GRAND ITASCA CLINIC AND HOSPITAL: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- GRAND ITASCA CLINIC AND HOSPITAL (EIN 41-1865874)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-15
- IRS object ID
- 201213209349305411
- Schema version
- 2011v1.2
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-15T13:34:56-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420714325 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCGLADREY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 801 NICOLLET MALL SUITE 1100 | 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 | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411865874 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAND ITASCA CLINIC AND HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | GRAN | NameControl |
| Phone | 2183265000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1601 GOLF COURSE ROAD | AddressLine1 |
| City | GRAND RAPIDS | City |
| State | MN | State |
| ZIP Code | 55744 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | SARAH GUSTAFSON | Name |
| Title | DIRECTOR OF FINANCE | Title |
| Phone | 2183265000 | Phone |
| Date Signed | 2012-11-13 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TODD A JACKSON | Name |
| PTIN | P00092672 | PTIN |
| Phone | 6123324300 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | MICHAEL YOUSO | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1601 GOLF COURSE ROAD | AddressLine1 |
| City | GRAND RAPIDS | City |
| State | MN | State |
| ZIP Code | 55744 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 76061205 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.GRANDITASCA.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1997 | YearFormation |
| State Legal Domicile | MN | StateLegalDomicile |
| Activity Or Mission Description | PATIENT-CENTERED EXCELLENCE | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 15 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 11 | NbrIndependentVotingMembers |
| Total Nbr Employees | 617 | TotalNbrEmployees |
| Total Nbr Volunteers | 104 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 34947939 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 74433876 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 234662 | InvestmentIncomePriorYear |
| Investment Income Current Year | 768209 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 505120 | OtherRevenuePriorYear |
| Other Revenue Current Year | 859120 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 35687721 | TotalRevenuePriorYear |
| Total Revenue Current Year | 76061205 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 20574572 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 43564249 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 160096 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 13824543 | OtherExpensePriorYear |
| Other Expenses Current Year | 30917887 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 34399115 | TotalExpensesPriorYear |
| Total Expenses Current Year | 74482136 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1288606 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1579069 | RevenuesLessExpensesCY |
| Total Assets BOY | 88939608 | TotalAssetsBOY |
| Total Assets EOY | 91295839 | TotalAssetsEOY |
| Total Liabilities BOY | 52568398 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 52405270 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 36371210 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 38890569 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | PROVIDE QUALITY, ACCESSIBLE, AND VALUABLE HEALTH CARE SERVICES VIA A HOSPITAL, HOME HEALTH AGENCY, AND CLINIC TO THE SURROUNDING RURAL COMMUNITY. | MissionDescription |
| Significant New Program Services | 1 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 59298930 | Expense |
| Revenue | 75292996 | Revenue |
| Description | 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 14 ACUTE REHAB BEDS, 34 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 620 PEOPLE INCLUDING 45 HEALTHCARE PROVIDERS.THE FACILITY SERVED APPROXIMATELY 2,392 INPATIENTS AND APPROXIMATELY 147,000 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 $301,482 OF CHARITY CARE, $1,039,001 DISCOUNT TO THE UNINSURED AND ABSORBED $1,297,961 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 $6,773 IN 2011 CALENDAR YEAR. IN ADDITION, GRAND ITASCA PROVIDED HEALTHCARE SUPPORT SERVICES OF $40,776 INCLUDING ASK-A-NURSE AND PATIENT TRANSPORTATION. GRAND ITASCA ALSO PAID $1,028,299 IN PAYMENTS FOR MINNESOTA CARE TAX AND MEDICAID SURCHARGES, WHICH WERE USED TO FUND CARE FOR THE INDIGENT AND UNDERINSURED. | Description |
