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GOOD SAMARITAN HOME OF QUINCY: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
GOOD SAMARITAN HOME OF QUINCY (EIN 37-0724112)
Tax period
2012-10-01 to 2013-09-30
Filed
2014-02-01
IRS object ID
201420329349300702
Schema version
2012v2.1
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)
Timestamp2014-02-01T09:20:29-06:00Timestamp
Tax Period End Date2013-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN208896204EIN

Preparer Firm Business Name PreparerFirmBusinessName

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

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO Box 1007AddressLine1
CityQuincyCity
StateILState
ZIP Code623061007ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN370724112EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Good Samaritan Home of QuincyBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlGOODNameControl
Phone2172238717Phone

US Address USAddress

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

Officer Officer

FieldValueIRS element (for citing)
NameMichael DuffyName
TitleAdministratorTitle
Phone2172228471Phone
Date Signed2013-12-19DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameDennis G KochName
PTINP01210686PTIN
Phone2172248484Phone
Date Prepared2014-02-01DatePrepared
Self EmployedXSelfEmployed
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMichael DuffyNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line13831 Newcastle DrAddressLine1
CityQuincyCity
StateILState
ZIP Code62301ZIPCode
FieldValueIRS element (for citing)
Gross Receipts18025754GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.gshq.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1953YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionTo maintain a home for the care of the aged, without regard to poverty or riches of residents.ActivityOrMissionDescription
Nbr Voting Members Governing Body21NbrVotingMembersGoverningBody
Nbr Independent Voting Members21NbrIndependentVotingMembers
Total Nbr Employees454TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year985260ContributionsGrantsPriorYear
Contributions Grants Current Year478865ContributionsGrantsCurrentYear
Program Service Revenue Prior Year14689533ProgramServiceRevenuePriorYear
Program Service Revenue CY14435240ProgramServiceRevenueCY
Investment Income Prior Year3519081InvestmentIncomePriorYear
Investment Income Current Year2967420InvestmentIncomeCurrentYear
Other Revenue Prior Year248228OtherRevenuePriorYear
Other Revenue Current Year144229OtherRevenueCurrentYear
Total Revenue Prior Year19442102TotalRevenuePriorYear
Total Revenue Current Year18025754TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year10724222SalariesEtcPriorYear
Salaries Etc Current Year9841505SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year79181TotalFundrsngExpCurrentYear
Other Expense Prior Year6951875OtherExpensePriorYear
Other Expenses Current Year6587632OtherExpensesCurrentYear
Total Expenses Prior Year17676097TotalExpensesPriorYear
Total Expenses Current Year16429137TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1766005RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1596617RevenuesLessExpensesCY
Total Assets BOY59920276TotalAssetsBOY
Total Assets EOY57992498TotalAssetsEOY
Total Liabilities BOY16407327TotalLiabilitiesBOY
Total Liabilities EOY12882932TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY43512949NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY45109566NetAssetsOrFundBalancesEOY
Mission DescriptionTo establish, support and maintain a home and related facilities for the care of the aged, without regard to poverty or riches of residents.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense15002765Expense
Revenue17546889Revenue
DescriptionNursing, therapy, home care and apartments for the elderly.Description
Total Program Service Expense15002765TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10965NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees454NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members21NbrVotingGoverningBodyMembers
Number Independent Voting Members21NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledILStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1The Good Samaritan Home of QuincyBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number2172238717TelephoneNumber

