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        <BusinessNameLine1>GOOD SAMARITAN MEDICAL MINISTRY OF GRACE UNITED METHODIST CHURCH</BusinessNameLine1>
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        <AddressLine1>1724 Crystal Ridge Ct</AddressLine1>
        <City>Riverside</City>
        <State>CA</State>
        <ZIPCode>92506</ZIPCode>
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    <Officer>
      <Name>Khanh Nguyen</Name>
      <Title>Treasurer</Title>
      <Phone>9517847406</Phone>
      <DateSigned>2011-08-14</DateSigned>
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      <Description>The Good Samaritan Medical Ministry's Mission is to reach out to the people of Vietnam through the healing ministry of the church by providing state of the art medical care through annual medical missions, education and in-country healthcare facilities. As stated the Ministry has 3 components. First, Summer Mission that provides direct patient care. Second, The Spring Mission provides educational services to Vietnamese medical and nursing professionals in the country. Third, support on going primary care clinics in the country. In 2009 the summer mission, 91 volunteers treated 4,500 patients in primary care settings in a 2 week period from July 23 through August 7, 2009. Services included medical, dental, optometric. We also operated on 43 patients at local provincial hospitals with diseases ranging from breast cancers to thyroid masses. There were other patients needing surgical care such as open heart surgeries, the Ministry paid for these patients to have surgeries at tertiary centers in Saigon. Each open heart surgeries cost an average of $2500 per patient.</Description>
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        <Description>In September 2010 the Ministry sponsored 3 physicians from Hue, Ha Noi, Saigon to the U.S. for 6 weeks training in Emergency Medicine and in November 2010 3 nurses from Hue College of Medicine were sponsored to the U.S. to study nursing at Riverside Community Hospital.</Description>
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      <ThirtyThreePercntTestsCY509>X</ThirtyThreePercntTestsCY509>
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    <IRS990ScheduleB documentId="R000003" softwareId="10000077" softwareVersion="v1.00">
      <ContributorInfo>
        <ContributorNumber>RESTRICTED</ContributorNumber>
        <ContributorNameBusiness>
          <BusinessNameLine1>RESTRICTED</BusinessNameLine1>
        </ContributorNameBusiness>
        <ContributorAddressUS>
          <AddressLine1>RESTRICTED</AddressLine1>
          <AddressLine2>RESTRICTED</AddressLine2>
          <City>RESTRICTED</City>
          <State>RESTRICTED</State>
          <ZIPCode>RESTRICTED</ZIPCode>
        </ContributorAddressUS>
        <AggregateContributions>RESTRICTED</AggregateContributions>
      </ContributorInfo>
    </IRS990ScheduleB>
    <IRS990ScheduleF documentId="R000004" softwareId="10000077" softwareVersion="v1.00">
      <GrantsToIndOutsideUS>
        <TypeOfAssistance>Provided funds for 6 children from Vietnam to have open heart surgeries to correct their congenital heart defects. These children were diagnosed by the team while doing mission in Vietnam and was not able to provide direct surgeries to them</TypeOfAssistance>
        <Region>East Asia and the Pacific</Region>
        <NumberOfRecipients>6</NumberOfRecipients>
        <AmountOfCashGrant>16167</AmountOfCashGrant>
        <MannerOfCashDisbursement>Paid to the local hospital for treatments</MannerOfCashDisbursement>
      </GrantsToIndOutsideUS>
      <GrantsToIndOutsideUS>
        <TypeOfAssistance>Provided airfare cost to 3 physicians, 3 nurses, 1 staff from Vietnam to come to the US for medical / nursing training from September 2010 - January 2011.</TypeOfAssistance>
        <Region>East Asia and the Pacific</Region>
        <NumberOfRecipients>7</NumberOfRecipients>
        <AmountOfCashGrant>8804</AmountOfCashGrant>
        <MannerOfCashDisbursement>Paid to airline to ticket costs</MannerOfCashDisbursement>
      </GrantsToIndOutsideUS>
      <TransferToForeignCorp>0</TransferToForeignCorp>
      <InterestInForeignTrust>0</InterestInForeignTrust>
      <OwnForeignCorp>0</OwnForeignCorp>
      <PassiveForeignInvestCo>0</PassiveForeignInvestCo>
      <ForeignPartnership>0</ForeignPartnership>
      <BoycottCountries>0</BoycottCountries>
      <Form990ScheduleFPartV>
        <Identifier>SchF_P03_S00_L00</Identifier>
        <ReturnReference>Schedule F, Part III</ReturnReference>
        <Explanation>Accounting method used for dispersing fund to patients and individuals in Vietnam is cash. Cash is paid on behalf of the individuals to the business in which those individuals need them. For example, cash is paid to a hospital on behalf of a patient needing surgeries.</Explanation>
      </Form990ScheduleFPartV>
    </IRS990ScheduleF>
    <IRS990ScheduleG documentId="R000005" softwareId="10000077" softwareVersion="v1.00">
      <EventsInformation>
        <NameOfEvent1>For the love of a child</NameOfEvent1>
        <GrossReceiptsEvent1>20000</GrossReceiptsEvent1>
        <CharitableContributionsEvent1>0</CharitableContributionsEvent1>
        <GrossRevenueEvent1>20000</GrossRevenueEvent1>
        <CashPrizesEvent1>0</CashPrizesEvent1>
        <NonCashPrizesEvent1>0</NonCashPrizesEvent1>
        <RentFacilityCostsEvent1>2318</RentFacilityCostsEvent1>
        <FoodAndBeverageEvent1>1128</FoodAndBeverageEvent1>
        <EntertainmentEvent1>0</EntertainmentEvent1>
        <OtherDirectExpensesEvent1>0</OtherDirectExpensesEvent1>
        <FoodAndBeverageOtherEvents>0</FoodAndBeverageOtherEvents>
        <EntertainmentOtherEvents>0</EntertainmentOtherEvents>
        <GrossReceiptsTotal>20000</GrossReceiptsTotal>
        <CharitableContributionsTotal>0</CharitableContributionsTotal>
        <GrossRevenueTotalEvents>20000</GrossRevenueTotalEvents>
        <CashPrizesTotalEvents>0</CashPrizesTotalEvents>
        <NonCashPrizesTotalEvents>0</NonCashPrizesTotalEvents>
        <RentFacilityCostsTotalEvents>2318</RentFacilityCostsTotalEvents>
        <FoodAndBeverageTotalEvents>1128</FoodAndBeverageTotalEvents>
        <EntertainmentTotalEvents>0</EntertainmentTotalEvents>
        <OtherDirectExpensesTotalEvents>0</OtherDirectExpensesTotalEvents>
        <DirectExpenseSummaryEvents>3446</DirectExpenseSummaryEvents>
        <NetIncomeSummary>16554</NetIncomeSummary>
      </EventsInformation>
    </IRS990ScheduleG>
    <IRS990ScheduleO documentId="R000006" softwareId="10000077" softwareVersion="v1.00">
      <GeneralExplanation>
        <Identifier>F990_P03_S00_L03</Identifier>
        <ReturnReference>Form 990, Part III, Line 3</ReturnReference>
        <Explanation>The Ministry discontinued the free clinic at Vinh Phuoc Church in Nha Trang. The church was no longer interested in providing this service to the community.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>F990_P06_S0B_L11a</Identifier>
        <ReturnReference>Form 990, Part VI, Section B, Line 11a</ReturnReference>
        <Explanation>The copy of the 990 form is distributed to Board members via email at least 24 hours for review before final transmission to the IRS. Approval for processing can be done via email and/or telephone.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>F990_P06_S0C_L19</Identifier>
        <ReturnReference>Form 990, Part VI, Section C, Line 19</ReturnReference>
        <Explanation>On the Ministry's website, the "About" page displays the following clause "If you would like to see a copy of our financial statement, please email us at info@gsmdm.org"</Explanation>
      </GeneralExplanation>
    </IRS990ScheduleO>
    <ReasonableCauseExplanation documentId="R000007" softwareId="10000077" softwareVersion="v1.00">
      <Explanation>The Ministry's volunteers in Vietnam were not able to gather all receipts and documentation for expenses on time for April 15 filing. All the documents had to be translated into English and mailed over the US for accounting.</Explanation>
    </ReasonableCauseExplanation>
  </ReturnData>
</Return>