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GLENCOE REGIONAL HEALTH SERVICES: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
GLENCOE REGIONAL HEALTH SERVICES (EIN 41-1949230)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-10-06
IRS object ID
201102799349300210
Schema version
2010v3.4
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

FieldValueIRS element (for citing)
Timestamp2011-10-06T10:25:42-05:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1LARSONALLEN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1220 SOUTH SIXTH STREET SUITE 300AddressLine1
CityMINNEAPOLISCity
StateMNState
ZIP Code55402ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN411949230EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1GLENCOE REGIONAL HEALTH SERVICESBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlGLENNameControl
Phone3208643121Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11805 HENNEPIN AVENUE NORTHAddressLine1
CityGLENCOECity
StateMNState
ZIP Code553361416ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJEFF GRANTName
TitleCHAIRPERSONTitle
Phone3208643121Phone
Date Signed2011-10-06DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameROBERT E SCHILEName
Phone6123764500Phone
Date Prepared2011-10-06DatePrepared
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJON BRABANDNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11805 HENNEPIN AVENUE NORTHAddressLine1
CityGLENCOECity
StateMNState
ZIP Code553361416ZIPCode
FieldValueIRS element (for citing)
Gross Receipts59948777GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.GRHSONLINE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1999YearFormation
State Legal DomicileMNStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE HIGH QUALITY, CONVENIENT AND PERSONAL HEALTH CARE TO THOSE WE SERVE.ActivityOrMissionDescription
Nbr Voting Members Governing Body7NbrVotingMembersGoverningBody
Nbr Independent Voting Members4NbrIndependentVotingMembers
Total Nbr Employees653TotalNbrEmployees
Total Nbr Volunteers235TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year263748ContributionsGrantsPriorYear
Contributions Grants Current Year375430ContributionsGrantsCurrentYear
Program Service Revenue Prior Year49105674ProgramServiceRevenuePriorYear
Program Service Revenue CY48763734ProgramServiceRevenueCY
Investment Income Prior Year-59032InvestmentIncomePriorYear
Investment Income Current Year518905InvestmentIncomeCurrentYear
Other Revenue Prior Year241409OtherRevenuePriorYear
Other Revenue Current Year227889OtherRevenueCurrentYear
Total Revenue Prior Year49551799TotalRevenuePriorYear
Total Revenue Current Year49885958TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year130213GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY15103GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year28435957SalariesEtcPriorYear
Salaries Etc Current Year29311037SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year18399451OtherExpensePriorYear
Other Expenses Current Year17585658OtherExpensesCurrentYear
Total Expenses Prior Year46965621TotalExpensesPriorYear
Total Expenses Current Year46911798TotalExpensesCurrentYear
Revenues Less Expenses Prior Year2586178RevenuesLessExpensesPriorYear
Revenues Less Expenses CY2974160RevenuesLessExpensesCY
Total Assets BOY70856509TotalAssetsBOY
Total Assets EOY74499893TotalAssetsEOY
Total Liabilities BOY29610879TotalLiabilitiesBOY
Total Liabilities EOY29087110TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY41245630NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY45412783NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionGLENCOE REGIONAL HEALTH SERVICES EXISTS TO PROVIDE HIGH QUALITY, CONVENIENT AND PERSONAL HEALTH CARE TO THOSE WE SERVE. WE DO SO BY PROVIDING COMPREHENSIVE, EVIDENCE-BASED, COST-EFFECTIVE HEALTH CARE SERVICES AND EDUCATION. WE COLLABORATE WITH OTHERS TO COORDINATE AND IMPROVE THE HEALTH OF OUR COMMUNITIES, AND COMMIT OUR SKILLS AND RESOURCES TO BENEFIT THE WHOLE PERSON THROUGH ALL STATES OF LIFE.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense39214732Expense
Grants15103Grants
Revenue41406079Revenue
DescriptionHOSPITAL - THE FACILITY IS LICENSED FOR 49 BEDS. MEDICAL/SURGICAL SERVICES ARE PROVIDED FOR ACUTE AND SWING BED PATIENTS. MAJOR SERVICES PROVIDED INCLUDE ER, MEDICAL IMAGING, SURGERY, LABORATORY, REHABILITATION THERAPY AND CLINIC SERVICES.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense2633980Expense
Revenue6905670Revenue
DescriptionNURSING HOME - THE LONG-TERM CARE UNIT IS A 110-BED SKILLED NURSING FACILITY, WITH ALL BEDS MEDICARE AND MEDICAID CERTIFIED.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense169294Expense
Revenue451985Revenue
DescriptionINDEPENDENT SENIOR LIVING - ORCHARD ESTATES IS A 40-UNIT SENIOR-HOUSING COMPLEX COMPRISED OF ONE AND TWO BEDROOM APARTMENTS.Description
FieldValueIRS element (for citing)
Total Program Service Expense42018006TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling1CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached0FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109627NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees653NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members7NbrVotingGoverningBodyMembers
