Liabilities / Assets
66th percentile
Higher debt load relative to assets than 66% of similar nonprofits.
Good Samaritan Health Services Foundation
990 • Fiscal year 2019 • EIN 36-3513553
Siviq Scores
Precomputed percentiles for this filing year versus similar nonprofits in the same peer cohort.
0.30x
Liabilities / Revenue
89th percentile
Higher debt load relative to revenue than 89% of similar nonprofits.
Net Margin
93rd percentile
Higher net margin than 93% of similar nonprofits.
Top Officer Pay
77th percentile
Higher top officer pay than 77% of similar nonprofits.
Top officer pay equals 63.6% of source-year revenue.
Asset Growth
9th percentile
Faster asset growth than 9% of similar nonprofits.
Revenue Growth
13th percentile
Faster revenue growth than 13% of similar nonprofits.
Balance Sheet
Assets
Down$1,835,772
Down $563,322 (-23%) from 2018
Net Assets
Up$1,286,518
Up $189,324 (+17%) from 2018
Liabilities
Down$549,254
Down $752,646 (-58%) from 2018
Revenue And Expenses
Revenue
Down$398,395
Down $118,018 (-23%) from 2018
Expenses
Down$188,332
Down $1,297,249 (-87%) from 2018
Net Income
Up$210,063
Up $1,179,231 (+122%) from 2018
Historical Trend
Jump To
Filing Snapshot
- Filing Period
- Apr 1, 2018 to Mar 31, 2019
- Signed
- Feb 14, 2020
- Return Version
- 2018v3.1
- Gross Receipts
- $1,150,068
Mission and Program Overview
Mission
Our mission is to provide financial resources and act in the best interests of the good samaritan hospital association with regard to both short-term and long-range needs, including but not limited to the purchase of new equipment and services and plant replacement. These resources shall be obtained by our active role in meeting and building relationships with potential donors, managing relationships with existing donors, and introducing new ways of fund raising as well as improving upon current methods. We will, furthermore, participate in the prudent management of all investments of the foundation for the benefit of the good samaritan hospital association.
To provide equipment and financial support for the advancement of medical, scientific, nursing, and health care delivery for Good Samaritan Hospital Association Rugby, ND.
Balance Sheet Detail
| Line | Beginning | End | Change |
|---|---|---|---|
| Assets | |||
| Investments in Publicly Traded Securities | $2,013,534 | $1,280,503 | ▼ $733,031 |
| Savings and Temporary Cash Investments | $348,373 | $474,156 | ▲ $125,783 |
| Total Assets | $2,399,094 | $1,835,772 | ▼ $563,322 |
| Other Assets Total | $37,187 | $81,113 | ▲ $43,926 |
| Liabilities | |||
| Other Liabilities | $1,244,589 | $510,104 | ▼ $734,485 |
| Accounts Payable and Accrued Expenses | $57,311 | $20,199 | ▼ $37,112 |
| Escrow Account Liability | - | $18,951 | - |
| Total Liabilities | $1,301,900 | $549,254 | ▼ $752,646 |
| Net Assets / Fund Balance | |||
| Temporarily Rstr Net Assets | $607,515 | $764,279 | ▲ $156,764 |
| Unrestricted Net Assets | $292,041 | $324,601 | ▲ $32,560 |
| Permanently Rstr Net Assets | $197,638 | $197,638 | → $0 |
| Total Net Assets Fund Balance | $1,097,194 | $1,286,518 | ▲ $189,324 |
| Total Liabilities and Net Assets / Fund Balance | $2,399,094 | $1,835,772 | ▼ $563,322 |
Endowment Activity
| Period | Beginning | Contrib. | Gain/Loss | Other Uses | End |
|---|---|---|---|---|---|
| 2018 | $197,638 | - | ▲ $23,812 | $23,812 | $197,638 |
| 2017 | $197,638 | - | ▲ $26,955 | $26,955 | $197,638 |
| 2016 | $199,995 | $35,739 | ▲ $20,421 | $58,517 | $197,638 |
| 2015 | $208,468 | - | ▼ $8,473 | - | $199,995 |
| 2014 | $177,801 | - | ▲ $30,667 | - | $208,468 |
Compensation and Service Providers
Employees
| Name | Title | Full / Part Time | Other | Total |
|---|---|---|---|---|
| Lee Holter | GSHA CFO (Aug-Mar) | - | $111,129 | $111,129 |
| Catherine Jelsing | Foundation Coordinator | FT | $48,298 | $48,298 |
| Dani Schell Director | Employee Rep (Through Aug 2018) | - | $24,802 | $24,802 |
Board Members and Trustees
| Name | Title |
|---|---|
| Tanner Johnson | President |
| Judge Michael Hurly | Vice president |
| Dr Kathy Santjer | Director |
| Patricia Paul | Director |
| Lynda Childress | Director (Starting Sept 2018) |
| Patrick Branco | Gsha CEO |
| Richard Baland | GSHA CFO (Apr-May) |
| Elizabeth Blessum | Secretary -Treasurer |
Revenue and Support
Revenue Composition
- Contributions and Grants
- $331,714
- Program Service Revenue
- $0
- Investment Income
- $69,806
- Other Revenue
- $-3,125
- All Other Contributions
- $308,311
- Change in Net Assets
- $210,063
Audited Revenue Reconciliation
- Revenue per Audited Statements
- $404,722
- Revenue Not Reported on Financial Statements
- $-6,327
- Revenue Not Reported on Form 990
- $-38,120
- Other Revenue Adjustments
- $-6,327
- Total Revenue per Audited Statements
- $366,602
- Total Revenue per Form 990
- $398,395
Expenses and Functional Allocation
Major Expense Lines
| Line Item | Amount |
|---|---|
