GOOD SAMARITAN HEALTH SERVICES INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- GOOD SAMARITAN HEALTH SERVICES INC (EIN 73-1559561)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-06-16
- IRS object ID
- 202241679349300239
- 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 | 2022-06-16T14:30:47-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 203911007 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MINERT & ASSOCIATES | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2488 E 81ST ST STE 145 | AddressLine1Txt |
| City | TULSA | CityNm |
| State Abbreviation | OK | StateAbbreviationCd |
| ZIP | 74137 | 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 | 731559561 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GOOD SAMARITAN HEALTH SERVICES INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GOOD | BusinessNameControlTxt |
| Phone | 9187104222 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1191 | AddressLine1Txt |
| City | TULSA | CityNm |
| State Abbreviation | OK | StateAbbreviationCd |
| ZIP | 74101 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOHN R CROUCH JR MD | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 9187104222 | PhoneNum |
| Signature | 2022-06-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JOHN R | PersonFirstNm |
| Person Last | CROUCH JR | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | TONY R MINERT | PreparerPersonNm |
| PTIN | P00290071 | PTIN |
| Phone | 9187421616 | PhoneNum |
| Preparation | 2022-06-16 | 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 | JOHN R CROUCH JR MD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1191 | AddressLine1Txt |
| City | TULSA | CityNm |
| State Abbreviation | OK | StateAbbreviationCd |
| ZIP | 74101 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $2,085,577 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.GOODSAMARITANHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1999 | FormationYr |
| Legal Domicile State | OK | LegalDomicileStateCd |
| Activity Or Mission | GOOD SAMARITAN HEALTH SERVICES,INC PROVIDE QUALITY HEALTH CARE TO THE UNDERSERVED POPULATIONS WITHIN THE COMMUNITY.THE ORGANIZATION INTEGRATE SUPPORT FROM THE COMMUNITY AND EMPHASIZE A HOLISTIC APPROACH TO HEALTHCARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 36 | TotalEmployeeCnt |
| Total Volunteers | 93 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $2,495,564 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,868,419 | CYContributionsGrantsAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $228,982 | PYOtherRevenueAmt |
| CY Other Revenue | $179,972 | CYOtherRevenueAmt |
| PY Total Revenue | $2,724,546 | PYTotalRevenueAmt |
| CY Total Revenue | $2,048,391 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $1,133,644 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,280,976 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $133,167 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,173,542 | PYOtherExpensesAmt |
| CY Other Expenses | $1,048,866 | CYOtherExpensesAmt |
| PY Total Expenses | $2,307,186 | PYTotalExpensesAmt |
| CY Total Expenses | $2,329,842 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $417,360 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$281,451 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $791,911 | TotalAssetsBOYAmt |
| Total Assets EOY | $429,189 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $7,900 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $265,050 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $784,011 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $164,139 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | GOOD SAMARITAN HEALTH SERVICES,INC PROVIDE QUALITY HEALTH CARE TO THE UNDERSERVED POPULATIONS WITHIN THE COMMUNITY.THE ORGANIZATION INTEGRATE SUPPORT FROM THE COMMUNITY AND EMPHASIZE A HOLISTIC APPROACH TO HEALTHCARE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $2,001,500 | ExpenseAmt |
