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        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>1700 STEPHEN STREET</AddressLine1Txt>
            <CityNm>LITTLE CHUTE</CityNm>
            <StateAbbreviationCd>WI</StateAbbreviationCd>
            <ZIPCd>54140</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>IT CONSULTING</ServicesDesc>
        <CompensationAmt>2096748</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>REVENTICS INC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>5575 DTC PARKWAY SUITE 125</AddressLine1Txt>
            <CityNm>GREENWOOD VILLAGE</CityNm>
            <StateAbbreviationCd>CO</StateAbbreviationCd>
            <ZIPCd>80111</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>SOFTWARE CONSULTING</ServicesDesc>
        <CompensationAmt>1741319</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>CLIFTON LARSON ALLEN LLP</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 1067</AddressLine1Txt>
            <CityNm>ST CLOUD</CityNm>
            <StateAbbreviationCd>MN</StateAbbreviationCd>
            <ZIPCd>56302</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>ACCOUNTING SERVICES</ServicesDesc>
        <CompensationAmt>338145</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>GARVISH IMMIGRATION LAW GROUP LLC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>2970 PEACHTREE ROAD SUITE 525</AddressLine1Txt>
            <CityNm>ATLANTA</CityNm>
            <StateAbbreviationCd>GA</StateAbbreviationCd>
            <ZIPCd>30305</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>LAW FIRM</ServicesDesc>
        <CompensationAmt>309226</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>HENRY COUNTY SOLDIERS' &amp; SAILORS' MEMORI</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>407 S WHITE ST</AddressLine1Txt>
            <CityNm>MOUNT PLEASANT</CityNm>
            <StateAbbreviationCd>IA</StateAbbreviationCd>
            <ZIPCd>52641</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>EMS SERVICES</ServicesDesc>
        <CompensationAmt>270000</CompensationAmt>
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      <CntrctRcvdGreaterThan100KCnt>9</CntrctRcvdGreaterThan100KCnt>
      <RelatedOrganizationsAmt>25000000</RelatedOrganizationsAmt>
      <AllOtherContributionsAmt>3524</AllOtherContributionsAmt>
      <TotalContributionsAmt>25003524</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>ADMINISTRATIVE REVENUE</Desc>
        <BusinessCd>561000</BusinessCd>
        <TotalRevenueColumnAmt>49466496</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>49466496</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>49466496</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>93633</TotalRevenueColumnAmt>
        <ExclusionAmt>93633</ExclusionAmt>
      </InvestmentIncomeGrp>
      <OtherRevenueMiscGrp>
        <Desc>MISCELLANEOUS REVENUE</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>15533</TotalRevenueColumnAmt>
        <ExclusionAmt>15533</ExclusionAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueTotalAmt>15533</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>74579186</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>49466496</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>109166</ExclusionAmt>
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      <InfoInScheduleOPartIXInd>X</InfoInScheduleOPartIXInd>
      <GrantsToDomesticOrgsGrp>
        <TotalAmt>3716953</TotalAmt>
        <ProgramServicesAmt>3716953</ProgramServicesAmt>
      </GrantsToDomesticOrgsGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>2844567</TotalAmt>
        <ManagementAndGeneralAmt>2844567</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>25586352</TotalAmt>
        <ManagementAndGeneralAmt>25586352</ManagementAndGeneralAmt>
      </OtherSalariesAndWagesGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>6768075</TotalAmt>
        <ManagementAndGeneralAmt>6768075</ManagementAndGeneralAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>1849007</TotalAmt>
        <ManagementAndGeneralAmt>1849007</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>8891064</TotalAmt>
        <ManagementAndGeneralAmt>8891064</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>404919</TotalAmt>
        <ManagementAndGeneralAmt>404919</ManagementAndGeneralAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>201856</TotalAmt>
        <ManagementAndGeneralAmt>201856</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>5589222</TotalAmt>
