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 420680407 GREAT RIVER MEDICAL CENTER 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 177753142 0 X HTTP://GREATRIVERMEDICAL.ORG X 1895 IA IMPROVING THE REGION'S HEALTH BY PROVIDING HIGH-QUALITY HEALTH CARE. 13 10 1817 420 161699 -53162 1338991 1059173 159780257 175807025 280462 48699 930613 60079 162330323 176974976 243824 931089 0 0 83962686 82393548 0 0 82647 78156092 84380390 162362602 167705027 -32279 9269949 360247562 360869470 102712371 97823717 257535191 263045753 X GREAT RIVER MEDICAL CENTER IS DEDICATED TO IMPROVING THE REGION'S HEALTH BY PROVIDING HIGH-QUALITY CARE, WORLD-CLASS CUSTOMER SERVICE, AND UNCOMPROMISING VALUE FOR OUR PATIENTS AND THEIR FAMILIES. 0 0 159693833 931089 175807025 GREAT RIVER MEDICAL CENTER (GRMC), LOCATED IN WEST BURLINGTON, IOWA, IS A 378-BED REGIONAL MEDICAL CENTER OFFERING ACUTE AND INTERMEDIATE CARE TO RESIDENTS OF SOUTHEAST IOWA, WEST CENTRAL ILLINOIS AND NORTHEAST MISSOURI. THE HOSPITAL OFFERS COMPREHENSIVE MEDICAL, EXTENSIVE SURGICAL, AND EMERGENCY CARE SERVICES. DURING FISCAL YEAR ENDING 6/30/15, GRMC HAD 6,979 PATIENT ADMISSIONS AND 81,124 PATIENT DAYS OF MEDICAL CARE. GRMC ALSO HAD 170,000 OUTPATIENT VISITS, 35,038 EMERGENCY ROOM VISITS AND 34,393 HOME HEALTH-CARE VISITS. GRMC PROVIDES MEDICAL SERVICES REGARDLESS OF ABILITY TO PAY AND ACCEPTS MEDICARE AND MEDICAID.THE HOSPITAL'S 160-BED KLEIN CENTER OFFERS LONG-TERM AND SKILLED CARE ON THE HOSPITAL'S CAMPUS. THE CANCER CENTER, WHICH PROVIDES MEDICAL AND RADIATION THERAPY SERVICES FOR THE TREATMENT OF VARIOUS FORMS OF CANCER AND BLOOD DISEASES, OFFERS THE LATEST THREE-DIMENSIONAL TREATMENT-PLANNING COMPUTER TECHNOLOGY AVAILABLE IN ONLY A FEW HEALTH-CARE CENTERS IN THE STATE. THE NEW WELLNESS PLAZA IS HOME TO ONE OF THE STATE'S PREMIER REHABILITATION AND FITNESS PROGRAMS. MORE THAN 120 PHYSICIANS AND 2000 EMPLOYEES SHARE GRMC'S COMMITMENT TO EXCELLENCE IN PATIENT CARE AND COMMUNITY SERVICE. 159693833 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 83 0 1817 1 1 1 0 0 0 0 0 0 0 0 0 X 13 10 1 1 0 0 1 1 1 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 DENNIS HINKLE VICE CHAIRMAN 1.00 1.00 X X 2589 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 1804 0 0 ROBERT FLEMING DIRECTOR 1.00 3.00 X 0 0 0 KENT GAUDIAN 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 DON SCHMIDGALL DIRECTOR 1.00 1.00 X 0 0 0 MARK RICHARDSON PRESIDENT/CEO 40.00 3.00 X X 0 728153 49208 TONY HAYES COO 40.00 3.00 X 0 411423 45722 TODD SLADKY CFO 40.00 3.00 X 0 387694 46352 DARWIN COOLEY DIRECTOR OF PHARMACY 40.00 0.00 X 169177 0 30715 KERRY FLEMING RECRUITER - MEDICAL STAFF 40.00 0.00 X 160200 0 29688 WILLIAM MYERS PHYSICAL THERAPIST 40.00 0.00 X 133184 0 15520 FRANCES STRAUSS DIRECTOR OF SURGICAL SERVI 40.00 0.00 X 142298 0 30050 JON WILLIAMS PHARMACIST 40.00 0.00 X 132208 0 25171 741460 1866561 300850 36 0 1 0 MUTUAL CONSULTING & MANAGEMENT SERVICES 1221 S GEAR AVE WEST BURLINGTON IA 52655 EXECUTIVE MANAGEMENT 3384792 GREAT RIVER PHYSICIANS & CLINICS INC 1221 S GEAR AVE WEST BURLINGTON IA 52655 PHYSICIANS 2116799 UNIVERSITY OF IOWA 200 HAWKINS DRIVE IOWA CITY IA 52242 PHYSICIAN SERVICES 460097 EXECUTIVE HEALTH RESOURCES INC 15 CAMPUS BLVD SUITE 200 NEWTOWN SQUARE PA 19073 PHYSICIAN ADVISORS 372411 HEI CONSULTING LLC 4913 S CASEY COURT INDEPENDENCE MO 64055 CONSULTANTS 299806 13 1059173 1059173 PATIENT SERVICE INCOME 621110 170340283 170340283 OTHER OPERATING INCOME 621300 5196842 5041477 155365 SE RENAL DIALYSIS K-1 621400 269900 269900 175807025 398994 398994 347859 350324 -2465 -2465 6334 -8799 77547 427842 -350295 -350295 -350295 MISCELLANEOUS INCOME 900099 62544 62544 62544 176974976 175651660 161699 102444 X 931089 931089 1714085 4393 1709692 64833086 64682122 96755 54209 2802369 2793583 6147 2639 8239137 8184571 47892 6674 4804871 4794232 6978 3661 1675100 1675100 74527 4188 70339 86185 86104 81 27315 27315 17006083 15796809 1196361 12913 22449611 22440793 7580 1238 1719834 1719583 71 180 279407 263802 15603 2 3003124 3003124 17017087 16889395 127692 1976812 361435 1615377 DRUGS 10323159 10323159 BAD DEBT 3886301 3886301 REPAIRS/MAINTENANCE 1795956 1790923 5033 FOOD 1705339 1677492 26917 930 1354550 60735 1293614 201 167705027 159693833 7928547 82647 3699138 14055060 24253316 23430698 404673 337275 2690566 3299445 2041869 2501277 311501735 151654005 171990414 159847730 153163472 155615224 1376700 1246600 627414 536161 360247562 360869470 9442343 9446871 80590445 74814561 12679583 13562285 102712371 97823717 X 253073032 259062924 3143775 2696665 1318384 1286164 257535191 263045753 360247562 360869470 X 9269949 212386 -3971773 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 27315 27315 0 PART II-B, LINE 1: GREAT RIVER MEDICAL CENTER PAID DUES TO THE AMERICAN HOSPITAL ASSOCIATION AND THE IOWA HOSPITAL ASSOCIATION. THESE ASSOCIATIONS PARTICIPATE IN LOBBYING ACTIVITIES RELATED TO HEALTHCARE. 4946488 4946488 126611319 34919891 91691428 11972330 6274811 5697519 167504648 110459303 57045345 466950 466950 159847730 152421519 F INSURANCE COMPANY ANNUITY DEPOSITS 3193705 F 155615224 DEFERRED COMPENSATION LIABILITY 1010197 THIRD PARTY PAYABLE 561124 PTO RESERVE 7393749 FAIR VALUE OF CASH FLOW HEDGING SWAP 3740176 PLEDGES LIABILITY 857039 13562285 X PART X, LINE 2: THE FOLLOWING IS AN EXCERPT FROM THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS, FOOTNOTE 1: THE ORGANIZATION IS 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. 1 1 X 1 X 225.000000000000 1 X 1 1 0 1 1 3591352 0 3591352 0.02140 23664656 20203716 3460940 0.02060 280305 462585 -182280 0.00000 27536313 20666301 6870012 0.04200 62073 0 62073 0.00040 963574 607832 355742 0.00210 931089 0 931089 0.00560 1956736 607832 1348904 0.00810 29493049 21274133 8218916 0.05010 1 3886301 0 55970242 61490727 -5520485 X 1 1 1 1 GREAT RIVER MEDICAL CENTER 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 GREATRIVERMEDICAL.ORG 290147H X X X GREAT RIVER MEDICAL CENTER 1 0 0 1 X X X X X X X X X 12 1 0 0 1 X HTTP://GREATRIVERMEDICAL.ORG/FILES/FILE/COMMUNITY%20HEALTH%20NEEDS%20ASSESS X 1 13 1 HTTP://GREATRIVERMEDICAL.ORG/FILES/IMAGE/GRMC/CHNA_RESPONSE.PDF 0 0 1 X 225.000000000000 300.000000000000 X X X X X 1 1 X X X 1 X HTTP://GREATRIVERMEDICAL.ORG/BILLING-AND-FINANCIAL-SERVICES/FINANCIAL-ASSIS X HTTP://GREATRIVERMEDICAL.ORG/BILLING-AND-FINANCIAL-SERVICES/FINANCIAL-ASSIS X X X X X 1 X 0 X X X X X 1 X 0 0 GREAT RIVER MEDICAL CENTER PART V, SECTION B, LINE 5: TO ENSURE THOROUGH RESPONSES FROM THE MEMBERS OF THE GREATER BURLINGTON COMMUNITY, GREAT RIVER MEDICAL CENTER USED FACE-TO-FACE INTERVIEWS WITH KEY STAKEHOLDERS FROM THE COMMUNITY AND DEVELOPED A PAPER SURVEY THAT ANY COMMUNITY MEMBER COULD COMPLETE. ALL PARTICIPANTS IN THIS COUNTYWIDE PROCESS IDENTIFIED AND ADDRESSED PRIORITY AREAS THAT WOULD IMPROVE THE HEALTH OF THE DES MOINES COUNTY COMMUNITY. EXTERNAL INTERVIEW PARTICIPANTS INCLUDED THE PUBLIC HEALTH OFFICER, THE DEPARTMENT DIRECTOR OF THE DES MOINES COUNTY DEPARTMENT OF PUBLIC HEALTH, A VARIETY OF PEOPLE FROM LOCAL AND STATE GOVERNMENT AGENCIES, AND LEADERS FROM COMMUNITY-BASED ORGANIZATIONS, FOUNDATIONS, AND ASSOCIATIONS. THESE PARTICIPANTS ARE EXPERTS