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GOOD SAMARITAN HOME OF QUINCY: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
GOOD SAMARITAN HOME OF QUINCY (EIN 37-0724112)
Tax period
2013-10-01 to 2014-09-30
Filed
2015-01-23
IRS object ID
201510239349300731
Schema version
2013v4.0
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)
Return2015-01-23T14:09:48-06:00ReturnTs
Tax Period End2014-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN208896204PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Dennis G Koch CPABusinessNameLine1

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1PO Box 1007AddressLine1
CityQuincyCity
StateILState
ZIP Code623061007ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2013-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN370724112EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Good Samaritan Home of QuincyBusinessNameLine1
FieldValueIRS element (for citing)
Business Name ControlGOODBusinessNameControlTxt
Phone2172238717PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12130 Harrison StreetAddressLine1
CityQuincyCity
StateILState
ZIP Code62301ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonWilliam WinnPersonNm
Person TitlePresidentPersonTitleTxt
Phone2172228471PhoneNum
Signature2015-01-23SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonDennis G KochPreparerPersonNm
PTINP01210686PTIN
Phone2172248484PhoneNum
Preparation2015-01-22PreparationDt
Self EmployedYes (X)SelfEmployedInd
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerMichael DuffyPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line13831 Newcastle DrAddressLine1
CityQuincyCity
StateILState
ZIP Code62301ZIPCode
FieldValueIRS element (for citing)
Gross Receipts$17,822,819GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.gshq.orgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1953FormationYr
Legal Domicile StateILLegalDomicileStateCd
Activity Or MissionTo maintain a home for the care of the aged, without regard to poverty or riches of residents.ActivityOrMissionDesc
Voting Members Governing Body21VotingMembersGoverningBodyCnt
Voting Members Independent21VotingMembersIndependentCnt
Total Employee440TotalEmployeeCnt
Total Volunteers180TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$478,865PYContributionsGrantsAmt
CY Contributions Grants$490,692CYContributionsGrantsAmt
PY Program Service Revenue$14,435,240PYProgramServiceRevenueAmt
CY Program Service Revenue$15,226,048CYProgramServiceRevenueAmt
PY Investment Income$2,967,420PYInvestmentIncomeAmt
CY Investment Income$1,991,363CYInvestmentIncomeAmt
PY Other Revenue$144,229PYOtherRevenueAmt
CY Other Revenue$114,716CYOtherRevenueAmt
PY Total Revenue$18,025,754PYTotalRevenueAmt
CY Total Revenue$17,822,819CYTotalRevenueAmt
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$9,841,505PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$10,115,789CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$80,999CYTotalFundraisingExpenseAmt
PY Other Expenses$6,587,632PYOtherExpensesAmt
CY Other Expenses$6,958,004CYOtherExpensesAmt
PY Total Expenses$16,429,137PYTotalExpensesAmt
CY Total Expenses$17,073,793CYTotalExpensesAmt
PY Revenues Less Expenses$1,596,617PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$749,026CYRevenuesLessExpensesAmt
Total Assets BOY$57,865,161TotalAssetsBOYAmt
Total Assets EOY$58,335,801TotalAssetsEOYAmt
Total Liabilities BOY$12,755,695TotalLiabilitiesBOYAmt
Total Liabilities EOY$12,477,309TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$45,109,466NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$45,858,492NetAssetsOrFundBalancesEOYAmt
MissionTo establish, support and maintain a home and related facilities for the care of the aged, without regard to poverty or riches of residents.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$15,922,599ExpenseAmt
Revenue$17,332,127RevenueAmt
DescNursing, therapy, home care and apartments for the elderly.Desc
Total Program Service Expenses$15,922,599TotalProgramServiceExpensesAmt
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
Temp Or Permanent EndowmentsYes (1)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related InvstYes (1)ReportProgramRelatedInvstInd
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 Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt BondsYes (1)TaxExemptBondsInd
Invest Tax Exempt Bonds0InvestTaxExemptBondsInd
Escrow Account0EscrowAccountInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
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 With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
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
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee440EmployeeCnt
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
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members21GoverningBodyVotingMembersCnt
Independent Voting Member21IndependentVotingMemberCnt
Family Or Business RlnYes (1)FamilyOrBusinessRlnInd
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 BodyYes (1)Form990ProvidedToGvrnBodyInd
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 FldILStatesWhereCopyOfReturnIsFldCd
Other WebsiteYes (X)OtherWebsiteInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1The Good Samaritan Home of QuincyBusinessNameLine1
FieldValueIRS element (for citing)
Phone2172238717PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12130 Harrison StreetAddressLine1
CityQuincyCity
StateILState
ZIP Code62301ZIPCode

Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
William Winn
President10.00Yes (X)Yes (X)$0$0$0
Laura Ehrhart
1st Vice President5.00Yes (X)Yes (X)$0$0$0
Larry Shepherd
2nd Vice President5.00Yes (X)Yes (X)$0$0$0
Steve Wavering
3rd Vice President5.00Yes (X)Yes (X)$0$0$0
Carla Derrick
Secretary/Treasurer5.00Yes (X)Yes (X)$0$0$0
Bob Johnson
Im Past President5.00Yes (X)Yes (X)$0$0$0
Mike Bickhaus
Director5.00Yes (X)$0$0$0
John Letts
Director5.00Yes (X)$0$0$0
Gena Awerkamp
Director5.00Yes (X)$0$0$0
Billie Menke
Director5.00Yes (X)$0$0$0
Ray Scheiter
Director5.00Yes (X)$0$0$0
Janet Schneeberger
Director5.00Yes (X)$0$0$0
Paul Kemner
Director5.00Yes (X)$0$0$0
Jerry Jackson
Director5.00Yes (X)$0$0$0
Daron Duke
Director5.00Yes (X)$0$0$0
Richard Walz
Director5.00Yes (X)$0$0$0
Michael Oberdahlhoff
Director5.00Yes (X)$0$0$0
Jeff Spear
Director5.00Yes (X)$0$0$0
John Heidbreder
Director5.00Yes (X)$0$0$0
Robert Young
Director5.00Yes (X)$0$0$0
Michael Duffy
Adminstrator45.00$136,748$0$14,109Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$136,748TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$14,109TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K3IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1CityContractorAddress/USAddress/CityStateContractorAddress/USAddress/StateZIP CodeContractorAddress/USAddress/ZIPCodeServicesServicesDescCompensationCompensationAmt
Kohl Wholesale
130 Jersey St Quincy IL 62301QuincyIL62301Cafeteria Food$933,146
First Choice Physical Therapy
5 W State 8th PlazaQuincyIL62305Physical Therapy$534,599
Maas Construction
3615 At Anthony RdQuincyIL62305Construction Services$373,669
CPI Qualified Plan Consultants
PO Box 167 Great Bend KS 67530QuincyIL62305Thrid Party Administration$370,211
Medline Industries
Dept CH 14400PalatineIL60055Nursing Supplies$230,751
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K13CntrctRcvdGreaterThan100KCnt
All Other Contributions$490,692AllOtherContributionsAmt
Total Contributions$490,692TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Room Care623000$7,805,055$7,805,055
Medicaid623000$3,329,424$3,329,424
Cottage Rentals623000$2,349,750$2,349,750
Medicare623000$1,741,819$1,741,819
FieldValueIRS element (for citing)
Total Program Service Revenue$15,226,048TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,991,363TotalRevenueColumnAmt
Related Or Exempt Func Income$1,991,363RelatedOrExemptFuncIncomeAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Barber/Beauty/Gift Shop623000$99,526$99,526
Miscellaneous623000$15,190$15,190
FieldValueIRS element (for citing)
Other Revenue Total$114,716OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$17,822,819TotalRevenueColumnAmt
Related Or Exempt Func Income$17,332,127RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$136,748TotalAmt
Management And General$136,748ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$8,324,668TotalAmt
Program Services$7,642,198ProgramServicesAmt
Management And General$618,438ManagementAndGeneralAmt
Fundraising$64,032FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$257,451TotalAmt
Program Services$232,493ProgramServicesAmt
Management And General$22,413ManagementAndGeneralAmt
Fundraising$2,545FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$798,902TotalAmt
Program Services$721,459ProgramServicesAmt
Management And General$67,919ManagementAndGeneralAmt
Fundraising$9,524FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$598,020TotalAmt
Program Services$542,178ProgramServicesAmt
Management And General$50,944ManagementAndGeneralAmt
Fundraising$4,898FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$55,712TotalAmt
Program Services$55,712ProgramServicesAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$228,771TotalAmt
Program Services$228,771ProgramServicesAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$53,546TotalAmt
Program Services$53,546ProgramServicesAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$643,032TotalAmt
Program Services$643,032ProgramServicesAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$79,791TotalAmt
Program Services$79,791ProgramServicesAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$246,957TotalAmt
Program Services$246,957ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,507,664TotalAmt
Program Services$1,507,664ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$511,593TotalAmt
Program Services$511,593ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
Food$915,416$915,416
Supplies$743,520$660,448$83,072
Therapy$547,550$547,550
Maintenance & Repairs$536,363$536,363

