GOOD SAMARITAN HOSPITAL FOUNDATION INC: Form 990, tax year 2024

View the entire original 990 at ProPublica ↗

Organization
GOOD SAMARITAN HOSPITAL FOUNDATION INC (EIN 35-1637684)
Tax period
2024-01-01 to 2024-12-31
Filed
2025-04-23
IRS object ID
202541199349301824
Schema version
2024v5.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2025-04-23T10:14:42-07:00ReturnTs
Tax Period End2024-12-31TaxPeriodEndDt
Return Type990ReturnTypeCd
Tax Period Begin2024-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN351637684EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1GOOD SAMARITAN HOSPITAL FOUNDATION INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlGOODBusinessNameControlTxt
Phone8128853192PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1328 N 2nd Street Suite 201AddressLine1Txt
CityVincennesCityNm
State AbbreviationINStateAbbreviationCd
ZIP47591ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonHelen SeirpPersonNm
Person TitlePresidentPersonTitleTxt
Phone8128853273PhoneNum
Signature2025-04-23SignatureDt
FieldValueIRS element (for citing)
IRS Responsible Prty Info CurrYes (1)IRSResponsiblePrtyInfoCurrInd
Tax2024TaxYr
Build TS2025-03-06 01:10:19ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerHelen SeirpPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1328 N 2nd StreetAddressLine1Txt
CityVincennesCityNm
State AbbreviationINStateAbbreviationCd
ZIP47591ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$725,664GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.gshvin.org/foundationWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1995FormationYr
Legal Domicile StateINLegalDomicileStateCd
Activity Or MissionThe mission of Good Samaritan Hospital Foundation is to raise private philanthropic support for Good Samaritan Hospital, its programs and services and to assure the continuation of the delivery of the highest quality medical and health care services that our community deserves and has come to expect. The services assist with charity care activities to assist the patients and families and provide equipment and educational opportunities for clinical staff.ActivityOrMissionDesc
Voting Members Governing Body17VotingMembersGoverningBodyCnt
Voting Members Independent0VotingMembersIndependentCnt
Total Employee2TotalEmployeeCnt
Total Volunteers25TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$275,961PYContributionsGrantsAmt
CY Contributions Grants$268,531CYContributionsGrantsAmt
PY Program Service Revenue$0PYProgramServiceRevenueAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$566,967PYInvestmentIncomeAmt
CY Investment Income$361,788CYInvestmentIncomeAmt
PY Other Revenue$125,073PYOtherRevenueAmt
CY Other Revenue$69,929CYOtherRevenueAmt
PY Total Revenue$968,001PYTotalRevenueAmt
CY Total Revenue$700,248CYTotalRevenueAmt
PY Grants And Similar Paid$449,308PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$308,782CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$216,254PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$136,309CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$103,669CYTotalFundraisingExpenseAmt
PY Other Expenses$215,573PYOtherExpensesAmt
CY Other Expenses$121,649CYOtherExpensesAmt
PY Total Expenses$881,135PYTotalExpensesAmt
CY Total Expenses$566,740CYTotalExpensesAmt
PY Revenues Less Expenses$86,866PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$133,508CYRevenuesLessExpensesAmt
Total Assets BOY$4,604,113TotalAssetsBOYAmt
Total Assets EOY$4,945,808TotalAssetsEOYAmt
Total Liabilities BOY$115TotalLiabilitiesBOYAmt
Total Liabilities EOY$182,623TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$4,603,998NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$4,763,185NetAssetsOrFundBalancesEOYAmt
MissionProvide excellent health care by promoting wellness, education and healing through trusting relationships.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$308,782ExpenseAmt
Grant$0GrantAmt
Revenue$0RevenueAmt
DescProvides support for Good Samaritan Hospital's programs and services. Services assist with charity care activities to assist the patients and their families and also provides equipment and educational opportunities for clinical staff.Desc
Total Other Prog Srvc Expense$0TotalOtherProgSrvcExpenseAmt
Total Other Prog Srvc Grant$0TotalOtherProgSrvcGrantAmt
Total Other Prog Srvc Revenue$0TotalOtherProgSrvcRevenueAmt
Total Program Service Expenses$308,782TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising ActivitiesYes (1)FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To IndividualsYes (1)GrantsToIndividualsInd
Schedule J Required0ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee2EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members17GoverningBodyVotingMembersCnt
Independent Voting Member0IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn Body0Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower Policy0WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldINStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonBrian BakerPersonNm
Phone8128853192PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1328 N 2nd StreetAddressLine1Txt
CityVincennesCityNm
State AbbreviationINStateAbbreviationCd
ZIP47591ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtKey EmployeeKeyEmployeeIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerInd
Nicole Coomer
Director40Yes (X)$58,815$0$0
Ashley Melvin
Donor Relation Coordinator40Yes (X)$38,475$0$0
Lowell Stoelting
Grant Committe Chair0.25$0$0$00Yes (X)
Patricia Buntrock
Scholarship Chair0.25$0$0$00Yes (X)
Joyce Villwock
Scholarship Chair0.25$0$0$0Yes (X)
Robert McLin
Board Member0.25$0$0$0Yes (X)
Dave Miller
Board Member0.25$0$0$0Yes (X)
Cindy Moore
Board Member0.25$0$0$0Yes (X)
Patty Niehaus
Board Member0.25$0$0$00Yes (X)
Tiffany Conover
Board Member0.25$0$0$00Yes (X)
Carson Thacker
Board Member0.25$0$0$00Yes (X)
Austin Muranaka MD
Board Member0.25$0$0$00Yes (X)
Patty Summers
Board Member0.25$0$0$00Yes (X)
Leslie Kidwell
Board Member0.25$0$0$00Yes (X)
Dennis Kordes
Board Member0.25$0$0$00Yes (X)
Kendall Vieke
Board Member0.25$0$0$00Yes (X)
Helen Seirp
President0.25$0$0$00Yes (X)
Regina McCord Fithian
Vice President0.25$0$0$00Yes (X)
Roy Ice
Treasurer0.25$0$0$00Yes (X)
Ann Hedde
Secretary0.25$0$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$97,290TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Federated Campaigns$16,789FederatedCampaignsAmt
Membership Dues$0MembershipDuesAmt
Fundraising$0FundraisingAmt
Related Organizations$0RelatedOrganizationsAmt
Government Grants$0GovernmentGrantsAmt
All Other Contributions$251,742AllOtherContributionsAmt
Noncash Contributions$0NoncashContributionsAmt
Total Contributions$268,531TotalContributionsAmt
Total Program Service Revenue$0TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$361,788TotalRevenueColumnAmt
Related Or Exempt Func Income$361,788RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt
Other$0OtherAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$95,345FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$0ContriRptFundraisingEventAmt
Fundraising Direct Expenses$25,416FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$69,929TotalRevenueColumnAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$69,929ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$0OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$700,248TotalRevenueColumnAmt
Related Or Exempt Func Income$361,788RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$69,929ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$266,463TotalAmt
Program Services$266,463ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$42,319TotalAmt
Program Services$42,319ProgramServicesAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$107,007TotalAmt
Program Services$0ProgramServicesAmt
Management And General$42,803ManagementAndGeneralAmt
Fundraising$64,204FundraisingAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$3,782TotalAmt
Program Services$0ProgramServicesAmt
Management And General$1,513ManagementAndGeneralAmt
Fundraising$2,269FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$17,361TotalAmt
Program Services$0ProgramServicesAmt
Management And General$6,944ManagementAndGeneralAmt
Fundraising$10,417FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$8,159TotalAmt
Program Services$0ProgramServicesAmt
Management And General$3,264ManagementAndGeneralAmt
Fundraising$4,895FundraisingAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt
Fundraising$0FundraisingAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$10,574TotalAmt
Program Services$0ProgramServicesAmt
Management And General$10,574ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$18,662TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$18,662FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,436TotalAmt
Program Services$0ProgramServicesAmt
Management And General$632ManagementAndGeneralAmt
Fundraising$804FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$3,838TotalAmt
Program Services$0ProgramServicesAmt
Management And General$1,420ManagementAndGeneralAmt
Fundraising$2,418FundraisingAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$3,452TotalAmt
Program Services$0ProgramServicesAmt
Management And General$3,452ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,603TotalAmt
Program Services$0ProgramServicesAmt
Management And General$1,603ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
Dues$1,935$0$1,935$0
General Expense$80,146$0$80,146$0
Investment transaction fees$3$0$3$0

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$566,740TotalAmt
Program Services$308,782ProgramServicesAmt
Management And General$154,289ManagementAndGeneralAmt
Fundraising$103,669FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$216,848BOYAmt
EOY$210,116EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$78,758BOYAmt
EOY$156,352EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$22,796LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$3,397LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$21,002BOYAmt
EOY$19,399EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$4,287,505BOYAmt
EOY$4,559,941EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$4,604,113BOYAmt
EOY$4,945,808EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$115BOYAmt
EOY$182,623EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$115BOYAmt
EOY$182,623EOYAmt
FieldValueIRS element (for citing)
Org Does Not Follow FASB117Yes (X)OrgDoesNotFollowFASB117Ind

Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp

FieldValueIRS element (for citing)
BOY$6,022,895BOYAmt
EOY$6,048,573EOYAmt

Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

FieldValueIRS element (for citing)
BOY-$1,418,897BOYAmt
EOY-$1,285,388EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$4,603,998BOYAmt
EOY$4,763,185EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$4,604,113BOYAmt
EOY$4,945,808EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$133,508ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$0NetUnrlzdGainsLossesInvstAmt
Donated Services And Use Fclts$0DonatedServicesAndUseFcltsAmt
Investment Expense$0InvestmentExpenseAmt
Prior Period Adjustments$0PriorPeriodAdjustmentsAmt
Other Changes In Net Assets$25,679OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewYes (1)AccountantCompileOrReviewInd

Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp

FieldValueIRS element (for citing)
Consol And Sep Basis Fincl StmtYes (X)ConsolAndSepBasisFinclStmtInd
FieldValueIRS element (for citing)
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consol And Sep Basis Fincl StmtYes (X)ConsolAndSepBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type1Yes (X)SupportingOrgType1Ind
Supported Organizations1SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp

Supported Organization Name SupportedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1Good Samaritan HospitalBusinessNameLine1Txt
FieldValueIRS element (for citing)
EIN356001532EIN
Organization Type3OrganizationTypeCd
Governing Document ListedYes (1)GoverningDocumentListedInd
Support$0SupportAmt
Other Support$0OtherSupportAmt
FieldValueIRS element (for citing)
Supported Organizations Total1SupportedOrganizationsTotalCnt
Support Sum$0SupportSumAmt
Other Support Sum$0OtherSupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

FieldValueIRS element (for citing)
Listed By Name Governing DocYes (1)ListedByNameGoverningDocInd
Suprt Org No IRS Determination0SuprtOrgNoIRSDeterminationInd
Supported Org Section C4560SupportedOrgSectionC456Ind
Supported Org Not Organized US0SupportedOrgNotOrganizedUSInd
Organization Change Suprt Org0OrganizationChangeSuprtOrgInd
Support Non Supported Org0SupportNonSupportedOrgInd
Payment Substantial Contribtr0PaymentSubstantialContribtrInd
Loan Disqualified Person0LoanDisqualifiedPersonInd
Controlled Disqualified Prsn0ControlledDisqualifiedPrsnInd
Disqualified Prsn Controll Int0DisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr Int0DisqualifiedPrsnOwnrIntInd
Excess Business Holdings Rules0ExcessBusinessHoldingsRulesInd
Contribution Controller0ContributionControllerInd
Contribution Family0ContributionFamilyInd
Contribution35 Controlled0Contribution35ControlledInd

Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp

FieldValueIRS element (for citing)
Power Appoint Majority Dir Trst0PowerAppointMajorityDirTrstInd
Operate Benefit Non Suprt Org0OperateBenefitNonSuprtOrgInd

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule A, Part I, Line 1Supports Good Samaritan Hospital
Schedule A, Part IV, Section B, Line 1Supports Good Samaritan Hospital

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$0InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis$0OtherCostOrOtherBasisAmt
Book Value$0BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$0InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis$0OtherCostOrOtherBasisAmt
Depreciation$0DepreciationAmt
Book Value$0BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$0InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis$0OtherCostOrOtherBasisAmt
Depreciation$0DepreciationAmt
Book Value$0BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$22,796InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis$0OtherCostOrOtherBasisAmt
Depreciation$3,397DepreciationAmt
Book Value$19,399BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$0InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis$0OtherCostOrOtherBasisAmt
Depreciation$0DepreciationAmt
Book Value$0BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$19,399TotalBookValueLandBuildingsAmt

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1Golf Cart RaffleEvent1Nm
Gross Receipts Event1$25,000GrossReceiptsEvent1Amt
Charitable Contri Event1$0CharitableContriEvent1Amt
Gross Revenue Event1$25,000GrossRevenueEvent1Amt
Cash Prizes Event1$0CashPrizesEvent1Amt
Non Cash Prizes Event1$0NonCashPrizesEvent1Amt
Rent Facility Costs Event1$0RentFacilityCostsEvent1Amt
Food And Beverage Event1$0FoodAndBeverageEvent1Amt
Entertainment Event1$0EntertainmentEvent1Amt
Other Direct Expenses Event1$10,671OtherDirectExpensesEvent1Amt
Event2Golf OutingEvent2Nm
Gross Receipts Event2$70,345GrossReceiptsEvent2Amt
Charitable Contri Event2$0CharitableContriEvent2Amt
Gross Revenue Event2$70,345GrossRevenueEvent2Amt
Cash Prizes Event2$3,000CashPrizesEvent2Amt
Non Cash Prizes Event2$0NonCashPrizesEvent2Amt
Rent Facility Costs Event2$4,640RentFacilityCostsEvent2Amt
Food And Beverage Event2$2,130FoodAndBeverageEvent2Amt
Entertainment Event2$4,975EntertainmentEvent2Amt
Other Direct Expenses Event2$0OtherDirectExpensesEvent2Amt
Other Events Total0OtherEventsTotalCnt
Gross Receipts Total$95,345GrossReceiptsTotalAmt
Charitable Contributions Tot$0CharitableContributionsTotAmt
Gross Revenue Total Events$95,345GrossRevenueTotalEventsAmt
Cash Prizes Total Events$3,000CashPrizesTotalEventsAmt
Non Cash Prizes Total Events$0NonCashPrizesTotalEventsAmt
Rent Fclty Costs Total Events$4,640RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events$2,130FoodAndBeverageTotalEventsAmt
Entertainment Total Events$4,975EntertainmentTotalEventsAmt
Oth Direct Expnss Total Events$10,671OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$25,416DirectExpenseSummaryEventsAmt
Net Income Summary$69,929NetIncomeSummaryAmt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1Good Samaritan HospitalBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1520 S 7th StreetAddressLine1Txt
CityVincennesCityNm
State AbbreviationINStateAbbreviationCd
ZIP47591ZIPCd
FieldValueIRS element (for citing)
Recipient EIN356001532RecipientEIN
IRC Section501 (c)(3)IRCSectionDesc
Cash Grant$189,733CashGrantAmt
Non Cash Assistance$0NonCashAssistanceAmt
Valuation Method UsedFMVValuationMethodUsedDesc
Non Cash Assistance0NonCashAssistanceDesc
Purpose Of Granthealth carePurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp

FieldValueIRS element (for citing)
Grant Typecollege scholarshipsGrantTypeTxt
Recipient1RecipientCnt
Cash Grant$10,000CashGrantAmt
Non Cash Assistance$0NonCashAssistanceAmt
Valuation Method UsedFMVValuationMethodUsedDesc

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule I, Part I, Line 2FormAndLineReferenceDesc
ExplanationGrant requests are submitted by the Hospital to Foundation. Applications submitted state use of funds and amount requested. Approvals are granted and funds awarded. On a monthly basis funds are reconciled and use of funds reported.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, Line 6The Foundation Members are the Board Members
Form 990, Part VI, Section A, Line 7aThe members elect new officers annually
Form 990, Part VI, Section A, Line 7bAny decisions of the governing body are subject to approval by the Board
Form 990, Part VI, Section B, Line 11bForm 990 is reviewed by Director of Foundation and the President of the Board
Form 990, Part VI, Section B, Line 12cFoundation Board members sign a conflict of interest form on an annual basis.
Form 990, Part VI, Section C, Line 19Available upon request
Form 990, Part XI, Line 9Elimination of inner corporate loans

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1Good Samaritan HospitalBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1520 S 7th StreetAddressLine1Txt
CityVincennesCityNm
State AbbreviationINStateAbbreviationCd
ZIP47591ZIPCd
FieldValueIRS element (for citing)
EIN356001532EIN
Primary ActivitieshealthcarePrimaryActivitiesTxt
Legal Domicile StateINLegalDomicileStateCd
Exempt Code Section501(c)(3)ExemptCodeSectionTxt
Public Charity StatusType IPublicCharityStatusTxt
Direct Controlling NAN/ADirectControllingNACd
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (1)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (3 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
Good Samaritan Hospital
b$189,733FMV
Good Samaritan Hospital
n$0FMV
Good Samaritan Hospital
o$107,007FMV

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