IN A RANGE OF AREAS INCLUDING PUBLIC HEALTH, MINORITY POPULATIONS, UNDERSERVED POPULATIONS, SOCIAL DETERMINANTS OF HEALTH, AND HEALTH AND SOCIAL SERVICES. THE EXTERNAL PARTICIPANTS WERE INTERVIEWED USING A STANDARDIZED LIST OF QUESTIONS. THE QUESTIONS WERE DESIGNED TO IDENTIFY IMPORTANT HEALTH CONCERNS IN THE COMMUNITY, SUGGEST METHODS GREAT RIVER MEDICAL CENTER COULD USE TO BETTER ENGAGE AND COLLABORATE WITH THE COMMUNITY AND OFFER SUGGESTIONS FOR ADDRESSING HEALTH CARE PRIORITIES AND RECOMMENDATIONS. INTERVIEWERS WERE INSTRUCTED TO ASK ANY QUESTIONS THEY FELT WERE RELEVANT. THEY WERE NOT CONSTRAINED TO THE QUESTIONS LISTED ON THE INTERVIEW TEMPLATE. THE SECOND SOURCE OF COMMUNITY-MEMBER RESPONSE WAS THROUGH A PAPER SURVEY MADE AVAILABLE AT SEVERAL LOCATIONS THROUGHOUT DES MOINES COUNTY. THE SURVEY ASKED RESPONDENTS A VARIETY OF QUESTIONS CENTERING ON THREE HEALTH CONCERNS: OBESITY, TEENAGE PREGNANCY, AND MENTAL HEALTH. THESE CONCERNS HAD BEEN IDENTIFIED AS PRIORITIES THROUGH THE 2010 DES MOINES COUNTY HEALTH NEEDS ASSESSMENT. QUESTIONS ASKED ABOUT THE SIGNIFICANCE OF EACH OF THE CONCERNS AND THE SERVICES AVAILABLE TO ADDRESS THE HEALTH PROBLEM. THE SURVEY ALSO ASKED RESPONDENTS TO RATE THE THREE HEALTH CONCERNS THAT SHOULD BE THE FOCUS FOR IMPROVEMENT. LAST, RESPONDENTS WERE INVITED TO EXPRESS THOUGHTS AND IDEAS ABOUT GREAT RIVER MEDICAL CENTER AND THE HEALTH OF DES MOINES COUNTY RESIDENTS. GREAT RIVER MEDICAL CENTER PART V, SECTION B, LINE 11: THE COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED THREE NEEDS FOR WHICH GREAT RIVER MEDICAL CENTER HAS DETERMINED IT WILL WORK TO IMPROVE IN OUR COMMUNITY: OBESITY, MENTAL HEALTH, AND HEALTHCARE ACCESS. TO IMPROVE THE COMMUNITY'S OVERALL HEALTH AND REDUCE OBESITY, GRMC HAS DEVELOPED SEVERAL PROGRAMS AND SERVICES. THE HEALTHY LIVING CLINIC, HEADED BY DR. MICHAEL ABOUASSALY, IS OPEN TO THE COMMUNITY AND PROMOTES HEALTHY LIFESTYLE BEHAVIORS AND CHOICES, INCORPORATING EDUCATION, MEAL PLANS, AND PERSONAL TRAINING. THE CLINIC HAS DESIGNED A PROGRAM CALLED OPERATION TRANSFORMATION, A SIX MONTH WEIGHT LOSS PROGRAM, WHICH FOCUSES ON CHANGING LIFESTYLE BEHAVIORS. THE GREAT RIVER WELLNESS PLAZA IS A STATE-OF-THE-ART WORKOUT AND REHABILITATION SERVICES FACILITY WHICH INCLUDES A ROCK CLIMBING WALL, FULL EXERCISE TRACK, AND HIGH PERFORMANCE WORKOUT CENTER. TO IMPROVE THE COMMUNITY'S ACCESS TO HEALTHCARE, GRMC OPENED THE FIRST RETAIL-BASED CARE CLINIC IN THE REGION. THE CLINIC IS OPEN TO ANYONE 18 MONTHS AND OLDER, AND NO APPOINTMENT IS NECESSARY. GRMC HAS ALSO HIRED AN IN-HOUSE PHYSICIAN RECRUITER, AND HAS SINCE ADDED OVER 80 PROVIDERS TO THE HEALTH SYSTEM, INCLUDING TWO NEW SPECIALISTS, AN INFECTIOUS DISEASE SPECIALIST AND A RHEUMATOLOGIST. FINALLY, TO MAINTAIN AND GROW OUR MENTAL HEALTH PRESENCE, GRMC WILL CONTINUE TO ACTIVELY RECRUIT NEW PROVIDERS, INCLUDING SPONSORING J1 AND H1B VISAS FOR PROVIDERS FROM FOREIGN MEDICAL SCHOOLS AND IS COMMITTED TO KEEPING ITS MENTAL HEALTH INPATIENT UNIT OPEN AND PROVIDING OUTPATIENT ACCESS TO PSYCHIATRISTS, EVEN AT A SUBSTANTIAL FINANCIAL LOSS TO THE ORGANIZATION.THE COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED TWO NEEDS THAT THE ORGANIZATION IS NOT CURRENTLY ADDRESSING. THE HOSPITAL STAKEHOLDERS FEEL THAT SUBSTANCE ABUSE AND TEENAGE PREGNANCIES ARE ISSUES BEST HANDLED BY ORGANIZATIONS THAT HAVE A BROADER IMPACT ON THESE PARTICULAR ISSUES. IF OR WHEN APPROACHED TO DEVELOP PARTNERSHIPS AND COLLABORATIONS TO COMBAT THESE TWO ISSUES, THE HOSPITAL WILL WELCOME THESE OPPORTUNITIES. GREAT RIVER MEDICAL CENTER PART V, SECTION B, LINE 20E: GRMC