2023-08-14T15:43:09-05:00 2022-09-30 111986323 MARCUM LLP 9 PARKWAY NORTH SUITE 200 DEERFIELD IL 60015 990 2021-10-01 370724112 GOOD SAMARITAN HOME OF QUINCY GOOD 2172238717 2130 HARRISON STREET QUINCY IL 62301 EMMA MCLEOD CEO 2172238717 2023-08-09 1 EMMA MCLEOD 999009999 ARIANA WARREN P01441395 8472826300 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z MATTHEW DORIAN 2130 HARRISON STREET QUINCY IL 62301 24848108 0 X WWW.GSHQ.ORG X 1925 IL SUPERIOR CHRISTIAN SERVICE IN A CHARITABLE COMMUNITY. 17 17 402 80 0 0 3633141 5745705 14579127 13770278 783734 607807 101573 107345 19097575 20231135 0 0 0 0 12386384 11872704 0 0 0 6617015 6816194 19003399 18688898 94176 1542237 32676656 32437749 7286638 7065374 25390018 25372375 SERVING OUR RESIDENTS, THEIR FAMILIES, STAFF AND THE GREATER COMMUNITY THROUGH COMPASSIONATE CARE. 0 0 12765210 10414493 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 2022, THE ORGANIZATION SERVED A DAILY AVERAGE OF 116 RESIDENTS THROUGH ITS SKILLED NURSING FACILITY. 2176933 2275146 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. 1418357 1080639 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 2022, THE ORGANIZATION SERVED A DAILY AVERAGE OF 18 RESIDENTS THROUGH ITS ASSISTED LIVING FACILITY. 16360500 1 1 0 1 0 0 0 0 1 1 1 1 0 1 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 17 17 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X MATTHEW DORIAN 2172238717 2130 HARRISON STREET QUINCY IL 62301 PAUL KEMNER PRESIDENT 1.00 1.00 X X 0 0 0 GARY BLICKHAN FIRST VICE PRESIDENT 1.00 1.00 X X 0 0 0 SHARON HIGGINS SECOND VICE PRESIDENT 1.00 1.00 X X 0 0 0 MARTIN GABRIEL THIRD VICE PRESIDENT 1.00 X X 0 0 0 JEFF SPEAR SECRETARY-TREASURER 1.00 X X 0 0 0 RICHARD BOWMAN DIRECTOR 1.00 X 0 0 0 ANDREW CASHMAN DIRECTOR 1.00 X 0 0 0 CHRIS DANIELS DIRECTOR 1.00 X 0 0 0 PATRICA GIBBS DIRECTOR 1.00 X 0 0 0 PATRICIA HUBBARD DIRECTOR 1.00 X 0 0 0 JERRY JACKSON DIRECTOR 1.00 1.00 X 0 0 0 MIKE OBERDAHLHOFF DIRECTOR 1.00 X 0 0 0 JOE OTT DIRECTOR 1.00 X 0 0 0 ROB OVERHOLSER DIRECTOR 1.00 X 0 0 0 RANDY RILEY DIRECTOR 1.00 1.00 X 0 0 0 KRISTEN ROGERS DIRECTOR - UNTIL 04/22 1.00 X 0 0 0 LARRY SHEPHERD DIRECTOR 1.00 1.00 X 0 0 0 STEVE WAVERING DIRECTOR 1.00 X 0 0 0 CHARLES NEWTON CHIEF EXEC. OFFICER - UNTIL 02/2022 40.00 5.00 X 132388 0 14256 EMMA MCLEOD COO - UNTIL 02/2022, THEN CEO 40.00 5.00 X 88086 0 3416 MATTHEW DORIAN CHIEF FINANCIAL OFFICER 40.00 5.00 X 52657 0 4414 DOROTHY DAGGS RESIDENT NURSE 60.00 X 143068 0 131 416199 0 22217 2 0 0 0 MIDWEST PHYSICAL THERAPY 62718 COLLECTION CENTER DRIVE CHICAGO IL 606930627 CONTRACTED THERAPY PROVIDER - PT - OT 374038 A FISHER BUILDERS INC 814 OHIO STREET QUINCY IL 62301 CONSTRUCTION CONTRACTOR 212492 PRIME TIME HEALTHCARE LLC PO BOX 3544 OMAHA NE 68103 STAFFING PROVIDER 162827 JRX PHARMACY SERVICES 2404 AVENUE FORT MADISON IA 52627 PHARMACY 156271 MATRIXCARE PO BOX 1414 MINNEAPOLIS MN 554801414 ELECTRONIC MEDICAL RECORDS & A/R BILLING 141369 7 1275 380000 5311259 53171 5745705 NET PATIENT SERVICE REVENUE 561499 11283732 11283732 COTTAGE RENTAL 561499 2285199 2285199 MANAGEMENT FEE 561499 200000 200000 CAFETERIA 561499 1347 1347 13770278 136676 136676 5088104 4616973 471131 471131 471131 MISCELLANEOUS INCOME 561499 107345 107345 107345 20231135 13770278 0 715152 310933 310933 9352041 8729542 622499 139432 133175 6257 1382014 1268730 113284 688284 621573 66711 35442 35442 91884 91884 40278 40278 491961 488407 3554 27961 27961 324111 189937 134174 308359 276538 31821 881797 799375 82422 2593 2593 96213 96213 1520567 1368510 152057 525063 477807 47256 OTHER 861603 511622 349981 FOOD & PROGRAM SUPPLIES 810153 729138 81015 PROVIDER TAX 410142 410142 MEDICAL SUPPLIES/DRUGS 356004 356004 32063 32063 18688898 16360500 2328398 0 1650 1650 230789 47994 896155 1094695 144318 135627 51154075 28948878 23332736 22205197 7869254 1745405 3849191 201754 3357990 32676656 32437749 1124475 1475610 1855900 1441678 4148259 3849191 158004 155235 0 143660 7286638 7065374 X 25290018 25272375 100000 100000 25390018 25372375 32676656 32437749 1542237 -1559880 0 X 0 1 X 1 1 1 X 214672 380771 818771 3633140 5745705 10793059 16670514 16196785 16017464 14579127 13770278 77234168 16885186 16577556 16836235 18212267 19515983 88027227 223725 166008 340813 322616 261491 1314653 0 223725 166008 340813 322616 261491 1314653 86712574 196707 179582 150616 138743 143048 808696 196707 179582 150616 138743 143048 808696 15614 54479 135491 101574 107345 414503 17097507 16811617 17122342 18452584 19766376 89250426 0.97160 0.97150 0.00910 0.00980 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME - 2017 AMOUNT: $ 15,614. 2018 AMOUNT: $ 54,479. 2019 AMOUNT: $ 135,491. 2020 AMOUNT: $ 101,574. 2021 AMOUNT: $ 107,345. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 670 670 0 PART II-B, LINE 1: THE ORGANIZATION PAYS DUES TO LEADING AGE ILLINOIS. THE PORTION OF DUES ATTRIBUTABLE TO LOBBYING IS $670. 0 1 X 121041 12662 5452 128251 106417 15356 732 121041 100000 6972 555 106417 100000 100000 100000 100000 0.00000 0.78000 0.22000 0 0 1135036 1135036 42927498 23352853 19574645 2701945 1976983 724962 4306009 3619042 686967 83587 83587 22205197 BONDS 3849191 C 3849191 RESIDENT TRUST FUND 155235 OTHER 74604 EMPLOYEE RETENTION TAX CREDIT RECEIVABLE 3028151 ASSETS LIMITED AS TO USE BY DONORS 100000 3357990 OTHER CURRENT LIABILITIES 143660 143660 X 18630977 -1559880 -1559880 20190857 40278 40278 20231135 18648620 0 18648620 40278 40278 18688898 