| Desc | FOR 24 YEARS GOOD SAMARITAN HEALTH SERVICES HAS BEEN HELPING FELLOW OKLAHOMANS REGAIN THEIR HEALTH IN TULSA AND THE SURROUNDING COMMUNITIES. WE PROVIDE FREE, QUALITY, AND COMPASSIONATE MEDICAL CARE EVERY WEEK AT SEVEN LOCATIONS PLUS ONE WOMEN'S HEALTHCARE CLINIC EACH MONTH USING THREE FULLY- EQUIPPED MEDICAL TRUCKS. IN 2021 WE PROVIDED 4587 MEDICAL VISITS TO 1776 PATIENTS AT 511 CLINICS. WE PARTNER WITH LOCAL CHURCHES WHICH PROVIDE WAITING ROOM AND PROCESSING FACILITIES, VOLUNTEERS FOR REGISTRATION, MEDICAL HISTORY AND VITALS, AND TRANSLATORS. THE PEOPLE WHO COME TO US ARE SICK, WITHOUT RESOURCES, AND OFTEN TIMES HOPELESS. WE TREAT PATIENTS REGARDLESS OF RACE, BACKGROUND, LEGAL STATUS, OR RELIGIOUS AFFILIATION. THE ONLY PREREQUISITE TO RECEIVING OUR FREE CARE IS THAT THEY DO NOT HAVE HEALTH INSURANCE. WE ARE THE ONLY FREE CLINIC IN THIS PART OF THE STATE THAT BRINGS HEALTHCARE TO THE PEOPLE IN AREAS OF GREATEST NEED USING MOBILE MEDICAL TRUCKS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | WE PROVIDE OTHER SPECIFIC PROGRAMS DESIGNED TO MEET THE NEEDS OF THE POPULATION WE SERVE. IN 2021, WE HELD 10 WOMEN'S HEALTHCARE CLINICS PROVIDING CARE FOR 214 WOMEN. WE PROVIDE PAP SMEARS, BREAST EXAMS, AND FREE MAMMOGRAM COUPONS. WE HELP WITH DIAGNOSTIC CO-PAYS, DEDUCTIBLE ASSISTANCE, TRANSPORTATION, AND INTERPRETER SERVICES. ALL OF OUR 600 DIABETIC PATIENTS RECEIVE RETINAL SCANS FOR DIABETIC RETINOPATHY, A LEADING CAUSE OF BLINDNESS IN DIABETICS. WE PARTNER WITH A LOCAL RETINAL SPECIALIST PROVIDER WHEN A PATIENT NEEDS TREATMENT FOR RETINOPATHY. WE PAY THE COST OF THE MEDICATIONS NEEDED FOR INJECTIONS AND SURGERY AND THE SPECIALIST PROVIDER DONATES HIS SERVICES. THE PEOPLE WHO BENEFIT FROM OUR SERVICES ARE THE UNDERSERVED AND UNINSURED INDIVIDUALS FROM THE GREATER TULSA AREA AND SURROUNDING COUNTIES. WE WERE ABLE TO HELP PEOPLE FROM 11 DIFFERENT COUNTRIES AND PREVENT OVER 750 EMERGENCY ROOM VISITS TO OUR LOCAL HOSPITALS. IN 2021, 65% OF OUR PATIENTS WERE FEMALE AND 35% WERE MALE. THE AVERAGE AGE WAS 50 YEARS OLD. THE DEMOGRAPHIC BREAKDOWN OF PATIENTS BY RACE WAS 30.8% CAUCASIAN, 36.8% MEXICAN/HISPANIC, 17.7% AFRICAN AMERICAN, 5.8% ASIAN, 8.2% OTHER, AND .03% MIDDLE EASTERN. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $2,001,500 | 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 | Yes (true) | 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 | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (true) | 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 | Yes (true) | 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 | 3 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 36 | 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 |
| 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 | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | 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 | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | 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 | OK | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | HEATH PLACEK | PersonNm |
| Phone | 9187104222 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1422 EAST 71ST ST | AddressLine1Txt |
| City | TULSA | CityNm |
| State Abbreviation | OK | StateAbbreviationCd |
| ZIP | 74136 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (7 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| LAUREL WILLISTON MD | ||||||
| VICE PRESIDE | 5.00 | Yes (X) | Yes (X) | $35,308 | $0 | $0 |
| MITCH DUININCK MD | ||||||
| PRESIDENT | 5.00 | Yes (X) | Yes (X) | $12,600 | $0 | $0 |
| MIKE BORDEN | ||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JOHN R CROUCH JR MD | ||||||
| EXECUTIVE DI | 5.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| VANESSA NEAL | ||||||
| CHAIRMAN | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| AUDREY H THOMSON | ||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |
| ANDREW L MURPHREE | ||||||
| TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $47,908 | TotalReportableCompFromOrgAmt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| All Other Contributions | $1,868,419 | AllOtherContributionsAmt |
| Noncash Contributions | $786,306 | NoncashContributionsAmt |
| Total Contributions | $1,868,419 | TotalContributionsAmt |
| Fundraising Gross Income | $217,158 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $37,186 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $179,972 | TotalRevenueColumnAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,048,391 | TotalRevenueColumnAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,071,057 | TotalAmt |
| Program Services | $857,763 | ProgramServicesAmt |
| Management And General | $124,259 | ManagementAndGeneralAmt |
| Fundraising | $89,035 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $125,936 | TotalAmt |
| Program Services | $94,801 | ProgramServicesAmt |
| Management And General | $21,657 | ManagementAndGeneralAmt |
| Fundraising | $9,478 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $83,983 | TotalAmt |
| Program Services | $67,259 | ProgramServicesAmt |
| Management And General | $9,743 | ManagementAndGeneralAmt |
| Fundraising | $6,981 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,878 | TotalAmt |
| Program Services | $9,439 | ProgramServicesAmt |
| Management And General | $9,439 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,048 | TotalAmt |
| Program Services | $4,524 | ProgramServicesAmt |
| Management And General | $4,524 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,876 | TotalAmt |
| Program Services | $38,907 | ProgramServicesAmt |
| Management And General | $12,969 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,145 | TotalAmt |
| Program Services | $23,145 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,184 | TotalAmt |
| Management And General | $1,184 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | FundraisingFundraisingAmt |
|---|---|---|---|
| MEDICAL OUTREACH | $791,942 | $791,942 | |
| CLINIC EXPENSES | $71,968 | $71,968 | |
| MEDICAL VAN EXPENSE | $32,143 | $32,143 | |
| IN-KIND DONATIONS | $17,666 | $17,666 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,016 | TotalAmt |
| Program Services | $9,609 | ProgramServicesAmt |
| Management And General | $11,400 | ManagementAndGeneralAmt |
| Fundraising | $10,007 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,329,842 | TotalAmt |
| Program Services | $2,001,500 | ProgramServicesAmt |
| Management And General | $195,175 | ManagementAndGeneralAmt |
| Fundraising | $133,167 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $671,041 | BOYAmt |
| EOY | $299,895 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $29,759 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $805,230 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $723,345 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $105,030 | BOYAmt |
| EOY | $81,885 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,840 | BOYAmt |
| EOY | $17,650 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $791,911 | BOYAmt |
| EOY | $429,189 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $1,075 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,900 | BOYAmt |
| EOY | $263,975 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,900 | BOYAmt |
| EOY | $265,050 | 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 | $467,818 | BOYAmt |
| EOY | -$92,700 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $316,193 | BOYAmt |
| EOY | $256,839 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $784,011 | BOYAmt |
| EOY | $164,139 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $791,911 | BOYAmt |
| EOY | $429,189 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$281,451 | ReconcilationRevenueExpnssAmt |
| Prior Period Adjustments | -$338,421 | PriorPeriodAdjustmentsAmt |
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
| Accountant Compile Or Review | Yes (true) | AccountantCompileOrReviewInd |
Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FS Audited | false | FSAuditedInd |
| Audit Committee | Yes (true) | AuditCommitteeInd |
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 | $1,684,352 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,359,122 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,941,556 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,495,564 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,884,152 | CurrentTaxYearAmt |
| Total | $10,364,746 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,684,352 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,359,122 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,941,556 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,495,564 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,884,152 | CurrentTaxYearAmt |
| Total | $10,364,746 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $10,364,746 | PublicSupportTotal170Amt |
| Total Support | $10,364,746 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $1,077,480 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 1.00000 | PublicSupportCY170Pct |
| Public Support PY170 | 1.00000 | 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
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $805,230 | OtherCostOrOtherBasisAmt |
