GOOD SAMARITAN FOUNDATION-DAYTON: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- GOOD SAMARITAN FOUNDATION-DAYTON (EIN 23-7296923)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-12
- IRS object ID
- 201333169349305048
- Schema version
- 2012v2.1
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule F
- Schedule G
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-12T15:51:40-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ERNST & YOUNG US LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 MONUMENT CIRCLE SUITE 2600 | AddressLine1 |
| City | INDIANAPOLIS | City |
| State | IN | State |
| ZIP Code | 46204 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 237296923 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Good Samaritan Hospital Foundation - Dayton | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % J MICHAEL SIMS | InCareOfName |
| Name Control | GOOD | NameControl |
| Phone | 9374999942 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 N MAIN ST | AddressLine1 |
| Address Line2 | Suite 500 | AddressLine2 |
| City | Dayton | City |
| State | OH | State |
| ZIP Code | 45402 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TIMOTHY D SNIDER | Name |
| Title | V/P - Finance | Title |
| Phone | 9374999942 | Phone |
| Date Signed | 2013-11-12 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3176817000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Marc S Martens President | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2222 Philadelphia Dr | AddressLine1 |
| City | Dayton | City |
| State | OH | State |
| ZIP Code | 45406 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 1229617 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Group Exemption Number | 0928 | GroupExemptionNumber |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.premierhealth.com | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1973 | YearFormation |
| State Legal Domicile | OH | StateLegalDomicile |
| Activity Or Mission Description | TO SUPPORT THE PATIENTS, STAFF AND EMPLOYEES OF GOOD SAMARITAN HOSPITAL AND ITS AFFILIATES BY FOSTERING CHARITABLE GIFTS FROM THOSE SHARING OUR COMMITMENT TO HEALTHCARE WITH EXCELLENCE AND COMPASSION. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 20 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 18 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 36 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 3010153 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 787608 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 263012 | InvestmentIncomePriorYear |
| Investment Income Current Year | 440483 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | -3033 | OtherRevenuePriorYear |
| Other Revenue Current Year | -2454 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 3270132 | TotalRevenuePriorYear |
| Total Revenue Current Year | 1225637 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 460683 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 342643 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 299578 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 430946 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 247773 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 123085 | OtherExpensePriorYear |
| Other Expenses Current Year | 104293 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 883346 | TotalExpensesPriorYear |
| Total Expenses Current Year | 877882 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 2386786 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 347755 | RevenuesLessExpensesCY |
| Total Assets BOY | 9579944 | TotalAssetsBOY |
| Total Assets EOY | 10360810 | TotalAssetsEOY |
| Total Liabilities BOY | 182404 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 415709 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 9397540 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 9945101 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO SUPPORT THE PATIENTS, STAFF AND EMPLOYEES OF GOOD SAMARITAN HOSPITAL AND ITS AFFILIATES BY FOSTERING CHARITABLE GIFTS FROM THOSE SHARING OUR COMMITMENT TO HEALTHCARE WITH EXCELLENCE AND COMPASSION. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 152097 | Expense |
| Grants | 152097 | Grants |
| Description | The Samaritan Homeless Clinic sees 2,500 patients annually with strong support from the Good Samaritan Hospital Foundation-Dayton. The Foundation provides funds for operating expenses, equipment updates and the expanded dental program. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 121146 | Expense |
| Grants | 121146 | Grants |
| Description | The equipment purchased through grants from the Duarte Foundation over the last three years has benefited Good Samaritan Hospital's patients in phenomenal ways. The microscope has provided more accuracy and increased safety to the patients. The new micro saws make huge differences to our patients and surgeons. The staff and surgeons truly appreciate this new state-of-the-art equipment that offers ease of handling and results in better outcomes for patients. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 111815 | Expense |
| Grants | 111815 | Grants |
| Description | A new fitness center for physicians and employees was opened in 2012 with state-of-the-art equipment funded by the Good Samaritan Hospital Foundation-Dayton. The center helps promote healthy lifestyles, thereby reducing health care costs for everyone. Over 1,000 physicians and employees are signed up to use the center. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 78508 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Grnt | 69400 | TotalOfOtherProgramServiceGrnt |
| Total Program Service Expense | 463566 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | true | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | true | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | true | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | true | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | false | Hospital |
| Grants To Organizations | true | GrantsToOrganizations |
| Grants To Individuals | true | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | true | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 12 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 20 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 18 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | OH | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | J MICHAEL SIMS | NamePerson |
| Telephone Number | 9374999942 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 N MAIN ST SUITE 500 | AddressLine1 |
| City | Dayton | City |
| State | OH | State |
| ZIP Code | 45402 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (21 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer |
|---|---|---|---|---|---|---|---|
| Clark E Beck Sr | |||||||
| Trustee | 0.5 | 0.0 | X | 0 | 0 | 0 | |
| Atindra N Chatterji MD | |||||||
| Trustee | 0.5 | 0.0 | X | 0 | 12285 | 0 | |
| John E Clough | |||||||
| Trustee | 0.5 | 0.0 | X | 0 | 0 | 0 | |
| Robert S Copeland | |||||||
| Trustee | 0.5 | 0.0 | X | 0 | 0 | 0 | |
| Karen O Crim | |||||||
| Trustee | 0.5 | 0.0 | X | 0 | 0 | 0 | |
| The Rev Joseph W Goetz | |||||||
| Trustee | 0.5 | 0.0 | X | 0 | 0 | 0 | |
| John J Haluschak MD | |||||||
| Trustee | 0.5 | 0.0 | X | 0 | 0 | 0 | |
| Laura G Harrelson ESQ | |||||||
| Trustee | 0.5 | 0.0 | X | 0 | 0 | 0 | |
| Hon Cynthia M Heck | |||||||
| Trustee | 0.5 | 0.0 | X | 0 | 0 | 0 | |
| Walter S Hoy | |||||||
| Trustee | 0.5 | 0.0 | X | 0 | 0 | 0 | |
| Gavin D Jenney PhD | |||||||
| Trustee | 0.5 | 0.0 | X | 0 | 0 | 0 | |
| E Michael Kersh | |||||||
| Trustee | 0.5 | 0.0 | X | 0 | 0 | 0 | |
| Lisa Orr | |||||||
| Secretary | 0.5 | 0.0 | X | 0 | 0 | 0 | X |
| Walter A Reiling MD | |||||||
| Chairman | 0.5 | 0.0 | X | 0 | 0 | 0 | X |
| Douglas A Talmage | |||||||
| Vice Chair | 0.5 | 0.0 | X | 0 | 0 | 0 | X |
| Marc Martens | |||||||
| President | 40.0 | 0.0 | X | 179039 | 0 | 16626 | X |
| Hon Patrick J Foley | |||||||
| Trustee | 0.5 | 0.0 | X | 0 | 0 | 0 | |
| Stephen B Levitt MD | |||||||
| Trustee | 0.5 | 0.0 | X | 0 | 0 | 0 | |
| Jennifer Tobiansky | |||||||
| Trustee | 0.5 | 0.0 | X | 0 | 0 | 0 | |
| Richard A Meyer | |||||||
| Trustee | 0.5 | 0.0 | X | 0 | 0 | 0 | |
| Janet Rogers | |||||||
| Treasurer | 0.5 | 39.5 | 0 | 155348 | 41583 | X | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 179039 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 167633 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 58209 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation
Name Of Contractor NameOfContractor
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | none | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Of Contractor | AddressOfContractor |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Federated Campaigns | 5990 | FederatedCampaigns |
| Fundraising Events | 58502 | FundraisingEvents |
| All Other Contributions | 723116 | AllOtherContributions |
| Noncash Contributions | 15900 | NoncashContributions |
| Total Contributions | 787608 | TotalContributions |
| Total Program Service Revenue | 0 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 221556 | TotalRevenueColumn |
| Exclusion | $221,556 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 218927 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 218927 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 218927 | TotalRevenueColumn |
| Exclusion | $218,927 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 1526 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 58502 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 3980 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -2454 | TotalRevenueColumn |
| Exclusion | -$2,454 | ExclusionAmount |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 0 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1225637 | TotalRevenueColumn |
| Exclusion | $438,029 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 327643 | Total |
| Program Services | 327643 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15000 | Total |
| Program Services | 15000 | ProgramServices |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 179397 | Total |
| Program Services | 44849 | ProgramServices |
| Management And General | 44849 | ManagementAndGeneral |
| Fundraising | 89699 | Fundraising |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 214923 | Total |
| Program Services | 53640 | ProgramServices |
| Management And General | 53640 | ManagementAndGeneral |
| Fundraising | 107643 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15788 | Total |
| Program Services | 3947 | ProgramServices |
| Management And General | 3947 | ManagementAndGeneral |
| Fundraising | 7894 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20838 | Total |
| Program Services | 5209 | ProgramServices |
| Management And General | 5209 | ManagementAndGeneral |
| Fundraising | 10420 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 31575 | Total |
| Management And General | 31575 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3090 | Total |
