GRAND ITASCA CLINIC AND HOSPITAL: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- GRAND ITASCA CLINIC AND HOSPITAL (EIN 41-1865874)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-15
- IRS object ID
- 201713199349311621
- Schema version
- 2016v3.0
- 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 | 2017-11-15T14:19:13-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 420714325 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RSM US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 801 NICOLLET MALL SUITE 1100 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | 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 | MIKE YOUSO | PersonNm |
| Person Title | PRESIDENT & CEO | PersonTitleTxt |
| Phone | 2183265000 | PhoneNum |
| Signature | 2017-11-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | TODD A JACKSON | PreparerPersonNm |
| PTIN | P00092672 | PTIN |
| Phone | 6123324300 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 108.171.131.188 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-11-15 | IPDt |
| IP Tm | 08:17:59 | IPTm |
| IP Timezone | CS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 01563F10D6676BDC9B96404AA3206AA292B808E6 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 5AB5DFEC54AF030231DDAA57F2AFD57D98013E0B | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MICHAEL YOUSO | PrincipalOfficerNm |
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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $85,774,726 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | 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 | PATIENT-CENTERED EXCELLENCE | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 740 | TotalEmployeeCnt |
| Total Volunteers | 102 | TotalVolunteersCnt |
| Total Gross UBI | $138,073 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $200,569 | PYContributionsGrantsAmt |
| CY Contributions Grants | $197,725 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $74,970,564 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $84,630,600 | CYProgramServiceRevenueAmt |
| PY Investment Income | $30,351 | PYInvestmentIncomeAmt |
| CY Investment Income | $138,968 | CYInvestmentIncomeAmt |
| PY Other Revenue | $841,987 | PYOtherRevenueAmt |
| CY Other Revenue | $802,594 | CYOtherRevenueAmt |
| PY Total Revenue | $76,043,471 | PYTotalRevenueAmt |
| CY Total Revenue | $85,769,887 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $11,507 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $50,679,378 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $50,284,997 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $372,155 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $33,985,828 | PYOtherExpensesAmt |
| CY Other Expenses | $36,840,878 | CYOtherExpensesAmt |
| PY Total Expenses | $84,665,206 | PYTotalExpensesAmt |
| CY Total Expenses | $87,137,382 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$8,621,735 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,367,495 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $77,400,313 | TotalAssetsBOYAmt |
| Total Assets EOY | $73,983,492 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $47,963,640 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $45,181,353 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $29,436,673 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $28,802,139 | 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 | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $71,555,911 | ExpenseAmt |
| Grant | $11,507 | GrantAmt |
| Revenue | $85,245,800 | 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 SUITES, A 24-HOUR EMERGENCY DEPARTMENT, OUTPATIENT MENTAL HEALTH SERVICES, OUTPATIENT REHABILITATION SERVICES, AND OUTPATIENT CLINIC SERVICES. THE FACILITY EMPLOYS APPROXIMATELY 539 PEOPLE INCLUDING 61 HEALTHCARE PROVIDERS.THE FACILITY SERVED APPROXIMATELY 1,647 INPATIENTS AND APPROXIMATELY 206,147 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 $416,756 OF CHARITY CARE, $528,889 DISCOUNT TO THE UNINSURED AND ABSORBED $13,007,587 OF UNPAID MEDICARE AND MEDICAID COSTS. GRAND ITASCA CLINIC AND HOSPITAL ALSO PROVIDES OTHER SUPPORT TO THE COMMUNITY THROUGH CASH AND IN-KIND DONATIONS THAT TOTALED $11,507 IN 2016 CALENDAR YEAR. IN ADDITION, GRAND ITASCA PROVIDED HEALTHCARE SUPPORT SERVICES OF $20,586 INCLUDING PATIENT TRANSPORTATION. GRAND ITASCA ALSO PAID $1,281,164 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 | $71,555,911 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | Yes (1) | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 49 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 740 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (1) | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TODD CHRISTENSON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| ELIZABETH MISKOVICH | ||||||||
| CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| COLLEEN NARDONE | ||||||||
| VICE CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| DALE ADAMS | ||||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JOSH SKELTON | ||||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| BETH BILY | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JANICE M ROURK MD | ||||||||
| DIRECTOR/PEDIATRIC MD | 40.00 | Yes (X) | $159,027 | $0 | $39,724 | 1.00 | ||
| JAMISON L HARKER MD | ||||||||
| DIRECTOR/INTERNAL MEDICINE MD | 40.00 | Yes (X) | $242,866 | $0 | $51,000 | 1.00 | ||
| STEVE BURGGRAF | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| KENT KOERBITZ | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JAMIE LEMKE | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| DENNY ROY | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| ANDY SHERMOEN | ||||||||
| DIRECTOR/FOUNDATION REP | 1.00 | Yes (X) | $0 | $0 | $0 | 1.00 | ||
| MICHAEL J YOUSO | ||||||||
| PRESIDENT & CEO | 40.00 | Yes (X) | $328,425 | $0 | $54,848 | |||
| DEBRA M NYQUIST | ||||||||
| CHIEF MEDICAL OFFICER | 40.00 | Yes (X) | $310,138 | $0 | $35,836 | |||
| COREY SMITH | ||||||||
| CONTROLLER | 40.00 | Yes (X) | $71,195 | $0 | $4,257 | |||
| EDWARD A TUSA | ||||||||
| VP FINANCE | 40.00 | Yes (X) | $53,466 | $0 | $11,594 | |||
| KURT W POSSAI | ||||||||
| ORTHOPEDIC SURGEION | 40.00 | $603,055 | $0 | $52,024 | Yes (X) | |||
| RYAN T NOVAK | ||||||||
| UROLOGIST MD | 40.00 | $589,962 | $0 | $52,024 | Yes (X) | |||
| TROY D ERICKSON | ||||||||
| ORTHOPEDIC SURGEON | 40.00 | $537,000 | $0 | $44,848 | Yes (X) | |||
| DEREK A BEYER | ||||||||
| OB/GYN MD CLINIC | 40.00 | $415,464 | $0 | $48,049 | Yes (X) | |||
| JOHN A KOLE | ||||||||
| OB/GYN MD CLINIC | 40.00 | $403,336 | $0 | $44,848 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,713,934 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $439,052 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 66 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| ALLINA HEALTH SYSTEM | |||||
| NW 7710 PO BOX 9383 | MINNEAPOLIS | MN | 55440 | IT/LAB SERVICES | $2,174,785 |
| WEATHERBY LOCUMS INC | |||||
| PO BOX 972633 | DALLAS | TX | 75397 | MEDICAL SERVICES | $497,146 |
| SOJOURN PATHOLOGY SERVICES | |||||
| 35328 COUNTY RD 63 | COHASSET | MN | 55721 | MEDICAL SERVICES | $339,000 |
| INFOR INC | |||||
| NW 7418 PO BOX 1450 | MINNEAPOLIS | MN | 55485 | IT SERVICES | $251,522 |
| SISU HEALTHCARE IT SOLUTIONS | |||||
| 5 WEST FIRST ST SUITE 200 | DULUTH | MN | 55802 | LAUNDRY SERVICES | $243,401 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 15 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $108,700 | RelatedOrganizationsAmt |
| All Other Contributions | $89,025 | AllOtherContributionsAmt |
| Total Contributions | $197,725 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| PATIENTS AND RESIDENT SERVICES | 621110 | $80,118,466 | $80,118,466 | |
| OTHER REVENUE | 621110 | $1,322,080 | $1,322,080 | |
| PHARMACY REVENUE | 621110 | $1,252,470 | $1,114,397 | $138,073 |
| MEANINGFUL USE REVENUE | 621110 | $972,960 | $972,960 | |
| REIMBURSED EXPENSES | 621110 | $964,624 | $964,624 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $84,630,600 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $143,507 | TotalRevenueColumnAmt |
| Exclusion | $143,507 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $300 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $4,839 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$4,539 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$4,539 | TotalRevenueColumnAmt |
| Exclusion | -$4,539 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| CDI PARTNERSHIP REVENUE | 621110 | $753,273 | $753,273 | |
| PURCHASE DISCOUNTS | 621110 | $49,321 | $49,321 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $802,594 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $85,769,887 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $85,245,800 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $138,073 | UnrelatedBusinessRevenueAmt |
| Exclusion | $188,289 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,507 | TotalAmt |
| Program Services | $11,507 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,371,205 | TotalAmt |
| Program Services | $1,114,519 | ProgramServicesAmt |
| Management And General | $250,555 | ManagementAndGeneralAmt |
| Fundraising | $6,131 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,410,094 | TotalAmt |
| Program Services | $32,845,433 | ProgramServicesAmt |
| Management And General | $7,383,980 | ManagementAndGeneralAmt |
| Fundraising | $180,681 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,009,050 | TotalAmt |
| Program Services | $1,632,961 | ProgramServicesAmt |
| Management And General | $367,106 | ManagementAndGeneralAmt |
| Fundraising | $8,983 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,568,791 | TotalAmt |
| Program Services | $2,900,723 | ProgramServicesAmt |
| Management And General | $652,111 | ManagementAndGeneralAmt |
| Fundraising | $15,957 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,925,857 | TotalAmt |
| Program Services | $2,378,144 | ProgramServicesAmt |
| Management And General | $534,631 | ManagementAndGeneralAmt |
| Fundraising | $13,082 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $186,053 | TotalAmt |
| Program Services | $151,224 | ProgramServicesAmt |
| Management And General | $33,997 | ManagementAndGeneralAmt |
| Fundraising | $832 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $206,474 | TotalAmt |
| Program Services | $167,823 | ProgramServicesAmt |
| Management And General | $37,728 | ManagementAndGeneralAmt |
| Fundraising | $923 | FundraisingAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $313 | TotalAmt |
| Management And General | $313 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,231,082 | TotalAmt |
| Program Services | $3,439,035 | ProgramServicesAmt |
| Management And General | $773,129 | ManagementAndGeneralAmt |
| Fundraising | $18,918 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $176,138 | TotalAmt |
| Program Services | $142,574 | ProgramServicesAmt |
| Management And General | $32,762 | ManagementAndGeneralAmt |
| Fundraising | $802 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,139,407 | TotalAmt |
| Program Services | $926,113 | ProgramServicesAmt |
| Management And General | $208,199 | ManagementAndGeneralAmt |
| Fundraising | $5,095 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $126,412 | TotalAmt |
| Program Services | $102,748 | ProgramServicesAmt |
| Management And General | $23,099 | ManagementAndGeneralAmt |
| Fundraising | $565 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $746,066 | TotalAmt |
| Program Services | $606,404 | ProgramServicesAmt |
| Management And General | $136,326 | ManagementAndGeneralAmt |
| Fundraising | $3,336 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $91,466 | TotalAmt |
