GRAND ITASCA CLINIC AND HOSPITAL: Form 990, tax year 2018
View the entire original 990 at ProPublica ↗
- Organization
- GRAND ITASCA CLINIC AND HOSPITAL (EIN 41-1865874)
- Tax period
- 2018-01-01 to 2018-12-31
- Filed
- 2019-11-05
- IRS object ID
- 201913099349301816
- Schema version
- 2018v3.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-11-05T12:44:41-06:00 | ReturnTs |
| Tax Period End | 2018-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAIRVIEW HEALTH SVCS | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2450 RIVERSIDE AVE S DEPT C-207 LE | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 554541450 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2018-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411865874 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAND ITASCA CLINIC AND HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GRAN | BusinessNameControlTxt |
| Phone | 2183265000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1601 GOLF COURSE ROAD | AddressLine1Txt |
| City | GRAND RAPIDS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55744 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JEAN MACDONELL | PersonNm |
| Person Title | PRESIDENT & CEO-GICH | PersonTitleTxt |
| Phone | 2183265000 | PhoneNum |
| Signature | 2019-09-18 | SignatureDt |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparation | 2019-11-05 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 162.96.9.40 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-11-05 | IPDt |
| IP Tm | 12:44:41 | IPTm |
| IP Timezone | CS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 9A7795162CD8FED1DB572D6341B886463E8B285F | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 9A7795162CD8FED1DB572D6341B886463E8B285F | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2018 | TaxYr |
| Build TS | 2020-03-31 21:24:44Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JEAN MACDONELL | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1680 GOLF COURSE ROAD | AddressLine1Txt |
| City | GRAND RAPIDS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55744 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $90,909,519 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.GRANDITASCA.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1997 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE QUALITY, ACCESSIBLE, AND VALUABLE HEALTH CARE SERVICES VIA A HOSPITAL, HOME HEALTH AGENCY, AND CLINIC TO THE SURROUNDING RURAL COMMUNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 769 | TotalEmployeeCnt |
| Total Volunteers | 98 | TotalVolunteersCnt |
| Total Gross UBI | $205,047 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $156,353 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $213,798 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,632,834 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $219,473,780 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $87,548,706 | CYProgramServiceRevenueAmt |
| PY Investment Income | $268,844 | PYInvestmentIncomeAmt |
| CY Investment Income | $291,391 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,273,456 | PYOtherRevenueAmt |
| CY Other Revenue | $1,436,588 | CYOtherRevenueAmt |
| PY Total Revenue | $221,229,878 | PYTotalRevenueAmt |
| CY Total Revenue | $90,909,519 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $53,681,204 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $57,611,579 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $29,385,595 | PYOtherExpensesAmt |
| CY Other Expenses | $31,137,891 | CYOtherExpensesAmt |
| PY Total Expenses | $83,066,799 | PYTotalExpensesAmt |
| CY Total Expenses | $88,749,470 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $138,163,079 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,160,049 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $58,607,872 | TotalAssetsBOYAmt |
| Total Assets EOY | $78,502,474 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $32,555,247 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $46,747,787 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $26,052,625 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $31,754,687 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | PROVIDE QUALITY, ACCESSIBLE, AND VALUABLE HEALTH CARE SERVICES VIA A HOSPITAL, HOME HEALTH AGENCY, AND CLINIC TO THE SURROUNDING RURAL COMMUNITY. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $78,514,702 | ExpenseAmt |
| Revenue | $88,780,247 | RevenueAmt |
| Desc | GRAND ITASCA CLINIC AND HOSPITAL IS AN INTEGRATED MULTI-SPECIALTY CLINIC AND ACUTE-SURGICAL HOSPITAL. THE FACILITY IS LICENSED FOR 64 BEDS WHICH ARE COMPRISED OF 48 MEDICAL BEDS, 10 INTENSIVE CARE BEDS AND 6 OB BEDS. IN ADDITION TO PROVIDING TRADITIONAL HOSPITAL SERVICES, THE FACILITY HAS FOUR SURGERY SITES, A 24-HOUR EMERGENCY DEPARTMENT, OUTPATIENT MENTAL HEALTH SERVICES, OUTPATIENT REHABILITATION SERVICES, AND OUTPATIENT CLINIC SERVICES. THE FACILITY EMPLOYS APPROXIMATELY 750 PEOPLE INCLUDING OVER 60 HEALTHCARE PROVIDERS. THE FACILITY SERVED OVER 1,700 INPATIENTS AND OVER 200,000 OUTPATIENT ENCOUNTERS INCLUDING CLINIC, EMERGENCY ROOM, OUTPATIENT IMAGING AND OUTPATIENT SURGICAL PROCEDURE. GRAND ITASCA SERVES THE PATIENT REGARDLESS OF THE PERSON'S ABILITY TO PAY. DURING THE CALENDAR YEAR, THE FACILITY PROVIDED 643,364 OF CHARITY CARE, 55,454 OF DISCOUNTS TO THE UNINSURED AND ABSORBED 15,188,129 OF UNPAID MEDICARE AND MEDICAID COSTS. GRAND ITASCA ALSO PAID 1,587,260 IN PAYMENTS FOR MINNESOTA CARE TAX AND MEDICAID SURCHARGES, WHICH WERE USED TO FUND CARE FOR THE INDIGENT AND UNDERINSURED. | Desc |
| Total Program Service Expenses | $78,514,702 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | Yes (true) | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (true) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 21 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 769 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (true) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (true) | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TODD CHRISTENSON | PersonNm |
| Phone | 2189991703 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1601 GOLF COURSE ROAD | AddressLine1Txt |
| City | GRAND RAPIDS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55744 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| M OSMAN AKHTAR | ||||||||
| DIR/COO END | 0.00 | 40.00 | Yes (X) | Yes (X) | $0 | $753,077 | $56,325 | |
| LAURA REED RN | ||||||||
| COO-FAIRIVEW | 1.00 | 40.00 | Yes (X) | Yes (X) | $0 | $638,399 | $85,201 | |
| LIZBETH THOMAS MD | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $566,346 | $86,689 | ||
| KEVIN NELSON MD | ||||||||
| DIRECTOR | 1.00 | 40.00 | Yes (X) | $0 | $407,845 | $94,989 | ||
| DR JAMISON HARKER | ||||||||
| DIRECTOR | 40.00 | 0.00 | Yes (X) | $292,847 | $0 | $43,293 | ||
| JAN ROURK MD | ||||||||
| DIRECTOR | 40.00 | 0.00 | Yes (X) | $169,917 | $0 | $26,360 | ||
| DALE ADAMS | ||||||||
| VICE-CHAIR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| BETH BILY | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| STEVE BURGGRAF | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| KENT KOERBITZ | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| ELIZABETH MISKOVICH | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| COLLEEN NARDONE | ||||||||
| CHAIR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| AMANDA OKECH | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| DENNIS ROY | ||||||||
| SECRETARY | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| JOSH SKELTON | ||||||||
| FINANCE COMM | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| JAMES HEREFORD | ||||||||
| PRES/CEO FAI | 0.00 | 40.00 | Yes (X) | $0 | $1,780,267 | $84,827 | ||
| MICHAEL YOUSO | ||||||||
| PRESIDENT & | 0.00 | 40.00 | Yes (X) | $0 | $401,832 | $85,137 | ||
| DANIEL SOULAR MD | ||||||||
| CMO-GICH | 40.00 | 0.00 | Yes (X) | $316,274 | $0 | $30,780 | ||
| JEAN MACDONELL | ||||||||
| PRESIDENT & | Yes (X) | $0 | $0 | $0 | ||||
| RYAN NOVAK MD | ||||||||
| UROLOGIST MD | 40.00 | 0.00 | $726,812 | $0 | $56,970 | Yes (X) | ||
| TROY ERICKSON MD | ||||||||
| ORTHOPEDIC S | 40.00 | 0.00 | $476,529 | $0 | $19,275 | Yes (X) | ||
| SHAWN OLSON MD | ||||||||
| GENERAL SURG | 40.00 | 0.00 | $423,320 | $0 | $30,431 | Yes (X) | ||
| DEREK BEYER MD | ||||||||
| OB/GYN MD | 40.00 | 0.00 | $414,646 | $0 | $44,263 | Yes (X) | ||
| DARIN SKAUDIS MD | ||||||||
| INTERNAL MED | 40.00 | 0.00 | $407,804 | $0 | $38,455 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,228,149 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $4,547,766 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $782,995 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 77 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| KRAUS-ANDERSON CONSTRUCTION | |||||
| 501 S 8TH STREET | MINNEAPOLIS | MN | 55404 | CONSTRUCTION | $1,495,110 |
| PREMIER STAFFING INC | |||||
| 243 WINKLER TRAIL | COLOGNE | MN | 55322 | STAFFING | $1,379,412 |
| AMERICAN EXPRESS | |||||
| 2925 CHICAGO AVENUE | MINNEAPOLIS | MN | 55407 | IT/LAB SERVICES | $1,220,313 |
| AMERIPRIDE SERVICES | |||||
| 519 EAST 19TH STREET | HIBBING | MN | 55746 | LAUNDRY SVCS. | $432,985 |
| JALALUDDIN AKBAR | |||||
| 750 E 34TH STREET | HIBBING | MN | 55746 | MEDICAL SVCS. | $392,619 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 21 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $1,632,834 | RelatedOrganizationsAmt |
| Total Contributions | $1,632,834 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| PATIENT SERVICES | 621110 | $84,648,722 | $84,648,722 | |
| PHARMACY | 446110 | $2,694,937 | $2,694,937 | |
| PHARMACY | 446110 | $205,047 | $205,047 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $87,548,706 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $255,319 | TotalRevenueColumnAmt |
| Exclusion | $255,319 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $35,716 | SecuritiesAmt |
| Other | $356 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $35,716 | SecuritiesAmt |
| Other | $356 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $36,072 | TotalRevenueColumnAmt |
| Exclusion | $36,072 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business | 621110 | BusinessCd |
| Total Revenue Column | $1,436,588 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,436,588 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,436,588 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $90,909,519 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $88,780,247 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $205,047 | UnrelatedBusinessRevenueAmt |
| Exclusion | $291,391 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $779,038 | TotalAmt |
| Program Services | $462,764 | ProgramServicesAmt |
| Management And General | $316,274 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,769,774 | TotalAmt |
| Program Services | $42,111,146 | ProgramServicesAmt |
| Management And General | $4,658,628 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,186,776 | TotalAmt |
| Program Services | $1,943,611 | ProgramServicesAmt |
| Management And General | $243,165 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,013,851 | TotalAmt |
| Program Services | $3,575,474 | ProgramServicesAmt |
| Management And General | $1,438,377 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,862,140 | TotalAmt |
| Program Services | $2,504,291 | ProgramServicesAmt |
| Management And General | $357,849 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $214,276 | TotalAmt |
| Program Services | $45,926 | ProgramServicesAmt |
| Management And General | $168,350 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,500 | TotalAmt |
| Management And General | $17,500 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,011 | TotalAmt |
| Management And General | $10,011 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,322 | TotalAmt |
| Management And General | $4,322 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,667,527 | TotalAmt |
| Program Services | $3,562,025 | ProgramServicesAmt |
| Management And General | $1,105,502 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $293,562 | TotalAmt |
| Management And General | $293,562 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,808,447 | TotalAmt |
| Program Services | $2,592,403 | ProgramServicesAmt |
| Management And General | $216,044 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,314,622 | TotalAmt |
| Program Services | $1,307,538 | ProgramServicesAmt |
| Management And General | $7,084 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $129,460 | TotalAmt |
| Program Services | $88,929 | ProgramServicesAmt |
| Management And General | $40,531 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $195,881 | TotalAmt |
| Program Services | $162,569 | ProgramServicesAmt |
| Management And General | $33,312 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,187,219 | TotalAmt |
| Program Services | $1,187,219 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,957,333 | TotalAmt |
| Program Services | $973,724 | ProgramServicesAmt |
| Management And General | $983,609 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,087 | TotalAmt |
| Program Services | $23,087 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $14,739,324 | $14,739,324 | |
| MEDICARE & MEDICAID | $1,587,260 | $1,587,260 | |
| REPAIR & MAINTENANCE | $721,540 | $720,446 | $1,094 |
| SUPPLIES - OTHER | $705,819 | $593,684 | $112,135 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $560,701 | TotalAmt |
| Program Services | $333,282 | ProgramServicesAmt |
| Management And General | $227,419 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $88,749,470 | TotalAmt |
| Program Services | $78,514,702 | ProgramServicesAmt |
| Management And General | $10,234,768 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$230,995 | BOYAmt |
| EOY | $888,716 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,367,463 | BOYAmt |
| EOY | $24,484,746 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,620,372 | BOYAmt |
| EOY | $10,483,213 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $143,947 | BOYAmt |
| EOY | $155,816 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,521 | BOYAmt |
| EOY | $69,523 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,805,772 | BOYAmt |
| EOY | $2,135,745 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $470,935 | BOYAmt |
| EOY | $576,005 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $38,203,744 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,532,061 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,296,867 | BOYAmt |
| EOY | $34,671,683 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,898,173 | BOYAmt |
| EOY | $1,909,928 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,162,817 | BOYAmt |
| EOY | $3,127,099 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $58,607,872 | BOYAmt |
| EOY | $78,502,474 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,445,171 | BOYAmt |
| EOY | $4,909,538 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,687 | BOYAmt |
| EOY | $37,194 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,365,662 | BOYAmt |
| EOY | $35,393,720 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,697,727 | BOYAmt |
| EOY | $6,407,335 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $32,555,247 | BOYAmt |
| EOY | $46,747,787 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,554,617 | BOYAmt |
| EOY | $31,256,679 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $498,008 | BOYAmt |
| EOY | $498,008 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,052,625 | BOYAmt |
| EOY | $31,754,687 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $58,607,872 | BOYAmt |
| EOY | $78,502,474 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $2,160,049 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $324,127 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $3,217,886 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $4,322 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $4,322 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART II-B, LINE 1 | FormAndLineReferenceDesc |
| Explanation | GRAND ITASCA CLINIC AND HOSPITAL PAYS DUES TO AMERICAN HOSPITAL ASSOCIATION AND MINNESOTA HOSPITAL ASSOCIATION (MHA). A PORTION OF THESE ANNUAL DUES ARE DETERMINED TO BE USED FOR LOBBYING PURPOSES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,194,000 | OtherCostOrOtherBasisAmt |
| Book Value | $1,194,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $29,191,896 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,598,882 | DepreciationAmt |
| Book Value | $27,593,014 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,699,954 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,833,804 | DepreciationAmt |
| Book Value | $3,866,150 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,117,894 | OtherCostOrOtherBasisAmt |
| Depreciation | $99,375 | DepreciationAmt |
| Book Value | $2,018,519 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $34,671,683 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| DEFERRED COMPENSATION OBLIGATIONS | $2,921,320 |
| OTHER ACCRUALS | $1,505,074 |
| THIRD PARTY PAYOR SETTLEMENTS | $1,272,091 |
| WORK COMP RESERVE | $708,850 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $6,407,335 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PAGE 3, PART X | FormAndLineReferenceDesc |
| Explanation | MOST OF FAIRVIEW'S CONTROLLED AFFILIATES ARE TAX-EXEMPT ORGANIZATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THESE ORGANIZATIONS ARE SUBJECT TO INCOME TAX ON ANY INCOME FROM UNRELATED BUSINESS ACTIVITES. FAIRVIEW ALSO OWNS OR CONTROLS CERTAIN TAXABLE AFFILIATES. FAIRVIEW FILES INCOME TAX RETURNS IN THE U.S FEDERAL JURISDICTION AND IN VARIOUS STATE AND LOCAL JURISDICTIONS. WITH FEW EXCEPTIONS, FAIRVIEW IS NO LONGER SUBJECT TO U.S. FEDERAL, STATE, AND LOCAL OR NON-U.S. INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2014. FAIRVIEW RECOGNIZED ALL TAX POSITIONS, INCLUDING THOSE POSITIONS IN A PREVIOUSLY FILED TAX RETURN OR A POSITION EXPECTED TO BE TAKEN IN A FUTURE TAX FILING THAT IS REFLECTED IN MEASURING CURRENT OR DEFERRED INCOME TAX ASSETS AND LIABILITIES, WHEN IT IS MORE LIKELY THAN NOT (LIKELIHOOD OF GREATER THAN 50%) THAT, BASED ON TECHNICAL MERITS, THE POSITION WILL BE SUSTAINED UPON EXAMINATION. THERE ARE NO UNCERTAIN TAX POSITIONS RECORDED IN THE CONSOLIDATED BALANCE SHEETS AS OF DECEMBER 31, 2018 OR 2017. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,062,591 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $19,486 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,043,105 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03430 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $23,794,824 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $11,992,839 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $11,801,985 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13300 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $26,857,415 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,012,325 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $14,845,090 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.16730 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,911 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,911 | NetCommunityBenefitExpnsAmt |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $673,085 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $591,944 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $81,141 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00090 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $674,996 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $591,944 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $83,052 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00090 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $27,532,411 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,604,269 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $14,928,142 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.16820 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,013,579 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $40,272 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $29,048,020 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $38,566,443 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$9,518,423 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CDI GRAND RAPIDS LL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | PROVIDE MRI, DIAGNOSTIC INJECTION AND PA | PrimaryActivitiesTxt |
| Org Profit Or Ownership | 0.55000 | OrgProfitOrOwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAND ITASCA CLINIC AND HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAND ITASCA CLINIC AND HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 18 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.GRANDITASCA.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | GRANDITASCA.ORG (UNDER NEWS & EVENTS) | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 150.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.GRANDITASCA.ORG | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.GRANDITASCA.ORG | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.GRANDITASCA.ORG | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FACILITY 1, GRAND ITASCA CLINIC AND HOSPITAL - PART V, LINE 3E | IN ORDER TO DETERMINE THE TOP HEALTH NEEDS IN THE COMMUNITY INDICATORS FROM SECONDARY DATA; DATA FROM WILDER RESEARCH ON THE LEADING CAUSES OF DEATH AND PREMATURE DEATH, AND THE SOCIAL DETERMINANTS OF HEALTH; AND PRIMARY DATA THAT MET TWO PIECES OF CRITERIA: (1) A NEED AND/OR BARRIER THAT WAS SAID MORE THAN ONE TIME, AND (2) A NEED AND/OR BARRIER THAT WAS REPEATED IN AT LEAST TWO OF THE GROUPS (E.G. BOTH A STAKEHOLDER INTERVIEW AND A COMMUNITY CONVERSATION) WERE USED. GRAND ITASCA'S COMMUNITY HEALTH STEERING COMMITTEE REVIEWED AND VALIDATED FINDINGS FROM THE PRIMARY AND SECONDARY DATA AND RECOMMENDED THREE HEALTH NEEDS TO BE ADOPTED FOR THE CLINIC AND HOSPITAL. THE THREE HEALTH NEEDS ARE CONSISTENT ACROSS ALL 11 FAIRVIEW HOSPITALS AND MEDICAL CENTERS AND ARE INTENTIONALLY BROAD TO ALLOW FOR LOCAL VARIATION DURING THE IMPLEMENTATION PLANNING PROCESS. WEIGHTED CRITERIA WAS USED TO PRIORITIZE HEALTH NEEDS. HIGHEST WEIGHT WAS GIVEN TO THE TWO CRITERION DEEMED MOST IMPORTANT BY THE STEERING COMMITTEE - CONTINUING WORK IN THE 2015 CHNA PRIORITY AREAS AND ENSURING FUTURE PRIORITIES ALIGNED WITH WHAT THE COMMUNITY IDENTIFIED AS TOP NEEDS. THE PRIORITIZATION CRITERIA WAS APPLIED TO THE TOP 25 HEALTH NEEDS IDENTIFIED IN THE GRAND ITASCA COMMUNITY. THE TOP 10 HEALTH NEEDS INCLUDE: 1.MENTAL HEALTH 2.ADOLESCENT MENTAL HEALTH 3.ADVERSE CHILDHOOD EXPERIENCES (ACES) 4.ACCESS TO HEALTHY FOODS 5.CANCER 6.HEART DISEASE 7.STIGMA - MENTAL HEALTH 8.WORKFORCE SHORTAGE 9.SUICIDE 10.TIED FOR TENTH (1) TRANSPORTATION (2) GROWING SENIOR POPULATION THROUGH A VOTING PROCESS, THE GRAND ITASCA CLINIC & HOSPITAL COMMUNITY HEALTH STEERING COMMITTEE VALIDATED THE FOLLOWING HEALTH NEEDS: -MENTAL HEALTH AND WELL-BEING -HEALTHY LIFESTYLES -ACCESS TO CARE AND RESOURCES THESE THREE PRIORITIES ARE CONSISTENT ACROSS ALL 11 FAIRVIEW HOSPITALS AND MEDICAL CENTERS AND ARE INTENTIONALLY BROAD TO ALLOW FOR LOCAL VARIATION DURING THE IMPLEMENTATION PLANNING PROCESS. |
| FACILITY 1, GRAND ITASCA CLINIC AND HOSPITAL - PART V, LINE 5 | GRAND ITASCA CLINIC & HOSPITAL HAS CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNA) SINCE 2013 TO SYSTEMATICALLY IDENTIFY, ANALYZE, AND PRIORITIZE THE CRITICAL NEEDS OF THE COMMUNITY AND ADDRESS THOSE NEEDS. THE 2018 CHNA BUILDS UPON PREVIOUS ASSESSMENTS AND WAS DEVELOPED IN PARTNERSHIP WITH COMMUNITY MEMBERS AND ORGANIZATIONS, LOCAL PUBLIC HEALTH AGENCIES, AND OTHER HOSPITALS AND HEALTH SYSTEMS. IT SERVES AS A TOOL FOR GUIDING POLICY, ADVOCACY, AND PROGRAM PLANNING. IT ALSO FULFILLS IRS REQUIREMENTS FOR CHNA AND IMPLEMENTATION STRATEGIES PURSUANT TO THE AFFORDABLE CARE ACT OF 2010, WHICH REQUIRES 501(C)(3) NONPROFIT HOSPITALS TO CONDUCT AN ASSESSMENT AT LEAST EVERY THREE YEARS AND PROVIDE AN ANNUAL EVALUATION OF IMPACT OF THE PREVIOUS IMPLEMENTATION STRATEGY. FOR ADDITIONAL DETAIL, SEE SECTION TITLED, EVALUATION OF IMPACT, 2017-2018 CHNA IMPLEMENTATION STRATEGY. THROUGH THIS PROCESS, GRAND ITASCA AIMS TO: -UNDERSTAND THE HEALTH STATUS AND NEEDS OF THE COMMUNITY IT SERVES BY ANALYZING CURRENT DEMOGRAPHICS, HEALTH DATA, AND BY COLLECTING DIRECT INPUT FROM COMMUNITY MEMBERS AND ORGANIZATIONS. -IDENTIFY THE STRENGTHS, ASSETS, AND RESOURCES AVAILABLE IN THE COMMUNITY TO SUPPORT HEALTH AND WELL-BEING. -ADDRESS SIGNIFICANT HEALTH NEEDS THROUGH PARTNERSHIPS WITH COMMUNITY MEMBERS AND ORGANIZATIONS, PUBLIC HEALTH AGENCIES, AND OTHER HOSPITALS AND HEALTH SYSTEMS. -CREATE A STRATEGIC IMPLEMENTATION PLAN REFLECTIVE OF THE DATA COLLECTED THROUGH THE CHNA PROCESS. -INFORM GRAND ITASCA'S COMMUNITY BENEFIT ACTIVITIES. GRAND ITASCA CLINIC & HOSPITAL COMMUNITY HEALTH STEERING COMMITTEE -BETSY JOHNSON, HEALTH AND NUTRITION EDUCATOR, UNIVERSITY OF MINNESOTA EXTENSION -CASSI CHRZANOWSKI, MARKETING AND COMMUNICATIONS MANAGER, GRAND ITASCA CLINIC & HOSPITAL -DAN SOULAR, MD, VPMA AND FAMILY MEDICINE PHYSICIAN, GRAND ITASCA CLINIC & HOSPITAL -JACI DAVID, PUBLIC POLICY PROGRAM OFFICER, BLANDIN FOUNDATION -JEAN MACDONELL, VP, CLINIC SERVICES AND COMPLIANCE, GRAND ITASCA CLINIC & HOSPITAL -JONI OLSON, SUPERINTENDENT, INDEPENDENT SCHOOL DISTRICT 318 -KELLY CHANDLER, PUBLIC HEALTH DIVISION MANAGER, ITASCA COUNTY PUBLIC HEALTH -KELLY KIRWIN, COMMUNITY RELATIONS AND FOUNDATION DIRECTOR, GRAND ITASCA CLINIC & HOSPITAL -KRIS BOLIN, DIRECTOR OF HEALTHY LIVING, ITASCA COUNTY FAMILY YMCA -MELANIE DEBAY, COMMUNITY EDUCATION DIRECTOR, INDEPENDENT SCHOOL DISTRICT 318 -MICHELLE INGLE, EDUCATION DIRECTOR, KOOTASCA COMMUNITY ACTION -MOLLY MCCANN, SHIP COORDINATOR, ITASCA COUNTY PUBLIC HEALTH AND GET FIT ITASCA -RENEE BYMARK, EXECUTIVE DIRECTOR, ELDERCIRCLE -SARA CITRINE, COMMUNITY HEALTH WORKER, KIESLER WELLNESS CENTER -SARAH BRUBAKER, COMMUNITY HEALTH WORKER, KIESLER WELLNESS CENTER -STEVE LONEY, DIRECTOR, KIESLER WELLNESS CENTER -TONI YOUNGDAHL, MD, FAMILY MEDICINE PHYSICIAN, GRAND ITASCA CLINIC & HOSPITAL |