| Management And General | 3090 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22156 | Total |
| Program Services | 5539 | ProgramServices |
| Management And General | 5539 | ManagementAndGeneral |
| Fundraising | 11078 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8748 | Total |
| Management And General | 6561 | ManagementAndGeneral |
| Fundraising | 2187 | Fundraising |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4503 | Total |
| Management And General | 1126 | ManagementAndGeneral |
| Fundraising | 3377 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2882 | Total |
| Management And General | 2882 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 386 | Total |
| Management And General | 386 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Expenses OtherExpenses (2 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| OUTSIDE SERVICES | 24550 | 6138 | 6138 | 12274 |
| OTHER | 6403 | 1601 | 1601 | 3201 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 877882 | Total |
| Program Services | 463566 | ProgramServices |
| Management And General | 166543 | ManagementAndGeneral |
| Fundraising | 247773 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2355478 | BOY |
| EOY | 349982 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 338840 | BOY |
| EOY | 245791 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 61767 | LandBuildingsEquipmentBasis |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 61767 | BOY |
| EOY | 61767 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5540823 | BOY |
| EOY | 8076098 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1283036 | BOY |
| EOY | 1627172 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9579944 | BOY |
| EOY | 10360810 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 38670 | BOY |
| EOY | 80685 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 106579 | BOY |
| EOY | 114214 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37155 | BOY |
| EOY | 220810 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 182404 | BOY |
| EOY | 415709 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1906948 | BOY |
| EOY | 2040396 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4190935 | BOY |
| EOY | 4497410 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3299657 | BOY |
| EOY | 3407295 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9397540 | BOY |
| EOY | 9945101 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9579944 | BOY |
| EOY | 10360810 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 347755 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 564134 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | -364328 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | true | AuditCommittee |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 1071796 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 493995 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 778384 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 474945 | CurrentTaxYearMinus1Year |
| Current Tax Year | 591080 | CurrentTaxYear |
| Total | 3410200 | Total |
Tax Rev Levied For Org Benefit170 TaxRevLeviedForOrgBenefit170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Value Srvc Fclts Furnished By Govt ValueSrvcFcltsFurnishedByGovt
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 1071796 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 493995 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 778384 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 474945 | CurrentTaxYearMinus1Year |
| Current Tax Year | 591080 | CurrentTaxYear |
| Total | 3410200 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amounts Subst Contributors Total | 413195 | AmountsSubstContributorsTotal |
| Public Support Total170 | 2997005 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 141224 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 177632 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 182292 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 151677 | CurrentTaxYearMinus1Year |
| Current Tax Year | 221556 | CurrentTaxYear |
| Total | 874381 | Total |
Net UBI NetUBI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Income170 OtherIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 4284581 | TotalSupport |
| Public Support Pertcentage170 | 0.69949 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.69724 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts |
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 7490592 | BeginningOfYearBalance |
| Contributions | 619003 | Contributions |
| Investment Earnings Or Losses | 283548 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 488438 | GrantsOrScholarships |
| End Of Year Balance | 7904705 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 6115921 | BeginningOfYearBalance |
| Contributions | 1707009 | Contributions |
| Investment Earnings Or Losses | -16123 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 316215 | GrantsOrScholarships |
| End Of Year Balance | 7490592 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 5840402 | BeginningOfYearBalance |
| Contributions | 648712 | Contributions |
| Investment Earnings Or Losses | 283214 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 656407 | GrantsOrScholarships |
| End Of Year Balance | 6115921 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 5612636 | BeginningOfYearBalance |
| Contributions | 254000 | Contributions |
| Investment Earnings Or Losses | 351106 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 377340 | GrantsOrScholarships |
