2016-05-16T08:58:11-05:00 2015-06-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2014-07-01 421193185 GREAT RIVER HEALTH SYSTEMS INC GREA 3197681000 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 TODD SLADKY CFO 3197681000 2016-05-13 1 KACIE MCEWEN P01599614 6123764500 2014 2016-08-17 19:52:53Z MARK RICHARDSON 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 1030 0 X WWW.GREATRIVERMEDICAL.ORG X 1983 IA TO SERVE AS A HOLDING COMPANY OF VARIOUS SUBSIDIARIES PROVIDING HEALTH CARE. 13 11 0 13 0 0 0 0 0 0 1132 1030 0 0 1132 1030 0 0 0 0 0 0 0 0 0 17180 11243 17180 11243 -16048 -10213 42230440 43862153 161358 66954 42069082 43795199 GREAT RIVER HEALTH SYSTEMS, 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 0 GREAT RIVER HEALTH SYSTEMS IS A REGIONAL INTEGRATED HEALTH-SYSTEM THAT INCLUDES GREAT RIVER MEDICAL CENTER, PHARMACIES, MEDICAL EQUIPMENT AND SUPPLIES PROVIDERS, AND PHYSICIAN CLINICS. 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 0 1 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 13 11 1 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X NANCY WHITAKER-KROPP 3197681000 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 DAN WIEDEMEIER CHAIRMAN 1.00 3.00 X X 0 0 0 DAN HINKLE VICE CHAIRMAN 1.00 1.00 X X 0 0 0 ROBERT MCCULLEY SECRETARY / TREASURER 1.00 1.00 X X 0 0 0 KENNETH ASPELMEIER DIRECTOR 1.00 3.00 X 0 0 0 RON CLOUSE DIRECTOR 1.00 1.00 X 0 0 0 LORRIN DEBLIECK DIRECTOR 1.00 1.00 X 0 0 0 ROBERT FLEMING DIRECTOR 1.00 3.00 X 0 0 0 KENT GUADIAN DIRECTOR 1.00 1.00 X 0 0 0 JO ELLEN HOTH MD DIRECTOR 1.00 1.00 X 0 0 0 MICHAEL MCCOY MD DIRECTOR 1.00 1.00 X 0 339291 28424 JOHN PHILLIPS MD DIRECTOR 1.00 1.00 X 0 0 0 DONALD SCHMIDGALL DIRECTOR 1.00 1.00 X 0 0 0 MARK RICHARDSON PRESIDENT/CEO 1.00 42.00 X X 0 728153 49208 TONY HAYES COO 1.00 42.00 X 0 411423 45722 TODD SLADKY CFO 1.00 42.00 X 0 387694 46352 0 1866561 169706 0 0 1 0 0 1030 1030 1030 0 0 1030 2064 2064 8200 8200 979 979 11243 0 11243 0 393531 149875 3096 0 1725 0 24140 18000 41807948 43694278 42230440 43862153 161358 66954 161358 66954 X 42069082 43795199 42069082 43795199 42230440 43862153 X -10213 1736330 X 0 1 X 1 0 X X 1 GREAT RIVER MEDICAL CENTER 420680407 3 1 11243 0 1 11243 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 PART IV, SECTION A, LINE 2: GREAT RIVER HEALTH SYSTEMS, INC. SUPPORTS GREAT RIVER MEDICAL CENTER, A 501(C)(3) ORGANIZATION CLASSIFIED AS A PUBLIC CHARITY UNDER IRC SECTION 170(B)(1)(A)(III). GREAT RIVER HEALTH SYSTEMS, INC. COMPLETED THE CALCULATIONS FOR THE SECTION 509(A)(2) PUBLIC SUPPORT TEST FOR GREAT RIVER MEDICAL CENTER FOR THE PERIOD 7/1/2010 - 6/30/15 AND DETERMINED THAT GREAT RIVER MEDICAL CENTER WOULD QUALIFY AS A PUBLICLY SUPPORTED ORGANIZATION UNDER IRC SECTION 509(A)(2). 0 INVESTMENT IN FOR-PROFIT SUBSIDIARIES 43694278 F 43694278 INTERCOMPANY PAYABLE 66954 66954 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. THE ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE AND LOCAL AUTHORITIES. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX EXEMPT STATUS. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAX EXCEPT FOR THOSE THAT ARE ALREADY REPORTED ANNUALLY. X X X X X X 0 0 0 0 0 0 0 0 0 MICHAEL MCCOY MD DIRECTOR 0 339291 0 0 0 0 0 10400 0 18024 0 367715 0 0 MARK RICHARDSON PRESIDENT/CEO 0 570487 0 30000 0 127666 0 10400 0 38808 0 777361 0 0 TONY HAYES COO 0 313821 0 0 0 97602 0 10400 0 35322 0 457145 0 0 TODD SLADKY CFO 0 356652 0 0 0 31042 0 10400 0 35952 0 434046 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 KENT GAUDIAN AND ROBERT MCCULLEY HAVE A BUSINESS RELATIONSHIP. ROBERT FLEMING, KENT GAUDIAN, KENNETH ASPELMEIER, DAN WIEDEMEIER, MARK RICHARDSON AND TODD SLADKY HAVE BUSINESS RELATIONSHIPS BY SERVING ON FOR-PROFIT SUBSIDIARIES OF GREAT RIVER HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 3 ALL EXECUTIVE LEADERSHIP FUNCTIONS FOR GREAT RIVER HEALTH SYSTEMS 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 SYSTEMS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY AN EXTERNAL ACCOUNTANT. A DRAFT OF THE FORM 990 IS REVIEWED IN DETAIL BY THE ACCOUNTANT, 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 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 SYSTEMS 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 SYSTEMS. 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 A BIENNIAL BASIS. THE DELIBERATIONS AND DECISIONS ARE DOCUMENTED IN MINUTES TAKEN AT THE MEETINGS. GREAT RIVER HEALTH SYTEMS PARTICIPATES AND UTILIZES FOUR 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 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 2012. FORM 990, PART VI, SECTION C, LINE 19 GREAT RIVER HEALTH SYSTEMS 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 13,200,000. LOSS ON INVESTMENT IN SUBSIDIARIES -11,463,670. 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) 11 - TYPE II GRHS 1 GREAT RIVER FOUNDATION INC 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421469162 SUPPORT RELATED ORGANIZATIONS IA 501(C)(3) 11 - TYPE II GRHS 1 RIVERVIEW SYSTEMS LTD 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421191960 MEDICAL SERVICES IA GRHS C 67715953 51093656 1.00000 1 GREAT RIVER MEDICAL SERVICES INC 1201 WEST AGENCY ROAD WEST BURLINGTON IA 52655 421493449 MEDICAL SERVICES IA GRHS C 162644 1797809 1.00000 1 MUTUAL CONSULTING & MANAGEMENT SERVICES 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421349668 MANAGEMENT SERVICES IA N/A C 1 HEALTH CARE REALTY 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421193532 REAL ESTATE IA N/A C 1 HERITAGE PARK PHARMACY 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421191957 PHARMACY IA N/A C 1 HERITAGE MEDICAL EQUIPMENT & SUPPLY 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421191958 MEDICAL SUPPLY IA N/A C 1 SOUTHEASTERN IOWA MEDICAL SERVICES 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421307141 PHYSICIAN CLINICS IA N/A C 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 GREAT RIVER FOUNDATION S 9700000 CASH GRMC FOUNDATION S 3500000 CASH