SOUTHEAST IOWA REGIONAL MEDICAL CENTER INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- SOUTHEAST IOWA REGIONAL MEDICAL CENTER INC (EIN 42-0680407)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-02-15
- IRS object ID
- 201410489349300421
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-02-15T11:59:49-06:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410746749 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 SOUTH SIXTH STREET SUITE 300 | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55402 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420680407 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GREAT RIVER MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | GREA | NameControl |
| Phone | 3197681000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1221 SOUTH GEAR AVENUE | AddressLine1 |
| City | WEST BURLINGTON | City |
| State | IA | State |
| ZIP Code | 52655 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TODD SLADKY | Name |
| Title | CFO | Title |
| Phone | 3197681000 | Phone |
| Date Signed | 2014-02-17 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KACIE MCEWEN | Name |
| PTIN | P01599614 | PTIN |
| Phone | 6123764500 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | MARK RICHARDSON | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1221 SOUTH GEAR AVENUE | AddressLine1 |
| City | WEST BURLINGTON | City |
| State | IA | State |
| ZIP Code | 52655 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 165808077 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.GREATRIVERMEDICAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1895 | YearFormation |
| State Legal Domicile | IA | StateLegalDomicile |
| Activity Or Mission Description | IMPROVING THE REGION'S HEALTH BY PROVIDING HIGH-QUALITY HEALTH CARE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 12 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1709 | TotalNbrEmployees |
| Total Nbr Volunteers | 424 | TotalNbrVolunteers |
| Total Gross UBI | 547445 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 958666 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1016251 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 171863980 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 163957745 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 600055 | InvestmentIncomePriorYear |
| Investment Income Current Year | 503139 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | -1252695 | OtherRevenuePriorYear |
| Other Revenue Current Year | 118667 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 172170006 | TotalRevenuePriorYear |
| Total Revenue Current Year | 165595802 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 4237225 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 1336000 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 80877822 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 81892550 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 88400 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 74896042 | OtherExpensePriorYear |
| Other Expenses Current Year | 77248319 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 160011089 | TotalExpensesPriorYear |
| Total Expenses Current Year | 160476869 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 12158917 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 5118933 | RevenuesLessExpensesCY |
| Total Assets BOY | 347121271 | TotalAssetsBOY |
| Total Assets EOY | 358931910 | TotalAssetsEOY |
| Total Liabilities BOY | 105853530 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 107387947 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 241267741 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 251543963 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 154482154 | Expense |
| Grants | 1336000 | Grants |
| Revenue | 163957745 | Revenue |
| Description | THE 213-BED ACUTE AND 160-BED LONG-TERM CARE HOSPITAL HAD 7,809 PATIENT ADMISSIONS AND 74,895 PATIENT DAYS OF MEDICAL CARE. IN ADDITION, NUMEROUS OUTPATIENT AND EMERGENCY ROOM PROCEDURES WERE PERFORMED. GREAT RIVER MEDICAL CENTER HAS ACCEPTED PAYMENT FROM MEDICARE AND MEDICAID, REDUCING MEDICAL BILLS FOR AREA RESIDENTS BY $143,670,900. COMMUNITY BENEFIT INFORMATION: SCHOOL PARTNERING $3,185; COMMUNITY EDUCATION $1,622; COMMUNITY INITIATIVE PARTICIPATION $11,737.50; PRENTAL EDUCATION $12,232.50; HEALTH FAIRS $5,298.46; COMMUNITY LIBRARY $30,482; CASH DONATIONS $1,336,000; TOTAL: $1,400,557 | Description |
| Total Program Service Expense | 154482154 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 87 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 1709 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 12 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | CHRISTINE DES JARDINS | NamePerson |
| Telephone Number | 3197681000 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1221 SOUTH GEAR AVENUE | AddressLine1 |
| City | WEST BURLINGTON | City |
| State | IA | State |
| ZIP Code | 52655 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (21 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| MARK RICHARDSON | ||||||||
| DIRECTOR / CEO | 40.00 | 1.00 | X | X | 0 | 668126 | 46494 | |
| KENT GAUDIAN | ||||||||
| CHAIRMAN | 1.00 | 0.00 | X | X | 0 | 0 | 0 | |
| DAN WIEDEMEIER | ||||||||
| VICE CHAIRMAN | 1.00 | 0.00 | X | X | 0 | 0 | 0 | |
| ROBERT MCCULLEY | ||||||||
| SECRETARY / TREASURER | 1.00 | 0.00 | X | X | 0 | 0 | 0 | |
| MICHAEL MCCOY MD | ||||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| LORRIN DEBLICK | ||||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| KENNETH ASPELMEIER | ||||||||
| DIRECTOR | 1.00 | 3.00 | X | 0 | 0 | 0 | ||
| DENNIS HINKLE | ||||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| JACK HOBBS | ||||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| JAN TOWNE | ||||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| JO ELLEN HOTH MD | ||||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| WILLIAM DAWS MD | ||||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| ROBERT FLEMING | ||||||||
| DIRECTOR | 1.00 | 3.00 | X | 0 | 0 | 0 | ||
| DON SCHMIDGALL | ||||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| TONY HAYES | ||||||||
| COO | 40.00 | 1.00 | X | 0 | 405763 | 43896 | ||
| TODD SLADKY | ||||||||
| CFO | 40.00 | 1.00 | X | 0 | 365701 | 45177 | ||
| DARWIN COOLEY | ||||||||
| DIRECTOR OF PHARMACY | 40.00 | 0.00 | 160445 | 0 | 32710 | X | ||
| JOHN MERCER III | ||||||||
| DIRECTOR OF FACILITIES | 40.00 | 0.00 | 133897 | 0 | 31461 | X | ||
| JEFFREY TAEGER | ||||||||
| DIRECTOR OF REHAB SERVICES | 40.00 | 0.00 | 127123 | 0 | 32127 | X | ||
| JON WILLIAMS | ||||||||
| PHARMACIST | 40.00 | 0.00 | 129177 | 0 | 25872 | X | ||
| TED SMITH | ||||||||
| PHYSICIAN'S ASSISTANT | 40.00 | 0.00 | 129350 | 0 | 24790 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 679992 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1439590 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 282527 | TotalOtherCompensation |
| Number Individuals GT100 K | 33 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| CARL A NELSON CO | |||||
| 1815 DES MOINES AVE | BURLINGTON | IA | 52601 | BUILDING CONSTRUCTION | 14853511 |
| SOUTHEASTERN IOWA MEDICAL SERVICES INC | |||||
| 1221 S GEAR AVE | WEST BURLINGTON | IA | 52655 | PHYSICIANS | 5492412 |
| MUTUAL CONSULTING & MANAGEMENT SERVICES | |||||
| 1221 S GEAR AVE | WEST BURLINGTON | IA | 52655 | EXECUTIVE MANAGEMENT | 3479928 |
| EXECUTIVE HEALTH RESOURCES INC | |||||
| 15 CAMPUS BLVD SUITE 200 | NEWTOWN SQUARE | PA | 19073 | PHYSICIAN ADVISORS | 429694 |
| UNIVERSITY OF IOWA HOSPITALS CLINICS | |||||
| 200 HAWKINS DRIVE | IOWA CITY | IA | 52242 | MEDICAL SERVICES | 358663 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 14 | NumberOfContractorsGT100K |
| All Other Contributions | 1016251 | AllOtherContributions |
| Total Contributions | 1016251 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| PATIENT SERVICE INCOME | 621110 | 160995662 | 160995662 | |
| OTHER OPERATING INCOME | 621300 | 2962083 | 2414638 | 547445 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 163957745 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 648085 | TotalRevenueColumn |
| Exclusion | $648,085 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 106725 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 54641 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 52084 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 52084 | TotalRevenueColumn |
| Exclusion | $52,084 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 12688 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 157634 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -144946 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -144946 | TotalRevenueColumn |
| Exclusion | -$144,946 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | MISCELLANEOUS INCOME | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 66583 | TotalRevenueColumn |
| Exclusion | $66,583 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 66583 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 165595802 | TotalRevenueColumn |
| Related Or Exempt Function Income | 163410300 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 547445 | UnrelatedBusinessRevenue |
| Exclusion | $621,806 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1336000 | Total |
| Program Services | 1336000 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1583941 | Total |
| Management And General | 1583941 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 63392720 | Total |
| Program Services | 63227720 | ProgramServices |
| Management And General | 113250 | ManagementAndGeneral |
| Fundraising | 51750 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2808646 | Total |
| Program Services | 2800546 | ProgramServices |
| Management And General | 5602 | ManagementAndGeneral |
| Fundraising | 2498 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9481185 | Total |
| Program Services | 9445211 | ProgramServices |
| Management And General | 23927 | ManagementAndGeneral |
| Fundraising | 12047 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4626058 | Total |
| Program Services | 4614517 | ProgramServices |
| Management And General | 8100 | ManagementAndGeneral |
| Fundraising | 3441 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1895987 | Total |
| Management And General | 1895987 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 65498 | Total |
| Program Services | 41143 | ProgramServices |
| Management And General | 24355 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 93655 | Total |
| Program Services | 93655 | ProgramServices |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17211072 | Total |
| Program Services | 16954389 | ProgramServices |
| Management And General | 242191 | ManagementAndGeneral |
| Fundraising | 14492 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18341356 | Total |
| Program Services | 18325817 | ProgramServices |
| Management And General | 14170 | ManagementAndGeneral |
| Fundraising | 1369 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 408601 | Total |
| Program Services | 240088 | ProgramServices |
| Management And General | 168513 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 420306 | Total |
| Program Services | 365124 | ProgramServices |
| Management And General | 54468 | ManagementAndGeneral |
| Fundraising | 714 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2981651 | Total |
| Program Services | 2981651 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11788164 | Total |
| Program Services | 11758509 | ProgramServices |
| Management And General | 29655 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1373032 | Total |
| Program Services | 724292 | ProgramServices |
| Management And General | 648740 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| DRUGS | 8592858 | 8592858 | ||
| BAD DEBT | 8009636 | 8009636 | ||
| REPAIRS/MAINTENANCE | 1755248 | 1750723 | 4525 | |
| FOOD | 1622892 | 1589894 | 31166 | 1832 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2688363 | Total |
| Program Services | 1630381 | ProgramServices |
| Management And General | 1057725 | ManagementAndGeneral |
