Civic Intelligence

Good Samaritan Clinic Inc

990 • Fiscal year 2016 • EIN 55-0708491

Jul 01, 2015 to Jun 30, 2016 • Filed on Feb 11, 2017

Organization ProfileGOODSAMARITANCLINICPARKERSBURGWV.COM
418 Grand Park Drive No 311Parkersburg, WV 26105

(304) 834-3986

Siviq Scores

Precomputed percentiles for this filing year versus similar nonprofits in the same peer cohort.

Liabilities / Assets

72nd percentile

0.05x

Higher debt load relative to assets than 72% of similar nonprofits.

2016 filings • 501(c)3 • <$500k nonprofits • Source year 2016

Liabilities / Revenue

81st percentile

0.10x

Higher debt load relative to revenue than 81% of similar nonprofits.

2016 filings • 501(c)3 • <$500k nonprofits • Source year 2016

Net Margin

4th percentile

-111%

Higher net margin than 4% of similar nonprofits.

2016 filings • 501(c)3 • <$500k nonprofits • Source year 2016

Top Officer Pay

96th percentile

$74,379

Higher top officer pay than 96% of similar nonprofits.

Top officer pay equals 65.4% of source-year revenue.

2016 filings • 501(c)3 • <$500k nonprofits • Source year 2016

Asset Growth

12th percentile

-38%

Faster asset growth than 12% of similar nonprofits.

2016 filings • 501(c)3 • <$500k nonprofits • Annualized from 2015 to 2016

Revenue Growth

10th percentile

-50%

Faster revenue growth than 10% of similar nonprofits.

2016 filings • 501(c)3 • <$500k nonprofits • Annualized from 2015 to 2016

Balance Sheet
Liabilities / Assets72nd percentile

Assets

Down

$232,138

Down $143,988 (-38%) from 2015

Net Assets

Down

$221,314

Down $143,517 (-39%) from 2015

Liabilities

Down

$10,824

Down $471 (-4.2%) from 2015

Revenue And Expenses
Liabilities / Revenue81st percentileNet Margin4th percentile

Revenue

Down

$113,795

Down $113,742 (-50%) from 2015

Expenses

Down

$239,754

Down $34,008 (-12%) from 2015

Net Income

Down

-$125,959

Down $79,734 (-172%) from 2015

Historical Trend

Balance Sheet Trend

Asset Growth12th percentile

The highlighted filing sits inside the broader history for assets, liabilities, and net assets.

$600K$400K$200K$0Assets 2011: $499,371Liabilities 2011: $10,262Net Assets 2011: $489,1092011Assets 2012: $503,005Liabilities 2012: $12,573Net Assets 2012: $490,4322012Assets 2013: $468,368Liabilities 2013: $14,610Net Assets 2013: $453,7582013Assets 2014: $425,370Liabilities 2014: $14,314Net Assets 2014: $411,0562014Assets 2015: $376,126Liabilities 2015: $11,295Net Assets 2015: $364,8312015Assets 2016: $232,138Liabilities 2016: $10,824Net Assets 2016: $221,3142016Assets 2017: $0Liabilities 2017: $0Net Assets 2017: $02017

Highlighted filing

2016

Assets$232,138
Liabilities$10,824
Net Assets$221,314
Open 2016 Filing

Operations Trend

Revenue Growth10th percentile

Revenue, expenses, and net income across loaded years, with this filing highlighted.

$600K$400K$200K$0-$200KRevenue 2011: $325,281Expenses 2011: $319,417Net Income 2011: $5,8642011Revenue 2012: $329,118Expenses 2012: $323,285Net Income 2012: $5,8332012Revenue 2013: $305,045Expenses 2013: $348,085Net Income 2013: -$43,0402013Revenue 2014: $451,787Expenses 2014: $494,489Net Income 2014: -$42,7022014Revenue 2015: $227,537Expenses 2015: $273,762Net Income 2015: -$46,2252015Revenue 2016: $113,795Expenses 2016: $239,754Net Income 2016: -$125,9592016Revenue 2017: $15,294Expenses 2017: $74,747Net Income 2017: -$59,4532017

Highlighted filing

2016

Revenue$113,795
Expenses$239,754
Net Income-$125,959
Open 2016 Filing
Jump To
Filing Snapshot
Filing Period
Jul 1, 2015 to Jun 30, 2016
Signed
Feb 11, 2017
Return Version
2015v3.0
Gross Receipts
$113,795
Mission and Program Overview

Mission

To provide the underinsured with access to a patient-centered medical home that facilitates quality care through partnerships between the individual and their health care team.

Free primary care health clinic for patients who have no insurance, medicare or medicaid and who fall within federal poverty guidelines.

Balance Sheet Detail
LineBeginningEndChange
Assets
Investments in Publicly Traded Securities$301,413$194,378▼ $107,035
Cash and Non-Interest-Bearing Accounts$32,929$19,793▼ $13,136
Prepaid Expenses and Deferred Charges$9,232$13,586▲ $4,354
Land, Buildings, and Equipment, Net$7,405$2,852▼ $4,553
Pledges and Grants Receivable$21,522$1,529▼ $19,993
Total Assets$376,126$232,138▼ $143,988
Other Assets Total$3,625--
Liabilities
Other Liabilities$7,868$7,868→ $0
Accounts Payable and Accrued Expenses$3,427$2,956▼ $471
Total Liabilities$11,295$10,824▼ $471
Net Assets / Fund Balance
Unrestricted Net Assets$364,831$221,314▼ $143,517
Total Net Assets Fund Balance$364,831$221,314▼ $143,517
Total Liabilities and Net Assets / Fund Balance$376,126$232,138▼ $143,988

Asset Categories

AssetBook ValueDepreciationBasis
Equipment$2,852$41,268$44,120
Compensation and Service Providers
Top Officer Pay96th percentile

Employees

NameTitleFull / Part TimeBaseTotal
Cindy MooreExecutive DirectorFT$74,379$74,379

Board Members and Trustees

NameTitle
Amy ArnoldPresident
Elizabeth StroblVice-president
Alita SellersBoard Member
John StiltnerBoard Member
Leah HopkinsBoard Member
Robert LincicomeBoard Member
Angie SmithSecretary/treasurer
Revenue and Support

Revenue Composition

Contributions and Grants
$96,576
Program Service Revenue
$4,579
Investment Income
$12,640
Other Revenue
$0
All Other Contributions
$24,217
Change in Net Assets
$-125,959
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Salaries, Compensation, and Employee Benefits$156,763
Other Expenses$82,991
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Current Officers, Directors, Trustees, and Key Employees$74,379--$74,379
Other Salaries and Wages$47,816$18,259-$66,075
Occupancy$47,618$7,114-$54,732
Payroll Taxes$11,119$1,661-$12,780
Fees for Services Accounting-$8,375-$8,375
Depreciation Depletion$3,961$592-$4,553
Office Expenses$2,923$1,518-$4,441
Pension Plan Contributions$3,070$459-$3,529
Conferences and Meetings$3,183--$3,183
Insurance$2,341$350-$2,691
Fees for Service Investment Mgmnt Fees-$2,102-$2,102
Other Expenses$56$162-$56
Total Functional Expenses$199,162$40,592$0$239,754
Fundraising, Events, and Gaming
Fundraising activities
No
Gaming activities
No
Professional fundraiser used
No

Fundraising and Gaming Totals

Line ItemAmount
Professional Fundraising Fees$0
Political and Lobbying Activity
Political campaign activity
No
Lobbying activity
No
Subject to proxy tax
No
Debt and Bond Financing

Other Reported Liabilities

LiabilityAmount
Compensated Absences$7,868
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Annual disclosure for covered persons
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
No
Key decisions subject to board approval
No
Management duties delegated
No

Governance Explanations

Form 990, Part VI, Section B, Line 11

“Form 990 is received and reviewed by the executive director and the executive committee of the board of directors prior to signing and filing with the internal revenue service.”

Form 990, Part VI, Section B, Line 12C

“The conflict of interest policy is distributed and explained to all board members.”

Form 990, Part VI, Section C, Line 19

“The agency makes its form 990 available upon request at its administrative offices.”

Filing and Contact Details

Filer

Filer Name
Good Samaritan Clinic Inc
EIN
55-0708491
Phone
3048343986
Address
418 GRAND PARK DRIVE NO 311, PARKERSBURG, WV 26105

Signing Officer

Name
Cindy Moore
Title
Executive Director
Phone
3048343986
Signed
2017-02-11
Discuss with paid preparer
Yes

Organization Details

Principal Officer
Cindy Moore
Formed
1991
Legal Domicile
Wv
Voting Board Members
7
Independent Board Members
7
Employees
8
Volunteers
0

Preparer

Firm
PERRY & ASSOCIATES CPA'S AC
Address
104 SOUTH SUGAR STREET, SAINT CLAIRSVILLE, OH 43950
Preparer
Michael a Musilli CPA
Phone
7406951569
Supplemental Narrative

Additional Explanations

FORM 990, PART XII, LINE 2C:

“The process has not changed since the prior year.”

Raw XML AppendixShowing 400 of 409 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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IRS990/Desc0PRIMARY CARE WAS PROVIDED TO 100 PATIENTS DURING THE FISCAL YEAR. PATIENTS ARE INTERVIEWED BY OFFICE STAFF TO DETERMINE THEIR QUALIFICATIONS FOR SERVICES AND ARE SCHEDULED FOR AN APPOINTMENT WITH A HEALTH CARE PROVIDER. DIAGNOSTIC TESTING, PHYSICAL THERAPY, HEALTH EDUCATION AND IN-PATIENT SERVICES ARE PROVIDED BY THE LOCAL HOSPITAL. REFERRALS TO PHYSICIAN SPECIALISTS WHEN NECESSARY ARE ALSO PART OF THE SERVICE.THE ROLL OUT OF THE AFFORDABLE CARE ACT AND ASSUMPTION THAT EVERYONE HAS HEALTHCARE COVERAGE LED TO SUBSTANTIAL CUTS IN STATE FUNDING FOR GOOD SAMARITAN CLINIC. IN FISCAL YEAR 2016 OUR STATE FUNDING DROPPED FROM $181,751 TO $ 72,359. IN AN ATTEMPT TO GENERATE REVENUE TO MAKE UP FOR THOSE CUTS THE BOARD OF DIRECTORS OF THE CLINIC DECIDED TO START ACCEPTING WV MEDICAID. IN FEBRUARY 2015 WE SAW OUR FIRST MEDICAID PATIENTS. IN STAYING WITH OUR MISSION WE CONTINUE TO SERVE ADULTS THAT HAVE NO INSURANCE AND HAVE INCOMES THAT FALL AT OR BELOW 250% OF THE FEDERAL POVERTY LEVELS AS WELL AS THE MEDICAID PATIENTS.
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IRS990ScheduleA/GrossReceiptsAdmissionsGrp/CurrentTaxYearAmt04579
IRS990ScheduleA/GrossReceiptsAdmissionsGrp/CurrentTaxYearMinus1YearAmt09452
IRS990ScheduleA/GrossReceiptsAdmissionsGrp/CurrentTaxYearMinus2YearsAmt017915
IRS990ScheduleA/GrossReceiptsAdmissionsGrp/CurrentTaxYearMinus3YearsAmt010483
IRS990ScheduleA/GrossReceiptsAdmissionsGrp/CurrentTaxYearMinus4YearsAmt024908
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IRS990ScheduleA/InvestmentIncomeAndUBTIGrp/CurrentTaxYearAmt012640
IRS990ScheduleA/InvestmentIncomeAndUBTIGrp/CurrentTaxYearMinus1YearAmt05642
IRS990ScheduleA/InvestmentIncomeAndUBTIGrp/CurrentTaxYearMinus2YearsAmt021133
IRS990ScheduleA/InvestmentIncomeAndUBTIGrp/CurrentTaxYearMinus3YearsAmt03463
IRS990ScheduleA/InvestmentIncomeAndUBTIGrp/CurrentTaxYearMinus4YearsAmt02223
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IRS990ScheduleA/InvestmentIncomeCYPct00.03050
IRS990ScheduleA/InvestmentIncomePYPct00.02160
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IRS990ScheduleA/PublicSupportPY509Pct00.97840
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IRS990ScheduleA/SubstAndDsqlfyPrsnsTotGrp/TotalAmt00
IRS990ScheduleA/SubstantialContributorsAmtGrp/TotalAmt00
IRS990ScheduleA/ThirtyThrPctSuprtTestsCY509Ind0X
IRS990ScheduleA/Total509Grp/CurrentTaxYearAmt0101155
IRS990ScheduleA/Total509Grp/CurrentTaxYearMinus1YearAmt0215238
IRS990ScheduleA/Total509Grp/CurrentTaxYearMinus2YearsAmt0488289
IRS990ScheduleA/Total509Grp/CurrentTaxYearMinus3YearsAmt0300671
IRS990ScheduleA/Total509Grp/CurrentTaxYearMinus4YearsAmt0326895
IRS990ScheduleA/Total509Grp/TotalAmt01432248
IRS990ScheduleA/TotalSupportCalendarYearGrp/CurrentTaxYearAmt0113795
IRS990ScheduleA/TotalSupportCalendarYearGrp/CurrentTaxYearMinus1YearAmt0220880
IRS990ScheduleA/TotalSupportCalendarYearGrp/CurrentTaxYearMinus2YearsAmt0509422
IRS990ScheduleA/TotalSupportCalendarYearGrp/CurrentTaxYearMinus3YearsAmt0304134
IRS990ScheduleA/TotalSupportCalendarYearGrp/CurrentTaxYearMinus4YearsAmt0329118
IRS990ScheduleA/TotalSupportCalendarYearGrp/TotalAmt01477349
IRS990ScheduleB/ContributorInformationGrp/ContributorBusinessName/BusinessNameLine10RESTRICTED
IRS990ScheduleB/ContributorInformationGrp/ContributorNum0RESTRICTED
IRS990ScheduleB/ContributorInformationGrp/ContributorUSAddress/AddressLine10RESTRICTED
IRS990ScheduleB/ContributorInformationGrp/ContributorUSAddress/AddressLine20RESTRICTED
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IRS990ScheduleB/ContributorInformationGrp/ContributorUSAddress/State0RESTRICTED
IRS990ScheduleB/ContributorInformationGrp/ContributorUSAddress/ZIPCode0RESTRICTED
IRS990ScheduleB/ContributorInformationGrp/TotalContributionsAmt0RESTRICTED
IRS990/ScheduleBRequiredInd01
IRS990ScheduleD/EquipmentGrp/BookValueAmt02852
IRS990ScheduleD/EquipmentGrp/DepreciationAmt041268
IRS990ScheduleD/EquipmentGrp/OtherCostOrOtherBasisAmt044120
IRS990ScheduleD/OtherLiabilitiesOrgGrp/Amt07868
IRS990ScheduleD/OtherLiabilitiesOrgGrp/Desc0COMPENSATED ABSENCES
IRS990ScheduleD/TotalBookValueLandBuildingsAmt02852
IRS990ScheduleD/TotalLiabilityAmt07868
IRS990/ScheduleJRequiredInd00
IRS990/ScheduleORequiredInd01
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0FORM 990 IS RECEIVED AND REVIEWED BY THE EXECUTIVE DIRECTOR AND THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS PRIOR TO SIGNING AND FILING WITH THE INTERNAL REVENUE SERVICE.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1THE CONFLICT OF INTEREST POLICY IS DISTRIBUTED AND EXPLAINED TO ALL BOARD MEMBERS.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt2THE AGENCY MAKES ITS FORM 990 AVAILABLE UPON REQUEST AT ITS ADMINISTRATIVE OFFICES.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt3THE PROCESS HAS NOT CHANGED SINCE THE PRIOR YEAR.
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc0FORM 990, PART VI, SECTION B, LINE 11
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc1FORM 990, PART VI, SECTION B, LINE 12C
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc2FORM 990, PART VI, SECTION C, LINE 19
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc3FORM 990, PART XII, LINE 2C:
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IRS990/SignificantChangeInd00
IRS990/SignificantNewProgramSrvcInd00
IRS990/StatesWhereCopyOfReturnIsFldCd0WV
IRS990/SubjectToProxyTaxInd00
IRS990/TaxablePartyNotificationInd00
IRS990/TaxExemptBondsInd00
IRS990/TempOrPermanentEndowmentsInd00
IRS990/TerminateOperationsInd00
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IRS990/TotalAssetsEOYAmt0232138
IRS990/TotalAssetsGrp/BOYAmt0376126
IRS990/TotalAssetsGrp/EOYAmt0232138
IRS990/TotalCompGreaterThan150KInd00
IRS990/TotalContributionsAmt096576
IRS990/TotalEmployeeCnt08
IRS990/TotalFunctionalExpensesGrp/FundraisingAmt00
IRS990/TotalFunctionalExpensesGrp/ManagementAndGeneralAmt040592
IRS990/TotalFunctionalExpensesGrp/ProgramServicesAmt0199162
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IRS990/TotalGrossUBIAmt00
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IRS990/TotalLiabilitiesGrp/EOYAmt010824
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IRS990/TotalOtherCompensationAmt00
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IRS990/TotalRevenueGrp/UnrelatedBusinessRevenueAmt00
IRS990/TotalVolunteersCnt00
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IRS990/TotReportableCompRltdOrgAmt00
IRS990/TrnsfrExmptNonChrtblRltdOrgInd00
IRS990/TypeOfOrganizationCorpInd0X
IRS990/UnrelatedBusIncmOverLimitInd00
IRS990/UnrestrictedNetAssetsGrp/BOYAmt0364831
IRS990/UnrestrictedNetAssetsGrp/EOYAmt0221314
IRS990/UponRequestInd0X
IRS990/USAddress/AddressLine1Txt0418 GRAND PARK DRIVE NO 311
IRS990/USAddress/CityNm0PARKERSBURG
IRS990/USAddress/StateAbbreviationCd0WV
IRS990/USAddress/ZIPCd026105
IRS990/VotingMembersGoverningBodyCnt07
IRS990/VotingMembersIndependentCnt07
IRS990/WebsiteAddressTxt0GOODSAMARITANCLINICPARKERSBURGWV.COM
IRS990/WhistleblowerPolicyInd01
ReturnHeader/BuildTS02017-02-10 21:41:12Z
ReturnHeader/BusinessOfficerGrp/DiscussWithPaidPreparerInd01
ReturnHeader/BusinessOfficerGrp/PersonNm0CINDY MOORE
ReturnHeader/BusinessOfficerGrp/PersonTitleTxt0EXECUTIVE DIRECTOR
ReturnHeader/BusinessOfficerGrp/PhoneNum03048343986
ReturnHeader/BusinessOfficerGrp/SignatureDt02017-02-11
ReturnHeader/Filer/BusinessName/BusinessNameLine1Txt0GOOD SAMARITAN CLINIC INC
ReturnHeader/Filer/BusinessNameControlTxt0GOOD
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ReturnHeader/Filer/PhoneNum03048343986
ReturnHeader/Filer/USAddress/AddressLine1Txt0418 GRAND PARK DRIVE NO 311
ReturnHeader/Filer/USAddress/CityNm0PARKERSBURG
ReturnHeader/Filer/USAddress/StateAbbreviationCd0WV
ReturnHeader/Filer/USAddress/ZIPCd026105
ReturnHeader/PreparerFirmGrp/PreparerFirmEIN0550771624
ReturnHeader/PreparerFirmGrp/PreparerFirmName/BusinessNameLine1Txt0PERRY & ASSOCIATES CPA'S AC
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/AddressLine1Txt0104 SOUTH SUGAR STREET
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/CityNm0SAINT CLAIRSVILLE

Document Assets

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Filings

Displayed year

2016 • Form 990Detailed filing. Detailed filing data is available for this year.

Open filing
Assets
$232,138
Liabilities
$10,824
Net assets
$221,314
Revenue
$113,795
Expenses
$239,754
Net income
-$125,959
Balance SheetOperations
YearAssetsLiabilitiesNet AssetsRevenueExpensesNet Income
2017Detailed filing. Detailed filing data is available for this year.$0.00$0.00$0.00$0.15$0.75$0.59
2016Detailed filing. Detailed filing data is available for this year.$2.32$0.11$2.21$1.14$2.40$1.26
2015Detailed filing. Detailed filing data is available for this year.$3.76$0.11$3.65$2.28$2.74$0.46
2014Detailed filing. Detailed filing data is available for this year.$4.25$0.14$4.11$4.52$4.94$0.43
2013Summary only. Only limited summary data is available for this year.$4.68$0.15$4.54$3.05$3.48$0.43
2012Summary only. Only limited summary data is available for this year.$5.03$0.13$4.90$3.29$3.23$0.06
2011Summary only. Only limited summary data is available for this year.$4.99$0.10$4.89$3.25$3.19$0.06