2011-05-13T14:28:45-05:00 2010-06-30 RSM McGladrey Inc 801 Nicollet Mall Suite 1100 Minneapolis MN 55402 990 2009-07-01 411865874 GRAND ITASCA CLINIC AND HOSPITAL GRAN 2183265000 1601 GOLF COURSE ROAD GRAND RAPIDS MN 55744 SARAH GUSTAFSON 2183265000 2011-05-05 1 Collin F Buzzell 6125738750 2009 2016-02-24 21:20:13Z MICHAEL YOUSO 1601 GOLF COURSE ROAD GRAND RAPIDS MN 55744 67698240 0 X WWW.GRANDITASCA.ORG X 1997 MN PROVIDE HEALTH CARE SERVICES INCLUDING A HOSPITAL, HOME HEALTH, AND CLINIC TO THE SURROUNDING COMMUNITY. 15 13 656 125 0 0 0 66743849 66307969 714556 734244 872501 656027 68330906 67698240 0 0 40394037 41392849 0 70455 28868098 28365713 69262135 69758562 -931229 -2060322 92024559 88104369 55497617 53584148 36526942 34520221 PROVIDE HEALTH SERVICES INCLUDING A HOSPITAL, HOME HEALTH, AND CLINIC TO THE SURROUNDING COMMUNITY. 0 0 58398381 66963996 Grand Itasca Clinic and Hospital is an integrated multi-specialty clinic and acute/surgical hospital. The facility is licensed for 64 beds which are comprised of 14 acute rehab beds, 34 medical beds, 10 intesnive care beds and 6 OB beds. In addition to providing traditional hospital services, the facility has four surgery suites, 24-hour emergency department, outpatient mental health services, outpatient rehabilitation services, and outpatient clinic services. The facility employs approximately 600 people including 41 healthcare providers.The facility served approximately 2600 inpatients and approximately 143,000 outpatient encounters including clinic, emergency room, outpatient imaging and outpatient surgical procedure. Grand Itasca serves the patient regardless of the person's ability to pay. During the year the facility provided $851,556 of charity care, $478,227 discount to the uninsured and absorbed $1,923,378 of unpaid Medicare and Medicaid costs. Grand Itasca Clinic and Hospital also provides other support to the community through cash and in-kind donations that totaled $51,439 iN FY10. In addition, Grand Itasca provided healthcare support services of $45,465 including Ask-A-Nurse and patient transportation. Grand Itasca also paid $1,194,101 in payments for Minnesota Care tax and Medicaid surcharges, which were used to fund care for the indigent and underinsured. 58398381 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 1 68 0 1 656 1 0 0 0 0 0 0 0 15 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X SARAH GUSTAFSON 2183265000 1601 GOLF COURSE ROAD GRAND RAPIDS MN 55744 Barbara McDonald 1.00 X X 0 0 0 Peter McDermott 1.00 X X 0 0 0 Mary Kosak 1.00 X X 0 0 0 Shelly Sterre 1.00 X X 0 0 0 Frank Allen 1.00 X 0 0 0 Mike Ives 1.00 X 0 0 0 Darlene Freeman 1.00 X 0 0 0 Marva Jean Hutchens 1.00 X 0 0 0 Ron Iannelli 1.00 X 0 0 0 Colleen Nardone 1.00 X 0 0 0 Terri Radovich 40.00 X 240131 0 27723 Barb Sanderson 1.00 X 0 0 0 Richard Helvig 40.00 X 196178 0 28438 Elizabeth Miskovich 1.00 X 634 0 28 Charles Kampen 1.00 X 0 0 0 Jack Carlisle 40.00 X 222938 0 29860 Steve Feltman 40.00 X 176984 0 27347 Mike Youso 40.00 X 0 0 0 Daniel Lister 40.00 X 680174 0 31779 Steven Haugen 40.00 X 417669 0 32191 Tim Gold 40.00 X 410868 0 24806 Roberta Zimmerman 40.00 X 355470 0 32165 Dennis Scherer 40.00 X 333906 0 31806 3034952 0 266143 54 0 1 0 QUEST DIAGNOSTICS PO Box 12989 CHICAGO IL 60693 Laboratory Services 422702 NORTHERN COUNTIES SECRETARIAL 6139 157th Lane NW RAMSEY MN 55303 Coding Services 353260 SHEILA INGRAM 317 Indian Woods Trail CYNTHIANA KY 41031 Interim Director Pharmacy 241151 ALEXANDRIA UROLOGY PA 14589 Oak Hill Road North SCANDIA MN 55073 Urology Services 222000 LAKE SUPERIOR LAUNDRY PO Box 488 SUPERIOR WI 54880 Laundry Services 204023 8 PATIENT AND RESIDENT S 621110 66307969 66307969 66307969 734244 734244 miscellaneous operatin 621110 656027 656027 656027 67698240 66963996 0 734244 950260 795510 153790 960 32894453 27537592 5323638 33223 2304992 1929624 373040 2328 2583392 2162687 418096 2609 2659752 2226612 430454 2686 68287 57166 11052 69 96056 80413 15546 97 429103 359224 69446 433 8358001 6996900 1352659 8442 934372 782209 151219 944 2023705 1694144 327517 2044 94936 79476 15364 96 2205302 1846169 356906 2227 4929413 4126658 797776 4979 278739 233346 45111 282 non phy fee 2974680 2490254 481422 3004 bad debt 2642870 2212479 427722 2669 EMPLOYEE RECRUITMENT/ED 451506 377978 73072 456 LICENSES 228417 191219 36967 231 FREIGHT 184910 154797 29926 187 2465416 2063924 399003 2489 69758562 58398381 11289726 70455 6666904 2786274 73884 10231327 13148388 1154633 1052571 787294 927846 74136847 23953010 53669722 50183837 19514679 19931569 92024559 88104369 6814565 6217014 38978165 37412432 9704887 9954702 55497617 53584148 X 36118931 34212210 408011 308011 36526942 34520221 92024559 88104369 X 0 1 1 X 0 X 607331 607331 44503749 9202838 35300911 29025767 14750172 14275595 50183837 DEFERRED FINANCING COSTS 1301987 ASSETS LIMITED TO USE 18421571 CHARITABLE REMAINDER TRUST 208011 19931569 OTHER ACCRUALS 385000 POST RETIREMENT BENEFIT 7201715 SELF INSURED WORKER'S COMP 445648 CAPITAL LEASE OBLIGATION 356605 CURRENT PORTION OF LONG TERM DEBT 1565734 9954702 Part X: Description of Uncertain Tax Positions Under FIN 48: EFFECTIVE JULY 1, 2009, THE ORGANIZATION ADOPTED THE PROVISIONS OF ASC 740, INCOME TAXES, RELATED TO ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES (FIN48). THE ADOPTION OF THE ASC 740 PROVISIONS HAD NO IMPACT ON THE CONSOLIDATED FINANCIAL STATEMENTS. 1 1 X 1 X 1 X 0 1 0 1 1 913443 0 913443 0.01360 4922688 3477081 1445607 0.02150 0 0 5836131 3477081 2359050 0.03510 82984 0 82984 0.00120 2000 0 2000 0.00000 0 0 0 0 11270 0 11270 0.00020 96254 96254 0.00140 5932385 3477081 2455304 0.03650 45465 0 45465 0.00070 51439 0 51439 0.00080 96904 96904 0.00150 1 1236802 309200 22834187 26396997 -3562810 X 1 0 GRAND ITASCA CLINIC AND HOSPITAL

1601 GOLF COURSE ROAD GRAND RAPIDS MN 55744

X X X Part III, Line 4: PATIENT ACCOUNTS RECEIVABLE DUE DIRECTLY FROM THE PATIENT ARE CARRIED AS THE ORIGINAL CHARGE FOR THE SERVICES PROVIDED LESS AMOUNTS COVERED BY THIRD-PARTY PAYORS AND LESS AN ESTIMATED ALLOWANCE FOR DOUBTFUL RECEIVABLES BASED ON A REVIEW OF OUTSTANDING AMOUNTS ON A MONTHLY BASIS. MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS, BY USING HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS, AND BY CONSIDERING THE PATIENT'S FINANCIAL HISTORY AND CREDIT HISTORY AND CURRENT ECONOMIC CONDITIONS. PATIENT ACCOUNTS RECEIVABLE ARE WRITTEN OFF WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE WHEN RECEIVED.The costing method used is to utilize the cost report to capture the cost to charge ratio. We then cost out total bad debt reported as charges to the cost of providing those services. From review of the number of applications denied for insufficient information we estimate 25% of bad debt is related to individuals who would qualify for charity care. Part III, Line 8: The shortfall is the cost of services provided to the medicare population in the community for which we do not recoup any payments from the patients. The costing methodology is to utlize the cost to charge ratio as determined by the cost report for that period. Part VI, Line 2: The healthcare needs of the community are assessed by market analysis, referral tracking and feedback from patients. Part VI, Line 3: The organization contacts individuals that are self-pay to assist in determining eligibility for federal, state and local governments, as well as under the organizations charity care policy. We also identify patients through conversations during the collection process. Part VI, Line 4: The community is a diverse community that has a large geographic area. The community has experienced high unemployment rates in the past year. The community has a large population of skilled workers which has been volatile in the recent economic downturn. Part VI, Line 5: The organization promotes the health of the community by offering various programs focusing on wellness. We also align with larger organizations to offer such programs such as cardiac education. These include classes such as a cooking class from our head chef, smoking cessation classes and various other offerings. We also offer pediatric programs to focus on reading and child development. These are just a few examples of the community activities we offer. Part VI, Line 6: We support many organizations that focus on promoting the health of the community. MN X X X 0 0 0 0 0 0 0 0 0 Terri Radovich 214636 0 0 0 25495 0 10923 0 16800 0 267854 0 0 0 Richard Helvig 186961 0 0 0 9217 0 9057 0 19381 0 224616 0 0 0 Jack Carlisle 200528 0 0 0 22410 0 10241 0 19619 0 252798 0 0 0 Steve Feltman 164968 0 0 0 12016 0 8195 0 19152 0 204331 0 0 0 Daniel Lister 496242 0 0 0 183932 0 11830 0 19949 0 711953 0 0 0 Steven Haugen 404473 0 0 0 13196 0 11830 0 20361 0 449860 0 0 0 Tim Gold 397672 0 0 0 13196 0 11830 0 12976 0 435674 0 0 0 Roberta Zimmerman 342274 0 0 0 13196 0 11830 0 20335 0 387635 0 0 0 Dennis Scherer 317884 0 0 0 16022 0 11654 0 20152 0 365712 0 0 0 GRAND RAPIDS STATE BANK SHELLY STEERE, TREASURER, IS VP OF THE BANK, WHICH IS GICH'S PRIMARY BANK 270839 INTEREST PAID FROM CD'S AND CHECKING/SAVINGS ACCOUNTS AT GRAND RAPIDS STATE BANK 0 Form 990, Part VI, Section B, line 11 FORM 990 IS COMPARED TO LAST YEARS RETURN AND THE CURRENT YEAR AUDIT. FORM 990 IS REVIEWED BY THE CONTROLLER PRIOR TO FILING. A COPY OF FORM 990 IS PRESENTED TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. Form 990, Part VI, Section B, line 12c BOARD MEMBERS SIGN THE CONFLICT OF INTEREST POLICY ANNUALLY. Form 990, Part VI, Section B, line 15 COMPENSATION IS DETERMINED BY ASSESSING THE MARKET THROUGH THE USE OF SURVEYS AND STUDIES AND DETERMINING PAY RATES AND RANGES FROM THE RESULTS OF THE ASSESSMENT. THE CEO COMPENSATION PACKAGE IS SUMMARIZED IN AN EMPLOYMENT AGREEMENT THAT IS APPROVED BY THE BOARD. THE COMPENSATION PACKAGE IS BASED UPON MARKET FOR THE POSITION. Form 990, Part VI, Section C, line 19 DOCUMENTS ARE AVAILABLE UPON REQUEST. AN ANNUAL REPORT IS ALSO ISSUED AND MAILED TO THE PATIENTS IN THE COMMUNITY. GRAND ITASCA FOUNDATION 1601 GOLF COURSE ROAD GRAND RAPIDS MN 55744 411560554 FINANCIAL SUPPORT OF GRAND ITASCA CLINIC & HOSPITAL MN 501(C)(3) 11(F) N/A 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0