| Fundraising | 257 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 160476869 | Total |
| Program Services | 154482154 | ProgramServices |
| Management And General | 5906315 | ManagementAndGeneral |
| Fundraising | 88400 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17874399 | BOY |
| EOY | 5375577 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19406050 | BOY |
| EOY | 18797527 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 519733 | BOY |
| EOY | 428208 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2509787 | BOY |
| EOY | 2866195 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1666347 | BOY |
| EOY | 1868495 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 308005925 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 141206630 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 144388748 | BOY |
| EOY | 166799295 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 158680289 | BOY |
| EOY | 160811668 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1214500 | BOY |
| EOY | 1258900 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 861418 | BOY |
| EOY | 726045 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 347121271 | BOY |
| EOY | 358931910 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10775232 | BOY |
| EOY | 7257028 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 79123333 | BOY |
| EOY | 86320549 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15954965 | BOY |
| EOY | 13810370 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 105853530 | BOY |
| EOY | 107387947 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 236853104 | BOY |
| EOY | 246813570 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3250655 | BOY |
| EOY | 3521223 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1163982 | BOY |
| EOY | 1209170 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 241267741 | BOY |
| EOY | 251543963 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 347121271 | BOY |
| EOY | 358931910 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 5118933 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 320897 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 4836392 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $31,226 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 31226 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | 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. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5099725 | OtherCostOrOtherBasis |
| Book Value | 5099725 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 122310811 | OtherCostOrOtherBasis |
| Depreciation | 29898543 | Depreciation |
| Book Value | 92412268 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 11697481 | OtherCostOrOtherBasis |
| Depreciation | 5088094 | Depreciation |
| Book Value | 6609387 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 150958707 | OtherCostOrOtherBasis |
| Depreciation | 106219993 | Depreciation |
| Book Value | 44738714 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 17939201 | OtherCostOrOtherBasis |
| Book Value | 17939201 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 166799295 | TotalOfBookValueLandBuildings |
Closely Held Equity Interests CloselyHeldEquityInterests
| Field | Value | IRS element (for citing) |
|---|---|---|
| Book Value | 155164159 | BookValue |
| Method Of Valuation | F | MethodOfValuation |
Other Securities OtherSecurities (2 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| CASH AND SHORT-TERM INVESTMENTS | 4326 | F |
| INSURANCE COMPANY ANNUITY DEPOSITS | 5643183 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 160811668 | TotalOfBookValueSecurities |
Other Liabilities OtherLiabilities (5 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DEFERRED COMPENSATION LIABILITY | $1,036,732 |
| THIRD PARTY PAYABLE | $1,372,441 |
| PTO RESERVE | $7,150,391 |
| FAIR VALUE OF CASH FLOW HEDGING SWAP | $4,204,556 |