| End Of Year Balance | 5840402 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 6295198 | BeginningOfYearBalance |
| Contributions | 501402 | Contributions |
| Investment Earnings Or Losses | -834842 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 349122 | GrantsOrScholarships |
| End Of Year Balance | 5612636 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 0.43000 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.57000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | false | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | true | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | true | AreRelatedOrgsListedScheduleR |
| Land | Land | |
| Buildings | Buildings | |
| Leasehold Improvements | LeaseholdImprovements | |
| Equipment | Equipment |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 61767 | OtherCostOrOtherBasis |
| Book Value | 61767 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 61767 | TotalOfBookValueLandBuildings |
| Financial Derivatives | FinancialDerivatives | |
| Closely Held Equity Interests | CloselyHeldEquityInterests |
Other Securities OtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | ALTERNATIVE INVESTMENTS | Description |
| Book Value | 1627172 | BookValue |
| Method Of Valuation | F | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 1627172 | TotalOfBookValueSecurities |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | INTER-COMPANY PAYABLES | Description |
| Amount | $220,810 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 220810 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part V, Line 4: | Identifier |
| Explanation | The Good Samaritan Hospital Foundation-Dayton (GSHF) makes every effort to always follow the intent and wishes of all its donors. The intended uses of the organization's endowment funds and/or earnings from endowment funds are driven by the wishes/restrictions placed on the funds by the donor. Permanent endowments result when a donation is received with a restriction that the principal or gift amount is to be retained in perpetuity and cannot be spent. The earnings from the permanent endowments are then used for the purpose specified by the donor. The "categories" of permanently restricted endowments are as follows: to fund the Foundation operations(40%); To support Good Samaritan Hospital's Homeless Clinic operations (26%); To benefit specific programs for a Samaritan Health Partners affiliate (9%); To provide educational programs for cancer patients(5%); and miscellaneous (20%). Temporary endowments are funds in which all or part of the principal may be expended only after the expiration of a stated period of time or occurrence of a specified event, depending on the donor's wishes. Earnings from temporarily restricted endowments can be either unrestricted or restricted. The GSHF uses the temporarily restricted endowments for the intended purpose set up by the donor, only after the period of time or specified event set by the donor has been met. Part X, Line 2: Good Samaritan Hospital Foundation-Dayton (GSHF) is affiliated with Premier Health (Premier), which is tax-exempt under section 501(c)(3) of the Internal Revenue Code. As such, there is no income tax liability recorded at December 31, 2012 and 2011. In addition, management annually reviews its tax positions and has determined that there no material uncertain tax positions that require recognition in the combined financial statements. | Explanation |
Schedule F IRS990ScheduleF
Accts Actvs Out US Table AcctsActvsOutUSTable (9 entries)
| RegionRegion | Type Of Activities ConductedTypeOfActivitiesConducted | Total ExpendituresTotalExpenditures |
|---|---|---|
| Central America and the Caribbean | Investments | 97033 |
| North America | Investments | 19407 |
| Sub-Saharan Africa | Investments | 48509 |
| East Asia and the Pacific | Investments | 621009 |
| Europe (Including Iceland and Greenland) | Investments | 1154689 |
| Middle East and North Africa | Investments | 19407 |
| Russia and the Newly Independent States | Investments | 29110 |
| South America | Investments | 116439 |
| South Asia | Investments | 29110 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subtotal Amount Spent | 2134713 | SubtotalAmountSpent |
| Total Amount Spent | 2134713 | TotalAmountSpent |
| Transfer To Foreign Corp | false | TransferToForeignCorp |
| Interest In Foreign Trust | false | InterestInForeignTrust |
| Own Foreign Corp | false | OwnForeignCorp |
| Passive Foreign Invest Co | false | PassiveForeignInvestCo |
| Foreign Partnership | false | ForeignPartnership |
| Boycott Countries | false | BoycottCountries |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | Ray of Hope | NameOfEvent1 |
| Gross Receipts Event1 | 60028 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 58502 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 1526 | GrossRevenueEvent1 |
| Other Direct Expenses Event1 | 3980 | OtherDirectExpensesEvent1 |
| Total Number Of Other Events | 0 | TotalNumberOfOtherEvents |
| Gross Receipts Total | 60028 | GrossReceiptsTotal |
| Charitable Contributions Total | 58502 | CharitableContributionsTotal |
| Gross Revenue Total Events | 1526 | GrossRevenueTotalEvents |
| Other Direct Expenses Total Events | 3980 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 3980 | DirectExpenseSummaryEvents |
| Net Income Summary | -2454 | NetIncomeSummary |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Good Samaritan Hospital | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 N Main St Suite 500 | AddressLine1 |
| City | Dayton | City |
| State | OH | State |
| ZIP Code | 45402 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 310536981 | EINOfRecipient |
| IRC Section | 501(c)(3) | IRCSection |
| Amount Of Cash Grant | 327643 | AmountOfCashGrant |
| Method Of Valuation | N/A | MethodOfValuation |
| Description Of Non Cash Assistance | N/A | DescriptionOfNonCashAssistance |
| Purpose Of Grant | Operations | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | Educational Scholarships | TypeOfGrant |
| Number Of Recipients | 15 | NumberOfRecipients |
| Amount Of Cash Grant | 15000 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part 1, Question 2: | Identifier |
| Explanation | All distributions (grants paid) follow the entities disbursement policy, including: (A) Assuming funds availability, hospital departmental personnel completes a foundation request form. For amounts in excess of $1,000, Director's & Vice-President's signatures are required to request foundation funding. (B) For request greater than $5,000, the Foundation's Distribution Committee reviews and approves the request. The check also requires a 2nd signature. (C) Reporting for grants is the responsibility of the operational unit. (D) Before disbursing funds, each request is verified/matched for its intended purpose. For example, scholarship requirements include a) GPA requirements; b) length of service; c) specific fields of study. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | true | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | true | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Janet Rogers | ||||||||||||||
| Treasurer | 0 | 125828 | 0 | 27297 | 0 | 2223 | 0 | 20840 | 0 | 20743 | 0 | 196931 | 0 | 0 |
| Marc Martens | ||||||||||||||
| President | 120569 | 0 | 57046 | 0 | 1424 | 0 | 6400 | 0 | 10226 | 0 | 195665 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part I, Question 6A and 6B: | Identifier |
| Explanation | Premier Health (Premier), which Good Samaritan Hospital Foundation-Dayton is affiliated with, has an incentive component for all executive and director level employees that ties a portion of their total compensation to organizational and individual objectives and outcomes. The organizational criterion is weighted according to balanced scorecard categories: Positive Work Environment (15%), Quality (30%), Patient Satisfaction (15%), Physician Partnership (15%), and Financial (25%). The financial category of the scorecard is based upon net earnings of the individual hospital and net earnings of the system as a whole. This financial target is set based upon the margin required to maintain the system AA credit rating. Incentive objectives for Directors and above are weighted 45% on organizational criteria, 45% on individual criteria, and 10% Organizational Effectiveness. The 2012 incentive plan amounts were paid to the participants in 2013. These are not reported as deferred compensation on the 2012 Form 990 based on the definition of deferred compensation contained in the Form 990 instructions. Per the instructions, "deferred compensation is generally treated as earned or accrued in the year that services are rendered, except when entitlement to payment is contingent on satisfaction of organizational goals or specified performance criteria (other than mere longevity of service) under the deferred compensation plan." Based on the incentive program's criteria outlined above, we believe the incentive payments meet the exception noted in the instructions. Such amounts are properly reported as compensation for Form 990 purposes when included in the participants' Form W-2 wages. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Form 990, Part I, Question 10: | Identifier |
| Explanation | The Good Samaritan Hospital-Dayton has designated its investments as trading. In accordance with the AICPA Guide for Healthcare, all unrealized gains and losses are recognized through the Profit and Loss statement. For 990 reporting, this activity is excluded per the instructions by the Internal Revenue Service. Form 990, Part III, Question 4d: This number represents the total expenditures of temporarily restricted funds for Good Samaritan Hospital net of programs described in service accomplishments. Form 990, Part VI, Section A, Question 6: Good Samaritan Hospital Foundation-Dayton has one corporate member. This member is Samaritan Health Partners, the parent of the Foundation. Form 990, Part VI, Section A, Question 7a: Samaritan Health Partners (SHP) has the sole authority to elect the Board of Trustees for Good Samaritan Hospital Foundation-Dayton. Form 990, Part VI, Section B, Question 11B: This 990 tax return and attached schedules (the return) are prepared by a staff member in the Tax Department of Premier Health (Premier), which Good Samaritan Hospital Foundation-Dayton is affiliated with. The return is reviewed by the Tax Manager and the Director of Tax Compliance of Premier. The return is concurrently sent to Ernst & Young U.S. LLP for their review. After all changes from the above groups are made, the return is reviewed by the Vice President/Controller of Premier and the Treasurer and President of this entity. A final version of the return is sent to Ernst & Young U.S. LLP for a final review and then provided to the Board of Trustees for review. At the meeting, the Vice President/Controller of Premier (or designee) shares detailed information on compensation and other key areas, as well as address any other questions from the Board of Trustees, pending their review. The 990 tax return is also shared with the Audit Committee of Premier. At the meeting, the Vice President/Controller of Premier (or designee) shares detailed information on compensation and other key areas, as well as addresses any other questions from the committee. Form 990, Part VI, Section B, Question 12C: Premier Health (Premier), which Good Samaritan Hospital Foundation-Dayton is affiliated with, requires all board members, officers, executives, and management personnel to annually review the Premier Comprehensive Conflict of Interest Statement, an explanatory memorandum, the Antitrust Compliance Policy, and complete an individual questionnaire disclosing any potential conflicts as defined in the Conflicts of Interest Policy. This is accomplished with a memo sent out annually from the Chairman of the Board and Chief Executive Officer of Premier to all board members, executive directors, vice presidents, directors, purchasing department staff, authorized purchasers, medical directors, department and section chairs, and all employed physicians. It includes an explanatory memorandum of specific activities that might give cause to a conflict and an individual questionnaire to disclose all such activities. This questionnaire must be completed and signed by the individual. Last, this memo includes a copy of the Antitrust Compliance Policy that must be signed by the individual. All of these documents are sent to the Corporate Compliance Officer. The Corporate Compliance Department ensures all forms are returned and retains the documents for five years. In addition, at each meeting of the Board or any Board Committee, following approval of the previous meeting's minutes, the Board or Committee Chair shall request any board member who perceives a potential conflict of interest on any of the meeting's agenda items to disclose the potential conflict. Additionally, at any Board or Board Committee meeting where the subject of conflicts of interest is discussed, the minutes shall contain the name of the party discussing a potential conflict of interest, the nature of the potential conflict of interest and whether a conflict of interest was found to exist. If a conflict of interest is determined by the board to exist, the member will be excused from participating in any discussion or voting on the particular agenda item. The Corporate Compliance Officer reports the results of the Premier Conflict of Interest questionnaires no less than annually to the Board of Trustees by way of the Compliance and Audit Committee. This review is documented in the minutes of the meeting. Periodically, the Internal Audit department will review a sample of completed Conflict of Interest questionnaires and report the results to the Compliance and Audit Committee. The annual conflict of interest questionnaires are individually summarized in a Word document and sent electronically to the Finance department for any necessary disclosures required on the 990 tax return. Form 990, Part VI, Section B, Question 15A and 15B: Premier Health (Premier), which Good Samaritan Hospital Foundation-Dayton is affiliated with, follows a market based compensation philosophy designed to attract and retain the executive talent required to meet the high performance standards of our board and our community. Premier annually reviews executive compensation survey data for a regional peer group of systems and hospitals that are similar in size and complexity to Premier and its affiliates. The data for the survey is provided by a third party consultant group that is independent of Premier. This report includes comparability for key executives, vice presidents, and director level positions. The independent comparability data is reviewed by the executive compensation committee on an annual basis. This committee is comprised of three members, all of which are independent. This committee reviews in detail the compensation for the Premier CEO, COO, CFO, Chief Strategy Officer, and the hospital CEOs. Other positions are reviewed at a high level for reasonableness. All the meeting minutes are documented and kept on file along with any comparability data and the consultant report. After the compensation committee reviews and approves the compensation actions, the process is audited by the internal audit department. The executive compensation committee presents the compensation actions to the Premier board annually. Form 990, Part VI, Section C, Question 19: The governing documents and financial statements are made available to the public when required by law or for accreditation purposes. The conflict of interest policy is available on the company website. Form 990, Part XI, Question 9: Pledge write-offs $(6,306) Capital Distributions (358,022) Total $(364,328) | Explanation |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| Good Samaritan Hospital | ||||||||||
| 110 N Main St Suite 500 | Dayton | OH | 45402 | 310536981 | Hospital | OH | 501(c)(3) | 3 | SHP | true |
| Samaritan Health Partners (SHP) | ||||||||||
| 110 N Main St Suite 500 | Dayton | OH | 45402 | 311107411 | Parent | OH | 501(c)(3) | 11-I | NA | false |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Beneficiary Trust (1) | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activity | Community Donor | PrimaryActivity |
| Legal Domicile State | OH | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | TRUST | TypeOfEntity |
| Controlled Org | false | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | true | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| Good Samaritan Hospital | ||
| B | 685665 | Cash |
| Good Samaritan Hospital | ||
| P | 430946 | Fair Value |
Comments