2018-10-31T10:06:00-05:00 2017-12-31 410991680 FAIRVIEW HEALTH SVCS 2450 RIVERSIDE AVE S DEPT C-207 LE MINNEAPOLIS MN 554541450 990 2017-01-01 411865874 GRAND ITASCA CLINIC AND HOSPITAL GRAN 2183265000 1601 GOLF COURSE ROAD GRAND RAPIDS MN 55744 MICHAEL YOUSO PRESIDENT & CEO 2183265000 2018-10-31 2018-10-31 162.96.9.2 2018-10-31 10:06:00 CD P 5F2368D6BDA3FF5FC3D597F604724298C59CD620 5CADB5576C0A467FBF6013688B7D33E9E8CCDAB4 2017 2018-06-14 16:35:46Z MICHAEL YOUSO 1601 GOLF COURSE ROAD GRAND RAPIDS MN 55744 221229878 false X WWW.GRANDITASCA.ORG X 1997 MN PROVIDE QUALITY, ACCESSIBLE, AND VALUABLE HEALTH CARE SERVICES VIA A HOSPITAL, HOME HEALTH AGENCY, AND CLINIC TO THE SURROUNDING RURAL COMMUNITY. 15 13 756 102 138162 -16923 197725 213798 84630600 219473780 138968 268844 802594 1273456 85769887 221229878 11507 0 0 50284997 53681204 0 0 36840878 29385595 87137382 83066799 -1367495 138163079 73983492 58607872 45181353 32555247 28802139 26052625 X PROVIDE QUALITY, ACCESSIBLE, AND VALUABLE HEALTH CARE SERVICES VIA A HOSPITAL, HOME HEALTH AGENCY, AND CLINIC TO THE SURROUNDING RURAL COMMUNITY. false false 75006825 87536288 GRAND ITASCA CLINIC AND HOSPITAL IS AN INTEGRATED MULTI-SPECIALTY CLINIC AND ACUTE-SURGICAL HOSPITAL. THE FACILITY IS LICENSED FOR 64 BEDS WHICH ARE COMPIRSED OF 48 MEDICAL BEDS, 10 INTENSIVE CARE BEDS AND 6 OB BEDS. IN ADDITION TO PROVIDING TRADITIONAL HOSPITAL SERVICES, THE FACILITY HAS FOUR SURGERY SITES, A 24-HOUR EMERGENCY DEPARTMENT, OUTPATIENT MENTAL HEALTH SERVICES, OUTPATIENT REHABILITATION SERVICES, AND OUTPATIENT CLINIC SERVICES. THE FACILITY EMPLOYS APPROXIMATELY 750 PEOPLE INCLUDING OVER 60 HEALTHCARE PROVIDERS. THE FACILITY SERVED OVER 1,600 INPATIENTS AND OVER 206,100 OUTPATIENT ENCOUNTERS INCLUDING CLINIC, EMERGENCY ROOM, OUTPATIENT IMAGING AND OUTPATIENT SURGICAL PROCEDURE. GRAND ITASCA SERVES THE PATIENT REGARDLESS OF THE PERSON'S ABILITY TO PAY. DURING THE CALENDAR YEAR, THE FACILITY PROVIDED 442,987 OF CHARITY CARE, 337,332 OF DISCOUNTS TO THE UNINSURED AND ABSORBED 11,689,792 OF UNPAID MEDICARE AND MEDICAID COSTS. GRAND ITASCA CLINIC AND HOSPITAL ALSO PROVIDES OTHER SUPPORT TO THE COMMUNITY THROUGH CASH AND IN-KIND DONATIONS THAT TOTALED 11,692 IN 2017 CALENDAR YEAR. IN ADDITION, GRAND ITASCA PROVIDED HEALTHCARE SUPPORT SERVICES OF 20,057 INCLUDING PATIENT TRANSPORTATION. GRAND ITASCA ALSO PAID 1,222,092 IN PAYMENTS FOR MINNESOTA CARE TAX AND MEDICAID SURCHARGES, WHICH WERE USED TO FUND CARE FOR THE INDIGENT AND UNDERINSURED. 75006825 true true false true false false false false false false true false false false true true false true false false false false false false false false true true false false true false false false true false false true false false false false false false true true true false false true 818 0 true 756 true true true false false false false false false false false false X 15 13 false false false false false false false true true false false true true true true true true true true true true MN X TODD CHRISTENSON 2189991703 1601 GOLF COURSE ROAD GRAND RAPIDS MN 55744 DR JAMISON HARKER DIRECTOR 40.00 X 277243 0 29767 DR JAN ROURK DIRECTOR 40.00 X 162689 0 8274 DALE ADAMS VICE-CHAIR 1.00 X 0 0 0 BETH VILY DIRECTOR 1.00 X 0 0 0 STEVE BURGGRAF DIRECTOR 1.00 X 0 0 0 KENT KOERBITZ DIRECTOR 1.00 X 0 0 0 JAMIE LEMKE DIRECTOR 1.00 X 0 0 0 ELIZABETH MISKOVICH DIRECTOR 1.00 X 0 0 0 COLLEEN NARDONE CHAIR 1.00 X 0 0 0 DENNIS ROY SECRETARY 1.00 X 0 0 0 JOSH SKELTON FINANCE COMM 1.00 X 0 0 0 ANDY SHERMOEN FOUNDATION R 1.00 X 0 0 0 JOHN DOHERTY DIRECTOR 1.00 X 0 0 0 DR KEVIN NELSON DIRECTOR 1.00 X 0 0 0 DR LIZBETH THOMAS DIRECTOR 1.00 X 0 0 0 JAMES HEREFORD PRES/CEO FAI X 0 1347774 23564 MICHAEL YOUSO PRESIDENT & 40.00 X 50333 336142 46273 TROY D ERICKSON ORTHOPEDIC S 40.00 X 610613 0 66501 RYAN T NOVAK UROLOGIST MD 40.00 X 609817 0 93414 KURT W POSSAI ORTHOPEDIC S 40.00 X 533219 0 60427 DEREK A BEYER OB/GYN MD 40.00 X 476254 0 38370 DARIN J SKAUDIS INTERNAL MED 40.00 X 412025 0 54177 3132193 1683916 420767 70 false true false KRAUS-ANDERSON CONSTRUCTION 501 S 8TH STREET MINNEAPOLIS MN 55404 CONSTRUCTION 1650754 AMERICAN EXPRESS ALLINA 2925 CHICAGO AVENUE MINNEAPOLIS MN 55407 IT/LAB SERVICES 1603839 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 MEDICAL SERVICE 698730 PREMIER STAFFING INC 243 WINKLER TRAIL COLOGNE MN 55322 STAFFING 439606 FAIRVIEW RANGE REGIONA HEALTHSERVIC 750 EAST 34TH STREET HIBBING MN 55746 309967 54 43439 170359 213798 PATIENT SERVICES 621110 216456459 216456459 PHARMACY 446110 2879159 2879159 PHARMACY 621110 138162 138162 219473780 141808 141808 127036 127036 127036 127036 OTHER 621110 1273456 1273456 1273456 221229878 219335618 138162 1542300 490265 439932 50333 44336990 39514908 4822082 2037190 1780477 256713 4093425 3341240 752185 2723334 2337207 386127 284727 48483 236244 17182 17182 134811 134811 3389424 2807281 582143 162096 162096 2462652 2386277 76375 1428498 1427875 623 76554 37387 39167 865410 865410 1576652 1576652 MEDICALSUPPLIES 14281107 14279703 1404 MISCELLANEOUS 1352239 955518 396721 MEDICARE & MEDICAID 1222092 1222092 SUPPLIES 1145452 1056465 88987 986699 929918 56781 83066799 75006825 8059974 0 2409040 -230995 5100204 4367463 99363 9389464 9620372 59013 143947 76412 72521 1643313 1805772 1117434 470935 34873520 1576653 35074330 33296867 11423039 6898173 7591880 2162817 73983492 58607872 6395235 8445171 534676 46687 28581066 19365662 9670376 4697727 45181353 32555247 X 28607227 25554617 194912 498008 28802139 26052625 73983492 58607872 138163079 -140912593 X false true X true false X false false false false false false false false true 300 300 false SCHEDULE C, PART II-B, LINE 1 GRAND ITASCA CLINIC AND HOSPITAL PAYS DUES TO MINNESOTA HOSPITAL ASSOCIATION (MHA), A PORTION OF WHICH RELATES TO LOBBYING ACTIVITIES. FOR CALENDAR YEAR 2017, MHA HAS DETERMINED THAT 2.9% OR OF ITS MEMBERSHIP DUES WERE USED FOR LOBBYING PURPOSES. 1194000 1194000 25747680 759515 24988165 4939350 651142 4288208 2992490 165996 2826494 33296867 DEFERRED COMPENSATION OBLIGATIONS 2921320 THIRD PARTY PAYOR SETTLEMENTS 750707 SELF INSURED WORKER'S COMP 561863 CURRENT PORTION OF LONG TERM DEBT 279381 OTHER ACCRUALS 123939 WORK COMP RESERVE 60517 4697727 X SCHEDULE D, PAGE 3, PART X THE ORGANIZATION IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND APPLICABALE MINNESOTA STATUTES. CONSEQUENTLY, NO PROVISION HAS BEEN MADE FOR INCOME TAXES. THE ORGANIZATION'S ANNUAL TAX FILINGS ARE SUBJECT TO REVIEW BY FEDERAL, STATE AND LOCAL AUTHORITIES. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEPORDIZE ITS TAX-EXEMPT STATUS. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR OTHER EXCISE TAXES. true true true X true X true true true false true true 1672396 7122 1665274 0.02000 22334750 12277688 10057062 0.12110 24007146 12284810 11722336 0.14110 74965 2381 72584 0.00090 11692 11692 0.00010 86657 2381 84276 0.00100 24093803 12287191 11806612 0.14210 true 2874680 718670 90574057 35429989 55144068 X true true CDI GRAND RAPIDS LL PROVIDE MRI, DIAGNOSTIC INJECTION AND PA 0.55000 1 1 GRAND ITASCA CLINIC AND HOSPITAL X X X GRAND ITASCA CLINIC AND HOSPITAL 1 false false true X X X X X X X X X X 16 true false false true X WWW.GRANDITASCA.ORG X true 16 true GRANDITASCA.ORG (UNDER NEWS & EVENTS) false false true X 150.000000000000 300.000000000000 X X X X X true true X X X X true X GRANDITASCA.ORG X GRANDITASCA.ORG X X X X X X true X false X X X true X false false FACILITY 1, GRAND ITASCA CLINIC AND HOSPITAL - PART V, LINE 3E GRAND ITASCA HAS ELECTED TO TARGET THE FOLLOWING TWO IDENTIFIED HEALTH NEEDS IN THE COMMUNITY: 1. HEALTHY LIVING. 2. MENTAL WELLNESS. GRAND ITASCA CLINIC AND HOSPITAL WORKED WITH COMMUNITY PARTNERS FOR: THE GROWTH OF MENTAL HEALTH SERVICES IN OUR COMMUNITY THROUGH THE EXPANSION OF THE KIESLER WELLNESS CENTER. (SHIP) FORCUSED ON HEALTHY EATING,PHYSICAL ACTIVITY AND REDUCING TOBACCO USE. FACILITY 1, GRAND ITASCA CLINIC AND HOSPITAL - PART V, LINE 5 GRAND ITASCA CLINIC AND HOSPITAL CONDUCTED THE COMMUNITY HEALTH NEEDS ASSESSMENT BY GATHERING INPUT FROM COMMUNITY PROFESSIONSLS INCLUDING REPRESENTATION FROM THE COUNTY PUBLIC NURSE, YMCA, UNITED WAY, CITY OFFICIALS, LOCAL HEALTHCARE PROFESSIONALS AND REPRESENTATION FROM THE GENERAL PUBLIC. THIS INFORMATION WAS GATHERED SESSIONS FACILITATED BY AN INDEPENDENT PARTY. FACILITY 1, GRAND ITASCA CLINIC AND HOSPITAL - PART V, LINE 11 THE HOSPITAL ADOPTED AN IMPLEMENTATION PLAN IN 2016 THAT WAS IMPLEMENTED IN 2017 TO SUSTAIN AND DEVELOP COMMUNITY BENEFIT PROGRAMS THAT 1) ADDRESS PRIORITIZED NEEDS FROM THE 2016 CHNA AND TO RESPOND TO ADDITIONAL COMMUNITY HEALTH NEEDS. GRAND ITASCA HAS ELECTED TO TARGET THE FOLLOWING TWO IDENTIFIED HEALTH NEEDS IN THE COMMUNITY: 1. HEALTHY LIVING. 2. MENTAL WELLNESS. FOR EACH OF THE PRIORITY NEEDS IDENTIFIED ABOE, GRAND ITASCA CLINIC AND HOSPITAL WILL WORK WITH COMMUNITY PARTNERS FOR: THE GROWTH OF MENTAL HEALTH SERVICES IN OUR COMMUNITY THROUGH THE EXPANSION OF THE KIESLER WELLNESS CENTER, AN INNOVATIVE, STRENGTH-BASED, COMMUNITY COLLABORATIVE MENTAL HEALTH RECOVERY CENTER. THE ALIGNMENT WITH PUBLIC HEALTH PRIORITIES AND EXISTING COLLABORATION WITH STATEWIDE HEALTH IMPROVEMENT PROGRAMS (SHIP) FORCUSED ON HEALTHY EATING, PHYSICAL ACTIVITY AND REDUCING TOBACCO USE. 1 GRAND ITASCA PROFESSIONAL BUILDING 111 SE 3RD STREET GRAND RAPIDS MN 55744 VARIOUS OUTPATIENT & BUSINESS SERVICES PART II - COMMUNITY BUILDING ACTIVITIES GRAND ITASCA'S COMMUNITY BUILDING ACTIVITIES PROMOTE THE HEALTH OF THE COMMUNITIES IT SERVES BY PROVIDING INNOVATIVE AND ADVANCED MEDICAL SERVICES, WITH HIGH-QUALITY, SEAMLESS PATIENT CARE IN MIND. GRAND ITASCA'S INTERPRETATION AND ED PATIENT TAXI CAB SERVICES ALLOW FOR THE CARE OF EACH AND EVERY PATIENT, NO MATTER THE INITIAL BARRIERS OR HARDSHIPS THAT MAY EXIST. THE NURSE ON-LINE PROGRAM, BY PROVIDING A 24 HOUR MEDICAL ADVICE HOTLINE, EMPOWERS PATIENTS TO MADE EDUCATED DECISIONS ABOUT THEIR MEDICAL TREATMENT. TRIAGE CAN BE COMPLETED PRIOR TO A PATIENT'S ARRIVAL, ALLOWING MEDICAL RESOURCES TO BE ALLOCATED MORE EFFICIENTLY AND EFFECTIVELY. PART VI, LINE 2 - NEEDS ASSESSMENT GRAND ITASCA REVIEWS APPLICABLE STATE AND COUNTY SURVEYS PERFORMED BY OTHER AGENCIES TO ASSESS THE NEEDS OF THE COMMUNITY. GRAND ITASCA WORKS WITH THESE AGENCIES TO PROVIDE THESE SERVICES WITHIN THE SCOPE OF THE MEDICAL FACILITY. PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE GRAND ITASCA HAS FINANCIAL ADVOCATES WORKING WITH UNINSURED PATIENTS TO ASSIST THEM IN COMPLETING APPLICATION FOR VARIOUS PROGRAMS THAT MAY PROVIDE THEM COVERAGE FOR MEDICAL SERVICES. PART VI, LINE 4 - COMMUNITY INFORMATION GRAND ITASCA SERVES THE PEOPLE OF GRAND RAPIDS AND THE SURROUNDING COMMUNITIES THROUGHOUT ITASCA COUNTY. THESE COMMUNITIES CONSIST PRIMARILY OF CAUCASIAN RACE, WITH GROWING POPULATIONS OF AMERICAN INDIAN, HISPANIC AND AFRICAN AMERICAN CITIZENS. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH GRAND ITASCA PROMOTES HEALTH IN THE COMMUNITY BY SUPPORTING THE LOCAL FREE CLINIC, THROUGH THE PROVISION OF MEDICAL SUPPLIES, BASIC LAB TEST AND BASIC X-RAYS TO THE PATIENTS OF THIS CLINIC AT NO CHARGE. GRAND ITASCA ALSO WORKS WITH A COMMUNITY COALITION TO DETERMINE THE HEALTH NEEDS OF THE COMMUNITY SERVED BY GRAND ITASCA CLINIC & HOSPITAL. PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT MINNESOTA X X X false false false false false false false false false DR JAMISON HARKER DIRECTOR 277243 29767 307010 DR JAN ROURK DIRECTOR 162689 8274 170963 JAMES HEREFORD PRES/CEO FAIRVIEW 1200014 147760 23564 1371338 MICHAEL YOUSO PRESIDENT & CEO 50333 306142 30000 3009 18900 24364 53342 379406 TROY D ERICKSON ORTHOPEDIC SURGEON 610613 38750 27751 677114 RYAN T NOVAK UROLOGIST MD 609817 53740 39674 703231 KURT W POSSAI ORTHOPEDIC SURGEON 533219 24000 36427 593646 DEREK A BEYER OB/GYN MD 476254 1646 36724 514624 DARIN J SKAUDIS INTERNAL MEDICINE MD 412025 18000 36177 466202 DR KATHRYN JOHNSON EMPLOYEE COMPENSATION PACKAGE X 50000 44360 false true true DR SHAWN OLSON EMPLOYEE COMPENSATION PACKAGE X 50000 44360 false true true DR RYAN NOVAK EMPLOYEE COMPENSATION PACKAGE X 100000 32461 false true true DR STACY HOLL EMPLOYEE COMPENSATION PACKAGE X 50000 13337 false true true DR KURT POSSAI EMPLOYEE COMPENSATION PACKAGE X 75000 9429 false true true 143947 DR SHANNON R HARKER WIFE OF DIRECTO 183916 COMPENSATION false FORM 990, PAGE 2, PART III, LINE 4A OF THE PERSON'S ABILITY TO PAY. DURING THE CALENDAR YEAR, THE FACILITY PROVIDED 442,987 OF CHARITY CARE, 337,332 OF DISCOUNTS TO THE UNINSURED AND ABSORBED 11,689,792 OF UNPAID MEDICARE AND MEDICAID COSTS. GRAND ITASCA CLINIC AND HOSPITAL ALSO PROVIDES OTHER SUPPORT TO THE COMMUNITY THROUGH CASH AND IN-KIND DONATIONS THAT TOTALED 11,692 IN 2017 CALENDAR YEAR. IN ADDITION, GRAND ITASCA PROVIDED HEALTHCARE SUPPORT SERVICES OF 20,057 INCLUDING PATIENT TRANSPORTATION. GRAND ITASCA ALSO PAID 1,222,092 IN PAYMENTS FOR MINNESOTA CARE TAX AND MEDICAID SURCHARGES, WHICH WERE USED TO FUND CARE FOR THE INDIGENT AND UNDERINSURED. FORM 990, PAGE 6, PART VI, LINE 11B THE TAX DEPARTMENT CONDUCTS A DETAILED REVIEW OF THE COMPLETED RETURN. THE FORM 990 IS THEN REVIEWED BY THE VICE PRESIDENT OF FINANCE AND A COPY IS PROVIDED TO THE FINANCE COMMITTEE AND BOARD OF DIRECTORS FOR APPROVAL PRIOR TO FILING THE RETURN WITH THE IRS. FORM 990, PAGE 6, PART VI, LINE 12C BOARD MEMBERS SIGN THE CONFLICT OF INTEREST POLICY ANNUALLY. FORM 990, PAGE 6, PART VI, LINE 15A COMPENSATION IS DETERMINED BY ASSESSING THE MARKET THROUGH THE USE OF SURVEYS AND STUDIES AND DETERMINING PAY RATES AND RANGES FROM THE RESULTS OF THE ASSESSMENT. THE CEO COMPENSATION PACKAGE IS SUMMARIZED IN AN EMPLOYMENT AGREEMENT THAT IS APPROVED BY THE BOARD. THE COMPENSATION PACKAGE IS BASED UPON MARKET FOR THE POSITION. FORM 990, PAGE 6, PART VI, LINE 15B COMPENSATION IS DETERMINED BY ASSESSING THE MARKET THROUGH THE USE OF SURVEYS AND STUDIES AND DETERMINING PAY RATES AND RANGES FROM THE RESULTS OF THE ASSESSMENT. THE CEO COMPENSATION PACKAGE IS SUMMARIZED IN AN EMPLOYMENT AGREEMENT THAT IS APPROVED BY THE BOARD. THE COMPENSATION PACKAGE IS BASED UPON MARKET FOR THE POSITION. FORM 990, PAGE 6, PART VI, LINE 19 FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D). FORM 990, PART XI, LINE 9 RE VALUED ASSETS -117,484,098 PURCHASED ACCOUNTING ADJUSTMENT -23,428,495 TOTAL -140,912,593 FAIRVIEW HEALTH SERVICES 2450 RIVERSIDE AVENUE MINNEAPOLIS MN 55454 410991680 HOSPITAL MN 501C3 3 N/A false GRAND ITASCA FOUNDATION 1601 GOLF COURSE ROAD GRAND RAPIDS MN 55744 411560554 FOUNDATION MN 501C3 12A GICH GRAND ITASCA CLINIC & HOSPITSL true CDI GRAND RAPIDS LLC 1601 GOLF COURSE ROAD GRAND ITASCA MN 55744 453783014 IMAGING SE MN N/A RELATED 686697 1851007 true true 0.55000 false false true false false false false false false false false false false true true false false true true FAIRVIEW HEALTH SERVICES S 16837172 COST GRAND ITASCA FOUNDATION C ACTUAL