Civic Intelligence

Good Samaritan Community Foundation

EIN 86-6306490 • 501(c)3 • Phoenix, AZ

Profile

Support the charitable beneficiary, banner health.

2901 N Central Ave Suite 160Phoenix, AZ 85012

n/A

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 2015

Liabilities / Revenue

Score unavailable

No value available

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

Source year 2015

Net Margin

Score unavailable

No value available

Net margin requires both revenue and expenses on the latest valid filing.

Source year 2015

Top Officer Pay

Score unavailable

No value available

No filing with officer rows is available for this organization yet.

Asset Growth

Score unavailable

No value available

A valid growth rate could not be computed from the available filing history.

Annualized from 2014 to 2015

Revenue Growth

3rd percentile

-100%

Faster revenue growth than 3% of similar nonprofits.

501(c)3 • <$500k nonprofits • Annualized from 2014 to 2015

Assets

Flat

$0

Flat from 2014

Liabilities

Flat

$0

Flat from 2014

Net Assets

Flat

$0

Flat from 2014

Revenue

Down

$0

Down $16,885 (-100%) from 2014

Expenses

Down

$0

Down $1,000,000 (-100%) from 2014

Net Income

Up

$0

Up $983,115 (+100%) from 2014

Trend Graphs

Balance Sheet Trend

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

$1$0Assets 2010: $0Liabilities 2010: $02010Assets 2011: $0Liabilities 2011: $0Net Assets 2011: $02011Assets 2012: $1Liabilities 2012: $02012Assets 2013: $1Liabilities 2013: $02013Assets 2014: $0Liabilities 2014: $0Net Assets 2014: $02014Assets 2015: $0Liabilities 2015: $0Net Assets 2015: $02015

Highlighted filing

2015

Assets$0
Liabilities$0
Net Assets$0

Operations Trend

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

$1.0M$500K$0-$500K-$1.0MRevenue 2010: -$27,432Expenses 2010: $0Net Income 2010: -$27,4322010Revenue 2011: -$119,223Expenses 2011: $250,000Net Income 2011: -$369,2232011Revenue 2012: $3,028Expenses 2012: $0Net Income 2012: $3,0282012Revenue 2013: -$60,716Expenses 2013: $0Net Income 2013: -$60,7162013Revenue 2014: $16,885Expenses 2014: $1,000,000Net Income 2014: -$983,1152014Revenue 2015: $0Expenses 2015: $0Net Income 2015: $02015

Highlighted filing

2015

Revenue$0
Expenses$0
Net Income$0

Filings

Latest Filing Detail
Jump To
Filing Snapshot
Filing Period
Aug 1, 2014 to Jul 31, 2015
Signed
Jun 13, 2016
Return Version
2015v2.1
Gross Receipts
$0
Mission and Program Overview

Mission

Support the charitable beneficiary, banner health.

Balance Sheet Detail
LineBeginningEndChange
Assets
Cash and Non-Interest-Bearing Accounts$0$0→ $0
Savings and Temporary Cash Investments$0$0→ $0
Accounts Receivable$0$0→ $0
Other Notes and Loans Receivable, Net$0$0→ $0
Pledges and Grants Receivable$0$0→ $0
Receivable From Disqualified Prsn$0$0→ $0
Receivables From Officers Etc$0$0→ $0
Investments Other Securities$0$0→ $0
Investments Program Related$0$0→ $0
Investments in Publicly Traded Securities$0$0→ $0
Land, Buildings, and Equipment, Net$0--
Pd in Cap Srpls Land Bldg Eqp Fund$0$0→ $0
Rtn Earn Endowment Incm Other Fnds$0$0→ $0
Cap Stk Tr Prin Current Funds$0$0→ $0
Intangible Assets$0$0→ $0
Inventories for Sale or Use$0$0→ $0
Loans From Officers Directors$0$0→ $0
Prepaid Expenses and Deferred Charges$0$0→ $0
Other Assets Total$0$0→ $0
Total Assets$0$0→ $0
Liabilities
Accounts Payable and Accrued Expenses$0$0→ $0
Grants Payable$0$0→ $0
Mortgage Notes Payable Secured by Investment Property$0$0→ $0
Unsecured Notes Loans Payable$0$0→ $0
Other Liabilities$0$0→ $0
Deferred Revenue$0$0→ $0
Escrow Account Liability$0$0→ $0
Tax Exempt Bond Liabilities$0$0→ $0
Total Liabilities$0$0→ $0
Net Assets / Fund Balance
Total Net Assets Fund Balance$0$0→ $0
Total Liabilities and Net Assets / Fund Balance$0$0→ $0
Compensation and Service Providers

