2021-05-04T13:59:05-07:00 2020-12-31 990 2020-01-01 351637684 GOOD SAMARITAN HOSPITAL FOUNDATION INC GOOD 8128853192 520 S Seventh Street Vincennes IN 47591 Helen Seirp President 8128853192 2021-05-04 0 11 0 AAL2 X 2020 2022-09-23 18:48:47Z Helen Seirp 520 South Seventh Street Vincennes IN 47591 1161766 0 X www.gshvin.org/main/foundation X 1995 IN The 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. 17 0 2 25 0 0 440347 499085 0 0 585634 620323 67647 28214 1093628 1147622 705858 885994 0 0 165025 166977 0 0 127011 108991 94438 979874 1147409 113754 213 4694911 4905158 213 5864 4694698 4899294 X Provide excellent health care by promoting wellness, education and healing through trusting relationships. 0 0 740256 0 0 Donations for an education center built at the hospital for educational use and available for public use. 31000 0 0 Provided college scholarships to students for higher education. 29549 0 0 Provided funding to purchase an arterial line trainer system for clinical education program to increase the skill sets of the hospital staff. 85189 0 0 The 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. 85189 0 0 885994 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 2 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 X 17 0 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 0 1 0 0 0 IN X Gary Hackney 8128853192 520 S Seventh Street Vincennes IN 47591 Gary Hackney Director 40 0 X 100682 0 0 Nicole Coomer Development Specialist 40 0 X 33260 0 0 Mark Gerkin Board Member 0.25 0 X 0 0 0 Anne Jacoby Board Member 0.25 0 X 0 0 0 Charles Johnson Board Member 0.25 0 X 0 0 0 Amrita Khurana Board Member 0.25 0 X 0 0 0 Regina McCord Fithian Board Member 0.25 0 X 0 0 0 Eli McCormick Board Member 0.25 0 X 0 0 0 Robert McLin Board Member 0.25 0 X 0 0 0 Dave Miller Board Member 0.25 0 X 0 0 0 Cindy Moore Board Member 0.25 0 X 0 0 0 Patty Niehaus Board Member 0.25 0 X 0 0 0 Gregg Strum Board Member 0.25 0 X 0 0 0 Joyce Villwock Board Member 0.25 0 X 0 0 0 Annette O'Rourke Board Member 0.25 0 X 0 0 0 Helen Seirp President 0.25 0 X 0 0 0 Patty Summers Vice President 0.25 0 X 0 0 0 Phil Mangin Treasurer 0.25 0 X 0 0 0 Thomas Ernst Secretary 0.25 0 X 0 0 0 133942 0 0 1 0 0 0 0 62118 0 0 0 0 436967 0 499085 0 620323 620323 0 0 0 0 0 0 0 0 0 0 0 0 0 0 42358 0 14144 28214 0 28214 0 1147622 620323 0 28214 851244 851244 34750 34750 134075 53630 80445 6950 2780 4170 15582 6233 9349 10370 4148 6222 14365 14365 1020 449 571 17840 6601 11239 650 650 4136 4136 63 63 Dues 642 0 642 0 General Expense 55262 0 55262 0 Bond Premium 460 0 460 0 1147409 885994 134404 127011 479813 442607 635093 401023 45473 44908 0 565 3580005 4060963 4694911 4905158 213 5864 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 213 5864 X 5092170 5296555 0 0 -397472 -397261 4694698 4899294 4694911 4905158 X 213 0 0 0 0 204383 X 1 X 1 X 1 0 X X 1 Good Samaritan Hospital 356001532 3 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Schedule A, Part IV, Section B, Line 1 Supports Good Samaritan Hospital RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 0 0 0 45473 0 44908 565 0 0 0 0 565 Impalas Virtual 27103 0 27103 0 1214 1795 2768 4500 426 Golf Tournament 15255 0 15255 150 100 2116 450 0 625 0 42358 0 42358 150 1314 3911 3218 4500 1051 14144 28214 1 Good Samaritan Hospital 520 S 7th S Vincennes IN 47591 356001532 501(c)(3) 850486 0 FMV 0 Health Care 1 0 Scholarships to Vincennes University 4 13000 0 Cash Value Scholarship to Wilmington College 1 4750 0 Cash Value Scholarships to Wabash Valley College 2 4000 0 Cash Value Scholarship to Indiana University Bloomington 1 2000 0 Cash Value Scholarship to Oakland City University Oakland IN 1 2000 0 Cash Value Scholarships to University Southern Indiana 2 1500 0 Cash Value Scholarship to Indiana State University 1 1000 0 Cash Value Scholarship to Marian University, Indianapolis IN 1 1000 0 Cash Value Scholarship to Butler University 1 500 0 Cash Value Scholarship to Murry State University 1 500 0 Cash Value Schedule I, Part I, Line 2 The funds paid for the scholarships are paid directly to the college or university. Schedule I, Part III The 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 Form 990, Part III, Line 4d The 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 6 The Foundation members are the Board members Form 990, Part VI, Section A, Line 7a The members elect new officers annually. Form 990, Part VI, Section A, Line 7b Any decisions of the governing body are subject to approval by the board. Form 990, Part VI, Section B, Line 11b The form 990 is reviewed by the Director of Accounting/Internal Auditor Form 990, Part VI, Section B, Line 12c Foundation Board Members sign a conflict of interest form on an annual basis Form 990, Part VI, Section C, Line 19 The Public may view the form(s) or have it(them) made available for copies upon written request. Form 990, Part XI, Line 9 Elimination of inner corporate loans Good Samaritan Hospital 520 S 7th Street Vincennes IN 47591 356001532 Health Care IN 501 (c) (3) Type 1 N/A 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 1