| Depreciation | $723,345 | DepreciationAmt |
| Book Value | $81,885 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $81,885 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| PHYSICIAN TREASURY | $229,837 |
| GRANT TREASURY | $27,002 |
| CREDIT CARDS | $7,136 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $263,975 | TotalLiabilityAmt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GALA | Event1Nm |
| Gross Receipts Event1 | $217,158 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $217,158 | GrossRevenueEvent1Amt |
| Other Direct Expenses Event1 | $37,186 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $217,158 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $217,158 | GrossRevenueTotalEventsAmt |
| Oth Direct Expnss Total Events | $37,186 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $37,186 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $179,972 | NetIncomeSummaryAmt |
Schedule M IRS990ScheduleM
Other Non Cash Contri Table OtherNonCashContriTableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 2 | ContributionCnt |
| Noncash Contributions Rpt F990 | $786,306 | 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 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 2, PART III, LINE 4A | FOR 24 YEARS GOOD SAMARITAN HEALTH SERVICES HAS BEEN HELPING FELLOW OKLAHOMANS REGAIN THEIR HEALTH IN TULSA AND THE SURROUNDING COMMUNITIES. WE PROVIDE FREE, QUALITY, AND COMPASSIONATE MEDICAL CARE EVERY WEEK AT SEVEN LOCATIONS PLUS ONE WOMEN'S HEALTHCARE CLINIC EACH MONTH USING THREE FULLY- EQUIPPED MEDICAL TRUCKS. IN 2021 WE PROVIDED 4587 MEDICAL VISITS TO 1776 PATIENTS AT 511 CLINICS. WE PARTNER WITH LOCAL CHURCHES WHICH PROVIDE WAITING ROOM AND PROCESSING FACILITIES, VOLUNTEERS FOR REGISTRATION, MEDICAL HISTORY AND VITALS, AND TRANSLATORS. THE PEOPLE WHO COME TO US ARE SICK, WITHOUT RESOURCES, AND OFTEN TIMES HOPELESS. WE TREAT PATIENTS REGARDLESS OF RACE, BACKGROUND, LEGAL STATUS, OR RELIGIOUS AFFILIATION. THE ONLY PREREQUISITE TO RECEIVING OUR FREE CARE IS THAT THEY DO NOT HAVE HEALTH INSURANCE. WE ARE THE ONLY FREE CLINIC IN THIS PART OF THE STATE THAT BRINGS HEALTHCARE TO THE PEOPLE IN AREAS OF GREATEST NEED USING MOBILE MEDICAL TRUCKS. |
| FORM 990, PAGE 2, PART III, LINE 4B | WE PROVIDE OTHER SPECIFIC PROGRAMS DESIGNED TO MEET THE NEEDS OF THE POPULATION WE SERVE. IN 2021, WE HELD 10 WOMEN'S HEALTHCARE CLINICS PROVIDING CARE FOR 214 WOMEN. WE PROVIDE PAP SMEARS, BREAST EXAMS, AND FREE MAMMOGRAM COUPONS. WE HELP WITH DIAGNOSTIC CO-PAYS, DEDUCTIBLE ASSISTANCE, TRANSPORTATION, AND INTERPRETER SERVICES. ALL OF OUR 600 DIABETIC PATIENTS RECEIVE RETINAL SCANS FOR DIABETIC RETINOPATHY, A LEADING CAUSE OF BLINDNESS IN DIABETICS. WE PARTNER WITH A LOCAL RETINAL SPECIALIST PROVIDER WHEN A PATIENT NEEDS TREATMENT FOR RETINOPATHY. WE PAY THE COST OF THE MEDICATIONS NEEDED FOR INJECTIONS AND SURGERY AND THE SPECIALIST PROVIDER DONATES HIS SERVICES. THE PEOPLE WHO BENEFIT FROM OUR SERVICES ARE THE UNDERSERVED AND UNINSURED INDIVIDUALS FROM THE GREATER TULSA AREA AND SURROUNDING COUNTIES. WE WERE ABLE TO HELP PEOPLE FROM 11 DIFFERENT COUNTRIES AND PREVENT OVER 750 EMERGENCY ROOM VISITS TO OUR LOCAL HOSPITALS. IN 2021, 65% OF OUR PATIENTS WERE FEMALE AND 35% WERE MALE. THE AVERAGE AGE WAS 50 YEARS OLD. THE DEMOGRAPHIC BREAKDOWN OF PATIENTS BY RACE WAS 30.8% CAUCASIAN, 36.8% MEXICAN/HISPANIC, 17.7% AFRICAN AMERICAN, 5.8% ASIAN, 8.2% OTHER, AND .03% MIDDLE EASTERN. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE BOARD WILL REVIEW THE 990 BEFORE IT IS SIGNED AND SUBMITTED TO THE IRS. |
| FORM 990, PAGE 6, PART VI, LINE 12C | THIS IS DISCUSSED AT AN ANNUAL BOARD MEETING AND EACH MEMBER IS REQUIRED TO SIGN A DISCLOSURE STATEMENT. |
| FORM 990, PAGE 6, PART VI, LINE 15A | COMPENSATION DECISIONS ARE MADE BY THE BOARD. |
| FORM 990, PAGE 6, PART VI, LINE 15B | COMPENSATION DECISIONS ARE MADE BY THE BOARD. |
| FORM 990, PAGE 6, PART VI, LINE 19 | GOVERNING DOCUMENTATION IS AVAILABLE UPON REQUEST. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| IN HIS IMAGE INTERNATIONAL INC | ||||||||||
| PO BOX 1191 | TULSA | OK | 74101 | 202953378 | TRAINING | OK | 501C3 | 2 | N/A | false |
| IN HIS IMAGE FAMILY MEDICINE RESIDE | ||||||||||
| 7501 S RIVERSIDE PARKWAY | TULSA | OK | 74136 | 731369680 | TRAINING | OK | 501C3 | 2 | N/A | false |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
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