TY 2020 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) JAMES HEREFORD...................................................................... PRES/CEO FAI	0.00 ................. 40.00		X		0	1,905,996	715,433
(2) LAURA REED RN...................................................................... COO-FAIRIVEW	1.00 ................. 40.00	X	X		0	844,330	204,477
(3) LIZBETH THOMAS MD...................................................................... DIRECTOR-END	40.00 ................. 0.00	X			638,559	0	176,722
(4) RYAN NOVAK MD...................................................................... PHYSICIAN	40.00 ................. 0.00			X	636,994	0	43,479
(5) DARIN SKAUDIS MD...................................................................... PHYSICIAN	40.00 .................			X	415,005	0	43,215
(6) JONATHAN GERMSCHEID MD...................................................................... PHYSICIAN	40.00 ................. 0.00			X	406,207	0	43,309
(7) SHAWN OLSON MD...................................................................... PHYSICIAN	40.00 ................. 0.00			X	414,236	0	34,854
(8) JOHN KOLE MD...................................................................... PHYSICIAN	40.00 ................. 0.00			X	403,611	0	43,493
(9) KEVIN NELSON MD...................................................................... DIRECTOR	1.00 ................. 40.00	X			0	343,505	101,049
(10) BRIAN AMDAHL MD...................................................................... DIRECTOR-NEW	1.00 ................. 40.00	X			0	375,214	65,880
(11) DANIEL SOULAR...................................................................... CMO-GICH	40.00 ................. 0.00		X		369,910	0	32,817
(12) KEITH MURPHY MD...................................................................... DIRECTOR- NE	40.00 ................. 0.00	X			330,025	0	23,968
(13) SIMON LICK MD...................................................................... DIRECTOR- NE	40.00 ................. 0.00	X			296,927	0	44,975
(14) DR JAMISON HARKER...................................................................... DIRECTOR-END	40.00 ................. 0.00	X			293,510	0	44,975
(15) JEAN MACDONELL...................................................................... PRESIDENT &	40.00 ................. 0.00		X		0	276,197	43,956
(16) JANICE ROURK MD...................................................................... DIRECTOR-END	40.00 ................. 0.00	X			198,573	0	29,867
(17) DALE ADAMS...................................................................... CHAIR	1.00 ................. 0.00	X			0	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
ORTHOPEDIC ASSOC OF DULUTH PA, 1000 E 1ST STREET SUITE 404 DULUTH,MN55805	MEDICAL SVCS	1,033,084
PREMIER STAFFING INC, 243 WINKLER TRAIL COLOGNE,MN55322	STAFFING	487,982
INFOR US INC, 380 SAINT PETER ST ST PAUL,MN55102	SUPPORT/MAINTEN	298,847
SHARED MEDICAL SERVCIES INC, 209 LIMESTONE PASS COTTAGE GROVE,WI53527	MEDICAL SVCS	210,750
MEDICAL SOLUTIONS LLC, 9101 WESTERN AVE OMAHA,NE68114	STAFFING	178,663
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 10

- 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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization

GRAND ITASCA CLINIC AND HOSPITAL

Employer identification number

41-1865874

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 12, 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 agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

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 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

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) 2020

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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(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 5 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 2020 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2019 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2020. 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—2019. 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—2020. 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—2019. 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) 2020

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(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) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(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 5 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 2020 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2019 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2020 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2019 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2020. 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—2019. 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) 2020

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, 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 lines 3b and 3c 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 box 12a or 12b in Part I, answer lines 4b and 4c 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 lines 5b and 5c 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) 2020

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 lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described in 11a above?

11b

A 35% controlled entity of a person described in line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, 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 line 2 above, 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 lines 2a and 2b 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 line 2a, above 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 lines 3a and 3b 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?If "Yes" or "No", 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) 2020

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 (explain in Part VI). 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 0.015 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 0.035	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) 2020

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	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2020 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2020	(iii) Distributable Amount for 2020
1 Distributable amount for 2020 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2020:
a From 2015.......
b From 2016.......
c From 2017.......
d From 2018.......
e From 2019.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2020 distributable amount
i Carryover from 2015 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2020 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2020 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2020, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2020. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2021. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2016.....
b Excess from 2017.....
c Excess from 2018.....
d Excess from 2019.....
e Excess from 2020.....

Schedule A (Form 990 or 990-EZ) (2020)

Schedule A (Form 990 or 990-EZ) 2020

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) 2020

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.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2020

Name of the organization

GRAND ITASCA CLINIC AND HOSPITAL

Employer identification number

41-1865874

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. Don't 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 isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020) Page 2

Name of organization GRAND ITASCA CLINIC AND HOSPITAL

Part I Contributors	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) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Page 3

Name of organization GRAND ITASCA CLINIC AND HOSPITAL		Employer identification number 41-1865874

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) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Page 4


Name of organization GRAND ITASCA CLINIC AND HOSPITAL			Employer identification number 41-1865874
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) (2020)

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

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

GRAND ITASCA CLINIC AND HOSPITAL

Employer identification number

41-1865874

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 (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

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) 2020

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) 2017	(b) 2018	(c) 2019	(d) 2020	(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) 2020

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|No

(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

3,754

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

3,754

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
SCHEDULE C, PART II-B, LINE 1	GRAND ITASCA CLINIC AND HOSPITAL PAYS DUES TO AMERICAN HOSPITAL ASSOCIATION AND MINNESOTA HOSPITAL ASSOCIATION (MHA). A PORTION OF THESE ANNUAL DUES ARE DETERMINED TO BE USED FOR LOBBYING PURPOSES.