| Total Program Service Expense | 59298930 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | 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 | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | 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 | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| 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 | 1 | 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 | 1 | 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 | 49 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 617 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| 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 | 15 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 11 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 1 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | 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 | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 0 | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | MN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SARAH GUSTAFSON | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2183265000 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1601 GOLF COURSE ROAD | AddressLine1 |
| City | GRAND RAPIDS | City |
| State | MN | State |
| ZIP Code | 55744 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (23 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| PETER MCDERMOTT | |||||||
| CHAIR | 1.00 | X | X | 0 | 0 | 0 | |
| MARVA JEAN HUTCHENS | |||||||
| 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 | |
| MIKE IVES | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| RON IANNELLI | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| COLLEEN NARDONE | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| BARBARA MCDONALD | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| ELIZABETH MISKOVICH | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| BARB SANDERSON | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| CHARLES KAMPEN | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| JANICE M ROURK | |||||||
| DIRECTOR/PEDIATRIC MD | 40.00 | X | 148416 | 0 | 27430 | ||
| JAMISON L HARKER | |||||||
| DIRECTOR/INTERNAL MEDICINE | 40.00 | X | 239843 | 0 | 34088 | ||
| RICHARD J HELVIG | |||||||
| DIRECTOR/FAMILY PHYSICIAN | 40.00 | X | 95056 | 0 | 817 | ||
| NATHAN M NOZNESKY | |||||||
| DIRECTOR/CHIEF MEDICAL OFFICER | 40.00 | X | X | 308611 | 0 | 30213 | |
| MICHAEL J YOUSO | |||||||
| PRESIDENT & CEO | 40.00 | X | 271485 | 0 | 34935 | ||
| JACK V CARLISLE | |||||||
| CHIEF MEDICAL OFFICER/FAMILY PHYSICIAN | 40.00 | X | 252868 | 0 | 34743 | ||
| BRUCE L LORENZ | |||||||
| CFO | 40.00 | X | 104599 | 0 | 7489 | ||
| TIMOTHY M GOLD | |||||||
| ANESTHESIOLOGIST MD | 40.00 | 404909 | 0 | 35215 | X | ||
| ROBERTA L ZIMMERMAN | |||||||
| PATHOLOGIST | 40.00 | 353574 | 0 | 30036 | X | ||
| JOHN A KOLE | |||||||
| GENERAL SURGEON CLINIC | 40.00 | 331924 | 0 | 35071 | X | ||
| DENNIS F SCHERER | |||||||
| EMERGENCY ROOM MD | 40.00 | 330086 | 0 | 30027 | X | ||
| DEBRA M NYQUIST | |||||||
| EMERGENCY ROOM MD | 40.00 | 304993 | 0 | 35071 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3146364 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 335135 | TotalOtherCompensation |
| Number Individuals GT100 K | 61 | 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 |
|---|---|---|---|---|---|
| MIDWEST MEDICAL INSURANCE CO | |||||
| PO BOX 86 | MINNEAPOLIS | MN | 55486 | INSURANCE COVERAGE | 394246 |
| INITIO INC | |||||
| 212 THIRD AVE N 3510 | MINNEAPOLIS | MN | 55401 | ADVERTISING AGENCY | 374373 |
| TRU SERVICES LLC | |||||
| 200 CUMMINGS CTR STE 272D | BEVERLY | MA | 01915 | INSURANCE COVERAGE | 301842 |
| ARAMARK UNIFORM SERVICES | |||||
| 1920 OAK STREET | LACROSSE | WI | 54603 | UNIFORM CLEANING | 286788 |
| MEMORIAL BLOOD CENTER MPLS INC | |||||
| PO BOX 1164 | MINNEAPOLIS | MN | 55480 | BLOOD REFERENCE LAB | 210375 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 8 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENTS AND RESIDENT | Description |
| Business Code | 621110 | BusinessCode |
| Total Revenue Column | 74433876 | TotalRevenueColumn |
| Related Or Exempt Function Income | 74433876 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 74433876 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 768209 | TotalRevenueColumn |
| Exclusion | $768,209 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| MISCELLANEOUS OPERATIN | 621110 | 702417 | 702417 |
| HEALTH RELATED ACTIVIT | 621110 | 179548 | 179548 |
| NET INCOME ATTRIBUTED | 621110 | -22845 | -22845 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 859120 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 76061205 | TotalRevenueColumn |
| Related Or Exempt Function Income | 75292996 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $768,209 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1281983 | Total |
| Program Services | 1027051 | ProgramServices |
| Management And General | 254826 | ManagementAndGeneral |
| Fundraising | 106 | Fundraising |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 34395627 | Total |
| Program Services | 27555778 | ProgramServices |
| Management And General | 6836994 | ManagementAndGeneral |
| Fundraising | 2855 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2221051 | Total |
| Program Services | 1779377 | ProgramServices |
| Management And General | 441490 | ManagementAndGeneral |
| Fundraising | 184 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2763117 | Total |
| Program Services | 2213649 | ProgramServices |
| Management And General | 549239 | ManagementAndGeneral |
| Fundraising | 229 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2902471 | Total |
| Program Services | 2325291 | ProgramServices |
| Management And General | 576939 | ManagementAndGeneral |
| Fundraising | 241 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 167467 | Total |
| Program Services | 134165 | ProgramServices |
| Management And General | 33288 | ManagementAndGeneral |
| Fundraising | 14 | Fundraising |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 99671 | Total |
| Program Services | 79851 | ProgramServices |
| Management And General | 19812 | ManagementAndGeneral |
| Fundraising | 8 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 204914 | Total |
| Program Services | 164165 | ProgramServices |
| Management And General | 40732 | ManagementAndGeneral |
| Fundraising | 17 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 999433 | Total |
| Program Services | 800688 | ProgramServices |
| Management And General | 198662 | ManagementAndGeneral |
| Fundraising | 83 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2272975 | Total |
| Program Services | 1820975 | ProgramServices |
| Management And General | 451811 | ManagementAndGeneral |
| Fundraising | 189 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 127229 | Total |
| Program Services | 101928 | ProgramServices |
| Management And General | 25290 | ManagementAndGeneral |
| Fundraising | 11 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1988290 | Total |
| Program Services | 1592902 | ProgramServices |
| Management And General | 395223 | ManagementAndGeneral |
| Fundraising | 165 | Fundraising |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 154887 | Total |
| Program Services | 124086 | ProgramServices |
| Management And General | 30788 | ManagementAndGeneral |
| Fundraising | 13 | Fundraising |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5359404 | Total |
| Program Services | 4293643 | ProgramServices |
| Management And General | 1065316 | ManagementAndGeneral |
| Fundraising | 445 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 577596 | Total |
| Program Services | 462736 | ProgramServices |
| Management And General | 114812 | ManagementAndGeneral |
| Fundraising | 48 | Fundraising |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| SUPPLIES | 9188480 | 7361276 | 1826441 | 763 |
| BAD DEBT | 3715798 | 2976882 | 738608 | 308 |
| NON PHY FEES | 2977668 | 2385535 | 591886 | 247 |
| MISC EXPENSES | 1963420 | 1201148 | 608195 | 154077 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1120655 | Total |
| Program Services | 897804 | ProgramServices |
| Management And General | 222758 | ManagementAndGeneral |
| Fundraising | 93 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 74482136 | Total |
| Program Services | 59298930 | ProgramServices |
| Management And General | 15023110 | ManagementAndGeneral |
| Fundraising | 160096 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5272997 | BOY |
| EOY | 12829047 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25051 | BOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12520762 | BOY |
