2012-04-09T10:10:18-05:00 2011-06-30 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2010-07-01 421193185 GREAT RIVER HEALTH SYSTEMS INC GREA 3197681000 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 TODD SLADKY 3197681000 2012-03-29 1 6123764500 2010 2016-02-24 21:20:13Z MARK RICHARDSON 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 8359721 0 X WWW.GREATRIVERMEDICAL.ORG X 1983 IA PROVIDE HEALTHCARE SERVICES 13 12 0 12 0 0 4000000 8350000 0 0 17586 9721 0 0 4017586 8359721 0 0 0 0 0 0 0 0 0 93546 73642 93546 73642 3924040 8286079 41816525 42463802 153318 384154 41663207 42079648 TO PROVIDE 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 1 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 0 0 0 1 1 1 1 1 1 0 0 0 X CHRISTINE DES JARDINS 3197681000 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 X KENNETH ASPELMEIER 1.00 X 0 0 0 KENT GAUDIAN 1.00 X X 0 0 0 MICHAEL MCCOY MD 1.00 X 0 0 0 LORRIN DEBLICK 1.00 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 JO ELLEN HOTH MD 1.00 X 0 0 0 ROBERT MCCULLEY 1.00 X X 0 0 0 MARK RICHARDSON 1.00 X X 0 640060 40654 DAN WIEDEMEIER 1.00 X X 0 0 0 ROBERT FLEMMING 1.00 X 0 0 0 DOUG PETERS MD 1.00 X 0 0 0 TONY HAYES 1.00 X 0 386674 38205 TODD SLADKY 1.00 X 0 326926 40161 0 1353660 119020 0 0 1 0 0 8350000 8350000 9721 9721 8359721 0 0 9721 23364 23364 34557 34557 15625 15625 96 96 73642 0 73642 0 557562 490021 414 229 148443 85307 22778 41110106 41865467 0 0 41816525 42463802 4846 153318 379308 153318 384154 X 41663207 42079648 41663207 42079648 41816525 42463802 X 8286079 -7869639 X X 0 1 1 X 0 X X X 0 0 0 GREAT RIVER MEDICAL CENTER 420680407 3 1 1 1 73642 1 73642 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 INVESTMENT IN FOR-PROFIT SUBSIDIARIES 41865467 F 41865467 DUE TO GRMC 379308 379308 X X X X X X 0 0 0 0 0 0 0 0 0 MARK RICHARDSON 0 377801 0 30000 0 232259 0 9800 0 30854 0 680714 0 0 TONY HAYES 0 313009 0 6800 0 66865 0 9800 0 28405 0 424879 0 0 TODD SLADKY 0 259169 0 5000 0 62757 0 9800 0 30361 0 367087 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 A, LINE 8B THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF GRHS' 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. FORM 990, PART VI, SECTION B, LINE 12C EVERY YEAR, THE ACCOUNTING SUPERVISOR IN THE ACCOUNTING DEPARTMENT PROVIDES THE BOARD OF DIRECTORS THE MEANING OF THE CONFLICT OF INTEREST STATEMENT, HOW IT APPLIES, HOW IT IMPACTS THT 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 C, LINE 19 GREAT RIVER HEALTH SYSTEMS MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. EXPLANATION FOR HOURS WORKED FORM 990, PART VII, SECTION A MARK 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: LOSS ON INVESTMENT IN SUBSIDIARY -7,869,639. TOTAL TO FORM 990, PART XI, LINE 5: -7,869,639. FORM 990, 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 INC 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421193186 FUNDRAISING IA 501(C)(3) 11 - TYPE II GRHS 1 GREAT RIVER FOUNDATION 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421469162 FUNDRAISING 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 43749515 58369380 1.00000 GREAT RIVER MEDICAL SERVICES INC 1201 WEST AGENCY ROAD WEST BURLINGTON IA 52655 421493449 MEDICAL SERVICES IA GRHS C 8385846 2511262 1.00000 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 GREAT RIVER FOUNDATION C 4450000 CASH GREAT RIVER MEDICAL CENTER C 3900000 CASH RIVERVIEW SYSTEMS LTD N 7376246 CASH RIVERVIEW SYSTEMS LTD R 2606686 CASH