2024-08-15T13:58:37-05:00 2023-09-30 111986323 MARCUM LLP 9 PARKWAY NORTH SUITE 200 DEERFIELD IL 60015 990 2022-10-01 461945910 GOOD SAMARITAN HOME FOUNDATION GOOD 2172238717 2130 HARRISON STREET QUINCY IL 62301 EMMA MCLEOD CEO 2172238717 2024-08-15 1 0 ARIANA N JORDAN P01441395 8472826300 2024-08-13 2022 2024-08-08 14:25:15Z EMMA MCLEOD 2130 HARRISON STREET QUINCY IL 62301 6443545 0 X WWW.GSHQ.ORG X 2013 IL TO SUPPORT THE MISSION OF THE GOOD SAMARITAN HOME OF QUINCY. 8 8 0 9 0 0 65828 67007 0 0 834601 934622 0 0 900429 1001629 380000 1425127 0 0 0 0 0 0 78443 319366 316937 699366 1742064 201063 -740435 13460054 13276670 0 1125 13460054 13275545 TO SUPPORT THE MISSION OF THE GOOD SAMARITAN HOME OF QUINCY. 0 0 1425127 1425127 THE GOOD SAMARITAN HOME FOUNDATION SUPPORTS THE GOOD SAMARITAN HOME OF QUINCY BY PROVIDING GRANTS. 1425127 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 8 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 IL X EMMA MCLEOD 2172238717 2130 HARRISON STREET QUINCY IL 62301 LAURA EHRHART PRESIDENT 1.00 X X 0 0 0 JERRY JACKSON VICE PRESIDENT 1.00 X X 0 0 0 LARRY SHEPHERD SECRETARY-TREASURER 1.00 X X 0 0 0 MIKE BICKHAUS BOARD MEMBER 1.00 X 0 0 0 LEWIN DAVIS BOARD MEMBER 1.00 X 0 0 0 MATRIN GABRIEL BOARD MEMBER 1.00 1.00 X 0 0 0 TRISH GIBBS BOARD MEMBER 1.00 X 0 0 0 SHARON HIGGINS BOARD MEMBER 1.00 1.00 X 0 0 0 BILL KELLER BOARD MEMBER 1.00 X 0 0 0 EMMA MCLEOD CHIEF EXECUTIVE OFFICER 5.00 40.00 X 0 128991 5660 MATTHEW DORIAN CHIEF FINANCIAL OFFICER 5.00 40.00 X 0 89006 8774 0 217997 14434 0 0 0 0 GOOD SAMARITAN HOME OF QUINCY 2130 HARRISON STREET QUINCY IL 62301 MANAGEMENT SERVICES 200000 1 67007 10298 67007 277591 277591 6098947 5441916 657031 657031 657031 1001629 0 0 934622 1425127 1425127 200000 140000 60000 2623 2623 35 35 85919 85919 8431 8431 1486 1486 FUNDRAISING 18443 18443 1742064 1425127 238494 78443 115584 97100 392949 175972 1000 12951521 12707054 295544 13460054 13276670 1125 0 1125 X 13460054 13275545 13460054 13275545 13460054 13276670 -740435 555925 0 X 0 0 0 X X 1 GOOD SAMARITAN HOME OF QUINCY 370724112 10 1 1425127 0 1 1425127 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SCHEDULE A, PART IV, SECTION C, LINE 1: ORGANIZATION MANAGEMENT: ACCORDING TO REG. SECT 1.509(A)-4(H)(1), IN ORDER FOR A SUPPORTING ORGANIZATION TO BE "SUPERVISED OR CONTROLLED IN CONNECTION WITH" ONE OR MORE PUBLICLY SUPPORTED ORGANIZATIONS, THERE MUST BE COMMON SUPERVISION OR CONTROL BY THE PERSONS SUPERVISING OR CONTROLLING BOTH THE SUPPORTING ORGANIZATION AND THE PUBLICLY SUPPORTED ORGANIZATIONS TO ENSURE THAT THE SUPPORTING ORGANIZATION WILL BE RESPONSIVE TO THE NEEDS AND REQUIREMENTS OF THE PUBLICLY SUPPORTED ORGANIZATION(S). THEREFORE, IN ORDER TO MEET SUCH REQUIREMENT, THE CONTROL OR MANAGEMENT OF THE SUPPORTING ORGANIZATION MUST BE VESTED IN THE SAME PERSONS THAT CONTROL OR MANAGE THE PUBLICLY SUPPORTED ORGANIZATIONS. THE MOST COMMON