TY 2015 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) DAN WIEDEMEIER...................................................................... CHAIRMAN	1.00 ................. 3.00	X	X	0	0
(2) DAN HINKLE...................................................................... CHAIRMAN (THROUGH SEPTEMBER 2015)	1.00 ................. 3.00	X	X	0	0
(3) ROBERT MCCULLEY...................................................................... VICE CHAIRMAN	1.00 ................. 1.00	X	X	0	0
(4) DOUG MARTIN...................................................................... SECRETARY / TREASURER	1.00 ................. 1.00	X	X	0	0
(5) RON CLOUSE...................................................................... DIRECTOR	1.00 ................. 1.00	X		0	0
(6) LORRIN DEBLIECK...................................................................... DIRECTOR	1.00 ................. 1.00	X		0	0
(7) TERRI DOWELL...................................................................... DIRECTOR	1.00 ................. 1.00	X		0	0
(8) ROBERT ENGBERG...................................................................... DIRECTOR	1.00 ................. 1.00	X		0	0
(9) ROBERT FLEMING...................................................................... DIRECTOR	1.00 ................. 3.00	X		0	0
(10) KENT GAUDIAN...................................................................... DIRECTOR	1.00 ................. 1.00	X		0	0
(11) JO ELLEN HOTH MD...................................................................... DIRECTOR (THROUGH SEPTEMBER 2015)	1.00 ................. 1.00	X		0	0
(12) BILL MALCOM...................................................................... DIRECTOR	1.00 ................. 1.00	X		0	0
(13) MICHAEL MCCOY MD...................................................................... DIRECTOR (THROUGH OCTOBER 2015)	1.00 ................. 1.00	X		341,911	24,147
(14) JOHN PHILLIPS MD...................................................................... DIRECTOR (THROUGH DECEMBER 2015)	1.00 ................. 1.00	X		0	0
(15) DON SCHMIDGALL...................................................................... DIRECTOR (THROUGH SEPTEMBER 2015)	1.00 ................. 1.00	X		0	0
(16) PATRICK WILLIAMS MD...................................................................... DIRECTOR	1.00 ................. 1.00	X		0	0
(17) MARK RICHARDSON...................................................................... PRESIDENT/CEO	40.00 ................. 3.00	X	X	735,915	33,844

(A) Name and business address	(B) Description of services	(C) Compensation
MUTUAL CONSULTING & MANAGEMENT SERVICES 1221 S GEAR AVE WEST BURLINGTON,IA52655	EXECUTIVE MANAGEMENT	4,148,430
GREAT RIVER PHYSICIANS & CLINICS INC 1221 S GEAR AVE WEST BURLINGTON,IA52655	PHYSICIANS	533,761
OPTUM EXECUTIVE HEALTH RESOURCES INC 3797 MOMENTUM PLACE CHICAGO,IL60689	PHYSICIAN SERVICES	475,284
WEATHERBY LOCUMS INC PO BOX 972633 DALLAS,TX75397	PROVIDER SERVICES	404,975
BELMERO INC 8362 TAMARCK VILLAGE 119-214 WOODBURY,MN55125	CONSULTANTS	378,437
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 19

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

GREAT RIVER MEDICAL CENTER

Employer identification number

42-0680407

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ))

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ..............

Provide the following information about the supported organization(s).

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10.

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2014. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2015. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the facts-and-circumstances test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2015

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513...
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2014. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2015

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2015 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Name of the organization

GREAT RIVER MEDICAL CENTER

Employer identification number

42-0680407

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2

Name of organization GREAT RIVER MEDICAL CENTER

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 3

Name of organization GREAT RIVER MEDICAL CENTER		Employer identification number 42-0680407

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 4


Name of organization GREAT RIVER MEDICAL CENTER			Employer identification number 42-0680407
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

GREAT RIVER MEDICAL CENTER

Employer identification number

42-0680407

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures ...................................................................................................................... SchCMd Bullet

Volunteer hours .............................................................................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2015

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ...............................................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ...........................................
c	Total lobbying expenditures (add lines 1a and 1b) .......................................................................
d	Other exempt purpose expenditures .........................................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ....................................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) ..........................................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ..........................................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ...........................................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ..............................................................................................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2012	(b) 2013	(c) 2014	(d) 2015	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2015

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

29,099

Total. Add lines 1c through 1i ....................................................................................................

29,099

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1:	GREAT RIVER MEDICAL CENTER PAID DUES TO THE AMERICAN HOSPITAL ASSOCIATION AND THE IOWA HOSPITAL ASSOCIATION. THESE ASSOCIATIONS PARTICIPATE IN LOBBYING ACTIVITIES RELATED TO HEALTHCARE.

Schedule C (Form 990 or 990EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

GREAT RIVER MEDICAL CENTER

Employer identification number

42-0680407

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

			(a) Donor advised funds	(b) Funds and other accounts

1	Total number at end of year ....
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ....

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ...........

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ............................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2015

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

Endowment Funds. Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations .................

3a(i)

(ii) related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land ...	4,946,488		4,946,488
b	Buildings	126,591,830	38,406,331	88,185,499
c	Leasehold improvements	11,972,330	6,821,113	5,151,217
d	Equipment ...	170,010,306	119,446,259	50,564,047
e	Other ...	2,276,506		2,276,506
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				151,123,757

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b)Book value	(c)Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests	148,306,924	F
(3)Other (A) INSURANCE COMPANY ANNUITY DEPOSITS	3,173,288	F
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	151,480,212

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
DEFERRED COMPENSATION LIABILITY	912,269
THIRD PARTY PAYABLE	1,468,540
PTO RESERVE	7,934,607
FAIR VALUE OF CASH FLOW HEDGING SWAP	4,345,421
PLEDGES LIABILITY	790,739
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	15,451,576
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

PART X, LINE 2:

THE ORGANIZATION IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. HOWEVER, THE ORGANIZATION IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE COMBINED FINANCIAL STATEMENTS.

Schedule D (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

GREAT RIVER MEDICAL CENTER

Employer identification number

42-0680407

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 22500.0000000000 %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	3,055,071		3,055,071	1.790 %
b	Medicaid (from Worksheet 3, column a) . . . . .	26,989,539	23,191,804	3,797,735	2.230 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	364,337	324,451	39,886	0.020 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	30,408,947	23,516,255	6,892,692	4.040 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	52,616		52,616	0.030 %
f	Health professions education (from Worksheet 5) . . .
g	Subsidized health services (from Worksheet 6) . . . .	1,090,982	734,069	356,913	0.210 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	141,418		141,418	0.080 %
j	Total. Other Benefits . .	1,285,016	734,069	550,947	0.320 %
k	Total. Add lines 7d and 7j .	31,693,963	24,250,324	7,443,639	4.360 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015

Schedule H (Form 990) 2015

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

4,747,691

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

57,423,742

Enter Medicare allowable costs of care relating to payments on line 5.....

64,485,275

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-7,061,533

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2015

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	GREAT RIVER MEDICAL CENTER 1221 SOUTH GEAR AVENUE WEST BURLINGTON,IA52655 GREATRIVERMEDICAL.ORG 290147H	X	X	X

Schedule H (Form 990) 2015

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	GREAT RIVER MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 15

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): HTTP://GREATRIVERMEDICAL.ORG/FILES/FILE/COMMUNITY%20HEALTH%20NEEDS%20ASSESS

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): HTTP://GREATRIVERMEDICAL.ORG/FILES/FILE/COMMUNITY%20HEALTH%20NEEDS%20ASSESS

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	GREAT RIVER MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 225.000000000000% and FPG family income limit for eligibility for discounted care of 300.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

HTTPS://GREATRIVERMEDICAL.ORG/BILLING-AND-FINANCIAL-SERVICES/FINANCIAL-ASSI

The FAP application form was widely available on a website (list url):

HTTPS://GREATRIVERMEDICAL.ORG/BILLING-AND-FINANCIAL-SERVICES/FINANCIAL-ASSI

A plain language summary of the FAP was widely available on a website (list url):
HTTPS://GREATRIVERMEDICAL.ORG/BILLING-AND-FINANCIAL-SERVICES/FINANCIAL-ASSI