| Program Services | $74,344 | ProgramServicesAmt |
| Management And General | $16,713 | ManagementAndGeneralAmt |
| Fundraising | $409 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,695,352 | TotalAmt |
| Program Services | $1,377,987 | ProgramServicesAmt |
| Management And General | $309,785 | ManagementAndGeneralAmt |
| Fundraising | $7,580 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,848,207 | TotalAmt |
| Program Services | $3,940,636 | ProgramServicesAmt |
| Management And General | $885,894 | ManagementAndGeneralAmt |
| Fundraising | $21,677 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $514,552 | TotalAmt |
| Program Services | $418,229 | ProgramServicesAmt |
| Management And General | $94,022 | ManagementAndGeneralAmt |
| Fundraising | $2,301 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| SUPPLIES | $14,019,211 | $11,394,852 | $2,561,676 | $62,683 |
| PROVISION FOR BAD DEBTS | $3,894,845 | $3,894,845 | ||
| REPAIRS & MAINT | $2,880,711 | $2,341,450 | $526,381 | $12,880 |
| MNCARE TAX | $754,490 | $613,252 | $137,865 | $3,373 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,330,099 | TotalAmt |
| Program Services | $1,081,108 | ProgramServicesAmt |
| Management And General | $243,044 | ManagementAndGeneralAmt |
| Fundraising | $5,947 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $87,137,382 | TotalAmt |
| Program Services | $71,555,911 | ProgramServicesAmt |
| Management And General | $15,209,316 | ManagementAndGeneralAmt |
| Fundraising | $372,155 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,497,039 | BOYAmt |
| EOY | $2,409,040 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,079,043 | BOYAmt |
| EOY | $5,100,204 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $80,293 | BOYAmt |
| EOY | $99,363 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,262,081 | BOYAmt |
| EOY | $9,389,464 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $133,226 | BOYAmt |
| EOY | $59,013 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $128,183 | BOYAmt |
| EOY | $76,412 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,243,676 | BOYAmt |
| EOY | $1,643,313 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,053,021 | BOYAmt |
| EOY | $1,117,434 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $75,662,001 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $40,587,671 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,545,744 | BOYAmt |
| EOY | $35,074,330 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,918,663 | BOYAmt |
| EOY | $11,423,039 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,459,344 | BOYAmt |
| EOY | $7,591,880 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $77,400,313 | BOYAmt |
| EOY | $73,983,492 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,836,509 | BOYAmt |
| EOY | $6,395,235 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $636,400 | BOYAmt |
| EOY | $534,676 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,046,029 | BOYAmt |
| EOY | $28,581,066 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,444,702 | BOYAmt |
| EOY | $9,670,376 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,963,640 | BOYAmt |
| EOY | $45,181,353 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,243,098 | BOYAmt |
| EOY | $28,607,227 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $193,575 | BOYAmt |
| EOY | $194,912 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,436,673 | BOYAmt |
| EOY | $28,802,139 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $77,400,313 | BOYAmt |