| EOY | 11313392 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1016932 | BOY |
| EOY | 940927 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1012960 | BOY |
| EOY | 1624635 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 75146992 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 30047562 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 48749713 | BOY |
| EOY | 45099430 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20341193 | BOY |
| EOY | 19488408 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 88939608 | BOY |
| EOY | 91295839 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6362600 | BOY |
| EOY | 6710496 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 36762521 | BOY |
| EOY | 35497521 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9443277 | BOY |
| EOY | 10197253 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 52568398 | BOY |
| EOY | 52405270 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 36063199 | BOY |
| EOY | 38582558 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 308011 | BOY |
| EOY | 308011 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 36371210 | BOY |
| EOY | 38890569 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 88939608 | BOY |
| EOY | 91295839 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 1579069 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 940291 | ReconcilationOtherChanges |
| 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 D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 607331 | OtherCostOrOtherBasis |
| Book Value | 607331 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 44509767 | OtherCostOrOtherBasis |
| Depreciation | 12109244 | Depreciation |
| Book Value | 32400523 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 236722 | OtherCostOrOtherBasis |
| Depreciation | 67370 | Depreciation |
| Book Value | 169352 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 29793172 | OtherCostOrOtherBasis |
| Depreciation | 17870948 | Depreciation |
| Book Value | 11922224 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 45099430 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (4 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| DEFERRED FINANCING COSTS | 1144275 |
| ASSETS LIMITED TO USE | 17658516 |
| CHARITABLE REMAINDER TRUST | 208011 |
| OTHER ASSETS | 477606 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 19488408 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (5 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| OTHER ACCURALS | $933,272 |
| POST RETIREMENT BENEFIT | $6,865,794 |
| SELF INSURED WORKER'S COMP | $504,857 |
| CAPITAL LEASE OBLIGATION | $652,198 |
| CURRENT PORTION OF LONG TERM DEBT | $1,241,132 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 10197253 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X: | ReturnReference |
| Explanation | 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, 2011. 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, 2007. | Explanation |
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 |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 0 | 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 | 373203 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 373203 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00530 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 16293494 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 14484279 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1809215 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02560 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 16666697 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 14484279 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2182418 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03090 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 40807 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 40807 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10500 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 10500 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7188 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 7188 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 58495 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 58495 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00080 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 16725192 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 14484279 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2240913 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03170 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 40826 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 40826 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 7188 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 7188 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 48014 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 48014 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $3,715,798 | BadDebtExpenseAmount |
| Amount Attributable To | 928950 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 28368851 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 28547864 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -179013 | 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 |
Form990 Schedule H Part IV Form990ScheduleHPartIV
Name Of Entity NameOfEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 CDI GRAND RAPIDS LLC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Ent Primary Activity | PROVIDE MRI, DIAGNOSTIC INJECTION AND PAIN MANAGEMENT SERVICES | DescriptionEntPrimaryActivity |
| Organization Profit Or Ownership | 0.55000 | OrganizationProfitOrOwnership |
| Officers Etc Profit Or Ownership | 0.00000 | OfficersEtcProfitOrOwnership |
| Physicans Profit Or Ownership | 0.00000 | PhysicansProfitOrOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | GRAND ITASCA CLINIC AND HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1601 GOLF COURSE ROAD | AddressLine1 |
| City | GRAND RAPIDS | City |
| State | MN | State |
| ZIP Code | 55744 | 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 | GRAND ITASCA CLINIC AND HOSPITAL | 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 | 300.000000000000 | 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 |
| Other Factors | X | OtherFactors |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 0 | IncludesPublicityMeasures |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Lawsuit | X | PermitLawsuit |
| Collection Activities | 1 | CollectionActivities |
| Lawsuit | X | Lawsuit |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Other Actions Taken | X | OtherActionsTaken |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Lowest Negotiated Rates | X | LowestNegotiatedRates |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 2 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (2 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| NEW SPIRIT WOMEN'S CLINIC | ||||
| 409 SE 13TH STREET | GRAND RAPIDS | MN | 55744 | CLINIC |
| GRAND ITASCA PROFESSIONAL BUILDING | ||||
| 111 SE 3RD STREET | GRAND RAPIDS | MN | 55744 | VARIOUS OUTPATIENT & BUSINESS SERVICES |
Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| 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 $ 3715798. | ||
| PART II: 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 V, SECTION B, LINE 11H: 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 15E: PRE-ADMISSION DEPOSIT, VERIFICATION OF INFORMATION, PAYMENT ARRANGEMENTS | GRAND ITASCA CLINIC AND HOSPITAL | |
| PART V, SECTION B, LINE 17E: PATIENT RECEIVES A SERIES OF LETTERS INDICATING ACTIONS TO BE TAKEN IF PAYMENT ARRANGEMENTS ARE NOT MADE WITH THE FACILITY. | GRAND ITASCA CLINIC AND HOSPITAL | |
| 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. | ||
| MN | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| 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 (10 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JANICE M ROURK | |||||||||||||
| 148416 | 0 | 0 | 0 | 0 | 0 | 10103 | 0 | 17327 | 0 | 175846 | 0 | 0 | 0 |
| JAMISON L HARKER | |||||||||||||
| 239843 | 0 | 0 | 0 | 0 | 0 | 16200 | 0 | 17888 | 0 | 273931 | 0 | 0 | 0 |
| NATHAN M NOZNESKY | |||||||||||||
| 308611 | 0 | 0 | 0 | 0 | 0 | 16900 | 0 | 13313 | 0 | 338824 | 0 | 0 | 0 |
| MICHAEL J YOUSO | |||||||||||||
| 271485 | 0 | 0 | 0 | 0 | 0 | 16900 | 0 | 18035 | 0 | 306420 | 0 | 0 | 0 |
| JACK V CARLISLE | |||||||||||||
| 252868 | 0 | 0 | 0 | 0 | 0 | 16900 | 0 | 17843 | 0 | 287611 | 0 | 0 | 0 |
| TIMOTHY M GOLD | |||||||||||||
| 404909 | 0 | 0 | 0 | 0 | 0 | 16900 | 0 | 18315 | 0 | 440124 | 0 | 0 | 0 |
| ROBERTA L ZIMMERMAN | |||||||||||||
| 353574 | 0 | 0 | 0 | 0 | 0 | 16900 | 0 | 13136 | 0 | 383610 | 0 | 0 | 0 |
| JOHN A KOLE | |||||||||||||
| 331924 | 0 | 0 | 0 | 0 | 0 | 16900 | 0 | 18171 | 0 | 366995 | 0 | 0 | 0 |
| DENNIS F SCHERER | |||||||||||||
| 330086 | 0 | 0 | 0 | 0 | 0 | 16900 | 0 | 13127 | 0 | 360113 | 0 | 0 | 0 |
| DEBRA M NYQUIST | |||||||||||||
| 304993 | 0 | 0 | 0 | 0 | 0 | 16900 | 0 | 18171 | 0 | 340064 | 0 | 0 | 0 |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAND RAPIDS STATE BANK | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | SHELLY STEERE, TREASURER, IS VP OF THE BANK, WHICH IS GICH'S PRIMARY BANK. | Relationship |
| Amount Of Transaction | 229725 | AmountOfTransaction |
| Description Of Transaction | INTEREST PAID FROM CD'S AND CHECKING/SAVINGS ACCOUNTS AT GRAND RAPIDS STATE BANK | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| NEW PROGRAM SERVICES | FORM 990, PART III, LINE 2 | IN 2011 GRAND ITASCA CLINIC & HOSPITAL ENTERED INTO A JOINT VENTURE, CDI GRAND RAPIDS, LLC, TO OFFER MRI AND DTI SERVICES. |
| FORM 990, PART VI, SECTION A, LINE 4 | THE GOVERNANCE COMMITTEE PRESENTED THE FINAL PROPOSED CHANGES TO THE BOARD BYLAWS AS FOLLOWS: SECTION 4.1: ADD: "A PROVIDER IS DEFINED AS A CREDENTIALED PHYSICIAN OR ALLIED HEALTH PROFESSIONAL." CHANGE: "SHALL" TO "MAY" IN THE DECLARATION THAT "OF THE PROVIDER DIRECTORS, FOUR SHALL BE PROVIDERS EMPLOYED BY THE CORPORATION AND ONE SHALL BE A LOCAL PROVIDER NOT EMPLOYED BY THE CORPORATION. ADD: "THE PROVIDER NOT EMPLOYED BY THE CORPORATION SHOULD BE A LICENSED PHYSICIAN IN ACTIVE PRACTICE." SECTION 8.6: ADD: THE GOVERNANCE COMMITTEE "SHALL ANNUALLY REVIEW THE REPORT FROM THE GRAND ITASCA COMPLIANCE OFFICER REGARDING POLICIES AND PROCEDURES OF GRAND ITASCA TO ASSURE COMPLIANCE WITH ALL REQUIREMENTS OF THE IRS, ESPECIALLY AS IT RELATES TO FILING THE IRS 990 FORM "- OIG, CPG (OFFICE OF INSPECTOR GENERAL, COMPLIANCE PROGRAM GUIDANCE FOR HOSPITALS)." DELETE: THE GOVERNANCE COMMITTEE WILL ASSURE THAT A COPY OF THE IRS FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO ITS FILING. DELETE: THE GOVERNANCE COMMITTEE WILL ASSURE THAT A COPY OF THE ORGANIZATIONS "CONFLICT OF INTEREST POLICY" IS ALIGNED WITH IRS REQUIREMENTS AND THAT ALL BOARD MEMBERS HAVE NOTICES OF COMPLIANCE ON FILE. MOTION WAS MADE AND SECONDED TO APPROVE THE PROPOSED CHANGES TO THE GRAND ITASCA BOARD BYLAWS AS PRESENTED. | |
| FORM 990, PART VI, SECTION B, LINE 11 | FORM 990 IS REVIEWED BY THE DIRECTOR 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. | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | FORM 990, PART XI, LINE 5: | CHANGE IN INTEREST IN HEALTH RELATED ACTIVITIES 903,698. FOUNDATION CHANGE IN NET ASSETS 14,440. UNCONSOLIDATING ADJUSTMENT 22,153. TOTAL TO FORM 990, PART XI, LINE 5: 940,291. |
| JOINT VENTURE WITH A TAXABLE ENTITY | FORM 990, PART VI, SECTION B, LINE 16A | GRAND ITASCA THOROUGHLY EVALUATED THE PARTICIPATION IN THE CDI JOINT VENTURE. THIS EVALUATION INCLUDED REVIEW BY ATTORNEYS AND OTHER THIRD PARTY CONSULTANTS. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAND ITASCA FOUNDATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1601 GOLF COURSE ROAD | AddressLine1 |
| City | GRAND RAPIDS | City |
| State | MN | State |
| ZIP Code | 55744 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411560554 | EIN |
| Primary Activities | FINANCIAL SUPPORT OF GRAND ITASCA CLINIC & HOSPITAL | PrimaryActivities |
| Legal Domicile State | MN | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | 11(F) | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAND ITASCA CLINIC & HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | 1 | ControlledOrg |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CDI GRAND RAPIDS LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1601 GOLF COURSE RD | AddressLine1 |
| City | GRAND RAPIDS | City |
| State | MN | State |
| ZIP Code | 55744 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 453783014 | EIN |
| Primary Activity | PROVIDE IN-HOUSE MRI AND DTI SERVICES | PrimaryActivity |
| Legal Domicile State | MN | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAND ITASCA CLINIC & HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | RELATED | PredominantIncomeType |
| Share Of Total Income | 22382 | ShareOfTotalIncome |
| Share Of EOY Assets | 844248 | ShareOfEOYAssets |
| Disproportionate Allocations | 1 | DisproportionateAllocations |
| General Or Managing Partner | 1 | GeneralOrManagingPartner |
| Percentage Ownership | 0.55000 | PercentageOwnership |
| 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 | 0 | 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 | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |