2024-08-15T14:01:34-05:00 2023-09-30 111986323 MARCUM LLP 9 PARKWAY NORTH SUITE 200 DEERFIELD IL 60015 990 2022-10-01 370724112 GOOD SAMARITAN HOME OF QUINCY GOOD 2172238717 2130 HARRISON STREET QUINCY IL 62301 EMMA MCLEOD CEO 2172238717 2024-08-15 1 0 ARIANA N JORDAN P01441395 8472826300 2024-08-14 2022 2024-08-08 14:25:15Z MATTHEW DORIAN 2130 HARRISON STREET QUINCY IL 62301 25717771 0 X WWW.GSHQ.ORG X 1925 IL SUPERIOR CHRISTIAN SERVICE IN A CHARITABLE COMMUNITY. 18 18 402 75 0 0 5745705 2342455 13770278 14872961 607807 433437 107345 187960 20231135 17836813 0 0 0 0 11872704 13550986 0 0 76723 6816194 6693963 18688898 20244949 1542237 -2408136 32437749 30241980 7065374 7175976 25372375 23066004 SERVING OUR RESIDENTS, THEIR FAMILIES, STAFF AND THE GREATER COMMUNITY THROUGH COMPASSIONATE CARE. 0 0 13828826 10895901 GOOD SAMARITAN HOME OF QUINCY OPERATES A SKILLED NURSING FACILITY. THIS FACILITY OFFERS 24-HOUR CARE. THERE IS AN EXTENSIVE ACTIVITY PROGRAM THAT INCLUDES OUTINGS, CRAFTS, COOKING, ENTERTAINMENT, AND DAILY CHAPEL SERVICES TO HELP KEEP RESIDENTS ACTIVE. GOOD SAMARITAN PROVIDES CHARITY CARE TO PATIENTS WHO ARE UNABLE TO PAY FOR SERVICES. DURING FY 2023, THE ORGANIZATION SERVED A DAILY AVERAGE OF 109 RESIDENTS THROUGH ITS SKILLED NURSING FACILITY. 2604228 2370002 GOOD SAMARITAN HOME OF QUINCY OFFERS 180 COTTAGES FOR INDEPENDENT LIVING. THE COTTAGES OFFER THE PRIVACY AND INDEPENDENCE OF HAVING YOUR OWN APARTMENT. COTTAGERS ARE WELCOME TO PARTICIPATE IN ACTIVITIES AT THE HOME, SUCH AS AQUATIC EXERCISE CLASSES, OUTINGS, ENTERTAINMENT, AND DAILY CHAPEL SERVICES. 1536938 1360044 GOOD SAMARITAN HOME OF QUINCY OFFERS AN ASSISTED LIVING FACILITY. THERE ARE SEVERAL ROOM SIZES, INCLUDING APARTMENT STYLE WITH KITCHENETTE IN EACH ROOM. RESIDENTS ARE ALSO WELCOME TO USE A COMMUNAL FULL KITCHEN. THERE IS ALSO AN EXTENSIVE ACTIVITY PORGRAM THAT INCLUDES OUTINGS, CRAFTS, COOKING, ENTERTAINMENT, DAILY CHAPEL SERVICES. DURING FY 2023, THE ORGANIZATION SERVED A DAILY AVERAGE OF 24 RESIDENTS THROUGH ITS ASSISTED LIVING FACILITY. 17969992 1 1 0 1 0 0 0 0 1 1 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 8 0 1 402 1 0 0 0 0 0 0 0 0 0 0 0 0 X 18 18 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X MATTHEW DORIAN 2172238717 2130 HARRISON STREET QUINCY IL 62301 SHARON HIGGINS PRESIDENT 1.00 1.00 X X 0 0 0 MARTIN GABRIEL FIRST VICE PRESIDENT 1.00 X X 0 0 0 PATRICA GIBBS SECOND VICE PRESIDENT 1.00 1.00 X X 0 0 0 BRIAN CANFIELD THIRD VICE PRESIDENT 1.00 X X 0 0 0 CHRIS DANIELS SECRETARY-TREASURER 1.00 X X 0 0 0 ERIC BARNES DIRECTOR 1.00 1.00 X X 0 0 0 GARY BLICKHAN DIRECTOR 1.00 1.00 X X 0 0 0 RICHARD BOWMAN DIRECTOR - UNTIL 9/30/22 1.00 X 0 0 0 ANDREW CASHMAN DIRECTOR 1.00 X 0 0 0 BRIAN DURANTE DIRECTOR 1.00 X 0 0 0 PATRICIA HUBBARD DIRECTOR 1.00 X 0 0 0 PAUL KEMNER DIRECTOR - UNTIL 9/30/22 1.00 1.00 X 0 0 0 MIKE OBERDAHLHOFF DIRECTOR - UNTIL 9/30/22 1.00 X 0 0 0 JOE OTT DIRECTOR 1.00 X 0 0 0 RANDY RILEY DIRECTOR 1.00 1.00 X 0 0 0 SETH RUNKLE DIRECTOR 1.00 1.00 X 0 0 0 JEFF SPEAR DIRECTOR - UNTIL 9/30/22 1.00 X 0 0 0 SELENA STEGEMAN DIRECTOR 1.00 1.00 X 0 0 0 STEVE WAVERING DIRECTOR - UNTIL 9/30/22 1.00 X 0 0 0 TIM WHITE DIRECTOR 1.00 X 0 0 0 EMMA MCLEOD CHIEF EXECUTIVE OFFICER 40.00 5.00 X 128991 0 5660 MATTHEW DORIAN CHIEF FINANCIAL OFFICER 40.00 5.00 X 89006 0 8774 CANDACE KLEEMEYER RESIDENT NURSE 50.00 X 110587 0 15718 328584 0 30152 2 0 0 0 MIDWEST PHYSICAL THERAPY PO BOX 30110 COLUMBIA MO 65205 CONTRACTED THERAPY PROVIDER - PT - OT 282622 SHIFTKEY PO BOX 735913 DALLAS TX 75373 STAFFING PROVIDER 227375 PETERS HEATING & AIR CONDITIONING 4520 BROADWAY QUINCY IL 62305 HVAC 166277 MATRIXCARE PO BOX 1414 MINNEAPOLIS MN 554801414 ELECTRONIC MEDICAL RECORDS & A/R BILLING 144749 WEAR LTC 527 N MADISON ST CARTHAGE IL 62321 PHARMACY 128349 6 14310 1425127 747244 155774 2342455 NET PATIENT SERVICE REVENUE 561499 12255945 12255945 COTTAGE RENTAL 561499 2413439 2413439 MANAGEMENT FEE 561499 200000 200000 CAFETERIA 561499 3577 3577 14872961 111079 111079 8203316 7820702 60256 382614 -60256 322358 322358 MISCELLANEOUS INCOME 561499 156848 156848 BAD DEBT RECOVERY 561499 31112 31112 187960 17836813 15306398 0 187960 260468 260468 10324490 9564795 715798 43897 161915 157420 4495 2079910 1898044 172897 8969 724203 652548 68548 3107 69250 69250 76444 76444 36510 36510 458497 434687 3060 20750 20841 20841 315602 195882 119720 343340 307321 36019 1136812 1029718 107094 7546 7546 108138 108138 1467461 1320715 146746 287531 261653 25878 FOOD & PROGRAM SUPPLIES 889067 800160 88907 PROVIDER TAX 623580 623580 OTHER 517272 415952 101320 MEDICAL SUPPLIES/DRUGS 307517 307517 28555 28555 20244949 17969992 2198234 76723 1650 1650 47994 143166 1094695 1060379 135627 158168 52605434 30371257 22205197 22234177 1745405 2730656 3849191 3532357 3357990 381427 32437749 30241980 1475610 2076329 1441678 1332100 3849191 3532357 155235 155352 143660 79838 7065374 7175976 X 25272375 22941004 100000 125000 25372375 23066004 32437749 30241980 -2408136 101765 0 X 0 1 X 1 0 X 380771 818771 3633140 5745705 2342455 12920842 16196785 16017464 14579127 13770278 14872961 75436615 16577556 16836235 18212267 19515983 17215416 88357457 166008 340813 322616 261491 229358 1320286 0 166008 340813 322616 261491 229358 1320286 87037171 179582 150616 138743 143048 111079 723068 179582 150616 138743 143048 111079 723068 54479 135491 101574 107345 187960 586849 16811617 17122342 18452584 19766376 17514455 89667374 0.97070 0.97160 0.00810 0.00910 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME - 2018 AMOUNT: $ 54,479. 2019 AMOUNT: $ 135,491. 2020 AMOUNT: $ 101,574. 2021 AMOUNT: $ 107,345. 2022 AMOUNT: $ 187,960. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 1 1 5839 5839 0 PART II-B, LINE 1: THE ORGANIZATION PAYS DUES TO ILLINOIS HEALTHCARE ASSOCIATION. THE PORTION OF DUES ATTRIBUTABLE TO LOBBYING IS $5,839. 0 1 X 128251 12031 745 139537 121041 12662 5452 128251 106417 15356 732 121041 100000 6972 555 106417 100000 100000 0.00000 0.71670 0.28330 0 0 1135036 1135036 43152147 24538956 18613191 2983721 2066284 917437 4403700 3766017 637683 930830 930830 22234177 BONDS 3532357 C 3532357 OTHER CURRENT LIABILITIES 79838 79838 X 17898565 98262 98262 17800303 36510 36510 17836813 20208439 0 20208439 36510 36510 20244949 PART IV, LINE 2B: THE ORGANIZATION IS THE TRUSTEE OF FUNDS RECEIVED ON BEHALF OF VARIOUS RESIDENTS. THE ORGANIZATION HAS A FIDUCIARY RESPONSIBILITY FOR THE ADMINISTRATION OF THE BANK ACCOUNT AND THE DISTRIBUTION OF THE FUNDS TO RESIDENTS. PART V, LINE 4: THE ORGANIZATION'S ENDOWMENT IS INVESTED TO PROVIDE INVESTMENT RETURNS TO FUND GENERAL OPERATIONS. PART X, LINE 2: THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. IN ADDITION, THE ORGANIZATION HAS BEEN DETERMINED BY THE INTERNAL REVENUE SERVICE NOT TO BE A "PRIVATE FOUNDATION" WITHIN THE MEANING OF SECTION 509(A) OF THE INTERNAL REVENUE CODE. THEREFORE, THE ORGANIZATION HAS MADE NO PROVISION FOR INCOME TAXES IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE ORGANIZATION EVALUATES ALL SIGNIFICANT TAX POSITIONS AS REQUIRED BY GAAP. THE ORGANIZATION DOES NOT BELIEVE THAT IT HAS TAKEN ANY TAX POSITIONS THAT WOULD REQUIRE THE RECORDING OF ANY ADDITIONAL TAX LIABILITY NOR DOES IT BELIEVE THAT THERE ARE ANY UNREALIZED TAX BENEFITS THAT WOULD EITHER INCREASE OR DECREASE WITHIN THE NEXT TWELVE MONTHS. IF THE ORGANIZATION WERE TO INCUR AN INCOME TAX LIABILITY IN THE FUTURE, THE INTEREST ON ANY TAX LIABILITY WOULD BE REPORTED AS INTEREST EXPENSE AND PENALTIES ON ANY INCOME TAX LIABILITY WOULD BE REPORTED AS INCOME TAX EXPENSE. THE ORGANIZATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS PENDING OR IN PROGRESS. A CITY OF QUINCY 376000378 2013-07-11 8000000 FINANCE PORTION OF GOOD SAMARITAN HOME 0 0 0 A 4427620 7960000 7960000 2013 1 0 1 1 A 0 0 0 0 0 0 1 A 0 1 0 0 1 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 4 THERE WAS A CHANGE IN 2023 TO REMOVE VOTING RIGHTS FROM MEMBERS. MEMBERSHIP NOW IS JUST A FUNDRAISING TOOL AND THEY NO LONGER HAVE IN DECISION MAKING FOR THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE FEDERAL FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE FORM 990 IS SENT TO THE BOARD MEMBERS FOR REVIEW BEFORE FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C EACH BOARD MEMBER IS REQUIRED TO SIGN A CONFLICT OF INTEREST STATEMENT AND CONFIDENTIALITY AGREEMENT. ANY CONFLICTS ARE ADDRESSED IMMEDIATELY OR BOARD MEMBERS ABSTAIN FROM VOTING IF THERE APPEARS TO BE A CONFLICT ON A CERTAIN ISSUE. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE CEO, AND CFO IS REVIEWED ANNUALLY. FOR THE CEO, THIS REVIEW WAS PERFORMED BY THE EXECUTIVE COMMITTEE. FOR THE CFO, THIS REVIEW WAS PERFORMED BY THE CEO AND BOARD OF DIRECTORS. COMPENSATION SURVEYS ARE UTILIZED DURING THE REVIEW PROCESSES. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE BY REQUEST. GOOD SAMARITAN HOME FOUNDATION 2130 HARRISON STREET QUINCY IL 62301 461945910 SUPPORTING ORGANIZATION IL 501(C)(3) LINE 12B, II GOOD SAMARITAN HOME OF QUINCY 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 GOOD SAMARITAN HOME FOUNDATION C 1425127 FMV GOOD SAMARITAN HOME FOUNDATION L 200000 FMV