Civic Intelligence

Good Samaritan Free Clinic

EIN 32-0024376 • 501(c)3 • Rock Island, IL

Profile

MEDICAL SERVICES

2570 24th Street No 127Rock Island, IL 61201

www.goodsamaritanfreeclinic.org

Siviq Scores

Precomputed percentiles relative to similar nonprofits. These scores are descriptive rather than judgmental.

Liabilities / Assets

Score unavailable

No value available

Liabilities-to-assets requires both liabilities and assets on the latest valid filing.

Source year 2014

Liabilities / Revenue

62nd percentile

0.00x

Tied with the lowest-debt nonprofits in its peer group.

501(c)3 • <$500k nonprofits • Source year 2014

Net Margin

3rd percentile

-1041%

Higher net margin than 3% of similar nonprofits.

501(c)3 • <$500k nonprofits • Source year 2014

Top Officer Pay

81st percentile

$0

Higher top officer pay than 81% of similar nonprofits.

Top officer pay equals 0.0% of source-year revenue.

501(c)3 • <$500k nonprofits • Source year 2014

Asset Growth

10th percentile

-100%

Faster asset growth than 10% of similar nonprofits.

501(c)3 • <$500k nonprofits • Annualized from 2013 to 2014

Revenue Growth

7th percentile

-89%

Faster revenue growth than 7% of similar nonprofits.

501(c)3 • <$500k nonprofits • Annualized from 2013 to 2014

Balance Sheet
Liabilities / AssetsScore unavailable

Assets

Down

$0

Down $40,265 (-100%) from 2013

Liabilities

Down

$0

Down $975 (-100%) from 2013

Net Assets

Down

$0

Down $39,290 (-100%) from 2013

Operations
Liabilities / Revenue62nd percentileNet Margin3rd percentile

Revenue

Down

$1,236

Down $10,140 (-89%) from 2013

Expenses

Down

$14,105

Down $19,639 (-58%) from 2013

Net Income

Up

-$12,869

Up $9,499 (+42%) from 2013

Trend Graphs

Balance Sheet Trend

Asset Growth10th percentile

Grouped bars show assets, liabilities, and net assets across loaded filings.

$60K$40K$20K$0Assets 2013: $40,265Liabilities 2013: $975Net Assets 2013: $39,2902013Assets 2014: $0Liabilities 2014: $0Net Assets 2014: $02014

Highlighted filing

2014

Assets$0
Liabilities$0
Net Assets$0
Open 2014 Filing

Operations Trend

Revenue Growth7th percentile

Revenue, expenses, and net income by year, with the latest filing highlighted.

$40K$20K$0-$20K-$40KRevenue 2013: $11,376Expenses 2013: $33,744Net Income 2013: -$22,3682013Revenue 2014: $1,236Expenses 2014: $14,105Net Income 2014: -$12,8692014

Highlighted filing

2014

Revenue$1,236
Expenses$14,105
Net Income-$12,869
Open 2014 Filing

Filings

Most recent year

2014 • Form 990EZDetailed filing. Detailed filing data is available for this year.

Open filing
Assets
$0
Liabilities
$0
Net assets
$0
Revenue
$1,236
Expenses
$14,105
Net income
-$12,869
Balance SheetOperations
YearAssetsLiabilitiesNet AssetsRevenueExpensesNet Income
2014Detailed filing. Detailed filing data is available for this year.$0.00$0.00$0.00$1.24$14.1$12.9
2013Detailed filing. Detailed filing data is available for this year.$40.3$0.98$39.3$11.4$33.7$22.4
Latest Filing Detail
Jump To
Filing Snapshot
Filing Period
Jan 1, 2014 to Dec 31, 2014
Signed
Aug 10, 2015
Return Version
2014v5.0
Gross Receipts
$1,236
Mission and Program Overview

Mission

MEDICAL SERVICES

Program Services

DescriptionGrantsExpenses
PROVIDE MEDICAL OFFICE VISITS FOR INDIVIDUALS WHO DO NOT HAVE MEDICAL INSURANCE AND DO NOT QUALIFY FOR STATE OR FEDERAL MEDICAL ASSISTANCE PROGRAMS$0$9,593
Compensation and Service Providers
Top Officer Pay81st percentile

Employees

NameTitleFull / Part TimeBaseOtherTotal
KERRY HUMESSecretary/Treasurer-$0--
REGINA BOLLAERTPresident-$0--
DEBBIE BECHTVice President-$0--
KEVIN KURTHDirector-$0--
JAY WILLSHURDirector-$0--
SUE HONSEDirector-$0--
ZIGRID ZAEHRINGERDirector-$0--
ALEXIA PATRAMANISDirector-$0--
LINDA GUEBERTDirector-$0--
Filing and Contact Details

Filer

Filer Name
Good Samaritan Free Clinic
EIN
32-0024376
Phone
3097214156
Address
2570 24TH STREET NO 127, ROCK ISLAND, IL 61201

Signing Officer

Name
Kerry Humes
Title
Treasurer
Phone
3097214156
Signed
2015-08-10
Discuss with paid preparer
Yes

Preparer

Firm
Carpentier Mitchell Goddard & Co LLC
Address
4915 21ST AVE A, MOLINE, IL 61265
Preparer
James E Taylor
Phone
3097623626
Supplemental Narrative

Additional Explanations

Form 990-ez, Part I, Line 4 - Other Investment Income

“Description: investment income. Amount: 1.”

Form 990-ez, Part I, Line 16 - Other Expenses

“Description: insurance. Amount: 500. Description: supplies. Amount: 209. Description: reimbursement. Amount: 5,656. Description: staff development. Amount: 1,952. Description: other expenses and fees. Amount: 412. Total to form 990-ez, line 16: 8,729.”

Form 990-ez, Part I, Line 20 - Other Changes in Net Assets

“Description: dissolution of the organization. Amount: -26,421.”

Form 990-ez, Part II, Line 26 - Other Liabilities

“Description: grants payable. Beg. Of year amount: 975. End of year amount: 0.”

Raw XML Appendix224 raw XML fields

This appendix keeps the raw XML leaves available for debugging and edge-case review. The human report above is the primary experience.

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IRS990EZ/OfficerDirectorTrusteeEmplGrp/TitleTxt0SECRETARY/TREASURER
IRS990EZ/OfficerDirectorTrusteeEmplGrp/TitleTxt1PRESIDENT
IRS990EZ/OfficerDirectorTrusteeEmplGrp/TitleTxt2VICE PRESIDENT
IRS990EZ/OfficerDirectorTrusteeEmplGrp/TitleTxt3DIRECTOR
IRS990EZ/OfficerDirectorTrusteeEmplGrp/TitleTxt4DIRECTOR
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IRS990EZ/OfficerDirectorTrusteeEmplGrp/TitleTxt6DIRECTOR
IRS990EZ/OfficerDirectorTrusteeEmplGrp/TitleTxt7DIRECTOR
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IRS990EZ/OperateHospitalInd00
IRS990EZ/Organization501c3Ind0X
IRS990EZ/OrganizationDissolvedEtcInd01
IRS990EZ/OrganizationHadUBIInd00
IRS990EZ/OtherChangesInNetAssetsAmt0-26421
IRS990EZ/OtherExpensesTotalAmt08729
IRS990EZ/PartVIHghstPdCntrctProfSrvcTxt0NONE
IRS990EZ/PartVIOfCompOfHghstPdEmplTxt0NONE
IRS990EZ/PoliticalCampaignActyInd00
IRS990EZ/PrimaryExemptPurposeTxt0MEDICAL SERVICES
IRS990EZ/PrintingPublicationsPostageAmt0149
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IRS990EZ/ProgramSrvcAccomplishmentGrp/GrantsAndAllocationsAmt00
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IRS990EZ/ProhibitedTaxShelterTransInd00
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IRS990EZ/SalariesOtherCompEmplBnftAmt03937
IRS990EZ/ScheduleBNotRequiredInd0X
IRS990EZ/SchoolOperatingInd00
IRS990EZ/StatesWhereCopyOfReturnIsFldCd0IL
IRS990EZ/SubjectToProxyTaxInd00
IRS990EZ/SumOfTotalLiabilitiesGrp/BOYAmt0975
IRS990EZ/SumOfTotalLiabilitiesGrp/EOYAmt00
IRS990EZ/TanningServicesProvidedInd00
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IRS990EZ/TaxReimbursedByOrganizationAmt00
IRS990EZ/TotalExpensesAmt014105
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IRS990EZ/TotalRevenueAmt01236
IRS990EZ/TrnsfrExmptNonChrtblRltdOrgInd00
IRS990EZ/TypeOfOrganizationCorpInd0X
IRS990EZ/WebsiteAddressTxt0WWW.GOODSAMARITANFREECLINIC.ORG
IRS990ScheduleA/AmountsRcvdDsqlfyPersonGrp/TotalAmt00
IRS990ScheduleA/GiftsGrantsContrisRcvd509Grp/CurrentTaxYearAmt01235
IRS990ScheduleA/GiftsGrantsContrisRcvd509Grp/CurrentTaxYearMinus1YearAmt08684
IRS990ScheduleA/GiftsGrantsContrisRcvd509Grp/CurrentTaxYearMinus2YearsAmt012392
IRS990ScheduleA/GiftsGrantsContrisRcvd509Grp/CurrentTaxYearMinus3YearsAmt070129
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IRS990ScheduleN/AssetsDistributedInd00
IRS990ScheduleN/AttorneyGeneralNotifiedInd00
IRS990ScheduleN/BondsOutstandingInd00
IRS990ScheduleN/DirectorOfSuccessorInd00
IRS990ScheduleN/EmployeeOfSuccessorInd00
IRS990ScheduleN/LiabilitiesPaidInd00
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/AssetsDistriOrExpnssPaidDesc0CASH
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/BusinessName/BusinessNameLine1Txt0TRINITY HEALTH FOUNDATION
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/DistributionDt02014-12-31
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/EIN0363321751
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IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/MethodOfFMVDeterminationTxt0ACCOUNT BALANCE (CHECKING AND SAVINGS)
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IRS990ScheduleN/SupplementalInformationDetail/FormAndLineReferenceDesc0PART II, LINE 2E:
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0DESCRIPTION: INVESTMENT INCOME. AMOUNT: 1.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1DESCRIPTION: INSURANCE. AMOUNT: 500. DESCRIPTION: SUPPLIES. AMOUNT: 209. DESCRIPTION: REIMBURSEMENT. AMOUNT: 5,656. DESCRIPTION: STAFF DEVELOPMENT. AMOUNT: 1,952. DESCRIPTION: OTHER EXPENSES AND FEES. AMOUNT: 412. TOTAL TO FORM 990-EZ, LINE 16: 8,729.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt2DESCRIPTION: DISSOLUTION OF THE ORGANIZATION. AMOUNT: -26,421.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt3DESCRIPTION: GRANTS PAYABLE. BEG. OF YEAR AMOUNT: 975. END OF YEAR AMOUNT: 0.
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc0FORM 990-EZ, PART I, LINE 4 - OTHER INVESTMENT INCOME
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc1FORM 990-EZ, PART I, LINE 16 - OTHER EXPENSES
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc2FORM 990-EZ, PART I, LINE 20 - OTHER CHANGES IN NET ASSETS
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc3FORM 990-EZ, PART II, LINE 26 - OTHER LIABILITIES
TransferPrsnlBnftContractsDecl/DeclarationDesc0THE ORGANIZATION DID NOT, DURING THE YEAR, RECEIVE ANY FUNDS, DIRECTLY,OR INDIRECTLY, TO PAY PREMIUMS ON A PERSONAL BENEFIT CONTRACT.THE ORGANIZATION, DID NOT, DURING THE YEAR, PAY ANY PREMIUMS, DIRECTLY,OR INDIRECTLY, ON A PERSONAL BENEFIT CONTRACT.
ReturnHeader/BuildTS02016-02-25 16:41:14Z
ReturnHeader/BusinessOfficerGrp/DiscussWithPaidPreparerInd01
ReturnHeader/BusinessOfficerGrp/PersonNm0KERRY HUMES
ReturnHeader/BusinessOfficerGrp/PersonTitleTxt0TREASURER
ReturnHeader/BusinessOfficerGrp/PhoneNum03097214156
ReturnHeader/BusinessOfficerGrp/SignatureDt02015-08-10
ReturnHeader/Filer/BusinessName/BusinessNameLine1Txt0GOOD SAMARITAN FREE CLINIC
ReturnHeader/Filer/BusinessNameControlTxt0GOOD
ReturnHeader/Filer/EIN0320024376
ReturnHeader/Filer/PhoneNum03097214156
ReturnHeader/Filer/USAddress/AddressLine1Txt02570 24TH STREET NO 127
ReturnHeader/Filer/USAddress/CityNm0ROCK ISLAND
ReturnHeader/Filer/USAddress/StateAbbreviationCd0IL
ReturnHeader/Filer/USAddress/ZIPCd061201
ReturnHeader/PreparerFirmGrp/PreparerFirmEIN0421192621
ReturnHeader/PreparerFirmGrp/PreparerFirmName/BusinessNameLine1Txt0CARPENTIER MITCHELL GODDARD & CO LLC
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/AddressLine1Txt04915 21ST AVE A
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/CityNm0MOLINE
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/StateAbbreviationCd0IL
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/ZIPCd061265
ReturnHeader/PreparerPersonGrp/PhoneNum03097623626
ReturnHeader/PreparerPersonGrp/PreparerPersonNm0JAMES E TAYLOR
ReturnHeader/ReturnTs02015-08-13T14:25:16-05:00
ReturnHeader/ReturnTypeCd0990EZ
ReturnHeader/TaxPeriodBeginDt02014-01-01
ReturnHeader/TaxPeriodEndDt02014-12-31
ReturnHeader/TaxYr02014

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