Address US AddressUS

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

Form990 Part VII Section A Form990PartVIISectionA (22 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
Robert Johnson
President10.00XX000
Gena Awerkamp
1st Vice President5.00XX000
William Winn
2nd Vice President5.00XX000
Laura Ehrhart
3rd Vice President5.00XX000
Carla Derrick
Secretary/Treasurer5.00XX000
Daron Duke
Im Past President5.00XX000
Mike Bickhaus
Director5.00X000
John Letts
Director5.00X000
Paula Reinhardt
Director5.00X000
Billie Menke
Director5.00X000
Ray Scheiter
Director5.00X000
Dean Hunziker
Director5.00X000
Charles Scholz
Director5.00X000
Jerry Jackson
Director5.00X000
Larry Shepherd
Director5.00X000
Richard Walz
Director5.00X000
Michael Oberdahlhoff
Director5.00X000
Janet Schneeberger
Director5.00X000
John Heidbreder
Director5.00X000
Robert Young
Director5.00X000
Steve Wavering
Director5.00X000
Michael Duffy
Adminstrator45.00137744015608X
FieldValueIRS element (for citing)
Total Reportable Comp From Org137744TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation15608TotalOtherCompensation
Number Individuals GT100 K2NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Maas Construction
3615 At Anthony RdQuincyIL62305Construction Services4421347
Kohl Wholesale
130 Jersey St Quincy IL 62301QuincyIL62301Cafeteria Food865720
First Choice Physical Therapy
5 W State 8th PlazaQuincyIL62305Physical Therapy601529
CPI Qualified Plan Consultants
PO Box 167 Great Bend KS 67530QuincyIL62305Thrid Party Administration398370
Wells Fargo Advisors
510 Maine St 9th FlQuincyIL62301Investment Services257796
FieldValueIRS element (for citing)
Number Of Contractors GT100 K14NumberOfContractorsGT100K
All Other Contributions478865AllOtherContributions
Total Contributions478865TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Room Care62300079618957961895
Medicaid62300027131852713185
Cottage Rentals62300021145432114543
Medicare62300016456171645617
FieldValueIRS element (for citing)
Total Program Service Revenue14435240TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column707193TotalRevenueColumn
Related Or Exempt Function Income707193RelatedOrExemptFunctionIncome

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities2260227Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities0Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities2260227Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column2260227TotalRevenueColumn
Related Or Exempt Function Income2260227RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Barber/Beauty/Gift Shop6230009523295232
Miscellaneous6230004899748997
FieldValueIRS element (for citing)
Total Other Revenue144229TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column18025754TotalRevenueColumn
Related Or Exempt Function Income17546889RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total8221830Total
Program Services7404589ProgramServices
Management And General754566ManagementAndGeneral
Fundraising62675Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total267251Total
Program Services240687ProgramServices
Management And General24059ManagementAndGeneral
Fundraising2505Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total759828Total
Program Services684302ProgramServices
Management And General66320ManagementAndGeneral
Fundraising9206Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total592596Total
Program Services532548ProgramServices
Management And General55253ManagementAndGeneral
Fundraising4795Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total42421Total
Management And General42421ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total27679Total
Management And General27679ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total212006Total
Management And General212006ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total2985Total
Management And General2985ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total531697Total
Program Services531697ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total311148Total
Program Services311148ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1393606Total
Program Services1393606ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total510742Total
Program Services510742ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Food892025892025
Supplies79577871928276496
Therapy486219486219
Licensing455898455898

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total925428Total
Program Services840022ProgramServices
Management And General85406ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total16429137Total
Program Services15002765ProgramServices
Management And General1347191ManagementAndGeneral
Fundraising79181Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY908335BOY
EOY917403EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY2271476BOY
EOY1279024EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY268756BOY
EOY123881EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2630874BOY
EOY2101815EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY389428BOY
EOY441248EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis46682781LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec16777940LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY27237550BOY
EOY29904841EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY26213857BOY
EOY23224286EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY59920276BOY
EOY57992498EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2459037BOY
EOY1769196EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY11471834BOY
EOY7915374EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY2476456BOY
EOY3198362EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY16407327BOY
EOY12882932EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY42959597BOY
EOY44691969EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY453352BOY
EOY317597EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY100000BOY
EOY100000EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY43512949BOY
EOY45109566EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY59920276BOY
EOY57992498EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses1596617ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years844034CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1119527CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years434410CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year985260CurrentTaxYearMinus1Year
Current Tax Year478865CurrentTaxYear
Total3862096Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years12965698CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years13164178CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years14334868CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year14689534CurrentTaxYearMinus1Year
Current Tax Year14435240CurrentTaxYear
Total69589518Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years13809732CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years14283705CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years14769278CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year15674794CurrentTaxYearMinus1Year
Current Tax Year14914105CurrentTaxYear
Total73451614Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50973451614PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1394822CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2615852CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years23383CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3519080CurrentTaxYearMinus1Year
Current Tax Year2967420CurrentTaxYear
Total10520557Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1394822CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2615852CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years23383CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3519080CurrentTaxYearMinus1Year
Current Tax Year2967420CurrentTaxYear
Total10520557Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years188892CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years206184CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years205025CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year248228CurrentTaxYearMinus1Year
Current Tax Year144229CurrentTaxYear
Total992558Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years15393446CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years17105741CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years14997686CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year19442102CurrentTaxYearMinus1Year
Current Tax Year18025754CurrentTaxYear
Total84964729Total
FieldValueIRS element (for citing)
Public Support Percentage5090.86450PublicSupportPercentage509
Prior Year Support Percentage0.94100PriorYearSupportPercentage
Investment Income Percentage0.12380InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.04630PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance28596406BeginningOfYearBalance
Contributions369637Contributions
Investment Earnings Or Losses2931120InvestmentEarningsOrLosses
Other Expenditures7287019OtherExpenditures
Administrative Expenses229406AdministrativeExpenses
End Of Year Balance24380738EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance27990135BeginningOfYearBalance
Contributions892976Contributions
Investment Earnings Or Losses3507128InvestmentEarningsOrLosses
Other Expenditures3566544OtherExpenditures
Administrative Expenses227289AdministrativeExpenses
End Of Year Balance28596406EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance32285791BeginningOfYearBalance
Contributions352352Contributions
Investment Earnings Or Losses7208InvestmentEarningsOrLosses
Other Expenditures4397420OtherExpenditures
Administrative Expenses257796AdministrativeExpenses
End Of Year Balance27990135EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance26692748BeginningOfYearBalance
Contributions3286598Contributions
Investment Earnings Or Losses2535488InvestmentEarningsOrLosses
Administrative Expenses229043AdministrativeExpenses
End Of Year Balance32285791EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Beginning Of Year Balance27366419BeginningOfYearBalance
Contributions806953Contributions
Investment Earnings Or Losses1222110InvestmentEarningsOrLosses
Other Expenditures2465598OtherExpenditures
Administrative Expenses237136AdministrativeExpenses
End Of Year Balance26692748EndOfYearBalance
FieldValueIRS element (for citing)
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1135037OtherCostOrOtherBasis
Book Value1135037BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis35446994OtherCostOrOtherBasis
Depreciation11327967Depreciation
Book Value24119027BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis10100750OtherCostOrOtherBasis
Depreciation5449973Depreciation
Book Value4650777BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings29904841TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionRefundable DepositsDescription
Amount$3,198,362Amount
FieldValueIRS element (for citing)
Total Of Amounts3198362TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt18025754TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal18025754RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99018025754TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt16429137TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal16429137ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99016429137TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Description of Intended Use of Endowment Funds: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.
Description of Uncertain Tax Positions Under FIN 48: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 CommitteeXCompensationCommittee
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonMichael DuffyNamePerson
TitleAdminstratorTitle
Base Compensation Filing Org137744BaseCompensationFilingOrg
Comp Based On Related Orgs0CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs0OtherCompensationRelatedOrgs
Deferred Comp Filing Org5490DeferredCompFilingOrg
Deferred Comp Related Orgs0DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org10118NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs0NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org153352TotalCompensationFilingOrg
Total Compensation Related Orgs0TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePart I, Line 3ReturnReference
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.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

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)
Issuer EIN376000378IssuerEIN
Date Issued2009-12-01DateIssued
Issue Price100IssuePrice
Description Of PurposeTo finance a portion of the Home's construction projectDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Year Of Subst Completion2011YearOfSubstCompletion
Current Refunding0CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Bond Iss Meet Prvt Security Pay Test0BondIssMeetPrvtSecurityPayTest
Change In Use Bond Financed Prop0ChangeInUseBondFinancedProp
Non Qualified Bond Remed Procdrs0NonQualifiedBondRemedProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T Filed1Form8038TFiled
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Written Proc To Monitor Reqs0WrittenProcToMonitorReqs

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

Return ReferenceReturnReferenceExplanationExplanation
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