USES AN OUTSIDE SOURCE TO SCREEN PATIENTS TO SEE IF THEY COULD BE ELIGIBLE FOR FINANCIAL ASSISTANCE. THE HOSPITAL GETS NOTIFICATION BACK AS TO HOW MUCH OF A FINANCIAL ASSISTANCE DISCOUNT THEY WOULD BE ELIGIBLE FOR. IF THE PATIENT DOESN'T RESPOND TO PHONE CALLS REGARDING THE FINANCIAL ASSISTANCE APPLICATION OR THEY DON'T COMPLETE THE APPLICATION, THE HOSPITAL MAY STILL DISCOUNT THE PATIENT'S CHARGES UNDER THEIR PRESUMPTIVE CHARITY POLICY. THE HOSPITAL'S PRESUMPTIVE CHARITY PROGRAM GIVES THE HOSPITAL THE OPPORTUNITY TO DISCOUNT PATIENT ACCOUNTS BASED ON INFORMATION IT MAY HAVE REGARDING A PATIENT BEING HOMELESS OR UNEMPLOYED. GREAT RIVER MEDICAL CENTER PART V, SECTION B, LINE 22D: THE MAXIMUM AMOUNT THAT CAN BE CHARGED IS BASED ON A CHARITY CARE MATRIX BASED ON THE FPG AND FAMILY SIZE. THE MAXIMUM AMOUNT CHARGED TO FAP-ELIGIBLE PATIENTS IS LESS THAN THE AMOUNTS GENERALLY BILLED TO PATIENTS COVERED BY COMMERCIAL INSURANCE. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY GREAT RIVER MEDICAL CENTER PART V, SECTION B, LINE 16A WEBSITE: HTTP://GREATRIVERMEDICAL.ORG/BILLING-AND-FINANCIAL-SERVICES/FINANCIAL-ASSIS GREAT RIVER MEDICAL CENTER PART V, SECTION B, LINE 16C WEBSITE: HTTP://GREATRIVERMEDICAL.ORG/BILLING-AND-FINANCIAL-SERVICES/FINANCIAL-ASSIS PART I, LINE 3C: GREAT RIVER MEDICAL CENTER (GRMC) USES THE FPG TO DETERMINE FREE OR DISCOUNTED CARE. INDIVIDUALS WHO ARE BELOW 225% OF THE FPG QUALIFY FOR FREE CARE. IN MOST INSTANCES, THEY HAVE TO PROVIDE FINANCIAL DOCUMENTATION AND FILL OUT A CHARITY CARE APPLICATION. THE HOSPITAL ALSO USES A PRESUMPTIVE CHARITY CARE PROGRAM THAT ANALYZES PUBLIC AND PRIVATE DATABASES TO HELP DETERMINE ELIGIBITY FOR CHARITY CARE. THESE INDIVIDUALS DO NOT HAVE ANY OTHER DOCUMENTATION TO PROVIDE. THIS PROGRAM IS USED AFTER COLLECTION ATTEMPTS HAVE BEEN DISCONTINUED. EXTRAORDINARY ASSETS ARE TAKEN INTO CONSIDERATION WHEN DETERMINING CHARITY CARE ELIGIBILITY. MEDICALLY INDIGENT INDIVIDUALS ARE COVERED UNDER THE SAME CHARITY CARE POLICY. INDIVIDUALS BETWEEN 225% AND 300% OF THE FEDERAL POVERTY LIMITS ARE GRANTED CHARITY ON A SLIDING SCALE. PART I, LINE 6A: GREAT RIVER HEALTH SYSTEM'S COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND RESPONSE REPORT CONDUCTED ON BEHALF OF GREAT RIVER MEDICAL CENTER IS MADE WIDELY AVAILABLE AND IS AVAILABLE ON THE ORGANIZATION'S WEBSITE. PART I, LINE 7: THE AMOUNTS INCLUDED IN PART I, LINE 7 WERE CALCULATED USING A RATIO OF COST TO CHARGES DERIVED FROM WORKSHEET 2 OF THE IRS SCHEDULE H INSTRUCTIONS. PART I, LINE 7G: THE SUBSIDIZED HEALTH SERVICES INCLUDED IN PART I, LINE 7G IS MENTAL HEALTH SERVICES PROVIDED BY GRMC. PART I, LN 7 COL(F): BAD DEBT EXPENSES OF $3,886,301 WERE SUBTRACTED FROM THE TOTAL EXPENSES IN CALCULATING THE PERCENTAGES IN PART I, LINE 7, COLUMN F. PART III, LINE 2: PAYMENT ARRANGEMENT INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENT WITH THIRD-PARTY PAYORS. PART III, LINE 3: WHEN THE ORGANIZATION IDENTIFIES A PATIENT AS ELIGIBLE FOR FINANCIAL ASSISTANCE, GRMC RECLASSIFIES THAT AMOUNT OF BAD DEBT INTO A FINANCIAL ASSISTANCE CODE. PART III, LINE 4: THE FOOTNOTE FROM THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE IS AS FOLLOWS: "PATIENT RECEIVABLES WHERE A THIRD-PARTY PAYOR IS RESPONSIBLE FOR PAYING THE AMOUNT ARE CARRIED AT A NET AMOUNT DETERMINED BY THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED, LESS AN ESTIMATE MADE FOR CONTRACTUAL ADJUSTMENTS OR DISCOUNTS PROVIDED TO THIRD-PARTY PAYORS. PATIENT RECEIVABLES DUE DIRECTLY FROM PATIENTS ARE CARRIED AT THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED LESS AMOUNTS COVERED BY THIRD-PARTY PAYORS AND LESS AN ESTIMATED ALLOWANCE FOR DOUBTFUL RECEIVABLES BASED ON A REVIEW OF ALL OUTSTANDING AMOUNTS ON A MONTHLY BASIS. MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS, BY HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS AND BY CONSIDERING THE PATIENTS' FINANCIAL HISTORY, CREDIT HISTORY AND CURRENT ECONOMIC CONDITIONS. THE MEDICAL CENTER DOES NOT CHARGE INTEREST ON PATIENT RECEIVABLES. PATIENT RECEIVABLES ARE WRITTEN OFF WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSES WHEN RECEIVED." PART III, LINE 8: THE ORGANIZATION DERIVED ITS COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT BY USING COST REPORT WORKSHEETS. MEDICARE COSTS ARE DETERMINED THROUGH THE MEDICARE COST FINDING PROCESS WHICH ALLOCATES GENERAL SERVICE CENTER COSTS TO REVENUE DEPARTMENTS. THE METHODOLOGY DESCRIBED IN THE INSTRUCTIONS TO SCHEDULE H, PART III, SECTION B, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE HOSPITAL AND DOES NOT REPRESENT THE TOTAL COMMUNITY BENEFIT CONFERRED IN THIS AREA. THE REASONS MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT ARE - ABSENT THE MEDICARE PROGRAM, IT IS LIKELY MANY OF THE INDIVIDUALS WOULD QUALIFY FOR FINANCIAL ASSISTANCE OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS. BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS. THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION IN REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS, AND THE AMOUNT SPENT TO COVER MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFIT NEEDS. PART III, LINE 9B: AN EXCERPT FROM GRMC'S FINANCIAL ASSISTANCE PROGRAM WRITTEN POLICY - SECTION 8, RELATIONSHIP OF FINANCIAL ASSISTANCE PROGRAM TO COLLECTION POLICIES: "GREAT RIVER MEDICAL CENTER MANAGEMENT SHALL DEVELOP POLICIES AND PROCEDURES FOR INTERNAL AND EXTERNAL COLLECTION PRACTICES THAT TAKE INTO ACCOUNT THE EXTENT TO WHICH THE PATIENT QUALIFIES FOR CHARITY, A PATIENT'S GOOD FAITH EFFORT TO APPLY FOR A GOVERNMENTAL PROGRAM OR FOR CHARITY FROM GREAT RIVER MEDICAL CENTER, AND A PATIENT'S GOOD FAITH EFFORT TO COMPLY WITH HIS OR HER PAYMENT AGREEMENTS WITH GREAT RIVER MEDICAL CENTER. FOR PATIENTS WHO QUALIFY FOR CHARITY AND WHO ARE COOPERATING IN GOOD FAITH EFFORT TO RESOLVE THEIR DISCOUNTED HOSPITAL BILLS, GREAT RIVER MEDICAL CENTER MAY OFFER EXTENDED PAYMENT PLANS, WILL NOT SEND UNPAID BILLS TO OUTSIDE COLLECTION AGENCIES, AND WILL CEASE ALL COLLECTION EFFORTS. GREAT RIVER MEDICAL CENTER AND AGENCIES ACTING ON BEHALF OF GREAT RIVER MEDICAL CENTER WILL NOT IMPOSE EXTRAORDINARY COLLECTION ACTIONS SUCH AS WAGE GARNISHMENTS; LIENS ON PRIMARY RESIDENCES, OR OTHER LEGAL ACTIONS FOR ANY PATIENT WITHOUT FIRST MAKING REASONABLE EFFORTS TO DETERMINE WHETHER THAT PATIENT IS ELIGIBLE FOR CHARITY CARE UNDER THIS FINANCIAL ASSISTANCE POLICY. REASONABLE EFFORTS SHALL INCLUDE: A) VALIDATING THAT THE PATIENT OWES THE UNPAID BILLS AND THAT ALL SOURCES OF THIRD-PARTY PAYMENTS HAVE BEEN IDENTIFIED AND BILLED BY THE HOSPITAL; B) DOCUMENTATION THAT GREAT RIVER MEDICAL CENTER HAS OR HAS ATTEMPTED TO OFFER THE PATIENT THE OPPORTUNITY TO APPLY FOR CHARITY CARE PURSUANT TO THIS POLICY AND THAT THE PATIENT HAS NOT COMPLIED WITH THE HOSPITAL'S APPLICATION REQUIREMENTS; C) DOCUMENTATION THAT THE PATIENT HAS BEEN OFFERED A PAYMENT PLAN BUT HAS NOT HONORED THE TERMS OF THAT PLAN." PART III, SECTION A, LINE 1 THE ORGANIZATION REPORTS BAD DEBT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). HFMA STATEMENT 15 IS FOLLOWED TO THE EXTENT THAT IT ALIGNS WITH THE GUIDELINES SET FORTH BY GAAP. PART VI, LINE 2: GRMC'S BOARD OF DIRECTORS