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	GREAT RIVER MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that
can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
GREAT RIVER MEDICAL CENTER	PART V, SECTION B, LINE 5: GREAT RIVER MEDICAL CENTER, A PART OF GREAT RIVER HEALTH SYSTEMS, COLLABORATED WITH THE DES MOINES COUNTY DEPARTMENT OF PUBLIC HEALTH TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT TO DISTINGUISH THE UNMET MEDICAL AND PUBLIC HEALTH NEEDS IN DES MOINES COUNTY.THE STUDY HAS THREE OBJECTIVES:1. TO CONDUCT AN ASSESSMENT THAT PROVIDES A FOUNDATION FOR GREAT RIVER HEALTH SYSTEMS AND ITS PARTNERS TO BUILD A CONSENSUS ABOUT THE AREA'S MOST CRITICAL HEALTH CARE NEEDS2. TO MEET STATE AND FEDERAL REQUIREMENTS FOR CONDUCTING COMMUNITY HEALTH NEEDS ASSESSMENTS - HOSPITALS, EVERY THREE YEARS; HEALTH DEPARTMENTS, EVERY FIVE YEARS3. TO DEVELOP ACTION PLANS FOR INTERVENTIONSINFORMATION WAS COLLECTED THROUGH LIVE COMMUNITYWIDE MEETINGS, PAPER AND EMAILED SURVEYS, FACE-TO-FACE INTERVIEWS, AND A REVIEW AND ANALYSIS OF PUBLICLY COLLECTED HEALTH AND DEMOGRAPHIC STATISTICS. THE SURVEY WAS MADE AVAILABLE AT SEVERAL LOCATIONS IN THE STUDY AREA. THE LOCATIONS WERE CHOSEN AND THE SURVEY WAS DESIGNED TO ELICIT PUBLIC RESPONSES ABOUT HEALTH NEEDS IN DES MOINES COUNTY. THE SURVEY INCLUDED MULTIPLE CHOICE, OPEN-ENDED AND SCALED QUESTIONS THAT ASKED PEOPLE WHAT THEY PERCEIVED TO BE THE GREATEST AREAS OF COMMUNITY NEED. ABOUT 400 SURVEYS WERE RETURNED AND ANALYZED.INTERVIEWS WERE CONDUCTED WITH 11 COMMUNITY PROFESSIONALS AND KEY INFORMANTS, INCLUDING PROFESSIONALS IN EDUCATION, LAW ENFORCEMENT, MINORITY POPULATIONS, PUBLIC HEALTH AND SOCIAL SERVICES, AND OTHER PEOPLE REPRESENTING UNDERSERVED POPULATIONS IN THE SERVICE AREA. THEY WERE ASKED TO IDENTIFY THE LARGEST HEALTH CONCERNS IN THE COMMUNITY AND TO SUGGEST WAYS TO IMPROVE UNMET HEALTH NEEDS.THE HEALTH AND DEMOGRAPHIC DATA AVAILABLE FOR DES MOINES COUNTY WAS INVESTIGATED BY FOCUSING ON THE PROBLEMS INDICATED FROM THE INTERVIEWS AND COMMUNITY SURVEY. USING INFORMATION FROM COLLABORATIVE MEETINGS AND SURVEYS, THE DES MOINES COUNTY COMMUNITY RANKED FOUR UNMET HEALTH NEEDS: - MENTAL HEALTH AND SUBSTANCE ABUSE - OBESITY - POVERTY - VIOLENT CRIMETHESE FOUR NEEDS WILL BE THE FOCUS OF GREAT RIVER HEALTH SYSTEMS'EFFORTS TO IMPROVE THE HEALTH OF DES MOINES COUNTY.
GREAT RIVER MEDICAL CENTER	PART V, SECTION B, LINE 6B: GREAT RIVER MEDICAL CENTER COLLABORATED WITH THE DES MOINES COUNTY DEPARTMENT OF PUBLIC HEALTH TO CONDUCT THEIR COMMUNITY HEALTH NEEDS ASSESSMENT.
GREAT RIVER MEDICAL CENTER	PART V, SECTION B, LINE 11: AS A RESULT OF THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT, THE HEALTH AND DEMOGRAPHIC DATA AVAILABLE FOR DES MOINES COUNTY WAS INVESTIGATED FOCUSING ON THE PROBLEMS INDICATED FROM THE INTERVIEWS AND COMMUNITY SURVEY. USING INFORMATION FROM COLLABORATIVE MEETINGS AND SURVEYS, THE DES MOINES COUNTY COMMUNITY RANKED FOUR UNMET HEALTH NEEDS:- MENTAL HEALTH AND SUBSTANCE ABUSE- OBESITY- POVERTY- VIOLENT CRIMEPARTICIPANTS IN THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS - INCLUDING GREAT RIVER HEALTH SYSTEMS EMPLOYEES - CHOSE OR WERE ASSIGNED TO ONE OF THE FOUR AREAS OF NEED. THE GROUPS FOLLOWED A MULTISTEP PROCESS TO DEVELOP THEIR PLANS:- DEFINE AND ANALYZE THE PROBLEM- DEVELOP A PURPOSE STATEMENT FOR THE OVERALL GOAL- DEFINE OBJECTIVES- IDENTIFY INTERVENTIONS- COMPLETE PLANTHESE GROUPS WILL CONTINUE MEETING TO ADDRESS THEIR ACTION PLAN OBJECTIVES AND TACTICS, AND SUBMIT QUARTERLY PROGRESS REPORTS GREAT RIVER HEALTH SYSTEMS AND THE DES MOINES COUNTY DEPARTMENT OF PUBLIC HEALTH.GREAT RIVER HEALTH SYSTEMS IS COMMITTED TO PROVIDING NEW AND ONGOING SERVICES TO HELP MEET THE IDENTIFIED NEEDS IN THE NEXT THREE YEARS. IT ALSO WILL CONTINUE PARTICIPATING IN COMMUNITYWIDE HEALTH IMPROVEMENTS. EACH OF THE FOUR HEALTH-NEEDS CATEGORIES BELOW BEGINS WITH THE HEALTH SYSTEM'S PLAN, FOLLOWED BY THE COMMUNITY'S PLAN.MENTAL HEALTH AND SUBSTANCE ABUSE- IMPROVE ACCESS- CRISIS INTERVENTION TEAM PROGRAM- DUAL-DIAGNOSIS PARTIAL HOSPITAL PROGRAM- BEHAVIORAL HEALTH ASSESSMENT TEAM- CRISIS STABILIZATION SERVICES- INCREASED COLLABORATION WITH JUDICIAL SYSTEM- INTAKE COORDINATOR- INTEGRATED CARE CLINIC- JAIL-DIVERSION PROGRAM- PARTIAL HOSPITAL PROGRAM- SUBSTANCE-ABUSE GROUP- COMMUNITY ACTION PLANOBESITY- SCHOOL PROGRAMS- COMMUNITY EDUCATION- GREAT RIVER HEALTH FITNESS- GREAT RIVER HEALTHY LIVING CLINIC- PIONEERING HEALTHY COMMUNITIES GRANT- COMMUNITY ACTION PLANVIOLENT CRIME- CRISIS INTERVENTION TEAM PROGRAM- MANAGEMENT OF AGGRESSIVE BEHAVIORS EMPLOYEE TRAINING PROGRAM- COMMUNITY ACTION PLAN- IDENTIFIED COMMUNITY PROGRAMS- COMMUNITY ACTION PLANPOVERTY- BRIDGES OUT OF POVERTY PROGRAM- FINANCIAL ASSISTANCE/CHARITY CARE- HEALTH INSURANCE MARKETPLACE AND PRESUMPTIVE MEDICARE ENROLLMENT- MEDICATION ASSISTANCE PROGRAM- COMMUNITY ACTION PLAN
