SOUTHEAST IOWA REGIONAL MEDICAL CENTER INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
SOUTHEAST IOWA REGIONAL MEDICAL CENTER INC (EIN 42-0680407)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-04-09
IRS object ID
201201009349300610
Schema version
2010v3.4
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-04-09T10:10:06-05:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1220 SOUTH SIXTH STREET SUITE 300AddressLine1
CityMINNEAPOLISCity
StateMNState
ZIP Code55402ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN420680407EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1GREAT RIVER MEDICAL CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlGREANameControl
Phone3197681000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11221 SOUTH GEAR AVENUEAddressLine1
CityWEST BURLINGTONCity
StateIAState
ZIP Code52655ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameTODD SLADKYName
TitleCFOTitle
Phone3197681000Phone
Date Signed2012-03-29DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Phone6123764500Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonTODD SLADKYNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11221 SOUTH GEAR AVENUEAddressLine1
CityWEST BURLINGTONCity
StateIAState
ZIP Code52655ZIPCode
FieldValueIRS element (for citing)
Gross Receipts171174482GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.GREATRIVERMEDICAL.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1895YearFormation
State Legal DomicileIAStateLegalDomicile
Activity Or Mission DescriptionIMPROVING THE REGION'S HEALTH BY PROVIDING HIGH-QUALITY HEALTH CARE.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees1746TotalNbrEmployees
Total Nbr Volunteers475TotalNbrVolunteers
Total Gross UBI501522TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year39280172ContributionsGrantsPriorYear
Contributions Grants Current Year9137222ContributionsGrantsCurrentYear
Program Service Revenue Prior Year159219042ProgramServiceRevenuePriorYear
Program Service Revenue CY160733018ProgramServiceRevenueCY
Investment Income Prior Year585890InvestmentIncomePriorYear
Investment Income Current Year684667InvestmentIncomeCurrentYear
Other Revenue Prior Year280174OtherRevenuePriorYear
Other Revenue Current Year399942OtherRevenueCurrentYear
Total Revenue Prior Year199365278TotalRevenuePriorYear
Total Revenue Current Year170954849TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year1119732GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY3990000GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year78390336SalariesEtcPriorYear
Salaries Etc Current Year82773616SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year86217TotalFundrsngExpCurrentYear
Other Expense Prior Year73686940OtherExpensePriorYear
Other Expenses Current Year73068872OtherExpensesCurrentYear
Total Expenses Prior Year153197008TotalExpensesPriorYear
Total Expenses Current Year159832488TotalExpensesCurrentYear
Revenues Less Expenses Prior Year46168270RevenuesLessExpensesPriorYear
Revenues Less Expenses CY11122361RevenuesLessExpensesCY
Total Assets BOY300910073TotalAssetsBOY
Total Assets EOY308090680TotalAssetsEOY
Total Liabilities BOY87750416TotalLiabilitiesBOY
Total Liabilities EOY83059070TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY213159657NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY225031610NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionGREAT 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 Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense154349996Expense
Grants3990000Grants
Revenue160733018Revenue
DescriptionTHE 213-BED ACUTE AND 143-BED LONG-TERM CARE HOSPITAL HAD 7,956 PATIENT ADMISSIONS AND 71,230 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 THE MEDICAL BILLS FOR AREA RESIDENTS BY $130,247,338. COMMUNITY BENEFIT INFORMATION: SCHOOL PARTNERING: $23,095COMMUNITY EDUCATION: $2,069COMMUNITY INITIATIVE PARTICIPATION: $17,175SCREENING/FIRST AID: $5,805PRENATAL EDUCTION: $13,878HEALTH FAIRS: $1,470CASH DONATIONS: $114,243TOTAL: $177,736Description
