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Nonprofiteer
← GOOD SAMARITAN REGIONAL HEALTH CENTER FOUNDATION

Form 990 for tax year 2024

Filed by GOOD SAMARITAN REGIONAL HEALTH CENTER FOUNDATION.

Totals

Total revenue
$762,377
Total expenses
$301,193
Contributions and grants received
$320,124
Grants paid
$159,224
Program service revenue
$142,794
Investment income
$310,875
Other revenue
-$11,416
Total assets, end of year
$4,353,647
Total liabilities, end of year
$108,875
Net assets or fund balances, end of year
$4,244,772
Program services expenses (Part IX)
$159,224
Management and general expenses
$0
Fundraising expenses
$141,969
Program service expenses (Part III)
$159,224

Program services were 52.9% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 1c · Fundraising events

    $71,055

  • 1d · Related organizations

    $65,000

  • 1e · Government grants (contributions)

    $100

  • 1f · All other contributions, gifts and grants

    $183,969

  • 1g · Noncash contributions included above

    $5,000

  • 2f · All other program service revenue

    total $142,794 · related or exempt $142,794

  • 3 · Investment income

    total $102,525 · excluded $102,525

  • 7a · Gross sales of assets other than inventory

    securities $208,350

  • 7b · Less cost or other basis and sales expenses

    securities $0

  • 7c · Gain or loss

    securities $208,350

  • 7d · Net gain or loss

    total $208,350 · excluded $208,350

  • 8a · Fundraising events: gross income

    $8,310

  • 8a · Fundraising events: contributions included on line 1c

    $71,055

  • 8b · Fundraising events: direct expenses

    $19,726

  • 8c · Net income from fundraising events

    total -$11,416 · excluded -$11,416

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $151,568 · program services $151,568

  • 2 · Grants to domestic individuals

    total $7,656 · program services $7,656

  • 7 · Other salaries and wages

    total $96,433 · fundraising $96,433

  • 10 · Payroll taxes

    total $7,926 · fundraising $7,926

  • 11g · Fees: other

    total $18,679 · fundraising $18,679

  • 12 · Advertising and promotion

    total $9,584 · fundraising $9,584

  • 13 · Office expenses

    total $1,433 · fundraising $1,433

  • 16 · Occupancy

    total $2,500 · fundraising $2,500

  • 17 · Travel

    total $1,340 · fundraising $1,340

  • 19 · Conferences, conventions and meetings

    total $704 · fundraising $704

  • 24a · Other expenses: OTHER EXPENSES

    total $1,933 · fundraising $1,933

  • 24b · Other expenses: BANK FEES

    total $915 · fundraising $915

  • 24c · Other expenses: TAXES

    total $522 · fundraising $522

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $717,482 · end of year $302,109

  • 2 · Savings and temporary cash investments

    beginning of year $1,669,626 · end of year $1,842,980

  • 3 · Pledges and grants receivable

    beginning of year $172,327 · end of year $152,577

  • 12 · Investments: other securities

    beginning of year $753,882 · end of year $1,639,140

  • 15 · Other assets

    beginning of year $416,841 · end of year $416,841

  • 25 · Other liabilities

    beginning of year $6,337 · end of year $108,875

  • 27 · Net assets without donor restrictions

    beginning of year $1,881,868 · end of year $2,249,215

  • 28 · Net assets with donor restrictions

    beginning of year $1,841,953 · end of year $1,995,557

Mission and programs · 2024

Mission

THROUGH OUR EXCEPTIONAL HEALTHCARE SERVICES, WE REVEAL THE HEALING PRESENCE OF GOD.

Activities or mission (Part I)

TO PROVIDE SUPPORT TO SSM HEALTH GOOD SAMARITAN HOSPITAL - MT. VERNON IN SUPPORT OF THEIR MISSION TO CONTINUE THE HEALING MINISTRY OF JESUS CHRIST BY IMPROVING REGIONAL QUALITY HEALTH SERVICES FOR EVERYONE.

  • PROVIDED PROGRAM AND CAPITAL SUPPORT TO THE HEALTHCARE INITIATIVES OF SSM HEALTH GOOD SAMARITAN HOSPITAL - MT. VERNON. PLEASE SEE SCHEDULE O FOR A COMPLETE DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS.

    Expenses $159,224 · Grants $159,224 · Revenue $142,794

As filed on the 2024 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • CAROL HAMERSKI

    TRUSTEE & SEC/TREAS

    Total calculated
    $0
    Hours/week
    1

  • BILL BECK

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • HUNT BONAN

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • REX CUSUMANO

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • NORMA FAIRCHILD

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • DR JOHNNY KAUSHAL

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • MICHAEL KROESCHEN

    TRUSTEE & CHAIRPERSON

    Total calculated
    $0
    Hours/week
    1

  • DR WES NEAL

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • MARCIA SCOTT

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • BRYAN STIREWALT

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • DARLA WEXSTTEN

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • LINDSEY BOWLIN

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • JEFF HAARMAN

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • ALICIA WOODWARD

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • DAMON HARBISON

    EX-OFFICIO-VOTE & HOSPITAL PRES

    Total calculated
    $796,069
    From this org
    $0
    From related orgs
    $575,496
    Other
    $220,573
    Hours/week
    1 + 55 related

    Schedule J breakdown matched by us

    Base
    $0 + $420,997 related
    Bonus
    $0 + $122,672 related
    Other
    $0 + $31,827 related
    Deferred
    $0 + $166,694 related
    Nontaxable benefits
    $0 + $53,879 related
    Filer's total
    $0 + $796,069 related

  • JEREMY FOTHERINGHAM

    EX-OFFICIO-VOTE & REGIONAL PRES

    Total calculated
    $1,940,338
    From this org
    $0
    From related orgs
    $1,310,180
    Other
    $630,158
    Hours/week
    1 + 55 related

    Schedule J breakdown matched by us

    Base
    $0 + $837,601 related
    Bonus
    $0 + $470,869 related
    Other
    $0 + $1,710 related
    Deferred
    $0 + $589,116 related
    Nontaxable benefits
    $0 + $41,042 related
    Filer's total
    $0 + $1,940,338 related

  • DOUGLAS LONG

    ASST SECRETARY & CLO OF SSM HEALTH

    Total calculated
    $2,287,921
    From this org
    $0
    From related orgs
    $1,587,150
    Other
    $700,771
    Hours/week
    1 + 55 related

    Schedule J breakdown matched by us

    Base
    $0 + $813,979 related
    Bonus
    $0 + $583,198 related
    Other
    $0 + $189,973 related
    Deferred
    $0 + $676,547 related
    Nontaxable benefits
    $0 + $24,224 related
    Filer's total
    $0 + $2,287,921 related

  • JOHN SNODSMITH

    REGIONAL VP FINANCE

    Total calculated
    $410,246
    From this org
    $0
    From related orgs
    $320,127
    Other
    $90,119
    Hours/week
    1 + 55 related

    Schedule J breakdown matched by us

    Base
    $0 + $264,636 related
    Bonus
    $0 + $40,328 related
    Other
    $0 + $15,163 related
    Deferred
    $0 + $59,973 related
    Nontaxable benefits
    $0 + $30,146 related
    Filer's total
    $0 + $410,246 related

  • KATHLEEN ZIBBY-DAMRON

    EXECUTIVE DIRECTOR

    Total calculated
    $206,888
    From this org
    $0
    From related orgs
    $168,593
    Other
    $38,295
    Hours/week
    20 + 20 related

    Schedule J breakdown matched by us

    Base
    $0 + $152,824 related
    Bonus
    $0 + $15,073 related
    Other
    $0 + $696 related
    Deferred
    $0 + $21,365 related
    Nontaxable benefits
    $0 + $16,930 related
    Filer's total
    $0 + $206,888 related

  • KAREN REWERTS

    FMR OFFICER & SYSTEM VP FINANCE

    Total calculated
    $1,080,323
    From this org
    $0
    From related orgs
    $845,480
    Other
    $234,843
    Hours/week
    0 + 55 related

    Schedule J breakdown matched by us

    Base
    $0 + $601,026 related
    Bonus
    $0 + $176,014 related
    Other
    $0 + $68,440 related
    Deferred
    $0 + $198,391 related
    Nontaxable benefits
    $0 + $36,452 related
    Filer's total
    $0 + $1,080,323 related

  • MATTHEW KINSELLA

    FMR OFFICER & REGIONAL VP FINANCE

    Total calculated
    $736,408
    From this org
    $0
    From related orgs
    $561,331
    Other
    $175,077
    Hours/week
    0 + 55 related

    Schedule J breakdown matched by us

    Base
    $0 + $417,285 related
    Bonus
    $0 + $101,437 related
    Other
    $0 + $42,609 related
    Deferred
    $0 + $132,986 related
    Nontaxable benefits
    $0 + $42,091 related
    Filer's total
    $0 + $736,408 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, and on a Form 990-PF Part VIII's — 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)

SCHEDULE J, PART I, LINE 3
THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL, (EXECUTIVE DIRECTOR), IS COMPENSATED BY A RELATED ORGANIZATION THAT UTILIZED THE FOLLOWING TO DETERMINE COMPENSATION: (1) INDEPENDENT COMPENSATION CONSULTANT; (2) COMPENSATION SURVEY OR STUDY; (3) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE.
SCHEDULE J, PART I, LINE 4B
PENSION RESTORATION PLAN: SSM HEALTH (SSMH) PROVIDES THIS SUPPLEMENTAL DEFINED BENEFIT NONQUALIFIED RETIREMENT PLAN TO ANY EMPLOYEE WHO IS A PARTICIPANT IN THE SSMH QUALIFIED DEFINED BENEFIT PLAN WHO EARNS OVER THE INTERNAL REVENUE SERVICE COMPENSATION LIMIT. THE PLAN "RESTORES" THE BENEFITS TO THESE EMPLOYEES THAT WOULD HAVE BEEN PROVIDED UNDER THE SSMH QUALIFIED PLAN IF THE REGULATIONS DID NOT IMPOSE COMPENSATION LIMITS. AN INDIVIDUAL CAN TAKE A DISTRIBUTION FROM THE PLAN AT (1) AGE 65 OR OLDER IF THE INDIVIDUAL IS STILL EMPLOYED BY SSMH OR (2) AGE 55 OR OLDER IF THE INDIVIDUAL IS NO LONGER EMPLOYED BY SSMH. NO INDIVIDUALS LISTED ON PART VII OF FORM 990 RECEIVED DISTRIBUTIONS FROM THE PLAN IN 2024. CAPITAL ACCUMULATION PLAN: SSMH PROVIDES THIS SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN TO EXECUTIVE LEVEL EMPLOYEES. THE ORGANIZATION CONTRIBUTED A PERCENTAGE OF THE EMPLOYEE'S BASE SALARY INTO THEIR CHOICE OF A SELECT LIST OF INVESTMENTS. THE DEPOSITS AND EARNINGS OF THE PLAN ARE OWNED BY SSMH AND ARE TAX-DEFERRED UNTIL A DISTRIBUTION IS MADE TO THE EMPLOYEE. IN ADDITION, THE PLAN HAS SPECIAL SAFEGUARDS IN PLACE TO PROTECT THE FUNDS FROM CONTINGENCIES, OTHER THAN INSOLVENCY. FOR CONTRIBUTIONS MADE TO THE PLAN IN 2014 OR AFTER, THE DISTRIBUTION WILL OCCUR AFTER THE COMPLETION OF FOUR PLAN YEARS FOR ALL EXECUTIVES THAT ARE STILL ACTIVELY EMPLOYED ON THE DISTRIBUTION DATE. ANY ACTIVE PARTICIPANT 65 YEARS OR OLDER WILL RECEIVE THE CONTRIBUTION IN THE CURRENT YEAR. THE FOLLOWING INDIVIDUALS LISTED ON PART VII OF THE FORM 990 RECEIVED DISTRIBUTIONS FROM THIS PLAN IN 2024. ALL DISTRIBUTIONS RECEIVED FROM THE PLAN IN THE CURRENT YEAR WERE INCLUDED IN THE INDIVIDUAL'S TAXABLE COMPENSATION. KAREN REWERTS $60,917 MATT KINSELLA - $41,165 JOHN SNODSMITH - $14,284 DAMON HARBISON - $30,371

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

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.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Related partnerships

Part III: related organizations taxable as a partnership, with the filer's share.

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

Provenance

Return type
form_990
Tax year
2024
Filed
17 November 2025
IRS schema version
2024v5.2
Source object
202503219349317715

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