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Nonprofiteer
← GOOD SAMARITAN MEDICAL OFFICE BLDG INC

Form 990 for tax year 2022

Filed by GOOD SAMARITAN MEDICAL OFFICE BLDG INC.

Totals

Total revenue
-$216,857
Total expenses
$4,235,867
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$2,711,817
Investment income
$0
Other revenue
-$2,928,674
Total assets, end of year
$119,584,726
Total liabilities, end of year
$159,727,940
Net assets or fund balances, end of year
-$40,143,214
Program services expenses (Part IX)
$4,143,639
Management and general expenses
$92,228
Fundraising expenses
$0
Program service expenses (Part III)
$4,143,639

Program services were 97.8% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

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

  • 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
    1.5 + 44.7 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

  • 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 & ASST 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

  • BRIAN SMOLSKIS THRU 9282023

    SYSTEM COO

    Total calculated
    $1,253,853
    From this org
    $0
    From related orgs
    $1,034,811
    Other
    $219,042
    Hours/week
    1.5 + 46.2 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

  • 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

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 (PIHW), A RELATED ORGANIZATION. PIHW 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:
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 2022 AND ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III): JAMES WEST $517,243 BRIAN SMOLSKIS $188,312 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
202442199349300444

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