Schedule C (Form 990 or 990EZ) 2020

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.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

GRAND ITASCA CLINIC AND HOSPITAL

Employer identification number

41-1865874

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 7/25/06, 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 FASB 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 FASB 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 FASB 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) 2020

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

Term 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 .....	1,194,000		1,194,000
b	Buildings ....	29,896,379	3,562,724	26,333,655
c	Leasehold improvements	517,460	201,134	316,326
d	Equipment ....	8,466,685	4,426,579	4,040,106
e	Other .....	347,876		347,876
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				32,231,963

Schedule D (Form 990) 2020

Page 3

Part VII

Investments - Other 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........
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program 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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
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
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	3,640,368
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) 2020

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

SCHEDULE D, PAGE 3, PART X

GRAND ITASCA CLINIC AND HOSPITAL AS PART OF FAIRVIEW RECOGNIZES ALL TAX POSITIONS, INCLUDING THOSE POSITIONS IN A PREVIOUSLY FILED TAX RETURN OR A POSITION EXPECTED TO BE TAKEN IN A FUTURE TAX FILING THAT IS REFLECTED IN MEASURING CURRENT OR DEFERRED INCOME TAX ASSETS AND LIABILITIES, WHEN IT IS MORE LIKELY THAN NOT (LIKELIHOOD OF GREATER THAN 50%) THAT, BASED ON TECHNICAL MERITS, THE POSITION WILL BE SUSTAINED UPON EXAMINATION. THERE ARE NO UNCERTAIN TAX POSITIONS RECORDED ON THE CONSOLIDATED BALANCE SHEETS AS OF DECEMBER 31, 2020 OR 2019. FAIRVIEW HAS MADE REASONABLE ESTIMATES OF THE PROVISION FOR INCOME TAXES AND ON EXISTING DEFERRED TAX BALANCES BASED ON ACCOUNTING GUIDANCE INCLUDED IN ASC 740, INCOME TAXES. FAIRVIEW DOES NOT EXPECT THAT THERE WILL BE A SIGNIFICANT CHANGE IN THE TOTAL AMOUNT OF UNRECOGNIZED TAX BENEFITS WITHIN THE NEXT 12 MONTHS.

Schedule D (Form 990) 2020

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

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

GRAND ITASCA CLINIC AND HOSPITAL

Employer identification number

41-1865874

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 %

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) . . .	1,281,576		1,281,576	1.320 %
b	Medicaid (from Worksheet 3, column a) . . . . .	17,555,077	11,331,877	6,223,200	6.430 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	18,836,653	11,331,877	7,504,776	7.750 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	456,961		456,961	0.470 %
f	Health professions education (from Worksheet 5) . . .	174,975	173,579	1,396
g	Subsidized health services (from Worksheet 6) . . . .	43,395	33,796	9,599	0.010 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	57,181		57,181	0.060 %
j	Total. Other Benefits . .	732,512	207,375	525,137	0.540 %
k	Total. Add lines 7d and 7j .	19,569,165	11,539,252	8,029,913	8.290 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2020

Schedule H (Form 990) 2020

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 Healthcare 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. ......

1,436,993

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. ......

28,740

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).....

37,718,345

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

45,325,916

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

-7,607,571

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 %
1CDI GRAND RAPIDS LL	PROVIDE MRI, DIAGNOSTIC INJECTION AND PA	55.000 %
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2020

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?1Name, 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	GRAND ITASCA CLINIC AND HOSPITAL	X	X	X

Schedule H (Form 990) 2020

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)

	GRAND ITASCA CLINIC AND HOSPITAL
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

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 18

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. ............................

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): WWW.GRANDITASCA.ORG

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 19

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

Yes

If "Yes" (list url): SEE SECTION C, LINE 7D

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) 2020

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	GRAND ITASCA CLINIC AND HOSPITAL
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 150.000000000000%
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)

Was widely publicized 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):

SEE SECTION C, LINE 16J

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

SEE SECTION C, LINE 16J

A plain language summary of the FAP was widely available on a website (list url):
SEE SECTION C, LINE 16J

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)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

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

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2020

Page 6

Part VFacility Information (continued)

Billing and Collections

	GRAND ITASCA CLINIC AND HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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 nonpayment?..................................

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

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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

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

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

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)

Schedule H (Form 990) 2020

Page 7

Part VFacility Information (continued)

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

	GRAND ITASCA CLINIC AND HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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 a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