Board Members and Trustees

Highest Paid Contractors

ContractorServicesLocationCompensation
NoneNone--
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$0
Investment Income
$0
Other Revenue
$0
Change in Net Assets
$0
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Grants and Similar Amounts Paid$0
Other Expenses$0
Professional Fundraising Fees$0
Salaries, Compensation, and Employee Benefits$0
Total Fundraising Expense$0
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
Insider Transactions and Loans

Loans and Receivables

Line ItemBeginningEndChange
Loans from Officers, Directors, Trustees, and Key Employees$0$0→ $0
Receivables from Disqualified Persons$0$0→ $0
Receivables from Officers, Directors, Trustees, and Key Employees$0$0→ $0
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
No
Management duties delegated
No

Governance Explanations

Form 990, Part VI, Line 6 and 7A

Line 6 - banner health is considered a member due to its ability as charitable beneficiary to receive a distribution of net assets upon dissolution. Line 7a - banner health, by official act of its president, may remove a banner health trustee and appoint a successor.

Form 990, Part VI, Line 11B

The 990 is reviewed by banner health's legal department, tax department, internal audit department and certain banner health officers. A meeting is held with the tax preparer and a line-by-line review is done prior to the filing of the return. The form 990 will be made available to the governing body at the next regularly scheduled board meeting after filing.

Form 990, Part VI, Line 12C

The organization follows the conflict of interest policy of its supported organization, banner health. The banner health internal audit department provides each party with a disclosure questionnaire. The internal audit department prepares a summary for the tax department. This summary is also presented to the audit committee. The tax department prepares the form 990 disclosure. This disclosure is presented to the legal department for review. Pursuant to banner's conflict of interest policy, all board members, officers and the director of audit services must disclose the existence of any financial interest that may give rise to a conflict of interest. Form 990, part vi, line 15a and 15b this organization does not compensate any officers or key employees. The compensation of the trustees is determined by a related tax-exempt organization. Form 990, part vi, lines 12a, 13, and 14 this entity does not itself issue policies. All policies are adopted and enforced through banner health as a charitable beneficiary.

Form 990, Part VI, Line 19

The organization's governing documents, audited financial statements, the governing documents, conflict of interest policy, and financial statements are not required to be made available to the public and therefore they are not.

Filing and Contact Details

Filer

Filer Name
Good Samaritan Community Foundation
EIN
86-6306490
In Care Of
% DAVID BIXBY
Phone
6027474000
Address
2901 N CENTRAL AVE SUITE 160, PHOENIX, AZ 85012

Signing Officer

Name
David Kaubisch
Title
Trustee
Phone
6027474000
Signed
2016-06-13
Discuss with paid preparer
Yes

Organization Details

Principal Officer
Andrea Kramer Petersen
Formed
2000
Legal Domicile
Az
Voting Board Members
2
Independent Board Members
0
Employees
0
Volunteers
0

Preparer

Firm
Ernst & Young US Llp
Address
2 N CENTRAL AVENUE STE 2300, PHOENIX, AZ 85004
Preparer
Brenda Griesemer
Phone
6027474000
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IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm0ANDREA KRAMER PETERSEN
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm1DAVID KAUBISCH
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt0TRUSTEE
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt1TRUSTEE
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IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt0THE COMPENSATION OF THE TRUSTEES IS DETERMINED BY A RELATED TAX-EXEMPT ORGANIZATION (BANNER HEALTH). SEE SCHEDULE O FORM 990, PART VI, LINES 15A AND 15B FOR THE PROCESS USED BY THE RELATED ORGANIZATION TO DETERMINE COMPENSATION.
IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt1EXEC 457(F) - COVERED EXECUTIVES COMPENSATED BY BANNER HEALTH. THIS NONQUALIFIED PLAN IS HELD AT FIDELITY INVESTMENTS. VESTING OCCURS UPON MEETING VESTING REQUIREMENTS (SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE) - EARLIER OF AGE 62, 5 YEARS FROM DATE OF DEPOSIT, OR RULE OF 80. TAXATION OCCURS UPON DISTRIBUTION (IF VESTED). THE ONLY CONTRIBUTIONS ALLOWED ARE EMPLOYER CONTRIBUTIONS. PAYOUT AMOUNTS ARE TAXABLE AND INCLUDED IN SCHEDULE J, PART II, COL B(III). DEPOSIT AMOUNTS ARE INCLUDED IN SCHEDULE J, PART II, COL (C). NAME 457(F) PAYOUT EMPLOYER 457(F) DEPOSIT ANDREA KRAMER PETERSEN $ 547 $ 0 DAVID KAUBISCH $18,788 $31,159 SCHEDULE J, PART I, LINE 7 Banner Health has a management incentive plan (MIP) which is based on company achievement of base and stretch targets for several financial and non-financial/clinical quality metrics that are established annually by the Banner Health board of directors. Awards are granted as a percentage of the participants base salary and vary with the position level of the participating employee, ranging from 24% to 80% of base salary. The MIP was accrued in 2014 for the 2015 MIP, and payouts on the 2015 MIP were paid in 2016. MIP compensation is included in Schedule J, Part II, Col B(II).
IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt2BONUS LIFE INSURANCE AS PART OF BANNER HEALTH'S EXECUTIVE SELECT BENEFIT PROGRAM (ESB), CERTAIN INDIVIDUALS PARTICIPATED IN THE BONUS LIFE INSURANCE PROGRAM (BLIP). ELIGIBLE EMPLOYEES COULD ELECT TO USE PART OF THEIR ESB ALLOWANCE TO PURCHASE BLIP THROUGH NORTHWESTERN MUTUAL. THE PARTICIPATING EMPLOYEE OWNS THE POLICY AND CAN ACCESS ITS CASH VALUE. THE ENTIRE AMOUNT PURCHASED IS REPORTED AS TAXABLE COMPENSATION IN COLUMN B(III) FOR THE FOLLOWING INDIVIDUAL: ANDREA KRAMER PETERSEN $8,655
IRS990ScheduleJ/SupplementalInformationDetail/FormAndLineReferenceDesc0SCHEDULE J, PART I, LINE 3
IRS990ScheduleJ/SupplementalInformationDetail/FormAndLineReferenceDesc1SCHEDULE J, PART I, LINE 4B
IRS990ScheduleJ/SupplementalInformationDetail/FormAndLineReferenceDesc2SCHEDULE J, PART II
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IRS990ScheduleN/DirectorOfSuccessorInd0false
IRS990ScheduleN/EmployeeOfSuccessorInd0false
IRS990ScheduleN/LiabilitiesPaidInd0true
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/AssetsDistriOrExpnssPaidDesc0NONE - SEE PART III
IRS990ScheduleN/OwnerOfSuccessorInd0false
IRS990ScheduleN/ReceiveCompensationInd0false
IRS990ScheduleN/RequiredToNotifyAGInd0false
IRS990ScheduleN/SupplementalInformationDetail/ExplanationTxt0IN 2014, GOOD SAMARITAN COMMUNITY FOUNDATION DISTRIBUTED ALL OF ITS ASSETS AND IT HAD NO ACTIVITY OR ASSETS IN 2015. GOOD SAMARITAN COMMUNITY FOUNDATION WAS DISSOLVED ON JULY 15, 2015.
IRS990ScheduleN/SupplementalInformationDetail/FormAndLineReferenceDesc0SCHEDULE N, PART I
IRS990/ScheduleORequiredInd0true
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0LINE 6 - BANNER HEALTH IS CONSIDERED A MEMBER DUE TO ITS ABILITY AS CHARITABLE BENEFICIARY TO RECEIVE A DISTRIBUTION OF NET ASSETS UPON DISSOLUTION. LINE 7A - BANNER HEALTH, BY OFFICIAL ACT OF ITS PRESIDENT, MAY REMOVE A BANNER HEALTH TRUSTEE AND APPOINT A SUCCESSOR.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1THE 990 IS REVIEWED BY BANNER HEALTH'S LEGAL DEPARTMENT, TAX DEPARTMENT, INTERNAL AUDIT DEPARTMENT AND CERTAIN BANNER HEALTH OFFICERS. A MEETING IS HELD WITH THE TAX PREPARER AND A LINE-BY-LINE REVIEW IS DONE PRIOR TO THE FILING OF THE RETURN. THE FORM 990 WILL BE MADE AVAILABLE TO THE GOVERNING BODY AT THE NEXT REGULARLY SCHEDULED BOARD MEETING AFTER FILING.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt2THE ORGANIZATION FOLLOWS THE CONFLICT OF INTEREST POLICY OF ITS SUPPORTED ORGANIZATION, BANNER HEALTH. THE BANNER HEALTH INTERNAL AUDIT DEPARTMENT PROVIDES EACH PARTY WITH A DISCLOSURE QUESTIONNAIRE. THE INTERNAL AUDIT DEPARTMENT PREPARES A SUMMARY FOR THE TAX DEPARTMENT. THIS SUMMARY IS ALSO PRESENTED TO THE AUDIT COMMITTEE. THE TAX DEPARTMENT PREPARES THE FORM 990 DISCLOSURE. THIS DISCLOSURE IS PRESENTED TO THE LEGAL DEPARTMENT FOR REVIEW. PURSUANT TO BANNER'S CONFLICT OF INTEREST POLICY, ALL BOARD MEMBERS, OFFICERS AND THE DIRECTOR OF AUDIT SERVICES MUST DISCLOSE THE EXISTENCE OF ANY FINANCIAL INTEREST THAT MAY GIVE RISE TO A CONFLICT OF INTEREST. FORM 990, PART VI, LINE 15A AND 15B THIS ORGANIZATION DOES NOT COMPENSATE ANY OFFICERS OR KEY EMPLOYEES. THE COMPENSATION OF THE TRUSTEES IS DETERMINED BY A RELATED TAX-EXEMPT ORGANIZATION. FORM 990, PART VI, LINES 12A, 13, AND 14 THIS ENTITY DOES NOT ITSELF ISSUE POLICIES. ALL POLICIES ARE ADOPTED AND ENFORCED THROUGH BANNER HEALTH AS A CHARITABLE BENEFICIARY.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt3THE ORGANIZATION'S GOVERNING DOCUMENTS, AUDITED FINANCIAL STATEMENTS, THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT REQUIRED TO BE MADE AVAILABLE TO THE PUBLIC AND THEREFORE THEY ARE NOT.
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc0FORM 990, PART VI, LINE 6 AND 7A
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc1FORM 990, PART VI, LINE 11B
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc2Form 990, Part VI, Line 12c
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc3FORM 990, PART VI, LINE 19
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IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EntityTypeTxt2FOREIGN CORP
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EntityTypeTxt3C CORP
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/ForeignAddress/AddressLine1Txt0PO BOX 1051
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/ForeignAddress/CityNm0GRAND CAYMAN
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/ForeignAddress/CountryCd0CJ
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/ForeignAddress/ProvinceOrStateNm0BWI
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/LegalDomicileStateCd0AR
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/LegalDomicileStateCd1AK
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/LegalDomicileStateCd2CA
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/LegalDomicileStateCd3AZ
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt0ACCOUNTABLE CARE
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt1MEDICAL SERVICES
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt2INVESTMENTS
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt3THIRD PARTY ADMIN
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/RelatedOrganizationName/BusinessNameLine1Txt0BANNER HEALTH NETWORK
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/RelatedOrganizationName/BusinessNameLine1Txt1TANANA VALLEY MEDICAL-SURGICAL GROUP INC
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/RelatedOrganizationName/BusinessNameLine1Txt2BANNER INDEMNITY LIMITED
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/RelatedOrganizationName/BusinessNameLine1Txt3BANNER PLAN ADMINISTRATION INC
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/AddressLine1Txt02901 N CENTRAL AVE SUITE 160
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/AddressLine1Txt11001 NOBLE STREET
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/AddressLine1Txt2445 W 5TH PLACE SUITE 101
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IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/CityNm1FAIRBANKS
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IRS990ScheduleR/IdRelatedOrgTxblPartnershipGrp/LegalDomicileStateCd1AZ
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