Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
MediumBullet Do not enter Social Security numbers on this form as it may be made public. By law, the IRS
generally cannot redact the information on the form.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
A For the 2013 calendar year, or tax year beginning 01-01-2013 , 2013, and ending 12-31-2013
BCheck if applicable:
CName of organization
GOOD SAMARITAN SOCIETY INC
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
4800 WEST 57TH STREET PO BOX 5038
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
SIOUX FALLS, SD571175038
D Employer identification number

46-0349951
E Telephone number

G Gross receipts $ 2,351,161
F Name and address of principal officer:
RAYE NAE NYLANDER
4800 WEST 57TH STREET PO BOX 5038
SIOUX FALLS,SD571175038
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.GOOD-SAM.COM
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1979
M State of legal domicile: SD
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: TO PROVIDE LOW INCOME HOUSING FOR THE ELDERLY AND DISABLED.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 15
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 9
5 Total number of individuals employed in calendar year 2013 (Part V, line 2a) ...... 5 16
6 Total number of volunteers (estimate if necessary) ............. 6 158
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 23,682 30,085
9 Program service revenue (Part VIII, line 2g) ......... 3,052,318 2,320,337
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... -5,118 -2,956
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 0 0
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 3,070,882 2,347,466
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 502,544 343,778
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 2,163,425 1,842,712
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 2,665,969 2,186,490
19 Revenue less expenses. Subtract line 18 from line 12....... 404,913 160,976
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 4,627,992 3,847,602
21 Total liabilities (Part X, line 26)............. 7,768,852 5,797,464
22 Net assets or fund balances. Subtract line 21 from line 20..... -3,140,860 -1,949,862
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2013)
Form 990 (2013)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ..............
1
Briefly describe the organization’s mission: TO PROVIDE LOW INCOME HOUSING FOR THE ELDERLY AND DISABLED.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 1,891,052 including grants of $   ) (Revenue $ 2,320,337 )
TO PROVIDE LOW INCOME HOUSING FOR ELDERLY AND DISABLED PERSONS. 91,668 RESIDENT DAYS IN 2013.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet1,891,052
Form 990 (2013)
Form 990 (2013)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part II........
4
 
No
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C,
Part III............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment.........................
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII Click to see attachment.................
12a
Yes
 
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions)....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....
20a
 
No
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
Form 990 (2013)
Form 990 (2013)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II...
21
 
No
22
Did the organization report more than $5,000 of grants or other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I........
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I...................
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If so, complete Schedule L, Part II....................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV ..........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes,"
complete Schedule L, Part IV.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV...
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N,
Part I........................... Click to see attachment
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II...................... Click to see attachment
32
Yes
 
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
 
No
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2...
35b
 
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2013)
Form 990 (2013)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V ..............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
33
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
16
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2013)
Form 990 (2013)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI ..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
15
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
9
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
Yes
 
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
 
No
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
NM
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletRAYE NAE NYLANDER4800 WEST 57TH STREET PO BOX 5038SIOUX FALLSSD571175038 (605) 362-3100
Form 990 (2013)
Form 990 (2013)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII ..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) NEIL GULSVIG........................................................................
CHAIRPERSON
 .10
.......................4.50 		X   X       0 0 0
(2) PATRICIA K HAUGEN........................................................................
CHAIRPERSON UNTIL JUNE 2013
 .10
.......................4.50 		X   X       0 0 0
(3) REV JOHN F HOLT........................................................................
FIRST VICE CHAIRPERSON
 .10
.......................3.80 		X   X       0 0 0
(4) CHRISTOPHER T JOHNSON........................................................................
MEMBER-EXEC. COMMITTEE
 .10
.......................3.80 		X   X       0 0 0
(5) THEODORE GRINDAL........................................................................
MEMBER-EXEC. COMMITTEE
 .10
.......................3.30 		X   X       0 0 0
(6) ELWIN L BROWN........................................................................
MEMBER
 .10
.......................3.80 		X           0 0 0
(7) LIANE M CONNELLY........................................................................
MEMBER
 .10
.......................3.30 		X           0 0 0
(8) MICHAEL DEUTH........................................................................
MEMBER
 .10
.......................50.00 		X           0 120,281 25,212
(9) KARI BERIT RAMLO GUSTAFSON........................................................................
MEMBER
 .10
.......................3.30 		X           0 0 0
(10) GWEN WAGSTROM HALAAS........................................................................
MEMBER
 .10
.......................3.30 		X           0 0 0
(11) TERESA HILDEBRANDT........................................................................
MEMBER
 .10
.......................50.00 		X           0 96,077 29,384
(12) MICHELE J JUFFER........................................................................
MEMBER
 .10
.......................50.00 		X           0 72,767 27,778
(13) GUY R MATSON........................................................................
MEMBER
 .10
.......................50.00 		X           0 98,864 32,280
(14) JOHN R RACEK........................................................................
MEMBER
 .10
.......................3.80 		X           0 0 0
(15) PHILIP M SAMUELSON........................................................................
MEMBER
 .10
.......................50.00 		X           0 97,967 6,842
(16) SHARON A ST MARY........................................................................
MEMBER
 .10
.......................50.00 		X           0 144,014 14,383
(17) LORI L BUSSLER........................................................................
MEMBER UNTIL JUNE 2013
 .10
.......................50.00 		X           0 81,504 30,535
Form 990 (2013)
Form 990 (2013)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) JOANNA L RANDALL........................................................................
MEMBER UNTIL JUNE 2013
 .10
.......................50.00 		X           0 132,839 6,197
(19) REV ANDREA DEGROOT-NESDAHL........................................................................
MEMBER UNTIL JUNE 2013
 .10
.......................3.30 		X           0 0 0
(20) JACK W MOORMAN........................................................................
MEMBER UNTIL JUNE 2013
 .10
.......................3.30 		X           0 0 0
(21) DAVID J HORAZDOVSKY........................................................................
PRESIDENT
 1.00
.......................55.00 		    X       0 680,057 14,411
(22) CYNTHIA L MOEGENBURG........................................................................
EXECUTIVE VP
 1.00
.......................55.00 		    X       0 315,265 14,383
(23) RAYE NAE NYLANDER........................................................................
EXECUTIVE VP AND TREASURER
 1.00
.......................55.00 		    X       0 327,807 14,383
(24) JOSEPH HERDINA........................................................................
ASSISTANT TREASURER
 1.00
.......................55.00 		    X       0 192,077 25,212
(25) SYLVIA GAUSE........................................................................
SECRETARY
 1.00
.......................40.00 		    X       0 63,253 17,322
(26) MISTY HAM-QUICK........................................................................
ASSISTANT SECRETARY
 1.00
.......................45.00 		    X       0 36,685 17,059








