2025-04-23T09:21:49-05:00 2024-06-30 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2023-07-01 862701018 HENRY COUNTY HEALTH CENTER INC HENR 3193853141 407 S WHITE STREET MT PLEASANT IA 52641 JEREMY ALEXANDER CFO 3193853141 2025-04-22 1 1 KURT BENNION CPA P01469618 4252506100 2023 2025-03-06 01:10:19Z GREAT RIVER HENRY COUNTY HEALTH CENTER TERESA COLGAN 407 S WHITE STREET MT PLEASANT IA 52641 65456835 0 X WWW.GREATRIVERHEALTH.ORG/HENRY-COUNTY-HEALTH-CENT X 2021 IA HENRY COUNTY HEALTH CENTER IS COMMITTED TO ENHANCING THE HEALTH OF INDIVIDUALS AND OUR COMMUNITIES THROUGH HIGH QUALITY, EFFECTIVE AND EFFICIENT SERVICES. 7 6 0 39 0 0 109625 8081950 39052362 56954594 0 36993 505271 383298 39667258 65456835 0 144358 0 0 15249010 18465779 0 0 0 25239782 34198583 40488792 52808720 -821534 12648115 30966020 45143076 26188284 27717225 4777736 17425851 HENRY COUNTY HEALTH CENTER IS COMMITTED TO ENHANCING THE HEALTH OF INDIVIDUALS AND OUR COMMUNITIES THROUGH HIGH QUALITY, EFFECTIVE AND EFFICIENT SERVICES. 0 0 37488959 144358 56954594 HENRY COUNTY HEALTH CENTER, INC., HAS ENTERED INTO A HOSPITAL LEASE AGREEMENT WHERE IT LEASES ALL OF THE FACILITIES AND OPERATIONS, EXCEPT THE AMBULANCE SERVICE, OF HENRY COUNTY SOLDIERS AND SAILORS MEMORIAL HOSPITAL, A COUNTY HOSPITAL ORGANIZED UNDER IOWA CODE CHAPTER 347. HENRY COUNTY HEALTH CENTER, INC. MANAGES AND OPERATES HEALTH CARE ORGANIZATIONS, INCLUDING OPERATING THE 74-BED CRITICAL ACCESS HOSPITAL THAT FEATURES 25 ACUTE CARE BEDS ALONG WITH A 49-BED LONG-TERM CARE FACILITY, PARK PLACE. HENRY COUNTY HEALTH CENTER, INC. ALSO MANAGES AND OPERATES A CLINICAL/GROUP PRACTICE LOCATED ON THE GROUNDS OF THE HOSPITAL AND RURAL HEALTH CLINICS IN THE SURROUNDING RURAL COMMUNITIES AND PROVIDES COMMUNITY HEALTH EDUCATION FOR THE COMMUNITY. 37488959 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 17 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 7 6 1 1 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 X CHERYL ALBIN 3197681000 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 MATT WENZEL FORMER DIRECTOR 0.50 42.50 X 0 1369580 11287 DR MICHAEL MCCOY DIRECTOR 0.50 42.50 X X 0 829861 51041 TERESA COLGAN CEO 40.00 0.00 X 0 494447 47551 DAVID MUHS CFO 40.00 0.00 X 177504 0 53115 DAVID FILE CHAIRPERSON 0.50 0.00 X X 0 0 0 WHITNEY ROGERS VICE CHAIRMAN & DIRECTOR 0.50 0.00 X X 0 0 0 SARA BETH SCHURR SECRETARY/TREASURER 0.50 0.00 X X 0 0 0 CHAD HUDSON DIRECTOR 0.50 0.00 X 0 0 0 JENNIFER MOUTRIE DIRECTOR 0.50 0.00 X 0 0 0 DR JOE TANSEY DIRECTOR 0.50 0.00 X 0 0 0 177504 2693888 162994 0 1 1 1 HALLMARK HEALTH CARE SOLUTIONS INC PO BOX 22937 NEW YORK NY 10087 CONTRACTED LABOR 1112417 PSYCHIATRIC MEDICAL CARE LLC PO BOX 734606 DALLAS TX 75373 CONTRACTED LABOR 574655 WAPITI MEDICAL STAFFING 107 FLYNN DRIVE SUITE 600 MILBANK SD 57252 EMERGENCY ROOM SERVICES 377203 AVEL ECARE MEDICAL GROUP PC 4500 N LEWIS AVE SIOUX FALLS SD 57104 TELEHEALTH SERVICES 207310 HELPING HANDS NURSING SOLUTIONS INC 5510 SERGEANT ROAD SIOUX CITY IA 51106 CONTRACTED LABOR 186330 7 8081950 8081950 NET PATIENT REVENUE 621400 54544561 54544561 OTHER OPERATING INCOME 621400 2165033 2165033 PARTNERSHIP INCOME 621400 245000 245000 56954594 36993 36993 371316 0 371316 371316 371316 MISCELLANEOUS INCOME 900099 11982 11982 11982 65456835 56954594 0 420291 X 144358 144358 14142116 11905235 2236881 3532811 2945610 587201 790852 673177 117675 59136 59136 233125 233125 18787858 10871752 7916106 2839847 670516 2169331 2845544 2104051 741493 809840 -117 809957 404013 -90 404103 MEDICAL SUPPLIES 5819689 5774936 44753 BAD DEBT EXPENSE 1393137 1393137 PROVIDER TAX 1006394 1006394 52808720 37488959 15319761 0 525226 4293439 5121452 16114588 881989 704532 1162525 1147312 23274828 22883205 30966020 45143076 2913458 3480022 23274826 24237203 26188284 27717225 X 4777736 17425851 4777736 17425851 30966020 45143076 12648115 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6506 6506 0 PART II-B, LINE 1: HENRY COUNTY HEALTH CENTER PAYS ASSOCIATION DUES TO THE IOWA HOSPITAL ASSOCIATION (IHA) AND AMERICAN HOSPITAL ASSOCIATION (AHA). PORTIONS OF THE ASSOCIATION DUES ARE EXPENDED BY THE ASSOCIATIONS FOR LOBBYING PURPOSES. 