GREAT RIVER MEDICAL CENTER	PART V, SECTION B, LINE 13H: GRMC MAY USE PRESUMPTIVE FINANCIAL ASSISTANCE ELIGIBILITY:THERE ARE INSTANCES WHEN A PATIENT/INDIVIDUAL MAY APPEAR TO BE ELIGIBLE FOR CHARITY-CARE DISCOUNTS, BUT THERE IS NO COMPLETED FINANCIAL ASSISTANCE FORM ON FILE BECAUSE OF A LACK OF SUPPORTING DOCUMENTATION. OFTEN THERE IS ADEQUATE INFORMATION PROVIDED BY THE PATIENT OR THROUGH OTHER RESOURCES THAT COULD PROVIDE SUFFICIENT EVIDENCE TO DETERMINE ELIGIBILITY.1. INFORMATION IS PROVIDED WEEKLY TO AVADYNE, AN OUTSIDE SOURCE. AVADYNE RETURNS RESULTS TO GREAT RIVER MEDICAL CENTER ABOUT PATIENT QUALIFICATIONS BASED ON OUR FINANCIAL ASSISTANCE POLICY.2. AVADYNE USES DEMOGRAPHIC AND HOUSEHOLD INFORMATION, AND CREDIT-SCORING TECHNOLOGY TO DETERMINE THE PERCENTAGE OF ASSISTANCE FOR WHICH A PATIENT MAY BE ELIGIBLE.3. GREAT RIVER MEDICAL CENTER WILL ATTEMPT TO CONTACT PATIENTS BASED ON THEIR PRESUMPTIVE ASSISTANCE QUALIFICATION TO ALLOW THE PATIENT TO APPLY FOR FINANCIAL ASSISTANCE.4. PATIENTS WILL NOT BE DISQUALIFIED FROM FINANCIAL ASSISTANCE BASED ON PRESUMPTIVE ASSISTANCE RESULTS.5. IF THE ACCOUNT IS PAST DUE AND THERE IS NO COMPLETED FINANCIAL ASSISTANCE APPLICATION OR SUPPORTING DOCUMENTATION, THE PATIENT'S ACCOUNT COULD BE CONSIDERED FOR FINANCIAL ASSISTANCE BASED ON AVADYNE'S RESULTS.6. PRESUMPTIVE ELIGIBILITY ALSO CAN BE DETERMINED BASED ON LIFE CIRCUMSTANCES INCLUDING: -ELIGIBILITY FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT ARE UNFUNDED -FOOD STAMP ELIGIBILITY -HOMELESS OR RECEIVED CARE FROM A HOMELESS CLINIC -LOW INCOME/SUBSIDIZED HOUSING PROVIDED AS A VALID ADDRESS -PARTICIPATION IN THE WOMEN INFANTS AND CHILDREN (WIC) PROGRAM -PATIENT IS DECEASED WITH NO KNOWN ESTATE -STATE-FUNDED PRESCRIPTION PROGRAMS -SUBSIDIZED SCHOOL LUNCH PROGRAM ELIGIBILITY7. IT ALSO IS ACCEPTABLE TO USE PROXY INFORMATION TO DETERMINE ELIGIBILITY WHEN INCOME LEVELS CANNOT BE DIRECTLY DETERMINED. SUCH INFORMATION COULD INCLUDE STATEMENTS LIKE "STAYS WITH FRIENDS OR "OCCASIONALLY WORKS."8. PATIENTS WHO MEET PRESUMPTIVE-CARE GUIDELINES MAY QUALIFY FOR FINANCIAL ASSISTANCE DISCOUNTS. THIS DETERMINATION IS AT THE DISCRETION OF GREAT RIVER MEDICAL CENTER.9. IN A SITUATION, WHERE PRESUMPTIVE ELIGIBILITY IS GIVEN TO A PATIENT AND A FINANCIAL ASSISTANCE APPLICATION IS OBTAINED LATER, THE UPDATED ELIGIBILITY WILL BE BASED ON THE FINANCIAL ASSISTANCE APPLICATION WITH SUPPORTING DOCUMENTATION. IN THIS CASE, GREAT RIVER MEDICAL CENTER COULD ADJUST FINANCIAL ASSISTANCE UP TO THREE MONTHS BEFORE THE APPLICATION DATE.
GREAT RIVER MEDICAL CENTER	PART V, SECTION B, LINE 20E: GRMC USES AN OUTSIDE SOURCE TO SCREEN PATIENTS TO SEE IF THEY COULD BE ELIGIBLE FOR FINANCIAL ASSISTANCE. THE HOSPITAL GETS NOTIFICATION BACK AS TO HOW MUCH OF A FINANCIAL ASSISTANCE DISCOUNT THEY WOULD BE ELIGIBLE FOR. IF THE PATIENT DOESN'T RESPOND TO PHONE CALLS REGARDING THE FINANCIAL ASSISTANCE APPLICATION OR THEY DON'T COMPLETE THE APPLICATION, THE HOSPITAL MAY STILL DISCOUNT THE PATIENT'S CHARGES UNDER THEIR PRESUMPTIVE CHARITY POLICY. THE HOSPITAL'S PRESUMPTIVE CHARITY PROGRAM GIVES THE HOSPITAL THE OPPORTUNITY TO DISCOUNT PATIENT ACCOUNTS BASED ON INFORMATION IT MAY HAVE REGARDING A PATIENT BEING HOMELESS OR UNEMPLOYED.
GREAT RIVER MEDICAL CENTER	PART V, SECTION B, LINE 22D: AMOUNTS GENERALLY BILLED AN AMOUNT EQUIVALENT TO THE AVERAGE AMOUNT BILLED TO PATIENTS WITH INSURANCE COVERAGE AFTER INSURANCE PAYS. THE "LOOK BACK" METHODOLOGY WAS USED IN THE DETERMINATION OF THE AMOUNT GENERALLY BILLED PERCENTAGE OF 40 PERCENT OF TOTAL CHARGES. THIS CALCULATION WAS BASED ON MEDICARE FEE FOR SERVICE, BLUE CROSS BLUE SHIELD AND COMMERCIAL INSURANCES' ACTUAL FISCAL YEAR 2014 HISTORICAL CLAIMS. THIS CALCULATION IS RE-EVALUATED ANNUALLY AND WILL BE PROVIDED TO PEOPLE BY REQUEST AT NO EXPENSE TO THE REQUESTING PARTY.
PART V, SECTION B, LINE 11	SUMMARY OF ACTIONS IN RESPONSE TO 2013 COMMUNITY HEALTH NEEDS ASSESSMENTTHE TOP THREE NEEDS IDENTIFIED WERE:- OBESITY- ACCESS- MENTAL HEALTHOVER THE NEXT THREE YEARS, THE HEALTH SYSTEM WORKED DILIGENTLY TO INCREASE ACCESS TO HEALTH CARE AND IMPROVE HEALTH IN THE IDENTIFIED AREAS.OBESITYONE-THIRD OF ADULTS IN DES MOINES COUNTY ARE OBESE, AND MANY MORE ARE OVERWEIGHT. SEVENTY-EIGHT PERCENT OF SURVEY RESPONDENTS SAID IT IS A SIGNIFICANT ISSUE. GREAT RIVER HEALTH SYSTEMS SET A GOAL TO INCREASE AWARENESS, ACCESS AND EDUCATION REGARDING HEALTHY BEHAVIORS.OBESITY PREVENTION EDUCATION:FROM 2013 TO 2015, GREAT RIVER HEALTH SYSTEMS PROVIDED AN EDUCATIONAL DISPLAY, NUTRITION INFORMATION AND ACTIVITIES AT 11 HEALTH FAIRS FOR CHILDREN, FAMILIES AND EMPLOYERS.GREAT RIVER HEALTH SYSTEMS IS A MEMBER OF THE SOUTHEAST IOWA REGIONAL COALITION FOR LIFESTYLE ENHANCEMENT, WHICH MEETS QUARTERLY. IT IS A MAJOR SPONSOR OF THE COALITION'S ANNUAL HEALTHY LIFESTYLE CONFERENCE FOR HEALTH CARE EDUCATORS AND PROVIDERS, GIVING FINANCIAL AND PROFESSIONAL SUPPORT.GREAT RIVER HEALTH FITNESSIN AUGUST 2013, GREAT RIVER HEALTH SYSTEMS OPENED ITS GREATLY EXPANDED EXERCISE FACILITY, GREAT RIVER HEALTH FITNESS. IT IS THE LARGEST AND MOST ADVANCED WORKOUT FACILITY IN DES MOINES COUNTY. THE NEW SPACE HOLDS DOUBLE THE AMOUNT OF WELLNESS EQUIPMENT AS THE ORIGINAL SPACE. NEW FEATURES WERE A FULL EXERCISE TRACK AND A THREE-STORY ROCK-CLIMBING TOWER, THE ONLY ONE IN THE REGION. THE WARM- AND COOL-WATER THERAPY POOLS CONTINUE TO PROVIDE EXERCISE AND THERAPY OPPORTUNITIES.FITNESS-CENTER USE IS GAUGED BY MEMBERSHIP CARD SCANS. THESE NUMBERS REFLECT GROWING USE OF GREAT RIVER HEALTH FITNESS: SEPTEMBER 2012 - 5,473; SEPTEMBER 2013 - 6,918; SEPTEMBER 2015 - 9,507SPECIAL PROGRAMS AND SERVICES OFFERED BY GREAT RIVER HEALTH FITNESS INCLUDE:- ABLE (A BETTER LIFE EVERY DAY) - A PROGRAM FOR PEOPLE WHO HAVE DIFFICULTY OBTAINING OR MAINTAINING A HEALTHY WEIGHT- DELAY THE DISEASE - AN EXERCISE PROGRAM FOR PEOPLE WITH PARKINSON'S DISEASE- FAME (FITNESS AND MOBILITY EXERCISE) - A PROGRAM FOR PEOPLE WHO HAVE HAD A STROKE- WELLNESS COACHING - AN EMPLOYEE WHO HAS A MASTER'S DEGREE IN HEALTH PROMOTION AND EMPHASIS ON WELLNESS COACHING WORKS WITH GREAT RIVER HEALTH SYSTEMS EMPLOYEES WHO DIDN'T PASS METABOLIC PANEL TESTING AND ARE CHOOSING TO BE IMPROVE THEIR HEALTH. MORE THAN 100 PEOPLE HAVE PARTICIPATED.GREAT RIVER HEALTHY LIVING CLINICIN 2015, GREAT RIVER HEALTHY LIVING CLINIC MOVED INTO THE NEW GREAT RIVER FAMILY PRACTICE CLINIC. IT HAS A DEMONSTRATION KITCHEN FOR HEALTHY COOKING PROGRAMS, WHICH FILL QUICKLY.THE CLINIC PROVIDES SERVICES THAT PROMOTE HEALTHY LIFESTYLE CHOICES, WHICH ARE CONDUCIVE TO LONG-TERM SUCCESS IN WEIGHT LOSS AND PREVENTING METABOLIC SYNDROME. ITS SIGNATURE PROGRAM, OPERATION TRANSFORMATION, ADDRESSES A GROUP OF RISK FACTORS ASSOCIATED WITH CORONARY ARTERY DISEASE, STROKE AND TYPE 2 DIABETES.THE PHYSICIAN-SUPERVISED WEIGHT-LOSS PROGRAM FOCUSES ON CHANGING LIFESTYLE BEHAVIORS COUPLED WITH NUTRITION GUIDANCE AND EXERCISE REGIMENS TO ACHIEVE LASTING WEIGHT-LOSS GOALS. ITS SUCCESS RATE IS GREATER THAN 90 PERCENT.AREA BUSINESSES, INCLUDING GREAT RIVER MEDICAL CENTER, HAVE BEGUN USING OPERATION TRANSFORMATION AS A WELLNESS BENEFIT FOR THEIR EMPLOYEES.THE HEALTHY LIVING CLINIC WORKED WITH AREA RESTAURANTS AND GREAT RIVER MEDICAL CENTER'S CAFETERIA TO PROVIDE OPERATION TRANSFORMATION- APPROVED HEALTHIER MENU ITEMS.THE HEALTHY LIVING CLINIC ALSO WORKS WITH THE BURLINGTON YMCA TO OFFER FINDING A HEALTHIER YOU, A PROGRAM THAT HELPS IMPROVE FITNESS AND EATING CHOICES.PIONEERING HEALTHY COMMUNITIES GRANT GREAT RIVER HEALTH SYSTEMS PARTICIPATES IN THE DES MOINES COUNTY LIVING WELL COALITION IN PARTNERSHIP WITH THE BURLINGTON YMCA. PROJECTS HAVE INCLUDED PLANNING, SUPPORTING AND IMPLEMENTING COMMUNITY GARDENS IN BURLINGTON TO SUPPORT HEALTHY EATING. FRUITS AND VEGETABLES GROWN ARE AVAILABLE TO THE COMMUNITY, AND SURPLUS ITEMS ARE OFFERED AT THE YMCA FOR A FREE-WILL DONATION.ACCESSSTAKEHOLDER INTERVIEWS AND PUBLIC SURVEYS SHOWED CONCERN FOR THE LACK OF ACCESS TO HEALTH CARE PROVIDERS AND THE DISPROPORTIONATELY LOW NUMBER OF PHYSICIANS FOR THE SIZE OF THE COMMUNITY. WITH A GOAL TO INCREASE ACCESS AND AWARENESS OF SERVICES, GREAT RIVER HEALTH SYSTEMS DEVELOPED A THREE-PART ACTION PLAN CONSISTING OF DEVELOPING GREAT RIVER QUICKCARE, PROVIDING CLINICAL SERVICES TO THE UNDERSERVED AND TIRELESSLY RECRUITING PHYSICIANS.GREAT RIVER QUICKCAREGREAT RIVER QUICKCARE OPENED IN OCTOBER 2012 TO PROVIDE PRIMARY CARE FOR PATIENTS WHO DON'T HAVE PRIMARY-CARE PROVIDERS OR WHO CAN'T GET IMMEDIATE APPOINTMENTS WITH THEIR PROVIDERS. THE WALK-IN CLINIC TREATS PEOPLE 18 MONTHS AND OLDER WHO HAVE LOWER-ACUITY ILLNESSES SUCH AS COLDS, INFLUENZA, EARACHES, PINK EYE AND INSECT BITES. IT ALSO OFFERS LIMITED LABORATORY SERVICES, AND CAMP AND SPORTS PHYSICALS. GREAT RIVER QUICKCARE PROVIDES COST-EFFECTIVE TREATMENT COMPARED TO EMERGENCY DEPARTMENT VISITS.POSTCARDS ANNOUNCING THE OPENING OF GREAT RIVER QUICKCARE WERE SENT TO EVERY HOME IN DES MOINES COUNTY. ADVERTISING CONTINUES IN NEWSPAPERS AND LOCAL PERIODICALS. INFORMATION ABOUT SERVICES APPEARS IN GREAT RIVER HEALTH SYSTEMS'SERVICE GUIDE AND ON THE HEALTH SYSTEMS'WEBSITESINCE ITS OPENING, GREAT RIVER QUICKCARE HAS:- INCREASED THE NUMBER OF PROVIDERS FROM ONE TO SEVEN- ADDED CERTIFIED MEDICAL ASSISTANTS- EXTENDED ITS SCHEDULE FROM FIVE DAYS A WEEK TO SEVEN- DOUBLED THE NUMBER OF EXAMINATION ROOMS AND ENLARGED THE WAITING AREATHE NUMBER OF PATIENTS TREATED YEARLY DOUBLED FROM 4,847 IN 2013 TO 9,875 IN 2015:PROVIDING CLINICAL SERVICES TO THE UNDERSERVED BESIDES EXPANDING SERVICES THROUGH GREAT RIVER QUICKCARE, GREAT RIVER FAMILY PRACTICE CLINIC OPENED IN SEPTEMBER 2015 WITH THREE NEW PROVIDERS. GREAT RIVER MEDICINE SPECIALISTS, GREAT RIVER NEPHROLOGY AND GREAT RIVER PULMONOLOGY EXTENDED THEIR HOURS, ADDED APPOINTMENT TIMES AND ADDED VISITING PHYSICIANS TO PROVIDE SERVICES IN SPECIALTY AREAS.IN 2014, GREAT RIVER HEALTH SYSTEMS FINANCIAL COUNSELORS COMPLETED TRAINING TO BECOME CERTIFIED APPLICATION COUNSELORS FOR THE HEALTH INSURANCE MARKETPLACE. THEY ARE AVAILABLE BY APPOINTMENT TO HELP IOWANS ENROLL IN HEALTH COVERAGE. THE STATE-BASED MARKETPLACE GIVES CONSUMERS A SINGLE SOURCE TO COMPARE OPTIONS, LEARN IF THEY CAN GET LOWER PREMIUMS OR FREE COVERAGE, AND ENROLL IN A PLAN.THE HOSPITAL WAS DESIGNATED A CHAMPION OF COVERAGE ORGANIZATION AND A CERTIFIED APPLICATION COUNSELOR ORGANIZATION BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. IT ALSO IS A PRESUMPTIVE MEDICAID ORGANIZATION. WITH BASIC INFORMATION, FINANCIAL COUNSELORS CAN ENROLL PATIENTS AND FAMILY MEMBERS LIKELY TO BE ELIGIBLE FOR MEDICAID IMMEDIATELY, WITHOUT WAITING FOR AN ELIGIBILITY DETERMINATION FROM THE STATE. MEDICAID WILL PAY THE HOSPITAL FOR THE SERVICES PROVIDED, JUST AS THOUGH THE PATIENT ALREADY ENROLLED IN MEDICAID.PHYSICIAN RECRUITMENTGREAT RIVER HEALTH SYSTEMS ADDED SEVEN PRIMARY- CARE PROVIDERS TO ITS MEDICAL STAFF IN THE AREAS OF FAMILY PRACTICE, INTERNAL MEDICINE AND QUICK CARE.MENTAL HEALTHGREAT RIVER MEDICAL CENTER IS THE ONLY HOSPITAL OFFERING ADULT INPATIENT MENTAL HEALTH SERVICES IN THE SOUTHEAST IOWA REGION. IT HAS AN EIGHT- BED BEHAVIORAL HEALTH UNIT. GREAT RIVER HEALTH SYSTEMS ALSO HAS AN OUTPATIENT MENTAL HEALTH AND SUBSTANCE ABUSE CLINIC.AS IDENTIFIED THROUGH THE COMMUNITY SURVEY AND STAKEHOLDER INTERVIEWS, THE HOSPITAL DETERMINED THE TWO GREATEST MENTAL HEALTH NEEDS ARE MAINTAINING OR INCREASING THE MENTAL HEALTH SERVICES IT PROVIDES AND INCREASING COMMUNITY EDUCATION ABOUT MENTAL HEALTH.IN THREE YEARS, GREAT RIVER HEALTH SYSTEMS RECRUITED THREE PSYCHIATRISTS, INCREASING THE TOTAL TO FIVE, AND INCREASED SERVICE LOCATIONS:- IN 2013, A PHYSICIAN BEGAN SEEING PATIENTS ONLY IN THE INPATIENT PSYCHIATRIC CARE UNIT. BY CONDUCTING PATIENT ROUNDS IN THE UNIT SEVERAL TIMES THROUGHOUT THE DAY, HE CONTINUALLY ASSESSES PATIENT STATUSES, MEDICINES AND PROGRESS, WHICH LEADS TO INCREASED PATIENT STABILITY, SHORTER LENGTHS OF STAY AND A HIGHER TURNOVER OF INPATIENT BEDS.