GOOD SAMARITAN HOSPITAL FOUNDATION INC: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
GOOD SAMARITAN HOSPITAL FOUNDATION INC (EIN 35-1637684)
Tax period
2020-01-01 to 2020-12-31
Filed
2021-05-04
IRS object ID
202131249349300748
Schema version
2020v4.0
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)
Return2021-05-04T13:59:05-07:00ReturnTs
Tax Period End2020-12-31TaxPeriodEndDt
Return Type990ReturnTypeCd
Tax Period Begin2020-01-01TaxPeriodBeginDt

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 Line1520 S Seventh StreetAddressLine1Txt
CityVincennesCityNm
State AbbreviationINStateAbbreviationCd
ZIP47591ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonHelen SeirpPersonNm
Person TitlePresidentPersonTitleTxt
Phone8128853192PhoneNum
Signature2021-05-04SignatureDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer0TrustedCustomerCd
OOB Security Verification11OOBSecurityVerificationCd
Last Submission Rqr OOB0LastSubmissionRqrOOBCd
Authentication Assurance LevelAAL2AuthenticationAssuranceLevelCd
Profile Password ChangeYes (X)ProfilePasswordChangeInd
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerHelen SeirpPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1520 South Seventh StreetAddressLine1Txt
CityVincennesCityNm
State AbbreviationINStateAbbreviationCd
ZIP47591ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$1,161,766GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.gshvin.org/main/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.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$440,347PYContributionsGrantsAmt
CY Contributions Grants$499,085CYContributionsGrantsAmt
PY Program Service Revenue$0PYProgramServiceRevenueAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$585,634PYInvestmentIncomeAmt
CY Investment Income$620,323CYInvestmentIncomeAmt
PY Other Revenue$67,647PYOtherRevenueAmt
CY Other Revenue$28,214CYOtherRevenueAmt
PY Total Revenue$1,093,628PYTotalRevenueAmt
CY Total Revenue$1,147,622CYTotalRevenueAmt
PY Grants And Similar Paid$705,858PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$885,994CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$165,025PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$166,977CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$127,011CYTotalFundraisingExpenseAmt
PY Other Expenses$108,991PYOtherExpensesAmt
CY Other Expenses$94,438CYOtherExpensesAmt
PY Total Expenses$979,874PYTotalExpensesAmt
CY Total Expenses$1,147,409CYTotalExpensesAmt
PY Revenues Less Expenses$113,754PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$213CYRevenuesLessExpensesAmt
Total Assets BOY$4,694,911TotalAssetsBOYAmt
Total Assets EOY$4,905,158TotalAssetsEOYAmt
Total Liabilities BOY$213TotalLiabilitiesBOYAmt
Total Liabilities EOY$5,864TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$4,694,698NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$4,899,294NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionProvide excellent health care by promoting wellness, education and healing through trusting relationships.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$740,256ExpenseAmt
Grant$0GrantAmt
Revenue$0RevenueAmt
DescDonations for an education center built at the hospital for educational use and available for public use.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$31,000ExpenseAmt
Grant$0GrantAmt
Revenue$0RevenueAmt
DescProvided college scholarships to students for higher education.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$29,549ExpenseAmt
Grant$0GrantAmt
Revenue$0RevenueAmt
DescProvided funding to purchase an arterial line trainer system for clinical education program to increase the skill sets of the hospital staff.Desc

Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp

FieldValueIRS element (for citing)
Expense$85,189ExpenseAmt
Grant$0GrantAmt
Revenue$0RevenueAmt
DescThe 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, provide equipment and educational opportunities for clinical staff.Desc
FieldValueIRS element (for citing)
Total Other Prog Srvc Expense$85,189TotalOtherProgSrvcExpenseAmt
Total Other Prog Srvc Grant$0TotalOtherProgSrvcGrantAmt
Total Other Prog Srvc Revenue$0TotalOtherProgSrvcRevenueAmt
Total Program Service Expenses$885,994TotalProgramServiceExpensesAmt
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
Quid Pro Quo ContributionsYes (1)QuidProQuoContributionsInd
Quid Pro Quo Contri DisclYes (1)QuidProQuoContriDisclInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Form8899 Filedind0Form8899Filedind
Form1098 C Filed0Form1098CFiledInd
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)
PersonGary HackneyPersonNm
Phone8128853192PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1520 S Seventh StreetAddressLine1Txt
CityVincennesCityNm
State AbbreviationINStateAbbreviationCd
ZIP47591ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerInd
Gary Hackney
Director400Yes (X)$100,682$0$0
Nicole Coomer
Development Specialist400Yes (X)$33,260$0$0
Mark Gerkin
Board Member0.250Yes (X)$0$0$0
Anne Jacoby
Board Member0.250Yes (X)$0$0$0
Charles Johnson
Board Member0.250Yes (X)$0$0$0
Amrita Khurana
Board Member0.250Yes (X)$0$0$0
Regina McCord Fithian
Board Member0.250Yes (X)$0$0$0
Eli McCormick
Board Member0.250Yes (X)$0$0$0
Robert McLin
Board Member0.250Yes (X)$0$0$0
Dave Miller
Board Member0.250Yes (X)$0$0$0
Cindy Moore
Board Member0.250Yes (X)$0$0$0
Patty Niehaus
Board Member0.250Yes (X)$0$0$0
Gregg Strum
Board Member0.250Yes (X)$0$0$0
Joyce Villwock
Board Member0.250Yes (X)$0$0$0
Annette O'Rourke
Board Member0.250Yes (X)$0$0$0
Helen Seirp
President0.250$0$0$0Yes (X)
Patty Summers
Vice President0.250$0$0$0Yes (X)
Phil Mangin
Treasurer0.250$0$0$0Yes (X)
Thomas Ernst
Secretary0.250$0$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$133,942TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K1IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Federated Campaigns$62,118FederatedCampaignsAmt
Membership Dues$0MembershipDuesAmt
Fundraising$0FundraisingAmt
Related Organizations$0RelatedOrganizationsAmt
Government Grants$0GovernmentGrantsAmt
All Other Contributions$436,967AllOtherContributionsAmt
Noncash Contributions$0NoncashContributionsAmt
Total Contributions$499,085TotalContributionsAmt
Total Program Service Revenue$0TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$620,323TotalRevenueColumnAmt
Related Or Exempt Func Income$620,323RelatedOrExemptFuncIncomeAmt
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$42,358FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$0ContriRptFundraisingEventAmt
Fundraising Direct Expenses$14,144FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$28,214TotalRevenueColumnAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$28,214ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$0OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,147,622TotalRevenueColumnAmt
Related Or Exempt Func Income$620,323RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$28,214ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$851,244TotalAmt
Program Services$851,244ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$34,750TotalAmt
Program Services$34,750ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$134,075TotalAmt
Management And General$53,630ManagementAndGeneralAmt
Fundraising$80,445FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$6,950TotalAmt
Management And General$2,780ManagementAndGeneralAmt
Fundraising$4,170FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$15,582TotalAmt
Management And General$6,233ManagementAndGeneralAmt
Fundraising$9,349FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$10,370TotalAmt
Management And General$4,148ManagementAndGeneralAmt
Fundraising$6,222FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$14,365TotalAmt
Fundraising$14,365FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,020TotalAmt
Management And General$449ManagementAndGeneralAmt
Fundraising$571FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$17,840TotalAmt
Management And General$6,601ManagementAndGeneralAmt
Fundraising$11,239FundraisingAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$650TotalAmt
Fundraising$650FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$4,136TotalAmt
Management And General$4,136ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$63TotalAmt
Management And General$63ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
Dues$642$0$642$0
General Expense$55,262$0$55,262$0
Bond Premium$460$0$460$0

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$1,147,409TotalAmt
Program Services$885,994ProgramServicesAmt
Management And General$134,404ManagementAndGeneralAmt
Fundraising$127,011FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$479,813BOYAmt
EOY$442,607EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$635,093BOYAmt
EOY$401,023EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$45,473LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$44,908LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$565EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$3,580,005BOYAmt
EOY$4,060,963EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$4,694,911BOYAmt
EOY$4,905,158EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$213BOYAmt
EOY$5,864EOYAmt

Grants Payable GrantsPayableGrp

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

Deferred Revenue DeferredRevenueGrp

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

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

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

Escrow Account Liability EscrowAccountLiabilityGrp

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

Loans From Officers Directors LoansFromOfficersDirectorsGrp

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

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

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

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

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

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$213BOYAmt
EOY$5,864EOYAmt
FieldValueIRS element (for citing)
Org Does Not Follow FASB117Yes (X)OrgDoesNotFollowFASB117Ind

Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp

FieldValueIRS element (for citing)
BOY$5,092,170BOYAmt
EOY$5,296,555EOYAmt

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-$397,472BOYAmt
EOY-$397,261EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$4,694,698BOYAmt
EOY$4,899,294EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$4,694,911BOYAmt
EOY$4,905,158EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$213ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$0NetUnrlzdGainsLossesInvstAmt
Donated Services And Use Fclts$0DonatedServicesAndUseFcltsAmt
Investment Expense$0InvestmentExpenseAmt
Prior Period Adjustments$0PriorPeriodAdjustmentsAmt
Other Changes In Net Assets$204,383OtherChangesInNetAssetsAmt
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

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule A, Part IV, Section B, Line 1FormAndLineReferenceDesc
ExplanationSupports Good Samaritan HospitalExplanationTxt

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$45,473InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis$0OtherCostOrOtherBasisAmt
Depreciation$44,908DepreciationAmt
Book Value$565BookValueAmt

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$565TotalBookValueLandBuildingsAmt

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1Impalas VirtualEvent1Nm
Gross Receipts Event1$27,103GrossReceiptsEvent1Amt
Charitable Contri Event1$0CharitableContriEvent1Amt
Gross Revenue Event1$27,103GrossRevenueEvent1Amt
Cash Prizes Event1$0CashPrizesEvent1Amt
Non Cash Prizes Event1$1,214NonCashPrizesEvent1Amt
Rent Facility Costs Event1$1,795RentFacilityCostsEvent1Amt
Food And Beverage Event1$2,768FoodAndBeverageEvent1Amt
Entertainment Event1$4,500EntertainmentEvent1Amt
Other Direct Expenses Event1$426OtherDirectExpensesEvent1Amt
Event2Golf TournamentEvent2Nm
Gross Receipts Event2$15,255GrossReceiptsEvent2Amt
Charitable Contri Event2$0CharitableContriEvent2Amt
Gross Revenue Event2$15,255GrossRevenueEvent2Amt
Cash Prizes Event2$150CashPrizesEvent2Amt
Non Cash Prizes Event2$100NonCashPrizesEvent2Amt
Rent Facility Costs Event2$2,116RentFacilityCostsEvent2Amt
Food And Beverage Event2$450FoodAndBeverageEvent2Amt
Entertainment Event2$0EntertainmentEvent2Amt
Other Direct Expenses Event2$625OtherDirectExpensesEvent2Amt
Other Events Total0OtherEventsTotalCnt
Gross Receipts Total$42,358GrossReceiptsTotalAmt
Charitable Contributions Tot$0CharitableContributionsTotAmt
Gross Revenue Total Events$42,358GrossRevenueTotalEventsAmt
Cash Prizes Total Events$150CashPrizesTotalEventsAmt
Non Cash Prizes Total Events$1,314NonCashPrizesTotalEventsAmt
Rent Fclty Costs Total Events$3,911RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events$3,218FoodAndBeverageTotalEventsAmt
Entertainment Total Events$4,500EntertainmentTotalEventsAmt
Oth Direct Expnss Total Events$1,051OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$14,144DirectExpenseSummaryEventsAmt
Net Income Summary$28,214NetIncomeSummaryAmt

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 SAddressLine1Txt
CityVincennesCityNm
State AbbreviationINStateAbbreviationCd
ZIP47591ZIPCd
FieldValueIRS element (for citing)
Recipient EIN356001532RecipientEIN
IRC Section501(c)(3)IRCSectionDesc
Cash Grant$850,486CashGrantAmt
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 (10 entries)

Grant TypeGrantTypeTxtRecipientRecipientCntCash GrantCashGrantAmtNon Cash AssistanceNonCashAssistanceAmtValuation Method UsedValuationMethodUsedDesc
Scholarships to Vincennes University4$13,000$0Cash Value
Scholarship to Wilmington College1$4,750$0Cash Value
Scholarships to Wabash Valley College2$4,000$0Cash Value
Scholarship to Indiana University Bloomington1$2,000$0Cash Value
Scholarship to Oakland City University Oakland IN1$2,000$0Cash Value
Scholarships to University Southern Indiana2$1,500$0Cash Value
Scholarship to Indiana State University1$1,000$0Cash Value
Scholarship to Marian University, Indianapolis IN1$1,000$0Cash Value
Scholarship to Butler University1$500$0Cash Value
Scholarship to Murry State University1$500$0Cash Value

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule I, Part I, Line 2The funds paid for the scholarships are paid directly to the college or university.
Schedule I, Part IIIThe number of recipients are chosen by the following criteria: Demonstrate Financial Need; Have a High School GPA of 3.0 and a minimum college GPA of 3.0; Complete / submit the required documentation for each scholarship; 3 letters of reference: 1 from non-family member, 1 from teacher/faculty member, 1 from supervisor/employer (if currently employed); Narrative of 250 words or less; Copy of acceptance form into health degree program; Completed GSH Scholarship Financial Information Form; Official High School/College transcripts

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part III, Line 4dThe 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, provide equipment and educational opportunities for clinical staff.
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 11bThe form 990 is reviewed by the Director of Accounting/Internal Auditor
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 19The Public may view the form(s) or have it(them) made available for copies upon written 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 ActivitiesHealth CarePrimaryActivitiesTxt
Legal Domicile StateINLegalDomicileStateCd
Exempt Code Section501 (c) (3)ExemptCodeSectionTxt
Public Charity StatusType 1PublicCharityStatusTxt
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 OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgYes (1)LoansOrGuaranteesFromOthOrgInd
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 OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (1)TransferToOtherOrgInd
Transfer From Other OrgYes (1)TransferFromOtherOrgInd

Comments

Anonymous: no account or email. Up to 2,000 characters, at most one link. Comments are checked automatically; some wait for review.