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GOOD SAMARITAN HEALTH CENTER OF COBB INC: Form 990, tax year 2023

View the entire original 990 at ProPublica ↗

Organization
GOOD SAMARITAN HEALTH CENTER OF COBB INC (EIN 32-0045238)
Tax period
2023-01-01 to 2023-12-31
Filed
2024-08-05
IRS object ID
202402189349300750
Schema version
2023v5.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2024-08-05T08:06:55-05:00ReturnTs
Tax Period End2023-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN582475857PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1NICHOLS CAULEY & ASSOCIATES LLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line11300 BELLEVUE AVENUEAddressLine1Txt
CityDUBLINCityNm
State AbbreviationGAStateAbbreviationCd
ZIP310214152ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2023-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN320045238EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1GOOD SAMARITAN HEALTH CENTER OFBusinessNameLine1Txt
Business Name Line2COBB INCBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlGOODBusinessNameControlTxt
Phone7704193120PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11605 ROBERTA DR SWAddressLine1Txt
CityMARIETTACityNm
State AbbreviationGAStateAbbreviationCd
ZIP300083855ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonCYRL KITCHENSPersonNm
Person TitleCHIEF EXECUTIVE OFFICERPersonTitleTxt
Phone7704193120PhoneNum
Signature2024-07-25SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd
FieldValueIRS element (for citing)
IRS Responsible Prty Info Curr0IRSResponsiblePrtyInfoCurrInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonGREGORY M CHAPMANPreparerPersonNm
PTINP01019632PTIN
Phone4782751163PhoneNum
Preparation2024-07-25PreparationDt
FieldValueIRS element (for citing)
Tax2023TaxYr
Build TS2024-08-08 14:25:15ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerCYRL KITCHENSPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11605 ROBERTA DR SWAddressLine1Txt
CityMARIETTACityNm
State AbbreviationGAStateAbbreviationCd
ZIP300083855ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$15,621,530GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.GOODSAMCOBB.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2002FormationYr
Legal Domicile StateGALegalDomicileStateCd
Activity Or MissionTHE ORGANIZATION'S MISSION IS TO SPREAD THE LOVE OF CHRIST BY PROVIDING QUALITY HEALTHCARE TO THOSE IN NEED.ActivityOrMissionDesc
Voting Members Governing Body12VotingMembersGoverningBodyCnt
Voting Members Independent12VotingMembersIndependentCnt
Total Employee65TotalEmployeeCnt
Total Volunteers101TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$11,008,849PYContributionsGrantsAmt
CY Contributions Grants$13,638,445CYContributionsGrantsAmt
PY Program Service Revenue$1,730,545PYProgramServiceRevenueAmt
CY Program Service Revenue$1,838,812CYProgramServiceRevenueAmt
PY Investment Income$5,536PYInvestmentIncomeAmt
CY Investment Income$40,382CYInvestmentIncomeAmt
PY Other Revenue$59,342PYOtherRevenueAmt
CY Other Revenue$50,423CYOtherRevenueAmt
PY Total Revenue$12,804,272PYTotalRevenueAmt
CY Total Revenue$15,568,062CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$3,555,120PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$3,943,291CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$56,937CYTotalFundraisingExpenseAmt
PY Other Expenses$8,182,555PYOtherExpensesAmt
CY Other Expenses$8,497,003CYOtherExpensesAmt
PY Total Expenses$11,737,675PYTotalExpensesAmt
CY Total Expenses$12,440,294CYTotalExpensesAmt
PY Revenues Less Expenses$1,066,597PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$3,127,768CYRevenuesLessExpensesAmt
Total Assets BOY$6,888,651TotalAssetsBOYAmt
Total Assets EOY$10,075,897TotalAssetsEOYAmt
Total Liabilities BOY$296,521TotalLiabilitiesBOYAmt
Total Liabilities EOY$355,999TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$6,592,130NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$9,719,898NetAssetsOrFundBalancesEOYAmt
MissionTHE ORGANIZATION'S MISSION IS TO SPREAD THE LOVE OF CHRIST BY PROVIDING QUALITY HEALTHCARE TO THOSE IN NEED.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$10,396,829ExpenseAmt
Revenue$1,882,471RevenueAmt
DescTHE ORGANIZATION PROVDIES PRIMARY MEDICAL, DENTAL AND COUNSELING SERVICES TO UNINSURED AND UNDERINSURED, WORKING POOR AND INDIGENT IN THE COMMUNITY. GOOD SAMARITAN'S FAMILY CENTERED APPROACH ENSURES THAT THEY DELIVER HIGH QUALITY AND PREVENTATIVE MEDICAL AND DENTAL SERVICES IN ADDITION TO COUNSELING, PHARMACEUTICAL, REFERRAL AND HEALTH EDUCATION PROGRAMS IN AN ATMOSPHERE OF DIGNITY, RESPECT, REGARDLESS OF RACE, ETHNICITY, RELIGION OR ABILTY TO PAY.Desc
Total Program Service Expenses$10,396,829TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising ActivitiesYes (1)FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash ContriYes (1)DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related Entity0RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document5IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee65EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members12GoverningBodyVotingMembersCnt
Independent Voting Member12IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn Body0Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldGAStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1GAYLE NELSONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone7704193120PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11605 ROBERTA DR SWAddressLine1Txt
CityMARIETTACityNm
State AbbreviationGAStateAbbreviationCd
ZIP300083855ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
DR CHRIS SMITH
CHAIRMAN OF BOARD0.00Yes (X)$0$0$0
REV GRANT COLE
SECRETARY0.00Yes (X)$0$0$0
GREG GRIGGS
TREASURER0.00Yes (X)$0$0$0
BARRY TEAGUE
BOARD OF DIRECTORS0.00Yes (X)$0$0$0
LYNDA AUSBURN
BOARD OF DIRECTORS0.00Yes (X)$0$0$0
BRENDA GASKINS
BOARD OF DIRECTORS0.00Yes (X)$0$0$0
ANNA LONGACRE MD
BOARD OF DIRECTORS0.00Yes (X)$0$0$0
DR JOHN SHERRER
BOARD OF DIRECTORS0.00Yes (X)$0$0$0
ENERY LUCENA VELEZ
BOARD OF DIRECTORS0.00Yes (X)$0$0$0
MASHONDOLA VALDRY
BOARD OF DIRECTORS0.00Yes (X)$0$0$0
DIEGO SHAEFER
BOARD OF DIRECTORS0.00Yes (X)$0$0$0
ALBERTO SCHIRMER
BOARD OF DIRECTORS0.00Yes (X)$0$0$0
CYRL KITCHENS
CEO40.00$270,363$0$0Yes (X)
GAYLE NELSON
CFO40.00$152,984$0$0Yes (X)
MARY KIM
DENTIST1.00$134,616$0$0Yes (X)
RYAN RANELLS
NURSE PRACTIONER1.00$104,472$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$662,435TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K4IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Government Grants$3,638,157GovernmentGrantsAmt
All Other Contributions$10,000,288AllOtherContributionsAmt
Noncash Contributions$6,348,644NoncashContributionsAmt
Total Contributions$13,638,445TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
MEDICAL PROGRAM REVENUES621300$962,715$962,715
DENTAL PROGRAM REVENUES621300$497,836$497,836
DISPENSARY REVENUES621300$299,793$299,793
INSURANCE PAYMENTS621300$64,268$64,268
MEDICARE AND MEDICAID621300$8,620$8,620

