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Nonprofiteer
← GOOD SAMARITAN HOSPITAL FREE CLINIC

Form 990 for tax year 2024

Filed by GOOD SAMARITAN HOSPITAL FREE CLINIC.

Totals

Total revenue
$1,051,008
Total expenses
$1,133,550
Contributions and grants received
$1,051,008
Grants paid
$17,507
Program service revenue
$0
Investment income
$0
Other revenue
$0
Total assets, end of year
$4,413,872
Total liabilities, end of year
$0
Net assets or fund balances, end of year
$4,413,872
Program services expenses (Part IX)
$1,133,550
Management and general expenses
$0
Fundraising expenses
$0
Program service expenses (Part III)
$1,133,550

Program services were 100.0% 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.

  • 1d · Related organizations

    $20,000

  • 1f · All other contributions, gifts and grants

    $1,031,008

Functional expenses

Part IX, the statement of functional expenses.

  • 2 · Grants to domestic individuals

    total $17,507 · program services $17,507

  • 11g · Fees: other

    total $603 · program services $603

  • 12 · Advertising and promotion

    total $1,730 · program services $1,730

  • 13 · Office expenses

    total $3,917 · program services $3,917

  • 14 · Information technology

    total $2,080 · program services $2,080

  • 16 · Occupancy

    total $63,667 · program services $63,667

  • 17 · Travel

    total $481 · program services $481

  • 19 · Conferences, conventions and meetings

    total $1,378 · program services $1,378

  • 24a · Other expenses: PAYROLL MANAGEMENT

    total $892,559 · program services $892,559

  • 24b · Other expenses: MEDICAL SUPPLIES

    total $127,567 · program services $127,567

  • 24c · Other expenses: EQUIPMENT

    total $14,084 · program services $14,084

  • 24d · Other expenses: RENOVATION EXP

    total $2,000 · program services $2,000

  • 24e · All other expenses

    total $5,977 · program services $5,977

Balance sheet

Part X, book values.

  • 15 · Other assets

    beginning of year $4,739,220 · end of year $4,413,872

  • 27 · Net assets without donor restrictions

    beginning of year $1,438,151 · end of year $1,355,609

  • 28 · Net assets with donor restrictions

    beginning of year $3,301,069 · end of year $3,058,263

Mission and programs · 2024

Mission

SEE SCHEDULE O

Activities or mission (Part I)

TO PROVIDE FREE HEALTH CARE TO THOSE WHO DON'T HAVE HEALTH INSURANCE NOR HAVE MEDICAID COVERAGE.

  • SEE SCHEDULE O

    Expenses $1,133,550 · Grants $17,507

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

Listed in Part VII

  • MARK CLEMENT

    CHAIRPERSON

    Total calculated
    $2,633,757
    From this org
    $0
    From related orgs
    $2,558,073
    Other
    $75,684
    Hours/week
    1 + 60 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,651,024 related
    Bonus
    $0 + $769,875 related
    Other
    $0 + $137,174 related
    Deferred
    $0 + $49,708 related
    Nontaxable benefits
    $0 + $25,976 related
    Filer's total
    $0 + $2,633,757 related

  • MIKE CROFTON

    TREASURER (START 7/24)

    Total calculated
    $606,906
    From this org
    $0
    From related orgs
    $524,900
    Other
    $82,006
    Hours/week
    1 + 60 related

    Schedule J breakdown matched by us

    Base
    $0 + $342,253 related
    Bonus
    $0 + $176,187 related
    Other
    $0 + $6,460 related
    Deferred
    $0 + $54,214 related
    Nontaxable benefits
    $0 + $27,792 related
    Filer's total
    $0 + $606,906 related

  • MARLA SILLIMAN

    PRESIDENT

    Total calculated
    $942,678
    From this org
    $0
    From related orgs
    $881,524
    Other
    $61,154
    Hours/week
    1 + 60 related

    Schedule J breakdown matched by us

    Base
    $0 + $663,789 related
    Bonus
    $0 + $186,748 related
    Other
    $0 + $30,987 related
    Deferred
    $0 + $48,110 related
    Nontaxable benefits
    $0 + $13,044 related
    Filer's total
    $0 + $942,678 related

  • JOHN WARD

    TRUSTEE

    Total calculated
    $969,215
    From this org
    $0
    From related orgs
    $881,518
    Other
    $87,697
    Hours/week
    1 + 60 related

    Schedule J breakdown matched by us

    Base
    $0 + $652,260 related
    Bonus
    $0 + $186,317 related
    Other
    $0 + $42,941 related
    Deferred
    $0 + $53,324 related
    Nontaxable benefits
    $0 + $34,373 related
    Filer's total
    $0 + $969,215 related

  • STEVE GRACEY

    SECRETARY

    Total calculated
    $849,776
    From this org
    $0
    From related orgs
    $759,998
    Other
    $89,778
    Hours/week
    1 + 60 related

    Schedule J breakdown matched by us

    Base
    $0 + $593,047 related
    Bonus
    $0 + $163,198 related
    Other
    $0 + $3,753 related
    Deferred
    $0 + $48,110 related
    Nontaxable benefits
    $0 + $41,668 related
    Filer's total
    $0 + $849,776 related

  • LINDA SMITH-BERRY

    EXECUTIVE DIRECTOR

    Total calculated
    $166,758
    From this org
    $0
    From related orgs
    $145,113
    Other
    $21,645
    Hours/week
    30 + 30 related

    Schedule J breakdown matched by us

    Base
    $0 + $112,785 related
    Bonus
    $0 + $16,637 related
    Other
    $0 + $15,691 related
    Deferred
    $0 + $10,113 related
    Nontaxable benefits
    $0 + $11,532 related
    Filer's total
    $0 + $166,758 related

  • ANDREW DEVOE

    FORMER OFFICER

    Total calculated
    $271,957
    From this org
    $0
    From related orgs
    $239,052
    Other
    $32,905
    Hours/week
    0

    Schedule J breakdown matched by us

    Base
    $0 + $129,459 related
    Bonus
    $0
    Other
    $0 + $109,593 related
    Deferred
    $0 + $18,521 related
    Nontaxable benefits
    $0 + $14,384 related
    Filer's total
    $0 + $271,957 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)

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 2024 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 2024 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.

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
13 May 2026
IRS schema version
2024v5.5
Source object
202601339349301315

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