IS COMMUNITY BASED. REPRESENTATIVES FROM VARIOUS SEGMENTS OF THE COMMUNITY MAKE UP THE BOARD. IN ADDITION, BOARD MEMBERS ARE SELECTED IN OUTLYING COMMUNITIES THAT GRMC SERVES. THESE BOARD MEMBERS CONSTANTLY PROVIDE INPUT TO THE HEALTHCARE NEEDS OF OUR COMMUNITY THROUGH THE ANNUAL STRATEGIC PLANNING PROCESS. PART VI, LINE 3: NOTIFICATION ABOUT GOVERNMENT PROGRAM AND/OR FINANCIAL ASSISTANCE FROM GRMC IS DISSEMINATED BY VARIOUS MEANS AT GRMC, WHICH INCLUDES - PUBLICATION OF NOTICES IN PATIENT BILLS AND POSTED NOTICES IN THE EMERGENCY ROOMS, ADMISSION FORMS, ADMITTING AND REGISTRATION DEPARTMENT, HOSPITAL BUSINESS OFFICES, AND THE FINANCIAL SERVICES OFFICE ON THE FACILITY CAMPUS. GRMC ALSO POSTS AT THE LOCAL DEPARTMENT OF HEALTH SERVICES OFFICE. GRMC ALSO PUBLISHES AND WIDELY PUBLICIZES A SUMMARY OF THE ASSISTANCE OPTIONS ON THE FACILITY WEBSITE AND IN BROCHURES AVAILABLE IN PATIENT ACCESS SITES. REFERRAL OF PATIENTS FOR CHARITY MAY BE MADE BY ANY MEMBER OF THE GRMC STAFF. ALSO REQUESTS FOR CHARITY MAY BE MADE BY THE PATIENT OR A FAMILY MEMBER, CLOSE FRIEND, OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS. FINANCIAL COUNSELORS MEET WITH PATIENTS TO ASSIST IN COMPLETING A QUESTIONNAIRE THAT HELPS THEM DETERMINE IF THE PATIENT QUALIFIES FOR A GOVERNMENT PROGRAM. PART VI, LINE 4: A REVIEW WAS CONDUCTED BY GRMC TO ANALYZE THE ORIGIN OF PATIENTS UTILIZING THE SERVICES PROVIDED BY THE MEDICAL CENTER. THE REVIEW INDICATED THAT DES MOINES COUNTY COMPRISES THE MEDICAL CENTER'S PRIMARY SERVICE AREA AND THAT THE SECONDARY SERVICE AREA OF THE MEDICAL CENTER CONSISTS OF HENRY, LEE, AND LOUISA COUNTIES IN IOWA AND HANCOCK AND HENDERSON COUNTIES IN ILLINOIS. BASED ON THE US CENSUS BUREAU STATISTICS FOR 2015, THE PRIMARY SERVICE AREA POPULATION IS ESTIMATED AT 40,055 RESIDENTS. THE SECONDARY SERVICE AREA POPULATIONS ARE ESTIMATED TO TOTAL 71,812 RESIDENTS. OVER AGE 65 GROUP IS CURRENTLY 18.8% OF THE PRIMARY SERVICE AREA POPULATION, AS COMPARED TO 15.8% OF THE STATE OF IOWA POPULATION AND 14.5% OF THE UNITED STATES POPULATION. THE MEDIAN HOUSEHOLD INCOME IN THE PRIMARY SERVICE AREA IS $42,146 COMPARED TO THE STATE AND NATIONAL AVERAGES OF $52,716 AND $53,482, RESPECTIVELY. THE PRIMARY SERVICE AREA POPULATION BELOW POVERTY LEVEL IS 15.7% AS COMPARED TO THE STATE AND NATIONAL AVERAGES OF 12.2% AND 14.8%, RESPECTIVELY.GREAT RIVER MEDICAL CENTER IS THE ONLY HOSPITAL IN THE PRIMARY SERVICE AREA AND THE LARGEST SERVICE PROVIDER, INCLUDING THE BROADEST SCOPE OF SERVICES, IN THE PRIMARY AND SECONDARY SERVICE AREAS. PART VI, LINE 5: GRMC FURTHERS ITS EFFORTS TO PROMOTE THE HEALTH OF THE COMMUNITY BY ENSURING THE MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS OF SUCH.GRMC PROVIDES MEMBERSHIP TO ALL PHYSICIANS WHO MEET MEMBERSHIP AND CLINICAL REQUIREMENTS.GRMC IS INVOLVED IN GETTING PHYSICIANS AND HEALTHCARE WORKERS TO THE AREA TO IMPROVE THE ACCESS TO HEALTHCARE NEEDS IN THE HOSPITAL'S SERVICE AREA. GRMC ALSO PROMOTES HEALTH CARE RELATED JOBS EDUCATION BY WORKING CLOSELY WITH SOUTHEASTERN COMMUNITY COLLEGE AND THEIR NURSING PROGRAM.GRMC PARTICIPATES IN COMMUNITY BENEFIT ACTIVITIES SUCH AS PARTNERING WITH LOCAL SCHOOLS, COMMUNITY EDUCATION, COMMUNITY INITIATIVE EVENTS, PRENATAL EDUCATION CLASSES, A HEALTH FAIR, AND A LIBRARY OPEN TO THE COMMUNITY.GRMC MAINTAINS AN EMERGENCY ROOM 24 HOURS A DAY, 7 DAYS A WEEK WHICH IS OPEN TO ALL, REGARDLESS OF ABILITY TO PAY.SURPLUS FUNDS OF THE HOSPITAL ARE INVESTED IN IMPROVING AND UPDATING CAPITAL EQUIPMENT AND INCREASING THE SERVICES OFFERED TO ALLOW FOR BETTER CARE OF THE PATIENTS THAT ARE SERVED. PART VI, LINE 6: GRMC IS PART OF A LARGER HEALTH SYSTEM, GREAT RIVER HEALTH SYSTEM.GREAT RIVER HEALTH SYSTEM CONSISTS OF ONE HOSPITAL, A HOSPICE HOUSE, HOME HEALTH SERVICES, AMBULANCE SERVICES, THREE PHARMACIES, A DURABLE MEDICAL EQUIPMENT COMPANY, A LONG-TERM CARE NURSING HOME AND MULTIPLE GENERAL AND SPECIALTY PHYSICIAN CLINICS.THE NON-HOSPITAL HEALTH-CARE FACILITIES THAT ARE OPERATED BY ORGANIZATIONS RELATED TO THE HOSPITAL INCLUDE THE FOLLOWING, LISTED IN ORDER OF SIZE: BURLINGTON AREA FAMILY PRACTICE, GREAT RIVER ORTHOPEDIC SPECIALISTS, GREAT RIVER WOMEN'S HEALTH, HERITAGE MEDICAL EQUIPMENT SUPPLY, KEOKUK CLINIC, HERITAGE PARK PHARMACY, GREAT RIVER MENTAL HEALTH, GREAT RIVER ANESTHESIA, HERITAGE PARTNERS PHARMACY, GREAT RIVER SURGEONS, GREAT RIVER UROLOGY, GREAT RIVER QUICK CARE, WAPELLO CLINIC, GREAT RIVER MEDICINE SPECIALISTS, HERITAGE FAMILY PHARMACY, HEALTHY LIVING CLINIC, MEDIAPOLIS CLINIC, GREAT RIVER NEPHROLOGY, GREAT RIVER PULMONOLOGY, GREAT RIVER EYE SPECIALISTS, GREAT RIVER GASTROENTEROLOGY, GREAT RIVER AUDIOLOGY, GREAT RIVER HOSPITALISTS, GREAT RIVER HEMATOLOGY & ONCOLOGY, AND GREAT RIVER CARDIOLOGY. PART VI, LINE 7 GRMC DOES NOT FILE A COMMUNITY BENEFIT REPORT WITH THE STATE OF IOWA. HOWEVER, COMMUNITY BENEFIT INFORMATION IS PROVIDED TO THE IOWA HOSPITAL ASSOCIATION. 1 SOUTHEASTERN COMMUNITY COLLEGE EDUCATION 1500 WEST AGENCY ROAD WEST BURLINGTON IA 52655 421212111 501(C)(3) 877039 SUPPORT CONSTRUCTION OF HEALTH PROFESSIONS BUILDING 1 0 PART I, LINE 2: GRANTEES ARE REQUIRED TO PROVIDE FOLLOW-UP INFORMATION WHEN THE PROJECT IS CARRIED OUT OR COMPLETED. IF GRANTEES DON'T COMPLY, GRMC DOES NOT PROVIDE FURTHER GRANTS TO THEM. X X 1 1 0 0 0 0 0 0 0 0 0 MICHAEL MCCOY MD DIRECTOR 0 339856 0 0 0 -565 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 DARWIN COOLEY DIRECTOR OF PHARMACY 166184 0 0 0 2993 0 9982 0 20733 0 199892 0 0 0 KERRY FLEMING RECRUITER - MEDICAL STAFF 70013 0 95300 0 -5113 0 4201 0 25487 0 189888 0 0 0 FRANCES STRAUSS DIRECTOR OF SURGICAL SERVI 145376 0 0 0 -3078 0 7812 0 22238 0 172348 0 0 0 JON WILLIAMS PHARMACIST 136961 0 0 0 -4753 0 7454 0 17717 0 157379 0 0 0 PART I, LINE 1A 1. DENNIS HINKLE, TRAVEL FOR COMPANIONS, $2,589 INCLUDED IN TAXABLE COMPENSATION 2. LORRIN DE BLIECK, TRAVEL FOR COMPANIONS, $1,804 INCLUDED IN TAXABLE COMPENSATION 3. MARK RICHARDSON, HEALTH/SOCIAL CLUB DUES, $4,227 INCLUDED IN TAXABLE WAGES 4. TONY HAYES, HEALTH/SOCIAL CLUB DUES, $4,227 INCLUDED IN TAXABLE WAGES 5. TODD SLADKY, TRAVEL FOR COMPANIONS, $66 INCLUDED IN TAXABLE WAGES AND HEALTH/SOCIAL CLUB DUES, $4,227 INCLUDED IN TAXABLE WAGES PART I, LINE 3 THE COMPENSATION OF THE PRESIDENT & CEO IS DETERMINED BY GREAT RIVER HEALTH SYSTEMS, A RELATED ORGANIZATION. THE FOLLOWING WERE USED BY GREAT RIVER HEALTH SYSTEMS IN DETERMINING THE PRESIDENT & CEO'S 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 A IOWA FINANCE AUTHORITY 521699886 462466BV4 2008-07-24 37475000 REFUND OF PRIOR ISSUE (12/19/97) 0 0 0 B DES MOINES COUNTY IOWA 426004310 250087AA1 2012-04-04 60000000 REFUND PRIOR ISSUE (7/25/01) & CONSTRUCT, RENOVATE, EXPAND & EQUIP FACILITY 0 0 0 A 10485000 37475070 306661 68339 70 37100000 2000 1 0 1 1 B 12175439 60000000 616000 30076758 29307242 2013 1 0 1 1 B 0 0 0 0 0 0 0 A 0 0 1 1 1 0 0 0 1 B 0 0 1 1 0 0 0 0 1 A 1 B 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: IOWA FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 01/24/2009 ISSUER NAME: DES MOINES COUNTY, IOWA DATE THE REBATE COMPUTATION WAS PERFORMED: 01/31/2013 PART IV, LINE 2, REBATE CALCULATION NOTE REGARDING THE 01/24/2009 REBATE COMPUTATION: SINCE THE BOND PROCEEDS HAVE BEEN SPENT, A SPENDING EXCEPTION WAS MET, AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA FIDE BASIS, NO FURTHER REBATE CALCULATIONS ARE NECESSARY. PART IV, LINE 2, REBATE CALCULATION NOTE REGARDING THE 01/31/2013 REBATE COMPUTATION: SINCE THE BOND PROCEEDS HAVE BEEN SPENT, A SPENDING EXCEPTION WAS MET, AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA FIDE BASIS, NO FURTHER REBATE CALCULATIONS ARE NECESSARY. PART II, LINE 3, COLUMN A THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN E DUE TO INVESTMENT EARNINGS. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF THE CHAIRMAN OF THE BOARD, THE PRESIDENT AND CHIEF EXECUTIVE OFFICER, AND TWO OR MORE ADDITIONAL TRUSTEES. 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 GUADIAN AND ROBERT MCCULLEY HAVE A BUSINESS RELATIONSHIP. ROBERT FLEMING, KENT GAUDIAN, KENNETH ASPELMEIER, DAN WEIDEMEIER, MARK RICHARDSON AND TODD SLADKY HAVE BUSINESS RELATIONSHIPS BY SERVING ON FOR-PROFIT RELATED ENTITIES OF GRMC. ROBERT FLEMING AND KERRY FLEMING HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 3 ALL EXECUTIVE LEADERSHIP FUNCTIONS FOR GREAT RIVER MEDICAL CENTER 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 A, LINE 6 GREAT RIVER HEALTH SYSTEMS INC., IS THE SOLE MEMBER OF GREAT RIVER MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7A ONE TRUSTEE IS THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF GREAT RIVER MEDICAL CENTER AND THE REMAINING TRUSTEES ARE ELECTED BY THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING MATTERS ARE AUTHORIZED ONLY AFTER APPROVAL OF THE MEMBER: A. MERGER, CONSOLIDATION, OR DISSOLUTION OF GREAT RIVER MEDICAL CENTER WITH ANY OTHER CORPORATION OR LEGAL ENTITY. B. ANY CHANGE IN GREAT RIVER MEDICAL CENTER'S ARTICLES OF INCORPORATION. 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 TO THE BOARD 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 MEDICAL CENTER 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 2015. FORM 990, PART VI, SECTION C, LINE 19 GREAT RIVER MEDICAL CENTER MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 15,796,809. MANAGEMENT AND GENERAL EXPENSES 1,196,361. FUNDRAISING EXPENSES 12,913. TOTAL EXPENSES 17,006,083. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN TRUST -507,232. TRANSFER FROM RELATED PARTY -3,464,541. GREAT RIVER HEALTH SYSTEMS INC 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421193185 HEALTH CARE IA 501(C)(3) 11 - TYPE 2 N/A 0 GRMC FOUNDATION CORP 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421193186 SUPPORT RELATED ORGANIZATIONS IA 501(C)(3) 11 - TYPE 2 GRHS 0 GREAT RIVER FOUNDATION INC 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421469162 SUPPORT RELATED ORGANIZATIONS IA 501(C)(3) 11 - TYPE 2 GRHS 0 RIVERVIEW SYSTEMS LTD 1221 SOUTH GEAR AVE WEST BURLINGTON IA 52655 421191960 MEDICAL SERVICES IA N/A C 0 GREAT RIVER MEDICAL SERVICES INC 1221 SOUTH GEAR AVE WEST BURLINGTON IA 52655 421493449 MEDICAL SERVICES IA N/A C 0 MUTUAL CONSULTING & MANAGEMENT SERVICES 1221 SOUTH GEAR AVE WEST BURLINGTON IA 52655 421349668 MANAGEMENT SERVICES IA N/A C 0 HEALTH CARE REALTY 1221 SOUTH GEAR AVE WEST BURLINGTON IA 52655 421193532 REAL ESTATE IA N/A C 0 HERITAGE PARK PHARMACY 1221 SOUTH GEAR AVE WEST BURLINGTON IA 52655 421191957 PHARMACY IA N/A C 0 HERITAGE MEDICAL EQUIPMENT & SUPPLY 1221 SOUTH GEAR AVE WEST BURLINGTON IA 52655 421191958 MEDICAL SUPPLY IA N/A C 0 SOUTHEASTERN IOWA MEDICAL SERVICES 1221 SOUTH GEAR AVE WEST BURLINGTON IA 52655 421307141 PHYSICIAN CLINICS IA N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1