        <ManagementAndGeneralAmt>5589222</ManagementAndGeneralAmt>
      </InformationTechnologyGrp>
      <OccupancyGrp>
        <TotalAmt>76341</TotalAmt>
        <ManagementAndGeneralAmt>76341</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>96084</TotalAmt>
        <ManagementAndGeneralAmt>96084</ManagementAndGeneralAmt>
      </TravelGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>519158</TotalAmt>
        <ManagementAndGeneralAmt>519158</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>14511</TotalAmt>
        <ManagementAndGeneralAmt>14511</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>SUPPORT COST</Desc>
        <TotalAmt>57197</TotalAmt>
        <ManagementAndGeneralAmt>57197</ManagementAndGeneralAmt>
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      <OtherExpensesGrp>
        <Desc>DUES, FEES &amp; PERMITS</Desc>
        <TotalAmt>53742</TotalAmt>
        <ManagementAndGeneralAmt>53742</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>REPAIRS</Desc>
        <TotalAmt>32310</TotalAmt>
        <ManagementAndGeneralAmt>32310</ManagementAndGeneralAmt>
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      <OtherExpensesGrp>
        <Desc>EQUIPMENT RENTAL</Desc>
        <TotalAmt>-1177</TotalAmt>
        <ManagementAndGeneralAmt>-1177</ManagementAndGeneralAmt>
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      <TotalFunctionalExpensesGrp>
        <TotalAmt>56700181</TotalAmt>
        <ProgramServicesAmt>3716953</ProgramServicesAmt>
        <ManagementAndGeneralAmt>52983228</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
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      <CashNonInterestBearingGrp>
        <BOYAmt>50000</BOYAmt>
        <EOYAmt>50004</EOYAmt>
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      <SavingsAndTempCashInvstGrp>
        <BOYAmt>2014423</BOYAmt>
        <EOYAmt>7839673</EOYAmt>
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      <AccountsReceivableGrp>
        <BOYAmt>299325</BOYAmt>
        <EOYAmt>1181141</EOYAmt>
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      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>826670</BOYAmt>
        <EOYAmt>2346977</EOYAmt>
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      <LandBldgEquipCostOrOtherBssAmt>7256159</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>819004</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>1031335</BOYAmt>
        <EOYAmt>6437155</EOYAmt>
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      <InvestmentsOtherSecuritiesGrp>
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        <EOYAmt>12537255</EOYAmt>
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        <BOYAmt>5771640</BOYAmt>
        <EOYAmt>10248948</EOYAmt>
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      <TotalAssetsGrp>
        <BOYAmt>21641454</BOYAmt>
        <EOYAmt>40641153</EOYAmt>
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      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>5994009</BOYAmt>
        <EOYAmt>6915603</EOYAmt>
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      <OtherLiabilitiesGrp>
        <BOYAmt>425742</BOYAmt>
        <EOYAmt>381910</EOYAmt>
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      <TotalLiabilitiesGrp>
        <BOYAmt>6419751</BOYAmt>
        <EOYAmt>7297513</EOYAmt>
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      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>15221703</BOYAmt>
        <EOYAmt>33343640</EOYAmt>
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      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>15221703</BOYAmt>
        <EOYAmt>33343640</EOYAmt>
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      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>21641454</BOYAmt>
        <EOYAmt>40641153</EOYAmt>
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      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
      <ReconcilationRevenueExpnssAmt>17879005</ReconcilationRevenueExpnssAmt>
      <OtherChangesInNetAssetsAmt>242932</OtherChangesInNetAssetsAmt>
      <InfoInScheduleOPartXIIInd>X</InfoInScheduleOPartXIIInd>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
      <FSAuditedInd>1</FSAuditedInd>
      <FSAuditedBasisGrp>
        <ConsolidatedBasisFinclStmtInd>X</ConsolidatedBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>1</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>0</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc1039100001">
      <SupportingOrganization509a3Ind>X</SupportingOrganization509a3Ind>
      <SupportingOrgType3FuncIntInd>X</SupportingOrgType3FuncIntInd>
      <IRSWrittenDeterminationInd>X</IRSWrittenDeterminationInd>
      <SupportedOrganizationsCnt>2</SupportedOrganizationsCnt>
      <SupportedOrgInformationGrp>
        <SupportedOrganizationName>
          <BusinessNameLine1Txt>SOUTHEAST IOWA REGIONAL MEDICAL CENTER</BusinessNameLine1Txt>
        </SupportedOrganizationName>
        <EIN>420680407</EIN>
        <OrganizationTypeCd>3</OrganizationTypeCd>
        <GoverningDocumentListedInd>0</GoverningDocumentListedInd>
        <SupportAmt>42783770</SupportAmt>
        <OtherSupportAmt>0</OtherSupportAmt>
      </SupportedOrgInformationGrp>
      <SupportedOrgInformationGrp>
        <SupportedOrganizationName>
          <BusinessNameLine1Txt>HENRY COUNTY HEALTH CENTER</BusinessNameLine1Txt>
        </SupportedOrganizationName>
        <EIN>862701018</EIN>
        <OrganizationTypeCd>3</OrganizationTypeCd>
        <GoverningDocumentListedInd>0</GoverningDocumentListedInd>
        <SupportAmt>4951070</SupportAmt>
        <OtherSupportAmt>0</OtherSupportAmt>
      </SupportedOrgInformationGrp>
      <SupportedOrganizationsTotalCnt>2</SupportedOrganizationsTotalCnt>
      <SupportSumAmt>47734840</SupportSumAmt>
      <OtherSupportSumAmt>0</OtherSupportSumAmt>
      <Form990SchASupportingOrgGrp>
        <ListedByNameGoverningDocInd>0</ListedByNameGoverningDocInd>
        <SuprtOrgNoIRSDeterminationInd>1</SuprtOrgNoIRSDeterminationInd>
        <SupportedOrgSectionC456Ind>0</SupportedOrgSectionC456Ind>
        <SupportedOrgNotOrganizedUSInd>0</SupportedOrgNotOrganizedUSInd>
        <OrganizationChangeSuprtOrgInd>0</OrganizationChangeSuprtOrgInd>
        <SupportNonSupportedOrgInd>1</SupportNonSupportedOrgInd>
        <PaymentSubstantialContribtrInd>0</PaymentSubstantialContribtrInd>
        <LoanDisqualifiedPersonInd>0</LoanDisqualifiedPersonInd>
        <ControlledDisqualifiedPrsnInd>0</ControlledDisqualifiedPrsnInd>
        <DisqualifiedPrsnControllIntInd>0</DisqualifiedPrsnControllIntInd>
        <DisqualifiedPrsnOwnrIntInd>0</DisqualifiedPrsnOwnrIntInd>
        <ExcessBusinessHoldingsRulesInd>0</ExcessBusinessHoldingsRulesInd>
        <ContributionControllerInd>0</ContributionControllerInd>
        <ContributionFamilyInd>0</ContributionFamilyInd>
        <Contribution35ControlledInd>0</Contribution35ControlledInd>
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      <Form990SchAType3SprtOrgAllGrp>
        <TimelyProvidedDocumentsInd>1</TimelyProvidedDocumentsInd>
        <OfficersCloseRelationshipInd>1</OfficersCloseRelationshipInd>
        <SupportedOrgVoiceInvestmentInd>1</SupportedOrgVoiceInvestmentInd>
      </Form990SchAType3SprtOrgAllGrp>
      <Form990SchAType3FuncIntGrp>
        <ParentSupportedOrgInd>X</ParentSupportedOrgInd>
        <AppointElectMajorityOfficerInd>1</AppointElectMajorityOfficerInd>
        <ExerciseDirectionPoliciesInd>1</ExerciseDirectionPoliciesInd>
      </Form990SchAType3FuncIntGrp>
      <Form990ScheduleAPartVIGrp>
        <FormAndLineReferenceDesc>PART I, LINE 12G, COLUMN IV:</FormAndLineReferenceDesc>
        <ExplanationTxt>SOUTHEAST IOWA REGIONAL MEDICAL CENTER IS NOT NAMED IN THE GOVERNING DOCUMENTS BECAUSE THE GOVERNING DOCUMENTS IDENTIFY GREAT RIVER HEALTH SYSTEM AND "ANY SUBSIDIARY CORPORATION OR ORGANIZATION" OF GREAT RIVER HEALTH SYSTEM, WHICH INCLUDES SOUTHEAST IOWA REGIONAL MEDICAL CENTER.</ExplanationTxt>
      </Form990ScheduleAPartVIGrp>
      <Form990ScheduleAPartVIGrp>
        <FormAndLineReferenceDesc>PART I, LINE 12G, COLUMN IV:</FormAndLineReferenceDesc>
        <ExplanationTxt>HENRY COUNTY HEALTH CENTER IS NOT NAMED IN THE GOVERNING DOCUMENTS BECAUSE THE GOVERNING DOCUMENTS IDENTIFY GREAT RIVER HEALTH SYSTEM AND "ANY SUBSIDIARY CORPORATION OR ORGANIZATION" OF GREAT RIVER HEALTH SYSTEM, WHICH INCLUDES HENRY COUNTY HEALTH CENTER.</ExplanationTxt>
      </Form990ScheduleAPartVIGrp>
      <Form990ScheduleAPartVIGrp>
        <FormAndLineReferenceDesc>PART IV, SECTION A, LINE 1:</FormAndLineReferenceDesc>
        <ExplanationTxt>GREAT RIVER HEALTH SYSTEM, INC IS THE PARENT COMPANY OF ALL ITS SUBSIDIARY ORGANIZATIONS. ITS MISSION AND PURPOSE IN ITS GOVERNING DOCUMENTS IS TO SUPPORT ALL OF ITS SUBSIDIARIES, WHICH INCLUDES SOUTHEAST IOWA REGIONAL MEDICAL CENTER, INC AND HENRY COUNTY HEALTH CENTER, INC.</ExplanationTxt>
      </Form990ScheduleAPartVIGrp>
      <Form990ScheduleAPartVIGrp>
        <FormAndLineReferenceDesc>PART IV, SECTION A, LINE 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>GREAT RIVER HEALTH SYSTEM SUPPORTS SUPPORTS HENRY COUNTY MEDICAL CENTER, A 501(C)(3) ORGANIZATION CLASSIFIED AS A PUBLIC CHARITY UNDER IRC SECTION 170(B)(1)(A)(III). GREAT RIVER HEALTH SYSTEM, INC. COMPLETED THE CALCULATIONS FOR THE SECTION 509(A)(2) PUBLIC SUPPORT TEST FOR HENRY COUNTY MEDICAL CENTER FOR THE PERIOD 7/1/20 - 6/30/2025 AND DETERMINED THAT IT WOULD QUALIFY AS A PUBLICLY SUPPORTED ORGANIZATION UNDER IRC SECTION 509(A)(2).</ExplanationTxt>
      </Form990ScheduleAPartVIGrp>
      <Form990ScheduleAPartVIGrp>
        <FormAndLineReferenceDesc>PART IV, SECTION D, LINE 3:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE CEO IS A VOTING MEMBER OF EACH BOARD OF DIRECTORS AND AS SUCH HE ENSURES THAT ALL ORGANIZATIONS OPERATE IN AGREEMENT UNDER THE LEADERSHIP OF GREAT RIVER HEALTH SYSTEM INC, THE PARENT COMPANY.</ExplanationTxt>
      </Form990ScheduleAPartVIGrp>
      <Form990ScheduleAPartVIGrp>
        <FormAndLineReferenceDesc>PART IV, SECTION E, LINE 3A:</FormAndLineReferenceDesc>
        <ExplanationTxt>GREAT RIVER HEALTH SYSTEM, INC (GRHS) IS THE PARENT AND SOLE MEMBER OF ALL SUBSIDIARIES. GRHS HAS THE SOLE POWER TO ELECT OR REMOVE ALL BOARD MEMBERS OF THE SUPPORTED ORGANIZATIONS.</ExplanationTxt>
      </Form990ScheduleAPartVIGrp>
      <Form990ScheduleAPartVIGrp>
        <FormAndLineReferenceDesc>PART IV, SECTION E, LINE 3B:</FormAndLineReferenceDesc>
        <ExplanationTxt>GRHS IS THE PARENT COMPANY OF VARIOUS SUBSIDIARY ORGANIZATIONS. GRHS SHALL SET POLICY EXPECTATIONS AND ALL SUBSIDIARY CORPORATIONS AND AFFILIATED ORGANIZATIONS SHALL CONDUCT THEMSELVES IN A MANNER TO SUPPORT SUCH INITIATIVES. ANY CONFLICT OR AMBIGUITY BETWEEN THESE BYLAWS AND THE BYLAWS OR GOVERNING DOCUMENTS OF ANY SUBSIDIARY CORPORATION, HOSPITAL MEDICAL STAFF OR AFFILIATED ORGANIZATION SHALL BE RESOLVED IN FAVOR OF THESE BYLAWS. ANY ACTION, EVEN A DELEGATED ACTION, MAY BE CANCELED, AMENDED OR OTHERWISE CHANGED BY THE GRHS BOARD, IN ITS SOLE DISCRETION. THE GRHS BOARD OF DIRECTORS, IN ADDITION TO THE GENERAL POWERS CONFERRED BY LAW AND THESE BYLAWS SHALL HAVE THE FOLLOWING SPECIFIC POWERS AS RELATED TO ANY SUBSIDIARY CORPORATION OR ORGANIZATION: 1. ELECT OR REMOVE THE BOARD OF DIRECTORS, OR ANY OTHER MEMBER OF THE BOARD OF DIRECTORS OF A SUBSIDIARY CORPORATION AND ANY AFFILIATED ORGANIZATION(S); 2. AMEND THE ARTICLES OF INCORPORATION OR THE BYLAWS OF A SUBSIDIARY CORPORATION AND ANY AFFILIATED ORGANIZATION(S); 3. DISSOLVE A SUBSIDIARY CORPORATION AND/OR ANY AFFILIATED ORGANIZATION OR APPROVE THE MERGER OF A SUBSIDIARY CORPORATION AND ANY AFFILIATED ORGANIZATION(S) WITH ANY OTHER CORPORATE ENTITY; 4. APPROVE STRATEGIC OR OTHER BUSINESS PLANS FOR A SUBSIDIARY CORPORATION AND ANY AFFILIATED ORGANIZATION(S); 5. APPROVE CAPITAL AND OPERATING BUDGETS OF A SUBSIDIARY CORPORATION AND ANY AFFILIATED ORGANIZATION(S); 6. APPROVAL OF ANY INDEBTEDNESS INCURRED BY A SUBSIDIARY CORPORATION AND ANY AFFILIATED ORGANIZATION(S); 7. TRANSFER, SALE OR CLOSURE OF ANY FACILITY, DEPARTMENT OR FUNCTION OF A SUBSIDIARY CORPORATION AND ANY AFFILIATED ORGANIZATION(S); 8. APPROVE ANY CHARITABLE DISBURSEMENTS, WHETHER INTERNAL OR EXTERNAL, IN EXCESS OF ONE HUNDRED THOUSAND DOLLARS IN THE AGGREGATE DURING ANY FISCAL YEAR, MADE BY A SUBSIDIARY CORPORATION OR ANY FOUNDATION ENTITY ASSOCIATED WITH HOSPITAL; 9. THE SALE, DISPOSITION, OR ANY ENCUMBRANCE (OTHER THAN ROUTINE LEASE TRANSACTIONS) OF ANY REAL ESTATE OWNED BY A SUBSIDIARY CORPORATION AND ANY AFFILIATED ORGANIZATION; 10. ADOPT, AMEND, OR TERMINATE EMPLOYEE BENEFIT PROGRAMS OR PLANS OF A SUBSIDIARY CORPORATION AND ANY AFFILIATED ORGANIZATION(S); 11. APPOINT OR TERMINATE THE CHIEF EXECUTIVE OFFICER OF A SUBSIDIARY CORPORATION AND ANY AFFILIATED ORGANIZATION(S); 12. APPROVE THE ELECTION OF ANY OFFICER OR CHAIRPERSON OF THE BOARD OF DIRECTORS OF A SUBSIDIARY CORPORATION AND ANY AFFILIATED ORGANIZATION(S); AND 13. TO TAKE ANY OTHER ACTION NECESSARY DEEMED IN THE BEST INTERESTS OF GRHS.</ExplanationTxt>
      </Form990ScheduleAPartVIGrp>
      <Form990ScheduleAPartVIGrp>
        <FormAndLineReferenceDesc>PART IV, SECTION A, LINE 6:</FormAndLineReferenceDesc>
