2015-05-15T09:13:44-05:00 2014-06-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2013-07-01 421193185 GREAT RIVER HEALTH SYSTEMS INC GREA 3197681000 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 TODD SLADKY CFO 3197681000 2015-05-11 1 KACIE MCEWEN P01599614 6123764500 2013 2016-02-25 16:41:14Z MARK RICHARDSON 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 1132 0 X WWW.GREATRIVERMEDICAL.ORG X 1983 IA TO SERVE AS A HOLDING COMPANY OF VARIOUS SUBSIDIARIES PROVIDING HEALTH CARE. 13 11 0 12 0 0 0 0 0 0 2654 1132 0 0 2654 1132 0 0 0 0 0 0 0 0 0 45676 17180 45676 17180 -43022 -16048 41045120 42230440 115193 161358 40929927 42069082 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 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 CHRISTINE DES JARDINS 3197681000 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 KENT GUADIAN CHAIRMAN 1.00 1.00 X X 0 0 0 DAN WIEDEMEIER VICE CHAIRMAN 1.00 1.00 X X 0 0 0 ROBERT MCCULLEY SECRETARY / TREASURER 1.00 1.00 X X 0 0 0 MICHAEL MCCOY MD DIRECTOR 1.00 1.00 X 0 321928 27608 LORRIN DEBLIECK DIRECTOR 1.00 1.00 X 0 0 0 KENNETH ASPELMEIER DIRECTOR 1.00 3.00 X 0 0 0 DENNIS HINKLE DIRECTOR 1.00 1.00 X 0 0 0 JAN TOWNE DIRECTOR 1.00 1.00 X 0 0 0 JO ELLEN HOTH MD DIRECTOR 1.00 1.00 X 0 0 0 ROBERT FLEMING DIRECTOR 1.00 3.00 X 0 0 0 DON SCHMIDGALL DIRECTOR 1.00 1.00 X 0 0 0 WILLIAM DAWS DIRECTOR 1.00 1.00 X 0 0 0 MARK RICHARDSON PRESIDENT/CEO 0.40 40.60 X X 0 702284 47184 TONY HAYES COO 0.40 40.60 X 0 442286 42193 TODD SLADKY CFO 0.40 40.60 X 0 402570 43998 0 1869068 160983 0 0 1 0 0 1132 1132 1132 0 0 1132 8490 8490 8450 8450 240 240 17180 0 17180 0 346335 393531 104 3096 21795 1725 24141 24140 40652745 41807948 41045120 42230440 115193 161358 115193 161358 X 40929927 42069082 40929927 42069082 41045120 42230440 X -16048 1155203 X 0 1 X 1 0 X X X 0 0 0 GREAT RIVER MEDICAL CENTER 420680407 3 1 1 1 17180 1 17180 0 INVESTMENT IN FOR-PROFIT SUBSIDIARIES 41807948 F 41807948 INTERCOMPANY PAYABLE 161358 161358 X PART X, LINE 2: DESCRIPTION FROM CONSOLIDATED AUDITED FINANCIAL STATEMENT 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. THE TAX RETURNS FOR THE YEARS 2009 THROUGH 2013 ARE OPEN TO EXAMINATION BY FEDERAL, STATE AND LOCAL AUTHORITIES. X X X X X X 0 0 0 0 0 0 0 0 0 MICHAEL MCCOY MD DIRECTOR 0 321928 0 0 0 0 0 10200 0 17408 0 349536 0 0 MARK RICHARDSON PRESIDENT/CEO 0 536948 0 45000 0 120336 0 10200 0 36984 0 749468 0 0 TONY HAYES COO 0 345374 0 0 0 96912 0 10200 0 31993 0 484479 0 0 TODD SLADKY CFO 0 320738 0 0 0 81832 0 10200 0 33798 0 446568 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, 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, ACCOUNTING MANAGER 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 ACCOUNTING MANAGER 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 ACCOUNTING MANAGER. 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 AN ANNUAL 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 15,350,000. LOSS IN INVESTMENT IN SUBSIDIARIES -14,194,797. 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 50407086 48357987 1.00000 1 GREAT RIVER MEDICAL SERVICES INC 1201 WEST AGENCY ROAD WEST BURLINGTON IA 52655 421493449 MEDICAL SERVICES IA GRHS C 6864393 2707883 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 12650000 CASH GRMC FOUNDATION S 2700000 CASH