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. X X 0 0 0 0 0 0 0 0 0 A CITY OF QUINCY 376000378 2013-07-11 8000000 FINANCE PORTION OF GOOD SAMARITAN HOME 0 0 0 A 3494583 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 6 THE ORGANIZATION HAS 7 TYPES OF MEMBERS: PATRON MEMBER, SUSTAINING MEMBER, SUPPORTING MEMBERS, ASSOCIATE MEMBER, REGULAR MEMBER, AND LIFETIME MEMBER. FORM 990, PART VI, SECTION A, LINE 7A EACH MEMBER OVER 18 YEARS OF AGE OF EACH CLASS SHALL BE ENTITLED TO ONE VOTE ON EACH MATTER SUBMITTED TO A VOTE OF THE MEMBERS. MEMBERS SHALL ATTEND AN ANNUAL MEETING TO ELECT BOARD MEMBERS. TWELVE (12) DIRECTORS OF THE BOARD SHALL BE ELECTED BY THE MEMBERSHIP, EACH SERVING A THREE-YEAR TERM, WHICH TERMS SHALL BE STAGGERED SO FOUR DIRECTORS SHALL BE ELECTED AT EACH ANNUAL MEETING. UP TO SEVEN (7) DIRECTORS OF THE BOARD MAY BE APPOINTED FROM ONE OR MORE OF THE FOLLOWING CORPORATION AFFILIATES AS FOLLOWS: UP TO TWO (2) DIRECTORS MAY BE APPOINTED BY THE IOWA CONFERENCE OF THE UNITED CHURCH OF CHRIST, UP TO THREE (3) DIRECTORS MAY BE APPOINTED BY ILLINOIS CONFERENCE OF THE UNITED CHURCH OF CHRIST, UP TO ONE (1) DIRECTOR MAY BE APPOINTED BY THE AUXILIARY OF THE CORPORATION, AND UP TO ONE (1) DIRECTOR MAY BE APPOINTED BY THE UNCLE SAMS OF THE CORPORATION, BOTH OF WHOM (AUXILIARY AND UNCLE SAMS) SHALL ALSO BE A MEMBER OF THE CORPORATION. THE APPOINTED MEMBERS OF THE BOARD SHALL SERVE FOR SUCH A PERIOD OF TIME, WITHOUT LIMITATION, AS IS DETERMINED BY THE APPOINTING BODY. FORM 990, PART VI, SECTION A, LINE 7B EACH MEMBER OVER 18 YEARS OF AGE OF EACH CLASS SHALL BE ENTITLED TO ONE VOTE ON EACH MATTER SUBMITTED TO A VOTE OF THE MEMBERS. MEMBERS SHALL ATTEND AN ANNUAL MEETING TO ELECT BOARD MEMBERS. TWELVE (12) DIRECTORS OF THE BOARD SHALL BE ELECTED BY THE MEMBERSHIP, EACH SERVING A THREE-YEAR TERM, WHICH TERMS SHALL BE STAGGERED SO FOUR DIRECTORS SHALL BE ELECTED AT EACH ANNUAL MEETING. UP TO SEVEN (7) DIRECTORS OF THE BOARD MAY BE APPOINTED FROM ONE OR MORE OF THE FOLLOWING CORPORATION AFFILIATES AS FOLLOWS: UP TO TWO (2) DIRECTORS MAY BE APPOINTED BY THE IOWA CONFERENCE OF THE UNITED CHURCH OF CHRIST, UP TO THREE (3) DIRECTORS MAY BE APPOINTED BY ILLINOIS CONFERENCE OF THE UNITED CHURCH OF CHRIST, UP TO ONE (1) DIRECTOR MAY BE APPOINTED BY THE AUXILIARY OF THE CORPORATION, AND UP TO ONE (1) DIRECTOR MAY BE APPOINTED BY THE UNCLE SAMS OF THE CORPORATION, BOTH OF WHOM (AUXILIARY AND UNCLE SAMS) SHALL ALSO BE A MEMBER OF THE CORPORATION. THE APPOINTED MEMBERS OF THE BOARD SHALL SERVE FOR SUCH A PERIOD OF TIME, WITHOUT LIMITATION, AS IS DETERMINED BY THE APPOINTING BODY. 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 380000 FMV GOOD SAMARITAN HOME FOUNDATION L 200000 FMV