- IN 2014, A PSYCHIATRIST BEGAN PROVIDING OUTPATIENT SERVICES AT COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA THROUGH A CONTRACT AGREEMENT. THIS MAKES BEHAVIORAL HEALTH SERVICES MORE ACCESSIBLE TO THE COMMUNITY'S UNDER- AND UNINSURED POPULATIONS, AND REDUCES THE PATIENT LOAD OF THE PSYCHIATRISTS AT THE HOSPITAL. AS A RESULT, MORE OFFICE APPOINTMENT TIMES ARE AVAILABLE.- IN 2015, A PSYCHIATRIST BEGAN HOLDING WEEKLY OFFICE HOURS AT GREAT RIVER WOMEN'S HEALTH, WHERE SHE SEES PATIENTS DURING SCHEDULED AND WALK-IN APPOINTMENTS.BESIDES THE FIVE PSYCHIATRISTS, THE HEALTH SYSTEM'S MENTAL HEALTH TREATMENT STAFF INCLUDES ONE NURSE PRACTITIONER, ONE PSYCHOLOGIST, TWO LICENSED MASTER SOCIAL WORKERS, THREE LICENSED THERAPISTS, AND TWO SUBSTANCE ABUSE COUNSELORS.
PART V, SECTION B, LINE 11 - CONTINUED	BEHAVIORAL HEALTH ASSESSMENT TEAMIN 2014, GREAT RIVER HEALTH SYSTEMS DEVELOPED A BEHAVIORAL HEALTH ASSESSMENT TEAM TO HELP MEET THE INCREASING NEED FOR MENTAL HEALTH SERVICES. THE TEAM CONSISTS OF THE BEHAVIORAL HEALTH DIRECTOR, SOCIAL WORK SUPERVISOR, A PSYCHIATRIST, FOUR ASSESSMENT SPECIALISTS AND AN ADDICTIONS SPECIALIST. IT WORKS WITH PATIENTS, PROVIDERS AND COMMUNITY AGENCIES TO ENSURE EXISTING SERVICES ARE PROVIDED EFFECTIVELY AND EFFICIENTLY. SERVICES ARE PROVIDED FOR PATIENTS IN THE ACUTE CARE CENTER, EMERGENCY DEPARTMENT AND INTENSIVE CARE UNIT.ACUTE CARE CENTER:- FOLLOWS PATIENTS WHO HAVE MENTAL HEALTH OR SUBSTANCE-ABUSE ISSUES- PROVIDES COMPLETE ASSESSMENTS ON PATIENTS WHO HAVE PSYCHIATRIC CONSULTATIONSEMERGENCY DEPARTMENT:- PROVIDES COMPLETE ASSESSMENTS ON PATIENTS WHO HAVE COURT COMMITTAL DOCUMENTS- PROVIDES COMPLETE ASSESSMENTS ON PATIENTS WITH MENTAL HEALTH OR SUBSTANCE-ABUSE ISSUES- HELPS PATIENTS WHO RETURN FREQUENTLY IN SEARCH OF OTHER RESOURCES- HELPS PATIENTS WHO NEED SOCIAL WORK SERVICESINTENSIVE CARE UNIT:- FOLLOWS PATIENTS WHO HAVE SUBSTANCE-ABUSE OR MENTAL HEALTH ISSUES- HELPS PATIENTS WHO NEED SOCIAL WORK SERVICES FOR MENTAL HEALTH OR SUBSTANCE ABUSE- COMPLETES ASSESSMENTS ON PATIENTS WITH MENTAL HEALTH OR SUBSTANCE-ABUSE ISSUESCRISIS STABILIZATION SERVICESGREAT RIVER HEALTH SYSTEMS'DIRECTOR OF BEHAVIORAL HEALTH WORKED WITH HOPE HAVEN AREA DEVELOPMENT CENTER TO DEVELOP CRITERIA FOR ITS CRISIS STABILIZATION SERVICES. THE FIVE- BED CRISIS SERVICE IS AVAILABLE TO ADULTS WITH A MENTAL ILLNESS OR DEVELOPMENTAL DISABILITY WHO TEMPORARILY CANNOT LIVE INDEPENDENTLY AND NEED IMMEDIATE INTERVENTION. PROVIDING OUTPATIENT PSYCHIATRIC CARE IN THIS SETTING REDUCES THE NEED FOR HOSPITAL ADMISSIONS.INCREASED COLLABORATION WITH JUDICIAL SYSTEM THE DIRECTOR OF BEHAVIORAL HEALTH AND MEDICAL DIRECTOR OF GREAT RIVER MENTAL HEALTH MEET WITH DES MOINES COUNTY JUDGES TWICE A YEAR TO DISCUSS THE PROCESS FOR MENTAL HEALTH COMMITTALS TO ENSURE THE BEST TREATMENT FOR PATIENTS.INTAKE COORDINATORAN INTAKE COORDINATOR POSITION WAS ESTABLISHED AT GREAT RIVER MENTAL HEALTH. IN FACE-TO-FACE APPOINTMENTS, THE COORDINATOR SCREENS NEW PATIENTS AND MAKES APPOINTMENTS WITH APPROPRIATE PROVIDERS TO IMPROVE TIMELINESS OF CARE.INTEGRATED CARE CLINICIN 2015, GREAT RIVER HEALTH SYSTEMS IMPLEMENTED AN INTEGRATED CARE CLINIC, OFFERING POPULATION- BASED HEALTH SERVICES THAT ADDRESS THE COMPREHENSIVE PHYSICAL AND MENTAL HEALTH NEEDS OF PATIENTS. THE FIRST OF ITS KIND IN SOUTHEAST IOWA, IT SERVES CLIENTS FROM OPTIMAE LIFESERVICES, AN ORGANIZATION THAT PROVIDES RESIDENTIAL AND SUPPORT SERVICES FOR PEOPLE WITH MENTAL ILLNESS OR DEVELOPMENTAL DISABILITIES.OPTIMAE CLIENTS MEET WITH A GREAT RIVER HEALTH SYSTEMS TEAM THAT INCLUDES A PRIMARY-CARE PROVIDER, PSYCHIATRIST, PHARMACIST AND OTHER HEALTH PROFESSIONALS. THIS APPROACH ELIMINATES THE NEED FOR MULTIPLE APPOINTMENTS, IMPROVES COMMUNICATION AMONG HEALTH CARE PROVIDERS AND REDUCES THE POTENTIAL FOR UNNECESSARY EMERGENCY DEPARTMENT VISITS OR ADMISSIONS.JAIL DIVERSION PROGRAMTHE NEW PROGRAM PROVIDES EVALUATION AND COORDINATION OF CARE FOR PEOPLE WHO ARE IN JAIL FOR SUSPECTED CRIMES THAT MAY BE THE RESULT OF THEIR MENTAL ILLNESSES.PARTIAL HOSPITAL PROGRAMTHE PARTIAL HOSPITAL PROGRAM, WHICH BEGAN IN 2015, IS FOR PATIENTS WHO DON'T REQUIRE INPATIENT HOSPITALIZATION BUT ARE IN NEED OF INTENSIVE MENTAL HEALTH SERVICES BEYOND WHAT THE OUTPATIENT CLINIC CAN PROVIDE. PATIENTS COME TO THE HOSPITAL FOR SIX HOURS A DAY, MONDAY THROUGH FRIDAY, FOR GROUP THERAPY, MEDICINE MANAGEMENT AND PSYCHIATRIC CARE. THE PROGRAM HELPS BRIDGE THE GAP BETWEEN INPATIENT AND OUTPATIENT SERVICES, HELPING PATIENTS GRADUALLY TRANSITION TO LESS-INTENSIVE PSYCHIATRIC SERVICES.SUBSTANCE ABUSE GROUPTO HELP BRIDGE THE THREE- TO SIX-WEEK WAITING PERIOD BEFORE BEING ADMITTED FOR INPATIENT REHABILITATION FOR SUBSTANCE ABUSE AT OTHER FACILITIES, GREAT RIVER MENTAL HEALTH ESTABLISHED A SUBSTANCE ABUSE GROUP THAT MEETS THREE TIMES A WEEK. RANDOM URINE DRUG SCREENS ARE CONDUCTED.

Schedule H (Form 990) 2015

Page 8

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2015

Page 9

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
PART I, LINE 3C:	GREAT RIVER MEDICAL CENTER (GRMC) USES THE FPG TO DETERMINE FREE OR DISCOUNTED CARE. INDIVIDUALS WHO ARE BELOW 225% OF THE FPG QUALIFY FOR FREE CARE. IN MOST INSTANCES, THEY HAVE TO PROVIDE FINANCIAL DOCUMENTATION AND FILL OUT A CHARITY CARE APPLICATION. THE HOSPITAL ALSO USES A PRESUMPTIVE CHARITY CARE PROGRAM THAT ANALYZES PUBLIC AND PRIVATE DATABASES TO HELP DETERMINE ELIGIBITY 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 INTO CONSIDERATION WHEN DETERMINING CHARITY CARE ELIGIBILITY. MEDICALLY INDIGENT INDIVIDUALS ARE COVERED UNDER THE SAME CHARITY CARE POLICY. INDIVIDUALS BETWEEN 225% AND 300% OF THE FEDERAL POVERTY LIMITS ARE GRANTED CHARITY ON A SLIDING SCALE.
PART I, LINE 7:	THE AMOUNTS INCLUDED IN PART I, LINE 7 WERE CALCULATED USING A RATIO OF COST TO CHARGES DERIVED FROM WORKSHEET 2 OF THE IRS SCHEDULE H INSTRUCTIONS.
PART I, LINE 7G:	THE SUBSIDIZED HEALTH SERVICES INCLUDED IN PART I, LINE 7G IS MENTAL HEALTH SERVICES PROVIDED BY GRMC.
PART I, LN 7 COL(F):	BAD DEBT EXPENSES OF $4,747,691 WERE SUBTRACTED FROM THE TOTAL EXPENSES IN CALCULATING THE PERCENTAGES IN PART I, LINE 7, COLUMN F.
PART III, LINE 4:	THE FOOTNOTE FROM THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE IS AS FOLLOWS: "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 WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSES WHEN RECEIVED."
PART III, LINE 8:	THE ORGANIZATION DERIVED ITS COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT BY USING COST REPORT WORKSHEETS. MEDICARE COSTS ARE DETERMINED THROUGH THE MEDICARE COST FINDING PROCESS WHICH ALLOCATES GENERAL SERVICE CENTER COSTS TO REVENUE DEPARTMENTS. THE METHODOLOGY DESCRIBED IN THE INSTRUCTIONS TO SCHEDULE H, PART III, SECTION B, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE HOSPITAL AND DOES NOT REPRESENT THE TOTAL COMMUNITY BENEFIT CONFERRED IN THIS AREA. THE REASONS MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT ARE - ABSENT THE MEDICARE PROGRAM, IT IS LIKELY MANY OF THE INDIVIDUALS WOULD QUALIFY FOR FINANCIAL ASSISTANCE OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS. BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS. THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION IN REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS, AND THE AMOUNT SPENT TO COVER MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFIT NEEDS.
PART III, LINE 9B:	AN EXCERPT FROM GRMC'S FINANCIAL ASSISTANCE PROGRAM WRITTEN POLICY - SECTION 8, RELATIONSHIP OF FINANCIAL ASSISTANCE PROGRAM TO COLLECTION POLICIES: "GREAT RIVER MEDICAL CENTER MANAGEMENT SHALL DEVELOP POLICIES AND PROCEDURES FOR INTERNAL AND EXTERNAL COLLECTION PRACTICES THAT TAKE INTO ACCOUNT THE EXTENT TO WHICH THE PATIENT QUALIFIES FOR CHARITY, A PATIENT'S GOOD FAITH EFFORT TO APPLY FOR A GOVERNMENTAL PROGRAM OR FOR CHARITY FROM GREAT RIVER MEDICAL CENTER, AND A PATIENT'S GOOD FAITH EFFORT TO COMPLY WITH HIS OR HER PAYMENT AGREEMENTS WITH GREAT RIVER MEDICAL CENTER. FOR PATIENTS WHO QUALIFY FOR CHARITY AND WHO ARE COOPERATING IN GOOD FAITH EFFORT TO RESOLVE THEIR DISCOUNTED HOSPITAL BILLS, GREAT RIVER MEDICAL CENTER MAY OFFER EXTENDED PAYMENT PLANS, WILL NOT SEND UNPAID BILLS TO OUTSIDE COLLECTION AGENCIES, AND WILL CEASE ALL COLLECTION EFFORTS. GREAT RIVER MEDICAL CENTER AND AGENCIES ACTING ON BEHALF OF GREAT RIVER MEDICAL CENTER WILL NOT IMPOSE EXTRAORDINARY COLLECTION ACTIONS SUCH AS WAGE GARNISHMENTS; LIENS ON PRIMARY RESIDENCES, OR OTHER LEGAL ACTIONS FOR ANY PATIENT WITHOUT FIRST MAKING REASONABLE EFFORTS TO DETERMINE WHETHER THAT PATIENT IS ELIGIBLE FOR CHARITY CARE UNDER THIS FINANCIAL ASSISTANCE POLICY. REASONABLE EFFORTS SHALL INCLUDE: A) VALIDATING THAT THE PATIENT OWES THE UNPAID BILLS AND THAT ALL SOURCES OF THIRD-PARTY PAYMENTS HAVE BEEN IDENTIFIED AND BILLED BY THE HOSPITAL; B) DOCUMENTATION THAT GREAT RIVER MEDICAL CENTER HAS OR HAS ATTEMPTED TO OFFER THE PATIENT THE OPPORTUNITY TO APPLY FOR CHARITY CARE PURSUANT TO THIS POLICY AND THAT THE PATIENT HAS NOT COMPLIED WITH THE HOSPITAL'S APPLICATION REQUIREMENTS; C) DOCUMENTATION THAT THE PATIENT HAS BEEN OFFERED A PAYMENT PLAN BUT HAS NOT HONORED THE TERMS OF THAT PLAN."
PART III, SECTION A, LINE 1	THE ORGANIZATION REPORTS BAD DEBT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). HFMA STATEMENT 15 IS FOLLOWED TO THE EXTENT THAT IT ALIGNS WITH THE GUIDELINES SET FORTH BY GAAP.
PART VI, LINE 2:	GRMC'S BOARD OF DIRECTORS IS COMMUNITY BASED. REPRESENTATIVES FROM VARIOUS SEGMENTS OF THE COMMUNITY MAKE UP THE BOARD. IN ADDITION, BOARD MEMBERS ARE SELECTED IN OUTLYING COMMUNITIES THAT GRMC SERVES. THESE BOARD MEMBERS CONSTANTLY PROVIDE INPUT TO THE HEALTHCARE NEEDS OF OUR COMMUNITY THROUGH THE ANNUAL STRATEGIC PLANNING PROCESS.
PART VI, LINE 3:	NOTIFICATION ABOUT GOVERNMENT PROGRAM AND/OR FINANCIAL ASSISTANCE FROM GRMC IS DISSEMINATED BY VARIOUS MEANS AT GRMC, WHICH INCLUDES - PUBLICATION OF NOTICES IN PATIENT BILLS AND POSTED NOTICES IN THE EMERGENCY ROOMS, ADMISSION FORMS, ADMITTING AND REGISTRATION DEPARTMENT, HOSPITAL BUSINESS OFFICES, AND THE FINANCIAL SERVICES OFFICE ON THE FACILITY CAMPUS. GRMC ALSO POSTS AT THE LOCAL DEPARTMENT OF HEALTH SERVICES OFFICE. GRMC ALSO PUBLISHES AND WIDELY PUBLICIZES A SUMMARY OF THE ASSISTANCE OPTIONS ON THE FACILITY WEBSITE AND IN BROCHURES AVAILABLE IN PATIENT ACCESS SITES. REFERRAL OF PATIENTS FOR CHARITY MAY BE MADE BY ANY MEMBER OF THE GRMC STAFF. ALSO REQUESTS FOR CHARITY MAY BE MADE BY THE PATIENT OR A FAMILY MEMBER, CLOSE FRIEND, OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS. FINANCIAL COUNSELORS MEET WITH PATIENTS TO ASSIST IN COMPLETING A QUESTIONNAIRE THAT HELPS THEM DETERMINE IF THE PATIENT QUALIFIES FOR A GOVERNMENT PROGRAM.
PART VI, LINE 4:	A REVIEW WAS CONDUCTED BY GRMC TO ANALYZE THE ORIGIN OF PATIENTS UTILIZING THE SERVICES PROVIDED BY THE MEDICAL CENTER. THE REVIEW INDICATED 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.BASED ON THE US CENSUS BUREAU STATISTICS FOR 2016, THE PRIMARY SERVICE AREA POPULATION IS ESTIMATED AT 39,739 RESIDENTS. THE SECONDARY SERVICE AREA POPULATIONS ARE ESTIMATED TO TOTAL 71,134 RESIDENTS. OVER AGE 65 GROUP IS CURRENTLY 19.4% OF THE PRIMARY SERVICE AREA POPULATION, AS COMPARED TO 16.1% OF THE STATE OF IOWA POPULATION AND 14.9% OF THE UNITED STATES POPULATION. THE MEDIAN HOUSEHOLD INCOME IN THE PRIMARY SERVICE AREA IS $44,423 COMPARED TO THE STATE AND NATIONAL AVERAGES OF $53,183 AND $53,889, RESPECTIVELY. THE PRIMARY SERVICE AREA POPULATION BELOW POVERTY LEVEL IS 14.7% AS COMPARED TO THE STATE AND NATIONAL AVERAGES OF 12.2% AND 13.5%, RESPECTIVELY.GREAT RIVER MEDICAL CENTER IS THE ONLY HOSPITAL IN THE PRIMARY SERVICE AREA AND THE LARGEST SERVICE PROVIDER, INCLUDING THE BROADEST SCOPE OF SERVICES, IN THE PRIMARY AND SECONDARY SERVICE AREAS.
PART VI, LINE 5:	GRMC FURTHERS ITS EFFORTS TO PROMOTE THE HEALTH OF THE COMMUNITY BY ENSURING THE MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS OF SUCH.GRMC PROVIDES MEMBERSHIP TO ALL PHYSICIANS WHO MEET MEMBERSHIP AND CLINICAL REQUIREMENTS.GMRC IS INVOLVED IN GETTING PHYSICIANS AND HEALTHCARE WORKERS TO THE AREA TO IMPROVE THE ACCESS TO HEALTHCARE NEEDS IN THE HOSPITAL'S SERVICE AREA. GRMC ALSO PROMOTES HEALTH CARE RELATED JOBS EDUCATION BY WORKING CLOSELY WITH SOUTHEASTERN COMMUNITY COLLEGE AND THEIR NURSING PROGRAM.GRMC PARTICIPATES IN COMMUNITY BENEFIT ACTIVITIES SUCH AS PARTNERING WITH LOCAL SCHOOLS, COMMUNITY EDUCATION, COMMUNITY INITIATIVE EVENTS, PRENATAL EDUCATION CLASSES, A HEALTH FAIR, AND A LIBRARY OPEN TO THE COMMUNITY.GRMC MAINTAINS AN EMERGENCY ROOM 24 HOURS A DAY, 7 DAYS A WEEK WHICH IS OPEN TO ALL, REGARDLESS OF ABILITY TO PAY.SURPLUS FUNDS OF THE HOSPITAL ARE INVESTED IN IMPROVING AND UPDATING CAPITAL EQUIPMENT AND INCREASING THE SERVICES OFFERED TO ALLOW FOR BETTER CARE OF THE PATIENTS THAT ARE SERVED.
PART VI, LINE 6:	GRMC IS PART OF A LARGER HEALTH SYSTEM, GREAT RIVER HEALTH SYSTEM.GREAT RIVER HEALTH SYSTEM CONSISTS OF ONE HOSPITAL, A HOSPICE HOUSE, HOME HEALTH SERVICES, AMBULANCE SERVICES, THREE PHARMACIES, A DURABLE MEDICAL EQUIPMENT COMPANY, A LONG-TERM CARE NURSING HOME AND MULTIPLE GENERAL AND SPECIALTY PHYSICIAN CLINICS.THE NON-HOSPITAL HEALTH-CARE FACILITIES THAT ARE OPERATED BY ORGANIZATIONS RELATED TO THE HOSPITAL INCLUDE THE FOLLOWING, LISTED IN ORDER OF SIZE: BURLINGTON AREA FAMILY PRACTICE, GREAT RIVER ORTHOPEDIC SPECIALISTS, GREAT RIVER WOMEN'S HEALTH, HERITAGE MEDICAL EQUIPMENT SUPPLY, KEOKUK CLINIC, HERITAGE PARK PHARMACY, GREAT RIVER MENTAL HEALTH, GREAT RIVER ANESTHESIA, HERITAGE PARTNERS PHARMACY, GREAT RIVER SURGEONS, GREAT RIVER UROLOGY, GREAT RIVER QUICK CARE, WAPELLO CLINIC, GREAT RIVER MEDICINE SPECIALISTS, HERITAGE FAMILY PHARMACY, HEALTHY LIVING CLINIC, MEDIAPOLIS CLINIC, GREAT RIVER NEPHROLOGY, GREAT RIVER PULMONOLOGY, GREAT RIVER EYE SPECIALISTS, GREAT RIVER GASTROENTEROLOGY, GREAT RIVER AUDIOLOGY, GREAT RIVER HOSPITALISTS, GREAT RIVER HEMATOLOGY & ONCOLOGY, AND GREAT RIVER CARDIOLOGY.
PART VI, LINE 7	GRMC DOES NOT FILE A COMMUNITY BENEFIT REPORT WITH THE STATE OF IOWA. HOWEVER, COMMUNITY BENEFIT INFORMATION IS PROVIDED TO THE IOWA HOSPITAL ASSOCIATION.

Schedule H (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
GREAT RIVER MEDICAL CENTER

Employer identification number
42-0680407

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section if applicable	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of non-cash assistance	(h) Purpose of grant or assistance

(1) FRIENDS OF THE BURLINGTON DEPOT PO BOX 26 BURLINGTON,IA52601	45-5506965	501(C)(3)	5,000	SUPPORT REVITALIZATION OF COMMUNITY HISTORIC SITE
(2) PURPLE & GRAY FOUNDATION 520 WASHINGTON STREET BURLINGTON,IA52601	45-5339253	501(C)(3)	5,000	SUPPORT DEVELOPMENT OF HIGH SCHOOL SPORTS PROGRAMS
(3) BURLINGTON NOTRE DAME FOUNDATION 702 S ROOSEVELT AVE BURLINGTON,IA52601	42-1192150	501(C)(3)	25,000	SUPPORT DEVELOPMENT OF HIGH SCHOOL SPORTS PROGRAMS
(4) GIRL SCOUTS OF EASTERN IOWA 1308 BROADWAY STREET WEST BURLINGTON,IA52655	42-1008848	501(C)(3)	25,000	SUPPORT RENOVATION OF YOUTH CAMPING SITES

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2015

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of non-cash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of non-cash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Return Reference	Explanation
PART I, LINE 2:	GRANTEES ARE REQUIRED TO PROVIDE FOLLOW-UP INFORMATION WHEN THE PROJECT IS CARRIED OUT OR COMPLETED. IF GRANTEES DON'T COMPLY, GRMC DOES NOT PROVIDE FURTHER GRANTS TO THEM.

Schedule I (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

GREAT RIVER MEDICAL CENTER

Employer identification number

42-0680407

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Yes

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization?

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization?

Any related organization? .........................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2015

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column(B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1MICHAEL MCCOY MDDIRECTOR (THROUGH OCTOBER 2015)	(i) (ii)	0 ------------- 346,923	0 ------------- 0	0 ------------- -5,012	0 ------------- 10,600	0 ------------- 13,547	0 ------------- 366,058	0 ------------- 0
2MARK RICHARDSONPRESIDENT/CEO	(i) (ii)	0 ------------- 558,249	0 ------------- 50,000	0 ------------- 127,666	0 ------------- 10,600	0 ------------- 23,244	0 ------------- 769,759	0 ------------- 0
3TONY HAYESCOO	(i) (ii)	0 ------------- 314,621	0 ------------- 10,000	0 ------------- 111,482	0 ------------- 10,600	0 ------------- 19,758	0 ------------- 466,461	0 ------------- 0
4TODD SLADKYCFO	(i) (ii)	0 ------------- 352,580	0 ------------- 10,000	0 ------------- 31,042	0 ------------- 10,600	0 ------------- 20,388	0 ------------- 424,610	0 ------------- 0
5DARWIN COOLEYDIRECTOR OF PHARMACY	(i) (ii)	192,879 ------------- 0	0 ------------- 0	-2,513 ------------- 0	10,102 ------------- 0	20,967 ------------- 0	221,435 ------------- 0	0 ------------- 0
6JOHN MERCER IIIDIRECTOR OF FACILITIES	(i) (ii)	141,860 ------------- 0	0 ------------- 0	-8,019 ------------- 0	8,141 ------------- 0	21,203 ------------- 0	163,185 ------------- 0	0 ------------- 0
7ELIZABETH YOREDIRECTOR OF CARDIOVASCULAR SERVICES	(i) (ii)	137,214 ------------- 0	0 ------------- 0	-171 ------------- 0	7,862 ------------- 0	10,159 ------------- 0	155,064 ------------- 0	0 ------------- 0
8FRANCES STRAUSSDIRECTOR OF SURGICAL SERVICES	(i) (ii)	154,699 ------------- 0	1,000 ------------- 0	-8,926 ------------- 0	8,026 ------------- 0	22,516 ------------- 0	177,315 ------------- 0	0 ------------- 0
9JON WILLIAMSPHARMACIST	(i) (ii)	143,279 ------------- 0	0 ------------- 0	-8,227 ------------- 0	7,559 ------------- 0	21,974 ------------- 0	164,585 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2015

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference

Explanation

PART I, LINE 1A

1. MARK RICHARDSON, HEALTH/SOCIAL CLUB DUES, $4,494 INCLUDED IN TAXABLE WAGES 2. TONY HAYES, TRAVEL FOR COMPANIONS, $326 INCLUDED IN TAXABLE WAGES AND HEALTH/SOCIAL CLUB DUES, $4,494 INCLUDED IN TAXABLE WAGES 3. TODD SLADKY, TRAVEL FOR COMPANIONS, $504 INCLUDED IN TAXABLE WAGES AND HEALTH/SOCIAL CLUB DUES, $4,494 INCLUDED IN TAXABLE WAGES 4. MICHAEL MCCOY, HEALTH/SOCIAL CLUB DUES, $1,873 INCLUDED IN TAXABLE WAGES

PART I, LINE 3

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 COMMITTEE

Schedule J (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Information about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
GREAT RIVER MEDICAL CENTER

Employer identification number
42-0680407

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	IOWA FINANCE AUTHORITY	52-1699886	462466BV4	07-24-2008	37,475,000	REFUND OF PRIOR ISSUE (12/19/97)		X		X		X
B	DES MOINES COUNTY IOWA	42-6004310	250087AA1	04-04-2012	60,000,000	REFUND PRIOR ISSUE (7/25/01) & CONSTRUCT, RENOVATE, EXPAND & EQUIP FACILITY		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	12,230,070		16,245,614
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	37,475,070		60,000,000
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	306,661		616,000
8 Credit enhancement from proceeds .............	68,339
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	70		30,076,758
11 Other spent proceeds .............	37,100,000		29,307,242
12 Other unspent proceeds .............
13 Year of substantial completion .............	2000		2013
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....	X		X
15 Were the bonds issued as part of an advance refunding issue? .....		X		X
16 Has the final allocation of proceeds been made? ..........	X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2015

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? .............		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........
6 Total of lines 4 and 5 .............
7 Does the bond issue meet the private security or payment test? ...		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X
b Exception to rebate? ........	X		X
c No rebate due? .........	X		X
If "Yes" to line 2c, provide in Part VI the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X			X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2015

Page 3

Part IV

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X

Part V

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X

Part VI

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation
DATE REBATE COMPUTATION PERFORMED	ISSUER NAME: IOWA FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 01/24/2009 ISSUER NAME: DES MOINES COUNTY, IOWA DATE THE REBATE COMPUTATION WAS PERFORMED: 01/31/2013
PART IV, LINE 2, REBATE CALCULATION	NOTE REGARDING THE 01/24/2009 REBATE COMPUTATION: SINCE THE BOND PROCEEDS HAVE BEEN SPENT, A SPENDING EXCEPTION WAS MET, AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA FIDE BASIS, NO FURTHER REBATE CALCULATIONS ARE NECESSARY.
PART IV, LINE 2, REBATE CALCULATION	NOTE REGARDING THE 01/31/2013 REBATE COMPUTATION: SINCE THE BOND PROCEEDS HAVE BEEN SPENT, A SPENDING EXCEPTION WAS MET, AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA FIDE BASIS, NO FURTHER REBATE CALCULATIONS ARE NECESSARY.
PART II, LINE 3, COLUMN A	THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN E DUE TO INVESTMENT EARNINGS.

Schedule K (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Information about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

GREAT RIVER MEDICAL CENTER

Employer identification number

42-0680407

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No










Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2015

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) KC FLEMING	FAMILY MEMBER OF ROBERT FLEMING, BOARD MEMBER	165,241	WAGES AND BENEFITS		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

GREAT RIVER MEDICAL CENTER

Employer identification number

42-0680407

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 1	THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF THE CHAIRMAN OF THE BOARD, THE PRESIDENT AND CHIEF EXECUTIVE OFFICER, AND TWO OR MORE ADDITIONAL TRUSTEES. 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.
FORM 990, PART VI, SECTION A, LINE 2	KENT GUADIAN AND ROBERT MCCULLEY HAVE A BUSINESS RELATIONSHIP. ROBERT FLEMING, KENT GAUDIAN, DAN WEIDEMEIER, MARK RICHARDSON AND TODD SLADKY HAVE BUSINESS RELATIONSHIPS BY SERVING ON FOR-PROFIT RELATED ENTITIES OF GRMC.
FORM 990, PART VI, SECTION A, LINE 3	ALL EXECUTIVE LEADERSHIP FUNCTIONS FOR GREAT RIVER MEDICAL CENTER 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 6	GREAT RIVER HEALTH SYSTEMS INC., IS THE SOLE MEMBER OF GREAT RIVER MEDICAL CENTER.
FORM 990, PART VI, SECTION A, LINE 7A	ONE 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 7B	THE FOLLOWING MATTERS ARE AUTHORIZED ONLY AFTER APPROVAL OF THE MEMBER: A. MERGER, CONSOLIDATION, OR DISSOLUTION OF GREAT RIVER MEDICAL CENTER 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 11	THE FORM 990 IS PREPARED BY AN EXTERNAL ACCOUNTANT. A DRAFT OF THE FORM 990 IS REVIEWED IN DETAIL BY THE ACCOUNTANT, DIRECTOR OF FINANCE AND CFO. ANY NECESSARY ADJUSTMENTS ARE MADE PRIOR TO FINALIZING THE FORM. A COPY OF THE FINAL FORM 990 IS MADE AVAILABLE TO THE BOARD MEMBERS FOR THEIR REVIEW PRIOR TO FILING WITH THE IRS. ANY QUESTIONS OF THE BOARD MEMBERS ARE ADDRESSED THROUGH THE ACCOUNTING DEPARTMENT.
FORM 990, PART VI, SECTION B, LINE 12C	EVERY YEAR, THE DIRECTOR OF FINANCE 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 DIRECTOR OF FINANCE. 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	COMPENSATION OF THE OFFICERS OF GREAT RIVER MEDICAL CENTER IS PAID BY A RELATED FOR-PROFIT SUBSIDIARY. THE COMPENSATION FOR THE CEO AND OTHER OFFICERS IS DETERMINED BY THE EXECUTIVE COMPENSATION COMMITTEE OF GREAT RIVER HEALTH SYSTEMS. THE ROLE OF THE COMPENSATION COMMITTEE IS TO ACT ON BEHALF OF THE BOARD IN ADOPTING, REVIEWING AND MAINTAINING AN EXECUTIVE COMPENSATION PHILOSOPHY. THE COMPENSATION COMMITTEE IS COMPRISED OF FIVE BOARD MEMBERS, ALL OF WHOM ARE INDEPENDENT FROM THE CEO AND OTHER OFFICERS. THE COMPENSATION COMMITTEE REVIEWS THE COMPENSATION OF THE CEO AND OTHER OFFICERS ON A BIENNIAL BASIS. THE DELIBERATIONS AND DECISIONS ARE DOCUMENTED IN MINUTES TAKEN AT THE MEETINGS. GREAT RIVER HEALTH SYTEMS PARTICIPATES AND UTILIZES FOUR EXECUTIVE SALARY SURVEYS TO DETERMINE COMPENSATION RANGES. THE COMMITTEE REVIEWS PREVAILING MARKET DATA TO ENSURE CONTINUED MARKET COMPETITIVENESS. THE COMPENSATION COMMITTEE ALSO ENGAGES AN INDEPENDENT THIRD PARTY COMPENSATION CONSULTING GROUP TO ASSESS AND VALIDATE THE ENTIRETY OF THE EXECUTIVE COMPENSATION AND BENEFITS PACKAGES TO ENSURE REGULATORY COMPLIANCE, EXTERNAL COMPETITIVENESS, AND INTERNAL EQUITY. THE MOST RECENT YEAR OF AN INDEPENDENT THIRD PARTY REVIEW WAS 2015.
FORM 990, PART VI, SECTION C, LINE 19	GREAT RIVER MEDICAL CENTER MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST.
FORM 990, PART XI, LINE 9:	CHANGE IN BENEFICIAL INTEREST IN TRUST -687,097. TRANSFER FROM RELATED PARTY -22,542,603.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

GREAT RIVER MEDICAL CENTER

Employer identification number

42-0680407

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)GREAT RIVER HEALTH SYSTEMS INC 1221 SOUTH GEAR AVENUE WEST BURLINGTON,IA52655 42-1193185	HEALTH CARE	IA	501(C)(3)	11 - TYPE 2	N/A		No
(2)GRMC FOUNDATION CORP 1221 SOUTH GEAR AVENUE WEST BURLINGTON,IA52655 42-1193186	SUPPORT RELATED ORGANIZATIONS	IA	501(C)(3)	11 - TYPE 2	GRHS		No
(3)GREAT RIVER FOUNDATION INC 1221 SOUTH GEAR AVENUE WEST BURLINGTON,IA52655 42-1469162	SUPPORT RELATED ORGANIZATIONS	IA	501(C)(3)	11 - TYPE 2	GRHS		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2015

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) RIVERVIEW SYSTEMS LTD 1221 SOUTH GEAR AVE WEST BURLINGTON,IA52655 42-1191960	MEDICAL SERVICES	IA	N/A	C				No
(2) GREAT RIVER MEDICAL SERVICES INC 1221 SOUTH GEAR AVE WEST BURLINGTON,IA52655 42-1493449	MEDICAL SERVICES	IA	N/A	C				No
(3) MUTUAL CONSULTING & MANAGEMENT SERVICES 1221 SOUTH GEAR AVE WEST BURLINGTON,IA52655 42-1349668	MANAGEMENT SERVICES	IA	N/A	C				No
(4) HEALTH CARE REALTY 1221 SOUTH GEAR AVE WEST BURLINGTON,IA52655 42-1193532	REAL ESTATE	IA	N/A	C				No
(5) HERITAGE PARK PHARMACY 1221 SOUTH GEAR AVE WEST BURLINGTON,IA52655 42-1191957	PHARMACY	IA	N/A	C				No
(6) HERITAGE MEDICAL EQUIPMENT & SUPPLY 1221 SOUTH GEAR AVE WEST BURLINGTON,IA52655 42-1191958	MEDICAL SUPPLY	IA	N/A	C				No
(7) SOUTHEASTERN IOWA MEDICAL SERVICES 1221 SOUTH GEAR AVE WEST BURLINGTON,IA52655 42-1307141	PHYSICIAN CLINICS	IA	N/A	C				No

Schedule R (Form 990) 2015

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2015

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2015

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2015

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: IMPROVING THE REGION'S HEALTH BY PROVIDING HIGH-QUALITY HEALTH CARE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	12
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	10
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	1,875
6	Total number of volunteers (estimate if necessary) .............	6	442
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	127,817
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	-27,434

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,059,173	972,790
9	Program service revenue (Part VIII, line 2g) .........	175,807,025	183,413,152
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	48,699	458,644
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	60,079	128,966
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	176,974,976	184,973,552
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	931,089	232,186
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	82,393,548	88,008,201
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 79,162
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	84,380,390	86,981,743
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	167,705,027	175,222,130
19	Revenue less expenses. Subtract line 18 from line 12.......	9,269,949	9,751,422
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	360,869,470	341,933,431
21	Total liabilities (Part X, line 26).............	97,823,717	92,971,201
22	Net assets or fund balances. Subtract line 21 from line 20.....	263,045,753	248,962,230

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 167,718,707 including grants of $ 232,186 ) (Revenue $ 183,413,152 )
	GREAT RIVER MEDICAL CENTER (GRMC), LOCATED IN WEST BURLINGTON, IOWA, IS A 378-BED REGIONAL MEDICAL CENTER OFFERING ACUTE AND INTERMEDIATE CARE TO RESIDENTS OF SOUTHEAST IOWA, WEST CENTRAL ILLINOIS AND NORTHEAST MISSOURI. THE HOSPITAL OFFERS COMPREHENSIVE MEDICAL, EXTENSIVE SURGICAL, AND EMERGENCY CARE SERVICES. DURING FISCAL YEAR ENDING 6/30/16, GRMC HAD 6,993 PATIENT ADMISSIONS AND 79,782 PATIENT DAYS OF MEDICAL CARE. GRMC ALSO HAD 170,000 OUTPATIENT VISITS, 35,077 EMERGENCY ROOM VISITS AND 35,522 HOME HEALTH-CARE VISITS. GRMC PROVIDES MEDICAL SERVICES REGARDLESS OF ABILITY TO PAY AND ACCEPTS MEDICARE AND MEDICAID.THE HOSPITAL'S 160-BED KLEIN CENTER OFFERS LONG-TERM AND SKILLED CARE ON THE HOSPITAL'S CAMPUS. THE CANCER CENTER, WHICH PROVIDES MEDICAL AND RADIATION THERAPY SERVICES FOR THE TREATMENT OF VARIOUS FORMS OF CANCER AND BLOOD DISEASES, OFFERS THE LATEST THREE-DIMENSIONAL TREATMENT-PLANNING COMPUTER TECHNOLOGY AVAILABLE IN ONLY A FEW HEALTH-CARE CENTERS IN THE STATE. THE WELLNESS PLAZA IS HOME TO ONE OF THE STATE'S PREMIER REHABILITATION AND FITNESS PROGRAMS. MORE THAN 120 PHYSICIANS AND 2000 EMPLOYEES SHARE GRMC'S COMMITMENT TO EXCELLENCE IN PATIENT CARE AND COMMUNITY SERVICE.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses167,718,707

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) TONY HAYES........................................................................ COO	40.00 .......................3.00	X		0	436,103	30,358
(19) TODD SLADKY........................................................................ CFO	40.00 .......................3.00	X		0	393,622	30,988
(20) DARWIN COOLEY........................................................................ DIRECTOR OF PHARMACY	40.00 .......................		X	190,366	0	31,069
(21) JOHN MERCER III........................................................................ DIRECTOR OF FACILITIES	40.00 .......................		X	133,841	0	29,344
(22) ELIZABETH YORE........................................................................ DIRECTOR OF CARDIOVASCULAR SERVICES	40.00 .......................		X	137,043	0	18,021
(23) FRANCES STRAUSS........................................................................ DIRECTOR OF SURGICAL SERVICES	40.00 .......................		X	146,773	0	30,542
(24) JON WILLIAMS........................................................................ PHARMACIST	40.00 .......................		X	135,052	0	29,533

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	743,075	1,907,551	257,846

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	972,790

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		972,790

			Business Code
2a	PATIENT SERVICE INCOME	621110	178,134,923	178,134,923
b	OTHER OPERATING INCOME	621300	4,886,029	4,759,827	126,202
c	SE RENAL DIALYSIS K-1	621400	392,200	392,200
d
e
f	All other program service revenue.
g Total.Add lines 2a–2f.....			183,413,152

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			537,821			537,821
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		309,937
b	Less: rental expenses		274,181
c	Rental income or (loss)		35,756
d	Net rental income or (loss)......			35,756		1,615	34,141
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses	79,177
c	Gain or (loss)	-79,177
d	Net gain or (loss).....			-79,177			-79,177
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	MISCELLANEOUS INCOME		900099	93,210			93,210
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			93,210
12	Total revenue. See Instructions......			184,973,552	183,286,950	127,817	585,995

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	232,186	232,186
2	Grants and other assistance to individuals in the United States. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	2,498,319		2,498,319
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	67,208,400	66,964,209	184,712	59,479
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	2,935,136	2,921,811	10,387	2,938
9	Other employee benefits .......	10,405,663	10,374,394	30,159	1,110
10	Payroll taxes ...........	4,960,683	4,943,448	12,845	4,390
11	Fees for services (non-employees):
a	Management ......	1,911,025		1,911,025
b	Legal .........	74,527	-4,364	78,891
c	Accounting ...........	86,185	86,185
d	Lobbying ...........	29,099		29,099
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	17,342,199	17,227,768	108,882	5,549
12	Advertising and promotion ....
13	Office expenses .......	1,194,416	1,181,288	11,512	1,616
14	Information technology ......
15	Royalties ..
16	Occupancy ...........	1,738,290	1,735,153	2,957	180
17	Travel ............	281,572	255,228	24,177	2,167
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........	2,606,754	2,606,754
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	16,540,502	16,432,026	108,476
23	Insurance ...	1,874,478	605,988	1,268,490
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	21,912,214	21,912,214
b	DRUGS	11,875,206	11,875,206
c	BAD DEBT	4,747,691	4,747,691
d	REPAIRS/MAINTENANCE	1,895,460	1,895,340	120
e	All other expenses	2,872,125	1,726,182	1,144,210	1,733
25	Total functional expenses. Add lines 1 through 24e	175,222,130	167,718,707	7,424,261	79,162
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........				1
2	Savings and temporary cash investments .........			14,055,060	2	9,684,978
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			23,430,698	4	18,677,386
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6
7	Notes and loans receivable, net ....			337,275	7	627,836
8	Inventories for sale or use ........			3,299,445	8	3,525,045
9	Prepaid expenses and deferred charges ......			2,501,277	9	3,680,360
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	315,797,460
b	Less: accumulated depreciation	10b	164,673,703	159,847,730	10c	151,123,757
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....			155,615,224	12	151,480,212
13	Investments—program-related. See Part IV, line 11 ..			1,246,600	13	1,238,800
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			536,161	15	1,895,057
16	Total assets. Add lines 1 through 15 (must equal line 34)...			360,869,470	16	341,933,431

17	Accounts payable and accrued expenses .....	9,446,871	17	8,520,239
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	74,814,561	20	68,999,386
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..		22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D	13,562,285	25	15,451,576
26	Total liabilities. Add lines 17 through 25..	97,823,717	26	92,971,201

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	259,062,924	27	245,797,624
28	Temporarily restricted net assets ...........	2,696,665	28	1,936,500
29	Permanently restricted net assets	1,286,164	29	1,228,106
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	263,045,753	33	248,962,230
34	Total liabilities and net assets/fund balances ........	360,869,470	34	341,933,431