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$888,089TotalAmt
Program Services$797,428ProgramServicesAmt
Management And General$90,661ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$17,073,793TotalAmt
Program Services$15,922,599ProgramServicesAmt
Management And General$1,070,195ManagementAndGeneralAmt
Fundraising$80,999FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$917,403BOYAmt
EOY$853,398EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,279,024BOYAmt
EOY$2,225,994EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$123,881BOYAmt
EOY$16,455EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$2,101,815BOYAmt
EOY$2,444,478EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$313,911BOYAmt
EOY$321,805EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$46,835,138LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$17,622,061LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$29,904,841BOYAmt
EOY$29,213,077EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$23,224,286BOYAmt
EOY$23,260,594EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$57,865,161BOYAmt
EOY$58,335,801EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,641,959BOYAmt
EOY$1,311,084EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$7,915,374BOYAmt
EOY$7,618,741EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$3,198,362BOYAmt
EOY$3,547,484EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$12,755,695BOYAmt
EOY$12,477,309EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$36,776,495BOYAmt
EOY$37,820,547EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$8,232,971BOYAmt
EOY$7,937,945EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$100,000BOYAmt
EOY$100,000EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$45,109,466BOYAmt
EOY$45,858,492EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$57,865,161BOYAmt
EOY$58,335,801EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$749,026ReconcilationRevenueExpnssAmt
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 Required0FederalGrantAuditRequiredInd

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$1,119,527CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$434,410CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$985,260CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$478,865CurrentTaxYearMinus1YearAmt
Current Tax Year$490,692CurrentTaxYearAmt
Total$3,508,754TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$13,164,178CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$14,334,868CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$14,689,534CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$14,435,240CurrentTaxYearMinus1YearAmt
Current Tax Year$15,226,048CurrentTaxYearAmt
Total$71,849,868TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$14,283,705CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$14,769,278CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$15,674,794CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$14,914,105CurrentTaxYearMinus1YearAmt
Current Tax Year$15,716,740CurrentTaxYearAmt
Total$75,358,622TotalAmt

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$75,358,622PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$2,615,852CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$23,383CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$3,519,080CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,967,420CurrentTaxYearMinus1YearAmt
Current Tax Year$1,991,363CurrentTaxYearAmt
Total$11,117,098TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$2,615,852CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$23,383CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$3,519,080CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,967,420CurrentTaxYearMinus1YearAmt
Current Tax Year$1,991,363CurrentTaxYearAmt
Total$11,117,098TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$206,184CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$205,025CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$248,228CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$144,229CurrentTaxYearMinus1YearAmt
Current Tax Year$114,716CurrentTaxYearAmt
Total$918,382TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$17,105,741CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$14,997,686CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$19,442,102CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$18,025,754CurrentTaxYearMinus1YearAmt
Current Tax Year$17,822,819CurrentTaxYearAmt
Total$87,394,102TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.86230PublicSupportCY509Pct
Public Support PY5090.86450PublicSupportPY509Pct
Investment Income CY0.12720InvestmentIncomeCYPct
Investment Income PY0.12380InvestmentIncomePYPct
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