1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 0 2,459,457 275,381
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet0
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
THE EVANGELICAL LUTHERAN GOOD SAMARITAN4800 WEST 57TH STREETSIOUX FALLSSD57108 MANAGEMENT FEES & SHARED SERVICES/EMPLOY 294,628
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet1
Form 990 (2013)
Form 990 (2013)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c 305
d Related organizations...1d 29,280
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		500
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 30,085
Program Service RevenueAmt Business Code
2a PROGRAM SERVICE REVENU 624100 2,275,613 2,275,613    
b ANCILLARY CHARGES 624100 43,946 43,946    
c MISCELLANEOUS 624100 778 778    
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 2,320,337
OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 739     739
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties...........MediumBullet        
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory    
b Less: cost or other basis and sales expenses   3,695
c Gain or (loss)   -3,695
d Net gain or (loss)..........MediumBullet -3,695     -3,695
8a Gross income from fundraising events (not including
$ 305
of contributions reported on line 1c). See Part IV, line 18 ..
a 0
b Less: direct expenses ...b 0
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Miscellaneous Revenue Business Code
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet  
12 Total revenue. See Instructions......MediumBullet 2,347,466 2,320,337 0 -2,956
Form 990 (2013)
Form 990 (2013)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21    
2 Grants and other assistance to individuals in the United States. See Part IV, line 22    
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees ....        
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 302,084 302,084    
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 5,640 5,640    
9 Other employee benefits ....... 13,107 13,107    
10 Payroll taxes ........... 22,947 22,947    
11 Fees for services (non-employees):        
a Management ...... 131,640   131,640  
b Legal ......... 31,231   31,231  
c Accounting ........... 37,999   37,999  
d Lobbying ...........        
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ......        
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 123,168 123,168    
12 Advertising and promotion .... 9,978 9,978    
13 Office expenses ....... 36,412 36,412    
14 Information technology ......        
15 Royalties ..        
16 Occupancy ........... 398,553 398,553    
17 Travel ............        
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 6,309 6,309    
20 Interest ........... 467,600 467,600    
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 327,356 327,356    
23 Insurance .............. 86,498   86,498  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a CONTRACTS - SERVICE PER 142,978 142,978    
b SERVICE EXPENSES 23,204 23,204    
c BAD DEBT 10,115 10,115    
d TAXES, LICENSE, PERMITS 1,553 1,553    
e All other expenses 8,118 48 8,070  
25 Total functional expenses. Add lines 1 through 24e 2,186,490 1,891,052 295,438 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2013)
Form 990 (2013)
Page 11
Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing .............   1  
2 Savings and temporary cash investments ......... 186,026 2 62,872
3 Pledges and grants receivable, net ...........   3  
4 Accounts receivable, net ............. 26,806 4 14,520
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
  6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use ..............   8  
9 Prepaid expenses and deferred charges .......... 12,857 9 15,485
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 13,074,203
b Less: accumulated depreciation ..... 10b 10,040,738 3,397,065 10c 3,033,465
11 Investments—publicly traded securities ..........   11  
12 Investments—other securities. See Part IV, line 11 .....   12  
13 Investments—program-related. See Part IV, line 11 .....   13  
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 1,005,238 15 721,260
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 4,627,992 16 3,847,602
Liabilities 17 Accounts payable and accrued expenses ......... 308,563 17 181,339
18 Grants payable .................   18  
19 Deferred revenue ................ 4,867 19 9,727
20 Tax-exempt bond liabilities .............   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties .. 6,731,785 23 4,903,943
24 Unsecured notes and loans payable to unrelated third parties .... 649,597 24 592,865
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 74,040 25 109,590
26 Total liabilities. Add lines 17 through 25......... 7,768,852 26 5,797,464
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. -3,408,151 27 -2,217,155
28 Temporarily restricted net assets ........... 267,291 28 267,293
29 Permanently restricted net assets ...........   29  
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... -3,140,860 33 -1,949,862
34 Total liabilities and net assets/fund balances ........ 4,627,992 34 3,847,602
Form 990 (2013)
Form 990 (2013)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
2,347,466
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
2,186,490
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
160,976
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
-3,140,860
5
Net unrealized gains (losses) on investments ...............
5
 