| EOY | $73,983,492 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,367,495 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $234,255 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $498,706 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | 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 (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | 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 | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $313 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $313 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | GICH PAYS DUES TO THE MINNESOTA HOSPITAL ASSOCIATION (MHA), A PORTION OF WHICH RELATES TO LOBBYING ACTIVITIES. FOR CALENDAR YEAR 2016, MHA HAS DETERMINED THAT 2.9% OR $313 OF ITS MEMBERSHIP DUES WERE USED FOR LOBBYING PURPOSES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $607,331 | OtherCostOrOtherBasisAmt |
| Book Value | $607,331 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $45,070,672 | OtherCostOrOtherBasisAmt |
| Depreciation | $20,090,426 | DepreciationAmt |
| Book Value | $24,980,246 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $29,353,974 | OtherCostOrOtherBasisAmt |
| Depreciation | $20,363,568 | DepreciationAmt |
| Book Value | $8,990,406 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $630,024 | OtherCostOrOtherBasisAmt |
| Depreciation | $133,677 | DepreciationAmt |
| Book Value | $496,347 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $35,074,330 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp (4 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| MUTUAL FUNDS | $5,813,418 | C |
| CERT OF DEPOSIT (TIME DEPOSITS) | $290,467 | C |
| CERT OF DEPOSIT (MARKETABLE SECURITIES) | $2,397,834 | C |
| DEFERRED COMPENSATION INVESTMENTS | $2,921,320 | C |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $11,423,039 | TotalBookValueSecuritiesAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| ASSETS LIMITED TO USE | $6,963,710 |
| CHARITABLE REMAINDER TRUST | $194,912 |
| OTHER ASSETS | $369,660 |
| CDI CONTROLLING INTEREST | $63,598 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $7,591,880 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (6 entries)
| DescDesc | AmtAmt |
|---|---|
| OTHER ACCRUALS | $395,013 |
| POST RETIREMENT BENEFIT | $2,545,266 |
| SELF INSURED WORKER'S COMP | $846,784 |
| CURRENT PORTION OF LONG TERM DEBT | $1,789,219 |
| THIRD PARTY PAYOR SETTLEMENTS | $1,172,774 |
| DEFERRED COMPENSATION OBLIGATIONS | $2,921,320 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $9,670,376 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE CORPORATION AND THE FOUNDATION HAVE REVIEWED THEIR TAX POSITIONS FOR ALL OPEN YEARS AND HAVE CONCLUDED THAT NO MATERIAL LIABILITIES EXIST AS OF DECEMBER 31, 2016 AND 2015. GENERALLY, THE CORPORATION AND THE FOUNDATION ARE NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL, STATE OR LOCAL TAX AUTHORITIES FOR YEARS PRIOR TO THE FISCAL YEAR ENDED DECEMBER 31, 2013. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $692,771 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $692,771 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00830 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $17,738,032 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,771,555 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,966,477 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05970 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $18,430,803 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,771,555 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,659,248 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06800 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,586 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $20,586 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,507 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $11,507 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $32,093 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $32,093 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $18,462,896 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,771,555 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,691,341 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06830 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $3,894,845 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $973,711 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $83,514,807 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $33,086,656 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $50,428,151 | 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 (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 CDI GRAND RAPIDS LLC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | PROVIDE MRI, DIAGNOSTIC INJECTION AND PAIN MANAGEMENT SERVICES | PrimaryActivitiesTxt |
| Org Profit Or Ownership | 0.55000 | OrgProfitOrOwnershipPct |
| Ofcr Etc Profit Or Ownership | 0.00000 | OfcrEtcProfitOrOwnershipPct |
| Physicians Profit Or Ownership | 0.00000 | PhysiciansProfitOrOwnershipPct |
| 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 |
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 |
| 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 | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | 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 |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | GRANDITASCA.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | GRANDITASCA.ORG (UNDER NEWS & EVENTS) | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | 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 (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | 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 (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | GRANDITASCA.ORG | FAPAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | 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 (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| GRAND ITASCA CLINIC AND HOSPITAL | PART V, SECTION B, LINE 5: GRAND ITASCA CLINIC AND HOSPITAL CONDUCTED THE COMMUNITY HEALTH NEEDS ASSESSMENT BY GATHERING INPUT FROM COMMUNITY PROFESSIONALS INCLUDING REPRESENTATION FROM THE COUNTY PUBLIC NURSE, YMCA, UNITED WAY, CITY OFFICIALS, LOCAL HEALTHCARE PROFESSIONALS AND REPRESENTATION FROM THE GENERAL PUBLIC. THIS INFORMATION WAS GATHERED DURING SESSIONS FACILITATED BY AN INDEPENDENT PARTY. |
| GRAND ITASCA CLINIC AND HOSPITAL | PART V, SECTION B, LINE 11: THE HOSPITAL ADOPTED AN IMPLEMENTATION PLAN IN 2016 THAT WILL BE IMPLEMENTED IN 2017 TO SUSTAIN AND DEVELOP COMMUNITY BENEFIT PROGRAMS THAT 1) ADDRESS PRIORITIZED NEEDS FROM THE 2016 CHNA AND TO RESPOND TO ADDITIONAL COMMUNITY HEALTH NEEDS.GRAND ITASCA HAS ELECTED TO TARGET THE FOLLOWING THREE IDENTIFIED HEALTH NEEDS IN THE COMMUNITY:1 - HEALTHY LIVING.2 - MENTAL WELLNESS.FOR EACH OF THE PRIORITY NEEDS IDENTIFIED ABOVE, GRAND ITASCA CLINIC AND HOSPITAL WILL WORK WITH COMMUNITY PARTNERS FOR:- THE GROWTH OF MENTAL HEALTH SERVICES IN OUR COMMUNITY THROUGH THE EXPANSION OF THE KIESLER WELLNESS CENTER, AN INNOVATIVE, STRENGTH-BASED, COMMUNITY COLLABORATIVE MENTAL HEALTH RECOVERY CENTER.- THE ALIGNMENT WITH PUBLIC HEALTH PRIORITIES AND EXISTING COLLABORATION WITH STATEWIDE HEALTH IMPROVEMENT PROGRAMS (SHIP) FOCUSED ON HEALTHY EATING, PHYSICAL ACTIVITY AND REDUCING TOBACCO USE. |
| GRAND ITASCA CLINIC AND HOSPITAL | PART V, SECTION B, LINE 20E: PATIENT RECEIVES A SERIES OF LETTERS INDICATING ACTIONS TO BE TAKEN IF PAYMENT ARRANGEMENTS ARE NOT MADE WITH THE FACILITY. |
| 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 | 1 - 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 (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7, COLUMN (F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 3,894,845. |
| 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: | AN ESTIMATE FOR BAD DEBT IS CALCULATED MONTHLY BASED ON AGED A/R DUE FROM PATIENTS TO INSURE WE HAVE AN APPROPRIATE ALLOWANCE FOR UNCOLLECTABLE ACCOUNTS. |
| PART III, LINE 3: | THE COSTING METHOD USED IS TO UTILIZE THE COST REPORT TO CAPTURE THE COST TO CHARGE RATIO. WE THEN COST OUT TOTAL BAD DEBT REPORTED AS CHARGES TO THE COST OF PROVIDING THOSE SERVICES. FROM REVIEW OF THE NUMBER OF APPLICATIONS DENIED FOR INSUFFICIENT INFORMATION WE ESTIMATE 25% OF BAD DEBT IS RELATED TO INDIVIDUALS WHO WOULD QUALIFY FOR CHARITY CARE. |
| PART III, LINE 4: | PATIENT ACCOUNTS RECEIVABLE, WHERE A THIRD-PARTY PAYOR IS RESPONSIBLE FOR PAYING THE AMOUNT, ARE CARRIED AT A NET AMOUNT DETERMINED BY THE ORIGINAL CHARGE FOR THE SERVICES PROVIDED, ADJUSTED BY AN ESTIMATE MADE FOR CONTRACTUAL ADJUSTMENTS OR DISCOUNTS PROVIDED TO THIRD-PARTY PAYORS.PATIENT ACCOUNTS RECEIVABLE DUE DIRECTLY FROM THE PATIENT ARE CARRIED AT THE ORIGINAL CHARGE FOR THE SERVICES PROVIDED LESS AMOUNTS COVERED BY THIRD-PARTY PAYORS AND LESS AN ESTIMATED ALLOWANCE FOR DOUBTFUL RECEIVABLES BASED ON A REVIEW OF OUTSTANDING AMOUNTS ON A MONTHLY BASIS. MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS, BY USING HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS, AND BY CONSIDERING THE PATIENTS FINANCIAL HISTORY AND CREDIT HISTORY, AND CURRENT ECONOMIC CONDITIONS. PATIENT ACCOUNTS RECEIVABLE ARE WRITTEN OFF WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD-DEBT EXPENSE WHEN RECEIVED. |
| PART III, LINE 8: | THE SHORTFALL IS THE COST OF SERVICES PROVIDED TO THE MEDICARE POPULATION IN THE COMMUNITY FOR WHICH WE DO NOT RECOUP ANY PAYMENTS FROM THE PATIENTS. THE COSTING METHODOLOGY IS TO UTILIZE THE COST TO CHARGE RATIO AS DETERMINED BY THE COST REPORT FOR THAT PERIOD. |
| PART III, LINE 9B: | ACCORDING TO ITS FINANCIAL POLICY, GRAND ITASCA CLINIC & HOSPITAL HOLDS RESPONSIBILITY FOR INFORMING ALL PATIENTS OF THEIR FINANCIAL OBLIGATIONS FOR SERVICES RECEIVED AND RESERVES THE RIGHT TO HOLD THE PATIENT OR HIS LEGAL REPRESENTATIVE ULTIMATELY RESPONSIBLE FOR ALL CHARGES INCURRED ONCE ANY COMMUNITY CARE DISCOUNT HAS BEEN ESTABLISHED BY THE ORGANIZATION. PATIENTS MAY BE REQUIRED TO MAKE PRE-ADMISSION DEPOSITS, PAY PRIOR OUTSTANDING ACCOUNTS IN FULL BEFORE RECEIVING ADDITIONAL SERVICES, OR ENTER INTO A PAYMENT AGREEMENT WITH GRAND ITASCA. IF DEEMED APPROPRIATE, GRAND ITASCA MAY REFER ACCOUNTS UNABLE TO BE COLLECTED IN-HOUSE TO A COLLECTION AGENCY, MAGISTRATE, OR ATTORNEY FOR FURTHER ACTION; OR TAKE LEGAL ACTION TO COLLECT ANY UNPAID BALANCES. |
| PART VI, LINE 2: | 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: | GRAND ITASCA HAS FINANCIAL ADVOCATES WORKING WITH UNINSURED PATIENTS TO ASSIST THEM IN COMPLETING APPLICATIONS FOR VARIOUS PROGRAMS THAT MAY PROVIDE THEM COVERAGE FOR MEDICAL SERVICES. |
| PART VI, LINE 4: | GRAND ITASCA SERVES THE PEOPLE OF GRAND RAPIDS AND THE SURROUNDING COMMUNITIES THROUGHOUT ITASCA COUNTY. THESE COMMUNITIES CONSIST PRIMARILY OF CAUCASIAN RACE, WITH GROWING POPULATIONS OF AMERICAN INDIAN, HISPANIC AND AFRICAN AMERICAN CITIZENS. |
| PART VI, LINE 5: | 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, REPORTS FILED WITH STATES | MN |
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 | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JANICE M ROURK MD | ||||||||||||||
| DIRECTOR/PEDIATRIC MD | $159,027 | $0 | $0 | $0 | $0 | $0 | $7,495 | $0 | $34,150 | $0 | $200,672 | $0 | $0 | $0 |
| JAMISON L HARKER MD | ||||||||||||||
| DIRECTOR/INTERNAL MEDICINE MD | $242,866 | $0 | $0 | $0 | $0 | $0 | $14,823 | $0 | $38,098 | $0 | $295,787 | $0 | $0 | $0 |
| MICHAEL J YOUSO | ||||||||||||||
| PRESIDENT & CEO | $328,425 | $0 | $0 | $0 | $0 | $0 | $25,847 | $0 | $31,562 | $0 | $385,834 | $0 | $0 | $0 |
| DEBRA M NYQUIST | ||||||||||||||
| CHIEF MEDICAL OFFICER | $310,138 | $0 | $0 | $0 | $0 | $0 | $15,847 | $0 | $22,074 | $0 | $348,059 | $0 | $0 | $0 |
| KURT W POSSAI | ||||||||||||||
| ORTHOPEDIC SURGEION | $603,055 | $0 | $0 | $0 | $0 | $0 | $15,847 | $0 | $38,531 | $0 | $657,433 | $0 | $0 | $0 |
| RYAN T NOVAK | ||||||||||||||
| UROLOGIST MD | $589,962 | $0 | $0 | $0 | $0 | $0 | $15,847 | $0 | $38,621 | $0 | $644,430 | $0 | $0 | $0 |
| TROY D ERICKSON | ||||||||||||||
| ORTHOPEDIC SURGEON | $537,000 | $0 | $0 | $0 | $0 | $0 | $15,847 | $0 | $31,380 | $0 | $584,227 | $0 | $0 | $0 |
| DEREK A BEYER | ||||||||||||||
| OB/GYN MD CLINIC | $415,464 | $0 | $0 | $0 | $0 | $0 | $11,872 | $0 | $38,490 | $0 | $465,826 | $0 | $0 | $0 |
| JOHN A KOLE | ||||||||||||||
| OB/GYN MD CLINIC | $403,336 | $0 | $0 | $0 | $0 | $0 | $15,847 | $0 | $31,427 | $0 | $450,610 | $0 | $0 | $0 |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp (4 entries)
| Relationship With OrgRelationshipWithOrgTxt | Loan PurposeLoanPurposeTxt | Loan From OrganizationLoanFromOrganizationInd | Original PrincipalOriginalPrincipalAmt | Balance DueBalanceDueAmt | DefaultDefaultInd | Board Or Committee ApprovalBoardOrCommitteeApprovalInd | Written AgreementWrittenAgreementInd |
|---|---|---|---|---|---|---|---|
| KURT W POSSAI | |||||||
| TOP 5 HIGHLY COMPENSATED EMPLOYEE | COMPENSATION PACKAGE | Yes (X) | $75,000 | $34,812 | 0 | Yes (1) | Yes (1) |
| RYAN T NOVAK | |||||||
| TOP 5 HIGHLY COMPENSATED EMPLOYEE | COMPENSATION PACKAGE | Yes (X) | $90,000 | $12,461 | 0 | Yes (1) | Yes (1) |
| TROY D ERICKSON | |||||||
| TOP 5 HIGHLY COMPENSATED EMPLOYEE | COMPENSATION PACKAGE | Yes (X) | $51,000 | $1,928 | 0 | Yes (1) | Yes (1) |
| DEREK A BEYER | |||||||
| TOP 5 HIGHLY COMPENSATED EMPLOYEE | COMPENSATION PACKAGE | Yes (X) | $50,000 | $9,812 | 0 | Yes (1) | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $59,013 | TotalBalanceDueAmt |
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHANNON HARKER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | WIFE OF DIRECTOR; PEDIATRIC MD CLINIC | RelationshipDescriptionTxt |
| Transaction | $173,327 | TransactionAmt |
| Transaction | DR. SHANNON HARKER IS A COMPENSATED DOCTOR OF GICH. | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | FORM 990 IS REVIEWED BY THE VICE PRESIDENT OF FINANCE AND A COPY IS PROVIDED TO THE FINANCE COMMITTEE AND BOARD OF DIRECTORS FOR APPROVAL PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | BOARD MEMBERS SIGN THE CONFLICT OF INTEREST POLICY ANNUALLY. |
| FORM 990, PART VI, SECTION B, LINE 15 | 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, PART VI, SECTION C, 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: | POST RETIREMENT BENEFITS OBLIGATION ADJUSTMENT 453,248. GAIN ON TEMP RESTRICTED INVESTMENTS 1,337. NET ASSETS RELEASED FROM RESTRICTIONS USED FOR PROPERTY & EQUIPMENT 44,121. |
| FORM 990, PART VI, SECTION B, LINE 16A | GRAND ITASCA THOROUGHLY EVALUATED THE PARTICIPATION IN THE CDI JOINT VENTURE. THIS EVALUATION INCLUDED REVIEW BY ATTORNEYS AND OTHER THIRD PARTY CONSULTANTS. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAND ITASCA FOUNDATION | BusinessNameLine1Txt |
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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411560554 | EIN |
| Primary Activities | FINANCIAL SUPPORT OF GRAND ITASCA CLINIC & HOSPITAL | PrimaryActivitiesTxt |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | 11(F) | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAND ITASCA CLINIC & HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
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 RD | AddressLine1Txt |
| City | GRAND RAPIDS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55744 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 453783014 | EIN |
| Primary Activities | PROVIDE IN-HOUSE MRI AND DTI SERVICES | PrimaryActivitiesTxt |
| Legal Domicile State | MN | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAND ITASCA CLINIC & HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | RELATED | PredominantIncomeTypeTxt |
| Share Of Total Income | $774,390 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $63,791 | ShareOfEOYAssetsAmt |
| Disproportionate Allocations | Yes (1) | DisproportionateAllocationsInd |
| General Or Managing Partner | Yes (1) | GeneralOrManagingPartnerInd |
| Ownership | 0.55000 | OwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAND ITASCA FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $108,700 | InvolvedAmt |
| Method Of Amount Determination | ACTUAL AMOUNT | MethodOfAmountDeterminationTxt |