2011-05-16T15:22:10-05:00 2010-06-30 LARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2009-07-01 421193185 great river health systems inc GREA 3197681000 1221 S gear Ave west burlington IA 52665 TODD SLADKY 3197681000 2011-05-16 1 6123764500 2009 2016-02-24 21:20:13Z TODD SLADKY 1221 S gear Ave west burlington IA 52665 4017586 0 X WWW.GREATRIVERMEDICAL.ORG X 1983 IA provide healthcare services 13 12 0 0 0 0 4000000 0 16681 17586 0 16681 4017586 0 0 0 0 0 14319 93546 14319 93546 2362 3924040 42767964 41816525 17432 153318 42750532 41663207 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 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 13 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X CHRISTINE DESJARDINS 3197681000 1221 S gear Ave west burlington IA 52665 X kenneth aspelmeier 1.00 X X 0 0 0 KENT GAUDIAN 1.00 X X 0 0 0 MICHAEL MCCOY MD 1.00 X 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 CARL HAYS MD 1.00 X 0 0 0 ROBERT MCCULLEY 1.00 X 0 0 0 MARK RICHARDSON 1.00 X X 0 406007 250421 DAN WIEDEMEIER 1.00 X 0 0 0 ROBERT FLEMMING 1.00 X 0 0 0 TONY HAYES 1.00 X 0 279231 108450 TODD SLADKY 1.00 X 0 251314 98137 0 936552 457008 0 0 1 0 0 4000000 4000000 17586 17586 4017586 17586 0 0 11424 11424 49446 49446 9040 9040 23543 23543 93 93 93546 0 93546 0 244512 557562 469 414 151511 148443 42371472 41110106 42767964 41816525 1580 15852 153318 17432 153318 X 42750532 41663207 42750532 41663207 42767964 41816525 X 0 1 1 X 0 X X X 0 0 0 great river medical center 420680407 3 1 1 1 93546 1 93546 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 INVESTMENT IN FOR-PROFIT SUBSIDIARIES 41110106 F 41110106 Due to GRMC 153318 153318 0 0 0 0 0 0 0 0 0 MARK RICHARDSON 0 376007 0 30000 0 0 0 200308 0 50113 0 656428 0 0 TONY HAYES 0 279231 0 0 0 0 0 68500 0 39950 0 387681 0 0 TODD SLADKY 0 251314 0 0 0 0 0 59500 0 38637 0 349451 0 0 Form 990, Part VI, Section B, line 11 A COPY OF GRHS' FORM 990 WAS DISTRIBUTED TO THE BOARD OF DIRECTORS FOR REVIEW PRIOR TO BEING FILED WITH THE IRS. Form 990, Part VI, Section B, line 12c WE HAVE A BOARD MEMBER WHO IS THE PRESIDENT OF THE LOCAL BANK WE DO BUSINESS WITH. THE BANK PRESIDENT IS NOT ALLOWED TO BE A PART OF ANY DISCUSSIONS RELATED TO BUSINESS WITH THE BANK AND DOES NOT VOTE ON ANY DECISIONS REGARDING DOING BUSINESS. ALL BOARD MEMBERS ARE REQUIRED TO FILL OUT A CONFLICT OF INTEREST FORM THAT IS THEN REVIEWED BY THE FINANCIAL SUPERVISOR IN THE ACCOUNTING DEPARTMENT. RELATIONSHIPS NOTED ON THE FORM MAY BE DISCUSSED WITH THE BOARD MEMBER IF THERE ARE QUESTIONS. EVERY YEAR, THE FINANCIAL SUPERVISOR PROVIDES TO THE BOARD THE MEANING OF THE CONFLICT OF INTEREST STATEMENT, HOW IT APPLIES, HOW IT IMPACTS THE BOARD, AND WHAT THEIR RESPONSIBILTIES ARE. 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. GREAT RIVER MEDICAL CENTER 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 420680407 HOSPITAL IA 501(C)(3) 3 N/A GREAT RIVER MEDICAL CENTER FOUNDATION 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421193186 FUNDRAISING IA 501(C)(3) 11 - TYPE II N/A GREAT RIVER FOUNDATION CORP 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421469162 FUNDRAISING IA 501(C)(3) 11 - TYPE II N/A RIVERVIEW SYSTEMS LTD PO BOX 640 WEST BURLINGTON IA 52655 421191960 MEDICAL SERVICES IA N/A C 30069220 41663208 1.00000 GREAT RIVER MEDICAL SERVICES INC 1201 WEST AGENCY ROAD WEST BURLINGTON IA 52655 421493449 MEDICAL SERVICES IA N/A C 8073363 2414124 1.00000 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 1 riverview systems ltd N 7543750 GREAT RIVER FOUNDATION CORP R 3000000 GREAT RIVER MEDICAL CENTER R 1754418