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) 2020

Page 8

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, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 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
FACILITY 1, GRAND ITASCA CLINIC AND HOSPITAL - PART V, LINE 3E	IN ORDER TO DETERMINE THE TOP HEALTH NEEDS IN THE COMMUNITY INDICATORS FROM SECONDARY DATA; DATA FROM WILDER RESEARCH ON THE LEADING CAUSES OF DEATH AND PREMATURE DEATH, AND THE SOCIAL DETERMINANTS OF HEALTH; AND PRIMARY DATA THAT MET TWO PIECES OF CRITERIA: (1) A NEED AND/OR BARRIER THAT WAS SAID MORE THAN ONE TIME, AND (2) A NEED AND/OR BARRIER THAT WAS REPEATED IN AT LEAST TWO OF THE GROUPS (E.G. BOTH A STAKEHOLDER INTERVIEW AND A COMMUNITY CONVERSATION) WERE USED. GRAND ITASCA'S COMMUNITY HEALTH STEERING COMMITTEE REVIEWED AND VALIDATED FINDINGS FROM THE PRIMARY AND SECONDARY DATA AND RECOMMENDED THREE HEALTH NEEDS TO BE ADOPTED FOR THE CLINIC AND HOSPITAL. THE THREE HEALTH NEEDS ARE CONSISTENT ACROSS ALL 11 FAIRVIEW HOSPITALS AND MEDICAL CENTERS AND ARE INTENTIONALLY BROAD TO ALLOW FOR LOCAL VARIATION DURING THE IMPLEMENTATION PLANNING PROCESS. WEIGHTED CRITERIA WERE USED TO PRIORITIZE HEALTH NEEDS. HIGHEST WEIGHT WAS GIVEN TO THE TWO CRITERION DEEMED MOST IMPORTANT BY THE STEERING COMMITTEE - CONTINUING WORK IN PREVIOUS CHNA PRIORITY AREAS AND ENSURING FUTURE PRIORITIES ALIGNED WITH WHAT THE COMMUNITY IDENTIFIED AS TOP NEEDS. THE PRIORITIZATION CRITERIA WAS APPLIED TO THE TOP 25 HEALTH NEEDS IDENTIFIED IN THE GRAND ITASCA COMMUNITY. THE TOP 10 HEALTH NEEDS INCLUDE: 1.MENTAL HEALTH 2.ADOLESCENT MENTAL HEALTH 3.ADVERSE CHILDHOOD EXPERIENCES (ACES) 4.ACCESS TO HEALTHY FOODS 5.CANCER 6.HEART DISEASE 7.STIGMA - MENTAL HEALTH 8.WORKFORCE SHORTAGE 9.SUICIDE 10.TIED FOR TENTH (1) TRANSPORTATION (2) GROWING SENIOR POPULATION THROUGH A VOTING PROCESS, THE GRAND ITASCA CLINIC & HOSPITAL COMMUNITY HEALTH STEERING COMMITTEE VALIDATED THE FOLLOWING HEALTH NEEDS: -MENTAL HEALTH AND WELL-BEING -HEALTHY LIFESTYLES -ACCESS TO CARE AND RESOURCES THESE THREE PRIORITIES ARE CONSISTENT ACROSS ALL 11 FAIRVIEW HOSPITALS AND MEDICAL CENTERS AND ARE INTENTIONALLY BROAD TO ALLOW FOR LOCAL VARIATION DURING THE IMPLEMENTATION PLANNING PROCESS.
FACILITY 1, GRAND ITASCA CLINIC AND HOSPITAL - PART V, LINE 3J	GRAND ITASCA CLINIC AND HOSPITAL IS PART OF M HEALTH FAIRVIEW, A COLLABORATION AMONG THE UNIVERSITY OF MINNESOTA, UNIVERSITY OF MINNESOTA PHYSICIANS, AND FAIRVIEW HEALTH SERVICES, IS COMMITTED TO PROVIDING BREAKTHROUGH CARE AND PROMOTING HEALTH EQUITY THROUGH ACADEMIC AND COMMUNITY MEDICINE. AS AN ANCHOR INSTITUTION, AN ORGANIZATION ROOTED IN OUR COMMUNITY, THIS COMMITMENT REACHES OUT INTO THE COMMUNITY. IN 2020, OUR PLANNED COMMUNITY OUTREACH AND EDUCATION EFFORTS TO IMPROVE HEALTH AND WELLBEING WERE DISRUPTED BY THE COVID-19 PANDEMIC AND CIVIL UNREST. OUR TEAMS WORKED CLOSELY WITH LOCAL COMMUNITY PARTNERS TO RE- PRIORITIZE IN ORDER TO MEET THE EMERGING NEEDS OF OUR NEIGHBORS. THE FOCUS OF OUR HEALTH AND WELLBEING WORK EACH YEAR IS GUIDED BY OUR COMMUNITY HEALTH NEEDS ASSESSMENTS AND IS CO-DESIGNED WITH THE COMMUNITIES WE SERVE. IN 2020, TO UNDERSTAND THE EMERGENT COMMUNITY HEALTH NEEDS AND ASSETS, WE LISTENED AND ENGAGED WITH COMMUNITY MEMBERS AND COLLABORATED WITH COMMUNITY-BASED ORGANIZATIONS, LOCAL PUBLIC HEALTH DEPARTMENTS, AND OTHER HEALTH SYSTEMS. THIS PROCESS HELPED US, IN ALIGNMENT WITH OUR PARTNERS, DIRECT OUR INVESTMENTS TO MAKE THE BIGGEST IMPACT. WE SWIFTLY ADAPTED OUR COMMUNITY BENEFIT ACTIVITIESCOMMUNITY-BASED PROGRAMS AND SERVICES, FINANCIAL ASSISTANCE, RESEARCH, AND HEALTH PROFESSIONS EDUCATIONTO MEET THE EVOLVING NEEDS OF OUR COMMUNITY. TOGETHER WITH OUR PARTNERS, WE FOUND NEW AND CREATIVE WAYS TO CONTINUE OUR EFFORTS TO IMPROVE HEALTH AND WELLBEING AND TO PROVIDE EQUITABLE CARE DURING A TIME WHEN INEQUITIES WERE EXACERBATED BY THE COVID-19 PANDEMIC. WE ALSO PARTNERED WITH ST. PAUL - RAMSEY COUNTY PUBLIC HEALTH AND THE MINNESOTA DEPARTMENT OF HEALTH TO PROVIDE STAFFING, COORDINATION, AND OUTREACH FOR MOBILE COVID-19 TESTING SITES AND IN 2021 VACCINATION CLINICS. ALTHOUGH OUR