Skip to content
Nonprofiteer
← GOOD SAMARITAN HOSPITAL FREE CLINIC

Form 990 for tax year 2023

Filed by GOOD SAMARITAN HOSPITAL FREE CLINIC.

Totals

Total revenue
$992,554
Total expenses
$1,037,767
Contributions and grants received
$992,554
Grants paid
$14,045
Program services expenses (Part IX)
$1,037,767
Management and general expenses
$0
Fundraising expenses
$0
Program service expenses (Part III)
$1,037,767

Program services were 100.0% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • MARK CLEMENT

    CHAIRPERSON

    Total calculated
    $2,292,310
    From this org
    $0
    From related orgs
    $2,219,557
    Other
    $72,753
    Hours/week
    1 + 60 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,575,958 related
    Bonus
    $0 + $606,615 related
    Other
    $0 + $36,984 related
    Deferred
    $0 + $47,735 related
    Nontaxable benefits
    $0 + $25,018 related
    Filer's total
    $0 + $2,292,310 related

  • ANDREW DEVOE

    TREASURER (END 2/24)

    Total calculated
    $1,209,124
    From this org
    $0
    From related orgs
    $1,121,641
    Other
    $87,483
    Hours/week
    1 + 60 related

    Schedule J breakdown matched by us

    Base
    $0 + $786,423 related
    Bonus
    $0 + $273,587 related
    Other
    $0 + $61,631 related
    Deferred
    $0 + $47,606 related
    Nontaxable benefits
    $0 + $39,877 related
    Filer's total
    $0 + $1,209,124 related

  • MARLA SILLIMAN

    PRESIDENT

    Total calculated
    $929,282
    From this org
    $0
    From related orgs
    $860,815
    Other
    $68,467
    Hours/week
    1 + 60 related

    Schedule J breakdown matched by us

    Base
    $0 + $630,713 related
    Bonus
    $0 + $183,544 related
    Other
    $0 + $46,558 related
    Deferred
    $0 + $55,871 related
    Nontaxable benefits
    $0 + $12,596 related
    Filer's total
    $0 + $929,282 related

  • JOHN WARD

    TRUSTEE

    Total calculated
    $933,371
    From this org
    $0
    From related orgs
    $850,111
    Other
    $83,260
    Hours/week
    1 + 60 related

    Schedule J breakdown matched by us

    Base
    $0 + $618,637 related
    Bonus
    $0 + $193,011 related
    Other
    $0 + $38,463 related
    Deferred
    $0 + $50,543 related
    Nontaxable benefits
    $0 + $32,717 related
    Filer's total
    $0 + $933,371 related

  • STEVE GRACEY

    SECRETARY

    Total calculated
    $830,534
    From this org
    $0
    From related orgs
    $744,735
    Other
    $85,799
    Hours/week
    1 + 60 related

    Schedule J breakdown matched by us

    Base
    $0 + $537,042 related
    Bonus
    $0 + $166,459 related
    Other
    $0 + $41,234 related
    Deferred
    $0 + $46,545 related
    Nontaxable benefits
    $0 + $39,254 related
    Filer's total
    $0 + $830,534 related

  • LINDA SMITH-BERRY

    EXECUTIVE DIRECTOR

    Total calculated
    $153,169
    From this org
    $0
    From related orgs
    $133,085
    Other
    $20,084
    Hours/week
    30 + 30 related

    Schedule J breakdown matched by us

    Base
    $0 + $107,097 related
    Bonus
    $0 + $18,073 related
    Other
    $0 + $7,915 related
    Deferred
    $0 + $9,016 related
    Nontaxable benefits
    $0 + $11,068 related
    Filer's total
    $0 + $153,169 related

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 4b · Supplemental nonqualified retirement plan

Answered no

  • 4a · Severance or change-of-control payment
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

PART I, LINE 4B
ELIGIBLE EXECUTIVES (GENERALLY VICE PRESIDENTS AND ABOVE) PARTICIPATE IN A PROGRAM THAT PROVIDES FOR SUPPLEMENTAL RETIREMENT BENEFITS. THE PAYMENT OF BENEFITS UNDER THE PROGRAM, IF ANY, IS ENTIRELY DEPENDENT UPON THE FACTS AND CIRCUMSTANCES UNDER WHICH THE EXECUTIVE TERMINATES EMPLOYMENT WITH THE ORGANIZATION. BENEFITS UNDER THE PROGRAM ARE UNFUNDED AND NON-VESTED. DUE TO THE SUBSTANTIAL RISK OF FORFEITURE PROVISION, THERE IS NO GUARANTEE THAT THESE EXECUTIVES WILL EVER RECEIVE ANY BENEFIT UNDER THE PROGRAM. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EXECUTIVE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. DURING THE 2023 CALENDAR YEAR, NONE OF THE INDIVIDUALS LISTED IN SCHEDULE J, PART II, RECEIVED A PAYMENT FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN WHICH WAS TREATED AS TAXABLE COMPENSATION BY TRIHEALTH, INC.
PART I, LINE 3:
TRIHEALTH, INC., A RELATED ORGANIZATION OF THE GOOD SAMARITAN HOSPITAL FREE CLINIC, USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR: * COMPENSATION COMMITTEE, * INDEPENDENT COMPENSATION CONSULTANT, * COMPENSATION SURVEY OR STUDY, AND * APPROVAL BY THE BOARD/COMPENSATION COMMITTEE.
PART I, LINE 4A:
THE REPORTABLE INDIVIDUALS OF THE GOOD SAMARITAN HOSPITAL FREE CLINIC ARE PAID BY TRIHEALTH, INC., A RELATED ORGANIZATION, RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE SECTION 501(A) AS AN ORGANIZATION DESCRIBED IN INTERNAL REVENUE CODE SECTION 501(C)(3). TRIHEALTH, INC. HAS A STANDARD EMPLOYEE SEVERANCE PACKAGE. GENERAL SEVERANCE PAY IS BASED ON LENGTH OF SERVICE. IN ADDITION, NOTICE PAY, IF APPLICABLE UNDER TRIHEALTH, INC. POLICY, MAY BE ADDED TO THE SEVERANCE PACKAGE AND THE AMOUNT OF NOTICE PAY WILL BE DETERMINED BY HUMAN RESOURCES IN ACCORDANCE WITH TRIHEALTH, INC. POLICY. PAYMENTS OF SEVERANCE ARE CONDITIONED UPON SIGNING A SEPARATION AND RELEASE AGREEMENT. DURING THE 2023 CALENDAR YEAR, NO REPORTABLE INDIVIDUAL(S) RECEIVED SEVERANCE PAYMENTS FROM TRIHEALTH, INC.

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

No itemized grants to organizations on this return.

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Provenance

Return type
form_990
Tax year
2023
Filed
13 May 2025
IRS schema version
2023v6.0
Source object
202501339349302495

Check it against the return as filed: the GivingTuesday Data Lake hosts a public copy of the original XML.

The source document this was parsed from is served over the API, which is where bulk and document access live.