| Grants and Similar Amounts Paid | $160,322 |
| Other Expenses | $28,010 |
| Professional Fundraising Fees | $0 |
| Salaries, Compensation, and Employee Benefits | $0 |
| Total Fundraising Expense | $0 |
Functional Expense Allocation
| Line Item | Program | Management | Fundraising | Total |
|---|---|---|---|---|
| Grants to Domestic Orgs | $160,322 | - | - | $160,322 |
| Fees for Service Investment Mgmnt Fees | - | $17,382 | - | $17,382 |
| Fees for Services Legal | - | $6,930 | - | $6,930 |
| All Other Expenses | - | $2,986 | - | $2,986 |
| Office Expenses | - | $556 | - | $556 |
| Advertising | - | $156 | - | $156 |
| Total Functional Expenses | $160,322 | $28,010 | $0 | $188,332 |
Audited Expense Reconciliation
| Line Item | Amount |
|---|---|
| Total Expenses per Form 990 | $188,332 |
| Total Expenses per Audited Statements | $177,277 |
| Expenses per Audited Statements | $170,950 |
| Expenses Not Reported on Financial Statements | $17,382 |
| Other Expense Adjustments | $17,382 |
| Expenses Not Reported on Form 990 | $6,327 |
International Activity
Grant and Assistance Recipients
| Recipient | Location | Category | Purpose | Amount |
|---|---|---|---|---|
| Good Samaritan Hospital Association | Rugby, ND | 501(c)(3) | To support operations and projects for hospital | $160,322 |
Fundraising, Events, and Gaming
- Fundraising activities
- Yes
- Gaming activities
- No
- Professional fundraiser used
- No
Fundraising and Gaming Totals
| Line Item | Amount |
|---|---|
| Fundraising Direct Expenses | $8,036 |
| Fundraising Gross Income | $4,911 |
| Professional Fundraising Fees | $0 |
Fundraising Events
| Event | Gross Receipts | Gross Revenue | Direct Expenses | Net Income |
|---|---|---|---|---|
| Charity Golf Classic | $28,314 | $4,911 | $3,138 | $1,773 |
| Total Events | $28,314 | $4,911 | $8,036 | $-3,125 |
Political and Lobbying Activity
- Political campaign activity
- No
- Lobbying activity
- No
- Subject to proxy tax
- No
Debt and Bond Financing
Other Reported Liabilities
| Liability | Amount |
|---|---|
| Related Party Trust Obligations | $510,104 |
Governance and Compliance
Governance Checklist
- Compiled or reviewed by an accountant
- No
- Annual disclosure for covered persons
- Yes
- Audit committee
- Yes
- Business relationship with family members
- No
- Business relationship with organization members
- No
- Material changes to governing documents
- No
- Compensation from other sources disclosed
- No
- CEO compensation reviewed
- No
- Other officer compensation reviewed
- No
- Conflict-of-interest policy
- Yes
- Audited financial statements prepared
- Yes
- Key decisions subject to board approval
- Yes
- Management duties delegated
- No
Governance Explanations
Form 990, Part VI, Section A, line 1
“The Executive Committee may act on behalf of the full board between regular meetings, but their decisions must be ratified by the full board.”
Form 990, Part VI, Section A, line 2
“Dani Schell has a business relationship wtih Patrick Branco, Lee Holter and Richard Baland.”
Form 990, Part VI, Section A, line 7A
“Directors must be approved by the Good Samaritan Hospital Association Board.”
Form 990, Part VI, Section A, line 7B
“The Foundation Board shall be answerable in all Foundation matters to the board of trustees of the Good Samaritan Hospital Association.”
Form 990, Part VI, Section A, line 8B
“No committees met separately from the board.”
Form 990, Part VI, Section B, line 11B
“An overview of the 990 is provided at a board meeting and the 990 is available to the board upon request.”
Form 990, Part VI, Section B, line 12C
“Covered Persons: All employees, managers, medical staff, executive leadership, board members, volunteers, contractors, and others engaged in the work place. A conflict of Interest Statement must be signed by each board member and shall be dated no later than December 31st of each year. Determination of conflict: All employees and board members are required to disclose any actual or potential conflict of interest and seek guidance on how to handle the situation. Conflict review: Actual or potential board member conflicts of interest must be disclosed to the Corporate Compliance Committee (CCC). The CCC will handle reports or concerns of situations that may give rise to a conflict of interest with the assistance of legal counsel. The CCC will issue its decision to the Covered Persons in writing and will document and file its decision. Restrictions on those with a conflict: In self-dealing transactions the board member shall not participate in the board decision-making and shall make full disclosure of their interests. If the fairness of the transaction is questioned, the burden of establishing fairness falls upon the trustee involved and the board member must seek guidance and approval from the CCC prior to pursuing any business or personal activity that may constitute a conflict of interest.”
Form 990, Part VI, Section B, line 15
“Good Samaritan Hospital Association, a related organization, has a process in place and determines compensation for the CEO and CFO. The Foundation coordinator/director is paid by the Good Samaritan Hospital Association. Wages are determined in the same manner as other Association employees based on wage bands, years of experience and merit increases.”
Form 990, Part VI, Section C, line 19
“The governing documents, conflict of interest policy, and financial statements are open for review by the general public upon request.”
Filing and Contact Details
Filer
- Filer Name
- Good Samaritan Health Services
- EIN
- 36-3513553
- Phone
- 7017765455
- Address
- 800 S Main Avenue, Rugby, ND 58368
Signing Officer
- Name
- Jerry Jurena
- Title
- CEO Good Samaritan Hospital Assoc.
- Phone
- 7017765455
- Signed
- 2020-02-14
- Discuss with paid preparer
- Yes
Organization Details
- Principal Officer
- Jerry Jurena
- Formed
- 1987
- Legal Domicile
- Nd
- Voting Board Members
- 6
- Independent Board Members
- 6
- Employees
- 0
- Volunteers
- 80
Preparer
- Firm
- Eide Bailly LLP
- Address
- 1730 Burnt Boat Loop Ste 100, Bismarck, ND 58503-0886
- Preparer
- Lisa Chaffee CPA
- Phone
- 7012551091
Supplemental Narrative
Financial Statement Notes
Part IV, Line 2B:
“Hope Lives Here is an employee assistance fund and is funded by employee volunteer contributions. Funds are kept in a separate checking account and a committee of employees reviews applications for assistance and awards funds according to set policies.”
Part V, Line 4:
“Endowment funds are used to support the operations of Good Samaritan Hospital Association. The Organization has part of the reported endowment assets ($37,187) held by the North Dakota Community Foundation. The remaining are held by the Organization.”
Part X, Line 2:
“The Foundation is organized as a North Dakota nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The entity is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Foundation is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Foundation has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990-T) with the IRS. The Foundation believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Foundation would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred.”
Part XI, Line 2D - Other Adjustments:
“Investment Fees shown in Revenue in audited Financial Statement -17,382.”
Part XI, Line 4B - Other Adjustments:
“Fundraising Expenses shown in Expense in audited Financial Statement -6,327.”
Part XII, Line 2D - Other Adjustments:
“Fundraising Expenses shown in Expense in audited Financial Statement 6,327.”
Part XII, Line 4B - Other Adjustments:
“Investment Fees shown in Revenue in audited Financial Statement 17,382.”
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| IRS990/Desc | 0 | Good Samaritan Health Services Foundation supports Heart of America Hospice. Heart of America Medical Center's interdisciplinary hospice team provides ongoing medical, emotional and spiritual support for patients of all ages and their families. They provide care for individuals with terminal illnesses such as alzheimer's, dementia, COPD, cancer, parkinson's disease, ALS and AIDS. Memorials, donations and funds raised by the Foundation supplement insurance payments so families can focus on loved ones without worrying about finances. The Foundation hosts an annual charity golf classic to also raise money for specific projects in support of Heart of America Medical Center. |
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| IRS990/GainOrLossGrp/SecuritiesAmt | 0 | 52066 |
| IRS990/GamingActivitiesInd | 0 | 0 |
| IRS990/GoverningBodyVotingMembersCnt | 0 | 6 |
| IRS990/GrantAmt | 0 | 160322 |
| IRS990/GrantsToDomesticOrgsGrp/ProgramServicesAmt | 0 | 160322 |
| IRS990/GrantsToDomesticOrgsGrp/TotalAmt | 0 | 160322 |
| IRS990/GrantsToIndividualsInd | 0 | 0 |
| IRS990/GrantsToOrganizationsInd | 0 | 1 |
| IRS990/GrantToRelatedPersonInd | 0 | 0 |
| IRS990/GrossAmountSalesAssetsGrp/SecuritiesAmt | 0 | 795703 |
| IRS990/GrossReceiptsAmt | 0 | 1150068 |
| IRS990/GroupReturnForAffiliatesInd | 0 | 0 |
| IRS990/IncludeFIN48FootnoteInd | 0 | 1 |
| IRS990/IndependentAuditFinclStmtInd | 0 | 1 |
| IRS990/IndependentVotingMemberCnt | 0 | 6 |
| IRS990/IndivRcvdGreaterThan100KCnt | 0 | 0 |
| IRS990/IndoorTanningServicesInd | 0 | 0 |
| IRS990/InfoInScheduleOPartIIIInd | 0 | X |
| IRS990/InfoInScheduleOPartVIInd | 0 | X |
| IRS990/InvestmentIncomeGrp/ExclusionAmt | 0 | 17740 |
| IRS990/InvestmentIncomeGrp/TotalRevenueColumnAmt | 0 | 17740 |
| IRS990/InvestmentInJointVentureInd | 0 | 0 |
| IRS990/InvestmentsPubTradedSecGrp/BOYAmt | 0 | 2013534 |
| IRS990/InvestmentsPubTradedSecGrp/EOYAmt | 0 | 1280503 |
| IRS990/IRPDocumentCnt | 0 | 0 |
| IRS990/IRPDocumentW2GCnt | 0 | 0 |
| IRS990/LegalDomicileStateCd | 0 | ND |
| IRS990/LessCostOthBasisSalesExpnssGrp/SecuritiesAmt | 0 | 743637 |
| IRS990/LoanOutstandingInd | 0 | 0 |
| IRS990/LobbyingActivitiesInd | 0 | 0 |
| IRS990/LocalChaptersInd | 0 | 0 |
| IRS990/MaterialDiversionOrMisuseInd | 0 | 0 |
| IRS990/MembersOrStockholdersInd | 0 | 0 |
| IRS990/MethodOfAccountingAccrualInd | 0 | X |
| IRS990/MinutesOfCommitteesInd | 0 | 0 |
| IRS990/MinutesOfGoverningBodyInd | 0 | 1 |
| IRS990/MissionDesc | 0 | Our mission is to provide financial resources and act in the best interests of the Good Samaritan Hospital Association with regard to both short-term and long-range needs, including but not limited to the purchase of new equipment and services and plant replacement. These resources shall be obtained by our active role in meeting and building relationships with potential donors, managing relationships with exisiting donors, and introducing new ways of fundraising as well as improving upon current methods. We will, furthermore, participate in the prudent management of all investments of the Foundation for the benefit of the Good Samaritan Hospital Association. |
| IRS990/MoreThan5000KToIndividualsInd | 0 | 0 |
| IRS990/MoreThan5000KToOrgInd | 0 | 0 |
| IRS990/NetAssetsOrFundBalancesBOYAmt | 0 | 1097194 |
| IRS990/NetAssetsOrFundBalancesEOYAmt | 0 | 1286518 |
| IRS990/NetGainOrLossInvestmentsGrp/ExclusionAmt | 0 | 52066 |
| IRS990/NetGainOrLossInvestmentsGrp/TotalRevenueColumnAmt | 0 | 52066 |
| IRS990/NetIncmFromFundraisingEvtGrp/ExclusionAmt | 0 | -3125 |
| IRS990/NetIncmFromFundraisingEvtGrp/TotalRevenueColumnAmt | 0 | -3125 |
| IRS990/NetUnrelatedBusTxblIncmAmt | 0 | 0 |
| IRS990/NetUnrlzdGainsLossesInvstAmt | 0 | -20738 |
| IRS990/NoncashContributionsAmt | 0 | 1709 |
| IRS990/NondeductibleContributionsInd | 0 | 0 |
| IRS990/OfficeExpensesGrp/ManagementAndGeneralAmt | 0 | 556 |
| IRS990/OfficeExpensesGrp/TotalAmt | 0 | 556 |
| IRS990/OfficerMailingAddressInd | 0 | 0 |
| IRS990/OperateHospitalInd | 0 | 0 |
| IRS990/Organization501c3Ind | 0 | X |
| IRS990/OrganizationFollowsSFAS117Ind | 0 | X |
| IRS990/OtherAssetsTotalGrp/BOYAmt | 0 | 37187 |
| IRS990/OtherAssetsTotalGrp/EOYAmt | 0 | 81113 |
| IRS990/OtherChangesInNetAssetsAmt | 0 | 0 |
| IRS990/OtherLiabilitiesGrp/BOYAmt | 0 | 1244589 |
| IRS990/OtherLiabilitiesGrp/EOYAmt | 0 | 510104 |
| IRS990/PartialLiquidationInd | 0 | 0 |
| IRS990/PayPremiumsPrsnlBnftCntrctInd | 0 | 0 |
| IRS990/PermanentlyRstrNetAssetsGrp/BOYAmt | 0 | 197638 |
| IRS990/PermanentlyRstrNetAssetsGrp/EOYAmt | 0 | 197638 |
| IRS990/PoliticalCampaignActyInd | 0 | 0 |
| IRS990/PrincipalOfficerNm | 0 | Jerry Jurena |
| IRS990/PriorPeriodAdjustmentsAmt | 0 | -1 |
| IRS990/ProfessionalFundraisingInd | 0 | 0 |
| IRS990/ProhibitedTaxShelterTransInd | 0 | 0 |
| IRS990/PYBenefitsPaidToMembersAmt | 0 | 0 |
| IRS990/PYContributionsGrantsAmt | 0 | 313110 |
| IRS990/PYExcessBenefitTransInd | 0 | 0 |
| IRS990/PYGrantsAndSimilarPaidAmt | 0 | 1472198 |
| IRS990/PYInvestmentIncomeAmt | 0 | 195337 |
| IRS990/PYOtherExpensesAmt | 0 | 13383 |
| IRS990/PYOtherRevenueAmt | 0 | 7966 |
| IRS990/PYProgramServiceRevenueAmt | 0 | 0 |
| IRS990/PYRevenuesLessExpensesAmt | 0 | -969168 |
| IRS990/PYSalariesCompEmpBnftPaidAmt | 0 | 0 |
| IRS990/PYTotalExpensesAmt | 0 | 1485581 |
| IRS990/PYTotalProfFndrsngExpnsAmt | 0 | 0 |
| IRS990/PYTotalRevenueAmt | 0 | 516413 |
| IRS990/QuidProQuoContributionsInd | 0 | 0 |
| IRS990/RcvFndsToPayPrsnlBnftCntrctInd | 0 | 0 |
| IRS990/ReconcilationRevenueExpnssAmt | 0 | 210063 |
| IRS990/RegularMonitoringEnfrcInd | 0 | 1 |
| IRS990/RelatedEntityInd | 0 | 1 |
| IRS990/RelatedOrganizationCtrlEntInd | 0 | 0 |
| IRS990/ReportInvestmentsOtherSecInd | 0 | 0 |
| IRS990/ReportLandBuildingEquipmentInd | 0 | 0 |
| IRS990/ReportOtherAssetsInd | 0 | 0 |
| IRS990/ReportOtherLiabilitiesInd | 0 | 1 |
| IRS990/ReportProgramRelatedInvstInd | 0 | 0 |
| IRS990/SavingsAndTempCashInvstGrp/BOYAmt | 0 | 348373 |
| IRS990/SavingsAndTempCashInvstGrp/EOYAmt | 0 | 474156 |
| IRS990ScheduleA/Form990ScheduleAPartVIGrp/ExplanationTxt | 0 | Description: One time contribution Date: 12/31/16 Amount: 266200. |
| IRS990ScheduleA/Form990ScheduleAPartVIGrp/FormAndLineReferenceDesc | 0 | Schedule A, Part VI, List of Unusual Grants: |
| IRS990ScheduleA/GiftsGrantsContriRcvd170Grp/CurrentTaxYearAmt | 0 | 331714 |
| IRS990ScheduleA/GiftsGrantsContriRcvd170Grp/CurrentTaxYearMinus1YearAmt | 0 | 313110 |
| IRS990ScheduleA/GiftsGrantsContriRcvd170Grp/CurrentTaxYearMinus2YearsAmt | 0 | 335469 |
| IRS990ScheduleA/GiftsGrantsContriRcvd170Grp/CurrentTaxYearMinus3YearsAmt | 0 | 104923 |
| IRS990ScheduleA/GiftsGrantsContriRcvd170Grp/CurrentTaxYearMinus4YearsAmt | 0 | 67921 |
| IRS990ScheduleA/GiftsGrantsContriRcvd170Grp/TotalAmt | 0 | 1153137 |
| IRS990ScheduleA/GrossInvestmentIncome170Grp/CurrentTaxYearAmt | 0 | 17740 |
| IRS990ScheduleA/GrossInvestmentIncome170Grp/CurrentTaxYearMinus1YearAmt | 0 | 15904 |
| IRS990ScheduleA/GrossInvestmentIncome170Grp/CurrentTaxYearMinus2YearsAmt | 0 | 20445 |
| IRS990ScheduleA/GrossInvestmentIncome170Grp/CurrentTaxYearMinus3YearsAmt | 0 | 16494 |
| IRS990ScheduleA/GrossInvestmentIncome170Grp/CurrentTaxYearMinus4YearsAmt | 0 | 29850 |
| IRS990ScheduleA/GrossInvestmentIncome170Grp/TotalAmt | 0 | 100433 |
| IRS990ScheduleA/GrossReceiptsRltdActivitiesAmt | 0 | 78373 |
| IRS990ScheduleA/PublicOrganization170Ind | 0 | X |
| IRS990ScheduleA/PublicSupportCY170Pct | 0 | 0.75270 |
| IRS990ScheduleA/PublicSupportPY170Pct | 0 | 0.65440 |
| IRS990ScheduleA/PublicSupportTotal170Amt | 0 | 943501 |
| IRS990ScheduleA/SubstantialContributorsTotAmt | 0 | 209636 |
| IRS990ScheduleA/ThirtyThrPctSuprtTestsCY170Ind | 0 | X |
| IRS990ScheduleA/TotalCalendarYear170Grp/CurrentTaxYearAmt | 0 | 331714 |
| IRS990ScheduleA/TotalCalendarYear170Grp/CurrentTaxYearMinus1YearAmt | 0 | 313110 |
| IRS990ScheduleA/TotalCalendarYear170Grp/CurrentTaxYearMinus2YearsAmt | 0 | 335469 |
| IRS990ScheduleA/TotalCalendarYear170Grp/CurrentTaxYearMinus3YearsAmt | 0 | 104923 |
| IRS990ScheduleA/TotalCalendarYear170Grp/CurrentTaxYearMinus4YearsAmt | 0 | 67921 |
| IRS990ScheduleA/TotalCalendarYear170Grp/TotalAmt | 0 | 1153137 |
| IRS990ScheduleA/TotalSupportAmt | 0 | 1253570 |
| IRS990ScheduleB/ContributorInformationGrp/ContributorBusinessName/BusinessNameLine1 | 0 | RESTRICTED |
| IRS990ScheduleB/ContributorInformationGrp/ContributorNum | 0 | RESTRICTED |
| IRS990ScheduleB/ContributorInformationGrp/ContributorUSAddress/AddressLine1 | 0 | RESTRICTED |
| IRS990ScheduleB/ContributorInformationGrp/ContributorUSAddress/AddressLine2 | 0 | RESTRICTED |
| IRS990ScheduleB/ContributorInformationGrp/ContributorUSAddress/City | 0 | RESTRICTED |
| IRS990ScheduleB/ContributorInformationGrp/ContributorUSAddress/State | 0 | RESTRICTED |
| IRS990ScheduleB/ContributorInformationGrp/ContributorUSAddress/ZIPCode | 0 | RESTRICTED |
| IRS990ScheduleB/ContributorInformationGrp/TotalContributionsAmt | 0 | RESTRICTED |
| IRS990/ScheduleBRequiredInd | 0 | 1 |
| IRS990ScheduleD/AgentTrusteeEtcInd | 0 | 0 |
| IRS990ScheduleD/BoardDesignatedBalanceEOYPct | 0 | 0.00000 |
| IRS990ScheduleD/CYEndwmtFundGrp/BeginningYearBalanceAmt | 0 | 197638 |
| IRS990ScheduleD/CYEndwmtFundGrp/EndYearBalanceAmt | 0 | 197638 |
| IRS990ScheduleD/CYEndwmtFundGrp/InvestmentEarningsOrLossesAmt | 0 | 23812 |
| IRS990ScheduleD/CYEndwmtFundGrp/OtherExpendituresAmt | 0 | 23812 |
| IRS990ScheduleD/CYMinus1YrEndwmtFundGrp/BeginningYearBalanceAmt | 0 | 197638 |
| IRS990ScheduleD/CYMinus1YrEndwmtFundGrp/EndYearBalanceAmt | 0 | 197638 |
| IRS990ScheduleD/CYMinus1YrEndwmtFundGrp/InvestmentEarningsOrLossesAmt | 0 | 26955 |
| IRS990ScheduleD/CYMinus1YrEndwmtFundGrp/OtherExpendituresAmt | 0 | 26955 |
| IRS990ScheduleD/CYMinus2YrEndwmtFundGrp/BeginningYearBalanceAmt | 0 | 199995 |
| IRS990ScheduleD/CYMinus2YrEndwmtFundGrp/ContributionsAmt | 0 | 35739 |
| IRS990ScheduleD/CYMinus2YrEndwmtFundGrp/EndYearBalanceAmt | 0 | 197638 |
| IRS990ScheduleD/CYMinus2YrEndwmtFundGrp/InvestmentEarningsOrLossesAmt | 0 | 20421 |
| IRS990ScheduleD/CYMinus2YrEndwmtFundGrp/OtherExpendituresAmt | 0 | 58517 |
| IRS990ScheduleD/CYMinus3YrEndwmtFundGrp/BeginningYearBalanceAmt | 0 | 208468 |
| IRS990ScheduleD/CYMinus3YrEndwmtFundGrp/EndYearBalanceAmt | 0 | 199995 |
| IRS990ScheduleD/CYMinus3YrEndwmtFundGrp/InvestmentEarningsOrLossesAmt | 0 | -8473 |
| IRS990ScheduleD/CYMinus4YrEndwmtFundGrp/BeginningYearBalanceAmt | 0 | 177801 |
| IRS990ScheduleD/CYMinus4YrEndwmtFundGrp/EndYearBalanceAmt | 0 | 208468 |
| IRS990ScheduleD/CYMinus4YrEndwmtFundGrp/InvestmentEarningsOrLossesAmt | 0 | 30667 |
| IRS990ScheduleD/EndowmentsHeldRelatedOrgInd | 0 | 0 |
| IRS990ScheduleD/EndowmentsHeldUnrelatedOrgInd | 0 | 1 |
| IRS990ScheduleD/ExpensesNotReportedAmt | 0 | 6327 |
| IRS990ScheduleD/ExpensesNotRptFinclStmtAmt | 0 | 17382 |
| IRS990ScheduleD/ExpensesSubtotalAmt | 0 | 170950 |
| IRS990ScheduleD/ExplanationProvidedInd | 0 | X |
| IRS990ScheduleD/FootnoteTextInd | 0 | X |
| IRS990ScheduleD/InclEscrowCustodialAcctLiabInd | 0 | 1 |
| IRS990ScheduleD/NetUnrealizedGainsInvstAmt | 0 | -20738 |
| IRS990ScheduleD/OtherExpensesIncludedAmt | 0 | 6327 |
| IRS990ScheduleD/OtherExpensesNotIncludedAmt | 0 | 17382 |
| IRS990ScheduleD/OtherLiabilitiesOrgGrp/Amt | 0 | 510104 |
| IRS990ScheduleD/OtherLiabilitiesOrgGrp/Desc | 0 | Related Party Trust Obligations |
| IRS990ScheduleD/OtherRevenueAmt | 0 | -17382 |
| IRS990ScheduleD/OtherRevenuesNotIncludedAmt | 0 | -6327 |
| IRS990ScheduleD/PrmnntEndowmentBalanceEOYPct | 0 | 1.00000 |
| IRS990ScheduleD/RevenueNotReportedAmt | 0 | -38120 |
| IRS990ScheduleD/RevenueNotReportedFinclStmtAmt | 0 | -6327 |
| IRS990ScheduleD/RevenueSubtotalAmt | 0 | 404722 |
| IRS990ScheduleD/SupplementalInformationDetail/ExplanationTxt | 0 | Hope Lives Here is an employee assistance fund and is funded by employee volunteer contributions. Funds are kept in a separate checking account and a committee of employees reviews applications for assistance and awards funds according to set policies. |
| IRS990ScheduleD/SupplementalInformationDetail/ExplanationTxt | 1 | Endowment funds are used to support the operations of Good Samaritan Hospital Association. The Organization has part of the reported endowment assets ($37,187) held by the North Dakota Community Foundation. The remaining are held by the Organization. |
| IRS990ScheduleD/SupplementalInformationDetail/ExplanationTxt | 2 | The Foundation is organized as a North Dakota nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The entity is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Foundation is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Foundation has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990-T) with the IRS. The Foundation believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Foundation would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. |
| IRS990ScheduleD/SupplementalInformationDetail/ExplanationTxt | 3 | Investment Fees shown in Revenue in audited Financial Statement -17,382. |
| IRS990ScheduleD/SupplementalInformationDetail/ExplanationTxt | 4 | Fundraising Expenses shown in Expense in audited Financial Statement -6,327. |
| IRS990ScheduleD/SupplementalInformationDetail/ExplanationTxt | 5 | Fundraising Expenses shown in Expense in audited Financial Statement 6,327. |
| IRS990ScheduleD/SupplementalInformationDetail/ExplanationTxt | 6 | Investment Fees shown in Revenue in audited Financial Statement 17,382. |
| IRS990ScheduleD/SupplementalInformationDetail/FormAndLineReferenceDesc | 0 | Part IV, Line 2b: |
| IRS990ScheduleD/SupplementalInformationDetail/FormAndLineReferenceDesc | 1 | Part V, Line 4: |
| IRS990ScheduleD/SupplementalInformationDetail/FormAndLineReferenceDesc | 2 | Part X, Line 2: |
| IRS990ScheduleD/SupplementalInformationDetail/FormAndLineReferenceDesc | 3 | Part XI, Line 2d - Other Adjustments: |
| IRS990ScheduleD/SupplementalInformationDetail/FormAndLineReferenceDesc | 4 | Part XI, Line 4b - Other Adjustments: |
| IRS990ScheduleD/SupplementalInformationDetail/FormAndLineReferenceDesc | 5 | Part XII, Line 2d - Other Adjustments: |
| IRS990ScheduleD/SupplementalInformationDetail/FormAndLineReferenceDesc | 6 | Part XII, Line 4b - Other Adjustments: |
| IRS990ScheduleD/TermEndowmentBalanceEOYPct | 0 | 0.00000 |
| IRS990ScheduleD/TotalBookValueLandBuildingsAmt | 0 | 0 |
| IRS990ScheduleD/TotalExpensesPerForm990Amt | 0 | 188332 |
| IRS990ScheduleD/TotalLiabilityAmt | 0 | 510104 |
| IRS990ScheduleD/TotalRevenuePerForm990Amt | 0 | 398395 |
| IRS990ScheduleD/TotalRevEtcAuditedFinclStmtAmt | 0 | 366602 |
| IRS990ScheduleD/TotExpnsEtcAuditedFinclStmtAmt | 0 | 177277 |
| IRS990ScheduleG/FundraisingEventInformationGrp/CharitableContributionsTotAmt | 0 | 23403 |
| IRS990ScheduleG/FundraisingEventInformationGrp/CharitableContriEvent1Amt | 0 | 23403 |
| IRS990ScheduleG/FundraisingEventInformationGrp/DirectExpenseSummaryEventsAmt | 0 | 8036 |
| IRS990ScheduleG/FundraisingEventInformationGrp/Event1Nm | 0 | Charity Golf Classic |
| IRS990ScheduleG/FundraisingEventInformationGrp/FoodAndBeverageEvent1Amt | 0 | 1404 |
| IRS990ScheduleG/FundraisingEventInformationGrp/FoodAndBeverageTotalEventsAmt | 0 | 1404 |
| IRS990ScheduleG/FundraisingEventInformationGrp/GrossReceiptsEvent1Amt | 0 | 28314 |
| IRS990ScheduleG/FundraisingEventInformationGrp/GrossReceiptsTotalAmt | 0 | 28314 |
| IRS990ScheduleG/FundraisingEventInformationGrp/GrossRevenueEvent1Amt | 0 | 4911 |
| IRS990ScheduleG/FundraisingEventInformationGrp/GrossRevenueTotalEventsAmt | 0 | 4911 |
| IRS990ScheduleG/FundraisingEventInformationGrp/NetIncomeSummaryAmt | 0 | -3125 |
| IRS990ScheduleG/FundraisingEventInformationGrp/NonCashPrizesEvent1Amt | 0 | 920 |
| IRS990ScheduleG/FundraisingEventInformationGrp/NonCashPrizesTotalEventsAmt | 0 | 920 |
| IRS990ScheduleG/FundraisingEventInformationGrp/OthDirectExpnssTotalEventsAmt | 0 | 3138 |
| IRS990ScheduleG/FundraisingEventInformationGrp/OtherDirectExpensesEvent1Amt | 0 | 3138 |
| IRS990ScheduleG/FundraisingEventInformationGrp/RentFacilityCostsEvent1Amt | 0 | 2574 |
| IRS990ScheduleG/FundraisingEventInformationGrp/RentFcltyCostsTotalEventsAmt | 0 | 2574 |
| IRS990ScheduleI/GrantRecordsMaintainedInd | 0 | 1 |
| IRS990ScheduleI/RecipientTable/CashGrantAmt | 0 | 160322 |
| IRS990ScheduleI/RecipientTable/IRCSectionDesc | 0 | 501(c)(3) |
| IRS990ScheduleI/RecipientTable/PurposeOfGrantTxt | 0 | To support operations and projects for hospital |
| IRS990ScheduleI/RecipientTable/RecipientBusinessName/BusinessNameLine1Txt | 0 | Good Samaritan Hospital Association |
| IRS990ScheduleI/RecipientTable/RecipientEIN | 0 | 450226419 |
| IRS990ScheduleI/RecipientTable/USAddress/AddressLine1Txt | 0 | 800 S Main Ave |
| IRS990ScheduleI/RecipientTable/USAddress/CityNm | 0 | Rugby |
| IRS990ScheduleI/RecipientTable/USAddress/StateAbbreviationCd | 0 | ND |
| IRS990ScheduleI/RecipientTable/USAddress/ZIPCd | 0 | 58368 |
| IRS990ScheduleI/SupplementalInformationDetail/ExplanationTxt | 0 | The Foundation board is answerable in all matters to the Association board of trustees. A member of the Good Samaritan Hospital Association board of trustees and the Association CEO serve on the Good Samaritan Health Services Foundation board of directors. As a representative of the Association board of trustees, the CEO advises the Foundation board on fundraising priorities and goals. Fundraising activities conducted by the Foundation on behalf of the Association include, but are not limited to: grant writing, presenting fundraising events, conducting fundraising campaigns, and soliciting individual gifts and memorials. Funds generated and managed by the Foundation are distributed to Good Samaritan Association in the following ways: 1. The Foundation director is authorized by the Foundation board to distribute up to $1,000 in donor-designated funds for specific Good Samaritan Hospital Association departments or projects. 2. The Foundation director is authorized by the Foundation board to manage and release grant funds designated by granting agencies for specific Good Samaritan Hospital Association departments or projects. 3. Distributions of more than $1,000, or distribution of undesignated Foundation funds, must be approved by a majority vote of the Foundation Board of Directors. |
| IRS990ScheduleI/SupplementalInformationDetail/FormAndLineReferenceDesc | 0 | Part I, Line 2: |
| IRS990ScheduleI/Total501c3OrgCnt | 0 | 1 |
| IRS990ScheduleI/TotalOtherOrgCnt | 0 | 0 |
| IRS990ScheduleJ/AnyNonFixedPaymentsInd | 0 | 0 |
| IRS990ScheduleJ/CompBasedOnRevenueOfFlngOrgInd | 0 | 0 |
| IRS990ScheduleJ/CompBsdNetEarnsFlngOrgInd | 0 | 0 |
| IRS990ScheduleJ/CompBsdNetEarnsRltdOrgsInd | 0 | 0 |
| IRS990ScheduleJ/CompBsdOnRevRelatedOrgsInd | 0 | 0 |
| IRS990ScheduleJ/EquityBasedCompArrngmInd | 0 | 0 |
| IRS990ScheduleJ/InitialContractExceptionInd | 0 | 0 |
Document Assets
No mirrored PDF or thumbnail assets are attached yet.
Filings
Displayed year
2019 • Form 990Detailed filing. Detailed filing data is available for this year.
- Assets
- $1,835,772
- Liabilities
- $549,254
- Net assets
- $1,286,518
- Revenue
- $398,395
- Expenses
- $188,332
- Net income
- $210,063