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
1,030,022
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
-1,949,862
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII .............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
Yes
 
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
Yes
 
Form 990 (2013)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
right arrow Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
GOOD SAMARITAN SOCIETY INC
 
Employer identification number

46-0349951
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization? ................
11g(i)
 
 
(ii) A family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) (iv) Is the organization in col. (i) listed in your governing document? (v) Did you notify the organization in col. (i) of your support? (vi) Is the organization in col. (i) organized in the U.S.? (vii) Amount of monetary support
Yes No Yes No Yes No
Total  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..  
6 Public support. Subtract line 5 from line 4.  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).  
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here.................................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . 57,295 56,580 130,540 22,672 30,085 297,172
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... 2,857,212 2,986,034 3,034,217 3,052,318 2,320,337 14,250,118
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5. 2,914,507 3,042,614 3,164,757 3,074,990 2,350,422 14,547,290
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...       22,672 29,280 51,952
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.           0
c Add lines 7a and 7b..       22,672 29,280 51,952
8 Public support (Subtract line 7c from line 6.) 14,495,338
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total
9 Amounts from line 6... 2,914,507 3,042,614 3,164,757 3,074,990 2,350,422 14,547,290
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. 3,015 1,878 1,364 1,117 739 8,113
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b. 3,015 1,878 1,364 1,117 739 8,113
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.).. 2,917,522 3,044,492 3,166,121 3,076,107 2,351,161 14,555,403
14
Section C. Computation of Public Support Percentage
15
15
99.590 %
16
16
99.770 %
Section D. Computation of Investment Income Percentage
17
17
0.060 %
18
18
0.080 %
19a
b
20
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2013

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Name of the organization
GOOD SAMARITAN SOCIETY INC
 
Employer identification number

46-0349951
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet $  
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 2
Name of organization
GOOD SAMARITAN SOCIETY INC
  		Employer identification number

46-0349951
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

   
RESTRICTED
RESTRICTED
RESTRICTED, RESTRICTEDRESTRICTED

$RESTRICTED


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 3
Name of organization
GOOD SAMARITAN SOCIETY INC
  		Employer identification number

46-0349951
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 4
Name of organization
GOOD SAMARITAN SOCIETY INC
  		Employer identification number

46-0349951
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Additional Data


Software ID:  
Software Version:  
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions. SchDMd Bullet Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
GOOD SAMARITAN SOCIETY INC
 
Employer identification number

46-0349951
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance ....          
b Contributions ........          
c Net investment earnings, gains, and losses          
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   262,130 262,130
b Buildings ................   11,420,858 8,996,678 2,424,180
c Leasehold improvements ............        
d Equipment ................   570,616 406,220 164,396
e Other .................   820,599 637,840 182,759
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 3,033,465
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) TENANT SECURITY DEPOSITS 61,497
(2) RESTRICTED DEPOSITS 644,641
(3) PREPAID LOAN FEES 3,662
(4) UTILITY DEPOSIT 230
(5) ESCROW DEPOSITS 11,230




Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 721,260
Part X
Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes  
TENANT SECURITY DEPOSITS 59,591
NATIONAL CAMPUS ADVANCES 49,999







Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 109,590
2. Liability for uncertain tax positions In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII ..................................................
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1 2,351,161
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e 0
3 Subtract line 2e from line 1..................... 3 2,351,161
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b -3,695
c Add lines 4a and 4b....................... 4c -3,695
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 2,347,466
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1 2,190,185
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d...................... 2e 0
3 Subtract line 2e from line 1..................... 3 2,190,185
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b -3,695
c Add lines 4a and 4b....................... 4c -3,695
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 2,186,490
Part XIII
Supplemental Information
Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
PART X, LINE 2: THE FORM 990 INCLUDES FIVE SEPARATE ENTITIES REQUIRED TO OBTAIN INDEPENDENT AUDITS. THE FOLLOWING STATEMENT EXISTS WITHIN THE FINANCIAL STATEMENTS OF EACH OF THE FIVE AUDITED ENTITIES: THE PROJECT BELIEVES IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE PROJECT WILL RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF INCURRED.
PART XI, LINE 4B - OTHER ADJUSTMENTS: LOSS ON SALE OF FIXED ASSETS -3,695.
PART XII, LINE 4B - OTHER ADJUSTMENTS: LOSS ON SALE OF FIXED ASSETS -3,695.
Schedule D (Form 990) 2013

Additional Data


Software ID:  
Software Version:  




Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
GOOD SAMARITAN SOCIETY INC
 
Employer identification number

46-0349951
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)SHARON A ST MARYMEMBER (i)
(ii)		 0
95,406 		0
0 		0
48,608 		0
0 		0
15,229 		0
159,243 		0
0
(2)DAVID J HORAZDOVSKYPRESIDENT (i)
(ii)		 0
584,133 		0
0 		0
95,924 		0
0 		0
15,256 		0
695,313 		0
0
(3)CYNTHIA L MOEGENBURGEXECUTIVE VP (i)
(ii)		 0
244,788 		0
0 		0
70,477 		0
0 		0
15,229 		0
330,494 		0
0
(4)RAYE NAE NYLANDEREXECUTIVE VP AND TREASURER (i)
(ii)		 0
245,780 		0
0 		0
82,027 		0
0 		0
15,229 		0
343,036 		0
0
(5)JOSEPH HERDINAASSISTANT TREASURER (i)
(ii)		 0
154,591 		0
0 		0
37,486 		0
0 		0
26,058 		0
218,135 		0
0
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Return Reference Explanation
Schedule J (Form 990) 2013

