copy ~,m 990 return of orgrnorganization exempt fromincome …

Return of OrgRnOrganization COPY

Exempt FromIncome Tax '4BNO~9~ '1001

Under seeNon501(c), 5 27,or4947(a)(1) oT~eInternal Revenue Code(except black lung L S OO benefit trust or private foundation)

" me organization may have to use a ropy of this return to satisfy state reporting requlremmts Department of the Treasury

A For the 201 B u,ausodu.

~na.n .e . .o.

wee. a. .p.

urm rn.n

~m.naa won Mo~.uw Wen,

vNa. C Name of organization D Emitlayeer Identification number

-Ip°(+OOD SAMARITAN HOSPITAL FOUNDATION INC . 52-2307122 MN x Pike . Number and street (or P O box d mad s not delivered to street address) RooMsurte E Telephone numbef

see 5601 LOCH RAVEN BLVD . ( 410 ) 772-6719

City or town, state a counVy, and ZIP + 4 "".e`,~~ ° u r.,n U ,~e~,w

IMO 3 omw

0 Section 601(c)(J) organizations and 6947(a)(7) nonexempt charitable H aria I are not epplsaDle to swoon 527 organizations trusts must attach a completed Schedule A (Form 990 or 990 His) Is this a group return for alfiliatp9 Q Yes O No

p Wpb aft II1yM, GppDSAM-1+m.ORG H(b) N'Yes" enter number d efillalra " N A

J organization type (Mack aVy me) " X 1501(.) ( 3 ) 1 hart no ) 947(a)(1) or 527 N(c) Are all affiliates IrchiCedJ QYn No

K Check here 1 if the organizations gross receipts are normalcy not more than $25,000 The (if-NO.- attach a list See

.

Hid) b this a spuab ~p+m feaa M ~n organization need not file a return with the RS but d the organization received a Form 990 Packmpe or ani:~ummewe ~ rou corn a Via X No

in the mail, it should file a rerun vAthoul financial data Soma atatn require a complete return 1 Enter 44gR GEN 1 N/A M Check loo L_j if the organization is not required

to attach Sch B (Form 990 990.EZ, a 990-PFD Gross receipts Add lines, 6b 8b 9b, and l0b to km 12 10'

1 Contributions, gifts, grants, and wmilar amounts received STMT 1 _. ~ ga~ D,~v,e~d`~public esupport , , , , , , , , , , , , , , , , , , , , to ld 286 871

rTC'U'LYit'~'B6uPPo . . . . " " . .

. . . 1b

tons (grants) , , , , � , � , 7 c

(~p~ "~pdy"t~ aa~imI1n~~,.m c) (a,ns 13,795 .419 oonu,ns 491,352 . )

N "Z " Pro~arK.tfM+E~e ~ we including government fees and contracts ((turn Part VII, tine 93) . : . : , .

du 95 assessments

QGOVI ' A L'~'~ings d temporary cash investments FI 7

-aDnMends and.Ip(Cfe t from securities , , , , , , ,

8 a Gross rents , , , , , Ba

b Less rental expenses , , , , , , , , , , , , , Bb

e Net rental income or (loss) (subtract line 6b from line 6a) 7 Other investment income (describe 01 1 8 a Gross amount from sales of assets other IA1 Securmes (B) Other

Y than inventory 504 , 157 Ba

b Less cost or other basis and sales expenses 491 , 452 . 8 b

C Gain or (low) (attach schedule)$TMT 1A 13 . 305 . BC

d Net gain or (loss) (combine line 8c, columns (A) and (B)) , , p . . . . . . . . . . . . . . . N 8 Special events and activities (attach schedule) 1~ a Gross revenue (not including E 18 , 764 0l

N contributions reported on line 1a), , , S= z _ , $Tt1'P, 3 1 9a 174 , 901

4 b Less direct expenses other than fundraising expenses 9 b 1 , 702 e Net income or (loss) from special events (subtract line 9b from line 9a) " " . " . .

10a Gross sales of inventory, less returns and allowances , , Oe b Less post of goods sold Ob

W e Gross profit or (loss) from sales of inventory (attach schedule) (subtract line 10b from line 10a). . , . . S 11 Other revenue (from Part VII, line 103)

72 Total revenue add lines 1d 2 3 45, 6c 7 , Sd , 9c, 10c, and 11 )

17 Program services ((torn line 44, column (B))

N 14 Management and general (from line 44, column (C))

a 15 Fundraising (from line 44, column (D))

W 18 Payments to alfilmtes (attach schedule)

17 Total expenses add lines 16 and 44 column A

18 Excess or (deficit) for the year (subtract line 17 horn line 12) V . . . . . . 19 Net assets or fund balances at beginning of year (horn line 73, column (A))

a 20 Other changes m net assets or fund balances (attach explanation) , $ZR1T 4 Y = 21 Net assets or fund balances at end of year (combine hrm 18 19 arid 20

For Paperwork Reduction Act Notice, see the separate Instructions ~s~ l7~ ie1o1o :ooo

SC2822 U473 05/03/2003 15 45 33 V01-7

ram 980 (200+)

3

~,m 990

-Statement of nn organizations mush complete column (a) columns (B) (q and (D) ere repuree for section Spt (cx3) and (e) oqersnat,ons Functional Expenses anasection a9a7(a)(7) nonexempt Charitable trusts dnaptvWtorutxn(SeeSpecdctrsuuamsonpage 2t)

Do not include amounts reported m dm 66 Bb 96 f06 cr76NPart l

22 Grants and allocations (attach schedule)

22 (non f ~onnm f )

23 Specific assistance to individuals (attach schedule) 23

24 Benefits paid to a far members (attach schedule) 24

25 Compensation o1 officers, directors, etc 25

26 Other salaries and wages , , 26

27 Pension plan contributions _ , 27

28 Other employee benefits , , 28

29 Payroll taxes 29

10 Professional fundraising fees JO

31 Accounting fees 31

32 Legal tees , , , , _ , 72

33 Supplies , , , , JS

34 Telephone , , , , , , ]4

35 Postage and shipping , , , , JS

36 Occupancy _ , , , , 38

37 Equipment rental and maintenance , , 37

JS Printing and publications , , , 38

39 Travel, , , 39

40 Conferences, conventions and meetings 40

41 Interest _ 41

42 Deprecation depletion etc (attach schedule) 42 43 Othere.penaeanacoereo,oow(cemea~BTMT 5 3d

b 4 31:

3c

d 3d

7e 44 Total functional expenses (add iinee n inroupn 43)

OWr!mGau c;?nipeCnycaunol9}fD1. cant

(B) Program C) Manegertner~ (D) FwWraqug services I

and general I

4

Statement of Program Service Accomplishments See Specific Instructions on a e 24 What is the organization's primary exempt purposed No, STMT 6 Program Service

Expenses All organizations must describe their exempt purpose achievements in a clear and concise manner State the number (Required tor50i(c)(i) and of clients served, publications issued etc douse achievements that are not measurable Section 501 c 3 and 4 (<) orgs aria a9a7(a)(t) )() () trusts but appeal for organizatrons and 4947(a)(7) nonexempt charitable trusts must also enter the amount of grants and allocations to others ) others ) a NJA________________________________________________________________________

------------------------------------------------------------------------------------------------------------------------------------------------------

Grants and allocations $ b

------------------------------------------------------------------------------------------------------------------------------------------------------

(Grants and allocations $ ) c

------------------------------------------------------------------------------------------------------------------------------------------------------

(Grants and allocations $ d

------------------------------------------------------------------------------------------------------------------------------------------------------

Grants and allocations $ e Other program services attach schedule Grants and allocations S T Total of Program Service Expenses (should equal line 44 column (B) Program services)

;c;ozozooo F«m990 (2007)

(11) Total

7

Jolnt Costs Check " U ii you are following SOP 98-2 Are any point costs from a combined educational campaign and fundraising solicitation reported in (B) Program semces? " F ] Yes X No If 'Yes; enter (p the aggregate amount of these point costs $ , (u) the amount allocated to Program services $

I i Y I ma I uavnuIea aim nm eaaeu i I unu uaIencea law III ea oo an u iol I ea, 0 o~ 1 ~g 1 is , og~, u~o

Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a particular organization How the public perceives an organization in such cases may be determined by the information presented on its return Therefore, please make sure the return is complete and accurate and fully describes, in Part III, the organizations programs and accomplishments

Jv 1eIaw7aoo

Form 990 (2001) 52-2307122

h-!= Balance Sheets (See Specific Instructions on page 24 )

Note: Where required, attached schedules and arriounts within the description (A) (3) column should be for end-of-year amounts on Beginning of year End of year

45 Cash - non-interest-0eanng . . . . 29 , 580 . 43 NONE 48 Savings and temporary cash investments . . . NO 48 2 , 263 , 589 .

47a Accounts receivable 47a b Less allowance for doubtful accounts 47b 47c

48a Pledges receivable , , , , , , , 48a 10 381 467 . b Less allowance for doubtful accounts 418b NONE 48c l 10 , 381 , 467

49 Grants receivable , , 48 SO Recervables from officers, directors, trustees, and key employees

(attach schedule) 30 51a Other notes and loans receivable (attach

schedule) 57a w b Less allowance for doubtful accounts , , , , S t b Sic N

52 Inventories for sale or use 52 . . . . . . . . SS Prepaid expenses and deferred charges . . . 53 34 Investments - securities (attach schedule) Cost ~ F MV . 54 SSa Investments - land, buildings, and

equipment basis _ SSa b Less accumulated deprecation (attach

schedule) , SSb SSe 56 Investments - other (attach schedule) 58 57a Land, buildings, and equipment basis 57a .

b Less accumulated depreciation (attach schedule) 57 b 57e

58 Other assets (describe " 58

59 Total assets add lines 45 through 58 must equal line 74 29 , 580 59 12 645 056 . 60 Accounts payable and accrued expenses NONE 80 21 , 000 . 61 Grants payable 61 62 Deferred revenue . . 82 63 Loans from officers, directors, trustees, and key employees (attach

schedule) 63 84a Tax-exempt bond liabilities (attach schedule) 84a

b Mortgages and other notes payable (attach schedule) 60b 65 Other liabilities (describe " STMT 7 ) NO 65 1 1 491 , 761*

88 Total liabilities add lines 60 through 65 NO 88 1 502 761 . Organizations that follow SFAS 777, cheek here " LxJ and complete lines

67 through 69 and lines 73 and 74 d 67 Unrestricted 29 , 580 87 628 939

68 Temporarily restricted , No 68 10 , 513 , 356 q 69 Permanently restricted 69 m a Organizations that do not follow SFAS 117, cheek here 10 and ~ complete lines 70 through 74 0 70 Capital stock, trust principal, or current funds 70

71 Paid-in or capital surplus, or land, budding, and equipment fund 77 ,n 72 Retained earnings, endowment, accumulated income, or other funds 72 x a 73 Total net assets or fund balances (add lines 67 through 69 OR lines

70 through 72, column (A) must equal line 19, and column (B) must equal line 21) 29 , 590 73 11,142-295 .

rceconaiiation of Revenue per wuartea Financial Statements with Revenue per Return (See Specific Instructions, page 26

neconcnwuon or expenses per Auartea Financial Statements with Expenses per Return NOT APPLICABLE

c Line a minus line b

d Amounts included on line 72,

Form 990 but not on line a

(1) Investment expenses

not included on line

6b, Form 990 t

(2) Other (specify)

S Add amounts on lines (1) and (2)

e Total revenue per line 12, Form 990

(line a plus line d)

Add amounts on lines (1) and (2) Ill e Total expenses per line 17, Form 990

Jv I Et0402000

a Total revenue, gains, and other support per audited financial statements 1

b Amounts included on line a but not on line 12, Form 990

(t) Net unrealized gains NOT APPLICABLI on investments S

(2) Donated services and use of facilities $

(3) Recoveries of prior year grants , , f

(4) Other (specity)

s Add amounts on lines (1) through (4)

a Total expenses and losses per audited financial statements

b Amounts included on line a but not on line 77, Form 990

(1) Donated services and use of facilities S

(2) Prior year adjustments

reported on line 20, Form 990 f

(7) Losses reported on line 20, Forth 990 $

(4) Other (specify)

Add amounts on lines (1) through (4) . c Line a minus line b d Amounts included on line 77, .

Form 990 but not on line a (1) Investment expenses

not included on line

6b, Form 990 S

(2) Other (specify)

List of Officers, Directors, Trustees, and Key Employees (List each one even it not compensated, see Specific

(B) Tithe and anage I (C) Compensation I (o) comriou'vn m I (E) E,~enx (p/ Name and address hours pei ~k (If not paid, enter empioy« omen pane 6 attounl an0 User

7 S Did any officer, director trustee or key employee receive aggregate compensation of more than $700 000 from your organization and all related organizations of which more than $10,000 was provided by the related organizations? " F~ Yes a No If 'Yes' attach schedule - see Specific Instructions on page 27 yTHT y

Fam990 (200,)

No

b Gross income from other sources (Do not net amounts due or paid to other

NONE " NONE d Enter Amount of tax on line 89c, above, reimbursed by the organization

SC2822 0473 09/24/2003 15 19 22 V01-7

78 DO the organization engage in any activity not previously reported to the IRS? If -Yes; attach a detailed descnptpn of each act" 77 Were any changes made in the organizing or governing documents but not reported to the IRS? , , , , ,

II 'Yes," attach a conformed copy of the changes 78 a Did the organization have unrelated business gross income of 57,000 a more dump the year covered by tin return?

b If -Yes,' has it filed a lax return on Form 990-T for this yeah

79 Was there a liquidation, dissolution termination or substantial contraction during the year? a 'Yes," attach a statement 80a Is the organization related (other than by association with a statewide or nationwide organization) through common

membership, governing bodies, trustees, officers, etc , to any other exempt or nonexempt organization? b If 'Yes,' enter the name of we organization 1 MEDSTAR HEALTH AND SUBSIDIARIES

and check whether it is 1_X_1 exempt CR )nonexempt 8 7 a Enter direct or indirect political expenditure See line 81 instructions , 1 81a I NON

b Did the organization file Form 11]0 "POL for this yea( , ,

82a Did the organization receive donated services or the use of matercals, equipment, w facilities at no charge

or at substantially less than fair rental value?

b it "Yes,' you may indicate the value of these items here Do not include this amount

as revenue in Part I or as an expense in Part II (See instructions in Part III )

83a Did the organization comply with the public inspection requirements for returns and exemption applications? , b Did the organization comply with the disclosure requirements relating to quid pro quo contributions?

84 a Did the organization solicit any contributions or gifts that were not tax deductible'! b II "Yes; did the organization include with every solicitation an express statement that such corrInbutions

or gifts were not tax deductible? . , , , . . . , . , . , 86 501/cJ(4) (5) or (6) organizations a Were substantially all dues nondeductible by members?

b Did the organization make only in-house lobbying expenditures of $2 000 or less If "Yes' was answered to either 85a or 85b, do not complete BSc through 85h below unless the organization

received a waiver for proxy lax owed for the poor year

c Dues, assessments, and similar amounts from members 86c

d Section 162(e) lobbying and political expenditures 85d

e Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices BSe

1 Taxable amount of lobbying and political expenditures (line 85d less 85e) 85f

g Does the organization elect to pay the section 6033(e) tax on the amount in 8517

h If section 6033(e)(1)(A) dues notices were sent, does the organization agree to add the amount in a5f to its reasonable estimate of dues allocable to nondeductible lobbying and political expenditures for the following tax yeah

86 501(c)(7) orqs Enter a Initiation lees and capital contributions included on line 12

b Gross receipts, included on line 72, for public use of club facilities

87 50 1(c)(12) wps Enter a Gross income from members or shareholders

sources against amounts due or received from them ) 88 At any time during the year, did the organization own a 50% or greater interest in a taxable corporation a

partnership, or an entity disregarded as separate from the organization under Regulations sections 301 7701-2 and 301 7707-3? If 'Ves' complete Part IX

89a 501(c)(3) organizations Enter Amount of tax imposed on the organization during the year under section 4911 jo. NONE , section 4912 " NONE , section 4955

b 507(c)(3) and 501(c)(4) ags Did the organization engage in any section 4958 excess bench transaction during the year or did it become aware of an excess benefit transaction from a prior year? II Yes," attach a statement explaining each transaction

c Enter Amount of la : imposed on the organization managers or disqualified persons during the year under

sections 4912, 4955 and 4958

903 List the states with which a copy of this return is filed t MARYLAND b Number of employees employed in the pay period that includes March 12, 2001 (See instructions) _ _ 190b NONE

91 The books are in care of " MARC HERGER Telephone no " 410-772-6719 Located at J~ 5565 STERRETT PLACE, 5TH FL COLUMBIA, HD LP " 4 Ito 21044

92 Section4947(a)(1) nonerempfchanfablatrush!lingFam990mlieuolFOrm1P91 " Checkhere

and enter the amount of tax-exempt interest received w accrued during the tax year " 192 ~ NONE

Form990 (2007)

JSA tE1O4t 7000

No : Enter puss amounts unless dherwue Unrelated business mc

indicated ~~ B

93 Program acmce revenue coos Amount

a

D

c

d

e

1 Medicare/MeOitaiO payrtK'nl5 g Fees and contracts from goientrinent agencies

94 Membership dues and assessments , ,

9 5 interest on swvqs am 2mnaarv ~ 96 Dividends and interest from securities 97 Net rental income w (loss) from real estate

a debt-financed property b not debt-financed property

98 Nit renhi income a (loss) tram personal polio rty . 99 Other investment Income, . . .

100 Gain or (ox,) hpn aaft of gab otM, pun rrnn6wy-1011 Net income or (loss) from spewl events 102 Gross profit or (low) from sain M vi,,aniory , 103 Other revenue a

b

c

d e

104 Subtotal (add columns (B), (D), and (E) 105 Total (add line 104, columns (B), (D), and (E)) Note Line 105 plus line 14 Part I should equal the amount on line 12 Pert I

512 513 , or 514 CE) Related a

Amount exempt function

" 194 .250 .

Line No I Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishment

Name address arid EiN of corporation a "2ennu" w Nature of actmhes Total income

(a) Did the organization during the year, receive any funds, directly or (b) Did the organization, during the year, pay premiums, direct) Note' If 'Yes"to !b). 61e Form 8870 and Form 4720 )see mstmrti

a mss of or(

J5'i, 1 E 1050 2 000

ana oeueT n is Mme cor

Please Sign I Signawr Idn Here

Type o~ glint name an0 title 1 Preparers'i(~ ,~

Paid vgnawre

Preparers Firm s name (a yours Use Only if seii~o") . ' 13

address and ZIP . a

Total number of others receiving over $50 000 for professional Se rvices t I NONE For Paperwork Reduction Act Notice see the Instructions for Form 990 and Form 990F2 Schedule A (Form 990 or 894EZ) 2001

Jv 1 E 1210 2 000

SCHEDULER Organization Exempt Under Section 501(c)(3) OMB No 1545{

(Form 990 of 990-EZ) (Except Private Foundation) and Section 601(e), 6010, 601ft 601(n), or Section d947(aKt) Nonexempt Charitable Trust O

Supplementary lnfortnation - (See separate instructions .) ~00 Department of the Treasury internal Re+mue Service " MUST be completed b the above or anizations and attached to their Form 990 a 990F2 Name of the organization Empbyn Identification numl

GOOD SAMARITAN HOSPITAL FOUNDATION INC. 52-2307122

Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and Trustees (See page 1 of the mstrucbons List each one If there are none, enter "None ")

(a) Name and address of each employee pale mve (b) Title and ave~ege (d) contributions to p) Et~ense

than 550 000 fours per reek (~) Cpm~ui,pn employee benefit plans 8 account and other

1~ -:~r --- ~i~~ . .~... .m

NONE

----------------------------------

----------------------------------

Total number of other employees paid over E50,000 . 11 1 NONE

Compensation of the Five Highest Paid Independent Contractors for Professional Services (See page 2 of the instructions List each one (whether Individuals or firms) If there are none, enter "None'

(a) Name and address of each independent contractor paid more loan 550 000 (D) Type of servxe (c) compensation

NONE

------------------------------------------------

------------------------------------------------

------------------------------------------------

------------------------------------------------

Statements About Activities (See page 2 of the instructions ) No

1 During the yew, has the organization attempted to Inhumes national, state, or local legislation . Including any

attempt to Influence public opinion on legislative matter or referendum? If Yes; enter the total expenses paid

or incurred in connection with the lobbying activities " f (Must equal amount OFF line 38, Part VI-!, v line i a Part VI-8 )

Organizations that made an election undo section 507(h) by filing Form 5768 must complete Part VFA Other organizations, checking Yes; must complete Part We AND attach a statement giving a detailed description of the lobbying activities

Z During the year, has the organization, either directly or indirectly, engaged In any of the following acb with any

substantial contributors, trustees, directors, officers, creators, key employees, or members of their families, or

with any taxable organization with which any such person is affiliated as an officer, directs, trustee, majority

owner, or principal benefiaaryl (H the answer to any quasi= a "Yes.' attach a detailed statement explaining

the trensactwis.J

a Sale, exchange, or leasing of propertyl , , , , , , , , , , . , , , , , , , , , , , , ,

b Lending of money or other extension of eredR7 , , , , , , , , , , , , , , , , , , , , , , , , ,

3 Does the organization make grants for Scholarships, fellowships, student loans, ete 7 (See Note below ) , , , 4 Do you have a section d03(b) annuity plan for your employees? . . . . . . . . . . . . . . . . . . . . . . Note Attach a statement to explain how the organization determines that individuals a organizations receiving grants

The or arnzation is not a private foundation because R is (Please check only ONE applicable hox ) 6 A church, convention of churches, or association of churches Section 170(b)(1)(A)(i) 6 A school Section 170(b)(1)(A)(n) (Also complete Part V ) T A hospital or a cooperative hospital service organization Section 170(b)(1)(A)(m)

8 ~ A Federal, state, or loyal government or governmental unit Section 170(b)(1)(A)(v)

9 A medial research organization operated in conjunction with a hospital Section 170(b)(1)(A)(ni) Enter the hosprtara mine, city,

and state "__________________________________ 7 0 Q An organization operated for the benefit o! a college or university owned or operated by a governmental unit Section 170(b)(1)(A)(rv)

(Also complete we Support Schedule m Part IV-A ) 11 a o M organization that normally receives a substantial part of its support from a govemmenhl unit a horn the general public

Section 170(b)(1)(A)(vi) (Also complete we Support Schedule n Part IV-A

11 b 8 A community trust Section 170(b)(1)(A)(h) (Also complete the Support Schedule m Part IV-A )

12 An organization that normally receives (1) more than 33 7/3% of its support from contributions, membership fees, and gross

receipts from activities related to its charitable, etc , functions - subject to certain exceptions, and (2) no more than 33 7/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired

by the organization attar June 30, 1975 See section 509(a)(2) (Also complete the Support Schedule m Part IV-A ) 13 OX An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations

described in (t) lines 5 through 12 above, or (2) section 501(c)(4), (5), or (6), if they meet the test of section 509(a)(2) (Sec

(b) Line number from above (a) Name(s) of supported organization(s)

-THE GOOD SAMARITAN HOSPITAL OF MAR_y

14 I I An organization organized and operated to test for public safety Section 509(a)(4) (See page 6 of the instructions I

Schedule A (Form 9!0 or 7lbEZ) 2001 J~ tEi3303000

SC2822 0473 05/03/2003 15 45 33 V01-7 10

c Furnishing of goods, services, a facilities? , . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . .

d Payment of compensation (or payment or reimbursement of expenses if more than $1,0W)'7 . ,FARM .99A, . F7U11' V . . .

e Transfer of any part of its income a assets? , , , , , , , , , , , , , , . , , , , , . , , , , , . , , , , . .

Reason for Non-Private Foundation Status (See pages 3 through 6 of the Instructions )

War

m990a990.EZ 7001 52-2307122 page 3 SUppoR Schedule (Complete only if you checked a box on line 10, 11, a 12 ) Ummslr meCrod olaceoumCnp. NOT APPLICABLE

15 Gifts, grants, and contributions received (Do

17 Gloss receipts from admissions. merchandise

sold or services performed. or furnishing of

facilities in any activity that s related to the

19 Net income from unrelated business

activities not included in line 18

ZO Tax revenues levied for the organizatiorfs

benefit and either paid to it or expended on

its behalf

21 The value of services or facilities furnished to

the organization by a governmental unit without charge Do not include the value of

services or facilities generally furnished to the

public without charge 22 Other income Attach a schedule Do not

include pain or (loss) from sale of capital assets

23 Total of tines 15 through 22

24 Line 23 minus line 17

27 Organizations described on line 12 a For amounts included in lines 15 16, and 17 that were received from a 'disqualified person' prepare a list for your records to show the name of, and total amounts received in each year from, each "disqualified person' Do not file this list with your return Enter the sum of such amounts for each year

(2000)---______ (1999) ______-_----------- (1998) ---NOT APPLICABLE (1997) ____----_-_--- b For any amount included in line 17 that was received from each person (other than 'disqualified persons'), prepare a list for your records to

show the name of and amount received for each year that was more than the larger of (1) the amount on line 25 for the year or (Z) E5000 (Include in the list organizations described in lines 5 through 11, as well a individuals) Do not file this list with your return After computing the difference between the amount received and the larger amount described in (1) or (Z), enter the sum of these differences (tie excess amounts) for each year

(2000) --___-----------(1999) __ _--- (1990) --_--__ _____(1997)______

c Add Amounts from column (e) for lines 15 16

17 20 21 - d Add Line 77a total and line 27b total 1 e Public support (line 27c total minus line 27d total)

f Total support for section 509(a)(2) test Enter amount on line 23, column (e) - "I 27f g Public support percentage (line 27e (numerator) divided by line 271(derrominator))

20 Unusual Grants Far an organization described in line 10 11, or 12 that received any unusual grants during 1997 through 7000, prepare a list la your records to show, for each year, the name of the contributor, the date and amount of the grant and a brief description of the nature of the grant Do not file this list with your return Do not include these grants in line 15

Schedule A (Form 990 or 990-Q) 20p7 JSu tE177t 2 000

18 Gross income from interest, dividends,

amounts received from payments on secunties

loans (section 512(a)(5)), rents, royalties, and

unrelated business taxable income (less

section 511 taxes) from businesses acquired

26 Organizations described on linen 10 or 11 a Enter 2°b of amount in column (e) line 24 NQ!Z JP$I,TCjB7,$ , b Prepare a list for your records to show the name of and amount contributed by each person (other than a

governmental unit or publicly supported organization) whose total gifts for 1997 through 2000 exceeded the amount shown in line 26a Do not file this list with your return Enter the total of all these excess amounts

c Total support for section 509(a)(1) test Enter line 24 column (e) d Add Amounts from column (e) for lines 18 19

22 26b e Public support (line 26c minus line 26d total) f Public support percentage (tine 76e (numerator) divided by tine 26c (denominator)) . .

74a Does the organization receive any financial aid or assistance from a governmental agency

D Has the organization's right to such aid ever been revoked or suspended II you answered "Yes' to either 34a or b, please explain using an attached statement

35 Does the organization certify that it has complied with the applicable requirements of sections 4 01 through 4 OS of A- Dr..- 75S0 7075 7 (` O SY7 -.e.. . ... .. .... ..i . . . . ..w . .., .~. . ... ....~.~ ..e .1 .r. .- . . ..w ....i. ... .

Schedule A (Form 990 or B9OEZ) 2007 J 5A SE 1770 2 000

52-2307122

ScheGUleA(FOrm990a990.EZ)7Wt NOT APPLICABLE Page 4 Private School Questionnaire (See page 7 of the instructions ) (To be completed ONLY by schools that checked the box on line 6 in Part IV)

29 Does the organization have a racially nondiscriminatory policy toward students by statement in Rs charter, bylaws, Yes No other governing instrument, or m a resolution of its governing body 29

70 Does the organization include a statement of its racially nondiscriminatory policy toward students m all ms . . brochures, catalogues, and other written communications with the public dealing with student admissions, programs, and scholarships JO

31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during the period of solicitation (or students, or during the registration period if it has no solicitation program, in a way that makes we policy known to all parts of the general community R serves 11 If "Yes," please describe, d "No," please explain (If you need more space, attach a separate statement )

----------------------------------------------------------------------------- ----------------------------------------------------------------------------- ----------------------------------------------------------------------------- -----------------------------------------------------------------------------

]2 Does the organization maintain the following a Records indicating the meal composition of the student body, faculty, and administrative staff? b Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory bass

e Copies of all catalogues, brochures, announcements, and other written communications to the public dealing with student admissions, programs, and scholarships

d Copies of all material used by the organization or on its behalf to solicit contributions?

If you answered "NO" to any of the above, please explain (If you need more space, attach a separate statement )

-----------------------------------------------------------------------------J3 Does the organization discriminate by race in any way with respect to

a Students' rights or privileges?

b Admissions policies?

c Employment of faculty or administrative staff

d Scholarships or other financial assistance

e Educational policies?

f Use of facilities?

g Athletic programs

h Other extracurricular activities?

If you answered "Yes" to any of the above, please explain (If you need more space, attach a separate statement )

----------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------

Schedule A Form 990 a 990-EZ 2007 52-2307122 Page 5 Lobbying Expenditures by Electing Public Charities (See page 9 of the Instructions ) (To be completed ONLY b an eligible organization that filed Form 5768 NOT APPLICABLE

Check " a H i1 the organization belongs to an affiliated group (:hrck t b if you checked "a" and 'limited conVOr provisions aooN

Limits on Lobbying Expenditures

(The term "expenditures" means amounts paid or incurred )

36 Total lobbying expenditures to influence public opinion (grassroots lobbying) 36 37 Total lobbying expenditures to influence a legislative body (direct lobbying) 37 18 Total lobbying expenditures (add lines 36 and 37) 38 39 Other exempt purpose expenditures 39 40 Total exempt purpose expenditures (add lines 38 and 39) 40 41 Lobbying nontaxable amount Enter the amount from the following table -

IT the amount on line 40 Is - The lobbying nontaxable amount is - Not wer 5500 000 ZO% of the amount m We 40 Over E500 000 but nod over $1,000 000 5100,000 plus 15% of me excess over E500 000 Over $1 000 000 bud not over 51 500 000 . 5175 000 plus 70% of the excess over $1000 000 47 O+er E7 500,000 but not over $77,000 000 , 5225 000 plus 5% of lie excess over $1 500 000 Over 517,000 000 37 000 000

42 Grassroots nontaxable amount (enter 25°.5 of line 41) 42 43 Subtract line 42 from line 36 Enter -0- if line 42 is more than line 36 41 44 Subtract line 41 from line 38 Enter -0- d line 41 is more than line 38 44

ated group 7o be completed totals for ALL electing

organizations

Lobbying Expenditures During 4-Year Averaging Period

(b) 1c1 (d) (e)

Grassroots lobbying

151 tE13403000

Caution 1/ there is en amount on either fine 43 or line 44, you must file Form 4720 1 1 4-Year Averaging Period Under Section 507(h)

(Some organizations that made a section 501(h) election do not have to complete all of the five columns below See the instructions for tines 45 through 50 on Pace 11 of the instructions 1

Calendar year (or fiscal (a) ear be Innm In " 2001 Lobbying nontaxable

Lobbying ceiling amount

Grassroots nontaxable

Grassroots ceiling amount II SIIYnII .nn~Y/o\\ . .

Activity by Nonelectmg Public Charities

During the year, did the organization attempt to influence national, state or local legislation, including any Yes No Amount attempt to influence public opinion on a legislative matter or referendum, through the use of

a Volunteers g

b Paid staff or management (Include compensation in expenses reported on lines c through h ) X e Media advertisements g d Mailings to members, legislators, or the public . . . . X e Publications, or published or broadcast statements X f Grants to other organizations for lobbying purposes X g Direct contact with legislators, their staffs, government officials, or a legislative body X h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means X I Total lobbying expenditures (add lines c through h )

If "Yes" to any of the above also attach a statement giving a detailed description of the lobbying acthrittes Schedule q (Form 990 0r 99042) ]007

Information Regarding Transfers To and Transactions Exempt Organizations (See page 12 of the instructions

51 Did the reporting organization directly or indirectly engage m any of we following vnth any other organization described in section 501(c) of we Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations

a Transfers from the reporting organization to a noncharitable exempt organization of Yes N, (1) Cash Sla(l) X . . . . . . . (u) Other assets all]) X

b Other transactions (I) Sales or exchanges of assets with a nonchantable exempt organization b(l) X (d) Purchases of assets from a noncharrtable exempt organization b(II) X

(fit) Rental of facilities . equipment, or other assets b(Ill) X (Iv) Reimbursement arrangements b(Iv) X (v) Loans or loan guarantees (vi) Performance of services or membership or fundraising solicitations

c Sharing of facilities, equipment, mailing lists, other assets, or paid employees d If the answer to any of the above is "Yes' complete the following schedule Column (b) should always show we fair market value of the

goods, other assets, or services given by the reporting organization If the organization received less than fair market value in any

tran .action or sharing arrangement. show in column (d) the value of we goods. other assets . a xrnces reserved

(a) I (b) I fcl I Idl LIf1e f10 Amount involved Name of noncnantaole exempt oRJan¢dtion Description of transfers transactions and "ring artangert~ents

52a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527 _ " E:] Yes ~X No

b If "Yes , " complete the followin g schedule

Name of organization Type of organization Description of relationship

Schedule A (Form 990 or 990-EZ) 2001 'Et3507000

52-2307122

Realised Gains/Losses

Stxk Da c hares Mean Value (by GSHF)

Canadian Nat'I Rail 6/17/02 4,000 49 025 f 196,100 00 Cendant Corp 6/17/02 3,500 15 580 54,530 00 First Data Corp 6/17/02 500 40 200 19,505 00 American Express 6/17/02 500 35 410 17,705 00 XL Capital Ltd 6/17/02 1,500 83 750 125,625 00 United Tech 6/17/02 1,150 67 815 7-7,98725

$ 491,452 25

STATIIMWT IA

Gooo Samaritan Hospital Foundation, Inc.

AttachmenlE

Date Sold Va u Gain/(Lossl

6/20/02 f 198,872 00 ; 2,77200 6/20/02 56,945 38 2,41538 6/20/02 19,964 39 45939 6/20/02 19,164 42 1,459.42 6/20/02 129,911 08 4,28608 6/20102 79,899 59 1,91234

$ 504,75686 513,304 .61'

TOTAL

STATEMENT 2

GOOD SAMARITAN HOSPITAL FOUNDATION, INC .

FORM 990, PART I - EXCLUDED CONTRIBUTIONS

DESCRIPTION

2002 GOLF TOURNAMENT

52-2307122

AMOUNT

18,764 . ------------

18,764 .

GOOD SAMARITAN HOSPITAL FOUNDATION, INC . 52-2307122

SC2822 0473 05/03/2003 15 :45 :33 V01-7 21 STATEMENT 3

FORM 990, PART I - SPECIAL FUNDRAISING EVENTS AND ACTIVITIES -------------

GROSS DIRECT NET DESCRIPTION REVENUE EXPENSES INCOME ----------- ------- -------- ------

2002 GOLF TOURNAMENT 174,901 . 1,702 . 173,199 . ------------ ------------ ------------

TOTALS 174,901 . 1,702 . 173,199 .

52-2307122

TOTAL

STATEMENT 4


FORM 990, PART I - OTHER DECREASES IN FUND BALANCES

DESCRIPTION

NET ASSETS RELEASED FROM RESTRICTION EQUITY TRANSFER

AMOUNT

2,592,536 . 517,278 .

------------3,109,814

SC2822 U473 04/08/2003 12 :52 :57 V01-7 23 STATEMENT 5


FORM 990, PART II - OTHER EXPENSES

DESCRIPTION FUNDRAISING ----------- -----------

MISCELLANEOUS 23,183 . FOOD SERVICE 611 . ADVERTISING 6 MARKETING 2,136 .

TOTALS 25,930 .

STATEI4ENT 6


FORM 990, PART III - ORGANIZATION'S PRIMARY EXEMPT PURPOSE

The Good Samaritan Hospital Foundation, Inc 's (the "Foundation") principal activities are to generate, administer, and manage grams, gifts, bequests, and trusts m support of The Good Samaritan Hospital of Maryland, Inc (the "Hospital"), an orgaruzaUon exempt from tax under Internal Revenue Code ("Code") Section 501(c)(3) The Foundation's activities will further the Hospital's exempt purposes through its support of the Hospital's exempt purpose programs, which include

Providing the Hospital's community the benefit of state-of-the-art medical facilities and equipment, Increasing access to quality healthcare for those in the Hospital's community with limited economic capacity; and, Helping contribute to the Hospital's presence as a vital, community-based leader among regional health care providers

The Foundation intends to carry out its principal activities of generating, administering, and managing gams, gifts, and bequests for the benefit of the Hospital m the following ways

Creating awareness in the Hospital's community of the long-term positive impact that philanthropic support can have on the Hospital's patients, programs and services, Centralizing the Hospital's fundraising and gift processing management activities in an organization (the Foundation) specifically structured to perform such tasks, and, Maxinuzmg the effectiveness and efficiency of the Hospital's fundraising and gift management activities by utilizing a professional staff which is focused and experienced m fund raising

Under the principles of Revenue Rulings 67-149 and 78-41, the Foundation qualifies for exemption as an organization described m Code Section 501(c)(3)

TOTALS

STATEMENT 7


FOi-M 990, PART IV - OTHER LIABILITIES

DESCRIPTION

PAYABLE TO GOOD SAMARITAN HOSPITAL CENTER

52-2307122

ENDING BOOK VALUE

NONE 1,481,761 .

---------------1,481,761 .


FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES

TITLE AND TIME NAIL AND ADDRESS DEVOTED TO POSITION COMPENSATION ---------------- ------------------- ------------

CONTRIBUTIONS EXPENSE ACCT TO EMPLOYEE AND OTHER

BENEFIT PLANS ALLOWANCES

SUSAN SKINNER 5601 LOCH RAVEN BLVD BALTIMORE, MD 21239

SEE ATTACHED LIST OF DIRECTORS

15,999 . 79,997 . GRAND TOTALS

STATEMENT 8 SC2822 0473 04/08/2003 12 :52 :57 VO1-7 26

DIR OF DEVELOPMENT 40 HRS/WK

79,997 15,999 . NONE

NONE

food Samaritan Hospital Foundation, Inc. Foundation Board Members

' Addresses and e-mails

Edmund J Fick 4 Haspert Rd, Apt D Baltimore, MD 21236 Anthony Read

Salomon Smith Barney 7 St Paul Street, Suite 1600 Baltimore, MD 21202

STATEMENT 8

William J Baird, Jr Willis of Maryland, Inc 10 North Park Drive Hunt Valley, MD 21031

Wilmot C. Ball, Jr, M D 10 Englewood Road Baltimore, MD 21210

Chaiics L Bajermann Clifton Gunderson LLP 9515 Deereco Road, Suite 500 Timonium, MD 21093

Lawrence M Beck President, GSH 5601 Loch Raven Blvd Russell Morgan Bldg #200 Baltimore, MD 21239

Deana L Butler VP Finance Good Samantan Hospital 5601 Loch Raven Blvd Baltimore, MD 21239

Sheldon M Glusman, M D GSH, Dept of Pathology 5601 Loch Raven Blvd . Baltimore, MD 21239

W Kenneth Gue CLU & Associates 1740 E Joppa Road, Suite 202 Baltimore, MD 21234

John P. McDacuel CEO MedStar Health 5565 Sterrett Place, 5'h Floor

Bishop William Newman The Catholic Center 320 Cathedral Street Baltimore, MD 21201

Helen F O'Bnen Director, Volunteer Services Good Samaritan Hospital 5601 Loch Raven Blvd Baltimore, MD 21239

52-2307122

Unless otherwise stated, officers work less than I hour a week and receive no compensation

STATEMENT 8

Fr. James M Reusing Pastoml Services Good Samaritan Hospital 5601 Loch Raven Blvd Baltimore, MID; 21 23co

James K. Smolev, M D Maryland Urology Associates 8322 Bellona Lane, Suite 202 Towson, MID 21204

Howard Steiner, M D President, Medical Staff Good Sarnantan Hospital 5601 Loch Raven Blvd Baltimore, MD 21239

Joel C Sweren Maryland Permanent Bank 9612 Reisterstown Road Owings Mills, MID 21117

W. Gordon Walker, M D. GSH, 3d Floor Main Hospital 5601 Loch Raven Blvd Baltimore, MD 21239

52-2307122

Form 990, PART V, COMPENSATION FROM RELATED E

STATENENT 9

GOOD'SAMARITAN HOSPITAL FOUNDATION, INC .

Contributions to Expenses and Name and Employee Benefit Other Related Organization Compensation Plans Allowances

Lawrence Beck 307,761 71,790 9,300 The Good Samaritan Hospital of MD, Inc . EIN 52-0591607

Deana Butler 137,329 14,015 NONE The Good Samaritan Hospital of MD, Inc . EIN 52-0591607

John McDaniel 760,345 112,492 13,200 Medstar Health, Inc . EIN 52-2087451

" if you are filing for an Automatic 3-Month Extension, complete only Part I and check this box " if you are filing for an Additional (not automatic) 3-Month Extension, complete only Part 11 (on page 2 of this form) Note* Do not complete Part H unless you have already been granted an automatic 3-month extension on a previously riled F;Drm 8868 T~art I Automatic 3-Month Extension of Time - Only submit original (no copies needed) Note: Form 990-T corporations requesting an automatic 6-month extension - check this box and complete Part I only 1~ El A# other corporations (including Form 990-C filers) must use Form 7004 to request an extension of time to rile income tax returns Partnershirls. REMICs and trusts must use Form 8736 to request an extension of time to rde Form 1065, 1066, or 1041

organization I Employer identification number 7122 tITAN HOSPITAL FOUNDATION

mom or suite no If a PO bM see instructions P,AVEN BOULEVAR.D

a foreign address, see instructions;

Form 990-T (corporation) Ej Form 4720 Form 990-T (sac 401 (a) or 408(a) trust) Form 5227 Form 990-T (trust other than above) Form 6069 Form 1041-A Form 8870

Form 990-BL Form 990-EZ

F-1 Form 990-PF

2 If this tax year is for less than 12 months, check reason [:] initial return E] Final return [:) Change in accountingpenod

3a It this application is for Form 990-BL, 990-PF, 990-T. 4720, or 6069, enter the tentative tax, less any nonrefundable credits See instructions $ N/A

b If this application is for Form 990-PF or 990-T, enter any refundable credits and estimated tax payments made Include any prior year overpayment allowed as a credit $ N/A

c Balance Due Subtract line 3b from line 3a Include your payment with this form, or, if required, deposit with FTD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System) See instructions $ 0

Signature and Verification Under penalties of pegury I declare that I have e,tamined this form including accompanying schedules and statements arid to the best of my knomedge and belief, it is tinue correct and complete and that I am authorized to prepare ths form

I

Tit]e ff~ CPA Date ff~ 11

Form 8868 (12-2000)

tSA SWFED9D56F i

Form n Application for Extension of Time To File an ,868 December, 2000) Exempt Organization Return OKS No 1545-1709 Depenin eni of the Theviury Internal Riiroervue Se,,,C0 lf~ File a separate application for each return

Type or print GOOD S File try the 77u-mber. strE due date for 5601 L filing your return See Clly~ town or instrictions BALTIM Check type of return to I [@ Form 990

" If the organization does not have an office or place of business in the United States, check this box I~ El " If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN) If this is for the whole group, check this box p. [:) If it is for part of the group, check this box p. F] and attach a list with the names and EiNs of all members the extension will cover

I I request an automatic 3-month (6-month . for 990-T corporation) extension of time until FEBRUARY 17 .20 03 to file the exempt organization return for the organization named above The extension is for the organization's return for li~ F~ calendar year 20 - or ji~ [X] tax year beginning JULY 1 -, 20 .9 -1, and ending JUNE 30 .20-9-2-

For Paperwork Reduction Act Notice. sea Instruction

Form SUS (1 2-2000)

STOP: Do not complete Part H if you were not already granted an automatic 3-month extension on a previously filed Form 8868

a If the organization does not have an office or place of business in the United States, check this box 1~ El a If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN) If this is for the whole group, check this box fl~ E] If it is for part of the group, check this box fi~ C] and attach a list with the names and EiNs of all members the extension is for

my 15- 20-0-.5- V I , 20~and ending -TOV6 *30 .20QA--Initial return Ej Final return E] Change in accountingpenod

BY Dirv= LINDA VEMK.009 Firinn.qr,pa. Alternate Mailing Address - Enter the address if you want the copy of this apP1118titibirifor arviaddificinat3-cirtionth extension returned to an address different than the one entered above

MARC R . SeUea, clo MEDET)"Irk NC-Pr(,T'*, _Twa .

or town. DrOVInce or state . and country bricluchna I or

Form 11868 (12 2000) SIT FED9056F 2

a If you are filing for an Addilional (not automatic) 3-Month Extension . complete only Part 11 and check this box PAS Note : Only c6impletil, Part If rif you have already been granted an automatic 3-month extension on a previfous)y Filed Form

a if you are fi ing for an Automatic 3-Month Extension, complete only Part I (on page 1) [-part it dditional (not automatic) 3-Month Extension of Time - Must ile Original and One Copy . Type or Name of Exempt Organ Employer identification number

(700D 4~a 0, 1 print 5AMA lvjw 140SP1r#(, F&J1JDA-r1&j . -,5e 5'2-23o'7127-File by the Number, street and room or suite no If a P 0 bco~ s instructions For IRS use only e)aended due date for %(,5 SMU&T ~Uaz ittung in own or post off-me, state. and ZIP dode For a foreign address, see instructions return Le 5V_11 '%

pe of return to be flidd (File a se0arate application for each return) 990 El Form 990-EZ [] Form 990-T (sec 401(a) or408(a) trust) Form 1041-A E] Form 5227 El Form 8870 990-BL r-1 Form 990-PF F-1 Form 990-T (trust other than above) Form 4720 n Form 6069

4 1 Fequest an additional 3-month extension of time until -5 For calendar year_ or other tax year beginning 6 If this tax year is for less than 12 months, check reason 7 State in detail why you need the extension ADDirio

Ba If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069 . enter the tentative tax. less any nonrefundable credits See instructions $

b If this application is for Form 990-PF, 990-T, 4720, or 6069 . enter any refundable credits and estimated tax payments made Include any prior year overpayment allowed as a credit and any amount paid previously with Form 8868 $

c Balance Due. Subtract line 8b from line 8a Include your payment with this form, or, if required, deposit with FTD coupon or, if required . by using EFTPS (Electronic Federal Tax Payment System) See instructions $

Signature and Verification Under peruillies of pegury I declare that I h~ exammed this form including accomparrying schedules and statements and to the best of my knowledge and belief, it is true, correi:t, and complete and that I am authoNlo to prepare this form

to Applicant -To Be We have approved this appocatibn Pleme attach this form to the organization's return We have not approved this application However. we have granted a 1 0-day grace period from the later of the date shown below or the due date of the Organization's return (including any pnor extensions) This grace period is considered to be a valid extension of time for elections otherwise required to be made on a timely return Pima attach this form to the orgaruzation's return

E] we have not approved this application After considering the reasons stated in dern 7, " cannot grant your request for an eidension of time to file We are not granting a 1 0-day grace period we cannot consider this application because 4 was filed after the due date of the return led

F] Other ME"WAMIMM

FFR 2 6 2003

Type or print

or apt no) Or a PO. box number

copy ~,m 990 return of orgrnorganization exempt fromincome …

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