PLANNED ACTIVITIES CHANGED DUE TO COVID-19, THEY REMAINED IN ALIGNMENT WITH THE PRIORITY HEALTH NEEDS OF THE COMMUNITY, AS IDENTIFIED IN OUR MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT. THE PRIORITY HEALTH NEEDS ARE MENTAL HEALTH AND WELLBEING, HEALTHY LIFESTYLES, AND ACCESS TO CARE AND RESOURCES. OUR EFFORTS TARGETED THE AGING POPULATION, PEOPLE OF COLOR AND INDIGENOUS PEOPLE, AND PEOPLE EXPERIENCING POVERTY. SOME EXAMPLES OF M HEALTH FAIRVIEWS POSITIVE IMPACT ON THE COMMUNITY IN 2020. LOW-BARRIER COVID-19 TESTING WE HOSTED 48 FREE COVID-19 TESTING CLINICS FOR UNDERSERVED COMMUNITIES IN PARTNERSHIP WITH CULTURAL GROUPS AND COMMUNITY PARTNER ORGANIZATIONS, INCLUDING ST. PAUL - RAMSEY COUNTY PUBLIC HEALTH AND THE MINNESOTA DEPARTMENT OF HEALTH. THE CLINICS SUPPORTED BLACK, INDIGENOUS, AND PEOPLE OF COLOR (BIPOC) COMMUNITIES AND PROVIDED 19,377 FREE, LOW-BARRIER TESTS IN COMMUNITY SETTINGS. FREE INFLUENZA VACCINE CLINICS INFLUENZA VACCINE CLINICS CONTINUED AS PLANNED IN 2020. OUR TEAMS GOT CREATIVE AND MOVED CLINICS OUTSIDE OR TO LARGER SPACES TO ALLOW FOR SOCIAL DISTANCING. DURING THE 2020-21 SEASON, 6,662 COMMUNITY MEMBERS WERE VACCINATED AT 105 CLINICS; 89 PERCENT OF VACCINE RECIPIENTS IDENTIFIED AS BIPOC. COVID-19 EDUCATION AND SUPPORT TO MINORITY COMMUNITIES CULTURAL BROKER SERVICES SHIFTED TO MEET THE EMERGENT NEEDS OF THE COMMUNITY, INCLUDING PROVIDING COVID-19 EDUCATION, SUPPORTING FAMILIES WITH RESOURCES TO REMAIN SHELTERED IN PLACE, DEBUNKING VACCINE MYTHS, CONNECTING INDIVIDUALS TO UNEMPLOYMENT RESOURCES, ASSISTING PEOPLE WITH RESOURCE NAVIGATION AND ADVOCACY, PROVIDING FOLLOW-UP AFTER COVID-19 PATIENTS ARE DISCHARGED, AND SEEKING OUT SOCIALLY ISOLATED INDIVIDUALS AND FAMILIES. THE CULTURAL BROKERS SERVED 1,573 COMMUNITY MEMBERS ON ST. PAULS EAST SIDE. EXPANDED ACCESS TO HEALTHCARE DESPITE COVID-19, WE MOVED FORWARD WITH EXPANSION PLANS AT HEALTH COMMONS CEDAR RIVERSIDE. OUR GOAL IS TO IMPROVE ACCESS FOR THE DIVERSE AND UNDERSERVED NEIGHBORHOOD BY PROVIDING FREE HEALTHCARE SERVICES THROUGH A FULL-TIME REGISTERED NURSE WHO REFLECTS THE COMMUNITY SHE IS SERVING. THERE WERE 5,926 VIRTUAL OR OUTDOOR VISITS TO HEALTH COMMONS CEDAR RIVERSIDE AND HEALTH COMMONS THE LIVING ROOM IN NORTH MINNEAPOLIS. FUNDING FOR COMMUNITY-BASED PARTNERS IMPACTED BY COVID-19 WE RESPONDED TO THE NEEDS OF OUR COMMUNITY-BASED PARTNER ORGANIZATIONS EXPERIENCING A SURGE IN DEMAND FOR THEIR SERVICES. THE FAIRVIEW FOUNDATION ESTABLISHED A COVID-19 COMMUNITY RESPONSE FUND AND DISTRIBUTED GRANTS TOTALING 290,000 TO 29 PARTNER ORGANIZATIONS. THE GRANTS DIRECTLY SUPPORTED OUR MOST VULNERABLE NEIGHBORS. FOOD FOR FRONTLINE HEALTHCARE WORKERS TO HELP OUR HEALTHCARE WORKERS CARING FOR PATIENTS ON THE FRONTLINE OF THE PANDEMIC, WE ESTABLISHED THE FEEDING THE FRONTLINES MINNESOTA FUND. THE FUND HELPED US DISTRIBUTE NUTRIENTDENSE, HEALTHY FOODS TO HEALTHCARE WORKERS DURING THEIR SHIFTS. WE WERE ABLE TO PROVIDE MORE THAN 20,000 MEALS AND NEARLY 9,600 SNACKS TO FRONTLINE HEALTHCARE WORKERS. VIRTUAL CLASSES TO SUPPORT HEALTH AND WELLBEING OUR HEALTH AND WELLBEING CLASSES QUICKLY MOVED TO A VIRTUAL FORMAT AND INCORPORATED COVID-19 EDUCATION. THE CLASSES INCLUDED MENTAL HEALTH AND STRESS RESILIENCE RESOURCES AND GRIEF SUPPORT SERVICES. OUR COMMUNITY PARTNERS WERE ESPECIALLY EXCITED TO OFFER THESE TO THEIR COMMUNITIES. 1,034 INDIVIDUALS ATTENDED HEALTH AND WELLBEING CLASSES AND 428 INDIVIDUALS RECEIVED TRAUMA INFORMED TRAINING OR MENTAL HEALTH FIRST AID. CARE NAVIGATION SUPPORT FOR UNDERSERVED COMMUNITIES OUR CULTURAL BROKERS PROVIDED CARE NAVIGATION SUPPORT TO HIGHER-RISK COVID-19 PATIENTS FROM OUR KAREN AND HMONG COMMUNITIES FOLLOWING HOSPITAL DISCHARGE.