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$5,580TotalRevenueColumnAmt
Related Or Exempt Func Income$5,580RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$1,838,812TotalProgramServiceRevenueAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$40,382TotalRevenueColumnAmt
Related Or Exempt Func Income$40,382RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$100,614FundraisingGrossIncomeAmt
Fundraising Direct Expenses$53,468FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$47,146TotalRevenueColumnAmt
Exclusion$47,146ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescOTHERDesc
Business621300BusinessCd
Total Revenue Column$3,277TotalRevenueColumnAmt
Related Or Exempt Func Income$3,277RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$3,277OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$15,568,062TotalRevenueColumnAmt
Related Or Exempt Func Income$1,882,471RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$47,146ExclusionAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$3,547,573TotalAmt
Program Services$2,514,004ProgramServicesAmt
Management And General$990,762ManagementAndGeneralAmt
Fundraising$42,807FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$209,879TotalAmt
Program Services$145,125ProgramServicesAmt
Management And General$53,667ManagementAndGeneralAmt
Fundraising$11,087FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$185,839TotalAmt
Program Services$112,790ProgramServicesAmt
Management And General$70,006ManagementAndGeneralAmt
Fundraising$3,043FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$114,482TotalAmt
Management And General$114,482ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$56,952TotalAmt
Program Services$18,828ProgramServicesAmt
Management And General$38,124ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$29,582TotalAmt
Management And General$29,582ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$101,920TotalAmt
Program Services$101,920ProgramServicesAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$34,610TotalAmt
Management And General$34,610ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$38,190TotalAmt
Management And General$38,190ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$208,899TotalAmt
Program Services$36,874ProgramServicesAmt
Management And General$172,025ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$69,041TotalAmt
Management And General$69,041ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
PROFESSIONAL SERVICES$4,097,428$4,097,428
DISPENSARY COSTS$2,353,799$2,353,799
BAD DEBTS$479,516$479,516
OTHER EXPENSES$265,713$265,713