Total Program Service Expense154349996TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096113NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees1746NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonCHRISTINE DES JARDINSNamePerson
Telephone Number3197681000TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11221 SOUTH GEAR AVENUEAddressLine1
CityWEST BURLINGTONCity
StateIAState
ZIP Code52655ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (20 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
KENNETH ASPELMEIER
DIRECTOR1.00X000
KENT GAUDIAN
CHAIRMAN1.00X000X
MICHAEL MCCOY MD
DIRECTOR1.00X000
LORRIN DEBLICK
DIRECTOR1.00X000
DENNIS HINKLE
DIRECTOR1.00X000
JACK HOBBS
DIRECTOR1.00X000
JAN TOWNE
DIRECTOR1.00X000
JO ELLEN HOTH MD
DIRECTOR1.00X000
ROBERT MCCULLEY
SECRETARY/TREASURER1.00X000X
MARK RICHARDSON
DIRECTOR/CEO1.00X064006040654X
DAN WIEDEMEIER
VICE CHAIRMAN1.00X000X
ROBERT FLEMMING
DIRECTOR1.00X000
DOUG PETERS MD
DIRECTOR1.00X000
TONY HAYES
COO1.00038667438205X
TODD SLADKY
CFO1.00032692640161X
DARWIN COOLEY
DIRECTOR OF PHARMACY40.00152288027828X
JON WILLIAMS
PHARMACIST40.00136143021625X
LEO BANWART
PHYSICIAN'S ASSISTANT40.00133230027932X
GAIL BOYD
DIRECTOR OF SURGICAL SERVICES40.00125587016679X
JOHN MERCER III
DIRECTOR OF FACILITIES40.00124803026678X
FieldValueIRS element (for citing)
Total Reportable Comp From Org672051TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1353660TotalReportableCompFrmRltdOrgs
Total Other Compensation239762TotalOtherCompensation
Number Individuals GT100 K22NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
SOUTHEASTERN IOWA MEDICAL SERVICES INC
1221 S GEAR AVEWEST BURLINGTONIA52655PHYSICIANS3862353
MUTUAL CONSULTING & MANAGEMENT SERVICES
1221 S GEAR AVEWEST BURLINGTONIA52655EXECUTIVE MANAGEMENT3391491
CARL A NELSON CO
1815 DES MOINES AVEBURLINGTONIA52601BUILDING CONSTRUCTION1496913
HORTY ELVING & ASSOCIATES
505 EAST GRANT STREETMINNEAPOLISMN55404ARCHITECTURE361665
BAUDINO LAW FIRM PC
2600 GRAND AVENUE STE 300DES MOINESIA50312LEGAL SERVICES289820
FieldValueIRS element (for citing)
Number Of Contractors GT100 K14NumberOfContractorsGT100K
Related Organizations7779556RelatedOrganizations
All Other Contributions1357666AllOtherContributions
Total Contributions9137222TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
PATIENT SERVICE INCOME621110158276443158276443
OTHER OPERATING INCOME62130024565751955053501522
FieldValueIRS element (for citing)
Total Program Service Revenue160733018TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column481671TotalRevenueColumn
Exclusion$481,671ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real98349Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real59351Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real38998Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column38998TotalRevenueColumn
Exclusion$38,998ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other363278Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other160282Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other202996Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column202996TotalRevenueColumn
Exclusion$202,996ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMISCELLANEOUS INCOMEDescription
Business Code900099BusinessCode
Total Revenue Column360944TotalRevenueColumn
Exclusion$360,944ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue360944TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column170954849TotalRevenueColumn
Related Or Exempt Function Income160231496RelatedOrExemptFunctionIncome
Unrelated Business Revenue501522UnrelatedBusinessRevenue
Exclusion$1,084,609ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total3990000Total
Program Services3990000ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1933692Total
Management And General1933692ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total61492831Total
Program Services61306195ProgramServices
Management And General137796ManagementAndGeneral
Fundraising48840Fundraising

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total2754114Total
Program Services2744633ProgramServices
Management And General7076ManagementAndGeneral
Fundraising2405Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total11854855Total
Program Services11820060ProgramServices
Management And General24568ManagementAndGeneral
Fundraising10227Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total4738124Total
Program Services4724861ProgramServices
Management And General9956ManagementAndGeneral
Fundraising3307Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total1435652Total
Management And General1435652ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total138896Total
Program Services26186ProgramServices
Management And General112710ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total99160Total
Program Services99160ProgramServices

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total348504Total
Program Services82984ProgramServices
Management And General265520ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total18480408Total
Program Services18462033ProgramServices
Management And General16983ManagementAndGeneral
Fundraising1392Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total711642Total
Program Services531795ProgramServices
Management And General179847ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total353619Total
Program Services323310ProgramServices
Management And General29698ManagementAndGeneral
Fundraising611Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total3250912Total
Program Services3250912ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total12426987Total
Program Services12204591ProgramServices
Management And General222396ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1605686Total
Program Services769873ProgramServices
Management And General835813ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
DRUGS83938718393871
CONTRACTUAL SERVICES823379681288058752417467
BAD DEBT72028337202833
SPECIALIST FEES45094734509473
FOOD15627241546492143641868

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total4314709Total
Program Services4231929ProgramServices
Management And General82680ManagementAndGeneral
Fundraising100Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total159832488Total
Program Services154349996ProgramServices
Management And General5396275ManagementAndGeneral
Fundraising86217Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY11155271BOY
EOY6873726EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY18622192BOY
EOY19145274EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY984954BOY
EOY673087EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY3099074BOY
EOY2770752EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1887318BOY
EOY1660000EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis261122563LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec133286335LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY130314077BOY
EOY127836228EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY133440511BOY
EOY147816225EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1406676BOY
EOY1315388EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY300910073BOY
EOY308090680EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY8080066BOY
EOY6347512EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY64281373BOY
EOY62315273EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY15388977BOY
EOY14396285EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY87750416BOY
EOY83059070EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY209155550BOY
EOY220583863EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2904229BOY
EOY3202523EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1099878BOY
EOY1245224EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY213159657BOY
EOY225031610EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY300910073BOY
EOY308090680EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses11122361ReconcilationRevenueExpenses
Reconcilation Other Changes749592ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$28,173OtherActivitiesAmount
Total Lobbying Expenditures IIB28173TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF OTHER LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1I:ReturnReference
ExplanationGREAT 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

FieldValueIRS element (for citing)
Other Cost Or Other Basis5159725OtherCostOrOtherBasis
Book Value5159725BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis96648800OtherCostOrOtherBasis
Depreciation28343372Depreciation
Book Value68305428BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis9334430OtherCostOrOtherBasis
Depreciation4144991Depreciation
Book Value5189439BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis144792156OtherCostOrOtherBasis
Depreciation100797972Depreciation
Book Value43994184BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis5187452OtherCostOrOtherBasis
Book Value5187452BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings127836228TotalOfBookValueLandBuildings

Closely Held Equity Interests CloselyHeldEquityInterests

FieldValueIRS element (for citing)
Book Value142476814BookValue
Method Of ValuationFMethodOfValuation

Other Securities OtherSecurities (2 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
CASH AND SHORT-TERM INVESTMENTS1287F
INSURANCE COMPANY ANNUITY DEPOSITS5338124F
FieldValueIRS element (for citing)
Total Of Book Value Securities147816225TotalOfBookValueSecurities

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
DEFERRED COMPENSATION LIABILITY$1,097,741
THIRD PARTY PAYABLE$2,830,000
PTO RESERVE$6,798,997
FAIR VALUE OF CASH FLOW HEDGING SWAP$3,669,547
FieldValueIRS element (for citing)
Total Of Amounts14396285TotalOfAmounts

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare

Discounted Other DiscountedOther

FieldValueIRS element (for citing)
OtherXOther
Discounted Other Percentage0.0DiscountedOtherPercentage
FieldValueIRS element (for citing)
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense3351900TotalCommunityBenefitExpense
Net Community Benefit Expense3351900NetCommunityBenefitExpense
Percent Of Total Expense0.02200PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense19633800TotalCommunityBenefitExpense
Direct Offsetting Revenue18229472DirectOffsettingRevenue
Net Community Benefit Expense1404328NetCommunityBenefitExpense
Percent Of Total Expense0.00920PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense22985700TotalCommunityBenefitExpense
Direct Offsetting Revenue18229472DirectOffsettingRevenue
Net Community Benefit Expense4756228NetCommunityBenefitExpense
Percent Of Total Expense0.03120PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense63592TotalCommunityBenefitExpense
Net Community Benefit Expense63592NetCommunityBenefitExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense114243TotalCommunityBenefitExpense
Net Community Benefit Expense114243NetCommunityBenefitExpense
Percent Of Total Expense0.00070PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense177835TotalCommunityBenefitExpense
Net Community Benefit Expense177835NetCommunityBenefitExpense
Percent Of Total Expense0.00110PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense23163535TotalCommunityBenefitExpense
Direct Offsetting Revenue18229472DirectOffsettingRevenue
Net Community Benefit Expense4934063NetCommunityBenefitExpense
Percent Of Total Expense0.03230PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$3,331,233BadDebtExpenseAmount
Amount Attributable To799496AmountAttributableTo
Amount Reimbursed By Medicare51677695AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare60206570CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-8528875MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1GREAT RIVER MEDICAL CENTERBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11221 SOUTH GEAR AVENUEAddressLine1
CityWEST BURLINGTONCity
StateIAState
ZIP Code52655ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)

ExplanationExplanation
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 ANALZYES 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 PROVERTY LIMITS ARE GRANTED CHARITY ON A SLIDING SCALE
PART I, L7 COL(F): BAD DEBT EXPENSES OF $7,202,833 WERE SUBTRACTED FROM THE TOTAL EXPENSES OF $159,832,488 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 (AT COST) 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 (AT COST) 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 24% 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 2011 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 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 QUESTIONAIRRE 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, 2011 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 40,751 RESIDENTS FOR 2010, WITH BURLINGTON AND WEST BURLINGTON TOTALING 28,631 AS OF 2010. THE OVER 65 AGE GROUP IS CURRENTLY 17.6% OF THE POPULATION WHICH IS HIGHER THAN THE STATE AVERAGE OF 14.8%. THE MEDIAN HOUSEHOLD INCOME WAS $42,115 WITH 12.8% OF THE POPULATION BEING BELOW THE POVERTY LEVEL. 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 6: 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 7: GREAT RIVER HEALTH SYSTEM SERVES AS A HOLDING COMPANY OF VARIOUS SUBSIDIARIES PROVIDING HEALTH CARE IN WEST BURLINGTON, IOWA.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (6 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
GREAT RIVER HEALTH SYSTEMS
1221 SOUTH GEAR AVENUEWEST BURLINGTONIA52655421193185501(C)(3)3900000SUPPORT GENERAL OPERATIONS.
SOUTHEASTERN COMMUNITY COLLEGE
1500 W AGENCY RDWEST BURLINGTONIA52655420926823501(C)(3)20000NURSING PROGRAM
PARTNERS FOR CONSERVATION FOUNDATION
PO BOX 714BURLINGTONIA52601421187080501(C)(3)10000TO EXPAND THE FLINT RIVER WALKING/HIKING TRAIL
THE SALVATION ARMY
217 S 3RD STBURLINGTONIA52601133485289501(C)(3)20000CAPITAL CAMPAIGN
GROW GREATER BURLINGTON
610 N 4TH ST STE 200BURLINGTONIA52601420982794501(C)(3)25000COMMUNTIY BENEFIT
THE UNIVERSITY OF IOWA FOUNDATION
PO BOX 4550IOWA CITYIA522444550426004813501(C)(3)15000COMMUNITY BENEFIT
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants6TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: GREAT RIVER MEDICAL CENTER ("GRMC") MAKES TWO TYPES OF GRANTS. FIRST, GRMC GRANTS MONEY TO RELATED ORGANIZATIONS UNDER THE COMMON CONTROL AND MANAGEMENT OF GREAT RIVER HEALTH SYSTEMS INC. SECOND, GRMC GRANTS MONEY TO WELL KNOWN AND WELL ESTABLISHED CHARITABLE ORGANIZATIONS IN ITS COMMUNITY. BECAUSE THE GRANT RECIPIENTS ARE GENERALLY REQUIRED TO FOLLOW THE SAME REPORTING AND COMPLIANCE LAWS AS GRMC, GRMC DOES NOT TAKE ANY SPECIAL MEASURES TO MONITOR THE USE OF GRANTED FUNDS. RATHER GRMC TRUSTS THAT EACH ORGANIZATION'S OVERSIGHT PROCESS WILL ENSURE THAT THE FUNDS ARE USED APPROPRIATELY.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
MARK RICHARDSON
0377801030000023225909800030854068071400
TONY HAYES
03130090680006686509800028405042487900
TODD SLADKY
02591690500006275709800030361036708700
DARWIN COOLEY
151637000651095780182500180116000
JON WILLIAMS
132294075000-3651073300142950157768000
LEO BANWART
131454090000-7224049040230280161162000
JOHN MERCER III
127385000-2582071180195600151481000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSUPPLEMENTAL INFORMATIONIdentifier
Return ReferencePART IIIReturnReference
ExplanationPART 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 COMMITTEEExplanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1IOWA FINANCE AUTHORITYBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN521699886IssuerEIN
CUSIP Number462466BV4CUSIPNumber
Date Issued2008-07-01DateIssued
Issue Price37475000IssuePrice
Description Of PurposePROCEEDS USED TO REFUND SERIES 1997 ADJUSTABLE DEMAND REVENUE BONDSDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Amount Retired4220000AmountRetired
Total Proceeds37475000TotalProceeds
Issuance Costs From Proceeds375000IssuanceCostsFromProceeds
Other Spent Proceeds37100000OtherSpentProceeds
Year Of Subst Completion2027YearOfSubstCompletion
Current Refunding0CurrentRefunding
Advance Refunding1AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Post Issuance Compliance Procdrs0PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 1PER THE BYLAWS OF THE ORGANIZATION: "THE BOARD OF DIRECTORS HAS AN EXECUTIVE COMMITTEE. 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 ALL ENDOWMENT AND OTHER CAPITAL FUNDS OF THE HOSPITAL."
FORM 990, PART VI, SECTION A, LINE 3ALL 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 A, LINE 6GREAT RIVER HEALTH SYSTEMS INC., IS THE SOLE MEMBER OF GREAT RIVER MEDICAL CENTER.
FORM 990, PART VI, SECTION A, LINE 7AONE 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 7BTHE FOLLOWING MATTERS ARE AUTHORIZED ONLY AFTER APPROVAL OF THE MEMBER: A. MERGER OR CONSOLIDATION 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 11A COPY OF GRMC'S FORM 990 WAS REVIEWED IN DETAIL BY MANAGEMENT AND THEN A COPY WAS DISTRIBUTED TO THE FULL BOARD OF DIRECTORS FOR APPROVAL PRIOR TO FILING WITH THE IRS.
EVERY YEAR, THE ACCOUNTING SUPERVISOR 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 SUPERVISOR. 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 12C
GREAT RIVER MEDICAL CENTER MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST.FORM 990, PART VI, SECTION C, LINE 19
EXPLANATION FOR HOURS WORKEDMARK RICHARDSON, TONY HAYES, AND TODD SLADKY, EACH SERVE GREAT RIVER HEALTH SYSTEMS INC., AND ITS RELATED ORGANIZATIONS. EACH INDIVIDUAL SPENDS APPROXIMATELY 40 HOURS PER WEEK COLLECTIVELY WORKING FOR ALL OF THE RELATED ORGANIZATIONS.FORM 990, PART VII, SECTION A
CHANGES IN NET ASSETS OR FUND BALANCES:UNREALIZED GAIN ON INTEREST RATE SWAP 749,592. TOTAL TO FORM 990, PART XI, LINE 5: 749,592.FORM 990, PART XI, LINE 5:
THIS PROCESS IS CONSISTENT WITH PRIOR YEARS.FORM 990, PART XII, LINE 2C

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
GREAT RIVER HEALTH SYSTEMS INC
1221 SOUTH GEAR AVENUEWEST BURLINGTONIA52655421193185HEALTH CAREIA501(C)(3)11 - TYPE 2N/A0
GRMC FOUNDATION INC
1221 SOUTH GEAR AVENUEWEST BURLINGTONIA52655421193186FUNDRAISINGIA501(C)(3)11 - TYPE 20GRHS
GREAT RIVER FOUNDATION
1221 SOUTH GEAR AVENUEWEST BURLINGTONIA52655421469162FUNDRAISINGIA501(C)(3)11 - TYPE 20GRHS

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntity
RIVERVIEW SYSTEMS LTD
PO BOX 640WEST BURLINGTONIA52655421191960MEDICAL SERVICESIAGRHSC
GREAT RIVER MEDICAL SERVICES INC
1201 WEST AGENCY ROADWEST BURLINGTONIA52655421493449MEDICAL SERVICESIAGRHSC
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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