GOOD SAMARITAN COMMUNITY HEALTH INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- GOOD SAMARITAN COMMUNITY HEALTH INC (EIN 20-1192339)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-10-01
- IRS object ID
- 202202749349300110
- Schema version
- 2021v4.0
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-10-01T17:10:23-04:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 592005908 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FREUND KATZ GOLDSTON YOUNG & CO PA | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10729 SW 104TH STREET | AddressLine1Txt |
| City | MIAMI | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 33176 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 201192339 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GOOD SAMARITAN COMMUNITY | BusinessNameLine1Txt |
| Business Name Line2 | HEALTH INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GOOD | BusinessNameControlTxt |
| Phone | 3055952769 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7701 SW 98TH STREET | AddressLine1Txt |
| City | MIAMI | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 33156 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOSE NERY MD | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 3055952769 | PhoneNum |
| Signature | 2022-09-20 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JOSE | PersonFirstNm |
| Person Last | NERY MD | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | STEVEN A YOUNG CPA | PreparerPersonNm |
| PTIN | P00206538 | PTIN |
| Phone | 3052791288 | PhoneNum |
| Preparation | 2022-10-01 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JOSE NERY MD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | C/O 7701 SW 98TH STREET | AddressLine1Txt |
| City | MIAMI | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 33156 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $230,086 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | NONE | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2004 | FormationYr |
| Legal Domicile State | FL | LegalDomicileStateCd |
| Activity Or Mission | THE MISSION OF GOOD SAMARITAN COMMUNITY HEALTH, INC. (GSCH) IS TO PROMOTE THE GOSPEL OF THE LORD JESUS CHRIST. GSCH PROVIDES PHYSICAL, EMOTIONAL AND SPIRITUAL AID TO HURTING PEOPLE IN OUR COMMUNITY AND OTHER AREAS IN THE WORLD WITH THE PURPOSE OF SHARING GOD'S LOVE THROUGH HIS SON, JESUS CHRIST. AS A PART OF ITS MISSION, GSCH ESTABLISHED AN OUTPATIENT MEDICAL CLINIC (MEDICAL CLINIC) TO PROVIDE LOW INCOME PERSONS ACCESS TO PRIMARY HEALTH CARE SERVICES REGARDLESS OF THEIR ABILITY TO PAY. THE MEDICAL CLINIC PROVIDES HIGH QUALITY, COST EFFICIENT, COMPASSIONATE HEALTH CARE SERVICES TO ALL, REGARDLESS OF RELIGION, CREED, RACE OR NATIONAL ORIGIN, INCLUDING, AS PERMITTED BY ITS RESOURCES, CHARITY CARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 6 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 4 | VotingMembersIndependentCnt |
| Total Employee | 4 | TotalEmployeeCnt |
| Total Volunteers | 20 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $227,400 | PYContributionsGrantsAmt |
| CY Contributions Grants | $223,481 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $6,480 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $6,605 | CYProgramServiceRevenueAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $233,880 | PYTotalRevenueAmt |
| CY Total Revenue | $230,086 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $377 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,594 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $104,655 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $99,630 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $105,535 | PYOtherExpensesAmt |
| CY Other Expenses | $103,678 | CYOtherExpensesAmt |
| PY Total Expenses | $210,567 | PYTotalExpensesAmt |
| CY Total Expenses | $204,902 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $23,313 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $25,184 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $124,113 | TotalAssetsBOYAmt |
