2014-02-15T11:58:21-06:00 2013-06-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2012-07-01 421193185 GREAT RIVER HEALTH SYSTEMS INC GREA 3197681000 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 TODD SLADKY 3197681000 2014-02-13 1 KACIE MCEWEN P01599614 6123764500 2012 2015-11-30 17:44:51Z MARK RICHARDSON 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 2654 0 X WWW.GREATRIVERMEDICAL.ORG X 1983 IA PROVIDE HEALTHCARE SERVICES 13 12 0 12 0 0 0 0 0 0 4075 2654 0 0 4075 2654 0 0 0 0 0 0 0 0 0 48050 45676 48050 45676 -43975 -43022 42073910 41045120 222710 115193 41851200 40929927 TO SERVE AS A HOLDING COMPANY OF VARIOUS SUBSIDIARIES PROVIDING HEALTH CARE. 0 0 0 0 0 TO SUPPORT GREAT RIVER MEDICAL CENTER, A NON-PROFIT 501(C)(3) ENTITY. 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 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 12 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X CHRISTINE DES JARDINS 3197681000 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 MARK RICHARDSON 0.30 40.60 X X 0 668126 46494 KENT GUADIAN 1.00 X X 0 0 0 DAN WIEDEMEIER 1.00 X X 0 0 0 ROBERT MCCULLEY 1.00 X X 0 0 0 MICHAEL MCCOY MD 1.00 X 0 0 0 LORRIN DEBLICK 1.00 X 0 0 0 KENNETH ASPELMEIER 1.00 3.00 X 0 0 0 DENNIS HINKLE 1.00 X 0 0 0 JACK HOBBS 1.00 X 0 0 0 JAN TOWNE 1.00 X 0 0 0 JOE ELLEN HOTH MD 1.00 X 0 0 0 DOUGLAS PETERS MD 1.00 X 0 0 0 ROBERT FLEMING 1.00 3.00 X 0 0 0 DON SCHMIDGALL 1.00 X 0 0 0 TONY HAYES 0.30 40.60 X 0 405763 43896 TODD SLADKY 0.30 40.60 X 0 365701 45177 0 1439590 135567 0 0 1 0 0 2654 2654 2654 0 0 2654 7692 7692 28173 28173 9705 9705 106 106 45676 0 45676 0 677932 346335 97 104 40747 21795 24141 24141 41330993 40652745 42073910 41045120 222710 115193 222710 115193 X 41851200 40929927 41851200 40929927 42073910 41045120 X -43022 -878251 X X 0 1 X 1 0 X X X 0 0 0 GREAT RIVER MEDICAL CENTER 420680407 3 1 1 1 45676 1 45676 0 INVESTMENT IN FOR-PROFIT SUBSIDIARIES 40652745 F 40652745 INTERCOMPANY PAYABLE 115193 115193 X X X X X X 0 0 0 0 0 0 0 0 0 MARK RICHARDSON 0 405196 0 40000 0 222930 0 10000 0 36494 0 714620 0 0 TONY HAYES 0 311237 0 20000 0 74526 0 10000 0 33896 0 449659 0 0 TODD SLADKY 0 265663 0 20000 0 80038 0 10000 0 35177 0 410878 0 0 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 GREAT RIVER HEALTH SYSTEMS' 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 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 THE COMPENSATION FOR THE CEO AND OTHER OFFICERS IS DETERMINED BY THE COMPENSATION COMMITTEE OF GRHS, HOWEVER THEIR SALARIES ARE PAID BY A RELATED FOR-PROFIT SUBSIDIARY. THE COMMITTEE USES THE FOLLOWING TO DETERMINE THE COMPENSATION OF THE CEO AND OTHER OFFICERS 1) INTEGRATED HEALTHCARE STRATEGIES EXECUTIVE COMPENSATION REPORT WHICH IS UPDATED EVER THREE YEARS AND IS AGED FOR THE YEARS IN BETWEEN, AND 2) THREE DIFFERENT NATIONAL EXECUTIVE COMPENSATION BENCHMARK SURVEYS. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: LOSS ON INVESTMENT IN SUBSIDIARY -7,407,742. TRANSFER FROM RELATED ORGANIZATIONS 6,529,491. PART XII, LINE 2C THE PROCESS IS CONSISTENT WITH PRIOR YEARS. 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 51140239 63619315 1.00000 0 GREAT RIVER MEDICAL SERVICES INC 1201 WEST AGENCY ROAD WEST BURLINGTON IA 52655 421493449 MEDICAL SERVICES IA GRHS C 8994016 2608451 1.00000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 GREAT RIVER FOUNDATION S 2850000 CASH GREAT RIVER MEDICAL CENTER S 3679495 CASH RIVERVIEW SYSTEMS LTD O 8972071 CASH RIVERVIEW SYSTEMS LTD S 805853 CASH