SOUTHEAST IOWA REGIONAL MEDICAL CENTER INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- SOUTHEAST IOWA REGIONAL MEDICAL CENTER INC (EIN 42-0680407)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-12
- IRS object ID
- 201731329349304983
- Schema version
- 2015v3.0
- 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 I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-12T15:23:34-05:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 SOUTH SIXTH STREET SUITE 300 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420680407 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GREAT RIVER MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GREA | BusinessNameControlTxt |
| Phone | 3197681000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1221 SOUTH GEAR AVENUE | AddressLine1Txt |
| City | WEST BURLINGTON | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52655 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TODD SLADKY | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 3197681000 | PhoneNum |
| Signature | 2017-05-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KACIE MCEWEN | PreparerPersonNm |
| PTIN | P01599614 | PTIN |
| Phone | 6123764500 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MARK RICHARDSON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1221 SOUTH GEAR AVENUE | AddressLine1Txt |
| City | WEST BURLINGTON | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52655 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $185,326,910 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | HTTP://GREATRIVERMEDICAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1895 | FormationYr |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Activity Or Mission | IMPROVING THE REGION'S HEALTH BY PROVIDING HIGH-QUALITY HEALTH CARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 1875 | TotalEmployeeCnt |
| Total Volunteers | 442 | TotalVolunteersCnt |
| Total Gross UBI | $127,817 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$27,434 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,059,173 | PYContributionsGrantsAmt |
| CY Contributions Grants | $972,790 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $175,807,025 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $183,413,152 | CYProgramServiceRevenueAmt |
| PY Investment Income | $48,699 | PYInvestmentIncomeAmt |
| CY Investment Income | $458,644 | CYInvestmentIncomeAmt |
| PY Other Revenue | $60,079 | PYOtherRevenueAmt |
| CY Other Revenue | $128,966 | CYOtherRevenueAmt |
| PY Total Revenue | $176,974,976 | PYTotalRevenueAmt |
| CY Total Revenue | $184,973,552 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $931,089 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $232,186 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $82,393,548 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $88,008,201 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $79,162 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $84,380,390 | PYOtherExpensesAmt |
| CY Other Expenses | $86,981,743 | CYOtherExpensesAmt |
| PY Total Expenses | $167,705,027 | PYTotalExpensesAmt |
| CY Total Expenses | $175,222,130 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $9,269,949 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $9,751,422 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $360,869,470 | TotalAssetsBOYAmt |
| Total Assets EOY | $341,933,431 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $97,823,717 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $92,971,201 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $263,045,753 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $248,962,230 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | GREAT RIVER MEDICAL CENTER IS DEDICATED TO IMPROVING THE REGION'S HEALTH BY PROVIDING HIGH-QUALITY CARE, WORLD-CLASS CUSTOMER SERVICE, AND UNCOMPROMISING VALUE FOR OUR PATIENTS AND THEIR FAMILIES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $167,718,707 | ExpenseAmt |
| Grant | $232,186 | GrantAmt |
| Revenue | $183,413,152 | RevenueAmt |
| Desc | GREAT RIVER MEDICAL CENTER (GRMC), LOCATED IN WEST BURLINGTON, IOWA, IS A 378-BED REGIONAL MEDICAL CENTER OFFERING ACUTE AND INTERMEDIATE CARE TO RESIDENTS OF SOUTHEAST IOWA, WEST CENTRAL ILLINOIS AND NORTHEAST MISSOURI. THE HOSPITAL OFFERS COMPREHENSIVE MEDICAL, EXTENSIVE SURGICAL, AND EMERGENCY CARE SERVICES. DURING FISCAL YEAR ENDING 6/30/16, GRMC HAD 6,993 PATIENT ADMISSIONS AND 79,782 PATIENT DAYS OF MEDICAL CARE. GRMC ALSO HAD 170,000 OUTPATIENT VISITS, 35,077 EMERGENCY ROOM VISITS AND 35,522 HOME HEALTH-CARE VISITS. GRMC PROVIDES MEDICAL SERVICES REGARDLESS OF ABILITY TO PAY AND ACCEPTS MEDICARE AND MEDICAID.THE HOSPITAL'S 160-BED KLEIN CENTER OFFERS LONG-TERM AND SKILLED CARE ON THE HOSPITAL'S CAMPUS. THE CANCER CENTER, WHICH PROVIDES MEDICAL AND RADIATION THERAPY SERVICES FOR THE TREATMENT OF VARIOUS FORMS OF CANCER AND BLOOD DISEASES, OFFERS THE LATEST THREE-DIMENSIONAL TREATMENT-PLANNING COMPUTER TECHNOLOGY AVAILABLE IN ONLY A FEW HEALTH-CARE CENTERS IN THE STATE. THE WELLNESS PLAZA IS HOME TO ONE OF THE STATE'S PREMIER REHABILITATION AND FITNESS PROGRAMS. MORE THAN 120 PHYSICIANS AND 2000 EMPLOYEES SHARE GRMC'S COMMITMENT TO EXCELLENCE IN PATIENT CARE AND COMMUNITY SERVICE. | Desc |
| Total Program Service Expenses | $167,718,707 | 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 | 0 | 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 | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | 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 | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 81 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 1875 | 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 | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | 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 | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | NANCY WHITAKER-KROPP | PersonNm |
| Phone | 3197681000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1221 SOUTH GEAR AVENUE | AddressLine1Txt |
| City | WEST BURLINGTON | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52655 | 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 |
|---|---|---|---|---|---|---|---|---|
| DAN WIEDEMEIER | ||||||||
| CHAIRMAN | 1.00 | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DAN HINKLE | ||||||||
| CHAIRMAN (THROUGH SEPTEMBER 2015) | 1.00 | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ROBERT MCCULLEY | ||||||||
| VICE CHAIRMAN | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DOUG MARTIN | ||||||||
| SECRETARY / TREASURER | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| RON CLOUSE | ||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| LORRIN DEBLIECK | ||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| TERRI DOWELL | ||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ROBERT ENGBERG | ||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ROBERT FLEMING | ||||||||
| DIRECTOR | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| KENT GAUDIAN | ||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JO ELLEN HOTH MD | ||||||||
| DIRECTOR (THROUGH SEPTEMBER 2015) | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BILL MALCOM | ||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MICHAEL MCCOY MD | ||||||||
| DIRECTOR (THROUGH OCTOBER 2015) | 1.00 | 1.00 | Yes (X) | $0 | $341,911 | $24,147 | ||
| JOHN PHILLIPS MD | ||||||||
| DIRECTOR (THROUGH DECEMBER 2015) | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DON SCHMIDGALL | ||||||||
| DIRECTOR (THROUGH SEPTEMBER 2015) | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| PATRICK WILLIAMS MD | ||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MARK RICHARDSON | ||||||||
| PRESIDENT/CEO | 40.00 | 3.00 | Yes (X) | Yes (X) | $0 | $735,915 | $33,844 | |
| TONY HAYES | ||||||||
| COO | 40.00 | 3.00 | Yes (X) | $0 | $436,103 | $30,358 | ||
| TODD SLADKY | ||||||||
| CFO | 40.00 | 3.00 | Yes (X) | $0 | $393,622 | $30,988 | ||
| DARWIN COOLEY | ||||||||
| DIRECTOR OF PHARMACY | 40.00 | $190,366 | $0 | $31,069 | Yes (X) | |||
| JOHN MERCER III | ||||||||
| DIRECTOR OF FACILITIES | 40.00 | $133,841 | $0 | $29,344 | Yes (X) | |||
| ELIZABETH YORE | ||||||||
| DIRECTOR OF CARDIOVASCULAR SERVICES | 40.00 | $137,043 | $0 | $18,021 | Yes (X) | |||
| FRANCES STRAUSS | ||||||||
| DIRECTOR OF SURGICAL SERVICES | 40.00 | $146,773 | $0 | $30,542 | Yes (X) | |||
| JON WILLIAMS | ||||||||
| PHARMACIST | 40.00 | $135,052 | $0 | $29,533 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $743,075 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,907,551 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $257,846 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 36 | 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 |
|---|---|---|---|---|---|
| MUTUAL CONSULTING & MANAGEMENT SERVICES | |||||
| 1221 S GEAR AVE | WEST BURLINGTON | IA | 52655 | EXECUTIVE MANAGEMENT | $4,148,430 |
| GREAT RIVER PHYSICIANS & CLINICS INC | |||||
| 1221 S GEAR AVE | WEST BURLINGTON | IA | 52655 | PHYSICIANS | $533,761 |
| OPTUM EXECUTIVE HEALTH RESOURCES INC | |||||
| 3797 MOMENTUM PLACE | CHICAGO | IL | 60689 | PHYSICIAN SERVICES | $475,284 |
| WEATHERBY LOCUMS INC | |||||
| PO BOX 972633 | DALLAS | TX | 75397 | PROVIDER SERVICES | $404,975 |
| BELMERO INC | |||||
| 8362 TAMARCK VILLAGE 119-214 | WOODBURY | MN | 55125 | CONSULTANTS | $378,437 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 19 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $972,790 | AllOtherContributionsAmt |
| Total Contributions | $972,790 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| PATIENT SERVICE INCOME | 621110 | $178,134,923 | $178,134,923 | |
| OTHER OPERATING INCOME | 621300 | $4,886,029 | $4,759,827 | $126,202 |
| SE RENAL DIALYSIS K-1 | 621400 | $392,200 | $392,200 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $183,413,152 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $537,821 | TotalRevenueColumnAmt |
| Exclusion | $537,821 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $309,937 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $274,181 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $35,756 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $35,756 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $1,615 | UnrelatedBusinessRevenueAmt |
| Exclusion | $34,141 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $79,177 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$79,177 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$79,177 | TotalRevenueColumnAmt |
| Exclusion | -$79,177 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS INCOME | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $93,210 | TotalRevenueColumnAmt |
| Exclusion | $93,210 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $93,210 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $184,973,552 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $183,286,950 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $127,817 | UnrelatedBusinessRevenueAmt |
| Exclusion | $585,995 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $232,186 | TotalAmt |
| Program Services | $232,186 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,498,319 | TotalAmt |
| Management And General | $2,498,319 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $67,208,400 | TotalAmt |
| Program Services | $66,964,209 | ProgramServicesAmt |
| Management And General | $184,712 | ManagementAndGeneralAmt |
| Fundraising | $59,479 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,935,136 | TotalAmt |
| Program Services | $2,921,811 | ProgramServicesAmt |
| Management And General | $10,387 | ManagementAndGeneralAmt |
| Fundraising | $2,938 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,405,663 | TotalAmt |
| Program Services | $10,374,394 | ProgramServicesAmt |
| Management And General | $30,159 | ManagementAndGeneralAmt |
| Fundraising | $1,110 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,960,683 | TotalAmt |
| Program Services | $4,943,448 | ProgramServicesAmt |
| Management And General | $12,845 | ManagementAndGeneralAmt |
| Fundraising | $4,390 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,911,025 | TotalAmt |
| Management And General | $1,911,025 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,527 | TotalAmt |
| Program Services | -$4,364 | ProgramServicesAmt |
| Management And General | $78,891 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $86,185 | TotalAmt |
| Program Services | $86,185 | ProgramServicesAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,099 | TotalAmt |
| Management And General | $29,099 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,342,199 | TotalAmt |
| Program Services | $17,227,768 | ProgramServicesAmt |
| Management And General | $108,882 | ManagementAndGeneralAmt |
| Fundraising | $5,549 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,194,416 | TotalAmt |
| Program Services | $1,181,288 | ProgramServicesAmt |
| Management And General | $11,512 | ManagementAndGeneralAmt |
| Fundraising | $1,616 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,738,290 | TotalAmt |
| Program Services | $1,735,153 | ProgramServicesAmt |
| Management And General | $2,957 | ManagementAndGeneralAmt |
| Fundraising | $180 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $281,572 | TotalAmt |
| Program Services | $255,228 | ProgramServicesAmt |
| Management And General | $24,177 | ManagementAndGeneralAmt |
| Fundraising | $2,167 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,606,754 | TotalAmt |
| Program Services | $2,606,754 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,540,502 | TotalAmt |
| Program Services | $16,432,026 | ProgramServicesAmt |
| Management And General | $108,476 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,874,478 | TotalAmt |
| Program Services | $605,988 | ProgramServicesAmt |
| Management And General | $1,268,490 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $21,912,214 | $21,912,214 | |
| DRUGS | $11,875,206 | $11,875,206 | |
| BAD DEBT | $4,747,691 | $4,747,691 | |
| REPAIRS/MAINTENANCE | $1,895,460 | $1,895,340 | $120 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,872,125 | TotalAmt |
| Program Services | $1,726,182 | ProgramServicesAmt |
| Management And General | $1,144,210 | ManagementAndGeneralAmt |
| Fundraising | $1,733 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $175,222,130 | TotalAmt |
| Program Services | $167,718,707 | ProgramServicesAmt |
| Management And General | $7,424,261 | ManagementAndGeneralAmt |
| Fundraising | $79,162 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,055,060 | BOYAmt |
| EOY | $9,684,978 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,430,698 | BOYAmt |
| EOY | $18,677,386 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $337,275 | BOYAmt |
| EOY | $627,836 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,299,445 | BOYAmt |
| EOY | $3,525,045 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,501,277 | BOYAmt |
| EOY | $3,680,360 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $315,797,460 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $164,673,703 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $159,847,730 | BOYAmt |
| EOY | $151,123,757 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $155,615,224 | BOYAmt |
| EOY | $151,480,212 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,246,600 | BOYAmt |
| EOY | $1,238,800 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $536,161 | BOYAmt |
| EOY | $1,895,057 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $360,869,470 | BOYAmt |
| EOY | $341,933,431 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,446,871 | BOYAmt |
| EOY | $8,520,239 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $74,814,561 | BOYAmt |
| EOY | $68,999,386 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,562,285 | BOYAmt |
| EOY | $15,451,576 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $97,823,717 | BOYAmt |
| EOY | $92,971,201 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $259,062,924 | BOYAmt |
| EOY | $245,797,624 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,696,665 | BOYAmt |
| EOY | $1,936,500 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,286,164 | BOYAmt |
| EOY | $1,228,106 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $263,045,753 | BOYAmt |
| EOY | $248,962,230 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $360,869,470 | BOYAmt |
