Form990-PF

Department of the Treasury
Internal Revenue Service

Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
bulletDo not enter social security numbers on this form as it may be made public.
bulletGo to www.irs.gov/Form990PF for instructions and the latest information.
OMB No. 1545-0052
2020
Open to Public Inspection
For calendar year 2020, or tax year beginning 01-01-2020 , and ending 12-31-2020
Name of foundation
GOOD SAMARITAN FOUNDATION INC
 
Number and street (or P.O. box number if mail is not delivered to street address)7400 FLOYDSBURG ROAD
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
CRESTWOOD, KY40014
A Employer identification number

31-1087598
B Telephone number (see instructions)

(502) 425-3884
C bullet
G Check all that apply:

D 1. Foreign organizations, check here............. bullet
2. Foreign organizations meeting the 85%
test, check here and attach computation ... bullet
E bullet
H Check type of organization:
F bullet
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)bullet$0J Accounting method:
 
(Part I, column (d) must be on cash basis.)
Part I Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).) (a) Revenue and
expenses per
books 		(b) Net investment
income 		(c) Adjusted net
income 		(d) Disbursements
for charitable
purposes
(cash basis only)
Revenue 1 Contributions, gifts, grants, etc., received (attach schedule) 73,984
2 Check bullet.............
3 Interest on savings and temporary cash investments 31 31  
4 Dividends and interest from securities... 405,797 405,797  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 301,513
b Gross sales price for all assets on line 6a 974,552
7 Capital gain net income (from Part IV, line 2)... 301,513
8 Net short-term capital gain.........  
9 Income modifications...........  
10a Gross sales less returns and allowances  
b Less: Cost of goods sold....  
c Gross profit or (loss) (attach schedule).....    
11 Other income (attach schedule)....... Click to see attachment 443 443  
12 Total. Add lines 1 through 11........ 781,768 707,784  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 0 0   0
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule)......... Click to see attachment 1,826 913   913
b Accounting fees (attach schedule)....... Click to see attachment 32,015 16,008   32,015
c Other professional fees (attach schedule).... Click to see attachment 207,187 202,187   5,000
17 Interest...............        
18 Taxes (attach schedule) (see instructions)...        
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 14,227 0   0
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 255,255 219,108   37,928
25 Contributions, gifts, grants paid....... 2,032,666 2,032,666
26 Total expenses and disbursements. Add lines 24 and 25 2,287,921 219,108   2,070,594
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -1,506,153
b Net investment income (if negative, enter -0-) 488,676
c Adjusted net income (if negative, enter -0-)...  
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2020)
Form 990-PF (2020)
Page 2
Part II Balance Sheets Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.) 		Beginning of year End of year
(a) Book Value (b) Book Value (c) Fair Market Value
Assets 1 Cash—non-interest-bearing.............      
2 Savings and temporary cash investments......... 1,418,083    
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet        
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions).....      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet        
8 Inventories for sale or use..............      
9 Prepaid expenses and deferred charges.......... 18,345    
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule)....... 15,823,619 0 0
c Investments—corporate bonds (attach schedule).......      
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule)..........      
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet) Click to see attachment40,647 Click to see attachment0 Click to see attachment0
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 17,300,694 0 0
Liabilities 17 Accounts payable and accrued expenses.......... 41,431  
18 Grants payable.................    
19 Deferred revenue.................    
20 Loans from officers, directors, trustees, and other disqualified persons    
21 Mortgages and other notes payable (attach schedule)......    
22 Other liabilities (describe bullet)    
23 Total liabilities (add lines 17 through 22)......... 41,431 0
Net Assets or Fund Balances Foundations that follow FASB ASC 958, check here bullet
and complete lines 24, 25, 29 and 30.
24 Net assets without donor restrictions........... 16,669,025 0
25 Net assets with donor restrictions............ 590,238 0
Foundations that do not follow FASB ASC 958, check here bullet
and complete lines 26 through 30.
26 Capital stock, trust principal, or current funds........    
27 Paid-in or capital surplus, or land, bldg., and equipment fund    
28 Retained earnings, accumulated income, endowment, or other funds    
29 Total net assets or fund balances (see instructions)..... 17,259,263 0
30 Total liabilities and net assets/fund balances (see instructions). 17,300,694 0
Part III
Analysis of Changes in Net Assets or Fund Balances
1
Total net assets or fund balances at beginning of year—Part II, column (a), line 29 (must agree with end-of-year figure reported on prior year’s return) ...............
1
17,259,263
2
Enter amount from Part I, line 27a .....................
2
-1,506,153
3
Other increases not included in line 2 (itemize) bulletClick to see attachment
3
6,144,548
4
Add lines 1, 2, and 3 ..........................
4
21,897,658
5
Decreases not included in line 2 (itemize) bulletClick to see attachment
5
21,897,658
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
0
Form 990-PF (2020)
Form 990-PF (2020)
Page 3
Part IV
Capital Gains and Losses for Tax on Investment Income
(a) List and describe the kind(s) of property sold (e.g., real estate,
2-story brick warehouse; or common stock, 200 shs. MLC Co.)		 (b)
How acquired
P—Purchase
D—Donation 		(c)
Date acquired
(mo., day, yr.) 		(d)
Date sold
(mo., day, yr.)
1 a PUBLICLY TRADED SECURITIES      
b
c
d
e
(e)
Gross sales price 		(f)
Depreciation allowed
(or allowable) 		(g)
Cost or other basis
plus expense of sale 		(h)
Gain or (loss)
(e) plus (f) minus (g)
a 974,552   673,039 301,513
b
c
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (l)
Gains (Col. (h) gain minus
col. (k), but not less than -0-) or
Losses (from col.(h))
(i)
F.M.V. as of 12/31/69 		(j)
Adjusted basis
as of 12/31/69 		(k)
Excess of col. (i)
over col. (j), if any
a       301,513
b
c
d
e
2 Capital gain net income or (net capital loss) Bracket If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7		 Bracket 2 301,513
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8 ................... 		Bracket 3  
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
SECTION 4940(e) REPEALED ON DECEMBER 20, 2019 - DO NOT COMPLETE
1 Reserved
(a)
Reserved 		(b)
Reserved 		(c)
Reserved 		(d)
Reserved
2
Reserved...........................
2
3
Reserved...........................
3
4
Reserved...........................
4
5
Reserved...........................
5
6
Reserved...........................
6
7
Reserved...........................
7
8
Reserved,..........................
8
Form 990-PF (2020)
Form 990-PF (2020)
Page 4
Part VI
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see instructions)
1a Exempt operating foundations described in section 4940(d)(2), check here Bullet and enter “N/A" on line 1. Bracket for line 1a
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions)
b Reserved................................ 1 6,793
c All other domestic foundations enter 1.39% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2 0
3 Add lines 1 and 2........................... 3 6,793
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 4 0
5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- ..... 5 6,793
6 Credits/Payments:
a 2020 estimated tax payments and 2019 overpayment credited to 2020 6a 7,309
b Exempt foreign organizations—tax withheld at source...... 6b 0
c Tax paid with application for extension of time to file (Form 8868)... 6c 1,000
d Backup withholding erroneously withheld ........... 6d 0
7 Total credits and payments. Add lines 6a through 6d.............. 7 8,309
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached. 8 6
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10 1,510
11 Enter the amount of line 10 to be: Credited to 2021 estimated taxBullet0 RefundedBullet 11 1,510
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? See the instructions
for the definition.................................
1b
 
No
If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$ 0(2) On foundation managers.bullet$ 0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$ 0
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?........
4a
 
No
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
 
 
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
Yes
 
If "Yes," attach the statement required by General Instruction T.Click to see list of attachments
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
  • By language in the governing instrument, or
  • By state legislation that effectively amends the governing instrument so that no mandatory directions
    • that conflict with the state law remain in the governing instrument?................
    6
    Yes
     
    7
    Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part II, col. (c),
    and Part XV..................................
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see instructions)
    bulletKY
    b
    If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
    General (or designate) of each state as required by General Instruction G? If "No," attach explanation .
    8b
    Yes
     
    9
    Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
    or 4942(j)(5) for calendar year 2020 or the taxable year beginning in 2020? See the instructions for Part XIV.
    If "Yes," complete Part XIV .............................
    9
     
    No
    10
    Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names
    and addresses. ...............................
    10
     
    No
    Form 990-PF (2020)
    Form 990-PF (2020)
    Page 5
    Part VII-A
    Statements Regarding Activities (continued)
    11
    At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
    meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions .............
    11
     
    No
    12
    Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
    advisory privileges? If "Yes," attach statement. See instructions.................
    12
     
    No
    13
    Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
    13
    Yes
     
    Website addressbulletWWW.KYUMC.ORG/GSF
    14
    The books are in care ofbulletGOOD SAMARITAN FOUNDATION INC Telephone no.bullet (502) 425-3884

    Located atbullet7400 FLOYDSBURG ROADCRESTWOODKY ZIP+4bullet40014
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 —check here .........bullet
    and enter the amount of tax-exempt interest received or accrued during the year ........bullet
    15
     
    16 At any time during calendar year 2020, did the foundation have an interest in or a signature or other authority over YesNo
    a bank, securities, or other financial account in a foreign country? .................
    16   No
    See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
    country bullet
    Part VII-B
    Statements Regarding Activities for Which Form 4720 May Be Required
    File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
    Yes
    No
    1a
    During the year did the foundation (either directly or indirectly):
    (1) Engage in the sale or exchange, or leasing of property with a disqualified person?
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person?......................
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person?
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
    (5) Transfer any income or assets to a disqualified person (or make any of either available
    for the benefit or use of a disqualified person)?...............
    (6) Agree to pay money or property to a government official? (Exception. Check "No"
    if the foundation agreed to make a grant to or to employ the official for a period
    after termination of government service, if terminating within 90 days.).......
    b
    If any answer is "Yes" to 1a(1)–(6), did any of the acts fail to qualify under the exceptions described in Regulations
    section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions ........
    1b
     
     
    ........bullet
    c
    Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
    that were not corrected before the first day of the tax year beginning in 2020?.............
    1c
     
    No
    2
    Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
    operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
    a
    At the end of tax year 2020, did the foundation have any undistributed income (lines 6d
    and 6e, Part XIII) for tax year(s) beginning before 2020?.............
    If "Yes," list the years bullet20, 20, 20, 20
    b
    Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)
    (relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
    to all years listed, answer "No" and attach statement—see instructions.) ..............
    2b
     
     
    c
    If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
    bullet20, 20, 20, 20
    3a
    Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
    any time during the year?......................
    b
    If "Yes," did it have excess business holdings in 2020 as a result of (1) any purchase by the foundation
    or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved
    by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3)
    the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine
    if the foundation had excess business holdings in 2020.)..................
    3b
     
     
    4a
    Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
    4a
     
    No
    b
    Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
    charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2020?
    4b
     
    No
    Form 990-PF (2020)
    Form 990-PF (2020)
    Page 6
    Part VII-B
    Statements Regarding Activities for Which Form 4720 May Be Required (continued)
    5a
    During the year did the foundation pay or incur any amount to:
    Yes
    No
    (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive?.............
    (3) Provide a grant to an individual for travel, study, or other similar purposes?
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 4945(d)(4)(A)? See instructions................
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals?.....
    b
    If any answer is "Yes" to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in
    Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions ......
    5b
     
     
    .........bullet
    c
    If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
    tax because it maintained expenditure responsibility for the grant?..........
    If "Yes," attach the statement required by Regulations section 53.4945–5(d).
    6a
    Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
    a personal benefit contract?.....................
    b
    Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ....
    6b
     
    No
    If "Yes" to 6b, file Form 8870.
    7a
    At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
    b
    If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction? ....
    7b
     
     
    8
    Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
    excess parachute payment during the year? .................
    Part VIII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors
    1 List all officers, directors, trustees, foundation managers and their compensation. See instructions
    (a) Name and address (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation
     (If not paid, enter
    -0-)     		(d) Contributions to employee benefit plans and deferred compensation (e) Expense account,
    other allowances
    RANDALL CAPPS VICE PRESIDENT
    1.00     		0 0 0
    922 KENSINGTON WAY
    BOWLING GREEN,KY42103
    KARLA FULLWOOD SECRETARY
    1.00     		0 0 0
    1501 TRINITY DRIVE
    OWENSBORO,KY42303
    OWEN DOLIN PRESIDENT
    1.00     		0 0 0
    4407 CATHERINE DRIVE
    CRESTWOOD,KY40014
    ALEX DOWNING DIRECTOR
    1.00     		0 0 0
    PO BOX 449
    FRANKLIN,KY42135
    RICH ROYSTER DIRECTOR
    1.00     		0 0 0
    1502 CIRCLE CREST DRIVE
    EDDYVILLE,KY42038
    JULIE PAXTON DIRECTOR
    1.00     		0 0 0
    PO BOX 985
    PRESTONBURG,KY41653
    CHARLES SHROLL DIRECTOR
    1.00     		0 0 0
    PO BOX 159
    CAMPTON,KY41301
    KEVIN THOMPSON DIRECTOR
    1.00     		0 0 0
    110 PEBBLE DRIVE
    GLASGOW,KY42141
    MARK GIBBONS DIRECTOR
    1.00     		0 0 0
    919 SCHERM
    OWENSBORO,KY42301
    DAVID GARVIN TREASURER
    1.00     		0 0 0
    2102 EMERSON AVE
    LOUISVILLE,KY40205
    KATHLEEN BRYANT DIRECTOR
    1.00     		0 0 0
    8613 AUTUMN RIDGE CT
    LOUISVILLE,KY40242
    2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
    (a) Name and address of each employee paid more than $50,000 (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation (d) Contributions to
    employee benefit
    plans and deferred
    compensation     		(e) Expense account,
    other allowances
    NONE
    Total number of other employees paid over $50,000...................bullet 0
    Form 990-PF (2020)
    Form 990-PF (2020)
    Page 7
    Part VIII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors (continued)
    3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
    (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
    NONE
    Total number of others receiving over $50,000 for professional services.............bullet0
    Part IX-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1  
    2  
    3  
    4  
    Part IX-B
    Summary of Program-Related Investments (see instructions)
    Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
    1  
    2  
    All other program-related investments. See instructions.
    3  
    Total. Add lines 1 through 3.........................bullet0
    Form 990-PF (2020)
    Form 990-PF (2020)
    Page 8
    Part X
    Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see instructions.)
    1
    Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
    purposes:
    a
    Average monthly fair market value of securities...................
    1a
    18,360,352
    b
    Average of monthly cash balances.......................
    1b
    309,210
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    18,669,562
    e
    Reduction claimed for blockage or other factors reported on lines 1a and
    1c (attach detailed explanation) .............
    1e
    0
    2
    Acquisition indebtedness applicable to line 1 assets..................
    2
    0
    3
    Subtract line 2 from line 1d.........................
    3
    18,669,562
    4
    Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
    instructions) .............................
    4
    280,043
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    18,389,519
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    919,476
    Part XI
    Distributable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here right arrow and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    919,476
    2a
    Tax on investment income for 2020 from Part VI, line 5......
    2a
    6,793
    b
    Income tax for 2020. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    6,793
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    912,683
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    912,683
    6
    Deduction from distributable amount (see instructions).................
    6
    0
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1 ...
    7
    912,683
    Part XII
    Qualifying Distributions (see instructions)
    1
    Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
    a
    Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 ..........
    1a
    2,070,594
    b
    Program-related investments—total from Part IX-B..................
    1b
    0
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes...............................
    2
     
    3
    Amounts set aside for specific charitable projects that satisfy the:
    a
    Suitability test (prior IRS approval required)....................
    3a
     
    b
    Cash distribution test (attach the required schedule) .................
    3b
     
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
    4
    2,070,594
    5
    Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
    income. Enter 1% of Part I, line 27b. See instructions.................
    5
    0
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    2,070,594
    Note: The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for
    the section 4940(e) reduction of tax in those years.
    Form 990-PF (2020)
    Form 990-PF (2020)
    Page 9
    Part XIII
    Undistributed Income (see instructions)
    (a)
    Corpus     		(b)
    Years prior to 2019     		(c)
    2019     		(d)
    2020
    1 Distributable amount for 2020 from Part XI, line 7 912,683
    2 Undistributed income, if any, as of the end of 2020:
    a Enter amount for 2019 only....... 0
    b Total for prior years:20, 20, 20 0
    3 Excess distributions carryover, if any, to 2020:
    a From 2015......  
    b From 2016...... 643,536
    c From 2017...... 480,674
    d From 2018...... 480,326
    e From 2019...... 65,458
    fTotal of lines 3a through e........ 1,669,994
    4Qualifying distributions for 2020 from Part
    XII, line 4: bullet$ 2,070,594
    a Applied to 2019, but not more than line 2a 0
    b Applied to undistributed income of prior years
    (Election required—see instructions).....     		0
    c Treated as distributions out of corpus (Election
    required—see instructions)........     		0
    d Applied to 2020 distributable amount..... 912,683
    e Remaining amount distributed out of corpus 1,157,911
    5 Excess distributions carryover applied to 2020. 0 0
    (If an amount appears in column (d), the
    same amount must be shown in column (a).)
    6Enter the net total of each column as
    indicated below:
    a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5 2,827,905
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ..........     		0
    c Enter the amount of prior years’ undistributed
    income for which a notice of deficiency has
    been issued, or on which the section 4942(a)
    tax has been previously assessed......     		0
    d Subtract line 6c from line 6b. Taxable amount
    —see instructions ...........     		0
    e Undistributed income for 2019. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		0
    f Undistributed income for 2020. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2021 ..........     		0
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (Election may
    be required - see instructions) .......     		0
    8 Excess distributions carryover from 2015 not
    applied on line 5 or line 7 (see instructions) ...     		0
    9Excess distributions carryover to 2021.
    Subtract lines 7 and 8 from line 6a ......     		2,827,905
    10 Analysis of line 9:
    a Excess from 2016.... 643,536
    b Excess from 2017.... 480,674
    c Excess from 2018.... 480,326
    d Excess from 2019.... 65,458
    e Excess from 2020.... 1,157,911
    Form 990-PF (2020)
    Form 990-PF (2020)
    Page 10
    Part XIV
    Private Operating Foundations (see instructions and Part VII-A, question 9)
    1a If the foundation has received a ruling or determination letter that it is a private operating
    foundation, and the ruling is effective for 2020, enter the date of the ruling....... bullet
     
    b Check box to indicate whether the organization is a private operating foundation described in section or
    2a Enter the lesser of the adjusted net
    income from Part I or the minimum
    investment return from Part X for each
    year listed ..........     		Tax year Prior 3 years (e) Total
    (a) 2020 (b) 2019 (c) 2018 (d) 2017
             
    b 85% of line 2a .........          
    c Qualifying distributions from Part XII,
    line 4 for each year listed .....     		         
    d Amounts included in line 2c not used directly
    for active conduct of exempt activities ..........     		         
    e Qualifying distributions made directly
    for active conduct of exempt activities.
    Subtract line 2d from line 2c ....     		         
    3 Complete 3a, b, or c for the
    alternative test relied upon:
    a “Assets" alternative test—enter:
    (1) Value of all assets ......          
    (2) Value of assets qualifying
    under section 4942(j)(3)(B)(i)    		          
    b “Endowment" alternative test— enter 2/3
    of minimum investment return shown in
    Part X, line 6 for each year listed...     		         
    c “Support" alternative test—enter:
    (1) Total support other than gross
    investment income (interest,
    dividends, rents, payments
    on securities loans (section
    512(a)(5)), or royalties) ....     		         
    (2) Support from general public
    and 5 or more exempt
    organizations as provided in
    section 4942(j)(3)(B)(iii)....     		         
    (3) Largest amount of support
    from an exempt organization    		          
    (4) Gross investment income          
    Part XV
    Supplementary Information (Complete this part only if the foundation had $5,000 or more in
    assets at any time during the year—see instructions.)
    1Information Regarding Foundation Managers:
    aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
    before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
    bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
    ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
    GRANT REVIEW COMMITTEE GOOD SAMARIT
    7400 FLOYDSBURG ROAD
    CRESTWOOD,KY40014
    (502) 425-3884
    bThe form in which applications should be submitted and information and materials they should include:
    COMPLETION OF APPLICATION FOR GRANT FORM, TWO PAGE MAXIMUM SUMMARY OF GRANT PURPOSE AND PROGRAM TO BE FUNDED, LIST OF THE ORGANIZATION'S DIRECTORS AND OFFICERS, COPY OF 501(C)(3) LETTER, COPY OF THE ORGANIZATION'S CURRENT ANNUAL OPERATING BUDGET AND MOST RECENT ANNUAL AUDIT REPORT, AND A COPY OF IRS FORM 990 WITH SCHEDULES FOR THE PRECEDING TWO YEARS, IF A TAX RETURN IS FILED. COMPLETE ONLINE APPLICATION AND SUBMIT REQUESTED ATTACHMENTS ON A CD OR EMAIL. IF THE ORGANIZATION RECEIVED A PRIOR YEAR GSF GRANT, A ONE PAGE NARRATIVE DESCRIBING THE GRANT'S PROGRESS AND SUCCESSES SHOULD BE PROVIDED. A BUDGET SUMMARY FOR THE GRANT SHOULD ALSO BE PROVIDED.
    cAny submission deadlines:
    MARCH 1
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    THE FOUNDATION LIMITS GRANTS TO CHARITABLE AND EDUCATIONAL ACTIVITIES RELATED TO HEALTH CARE AND HEALTH EDUCATION IN THE COMMONWEALTH OF KENTUCKY. PRIMARY/PREVENTIVE HEALTH CARE PROPOSALS SERVING LOW INCOME AND UNINSURED INDIVIDUALS IN UNDERSERVED AREAS OF THE COMMONWEALTH ARE A PRIORITY FOR FUNDING. THE FOUNDATION DOES NOT FUND PROPOSALS FROM FOR-PROFIT ORGANIZATIONS OR FROM PRIVATE INDIVIDUALS. IT DOES NOT FUND PROPOSALS FROM PARTISAN POLITICAL ENTITIES, FROM FRATERNAL ORGANIZATIONS, FROM VETERANS ORGANIZATIONS, OR FROM NATIONAL ORGANIZATIONS. PROPOSALS FOCUSING ON FUNDRAISING ACTIVITIES (E.G. CHARITABLE TOURNAMENTS, MEAL FUNCTIONS, TEAM SPONSORSHIPS OR TICKET PURCHASES) ARE NOT FUNDED. THE FOUNDATION DOES NOT FUND PROPOSALS TO CREATE OR SUPPORT YOUTH ATHLETIC ACTIVITIES.
    Form 990-PF (2020)
    Form 990-PF (2020)
    Page 11
    Part XV
    Supplementary Information (continued)
    3 Grants and Contributions Paid During the Year or Approved for Future Payment
    Recipient If recipient is an individual,
    show any relationship to
    any foundation manager
    or substantial contributor
    		 Foundation
    status of
    recipient     		Purpose of grant or
    contribution     		Amount
    Name and address (home or business)
    aPaid during the year
    ALDERSGATE
    7400 FLOYDSBURG ROAD
    CRESTWOOD,KY40014     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 147,974
    AMERICANA COMMUNITY CENTER INC
    4801 SOUTHSIDE DRIVE
    LOUISVILLE,KY40214     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 5,000
    APPALRED
    120 N FRONT AVE
    PRESTONBURG,KY41653     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 28,642
    BLUEGRASS CARE NAVIGATORS
    1 ST JOSEPH DRIVE
    LEXINGTON,KY40504     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 11,636
    BOYS & GIRLS HAVEN
    2301 GOLDSMITH LANE
    LOUISVILLE,KY40218     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 28,625
    CENTER FOR COURAGEOUS KIDS
    1501 BURNLEY ROAD
    SCOTTSVILLE,KY42164     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 22,500
    CHRYSALIS HOUSE
    1589 HILL RISE DRIVE
    LEXINGTON,KY40504     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 10,000
    COMMUNITY DENTAL CLINIC
    2811 NEW HARTFORD RD SUITE A
    OWENSBORO,KY42303     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 2,500
    COVINGTON LADIES HOME
    702 GARRARD STREET
    COVINGTON,KY41011     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 15,574
    EASTERN KENTUCKY UNIVERSITY WESLEY FOUNDATION
    401 UNIVERSITY DRIVE
    RICHMOND,KY40475     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 17,683
    ENCOUNTER MISSION
    PO BOX 508 509 DEPOT ROAD
    PAINSTVILLE,KY41240     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 68,500
    FAMILY COMMUNITY CLINIC
    1420 E WASHINGTON STREET
    LOUISVILLE,KY40206     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 7,500
    FOURTH AVENUE UNITED METHODIST CHURCH
    318 W ST CATHERINE ST
    LOUISVILLE,KY40203     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 10,000
    GLASGOW FIRST UNITED METHODIST CHURCH
    500 SOUTH GLASGOW STREET
    GLASGOW,KY42141     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 8,000
    HILLCREST BRUCE
    1819 ELOISE STREET
    ASHLAND,KY41101     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 151,900
    HOME OF THE INNOCENTS
    1100 EAST MARKET STREET
    LOUISVILLE,KY40206     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 37,958
    HOPE HEALTH CLINIC
    1025 SANIBEL WAY SUITE E
    LAGRANGE,KY40031     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 18,581
    IDA SPENCE MISSION
    PO BOX 121319
    COVINGTON,KY41012     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 17,000
    ISAIAH HOUSE RECOVERY CENTER
    2084 MAIN STREET
    WILLISBURG,KY40078     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 14,221
    KY ANNUAL CONFERENCE OF THE UNITED METHODIST CHURCH INC
    7400 FLOYDSBURG ROAD
    CRESTWOOD,KY40014     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 144,600
    KENTUCKY BOARD OF PENSIONS
    7400 FLOYDSBURG ROAD
    CRESTWOOD,KY40014     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 15,000
    KENTUCKY CANCERLINK
    2425 REGENCY ROAD SUITE B
    LEXINGTON,KY40503     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 7,000
    KENTUCKY STATE UNIVERSITY WESLEY FOUNDATION
    400 E MAIN STREET
    FRANKFORT,KY40601     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 25,308
    KENTUCKY WESLEYAN COLLEGE
    3000 FREDERICA STREET
    OWENSBORO,KY42301     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 33,040
    LEWIS MEMORIAL HOME
    2905 BOWLING GREEN ROAD
    FRANKLIN,KY42134     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 17,000
    LEXINGTON HEARING AND SPEECH CENTER
    350 HENRY CLAY BLVD
    LEXINGTON,KY40502     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 9,908
    LIFEHOUSE MATERNITY HOME
    2710 RIEDLING DRIVE
    LOUISVILLE,KY40206     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 2,000
    LIGHTHOUSE MINISTRIES
    5312 SHEPHERDSVILLE ROAD
    LOUISVILLE,KY40228     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 35,000
    LINDSEY WILSON COLLEGE
    210 LINDSEY WILSON STREET
    COLUMBIA,KY42728     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 54,696
    LOUCON CAMP & RETREAT
    8044 ANNETA ROAD
    LEITCHFIELD,KY42754     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 198,069
    MARYHURST
    1015 DORSEY LANE
    LOUISVILLE,KY40223     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 20,000
    METHODIST CHILDREN'S HOME OF KY
    1115 ASHGROVE ROAD
    NICHOLASVILLE,KY40356     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 80,298
    MIDDLETOWN UNITED METHODIST CHURCH
    11902 OLD SHELBYVILLE ROAD
    LOUISVILLE,KY40243     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 8,567
    MISSION HEALTH LEXINGTON
    230 S MARTIN LUTHER KING BLVD
    LEXINGTON,KY40508     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 20,000
    MOREHEAD STATE WESLEY FOUNDATION
    304 UNIVERSITY BLVD
    MOREHEAD,KY40351     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 19,500
    NATHANIEL MISSION
    1109 VERSAILLES ROAD SUITE 400
    LEXINGTON,KY40508     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 131,420
    NORTHERN KENTUCKY UNIVERSITY WESLEY FOUNDATION
    LOUIE B NUNN DR
    HIGHLAND HEIGHTS,KY41099     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 14,250
    PILLAR (APPLE PATCH COMMUNITY INC)
    7408 HIGHWAY 329
    CRESTWOOD,KY40014     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 13,355
    PORTLAND PROMISE CENTER
    PO BOX 11865
    LOUISVILLE,KY40251     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 23,000
    RADIO EYE INC
    1733 RUSSELL CAVE ROAD
    LEXINGTON,KY40505     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 12,940
    RAPHA MINISTRIES
    137 N MAIN STREET
    WINCHESTER,KY40391     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 4,800
    RED BIRD CLINIC DENTAL
    70 QUEENDALE CENTER
    BEVERLY,KY40913     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 150,000
    RED BIRD CLINIC HEALTH
    70 QUEENDALE CENTER
    BEVERLY,KY40913     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 39,770
    REFUGE FOR WOMEN KY EMERGENCY HOUSING
    342 WALLER AVENUE SUITE D
    LEXINGTON,KY40504     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 5,450
    SECOND LIFE FAMILY RESOURCES
    353 PRESTON AVENUE
    LEXINGTON,KY40502     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 5,000
    SOUTH LOUISVILLE COMMUNITY MINISTRIES
    415 1/2 W ASHLAND AVENUE
    LOUISVILLE,KY40214     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 5,000
    ST MATTHEWS UNITED METHODIST CHURCH
    319 BROWNS LANE
    LOUISVILLE,KY40207     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 5,000
    THE FOUNDRY
    531 WEST 11TH AVENUE
    BOWLING GREEN,KY42101     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 51,750
    THE POST CLINIC INC
    15 STERLING AVENUE
    MT STERLING,KY40353     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 26,495
    UNION COLLEGE
    310 COLLEGE STREET
    BARBOURVILLE,KY40906     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 55,212
    UNIVERSITY OF KENTUCKY WESLEY FOUNDATION
    508 COLUMBIA AVE
    LEXINGTON,KY40508     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 38,258
    UNIVERSITY OF LOUISVILLE WESLEY FOUNDATION
    2301 S 3RD STREET
    LOUISVILLE,KY40292     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 17,500
    WASHINGTON UNITED METHODIST CHURCH
    1917 US-68
    OLD WASHINGTON,KY41096     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 2,054
    WESLEY HOUSE
    5114 PRESTON HWY
    LOUISVILLE,KY40213     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 17,000
    WESLEY MANOR RETIREMENT COMMUNITY
    5012 E MANSLICK ROAD
    LOUISVILLE,KY40219     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 44,051
    WESLEY VILLAGE
    1125 LEXINGTON ROAD
    WILMORE,KY40390     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 42,000
    WESTERN KENTUCKY UNIVERSITY WESLEY FOUNDATION
    1355 COLLEGE STREET
    BOWLING GREEN,KY42101     		NONE PUBLIC CHARITY TO SUPPORT THE ORGANIZATION'S MISSION 14,581
    Total .................................bullet 3a 2,032,666
    bApproved for future payment
    Total .................................bullet 3b 0
    Form 990-PF (2020)
    Form 990-PF (2020)
    Page 12
    Part XVI-A
    Analysis of Income-Producing Activities
    Enter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 (e)
    Related or exempt
    function income
    (See instructions.)
    1Program service revenue: (a)
    Business code     		(b)
    Amount     		(c)
    Exclusion code     		(d)
    Amount
    a
    b
    c
    d
    e
    f
    gFees and contracts from government agencies          
    2 Membership dues and assessments....          
    3 Interest on savings and temporary cash
    investments ...........     		    14 31  
    4 Dividends and interest from securities....     14 405,797  
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property.....          
    6 Net rental income or (loss) from personal property          
    7 Other investment income.....     14 443  
    8 Gain or (loss) from sales of assets other than
    inventory ............     		    18 301,513  
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory          
    11 Other revenue: a
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e).. 0 707,784 0
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    707,784
    (See worksheet in line 13 instructions to verify calculations.)
    Part XVI-B
    Relationship of Activities to the Accomplishment of Exempt Purposes
    Line No.
    DownArrow     		Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to
    the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
    instructions.)
    Form 990-PF (2020)
    Form 990-PF (2020)
    Page 13
    Part XVII
    Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
    1
    Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
    Yes
    No
    a
    Transfers from the reporting foundation to a noncharitable exempt organization of:
    (1) Cash...................................
    1a(1)
     
    No
    (2) Other assets.................................
    1a(2)
     
    No
    b
    Other transactions:
    (1) Sales of assets to a noncharitable exempt organization....................
    1b(1)
     
    No
    (2) Purchases of assets from a noncharitable exempt organization..................
    1b(2)
     
    No
    (3) Rental of facilities, equipment, or other assets.......................
    1b(3)
     
    No
    (4) Reimbursement arrangements...........................
    1b(4)
     
    No
    (5) Loans or loan guarantees.............................
    1b(5)
     
    No
    (6) Performance of services or membership or fundraising solicitations................
    1b(6)
     
    No
    c
    Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............
    1c
     
    No
    d
    If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair market value
    of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
    in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.
    (a) Line No. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements
    2a
    Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
    described in section 501(c) (other than section 501(c)(3)) or in section 527? ...........
    b
    If "Yes," complete the following schedule.

    (a) Name of organization (b) Type of organization (c) Description of relationship
    Sign Here
    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 taxpayer) is based on all information of which preparer has any knowledge.
    Bullet Bullet
    May the IRS discuss this return
    with the preparer shown below?
    See instructions.
    Signature of officer or trustee Date Title
    Paid Preparer Use Only Print/Type preparer's name Preparer's Signature Date PTIN
    Firm's name SmallBullet
    		 Firm's EIN SmallBullet
    Firm's address SmallBullet


    		 Phone no.
    Form 990-PF (2020)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description
    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 Go to www.irs.gov/Form990 for the latest information.
    OMB No. 1545-0047
    2020
    Name of the organization
    GOOD SAMARITAN FOUNDATION INC
     
    Employer identification number

    31-1087598
    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 isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2020)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2020) Page 2
    Name of organization
    GOOD SAMARITAN FOUNDATION INC
          		Employer identification number
    31-1087598
    Part I
    Contributors
    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
    1
    TRUST UNDER WILL OF ELISABETH SPANTON
     
    C/O JP MORGAN CHASE 270 PARK AVENUE
     
    NEW YORK, NY100172014

    		$ 36,367


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    2
    STATE STREET UNITED METHODIST CHURCH
     
    1101 STATE STREET
     
    BOWLING GREEN, KY42101

    		$ 24,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    3
    LINDSEY WILSON COLLEGE
     
    210 LINDSEY WILSON STREET
     
    COLUMBIA, KY42728

    		$ 6,588


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    4
    YOUTHBUILD LOUISVILLE
     
    800 S PRESTON STREET
     
    LOUISVILLE, KY40203

    		$ 6,824


    (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) (2020)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
    Page 3
    Name of organization
    GOOD SAMARITAN FOUNDATION INC
          		Employer identification number

    31-1087598
    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) (2020)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
    Page 4
    Name of organization
    GOOD SAMARITAN FOUNDATION INC
          		Employer identification number

    31-1087598
    Part III
    Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. 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) (2020)
    Additional Data


    Software ID:  
    Software Version:  

    TY 2020 AccountingFeesSchedule
    Name:
    GOOD SAMARITAN FOUNDATION INC
    EIN:
    31-1087598
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    ACCOUNTING FEES 32,015 16,008   32,015

    TY 2020 DissolutionStmt
    Name:
    GOOD SAMARITAN FOUNDATION INC
    EIN:
    31-1087598
    Dissolution Name Dissolution Address Explanation Dissolution Amount
    KENTUCKY ANNUAL CONFERENCE UNITED METHODIST CHURCH INC 7400 FLOYDSBURG ROAD
    CRESTWOOD,KY40014     		THE ASSETS OF THE FOUNDATION THAT WERE TRANSFERRED WILL BE USED TO PROVIDE GRANTS TO CHARITABLE AND EDUCATIONAL ACTIVITIES THAT "INSPIRE, EQUIP, AND EMPOWER SUSTAINABLE MINISTRIES TO SUPPORT SPIRITUAL AND PHYSICAL NEEDS" IN THE COMMONWEALTH OF KENTUCKY. THE ASSETS THAT WERE TRANSFERRED ARE CASH, INVESTMENTS, CERTIFICATES OF DEPOSIT AND BENEFICIAL INTEREST IN A PERPETUAL TRUST. 21,897,658


    TY 2020 LiquidationExplanationStmt
    Name:
    GOOD SAMARITAN FOUNDATION INC
    EIN:
    31-1087598
    Statement:
    THE GOOD SAMARITAN FOUNDATION, INC. DISSOLVED AS OF DECEMBER 21, 2020. THE ASSETS OF THE FOUNDATION WERE TRANSFERRED TO THE KENTUCKY ANNUAL CONFERENCE OF THE UNITED METHODIST CHURCH, INC. THE RECIPIENT'S ADDRESS IS: 7400 FLOYDSBURG ROAD, CRESTWOOD, KY 40014. THE FAIR MARKET VALUE OF THE TRANSFERRED ASSETS IN TOTAL IS $21,897,658. THE ASSETS THAT WERE TRANSFERRED ARE MADE UP OF THE FOLLOWING: -CASH - $121,364 -ACCOUNTS RECEIVABLE - $23 -INVESTMENTS (STOCK) - $21,632,656 -PREPAID EXPENSES - $22,580 -BENEFICIAL INTEREST IN PERPETUAL TRUST - $898,059 -CERTIFICATES OF DEPOSIT - $96,369 -ACCOUNTS PAYABLE & ACCRUED EXPENSES - $(873,393) TOTAL FAIR MARKET VALUE - $21,897,658


    TY 2020 LegalFeesSchedule
    Name:
    GOOD SAMARITAN FOUNDATION INC
    EIN:
    31-1087598
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    LEGAL FEES 1,826 913   913


    TY 2020 OtherAssetsSchedule
    Name:
    GOOD SAMARITAN FOUNDATION INC
    EIN:
    31-1087598
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    INTEREST AND DIVIDENDS RECEIVABLE 97 0 0
    GRANT REFUNDS RECEIVABLE 7 0 0
    RECEIVABLE-SPANTON 40,543 0 0


    TY 2020 OtherDecreasesSchedule
    Name:
    GOOD SAMARITAN FOUNDATION INC
    EIN:
    31-1087598
    Description Amount
    TRANSFER OF FUNDS TO KY ANNUAL CONFERENCE 21,897,658


    TY 2020 OtherExpensesSchedule
    Name:
    GOOD SAMARITAN FOUNDATION INC
    EIN:
    31-1087598
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    OFFICE SUPPLIES 64 0   0
    BANK FEES 117 0   0
    FILING FEES 11 0   0
    POST EMPLOYMENT BENEFITS 14,035 0   0


    TY 2020 OtherIncomeSchedule2
    Name:
    GOOD SAMARITAN FOUNDATION INC
    EIN:
    31-1087598
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    INVESTMENTS-LITIGATION SETTLEMENT PROCEEDS 443 443 443


    TY 2020 OtherIncreasesSchedule
    Name:
    GOOD SAMARITAN FOUNDATION INC
    EIN:
    31-1087598
    Description Amount
    UNREALIZED GAIN 2,263,687
    NET GAIN ON BENEFICIAL INTEREST IN PERPETUAL TRUST 47,226
    PRIOR PERIOD ADJUSTMENT 3,833,635


    TY 2020 OtherProfessionalFeesSchedule
    Name:
    GOOD SAMARITAN FOUNDATION INC
    EIN:
    31-1087598
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    INVESTMENT FEES 197,187 197,187   0
    KAC STAFF FEE 10,000 5,000   5,000