2014-11-13T11:54:49-06:00 2013-12-31 420714325 MCGLADREY LLP 801 NICOLLET MALL SUITE 1100 MINNEAPOLIS MN 55402 990 2013-01-01 411865874 GRAND ITASCA CLINIC AND HOSPITAL GRAN 2183265000 1601 GOLF COURSE ROAD GRAND RAPIDS MN 55744 SARAH GUSTAFSON VP OF FINANCE 2183265000 2014-11-10 1 TODD A JACKSON P00092672 6123324300 2013 2015-11-30 17:44:51Z MICHAEL YOUSO 1601 GOLF COURSE ROAD GRAND RAPIDS MN 55744 78719343 0 X WWW.GRANDITASCA.ORG X 1997 MN PATIENT-CENTERED EXCELLENCE 14 11 715 120 0 0 158334 185187 67916852 78321446 767044 3007 3221299 209703 72063529 78719343 0 13956 0 0 46115746 49154241 0 0 234105 28369430 29430932 74485176 78599129 -2421647 120214 87144906 86748316 50451574 47720181 36693332 39028135 X PROVIDE QUALITY, ACCESSIBLE, AND VALUABLE HEALTH CARE SERVICES VIA A HOSPITAL, HOME HEALTH AGENCY, AND CLINIC TO THE SURROUNDING RURAL COMMUNITY. 0 1 66511624 13956 78531149 GRAND ITASCA CLINIC AND HOSPITAL IS AN INTEGRATED MULTI-SPECIALTY CLINIC AND ACUTE/SURGICAL HOSPITAL. THE FACILITY IS LICENSED FOR 64 BEDS WHICH ARE COMPRISED OF 48 MEDICAL BEDS, 10 INTENSIVE CARE BEDS AND 6 OB BEDS. IN ADDITION TO PROVIDING TRADITIONAL HOSPITAL SERVICES, THE FACILITY HAS FOUR SURGERY SUITES, A 24-HOUR EMERGENCY DEPARTMENT, OUTPATIENT MENTAL HEALTH SERVICES, OUTPATIENT REHABILITATION SERVICES, AND OUTPATIENT CLINIC SERVICES. THE FACILITY EMPLOYS APPROXIMATELY 621 PEOPLE INCLUDING 58 HEALTHCARE PROVIDERS.THE FACILITY SERVED APPROXIMATELY 2,035 INPATIENTS AND APPROXIMATELY 198,000 OUTPATIENT ENCOUNTERS INCLUDING CLINIC, EMERGENCY ROOM, OUTPATIENT IMAGING AND OUTPATIENT SURGICAL PROCEDURE. GRAND ITASCA SERVES THE PATIENT REGARDLESS OF THE PERSON'S ABILITY TO PAY. DURING THE CALENDAR YEAR, THE FACILITY PROVIDED $204,900 OF CHARITY CARE, $126,922 DISCOUNT TO THE UNINSURED AND ABSORBED $5,073,845 OF UNPAID MEDICARE AND MEDICAID COSTS. GRAND ITASCA CLINIC AND HOSPITAL ALSO PROVIDES OTHER SUPPORT TO THE COMMUNITY THROUGH CASH AND IN-KIND DONATIONS THAT TOTALED $13,956 IN THE 2013 CALENDAR YEAR. IN ADDITION, GRAND ITASCA PROVIDED HEALTHCARE SUPPORT SERVICES OF $35,184 INCLUDING ASK-A-NURSE AND PATIENT TRANSPORTATION. GRAND ITASCA ALSO PAID $1,097,262 IN PAYMENTS FOR MINNESOTA CARE TAX AND MEDICAID SURCHARGES, WHICH WERE USED TO FUND CARE FOR THE INDIGENT AND UNDERINSURED. 66511624 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 1 43 0 1 715 1 0 0 0 0 0 0 0 0 0 0 X 14 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 MN X SARAH GUSTAFSON 2183265000 1601 GOLF COURSE ROAD GRAND RAPIDS MN 55744 MARVA JEAN HUTCHENS CHAIR 1.00 X X 0 0 0 ELIZABETH MISKOVICH VICE CHAIR 1.00 X X 0 0 0 MARY KOSAK SECRETARY 1.00 X X 0 0 0 SHELLY STEERE TREASURER 1.00 X X 0 0 0 RON IANNELLI DIRECTOR 1.00 X 0 0 0 MIKE IVES DIRECTOR 1.00 X 0 0 0 CHARLES KAMPEN DIRECTOR 1.00 X 0 0 0 KENT KOERBITZ DIRECTOR 1.00 X 0 0 0 BARB SANDERSON DIRECTOR 1.00 X 0 0 0 JOSH SKELTON DIRECTOR 1.00 X 0 0 0 JANICE M ROURK DIRECTOR/PEDIATRIC MD 40.00 X 159327 0 27765 JAMISON L HARKER DIRECTOR/INTERNAL MEDICINE MD 40.00 X 245694 0 36424 BARB UNGER DIRECTOR 1.00 X 0 0 0 COLLEEN NARDONE DIRECTOR 1.00 X 0 0 0 MICHAEL J YOUSO PRESIDENT & CEO 40.00 X 283219 0 35126 NATHAN M NOZNESKY CHIEF MEDICAL OFFICER (FORMER) 40.00 X 276697 0 32015 DEBRA NYQUIST CHIEF MEDICAL OFFICER 40.00 X 311213 0 37732 SARAH GUSTAFSON VP FINANCE 40.00 X 129421 0 9324 HANS SERLETH GENERAL SURGEON CLINIC 40.00 X 617560 0 34061 KARYSSE TRANDEM OB/GYN MD CLINIC 40.00 X 349532 0 23621 JOHN A KOLE GENERAL SURGEON CLINIC 40.00 X 378414 0 37612 DENNIS SCHERER EMERGENCY ROOM MD 40.00 X 324171 0 31870 DARIN SKAUDIS INTERNAL MEDICINE MD CLINIC 40.00 X 315149 0 37024 3390397 0 342574 65 0 1 0 ARAMARK UNIFORM SERVICES 26605 NETWORK PLACE CHICAGO IL 60673 UNIFORM CLEANING 423605 FAIRVIEW RRHS 750 E 34TH ST HIBBING MN 55746 MEDICAL SERVICES 355163 MACLEOD & CO 10 S FIFTH STREET STE 954 MINNEAPOLIS MN 55402 ADVERTISING AGENCY 232552 EXPERIENCED RESOURCES LLC PO BOX 201005 BLOOMINGTON MN 55420 STAFFING SERVICES 179344 EXECUTIVE HEALTH RESOURCES INC PO BOX 822688 PHILADELPHIA PA 19182 ADMINISTRATIVE CONSULTING 162558 9 24282 160905 185187 PATIENTS AND RESIDENT SERVICES 621110 76629083 76629083 MISCELLANEOUS OPERATING INCOME 621110 1692363 1692363 78321446 3007 0 3007 3007 3007 MISCELLANEOUS INCOME 621110 162699 162699 CDI PARTNERSHIP REVENUE 621110 47004 47004 209703 78719343 78531149 0 3007 13956 13956 1583957 1330163 248879 4915 37393378 31401916 5875423 116039 2246451 1886507 352973 6971 4503262 3781714 707574 13974 3427193 2878061 538497 10635 76419 64175 12007 237 71379 59942 11215 222 1976 1976 357777 300451 56216 1110 2421216 2033269 380433 7514 145216 121948 22817 451 1718750 1443358 270058 5334 3956566 3322614 621674 12278 560497 470690 88068 1739 SUPPLIES 10130233 8507084 1591711 31438 BAD DEBTS 3145717 3145717 NON PHY FEES 2989237 2510278 469683 9276 REPAIRS AND MAINT 1153718 968860 181278 3580 2702231 2270921 422918 8392 78599129 66511624 11853400 234105 5796723 8342679 8292015 7191290 14589756 13140967 1066406 897412 878530 1298502 79924082 38191002 43511354 41733080 6702795 7224601 6307327 6919785 87144906 86748316 7067368 5657960 176235 224301 34256909 33129340 8951062 8708580 50451574 47720181 X 36485321 38820124 208011 208011 36693332 39028135 87144906 86748316 X 120214 31784 2182805 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1976 1976 0 PART II-B, LINE 1: GICH PAYS DUES TO THE MINNESOTA HOSPITAL ASSOCIATION (MHA), A PORTION OF WHICH RELATES TO LOBBYING ACTIVITIES. FOR CALENDAR YEAR 2013, MHA HAS DETERMINED THAT 3.8% OR $1,976 OF ITS MEMBERSHIP DUES WERE USED FOR LOBBYING PURPOSES. 607331 607331 44906573 15973928 28932645 34410178 22217074 12193104 41733080 MUTUAL FUNDS 3594131 C CERT OF DEPOSIT (TIME DEPOSITS) 352809 C CERT OF DEPOSIT (MARKETABLE SECURITIES) 2395967 C BOARD DESIGNATED FUNDS 881694 C 7224601 DEFERRED FINANCING COSTS 947188 ASSETS LIMITED TO USE 5410691 CHARITABLE REMAINDER TRUST 208011 OTHER ASSETS 353895 6919785 OTHER ACCRUALS 244630 POST RETIREMENT BENEFIT 5939372 SELF INSURED WORKER'S COMP 637432 CURRENT PORTION OF LONG TERM DEBT 1478522 THIRD PARTY PAYOR SETTLEMENTS 313472 PAYABLE TO FOUNDATION 95152 8708580 X PART X, LINE 2: THE CORPORATION AND FOUNDATION HAVE REVIEWED THEIR TAX POSITIONS FOR ALL OPEN TAX YEARS AND HAVE CONCLUDED THAT NO MATERIAL LIABILITIES EXIST AS OF DECEMBER 31, 2013. GENERALLY, THE CORPORATION AND FOUNDATION ARE NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL, STATE OR LOCAL TAX AUTHORITIES FOR YEARS PRIOR TO THE FISCAL YEAR ENDED JUNE 20, 2010. 1 1 1 X 1 X 1 1 1 0 1 1 599828 0 599828 0.00790 15774655 14195037 1579618 0.02090 16374483 14195037 2179446 0.02880 34786 34786 0.00050 9000 9000 0.00010 13956 13956 0.00020 57742 57742 0.00080 16432225 14195037 2237188 0.02960 35185 35185 0.00050 35185 35185 0.00050 1 3145717 786429 27565716 31566220 -4000504 X 1 1 1 CDI GRAND RAPIDS LLC PROVIDE MRI, DIAGNOSTIC INJECTION AND PAIN MANAGEMENT SERVICES 0.55000 0.00000 0.00000 1 1 GRAND ITASCA CLINIC AND HOSPITAL 1601 GOLF COURSE ROAD GRAND RAPIDS MN 55744 X X X GRAND ITASCA CLINIC AND HOSPITAL 1 1 X X X X X X X X X 13 1 0 1 X GRANDITASCA.ORG X X X X 0 0 1 1 300.000000000000 1 300.000000000000 1 X X X 1 1 X X 1 X X X 1 X X X X X 1 X 0 0 GRAND ITASCA CLINIC AND HOSPITAL PART V, SECTION B, LINE 3: GRAND ITASCA CLINIC AND HOSPITAL CONDUCTED THE COMMUNITY HEALTH NEEDS ASSESSMENT BY GATHERING INPUT FROM COMMUNITY PROFESSIONALS INCLUDING REPRESENTATION FROM THE COUNTY PUBLIC NURSE, YMCA, UNITED WAY, CITY OFFICIALS, LOCAL HEALTHCARE PROFESSIONALS AND REPRESENTATION FROM THE GENERAL PUBLIC. THIS INFORMATION WAS GATHERED DURING SESSIONS FACILITATED BY AN INDEPENDENT PARTY. GRAND ITASCA CLINIC AND HOSPITAL PART V, SECTION B, LINE 7: THE HOSPITAL ADOPTED AN IMPLEMENTATION PLAN IN 2013 THAT WILL BE IMPLEMENTED IN 2014 TO SUSTAIN AND DEVELOP COMMUNITY BENEFIT PROGRAMS THAT 1) ADDRESS PRIORITIZED NEEDS FROM THE 2012-2013 CHNA AND 2) RESPOND TO ADDITIONAL COMMUNITY HEALTH NEEDS. GRAND ITASCA HAS ELECTED TO TARGET THE FOLLOWING THREE IDENTIFIED HEALTH NEEDS IN THE COMMUNITY:1 - PREVENTION OF CHRONIC DISEASE INCLUDING HEART DISEASE, STROKE, AND CANCER.2 - MANAGEMENT OF CHRONIC DISEASE INCLUDING HEART DISEASE, STROKE, AND CANCER.3 - PREVENTION AND REDUCTION IN ALCOHOL AND DRUG USE IN ITASCA COUNTY.FOR EACH OF THE PRIORITY NEEDS IDENTIFIED ABOVE, GRAND ITASCA CLINIC AND HOSPITAL WILL WORK WITH COMMUNITY PARTNERS TO:- STRENGHTEN COMMUNITY CONNECTIONS, OUTREACH AND SUPPORT FOR INITIATIVES IDENTIFIED ABOVE- REDUCE RISKY BEHAVIORS- DEVELOP MEASURABLE GOALS AND OBJECTIVES UTILIZING BIOMETRIC SCREENING AND RESCREENING DATA COLLECTED FROM HEALTHY COMMUNITIES PARTNERSHIP PARTICIPANTS- DEVELOP DETAILED WORK PLANS.NEEDS NOT BEING ADDRESSED - WHILE IDENTIFIED BY THE STEERING COMMITTEE AS PROBABLE HEALTH NEEDS IN ITASCA COUNTY, GRAND ITASCA FEELS THAT THESE NEEDS REQUIRE FURTHER EVAULATION.- TRANSPORTATION: ALTHOUGH A TOPIC OF DISCUSSION AT BOTH THE STEERING COMMITTEE AND COMMUNITY MEETINGS, TRANSPORTATION DATA IN RURAL AREAS IS NOT READILY AVAILABLE; THUS, MAKING IT DIFFICULT TO PINPOINT THE NUMBER AND TYPES OF HEALTH CARE TRANSPORTATION THAT MAY BE NEEDED. THE STEERING COMMITTEE CONCLUDED THAT THIS ISSUE WOULD REQUIRE FURTHER RESEARCH AND BETTER SUITED TO A POINT OF DISCUSSION AT THE CITY AND COUNTY GOVERNMENT LEVELS.- REDUCING UNINSURED RATE IN ITASCA COUNTY: PROVIDING CONVENIENT ACCESS TO NECESSARY MEDICAL CARE REGARDLESS OF ONE'S ABILITY TO PAY IS IMPORTANT TO GRAND ITASCA. CURRENTLY GRAND ITASCA ASSISTS THOSE PERSONS WITH INSURANCE AND FINANCIAL COUNSELING ON AS-NEEDED BASIS. DUE TO THE EXPANSION OF AFFORDABLE INSURANCE OPTIONS THAT WILL BECOME AVAILABLE TO ALL MINNESOTA RESIDENTS IN LATE 2013 THE UNINSURED RATE IN ITASCA COUNTY IN EXPECTED TO GO DOWN. - MENTAL HEALTH MANAGEMENT: SEVERAL MENTAL HEALTH ISSUES WERE IDENTIFIED AS PART OF THE MN STUDENT SURVEY BUT BECAUSE OF THE LIMITED DEMOGRAPHIC SEGMENT OF RESONDENTS, ADDITIONAL INFORMATION IS NEEDED TO CLARIFY THE EXTENT OF THE NEED. TO OBTAIN THIS NECESSARY INFORMATION, ITASCA COUNTY CONDUCTED A SERIES OF COMMUNITY CONVERSATIONS ON MENTAL HEALTH IN FALL OF 2013. A REPRESENTATIVE OF THE GRAND ITASCA BOARD IS CURRENTLY PARTICIPATING IN THE PROCESS. GRAND ITASCA CLINIC AND HOSPITAL PART V, SECTION B, LINE 12I: CHARITY CARE IS BASED UPON THE INCOME AND ASSET LEVELS OF THE PATIENT APPLYING FOR ASSISTANCE. THE PATIENT IS REQUIRED TO SUBMIT AN APPLICATION FOR MEDICAL ASSISTANCE AS PART OF THE PROCESS. GRAND ITASCA CLINIC AND HOSPITAL PART V, SECTION B, LINE 16E: PRE-ADMISSION DEPOSIT, VERIFICATION OF INFORMATION, PAYMENT ARRANGEMENTS GRAND ITASCA CLINIC AND HOSPITAL PART V, SECTION B, LINE 18E: PATIENT RECEIVES A SERIES OF LETTERS INDICATING ACTIONS TO BE TAKEN IF PAYMENT ARRANGEMENTS ARE NOT MADE WITH THE FACILITY. 1 GRAND ITASCA PROFESSIONAL BUILDING 111 SE 3RD STREET GRAND RAPIDS MN 55744 VARIOUS OUTPATIENT & BUSINESS SERVICES PART I, LINE 7: THE COSTING METHOD USED IS TO UTILIZE THE COST REPORT TO CAPTURE THE COST TO CHARGE RATIO. WE THEN COST OUT TOTAL BAD DEBT REPORTED AS CHARGES TO THE COST OF PROVIDING THOSE SERVICES. FROM REVIEW OF THE NUMBER OF APPLICATIONS DENIED FOR INSUFFICIENT INFORMATION WE ESTIMATE 25% OF BAD DEBT IS RELATED TO INDIVIDUALS WHO WOULD QUALIFY FOR CHARITY CARE. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 3,145,717. PART II, COMMUNITY BUILDING ACTIVITIES: GRAND ITASCA'S COMMUNITY BUILDING ACTIVITIES PROMOTE THE HEALTH OF THE COMMUNITIES IT SERVES BY PROVIDING INNOVATIVE AND ADVANCED MEDICAL SERVICES, WITH HIGH-QUALITY, SEAMLESS PATIENT CARE IN MIND. GRAND ITASCA'S INTERPRETATION AND ED PATIENT TAXI CAB SERVICES ALLOW FOR THE CARE OF EACH AND EVERY PATIENT, NO MATTER THE INITIAL BARRIERS OR HARDSHIPS THAT MAY EXIST. THE NURSE ON-LINE PROGRAM, BY PROVIDING A 24-HOUR MEDICAL ADVICE HOTLINE, EMPOWERS PATIENTS TO MAKE EDUCATED DECISIONS ABOUT THEIR MEDICAL TREATMENT. TRIAGE CAN BE COMPLETED PRIOR TO A PATIENT'S ARRIVAL, ALLOWING MEDICAL RESOURCES TO BE ALLOCATED MORE EFFICIENTLY AND EFFECTIVELY. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE, WHERE A THIRD-PARTY PAYOR IS RESPONSIBLE FOR PAYING THE AMOUNT, ARE CARRIED AT A NET AMOUNT DETERMINED BY THE ORIGINAL CHARGE FOR THE SERVICES PROVIDED, ADJUSTED BY AN ESTIMATE MADE FOR CONTRACTUAL ADJUSTMENTS OR DISCOUNTS PROVIDED TO THIRD-PARTY PAYORS.PATIENT ACCOUNTS RECEIVABLE DUE DIRECTLY FROM THE PATIENT ARE CARRIED AT THE ORIGINAL CHARGE FOR THE SERVICES PROVIDED LESS AMOUNTS COVERED BY THIRD-PARTY PAYORS AND LESS AN ESTIMATED ALLOWANCE FOR DOUBTFUL RECEIVABLES BASED ON A REVIEW OF OUTSTANDING AMOUNTS ON A MONTHLY BASIS. MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS, BY USING HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS, AND BY CONSIDERING THE PATIENT'S FINANCIAL HISTORY AND CREDIT HISTORY AND CURRENT ECONOMIC CONDITIONS. PATIENT ACCOUNTS RECEIVABLE ARE WRITTEN OFF WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE WHEN RECEIVED. PART III, LINE 8: THE SHORTFALL IS THE COST OF SERVICES PROVIDED TO THE MEDICARE POPULATION IN THE COMMUNITY FOR WHICH WE DO NOT RECOUP ANY PAYMENTS FROM THE PATIENTS. THE COSTING METHODOLOGY IS TO UTLIZE THE COST TO CHARGE RATIO AS DETERMINED BY THE COST REPORT FOR THAT PERIOD. PART III, LINE 9B: ACCORDING TO ITS FINANCIAL POLICY, GRAND ITASCA CLINIC & HOSPITAL HOLDS RESPONSIBILITY FOR INFORMING ALL PATIENTS OF THEIR FINANCIAL OBLIGATIONS FOR SERVICES RECEIVED AND RESERVES THE RIGHT TO HOLD THE PATIENT OR HIS LEGAL REPRESENTATIVE ULTIMATELY RESPONSIBLE FOR ALL CHARGES INCURRED ONCE ANY COMMUNITY CARE DISCOUNT HAS BEEN ESTABLISHED BY THE ORGANIZATION. PATIENTS MAY BE REQUIRED TO MAKE PRE-ADMISSION DEPOSITS, PAY PRIOR OUTSTANDING ACCOUNTS IN FULL BEFORE RECEIVING ADDITIONAL SERVICES, OR ENTER INTO A PAYMENT ARRANGEMENT WITH GRAND ITASCA. IF DEEMED APPROPRIATE, GRAND ITASCA MAY REFER ACCOUNTS UNABLE TO BE COLLECTED IN-HOUSE TO A COLLECTION AGENCY, MAGISTRATE, OR ATTORNEY FOR FURTHER ACTION; OR TAKE LEGAL ACTION TO COLLECT ANY UNPAID BALANCES. PART VI, LINE 2: GRAND ITASCA REVIEWS APPLICABLE STATE AND COUNTY SURVEYS PERFORMED BY OTHER AGENCIES TO ASSESS THE NEEDS OF THE COMMUNITY. GRAND ITASCA WORKS WITH THESE AGENCIES TO PROVIDE THESE SERVICES WITHIN THE SCOPE OF THE MEDICAL FACILITY. PART VI, LINE 3: GRAND ITASCA HAS FINANCIAL ADVOCATES WORKING WITH UNINSURED PATIENTS TO ASSIST THEM IN COMPLETING APPLICATIONS FOR VARIOUS PROGRAMS THAT MAY PROVIDE THEM COVERAGE FOR MEDICAL SERVICES. PART VI, LINE 4: GRAND ITASCA SERVES THE PEOPLE OF GRAND RAPIDS AND THE SURROUNDING COMMUNITIES THROUGHOUT ITASCA COUNTY. THESE COMMUNITIES CONSIST PRIMARILY OF CAUCASIAN RACE, WITH GROWING POPULATIONS OF AMERICAN INDIAN, HISPANIC, AND AFRICAN AMERICAN CITIZENS PART VI, LINE 5: GRAND ITASCA PROMOTES HEALTH IN THE COMMUNITY BY SUPPORTING THE LOCAL FREE CLINIC, THROUGH THE PROVISION OF MEDICAL SUPPLIES, BASIC LAB TESTS AND BASIC X-RAYS TO THE PATIENTS OF THIS CLINIC AT NO CHARGE. GRAND ITASCA ALSO WORKS WITH A COMMUNITY COALITION TO DETERMINE THE HEALTH NEEDS OF THE COMMUNITY SERVICED BY GRAND ITASCA CLINIC & HOSPITAL. PART VI, LINE 7, REPORTS FILED WITH STATES MN 0 PART I, LINE 2: THE HOPSITAL PROVIDES GRANTS TO VARIOUS CHARITABLE ORGANIZATIONS. THE HOSPITAL DOES NOT MONITOR THE FUNDS AFTER DISTRIBUTION, AS THEY ARE ALL RELATIVELY SMALL AMOUNTS. X X X 0 0 0 0 0 0 0 0 0 JANICE M ROURK DIRECTOR/PEDIATRIC MD 159327 0 0 0 0 0 9649 0 18116 0 187092 0 0 0 JAMISON L HARKER DIRECTOR/INTERNAL MEDICINE MD 245694 0 0 0 0 0 16861 0 19563 0 282118 0 0 0 MICHAEL J YOUSO PRESIDENT & CEO 283219 0 0 0 0 0 15249 0 19877 0 318345 0 0 0 NATHAN M NOZNESKY CHIEF MEDICAL OFFICER (FORMER) 276697 0 0 0 0 0 17553 0 14462 0 308712 0 0 0 DEBRA NYQUIST CHIEF MEDICAL OFFICER 311213 0 0 0 0 0 17821 0 19911 0 348945 0 0 0 HANS SERLETH GENERAL SURGEON CLINIC 617560 0 0 0 0 0 15249 0 18812 0 651621 0 0 0 KARYSSE TRANDEM OB/GYN MD CLINIC 349532 0 0 0 0 0 15249 0 8372 0 373153 0 0 0 JOHN A KOLE GENERAL SURGEON CLINIC 378414 0 0 0 0 0 17701 0 19911 0 416026 0 0 0 DENNIS SCHERER EMERGENCY ROOM MD 324171 0 0 0 0 0 17616 0 14254 0 356041 0 0 0 DARIN SKAUDIS INTERNAL MEDICINE MD CLINIC 315149 0 0 0 0 0 17441 0 19583 0 352173 0 0 0 GRAND RAPIDS STATE BANK SHELLY STEERE, TREASURER, IS VP OF THE BANK, WHICH IS GICH'S PRIMARY BANK. 116183 INTEREST PAID FROM CD'S AND CHECKING/SAVINGS ACCOUNTS AT GRAND RAPIDS STATE BANK 0 FORM 990, PART III, LINE 3 THE HOSPITAL'S ACUTE REHAB SERVICES WERE DISCONTINUED IN 2013. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS REVIEWED BY THE VP OF FINANCE AND A COPY IS PRESENTED TO THE FINANCE COMMITTEE AND BOARD OF DIRECTORS FOR APPROVAL PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS SIGN THE CONFLICT OF INTEREST POLICY ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION IS DETERMINED BY ASSESSING THE MARKET THROUGH THE USE OF SURVEYS AND STUDIES AND DETERMINING PAY RATES AND RANGES FROM THE RESULTS OF THE ASSESSMENT. THE CEO COMPENSATION PACKAGE IS SUMMARIZED IN AN EMPLOYMENT AGREEMENT THAT IS APPROVED BY THE BOARD. THE COMPENSATION PACKAGE IS BASED UPON MARKET FOR THE POSITION. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE UPON REQUEST. AN ANNUAL REPORT IS ALSO ISSUED AND MAILED TO PATIENTS IN THE COMMUNITY. FORM 990, PART XI, LINE 9: INVESTEMENT IN CDI 1,503,150. POST RETIREMENT BENEFITS OBLIGATION ADJUSTMENT 674,309. NET ASSETS RELEASED FROM RESTRICTIONS USED FOR PROPERTY & EQUIPMENT 5,554. EQUITY TRANSFER TO FOUNDATION -208. FORM 990, PART VI, SECTION B, LINE 16A GRAND ITASCA THOROUGHLY EVALUATED THE PARTICIPATION IN THE CDI JOINT VENTURE. THIS EVALUATION INCLUDED REVIEW BY ATTORNEYS AND OTHER THIRD PARTY CONSULTANTS. GRAND ITASCA FOUNDATION 1601 GOLF COURSE ROAD GRAND RAPIDS MN 55744 411560554 FINANCIAL SUPPORT OF GRAND ITASCA CLINIC & HOSPITAL MN 501(C)(3) 11(F) GRAND ITASCA CLINIC & HOSPITAL 1 CDI GRAND RAPIDS LLC 1601 GOLF COURSE RD GRAND RAPIDS MN 55744 453783014 PROVIDE IN-HOUSE MRI AND DTI SERVICES MN GRAND ITASCA CLINIC & HOSPITAL RELATED 3314368 1499545 1 1 0.55000 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 1 1 1 CDI GRAND RAPIDS LLC R 2978927 ACTUAL AMOUNT CDI GRAND RAPIDS LLC S 1503150 ACTUAL AMOUNT