Additional Data


Software ID:  
Software Version:  
SCHEDULE N
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Liquidation, Termination, Dissolution, or Significant Disposition of Assets
bullet Complete if the organization answered "Yes" to Form 990, Part IV, lines 31 or 32; or Form 990-EZ, line 36.
bullet Attach certified copies of any articles of dissolution, resolutions, or plans.
bullet Attach to Form 990 or 990-EZ.
bulletInformation about Schedule N (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
GOOD SAMARITAN SOCIETY INC
 
Employer identification number
46-0349951
Part I
Liquidation, Termination, or Dissolution. Complete this part if the organization answered "Yes" to Form 990, Part IV, line 31, or Form 990-EZ, line 36.
Part I can be duplicated if additional space is needed.
1(a)Description of asset(s)
distributed or transaction
expenses paid		 (b)Date of
distribution		 (c)Fair market value of
asset(s) distributed or
amount of transaction
expenses		 (d)Method of
determining FMV for
asset(s) distributed or
transaction expenses		 (e)EIN of recipient (f)Name and address of recipient (g)IRC section
of recipient(s) (if
tax-exempt) or type
of entity




















Yes
No
2
Did or will any officer, director, trustee, or key employee of the organization:
a
Become a director or trustee of a successor or transferee organization? . . . . . . . . . . . . . . . . . . . . .
2a
 
 
b
Become an employee of, or independent contractor for, a successor or transferee organization? . . . . . . . . . . . . . . . .
2b
 
 
c
Become a direct or indirect owner of a successor or transferee organization? . . . . . . . . . . . . . . . . . . . .
2c
 
 
d
Receive, or become entitled to, compensation or other similar payments as a result of the organization's liquidation, termination, or dissolution? . . . . .
2d
 
 
e
If the organization answered "Yes" to any of the questions on lines 2a through 2d, provide the name of the person involved and explain in Part III. bullet
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or Form 990-EZ.
Cat. No. 50087Z
Schedule N (Form 990 or 990-EZ) (2013)

Schedule N (Form 990 or 990-EZ) (2013)
Page 2
Part I
Liquidation, Termination, or Dissolution (continued)
Note. If the organization distributed all of its assets during the tax year, then Form 990, Part X, column (B), line 16 (Total assets), and line 26 (Total liabilities), should equal -0-.
Yes
No
3
Did the organization distribute its assets in accordance with its governing instrument(s)? If "No," describe in Part III . . . . . . . . . . .
3
 
 
4a
Is the organization required to notify the attorney general or other appropriate state official of its intent to dissolve, liquidate, or terminate? . . . . . .
4a
 
 
b
If "Yes," did the organization provide such notice? . . . . . . . . . . . . . . . . . . . . . . . . . .
4b
 
 
5
Did the organization discharge or pay all of its liabilities in accordance with state laws? . . . . . . . . . . . . . . . . .
5
 
 
6a
Did the organization have any tax-exempt bonds outstanding during the year? . . . . . . . . . . . . . . . . . . . .
6a
 
 
b
Did the organization discharge or defease all of its tax-exempt bond liabilities during the tax year in accordance with the Internal Revenue Code and state laws? .
6b
 
 
c
If "Yes" to line 6b, describe in Part III how the organization defeased or otherwise settled these liabilities. If "No," explain in Part III.

Part II
Sale, Exchange, Disposition, or Other Transfer of More Than 25% of the Organization's Assets. Complete this part if the organization answered "Yes" to Form 990, Part IV, line 32, or Form 990-EZ, line 36. Part II can be duplicated if additional space is needed.
1(a) Description of asset(s)
distributed or transaction
expenses paid		 (b) Date of
distribution		 (c) Fair market value of
asset(s) distributed or
amount of transaction
expenses		 (d) Method of
determining FMV for
asset(s) distributed or
transaction expenses		 (e) EIN of recipient (f) Name and address of recipient (g) IRC section
of recipient(s) (if
tax-exempt) or type
of entity
FIXED ASSETS 02-28-2013 406,438 NET BOOK VALUE 45-3946645 LEA COUNTY GOOD SAMARITAN HOUSING INC
 
4800 WEST 57TH STREET PO BOX
SIOUX FALLS,SD571175038 		501(C)(3)
CASH AND RECEIVABLES 02-28-2013 13,517 NET BOOK VALUE 45-3946645 LEA COUNTY GOOD SAMARITAN HOUSING INC
 
4800 WEST 57TH STREET PO BOX
SIOUX FALLS,SD571175038 		501(C)(3)
MORTGAGE 02-28-2013 -1,449,977 NET BOOK VALUE 45-3946645 LEA COUNTY GOOD SAMARITAN HOUSING INC
 
4800 WEST 57TH STREET PO BOX
SIOUX FALLS,SD571175038 		501(C)(3)












Yes
No
2
Did or will any officer, director, trustee, or key employee of the organization:
a
Become a director or trustee of a successor or transferee organization? . . . . . . . . . . . . . . . . . . . . .
2a
 
 
b
Become an employee of, or independent contractor for, a successor or transferee organization? . . . . . . . . . . . . . . . .
2b
 
 
c
Become a direct or indirect owner of a successor or transferee organization? . . . . . . . . . . . . . . . . . . . . .
2c
 
 
d
Receive, or become entitled to, compensation or other similar payments as a result of the organization’s significant disposition of assets? . . . . . . .
2d
 
 
e
If the organization answered "Yes" to any of the questions on lines 2a through 2d, provide the name of the person involved and explain in Part III. bullet
Schedule N(Form 990 or 990-EZ) (2013)

Schedule N (Form 990 or 990-EZ) (2013)
Page 3
Part III
Supplemental Information. Provide the information required by Part I, lines 2e and 6c, and Part II, line 2e. Also complete this part to provide any additional information.
Return Reference Explanation
PART II, LINE 2E: PERSON(S) INVOLVED: THE FOLLOWING OFFICERS AND BOARD MEMBERS CONTINUE TO ACT IN THE SAME CAPACITY FOR LEA COUNTY GOOD SAMARITAN HOUSING, INC. DAVID J. HORAZDOVSKY - PRES/VICE PRES/CHAIRPATRICIA K. HAUGEN - FIRST VICE CHAIRPERSON TIL JUNE 13RAYE NAE NYLANDER - TREASURER/SECRETARY NEIL L GULSVIG - FIRST VICE CHAIRPERSONCHRISTOPHONER JOHNSON - SECOND VICE CHAIRPERSONREV. JOHN F. HOLT - THIRD VICE CHAIRPERSONELWIN L. BROWN - MEMBERJOHN RACEK - MEMBER
Schedule N (Form 990 or 990-EZ) (2013)


Additional Data


Software ID:  
Software Version:  


SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
GOOD SAMARITAN SOCIETY INC
 
Employer identification number

46-0349951
Return Reference Explanation
FORM 990, PART III, LINE 3 THIS CORPORATION'S RETURN ENCOMPASSES THE ACTIVITY OF FIVE INDIVIDUAL PROJECTS. ON FEBRUARY 28, 2013, ONE OF THE PROJECTS - THE CEDARS, REFINANCED ITS SECTION 202 DIRECT LOAN WITH A SECTION 223(F) HUD INSURED MORTGAGE AND TRANSFERRED SUBSTANTIALLY ALL OF ITS EXISTING ASSETS TO LEA COUNTY GOOD SAMARITAN HOUSING, INC., A SOUTH DAKOTA NON-PROFIT CORPORATION CONTROLLED BY THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY (TELGSS).
FORM 990, PART VI, SECTION A, LINE 3 THIS CORPORATION'S RETURN ENCOMPASSES THE ACTIVITY OF FIVE INDIVIDUAL PROJECTS. THE MANAGEMENT DUTIES OF EACH OF THE PROJECTS HAVE BEEN DELEGATED TO EACH INDIVIDUAL PROJECTS' SPONSOR, THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY (TELGSS). THE PROJECTS PAY TELGSS A MANAGEMENT FEE EQUAL TO A PERCENTAGE OF REVENUE OTHER THAN INVESTMENT AND GIFT INCOME. THE FEES HAVE BEEN APPROVED BY THE US DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT.
FORM 990, PART VI, SECTION A, LINE 6 BOARD MEMBERS OF THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY ARE MEMBERS OF GOOD SAMARITAN SOCIETY.
FORM 990, PART VI, SECTION A, LINE 7A THE BOARD MEMBERS ARE APPOINTED BY THE DIRECTORS OF THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY.
FORM 990, PART VI, SECTION A, LINE 7B ARTICLES OF INCORPORATION AND BY-LAW CHANGES REQUIRE THE APPROVAL OF THE BOARD OF THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY.
FORM 990, PART VI, SECTION B, LINE 11 ACCOUNTANTS WITH THE MANAGING AGENT, THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY, REVIEW THE 990 IN DETAIL PRIOR TO IT BEING FILED. ANY QUESTIONS ARE RESOLVED WITH THE TREASURER AND/OR THE PRESIDENT OF THE CORPORATION PRIOR TO THE 990 BEING FILED. A COPY OF THE 990 IS PROVIDED TO THE ORGANIZATION'S GOVERNING BODY PRIOR TO THE FORM 990 BEING FILED.
FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY THAT COVERS SUBSTANTIALLY ALL EMPLOYEES. ALL EMPLOYEES ARE REQUIRED TO REPORT ANY POTENTIAL CONFLICTS TO THE APPROPRIATE INDIVIDUAL AS INDICATED IN THE POLICY. ALL POTENTIAL CONFLICTS ARE INVESTIGATED TO DETERMINE IF A CONFLICT EXISTS. IF APPROVAL IS GIVEN TO PROCEED WITH THE ACTION, A COPY OF THE APPROVAL IS DOCUMENTED IN THE EMPLOYEE'S PERSONNEL FILE. THE ORGANIZATION ASKS THAT ALL OFFICERS AND DIRECTORS COMPLY WITH THE IRS CONFLICT OF INTEREST AND DISCLOSURE CERTIFICATION. THE ORGANIZATION ADOPTED A POLICY CHANGE IN 2011 AND NOW REQUIRES ALL OFFICERS AND DIRECTORS TO PROVIDE A SIGNED COPY TO THE CORPORATION'S MAIN OFFICE ANNUALLY.
FORM 990, PART VI, SECTION C, LINE 19 THIS CORPORATION'S RETURN ENCOMPASSES THE ACTIVITY OF FIVE INDIVIDUAL PROJECTS. THE PROJECTS MAKE THEIR GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 9: TRANSFER OF EQUITY 1,030,022.
FORM 990, PART VI, LINES 15A AND 15B THE CORPORATION DOES NOT EMPLOY A CEO, EXECUTIVE DIRECTOR, TOP MANAGEMENT OFFICIAL, OR KEY EMPLOYEE. THE MANAGEMENT FUNCTIONS OF THE CORPORATION HAVE BEEN OUTSOURCED TO THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY.
FORM 990, PART XII, LINES 1-3: THIS CORPORATION'S RETURN ENCOMPASSES THE ACTIVITY OF FIVE INDIVIDUAL PROJECTS REQUIRED TO UNDERGO AN AUDIT AS SET FORTH IN THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133. FOUR PROJECTS UNDERWENT SUCH AUDITS ACCORDINGLY FOR THE YEAR ENDED DECEMBER 31, 2013. THE INDEPENDENT AUDITORS ISSUED UNQUALIFIED OPINIONS ON EACH OF THE FOUR AUDITS. THE OTHER PROJECT - THE CEDARS REFINANCED ITS SECTION 202 DIRECT LOAN WITH A SECTION 223(F) HUD INSURED MORTGAGE AND TRANSFERRED SUBSTANTIALLY ALL OF ITS EXISTING ASSETS TO LEA COUNTY GOOD SAMARITAN HOUSING, INC. ON FEBRUARY 28, 2013. THEREFORE, THIS PROJECT UNDERWENT THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133 FOR THE YEAR ENDED FEBRUARY 27, 2013.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2013

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.
MediumBullet Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
GOOD SAMARITAN SOCIETY INC
 
Employer identification number

46-0349951
Part I
Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










Part II
Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1) GOOD SAMARITAN HOLDINGS LLC

4800 W 57TH STREET

SIOUX FALLS,SD57117
75-2979560 		DEVELOP SENIOR HOUSING AND ASSISTED LIVING SERVICES SD 501(C)(3) LINE 11A, I THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(2) BOISE GOOD SAMARITAN HOUSING INC

4800 W 57TH STREET

SIOUX FALLS,SD57117
36-3370371 		PROVIDE LOW INCOME HOUSING TO ELDERLY AND DISABLED PERSONS SD 501(C)(3) PF THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(3) SIOUX FALLS GOOD SAMARITAN HOUSING INC

4800 W 57TH STREET

SIOUX FALLS,SD57117
46-0385187 		PROVIDE LOW INCOME HOUSING TO ELDERLY AND DISABLED PERSONS SD 501(C)(3) LINE 9 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(4) LOVINGTON GOOD SAMARITAN HOUSING INC

4800 W 57TH STREET

SIOUX FALLS,SD57117
46-0392944 		PROVIDE LOW INCOME HOUSING TO ELDERLY AND DISABLED PERSONS SD 501(C)(3) LINE 9 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(5) PROPHETSTOWN GOOD SAMARITAN HOUSING INC

4800 W 57TH STREET

SIOUX FALLS,SD57117
46-0392943 		PROVIDE LOW INCOME HOUSING TO ELDERLY AND DISABLED PERSONS SD 501(C)(3) LINE 9 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(6) MILLARD GOOD SAMARITAN HOUSING GP INC

4800 W 57TH STREET

SIOUX FALLS,SD57117
46-0396332 		GENERAL PARTNER OF MILLARD GOOD SAMARITAN HOUSING, LP SD 501(C)(3) LINE 11A, I THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(7) OLATHE GOOD SAMARITAN HOUSING INC

4800 W 57TH STREET

SIOUX FALLS,SD57117
46-0396398 		GENERAL PARTNER OF OLATHE GOOD SAMARITAN HOUSING, LP SD 501(C)(3) LINE 11A, I THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(8) JASONVILLE GOOD SAMARITAN HOUSING INC

4800 W 57TH STREET

SIOUX FALLS,SD57117
46-0396355 		PROVIDE LOW INCOME HOUSING TO ELDERLY AND DISABLED PERSONS SD 501(C)(3) LINE 9 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(9) KEARNEY GOOD SAMARITAN HOUSING INC

4800 W 57TH STREET

SIOUX FALLS,SD57117
46-0421846 		PROVIDE LOW INCOME HOUSING TO ELDERLY AND DISABLED PERSONS SD 501(C)(3) PF THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(10) HASTINGS GOOD SAMARITAN HOUSING INC

4800 W 57TH STREET

SIOUX FALLS,SD57117
46-0434693 		PROVIDE LOW INCOME HOUSING TO ELDERLY AND DISABLED PERSONS SD 501(C)(3) LINE 9 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(11) BROOKINGS GOOD SAMARITAN HOUSING INC

4800 W 57TH STREET

SIOUX FALLS,SD57117
46-0439509 		PROVIDE LOW INCOME HOUSING TO ELDERLY AND DISABLED PERSONS SD 501(C)(3) LINE 9 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(12) GRANTS GOOD SAMARITAN HOUSING INC

4800 W 57TH STREET

SIOUX FALLS,SD57117
46-0439511 		PROVIDE LOW INCOME HOUSING TO ELDERLY AND DISABLED PERSONS SD 501(C)(3) LINE 9 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(13) EL PASO GOOD SAMARITAN HOUSING INC

4800 W 57TH STREET

SIOUX FALLS,SD57117
27-2876627 		PROVIDE LOW INCOME HOUSING TO ELDERLY AND DISABLED PERSONS SD 501(C)(3) LINE 9 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(14) VALENTINE GOOD SAMARITAN HOUSING INC

4800 W 57TH STREET

SIOUX FALLS,SD57117
91-1751139 		PROVIDE LOW INCOME HOUSING TO ELDERLY AND DISABLED PERSONS SD 501(C)(3) LINE 9 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(15) JEFFERSONTOWN GOOD SAMARITAN HOUSING INC

4800 W 57TH STREET

SIOUX FALLS,SD57117
91-1751137 		PROVIDE LOW INCOME HOUSING TO ELDERLY AND DISABLED PERSONS SD 501(C)(3) LINE 9 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(16) GOLDBECK TOWERS GOOD SAMARITAN HOUSING INC

4800 W 57TH STREET

SIOUX FALLS,SD57117
91-1751135 		PROVIDE LOW INCOME HOUSING TO ELDERLY AND DISABLED PERSONS SD 501(C)(3) LINE 9 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(17) WISCONSIN GOOD SAMARITAN HOUSING INC

4800 W 57TH STREET

SIOUX FALLS,SD57117
46-0447338 		PROVIDE LOW INCOME HOUSING TO ELDERLY AND DISABLED PERSONS SD 501(C)(3) LINE 9 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(18) SOUTH DAYTONA BEACH GOOD SAMARITAN HOUSING INC

4800 W 57TH STREET

SIOUX FALLS,SD57117
46-0461264 		PROVIDE LOW INCOME HOUSING TO ELDERLY AND DISABLED PERSONS SD 501(C)(3) LINE 9 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(19) WINFIELD GOOD SAMARITAN HOUSING INC

4800 W 57TH STREET

SIOUX FALLS,SD57117
20-1115155 		PROVIDE LOW INCOME HOUSING TO ELDERLY AND DISABLED PERSONS SD 501(C)(3) LINE 9 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(20) INVER GROVE HEIGHTS GOOD SAMARITAN HOUSING INC

4800 W 57TH STREET

SIOUX FALLS,SD57117
76-0789504 		PROVIDE LOW INCOME HOUSING TO ELDERLY AND DISABLED PERSONS SD 501(C)(3) LINE 9 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(21) LEMARS GOOD SAMARITAN HOUSING INC

4800 W 57TH STREET

SIOUX FALLS,SD57117
20-4714415 		PROVIDE LOW INCOME HOUSING TO ELDERLY AND DISABLED PERSONS SD 501(C)(3) LINE 9 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(22) ALLIANCE GOOD SAMARITAN HOUSING INC

4800 W 57TH STREET

SIOUX FALLS,SD57117
20-4714573 		PROVIDE LOW INCOME HOUSING TO ELDERLY AND DISABLED PERSONS SD 501(C)(3) LINE 9 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(23) SIOUX FALLS 57 GOOD SAMARITAN HOUSING INC

4800 W 57TH STREET

SIOUX FALLS,SD57117
20-4714647 		PROVIDE LOW INCOME HOUSING TO ELDERLY AND DISABLED PERSONS SD 501(C)(3) LINE 9 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(24) THE EVANGELICAL LUTHERAN GOOD SAMARITAN FOUNDATION

4800 W 57TH STREET

SIOUX FALLS,SD57117
46-0422866 		ASSIST TELGSS IN PROVIDING SENIOR CARE MN 501(C)(3) LINE 11A, I THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(25) THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY

4800 W 57TH STREET

SIOUX FALLS,SD57117
45-0228055 		PROVIDE SENIOR CARE ND 501(C)(3) LINE 9  
 
No
(26) HASTINGS VILLAGE GARDENS GOOD SAMARITAN HOUSING GP INC

4800 W 57TH STREET

SIOUX FALLS,SD57117
27-1212446 		GENERAL PARTNER OF HASTINGS VILLAGE GARDENS GOOD SAMARITAN HOUSING, LP SD 501(C)(3) LINE 11A, I THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(27) GREELEY GOOD SAMARITAN HOUSING INC

4800 W 57TH STREET

SIOUX FALLS,SD57117
46-0456087 		PROVIDE LOW INCOME HOUSING TO ELDERLY AND DISABLED PERSONS SD 501(C)(3) LINE 9 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(28) LEA COUNTY GOOD SAMARITAN HOUSING INC

4800 W 57TH STREET

SIOUX FALLS,SD57117
45-3946645 		PROVIDE LOW INCOME HOUSING TO ELDERLY AND DISABLED PERSONS SD 501(C)(3) LINE 9 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(29) SIOUX FALLS DOWNTOWN GOOD SAMARITAN HOUSING GP INC

4800 W 57TH STREET

SIOUX FALLS,SD57117
45-2473519 		FUTURE GENERAL PARTNER OF LIHTC LIMITED PARTNERSHIP SD 501(C)(3) LINE 11A, I THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(30) PRESCOTT GOOD SAMARITAN HOUSING GP INC

4800 W 57TH STREET

SIOUX FALLS,SD57117
27-5114421 		GENERAL PARTNER OF PRESCOTT GOOD SAMARITAN HOUSING, LP SD 501(C)(3) LINE 11A, I THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(31) INDIANOLA COUNTY GOOD SAMARITAN HOUSING GP INC

4800 W 57TH STREET

SIOUX FALLS,SD57117
46-1328052 		GENERAL PARTNER OF INDIANOLA GOOD SAMARITAN HOUSING, LP SD 501(C)(3) LINE 11A, I THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(32) ADAMS COUNTY GOOD SAMARITAN HOUSING GP INC

4800 W 57TH STREET

SIOUX FALLS,SD57117
46-1495572 		GENERAL PARTNER OF ADAMS COUNTY GOOD SAMARITAN HOUSING, LP SD 501(C)(3) LINE 11A, I THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(33) RAPID CITY GOOD SAMARITAN HOUSING GP INC

4800 W 57TH STREET

SIOUX FALLS,SD57117
46-1579750 		GENERAL PARTNER OF RAPID CITY GOOD SAMARITAN HOUSING, LP SD 501(C)(3) LINE 11A, I THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
(34) WELD COUNTY GOOD SAMARITAN HOUSING GP INC

4800 W 57TH STREET

SIOUX FALLS,SD57117
46-1591360 		GENERAL PARTNER OF WELD COUNTY GOOD SAMARITAN HOUSING, LP SD 501(C)(3) LINE 11A, I THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) OLATHE GOOD SAMARITAN HOUSING LIMITED PARTNERSHIP

4800 W 57TH STREET
SIOUX FALLS,SD57117
20-5297369 		PROVIDE HOUSING FOR LOW-INCOME TENANTS SD N/A
                  
(2) SIOUX FALLS DOWNTOWN GOOD SAMARITAN LIMITED PARTNERSHIP

4800 W 57TH STREET
SIOUX FALLS,SD57117
32-0377442 		PROVIDE HOUSING FOR LOW-INCOME TENANTS SD N/A
                  
(3) HASTINGS VILLAGE GARDENS GOOD SAMARITAN HOUSING LP

4800 W 57TH STREET
SIOUX FALLS,SD57117
27-1212511 		PROVIDE HOUSING FOR LOW-INCOME TENANTS SD N/A
                  
(4) MILLARD GOOD SAMARITAN HOUSING LIMITED PARTNERSHIP

4800 W 57TH STREET
SIOUX FALLS,SD57117
27-1212324 		PROVIDE HOUSING FOR LOW-INCOME TENANTS SD N/A
                  
(5) PRESCOTT GOOD SAMARITAN HOUSING LIMITED PARTNERSHIP

4800 W 57TH STREET
SIOUX FALLS,SD57117
27-5115281 		PROVIDE HOUSING FOR LOW-INCOME TENANTS SD N/A
                  
(6) INDIANOLA GOOD SAMARITAN HOUSING LIMITED PARTNERSHIP

4800 W 57TH STREET
SIOUX FALLS,SD57117
30-0755780 		PROVIDE HOUSING FOR LOW-INCOME TENANTS SD N/A
                  
(7) ADAMS COUNTY GOOD SAMARITAN HOUSING LIMITED PARTNERSHIP

4800 W 57TH STREET
SIOUX FALLS,SD57117
38-3896526 		PROVIDE HOUSING FOR LOW-INCOME TENANTS SD N/A
                  
(8) RAPID CITY GOOD SAMARITAN HOUSING LIMITED PARTNERSHIP

4800 W 57TH STREET
SIOUX FALLS,SD57117
35-2466169 		PROVIDE HOUSING FOR LOW-INCOME TENANTS SD N/A
                  
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) GOOD SAMARITAN HUMANITARIAN SERVICE INC

4800 W 57TH STREET
SIOUX FALLS,SD57117
20-5533741 		MANAGEMENT AND UNBUNDLED SERVICES; UNRELATED BUSINESS ACTIVITIES SD N/A
 C         No
(2) GOOD SAMARITAN SOCIETY INSURANCE LTD

4800 W 57TH STREET
SIOUX FALLS,SD57117
98-0379099 		INSURANCE CJ N/A
 C         No
(3) IDAHO SAMARITAN HOUSING INC

4800 W 57TH STREET
SIOUX FALLS,SD57117
46-0424311 		PROVIDE LOW INCOME HOUSING TO ELDERLY AND DISABLED PERSONS SD N/A
 C         No
(4) INDIANOLA GOOD SAMARITAN HOUSING GP INC

4800 W 57TH STREET
SIOUX FALLS,SD57117
46-1328052 		PROVIDE LOW INCOME HOUSING TO ELDERLY AND DISABLED PERSONS SD N/A
 C         No
(5) ADAMS COUNTY GOOD SAMARITAN HOUSING GP INC

4800 W 57TH STREET
SIOUX FALLS,SD57117
46-1495572 		PROVIDE LOW INCOME HOUSING TO ELDERLY AND DISABLED PERSONS SD N/A
 C         No




Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
Yes
 
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved





Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V?UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
Schedule R (Form 990) 2013
Additional Data


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