FACILITY 1, GRAND ITASCA CLINIC AND HOSPITAL - PART V, LINE 5	GRAND ITASCA CLINIC & HOSPITAL HAS CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNA) SINCE 2013 TO SYSTEMATICALLY IDENTIFY, ANALYZE, AND PRIORITIZE THE CRITICAL NEEDS OF THE COMMUNITY AND ADDRESS THOSE NEEDS. THE 2018 CHNA BUILDS UPON PREVIOUS ASSESSMENTS AND WAS DEVELOPED IN PARTNERSHIP WITH COMMUNITY MEMBERS AND ORGANIZATIONS, LOCAL PUBLIC HEALTH AGENCIES, AND OTHER HOSPITALS AND HEALTH SYSTEMS. IT SERVES AS A TOOL FOR GUIDING POLICY, ADVOCACY, AND PROGRAM PLANNING. IT ALSO FULFILLS IRS REQUIREMENTS FOR CHNA AND IMPLEMENTATION STRATEGIES PURSUANT TO THE AFFORDABLE CARE ACT OF 2010, WHICH REQUIRES 501(C)(3) NONPROFIT HOSPITALS TO CONDUCT AN ASSESSMENT AT LEAST EVERY THREE YEARS AND PROVIDE AN ANNUAL EVALUATION OF IMPACT OF THE PREVIOUS IMPLEMENTATION STRATEGY. FOR ADDITIONAL DETAIL, SEE SECTION TITLED, EVALUATION OF IMPACT, 2017-2018 CHNA IMPLEMENTATION STRATEGY. THROUGH THIS PROCESS, GRAND ITASCA AIMS TO: -UNDERSTAND THE HEALTH STATUS AND NEEDS OF THE COMMUNITY IT SERVES BY ANALYZING CURRENT DEMOGRAPHICS, HEALTH DATA, AND BY COLLECTING DIRECT INPUT FROM COMMUNITY MEMBERS AND ORGANIZATIONS. -IDENTIFY THE STRENGTHS, ASSETS, AND RESOURCES AVAILABLE IN THE COMMUNITY TO SUPPORT HEALTH AND WELL-BEING. -ADDRESS SIGNIFICANT HEALTH NEEDS THROUGH PARTNERSHIPS WITH COMMUNITY MEMBERS AND ORGANIZATIONS, PUBLIC HEALTH AGENCIES, AND OTHER HOSPITALS AND HEALTH SYSTEMS. -CREATE A STRATEGIC IMPLEMENTATION PLAN REFLECTIVE OF THE DATA COLLECTED THROUGH THE CHNA PROCESS. -INFORM GRAND ITASCA'S COMMUNITY BENEFIT ACTIVITIES. GRAND ITASCA CLINIC & HOSPITAL COMMUNITY HEALTH STEERING COMMITTEE -BETSY JOHNSON, HEALTH AND NUTRITION EDUCATOR, UNIVERSITY OF MINNESOTA EXTENSION -CASSI CHRZANOWSKI, MARKETING AND COMMUNICATIONS MANAGER, GRAND ITASCA CLINIC & HOSPITAL -DAN SOULAR, MD, VPMA AND FAMILY MEDICINE PHYSICIAN, GRAND ITASCA CLINIC & HOSPITAL -JACI DAVID, PUBLIC POLICY PROGRAM OFFICER, BLANDIN FOUNDATION -JEAN MACDONELL, VP, CLINIC SERVICES AND COMPLIANCE, GRAND ITASCA CLINIC & HOSPITAL -JONI OLSON, SUPERINTENDENT, INDEPENDENT SCHOOL DISTRICT 318 -KELLY CHANDLER, PUBLIC HEALTH DIVISION MANAGER, ITASCA COUNTY PUBLIC HEALTH -KELLY KIRWIN, COMMUNITY RELATIONS AND FOUNDATION DIRECTOR, GRAND ITASCA CLINIC & HOSPITAL -KRIS BOLIN, DIRECTOR OF HEALTHY LIVING, ITASCA COUNTY FAMILY YMCA -MELANIE DEBAY, COMMUNITY EDUCATION DIRECTOR, INDEPENDENT SCHOOL DISTRICT 318 -MICHELLE INGLE, EDUCATION DIRECTOR, KOOTASCA COMMUNITY ACTION -MOLLY MCCANN, SHIP COORDINATOR, ITASCA COUNTY PUBLIC HEALTH AND GET FIT ITASCA -RENEE BYMARK, EXECUTIVE DIRECTOR, ELDERCIRCLE -SARA CITRINE, COMMUNITY HEALTH WORKER, KIESLER WELLNESS CENTER -SARAH BRUBAKER, COMMUNITY HEALTH WORKER, KIESLER WELLNESS CENTER -STEVE LONEY, DIRECTOR, KIESLER WELLNESS CENTER -TONI YOUNGDAHL, MD, FAMILY MEDICINE PHYSICIAN, GRAND ITASCA CLINIC & HOSPITAL
FACILITY 1, GRAND ITASCA CLINIC AND HOSPITAL - PART V, LINE 7D	SCHEDULE H, PART V, LINE 7A & LINE 10A: THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY ARE LOCATED AT: HTTPS://PRD- CD.GRANDITASCA.ORG/-/MEDIA/MHEALTHFAIRVIEW/PROJECT/GRANDITASCAORG/GICH_CHNA -_-CHIP.ASHX
FACILITY 1, GRAND ITASCA CLINIC AND HOSPITAL - PART V, LINE 11	COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNAS) WERE CONDUCTED IN 2018. AN ESSENTIAL PART OF THE CHNA PROCESS WAS THE IDENTIFICATION OF PRIORITY NEEDS IN THE LOCAL COMMUNITY. THE HOSPITALS AND/OR MEDICAL CENTERS IDENTIFIED THE FOLLOWING PRIORITY NEEDS FOR GRAND ITASCA CLINIC & HOSPITAL: MENTAL HEALTH AND WELL-BEING, HEALTHY LIFESTYLES, ACCESS TO CARE AND SERVICES. EACH HOSPITAL AND/OR MEDICAL CENTER DEVELOPED A HOSPITAL SPECIFIC IMPLEMENTATION PLAN AROUND ITS PRIORITY HEALTH ISSUES ALONG WITH A SYSTEM FOCUS ON POLICY, SYSTEM, AND ENVIRONMENTAL (PSE) CHANGE TO ADDRESS THEIR IDENTIFIED PRIORITY NEEDS. EACH PROGRAM IS EVALUATED ON AN ANNUAL BASIS AGAINST PROGRAM SPECIFIC ANTICIPATED IMPACTS. AS PART OF THE EVALUATION PROCESS EACH PROGRAM INDICATOR IS ASSIGNED A VALUE OF "GREEN", "YELLOW- OR "RED" BASED UPON THE CRITERIA THAT FOLLOWS. A RATING OF "GREEN" MEANS THAT THE PROGRAM (A) MET, OR EXCEEDED, 2020 HOSPITAL GOAL/S AS WRITTEN IN HOSPITAL IMPLEMENTATION PLAN (B) IT HAS COUNT DATA TIED TO BOTH GOAL/S AND ANTICIPATED IMPACT/S (C) THERE IS AN EVALUATION TOOL WITH MEASURE TIED TO ANTICIPATED IMPACT/S. A RATING OF "YELLOW" MEANS THAT THE PROGRAM (A) HAD PARTIAL COMPLETION OF 2020 HOSPITAL GOAL/S AS WRITTEN IN HOSPITAL IMPLEMENTATION PLAN (B) IT HAS COUNT DATA TIED TO EITHER GOAL/S OR ANTICIPATED IMPACT/S BUT NOT BOTH (C)THERE IS AN EVALUATION TOOL WITHOUT MEASURE TIED TO ANTICIPATED IMPACT/S. A RATING OF "RED" MEANS THAT THE PROGRAM (A) DID NOT COMPLETE THE 2020 HOSPITAL GOAL/S WRITTEN IN HOSPITAL IMPLEMENTATION PLAN (B) THERE WAS NO COUNT DATA (C) THERE WAS NO EVALUATION TOOL/S. POLICY, SYSTEM, AND ENVIRONMENTAL (PSE) CHANGE INITIATIVES OFTEN TAKE MULTIPLE YEARS TO PLAN AND IMPLEMENT. USING A CDC EVALUATION FRAMEWORK EACH PSE INITIATIVE IS MONITORED AND EVALUATED ANNUALLY AGAINST ANTICIPATED ACTIVITIES AND MILESTONES LINKED TO THE SIX CONNECTED PSE EVALUATION STEPS. THE SIX CONNECTED STEPS OF PSE CHANGE WE TRACKED FOR MONITORING AND EVALUATION PURPOSES ARE (1) ENGAGE STAKEHOLDERS, (2) DESCRIBE THE PROGRAM, (3) FOCUS THE EVALUATION DESIGN, (4) GATHER CREDIBLE EVIDENCE, (5) JUSTIFY CONCLUSIONS, AND (6) ENSURE USE AND SHARE LESSONS LEARNED. OUR 2020 EVALUATION OF THE PSE INITIATIVES NOTE THE SPECIFIC PSE STEP/S FOR THAT INITIATIVES BASED ON THE ACTIVITIES. IN 2020 WE ARE IDENTIFYING PSE INITIATIVE SPECIFIC METRICS RELATED TO EACH STEP TO DEEPEN OUR EVALUATION OF OUTCOMES IN FUTURE YEARS. ANY PROGRAMMATIC ANTICIPATED IMPACT THAT RECEIVED A RATING OF "YELLOW- OR "RED" HAS A CORRESPONDING BRIEF EXPLANATION AND 2020 ACTION PLAN. IN 2020 WE WILL CONTINUE REFINING THE RATING SYSTEM AND CORRESPONDING PROGRAMMATIC AND PSE EVALUATION AS PART OF OUR COMMITMENT TO CONTINUOUS PROCESS IMPROVEMENT. DETAILED RESULTS AND ACTION PLANS ON PROGRAM AND PSE INITIATIVES ARE AVAILABLE UPON REQUEST. PRIORITY: MENTAL HEALTH AND WELLBEING: GRAND ITASCA CLINIC & HOSPITAL OFFERED THE EVIDENCE-BASED MENTAL HEALTH FIRST AID PROGRAM. THE PROGRAM INTRODUCES RISK FACTORS AND WARNING SIGNS OF COMMON MENTAL HEALTH AND SUBSTANCE USE DISORDERS, BUILDS UNDERSTANDING OF THEIR IMPACT, AND REVIEWS SUPPORT OPTIONS. THE INTERACTIVE COURSE TEACHES PARTICIPANTS HOW TO OFFER INITIAL HELP TO AN INDIVIDUAL WHO MAY BE EXPERIENCING A MENTAL HEALTH CONCERN OR CRISIS AND CONNECT THEM TO THE APPROPRIATE RESOURCES. YOUTH MENTAL HEALTH FIRST AID IS THE SECOND CORE PROGRAM WHICH FOCUSES ON MENTAL HEALTH CONCERNS AMONG YOUTH AGES 12-18. THE 2020 ANTICIPATED IMPACT FOR THE MENTAL HEALTH FIRST AID PROGRAMS WAS AN INCREASE IN PARTICIPANTS' ABILITY TO RECOGNIZE AND CORRECT MISCONCEPTIONS ABOUT MENTAL HEALTH AND MENTAL ILLNESS. THE ANTICIPATED IMPACT WAS ASSIGNED A VALUE OF "GREEN". 2020 IMPACT: GREEN - OUTCOME: 44% INCREASE FROM PRE-SURVEY (53%) TO POST- SURVEY (97%) IN RESPONSE TO THE FOLLOWING: I STRONGLY AGREE OR AGREE THAT I CAN RECOGNIZE AND CORRECT MISCONCEPTIONS ABOUT MENTAL HEALTH, SUBSTANCE USE AND MENTAL ILLNESS AS I ENCOUNTER THEM. EVALUATION OF SURVEY RESULTS WAS ADJUSTED IN 2020, TO REFLECT A CHANGE, AS IN 2019 OUTCOMES WERE BASED ON POST-SURVEY ONLY. PRIORITY: HEALTHY LIFESTYLES: GRAND ITASCA CLINIC & HOSPITAL OFFERED THE EVIDENCE-BASED LIVING WELL SUITE WHICH INCLUDED THREE PROGRAMS THAT WERE DEVELOPED BY STANFORD UNIVERSITY'S PATIENT EDUCATION RESEARCH CENTER. (1) CHRONIC DISEASE SELF-MANAGEMENT IS A WORKSHOP GIVEN 2.5 HOURS ONCE A WEEK, FOR SIX WEEKS OFFERED TO INDIVIDUALS AND THEIR CAREGIVERS WHO ARE LIVING WITH CHRONIC CONDITIONS. SUBJECTS ADDRESSED INCLUDE MEDICATION USE, COMMUNICATION WITH DOCTORS AND CAREGIVERS, NUTRITION, AND FITNESS- WITH PRACTICAL EXERCISES AND ADVICE DESIGNED TO MEET PARTICIPANTS' NEEDS. (2) CHRONIC PAIN SELF-MANAGEMENT IS A WORKSHOP GIVEN 2 HOURS ONCE A WEEK, FOR SIX WEEKS, IN COMMUNITY SETTINGS. THE WORKSHOP HELPS PARTICIPANTS, AND THEIR SUPPORT PERSON, DEAL WITH THE ONGOING ISSUES ASSOCIATED WITH CHRONIC PAIN. (3) DIABETES SELF-MANAGEMENT IS A 6 WEEK ONCE A WEEK PROGRAM DEVELOPED TO HELPS THOSE LIVING WITH DIABETES OR PRE-DIABETES TO IMPROVE THEIR GENERAL HEALTH. THE 2020 ANTICIPATED IMPACT FOR THE LIVING WELL SUITE WAS AN INCREASE PARTICIPANTS' PERCEPTION OF POSITIVE LIFESTYLE CHANGES. THE ANTICIPATED IMPACT WAS ASSIGNED A VALUE OF "GREEN". 2020 IMPACT: GREEN - OUTCOME: 80% OF PARTICIPANTS THAT RESPONDED TO THE POST PROGRAM SURVEY INDICATED THAT THEY STRONGLY AGREE OR AGREE WITH THE FOLLOWING STATEMENT: THE PROGRAM HAS HELPED THEM MANAGE CHRONIC CONDITION (S). PRIORITY: ACCESS TO CARE AND RESOURCES GRAND ITASCA CLINIC & HOSPITAL OFFERED THE EVIDENCE-BASED LIVING WELL SUITE WHICH INCLUDED THREE PROGRAMS THAT WERE DEVELOPED BY STANFORD UNIVERSITY'S PATIENT EDUCATION RESEARCH CENTER. (1) CHRONIC DISEASE SELF-MANAGEMENT IS A WORKSHOP GIVEN 2.5 HOURS ONCE A WEEK, FOR SIX WEEKS OFFERED TO INDIVIDUALS AND THEIR CAREGIVERS WHO ARE LIVING WITH CHRONIC CONDITIONS. SUBJECTS ADDRESSED INCLUDE MEDICATION USE, COMMUNICATION WITH DOCTORS AND CAREGIVERS, NUTRITION, AND FITNESS- WITH PRACTICAL EXERCISES AND ADVICE DESIGNED TO MEET PARTICIPANTS' NEEDS. (2) CHRONIC PAIN SELF-MANAGEMENT IS A WORKSHOP GIVEN 2 HOURS ONCE A WEEK, FOR SIX WEEKS, IN COMMUNITY SETTINGS. THE WORKSHOP HELPS PARTICIPANTS, AND THEIR SUPPORT PERSON, DEAL WITH THE ONGOING ISSUES ASSOCIATED WITH CHRONIC PAIN. (3) DIABETES SELF-MANAGEMENT IS A 6 WEEK ONCE A WEEK PROGRAM DEVELOPED TO HELPS THOSE LIVING WITH DIABETES OR PRE-DIABETES TO IMPROVE THEIR GENERAL HEALTH. THE 2020 ANTICIPATED IMPACT FOR THE LIVING WELL SUITE WAS AN INCREASE IN PARTICIPANTS WHO AGREE THAT THE PROGRAM HELPS THEM WORK WITH THEIR HEALTH CARE PROVIDERS. THE ANTICIPATED IMPACT WAS ASSIGNED A VALUE OF "GREEN". 2020 IMPACT: GREEN - OUTCOME: 47% OF PARTICIPANTS THAT RESPONDED TO THE POST PROGRAM SURVEY INDICATED THAT THEY STRONGLY AGREE OR AGREE WITH THE FOLLOWING STATEMENT: THE PROGRAM HAS HELPED THEM WORK WITH HEALTHCARE PROFESSIONALS. GRAND ITASCA CLINIC & HOSPITAL OFFERED THE EVIDENCE-BASED MENTAL HEALTH FIRST AID PROGRAM. THE PROGRAM INTRODUCES RISK FACTORS AND WARNING SIGNS OF COMMON MENTAL HEALTH AND SUBSTANCE USE DISORDERS, BUILDS UNDERSTANDING OF THEIR IMPACT, AND REVIEWS SUPPORT OPTIONS. THE INTERACTIVE COURSE TEACHES PARTICIPANTS HOW TO OFFER INITIAL HELP TO AN INDIVIDUAL WHO MAY BE EXPERIENCING A MENTAL HEALTH CONCERN OR CRISIS AND CONNECT THEM TO THE APPROPRIATE RESOURCES. YOUTH MENTAL HEALTH FIRST AID IS THE SECOND CORE PROGRAM WHICH FOCUSES ON MENTAL HEALTH CONCERNS AMONG YOUTH AGES 12-18. THE 2020 ANTICIPATED IMPACT FOR THE MENTAL HEALTH FIRST AID PROGRAMS WAS INCREASE PARTICIPANTS' CONFIDENCE IN ASSISTING SOMEONE TO CONNECT WITH PROFESSIONAL RESOURCES. THE ANTICIPATED IMPACT WAS ASSIGNED A VALUE OF "GREEN". 2020 IMPACT: GREEN - OUTCOME: 34% INCREASE FROM PRE-SURVEY (63%) TO POST- SURVEY (97%) IN RESPONSE TO THE FOLLOWING: I STRONGLY AGREE OR AGREE THAT I CAN ASSIST SOMEONE WHO MAY BE DEALING WITH A MENTAL HEALTH PROBLEM, SUBSTANCE USE CHALLENGE OR CRISIS IN SEEKING PROFESSIONAL HELP. EVALUATION OF SURVEY RESULTS WAS ADJUSTED IN 2020, TO REFLECT A CHANGE, AS IN 2019 OUTCOMES WERE BASED ON POST-SURVEY ONLY. NEEDS IDENTIFIED BUT NOT ADDRESSED ALTHOUGH THE FOLLOWING HEALTH NEEDS WERE NOT SELECTED AS PRIORITY NEEDS, GRAND ITASCA CLINIC & HOSPITAL WILL CONTINUE TO SUPPORT WORK ALIGNED WITH ADDRESSING THESE NEEDS AS APPROPRIATE PARTICULARLY WHEN DOING SO WOULD ADDRESS THE SOCIAL DETERMINANTS OF HEALTH AND/OR THE LEADING CAUSES OF PREMATURE DEATH. AFFORDABLE, HEALTHY, AND SAFE HOUSING: THIS ISSUE IS BEYOND WHAT GRAND ITASCA CLINIC & HOSPITAL RESOURCES CAN SUPPORT AT THIS TIME. ASTHMA: THIS ISSUE WILL BE ADDRESSED AS PART OF PATIENT CARE BUT FALLS OUTSIDE THE SCOPE OF THE COMMUNITY-BASED CHNA IMPLEMENTATION STRATEGY. CHRONIC LOWER RESPIRATORY DISEASE: THIS ISSUE WILL BE ADDRESSED AS PART OF PATIENT CARE BUT FALLS OUTSIDE THE SCOPE OF THE COMMUNITY-BASED CHNA IMPLEMENTATION STRATEGY. CLINIC HOURS: THIS ISSUE WILL BE ADDRESSED AS PART OF PATIENT CARE BUT FALLS OUTSIDE THE SCOPE OF THE COMMUNITY-BASED CHNA IMPLEMENTATION STRATEGY. COS
FACILITY 1, GRAND ITASCA CLINIC AND HOSPITAL - PART V, LINE 16J	A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS POSTED IN VARIOUS LOCATIONS IN THE HOSPITAL. PART V, LINE 16A, FAP WEBSITE: HTTPS://WWW.FAIRVIEW.ORG/~/MEDIA/FAIRVIEW/PDFS/BILLING/FINANCIAL- ASSISTANCE-POLICY-2020-FINAL-VERSION_EN.ASHX?LA=EN PART V, LINE 16B, FAP APPLICATION WEBSITE: HTTPS://WWW.FAIRVIEW.ORG/BILLING/FAIRVIEW-CHARITY-CARE HTTP://WWW.FVFILES.COM/2266.PDF PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE: HTTPS://WWW.FAIRVIEW.ORG/~/MEDIA/FAIRVIEW/PDFS/BILLING/4454EN-FINANCIAL- ASSISTANCE-PLS-2020.ASHX?LA=EN

