SOUTHEAST IOWA REGIONAL MEDICAL CENTER INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- SOUTHEAST IOWA REGIONAL MEDICAL CENTER INC (EIN 42-0680407)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2013-02-15
- IRS object ID
- 201310469349301556
- Schema version
- 2011v1.5
- 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 O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-02-15T10:48:29-06:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410746749 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 SOUTH SIXTH STREET SUITE 300 | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55402 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420680407 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GREAT RIVER MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | GREA | NameControl |
| Phone | 3197681000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1221 SOUTH GEAR AVENUE | AddressLine1 |
| City | WEST BURLINGTON | City |
| State | IA | State |
| ZIP Code | 52655 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TODD SLADKY | Name |
| Title | CFO | Title |
| Phone | 3197681000 | Phone |
| Date Signed | 2013-02-15 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KOREY L BOELTER | Name |
| PTIN | P00775161 | PTIN |
| Phone | 6123764500 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | MARK RICHARDSON | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1221 SOUTH GEAR AVENUE | AddressLine1 |
| City | WEST BURLINGTON | City |
| State | IA | State |
| ZIP Code | 52655 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 172262744 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.GREATRIVERMEDICAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1895 | YearFormation |
| State Legal Domicile | IA | StateLegalDomicile |
| Activity Or Mission Description | IMPROVING THE REGION'S HEALTH BY PROVIDING HIGH-QUALITY HEALTH CARE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 12 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1730 | TotalNbrEmployees |
| Total Nbr Volunteers | 437 | TotalNbrVolunteers |
| Total Gross UBI | 471812 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -29900 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 9137222 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 958666 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 160733018 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 171863980 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 684667 | InvestmentIncomePriorYear |
| Investment Income Current Year | 600055 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 399942 | OtherRevenuePriorYear |
| Other Revenue Current Year | -1252695 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 170954849 | TotalRevenuePriorYear |
| Total Revenue Current Year | 172170006 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 3990000 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 4237225 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 82773616 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 80877822 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 85282 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 73068872 | OtherExpensePriorYear |
| Other Expenses Current Year | 74896042 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 159832488 | TotalExpensesPriorYear |
| Total Expenses Current Year | 160011089 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 11122361 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 12158917 | RevenuesLessExpensesCY |
| Total Assets BOY | 308090680 | TotalAssetsBOY |
| Total Assets EOY | 347121271 | TotalAssetsEOY |
| Total Liabilities BOY | 83059070 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 105853530 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 225031610 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 241267741 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 155320687 | Expense |
| Grants | 4237225 | Grants |
| Revenue | 171863980 | Revenue |
| Description | THE 213-BED ACUTE AND 143-BED LONG-TERM CARE HOSPITAL HAD 7,982 PATIENT ADMISSIONS AND 69,508 PATIENT DAYS OF MEDICAL CARE. IN ADDITION, NUMEROUS OUTPATIENT AND EMERGENCY ROOM PROCEDURES WERE PERFORMED. GREAT RIVER MEDICAL CENTER HAS ACCEPTED PAYMENT FROM MEDICARE AND MEDICAID REDUCING THE MEDICAL BILLS FOR AREA RESIDENTS BY $131,175,694. COMMUNITY BENEFIT INFORMATION: SCHOOL PARTNERING: $4,339COMMUNITY EDUCATION: $210COMMUNITY INITIATIVE PARTICIPATION: $15,253SCREENING/FIRST AID: $6,711PRENATAL EDUCTION: $15,960HEALTH FAIRS: $6,428SUPPORT GROUPS: $493COMMUNITY LIBRARY: $29,450CASH DONATIONS: $4,237,225TOTAL: $316,069 | Description |
| Total Program Service Expense | 155320687 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 91 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 1730 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 12 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | CHRISTINE DES JARDINS | NamePerson |
| Telephone Number | 3197681000 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1221 SOUTH GEAR AVENUE | AddressLine1 |
| City | WEST BURLINGTON | City |
| State | IA | State |
| ZIP Code | 52655 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (20 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| KENNETH ASPELMEIER | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| KENT GAUDIAN | |||||||
| CHAIRMAN | 1.00 | X | 0 | 0 | 0 | X | |
| MICHAEL MCCOY MD | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| LORRIN DEBLICK | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| DENNIS HINKLE | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| JACK HOBBS | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| JAN TOWNE | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| JO ELLEN HOTH MD | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| ROBERT MCCULLEY | |||||||
| SECRETARY/TREASURER | 1.00 | X | 0 | 0 | 0 | X | |
| MARK RICHARDSON | |||||||
| DIRECTOR/CEO | 1.00 | X | 0 | 931563 | 43690 | X | |
| DAN WIEDEMEIER | |||||||
| VICE CHAIRMAN | 1.00 | X | 0 | 0 | 0 | X | |
| ROBERT FLEMING | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| WILLIAMS DAWS MD | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| TONY HAYES | |||||||
| COO | 1.00 | 0 | 464067 | 41120 | X | ||
| TODD SLADKY | |||||||
| CFO | 1.00 | 0 | 424267 | 41677 | X | ||
| DARWIN COOLEY | |||||||
| DIRECTOR OF PHARMACY | 40.00 | 162650 | 0 | 30203 | X | ||
| JON WILLIAMS | |||||||
| PHARMACIST | 40.00 | 126780 | 0 | 23796 | X | ||
| GAIL BOYD | |||||||
| DIRECTOR OF SURGICAL SERVICES | 40.00 | 128655 | 0 | 18541 | X | ||
| JOHN MERCER III | |||||||
| DIRECTOR OF FACILITIES | 40.00 | 134130 | 0 | 29226 | X | ||
| TED SMITH | |||||||
| PHYSICIANS ASSISTANT | 40.00 | 123478 | 0 | 19798 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 675693 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1819897 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 248051 | TotalOtherCompensation |
| Number Individuals GT100 K | 29 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| CARL A NELSON CO | |||||
| 1815 DES MOINES AVE | BURLINGTON | IA | 52601 | BUILDING CONSTRUCTION | 18189785 |
| SOUTHEASTERN IOWA MEDICAL SERVICES INC | |||||
| 1221 S GEAR AVE | WEST BURLINGTON | IA | 52655 | PHYSICIANS | 3613749 |
| MUTUAL CONSULTING & MANAGEMENT SERVICES | |||||
| 1221 S GEAR AVE | WEST BURLINGTON | IA | 52655 | EXECUTIVE MANAGEMENT | 2969136 |
| HORTY ELVING & ASSOCIATES | |||||
| 505 EAST GRANT STREET | MINNEAPOLIS | MN | 55404 | ARCHITECTURE | 888099 |
| EXECUTIVE HEALTH RESOURCES INC | |||||
| 15 CAMPUS BLVD SUITE 200 | NEWTOWN SQUARE | PA | 19073 | PHYSICIAN ADVISORS | 354859 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 7 | NumberOfContractorsGT100K |
| All Other Contributions | 958666 | AllOtherContributions |
| Total Contributions | 958666 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| PATIENT SERVICE INCOME | 621110 | 166945627 | 166945627 | |
| OTHER OPERATING INCOME | 621300 | 4918353 | 4446541 | 471812 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 171863980 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 614471 | TotalRevenueColumn |
| Exclusion | $614,471 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 98897 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 66448 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 32449 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 32449 | TotalRevenueColumn |
| Exclusion | $32,449 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 11874 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 26290 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -14416 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -14416 | TotalRevenueColumn |
| Exclusion | -$14,416 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| MISCELLANEOUS INCOME | 900099 | 94085 | $94,085 |
| LOSS ON BOND REFINANCE | 900099 | -1379229 | -$1,379,229 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | -1285144 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 172170006 | TotalRevenueColumn |
| Related Or Exempt Function Income | 171392168 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 471812 | UnrelatedBusinessRevenue |
| Exclusion | -$652,640 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4237225 | Total |
| Program Services | 4237225 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1555394 | Total |
| Management And General | 1555394 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 61592482 | Total |
| Program Services | 61433498 | ProgramServices |
| Management And General | 109142 | ManagementAndGeneral |
| Fundraising | 49842 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2770559 | Total |
| Program Services | 2763988 | ProgramServices |
| Management And General | 4145 | ManagementAndGeneral |
| Fundraising | 2426 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10410699 | Total |
| Program Services | 10376211 | ProgramServices |
| Management And General | 22547 | ManagementAndGeneral |
| Fundraising | 11941 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4548688 | Total |
| Program Services | 4537542 | ProgramServices |
| Management And General | 7767 | ManagementAndGeneral |
| Fundraising | 3379 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1413742 | Total |
| Management And General | 1413742 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 46725 | Total |
| Program Services | 10200 | ProgramServices |
| Management And General | 36525 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 87400 | Total |
| Management And General | 87400 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13352372 | Total |
| Program Services | 12984064 | ProgramServices |
| Management And General | 354377 | ManagementAndGeneral |
| Fundraising | 13931 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19011335 | Total |
| Program Services | 18997422 | ProgramServices |
| Management And General | 12504 | ManagementAndGeneral |
| Fundraising | 1409 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 707802 | Total |
| Program Services | 575835 | ProgramServices |
| Management And General | 131967 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 297382 | Total |
| Program Services | 291113 | ProgramServices |
| Management And General | 5469 | ManagementAndGeneral |
| Fundraising | 800 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2896609 | Total |
| Program Services | 2896609 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11888677 | Total |
| Program Services | 11729839 | ProgramServices |
| Management And General | 158838 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1698774 | Total |
| Program Services | 1087439 | ProgramServices |
| Management And General | 611335 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| BAD DEBT | 9731455 | 9731455 | ||
| DRUGS | 8217908 | 8217908 | ||
| OTHER EXPENSES | 3979622 | 3899215 | 80090 | 317 |
| FOOD | 1566239 | 1551124 | 13878 | 1237 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 160011089 | Total |
| Program Services | 155320687 | ProgramServices |
| Management And General | 4605120 | ManagementAndGeneral |
| Fundraising | 85282 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6873726 | BOY |
| EOY | 17874399 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19145274 | BOY |
| EOY | 19406050 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 673087 | BOY |
| EOY | 519733 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2770752 | BOY |
| EOY | 2509787 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1660000 | BOY |
| EOY | 1666347 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 289196472 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 144807724 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 127836228 | BOY |
| EOY | 144388748 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 147816225 | BOY |
| EOY | 159894789 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1315388 | BOY |
| EOY | 861418 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 308090680 | BOY |
| EOY | 347121271 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6347512 | BOY |
| EOY | 10775232 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 62315273 | BOY |
| EOY | 79123333 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14396285 | BOY |
| EOY | 15954965 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 83059070 | BOY |
| EOY | 105853530 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 220583863 | BOY |
| EOY | 236853104 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3202523 | BOY |
| EOY | 3250655 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1245224 | BOY |
| EOY | 1163982 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 225031610 | BOY |
| EOY | 241267741 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 308090680 | BOY |
| EOY | 347121271 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 12158917 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 4077214 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $30,646 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 30646 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| 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. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5159725 | OtherCostOrOtherBasis |
| Book Value | 5159725 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 97932705 | OtherCostOrOtherBasis |
| Depreciation | 30826427 | Depreciation |
| Book Value | 67106278 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 9549238 | OtherCostOrOtherBasis |
| Depreciation | 4692053 | Depreciation |
| Book Value | 4857185 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 151472059 | OtherCostOrOtherBasis |
| Depreciation | 109289244 | Depreciation |
| Book Value | 42182815 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 25082745 | OtherCostOrOtherBasis |
| Book Value | 25082745 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 144388748 | TotalOfBookValueLandBuildings |
Closely Held Equity Interests CloselyHeldEquityInterests
| Field | Value | IRS element (for citing) |
|---|---|---|
| Book Value | 152441343 | BookValue |
| Method Of Valuation | F | MethodOfValuation |
Other Securities OtherSecurities (2 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| CASH AND SHORT-TERM INVESTMENTS | 2001773 | F |
| INSURANCE COMPANY ANNUITY DEPOSITS | 5451673 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 159894789 | TotalOfBookValueSecurities |
Other Liabilities OtherLiabilities (5 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DEFERRED COMPENSATION LIABILITY | $1,034,032 |
| THIRD PARTY PAYABLE | $1,557,463 |
| PTO RESERVE | $7,039,315 |
| FAIR VALUE OF CASH FLOW HEDGING SWAP | $6,191,655 |
| PLEDGES LIABILITY | $132,500 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 15954965 | TotalOfAmounts |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Discounted Other Percentage | 0.0 | DiscountedOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3489419 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 3489419 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02320 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 18073727 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 18121781 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -48054 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 21563146 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 18121781 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3441365 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02320 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 78844 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 78844 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4237225 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 4237225 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02820 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4316069 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 4316069 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02870 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 25879215 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 18121781 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 7757434 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05190 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $9,731,455 | BadDebtExpenseAmount |
| Amount Attributable To | 2335549 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 52919145 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 71493834 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -18574689 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GREAT RIVER MEDICAL CENTER | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1221 SOUTH GEAR AVENUE | AddressLine1 |
| City | WEST BURLINGTON | City |
| State | IA | State |
| ZIP Code | 52655 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GREAT RIVER MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 300.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART I, LINE 3C: THE ORGANIZATION USES THE FPG TO DETERMINE FREE OR DISCOUNTED CARE. INDIVIDUALS WHO ARE BELOW 200% OF THE FPG QUALIFY FOR FREE CARE. IN MOST INSTANCES, THEY HAVE TO PROVIDE FINANCIAL DOCUMENTATION AND FILL OUT A CHARITY CARE APPLICATION. WE ALSO USE A PRESUMPTIVE CHARITY CARE PROGRAM THAT ANALYZES PUBLIC AND PRIVATE DATABASES TO HELP DETERMINE ELIGIBILITY 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 IN TO CONSIDERATION WHEN DETERMINING CHARITY CARE ELIGIBILITY. MEDICALLY INDIGENT INDIVIDUALS ARE COVERED UNDER THE SAME CHARITY CARE POLICY. INDIVIDUALS BETWEEN 200% 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, L7 COL(F): BAD DEBT EXPENSES OF $9,731,455 WERE SUBTRACTED FROM THE TOTAL EXPENSES OF $160,011,089 IN CALCULATING THE PERCENTAGES IN PART I, LINE 7, COLUMN F. | |
| PART III, LINE 4: THE FOLLOWING IS FROM THE "ACCOUNTS RECEIVABLE AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS" PARAGRAPH IN NOTE 1 TO THE GREAT RIVER MEDICAL CENTER, GRMC FOUNDATION AND GREAT RIVER FOUNDATION, INC. COMBINED FINANCIAL STATEMENTS:"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 AS BAD DEBT EXPENSES WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF RECEIVABLES PEVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE WHEN RECEIVED."THE AMOUNT OF BAD DEBT EXPENSE REPORTED IN PART III, LINE 2 IS CALCULATED AS FOLLOWS: PAYMENT ARRANGEMENT INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS.THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY INCLUDED IN PART III, LINE 3 IS DETERMINED AS FOLLOWS: IF AN INDIVIDUAL DOES NOT HAVE A RESIDENCE THAT CAN BE USED TO RUN THROUGH THE PRESEUMPTIVE CHARITY CARE APPLICATION AND THEY DO NOT FILL OUT THE APPROPRIATE PAPERWORK TO APPLY FOR CHARITY, THEIR ACCOUNT BALANCE WILL BE WRITTEN OFF TO BAD DEBT. BASED UPON A REVIEW OF CHARITY APPLICATIONS THAT WERE REJECTED DUE TO INCOMPLETE/MISSING INFORMATION, IT HAS BEEN DETERMINED THAT APPROXIMATELY 24% OF THE APPLICATIONS WE RECEIVE ARE REJECTED BUT THE PATIENT APPEARS TO QUALIFY FOR CHARITY BUT THEY HAVEN'T NOT COMPLETED THE APPROPRIATE FORMS. | |
| PART III, LINE 8: A COST-TO-CHARGE RATIO AS DETERMINED BY THE 2012 MEDICARE COST REPORT WAS USED TO DETERMINE THE AMOUNTS IN PART III, LINES 5 AND 6. THE SHORTFALL REPORTED ON PART III, LINE 7 REPRESENTS THE CO-INSURANCE AND PATIENT DEDUCTIBLE AMOUNTS. | |
| PART III, LINE 9B: COLLECTION EFFORTS ARE DISCONTINUED ONCE THE PATIENT HAS BEEN APPROVED FOR CHARITY CARE. | |
| PART V, SECTION B, LINE 19D: THE MAXIMUM AMOUNT THAT CAN BE CHARGED IS BASED ON A CHARITY CARE MATRIX BASED ON THE FPG AND FAMILY SIZE. | GREAT RIVER MEDICAL CENTER |
| PART VI, LINE 2: GRMC IS AN ACTIVE PARTICIPANT IN COMMUNITY AND COUNTY GOVERNMENT TASK FORCES ON HEALTH NEEDS ASSESSMENT AND HEALTH SERVICES PLANNING AND COORDINATION. GRMC ASSESSES OUR COMMUNITIES' NEEDS THROUGH PROGRAMS WE OFFER, REQUESTS THAT ARE RECEIVED, AND OUR OWN STAFF INVOLVEMENT IN THEIR COMMUNITIES. WE ALSO COLLABORATE WITH OTHER COMMUNITY ORGANIZATIONS AS WELL, WHEN OUR SERVICES ARE NEEDED. AN ANNUAL HEALTH FAIR IS HOSTED TO PROVIDE INFORMATION AND EDUCATION TO OUR COMMUNITY ABOUT HEALTH ISSUES AND TO PROMOTE OUR HEALTHCARE SERVICES. WE ENCOURAGE OUR COMMUNITY MEMBERS TO TAKE AN ACTIVE ROLE IN THEIR OWN HEALTH CARE BY TAKING STEPS TOWARDS A HEALTHIER LIFESTYLE THROUGH MEMBERSHIP TO OUR GYM, A MULTITUDE OF EXERCISE PROGRAMS OFFERED THROUGH OUR FACILITY, AND OFFERING MANY WELLNESS PROGRAMS TO THE COMMUNITY. | |
| PART VI, LINE 3: FINANCIAL COUNSELORS MEET WITH PATIENTS. THE PATIENT FILLS OUT A QUESTIONAIRRE THAT HELPS THEM DETERMINE IF THEY QUALIFY FOR MEDICAID, CRIME VICTIMS, COBRA, AND OTHER MISC PROGRAMS. ON THE STATEMENTS, THERE IS PRINTED INFORMATION ABOUT FINANCIAL ASSISTANCE AND THE FINANCIAL ASSISTANCE APPLICATION IS ON THE HOSPITAL WEBSITE. THERE ARE PLANS TO ALSO HAVE THE CHARITY CARE POLICY AVAILABLE VIA THE WEB. | |
| PART VI, LINE 4: A REVIEW CONDUCTED BY THE MEDICAL CENTER ANALYZING THE ORIGIN OF PATIENTS UTILIZING THE SERVICES PROVIDED BY MEDICAL CENTER DURING THE FISCAL YEAR ENDED JUNE 30, 2012 INDICATES 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. THE DES MOINES COUNTY POPULATION IS ESTIMATED AT 40,169 RESIDENTS FOR 2011, WITH BURLINGTON AND WEST BURLINGTON TOTALING 28,532 AS OF 2011. THE OVER 65 AGE GROUP IS CURRENTLY 17.7% OF THE POPULATION WHICH IS HIGHER THAN THE STATE AVERAGE OF 14.9%. THE MEDIAN HOUSEHOLD INCOME WAS $43,111 COMPARED TO THE STATE AVERAGE OF $50,451. DES MOINES COUNTY POPULATION BELOW POVERTY LEVEL IS 14.4% COMPARED TO THE STATE AVERAGE OF 11.9%. GREAT RIVER MEDICAL CENTER IS PART OF A LARGER HEALTH SYSTEM THAT CONSISTS OF ONE HOSPITAL, MULTIPLE SPECIALTY PHYSICIAN CLINICS, HOME HEALTH SERVICES, A HOSPICE HOUSE, AMBULANCE SERVICES, A DAY CARE CENTER, THREE PHARMACIES, A DURABLE MEDICAL EQUIPMENT COMPANY, AND A LONG-TERM CARE NURSING HOME. | |
| PART VI, LINE 5: GRMC IS INVOLVED IN GETTING PHYSICIANS AND HEALTHCARE WORKERS TO THE AREA TO IMPROVE THE ACCESS TO HEALTHCARE NEEDS IN THE MEDICAL CENTER'S SERVICE AREA. GRMC ALSO PROMOTES HEALTH CARE RELATED JOBS EDUCATION BY WORKING CLOSELY WITH SOUTHEASTERN COMMUNITY COLLEGE AND THEIR NURSING PROGRAM.THE HOSPITAL ALSO PROVIDES MEMBERSHIP TO ALL PHYSICIANS WHO MEET MEMBERSHIP AND CLINICAL REQUIREMENTS. SURPLUS FUNDS ARE INVESTED IN IMPROVED AND/OR UPDATED CAPITAL EQUIPMENT TO ALLOW FOR BETTER CARE OF THE PATIENTS THAT ARE SERVED. | |
| PART VI, LINE 6: GREAT RIVER HEALTH SYSTEM SERVES AS A HOLDING COMPANY OF VARIOUS SUBSIDIARIES PROVIDING HEALTH CARE IN WEST BURLINGTON, IOWA. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (10 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| COMMUNITY ACTION OF SOUTHEAST IOWA | |||||||
| 2850 MT PLEASANT ST SUITE 108 | BURLINGTON | IA | 52601 | 420923961 | 501C3 | 40000 | MEDICAL ASSISTANCE PROGRAM |
| GROW GREATER BURLINGTON | |||||||
| 610 N 4TH ST SUITE 200 | BURLINGTON | IA | 52601 | 420982794 | 501C3 | 25000 | COMMUNITY BENEFIT |
| THE SALVATION ARMY | |||||||
| 217 S 3RD STREET | BURLINGTON | IA | 52601 | 133485289 | 501C3 | 20000 | CAPITAL CAMPAIGN |
| SOUTHEASTERN COMMUNITY COLLEGE | |||||||
| 1500 W AGENCY RD | WEST BURLINGTON | IA | 52655 | 420926823 | 501C3 | 20000 | NURSING PROGRAM |
| THE UNIVERSITY OF IOWA FOUNDATION | |||||||
| PO BOX 4550 | IOWA CITY | IA | 522444550 | 426004813 | 501C3 | 15000 | COMMUNITY BENEFIT |
| NORTH HENDERSON CO AMBULANCE | |||||||
| 809 PUTMAN ST | OQUAWKA | IL | 61469 | 364089806 | 501C3 | 13200 | RESCUE EQUIPMENT |
| IOWA WESLEYAN COLLEGE | |||||||
| 601 N MAIN ST | MT PLEASANT | IA | 52641 | 420680332 | 501C3 | 10000 | NURSING PROGRAM |
| MORNING SUN COMMUNITY AMBULANCE | |||||||
| PO BOX 174 | MORNING SUN | IA | 52640 | 421322329 | 501C3 | 8515 | RESCUE EQUIPMENT |
| SPECIAL NEEDS FOUNDATION OF DES MOINES COUNTY | |||||||
| 829 HARRISON AVENUE | BURLINGTON | IA | 52601 | 421090677 | 501C3 | 7500 | MEDICAL EQUIPMENT |
| GREAT RIVER FOUNDATION | |||||||
| 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 421469162 | 501C3 | 4000000 | COMMUNITY BENEFIT RELATED TO THE GENERAL OPERATIONS OF SEIMS. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 10 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: 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. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARK RICHARDSON | |||||||||||||
| 0 | 424878 | 0 | 283234 | 0 | 223451 | 0 | 9800 | 0 | 33890 | 0 | 975253 | 0 | 0 |
| TONY HAYES | |||||||||||||
| 0 | 310577 | 0 | 86498 | 0 | 66992 | 0 | 9800 | 0 | 31320 | 0 | 505187 | 0 | 0 |
| TODD SLADKY | |||||||||||||
| 0 | 257772 | 0 | 86498 | 0 | 79997 | 0 | 9800 | 0 | 31877 | 0 | 465944 | 0 | 0 |
| DARWIN COOLEY | |||||||||||||
| 162093 | 0 | 0 | 0 | 557 | 0 | 9736 | 0 | 20467 | 0 | 192853 | 0 | 0 | 0 |
| JON WILLIAMS | |||||||||||||
| 126780 | 0 | 0 | 0 | 0 | 0 | 7466 | 0 | 16330 | 0 | 150576 | 0 | 0 | 0 |
| JOHN MERCER III | |||||||||||||
| 134130 | 0 | 0 | 0 | 0 | 0 | 7382 | 0 | 21844 | 0 | 163356 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SUPPLEMENTAL INFORMATION | Identifier |
| Return Reference | PART III | ReturnReference |
| Explanation | PART I, LINE 2: 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 | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|
| IOWA FINANCE AUTHORITY | |||||||
| 521699886 | 462466BV4 | 2008-07-01 | 37475000 | PROCEEDS USED TO REFUND SERIES 1997 ADJUSTABLE DEMAND REVENUE BONDS | 0 | 0 | 0 |
| DES MOINES COUNTY IOWA | |||||||
| 426004310 | 250087AA1 | 2012-04-04 | 60000000 | PROCEEDS USED TO REFUND SERIES 2001 HEALTHCARE REVENUE BONDS | 0 | 0 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Amount RetiredAmountRetired | Total ProceedsTotalProceeds | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Capital ExpendituresCapitalExpenditures | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind | Other Spent ProceedsOtherSpentProceeds |
|---|---|---|---|---|---|---|---|---|---|
| 5685000 | 37475000 | 375000 | 37100000 | 2027 | 0 | 1 | 1 | 1 | |
| 666667 | 48000000 | 665624 | 17854376 | 2027 | 0 | 1 | 1 | 1 | 29480000 |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs |
|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 1 |
| 0 | 0 | 0 | 0 | 1 |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8038 T Filed | 0 | Form8038TFiled |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Exception To Rebate | 0 | ExceptionToRebate |
Form990 Schedule K Part VI Form990ScheduleKPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SCHEDULE K, PART II, LINE 3 | Identifier |
| Return Reference | BOND PROCEEDS | ReturnReference |
| Explanation | THE TOTAL PROCEEDS OF THE 2012 BOND ISSUE INCLUDED ON PART II, LINE 3 OF COLUMN A, DOES NOT MATCH THE TOTAL ISSUE PRICE INCLUDED ON PART I, LINE B OF COLUMN E BECAUSE ONLY A PORTION OF THE TOTAL ISSUE WAS RELEASED ON A MONTHLY BASIS RESULTING IN GRMC ONLY RECEIVING $48 MILLION OF THE TOTAL ISSUANCE AS OF FISCAL YEAR END JUNE 30, 2012. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (12 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| CONTRIBUTION REVENUES | FORM 990, PART I, LINE 8 | FOR THE YEAR ENDED JUNE 30, 2012, IT WAS DECIDED BY MANAGEMENT TO TREAT ANY INTERCOMPANY NET ASSET TRANSFERS AS RECONCILING ITEMS TO NET ASSETS INSTEAD OF CLASSIFYING THEM AS CONTRIBUTION REVENUES. RECONCILING ITEMS ARE INCLUDED IN PART XI, LINE 5. DUE TO THIS CHANGE, THE CONTRIBUTION REVENUES ARE NOT COMPARABLE BETWEEN THE CURRENT YEAR AND PRIOR YEAR FORM 990. |
| 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. THE EXECUTIVE COMMITTEE HAS GENERAL RESPONSIBILITY FOR THE INVESTMENT OF AN ENDOWMENT AND OTHER CAPITAL FUNDS OF THE HOSPITAL. | |
| FORM 990, PART VI, SECTION A, LINE 3 | ALL EXECUTIVE LEADERSHIP FUNCTIONS FOR GREAT RIVER MEDICAL CENTER, AND ITS SUBSIDIARIES 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 | GREAT RIVER MEDICAL CENTER FORM 990 WILL BE SENT OUT BY SECURE EMAIL MESSAGE TO ALL BOARD MEMBERS PRIOR TO FILING. IF THERE ARE ANY QUESTIONS, THEY CAN CONTACT THE ACCOUNTING OFFICE OR THEY CAN BE ADDRESSED AT THE NEXT BOARD MEETING. | |
| FORM 990, PART VI, SECTION B, LINE 12C | EVERY YEAR, THE ACCOUNTING MANAGER 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 ACCOUNTING MANAGER. 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 C, LINE 19 | GREAT RIVER MEDICAL CENTER MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. | |
| EXPLANATION FOR HOURS WORKED | FORM 990, PART VII, SECTION A | MARK RICHARDSON, CEO, TONY HAYES, COO, AND TODD SLADKY, CFO EACH SERVE AS OFFICERS FOR GREAT RIVER HEALTH SYSTEMS AND ITS RELATED ORGANIZATIONS IDENTIFIED IN SCHEDULE R. EACH INDIVIDUAL SPENDS APPROXIMATELY 40 HOURS PER WEEK COLLECTIVELY SERVING AS OFFICERS FOR ALL OF THE RELATED ORGANIZATIONS. IN ADDITION TO THE ABOVE, ROBERT FLEMMING AND KENNETH ASPELMEIER SERVE AS BOARD MEMBERS FOR GREAT RIVER HEALTH SYSTEMS, GREAT RIVER MEDICAL CENTER, GRMC FOUNDATION, AND GREAT RIVER FOUNDATION. EACH INDIVIDUAL SPENDS APPROXIMATELY 1 HOUR PER WEEK COLLECTIVELY SERVING AS BOARD MEMBERS FOR THE ORGANIZATIONS LISTED ABOVE. |
| CHANGES IN NET ASSETS OR FUND BALANCES: | FORM 990, PART XI, LINE 5: | NET UNREALIZED LOSSES ON INVESTMENTS: -76,891. UNREALIZED GAIN ON INTEREST RATE SWAP -2,522,108. TRANSFER FROM RELATED PARTY 6,676,213. TOTAL TO FORM 990, PART XI, LINE 5: 4,077,214. |
| FORM 990, PART XII, LINE 2C | THIS PROCESS IS CONSISTENT WITH PRIOR YEARS. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 INC | |||||||||||
| 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 421193186 | SUPPORT RELATED ORGANIZATIONS | IA | 501(C)(3) | 11 - TYPE 2 | 0 | GRHS | |
| GREAT RIVER FOUNDATION | |||||||||||
| 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 421469162 | SUPPORT RELATED ORGANIZATIONS | IA | 501(C)(3) | 11 - TYPE 2 | 0 | GRHS | |
Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity |
|---|---|---|---|---|---|---|---|---|
| RIVERVIEW SYSTEMS LTD | ||||||||
| PO BOX 640 | WEST BURLINGTON | IA | 52655 | 421191960 | MEDICAL SERVICES | IA | GRHS | C |
| GREAT RIVER MEDICAL SERVICES INC | ||||||||
| 1201 WEST AGENCY ROAD | WEST BURLINGTON | IA | 52655 | 421493449 | MEDICAL SERVICES | IA | GRHS | C |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |