Other liabilities

    beginning of year $464,617 · end of year $264,562

  • 27 · Net assets without donor restrictions

    beginning of year -$1,415,787 · end of year -$1,416,953

  • 28 · Net assets with donor restrictions

    beginning of year $2,175,037 · end of year $2,440,794

Mission and programs · 2022

Mission

THE ORTHOPEDIC INSTITUTE IS A 509(A)(3) SUPPORTING ORGANIZATION OF THE PIH HEALTH GOOD SAMARITAN HOSPITAL. THE GENERAL PURPOSES OF THE INSTITUTE INCLUDE SUPPORT OF RESEARCH AND EDUCATIONAL ACTIVITY IN CONNECTION WITH THE OPERATION OF THE HOSPITAL, WITH A FOCUS ON ORTHOPEDIC ACTIVITIES; PARTICIPATION IN FUND-RAISING AND DEVELOPMENT IN SUPPORT OF SUCH ACTIVITIES; THE ADMINISTRATION OF GIFTS, FUNDS, AND OTHER ASSETS PROVIDED TO THE INSTITUTE BY THE HOSPITAL OR DIRECTLY OBTAINED BY THE INSTITUTE; AND THE DISBURSEMENT OF SUCH FUNDS FOR PURPOSES DESCRIBED HEREIN.

Activities or mission (Part I)

RESEARCH AND EDUCATIONAL ACTIVITY WITH A FOCUS ON ORTHOPEDIC ACTIVITY.

  • THE ORTHOPEDIC INSTITUTE PREVIOUSLY PROVIDED SUPPORT FOR CLINICAL RESEARCH AND EDUCATIONAL ACTIVITIES IN CONNECTION WITH THE OPERATION OF ITS SUPPORTED ORGANIZATION, PIH HEALTH GOOD SAMARITAN HOSPITAL. THE ORGANIZATION IS IN A TRANSITION PHASE AND IS IN THE PROCESS OF EVALUATING PLANS FOR FUTURE ACTIVITIES.

    Expenses $4,116 · Grants $2,950

As filed on the 2022 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • 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
    1.5 + 50.7 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

  • 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
    1.5 + 50.7 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 & ASSISTANT TREASURER

    Total calculated
    $900,280
    From this org
    $0
    From related orgs
    $749,812
    Other
    $150,468
    Hours/week
    1.5 + 50.7 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

  • ANITA CHOU

    FORMER CFO & ASSISTANT 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

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, and on a Form 990-PF Part VIII's — 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, LINES 4A-B
ANITA CHOU RECEIVED A SEVERANCE PAYMENT 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.
PART I, LINE 3:
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 ORGAANIZATIONS; (4) COMPENSATION SURVEY OR STUDY; (5) APPROVAL BY THE BOARD.
PART I, LINE 4A:
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 THE FOLLOWING AMOUNTS ARE 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

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

No itemized grants to organizations on this return.

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.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

Provenance

Return type
form_990
Tax year
2022
Filed
31 July 2024
IRS schema version
2022v5.0
Source object
202412199349301036

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