WAY TO SATISFY THIS REQUIREMENT IS WITH 50% BOARD OVERLAP, HOWEVER, THAT IS NOT REQUIRED. GOOD SAMARITAN HOME OF QUINCY, EIN 37-0724112, IS THE SUPPORTED ORGANIZATION. THE CEO AND CFO OF GOOD SAMARITAN HOME OF QUINCY ARE ELECTED OFFICERS OF THE FOUNDATION AND THE FOUNDATION HAS A MANAGEMENT AGREEMENT WITH THE HOME IN WHICH THE HOME PROVIDES MANAGEMENT AND FINANCIAL OVERSIGHT. THERE ARE ALSO THREE OUT OF EIGHT OVERLAPPING BOARD MEMBERS BETWEEN THE TWO ORGANIZATIONS. THE CEO, CFO, AND THREE BOARD MEMBERS THAT ALSO SERVE ON THE GOOD SAMARITAN HOME OF QUINCY BOARD COMBINE FOR A TOTAL OF FIVE OUT OF TEN GOOD SAMARITAN HOME FOUNDATION BOARD MEETING ATTENDEES, WHICH IS 50% OVERLAP. ACCORDING TO THE GOOD SAMARITAN HOME FOUNDATION BYLAWS, THE PRESIDENT, FIRST VICE PRESIDENT, AND SECOND VICE PRESIDENT OF GOOD SAMARITAN HOME OF QUINCY WILL ALWAYS SERVE ON THE BOARD OF GOOD SAMARITAN HOME FOUNDATION. ADDITIONALLY, THE FINANCE TEAM FROM GOOD SAMARITAN HOME OF QUINCY OVERSEES ALL FINANCES FOR BOTH ORGANIZATIONS. THE ORGANIZATIONAL DOCUMENTS ALSO STATE THE ORGANIZATIONS PURPOSE IS TO RECEIVE AND DISBURSE FUNDS, PROPERTY, AND GIFTS OF ANY KIND EXCLUSIVELY FOR THE BENEFIT OF GOOD SAMARITAN HOME OF QUINCY, A 501(C)(3) TAX-EXEMPT ORGANIZATION CLASSIFIED UNDER SECTION 509(A)(2). UPON DISSOLUTION OF GOOD SAMARITAN HOME FOUNDATION, ALL ASSETS WILL BE DISTRIBUTED TO GOOD SAMARITAN HOME OF QUINCY. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 PART XII, LINE 2D - OTHER ADJUSTMENTS: AMORT. 1 GOOD SAMARITAN HOME OF QUINCY 2130 HARRISON STREET QUINCY IL 62301 370724112 501(C)(3) 1425127 0 FMV SUPPORT 1 0 PART I, LINE 2: THE ONLY GRANT AWARDED WAS PROVIDED TO A DOMESTIC ORGANIZATION WITH SHARED GOVERNANCE. ACCORDINGLY, FORMAL PROCEDURES WERE NOT PLACED FOR SELF-MONITORING. THE CLOSE RELATIONSHIP ENABLES THE ORGANIZATION TO MONITOR THE USE OF THE ASSISTANCE PROVIDED. FORM 990, PART VI, SECTION A, LINE 3 GOOD SAMARITAN HOME OF QUINCY PROVIDES MANAGEMENT SERVICES TO GOOD SAMARITAN HOME FOUNDATION UNDER A MANAGEMENT CONTRACT TO OPERATE AND ASSIST WITH FUNDRAISING NEEDS OF THE FOUNDATION. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES THAT MAY ACT ON BEHALF OF THE FULL BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE FEDERAL FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. A DRAFT OF THE RETURN IS REVIEWED BY THE BOARD BEFORE BEING FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C EACH BOARD MEMBER IS REQUIRED TO SIGN A CONFLICT OF INTEREST STATEMENT AND CONFIDENTIALITY AGREEMENT. IF ANY CONFLICTS/ISSUES ARISE, IT IS IMMEDIATELY DEALT WITH BY THE EXECUTIVE COMMITTEE, ADMINISTRATION AND OR BOTH. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE BY REQUEST. GOOD SAMARITAN HOME OF QUINCY 2130 HARRISON STREET QUINCY IL 62301 370724112 CHRISTIAN SERVICE WITHIN CHARITABLE COMMUNITY. IL 501(C)(3) LINE 10 N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0