| Total Assets EOY | $128,948 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $21,566 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,217 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $102,547 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $127,731 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF GOOD SAMARITAN COMMUNITY HEALTH, INC. (GSCH) IS TO PROMOTE THE GOSPEL OF THE LORD JESUS CHRIST. GSCH PROVIDES PHYSICAL, EMOTIONAL AND SPIRITUAL AID TO HURTING PEOPLE IN OUR COMMUNITY AND OTHER AREAS IN THE WORLD WITH THE PURPOSE OF SHARING GOD'S LOVE THROUGH HIS SON, JESUS CHRIST. AS A PART OF ITS MISSION, GSCH ESTABLISHED AN OUTPATIENT MEDICAL CLINIC (MEDICAL CLINIC) TO PROVIDE LOW INCOME PERSONS ACCESS TO PRIMARY HEALTH CARE SERVICES REGARDLESS OF THEIR ABILITY TO PAY. THE MEDICAL CLINIC PROVIDES HIGH QUALITY, COST EFFICIENT, COMPASSIONATE HEALTH CARE SERVICES TO ALL, REGARDLESS OF RELIGION, CREED, RACE OR NATIONAL ORIGIN, INCLUDING, AS PERMITTED BY ITS RESOURCES, CHARITY CARE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $107,544 | ExpenseAmt |
| Revenue | $6,605 | RevenueAmt |
| Desc | GSCH'S MAIN ACTIVITY HAS BEEN THE OPERATION OF A MEDICAL CLINIC IN MIAMI AND NARANJA, FLORIDA. SINCE SEPTEMBER 2007, THE MEDICAL CLINIC HAS PRIMARILY PROVIDED CHARITY CARE MEDICAL SERVICES TO THOSE WITH NO MEDICAL INSURANCE OF ANY KIND AND WHOSE INCOME IS AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES. PATIENTS HAVE BEEN CHARGED ON A SLIDING FEE SCALE WHICH ADJUSTS CHARGES BASED ON THE PATIENT'S FAMILY SIZE AND INCOME, IN RELATION TO THE FEDERAL POVERTY GUIDELINES. APPROXIMATELY 95% OF THE PATIENTS SERVED HAVE INCOME AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES AND ACCORDINGLY, THEIR FEES HAVE BEEN SIGNIFICANTLY LESS THAN THE VALUE PROVIDED. PATIENT CARE HAS CONTINUED THROUGH THE COVID-19 PANDEMIC. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $66,571 | ExpenseAmt |
| Desc | AS OF AUGUST 2011 GSCH WAS INVOLVED IN SHORT-TERM MISSION TRIPS TO NICARAGUA,OTHER LATIN AMERICAN AND CARRIBEAN COUNTRIES WITH THE PURPOSE OF SPREADING THE LOVE OF JESUS CHRIST , WHILE PROVIDING NEEDY PEOPLE LIVING IN REMOTE RURAL AREAS WITH FREE MEDICAL CARE, MEDICINES AND MEDICAL SUPPLIES, PLUS DONATED SHOES AND CLOTHING. AS OF DECEMBER 31, 2019 THIRTY- TWO MISSION TRIPS WERE CARRIED OUT, WITH A TOTAL OF OVER 11,500 MEDICAL CONSULTS. NICARAGUA IS THE POOREST COUNTRY IN CENTRAL AMERICA AND THE SECOND POOREST IN THE WESTERN HEMISPHERE. UNDEREMPLOYMENT AND POVERTY ARE WIDESPREAD. IN 2019, GSCH MADE MISSION TRIPS TO CUBA AND BRAZIL. OVER 500 MEDICAL CONSULTS WERE PROVIDED. DUE TO COVID-19, FOREIGN MISSION TRIPS HAVE BEEN SUSPENDED . HOWEVER, MEDICAL SUPPLIES DONATED BY AND PURCHASED FROM KINGSWAY CHARITIES HAVE BEEN SHIPPED TO SOUTH AMERICA AND THE CARRIBEAN. THERE HAVE ALSO BEEN LOCAL MISSIONS. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,594 | ExpenseAmt |
| Grant | $1,594 | GrantAmt |
| Desc | PROVIDE ASSISTANCE TO THE POOR, DISTRESSED AND UNDERPRIVILEGED. NINE GRANTS WERE MADE. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $13 | ExpenseAmt |
| Desc | OTHER PROGRAM SERVICES, EXPENSES IS FOR DEPRECIATION OF FIXED ASSETS USED IN THE MEDICAL CLINIC WHICH IS REPORTED IN FORM 990, PART III, LINE 4A. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $13 | TotalOtherProgSrvcExpenseAmt |
| Total Program Service Expenses | $175,722 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | Yes (true) | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | false | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | Yes (true) | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 4 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 6 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 4 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | false | ConflictOfInterestPolicyInd |
| Whistleblower Policy | false | WhistleblowerPolicyInd |
| Document Retention Policy | false | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | FL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DEBORA NERY | PersonNm |
| Phone | 3055952769 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | C/O 7701 SW 98TH STREET | AddressLine1Txt |
| City | MIAMI | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 33156 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (6 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| DEBRA NERY RN | ||||||
| TREASURER | 18.00 | Yes (X) | Yes (X) | $15,600 | $0 | $0 |
| JOSE NERY MD | ||||||
| PRESIDENT | 18.00 | Yes (X) | Yes (X) | $0 | $0 | $330 |
| DIEGO SEQUERA LOZADA | ||||||
| EXECUTIVE SE | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| JONAS MOSTAFA | ||||||
| VP | 18.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| CARLOS SIMOES | ||||||
| COUNSELOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| STEVEN YOUNG | ||||||