| EOY | $341,933,431 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $9,751,422 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$605,245 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$23,229,700 | 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 | $29,099 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $29,099 | 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 | GREAT RIVER MEDICAL CENTER PAID DUES TO THE AMERICAN HOSPITAL ASSOCIATION AND THE IOWA HOSPITAL ASSOCIATION. THESE ASSOCIATIONS PARTICIPATE IN LOBBYING ACTIVITIES RELATED TO HEALTHCARE. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,946,488 | OtherCostOrOtherBasisAmt |
| Book Value | $4,946,488 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $126,591,830 | OtherCostOrOtherBasisAmt |
| Depreciation | $38,406,331 | DepreciationAmt |
| Book Value | $88,185,499 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $11,972,330 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,821,113 | DepreciationAmt |
| Book Value | $5,151,217 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $170,010,306 | OtherCostOrOtherBasisAmt |
| Depreciation | $119,446,259 | DepreciationAmt |
| Book Value | $50,564,047 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,276,506 | OtherCostOrOtherBasisAmt |
| Book Value | $2,276,506 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $151,123,757 | TotalBookValueLandBuildingsAmt |
Closely Held Equity Interests CloselyHeldEquityInterestsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Book Value | $148,306,924 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INSURANCE COMPANY ANNUITY DEPOSITS | Desc |
| Book Value | $3,173,288 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $151,480,212 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)
| DescDesc | AmtAmt |
|---|---|
| DEFERRED COMPENSATION LIABILITY | $912,269 |
| THIRD PARTY PAYABLE | $1,468,540 |
| PTO RESERVE | $7,934,607 |
| FAIR VALUE OF CASH FLOW HEDGING SWAP | $4,345,421 |
| PLEDGES LIABILITY | $790,739 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $15,451,576 | 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 ORGANIZATION IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. HOWEVER, THE ORGANIZATION IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE COMBINED FINANCIAL STATEMENTS. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 225.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | 0 | ExpensesExceedBudgetInd |
| 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 | $3,055,071 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,055,071 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01790 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $26,989,539 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $23,191,804 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,797,735 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02230 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $364,337 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $324,451 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $39,886 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $30,408,947 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $23,516,255 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,892,692 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04040 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $52,616 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $52,616 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,090,982 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $734,069 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $356,913 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00210 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $141,418 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $141,418 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,285,016 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $734,069 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $550,947 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00320 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $31,693,963 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $24,250,324 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,443,639 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04360 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $4,747,691 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $57,423,742 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $64,485,275 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$7,061,533 | 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 |
| 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 | GREAT RIVER MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1221 SOUTH GEAR AVENUE | AddressLine1Txt |
| City | WEST BURLINGTON | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52655 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | GREATRIVERMEDICAL.ORG | WebsiteAddressTxt |
| State License | 290147H | StateLicenseNum |
| 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 | GREAT RIVER MEDICAL CENTER | 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 |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTP://GREATRIVERMEDICAL.ORG/FILES/FILE/COMMUNITY%20HEALTH%20NEEDS%20ASSESS | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTP://GREATRIVERMEDICAL.ORG/FILES/FILE/COMMUNITY%20HEALTH%20NEEDS%20ASSESS | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| 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 | 225.000000000000 | 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 |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| 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 |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://GREATRIVERMEDICAL.ORG/BILLING-AND-FINANCIAL-SERVICES/FINANCIAL-ASSI | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://GREATRIVERMEDICAL.ORG/BILLING-AND-FINANCIAL-SERVICES/FINANCIAL-ASSI | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://GREATRIVERMEDICAL.ORG/BILLING-AND-FINANCIAL-SERVICES/FINANCIAL-ASSI | 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 |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| GREAT RIVER MEDICAL CENTER | PART V, SECTION B, LINE 5: GREAT RIVER MEDICAL CENTER, A PART OF GREAT RIVER HEALTH SYSTEMS, COLLABORATED WITH THE DES MOINES COUNTY DEPARTMENT OF PUBLIC HEALTH TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT TO DISTINGUISH THE UNMET MEDICAL AND PUBLIC HEALTH NEEDS IN DES MOINES COUNTY.THE STUDY HAS THREE OBJECTIVES:1. TO CONDUCT AN ASSESSMENT THAT PROVIDES A FOUNDATION FOR GREAT RIVER HEALTH SYSTEMS AND ITS PARTNERS TO BUILD A CONSENSUS ABOUT THE AREA'S MOST CRITICAL HEALTH CARE NEEDS2. TO MEET STATE AND FEDERAL REQUIREMENTS FOR CONDUCTING COMMUNITY HEALTH NEEDS ASSESSMENTS - HOSPITALS, EVERY THREE YEARS; HEALTH DEPARTMENTS, EVERY FIVE YEARS3. TO DEVELOP ACTION PLANS FOR INTERVENTIONSINFORMATION WAS COLLECTED THROUGH LIVE COMMUNITYWIDE MEETINGS, PAPER AND EMAILED SURVEYS, FACE-TO-FACE INTERVIEWS, AND A REVIEW AND ANALYSIS OF PUBLICLY COLLECTED HEALTH AND DEMOGRAPHIC STATISTICS. THE SURVEY WAS MADE AVAILABLE AT SEVERAL LOCATIONS IN THE STUDY AREA. THE LOCATIONS WERE CHOSEN AND THE SURVEY WAS DESIGNED TO ELICIT PUBLIC RESPONSES ABOUT HEALTH NEEDS IN DES MOINES COUNTY. THE SURVEY INCLUDED MULTIPLE CHOICE, OPEN-ENDED AND SCALED QUESTIONS THAT ASKED PEOPLE WHAT THEY PERCEIVED TO BE THE GREATEST AREAS OF COMMUNITY NEED. ABOUT 400 SURVEYS WERE RETURNED AND ANALYZED.INTERVIEWS WERE CONDUCTED WITH 11 COMMUNITY PROFESSIONALS AND KEY INFORMANTS, INCLUDING PROFESSIONALS IN EDUCATION, LAW ENFORCEMENT, MINORITY POPULATIONS, PUBLIC HEALTH AND SOCIAL SERVICES, AND OTHER PEOPLE REPRESENTING UNDERSERVED POPULATIONS IN THE SERVICE AREA. THEY WERE ASKED TO IDENTIFY THE LARGEST HEALTH CONCERNS IN THE COMMUNITY AND TO SUGGEST WAYS TO IMPROVE UNMET HEALTH NEEDS.THE HEALTH AND DEMOGRAPHIC DATA AVAILABLE FOR DES MOINES COUNTY WAS INVESTIGATED BY FOCUSING ON THE PROBLEMS INDICATED FROM THE INTERVIEWS AND COMMUNITY SURVEY. USING INFORMATION FROM COLLABORATIVE MEETINGS AND SURVEYS, THE DES MOINES COUNTY COMMUNITY RANKED FOUR UNMET HEALTH NEEDS: - MENTAL HEALTH AND SUBSTANCE ABUSE - OBESITY - POVERTY - VIOLENT CRIMETHESE FOUR NEEDS WILL BE THE FOCUS OF GREAT RIVER HEALTH SYSTEMS'EFFORTS TO IMPROVE THE HEALTH OF DES MOINES COUNTY. |
| GREAT RIVER MEDICAL CENTER | PART V, SECTION B, LINE 6B: GREAT RIVER MEDICAL CENTER COLLABORATED WITH THE DES MOINES COUNTY DEPARTMENT OF PUBLIC HEALTH TO CONDUCT THEIR COMMUNITY HEALTH NEEDS ASSESSMENT. |
| GREAT RIVER MEDICAL CENTER | PART V, SECTION B, LINE 11: AS A RESULT OF THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT, THE HEALTH AND DEMOGRAPHIC DATA AVAILABLE FOR DES MOINES COUNTY WAS INVESTIGATED FOCUSING ON THE PROBLEMS INDICATED FROM THE INTERVIEWS AND COMMUNITY SURVEY. USING INFORMATION FROM COLLABORATIVE MEETINGS AND SURVEYS, THE DES MOINES COUNTY COMMUNITY RANKED FOUR UNMET HEALTH NEEDS:- MENTAL HEALTH AND SUBSTANCE ABUSE- OBESITY- POVERTY- VIOLENT CRIMEPARTICIPANTS IN THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS - INCLUDING GREAT RIVER HEALTH SYSTEMS EMPLOYEES - CHOSE OR WERE ASSIGNED TO ONE OF THE FOUR AREAS OF NEED. THE GROUPS FOLLOWED A MULTISTEP PROCESS TO DEVELOP THEIR PLANS:- DEFINE AND ANALYZE THE PROBLEM- DEVELOP A PURPOSE STATEMENT FOR THE OVERALL GOAL- DEFINE OBJECTIVES- IDENTIFY INTERVENTIONS- COMPLETE PLANTHESE GROUPS WILL CONTINUE MEETING TO ADDRESS THEIR ACTION PLAN OBJECTIVES AND TACTICS, AND SUBMIT QUARTERLY PROGRESS REPORTS GREAT RIVER HEALTH SYSTEMS AND THE DES MOINES COUNTY DEPARTMENT OF PUBLIC HEALTH.GREAT RIVER HEALTH SYSTEMS IS COMMITTED TO PROVIDING NEW AND ONGOING SERVICES TO HELP MEET THE IDENTIFIED NEEDS IN THE NEXT THREE YEARS. IT ALSO WILL CONTINUE PARTICIPATING IN COMMUNITYWIDE HEALTH IMPROVEMENTS. EACH OF THE FOUR HEALTH-NEEDS CATEGORIES BELOW BEGINS WITH THE HEALTH SYSTEM'S PLAN, FOLLOWED BY THE COMMUNITY'S PLAN.MENTAL HEALTH AND SUBSTANCE ABUSE- IMPROVE ACCESS- CRISIS INTERVENTION TEAM PROGRAM- DUAL-DIAGNOSIS PARTIAL HOSPITAL PROGRAM- BEHAVIORAL HEALTH ASSESSMENT TEAM- CRISIS STABILIZATION SERVICES- INCREASED COLLABORATION WITH JUDICIAL SYSTEM- INTAKE COORDINATOR- INTEGRATED CARE CLINIC- JAIL-DIVERSION PROGRAM- PARTIAL HOSPITAL PROGRAM- SUBSTANCE-ABUSE GROUP- COMMUNITY ACTION PLANOBESITY- SCHOOL PROGRAMS- COMMUNITY EDUCATION- GREAT RIVER HEALTH FITNESS- GREAT RIVER HEALTHY LIVING CLINIC- PIONEERING HEALTHY COMMUNITIES GRANT- COMMUNITY ACTION PLANVIOLENT CRIME- CRISIS INTERVENTION TEAM PROGRAM- MANAGEMENT OF AGGRESSIVE BEHAVIORS EMPLOYEE TRAINING PROGRAM- COMMUNITY ACTION PLAN- IDENTIFIED COMMUNITY PROGRAMS- COMMUNITY ACTION PLANPOVERTY- BRIDGES OUT OF POVERTY PROGRAM- FINANCIAL ASSISTANCE/CHARITY CARE- HEALTH INSURANCE MARKETPLACE AND PRESUMPTIVE MEDICARE ENROLLMENT- MEDICATION ASSISTANCE PROGRAM- COMMUNITY ACTION PLAN |
| GREAT RIVER MEDICAL CENTER | PART V, SECTION B, LINE 13H: GRMC MAY USE PRESUMPTIVE FINANCIAL ASSISTANCE ELIGIBILITY:THERE ARE INSTANCES WHEN A PATIENT/INDIVIDUAL MAY APPEAR TO BE ELIGIBLE FOR CHARITY-CARE DISCOUNTS, BUT THERE IS NO COMPLETED FINANCIAL ASSISTANCE FORM ON FILE BECAUSE OF A LACK OF SUPPORTING DOCUMENTATION. OFTEN THERE IS ADEQUATE INFORMATION PROVIDED BY THE PATIENT OR THROUGH OTHER RESOURCES THAT COULD PROVIDE SUFFICIENT EVIDENCE TO DETERMINE ELIGIBILITY.1. INFORMATION IS PROVIDED WEEKLY TO AVADYNE, AN OUTSIDE SOURCE. AVADYNE RETURNS RESULTS TO GREAT RIVER MEDICAL CENTER ABOUT PATIENT QUALIFICATIONS BASED ON OUR FINANCIAL ASSISTANCE POLICY.2. AVADYNE USES DEMOGRAPHIC AND HOUSEHOLD INFORMATION, AND CREDIT-SCORING TECHNOLOGY TO DETERMINE THE PERCENTAGE OF ASSISTANCE FOR WHICH A PATIENT MAY BE ELIGIBLE.3. GREAT RIVER MEDICAL CENTER WILL ATTEMPT TO CONTACT PATIENTS BASED ON THEIR PRESUMPTIVE ASSISTANCE QUALIFICATION TO ALLOW THE PATIENT TO APPLY FOR FINANCIAL ASSISTANCE.4. PATIENTS WILL NOT BE DISQUALIFIED FROM FINANCIAL ASSISTANCE BASED ON PRESUMPTIVE ASSISTANCE RESULTS.5. IF THE ACCOUNT IS PAST DUE AND THERE IS NO COMPLETED FINANCIAL ASSISTANCE APPLICATION OR SUPPORTING DOCUMENTATION, THE PATIENT'S ACCOUNT COULD BE CONSIDERED FOR FINANCIAL ASSISTANCE BASED ON AVADYNE'S RESULTS.6. PRESUMPTIVE ELIGIBILITY ALSO CAN BE DETERMINED BASED ON LIFE CIRCUMSTANCES INCLUDING: -ELIGIBILITY FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT ARE UNFUNDED -FOOD STAMP ELIGIBILITY -HOMELESS OR RECEIVED CARE FROM A HOMELESS CLINIC -LOW INCOME/SUBSIDIZED HOUSING PROVIDED AS A VALID ADDRESS -PARTICIPATION IN THE WOMEN INFANTS AND CHILDREN (WIC) PROGRAM -PATIENT IS DECEASED WITH NO KNOWN ESTATE -STATE-FUNDED PRESCRIPTION PROGRAMS -SUBSIDIZED SCHOOL LUNCH PROGRAM ELIGIBILITY7. IT ALSO IS ACCEPTABLE TO USE PROXY INFORMATION TO DETERMINE ELIGIBILITY WHEN INCOME LEVELS CANNOT BE DIRECTLY DETERMINED. SUCH INFORMATION COULD INCLUDE STATEMENTS LIKE "STAYS WITH FRIENDS OR "OCCASIONALLY WORKS."8. PATIENTS WHO MEET PRESUMPTIVE-CARE GUIDELINES MAY QUALIFY FOR FINANCIAL ASSISTANCE DISCOUNTS. THIS DETERMINATION IS AT THE DISCRETION OF GREAT RIVER MEDICAL CENTER.9. IN A SITUATION, WHERE PRESUMPTIVE ELIGIBILITY IS GIVEN TO A PATIENT AND A FINANCIAL ASSISTANCE APPLICATION IS OBTAINED LATER, THE UPDATED ELIGIBILITY WILL BE BASED ON THE FINANCIAL ASSISTANCE APPLICATION WITH SUPPORTING DOCUMENTATION. IN THIS CASE, GREAT RIVER MEDICAL CENTER COULD ADJUST FINANCIAL ASSISTANCE UP TO THREE MONTHS BEFORE THE APPLICATION DATE. |
| GREAT RIVER MEDICAL CENTER | PART V, SECTION B, LINE 20E: GRMC USES AN OUTSIDE SOURCE TO SCREEN PATIENTS TO SEE IF THEY COULD BE ELIGIBLE FOR FINANCIAL ASSISTANCE. THE HOSPITAL GETS NOTIFICATION BACK AS TO HOW MUCH OF A FINANCIAL ASSISTANCE DISCOUNT THEY WOULD BE ELIGIBLE FOR. IF THE PATIENT DOESN'T RESPOND TO PHONE CALLS REGARDING THE FINANCIAL ASSISTANCE APPLICATION OR THEY DON'T COMPLETE THE APPLICATION, THE HOSPITAL MAY STILL DISCOUNT THE PATIENT'S CHARGES UNDER THEIR PRESUMPTIVE CHARITY POLICY. THE HOSPITAL'S PRESUMPTIVE CHARITY PROGRAM GIVES THE HOSPITAL THE OPPORTUNITY TO DISCOUNT PATIENT ACCOUNTS BASED ON INFORMATION IT MAY HAVE REGARDING A PATIENT BEING HOMELESS OR UNEMPLOYED. |
| GREAT RIVER MEDICAL CENTER | PART V, SECTION B, LINE 22D: AMOUNTS GENERALLY BILLED AN AMOUNT EQUIVALENT TO THE AVERAGE AMOUNT BILLED TO PATIENTS WITH INSURANCE COVERAGE AFTER INSURANCE PAYS. THE "LOOK BACK" METHODOLOGY WAS USED IN THE DETERMINATION OF THE AMOUNT GENERALLY BILLED PERCENTAGE OF 40 PERCENT OF TOTAL CHARGES. THIS CALCULATION WAS BASED ON MEDICARE FEE FOR SERVICE, BLUE CROSS BLUE SHIELD AND COMMERCIAL INSURANCES' ACTUAL FISCAL YEAR 2014 HISTORICAL CLAIMS. THIS CALCULATION IS RE-EVALUATED ANNUALLY AND WILL BE PROVIDED TO PEOPLE BY REQUEST AT NO EXPENSE TO THE REQUESTING PARTY. |
| PART V, SECTION B, LINE 11 | SUMMARY OF ACTIONS IN RESPONSE TO 2013 COMMUNITY HEALTH NEEDS ASSESSMENTTHE TOP THREE NEEDS IDENTIFIED WERE:- OBESITY- ACCESS- MENTAL HEALTHOVER THE NEXT THREE YEARS, THE HEALTH SYSTEM WORKED DILIGENTLY TO INCREASE ACCESS TO HEALTH CARE AND IMPROVE HEALTH IN THE IDENTIFIED AREAS.OBESITYONE-THIRD OF ADULTS IN DES MOINES COUNTY ARE OBESE, AND MANY MORE ARE OVERWEIGHT. SEVENTY-EIGHT PERCENT OF SURVEY RESPONDENTS SAID IT IS A SIGNIFICANT ISSUE. GREAT RIVER HEALTH SYSTEMS SET A GOAL TO INCREASE AWARENESS, ACCESS AND EDUCATION REGARDING HEALTHY BEHAVIORS.OBESITY PREVENTION EDUCATION:FROM 2013 TO 2015, GREAT RIVER HEALTH SYSTEMS PROVIDED AN EDUCATIONAL DISPLAY, NUTRITION INFORMATION AND ACTIVITIES AT 11 HEALTH FAIRS FOR CHILDREN, FAMILIES AND EMPLOYERS.GREAT RIVER HEALTH SYSTEMS IS A MEMBER OF THE SOUTHEAST IOWA REGIONAL COALITION FOR LIFESTYLE ENHANCEMENT, WHICH MEETS QUARTERLY. IT IS A MAJOR SPONSOR OF THE COALITION'S ANNUAL HEALTHY LIFESTYLE CONFERENCE FOR HEALTH CARE EDUCATORS AND PROVIDERS, GIVING FINANCIAL AND PROFESSIONAL SUPPORT.GREAT RIVER HEALTH FITNESSIN AUGUST 2013, GREAT RIVER HEALTH SYSTEMS OPENED ITS GREATLY EXPANDED EXERCISE FACILITY, GREAT RIVER HEALTH FITNESS. IT IS THE LARGEST AND MOST ADVANCED WORKOUT FACILITY IN DES MOINES COUNTY. THE NEW SPACE HOLDS DOUBLE THE AMOUNT OF WELLNESS EQUIPMENT AS THE ORIGINAL SPACE. NEW FEATURES WERE A FULL EXERCISE TRACK AND A THREE-STORY ROCK-CLIMBING TOWER, THE ONLY ONE IN THE REGION. THE WARM- AND COOL-WATER THERAPY POOLS CONTINUE TO PROVIDE EXERCISE AND THERAPY OPPORTUNITIES.FITNESS-CENTER USE IS GAUGED BY MEMBERSHIP CARD SCANS. THESE NUMBERS REFLECT GROWING USE OF GREAT RIVER HEALTH FITNESS: SEPTEMBER 2012 - 5,473; SEPTEMBER 2013 - 6,918; SEPTEMBER 2015 - 9,507SPECIAL PROGRAMS AND SERVICES OFFERED BY GREAT RIVER HEALTH FITNESS INCLUDE:- ABLE (A BETTER LIFE EVERY DAY) - A PROGRAM FOR PEOPLE WHO HAVE DIFFICULTY OBTAINING OR MAINTAINING A HEALTHY WEIGHT- DELAY THE DISEASE - AN EXERCISE PROGRAM FOR PEOPLE WITH PARKINSON'S DISEASE- FAME (FITNESS AND MOBILITY EXERCISE) - A PROGRAM FOR PEOPLE WHO HAVE HAD A STROKE- WELLNESS COACHING - AN EMPLOYEE WHO HAS A MASTER'S DEGREE IN HEALTH PROMOTION AND EMPHASIS ON WELLNESS COACHING WORKS WITH GREAT RIVER HEALTH SYSTEMS EMPLOYEES WHO DIDN'T PASS METABOLIC PANEL TESTING AND ARE CHOOSING TO BE IMPROVE THEIR HEALTH. MORE THAN 100 PEOPLE HAVE PARTICIPATED.GREAT RIVER HEALTHY LIVING CLINICIN 2015, GREAT RIVER HEALTHY LIVING CLINIC MOVED INTO THE NEW GREAT RIVER FAMILY PRACTICE CLINIC. IT HAS A DEMONSTRATION KITCHEN FOR HEALTHY COOKING PROGRAMS, WHICH FILL QUICKLY.THE CLINIC PROVIDES SERVICES THAT PROMOTE HEALTHY LIFESTYLE CHOICES, WHICH ARE CONDUCIVE TO LONG-TERM SUCCESS IN WEIGHT LOSS AND PREVENTING METABOLIC SYNDROME. ITS SIGNATURE PROGRAM, OPERATION TRANSFORMATION, ADDRESSES A GROUP OF RISK FACTORS ASSOCIATED WITH CORONARY ARTERY DISEASE, STROKE AND TYPE 2 DIABETES.THE PHYSICIAN-SUPERVISED WEIGHT-LOSS PROGRAM FOCUSES ON CHANGING LIFESTYLE BEHAVIORS COUPLED WITH NUTRITION GUIDANCE AND EXERCISE REGIMENS TO ACHIEVE LASTING WEIGHT-LOSS GOALS. ITS SUCCESS RATE IS GREATER THAN 90 PERCENT.AREA BUSINESSES, INCLUDING GREAT RIVER MEDICAL CENTER, HAVE BEGUN USING OPERATION TRANSFORMATION AS A WELLNESS BENEFIT FOR THEIR EMPLOYEES.THE HEALTHY LIVING CLINIC WORKED WITH AREA RESTAURANTS AND GREAT RIVER MEDICAL CENTER'S CAFETERIA TO PROVIDE OPERATION TRANSFORMATION- APPROVED HEALTHIER MENU ITEMS.THE HEALTHY LIVING CLINIC ALSO WORKS WITH THE BURLINGTON YMCA TO OFFER FINDING A HEALTHIER YOU, A PROGRAM THAT HELPS IMPROVE FITNESS AND EATING CHOICES.PIONEERING HEALTHY COMMUNITIES GRANT GREAT RIVER HEALTH SYSTEMS PARTICIPATES IN THE DES MOINES COUNTY LIVING WELL COALITION IN PARTNERSHIP WITH THE BURLINGTON YMCA. PROJECTS HAVE INCLUDED PLANNING, SUPPORTING AND IMPLEMENTING COMMUNITY GARDENS IN BURLINGTON TO SUPPORT HEALTHY EATING. FRUITS AND VEGETABLES GROWN ARE AVAILABLE TO THE COMMUNITY, AND SURPLUS ITEMS ARE OFFERED AT THE YMCA FOR A FREE-WILL DONATION.ACCESSSTAKEHOLDER INTERVIEWS AND PUBLIC SURVEYS SHOWED CONCERN FOR THE LACK OF ACCESS TO HEALTH CARE PROVIDERS AND THE DISPROPORTIONATELY LOW NUMBER OF PHYSICIANS FOR THE SIZE OF THE COMMUNITY. WITH A GOAL TO INCREASE ACCESS AND AWARENESS OF SERVICES, GREAT RIVER HEALTH SYSTEMS DEVELOPED A THREE-PART ACTION PLAN CONSISTING OF DEVELOPING GREAT RIVER QUICKCARE, PROVIDING CLINICAL SERVICES TO THE UNDERSERVED AND TIRELESSLY RECRUITING PHYSICIANS.GREAT RIVER QUICKCAREGREAT RIVER QUICKCARE OPENED IN OCTOBER 2012 TO PROVIDE PRIMARY CARE FOR PATIENTS WHO DON'T HAVE PRIMARY-CARE PROVIDERS OR WHO CAN'T GET IMMEDIATE APPOINTMENTS WITH THEIR PROVIDERS. THE WALK-IN CLINIC TREATS PEOPLE 18 MONTHS AND OLDER WHO HAVE LOWER-ACUITY ILLNESSES SUCH AS COLDS, INFLUENZA, EARACHES, PINK EYE AND INSECT BITES. IT ALSO OFFERS LIMITED LABORATORY SERVICES, AND CAMP AND SPORTS PHYSICALS. GREAT RIVER QUICKCARE PROVIDES COST-EFFECTIVE TREATMENT COMPARED TO EMERGENCY DEPARTMENT VISITS.POSTCARDS ANNOUNCING THE OPENING OF GREAT RIVER QUICKCARE WERE SENT TO EVERY HOME IN DES MOINES COUNTY. ADVERTISING CONTINUES IN NEWSPAPERS AND LOCAL PERIODICALS. INFORMATION ABOUT SERVICES APPEARS IN GREAT RIVER HEALTH SYSTEMS'SERVICE GUIDE AND ON THE HEALTH SYSTEMS'WEBSITESINCE ITS OPENING, GREAT RIVER QUICKCARE HAS:- INCREASED THE NUMBER OF PROVIDERS FROM ONE TO SEVEN- ADDED CERTIFIED MEDICAL ASSISTANTS- EXTENDED ITS SCHEDULE FROM FIVE DAYS A WEEK TO SEVEN- DOUBLED THE NUMBER OF EXAMINATION ROOMS AND ENLARGED THE WAITING AREATHE NUMBER OF PATIENTS TREATED YEARLY DOUBLED FROM 4,847 IN 2013 TO 9,875 IN 2015:PROVIDING CLINICAL SERVICES TO THE UNDERSERVED BESIDES EXPANDING SERVICES THROUGH GREAT RIVER QUICKCARE, GREAT RIVER FAMILY PRACTICE CLINIC OPENED IN SEPTEMBER 2015 WITH THREE NEW PROVIDERS. GREAT RIVER MEDICINE SPECIALISTS, GREAT RIVER NEPHROLOGY AND GREAT RIVER PULMONOLOGY EXTENDED THEIR HOURS, ADDED APPOINTMENT TIMES AND ADDED VISITING PHYSICIANS TO PROVIDE SERVICES IN SPECIALTY AREAS.IN 2014, GREAT RIVER HEALTH SYSTEMS FINANCIAL COUNSELORS COMPLETED TRAINING TO BECOME CERTIFIED APPLICATION COUNSELORS FOR THE HEALTH INSURANCE MARKETPLACE. THEY ARE AVAILABLE BY APPOINTMENT TO HELP IOWANS ENROLL IN HEALTH COVERAGE. THE STATE-BASED MARKETPLACE GIVES CONSUMERS A SINGLE SOURCE TO COMPARE OPTIONS, LEARN IF THEY CAN GET LOWER PREMIUMS OR FREE COVERAGE, AND ENROLL IN A PLAN.THE HOSPITAL WAS DESIGNATED A CHAMPION OF COVERAGE ORGANIZATION AND A CERTIFIED APPLICATION COUNSELOR ORGANIZATION BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. IT ALSO IS A PRESUMPTIVE MEDICAID ORGANIZATION. WITH BASIC INFORMATION, FINANCIAL COUNSELORS CAN ENROLL PATIENTS AND FAMILY MEMBERS LIKELY TO BE ELIGIBLE FOR MEDICAID IMMEDIATELY, WITHOUT WAITING FOR AN ELIGIBILITY DETERMINATION FROM THE STATE. MEDICAID WILL PAY THE HOSPITAL FOR THE SERVICES PROVIDED, JUST AS THOUGH THE PATIENT ALREADY ENROLLED IN MEDICAID.PHYSICIAN RECRUITMENTGREAT RIVER HEALTH SYSTEMS ADDED SEVEN PRIMARY- CARE PROVIDERS TO ITS MEDICAL STAFF IN THE AREAS OF FAMILY PRACTICE, INTERNAL MEDICINE AND QUICK CARE.MENTAL HEALTHGREAT RIVER MEDICAL CENTER IS THE ONLY HOSPITAL OFFERING ADULT INPATIENT MENTAL HEALTH SERVICES IN THE SOUTHEAST IOWA REGION. IT HAS AN EIGHT- BED BEHAVIORAL HEALTH UNIT. GREAT RIVER HEALTH SYSTEMS ALSO HAS AN OUTPATIENT MENTAL HEALTH AND SUBSTANCE ABUSE CLINIC.AS IDENTIFIED THROUGH THE COMMUNITY SURVEY AND STAKEHOLDER INTERVIEWS, THE HOSPITAL DETERMINED THE TWO GREATEST MENTAL HEALTH NEEDS ARE MAINTAINING OR INCREASING THE MENTAL HEALTH SERVICES IT PROVIDES AND INCREASING COMMUNITY EDUCATION ABOUT MENTAL HEALTH.IN THREE YEARS, GREAT RIVER HEALTH SYSTEMS RECRUITED THREE PSYCHIATRISTS, INCREASING THE TOTAL TO FIVE, AND INCREASED SERVICE LOCATIONS:- IN 2013, A PHYSICIAN BEGAN SEEING PATIENTS ONLY IN THE INPATIENT PSYCHIATRIC CARE UNIT. BY CONDUCTING PATIENT ROUNDS IN THE UNIT SEVERAL TIMES THROUGHOUT THE DAY, HE CONTINUALLY ASSESSES PATIENT STATUSES, MEDICINES AND PROGRESS, WHICH LEADS TO INCREASED PATIENT STABILITY, SHORTER LENGTHS OF STAY AND A HIGHER TURNOVER OF INPATIENT BEDS.- IN 2014, A PSYCHIATRIST BEGAN PROVIDING OUTPATIENT SERVICES AT COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA THROUGH A CONTRACT AGREEMENT. THIS MAKES BEHAVIORAL HEALTH SERVICES MORE ACCESSIBLE TO THE COMMUNITY'S UNDER- AND UNINSURED POPULATIONS, AND REDUCES THE PATIENT LOAD OF THE PSYCHIATRISTS AT THE HOSPITAL. AS A RESULT, MORE OFFICE APPOINTMENT TIMES ARE AVAILABLE.- IN 2015, A PSYCHIATRIST BEGAN HOLDING WEEKLY OFFICE HOURS AT GREAT RIVER WOMEN'S HEALTH, WHERE SHE SEES PATIENTS DURING SCHEDULED AND WALK-IN APPOINTMENTS.BESIDES THE FIVE PSYCHIATRISTS, THE HEALTH SYSTEM'S MENTAL HEALTH TREATMENT STAFF INCLUDES ONE NURSE PRACTITIONER, ONE PSYCHOLOGIST, TWO LICENSED MASTER SOCIAL WORKERS, THREE LICENSED THERAPISTS, AND TWO SUBSTANCE ABUSE COUNSELORS. |
| PART V, SECTION B, LINE 11 - CONTINUED | BEHAVIORAL HEALTH ASSESSMENT TEAMIN 2014, GREAT RIVER HEALTH SYSTEMS DEVELOPED A BEHAVIORAL HEALTH ASSESSMENT TEAM TO HELP MEET THE INCREASING NEED FOR MENTAL HEALTH SERVICES. THE TEAM CONSISTS OF THE BEHAVIORAL HEALTH DIRECTOR, SOCIAL WORK SUPERVISOR, A PSYCHIATRIST, FOUR ASSESSMENT SPECIALISTS AND AN ADDICTIONS SPECIALIST. IT WORKS WITH PATIENTS, PROVIDERS AND COMMUNITY AGENCIES TO ENSURE EXISTING SERVICES ARE PROVIDED EFFECTIVELY AND EFFICIENTLY. SERVICES ARE PROVIDED FOR PATIENTS IN THE ACUTE CARE CENTER, EMERGENCY DEPARTMENT AND INTENSIVE CARE UNIT.ACUTE CARE CENTER:- FOLLOWS PATIENTS WHO HAVE MENTAL HEALTH OR SUBSTANCE-ABUSE ISSUES- PROVIDES COMPLETE ASSESSMENTS ON PATIENTS WHO HAVE PSYCHIATRIC CONSULTATIONSEMERGENCY DEPARTMENT:- PROVIDES COMPLETE ASSESSMENTS ON PATIENTS WHO HAVE COURT COMMITTAL DOCUMENTS- PROVIDES COMPLETE ASSESSMENTS ON PATIENTS WITH MENTAL HEALTH OR SUBSTANCE-ABUSE ISSUES- HELPS PATIENTS WHO RETURN FREQUENTLY IN SEARCH OF OTHER RESOURCES- HELPS PATIENTS WHO NEED SOCIAL WORK SERVICESINTENSIVE CARE UNIT:- FOLLOWS PATIENTS WHO HAVE SUBSTANCE-ABUSE OR MENTAL HEALTH ISSUES- HELPS PATIENTS WHO NEED SOCIAL WORK SERVICES FOR MENTAL HEALTH OR SUBSTANCE ABUSE- COMPLETES ASSESSMENTS ON PATIENTS WITH MENTAL HEALTH OR SUBSTANCE-ABUSE ISSUESCRISIS STABILIZATION SERVICESGREAT RIVER HEALTH SYSTEMS'DIRECTOR OF BEHAVIORAL HEALTH WORKED WITH HOPE HAVEN AREA DEVELOPMENT CENTER TO DEVELOP CRITERIA FOR ITS CRISIS STABILIZATION SERVICES. THE FIVE- BED CRISIS SERVICE IS AVAILABLE TO ADULTS WITH A MENTAL ILLNESS OR DEVELOPMENTAL DISABILITY WHO TEMPORARILY CANNOT LIVE INDEPENDENTLY AND NEED IMMEDIATE INTERVENTION. PROVIDING OUTPATIENT PSYCHIATRIC CARE IN THIS SETTING REDUCES THE NEED FOR HOSPITAL ADMISSIONS.INCREASED COLLABORATION WITH JUDICIAL SYSTEM THE DIRECTOR OF BEHAVIORAL HEALTH AND MEDICAL DIRECTOR OF GREAT RIVER MENTAL HEALTH MEET WITH DES MOINES COUNTY JUDGES TWICE A YEAR TO DISCUSS THE PROCESS FOR MENTAL HEALTH COMMITTALS TO ENSURE THE BEST TREATMENT FOR PATIENTS.INTAKE COORDINATORAN INTAKE COORDINATOR POSITION WAS ESTABLISHED AT GREAT RIVER MENTAL HEALTH. IN FACE-TO-FACE APPOINTMENTS, THE COORDINATOR SCREENS NEW PATIENTS AND MAKES APPOINTMENTS WITH APPROPRIATE PROVIDERS TO IMPROVE TIMELINESS OF CARE.INTEGRATED CARE CLINICIN 2015, GREAT RIVER HEALTH SYSTEMS IMPLEMENTED AN INTEGRATED CARE CLINIC, OFFERING POPULATION- BASED HEALTH SERVICES THAT ADDRESS THE COMPREHENSIVE PHYSICAL AND MENTAL HEALTH NEEDS OF PATIENTS. THE FIRST OF ITS KIND IN SOUTHEAST IOWA, IT SERVES CLIENTS FROM OPTIMAE LIFESERVICES, AN ORGANIZATION THAT PROVIDES RESIDENTIAL AND SUPPORT SERVICES FOR PEOPLE WITH MENTAL ILLNESS OR DEVELOPMENTAL DISABILITIES.OPTIMAE CLIENTS MEET WITH A GREAT RIVER HEALTH SYSTEMS TEAM THAT INCLUDES A PRIMARY-CARE PROVIDER, PSYCHIATRIST, PHARMACIST AND OTHER HEALTH PROFESSIONALS. THIS APPROACH ELIMINATES THE NEED FOR MULTIPLE APPOINTMENTS, IMPROVES COMMUNICATION AMONG HEALTH CARE PROVIDERS AND REDUCES THE POTENTIAL FOR UNNECESSARY EMERGENCY DEPARTMENT VISITS OR ADMISSIONS.JAIL DIVERSION PROGRAMTHE NEW PROGRAM PROVIDES EVALUATION AND COORDINATION OF CARE FOR PEOPLE WHO ARE IN JAIL FOR SUSPECTED CRIMES THAT MAY BE THE RESULT OF THEIR MENTAL ILLNESSES.PARTIAL HOSPITAL PROGRAMTHE PARTIAL HOSPITAL PROGRAM, WHICH BEGAN IN 2015, IS FOR PATIENTS WHO DON'T REQUIRE INPATIENT HOSPITALIZATION BUT ARE IN NEED OF INTENSIVE MENTAL HEALTH SERVICES BEYOND WHAT THE OUTPATIENT CLINIC CAN PROVIDE. PATIENTS COME TO THE HOSPITAL FOR SIX HOURS A DAY, MONDAY THROUGH FRIDAY, FOR GROUP THERAPY, MEDICINE MANAGEMENT AND PSYCHIATRIC CARE. THE PROGRAM HELPS BRIDGE THE GAP BETWEEN INPATIENT AND OUTPATIENT SERVICES, HELPING PATIENTS GRADUALLY TRANSITION TO LESS-INTENSIVE PSYCHIATRIC SERVICES.SUBSTANCE ABUSE GROUPTO HELP BRIDGE THE THREE- TO SIX-WEEK WAITING PERIOD BEFORE BEING ADMITTED FOR INPATIENT REHABILITATION FOR SUBSTANCE ABUSE AT OTHER FACILITIES, GREAT RIVER MENTAL HEALTH ESTABLISHED A SUBSTANCE ABUSE GROUP THAT MEETS THREE TIMES A WEEK. RANDOM URINE DRUG SCREENS ARE CONDUCTED. |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | GREAT RIVER MEDICAL CENTER (GRMC) USES THE FPG TO DETERMINE FREE OR DISCOUNTED CARE. INDIVIDUALS WHO ARE BELOW 225% OF THE FPG QUALIFY FOR FREE CARE. IN MOST INSTANCES, THEY HAVE TO PROVIDE FINANCIAL DOCUMENTATION AND FILL OUT A CHARITY CARE APPLICATION. THE HOSPITAL ALSO USES A PRESUMPTIVE CHARITY CARE PROGRAM THAT ANALYZES PUBLIC AND PRIVATE DATABASES TO HELP DETERMINE ELIGIBITY FOR CHARITY CARE. THESE INDIVIDUALS DO NOT HAVE ANY OTHER DOCUMENTATION TO PROVIDE. THIS PROGRAM IS USED AFTER COLLECTION ATTEMPTS HAVE BEEN DISCONTINUED. EXTRAORDINARY ASSETS ARE TAKEN INTO CONSIDERATION WHEN DETERMINING CHARITY CARE ELIGIBILITY. MEDICALLY INDIGENT INDIVIDUALS ARE COVERED UNDER THE SAME CHARITY CARE POLICY. INDIVIDUALS BETWEEN 225% AND 300% OF THE FEDERAL POVERTY LIMITS ARE GRANTED CHARITY ON A SLIDING SCALE. |
| PART I, LINE 7: | THE AMOUNTS INCLUDED IN PART I, LINE 7 WERE CALCULATED USING A RATIO OF COST TO CHARGES DERIVED FROM WORKSHEET 2 OF THE IRS SCHEDULE H INSTRUCTIONS. |
| PART I, LINE 7G: | THE SUBSIDIZED HEALTH SERVICES INCLUDED IN PART I, LINE 7G IS MENTAL HEALTH SERVICES PROVIDED BY GRMC. |
| PART I, LN 7 COL(F): | BAD DEBT EXPENSES OF $4,747,691 WERE SUBTRACTED FROM THE TOTAL EXPENSES IN CALCULATING THE PERCENTAGES IN PART I, LINE 7, COLUMN F. |
| PART III, LINE 4: | THE FOOTNOTE FROM THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE IS AS FOLLOWS: "PATIENT RECEIVABLES WHERE A THIRD-PARTY PAYOR IS RESPONSIBLE FOR PAYING THE AMOUNT ARE CARRIED AT A NET AMOUNT DETERMINED BY THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED, LESS AN ESTIMATE MADE FOR CONTRACTUAL ADJUSTMENTS OR DISCOUNTS PROVIDED TO THIRD-PARTY PAYORS. PATIENT RECEIVABLES DUE DIRECTLY FROM PATIENTS ARE CARRIED AT THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED LESS AMOUNTS COVERED BY THIRD-PARTY PAYORS AND LESS AN ESTIMATED ALLOWANCE FOR DOUBTFUL RECEIVABLES BASED ON A REVIEW OF ALL OUTSTANDING AMOUNTS ON A MONTHLY BASIS. MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS, BY HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS AND BY CONSIDERING THE PATIENTS' FINANCIAL HISTORY, CREDIT HISTORY AND CURRENT ECONOMIC CONDITIONS. THE MEDICAL CENTER DOES NOT CHARGE INTEREST ON PATIENT RECEIVABLES. PATIENT RECEIVABLES ARE WRITTEN OFF WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSES WHEN RECEIVED." |
| PART III, LINE 8: | THE ORGANIZATION DERIVED ITS COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT BY USING COST REPORT WORKSHEETS. MEDICARE COSTS ARE DETERMINED THROUGH THE MEDICARE COST FINDING PROCESS WHICH ALLOCATES GENERAL SERVICE CENTER COSTS TO REVENUE DEPARTMENTS. THE METHODOLOGY DESCRIBED IN THE INSTRUCTIONS TO SCHEDULE H, PART III, SECTION B, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE HOSPITAL AND DOES NOT REPRESENT THE TOTAL COMMUNITY BENEFIT CONFERRED IN THIS AREA. THE REASONS MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT ARE - ABSENT THE MEDICARE PROGRAM, IT IS LIKELY MANY OF THE INDIVIDUALS WOULD QUALIFY FOR FINANCIAL ASSISTANCE OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS. BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS. THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION IN REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS, AND THE AMOUNT SPENT TO COVER MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFIT NEEDS. |
| PART III, LINE 9B: | AN EXCERPT FROM GRMC'S FINANCIAL ASSISTANCE PROGRAM WRITTEN POLICY - SECTION 8, RELATIONSHIP OF FINANCIAL ASSISTANCE PROGRAM TO COLLECTION POLICIES: "GREAT RIVER MEDICAL CENTER MANAGEMENT SHALL DEVELOP POLICIES AND PROCEDURES FOR INTERNAL AND EXTERNAL COLLECTION PRACTICES THAT TAKE INTO ACCOUNT THE EXTENT TO WHICH THE PATIENT QUALIFIES FOR CHARITY, A PATIENT'S GOOD FAITH EFFORT TO APPLY FOR A GOVERNMENTAL PROGRAM OR FOR CHARITY FROM GREAT RIVER MEDICAL CENTER, AND A PATIENT'S GOOD FAITH EFFORT TO COMPLY WITH HIS OR HER PAYMENT AGREEMENTS WITH GREAT RIVER MEDICAL CENTER. FOR PATIENTS WHO QUALIFY FOR CHARITY AND WHO ARE COOPERATING IN GOOD FAITH EFFORT TO RESOLVE THEIR DISCOUNTED HOSPITAL BILLS, GREAT RIVER MEDICAL CENTER MAY OFFER EXTENDED PAYMENT PLANS, WILL NOT SEND UNPAID BILLS TO OUTSIDE COLLECTION AGENCIES, AND WILL CEASE ALL COLLECTION EFFORTS. GREAT RIVER MEDICAL CENTER AND AGENCIES ACTING ON BEHALF OF GREAT RIVER MEDICAL CENTER WILL NOT IMPOSE EXTRAORDINARY COLLECTION ACTIONS SUCH AS WAGE GARNISHMENTS; LIENS ON PRIMARY RESIDENCES, OR OTHER LEGAL ACTIONS FOR ANY PATIENT WITHOUT FIRST MAKING REASONABLE EFFORTS TO DETERMINE WHETHER THAT PATIENT IS ELIGIBLE FOR CHARITY CARE UNDER THIS FINANCIAL ASSISTANCE POLICY. REASONABLE EFFORTS SHALL INCLUDE: A) VALIDATING THAT THE PATIENT OWES THE UNPAID BILLS AND THAT ALL SOURCES OF THIRD-PARTY PAYMENTS HAVE BEEN IDENTIFIED AND BILLED BY THE HOSPITAL; B) DOCUMENTATION THAT GREAT RIVER MEDICAL CENTER HAS OR HAS ATTEMPTED TO OFFER THE PATIENT THE OPPORTUNITY TO APPLY FOR CHARITY CARE PURSUANT TO THIS POLICY AND THAT THE PATIENT HAS NOT COMPLIED WITH THE HOSPITAL'S APPLICATION REQUIREMENTS; C) DOCUMENTATION THAT THE PATIENT HAS BEEN OFFERED A PAYMENT PLAN BUT HAS NOT HONORED THE TERMS OF THAT PLAN." |
| PART III, SECTION A, LINE 1 | THE ORGANIZATION REPORTS BAD DEBT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). HFMA STATEMENT 15 IS FOLLOWED TO THE EXTENT THAT IT ALIGNS WITH THE GUIDELINES SET FORTH BY GAAP. |
| PART VI, LINE 2: | GRMC'S BOARD OF DIRECTORS IS COMMUNITY BASED. REPRESENTATIVES FROM VARIOUS SEGMENTS OF THE COMMUNITY MAKE UP THE BOARD. IN ADDITION, BOARD MEMBERS ARE SELECTED IN OUTLYING COMMUNITIES THAT GRMC SERVES. THESE BOARD MEMBERS CONSTANTLY PROVIDE INPUT TO THE HEALTHCARE NEEDS OF OUR COMMUNITY THROUGH THE ANNUAL STRATEGIC PLANNING PROCESS. |
