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Nonprofiteer
← GOOD SAMARITAN MEDICAL OFFICE BLDG INC

Form 990 for tax year 2024

Filed by GOOD SAMARITAN MEDICAL OFFICE BLDG INC.

Totals

Total revenue
-$865,061
Total expenses
$4,813,356
Contributions and grants received
$0
Grants paid
$0
Program services expenses (Part IX)
$4,706,688
Management and general expenses
$106,668
Fundraising expenses
$0
Program service expenses (Part III)
$4,706,688

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
    $1,663,779
    From this org
    $0
    From related orgs
    $1,623,596
    Other
    $40,183
    Hours/week
    1.5 + 50.7 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,603,998 related
    Bonus
    $0
    Other
    $0 + $19,598 related
    Deferred
    $0 + $18,300 related
    Nontaxable benefits
    $0 + $21,883 related
    Filer's total
    $0 + $1,663,779 related

  • PEGGY CHULACK

    SYSTEM CAO & ASST SECRETARY

    Total calculated
    $1,515,125
    From this org
    $0
    From related orgs
    $1,481,245
    Other
    $33,880
    Hours/week
    1.5 + 50.7 related

    Schedule J breakdown matched by us

    Base
    $0 + $872,084 related
    Bonus
    $0
    Other
    $0 + $609,161 related
    Deferred
    $0 + $18,300 related
    Nontaxable benefits
    $0 + $15,580 related
    Filer's total
    $0 + $1,515,125 related

  • ROSALIO LOPEZ MD

    SYSTEM CSO/CMO

    Total calculated
    $1,396,488
    From this org
    $0
    From related orgs
    $1,344,833
    Other
    $51,655
    Hours/week
    1.5 + 44.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $987,835 related
    Bonus
    $0
    Other
    $0 + $356,998 related
    Deferred
    $0 + $41,300 related
    Nontaxable benefits
    $0 + $10,355 related
    Filer's total
    $0 + $1,396,488 related

  • VID SHIVARAMAN

    SYSTEM CFO & ASST TREASURER

    Total calculated
    $1,085,954
    From this org
    $0
    From related orgs
    $870,104
    Other
    $215,850
    Hours/week
    1.5 + 50.7 related

    Schedule J breakdown matched by us

    Base
    $0 + $862,548 related
    Bonus
    $0
    Other
    $0 + $7,556 related
    Deferred
    $0 + $190,785 related
    Nontaxable benefits
    $0 + $25,065 related
    Filer's total
    $0 + $1,085,954 related

  • BRIAN SMOLSKIS

    FORMER - SYSTEM COO

    Total calculated
    $1,106,036
    From this org
    $0
    From related orgs
    $1,089,063
    Other
    $16,973
    Hours/week
    0

    Schedule J breakdown matched by us

    Base
    $0
    Bonus
    $0
    Other
    $0 + $1,089,063 related
    Deferred
    $0
    Nontaxable benefits
    $0 + $16,973 related
    Filer's total
    $0 + $1,106,036 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 — 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)

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 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 THE FOLLOWING AMOUNTS BECAME VESTED OR WERE PAID-OUT IN 2024 AND ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III): BRIAN SMOLSKIS - $197,952 PEGGY CHULACK - $600,326 ROSALIO LOPEZ - $338,214

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.

Provenance

Return type
form_990
Tax year
2024
IRS schema version
2024v5.1
Source object
202622269349302817

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