| COUNSELOR | 0.25 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $15,600 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $330 | TotalOtherCompensationAmt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Government Grants | $20,000 | GovernmentGrantsAmt |
| All Other Contributions | $203,481 | AllOtherContributionsAmt |
| Noncash Contributions | $56,353 | NoncashContributionsAmt |
| Total Contributions | $223,481 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE REVENUE | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $6,605 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $6,605 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $6,605 | TotalProgramServiceRevenueAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $230,086 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $6,605 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,594 | TotalAmt |
| Program Services | $1,594 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $90,956 | TotalAmt |
| Program Services | $67,556 | ProgramServicesAmt |
| Management And General | $23,400 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,674 | TotalAmt |
| Program Services | $6,462 | ProgramServicesAmt |
| Management And General | $2,212 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13 | TotalAmt |
| Program Services | $13 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| MISSION TRIPS MEDICINE | $61,706 | $61,706 |
| MOBILE HEALTH UNIT AUTO | $8,497 | $8,497 |
| INSURANCE MALPRACTICE | $6,965 | $6,965 |
| FACILITY | $5,500 | $5,500 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,997 | TotalAmt |
| Program Services | $17,429 | ProgramServicesAmt |
| Management And General | $3,568 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $204,902 | TotalAmt |
| Program Services | $175,722 | ProgramServicesAmt |
| Management And General | $29,180 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $124,082 | BOYAmt |
| EOY | $128,930 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $346,808 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $346,790 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31 | BOYAmt |
| EOY | $18 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $124,113 | BOYAmt |
| EOY | $128,948 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,566 | BOYAmt |
| EOY | $1,217 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,000 | BOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,566 | BOYAmt |
| EOY | $1,217 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $102,547 | BOYAmt |
| EOY | $127,731 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $102,547 | BOYAmt |
| EOY | $127,731 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $124,113 | BOYAmt |
| EOY | $128,948 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $25,184 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | false | FSAuditedInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $273,292 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $202,540 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $227,187 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $227,400 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $223,481 | CurrentTaxYearAmt |
| Total | $1,153,900 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $273,292 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $202,540 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $227,187 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $227,400 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $223,481 | CurrentTaxYearAmt |
| Total | $1,153,900 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $566,922 | SubstantialContributorsTotAmt |
| Public Support Total170 | $586,978 | PublicSupportTotal170Amt |
| Total Support | $1,153,900 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $117,784 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.50870 | PublicSupportCY170Pct |
| Public Support PY170 | 0.49160 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $320,268 | OtherCostOrOtherBasisAmt |
| Depreciation | $320,268 | DepreciationAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $26,540 | OtherCostOrOtherBasisAmt |
| Depreciation | $26,522 | DepreciationAmt |
| Book Value | $18 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $18 | TotalBookValueLandBuildingsAmt |
Schedule F IRS990ScheduleF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | false | GrantRecordsMaintainedInd |
Account Activities Outside US AccountActivitiesOutsideUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Region | SOUTH AMERICA AND CARRIBEAN | RegionTxt |
| Type Of Activities Conducted | PROGRAM SERVICES | TypeOfActivitiesConductedTxt |
| Specific Services Provided | MISSIONS AND MEDICAL | SpecificServicesProvidedTxt |
| Region Total Expenditures | $61,706 | RegionTotalExpendituresAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subtotal Spent | $61,706 | SubtotalSpentAmt |
| Total Spent | $61,706 | TotalSpentAmt |
| Transfer To Foreign Corp | false | TransferToForeignCorpInd |
| Interest In Foreign Trust | false | InterestInForeignTrustInd |
| Foreign Corp Ownership | false | ForeignCorpOwnershipInd |
| Passive Foreign Investmest Co | false | PassiveForeignInvestmestCoInd |
| Foreign Partnership | false | ForeignPartnershipInd |
| Boycott Countries | false | BoycottCountriesInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE F, PAGE 1, PART I, LINE 3 | SOUTH AMERICA AND CARRIBEAN 61,706 0 |
| SCHEDULE F, PAGE 5, PART V | SCHEDULE F, STATEMENT OF ACTIVITIES OUTSIDE THE UNITED STATES PART 1, LINE 3, COLUMN F, TOTAL EXPEDITURES. ACCOUNTING METHOD USED: ACCRUAL. |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $56,353 | NoncashContributionsRptF990Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | false | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | false | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE M, PAGE 2, PART II | FormAndLineReferenceDesc |
| Explanation | PART 1, LINE 20, DRUGS AND MEDICAL SUPPLIES, COLUMN (B), NUMBER OF CONTRIBUTION OR ITEMS CONTRIBUTED: THE NUMBER OF CONTRIBUTIONS RECEIVED WAS REPORTED. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990 - ORGANIZATION'S MISSION | THE MISSION OF GOOD SAMARITAN COMMUNITY HEALTH, INC. (GSCH) IS TO PROMOTE THE GOSPEL OF THE LORD JESUS CHRIST. GSCH PROVIDES PHYSICAL, EMOTIONAL AND SPIRITUAL AID TO HURTING PEOPLE IN OUR COMMUNITY AND OTHER AREAS IN THE WORLD WITH THE PURPOSE OF SHARING GOD'S LOVE THROUGH HIS SON, JESUS CHRIST. AS A PART OF ITS MISSION, GSCH ESTABLISHED AN OUTPATIENT MEDICAL CLINIC (MEDICAL CLINIC) TO PROVIDE LOW INCOME PERSONS ACCESS TO PRIMARY HEALTH CARE SERVICES REGARDLESS OF THEIR ABILITY TO PAY. THE MEDICAL CLINIC PROVIDES HIGH QUALITY, COST EFFICIENT, COMPASSIONATE HEALTH CARE SERVICES TO ALL, REGARDLESS OF RELIGION, CREED, RACE OR NATIONAL ORIGIN, INCLUDING, AS PERMITTED BY ITS RESOURCES, CHARITY CARE. |
| FORM 990, PAGE 1, PART I, LINE 6 | VOLUNTEERS ASSIT IN PROGRAM AND ADMINITRATIVE WORK. |
| FORM 990, PAGE 2, PART III, LINE 4B | AS OF AUGUST 2011 GSCH WAS INVOLVED IN SHORT-TERM MISSION TRIPS TO NICARAGUA,OTHER LATIN AMERICAN AND CARRIBEAN COUNTRIES WITH THE PURPOSE OF SPREADING THE LOVE OF JESUS CHRIST , WHILE PROVIDING NEEDY PEOPLE LIVING IN REMOTE RURAL AREAS WITH FREE MEDICAL CARE, MEDICINES AND MEDICAL SUPPLIES, PLUS DONATED SHOES AND CLOTHING. AS OF DECEMBER 31, 2019 THIRTY- TWO MISSION TRIPS WERE CARRIED OUT, WITH A TOTAL OF OVER 11,500 MEDICAL CONSULTS. NICARAGUA IS THE POOREST COUNTRY IN CENTRAL AMERICA AND THE SECOND POOREST IN THE WESTERN HEMISPHERE. UNDEREMPLOYMENT AND POVERTY ARE WIDESPREAD. IN 2019, GSCH MADE MISSION TRIPS TO CUBA AND BRAZIL. OVER 500 MEDICAL CONSULTS WERE PROVIDED. DUE TO COVID-19, FOREIGN MISSION TRIPS HAVE BEEN SUSPENDED . HOWEVER, MEDICAL SUPPLIES DONATED BY AND PURCHASED FROM KINGSWAY CHARITIES HAVE BEEN SHIPPED TO SOUTH AMERICA AND THE CARRIBEAN. THERE HAVE ALSO BEEN LOCAL MISSIONS. |
| FORM 990, PAGE 2, PART III, LINE 4D | OTHER PROGRAM SERVICES, EXPENSES IS FOR DEPRECIATION OF FIXED ASSETS USED IN THE MEDICAL CLINIC WHICH IS REPORTED IN FORM 990, PART III, LINE 4A. |
| FORM 990, PAGE 6, PART VI, LINE 2 | JOSE NERY, MD DEBRA NERY, RN PRESIDENT TREASURER MARRIED |
| FORM 990, PAGE 6, PART VI, LINE 11B | A COMPLETE COPY OF FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS BEFORE IT IS FILED. |
| FORM 990, PAGE 6, PART VI, LINE 15A | BOARD APPROVAL IS REQUIRED. COMPARABILTY DATA IS USED TO DETERMINE COMPENSATION. |
| FORM 990, PAGE 6, PART VI, LINE 15B | BOARD APPROVAL IS REQUIRED. COMPARABLITY DATA IS USED TO DETERMINE COMPENSATION. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 24E | MISSION TRIPS 4,865 0 0 MEDICAL RECORD 4,539 0 0 COMPUTER AND INTERNET 1,338 1,338 0 TELEPHONE 1,338 1,338 0 CLINIC EXPENSES 2,245 0 0 OFFICE 1,819 0 0 DUES AND SUBSCRIPTIONS 787 787 0 MEALS AND ENTERTAINMENT 105 105 0 ADVERTISING & PROMOTIONAL 203 0 0 LICENSE AND TAXES 190 0 0 TOTAL 17,429 3,568 0 |
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