Number Independent Voting Members4NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledMNStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1CHERYL TRIPPELBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3208647758TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11805 HENNEPIN AVENUE NORTHAddressLine1
CityGLENCOECity
StateMNState
ZIP Code553361416ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (18 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
JEFF GRANT
CHAIR0.50XX120000
DR DOUG WAGONER
VICE CHAIR & PHYSICIAN40.50XX252807027546
JIM WATERS
SECRETARY0.50XX110000
DR JOHN BERGSENG
DIRECTOR & PHYSICIAN40.50X431052027772
MIKE LONG
DIRECTOR0.50X70000
CAROL HAUKOS
DIRECTOR0.50X30000
DR BRYAN PETERSEN
DIRECTOR & PHYSICIAN40.50X291512032881
JEANNE CONKEL
DIRECTOR0.50X100000
JAN BRATSCH
DIRECTOR0.50X100000
JON BRABAND
PRESIDENT & CEO40.00X208071040436
JOHN DOIDGE
VP OF FINANCE40.00X147992025382
DR JOHN MARK JOHNSON
PHYSICIAN40.00374567033002X
DR ROBERT ZAJAC
PHYSICIAN40.00336364032663X
DR CHAD ROBBINS
PHYSICIAN40.00306489032086X
DR PREMAN SINGH
PHYSICIAN40.0027469209486X
ROBERT LARTER
DIRECTOR OF PERIOPERATIVE SERVICES40.00252491016255X
DR PETER SMYTH
PHYSICIAN40.00233738019933X
DR KRISTINE KNUDTEN
PHYSICIAN40.00251704028157X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3366779TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation325599TotalOtherCompensation
Number Individuals GT100 K30NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
SHARED MEDICAL SERVICES
PO BOX 330COTTAGE GROVEWI53527MRI SERVICES308200
QUEST DIAGNOSTICS
PO BOX 12989CHICAGOIL60693REFERENCE LAB302226
PARK NICOLLETMETHODIST HOSPITAL
PO BOX 16300ST LOUIS PARKMN55416MANAGEMENT FEES255545
CONSULTING RADIOLOGISTS
1221 NICOLLET MALL STE 600MINNEAPOLISMN55403NUCLEAR MED TECH193680
ALLINA HOSPITALS & CLINICS
PO BOX 9383 NW7710MINNEAPOLISMN55440ECHO FEES180087
FieldValueIRS element (for citing)
Number Of Contractors GT100 K11NumberOfContractorsGT100K
Government Grants196902GovernmentGrants
All Other Contributions178528AllOtherContributions
Total Contributions375430TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
HOSPITAL6230004131730641317306
NURSING HOME62300069056706905670
SENIOR LIVING623990451985451985
EQUITY INVEST. INCOME6230004670746707
OTHER PROGRAM REVENUES6230004206642066
FieldValueIRS element (for citing)
Total Program Service Revenue48763734TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column598671TotalRevenueColumn
Exclusion$598,671ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real6028Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real6028Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column6028TotalRevenueColumn
Exclusion$6,028ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities9981853Securities
Other1200Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities10059884Securities
Other2935Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-78031Securities
Other-1735Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-79766TotalRevenueColumn
Exclusion-$79,766ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
CAFETERIA REVENUE722210177101$177,101
MISCELLANEOUS90009944760$44,760
FieldValueIRS element (for citing)
Total Other Revenue221861TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column49885958TotalRevenueColumn
Related Or Exempt Function Income48763734RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$746,794ExclusionAmount

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total15103Total
Program Services15103ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1290719Total
Program Services862970ProgramServices
Management And General427749ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total21891933Total
Program Services20934231ProgramServices
Management And General957702ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total788016Total
Program Services740412ProgramServices
Management And General47604ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total3859248Total
Program Services3626111ProgramServices
Management And General233137ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1481121Total
Program Services1391647ProgramServices
Management And General89474ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total7038Total
Program Services7038ProgramServices

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total60828Total
Program Services60828ProgramServices

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total2624364Total
Program Services2051450ProgramServices
Management And General572914ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total217257Total
Program Services4294ProgramServices
Management And General212963ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1186836Total
Program Services969054ProgramServices
Management And General217782ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total199979Total
Management And General199979ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1091197Total
Program Services1091197ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total218843Total
Program Services170230ProgramServices
Management And General48613ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total8135Total
