2020-07-15T14:51:33-05:00 2019-06-30 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2018-07-01 421193185 GREAT RIVER HEALTH SYSTEM INC GREA 3197681000 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 JEREMY ALEXANDER CFO 3197681000 2020-07-15 1 KOREY BOELTER P00775161 6123764500 2020-07-15 67.137.57.251 2020-07-15 12:33:42 PD P 9C1DED54EE6A56468881F41BE7A7DD662CF8FCB7 6F9DF1F17F908910C6C25D31107CE60C7FCD5FB0 2018 2021-01-29 14:40:06Z MATT WENZEL 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 10266 0 X WWW.GREATRIVERMEDICAL.ORG X 1983 IA TO SERVE AS A HOLDING COMPANY OF VARIOUS SUBSIDIARIES PROVIDING HEALTH CARE. 13 12 0 13 0 0 0 0 0 0 22502 10266 0 0 22502 10266 1537276 0 0 0 0 0 0 0 0 2308 146348 1539584 146348 -1517082 -136082 44598539 44707180 615731 251344 43982808 44455836 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 143756 0 0 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. 143756 1 0 0 0 0 0 0 0 0 0 0 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 1 1 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 13 12 1 1 1 0 0 1 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X NANCY WHITAKER-KROPP 3197681000 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 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 ROBERT FLEMING SECRETARY/TREASURER 1.00 3.00 X X 0 0 0 DEANNA BARR DIRECTOR 1.00 1.00 X 0 0 0 MARK CLEVELAND DIRECTOR (THROUGH JUNE 2019) 1.00 1.00 X 0 0 0 LORRIN DEBLIECK DIRECTOR (THROUGH DECEMBER 2018) 1.00 1.00 X 0 0 0 TERRI DOWELL DIRECTOR 1.00 1.00 X 0 0 0 KENT GAUDIAN DIRECTOR (THROUGH MAY 2019) 1.00 1.00 X 0 0 0 JASON HUTCHESON DIRECTOR 1.00 1.00 X 0 0 0 BILL MALCOM DIRECTOR 1.00 1.00 X 0 0 0 ROBERT MCCULLEY DIRECTOR (THROUGH SEPTEMBER 2018) 1.00 1.00 X X 0 0 0 JOHN MCKILLIP DIRECTOR 1.00 1.00 X 0 0 0 KENT SEVERSON DIRECTOR 1.00 1.00 X 0 0 0 DAN WIEDEMEIER DIRECTOR 1.00 1.00 X 0 0 0 PATRICK WILLIAMS MD DIRECTOR 1.00 1.00 X 0 0 0 MATT WENZEL PRESIDENT/CEO 1.00 42.00 X X 0 721153 27591 TONY HAYES EXECUTIVE VICE PRESIDENT (THROUGH APRIL 2019) 1.00 42.00 X 0 546239 39185 TODD SLADKY CFO (THROUGH NOVEMBER 2018) 1.00 42.00 X 0 419134 38264 JEREMY ALEXANDER CFO 1.00 42.00 X 0 55751 1036 0 1742277 106076 0 0 1 0 0 10266 10266 10266 0 0 10266 2592 2592 OTHER SUPPLIES 143756 143756 146348 143756 2592 0 684574 489909 420969 223679 43090860 43993592 402136 0 44598539 44707180 3 0 615728 251344 615731 251344 X 43982808 44455836 43982808 44455836 44598539 44707180 X -136082 609110 X 0 1 X 1 0 X X 2 GREAT RIVER MEDICAL CENTER 420680407 3 1 146348 0 FORT MADISON COMMUNITY HOSPITAL 421081055 3 1 0 0 2 146348 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 PART IV, SEC. A, LINE 2 GRHS SUPPORTS GREAT RIVER MEDICAL CENTER, A 501(C)(3) ORGANIZATION CLASSIFIED AS A PUBLIC CHARITY UNDER IRC SECTION 170(B)(1)(A)(III). GRHS COMPLETED THE CALCULATIONS FOR 509(A)(2) PUBLIC SUPPORT TEST FOR GREAT RIVER MEDICAL CENTER FOR THE PERIOD 7/1/2014-6/30/2019 AND DETERMINED THAT GREAT RIVER MEDICAL CENTER WOULD QUALIFY AS A PUBLICLY SUPPORTED ORGANIZATION UNDER IRC SECTION 509(A)(2). PART IV, SEC. A, LINE 5A DURING THE FISCAL YEAR, GREAT RIVER HEALTH SYSTEM ACQUIRED FORT MADISON COMMUNITY HOSPITAL (EIN: 42-1081055), A 501(C)(3) ORGANZATION. UNDER THE DIRECTION OF GREAT RIVER HEALTH SYSTEM'S BOARD OF DIRECTORS, THE ORGANIZATION AMENDED ITS BYLAWS TO IDENTIFY FORT MADISON COMMUNITY HOSPITAL AS A SUPPORT ORGANIZATION. 0 INVESTMENT IN FOR-PROFIT SUBSIDIARIES 43993592 F 43993592 INTERCOMPANY PAYABLE 251344 251344 X PART X, LINE 2: THE ORGANIZATION AND ITS THREE 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. X X X X X X 0 0 0 0 0 0 0 0 0 MATT WENZEL PRESIDENT/CEO 0 721153 0 0 0 0 0 0 0 27591 0 748744 0 0 TONY HAYES EXECUTIVE VICE PRESIDENT (THROUGH APRIL 2019) 0 317826 0 78451 0 149962 0 0 0 39185 0 585424 0 0 TODD SLADKY CFO (THROUGH NOVEMBER 2018) 0 419134 0 0 0 0 0 0 0 38264 0 457398 0 0 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, TONEY HAYES, JEREMY ALEXANDER AND TODD SLADKY HAVE BUSINESS RELATIONSHIPS BY SERVING AS OFFICERS AND/OR BOARD MEMBERS OF FOR-PROFIT ENTITIES RELATED TO GRMC. KENT GAUDIAN, DOUGLAS MARTIN AND ROBERT MCCULLEY HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 3 ALL EXECUTIVE LEADERSHIP FUNCTIONS FOR GREAT RIVER HEALTH SYSTEM INC., AND ITS SUBSIDIARIES ARE PROVIDED BY MUTUAL CONSULTING AND MANAGEMENT SERVICES, INC. MUTUAL CONSULTING AND MANAGEMENT SERVICES IS A SUBSIDIARY OF RIVERVIEW SYSTEMS LTD, WHICH IS A SUBSIDIARY OF GREAT RIVER HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION'S BYLAWS WERE AMENDED IN JULY 2018 TO REFLECT THE ACQUISITION OF FORT MADISON COMMUNITY HOSPITAL, A TAX-EXEMPT ORGANIZATION. ONE OF THE GREAT RIVER HEALTH SYSTEM'S BOARD MEMBERS IS APPOINTED BY THE BOARD OF DIRECTORS OF FORT MADISON COMMUNITY HOSPITAL, SUBJECT TO APPROVAL BY GREAT RIVER HEALTH SYSTEM'S BOARD OF DIRECTORS 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. FORM 990, PART VI, SECTION B, LINE 12C EVERY YEAR, THE DIRECTOR OF FINANCE IN THE ACCOUNTING DEPARTMENT PROVIDES THE BOARD OF DIRECTORS THE MEANING OF THE CONFLICT OF INTEREST STATEMENT, HOW IT APPLIES, HOW IT IMPACTS THE BOARD, AND WHAT THEIR RESPONSIBILITIES ARE. ALL BOARD MEMBERS ARE REQUIRED TO FILL OUT A CONFLICT OF INTEREST FORM AND THE FORM IS THEN REVIEWED BY THE DIRECTOR OF FINANCE. RELATIONSHIPS NOTED ON THE FORM MAY BE DISCUSSED WITH THE BOARD MEMBER IF THERE ARE QUESTIONS. IF AN INDIVIDUAL HAS A CONFLICT OF INTEREST, THEY MAY NOT PARTICIPATE IN DISCUSSIONS OF THE TRANSACTION AND MAY NOT VOTE ON MATTERS RELATED TO THE TRANSACTION. FORM 990, PART VI, SECTION 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 2018. 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 23,600,000. LOSS ON INVESTMENT IN SUBSIDIARIES -22,990,890. GREAT RIVER HEALTH ALLIANCE 1221 S GEAR AVENUE WEST BURLINGTON IA 52655 830728216 ACCOUNTABLE CARE ORGANZIATION IA 0 0 GRHS GREAT RIVER MEDICAL CENTER 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 420680407 HOSPITAL IA 501(C)(3) 3 GRHS 1 GRMC FOUNDATION CORP 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421193186 SUPPORT RELATED ORGANIZATIONS IA 501(C)(3) 12 - TYPE II GRHS 1 GREAT RIVER FOUNDATION INC 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421469162 SUPPORT RELATED ORGANIZATIONS IA 501(C)(3) 12 - TYPE II GRHS 1 FORT MADISON COMMUNITY HOSPITAL 5445 AVENUE O FORT MADISON IA 52627 421081055 HOSPITAL IA 501(C)(3) 3 GRHS 1 RIVERVIEW SYSTEMS LTD 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421191960 MEDICAL SERVICES IA GRHS C 21069 153816805 1.00000 1 GREAT RIVER MEDICAL SERVICES INC 1201 WEST AGENCY ROAD WEST BURLINGTON IA 52655 421493449 MEDICAL SERVICES IA GRHS C 1.00000 1 MUTUAL CONSULTING & MANAGEMENT SERVICES 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421349668 MANAGEMENT SERVICES IA RIVERVIEW SYSTEMS LTD C 5587042 4578593 1.00000 1 HEALTH CARE REALTY 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421193532 REAL ESTATE IA RIVERVIEW SYSTEMS LTD C 2597726 34216581 1.00000 1 HERITAGE PARK PHARMACY 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421191957 PHARMACY IA RIVERVIEW SYSTEMS LTD C 2616549 3893520 1.00000 1 HERITAGE MEDICAL EQUIPMENT & SUPPLY 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421191958 MEDICAL SUPPLY IA RIVERVIEW SYSTEMS LTD C 1875229 1958987 1.00000 1 SOUTHEASTERN IOWA MEDICAL SERVICES 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421307141 PHYSICIAN CLINICS IA RIVERVIEW SYSTEMS LTD C 58359182 9607204 1.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 GREAT RIVER FOUNDATION S 18800000 CASH GREAT RIVER MEDICAL CENTER S 4800000 CASH FORT MADISON COMMUNITY HOSPITAL S 12000000 CASH