| PLEDGES LIABILITY | $46,250 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 13810370 | TotalOfAmounts |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3991024 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 3991024 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02620 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 18964960 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 19770976 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -806016 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 22955984 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 19770976 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3185008 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02620 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 64557 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 64557 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1336000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1336000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00880 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1400557 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1400557 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00920 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 24356541 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 19770976 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4585565 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03540 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $8,009,636 | BadDebtExpenseAmount |
| Amount Attributable To | 1201445 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 53197629 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 58007636 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -4810007 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GREAT RIVER MEDICAL CENTER | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1221 SOUTH GEAR AVENUE | AddressLine1 |
| City | WEST BURLINGTON | City |
| State | IA | State |
| ZIP Code | 52655 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GREAT RIVER MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 0 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Develop Community Plan | X | DevelopCommunityPlan |
| Participate Community Plan | X | ParticipateCommunityPlan |
| Include Operational Plans | X | IncludeOperationalPlans |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | 0 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 300.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Other Actions Taken | X | OtherActionsTaken |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART I, LINE 3C: THE ORGANIZATION USES THE FPG TO DETERMINE FREE OR DISCOUNTED CARE. INDIVIDUALS WHO ARE BELOW 200% OF THE FPG QUALIFY FOR FREE CARE. IN MOST INSTANCES, THEY HAVE TO PROVIDE FINANCIAL DOCUMENTATION AND FILL OUT A CHARITY CARE APPLICATION. WE ALSO USE A PRESUMPTIVE CHARITY CARE PROGRAM THAT ANALYZES PUBLIC AND PRIVATE DATABASES TO HELP DETERMINE ELIGIBILITY 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 IN TO CONSIDERATION WHEN DETERMINING CHARITY CARE ELIGIBILITY. MEDICALLY INDIGENT INDIVIDUALS ARE COVERED UNDER THE SAME CHARITY CARE POLICY. INDIVIDUALS BETWEEN 200% AND 300% OF THE FEDERAL POVERTY LIMITS ARE GRANTED CHARITY ON A SLIDING SCALE. | |
| 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, L7 COL(F): BAD DEBT EXPENSES OF $8,009,636 WERE SUBTRACTED FROM THE TOTAL EXPENSES OF $160,476,869 IN CALCULATING THE PERCENTAGES IN PART I, LINE 7, COLUMN F. | |
| PART III, LINE 4: THE FOLLOWING IS FROM THE "ACCOUNTS RECEIVABLE AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS" PARAGRAPH IN NOTE 1 TO THE GREAT RIVER MEDICAL CENTER, GRMC FOUNDATION AND GREAT RIVER FOUNDATION, INC. COMBINED FINANCIAL STATEMENTS:"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 AS BAD DEBT EXPENSES WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF RECEIVABLES PEVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE WHEN RECEIVED."THE AMOUNT OF BAD DEBT EXPENSE REPORTED IN PART III, LINE 2 IS CALCULATED AS FOLLOWS: 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 AGREEMENTS WITH THIRD-PARTY PAYORS.THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY INCLUDED IN PART III, LINE 3 IS DETERMINED AS FOLLOWS: IF AN INDIVIDUAL DOES NOT HAVE A RESIDENCE THAT CAN BE USED TO RUN THROUGH THE PRESEUMPTIVE CHARITY CARE APPLICATION AND THEY DO NOT FILL OUT THE APPROPRIATE PAPERWORK TO APPLY FOR CHARITY, THEIR ACCOUNT BALANCE WILL BE WRITTEN OFF TO BAD DEBT. BASED UPON A REVIEW OF CHARITY APPLICATIONS THAT WERE REJECTED DUE TO INCOMPLETE/MISSING INFORMATION, IT HAS BEEN DETERMINED THAT APPROXIMATELY 15% OF THE APPLICATIONS WE RECEIVE ARE REJECTED BUT THE PATIENT APPEARS TO QUALIFY FOR CHARITY BUT THEY HAVEN'T NOT COMPLETED THE APPROPRIATE FORMS. | |