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$646,871TotalAmt
Program Services$536,545ProgramServicesAmt
Management And General$110,326ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$12,440,294TotalAmt
Program Services$10,396,829ProgramServicesAmt
Management And General$1,986,528ManagementAndGeneralAmt
Fundraising$56,937FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$3,576,268BOYAmt
EOY$2,309,535EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
EOY$2,312,477EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$89,681BOYAmt
EOY$676,556EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$9,045BOYAmt
EOY$8,610EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$47,451BOYAmt
EOY$56,814EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$6,471,066LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$1,759,161LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$3,166,206BOYAmt
EOY$4,711,905EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$6,888,651BOYAmt
EOY$10,075,897EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$186,647BOYAmt
EOY$234,630EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$109,874BOYAmt
EOY$121,369EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$296,521BOYAmt
EOY$355,999EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$5,940,010BOYAmt
EOY$9,591,067EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$652,120BOYAmt
EOY$128,831EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$6,592,130BOYAmt
EOY$9,719,898EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$6,888,651BOYAmt
EOY$10,075,897EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$3,127,768ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit RequiredYes (1)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (1)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$17,440,282CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$9,195,817CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$9,776,048CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$11,008,849CurrentTaxYearMinus1YearAmt
Current Tax Year$13,638,445CurrentTaxYearAmt
Total$61,059,441TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,508,117CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,334,940CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,542,047CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,733,287CurrentTaxYearMinus1YearAmt
Current Tax Year$1,842,089CurrentTaxYearAmt
Total$7,960,480TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$18,948,399CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$10,530,757CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$11,318,095CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$12,742,136CurrentTaxYearMinus1YearAmt
Current Tax Year$15,480,534CurrentTaxYearAmt
Total$69,019,921TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$69,019,921PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years$709CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$5,536CurrentTaxYearMinus1YearAmt
Current Tax Year$40,382CurrentTaxYearAmt
Total$46,627TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years$709CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$5,536CurrentTaxYearMinus1YearAmt
Current Tax Year$40,382CurrentTaxYearAmt
Total$46,627TotalAmt