| PART VI, LINE 3: | NOTIFICATION ABOUT GOVERNMENT PROGRAM AND/OR FINANCIAL ASSISTANCE FROM GRMC IS DISSEMINATED BY VARIOUS MEANS AT GRMC, WHICH INCLUDES - PUBLICATION OF NOTICES IN PATIENT BILLS AND POSTED NOTICES IN THE EMERGENCY ROOMS, ADMISSION FORMS, ADMITTING AND REGISTRATION DEPARTMENT, HOSPITAL BUSINESS OFFICES, AND THE FINANCIAL SERVICES OFFICE ON THE FACILITY CAMPUS. GRMC ALSO POSTS AT THE LOCAL DEPARTMENT OF HEALTH SERVICES OFFICE. GRMC ALSO PUBLISHES AND WIDELY PUBLICIZES A SUMMARY OF THE ASSISTANCE OPTIONS ON THE FACILITY WEBSITE AND IN BROCHURES AVAILABLE IN PATIENT ACCESS SITES. REFERRAL OF PATIENTS FOR CHARITY MAY BE MADE BY ANY MEMBER OF THE GRMC STAFF. ALSO REQUESTS FOR CHARITY MAY BE MADE BY THE PATIENT OR A FAMILY MEMBER, CLOSE FRIEND, OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS. FINANCIAL COUNSELORS MEET WITH PATIENTS TO ASSIST IN COMPLETING A QUESTIONNAIRE THAT HELPS THEM DETERMINE IF THE PATIENT QUALIFIES FOR A GOVERNMENT PROGRAM. |
| PART VI, LINE 4: | A REVIEW WAS CONDUCTED BY GRMC TO ANALYZE THE ORIGIN OF PATIENTS UTILIZING THE SERVICES PROVIDED BY THE MEDICAL CENTER. THE REVIEW INDICATED THAT DES MOINES COUNTY COMPRISES THE MEDICAL CENTER'S PRIMARY SERVICE AREA AND THAT THE SECONDARY SERVICE AREA OF THE MEDICAL CENTER CONSISTS OF HENRY, LEE, AND LOUISA COUNTIES IN IOWA AND HANCOCK AND HENDERSON COUNTIES IN ILLINOIS.BASED ON THE US CENSUS BUREAU STATISTICS FOR 2016, THE PRIMARY SERVICE AREA POPULATION IS ESTIMATED AT 39,739 RESIDENTS. THE SECONDARY SERVICE AREA POPULATIONS ARE ESTIMATED TO TOTAL 71,134 RESIDENTS. OVER AGE 65 GROUP IS CURRENTLY 19.4% OF THE PRIMARY SERVICE AREA POPULATION, AS COMPARED TO 16.1% OF THE STATE OF IOWA POPULATION AND 14.9% OF THE UNITED STATES POPULATION. THE MEDIAN HOUSEHOLD INCOME IN THE PRIMARY SERVICE AREA IS $44,423 COMPARED TO THE STATE AND NATIONAL AVERAGES OF $53,183 AND $53,889, RESPECTIVELY. THE PRIMARY SERVICE AREA POPULATION BELOW POVERTY LEVEL IS 14.7% AS COMPARED TO THE STATE AND NATIONAL AVERAGES OF 12.2% AND 13.5%, RESPECTIVELY.GREAT RIVER MEDICAL CENTER IS THE ONLY HOSPITAL IN THE PRIMARY SERVICE AREA AND THE LARGEST SERVICE PROVIDER, INCLUDING THE BROADEST SCOPE OF SERVICES, IN THE PRIMARY AND SECONDARY SERVICE AREAS. |
| PART VI, LINE 5: | GRMC FURTHERS ITS EFFORTS TO PROMOTE THE HEALTH OF THE COMMUNITY BY ENSURING THE MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS OF SUCH.GRMC PROVIDES MEMBERSHIP TO ALL PHYSICIANS WHO MEET MEMBERSHIP AND CLINICAL REQUIREMENTS.GMRC IS INVOLVED IN GETTING PHYSICIANS AND HEALTHCARE WORKERS TO THE AREA TO IMPROVE THE ACCESS TO HEALTHCARE NEEDS IN THE HOSPITAL'S SERVICE AREA. GRMC ALSO PROMOTES HEALTH CARE RELATED JOBS EDUCATION BY WORKING CLOSELY WITH SOUTHEASTERN COMMUNITY COLLEGE AND THEIR NURSING PROGRAM.GRMC PARTICIPATES IN COMMUNITY BENEFIT ACTIVITIES SUCH AS PARTNERING WITH LOCAL SCHOOLS, COMMUNITY EDUCATION, COMMUNITY INITIATIVE EVENTS, PRENATAL EDUCATION CLASSES, A HEALTH FAIR, AND A LIBRARY OPEN TO THE COMMUNITY.GRMC MAINTAINS AN EMERGENCY ROOM 24 HOURS A DAY, 7 DAYS A WEEK WHICH IS OPEN TO ALL, REGARDLESS OF ABILITY TO PAY.SURPLUS FUNDS OF THE HOSPITAL ARE INVESTED IN IMPROVING AND UPDATING CAPITAL EQUIPMENT AND INCREASING THE SERVICES OFFERED TO ALLOW FOR BETTER CARE OF THE PATIENTS THAT ARE SERVED. |
| PART VI, LINE 6: | GRMC IS PART OF A LARGER HEALTH SYSTEM, GREAT RIVER HEALTH SYSTEM.GREAT RIVER HEALTH SYSTEM CONSISTS OF ONE HOSPITAL, A HOSPICE HOUSE, HOME HEALTH SERVICES, AMBULANCE SERVICES, THREE PHARMACIES, A DURABLE MEDICAL EQUIPMENT COMPANY, A LONG-TERM CARE NURSING HOME AND MULTIPLE GENERAL AND SPECIALTY PHYSICIAN CLINICS.THE NON-HOSPITAL HEALTH-CARE FACILITIES THAT ARE OPERATED BY ORGANIZATIONS RELATED TO THE HOSPITAL INCLUDE THE FOLLOWING, LISTED IN ORDER OF SIZE: BURLINGTON AREA FAMILY PRACTICE, GREAT RIVER ORTHOPEDIC SPECIALISTS, GREAT RIVER WOMEN'S HEALTH, HERITAGE MEDICAL EQUIPMENT SUPPLY, KEOKUK CLINIC, HERITAGE PARK PHARMACY, GREAT RIVER MENTAL HEALTH, GREAT RIVER ANESTHESIA, HERITAGE PARTNERS PHARMACY, GREAT RIVER SURGEONS, GREAT RIVER UROLOGY, GREAT RIVER QUICK CARE, WAPELLO CLINIC, GREAT RIVER MEDICINE SPECIALISTS, HERITAGE FAMILY PHARMACY, HEALTHY LIVING CLINIC, MEDIAPOLIS CLINIC, GREAT RIVER NEPHROLOGY, GREAT RIVER PULMONOLOGY, GREAT RIVER EYE SPECIALISTS, GREAT RIVER GASTROENTEROLOGY, GREAT RIVER AUDIOLOGY, GREAT RIVER HOSPITALISTS, GREAT RIVER HEMATOLOGY & ONCOLOGY, AND GREAT RIVER CARDIOLOGY. |
| PART VI, LINE 7 | GRMC DOES NOT FILE A COMMUNITY BENEFIT REPORT WITH THE STATE OF IOWA. HOWEVER, COMMUNITY BENEFIT INFORMATION IS PROVIDED TO THE IOWA HOSPITAL ASSOCIATION. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| FRIENDS OF THE BURLINGTON DEPOT | |||||||
| PO BOX 26 | BURLINGTON | IA | 52601 | 455506965 | 501(C)(3) | $5,000 | SUPPORT REVITALIZATION OF COMMUNITY HISTORIC SITE |
| PURPLE & GRAY FOUNDATION | |||||||
| 520 WASHINGTON STREET | BURLINGTON | IA | 52601 | 455339253 | 501(C)(3) | $5,000 | SUPPORT DEVELOPMENT OF HIGH SCHOOL SPORTS PROGRAMS |
| BURLINGTON NOTRE DAME FOUNDATION | |||||||
| 702 S ROOSEVELT AVE | BURLINGTON | IA | 52601 | 421192150 | 501(C)(3) | $25,000 | SUPPORT DEVELOPMENT OF HIGH SCHOOL SPORTS PROGRAMS |
| GIRL SCOUTS OF EASTERN IOWA | |||||||
| 1308 BROADWAY STREET | WEST BURLINGTON | IA | 52655 | 421008848 | 501(C)(3) | $25,000 | SUPPORT RENOVATION OF YOUTH CAMPING SITES |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 4 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | GRANTEES ARE REQUIRED TO PROVIDE FOLLOW-UP INFORMATION WHEN THE PROJECT IS CARRIED OUT OR COMPLETED. IF GRANTEES DON'T COMPLY, GRMC DOES NOT PROVIDE FURTHER GRANTS TO THEM. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | Yes (X) | TravelForCompanionsInd |
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MICHAEL MCCOY MD | ||||||||||||||
| DIRECTOR (THROUGH OCTOBER 2015) | $0 | $346,923 | $0 | $0 | $0 | -$5,012 | $0 | $10,600 | $0 | $13,547 | $0 | $366,058 | $0 | $0 |
| MARK RICHARDSON | ||||||||||||||
| PRESIDENT/CEO | $0 | $558,249 | $0 | $50,000 | $0 | $127,666 | $0 | $10,600 | $0 | $23,244 | $0 | $769,759 | $0 | $0 |
| TONY HAYES | ||||||||||||||
| COO | $0 | $314,621 | $0 | $10,000 | $0 | $111,482 | $0 | $10,600 | $0 | $19,758 | $0 | $466,461 | $0 | $0 |
| TODD SLADKY | ||||||||||||||
| CFO | $0 | $352,580 | $0 | $10,000 | $0 | $31,042 | $0 | $10,600 | $0 | $20,388 | $0 | $424,610 | $0 | $0 |
| DARWIN COOLEY | ||||||||||||||
| DIRECTOR OF PHARMACY | $192,879 | $0 | $0 | $0 | -$2,513 | $0 | $10,102 | $0 | $20,967 | $0 | $221,435 | $0 | $0 | $0 |
| JOHN MERCER III | ||||||||||||||
| DIRECTOR OF FACILITIES | $141,860 | $0 | $0 | $0 | -$8,019 | $0 | $8,141 | $0 | $21,203 | $0 | $163,185 | $0 | $0 | $0 |
| ELIZABETH YORE | ||||||||||||||
| DIRECTOR OF CARDIOVASCULAR SERVICES | $137,214 | $0 | $0 | $0 | -$171 | $0 | $7,862 | $0 | $10,159 | $0 | $155,064 | $0 | $0 | $0 |
| FRANCES STRAUSS | ||||||||||||||
| DIRECTOR OF SURGICAL SERVICES | $154,699 | $0 | $1,000 | $0 | -$8,926 | $0 | $8,026 | $0 | $22,516 | $0 | $177,315 | $0 | $0 | $0 |
| JON WILLIAMS | ||||||||||||||
| PHARMACIST | $143,279 | $0 | $0 | $0 | -$8,227 | $0 | $7,559 | $0 | $21,974 | $0 | $164,585 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | 1. MARK RICHARDSON, HEALTH/SOCIAL CLUB DUES, $4,494 INCLUDED IN TAXABLE WAGES 2. TONY HAYES, TRAVEL FOR COMPANIONS, $326 INCLUDED IN TAXABLE WAGES AND HEALTH/SOCIAL CLUB DUES, $4,494 INCLUDED IN TAXABLE WAGES 3. TODD SLADKY, TRAVEL FOR COMPANIONS, $504 INCLUDED IN TAXABLE WAGES AND HEALTH/SOCIAL CLUB DUES, $4,494 INCLUDED IN TAXABLE WAGES 4. MICHAEL MCCOY, HEALTH/SOCIAL CLUB DUES, $1,873 INCLUDED IN TAXABLE WAGES |
| PART I, LINE 3 | THE COMPENSATION OF THE PRESIDENT & CEO IS DETERMINED BY GREAT RIVER HEALTH SYSTEMS, A RELATED ORGANIZATION. THE FOLLOWING WERE USED BY GREAT RIVER HEALTH SYSTEMS IN DETERMINING THE PRESIDENT & CEO'S COMPENSATION: 1. COMPENSATION COMMITTEE 2. INDEPENDENT COMPENSATION CONSULTANT 3. FORM 990 OF OTHER ORGANIZATIONS 4. WRITTEN EMPLOYMENT CONTRACT 5. COMPENSATION SURVEY OR STUDY 6. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | CUSIPCUSIPNum | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|---|
| IOWA FINANCE AUTHORITY | ||||||||
| A | 521699886 | 462466BV4 | 2008-07-24 | $37,475,000 | REFUND OF PRIOR ISSUE (12/19/97) | 0 | 0 | 0 |
| DES MOINES COUNTY IOWA | ||||||||
| B | 426004310 | 250087AA1 | 2012-04-04 | $60,000,000 | REFUND PRIOR ISSUE (7/25/01) & CONSTRUCT, RENOVATE, EXPAND & EQUIP FACILITY | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Credit EnhancementCreditEnhancementAmt | Capital ExpendituresCapitalExpendituresAmt | Other Spent ProceedsOtherSpentProceedsAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| A | $12,230,070 | $37,475,070 | $306,661 | $68,339 | $70 | $37,100,000 | 2000 | Yes (1) | 0 | Yes (1) | Yes (1) |
| B | $16,245,614 | $60,000,000 | $616,000 | $30,076,758 | $29,307,242 | 2013 | Yes (1) | 0 | Yes (1) | Yes (1) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | B | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | 0 | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | Yes (1) | Yes (1) | Yes (1) | 0 | 0 | 0 | Yes (1) |
| B | 0 | 0 | Yes (1) | Yes (1) | 0 | 0 | 0 | 0 | Yes (1) |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | Yes (1) |
| B | Yes (1) |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| DATE REBATE COMPUTATION PERFORMED | ISSUER NAME: IOWA FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 01/24/2009 ISSUER NAME: DES MOINES COUNTY, IOWA DATE THE REBATE COMPUTATION WAS PERFORMED: 01/31/2013 |
| PART IV, LINE 2, REBATE CALCULATION | NOTE REGARDING THE 01/24/2009 REBATE COMPUTATION: SINCE THE BOND PROCEEDS HAVE BEEN SPENT, A SPENDING EXCEPTION WAS MET, AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA FIDE BASIS, NO FURTHER REBATE CALCULATIONS ARE NECESSARY. |
| PART IV, LINE 2, REBATE CALCULATION | NOTE REGARDING THE 01/31/2013 REBATE COMPUTATION: SINCE THE BOND PROCEEDS HAVE BEEN SPENT, A SPENDING EXCEPTION WAS MET, AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA FIDE BASIS, NO FURTHER REBATE CALCULATIONS ARE NECESSARY. |
| PART II, LINE 3, COLUMN A | THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN E DUE TO INVESTMENT EARNINGS. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KC FLEMING | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | FAMILY MEMBER OF ROBERT FLEMING, BOARD MEMBER | RelationshipDescriptionTxt |
| Transaction | $165,241 | TransactionAmt |
| Transaction | WAGES AND BENEFITS | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF THE CHAIRMAN OF THE BOARD, THE PRESIDENT AND CHIEF EXECUTIVE OFFICER, AND TWO OR MORE ADDITIONAL TRUSTEES. WHEN THE BOARD IS NOT IN SESSION, THE EXECUTIVE COMMITTEE SHALL HAVE AND EXERCISE THE POWER AND AUTHORITY OF THE BOARD TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION, SUBJECT TO ANY PRIOR LIMITATIONS IMPOSED BY THE BOARD OR BY STATUTE. |
| FORM 990, PART VI, SECTION A, LINE 2 | KENT GUADIAN AND ROBERT MCCULLEY HAVE A BUSINESS RELATIONSHIP. ROBERT FLEMING, KENT GAUDIAN, DAN WEIDEMEIER, MARK RICHARDSON AND TODD SLADKY HAVE BUSINESS RELATIONSHIPS BY SERVING ON FOR-PROFIT RELATED ENTITIES OF GRMC. |
| FORM 990, PART VI, SECTION A, LINE 3 | ALL EXECUTIVE LEADERSHIP FUNCTIONS FOR GREAT RIVER MEDICAL CENTER ARE PROVIDED BY MUTUAL CONSULTING AND MANAGEMENT SERVICES, INC. MUTUAL CONSULTING AND MANAGEMENT SERVICES IS A SUBSIDIARY OF RIVERVIEW SYSTEMS LTD, WHICH IS A SUBSIDIARY OF GREAT RIVER HEALTH SYSTEMS. |
| FORM 990, PART VI, SECTION A, LINE 6 | GREAT RIVER HEALTH SYSTEMS INC., IS THE SOLE MEMBER OF GREAT RIVER MEDICAL CENTER. |
| FORM 990, PART VI, SECTION A, LINE 7A | ONE TRUSTEE IS THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF GREAT RIVER MEDICAL CENTER AND THE REMAINING TRUSTEES ARE ELECTED BY THE SOLE MEMBER. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE FOLLOWING MATTERS ARE AUTHORIZED ONLY AFTER APPROVAL OF THE MEMBER: A. MERGER, CONSOLIDATION, OR DISSOLUTION OF GREAT RIVER MEDICAL CENTER WITH ANY OTHER CORPORATION OR LEGAL ENTITY. B. ANY CHANGE IN GREAT RIVER MEDICAL CENTER'S ARTICLES OF INCORPORATION. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 IS PREPARED BY AN EXTERNAL ACCOUNTANT. A DRAFT OF THE FORM 990 IS REVIEWED IN DETAIL BY THE ACCOUNTANT, DIRECTOR OF FINANCE AND CFO. ANY NECESSARY ADJUSTMENTS ARE MADE PRIOR TO FINALIZING THE FORM. A COPY OF THE FINAL FORM 990 IS MADE AVAILABLE TO THE BOARD MEMBERS FOR THEIR REVIEW PRIOR TO FILING WITH THE IRS. ANY QUESTIONS OF THE BOARD MEMBERS ARE ADDRESSED THROUGH THE ACCOUNTING DEPARTMENT. |
| FORM 990, PART VI, SECTION B, LINE 12C | EVERY YEAR, THE DIRECTOR OF FINANCE IN THE ACCOUNTING DEPARTMENT PROVIDES TO THE BOARD THE MEANING OF THE CONFLICT OF INTEREST STATEMENT, HOW IT APPLIES, HOW IT IMPACTS THE BOARD, AND WHAT THEIR RESPONSIBILITIES ARE. ALL BOARD MEMBERS ARE REQUIRED TO FILL OUT A CONFLICT OF INTEREST FORM AND THE FORM IS THEN REVIEWED BY THE DIRECTOR OF FINANCE. RELATIONSHIPS NOTED ON THE FORM MAY BE DISCUSSED WITH THE BOARD MEMBER IF THERE ARE QUESTIONS. IF AN INDIVIDUAL HAS A CONFLICT OF INTEREST, THEY MAY NOT PARTICIPATE IN DISCUSSIONS OF THE TRANSACTION AND MAY NOT VOTE ON MATTERS RELATED TO THE TRANSACTION. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION OF THE OFFICERS OF GREAT RIVER MEDICAL CENTER IS PAID BY A RELATED FOR-PROFIT SUBSIDIARY. THE COMPENSATION FOR THE CEO AND OTHER OFFICERS IS DETERMINED BY THE EXECUTIVE COMPENSATION COMMITTEE OF GREAT RIVER HEALTH SYSTEMS. THE ROLE OF THE COMPENSATION COMMITTEE IS TO ACT ON BEHALF OF THE BOARD IN ADOPTING, REVIEWING AND MAINTAINING AN EXECUTIVE COMPENSATION PHILOSOPHY. THE COMPENSATION COMMITTEE IS COMPRISED OF FIVE BOARD MEMBERS, ALL OF WHOM ARE INDEPENDENT FROM THE CEO AND OTHER OFFICERS. THE COMPENSATION COMMITTEE REVIEWS THE COMPENSATION OF THE CEO AND OTHER OFFICERS ON A BIENNIAL BASIS. THE DELIBERATIONS AND DECISIONS ARE DOCUMENTED IN MINUTES TAKEN AT THE MEETINGS. GREAT RIVER HEALTH SYTEMS PARTICIPATES AND UTILIZES FOUR EXECUTIVE SALARY SURVEYS TO DETERMINE COMPENSATION RANGES. THE COMMITTEE REVIEWS PREVAILING MARKET DATA TO ENSURE CONTINUED MARKET COMPETITIVENESS. THE COMPENSATION COMMITTEE ALSO ENGAGES AN INDEPENDENT THIRD PARTY COMPENSATION CONSULTING GROUP TO ASSESS AND VALIDATE THE ENTIRETY OF THE EXECUTIVE COMPENSATION AND BENEFITS PACKAGES TO ENSURE REGULATORY COMPLIANCE, EXTERNAL COMPETITIVENESS, AND INTERNAL EQUITY. THE MOST RECENT YEAR OF AN INDEPENDENT THIRD PARTY REVIEW WAS 2015. |
| FORM 990, PART VI, SECTION C, LINE 19 | GREAT RIVER MEDICAL CENTER MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | CHANGE IN BENEFICIAL INTEREST IN TRUST -687,097. TRANSFER FROM RELATED PARTY -22,542,603. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| GREAT RIVER HEALTH SYSTEMS INC | |||||||||||
| 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 421193185 | HEALTH CARE | IA | 501(C)(3) | 11 - TYPE 2 | N/A | 0 | |
| GRMC FOUNDATION CORP | |||||||||||
| 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 421193186 | SUPPORT RELATED ORGANIZATIONS | IA | 501(C)(3) | 11 - TYPE 2 | 0 | GRHS | |
| GREAT RIVER FOUNDATION INC | |||||||||||
| 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 421469162 | SUPPORT RELATED ORGANIZATIONS | IA | 501(C)(3) | 11 - TYPE 2 | 0 | GRHS | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| RIVERVIEW SYSTEMS LTD | |||||||||
| 1221 SOUTH GEAR AVE | WEST BURLINGTON | IA | 52655 | 421191960 | MEDICAL SERVICES | IA | N/A | C | 0 |
| GREAT RIVER MEDICAL SERVICES INC | |||||||||
| 1221 SOUTH GEAR AVE | WEST BURLINGTON | IA | 52655 | 421493449 | MEDICAL SERVICES | IA | N/A | C | 0 |
| MUTUAL CONSULTING & MANAGEMENT SERVICES | |||||||||
| 1221 SOUTH GEAR AVE | WEST BURLINGTON | IA | 52655 | 421349668 | MANAGEMENT SERVICES | IA | N/A | C | 0 |
| HEALTH CARE REALTY | |||||||||
| 1221 SOUTH GEAR AVE | WEST BURLINGTON | IA | 52655 | 421193532 | REAL ESTATE | IA | N/A | C | 0 |
| HERITAGE PARK PHARMACY | |||||||||
| 1221 SOUTH GEAR AVE | WEST BURLINGTON | IA | 52655 | 421191957 | PHARMACY | IA | N/A | C | 0 |
| HERITAGE MEDICAL EQUIPMENT & SUPPLY | |||||||||
| 1221 SOUTH GEAR AVE | WEST BURLINGTON | IA | 52655 | 421191958 | MEDICAL SUPPLY | IA | N/A | C | 0 |
| SOUTHEASTERN IOWA MEDICAL SERVICES | |||||||||
| 1221 SOUTH GEAR AVE | WEST BURLINGTON | IA | 52655 | 421307141 | PHYSICIAN CLINICS | IA | N/A | C | 0 |
| 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 | 0 | 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 | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |