← GOOD SAMARITAN HOSPITAL FOUNDATION INC

Form 990 for tax year 2022

Filed by GOOD SAMARITAN HOSPITAL FOUNDATION INC.

Totals

Total revenue: -$181,576
Total expenses: $636,449
Contributions and grants received: $290,877
Grants paid: $337,055
Program service revenue: $0
Investment income: -$568,043
Other revenue: $95,590
Total assets, end of year: $4,190,547
Total liabilities, end of year: $229
Net assets or fund balances, end of year: $4,190,318
Program services expenses (Part IX): $337,055
Management and general expenses: $168,747
Fundraising expenses: $130,648
Program service expenses (Part III): $337,055

Program services were 53.0% 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.

1a · Federated campaigns

$53,211
1b · Membership dues

$0
1c · Fundraising events

$0
1d · Related organizations

$0
1e · Government grants (contributions)

$0
1f · All other contributions, gifts and grants

$237,666
1g · Noncash contributions included above

$0
2a · Program service revenue

total $0 · related or exempt $0 · unrelated business $0 · excluded $0
2b · Program service revenue

total $0 · related or exempt $0 · unrelated business $0 · excluded $0
2c · Program service revenue

total $0 · related or exempt $0 · unrelated business $0 · excluded $0
2d · Program service revenue

total $0 · related or exempt $0 · unrelated business $0 · excluded $0
2e · Program service revenue

total $0 · related or exempt $0 · unrelated business $0 · excluded $0
2f · All other program service revenue

total $0 · related or exempt $0 · unrelated business $0 · excluded $0
3 · Investment income

total -$568,043 · related or exempt $0 · unrelated business $0 · excluded $0
4 · Income from investment of tax-exempt bond proceeds

total $0 · related or exempt $0 · unrelated business $0 · excluded $0
5 · Royalties

total $0 · related or exempt $0 · unrelated business $0 · excluded $0
6a · Gross rents

real property $0 · personal property $0
6b · Less rental expenses

real property $0 · personal property $0
6c · Rental income or loss

real property $0 · personal property $0
6d · Net rental income or loss

total $0 · related or exempt $0 · unrelated business $0 · excluded $0
7a · Gross sales of assets other than inventory

securities $0 · other assets $0
7b · Less cost or other basis and sales expenses

securities $0 · other assets $0
7c · Gain or loss

securities $0 · other assets $0
7d · Net gain or loss

total $0 · related or exempt $0 · unrelated business $0 · excluded $0
8a · Fundraising events: gross income

$119,558
8a · Fundraising events: contributions included on line 1c

$0
8b · Fundraising events: direct expenses

$23,968
8c · Net income from fundraising events

total $95,590 · unrelated business $0 · excluded $0
9a · Gaming: gross income

$0
9b · Gaming: direct expenses

$0
9c · Net income from gaming

total $0 · related or exempt $0 · unrelated business $0 · excluded $0
10a · Gross sales of inventory

$0
10b · Cost of goods sold

$0
10c · Net income from sales of inventory

total $0 · related or exempt $0 · unrelated business $0 · excluded $0
11a · Other revenue

total $0 · related or exempt $0 · unrelated business $0 · excluded $0
11b · Other revenue

total $0 · related or exempt $0 · unrelated business $0 · excluded $0
11c · Other revenue

total $0 · related or exempt $0 · unrelated business $0 · excluded $0
11d · All other revenue

total $0 · related or exempt $0 · unrelated business $0 · excluded $0
11e · Other revenue, total

$0

Functional expenses

Part IX, the statement of functional expenses.

1 · Grants to domestic organizations and governments

total $285,605 · program services $285,605
2 · Grants to domestic individuals

total $51,450 · program services $51,450
3 · Grants to foreign organizations and individuals

total $0 · program services $0
4 · Benefits paid to or for members

total $0 · program services $0
5 · Compensation of officers, directors and key employees

total $131,140 · program services $0 · management and general $52,456 · fundraising $78,684
6 · Compensation of disqualified persons

total $0 · program services $0 · management and general $0 · fundraising $0
7 · Other salaries and wages

total $24 · program services $0 · management and general $17 · fundraising $7
8 · Pension plan contributions

total $2,782 · program services $0 · management and general $1,113 · fundraising $1,669
9 · Other employee benefits

total $12,227 · program services $0 · management and general $4,891 · fundraising $7,336
10 · Payroll taxes

total $9,721 · program services $0 · management and general $3,888 · fundraising $5,833
11a · Fees: management

total $0 · program services $0 · management and general $0 · fundraising $0
11b · Fees: legal

total $0 · program services $0 · management and general $0 · fundraising $0
11c · Fees: accounting

total $0 · program services $0 · management and general $0 · fundraising $0
11d · Fees: lobbying

total $0 · program services $0 · management and general $0 · fundraising $0
11e · Fees: professional fundraising services

total $0 · fundraising $0
11f · Fees: investment management

total $19,576 · program services $0 · management and general $19,576 · fundraising $0
11g · Fees: other

total $0 · program services $0 · management and general $0 · fundraising $0
12 · Advertising and promotion

total $31,672 · program services $0 · management and general $0 · fundraising $31,672
13 · Office expenses

total $4,501 · program services $0 · management and general $1,981 · fundraising $2,521
14 · Information technology

total $4,644 · program services $0 · management and general $1,718 · fundraising $2,926
15 · Royalties

total $0 · program services $0 · management and general $0 · fundraising $0
16 · Occupancy

total $0 · program services $0 · management and general $0 · fundraising $0
17 · Travel

total $0 · program services $0 · management and general $0 · fundraising $0
18 · Travel or entertainment for public officials

total $0 · program services $0 · management and general $0 · fundraising $0
19 · Conferences, conventions and meetings

total $4,492 · program services $0 · management and general $4,492 · fundraising $0
20 · Interest

total $0 · program services $0 · management and general $0 · fundraising $0
21 · Payments to affiliates

total $0 · program services $0 · management and general $0 · fundraising $0
22 · Depreciation, depletion and amortization

total $125 · program services $0 · management and general $125 · fundraising $0
23 · Insurance

total $0 · program services $0 · management and general $0 · fundraising $0
24a · Other expenses: Dues

total $1,131 · program services $0 · management and general $1,131 · fundraising $0
24b · Other expenses: General Expense

total $67,438 · program services $0 · management and general $67,438 · fundraising $0
24c · Other expenses: Bond Premium

total $9,311 · program services $0 · management and general $9,311 · fundraising $0
24d · Other expenses: Books & Subscriptions

total $610 · program services $0 · management and general $610 · fundraising $0
24e · All other expenses

total $0 · program services $0 · management and general $0 · fundraising $0
26 · Joint costs (an allocation of the lines above)

total $0 · program services $0 · management and general $0 · fundraising $0

Balance sheet

Part X, book values.

1 · Cash, non-interest-bearing

beginning of year $213,917 · end of year $381,535
2 · Savings and temporary cash investments

beginning of year $397,495 · end of year $89,663
3 · Pledges and grants receivable

beginning of year $0 · end of year $0
4 · Accounts receivable

beginning of year $0 · end of year $0
5 · Loans and receivables from officers and key people

beginning of year $0 · end of year $0
6 · Loans and receivables from disqualified persons

beginning of year $0 · end of year $0
7 · Other notes and loans receivable

beginning of year $0 · end of year $0
8 · Inventories for sale or use

beginning of year $0 · end of year $0
9 · Prepaid expenses and deferred charges

beginning of year $0 · end of year $0
10a · Land, buildings and equipment: cost or other basis

$45,473
10b · Land, buildings and equipment: accumulated depreciation

$45,159
10c · Land, buildings and equipment, net

beginning of year $440 · end of year $314
11 · Investments: publicly traded securities

beginning of year $3,998,806 · end of year $3,719,035
12 · Investments: other securities

beginning of year $0 · end of year $0
13 · Investments: program-related

beginning of year $0 · end of year $0
14 · Intangible assets

beginning of year $0 · end of year $0
15 · Other assets

beginning of year $0 · end of year $0
17 · Accounts payable and accrued expenses

beginning of year -$206,704 · end of year $229
18 · Grants payable

beginning of year $0 · end of year $0
19 · Deferred revenue

beginning of year $0 · end of year $0
20 · Tax-exempt bond liabilities

beginning of year $0 · end of year $0
21 · Escrow or custodial account liability

beginning of year $0 · end of year $0
22 · Loans and payables to officers and key people

beginning of year $0 · end of year $0
23 · Secured mortgages and notes payable

beginning of year $0 · end of year $0
24 · Unsecured notes and loans payable

beginning of year $0 · end of year $0
25 · Other liabilities

beginning of year $0 · end of year $0
29 · Capital stock, trust principal or current funds

beginning of year $5,505,110 · end of year $5,696,080
30 · Paid-in or capital surplus, or land, building or equipment fund

beginning of year $0 · end of year $0
31 · Retained earnings, endowment or other funds

beginning of year -$687,748 · end of year -$1,505,762

Mission and programs · 2022

Mission

Provide excellent health care by promoting wellness education and healing through trusting relationships.

Activities or mission (Part I)

The mission of Good Samaritan Hospital Foundation is to raise private philanthropic support for Good Samaritan Hospital its programs and services and to assure the continuation of the delivery of the highest quality medical and health care services that our community deserves and has come to expect. The services assist with charity care activities to assist the patients and families provide equipment and educational opportunities for clinical staff

Provides support for Good Samaritan Hospital's programs and services. Services assist with charity care activities to assist the patients and their families and also provides equipment and educational opportunities for clinical staff.

Expenses $337,055

As filed on the 2022 return.

Listed in Part VII

Helen Seirp

President

Total calculated

$0

Hours/week

0.25
Patty Summers

Vice President

Total calculated

$0

Hours/week

0.25
Gregg Strum

Interim Treasurer

Total calculated

$0

Hours/week

0.25
Regina McCord Fithian

Secretary

Total calculated

$0

Hours/week

0.25
Joyce Villwock

Board Member

Total calculated

$0

Hours/week

0.25
Robert McLin

Board Member

Total calculated

$0

Hours/week

0.25
Dave Miller

Board Member

Total calculated

$0

Hours/week

0.25
Cindy Moore

Board Member

Total calculated

$0

Hours/week

0.25
Patty Niehaus

Board Member

Total calculated

$0

Hours/week

0.25
Tiffany Conover

Board Member

Total calculated

$0

Hours/week

0.25
Linda Rice

Board Member

Total calculated

$0

Hours/week

0.25
Anne Hedde

Board Member

Total calculated

$0

Hours/week

0.25
Carson Thacker

Board Member

Total calculated

$0

Hours/week

0.25
Lowell Stoelting

Board Member

Total calculated

$0

Hours/week

0.25
Dr Austin Muranaka

Board Member

Total calculated

$0

Hours/week

0.25
Patricia Buntrock

Board Member

Total calculated

$0

Hours/week

0.25
Roy Ice

Board Member

Total calculated

$0

Hours/week

0.25
Nicole Coomer

Director

Total calculated

$74,833

From this org

$74,833

From related orgs

$0

Other

$0

Hours/week

40
Tina Meeks

Business Relations Development Coordinator

Total calculated

$50,905

From this org

$50,905

From related orgs

$0

Other

$0

Hours/week

40
Gary Hackney

Director

Total calculated

$1,299

From this org

$1,299

From related orgs

$0

Other

$0

Hours/week

0

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.

Grants on this return

Good Samaritan Hospital

$75,300

health care

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.

Good Samaritan Hospital

501(C)(3) · Healthcare · IN

Provenance

Return type: form_990
Tax year: 2022
Filed: 3 November 2023
IRS schema version: 2022v5.0
Source object: 202313079349300106

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