0 RIGHT-OF-USE LEASE ASSETS 22883205 22883205 RIGHT-OF-USE LEASE LIABILITIES 22883205 INTERCOMPANY PAYABLE 1353998 24237203 X PART X, LINE 2: THE ORGANIZATION IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. HOWEVER, THE ORGANIZATION IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE CONSOLIDATED FINANCIAL STATEMENTS. 1 1 X 1 X 1 X 1 1 0 1 1 87938 87938 0.00170 5108414 5889649 0 0.00000 5196352 5889649 87938 0.00170 161212 161212 0.00310 161212 161212 0.00310 5357564 5889649 249150 0.00480 1 1393137 176928 14444816 14648826 -204010 X 1 1 1 1 HENRY COUNTY HEALTH CENTER 407 SOUTH WHITE STREET MT PLEASANT IA 52641 WWW.GREATRIVERHEALTH.ORG/HENRY-COUNTY- 440047H X X X X HENRY COUNTY HEALTH CENTER 1 0 0 1 X X X X X X X X X 23 1 0 1 1 X SEE LINE 7D X X 1 23 1 SEE LINE 7D 0 1 X 200.000000000000 300.000000000000 X X X X X X 1 1 X X X X 1 X SEE LINE 16J X SEE LINE 16J X SEE LINE 16J X X X X X X X 1 X 0 X X X X X 1 X 0 0 HENRY COUNTY HEALTH CENTER PART V, SECTION B, LINE 5: HENRY COUNTY HEALTH CENTER, PART OF GREAT RIVER HEALTH SYSTEM, CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT TO DISTINGUISH THE UNMET MEDICAL AND PUBLIC HEALTH NEEDS IN HENRY COUNTY.THE STUDY HAS THREE OBJECTIVES:1. TO CONDUCT AN ASSESSMENT THAT PROVIDES A FOUNDATION FOR HENRY COUNTY HEALTH CENTER AND ITS PARTNERS TO BUILD A CONSENSUS ABOUT THE AREA'S MOST CRITICAL HEALTH CARE NEEDS2. TO MEET STATE AND FEDERAL REQUIREMENTS FOR HOSPITALS THAT MUST CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT EVERY 3 YEARS3. TO DEVELOP ACTION PLANS FOR INTERVENTIONS TO ADDRESS CONCERNS HIGHLIGHTED BY THE COMMUNITY AND HEALTH DATAINFORMATION WAS COLLECTED THROUGH A COMMUNITY SURVEY AND SECONDARY DATA FROM A VARIETY OF SOURCES FROM STATE AND NATIONAL ORGANIZATIONS. THE SURVEY WAS MADE AVAILABLE ONLINE AND AT PUBLIC LOCATIONS ACROSS THE COUNTY. THE SURVEY WAS TRANSLATED INTO SPANISH AND OUTREACH ACTIVITIES TARGETED TYPICALLY UNDERREPRESENTED GROUPS. A TOTAL OF 641 COMPLETED SURVEYS WERE RETURNED, WHICH IS OVER 3% OF THE POPULATION IN HENRY COUNTY.THE ASSESSMENT IDENTIFIED EIGHT PRIORITIES THATE NEED TO BE ADDRESSED IN ORDER TO MAKE HENRY COUNTY A HEALTHIER PLACE TO LIVE AND WORK. SIX OF THE EIGHT WERE CHOOSEN TO BE A PART OF THE IMPROVEMENT PLAN. THE FOLLOWING SIX UNMET HEALTH NEEDS WERE CHOSEN: -MENTAL HEALTH -CANCER -HEALTHLY FOOD ACCESS & AWARENESS -ACTIVE LIVING -OLDER ADULT HEALTH AND AGING ISSUES -ACCESS TO CARETHESE SIX AREAS WILL BE THE FOCUS OF HENRY COUNTY HEALTH CENTER'S EFFORTS TO IMPROVE THE HEALTH OF HENRY COUNTY. HENRY COUNTY HEALTH CENTER PART V, SECTION B, LINE 6B: HENRY COUNTY HEALTH CENTER CONTINUALLY WORKS WITH PARTNERS AND STAKEHOLDERS OUTSIDE THE HOSPITAL TO MEET THE HEALTH NEEDS OF THE COMMUNITY. HENRY COUNTY HEALTH CENTER COLLABORATED WITH HENRY COUNTY PUBLIC HEALTH, ISU EXTENSION AND OUTREACH, AND HEALTHY HENRY COUNTY COMMUNITIES ON A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT. HENRY COUNTY HEALTH CENTER PART V, SECTION B, LINE 7D: HTTPS://WWW.GREATRIVERHEALTH.ORG/DOCUMENTS/2023-HENRY-COUNTY-COMMUNITY-HEALTH-ASSESSMENT_FINAL.PDF HENRY COUNTY HEALTH CENTER PART V, SECTION B, LINE 11: HENRY COUNTY HEALTH CENTER WORKED WITH HENRY COUNTY RESPECTIVE PARTNERS TO REVIEW THE DATA AND INFORMATION GATHERED BY THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. AFTER REVIEWING THE DATA FROM THE SURVEY, THE FOLLOWING HIGH PRIORITY HEALTH CONCERNS WERE SELECTED: - MENTAL HEALTH - CANCER - HEALTHY FOOD ACCESS & AWARENESS - ACTIVE LIVING - OLDER ADULT HEALTH AND AGING ISSUES - ACCESS TO CARELEADERS AT HENRY COUNTY HEALTH CENTER HIGHLIGHTED THE FOLLOWING IMPLEMENTATION STRATEGIES, POTENTIAL IMPACTS, AND RESOURCES NEEDED FOR EACH FOCUS AREA.MENTAL HEALTH- EXPAND EXISTING PROGRAMS- RECRUITMENT- EXPAND SENIOR LIFE SOLUTIONS- PROMOTE EXISTING TRANSPORTATION SERVICESCANCER- PROMOTE AND SUPPORT PROGRAMS- CREATE FLYER LISTING SERVICES- EDUCATE ABOUT CANCER SCREENING RECOMMENDATIONSHEALTHY FOOD ACCESS AND AWARENESS - SUPPORT AND PROMOTE FOOD DONATIONS- PROMOTE FOOD ASSISTANCE PROGRAMS- INCREASE EXPOSURE TO AND EDUCATION IN SCHOOLS AND CREATE COMMUNITY EDUCATION CLASSESACTIVE LIVING-HOST AND PROMOTE FREE COMMUNITY ACTIVITIES-PROMOTE OUTDOOR FACILITIES-EXPLORE SHARED USE AGREEMENTS WITH SCHOOL FACILITIESOLDER ADULT HEALTH AND AGING ISSUES- PROMOTE HENRY COUNTY LIFELINE SERVICES- DEVELOP AND PROMOTE A FALL PREVENTION PROGRAM- PROMOTE FINANCIAL ASSISTANCE- TEACH COMMUNITY BLOOD PRESSURE MONITORING ACCESS TO CARE- PROMOTE PUBLIC TRANSPORTATION- PROMOTE SHIIP- PROMOTE DELIVERY SERVICES- DEVELOP CHRONIC CARE MANAGEMENT PROGRAM HENRY COUNTY HEALTH CENTER PART V, SECTION B, LINE 13H: HCHC MAY USE PRESUMPTIVE FINANCIAL ASSISTANCE ELIGIBILITY:THERE ARE INSTANCES WHEN A PATIENT/INDIVIDUAL MAY APPEAR TO BE ELIGIBLE FOR CHARITY-CARE DISCOUNTS, BUT THERE IS NO COMPLETED FINANCIAL ASSISTANCE FORM ON FILE BECAUSE OF A LACK OF SUPPORTING DOCUMENTATION. OFTEN THERE IS ADEQUATE INFORMATION PROVIDED BY THE PATIENT OR THROUGH OTHER RESOURCES THAT COULD PROVIDE SUFFICIENT EVIDENCE TO DETERMINE ELIGIBILITY.1. INFORMATION IS PROVIDED WEEKLY TO AN OUTSIDE SOURCE. OUTSIDE SOURCE RETURNS RESULTS TO HENRY COUNTY HEALTH CENTER ABOUT PATIENT QUALIFICATIONS BASED ON OUR FINANCIAL ASSISTANCE POLICY.2. OUTSIDE SOURCE USES DEMOGRAPHIC AND HOUSEHOLD INFORMATION, AND CREDIT-SCORING TECHNOLOGY TO DETERMINE THE PERCENTAGE OF ASSISTANCE FOR WHICH A PATIENT MAY BE ELIGIBLE.3. HENRY COUNTY HEALTH CENTER WILL ATTEMPT TO CONTACT PATIENTS BASED ON THEIR PRESUMPTIVE ASSISTANCE QUALIFICATION TO ALLOW THE PATIENT TO APPLY FOR FINANCIAL ASSISTANCE.4. PATIENTS WILL NOT BE DISQUALIFIED FROM FINANCIAL ASSISTANCE BASED ON PRESUMPTIVE ASSISTANCE RESULTS.5. IF THE ACCOUNT IS PAST DUE AND THERE IS NO COMPLETED FINANCIAL ASSISTANCE APPLICATION OR SUPPORTING DOCUMENTATION, THE PATIENT'S ACCOUNT COULD BE CONSIDERED FOR FINANCIAL ASSISTANCE BASED ON OUTSIDE SOURCE'S RESULTS.6. PRESUMPTIVE ELIGIBILITY ALSO CAN BE DETERMINED BASED ON LIFE CIRCUMSTANCES INCLUDING: -ELIGIBILITY FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT ARE UNFUNDED -FOOD STAMP ELIGIBILITY -HOMELESS OR RECEIVED CARE FROM A HOMELESS CLINIC -LOW INCOME/SUBSIDIZED HOUSING PROVIDED AS A VALID ADDRESS -PARTICIPATION IN THE WOMEN INFANTS AND CHILDREN (WIC) PROGRAM -PATIENT IS DECEASED WITH NO KNOWN ESTATE -STATE-FUNDED PRESCRIPTION PROGRAMS -SUBSIDIZED SCHOOL LUNCH PROGRAM ELIGIBILITY7. IT ALSO IS ACCEPTABLE TO USE PROXY INFORMATION TO DETERMINE ELIGIBILITY WHEN INCOME LEVELS CANNOT BE DIRECTLY DETERMINED. SUCH INFORMATION COULD INCLUDE STATEMENTS LIKE "STAYS WITH FRIENDS OR "OCCASIONALLY WORKS."8. PATIENTS WHO MEET PRESUMPTIVE-CARE GUIDELINES MAY QUALIFY FOR FINANCIAL ASSISTANCE DISCOUNTS. THIS DETERMINATION IS AT THE DISCRETION OF HENRY COUNTY HEALTH CENTER.9. IN A SITUATION, WHERE PRESUMPTIVE ELIGIBILITY IS GIVEN TO A PATIENT AND A FINANCIAL ASSISTANCE APPLICATION IS OBTAINED LATER, THE UPDATED ELIGIBILITY WILL BE BASED ON THE FINANCIAL ASSISTANCE APPLICATION WITH SUPPORTING DOCUMENTATION. IN THIS CASE, HENRY COUNTY HEALTH CENTER COULD ADJUST FINANCIAL ASSISTANCE UP TO THREE MONTHS BEFORE THE APPLICATION DATE. HENRY COUNTY HEALTH CENTER PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY AND FINANCIAL ASSISTANCE APPLICATION ARE AVAILABLE ONLINE AT WWW.GREATRIVERHEALTH.ORG/PATIENTS-VISITORS/BILLING-FINANCIAL-SERVICES/ HENRY COUNTY HEALTH CENTER PART V, SECTION B, LINE 20E: HCHC USES AN OUTSIDE SOURCE TO SCREEN PATIENTS TO SEE IF THEY COULD BE ELIGIBLE FOR FINANCIAL ASSISTANCE. THE HOSPITAL GETS NOTIFICATION BACK AS TO HOW MUCH OF A FINANCIAL ASSISTANCE DISCOUNT THEY WOULD BE ELIGIBLE FOR. IF THE PATIENT DOESN'T RESPOND TO PHONE CALLS REGARDING THE FINANCIAL ASSISTANCE APPLICATION OR THEY DON'T COMPLETE THE APPLICATION, THE HOSPITAL MAY STILL DISCOUNT THE PATIENT'S CHARGES UNDER THEIR PRESUMPTIVE CHARITY POLICY. THE HOSPITAL'S PRESUMPTIVE CHARITY PROGRAM GIVES THE HOSPITAL THE OPPORTUNITY TO DISCOUNT PATIENT ACCOUNTS BASED ON INFORMATION IT MAY HAVE REGARDING A PATIENT BEING HOMELESS OR UNEMPLOYED. 8 1 - PARK PLACE ELDER LIVING 401 S VAN BUREN STREET MT PLEASANT IA 52641 NURSING HOME CARE 2 - HCHC - MT PLEASANT CLINIC 407 S WHITE STREET SUITE 103 MT PLEASANT IA 52641 PROVIDER HEALTH CLINIC 3 - HCHC - WINFIELD CLINIC 110 W PINE STREET WINFIELD IA 52659 PROVIDER HEALTH CLINIC 4 - HCHC - WAYLAND CLINIC 227 W MAIN STREET WAYLAND IA 52654 PROVIDER HEALTH CLINIC 5 - HCHC - NEW LONDON CLINIC 111 W WASHINGTON STREET NEW LONDON IA 52645 PROVIDER HEALTH CLINIC 6 - HCHC - WAPELLO CLINIC 220 MULBERRY STREET SUITE A WAPELLO IA 52653 PROVIDER HEALTH CLINIC 7 - HCHC - KEOKUK CLINIC 3285 MAIN STREET KEOKUK IA 52632 PROVIDER HEALTH CLINIC 8 - HCHC - MEDIAPOLIS CLINIC 401 N ORCHARD STREET MEDIAPOLIS IA 52637 PROVIDER HEALTH CLINIC PART I, LINE 3C: HENRY COUNTY HEALTH CENTER (HCHC) USES THE FPG TO DETERMINE FREE OR DISCOUNTED CARE. INDIVIDUALS WHO ARE BELOW 200% OF THE FPG QUALIFY FOR FREE CARE. IN MOST INSTANCES, THEY HAVE TO PROVIDE FINANCIAL DOCUMENTATION AND FILL OUT A CHARITY CARE APPLICATION. THE HOSPITAL ALSO USES A PRESUMPTIVE CHARITY CARE PROGRAM THAT ANALYZES PUBLIC AND PRIVATE DATABASES TO HELP DETERMINE ELIGIBILITY FOR CHARITY CARE. THESE INDIVIDUALS DO NOT HAVE ANY OTHER DOCUMENTATION TO PROVIDE. THIS PROGRAM IS USED AFTER COLLECTION ATTEMPTS HAVE BEEN DISCONTINUED. EXTRAORDINARY ASSETS ARE TAKEN INTO CONSIDERATION WHEN DETERMINING CHARITY CARE ELIGIBILITY. MEDICALLY INDIGENT INDIVIDUALS ARE COVERED UNDER THE SAME CHARITY CARE POLICY. INDIVIDUALS BETWEEN 200% AND 300% OF THE FEDERAL POVERTY LIMITS ARE GRANTED CHARITY ON A SLIDING SCALE. PART I, LINE 7: THE AMOUNTS INCLUDED IN PART I, LINES 7A-7D WERE CALCULATED USING COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 OF THE IRS SCHEDULE H INSTRUCTIONS. PART I, LINES 7E-7J ARE ACTUAL COSTS. PART I, LN 7 COL(F): BAD DEBT EXPENSES OF $1,393,137 WERE SUBTRACTED FROM THE TOTAL EXPENSES IN CALCULATING THE PERCENTAGES IN PART I, LINE 7, COLUMN F. PART III, LINE 2: THE HEALTH CENTER DETERMINES THE TRANSACTION PRICE BASED ON STANDARD CHARGES FOR GOODS AND SERVICES PROVIDED, REDUCED BY CONTRACTUAL ADJUSTMENTS PROVIDED TO THIRD PARTY PAYORS, DISCOUNTS PROVIDED TO UNINSURED PATIENTS IN ACCORDANCE WITH THE HEALTH CENTER'S POLICY, AND OR IMPLICIT PRICE CONCESSIONS PROVIDED TO UNINSURED PATIENTS. THE HEALTH CENTER DETERMINES ITS ESTIMATES OF CONTRACTUAL ADJUSTMENTS AND DISCOUNTS BASED ON CONTRACTUAL AGREEMENTS, ITS DISCOUNT POLICIES AND HISTORICAL EXPERIENCE. THE HEALTH CENTER DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH VARIOUS CLASSES OF PATIENTS. PART III, LINE 3: THE ESTIMATED AMOUNT OF THE ORGANIZATION'S IMPLICIT PRICE CONCESSIONS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BASED ON THE PERCENTAGE OF INDIVIDUALS LIVING BELOW THE POVERTY LEVEL. 12.7% CAN REASONABLY BE CONSIDERED A COMMUNITY BENEFIT AS IT WOULD HAVE BEEN WRITTEN OFF TO CHARITY CARE. PART III, LINE 4: SEE THE "PATIENTS RECEIVABLES" PARAGRAPH IN NOTE 1 ON PAGE 8 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS FOR A DESCRIPTION OF BAD DEBT EXPENSE. PART III, LINE 8: THE ORGANIZATION DERIVED ITS COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT BY USING COST REPORT WORKSHEETS. MEDICARE COSTS ARE DETERMINED THROUGH THE MEDICARE COST FINDING PROCESS WHICH ALLOCATES GENERAL SERVICE CENTER COSTS TO REVENUE DEPARTMENTS. THE METHODOLOGY DESCRIBED IN THE INSTRUCTIONS TO SCHEDULE H, PART III, SECTION B, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE HOSPITAL AND DOES NOT REPRESENT THE TOTAL COMMUNITY BENEFIT CONFERRED IN THIS AREA. THE REASONS MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT ARE (A) ABSENT THE MEDICARE PROGRAM, IT IS LIKELY MANY OF THE INDIVIDUALS WOULD QUALIFY FOR FINANCIAL ASSISTANCE OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS; (B) BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS; AND (C) THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION IN REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS, AND THE AMOUNT SPENT TO COVER MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFIT NEEDS. PART III, LINE 9B: EACH PATIENT RECEIVES CARE REGARD LESS OF THE ABILITY TO PAY. ANY PATIENT CAN APPLY FOR FINANCIAL ASSISTANCE PRIOR TOO RAFTER RECEIVING A STATEMENT FOR SERVICES. THERE ARE NO COLLECTION EFFORTS WHILE AN INDIVIDUAL IS IN THE PROCESS OF APPLYING FOR FINANCIAL ASSISTANCE. THE HOSPITAL WILL NOT PURSUE EXTRAORDINARY COLLECTION ACTIVITIES ON PATIENTS FOR AT LEAST 120 DAYS FROM THE DATE OF THE FIRST STATEMENT AND PROVIDES PATIENTS 240 DAYS TO APPLY FOR ASSISTANCE. PART VI, LINE 2: HENRY COUNTY HEALTH CENTER, INC., RECEIVED TAX EXEMPT STATUS AS A 501(C)(3) IN MARCH 2021 AND ENTERED INTO A HOSPITAL LEASE AGREEMENT WHERE IT LEASES ALL OF THE FACILITIES AND OPERATIONS, EXCEPT THE AMBULANCE SERVICE, OF HENRY COUNTY SOLDIERS AND SAILORS MEMORIAL HOSPITAL, A COUNTY HOSPITAL ORGANIZED UNDER IOWA CODE CHAPTER 347. HENRY COUNTY HEALTH CENTER, INC. MANAGES AND OPERATES HEALTH CARE ORGANIZATIONS. THIS INCLUDES OPERATING THE 74-BED CRITICAL ACCESS HOSPITAL THAT FEATURES 25 ACUTE CARE BEDS ALONG WITH A 49-BED LONG TERM CARE FACILITY, PARK PLACE. HENRY COUNTY HEALTH CENTER, INC. ALSO MANAGES AND OPERATES A CLINICAL/GROUP PRACTICE LOCATED ON THE GROUNDS OF THE HOSPITAL AND SEVEN RURAL HEALTH CLINICS IN THE SURROUNDING RURAL COMMUNITIES AND PROVIDES COMMUNITY HEALTH EDUCATION FOR THE COMMUNITY. PART VI, LINE 3: NOTIFICATION ABOUT GOVERNMENT PROGRAM AND/OR FINANCIAL ASSISTANCE FROM HCHC IS DISSEMINATED BY VARIOUS MEANS AT HCHC, WHICH INCLUDES PUBLICATION OF NOTICES IN PATIENT BILLS AND POSTED NOTICES IN THE EMERGENCY ROOMS, ADMISSION FORMS, ADMITTING AND REGISTRATION DEPARTMENT, HOSPITAL BUSINESS OFFICES, AND THE FINANCIAL SERVICES OFFICE ON THE FACILITY CAMPUS. HCHC ALSO POSTS AT THE LOCAL DEPARTMENT OF HEALTH SERVICES OFFICE. HCHC ALSO PUBLISHES AND WIDELY PUBLICIZES A SUMMARY OF THE ASSISTANCE OPTIONS ON THE FACILITY WEBSITE AND IN BROCHURES AVAILABLE IN PATIENT ACCESS SITES. REFERRAL OF PATIENTS FOR CHARITY MAY BE MADE BY ANY MEMBER OF THE SEIRMC STAFF. ALSO REQUESTS FOR CHARITY MAY BE MADE BY THE PATIENT OR A FAMILY MEMBER, CLOSE FRIEND, OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS. FINANCIAL COUNSELORS MEET WITH PATIENTS TO ASSIST IN COMPLETING A QUESTIONNAIRE THAT HELPS THEM DETERMINE IF THE PATIENT QUALIFIES FOR A GOVERNMENT PROGRAM. PART VI, LINE 4: LOCATED IN SOUTHEAST IOWA, MOUNT PLEASANT IS AT THE CROSSROADS OF U.S. HIGHWAY 218 AND U.S. 34. HENRY COUNTY HAS 11 CITIES AND MORE THAN 20,000 PEOPLE. THE MEDIAN HOUSEHOLD INCOME IN HENRY COUNTY IS $64,604. THIS IS LOWER THAN THE STATE MEDIAN ($73,147) AND NATIONAL MEDIAN ($78,538). 12.7% OF ALL RESIDENTS AND 15.2% OF CHILDREN UNDER THE AGE OF 18 LIVE IN HOUSEHOLDS EARNING LESS THAN THE FEDERAL POVERTY LEVEL. THE STATE POVERTY LEVEL IS 11.3% FOR ALL RESIDENTS AND 12.2% FOR CHILDERN UNDER THE AGE OF 18. THE FEDERAL LEVEL IS 12.6% FOR ALL RESIDENTS AND 16.3% FOR CHILDERN UNDER THE AGE OF 18. 20.8% OF THE POPULATION IS 65 YEARS OR OLDER WHICH IS HIGHER THAN IOWA'S OVERALL RATE OF 18.6%. THERE IS A LOWER PERCENTAGE OF YOUNG PEOPLE UNDER THE AGE OF 30 LIVING IN HENRY COUNTY (37.5%) COMPARED TO IOWA (38.7%). ACCORDING TO THE U.S. CENSUS 2020 ESTIMATES, HENRY COUNTY IS 92.8% WHITE, 2.6% BLACK OR AFRICAN AMERICAN, 0.5% AMERICAN INDIAN AND ALASKA NATIVE, 2.2% ASIAN, 5.5% HISPANIC OR LATINO, AND 1.8% TWO OR MORE RACES. PART VI, LINE 5: THE BOARD MEMBERS LIVE IN THE HOSPITAL SERVICE AREA AND USE THE FACILITY. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. HENRY COUNTY HEALTH CENTER USES SURPLUS FUNDS TO INVEST IN HOSPITAL EQUIPMENT AND IMPROVEMENTS. PART VI, LINE 6: HENRY COUNTY HEALTH CENTER IS PART OF GREAT RIVER HEALTH SYSTEM.GREAT RIVER HEALTH SYSTEM CONSISTS OF TWO HOSPITALS, A HOSPICE HOUSE, HOME HEALTH SERVICES, AMBULANCE SERVICES, THREE PHARMACIES, A DURABLE MEDICAL EQUIPMENT COMPANY, A LONG-TERM CARE NURSING HOME, ABOUT 25 PRIMARY-CARE AND SPECIALTY PHYSICIAN CLINICS, AND IS AFFILIATED WITH AN OUTPATIENT RENAL DIALYSIS CENTER.THE NON-HOSPITAL HEALTH CARE FACILITIES THAT ARE OPERATED BY ORGANIZATIONS RELATED TO THE HOSPITAL ARE: GREAT RIVER HEALTH SYSTEM-ANESTHESIA; GREAT RIVER HEALTH SYSTEM-AUDIOLOGY; GREAT RIVER HEALTH SYSTEM-BUSINESS HEALTH; GREAT RIVER HEALTH SYSTEM-CANCER CENTER; GREAT RIVER HEALTH SYSTEM-CARDIOLOGY; GREAT RIVER HEALTH SYSTEM-DIABETIC FOOT CLINIC; GREAT RIVER HEALTH SYSTEM-EYE SPECIALISTS; GREAT RIVER HEALTH SYSTEM-FAMILY MEDICINE; GREAT RIVER HEALTH SYSTEM-FAMILY MEDICINE, MERCY PLAZA; GREAT RIVER HEALTH SYSTEM-GASTROENTEROLOGY; GREAT RIVER HEALTH SYSTEM-HEALTHY LIVING; GREAT RIVER HEALTH SYSTEM-HERITAGE FAMILY PHARMACY; GREAT RIVER HEALTH SYSTEM-HERITAGE MEDICAL EQUIPMENT AND SUPPLIES; GREAT RIVER HEALTH SYSTEM-HERITAGE PARK PHARMACY; GREAT RIVER HEALTH SYSTEM-HERITAGE PARTNERS PHARMACY; GREAT RIVER HEALTH SYSTEM-KEOKUK; GREAT RIVER HEALTH SYSTEM-MEDIAPOLIS; GREAT RIVER HEALTH SYSTEM-MEDICINE SPECIALISTS; GREAT RIVER HEALTH SYSTEM-MENTAL HEALTH; GREAT RIVER HEALTH SYSTEM-NEPHROLOGY; GREAT RIVER HEALTH SYSTEM-ORTHOPAEDIC SPECIALISTS; GREAT RIVER HEALTH SYSTEM-PULMONOLOGY; GREAT RIVER HEALTH SYSTEM-QUICK CARE; GREAT RIVER HEALTH SYSTEM-SURGEONS; GREAT RIVER HEALTH SYSTEM-UROLOGY; GREAT RIVER HEALTH SYSTEM-WAPELLO; GREAT RIVER HEALTH SYSTEM-WEST POINT; GREAT RIVER HEALTH SYSTEM-WOMEN'S HEALTH; GREAT RIVER HEALTH SYSTEM-WOUND AND HYPERBARIC; SOUTHEASTERN RENAL DIALYSIS. PART VI, LINE 7: HCHC DOES NOT FILE A COMMUNITY BENEFIT REPORT WITH THE STATE OF IOWA. HOWEVER, COMMUNITY BENEFIT INFORMATION IS PROVIDED TO THE IOWA HOSPITAL ASSOCIATION. 1 CHARITY CARE 564 144358 0 N/A N/A PART I, LINE 2: HCHC DOES NOT PROVIDE CASH ASSISTANCE TO INDIVIDUALS. RATHER THAN GIVING CASH OR NON-CASH ITEMS TO INDIVIDUALS, HCHC PROVIDES DISCOUNTS ON ITS SERVICES, IN THE FORM OF CHARITY CARE, TO INDIVIDUALS WHO MEET SPECIFIED ELIGIBILITY CRITERIA. HCHC USES AN OUTSIDE SOURCE TO SCREEN PATIENTS TO SEE IF THEY COULD BE ELIGIBLE FOR FINANCIAL ASSISTANCE. THE HOSPITAL GETS NOTIFICATION BACK AS TO HOW MUCH OF A FINANCIAL ASSISTANCE DISCOUNT THEY WOULD BE ELIGIBLE FOR. IF THE PATIENT DOESN'T RESPOND TO PHONE CALLS REGARDING THE FINANCIAL ASSISTANCE APPLICATION OR THEY DON'T COMPLETE THE APPLICATION, THE HOSPITAL MAY STILL DISCOUNT THE PATIENT'S CHARGES UNDER THEIR PRESUMPTIVE CHARITY POLICY, THE HOSPITAL'S PRESUMPTIVE CHARITY PROGRAM GIVES THE HOSPITAL THE OPPORTUNITY TO DISCOUNT PATIENT ACCOUNTS BASED ON INFORMATION IT MAY HAVE REGARDING A PATIENT BEING HOMELESS OR UNEMPLOYED. HCHC INC USES THE FPG TO DETERMINE FREE OR DISCOUNTED CARE. INDIVIDUALS WHO ARE BELOW 200% OF THE FPG QUALIFY FOR FREE CARE. IN MOST INSTANCES, THEY HAVE TO PROVIDE FINANCIAL DOCUMENTATION AND FILL OUT A CHARITY CARE APPLICATION. THE HOSPITAL ALSO USES PRESUMPTIVE CHARITY CARE PROGRAM THAT ANALYZES PUBLIC AND PRIVATE DATABASES TO HELP DETERMINE ELIGIBILITY FOR CHARITY CARE. THESE INDIVIDUALS DO NOT HAVE ANY OTHER DOCUMENTATION TO PROVIDE. THIS PROGRAM IS USED AFTER COLLECTION ATTEMPTS HAVE BEEN DISCONTINUED. EXTRAORDINARY ASSETS ARE TAKEN INTO CONSIDERATION WHEN DETERMINING CHARITY CARE ELIGIBILITY. MEDICALLY INDIGENT INDIVIDUALS ARE COVERED UNDER THE SAME CHARITY CARE POLICY. INDIVIDUALS BETWEEN 200% AND 300% OF THE FEDERAL POVERTY LIMITS ARE GRANTED CHARITY ON A SLIDING SCALE. 1 0 0 0 0 0 0 0 0 MATT WENZEL FORMER DIRECTOR 0 326969 0 0 0 1042611 0 0 0 11287 0 1380867 0 0 DR MICHAEL MCCOY DIRECTOR 0 751696 0 56250 0 21915 0 16500 0 34541 0 880902 0 0 TERESA COLGAN CEO 0 467052 0 19570 0 7825 0 16500 0 31051 0 541998 0 0 DAVID MUHS CFO 176931 0 0 0 573 0 17476 0 35639 0 230619 0 0 0 PART I, LINE 3 THE COMPENSATION OF DR. MICHAEL MCCOY AND TERESA COLGAN IS PAID BY DETERMINED BY GREAT RIVER HEALTH SYSTEM. THE FOLLOWING WERE USED BY GREAT RIVER HEALTH SYSTEM IN DETERMINING THE OFFICERS' COMPENSATION: 1. COMPENSATION COMMITTEE 2. INDEPENDENT COMPENSATION CONSULTANT 3. FORM 990 OF OTHER ORGANIZATIONS 4. WRITTEN EMPLOYMENT CONTRACT 5. COMPENSATION SURVEY OR STUDY 6. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4A MATT WENZEL RECEIVED A SEVERANCE PAYMENT OF $855,096. THIS AMOUNT WERE INCLUDED IN W-2 WAGES. FORM 990, PART VII, SECTION A, LINE 5: DAVID MUHS IS EMPLOYED BY HENRY COUNTY SOLDIERS & SAILORS MEMORIAL HOSPITAL. DR. JOE TANSEY IS EMPLOYED BY HENRY COUNTY SOLDIERS & SAILORS MEMORIAL HOSPITAL. DR. JOE TANSEY RECEIVED $637,975 REPORTABLE COMPENSATION AND $70,773 OTHER COMPENSATION FOR CALENDAR YEAR 2023. THE EMPLOYEES FROM THAT HOSPITAL ARE LEASED TO HENRY COUNTY HEALTH CENTER INC. FORM 990, PART VI, SECTION A, LINE 2 JEREMY ALEXANDER, DR. MICHAEL MCCOY, AND MATT WENZEL ARE ON THE BOARDS FOR THE RELATED ENTITIES OF GREAT RIVER HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 3 EXECUTIVES AND EMPLOYEES OF GREAT RIVER HEALTH SYSTEM, INC., MANAGE THE ACTIVITIES OF THE HENRY COUNTY HEALTH CENTER, INC. THE CFO IS AN EMPLOYEE OF HENRY COUNTY SOLDIERS AND SAILORS MEMORIAL HOSPITAL AND PROVIDES SERVICES THROUGH A SERVICES AGREEMENT WITH THAT ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 6 GREAT RIVER HEALTH SYSTEM, INC., AN IOWA NONPROFIT CORPORATION, IS THE SOLE MEMBER OF HENRY COUNTY HEALTH CENTER, INC. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER, GREAT RIVER HEALTH SYSTEM, INC (GRHS), HAS THE SOLE POWER TO ELECT OR REMOVE ALL BOARD MEMBERS OF HENRY COUNTY HEALTH CENTER. THE NOMINATING COMMITTEE SHALL PRESENT A RECOMMENDATION FOR THE ELECTION OF DIRECTORS TO THE BOARD, WHICH UPON APPROVAL OF THE BOARD AND THE SUBSEQUENT APPROVAL OF GRHS, SHALL BE ELECTED TO THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B THE GRHS BOARD OF DIRECTORS HAS THE FOLLOWING SPECIFIC POWERS RELATED TO ALL SUBSIDIARY CORPORATIONS AND AFFILIATED ORGANIZATIONS: 1. ELECT OR REMOVE THE BOARD OF DIRECTORS, OR ANY OTHER MEMBER OF THE BOARD OF DIRECTORS; 2. AMEND THE ARTICLES OF INCORPORATION OR THE BYLAWS; 3. DISSOLVE OR APPROVE MERGER WITH ANY OTHER CORPORATE ENTITY; 4. APPROVE STRATEGIC OR OTHER BUSINESS PLANS; 5. APPROVE CAPITAL AND OPERATING BUDGETS; 6. APPROVAL OF ANY INDEBTEDNESS INCURRED; 7. TRANSFER, SELL OR CLOSE ANY FACILITY, DEPARTMENT OR FUNCTION; 8. APPROVE ANY CHARITABLE DISBURSEMENTS, WHETHER INTERNAL OR EXTERNAL, IN EXCESS OF ONE HUNDRED THOUSAND DOLLARS ($100,000.00) IN THE AGGREGATE DURING ANY FISCAL YEAR; 9. THE SALE, DISPOSITION OR ANY ENCUMBRANCE (OTHER THAN ROUTINE LEASE TRANSACTIONS) OF ANY REAL ESTATE; 10. ADOPT, AMEND, OR TERMINATE EMPLOYEE BENEFIT PROGRAMS OR PLANS; 11. APPOINT OR TERMINATE THE CHIEF EXECUTIVE OFFICER; 12. APPROVE THE ELECTION OF ANY OFFICER OR CHAIRPERSON OF THE BOARD OF DIRECTORS; AND 13. TO TAKE ANY OTHER ACTION NECESSARY DEEMED IN THE BEST INTERESTS OF GRHS. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PREPARED BY AN EXTERNAL ACCOUNTANT. A DRAFT OF THE FORM 990 WAS REVIEWED IN DETAIL BY A MEMBER OF THE ACCOUNTING DEPARTMENT, CORPORATE CONTROLLER, AND CFO. ANY NECESSARY ADJUSTMENTS WERE MADE PRIOR TO FINALIZING THE FORM. A COPY OF THE FINAL FORM 990 WAS MADE AVAILABLE TO THE BOARD MEMBERS FOR THEIR REVIEW PRIOR TO FILING WITH THE IRS. ANY QUESTIONS OF THE BOARD MEMBERS WERE ADDRESSED THROUGH THE ACCOUNTING DEPARTMENT. FORM 990, PART VI, SECTION B, LINE 12C BOTH CORPORATE AND SUBSIDIARY BOARD MEMBERS ARE PROVIDED EDUCATION REGARDING CONFLICTS OF INTEREST. THIS EDUCATION IS PROVIDED BY THE CHIEF COMPLIANCE OFFICER. ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE FORM. RELATIONSHIPS NOTED ON THIS FORM MAY BE DISCUSSED WITH THE RESPECTIVE BOARD MEMBER IF THERE ARE QUESTIONS. IF AN INDIVIDUAL HAS A CONFLICT OF INTEREST, THEY MAY NOT PARTICIPATE IN DISCUSSIONS RELATING TO THE TRANSACTION IN QUESTION AND MAY NOT VOTE ON MATTERS RELATED TO THE TRANSACTION. CONFLICT OF INTEREST PROCEEDINGS ARISING FROM CONFLICTS OF INTEREST ARE DOCUMENTED IN THE BOARD MINUTES. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF OFFICERS IS PAID BY GREAT RIVER HEALTH SYSTEM INC. THE COMPENSATION FOR THE CEO AND OTHER OFFICERS IS DETERMINED BY THE EXECUTIVE COMPENSATION COMMITTEE OF GREAT RIVER HEALTH SYSTEM, INC. THE ROLE OF THE COMPENSATION COMMITTEE IS TO ACT ON BEHALF OF THE CORPORATE BOARD OF DIRECTORS IN ADOPTING, REVIEWING AND MAINTAINING AN EXECUTIVE COMPENSATION PHILOSOPHY. THE COMPENSATION COMMITTEE IS COMPRISED OF THREE BOARD MEMBERS, ALL OF WHOM ARE INDEPENDENT FROM THE CEO AND OTHER OFFICERS. THE COMPENSATION COMMITTEE REVIEWS THE COMPENSATION OF THE CEO AND OTHER OFFICERS ON AN ANNUAL BASIS. THE DELIBERATIONS AND DECISIONS ARE DOCUMENTED IN MINUTES TAKEN AT THE MEETINGS. GREAT RIVER HEALTH SYSTEM, INC. PARTICIPATES IN AND UTILIZES EXECUTIVE SALARY SURVEYS TO DETERMINE COMPENSATION RANGES. THE COMMITTEE REVIEWS PREVAILING MARKET DATA TO ENSURE CONTINUED MARKET COMPETITIVENESS. THE COMPENSATION COMMITTEE ALSO ENGAGES AN INDEPENDENT THIRD PARTY COMPENSATION CONSULTING GROUP BIENNIALLY TO ASSESS AND VALIDATE THE ENTIRETY OF EXECUTIVE COMPENSATION AND BENEFITS PACKAGES TO ENSURE REGULATORY COMPLIANCE, EXTERNAL COMPETITIVENESS, AND INTERNAL EQUITY. THE MOST RECENT YEAR OF AN INDEPENDENT THIRD PARTY REVIEW WAS 2024. FORM 990, PART VI, SECTION C, LINE 19 HENRY COUNTY HEALTH CENTER MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 10,871,752. MANAGEMENT AND GENERAL EXPENSES 7,916,106. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,787,858. FORM 990, PART XII, LINE 2C: THE PROCESS FOR OVERSIGHT AND SELECTION OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. GREAT RIVER HEALTH SYSTEM INC 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421193185 HEALTH CARE IA 501(C)(3) LINE 12C, III-FI N/A 0 SOUTHEAST IOWA REGIONAL MEDICAL CENTER 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 420680407 HOSPITAL IA 501(C)(3) LINE 3 GREAT RIVER HEALTH SYSTEM INC 0 GRHS HOLDINGS INC 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421193186 SUPPORT RELATED ORGANIZATIONS IA 501(C)(3) LINE 12B, II GREAT RIVER HEALTH SYSTEM INC 0 GREAT RIVER HEALTH FOUNDATION INC 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421446727 SUPPORT RELATED ORGANIZATIONS IA 501(C)(3) LINE 12B, II GREAT RIVER HEALTH SYSTEM INC 0 SOUTHEAST RENAL DIALYSIS LC 507 SOUTH WHITE STREET MOUNT PLEASANT IA 52641 391878280 MEDICAL SERVICES IA N/A RELATED 242177 1633130 1 0 0.25000 RIVERVIEW SYSTEM LTD 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421191960 MEDICAL SERVICES IA N/A C 0 GREAT RIVER MEDICAL SERVICES INC 1201 WEST AGENCY ROAD WEST BURLINGTON IA 52655 421493449 MEDICAL SERVICES IA N/A C 0 MUTUAL CONSULTING & MANAGEMENT SERVICES 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421349668 MANAGEMENT SERVICES IA N/A C 0 HERITAGE PARK PHARMACY 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421191957 PHARMACY IA N/A C 0 HERITAGE MEDICAL EQUIPMENT & SUPPLY 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421191958 MEDICAL SUPPLY IA N/A C 0 RIGHTCHOICE INC 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 923383523 STAFFING AGENCY IA N/A C 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0