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← ORTHOPEDIC INSTITUTE OF THE HOSPITAL OF THE GOOD SAMARITAN

Form 990 for tax year 2023

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

Totals

Total revenue
$29,201
Total expenses
$9,537
Contributions and grants received
$25,000
Grants paid
$8,371
Program service revenue
$0
Investment income
$4,201
Other revenue
$0
Total assets, end of year
$1,597,281
Total liabilities, end of year
$0
Net assets or fund balances, end of year
$1,597,281
Program services expenses (Part IX)
$9,537
Management and general expenses
$0
Fundraising expenses
$0
Program service expenses (Part III)
$9,537

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

    $25,000

  • 2f · All other program service revenue

    total $0 · related or exempt $0 · unrelated business $0 · excluded $0

  • 3 · Investment income

    total $69,711 · excluded $69,711

  • 6c · Rental income or loss

    real property $0 · personal property $0

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

    securities $65,510

  • 7c · Gain or loss

    securities -$65,510 · other assets $0

  • 7d · Net gain or loss

    total -$65,510 · excluded -$65,510

  • 11d · All other revenue

    total $0 · related or exempt $0 · unrelated business $0 · excluded $0

  • 11e · Other revenue, total

    $0

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $8,371 · program services $8,371

  • 11g · Fees: other

    total $0 · program services $0 · management and general $0 · fundraising $0

  • 22 · Depreciation, depletion and amortization

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

  • 24e · All other expenses

    total $0 · program services $0 · management and general $0 · fundraising $0

Balance sheet

Part X, book values.

  • 5 · Loans and receivables from officers and key people

    end of year $0

  • 6 · Loans and receivables from disqualified persons

    end of year $0

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

    $12,600

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

    $3,499

  • 10c · Land, buildings and equipment, net

    beginning of year $10,267 · end of year $9,101

  • 11 · Investments: publicly traded securities

    beginning of year $1,278,135 · end of year $1,364,814

  • 12 · Investments: other securities

    beginning of year $0

  • 13 · Investments: program-related

    beginning of year $0

  • 15 · Other assets

    beginning of year $0 · end of year $223,366

  • 22 · Loans and payables to officers and key people

    end of year $0

  • 25 · Other liabilities

    beginning of year $264,562 · end of year $0

  • 27 · Net assets without donor restrictions

    beginning of year -$1,416,953 · end of year -$1,418,120

  • 28 · Net assets with donor restrictions

    beginning of year $2,440,794 · end of year $3,015,401

Mission and programs · 2023

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 $9,537 · Grants $8,371

As filed on the 2023 return.

Listed in Part VII

  • James West

    SYSTEM PRESIDENT & CEO

    Total calculated
    $2,562,270
    From this org
    $0
    From related orgs
    $2,523,533
    Other
    $38,737
    Hours/week
    1.5 + 50.7 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,565,657 related
    Bonus
    $0 + $383,472 related
    Other
    $0 + $574,404 related
    Deferred
    $0 + $18,000 related
    Nontaxable benefits
    $0 + $20,737 related
    Filer's total
    $0 + $2,562,270 related

  • Peggy Chulack

    SYSTEM CAO & ASST SECRETARY

    Total calculated
    $1,651,984
    From this org
    $0
    From related orgs
    $1,619,441
    Other
    $32,543
    Hours/week
    1.5 + 50.7 related

    Schedule J breakdown matched by us

    Base
    $0 + $909,522 related
    Bonus
    $0 + $151,215 related
    Other
    $0 + $558,704 related
    Deferred
    $0 + $18,000 related
    Nontaxable benefits
    $0 + $14,543 related
    Filer's total
    $0 + $1,651,984 related

  • Vid Shivaraman

    SYSTEM CFO & ASST TREASURER

    Total calculated
    $1,081,174
    From this org
    $0
    From related orgs
    $884,098
    Other
    $197,076
    Hours/week
    1.5 + 50.7 related

    Schedule J breakdown matched by us

    Base
    $0 + $782,967 related
    Bonus
    $0 + $93,639 related
    Other
    $0 + $7,492 related
    Deferred
    $0 + $176,607 related
    Nontaxable benefits
    $0 + $20,469 related
    Filer's total
    $0 + $1,081,174 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

  • 4b · Supplemental nonqualified retirement plan

Answered no

  • 4a · Severance or change-of-control payment
  • 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)

Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan
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 2023 AND ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B) (III) JAMES WEST $552,201 PEGGY CHULACK $545,719
Schedule J, Part I, Line 3
COMPENSATION FOR THE CEO WAS ESTABLISHED AND PAID BY PIH HEALTH 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; AND (5) APPROVAL BY THE BOARD.

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

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.

  • DRMC Properties Inc

    C Corporation · REAL ESTATE · CA

    Directly controlled by NA

  • HealthMed Services Inc

    C Corporation · HEALTHCARE · CA

    Directly controlled by NA

  • PIH Health Care Solutions

    C Corporation · HEALTHCARE · CA

    Directly controlled by NA

  • PIH Insurance Co A Reciprocal Risk Retention Group

    Trust · CAPTIVE INSURANCE · HI

    Directly controlled by NA

  • PIH Health RE

    Trust · CAPTIVE INSURANCE · HI

    Directly controlled by NA

  • Pioneer Medical Group Inc

    C Corporation · MEDICAL SERVICES · CA

    Directly controlled by NA

  • Pioneer Provider Network A Medical Group Inc

    C Corporation · Management Services · CA

    Directly controlled by NA

Provenance

Return type
form_990
Tax year
2023
Filed
13 August 2025
IRS schema version
2023v6.0
Source object
202502259349302005

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