2017-11-15T14:19:13-06:00 2016-12-31 420714325 RSM US LLP 801 NICOLLET MALL SUITE 1100 MINNEAPOLIS MN 55402 990 2016-01-01 411865874 GRAND ITASCA CLINIC AND HOSPITAL GRAN 2183265000 1601 GOLF COURSE ROAD GRAND RAPIDS MN 55744 MIKE YOUSO PRESIDENT & CEO 2183265000 2017-11-15 1 TODD A JACKSON P00092672 6123324300 108.171.131.188 2017-11-15 08:17:59 CS P 01563F10D6676BDC9B96404AA3206AA292B808E6 5AB5DFEC54AF030231DDAA57F2AFD57D98013E0B 2016 2017-02-10 21:41:12Z MICHAEL YOUSO 1601 GOLF COURSE ROAD GRAND RAPIDS MN 55744 85774726 0 X WWW.GRANDITASCA.ORG X 1997 MN PATIENT-CENTERED EXCELLENCE 12 10 740 102 138073 0 200569 197725 74970564 84630600 30351 138968 841987 802594 76043471 85769887 0 11507 0 0 50679378 50284997 0 0 372155 33985828 36840878 84665206 87137382 -8621735 -1367495 77400313 73983492 47963640 45181353 29436673 28802139 X PROVIDE QUALITY, ACCESSIBLE, AND VALUABLE HEALTH CARE SERVICES VIA A HOSPITAL, HOME HEALTH AGENCY, AND CLINIC TO THE SURROUNDING RURAL COMMUNITY. 0 0 71555911 11507 85245800 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. 71555911 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 49 0 1 740 1 1 1 0 0 0 0 0 0 0 0 0 X 12 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 MN X TODD CHRISTENSON 2189991703 1601 GOLF COURSE ROAD GRAND RAPIDS MN 55744 ELIZABETH MISKOVICH CHAIR 1.00 X X 0 0 0 COLLEEN NARDONE VICE CHAIR 1.00 X X 0 0 0 DALE ADAMS SECRETARY 1.00 X X 0 0 0 JOSH SKELTON TREASURER 1.00 X X 0 0 0 BETH BILY DIRECTOR 1.00 X 0 0 0 JANICE M ROURK MD DIRECTOR/PEDIATRIC MD 40.00 1.00 X 159027 0 39724 JAMISON L HARKER MD DIRECTOR/INTERNAL MEDICINE MD 40.00 1.00 X 242866 0 51000 STEVE BURGGRAF DIRECTOR 1.00 X 0 0 0 KENT KOERBITZ DIRECTOR 1.00 X 0 0 0 JAMIE LEMKE DIRECTOR 1.00 X 0 0 0 DENNY ROY DIRECTOR 1.00 X 0 0 0 ANDY SHERMOEN DIRECTOR/FOUNDATION REP 1.00 1.00 X 0 0 0 MICHAEL J YOUSO PRESIDENT & CEO 40.00 X 328425 0 54848 DEBRA M NYQUIST CHIEF MEDICAL OFFICER 40.00 X 310138 0 35836 COREY SMITH CONTROLLER 40.00 X 71195 0 4257 EDWARD A TUSA VP FINANCE 40.00 X 53466 0 11594 KURT W POSSAI ORTHOPEDIC SURGEION 40.00 X 603055 0 52024 RYAN T NOVAK UROLOGIST MD 40.00 X 589962 0 52024 TROY D ERICKSON ORTHOPEDIC SURGEON 40.00 X 537000 0 44848 DEREK A BEYER OB/GYN MD CLINIC 40.00 X 415464 0 48049 JOHN A KOLE OB/GYN MD CLINIC 40.00 X 403336 0 44848 3713934 0 439052 66 0 1 0 ALLINA HEALTH SYSTEM NW 7710 PO BOX 9383 MINNEAPOLIS MN 55440 IT/LAB SERVICES 2174785 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 MEDICAL SERVICES 497146 SOJOURN PATHOLOGY SERVICES 35328 COUNTY RD 63 COHASSET MN 55721 MEDICAL SERVICES 339000 INFOR INC NW 7418 PO BOX 1450 MINNEAPOLIS MN 55485 IT SERVICES 251522 SISU HEALTHCARE IT SOLUTIONS 5 WEST FIRST ST SUITE 200 DULUTH MN 55802 LAUNDRY SERVICES 243401 15 108700 89025 197725 PATIENTS AND RESIDENT SERVICES 621110 80118466 80118466 OTHER REVENUE 621110 1322080 1322080 PHARMACY REVENUE 621110 1252470 1114397 138073 MEANINGFUL USE REVENUE 621110 972960 972960 REIMBURSED EXPENSES 621110 964624 964624 84630600 143507 143507 300 4839 -4539 -4539 -4539 CDI PARTNERSHIP REVENUE 621110 753273 753273 PURCHASE DISCOUNTS 621110 49321 49321 802594 85769887 85245800 138073 188289 11507 11507 1371205 1114519 250555 6131 40410094 32845433 7383980 180681 2009050 1632961 367106 8983 3568791 2900723 652111 15957 2925857 2378144 534631 13082 186053 151224 33997 832 206474 167823 37728 923 313 313 4231082 3439035 773129 18918 176138 142574 32762 802 1139407 926113 208199 5095 126412 102748 23099 565 746066 606404 136326 3336 91466 74344 16713 409 1695352 1377987 309785 7580 4848207 3940636 885894 21677 514552 418229 94022 2301 SUPPLIES 14019211 11394852 2561676 62683 PROVISION FOR BAD DEBTS 3894845 3894845 REPAIRS & MAINT 2880711 2341450 526381 12880 MNCARE TAX 754490 613252 137865 3373 1330099 1081108 243044 5947 87137382 71555911 15209316 372155 1497039 2409040 5079043 5100204 80293 99363 10262081 9389464 133226 59013 128183 76412 1243676 1643313 1053021 1117434 75662001 40587671 38545744 35074330 10918663 11423039 8459344 7591880 77400313 73983492 4836509 6395235 636400 534676 31046029 28581066 11444702 9670376 47963640 45181353 X 29243098 28607227 193575 194912 29436673 28802139 77400313 73983492 X -1367495 234255 498706 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 313 313 0 PART II-B, LINE 1: 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. 607331 607331 45070672 20090426 24980246 29353974 20363568 8990406 630024 133677 496347 35074330 MUTUAL FUNDS 5813418 C CERT OF DEPOSIT (TIME DEPOSITS) 290467 C CERT OF DEPOSIT (MARKETABLE SECURITIES) 2397834 C DEFERRED COMPENSATION INVESTMENTS 2921320 C 11423039 ASSETS LIMITED TO USE 6963710 CHARITABLE REMAINDER TRUST 194912 OTHER ASSETS 369660 CDI CONTROLLING INTEREST 63598 7591880 OTHER ACCRUALS 395013 POST RETIREMENT BENEFIT 2545266 SELF INSURED WORKER'S COMP 846784 CURRENT PORTION OF LONG TERM DEBT 1789219 THIRD PARTY PAYOR SETTLEMENTS 1172774 DEFERRED COMPENSATION OBLIGATIONS 2921320 9670376 X PART X, LINE 2: 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. 1 1 1 X 1 X 1 1 1 0 1 1 692771 0 692771 0.00830 17738032 12771555 4966477 0.05970 0 0 18430803 12771555 5659248 0.06800 20586 0 20586 0.00020 11507 0 11507 0.00010 32093 32093 0.00030 18462896 12771555 5691341 0.06830 1 3894845 973711 83514807 33086656 50428151 X 1 1 1 CDI GRAND RAPIDS LLC PROVIDE MRI, DIAGNOSTIC INJECTION AND PAIN MANAGEMENT SERVICES 0.55000 0.00000 0.00000 1 1 GRAND ITASCA CLINIC AND HOSPITAL 1601 GOLF COURSE ROAD GRAND RAPIDS MN 55744 X X X GRAND ITASCA CLINIC AND HOSPITAL 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X GRANDITASCA.ORG X 1 16 1 GRANDITASCA.ORG (UNDER NEWS & EVENTS) 0 1 X 150.000000000000 300.000000000000 X X X X X 1 1 X X X X 1 X GRANDITASCA.ORG X GRANDITASCA.ORG X X X X X X 1 X 0 X X X 1 X 0 0 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. 1 1 - GRAND ITASCA PROFESSIONAL BUILDING 111 SE 3RD STREET GRAND RAPIDS MN 55744 VARIOUS OUTPATIENT & BUSINESS SERVICES 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 X X X 0 0 0 0 0 0 0 0 0 JANICE M ROURK MD DIRECTOR/PEDIATRIC MD 159027 0 0 0 0 0 7495 0 34150 0 200672 0 0 0 JAMISON L HARKER MD DIRECTOR/INTERNAL MEDICINE MD 242866 0 0 0 0 0 14823 0 38098 0 295787 0 0 0 MICHAEL J YOUSO PRESIDENT & CEO 328425 0 0 0 0 0 25847 0 31562 0 385834 0 0 0 DEBRA M NYQUIST CHIEF MEDICAL OFFICER 310138 0 0 0 0 0 15847 0 22074 0 348059 0 0 0 KURT W POSSAI ORTHOPEDIC SURGEION 603055 0 0 0 0 0 15847 0 38531 0 657433 0 0 0 RYAN T NOVAK UROLOGIST MD 589962 0 0 0 0 0 15847 0 38621 0 644430 0 0 0 TROY D ERICKSON ORTHOPEDIC SURGEON 537000 0 0 0 0 0 15847 0 31380 0 584227 0 0 0 DEREK A BEYER OB/GYN MD CLINIC 415464 0 0 0 0 0 11872 0 38490 0 465826 0 0 0 JOHN A KOLE OB/GYN MD CLINIC 403336 0 0 0 0 0 15847 0 31427 0 450610 0 0 0 KURT W POSSAI TOP 5 HIGHLY COMPENSATED EMPLOYEE COMPENSATION PACKAGE X 75000 34812 0 1 1 RYAN T NOVAK TOP 5 HIGHLY COMPENSATED EMPLOYEE COMPENSATION PACKAGE X 90000 12461 0 1 1 TROY D ERICKSON TOP 5 HIGHLY COMPENSATED EMPLOYEE COMPENSATION PACKAGE X 51000 1928 0 1 1 DEREK A BEYER TOP 5 HIGHLY COMPENSATED EMPLOYEE COMPENSATION PACKAGE X 50000 9812 0 1 1 59013 SHANNON HARKER WIFE OF DIRECTOR; PEDIATRIC MD CLINIC 173327 DR. SHANNON HARKER IS A COMPENSATED DOCTOR OF GICH. 0 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. GRAND ITASCA FOUNDATION 1601 GOLF COURSE ROAD GRAND RAPIDS MN 55744 411560554 FINANCIAL SUPPORT OF GRAND ITASCA CLINIC & HOSPITAL MN 501(C)(3) 11(F) GRAND ITASCA CLINIC & HOSPITAL 1 CDI GRAND RAPIDS LLC 1601 GOLF COURSE RD GRAND RAPIDS MN 55744 453783014 PROVIDE IN-HOUSE MRI AND DTI SERVICES MN GRAND ITASCA CLINIC & HOSPITAL RELATED 774390 63791 1 1 0.55000 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 GRAND ITASCA FOUNDATION C 108700 ACTUAL AMOUNT