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$24,380,738BeginningYearBalanceAmt
Contributions$333,701ContributionsAmt
Investment Earnings Or Losses$1,995,544InvestmentEarningsOrLossesAmt
Other Expenditures$1,550,884OtherExpendituresAmt
Administrative Expenses$199,739AdministrativeExpensesAmt
End Year Balance$24,959,360EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$28,596,406BeginningYearBalanceAmt
Contributions$369,637ContributionsAmt
Investment Earnings Or Losses$2,931,120InvestmentEarningsOrLossesAmt
Other Expenditures$7,287,019OtherExpendituresAmt
Administrative Expenses$229,406AdministrativeExpensesAmt
End Year Balance$24,380,738EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$27,990,135BeginningYearBalanceAmt
Contributions$892,976ContributionsAmt
Investment Earnings Or Losses$3,507,128InvestmentEarningsOrLossesAmt
Other Expenditures$3,566,544OtherExpendituresAmt
Administrative Expenses$227,289AdministrativeExpensesAmt
End Year Balance$28,596,406EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$32,285,791BeginningYearBalanceAmt
Contributions$352,352ContributionsAmt
Investment Earnings Or Losses$7,208InvestmentEarningsOrLossesAmt
Other Expenditures$4,397,420OtherExpendituresAmt
Administrative Expenses$257,796AdministrativeExpensesAmt
End Year Balance$27,990,135EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$26,692,748BeginningYearBalanceAmt
Contributions$3,286,598ContributionsAmt
Investment Earnings Or Losses$2,535,488InvestmentEarningsOrLossesAmt
Administrative Expenses$229,043AdministrativeExpensesAmt
End Year Balance$32,285,791EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY1.00000BoardDesignatedBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org0EndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,135,037OtherCostOrOtherBasisAmt
Book Value$1,135,037BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$35,456,525OtherCostOrOtherBasisAmt
Depreciation$11,971,135DepreciationAmt
Book Value$23,485,390BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$10,243,576OtherCostOrOtherBasisAmt
Depreciation$5,650,926DepreciationAmt
Book Value$4,592,650BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$29,213,077TotalBookValueLandBuildingsAmt

Invst Program Related Org InvstProgramRelatedOrgGrp (4 entries)

DescDescBook ValueBookValueAmtMethod ValuationMethodValuationCd
US Government Bonds$1,309,867F
US Governmant Agencies$1,993,665F
Corporate Bonds$609,526F
Mutual Funds & Equities$19,347,536F
FieldValueIRS element (for citing)
Total Book Value Program Rltd$23,260,594TotalBookValueProgramRltdAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescRefundable DepositsDesc
Amt$3,547,484Amt
FieldValueIRS element (for citing)
Total Liability$3,547,484TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$17,822,819TotalRevEtcAuditedFinclStmtAmt
Revenue Not Reported$0RevenueNotReportedAmt
Revenue Subtotal$17,822,819RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$17,822,819TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$17,073,793TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$17,073,793ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$17,073,793TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part V, Line 4:The Home's endowment fund is used to 1) provide income to offset operating costs in order to provide affordable skilled nursing care to residents and 2) provide a source of income to pay for capital improvements to the Home's physical plant.
Part X, Line 2:The evaluation of a tax position in accordance with this Interpretation 48 is a two-step process. The first step is recognition: The organization determines whether it is more likely than not that a tax position will be sustained upon examination, including resolution of any related appeals or litigation processes, based on the technical merits of the position. In evaluating whether a tax position has met the more-likely-than-not recognition threshold, the enterprise should presume that the position will be examined by the appropriate taxing authority that has full knowledge of all relevant information. The second step is measurement: A tax position that meets the more-likely-than-not recognition threshold is measured to determine the amount of benefit to recognize in the financial statements. The tax position is measured at the largest amount of benefit that is greater than 50 percent likely of being realized upon ultimate settlement. Implementation of ASC Section 740 began with Good Samaritan's year ended September 30, 2009. The implementation of ASC Section 740 has not had any material effect on the financial statements of the Good Samaritan Home of Quincy.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
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

FieldValueIRS element (for citing)
PersonMichael DuffyPersonNm
TitleAdminstratorTitleTxt
Base Compensation Filing Org$136,748BaseCompensationFilingOrgAmt
Compensation Based On Rltd Orgs$0CompensationBasedOnRltdOrgsAmt
Bonus Filing Organization$0BonusFilingOrganizationAmount
Bonus Related Organizations$0BonusRelatedOrganizationsAmt
Other Compensation Filing Org$0OtherCompensationFilingOrgAmt
Other Compensation Rltd Orgs$0OtherCompensationRltdOrgsAmt
Deferred Compensation Flng Org$5,435DeferredCompensationFlngOrgAmt
Deferred Comp Rltd Orgs$0DeferredCompRltdOrgsAmt
Nontaxable Benefits Filing Org$8,674NontaxableBenefitsFilingOrgAmt
Nontaxable Benefits Rltd Orgs$0NontaxableBenefitsRltdOrgsAmt
Total Compensation Filing Org$150,857TotalCompensationFilingOrgAmt
Total Compensation Rltd Orgs$0TotalCompensationRltdOrgsAmt
Comp Report Prior990 Filing Org$0CompReportPrior990FilingOrgAmt
Comp Report Prior990 Rltd Orgs$0CompReportPrior990RltdOrgsAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart I, Line 3FormAndLineReferenceDesc
ExplanationThe Board's Executive Committee serves as the compensation committee and reviews the compensation of the Administrator annually. Salary comparisons are made to other comparable nursing homes in the area when determining the salary.ExplanationTxt

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1City of Quincy Adams County IllinoisBusinessNameLine1
FieldValueIRS element (for citing)
Bond Issuer EIN376000378BondIssuerEIN
Bond Issued2009-12-01BondIssuedDt
Issue Price$100IssuePriceAmt
PurposeTo finance a portion of the Home's construction projectPurposeDesc
Defeased0DefeasedInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Pool Financing0PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$293,936RetiredAmt
Substantial Completion2011SubstantialCompletionYr
Current Refunding0CurrentRefundingInd
Advance Refunding0AdvanceRefundingInd
Final Allocation MadeYes (1)FinalAllocationMadeInd
Adequate Books And Rec MaintYes (1)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed Property0OwningBondFinancedPropertyInd
Any Lease Arrangements0AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop0MgmtContractBondFincdPropInd
Any Research Agreements0AnyResearchAgreementsInd
Bond Iss Meet Prvt Sec Pymt Test0BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop0ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond Remdtd0ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T FiledYes (1)Form8038TFiledInd
Variable Rate Issue0VariableRateIssueInd
Hedge Identified In Bks And Rec0HedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGICInd
Gross Proceeds Invested0GrossProceedsInvestedInd
Written Proc To Monitor Reqs0WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective Action0ProceduresCorrectiveActionInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, line 2One board member is a partner in the law firm that represents the Organization, a second board member is a principal in a painting firm that was hired by the general contractor overseeing the construction and renovation project undertaken by the Organization.
Form 990, Part VI, Section B, line 11Federal Form 990 and the audited financial statements are presented to the Board of Directors for their review. The auditor is available to members of the finance committee for questions before the 990 is filed.
Form 990, Part VI, Section B, line 12cOfficers and directors are required to disclose any potential conflicts of interest to the CEO and to abstain from voting on any such item.
Form 990, Part VI, Section B, line 15The Executive Committee of the Organization annually reviews the performance of the Administrator and Assistant Administrator. Compensation is determined by reviewing the performance assessment and comparable salaries of like individuals in area and regional nursing homes of similar size. The salary package is approved by the Executive Committee and documented in the records of the Organization.
Form 990, Part VI, Section C, line 18Federal Form 990 is available online at www.guidestar.org
Form 990, Part VI, Section C, line 19Information regarding the tax-exempt status of the Organization is available upon request. Federal Form 990 is available upon request or online at www.guidestar.org
Form 990, Part XI, Line 2CThe Finance Commitee of the Board of Directors is responsible for oversight of the audit