Program Services8135ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total1234476Total
Program Services1234476ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total3223566Total
Program Services3223566ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total698850Total
Program Services227207ProgramServices
Management And General471643ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
MEDICAL EXPENSES2997790299772664
LICENSES & TAXES1247630734701174160
DRUGS114421111392534958
BAD DEBT EXPENSE752467752467
REPAIRS & MAINTENANCE26737724765019727

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total404814Total
Program Services189491ProgramServices
Management And General215323ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total46911798Total
Program Services42018006ProgramServices
Management And General4893792ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY7618180BOY
EOY8434552EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY18207141BOY
EOY23661926EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY6638322BOY
EOY6543268EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY245453BOY
EOY287019EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY792851BOY
EOY569518EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis56171486LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec32194821LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY25575683BOY
EOY23976665EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY10102043BOY
EOY9235291EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY864891BOY
EOY911598EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY396753BOY
EOY371068EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY415192BOY
EOY508988EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY70856509BOY
EOY74499893EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY3561676BOY
EOY3607651EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY25602937BOY
EOY24938681EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY31074BOY
EOY31790EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY415192BOY
EOY508988EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY29610879BOY
EOY29087110EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY41245630BOY
EOY45412783EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY41245630BOY
EOY45412783EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY70856509BOY
EOY74499893EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses2974160ReconcilationRevenueExpenses
Reconcilation Other Changes1192993ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations1GrantsOtherOrganizations
Grants Other Organizations$2,348GrantsOtherOrganizationsAmount
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities0OtherActivities
Total Lobbying Expenditures IIB2348TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF OTHER LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1I:ReturnReference
ExplanationLOBBYING PORTION OF ASSOCIATION DUES PAID TO AHA AND MHA.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtc
Included On FS1IncludedOnFS

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1221121OtherCostOrOtherBasis
Book Value1221121BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis29712277OtherCostOrOtherBasis
Depreciation18914454Depreciation
Book Value10797823BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis1410463OtherCostOrOtherBasis
Depreciation1040145Depreciation
Book Value370318BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis23607331OtherCostOrOtherBasis
Depreciation12240222Depreciation
Book Value11367109BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis220294OtherCostOrOtherBasis
Book Value220294BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings23976665TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDEFERRED COMPENSATIONDescription
Amount$508,988Amount
FieldValueIRS element (for citing)
Total Of Amounts508988TotalOfAmounts
Total Revenue49885958TotalRevenue
Total Expenses46911798TotalExpenses
Excess Or Deficit For Year2974160ExcessOrDeficitForYear
Net Unrealized GL On Investments1192993NetUnrealizedGLOnInvestments
Total Adjustments1192993TotalAdjustments
Excess Or Deficit Per FS4167153ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt48975438TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments1192993NetUnrealizedGainsInvestments
Revenue Not Rptd F9901192993RevenueNotRptdF990
Revenue Subtotal47782445RevenueSubtotal
Other Revenues Not Included2103513OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt2103513RevenueNotRptdOnFinStmt
Total Revenue Per Form99049885958TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt46911798TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal46911798ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99046911798TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART IV, LINE 2B:INDEPENDENT SENIOR LIVING TENANTS MAKE SECURITY DEPOSITS WHEN THEY MOVE IN TO THE FACILITY. DEPOSITS, WITH INTEREST, LESS ANY COSTS OF REPAIRS, ARE RETURNED TO TENANTS OR THEIR ESTATES WHEN THE TENANT LEAVES THE FACILITY. THE ORGANIZATION HOLDS SMALL AMOUNTS DEPOSITED BY RESIDENTS OF THE NURSING HOME ON THEIR BEHALF. RESIDENTS MAY MAKE DEPOSITS OR WITHDRAWALS AT ANY TIME.
