| Field | Data |
|---|---|
| EIN | 81-5119777 |
| Case Number | EO-2020307-000738 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | GOOD SAMARITAN CLINIC INC |
| Organization’s Mailing Address | PO BOX 609 |
| City | SHOSHONE |
| State | ID |
| ZIP | 83352 |
| Accounting period End | 12 |
| Primary contact name | KEITH DAVIS |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
KEITH DAVIS
BOARD CHAIR
113 S APPLE ST
SHOSHONE ID 83352-0609
PAM LOWDER
VICE CHAIR
113 S APPLE ST / PO BOX 609
SHOSHONE ID 83352-0609
LAI LONNIE ROGERS
SECRETARY-TREASURER
113 S APPLE ST / PO BOX 609
SHOSHONE ID 83352-0609
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 1/19/2017 |
| Organization Incorporation State | ID |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | E32 - Ambulatory Health Center, Community Clinic |
| Organization’s purpose | Charitable: Yes Religious: No Educational: No Scientific: No Literary: No Public Safety: No Amateur Sports: No Cruelty Prevention: No |
| Qualify For Exemption | No |
| Legislation influence | No |
| Compensation of Officer director trustee | No |
| Donation of funds | No |
| Conducting Activities Outside of United States | No |
| Financial transactions with officers | No |
| Unrelated Gross Income $1,000 or More | No |
| Gaming Activity | No |
| Disaster relief assistance | No |
| One Third Support Public | Yes |
| One Third Support Gifts | No |
| Benefit of College | No |
| Private Foundation 508(e) | No |
| Seeking Retroactive Reinstatement | Yes |
| Seeking Section 7 Reinstatement | No |
| Correctness Declaration | Yes |
| Signature Name | KEITH DAVIS |
| Signature Title | BOARD CHAIR |
| Signature Date | 10/30/2020 |
| EIN | 81-5119777 |
| Case Number | EO-2017030-000252 |
| Form 1023-EZ version | 62014 |
| Eligibility Worksheet | 1 |
| Organization Name | GOOD SAMARITAN CLINIC INC |
| Organization’s Mailing Address | PO BOX 609 |
| City | SHOSHONE |
| State | ID |
| ZIP | 83352-0609 |
| Accounting period End | 12 |
| Primary contact name | JOHN SEXTON |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
KEITH E DAVIS MD
BOARD OF DIRECTORS
113 S APPLE ST
SHOSHONE ID 83352
JOHN SEXTON
BOARD OF DIRECTORS
STARLIGHT
TWIN FALLS ID 83301
PAM LOWDER
BOARD OF DIRECTORS
113 S APPLE ST
SHOSHONE ID 83352
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 1/19/2017 |
| Organization Incorporation State | ID |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | E21 - Community Health Systems |
| Organization’s purpose | Charitable: Yes Religious: No Educational: No Scientific: No Literary: No Public Safety: No Amateur Sports: No Cruelty Prevention: No |
| Qualify For Exemption | No |
| Legislation influence | No |
| Compensation of Officer director trustee | No |
| Donation of funds | No |
| Conducting Activities Outside of United States | No |
| Financial transactions with officers | No |
| Unrelated Gross Income $1,000 or More | No |
| Gaming Activity | No |
| Disaster relief assistance | No |
| One Third Support Public | Yes |
| One Third Support Gifts | No |
| Benefit of College | No |
| Private Foundation 508(e) | No |
| Seeking Retroactive Reinstatement | No |
| Seeking Section 7 Reinstatement | No |
| Correctness Declaration | Yes |
| Signature Name | |
| Signature Title | |
| Signature Date |
Click on the save icon from a search results or organization page.