| PART III, LINE 8: A COST-TO-CHARGE RATIO AS DETERMINED BY THE 2013 MEDICARE COST REPORT WAS USED TO DETERMINE THE AMOUNTS IN PART III, LINES 5 AND 6. THE SHORTFALL REPORTED ON PART III, LINE 7 REPRESENTS THE CO-INSURANCE AND PATIENT DEDUCTIBLE AMOUNTS. | |
| PART III, LINE 9B: COLLECTION EFFORTS ARE DISCONTINUED ONCE THE PATIENT HAS BEEN APPROVED FOR CHARITY CARE. | |
| PART V, SECTION B, LINE 3: 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 5C: HTTP://GREATRIVERMEDICAL.ORG/ | GREAT RIVER MEDICAL CENTER |
| PART V, SECTION B, LINE 7: OUR STAKEHOLDERS FEEL THAT SUBSTANCE ABUSE AND TEENAGE PREGNANCIES ARE ISSUES BEST HANDLED BY ORGANIZATIONS THAT CAN HAVE A BROADER IMPACT ON THE ISSUE. HOWEVER, IF OR WHEN APPROACHED TO DEVELOP PARTNERSHIPS AND COLLABORATIONS TO COMBAT THESE TWO ISSUES, GRMC WILL WELCOME THESE OPPORTUNITIES. | GREAT RIVER MEDICAL CENTER |
| PART V, SECTION B, LINE 18E: THE HOSPITAL USES AN OUTSIDE SOURCE TO SCREEN PATIENTS TO SEE IF THEY COULD BE ELIGIBLE FOR FINANCIAL ASSISTANCE. WE GET NOTIFICATION BACK AS TO HOW MUCH OF A FINANCIAL ASSISTANCE DISCOUNT THEY WOULD BE ELIGIBLE FOR. IF THE PATIENT DOESN'T RESPOND TO OUR PHONE CALLS REGARDING FINANCIAL ASSISTANCE APPLICATION OR THEY DON'T COMPLETE THE APPLICATION, THE HOSPITAL WILL DISCOUNT THE PATIENT'S CHARGES AND THIS IS CONSIDERED PRESUMPTIVE CHARITY. PRESUMPTIVE CHARITY IS ALSO STATED IN OUR POLICY. IT ALSO GIVES THE HOSPITAL THE OPPORTUNITY TO DISCOUNT PATIENT ACCOUNTS BASED ON INFORMATION THAT WE MAY HAVE REGARDING A PATIENT BEING HOMELESS OR UNEMPLOYED. | GREAT RIVER MEDICAL CENTER |
| PART V, SECTION B, LINE 20D: 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. | GREAT RIVER MEDICAL CENTER |
| PART VI, LINE 2: GRMC IS AN ACTIVE PARTICIPANT IN COMMUNITY AND COUNTY GOVERNMENT TASK FORCES ON HEALTH NEEDS ASSESSMENT AND HEALTH SERVICES PLANNING AND COORDINATION. GRMC ASSESSES OUR COMMUNITIES' NEEDS THROUGH PROGRAMS WE OFFER, REQUESTS THAT ARE RECEIVED, AND OUR OWN STAFF INVOLVEMENT IN THEIR COMMUNITIES. WE ALSO COLLABORATE WITH OTHER COMMUNITY ORGANIZATIONS AS WELL, WHEN OUR SERVICES ARE NEEDED. AN ANNUAL HEALTH FAIR IS HOSTED TO PROVIDE INFORMATION AND EDUCATION TO OUR COMMUNITY ABOUT HEALTH ISSUES AND TO PROMOTE OUR HEALTHCARE SERVICES. WE ENCOURAGE OUR COMMUNITY MEMBERS TO TAKE AN ACTIVE ROLE IN THEIR OWN HEALTH CARE BY TAKING STEPS TOWARDS A HEALTHIER LIFESTYLE THROUGH MEMBERSHIP TO OUR GYM, A MULTITUDE OF EXERCISE PROGRAMS OFFERED THROUGH OUR FACILITY, AND OFFERING MANY WELLNESS PROGRAMS TO THE COMMUNITY. | |
| PART VI, LINE 3: FINANCIAL COUNSELORS MEET WITH PATIENTS. THE PATIENT FILLS OUT A QUESTIONNAIRE THAT HELPS THEM DETERMINE IF THEY QUALIFY FOR MEDICAID, CRIME VICTIMS, COBRA, AND OTHER MISC PROGRAMS. ON THE STATEMENTS, THERE IS PRINTED INFORMATION ABOUT FINANCIAL ASSISTANCE AND THE FINANCIAL ASSISTANCE APPLICATION IS ON THE HOSPITAL WEBSITE. THERE ARE PLANS TO ALSO HAVE THE CHARITY CARE POLICY AVAILABLE VIA THE WEB. | |
| PART VI, LINE 4: A REVIEW CONDUCTED BY THE MEDICAL CENTER ANALYZING THE ORIGIN OF PATIENTS UTILIZING THE SERVICES PROVIDED BY MEDICAL CENTER DURING THE FISCAL YEAR ENDED JUNE 30, 2013 INDICATES 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. THE DES MOINES COUNTY POPULATION IS ESTIMATED AT 40,340 RESIDENTS FOR 2012, WITH BURLINGTON AND WEST BURLINGTON TOTALING 28,633 AS OF 2012. THE OVER 65 AGE GROUP IS CURRENTLY 18.1% OF THE POPULATION WHICH IS HIGHER THAN THE STATE AVERAGE OF 15.3%. THE MEDIAN HOUSEHOLD INCOME WAS $43,427 COMPARED TO THE STATE AVERAGE OF $51,129. DES MOINES COUNTY POPULATION BELOW POVERTY LEVEL IS 14.5% COMPARED TO THE STATE AVERAGE OF 12.2%. GREAT RIVER MEDICAL CENTER IS PART OF A LARGER HEALTH SYSTEM THAT CONSISTS OF ONE HOSPITAL, MULTIPLE SPECIALTY PHYSICIAN CLINICS, HOME HEALTH SERVICES, A HOSPICE HOUSE, AMBULANCE SERVICES, A DAY CARE CENTER, THREE PHARMACIES, A DURABLE MEDICAL EQUIPMENT COMPANY, AND A LONG-TERM CARE NURSING HOME. | |
| PART VI, LINE 5: GRMC IS INVOLVED IN GETTING PHYSICIANS AND HEALTHCARE WORKERS TO THE AREA TO IMPROVE THE ACCESS TO HEALTHCARE NEEDS IN THE MEDICAL CENTER'S SERVICE AREA. GRMC ALSO PROMOTES HEALTH CARE RELATED JOBS EDUCATION BY WORKING CLOSELY WITH SOUTHEASTERN COMMUNITY COLLEGE AND THEIR NURSING PROGRAM.THE HOSPITAL ALSO PROVIDES MEMBERSHIP TO ALL PHYSICIANS WHO MEET MEMBERSHIP AND CLINICAL REQUIREMENTS. SURPLUS FUNDS ARE INVESTED IN IMPROVED AND/OR UPDATED CAPITAL EQUIPMENT TO ALLOW FOR BETTER CARE OF THE PATIENTS THAT ARE SERVED. | |
| PART VI, LINE 6: GREAT RIVER HEALTH SYSTEM SERVES AS A HOLDING COMPANY OF VARIOUS SUBSIDIARIES PROVIDING HEALTH CARE IN WEST BURLINGTON, IOWA. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (6 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| COMMUNITY ACTION OF SOUTHEAST IOWA | |||||||
| 2850 MT PLEASANT ST SUITE 108 | BURLINGTON | IA | 52601 | 420923961 | 501C3 | 20000 | MEDICAL ASSISTANCE PROGRAM |
| BURLINGTON NOON LIONS CLUB | |||||||
| 2601 CLEARVIEW AVENUE | BURLINGTON | IA | 52601 | 426056542 | 501C3 | 10000 | COMMUNITY BENEFIT |
| HOPE HAVEN | |||||||
| 1307 BROADWAY | WEST BURLINGTON | IA | 52655 | 421000580 | 501C3 | 20000 | COMMUNITY BENEFIT |
| MED-FORCE - QUAD CITY HELICOPTER EMS | |||||||
| 6907 NOTTINGHAM LANE | BETTENDORF | IA | 52722 | 421506559 | 501C3 | 6500 | COMMUNITY BENEFIT |
| GREAT RIVER FOUNDATION | |||||||
| 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 421469162 | 501C3 | 1200000 | COMMUNITY BENEFIT RELATED TO THE GENERAL OPERATIONS OF GRPC. |
| BIGGSVILLE FIRE PROTECTION DISTRICT | |||||||
| PO BOX 43 | BIGGSVILLE | IL | 61418 | 376146823 | 501C3 | 5520 | COMMUNITY BENEFIT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 10 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, 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. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARK RICHARDSON | ||||||||||||||
| DIRECTOR / CEO | 0 | 405196 | 0 | 40000 | 0 | 222930 | 0 | 10000 | 0 | 36494 | 0 | 714620 | 0 | 0 |
| TONY HAYES | ||||||||||||||
| COO | 0 | 311237 | 0 | 20000 | 0 | 74526 | 0 | 10000 | 0 | 33896 | 0 | 449659 | 0 | 0 |
| TODD SLADKY | ||||||||||||||
| CFO | 0 | 265663 | 0 | 20000 | 0 | 80038 | 0 | 10000 | 0 | 35177 | 0 | 410878 | 0 | 0 |
| DARWIN COOLEY | ||||||||||||||
| DIRECTOR OF PHARMACY | 160098 | 0 | 100 | 0 | 247 | 0 | 10086 | 0 | 22624 | 0 | 193155 | 0 | 0 | 0 |
| JOHN MERCER III | ||||||||||||||
| DIRECTOR OF FACILITIES | 133797 | 0 | 100 | 0 | 0 | 0 | 7581 | 0 | 23880 | 0 | 165358 | 0 | 0 | 0 |
| JEFFREY TAEGER | ||||||||||||||
| DIRECTOR OF REHAB SERVICES | 127023 | 0 | 100 | 0 | 0 | 0 | 6565 | 0 | 25562 | 0 | 159250 | 0 | 0 | 0 |
| JON WILLIAMS | ||||||||||||||
| PHARMACIST | 129077 | 0 | 100 | 0 | 0 | 0 | 7606 | 0 | 18266 | 0 | 155049 | 0 | 0 | 0 |
| TED SMITH | ||||||||||||||
| PHYSICIAN'S ASSISTANT | 120250 | 0 | 9100 | 0 | 0 | 0 | 5600 | 0 | 19190 | 0 | 154140 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SUPPLEMENTAL INFORMATION | Identifier |
| Return Reference | PART III | ReturnReference |
| Explanation | PART I, LINE 2: 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 | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Bond ReferenceBondReferenceCd | Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|---|
| IOWA FINANCE AUTHORITY | ||||||||
| A | 521699886 | 462466BV4 | 2008-07-24 | 37475000 | REFUND OF PRIOR ISSUE (12/19/97) | 0 | 0 | 0 |
| DES MOINES COUNTY IOWA | ||||||||
| B | 426004310 | 250087AA1 | 2012-04-04 | 60000000 | REFUND PRIOR ISSUE (7/25/01) & CONSTRUCT, RENOVATE, EXPAND & EQUIP FACILITY | 0 | 0 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Bond ReferenceBondReferenceCd | Amount RetiredAmountRetired | Total ProceedsTotalProceeds | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Credit EnhancementCreditEnhancement | Capital ExpendituresCapitalExpenditures | Other Spent ProceedsOtherSpentProceeds | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind |
|---|---|---|---|---|---|---|---|---|---|---|---|
| A | 7215000 | 37475070 | 306661 | 68339 | 70 | 37100000 | 2000 | 1 | 0 | 1 | 1 |
| B | 4035088 | 60000000 | 616000 | 30076758 | 29307242 | 2013 | 1 | 0 | 1 | 1 |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Bond Iss Meet Prvt Security Pay TestBondIssMeetPrvtSecurityPayTest | Change In Use Bond Financed PropChangeInUseBondFinancedProp | Non Qualified Bond Remed ProcdrsNonQualifiedBondRemedProcdrs |
|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| B | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiled | Rebate Not Due YetRebateNotDueYet | Exception To RebateExceptionToRebate | No Rebate DueNoRebateDue | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Written Proc To Monitor ReqsWrittenProcToMonitorReqs |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 1 | 1 | 1 | 0 | 0 | 0 | 0 |
| B | 0 | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 0 |
Form990 Schedule K Part V Form990ScheduleKPartV (2 entries)
| Bond ReferenceBondReferenceCd | Proc To Undertk Corrective ActionProcToUndertkCorrectiveAction |
|---|---|
| A | 0 |
| B | 0 |
Form990 Schedule K Part VI Form990ScheduleKPartVI (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SCHEDULE K PART IV, ARBITRAGE, LINE 2C | 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. | |
| PART III, PRIVATE BUSINESS USE | SPECIAL RULES FOR REFUNDING OF PRE-2003 ISSUES | GRMC IS NOT REQUIRED TO COMPLETE PART III OF SCHEDULE K FOR EITHER BONDS BECAUSE THE BOND ISSUANCES LISTED IN PART I WERE TO REFUND BONDS ISSUED PRIOR TO JANUARY 1, 2003. THE TAX SOFTWARE USED TO PREPARE THE FORM 990 DOESN'T ALLLOW FOR THE SUPPRESSING OF THIS SECTION, THEREFORE, THESE ANSWERS ARE ANSWERED NO INSTEAD OF BEING LEFT BLANK. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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. THE EXECUTIVE COMMITTEE HAS GENERAL RESPONSIBILITY FOR THE INVESTMENT OF AN ENDOWMENT AND OTHER CAPITAL FUNDS OF THE HOSPITAL. | |
| 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 | GREAT RIVER MEDICAL CENTER FORM 990 WILL BE SENT OUT BY SECURE EMAIL MESSAGE TO ALL BOARD MEMBERS PRIOR TO FILING. IF THERE ARE ANY QUESTIONS, THEY CAN CONTACT THE ACCOUNTING OFFICE OR THEY CAN BE ADDRESSED AT THE NEXT BOARD MEETING. | |
| FORM 990, PART VI, SECTION B, LINE 12C | EVERY YEAR, THE ACCOUNTING MANAGER 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 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 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 10,982,828. MANAGEMENT AND GENERAL EXPENSES 242,191. FUNDRAISING EXPENSES 14,492. TOTAL EXPENSES 11,239,511. SPECIALIST FEES: PROGRAM SERVICE EXPENSES 5,971,561. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,971,561. | OTHER FEES |
| FORM 990, PART XI, LINE 9: | UNREALIZED GAIN ON INTEREST RATE SWAP 1,987,099. TRANSFER FROM RELATED PARTY 2,849,293. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2C | THIS PROCESS IS CONSISTENT WITH PRIOR YEARS. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | 0 | GRHS | |
| GREAT RIVER FOUNDATION INC | |||||||||||
| 1221 SOUTH GEAR AVENUE | WEST BURLINGTON | IA | 52655 | 421469162 | SUPPORT RELATED ORGANIZATIONS | IA | 501(C)(3) | 11 - TYPE 2 | 0 | GRHS | |
Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Type Of EntityTypeOfEntity | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|
| RIVERVIEW SYSTEMS LTD | |||||||||
| PO BOX 640 | WEST BURLINGTON | IA | 52655 | 421191960 | MEDICAL SERVICES | IA | N/A | C | 0 |
| GREAT RIVER MEDICAL SERVICES INC | |||||||||
| 1201 WEST AGENCY ROAD | WEST BURLINGTON | IA | 52655 | 421493449 | MEDICAL SERVICES | IA | N/A | C | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
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