PART X:THE FACILITY HAS ELECTED TO ADOPT GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE FACILITY FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES FOR EVALUATING UNCERTAIN TAX POSITIONS. THE ADOPTION OF THIS STANDARD HAS NO EFFECT ON THE FINANCIAL STATEMENTS.DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:
UNRESTRICTED CONTRIBUTIONS AND GRANT 176,059. INVESTMENT INCOME 1,705,807. EQUITY IN INCOME OF AFFILIATED ORGANIZATION 46,707. RENTAL PROPERTY 6,028. MISCELLANEOUS 64,954. LOSS ON DISPOSAL OF ASSETS -1,735. CAPITAL GRANTS AND CONTRIBUTIONS 105,693.PART XII, LINE 4B - OTHER ADJUSTMENTS:

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent200 DXPcent200D
Free Disc Care Medically Indigent0FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense1026037TotalCommunityBenefitExpense
Net Community Benefit Expense1026037NetCommunityBenefitExpense
Percent Of Total Expense0.02190PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense8796748TotalCommunityBenefitExpense
Direct Offsetting Revenue7587773DirectOffsettingRevenue
Net Community Benefit Expense1208975NetCommunityBenefitExpense
Percent Of Total Expense0.02580PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense9822785TotalCommunityBenefitExpense
Direct Offsetting Revenue7587773DirectOffsettingRevenue
Net Community Benefit Expense2235012NetCommunityBenefitExpense
Percent Of Total Expense0.04770PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense278668TotalCommunityBenefitExpense
Direct Offsetting Revenue38660DirectOffsettingRevenue
Net Community Benefit Expense240008NetCommunityBenefitExpense
Percent Of Total Expense0.00510PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense73969TotalCommunityBenefitExpense
Direct Offsetting Revenue73484DirectOffsettingRevenue
Net Community Benefit Expense485NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense54708TotalCommunityBenefitExpense
Direct Offsetting Revenue47879DirectOffsettingRevenue
Net Community Benefit Expense6829NetCommunityBenefitExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Percent Of Total Expense0.00000PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense96157TotalCommunityBenefitExpense
Net Community Benefit Expense96157NetCommunityBenefitExpense
Percent Of Total Expense0.00200PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense503502TotalCommunityBenefitExpense
Direct Offsetting Revenue160023DirectOffsettingRevenue
Net Community Benefit Expense343479NetCommunityBenefitExpense
Percent Of Total Expense0.00720PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense10326287TotalCommunityBenefitExpense
Direct Offsetting Revenue7747796DirectOffsettingRevenue
Net Community Benefit Expense2578491NetCommunityBenefitExpense
Percent Of Total Expense0.05490PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense10232TotalCommunityBuildingExpense
Net Community Building Expense10232NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense10232TotalCommunityBuildingExpense
Net Community Building Expense10232NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$435,449BadDebtExpenseAmount
Amount Reimbursed By Medicare9655031AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare10058446CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-403415MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1GLENCOE REGIONAL HEALTH SERVICESBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11805 HENNEPIN AVENUE NORTHAddressLine1
CityGLENCOECity
StateMNState
ZIP Code55336ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours
OtherNURSING HOME/SNFOther

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities2NumberOfOtherFacilities

Other Facilities OtherFacilities (2 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
GLENCOE REGIONAL HEALTH SERVICES
1024 CENTRAL AVENUELESTER PRAIRIEMN55354CLINIC
GLENCOE REGIONAL HEALTH SERVICES
300 BOWMAN STREETSTEWARTMN55385CLINIC

Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)

ExplanationExplanation
PART I, LINE 7: THE AMOUNTS IN PART I, LINE 7 WERE CALCULATED USING A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 IN THE IRS INSTRUCTIONS TO FORM 990, SCHEDULE H.
PART I, LINE 7G: THE ORGANIZATION DID NOT INCLUDE ANY COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC IN ITS SUBSIDIZED HEALTH SERVICES IN SCHEDULE H, PART I, LINE 7G.
PART I, L7 COL(F): BAD DEBT EXPENSE REPORTED IN FORM 990, PART IX, LINE 24D WERE $752,467. THIS AMOUNT WAS SUBTRACTED IN CALCULATING THE PERCENTAGES IN SCHEDULE H, PART I, LINE 7, COLUMN F.