| FACILITY 1, GRAND ITASCA CLINIC AND HOSPITAL - PART V, LINE 11 | A REVIEW OF CURRENT COMMUNITY BENEFIT PROGRAMS FOUND THAT THE HOSPITAL IS MEETING EXISTING COMMUNITY NEEDS THROUGH PROVISION OF CHARITY CARE, MEDICAID SERVICES, ON THE JOB TRAINING PROGRAMS, COMMUNITY HEALTH FAIRS, TELECARE, A TELEPHONE CHECK-IN PROGRAM, FUNDING FOR TRANSPORTATION FOR LOW-INCOME INDIVIDUALS, FINANCIAL SUPPORT FOR PROGRAMS AT NORMANDALE CENTER FOR HEALING AND WHOLENESS AND EDUCATIONAL PROGRAMS. THESE ACTIVITIES WERE DETERMINED TO BE VALUABLE PRIORITIES FOR THE HOSPITALS IMPLEMENTATION STRATEGY. THE MEDICAL CENTER IDENTIFIED PROGRAMMING TO ADDRESS THE IDENTIFIED PRIORITY NEEDS. EACH SELECTED PROGRAM IS EVALUATED ON AN ANNUAL BASIS AGAINST PROGRAM SPECIFIC ANTICIPATED IMPACTS. AS PART OF THE EVALUATION PROCESS EACH INDICATOR IS ASSIGNED A VALUE OF "GREEN- OR "RED" BASED UPON THE FOLLOWING CRITERIA. GREEN: MET, OR EXCEEDED ANNUAL GOALS RED: NO COMPLETION OR PARTIAL COMPLETION OF ANNUAL GOALS. HEALTHY LIFESTYLES 1.GRAND ITASCA CLINIC AND HOSPITAL IS COLLABORATED WITH FAIRVIEW'S FIVE HOSPITALS IN THE EVIDENCE-BASED LIVING WELL: CHRONIC DISEASE SELF- MANAGEMENT PROGRAM DEVELOPED BY STANFORD MEDICINE. THE FORMAT IS A WORKSHOP OF TWO-AND-A-HALF-HOURS, ONCE A WEEK, FOR SIX WEEKS, IN A COMMUNITY SETTING. EVALUATION IS BUILT INTO THE DESIGN OF THE PROGRAM AROUND THE FOLLOWING TOPICS: SELF-MANAGEMENT BEHAVIORS, SELF-EFFICACY, HEALTH STATUS, HEALTH CARE UTILIZATION AND EDUCATION. IN PARTNERSHIP WITH THE FAIRVIEW FOUNDATION, FAIRVIEW IS COMMITTED TO THE RESOURCE NEEDS AND IMPLEMENTATION OF THIS PROGRAM. THE 2018 ANTICIPATED IMPACTS FOR THE CHRONIC DISEASE SELF-MANAGEMENT PROGRAM ARE TO (1) INCREASE PARTICIPANT KNOWLEDGE OF TECHNIQUES TO DEAL WITH PROBLEMS SUCH AS FRUSTRATION, FATIGUE, PAIN AND ISOLATION, (2) INCREASE PARTICIPANT KNOWLEDGE OF APPROPRIATE EXERCISE FOR MAINTAINING AND IMPROVING STRENGTH, FLEXIBILITY, AND ENDURANCE, (3) INCREASE PARTICIPANT KNOWLEDGE OF APPROPRIATE USE OF MEDICATIONS, (4) INCREASE PARTICIPANT ABILITY TO COMMUNICATE EFFECTIVELY WITH FAMILY, FRIENDS AND HEALTH PROFESSIONALS, (5) INCREASE PARTICIPANTS DECISION-MAKING ABILITY AND (6) INCREASE PARTICIPANTS' ABILITY TO EVALUATE NEW TREATMENTS. 2018 IMPACTS: ONE WORKSHOP WAS CONDUCTED WITH 10 PARTICIPANTS. SIX OF SIX ANTICIPATED IMPACTS WERE ASSIGNED A RATING OF "GREEN" (EVALUATION FINDINGS AVAILABLE UPON REQUEST) MENTAL WELLNESS 1.GRAND ITASCA CLINIC AND HOSPITAL OFFERED THE EVIDENCE-BASED MENTAL HEALTH FIRST AID USA AND YOUTH MENTAL HEALTH FIRST AID USA PROGRAMS. PARTICIPANTS ATTEND AN EIGHT-HOUR CLASS IN WHICH THEY RECEIVE AN OVERVIEW OF THE RISK FACTORS OF COMMON MENTAL HEALTH AND SUBSTANCE ABUSE ILLNESSES AND PARTICIPATE IN ROLE-PLAYING SIMULATIONS TO LEARN HOW TO SUCCESSFULLY OFFER HELP TO THOSE IN CRISIS. EVALUATION (E.G., PARTICIPANT PRE- AND POST-TEST AND A SIX-MONTH EVALUATION) IS BUILT INTO THE DESIGN OF THE PROGRAM. IN PARTNERSHIP WITH THE FAIRVIEW FOUNDATION, FAIRVIEW IS COMMITTED TO THE RESOURCE NEEDS AND IMPLEMENTATION OF THIS PROGRAM. THE 2018 ANTICIPATED IMPACTS FOR THE MENTAL HEALTH FIRST AID PROGRAMS ARE TO (1) INCREASE KNOWLEDGE OF THE SIGNS, SYMPTOMS AND RISK FACTORS OF MENTAL ILLNESSES, (2) INCREASE KNOWLEDGE OF THE IMPACT OF MENTAL AND SUBSTANCE USE DISORDERS IN PARTICIPANTS, (3) INCREASE AWARENESS OF LOCAL RESOURCES AND WHERE TO TURN FOR HELP AND (4) BUILD CAPACITY TO ASSESS A SITUATION AND HELP AN INDIVIDUAL IN DISTRESS. 2018 IMPACTS: TWO ADULT CLASSES AND ONE YOUTH CLASS WAS HELD WITH A TOTAL OF 58 PARTICIPANTS. ALL FOUR ANTICIPATED IMPACTS WERE ASSIGNED A VALUE OF "GREEN" (EVALUATION FINDINGS AVAILABLE UPON REQUEST 2.GRAND ITASCA CLINIC AND HOSPITAL COLLABORATED WITH FAIRVIEW HEALTH SERVICES OTHER FIVE HOSPITALS AND MEDICAL CENTERS, LOCAL PUBLIC HEALTH AND HOSPITAL VENDORS ON A RETHINK YOUR DRINK, EVERY SIP COUNTS CAMPAIGN. THIS CAMPAIGN IS AN INITIATIVE TO EDUCATE COMMUNITY RESIDENTS, HOSPITAL PATIENTS, PATIENTS' FAMILIES AND EMPLOYEES ON THE HEALTH RISKS ASSOCIATED WITH DRINKING SUGAR-LOADED BEVERAGES. IN PARTNERSHIP WITH THE FAIRVIEW FOUNDATION, FAIRVIEW IS COMMITTED TO THE RESOURCE NEEDS AND IMPLEMENTATION OF THIS PROGRAM. THE 2018 ANTICIPATED IMPACTS FOR THE RETHINK YOUR DRINK, EVERY SIP COUNTS CAMPAIGN ARE TO (1) INCREASE AWARENESS OF THE RISKS ASSOCIATED WITH DRINKING SUGAR-SWEETENED BEVERAGES AMONGST COMMUNITY RESIDENTS, FAIRVIEW PATIENTS AND EMPLOYEES AND (2) REVIEW EXISTING VENDING CONTRACTS TO BRING THEM IN ALIGNMENT WITH PARTNERSHIP FOR HEALTHIER AMERICA'S GOAL OF LESS THAN 20 PERCENT OF VENDING BEVERAGES ARE SUGAR-SWEETENED. 2018 IMPACTS: ONE PRESENTATION WAS CONDUCTED WITH FIVE ATTENDEES. TWO OF TWO ANTICIPATED IMPACTS WAS ASSIGNED A RATING OF "GREEN" THE OTHER ANTICIPATED IMPACT WAS ASSIGNED A RATING OF "RED" AS NO RETHINK YOUR DRINK PRESENTATIONS WERE CONDUCTED AND MEASURED IN 2018 (EVALUATION FINDINGS AVAILABLE UPON REQUEST). THE DRUG DISPOSAL PROGRAM HELPS TO PREVENT UNNECESSARY DEATHS DUE TO ACCIDENTAL MEDICATION EXPOSURE, AND IN DIVERTING MEDICINES FROM ENTERING THE ENVIRONMENT VIA HOUSEHOLD TRASH OR FLUSHING, BY RAISING AWARENESS OF THE NEGATIVE IMPACTS OF IMPROPER DRUG DISPOSAL AND REDUCING THE AMOUNT OF UNWANTED OR UNUSED MEDICATIONS IN HOUSEHOLDS IN ITASCA COUNTY BY INSTALLING A SAFE DRUG DISPOSAL BOX IN THE GRAND ITASCA CLINIC & HOSPITAL PHARMACY. THE ANTICIPATED IMPACTS FOR THE DRUG DISPOSAL PROGRAM ARE TO: (1) INCREASE AWARENESS OF THE NEGATIVE IMPACTS ASSOCIATED WITH IMPROPER DRUG DISPOSAL INCLUDING DRUG ABUSE, ACCIDENTAL OVERDOSE AND ENVIRONMENTAL DAMAGE AMONGST COMMUNITY RESIDENTS, GRAND ITASCA PATIENTS AND EMPLOYEES (2) REDUCE THE AMOUNT OF UNWANTED OR UNUSED MEDICATIONS IN HOUSEHOLDS IN ITASCA COUNTY (3) COLLABORATE WITH ITASCA COUNTY SHERIFF DEPARTMENT TO CREATE SHARED PRACTICES AND GUIDELINES FOR ONGOING DRUG COLLECTION AND TARGETED DISPOSAL EVENTS SEMI-ANNUALLY AND AN ONGOING BASIS (4) EDUCATE PROVIDERS, PHARMACY STAFF AND INTERNS ON THE DANGERS OF IMPROPER DRUG DISPOSAL. 2018 IMPACTS: 516 POUNDS OF MEDICATION WERE DISPOSED OF IN THE DRUG DISPOSAL BOX. GRAND ITASCA CLINIC & HOSPITAL COLLABORATED WITH THE ITASCA COUNTY SHERIFF'S DEPARTMENT IN HOSTING ONE DRUG TAKE-BACK EVENT; 41 POUNDS OF MEDICATION WERE COLLECTED DURING THE TWO EVENTS. 2 OF 4 ANTICIPATED IMPACTS WAS ASSIGNED A RATING OF "GREEN" THE OTHER ANTICIPATED IMPACT WAS ASSIGNED A RATING OF "RED". ALTHOUGH THE FOLLOWING HEALTH NEEDS WERE NOT SELECTED AS PRIORITY NEEDS, GRAND ITASCA CLINIC & HOSPITAL WILL CONTINUE TO SUPPORT WORK ALIGNED WITH ADDRESSING THESE NEEDS AS APPROPRIATE PARTICULARLY WHEN DOING SO WOULD ADDRESS THE SOCIAL DETERMINANTS OF HEALTH AND/OR THE LEADING CAUSES OF PREMATURE DEATH. AFFORDABLE, HEALTHY, AND SAFE HOUSING: THIS ISSUE IS BEYOND WHAT GRAND ITASCA CLINIC & HOSPITAL RESOURCES CAN SUPPORT AT THIS TIME. ASTHMA: THIS ISSUE WILL BE ADDRESSED AS PART OF PATIENT CARE BUT FALLS OUTSIDE THE SCOPE OF THE COMMUNITY-BASED CHNA IMPLEMENTATION STRATEGY. CHRONIC LOWER RESPIRATORY DISEASE: THIS ISSUE WILL BE ADDRESSED AS PART OF PATIENT CARE BUT FALLS OUTSIDE THE SCOPE OF THE COMMUNITY-BASED CHNA IMPLEMENTATION STRATEGY. CLINIC HOURS: THIS ISSUE WILL BE ADDRESSED AS PART OF PATIENT CARE BUT FALLS OUTSIDE THE SCOPE OF THE COMMUNITY-BASED CHNA IMPLEMENTATION STRATEGY. COST ASSOCIATED WITH CARE: THIS ISSUE WILL BE ADDRESSED AS PART OF PATIENT CARE BUT FALLS OUTSIDE THE SCOPE OF THE COMMUNITY-BASED CHNA IMPLEMENTATION STRATEGY. PATIENT ADVOCATE/NAVIGATOR: THIS ISSUE WILL BE ADDRESSED AS PART OF PATIENT CARE BUT FALLS OUTSIDE THE SCOPE OF THE COMMUNITY-BASED CHNA IMPLEMENTATION STRATEGY. STROKE: THIS ISSUE WILL BE ADDRESSED AS PART OF PATIENT CARE BUT FALLS OUTSIDE THE SCOPE OF THE COMMUNITY-BASED CHNA IMPLEMENTATION STRATEGY. TRANSPORTATION: THIS ISSUE IS BEYOND WHAT GRAND ITASCA CLINIC & HOSPITAL RESOURCES CAN SUPPORT AT THIS TIME. WAIT TIMES TO APPOINTMENT DATE: THIS ISSUE WILL BE ADDRESSED AS PART OF PATIENT CARE BUT FALLS OUTSIDE THE SCOPE OF THE COMMUNITY-BASED CHNA IMPLEMENTATION STRATEGY. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAND ITASCA PROFESSIONAL BUILDING | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 SE 3RD STREET | AddressLine1Txt |
| City | GRAND RAPIDS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55744 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | VARIOUS OUTPATIENT & BUSINESS SERVICES | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C - OTHER INCOME BASED CRITERIA FOR FREE OR DISCOUNTED CARE | PATIENTS THAT ARE ELIGIBLE FOR THE ORGANIZATION'S COMMUNITY CARE PROGRAM OR OTHER CHARITY CARE PLANS MAY RECEIVE A REDUCTION ON AMOUNTS OWED OR UP TO 100% OF TOTAL CHARGES. THE ORGANIZATION INFORMS PATIENTS ABOUT THE COMMUNITY CARE PROGRAM PRIOR TO DELIVERY OF SERVICES IF FEASIBLE AND AS APPROPRIATE AND DURING THE BILLING PROCESS. UNINSURED PATIENTS WITH HOUSEHOLD INCOME UP TO 150% OF THE FEDERAL POVERTY LEVEL QUALIFY FOR A 100% DISCOUNT OF THE TOTAL CHARGES. UNINSURED PATIENTS WITH A HOUSEHOLD INCOME GREATER THAN 300% OF THE FEDERAL POVERTY LEVEL AND BELOW 125,000 ARE CHARGED A DISCOUNT RATE EQUAL TO THE RATE FROM HOSPITAL'S HIGHEST VOLUME PRIVATE PAYOR CONTRACT. |
| PART I, LINE 7, COLUMN (F) - EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE | THERE IS NO BAD DEBT EXPENSE INCLUDED IN FORM 990 PART IX AS AN EXPENSE. DUE TO THE ADOPTION OF NEW GAAP REPORTING, THE BAD DEBT EXPENSE HAS BEEN INCLUDED WITH "DISCOUNTS" NETTED AGAINST PATIENT SERVICE REVENUE ON PART VIII OF FORM 990. |
| PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION | THE AMOUNTS REPORTED ON FORM 990, SCHEDULE H, PART I, LINE 7A THROUGH 7C WERE DETERMINED USING THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 IN THE SCHEDULE H, FORM 990 INSTRUCTIONS. FORM 990, SCHEDULE H, PART I, LINES 7E THROUGH 7J ARE REPORTED AT CHARGES AS RECORDED BY THE ORGANIZATION. |
| PART II - COMMUNITY BUILDING ACTIVITIES | GRAND ITASCA'S COMMUNITY BUILDING ACTIVITIES PROMOTE THE HEALTH OF THE COMMUNITIES IT SERVES BY PROVIDING INNOVATIVE AND ADVANCED MEDICAL SERVICES, WITH HIGH-QUALITY, SEAMLESS PATIENT CARE IN MIND. GRAND ITASCA'S INTERPRETATION AND ED PATIENT TAXI CAB SERVICES ALLOW FOR THE CARE OF EACH AND EVERY PATIENT, NO MATTER THE INITIAL BARRIERS OR HARDSHIPS THAT MAY EXIST. THE NURSE ON-LINE PROGRAM, BY PROVIDING A 24 HOUR MEDICAL ADVICE HOTLINE, EMPOWERS PATIENTS TO MAKE EDUCATED DECISIONS ABOUT THEIR MEDICAL TREATMENT. TRIAGE CAN BE COMPLETED PRIOR TO A PATIENT'S ARRIVAL, ALLOWING MEDICAL RESOURCES TO BE ALLOCATED MORE EFFICIENTLY AND EFFECTIVELY. |
| PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY | THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. THERE IS NO BAD DEBT EXPENSE INCLUDED IN FORM 990 PART IX AS AN EXPENSE. DUE TO THE ADOPTION OF NEW GAAP REPORTING, THE BAD DEBT EXPENSE HAS BEEN INCLUDED WITH "DISCOUNTS" NETTED AGAINST PATIENT SERVICE REVENUE ON PART VIII OF FORM 990. |
| PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCE | THE BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS THAT MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. |
| BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS | CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE. SEE NOTE 6 OF THE AUDITED FINANCIAL STATEMENTS FOR ADDITIONAL INFORMATION. |
| PART III, LINE 8 - MEDICARE EXPLANATION | IT IS PART OF THE ORGANIZATION'S MISSION THAT COMMUNITY BENEFIT ACTIVITY IS CARRIED OUT BY STAFF/LEADERSHIP AT EACH FACILITY BASED ON THE HEALTH CARE NEEDS IN THAT SERVICE AREA. THE MEDICARE COST TO CHARGE RATIO REPORTING IS CALCULATED SERVICE LINE BY SERVICE LINE. OTHER EXPENSES ARE CALCULATED USING THE OVERALL COST TO CHARGE RATIO. UNCOMPENSATED COSTS RESULTING FROM MEDICARE, MEDICAID AND STATE AND LOCAL INDIGENT CARE PROGRAMS ARE CONSIDERED A COMMUNITY BENEFIT BECAUSE OF THE SIGNIFICANT DIFFERENCES BETWEEN ACTUAL COSTS AND REIMBURSEMENT. |
| PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION | AFTER OUR PATIENTS HAVE RECEIVED SERVICES, IT IS THE POLICY OF THE ORGANIZATION TO BILL PATIENTS AND THEIR APPLICABLE PAYORS ON A TIMELY AND ACCURATE BASIS. DURING THIS BILLING AND COLLECTION PROCESS, STAFF IS COMMITTED TO PROVIDING QUALITY CUSTOMER SERVICE AND TIMELY FOLLOW UP ON ALL OUTSTANDING ACCOUNTS. BILLING: IT IS THE GOAL OF THE ORGANIZATION TO BILL ALL CLAIMS ACCURATELY AND ON A TIMELY BASIS. ALTHOUGH DEPENDENT ON INFORMATION AND COMMUNICATIONS FROM PATIENTS AND PAYORS, THE ORGANIZATION WILL PROVIDE SUFFICIENT FOLLOW UP SERVICE TO ENSURE THAT PATIENTS RECEIVE ACCURATE ACCOUNT AND BILLING INFORMATION AND HAVE THE OPPORTUNITY TO MAKE PAYMENT AND/OR APPLY FOR COMMUNITY CARE. THE ORGANIZATION HAS AGREED TO CERTAIN BILLING AND COLLECTION PRACTICES BY AN AGREEMENT WITH THE MINNESOTA ATTORNEY GENERAL'S OFFICE. THERE ARE FINANCIAL COUNSELORS AT EVERY ENTITY MONDAY THROUGH FRIDAY WHO INTERACT WITH THE PATIENTS IN PERSON AND OVER THE PHONE TO INFORM OF PROGRAMS AVAILABLE TO THEM AS WELL AS ASSIST THEM IN APPLYING FOR THE PROGRAMS. THE INFORMATION ABOUT NEEDING ASSISTANCE WITH PAYING THE BILL IS POSTED ON SIGNS IN THE HOSPITALS AND MATERIALS ARE DISTRIBUTED TO SELF-PAY PATIENTS BY REGISTRATION STAFF. THE STATEMENTS SENT OUT AFTER THE VISIT PROVIDE THIS INFORMATION AS WELL. IF A PATIENT/FAMILY MEMBER CALLS THE CENTRAL BUSINESS OFFICE CUSTOMER SERVICE STAFF TO ASK FOR ASSISTANCE WITH PAYING THEIR BILL, THEY ARE INFORMED ABOUT OPTIONS AT THAT TIME. THE ORGANIZATION PROVIDES AN INTERPRETER SERVICE THAT INTERPRETS CONVERSATIONS OVER THE PHONE. THIS SERVICE CAN BE USED EITHER AS A THREE-WAY PHONE CALL OR THE FINANCIAL COUNSELOR, IN A ROOM WITH THE PATIENT OR FAMILY CAN PLACE THE CALL TOGETHER TO THE INTERPRETER PHONE SERVICE. THE INTERPRETER SERVICES LINE ACCOMMODATES CLOSE TO 200 LANGUAGES. THE BILLING PROCESS WILL BE ASSISTED BY THE FOLLOWING GUIDELINES: 1) FOR ALL INSURED PATIENTS, THE ORGANIZATION WILL BILL ALL THIRD PARTY PAYOR INFORMATION (AS PROVIDED BY OR VERIFIED BY THE PATIENT) ON A TIMELY AND ACCURATE BASIS. 2) FOR ALL UNINSURED PATIENTS WITH MINNESOTA RESIDENCY RECEIVING HOSPITAL BASED SERVICES DEEMED MEDICALLY NECESSARY. THE ORGANIZATION WILL APPLY AN UNINSURED DISCOUNT EQUAL TO THE DISCOUNT PROVIDER TO OUR LARGEST CONTRACTED NON-GOVERNMENT PAYOR, ANY REMAINING BALANCE WILL BE BILLED TO THE PATIENT IN A TIMELY AND MANNER. 3) ALL BILLED PATIENTS HAVE THE OPPORTUNITY TO CONTACT THE ORGANIZATION REGARDING FINANCIAL ASSISTANCE FOR THEIR ACCOUNTS. FINANCIAL ASSISTANCE MAY INCLUDE COMMUNITY CARE, PAYMENT ARRANGEMENTS, MEDICAL ASSISTANCE OR OTHER APPLICABLE PROGRAMS. 4) IF A PATIENT CONTACTS THE ORGANIZATION REGARDING COMMUNITY CARE BEFORE THE ACCOUNT IS REFERRED TO A COLLECTION AGENCY OR ATTORNEY, AN APPLICATION AND REQUIRED DOCUMENTATION IS REQUESTED (INCOME VERIFICATION ETC.), THE ACCOUNT WILL THEN BE PROCESSED BASED ON THE OUTCOME OF THE COMMUNITY CARE DETERMINATION. 5) THE ORGANIZATION TAKES REASONABLE MEASURES TO AVOID REFERRING AN ACCOUNT TO COLLECTION UNLESS THERE ARE NO RESPONSES FROM THE PATIENT. IF A PATIENT CONTACTS THE ORGANIZATION REGARDING COMMUNITY CARE AFTER THEIR ACCOUNT HAS BEEN REFERRED TO A COLLECTION AGENCY OR ATTORNEY, THE ORGANIZATION WILL SEND AN APPLICATION TO THE PATIENT PROVIDED THE ACCOUNT MEETS THE COMMUNITY CARE REQUIREMENTS. IF THE COMPLETED APPLICATION ALONG WITH REQUIRED DOCUMENTATION (INCOME VERIFICATION, ETC.) IS SUBMITTED, ALL COLLECTION ACTION WILL BE SUSPENDED UNTIL THE PATIENT IS NOTIFIED OF THE ORGANIZATION'S DETERMINATION. |
| PART VI, LINE 2 - NEEDS ASSESSMENT | GRAND ITASCA REVIEWS APPLICABLE STATE AND COUNTY SURVEYS PERFORMED BY OTHER AGENCIES TO ASSESS THE NEEDS OF THE COMMUNITY. GRAND ITASCA WORKS WITH THESE AGENCIES TO PROVIDE THESE SERVICES WITHIN THE SCOPE OF THE MEDICAL FACILITY. |
| PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | GRAND ITASCA HAS FINANCIAL ADVOCATES WORKING WITH UNINSURED PATIENTS TO ASSIST THEM IN COMPLETING APPLICATION FOR VARIOUS PROGRAMS THAT MAY PROVIDE THEM COVERAGE FOR MEDICAL SERVICES. |
| PART VI, LINE 4 - COMMUNITY INFORMATION | GRAND ITASCA SERVES THE PEOPLE OF GRAND RAPIDS AND THE SURROUNDING COMMUNITIES THROUGHOUT ITASCA COUNTY. THE COMMUNITY INCLUDES 15 ZIP CODES WHERE APPROXIMATELY 80 PERCENT OF ITS PATIENTS LIVE, THE CITY WHERE THE HOSPITAL RESIDES, GRAND RAPIDS, MN, AND THE COUNTY WHERE THE HOSPITAL RESIDES, ITASCA COUNTY. NINETY-FOUR PERCENT OF GRAND ITASCA EMPLOYEES LIVE WITHIN THE DEFINED COMMUNITY. |
| PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH | GRAND ITASCA PROMOTES HEALTH IN THE COMMUNITY BY SUPPORTING THE LOCAL FREE CLINIC, THROUGH THE PROVISION OF MEDICAL SUPPLIES, BASIC LAB TEST AND BASIC X-RAYS TO THE PATIENTS OF THIS CLINIC AT NO CHARGE. GRAND ITASCA ALSO WORKS WITH A COMMUNITY COALITION TO DETERMINE THE HEALTH NEEDS OF THE COMMUNITY SERVED BY GRAND ITASCA CLINIC & HOSPITAL. |
| PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT | MINNESOTA |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (14 entries)
| TitleTitleTxt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|---|---|---|---|---|---|
| M OSMAN AKHTAR | |||||||||
| DIR/COO END 8-2018 | $615,779 | $137,298 | $41,076 | $15,249 | $809,402 | ||||
| LAURA REED RN | |||||||||
| COO-FAIRIVEW | $599,498 | $38,901 | $43,000 | $42,201 | $723,600 | ||||
| LIZBETH THOMAS MD | |||||||||
| DIRECTOR | $412,527 | $153,819 | $43,000 | $43,689 | $653,035 | ||||
| KEVIN NELSON MD | |||||||||
| DIRECTOR | $336,525 | $71,320 | $52,709 | $42,280 | $502,834 | ||||
| DR JAMISON HARKER | |||||||||
| DIRECTOR | $292,847 | $15,900 | $27,393 | $336,140 | |||||
| JAN ROURK MD | |||||||||
| DIRECTOR | $169,917 | $7,983 | $18,377 | $196,277 | |||||
| JAMES HEREFORD | |||||||||
| PRES/CEO FAIRVIEW | $1,340,912 | $439,355 | $42,546 | $42,281 | $1,865,094 | ||||
| MICHAEL YOUSO | |||||||||
| PRESIDENT & CEO-GICH | $323,773 | $78,059 | $42,968 | $42,169 | $486,969 | ||||
| DANIEL SOULAR MD | |||||||||
| CMO-GICH | $316,274 | $15,441 | $15,339 | $347,054 | |||||
| RYAN NOVAK MD | |||||||||
| UROLOGIST MD | $726,812 | $34,945 | $22,025 | $783,782 | |||||
| TROY ERICKSON MD | |||||||||
| ORTHOPEDIC SURGEON | $476,529 | $16,445 | $2,830 | $495,804 | |||||
| SHAWN OLSON MD | |||||||||
| GENERAL SURGEON | $423,320 | $14,202 | $16,229 | $453,751 | |||||
| DEREK BEYER MD | |||||||||
| OB/GYN MD | $414,646 | $16,445 | $27,818 | $458,909 | |||||
| DARIN SKAUDIS MD | |||||||||
| INTERNAL MEDICINE MD | $407,804 | $16,445 | $22,010 | $446,259 | |||||
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE J, PAGE 1, PART I, LINE 4 | FormAndLineReferenceDesc |
| Explanation | M. OSMAN AKHTAR 0 16,569 0 | ExplanationTxt |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp (7 entries)
| Relationship With OrgRelationshipWithOrgTxt | Loan From OrganizationLoanFromOrganizationInd | Original PrincipalOriginalPrincipalAmt | Balance DueBalanceDueAmt | DefaultDefaultInd | Board Or Committee ApprovalBoardOrCommitteeApprovalInd | Written AgreementWrittenAgreementInd | Loan PurposeLoanPurposeTxt |
|---|---|---|---|---|---|---|---|
| DR SCOTT JOHNSON | |||||||
| EMPLOYEE | Yes (X) | $50,000 | $42,949 | false | Yes (true) | Yes (true) | |
| DR KATHRYN JOHNSON | |||||||
| EMPLOYEE | Yes (X) | $50,000 | $27,438 | false | Yes (true) | Yes (true) | COMPENSATION PACKAGE |
| DR SHAWN OLSON | |||||||
| EMPLOYEE | Yes (X) | $50,000 | $27,438 | false | Yes (true) | Yes (true) | COMPENSATION PACKAGE |
| DR OGECHUKWU ADEKWEH | |||||||
| EMPLOYEE | Yes (X) | $30,000 | $26,616 | false | Yes (true) | Yes (true) | COMPENSATION PACKAGE |
| DR JAY SONDER | |||||||
| EMPLOYEE | Yes (X) | $20,000 | $16,334 | false | Yes (true) | Yes (true) | COMPENSATION PACKAGE |
| DR RYAN NOVAK | |||||||
| EMPLOYEE | Yes (X) | $100,000 | $12,357 | false | Yes (true) | Yes (true) | COMPENSATION PACKAGE |
| DR ERIC WARNE | |||||||
| EMPLOYEE | Yes (X) | $5,000 | $2,684 | false | Yes (true) | Yes (true) | COMPENSATION PACKAGE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $155,816 | TotalBalanceDueAmt |
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DR SHANNON R HARKER | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | WIFE OF DIRECTO | RelationshipDescriptionTxt |
| Transaction | $193,374 | TransactionAmt |
| Transaction | COMPENSATION | TransactionDesc |
| Sharing Of Revenues | false | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 2, PART III, LINE 4A | GRAND ITASCA CLINIC AND HOSPITAL IS AN INTEGRATED MULTI-SPECIALTY CLINIC AND ACUTE-SURGICAL HOSPITAL. THE FACILITY IS LICENSED FOR 64 BEDS WHICH ARE COMPRISED OF 48 MEDICAL BEDS, 10 INTENSIVE CARE BEDS AND 6 OB BEDS. IN ADDITION TO PROVIDING TRADITIONAL HOSPITAL SERVICES, THE FACILITY HAS FOUR SURGERY SITES, A 24-HOUR EMERGENCY DEPARTMENT, OUTPATIENT MENTAL HEALTH SERVICES, OUTPATIENT REHABILITATION SERVICES, AND OUTPATIENT CLINIC SERVICES. THE FACILITY EMPLOYS APPROXIMATELY 750 PEOPLE INCLUDING OVER 60 HEALTHCARE PROVIDERS. THE FACILITY SERVED OVER 1,700 INPATIENTS AND OVER 200,000 OUTPATIENT ENCOUNTERS INCLUDING CLINIC, EMERGENCY ROOM, OUTPATIENT IMAGING AND OUTPATIENT SURGICAL PROCEDURE. GRAND ITASCA SERVES THE PATIENT REGARDLESS OF THE PERSON'S ABILITY TO PAY. DURING THE CALENDAR YEAR, THE FACILITY PROVIDED 643,364 OF CHARITY CARE, 55,454 OF DISCOUNTS TO THE UNINSURED AND ABSORBED 15,188,129 OF UNPAID MEDICARE AND MEDICAID COSTS. GRAND ITASCA ALSO PAID 1,587,260 IN PAYMENTS FOR MINNESOTA CARE TAX AND MEDICAID SURCHARGES, WHICH WERE USED TO FUND CARE FOR THE INDIGENT AND UNDERINSURED. |
| FORM 990, PART V | LINE 1A: GRAND ITASCA CLINIC AND HOSPITAL WAS INTEGRATED INTO THE FAIRVIEW HEALTH SERVICES FAMILY IN 2017. FAIRVIEW HEALTH SERVICES IS A TAX-EXEMPT, NON- PROFIT 501(C)(3) ORGANIZATION. AS PART OF THIS COMBINATION, THE ACCOUNTS PAYABLE FORM 1099 PROCESSING WAS TRANSITIONED TO FAIRVIEW HEALTH SERVICES DURING 2018. THE NUMBER OF FORM 1099'S REPORTED ON THIS TAX RETURN REFLECT ONLY WHAT GRAND ITASCA CLINIC AND HOSPITAL PROCESSED IN 2018 BEFORE TRANSITIONING ALL ACCOUNTS PAYABLE ACTIVITY AND FORM 1099 PROCESSING TO FAIRVIEW HEALTH SERVICES. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE TAX DEPARTMENT CONDUCTS A DETAILED REVIEW OF THE COMPLETED RETURN. THE FORM 990 IS THEN REVIEWED BY THE GRAND ITASCA DIRECTOR OF FINANCE AND A COPY IS PROVIDED TO THE FINANCE COMMITTEE AND BOARD OF DIRECTORS FOR APPROVAL PRIOR TO FILING THE RETURN WITH THE IRS. |
| FORM 990, PAGE 6, PART VI, LINE 12C | BOARD MEMBERS SIGN THE CONFLICT OF INTEREST POLICY ANNUALLY. |
| FORM 990, PAGE 6, PART VI, LINE 15A | COMPENSATION IS DETERMINED BY ASSESSING THE MARKET THROUGH THE USE OF SURVEYS AND STUDIES AND DETERMINING PAY RATES AND RANGES FROM THE RESULTS OF THE ASSESSMENT. THE CEO COMPENSATION PACKAGE IS SUMMARIZED IN AN EMPLOYMENT AGREEMENT THAT IS APPROVED BY THE BOARD. THE COMPENSATION PACKAGE IS BASED UPON MARKET FOR THE POSITION. |
| FORM 990, PAGE 6, PART VI, LINE 15B | COMPENSATION IS DETERMINED BY ASSESSING THE MARKET THROUGH THE USE OF SURVEYS AND STUDIES AND DETERMINING PAY RATES AND RANGES FROM THE RESULTS OF THE ASSESSMENT. THE CEO COMPENSATION PACKAGE IS SUMMARIZED IN AN EMPLOYMENT AGREEMENT THAT IS APPROVED BY THE BOARD. THE COMPENSATION PACKAGE IS BASED UPON MARKET FOR THE POSITION. |
| FORM 990, PAGE 6, PART VI, LINE 19 | FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D). |
| FORM 990, PART XI, LINE 9 | RESTRICTED FUNDS 1,632,834 OTHER FUND BALANCE ADJUSTMENTS 1,585,052 TOTAL 3,217,886 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Business Name Line2DirectControllingEntityName/BusinessNameLine2Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| FAIRVIEW HEALTH SERVICES | ||||||||||||
| 2450 RIVERSIDE AVENUE | MINNEAPOLIS | MN | 55454 | 410991680 | HOSPITAL | MN | 501C3 | 3 | N/A | false | ||
| GRAND ITASCA FOUNDATION | ||||||||||||
| 1601 GOLF COURSE ROAD | GRAND RAPIDS | MN | 55744 | 411560554 | FOUNDATION | MN | 501C3 | 12A | Yes (true) | GICH | GRAND ITASCA CLINIC & HOSPITSL | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CDI GRAND RAPIDS LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1601 GOLF COURSE ROAD | AddressLine1Txt |
| City | GRAND ITASCA | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55744 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 453783014 | EIN |
| Primary Activities | IMAGING SE | PrimaryActivitiesTxt |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Predominant Income Type | RELATED | PredominantIncomeTypeTxt |
| Disproportionate Allocations | Yes (true) | DisproportionateAllocationsInd |
| General Or Managing Partner | Yes (true) | GeneralOrManagingPartnerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| FAIRVIEW HEALTH SERVICES | ||
| R | $16,567,504 | COST |
| GRAND ITASCA FOUNDATION | ||
| C | $1,632,834 | ACTUAL |