        <ExplanationTxt>GRANTS ARE MADE TO COMMUNITY ORGANIZATIONS AND AGENCIES TO FURTHER THEIR CHARITABLE ACTIVITIES. THESE GRANTS ARE MADE AS DIRECTED BY SOUTHEAST IOWA REGIONAL MEDICAL CENTER OR HENRY COUNTY HEALTH CENTER IN FURTHERANCE OF ITS MISSION, BECAUSE SUPPORTING OTHER LOCAL ORGANIZATIONS IN THEIR EFFORTS TO FILL THE COMMUNITY'S NEEDS ALSO IMPACTS THE PHYSICAL HEALTH OF INDIVIDUALS IN OUR COMMUNITY.</ExplanationTxt>
      </Form990ScheduleAPartVIGrp>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="RetDoc1234500001">
      <ContributorInformationGrp>
        <ContributorNum>RESTRICTED</ContributorNum>
        <ContributorBusinessName>
          <BusinessNameLine1>RESTRICTED</BusinessNameLine1>
        </ContributorBusinessName>
        <ContributorUSAddress>
          <AddressLine1>RESTRICTED</AddressLine1>
          <AddressLine2>RESTRICTED</AddressLine2>
          <City>RESTRICTED</City>
          <State>RESTRICTED</State>
          <ZIPCode>RESTRICTED</ZIPCode>
        </ContributorUSAddress>
        <TotalContributionsAmt>RESTRICTED</TotalContributionsAmt>
      </ContributorInformationGrp>
    </IRS990ScheduleB>
    <IRS990ScheduleD documentId="RetDoc1040000001">
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>3225434</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>819004</DepreciationAmt>
        <BookValueAmt>2406430</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <OtherCostOrOtherBasisAmt>4030725</OtherCostOrOtherBasisAmt>
        <BookValueAmt>4030725</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>6437155</TotalBookValueLandBuildingsAmt>
      <OtherSecuritiesGrp>
        <Desc>INVESTMENT IN FOR-PROFIT SUBSIDIARIES</Desc>
        <BookValueAmt>11465249</BookValueAmt>
        <MethodValuationCd>F</MethodValuationCd>
      </OtherSecuritiesGrp>
      <OtherSecuritiesGrp>
        <Desc>SERP ASSET</Desc>
        <BookValueAmt>1072006</BookValueAmt>
        <MethodValuationCd>F</MethodValuationCd>
      </OtherSecuritiesGrp>
      <TotalBookValueSecuritiesAmt>12537255</TotalBookValueSecuritiesAmt>
      <OtherAssetsOrgGrp>
        <Desc>DUE FROM RELATED ORGANIZATIONS</Desc>
        <BookValueAmt>10248948</BookValueAmt>
      </OtherAssetsOrgGrp>
      <TotalBookValueOtherAssetsAmt>10248948</TotalBookValueOtherAssetsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>SERP LIABILITIES</Desc>
        <Amt>381910</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>381910</TotalLiabilityAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART X, LINE 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION AND ITS FIVE NOT-FOR-PROFIT SUBSIDIARIES ARE EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. HOWEVER, THE ORGANIZATION IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE CONSOLIDATED FINANCIAL STATEMENTS.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleI documentId="RetDoc1041900001">
      <GrantRecordsMaintainedInd>1</GrantRecordsMaintainedInd>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>GREAT RIVER HEALTH FOUNDATION INC</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>1221 SOUTH GEAR AVENUE</AddressLine1Txt>
          <CityNm>WEST BURLINGTON</CityNm>
          <StateAbbreviationCd>IA</StateAbbreviationCd>
          <ZIPCd>52655</ZIPCd>
        </USAddress>
        <RecipientEIN>421446727</RecipientEIN>
        <IRCSectionDesc>501(C)(3)</IRCSectionDesc>
        <CashGrantAmt>216953</CashGrantAmt>
        <NonCashAssistanceAmt>0</NonCashAssistanceAmt>
        <ValuationMethodUsedDesc>N/A</ValuationMethodUsedDesc>
        <NonCashAssistanceDesc>N/A</NonCashAssistanceDesc>
        <PurposeOfGrantTxt>COMMUNITY SUPPORT FUNDING FOR THE FOUNDATION</PurposeOfGrantTxt>
      </RecipientTable>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>RIVERVIEW SYSTEM LTD</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>1221 SOUTH GEAR AVENUE</AddressLine1Txt>
          <CityNm>WEST BURLINGTON</CityNm>
          <StateAbbreviationCd>IA</StateAbbreviationCd>
          <ZIPCd>52655</ZIPCd>
        </USAddress>
        <RecipientEIN>421191960</RecipientEIN>
        <CashGrantAmt>3500000</CashGrantAmt>
        <NonCashAssistanceAmt>0</NonCashAssistanceAmt>
        <ValuationMethodUsedDesc>N/A</ValuationMethodUsedDesc>
        <NonCashAssistanceDesc>N/A</NonCashAssistanceDesc>
        <PurposeOfGrantTxt>OPERATING SUPPORT</PurposeOfGrantTxt>
      </RecipientTable>
      <Total501c3OrgCnt>1</Total501c3OrgCnt>
      <TotalOtherOrgCnt>1</TotalOtherOrgCnt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LINE 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>GRANTS ARE MADE TO COMMUNITY ORGANIZATIONS AND AGENCIES TO FURTHER THEIR CHARITABLE ACTIVITIES. THESE GRANTS ARE MADE AS DIRECTED BY SOUTHEAST IOWA REGIONAL MEDICAL CENTER OR HENRY COUNTY HEALTH CENTER IN FURTHERANCE OF ITS MISSION, BECAUSE SUPPORTING OTHER LOCAL ORGANIZATIONS IN THEIR EFFORTS TO FILL THE COMMUNITY'S NEEDS ALSO IMPACTS THE PHYSICAL HEALTH OF INDIVIDUALS IN OUR COMMUNITY. TRANSFERS ARE MADE TO A RELATED ORGANIZATION. COMMON EXECUTIVE OVERSIGHT BETWEEN THE TWO ORGANIZATIONS ENSURE THAT ALL TRANSFERRED ASSETS ARE USED FOR APPROPRIATE CHARITABLE PURPOSES.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleI>
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      <ClubDuesOrFeesInd>X</ClubDuesOrFeesInd>
      <WrittenPolicyRefTAndEExpnssInd>1</WrittenPolicyRefTAndEExpnssInd>
      <SubstantiationRequiredInd>1</SubstantiationRequiredInd>
      <CompensationCommitteeInd>X</CompensationCommitteeInd>
      <IndependentConsultantInd>X</IndependentConsultantInd>
      <Form990OfOtherOrganizationsInd>X</Form990OfOtherOrganizationsInd>
      <CompensationSurveyInd>X</CompensationSurveyInd>
      <BoardOrCommitteeApprovalInd>X</BoardOrCommitteeApprovalInd>
      <SeverancePaymentInd>1</SeverancePaymentInd>
      <SupplementalNonqualRtrPlanInd>1</SupplementalNonqualRtrPlanInd>
      <EquityBasedCompArrngmInd>0</EquityBasedCompArrngmInd>
      <CompBasedOnRevenueOfFlngOrgInd>0</CompBasedOnRevenueOfFlngOrgInd>
      <CompBsdOnRevRelatedOrgsInd>0</CompBsdOnRevRelatedOrgsInd>
      <CompBsdNetEarnsFlngOrgInd>0</CompBsdNetEarnsFlngOrgInd>
      <CompBsdNetEarnsRltdOrgsInd>0</CompBsdNetEarnsRltdOrgsInd>
      <AnyNonFixedPaymentsInd>0</AnyNonFixedPaymentsInd>
      <InitialContractExceptionInd>0</InitialContractExceptionInd>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>DR MICHAEL MCCOY</PersonNm>
        <TitleTxt>CEO</TitleTxt>
        <BaseCompensationFilingOrgAmt>835743</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>238910</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>14478</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>17250</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>30542</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>1136923</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MATT WENZEL</PersonNm>
        <TitleTxt>FORMER PRESIDENT/CEO</TitleTxt>
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        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
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        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
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        <DeferredCompensationFlngOrgAmt>0</DeferredCompensationFlngOrgAmt>
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        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>975975</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>JEREMY ALEXANDER</PersonNm>
        <TitleTxt>CFO</TitleTxt>
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        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>105546</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>1140</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>17250</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>42838</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>749117</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>DR JOEL RYON</PersonNm>
        <TitleTxt>EXECUTIVE VP CHIEF MEDICAL</TitleTxt>
        <BaseCompensationFilingOrgAmt>422079</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>91020</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>14896</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>12938</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>41436</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>582369</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>TERESA COLGAN - EXEC</PersonNm>
        <TitleTxt>VP CHIEF EXECUTIVE OFFICER</TitleTxt>
        <BaseCompensationFilingOrgAmt>382971</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>81690</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>38616</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>17250</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>32676</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>553203</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MICHAEL YOST - EXEC</PersonNm>
        <TitleTxt>VP CHIEF HUMAN RESOURCES</TitleTxt>
        <BaseCompensationFilingOrgAmt>343258</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>83884</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>13300</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>17250</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>38313</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>496005</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>RUSSELL RODRIGUEZ - EXEC</PersonNm>
        <TitleTxt>VP CHIEF CLINICAL OPERATIONS</TitleTxt>
        <BaseCompensationFilingOrgAmt>340478</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>74037</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>14896</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>15618</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>42838</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>487867</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>TOMI HAGAN</PersonNm>
        <TitleTxt>EXECUTIVE VP CHIEF COMPLIANCE</TitleTxt>
        <BaseCompensationFilingOrgAmt>245903</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>53618</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>14946</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>14061</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>30326</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>358854</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LINE 1A</FormAndLineReferenceDesc>
        <ExplanationTxt>DR, MICHAEL MCCOY, HEALTH/SOCIAL CLUB DUES $6,024. THIS AMOUNT WAS INCLUDED IN TAXABLE COMPENSATION.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LINES 4A-B</FormAndLineReferenceDesc>
        <ExplanationTxt>MATT WENZEL'S COMPENSATION REPORTED ON FORM 990, PART VII INCLUDED $763,894 FOR SEVERANCE; TERMS AND CONDITIONS WERE AS FOLLOWS: SEVERANCE PACKAGE. THE ORGANIZATION MAINTAINS A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN (457(F)). IN CALENDAR YEAR 2024, NO DISTRIBUTIONS WERE MADE OUT OF THE PLAN. IN CALENDAR YEAR 2024, THE FOLLOWING CONTRIBUTIONS WERE MADE THE THE INDIVIDUALS PLAN: DR. MICHALE MCCOY - $175,750 JEREMY ALEXANDER - $67,713 DR. JOEL RYON - $62,046 TERESA COLGAN - $50,882 MICHAEL YOST - $49,894 RUSSELL RODRIGUEZ - $50,011 TOMI HAGAN - $36,205</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 1A</FormAndLineReferenceDesc>
        <ExplanationTxt>DR. MICHAEL MCCOY, PRESIDENT, IS NOT INDEPENDENT. THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF THE CHAIRMAN OF THE BOARD, THE PRESIDENT AND CEO AND TWO OR MORE ADDITIONAL DIRECTORS. WHEN THE BOARD IS NOT IN SESSION, THE EXECUTIVE COMMITTEE SHALL HAVE AND EXERCISE THE POWER AND AUTHORITY OF THE BOARD TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION, SUBJECT TO ANY PRIOR LIMITATIONS IMPOSED BY THE BOARD BY STATUTE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 2</FormAndLineReferenceDesc>
        <ExplanationTxt>DR. MICHAEL MCCOY, JEREMY ALEXANDER, ROBERT ENGBERG, DOUG MARTIN, AND TERESA COLGAN HAVE A BUSINESS RELATIONSHIP. THEY SERVE ON THE FOR-PROFIT SUBSIDIARIES OF GREAT RIVER HEALTH SYSTEM.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 7A</FormAndLineReferenceDesc>
        <ExplanationTxt>GREAT RIVER HEALTH SYSTEM'S MEDICAL STAFF ELECT THE CHIEF OF STAFF, WHO IS A VOTING MEMBER OF THE BOARD OF DIRECTORS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE FORM 990 IS PREPARED BY AN EXTERNAL ACCOUNTANT. A DRAFT OF THE FORM 990 IS REVIEWED IN DETAIL BY THE CORPORATE CONTROLLER AND CFO. ANY NECESSARY ADJUSTMENTS ARE MADE PRIOR TO FINALIZING THE FORM. A COPY OF THE FINAL FORM 990 IS MADE AVAILABLE TO THE BOARD MEMBERS FOR THEIR REVIEW PRIOR TO FILING WITH THE IRS. ANY QUESTIONS OF THE BOARD MEMBERS ARE ADDRESSED THROUGH THE ACCOUNTING DEPARTMENT.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>BOTH CORPORATE AND SUBSIDIARY BOARD MEMBERS ARE PROVIDED EDUCATION REGARDING CONFLICTS OF INTEREST. THIS EDUCATION IS PROVIDED BY THE CHIEF COMPLIANCE OFFICER. ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE FORM. RELATIONSHIPS NOTED ON THE THIS FORM MAY BE DISCUSSED WITH THE RESPECTIVE BOARD MEMBER IF THERE ARE QUESTIONS. IF AN INDIVIDUAL HAS A CONFLICT OF INTEREST, THEY MAY NOT PARTICIPATE IN DISCUSSIONS RELATING TO THE TRANSACTION IN QUESTION AND MAY NOT VOTE ON MATTERS RELATED TO THE TRANSACTION.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15</FormAndLineReferenceDesc>
        <ExplanationTxt>THE COMPENSATION FOR THE CEO AND OTHER OFFICERS IS DETERMINED BY THE EXECUTIVE COMPENSATION COMMITTEE OF GREAT RIVER HEALTH SYSTEM, INC. THE ROLE OF THE COMPENSATION COMMITTEE IS TO ACT ON BEHALF OF THE BOARD IN ADOPTING, REVIEWING AND MAINTAINING AN EXECUTIVE COMPENSATION PHILOSOPHY. THE COMPENSATION COMMITTEE IS COMPRISED OF FIVE BOARD MEMBERS, ALL OF WHOM ARE INDEPENDENT FROM THE CEO AND OTHER OFFICERS. THE COMPENSATION COMMITTEE REVIEWS THE COMPENSATION OF THE CEO AND OTHER OFFICERS ON AN ANNUAL BASIS. THE DELIBERATIONS AND DECISIONS ARE DOCUMENTED IN MINUTES TAKEN AT THE MEETINGS. GREAT RIVER HEALTH SYSTEM, INC. PARTICIPATES IN AND UTILIZES THREE EXECUTIVE SALARY SURVEYS TO DETERMINE COMPENSATION RANGES. THE COMMITTEE REVIEWS PREVAILING MARKET DATA TO ENSURE CONTINUED MARKET COMPETITIVENESS. THE COMPENSATION COMMITTEE ALSO ENGAGES AN INDEPENDENT THIRD PARTY COMPENSATION CONSULTING GROUP BIENNIALLY TO ASSESS AND VALIDATE THE ENTIRETY OF THE EXECUTIVE COMPENSATION AND BENEFITS PACKAGES TO ENSURE REGULATORY COMPLIANCE, EXTERNAL COMPETITIVENESS, AND INTERNAL EQUITY. THE MOST RECENT YEAR OF AN INDEPENDENT THIRD PARTY REVIEW WAS 2025.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>GREAT RIVER HEALTH SYSTEM, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART IX, LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 8,891,064. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,891,064.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XI, LINE 9:</FormAndLineReferenceDesc>
        <ExplanationTxt>GAIN ON INVESTMENT IN SUBSIDIARIES 242,932.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XII, LINE 2C:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE PROCESS FOR OVERSIGHT AND SELECTION OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
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          <CityNm>WEST BURLINGTON</CityNm>
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          <AddressLine1Txt>1221 SOUTH GEAR AVENUE</AddressLine1Txt>
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        <PrimaryActivitiesTxt>MANAGEMENT SERVICES</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>IA</LegalDomicileStateCd>
        <DirectControllingEntityName>
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        <USAddress>
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      <GiftGrntOrCapContriToOthOrgInd>1</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>1</GiftGrntCapContriFromOthOrgInd>
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      <LoansOrGuaranteesFromOthOrgInd>0</LoansOrGuaranteesFromOthOrgInd>
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      <AssetExchangeInd>0</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>0</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>0</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>0</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>0</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>1</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>1</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>0</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>0</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>0</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>0</TransferFromOtherOrgInd>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>SOUTHEAST IOWA REGIONAL MEDICAL CENTER INC</BusinessNameLine1Txt>
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        <TransactionTypeTxt>C</TransactionTypeTxt>
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        <MethodOfAmountDeterminationTxt>CASH</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>GREAT RIVER HEALTH FOUNDATION INC</BusinessNameLine1Txt>
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        <TransactionTypeTxt>B</TransactionTypeTxt>
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      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>HENRY COUNTY HEALTH CENTER INC</BusinessNameLine1Txt>
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        <TransactionTypeTxt>C</TransactionTypeTxt>
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        <MethodOfAmountDeterminationTxt>CASH</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>RIVERVIEW SYSTEM LTD</BusinessNameLine1Txt>
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        <TransactionTypeTxt>B</TransactionTypeTxt>
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        <MethodOfAmountDeterminationTxt>CASH</MethodOfAmountDeterminationTxt>
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    </IRS990ScheduleR>
  </ReturnData>
</Return>