PART II: OUR COMMUNITY BUILDING ACTIVITIES PROMOTE THE HEALTH OF OUR COMMUNITIES THROUGH DISASTER PREPAREDNESS EFFORTS, CASE MANAGEMENT OF UNDERINSURED AND UNINSURED PATIENTS, FINANCIAL AND IN-KIND SUPPORT, AND EDUCATION. FIRST, THROUGH DISASTER PREPAREDNESS TRAINING, WE SUPPORT AND PROTECT THE HEALTH OF OUR COMMUNITIES BY WORKING TO INSURE THAT THOSE NEEDING MEDICAL ATTENTION CAN ACCESS QUALITY CARE IN A SAFE AND TIMELY MANNER. DISASTER PREPAREDNESS EFFORTS ARE A YEAR-ROUND ACTIVITY, AS DISASTERS CAN INCLUDE PANDEMICS, NATURAL DISASTERS AND MASS CASUALTY SITUATIONS. SECOND, BY PROVIDING CASE MANAGEMENT OF UNDERINSURED AND UNINSURED PATIENTS, WE WORK TO HELP PATIENTS RETURN HOME AND REGAIN THEIR INDEPENDENCE AFTER AN ILLNESS, INJURY OR SURGERY. IN CASES WHERE IT IS NOT POSSIBLE FOR SOMEONE TO RETURN HOME, WE WORK TO MAKE SURE THEY HAVE ACCESS TO THE CARE AND RESOURCES THEY NEED TO CONTINUE THEIR RECOVERY OR LIVE WITH DIGNITY. THROUGH HELPING OUR PATIENTS OBTAIN FINANCIAL SUPPORT, AS WELL AS OBTAIN ACCESS TO COMMUNITY SUPPORT SYSTEMS, WE WORK TO ENSURE THAT THEY GET ADDITIONAL SERVICES THAT MAY BE NEEDED TO ASSIST IN THEIR RECOVERY. THIS PROMOTES THE HEALTH OF THE COMMUNITY BY INSURING THAT PATIENTS HAVE THE SUPPORT AND RESOURCES THEY NEED TO RETURN TO THE COMMUNITY AS PRODUCTIVE CITIZENS, AS WELL HELPING TO CREATE A COMMUNITY IN WHICH PEOPLE ARE VALUED AND TREATED WITH RESPECT. THIRD, BY PROVIDING FINANCIAL AND IN-KIND SUPPORT TO THE GLENCOE AREA CHAMBER OF COMMERCE, WE SUPPORT THE ECONOMIC HEALTH OF OUR REGION. A STRONG LOCAL ECONOMY CONTRIBUTES TO THE OVERALL HEALTH AND WELL-BEING OF ALL ITS RESIDENTS. BY PROVIDING FINANCIAL AND IN-KIND SUPPORT FOR COMMUNITY ACTIVITIES, SUCH AS THE MCLEOD COUNTY FOOD DRIVE CHALLENGE, WE ENHANCE THE QUALITY OF LIFE IN OUR COMMUNITY. FINALLY, BY PROVIDING EDUCATIONAL PRESENTATIONS AND TOURS TO OUR AREA SCHOOLS, WE ARE INVESTING IN A FUTURE GENERATION OF HEALTH CARE WORKERS WHO MAY SOMEDAY PROVIDE DIRECT CARE TO OUR PATIENTS AND OTHERS IN THE COMMUNITIES WE SERVE. WE ARE ALSO EDUCATING INDIVIDUALS ABOUT THE WORK WE DO, WHY WE DO IT, AND HOW OUR EFFORTS AFFECT THEIR LIVES AND THE LIVES OF OTHERS.
PART III, LINE 4: THE FACILITY PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED ON MANAGEMENT'S JUDGMENT. PATIENTS AND RESIDENTS ARE NOT REQUIRED TO PROVIDE COLLATERAL FOR SERVICES PROVIDED. PAYMENT FOR SERVICES IS REQUIRED WITHIN 30 DAYS OF RECEIPT OF INVOICE. PAST DUE ACCOUNTS ARE INDIVIDUALLY ANALYZED FOR COLLECTIBILITY, AND THEN TURNED OVER TO COLLECTION AGENTS. ACCOUNTS FOR WHICH NO PAYMENTS HAVE BEEN RECEIVED ARE ANALYZED AND AFTER APPROVAL ARE WRITTEN OFF. IN ADDITION, AN ALLOWANCE IS ESTIMATED FOR OTHER ACCOUNTS BASED ON HISTORICAL EXPERIENCE OF THE FACILITY.BAD DEBT EXPENSE (AT COST) IS CALCULATED BY APPLYING THE COST-TO-CHARGE RATIO TO THE TOTAL BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS.
PART III, LINE 8: THE ORGANIZATION USES A COST-TO-CHARGE RATIO TO CALCULATE THE MEDICARE ALLOWABLE COSTS REPORTED IN ITS MEDICARE COST REPORT. THE ORGANIZATION USES THE MEDICARE REIMBURSEMENT PROVIDER MANUAL 15-2 TO DETERMINE ACCEPTABLE METHODOLOGIES.
PART III, LINE 9B: OUR GENERAL DEBT COLLECTION POLICY FOR ALL PATIENTS IS AS FOLLOWS: TWO BILLING STATEMENTS ARE SENT OUT TO THE PATIENT. ACCOUNTS WITH NO SELF-PAY ACTIVITY WITHIN TWO MONTHS RECEIVE A FIRST REMINDER LETTER. IF NO PAYMENT IS RECEIVED WITHIN ONE MONTH OF THE FIRST REMINDER LETTER, A SECOND REMINDER IS SENT. IF NO PAYMENT IS MADE WITHIN THREE WEEKS OF THE SECOND LETTER BEING SENT, A PHONE CALL IS PLACED TO THE PATIENT IN ORDER TO SET UP PAYMENT ARRANGEMENTS. IF AN AGREEMENT IS NOT MET THE ACCOUNT IS SENT TO COLLECTIONS. IN ALL, PATIENTS RECEIVE FOUR NOTICES BEFORE AN ACCOUNT IS SENT TO COLLECTIONS. PAYMENT PLANS ARE AVAILABLE TO ALL PATIENTS REGARDLESS OF INSURANCE COVERAGE OR FINANCIAL SITUATION. WE DO NOT CHARGE INTEREST OR FEES ON PAYMENT PLANS. FOR 2010, THERE WAS A MINIMUM $50.00 PAYMENT REQUIRED ON PAYMENT PLANS.IF PATIENTS CONTACT US ABOUT THEIR BILL, WE WILL REFER THEM TO FINANCIAL ASSISTANCE PROGRAMS THAT ARE AVAILABLE OR DETERMINE IF THEY ARE ELIGIBLE FOR CHARITY CARE PROGRAMS OR UNINSURED DISCOUNT PROGRAMS. INFORMATION ABOUT THE DISCOUNTS AND PROGRAMS THAT ARE AVAILABLE TO PATIENTS CAN ALSO BE FOUND ON THE BACK OF EACH MONTHLY STATEMENT AND ON EACH PAYMENT REMINDER LETTER THAT IS SENT. WHEN INSURANCE COMPANIES NEED MORE INFORMATION FROM THE PATIENT TO PROCESS THE CLAIM, WE WILL CALL THE PATIENT AND SEND THE PATIENT A REMINDER LETTER ASKING THE PATIENT TO CONTACT THEIR INSURANCE COMPANY.
PART VI, LINE 2: GRHS ASSESSES OUR COMMUNITIES' HEALTH NEEDS THROUGH VARIOUS METHODS. WE HAVE CONDUCTED COMMUNITY-BASED RESEARCH ON SEVERAL OCCASIONS, INCLUDING USE OF FOCUS GROUPS AND STATISTICALLY VALID TELEPHONIC SURVEYS. DURING OUR ANNUAL STRATEGIC PLANNING PROCESS, WE REVIEW UTILIZATION TRENDS, ALONG WITH THE RESULTS OF ANY COMMUNITY-BASED RESEARCH CONDUCTED THAT YEAR. WE SOLICIT FEEDBACK FROM OUR MEDICAL STAFF REGARDING ISSUES AND TRENDS THEY SEE. WE VERIFY THOSE TRENDS, AS WELL AS IDENTIFY OTHER ISSUES AND NEEDS BY CONDUCTING INTERNAL RESEARCH AND REVIEWS OF PATIENT DATA AND STATISTICS. WE ALSO MONITOR FEEDBACK RECEIVED THROUGH PATIENT SATISFACTION SURVEYS. IN ADDITION, WE SURVEY OUR PATIENTS AT ALL OF OUR COMMUNITY HEALTH EVENTS TO FIND OUT WHAT TOPICS THEY'D LIKE TO KNOW MORE ABOUT. WE ALSO COLLABORATE WITH LOCAL PUBLIC HEALTH AND OTHER AGENCIES AS APPROPRIATE TO LEARN ABOUT OUR COMMUNITIES' NEEDS.
PART VI, LINE 3: GRHS EDUCATES AND INFORMS PATIENTS ABOUT FINANCIAL ASSISTANCE, CHARITY CARE AND UNINSURED DISCOUNT PROGRAMS IN ALL BILLING INVOICES SENT. THE INFORMATION IS LISTED ON THE BACK OF THE BILLING STATEMENT. WE ALSO POST THE INFORMATION IN OUR FACILITY AND INCLUDE IT ON OUR WEB SITE, WWW.GRHSONLINE.ORG. IN ADDITION, WE PROVIDE A REPORT BACK TO THE COMMUNITY ANNUALLY ABOUT OUR FINANCES AND CHARITY CARE AMOUNTS. THIS REPORT IS SENT TO ALL OF OUR PATIENTS, AS WELL AS THE RESIDENTS IN THE COMMUNITIES WE SERVE.
PART VI, LINE 4: PATIENTS CARED FOR BY GRHS RESIDE, PRIMARILY, IN AN AREA WITHIN A RADIUS OF TWENTY MILES OF THE CITY OF GLENCOE, WHICH IS APPROXIMATELY 55 MILES WEST OF MINNEAPOLIS. IN THE 12-MONTH PERIOD JANUARY - DECEMBER 2010, 44.5% OF THE INPATIENTS ADMITTED TO GRHS RESIDED IN GLENCOE, AND ANOTHER 44.6% OF THE INPATIENTS ADMITTED RESIDED WITHIN TWENTY MILES OF GLENCOE (FOR A TOTAL OF 89.1%). THE POPULATION OF GRHS'S PRIMARY SERVICE AREA WAS PROJECTED TO BE 29,148 IN 2000, AN INCREASE OF 4.8% SINCE 1990. THE REPORTED POPULATION OF THE CITY OF GLENCOE FOR THE YEAR 2000 WAS 5,306.
PART VI, LINE 7: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantEMPLOYEE SCHOLARSHIPSTypeOfGrant
Number Of Recipients14NumberOfRecipients
Amount Of Cash Grant14953AmountOfCashGrant
Method Of ValuationCOSTMethodOfValuation

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: GLENCOE REGIONAL HEALTH SERVICES PROVIDES TUITION REIMBURSEMENT ASSISTANCE TO EMPLOYEES. EMPLOYEES ARE REQUIRED TO COMPLETE THE REIMBURSEMENT REQUEST FORM, WHICH IS TO BE SIGNED BY THEIR SUPERVISOR, PRIOR TO BEGINNING THEIR COURSE(S) TO RESERVE FUNDS. THEY ARE TO INCLUDE A DESCRIPTION OF THE COURSE(S) THEY PLAN TO TAKE, AND RECEIPTS FOR TUITION AND BOOKS, (FEES ARE NOT ELIGIBLE FOR REIMBURSEMENT), WITH THEIR REQUEST. ONCE EMPLOYEES HAVE SUCCESSFULLY PASSED/COMPLETED THEIR COURSE(S) THEY ARE TO SUBMIT THEIR GRADES-WE REQUIRE C OR BETTER, AND THEN ARE ELIGIBLE FOR REIMBURSEMENT. EMPLOYEES ARE RESPONSIBLE FOR ALL UP-FRONT COSTS.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (12 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
DR DOUG WAGONER
2419130969401200000275460280353000
DR JOHN BERGSENG
4100700200820900000277720458824000
DR BRYAN PETERSEN
27864401081402054000328810324393000
JON BRABAND
18032702774400000404360248507000
JOHN DOIDGE
1414570653500067970185850173374000
DR JOHN MARK JOHNSON
35813001643700000330020407569000
DR ROBERT ZAJAC
32066101570300000326630369027000
DR CHAD ROBBINS
28646101402806000000320860338575000
DR PREMAN SINGH
271367033250000094860284178000
ROBERT LARTER
2524910000000162550268746000
DR PETER SMYTH
2222920544606000000199330253671000
DR KRISTINE KNUDTEN
24019901150500000281570279861000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART I, LINE 4BJOHN DOIDGE - 457(B) PLAN - $16,500 ROBERT LARTER - 457(B) PLAN - $16,500
PART IIIJON BRABAND (CEO) IS EMPLOYED BY PARK NICOLLET, AN UNRELATED THIRD PARTY. HE OPERATES AS CEO OF GLENCOE REGIONAL HEALTH SERVICES UNDER A MANAGEMENT CONTRACT WITH PARK NICOLLET. AS SUCH, HIS COMPENSATION IS REPORTED ON FORM 990, PART VII AND ON SCHEDULE J, PART II.SUPPLEMENTAL INFORMATION

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1CITY OF GLENCOEBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN416005185IssuerEIN
CUSIP Number378160BF1CUSIPNumber
Date Issued2005-08-18DateIssued
Issue Price25440900IssuePrice
Description Of PurposeDEFEASE PART OF 2001 REV. BONDS & FUND EXPANSATION OF MEDICAL/SURGICAL UNIT.DescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Amount Retired1550900AmountRetired
Total Proceeds25499173TotalProceeds
Amount In Reserve Fund353688AmountInReserveFund
Refunding Escrow19021387RefundingEscrow
Issuance Costs From Proceeds466682IssuanceCostsFromProceeds
Capital Expenditures5709899CapitalExpenditures
Current Refunding0CurrentRefunding
Advance Refunding1AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Prcntge Prvt Business Use By Others0.00000PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.00000PercentageOfPrvtBusinessReUBI
Total Private Business Use0.00000TotalPrivateBusinessUse
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Form990 Schedule K Part V Form990ScheduleKPartV

FieldValueIRS element (for citing)
IdentifierSCHEDULE K, PART II, LINE 3Identifier
Return ReferenceDIFFERENCE FROM ISSUE PRICEReturnReference
ExplanationTHE GROSS PROCEEDS REPORTED ON PART II, LINE 3 ARE GREATER THAN THE ISSUE PRICE REPORTED ON PART I, COLUMN (E) BY $58,273. THE DIFFERENCE IS PROCEEDS USED FOR ACCRUED INTEREST.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 3THE ORGANIZATION HAS A CONTRACTUAL ARRANGEMENT WITH PARK NICOLLET HEALTH SERVICES, UNDER WHICH PARK NICOLLET HEALTH SERVICES PROVIDES A CHIEF EXECUTIVE OFFICER, MANAGEMENT CONSULTATION, AND OTHER SERVICES TO THE FACILITY. THE ARRANGEMENT DOES NOT ALTER THE AUTHORITY OR RESPONSIBILITY OF THE BOARD OF DIRECTORS OF GLENCOE REGIONAL HEALTH SERVICES.
FORM 990, PART VI, SECTION B, LINE 11THE 990 REPORT WAS REVIEWED WITH THE BOARD MEMBERS AT A REGULARY SCHEDULED BOARD MEETING. THE BOARD WAS ASKED TO APPROVE THE DOCUMENT PRIOR TO SUBMISSION TO THE IRS.
GLENCOE REGIONAL HEALTH SERVICES HAS A CONFLICT OF INTEREST POLICY THAT APPLIES TO ALL MEMBERS OF THE BOARD OF DIRECTORS, MEMBERS OF A COMMITTEE OF THE BOARD OF DIRECTORS, AND SENIOR MANAGEMENT. ANNUALLY, THE BOARD MEMBERS AND SENIOR MANAGMENT ARE ASKED TO COMPLETE THE CONFLICT OF INTEREST DECLARATION. ANY INDIVIDUAL HAVING A CONFLICT OF INTEREST IS REQUIRED TO INFORM THE BOARD OR COMMITTEE. THE INDIVIDUAL ABSTAINS FROM VOTING ON THE MATTER, BUT IS PERMITTED TO BRIEFLY STATE THEIR POSITION AND ANSWER PERTINENT QUESTIONS. THE MINUTES OF THE MEETING REFLECT THAT THE DISCLOSURE WAS MADE AND THAT THE PERSON ABSTAINED FROM VOTING. THE PRESIDENT AND CEO IS RESPONSIBLE FOR MONITORING CONFLICTS OF INTEREST.FORM 990, PART VI, SECTION B, LINE 12C
THE CEO REVIEW PROCESS IS PERFORMED UNDER THE DIRECTION OF PARK NICOLLET AND INDEPENDENT COMPARISON DATA IS USED TO ESTABLISH COMPENSATION. THE BOARD OF DIRECTORS FINALIZES THE REVIEW AND COMPENSATION. THE VICE PRESIDENT OF FINANCE REVIEW IS CONDUCTED BY THE CEO AND COMPENSATION IS DETERMINED USING INDEPENDENT COMPARISON DATA. BOTH POSITIONS WERE REVIEWED IN 2010.FORM 990, PART VI, SECTION B, LINE 15
THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST. ANNUAL FINANCIAL STATEMENTS ARE PUBLISHED ONCE PER YEAR IN THE FACILITY PUBLICATION TOUCHING LIVES. THE TOUCHING LIVES PUBLICATION IS MAILED TO ALL RESIDENTS IN THE FACILITY'S SERVICE AREA.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED GAINS ON INVESTMENTS: 1,192,993.FORM 990, PART XI, LINE 5: