2012-11-14T11:13:55-06:00 2011-12-31 741695589 HARPER & PEARSON COMPANY PC ONE RIVERWAY SUITE 1000 HOUSTON TX 77056 990 2011-01-01 741235398 GOOD SAMARITAN FOUNDATION OF TEXAS INC GOOD 7135294646 3355 W ALABAMA STREET SUITE 1025 HOUSTON TX 77098 MICHELLE HILDRETH 7135294646 2012-11-13 1 GUY T TABOR CPA P00171798 7136222310 2011 2016-02-24 21:20:13Z MICHELLE HILDRETH 3355 W ALABAMA STREET SUITE 1025 HOUSTON TX 77098 1317074 0 X WWW.GSFTX.ORG X 1951 TX TO INCREASE THE QUANTITY OF NURSES DEDICATED TO CLINICAL CARE AND TO IMPROVE THE QUALITY OF NURSE EDUCATION AND TRAINING. 21 21 3 6 0 0 593162 765403 0 0 18154 13026 92697 91921 704013 870350 392000 425000 0 0 287939 237561 0 0 107736 232949 234569 912888 897130 -208875 -26780 1643530 1555761 22875 23062 1620655 1532699 X GOOD SAMARITAN FOUNDATION (GSF) IS A FUNDRAISING AND GRANT-MAKING ORGANIZATION DEDICATED SOLELY TO TEXAS NURSING. ITS MISSION IS TO INCREASE THE QUANTITY OF NURSES DEDICATED TO CLINICAL CARE AND TO IMPROVE THE QUALITY OF NURSE EDUCATION AND TRAINING. GSF GRANT PROGRAMS ADDRESS SEVERAL COMPLEX ISSUES AFFECTING THE PRACTICE OF NURSING, INCLUDING WORKFORCE SHORTAGES, THE SKILLS GAP BETWEEN NURSING EDUCATION AND PRACTICE, LIMITS TO ENROLLMENT IN NURSING SCHOOLS, A RAPIDLY CHANGING PRACTICE ENVIRONMENT, AND AN AGING POPULATION AND ITS SPECIAL HEALTHCARE NEEDS. 0 0 619004 415000 NURSING SCHOLARSHIPS. GOOD SAMARITAN FOUNDATION MADE GRANTS TO 250 STUDENTS ATTENDING 53 DIFFERENT SCHOOLS OF NURSING IN THE HOUSTON AND GULF COAST REGION IN 2011. OF THOSE, 71 STUDENTS WERE ENROLLED IN LVN OR ADN PROGRAMS, 77 WERE PURSUING BACHELOR'S DEGREES IN NURSING, 75 WERE PURSUING MASTER'S DEGREES, AND 27 WERE ENROLLED IN DOCTORIAL STUDIES. 10000 10000 GRANT TO COLLEGES OF NURSING AND OTHER ORGANIZATIONS. IN FULFILLIMENT OF A FIVE-YEAR COMMITMENT TO TEXAS WOMAN'S UNIVERSITY, GOOD SAMARITAN GRANTED $10,000 IN 2011 TO TWU NELDA STARK COLLEGE OF NURSING IN HOUSTON TO ASSIST IT IN PRESENTING A LECTURE SERIES TO PROFESSIONAL NURSES. THE SERIES WAS APPROVED FOR CONTINUING NURSING EDUCATION CREDITS. IN 2011 NANCY DUNTON, PHD, RN PRESENTED "PREVENTING NEVER EVENTS: HOW TO USE NURSING DATA TO ENSURE QUALITY PATIENT CARE;" THERE WERE 127 ATTENDEES. 629004 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 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 0 1 0 0 1 3 1 0 0 0 0 0 1 1 0 0 0 0 X 21 21 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X X MELISSA SCHMIDT 7135294646 3355 W ALABAMA STREET SUITE 1025 HOUSTON TX 77098 JASON FERTITTA 2.00 X X 0 0 0 MELBERN G GLASSCOCK 0.50 X 0 0 0 L PROCTOR THOMAS III 0.10 X 0 0 0 THOMAS C LIVENGOOD 1.00 X X 0 0 0 WILLIAM V CONOVER II 0.10 X 0 0 0 LEE LD TUTTLE MD 0.10 X 0 0 0 J VIRGIL WAGGONER 0.10 X 0 0 0 JACK APPLE 0.10 X 0 0 0 MARY LOU CHAPMAN 0.10 X 0 0 0 ROSEMARY PEARSON CREASEY 0.10 X 0 0 0 SUSAN P STASNEY 0.50 X X 0 0 0 JUANITA F ROMANS 0.30 X 0 0 0 THURMAN ANDRESS 0.10 X 0 0 0 ERIC F BERKMAN MD 0.10 X 0 0 0 MOLLIE CASTANEDA 0.30 X 0 0 0 LARRY S LEWIS 0.10 X 0 0 0 ANN SCANLON-MCGINITY PHD RN 0.10 X 0 0 0 CHARLES A WILLIAMS 0.10 X 0 0 0 HARRIET HART WALLACE 0.10 X 0 0 0 CHARLES H MCCOLLUM MD 0.10 X 0 0 0 JAMES T WILLERSON MD 0.10 X 0 0 0 STEVEN P MACH 0.10 X 0 0 0 EDUARDO A SANCHEZ 0.10 X 0 0 0 RICHARD E WAINERDI PHD 0.10 X 0 0 0 CHRISTOPHER DEWHURST 0.10 X 0 0 0 WARREN HARRIS 0.10 X 0 0 0 CLARK P WHITESIDE 45.00 X 42808 0 0 MICHELLE HILDRETH 45.00 X 48077 0 0 90885 0 0 0 0 0 0 0 431760 27500 306143 25000 765403 21440 21440 91921 91921 315100 323514 -8414 -8414 -8414 123210 431760 123210 0 870350 0 0 104947 10000 10000 415000 415000 96604 16810 33811 45983 103452 58147 32622 12683 21706 8453 9653 3600 15799 5920 5246 4633 51 51 30871 30871 10000 10000 6805 6805 18204 12743 3641 1820 37196 26037 7439 3720 1959 921 1038 645 129 258 258 678 678 4903 2353 1079 1471 SPECIAL EVENTS EXPENSES 90012 65312 24700 BAD DEBT EXPENSE 17000 17000 ROYALTY TAXES 5990 5990 TELEPHONE 4857 3400 971 486 5398 3779 1080 539 897130 629004 160390 107736 162997 187398 69500 162665 31833 29926 14677 18500 49468 48267 1879 1201 765882 589764 596762 566307 1643530 1555761 12875 10497 10000 0 0 12565 22875 23062 X 480558 383224 1140097 1149475 1620655 1532699 1643530 1555761 X -26780 -61176 X 0 1 1 X 0 X 744583 544988 541336 593162 765403 3189472 168991 157185 190212 150240 123210 789838 913574 702173 731548 743402 888613 3979310 154454 116220 333900 334350 398885 1337809 0 154454 116220 333900 334350 398885 1337809 2641501 139162 223663 144515 111865 113361 732566 139162 223663 144515 111865 113361 732566 1052736 925836 876063 855267 1001974 4711876 0.56060 0.53510 0.15550 0.14620 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 596762 -690 27500 2265 566307 561991 58965 20929 3265 596762 491283 92199 19017 2474 561991 0.00000 1.00000 0.00000 0 0 49468 48267 1201 1201 BENEFICIAL INTEREST IN GOOD SAMARITAN ENDOWMENT 566307 566307 LEASE LIABILITY 12565 12565 870350 897130 -26780 -5721 -55455 -61176 -87956 976974 123210 123210 853764 16586 16586 870350 1020340 123210 123210 897130 0 897130 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: TO PROVIDE A SOURCE OF PERMANENT FUNDING FOR GOOD SAMARITAN FOUNDATION OF TEXAS, INC. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE FOUNDATION BELIEVES THAT ALL SIGNIFICANT TAX POSITIONS UTILIZED BY THE FOUNDATION WILL MORE LIKELY THAN NOT BE SUSTAINED UPON EXAMINATION. AS OF DECEMBER 31, 2011, THE TAX YEARS THAT REMAIN SUBJECT TO EXAMINATION BY THE MAJOR TAX JURISDICTIONS UNDER THE STATUTE OF LIMITATION ARE FROM THE FISCAL YEAR 2008 FORWARD (WITH LIMITED EXCEPTIONS). TAX PENALTIES AND INTEREST, IF ANY, WOULD BE ACCRUED AS INCURRED AND WOULD BE CLASSIFIED AS ADMINISTRATION EXPENSE IN THE STATEMENT OF ACTIVITIES. AS OF DECEMBER 31, 2011, THERE WERE NO ACCRUALS RECORDED FOR ANY TAX CONTINGENCIES. PART XI, LINE 8 - OTHER ADJUSTMENTS: NET CHANGE IN BENEFICIAL INTEREST IN GOOD SAMARITAN ENDOWMENT -30,455. NONCASH CONTRIBUTIONS RECEIVED -25,000. TOTAL TO SCHEDULE D, PART XI, LINE 8: -55,455. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENTS - DIRECT EXPENSE 123,210. PART XII, LINE 4B - OTHER ADJUSTMENTS: REALIZED LOSS ON SALE OF INVESTMENTS -8,414. NONCASH CONTRIBUTIONS RECEIVED 25,000. PART XIII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENTS - DIRECT EXPENSE 123,210. PEARL BALL 251870 201748 50122 50122 GOLF TOURNAMENT 178500 105412 73088 73088 1 124600 124600 0 554970 431760 123210 123210 123210 0 1 TEXAS WOMAN'S UNIVERSITY 6700 FANNIN SUITE 7519 HOUSTON TX 77030 756002618 501(C)(3) 10000 ASSIST IN LECTURE SERIES 1 0 NURSING SCHOLARSHIPS 250 415000 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: GRANT REQUESTS ARE MADE ONLINE THROUGH THE FOUNDATION'S WEBSITE. APPLICATIONS ARE ACCEPTED THREE TIMES A YEAR: SPRING SEMESTER, JANUARY 1 - FEBRUARY 15, SUMMER SEMESTER MAY 15 - JUNE 30 AND FALL SEMESTER AUGUST 1 - SEPTEMBER 15. AT INITIAL APPLICATION TIME APPLICANTS MUST COMPLETELY FILL OUT APPLICATION, PROVIDE AN ESSAY ON WHY THEY ARE INTERESTED IN BECOMING A NURSE, PROVIDE A LETTER OF RECOMMENDATION, THEIR RESUME, PHOTO ID, THEIR W2 AND PROOF OF CITIZENSHIP. SCHOLARSHIP RECIPIENTS RECEIVE THEIR FUNDING AT THE END OF EACH SEMESTER. APPLICANTS RECEIVING FUNDING ARE REQUIRED TO PRODUCE THEIR FEE SCHEDULE, CLASS SCHEDULE AND GRADES, PROVIDE ALL EXPENSES INCLUDING BOOK FEES, TUITION AND LAB FEES. FORM 990, PART VI, SECTION B, LINE 11 AFTER PREPARATION AND REVIEW BY THE EXECUTIVE DIRECTOR AND HARPER AND PEARSON, A COPY OF THE FORM 990 IS SENT TO THE CHAIRMAN OF THE BOARD, MR. J.L. FERTITTA, A COPY IS SENT TO THE BOARD TREASURER, MR. T. LIVENGOOD AND THE BALANCE OF THE EXECUTIVE COMMITTEE BOARD OF TRUSTEES FOR FINAL REVIEW AND APPROVAL. AFTER CAREFUL REVIEW AND CONSIDERATION COMMENTS ARE COMPILED BY THE EXECUTIVE DIRECTOR. ALL COMMENTS AND QUESTIONS ARE ADDRESSED, DISCUSSED AND COMPARED TO THE ANNUAL AUDIT BEFORE FINAL SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C A COPY OF THE CONFLICT OF INTEREST POLICY IS FURNISHED TO EACH TRUSTEE, OFFICER AND STAFF MEMBER WHO SERVES THE GOOD SAMARITAN ORGANIZATION OR WHO MAY BECOME ASSOCIATED WITH IT (VOLUNTEERS). THE POLICY AND ITS APPLICATION IS REVIEWED ANNUALLY FOR THE INFORMATION AND GUIDANCE OF TRUSTEES, OFFICERS AND STAFF MEMBERS, EACH OF WHOM HAS A CONTINUING RESPONSIBILITY TO SCRUTINIZE THEIR TRANSACTIONS AND OUTSIDE BUSINESS INTERESTS AND RELATIONSHIPS FOR POTENTIAL CONFLICTS OF INTEREST, AND MAKE SUCH DISCLOSURES AS DESCRIBED BY IN THE POLICY. ANNUALLY, THE BOARD CHAIR MEETS WITH EACH TRUSTEE AT THE ANNUAL BOARD MEETING, USUALLY IN EARLY NOVEMBER, AND ASKS FOR A COMPLETE A CERTIFICATION OF AGREEMENT WITH POLICY AND DISCLOSE OF ANY KNOW CONFLICTS OF INTEREST UPON HIS OR HER ELECTION OR RE-ELECTION TO THE BOARD. IN 2011, THERE WERE NO CONFLICTS OF INTEREST WITH THE TRUSTEES, OFFICERS OR STAFF. IN ADDITION THE EXECUTIVE DIRECTOR AND EACH STAFF MEMBER IS ASKED TO COMPLETE A CERTIFICATION ANNUALLY, THIS OCCURS BY THE END OF EACH CALENDAR YEAR. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES REVIEWS VARIOUS INDEPENDENT SOURCES OF NONPROFIT INDUSTRY DATA REGARDING THE LEVELS AND TYPES OF COMPENSATION BEING PAID TO PERSONS IN THE NONPROFIT SECTOR BY JOB FUNCTION. RECOMMENDATIONS OF THE EXECUTIVE COMMITTEE FOR INDIVIDUAL COMPENSATION AND BENEFITS PACKAGES ARE PRESENTED TO AND APPROVED BY THE FULL BOARD OF TRUSTEES AT THE ANNUAL MEETING HELD EVERY NOVEMBER. FORM 990, PART VI, SECTION C, LINE 19 ALL CORPORATE RECORDS ARE AVAILABLE TO THE GENERAL PUBLIC FOR REVIEW AT THE FOUNDATION'S MAIN OFFICE DURING NORMAL BUSINESS HOURS UPON WRITTEN REQUEST WITH REASONABLE NOTICE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -5,721. NET CHANGE IN BENEFICIAL INTEREST IN GOOD SAMARITAN ENDOWMENT -30,455. NONCASH CONTRIBUTIONS RECEIVED -25,000. TOTAL TO FORM 990, PART XI, LINE 5: -61,176. GOOD SAMARITAN ENDOWMENT INC 3355 W ALABAMA STREET SUITE 1025 HOUSTON TX 77098 201930300 SOURCE OF PERMANENT FUNDING FOR GOOD SAMARITAN FOUNDATION OF TEXAS, INC TX 501(C)(3) LINE 11C, III-FI 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 GOOD SAMARITAN ENDOWMENT INC C 27500