Net Income From Other UBI NetIncomeFromOtherUBIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$74,352CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$69,967CurrentTaxYearMinus3YearsAmt
Total$144,319TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$19,022,751CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$10,600,724CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$11,318,804CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$12,747,672CurrentTaxYearMinus1YearAmt
Current Tax Year$15,520,916CurrentTaxYearAmt
Total$69,210,867TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.99720PublicSupportCY509Pct
Public Support PY5090.99690PublicSupportPY509Pct
Investment Income CY0.00070InvestmentIncomeCYPct
Investment Income PY0.00010InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$402,595OtherCostOrOtherBasisAmt
Book Value$402,595BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$4,674,053OtherCostOrOtherBasisAmt
Depreciation$828,042DepreciationAmt
Book Value$3,846,011BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,256,522OtherCostOrOtherBasisAmt
Depreciation$931,119DepreciationAmt
Book Value$325,403BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$137,896OtherCostOrOtherBasisAmt
Book Value$137,896BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$4,711,905TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescACCRUED LEAVEDesc
Amt$121,369Amt
FieldValueIRS element (for citing)
Total Liability$121,369TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$15,621,530TotalRevEtcAuditedFinclStmtAmt
Revenue Not Reported$0RevenueNotReportedAmt
Revenue Subtotal$15,621,530RevenueSubtotalAmt
Other Revenues Not Included-$53,468OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt-$53,468RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$15,568,062TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$12,493,762TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$53,468OtherExpensesIncludedAmt
Expenses Not Reported$53,468ExpensesNotReportedAmt
Expenses Subtotal$12,440,294ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$12,440,294TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART X, LINE 2:GOOD SAMARITAN HEALTH CENTER OF COBB, INC. IS ORGANIZED AS A GEORGIA NONPROFIT CORPORATIONS AND HAS BEEN RECOGNIZED BY THE IRS AS EXEMPT FROM FEDERAL INCOME TAXES UNDER IRC SECTION 501(A) AS AN ORGANIZATION DESCRIBED IN IRC SECTION 501(C)(3), QUALIFIES FOR THE CHARITABLE CONTRIBUTION DEDUCTION, AND HAS BEEN DETERMINED NOT TO BE A PRIVATE FOUNDATION. THE ORGANIZATION IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, IT IS SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO OUR EXEMPT PURPOSES. WE HAVE DETERMINED THAT WE ARE NOT SUBJECT TO UNRELATED BUSINESS INCOME TAX AND HAVE NOT FILED AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990T) WITH THE IRS. THE ORGANIZATION BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE ORGANIZATION'S FORM 990 IS SUBJECT TO EXAMINATION BY THE IRS, GENERALLY FOR THREE YEARS AFTER IT IS FILED.
PART XI, LINE 4B - OTHER ADJUSTMENTS:DIRECT FUNDRAISING EXPENSE -53,468.
PART XII, LINE 2D - OTHER ADJUSTMENTS:DIRECT FUNDRAISING EXPENSE 53,468.

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1GOLF TOURNAMENTEvent1Nm
Gross Receipts Event1$100,614GrossReceiptsEvent1Amt
Gross Revenue Event1$100,614GrossRevenueEvent1Amt
Other Direct Expenses Event1$53,468OtherDirectExpensesEvent1Amt
Gross Receipts Total$100,614GrossReceiptsTotalAmt
Gross Revenue Total Events$100,614GrossRevenueTotalEventsAmt
Oth Direct Expnss Total Events$53,468OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$53,468DirectExpenseSummaryEventsAmt
Net Income Summary$47,146NetIncomeSummaryAmt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
CYRL KITCHENS
CEO$270,363$0$0$0$0$0$0$0$0$0$270,363$0$0$0
GAYLE NELSON
CFO$152,984$0$0$0$0$0$0$0$0$0$152,984$0$0$0

Schedule M IRS990ScheduleM

Other Non Cash Contri Table OtherNonCashContriTableGrp

FieldValueIRS element (for citing)
Non Cash CheckboxYes (X)NonCashCheckboxInd
DescMEDICAL SERVICESDesc
Contribution0ContributionCnt
Noncash Contributions Rpt F990$6,348,644NoncashContributionsRptF990Amt
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGiftsInd
Third Parties Used0ThirdPartiesUsedInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11BRETURN WILL BE REVIEWED PRIOR TO FILING
FORM 990, PART VI, SECTION B, LINE 12CTHE OFFICERS, DIRECTORS AND KEY EMPLOYEES MUST SIGN THE DISCLOSURE FORM ANNUALLY. THESE FORMS ARE MATCHED AGAINST A LIST OF SUCH PEOPLE.
FORM 990, PART VI, SECTION B, LINE 15EXECUTIVE BOARD RESEARCHES AND PROVIDES INFORMATION TO MAKE A RECOMMENDATION TO THE FULL BOARD FOR THE SALARY AND BENEFITS OF HIGHLY COMPENSATED EMPLOYEES AND CONSULTANTS BASED ON A REVIEW OF COMPARABLE DATA. THE BOARD THEN DOCUMENTS HOW IT REACHED ITS DECISION.
FORM 990, PART VI, SECTION C, LINE 19WEBSITE
AUDIT COMMITTEETHE ORGANIZATION HAS AN AUDIT COMMITTEE THAT OVERSEES THE INDEPENDENT AUDIT. THIS IS CONSISTENT WITH PRIOR YEAR.