2022-05-12T15:06:43-05:00 2021-06-30 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2020-07-01 421193185 GREAT RIVER HEALTH SYSTEM INC GREA 3197681000 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 JEREMY ALEXANDER CFO 3197681000 2022-05-11 1 JEREMY ALEXANDER XXX-XX-XXXX KOREY BOELTER P00775161 6123764500 2022-05-11 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z MATT WENZEL 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 11348232 0 X WWW.GREATRIVERMEDICAL.ORG X 1983 IA TO SERVE AS A HOLDING COMPANY OF VARIOUS SUBSIDIARIES PROVIDING HEALTH CARE. 8 7 0 12 0 0 0 0 0 11345717 10976 1272 572749 1243 583725 11348232 0 0 0 0 0 11139375 0 0 0 9398 632483 9398 11771858 574327 -423626 43809288 45236336 1769646 3851442 42039642 41384894 GREAT RIVER HEALTH SYSTEM, INC. (GRHS) IS A NON-STOCK, NOT-FOR-PROFIT CORPORATION ORGANIZED FOR THE PURPOSE OF SERVING AS A HOLDING COMPANY OF VARIOUS SUBSIDIARIES PROVIDING HEALTH CARE. 0 0 0 0 11345717 GREAT RIVER HEALTH SYSTEM IS A REGIONAL INTEGRATED HEALTH-SYSTEM THAT INCLUDES GREAT RIVER MEDICAL CENTER, FORT MADISON COMMUNITY HOSPITAL, PHARMACIES, MEDICAL EQUIPMENT AND SUPPLIES PROVIDERS, AND PHYSICIAN CLINICS. 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 8 7 1 1 1 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X CHERYL ALBIN 3197681000 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 MATT WENZEL PRESIDENT/CEO 24.00 16.00 X X 0 859097 55534 DOUG MARTIN CHAIRMAN 1.00 3.00 X X 0 0 0 ROBERT ENGBERG VICE CHAIRMAN 1.00 3.00 X X 0 0 0 TERRI DOWELL SECRETARY/TREASURER 1.00 3.00 X X 0 0 0 DEANNA BARR DIRECTOR 1.00 1.00 X 0 0 0 JASON HUTCHESON DIRECTOR TILL 01/2021 1.00 1.00 X 0 0 0 BILL MALCOM DIRECTOR TILL 01/2021 1.00 1.00 X 0 0 0 KAREN MARINO DIRECTOR TILL 01/2021 1.00 1.00 X 0 0 0 JOHN MCKILLIP DIRECTOR 1.00 1.00 X 0 0 0 CARLA MCNAMEE DIRECTOR 1.00 1.00 X 0 0 0 DAN WIEDEMEIER DIRECTOR 1.00 1.00 X 0 0 0 JEREMY ALEXANDER CFO 1.00 42.00 X 0 500802 45513 0 1359899 101047 0 0 1 0 0 ADMINISTRATIVE REVENUE 561000 11345717 11345717 11345717 1272 1272 MISCELLANEOUS REVENUE 900099 1243 1243 1243 11348232 11345717 0 2515 8682217 8682217 1882339 1882339 574819 574819 616723 616723 4639 4639 1807 1807 SUPPORT COSTS 7908 7908 DUES, FEES & PERMITS 1243 1243 REPAIRS 163 163 11771858 0 11771858 0 4700 29700 2589574 3181376 0 1977118 10000 10000 14250 0 0 14250 41205014 40023892 43809288 45236336 20200 3259785 1749446 591657 1769646 3851442 X 42039642 41384894 42039642 41384894 43809288 45236336 X -423626 -231122 X X 0 1 X 1 0 X X X 2 GREAT RIVER MEDICAL CENTER 420680407 3 1 426137 0 FORT MADISON COMMUNITY HOSPITAL 421081055 3 1 0 0 2 426137 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 14250 14250 14250 INVESTMENT IN FOR-PROFIT SUBSIDIARIES 40023892 F 40023892 INTERCOMPANY PAYABLE 591657 591657 X PART X, LINE 2: THE ORGANIZATION IS 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. 0 0 0 0 0 0 0 0 0 MATT WENZEL PRESIDENT/CEO 0 855707 0 0 0 3390 0 11400 0 44134 0 914631 0 0 JEREMY ALEXANDER CFO 0 499517 0 0 0 1285 0 11400 0 34113 0 546315 0 0 PART I, LINE 3 THE COMPENSATION OF THE OFFICERS IS PAID BY RIVERVIEW SYSTEMS LTD., A RELATED ORGANIZATION, BUT DETERMINED BY GREAT RIVER HEALTH SYSTEM. THE FOLLOWING WERE USED BY GREAT RIVER HEALTH SYSTEM IN DETERMINING THE OFFICERS COMPENSATION: 1. COMPENSATION COMMITTEE 2. INDEPENDENT COMPENSATION CONSULTANT 3. FORM 990 OF OTHER ORGANIZATIONS 4. WRITTEN EMPLOYMENT CONTRACT 5. COMPENSATION SURVEY OR STUDY 6. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE FORM 990, PART VI, SECTION A, LINE 1 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 OR BY STATUTE. FORM 990, PART VI, SECTION A, LINE 2 MATT WENZEL AND JEREMY ALEXANDER HAVE BUSINESS RELATIONSHIPS FOR SERVING ON THE FOR-PROFIT SUBSIDIARIES OF GRHS. FORM 990, PART VI, SECTION A, LINE 3 ALL EXECUTIVE LEADERSHIP FUNCTIONS FOR GREAT RIVER MEDICAL CENTER FOUNDATION ARE PROVIDED BY MUTUAL CONSULTING AND MANAGEMENT SERVICES, INC. MUTUAL CONSULTING AND MANAGEMENT SERVICES IS A SUBSIDIARY OF RIVERVIEW SYSTEMS LTD, WHICH IS A SUBSIDIARY OF GREAT RIVER HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION AMENDED THEIR BYLAWS IN JANUARY 2021. THE BOARD SIZE WAS DROPPED TO A TOTAL OF 9 MEMBERS. THE COMMITTEE STRUCTURE OUTLINED FOUR STANDING COMMITTEES THAT THE BOARD MEMBERS WOULD ATTEND. FORM 990, PART VI, SECTION A, LINE 7A GREAT RIVER HEALTH SYSTEM'S MEDICAL STAFF ELECT THE CHIEF OF STAFF, WHO IS A VOTING MEMBER OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN EXTERNAL ACCOUNTANT. A DRAFT OF THE FORM 990 IS REVIEWED IN DETAIL BY A MEMBER OF THE ACCOUNTING DEPARTMENT, DIRECTOR OF FINANCE 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. FORM 990, PART VI, SECTION B, LINE 12C 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. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF THE OFFICERS OF GREAT RIVER HEALTH SYSTEM IS PAID BY A RELATED FOR-PROFIT SUBSIDIARY. THE COMPENSATION FOR THE CEO AND OTHER OFFICERS IS DETERMINED BY THE EXECUTIVE COMPENSATION COMMITTEE OF GREAT RIVER HEALTH SYSTEM. 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 PARTICIPATES 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 2021. FORM 990, PART VI, SECTION C, LINE 19 GREAT RIVER HEALTH SYSTEM MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: TRANSFER FROM RELATED ORGANIZATIONS 8,350,000. LOSS ON INVESTMENT IN SUBSIDIARIES -8,581,122. PART XII LINE 2C THE PROCESS FOR OVERSEEING AND SELECTING AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. GREAT RIVER MEDICAL CENTER 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 420680407 HOSPITAL IA 501(C)(3) LINE 3 GREAT RIVER HEALTH SYSTEM INC 1 GRMC FOUNDATION CORP 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421193186 SUPPORT RELATED ORGANIZATIONS IA 501(C)(3) LINE 12B, II GREAT RIVER HEALTH SYSTEM INC 1 GREAT RIVER FOUNDATION INC 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421469162 SUPPORT RELATED ORGANIZATIONS IA 501(C)(3) LINE 12B, II GREAT RIVER HEALTH SYSTEM INC 1 FORT MADISON COMMUNITY HOSPITAL 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421081055 HOSPITAL IA 501(C)(3) LINE 3 GREAT RIVER HEALTH SYSTEM INC 1 RIVERVIEW SYSTEMS LTD 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421191960 MEDICAL SERVICES IA GREAT RIVER HEALTH SYSTEM INC C -9642765 182149200 1.00000 1 GREAT RIVER MEDICAL SERVICES INC 1201 WEST AGENCY ROAD WEST BURLINGTON IA 52655 421493449 MEDICAL SERVICES IA GREAT RIVER HEALTH SYSTEM INC C 1.00000 1 MUTUAL CONSULTING & MANAGEMENT SERVICES 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421349668 MANAGEMENT SERVICES IA RIVERVIEW SYSTEMS LTD C 1 HEALTH CARE REALTY 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421193532 REAL ESTATE IA RIVERVIEW SYSTEMS LTD C 1 HERITAGE PARK PHARMACY 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421191957 PHARMACY IA RIVERVIEW SYSTEMS LTD C 1 HERITAGE MEDICAL EQUIPMENT & SUPPLY 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421191958 MEDICAL SUPPLY IA RIVERVIEW SYSTEMS LTD C 1 SOUTHEASTERN IOWA MEDICAL SERVICES 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421307141 PHYSICIAN CLINICS IA RIVERVIEW SYSTEMS LTD C 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 GREAT RIVER FOUNDATION R 8350000 CASH FORT MADISON COMMUNITY HOSPITAL A 33264 CASH