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GOOD SAMARITAN COMMUNITY HEALTH INC: Form 990EZ, tax year 2015

View the entire original 990 at ProPublica ↗

Organization
GOOD SAMARITAN COMMUNITY HEALTH INC (EIN 20-1192339)
Tax period
2015-01-01 to 2015-12-31
Filed
2016-11-08
IRS object ID
201603139349200010
Schema version
2015v2.1
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)
Return2016-11-08T07:43:23-06:00ReturnTs
Tax Period End2015-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN592005908PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1FREUND KATZ GOLDSTON YOUNG & CO PABusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line110729 SW 104TH STREETAddressLine1Txt
CityMIAMICityNm
State AbbreviationFLStateAbbreviationCd
ZIP33176ZIPCd
FieldValueIRS element (for citing)
Return Type990EZReturnTypeCd
Tax Period Begin2015-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN201192339EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1GOOD SAMARITAN COMMUNITYBusinessNameLine1Txt
Business Name Line2HEALTH INCBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlGOODBusinessNameControlTxt
Phone3055952769PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line17701 SW 98TH STREETAddressLine1Txt
CityMIAMICityNm
State AbbreviationFLStateAbbreviationCd
ZIP33156ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJOSE NERY MDPersonNm
Person TitlePRESIDENTPersonTitleTxt
Phone3055952769PhoneNum
Signature2016-10-18SignatureDt

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonSTEVEN A YOUNG CPAPreparerPersonNm
PTINP00206538PTIN
Phone3052791288PhoneNum
Preparation2016-11-02PreparationDt
FieldValueIRS element (for citing)
Tax2015TaxYr
Build TS2017-02-10 21:41:12ZBuildTS

Form 990-EZ IRS990EZ

FieldValueIRS element (for citing)
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Website AddressN/AWebsiteAddressTxt
Organization501c3Yes (X)Organization501c3Ind
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Gross Receipts$190,220GrossReceiptsAmt
Info In Schedule O Part IYes (X)InfoInScheduleOPartIInd
Contributions Gifts Grants Etc$151,747ContributionsGiftsGrantsEtcAmt
Program Service Revenue$29,973ProgramServiceRevenueAmt
Sale Of Assets Gross$8,500SaleOfAssetsGrossAmt
Cost Or Other Basis Expense Sale$1,565CostOrOtherBasisExpenseSaleAmt
Gain Or Loss From Sale Of Assets$6,935GainOrLossFromSaleOfAssetsAmt
Total Revenue$188,655TotalRevenueAmt
Grants And Similar Amounts Paid$1,200GrantsAndSimilarAmountsPaidAmt
Salaries Other Comp Empl Bnft$51,757SalariesOtherCompEmplBnftAmt
Fees And Other Pymt To Ind Cntrct$274FeesAndOtherPymtToIndCntrctAmt
Other Expenses Total$157,218OtherExpensesTotalAmt
Total Expenses$210,449TotalExpensesAmt
Excess Or Deficit For Year-$21,794ExcessOrDeficitForYearAmt
Net Assets Or Fund Balances BOY$106,089NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$84,295NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIYes (X)InfoInScheduleOPartIIInd

Cash Savings And Investments CashSavingsAndInvestmentsGrp

FieldValueIRS element (for citing)
BOY$19,374BOYAmt
EOY$29,381EOYAmt

Other Assets Total Detail OtherAssetsTotalDetail

FieldValueIRS element (for citing)
BOY$87,338BOYAmt
EOY$56,271EOYAmt

Form990 Total Assets Form990TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$106,712BOYAmt
EOY$85,652EOYAmt

Sum Of Total Liabilities SumOfTotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$623BOYAmt
EOY$1,357EOYAmt

Net Assets Or Fund Balances NetAssetsOrFundBalancesGrp

FieldValueIRS element (for citing)
BOY$106,089BOYAmt
EOY$84,295EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
Primary Exempt PurposeTHE 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.PrimaryExemptPurposeTxt

Program Srvc Accomplishment ProgramSrvcAccomplishmentGrp (4 entries)

Description Program Srvc AccomDescriptionProgramSrvcAccomTxtProgram Service ExpensesProgramServiceExpensesAmtGrants And AllocationsGrantsAndAllocationsAmt
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. AN AVERAGE OF 200 PATIENTS A MONTH HAVE RECEIVED HEALTH CARE AT THE MEDICAL CLINIC.$80,247
AS OF AUGUST 2011 GSCH HAS BEEN INVOLVED IN SHORT-TERM MISSION TRIPS TO NICARAGUA, CENTRAL AMERICA, 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, 2015 TWENTY-ONE MISSION TRIPS HAVE BEEN CARRIED OUT, WITH A TOTAL OF OVER 6,900 MEDICAL CONSULTS. NICARAGUA IS THE POOREST COUNTRY IN CENTRAL AMERICA AND THE SECOND POOREST IN THE WESTERN HEMISPHERE. UNDEREMPLOYMENT AND POVERTY ARE WIDESPREAD.$69,649
PROVIDE ASSISTANCE TO THE POOR, DISTRESSED AND UNDERPRIVILEGED. FOUR GRANTS WERE MADE.$1,200$1,200
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.$45,650
FieldValueIRS element (for citing)
Total Program Service Expenses$196,746TotalProgramServiceExpensesAmt

Officer Director Trustee Empl OfficerDirectorTrusteeEmplGrp (9 entries)

TitleTitleTxtAverage Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRtCompensationCompensationAmtExpense Account Other AllwncExpenseAccountOtherAllwncAmt
DEBRA NERY RN
TREASURER21.00$0
JOSE NERY MD
PRESIDENT21.00$0$414
JONAS MOSTAFA
VP21.00$0
CARLOS ANDRADE
SECRETARY1.00$0
JAZMIN ANDRADE
ASSISTANT TR1.00$0
CARLOS SIMOES
DIRECTOR1.00$0
GEORGE INOUE
DIRECTOR1.00$0
ROBERTO RIGUERO
DIRECTOR1.00$0
STEVEN YOUNG
DIRECTOR0.25$0
FieldValueIRS element (for citing)
Activities Not Previously RptfalseActivitiesNotPreviouslyRptInd
Chg Made To Orgnzng Doc Not RptfalseChgMadeToOrgnzngDocNotRptInd
Organization Had UBIfalseOrganizationHadUBIInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Organization Dissolved EtcfalseOrganizationDissolvedEtcInd
Form1120 Pol FiledfalseForm1120PolFiledInd
Made Loans To From OfficersfalseMadeLoansToFromOfficersInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
States Where Copy Of Return Is FldFLStatesWhereCopyOfReturnIsFldCd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonDEBORA NERYPersonNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1C/O 7701 SW 98TH STREETAddressLine1Txt
CityMIAMICityNm
State AbbreviationFLStateAbbreviationCd
ZIP33156ZIPCd
FieldValueIRS element (for citing)
Phone3055952769PhoneNum
FieldValueIRS element (for citing)
Foreign Financial AccountfalseForeignFinancialAccountInd
Foreign OfficeYes (true)ForeignOfficeInd
Foreign Office CountryNUForeignOfficeCountryCd
Donor Advised FndsfalseDonorAdvisedFndsInd
Operate HospitalfalseOperateHospitalInd
Tanning Services ProvidedfalseTanningServicesProvidedInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Transaction With Control EntfalseTransactionWithControlEntInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
School OperatingfalseSchoolOperatingInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Part VI Of Comp Of Hghst Pd EmplNONEPartVIOfCompOfHghstPdEmplTxt
Part VI Hghst Pd Cntrct Prof SrvcNONEPartVIHghstPdCntrctProfSrvcTxt
Filed Schedule AYes (true)FiledScheduleAInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$180,149CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$202,836CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$45,775CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$76,450CurrentTaxYearMinus1YearAmt
Current Tax Year$151,747CurrentTaxYearAmt
Total$656,957TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$180,149CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$202,836CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$45,775CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$76,450CurrentTaxYearMinus1YearAmt
Current Tax Year$151,747CurrentTaxYearAmt
Total$656,957TotalAmt
FieldValueIRS element (for citing)
Substantial Contributors Tot$272,512SubstantialContributorsTotAmt
Public Support Total170$384,445PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years$21CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$5CurrentTaxYearMinus2YearsAmt
Total$26TotalAmt
FieldValueIRS element (for citing)
Total Support$656,983TotalSupportAmt
Gross Receipts Rltd Activities$177,267GrossReceiptsRltdActivitiesAmt
Public Support CY1700.58520PublicSupportCY170Pct
Public Support PY1700.51950PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

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 O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990-EZ, PART I, LINE 16EXPENSES BANK CHARGES 30 COMPUTER AND INTERNET 1,968 DUES AND SUBSCRIPTIONS 1,283 INSURANCE 8,302 LICENSE AND TAXES 200 MEALS AND ENTERTAINMENT 509 MEDICAL RECORD 3,240 MISSION TRIPS MEDICINE 65,230 CLINIC EXPENSES 6,124 MISSION TRIPS 4,419 MOBILE HEALTH UNIT AUTO 12,243 OFFICE 2,810 REPAIRS AND MAINTENANCE 325 TELEPHONE 3,872 TRAVEL 1,013 NON-INVESTMENT DEPRECIATION 45,650 TOTAL 157,218
FORM 990-EZ, PART II, LINE 24EMPLOYEE ADVANCE 866 0 347,713 346,808 LESS ACCUMULATED DEPRECIATION 261,241 290,537 TOTAL 87,338 56,271
FORM 990-EZ, PART II, LINE 26ACCOUNTS PAYABLE AND ACCRUED EXPENSES 623 1,357
FORM 990-EZ, PART IIITHE 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-EZ, PART III, LINE 28GSCH'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. AN AVERAGE OF 200 PATIENTS A MONTH HAVE RECEIVED HEALTH CARE AT THE MEDICAL CLINIC.
FORM 990-EZ, PART III, LINE 29AS OF AUGUST 2011 GSCH HAS BEEN INVOLVED IN SHORT-TERM MISSION TRIPS TO NICARAGUA, CENTRAL AMERICA, 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, 2015 TWENTY-ONE MISSION TRIPS HAVE BEEN CARRIED OUT, WITH A TOTAL OF OVER 6,900 MEDICAL CONSULTS. NICARAGUA IS THE POOREST COUNTRY IN CENTRAL AMERICA AND THE SECOND POOREST IN THE WESTERN HEMISPHERE. UNDEREMPLOYMENT AND POVERTY ARE WIDESPREAD.
FORM 990-EZ, PART III, LINE 31OTHER PROGRAM SERVICES, EXPENSES IS FOR DEPRECIATION OF FIXED ASSETS USED IN THE MEDICAL CLINIC WHICH IS REPORTED IN FORM 990, PART III, LINE 4A.

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