Schedule H (Form 990) 2020

Page 9

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?1
Name and address		Type of Facility (describe)
1	GRAND ITASCA PROFESSIONAL BUILDING 111 SE 3RD STREET GRAND RAPIDS,MN55744	VARIOUS OUTPATIENT & BUSINESS SERVICES
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2020

Page 10

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
SCHEDULE H, PART I, LINE 3C	PATIENTS THAT ARE ELIGIBLE FOR THE ORGANIZATION'S COMMUNITY CARE PROGRAM OR OTHER CHARITY CARE PLANS MAY RECEIVE A REDUCTION ON AMOUNTS OWED OR UP TO 100% OF TOTAL CHARGES. THE ORGANIZATION INFORMS PATIENTS ABOUT THE COMMUNITY CARE PROGRAM PRIOR TO DELIVERY OF SERVICES IF FEASIBLE AND AS APPROPRIATE AND DURING THE BILLING PROCESS. UNINSURED PATIENTS WITH HOUSEHOLD INCOME UP TO 150% OF THE FEDERAL POVERTY LEVEL QUALIFY FOR A 100% DISCOUNT OF THE TOTAL CHARGES. UNINSURED PATIENTS WITH A HOUSEHOLD INCOME GREATER THAN 300% OF THE FEDERAL POVERTY LEVEL AND BELOW 125,000 ARE CHARGED A DISCOUNT RATE EQUAL TO THE RATE FROM HOSPITAL'S HIGHEST VOLUME PRIVATE PAYOR CONTRACT.
SCHEDULE H, PART I, LINE 7G	THERE ARE NO COSTS ASSOCIATED WITH PHYSICIAN CLINICS INCLUDED IN LINE 7G.
SCHEDULE H, PART I, LINE 7, COLUMN (F)	THERE IS NO BAD DEBT EXPENSE INCLUDED IN FORM 990 PART IX AS AN EXPENSE. DUE TO THE ADOPTION OF NEW GAAP REPORTING, THE BAD DEBT EXPENSE HAS BEEN INCLUDED WITH "DISCOUNTS" NETTED AGAINST PATIENT SERVICE REVENUE ON PART VIII OF FORM 990.
SCHEDULE H, PART I, LINE 7	THE AMOUNTS REPORTED ON FORM 990, SCHEDULE H, PART I, LINE 7A THROUGH 7C WERE DETERMINED USING THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 IN THE SCHEDULE H, FORM 990 INSTRUCTIONS. THE CALCULATION WAS UPDATED FOR TAX YEAR 2019 AS IT WAS DISCOVERED THAT COMMUNITY BENEFIT COSTS FOR FINANCIAL ASSISTANCE AND MEDICAID WERE OVERSTATED IN PRIOR YEARS. THE OVERSTATEMENT WAS RELATED TO THE ALLOCATION OF PROVIDER TAXES AND MISTREATMENT OF OFFSETTING REVENUE FROM THE UNCOMPENSATED POOL. FOR TAX YEAR 2019 THIS RESULTED IN THE PERCENT OF TOTAL EXPENSE TO CHANGE FROM 15.91% TO 9.05%. THE ORGANIZATION WILL USE THIS CALCULATION IN FUTURE YEARS. FORM 990, SCHEDULE H, PART I, LINES 7E THROUGH 7J ARE REPORTED AT CHARGES AS RECORDED BY THE ORGANIZATION.
SCHEDULE H, PART II	GRAND ITASCA'S COMMUNITY BUILDING ACTIVITIES PROMOTE THE HEALTH OF THE COMMUNITIES IT SERVES BY PROVIDING INNOVATIVE AND ADVANCED MEDICAL SERVICES, WITH HIGH-QUALITY, SEAMLESS PATIENT CARE IN MIND. GRAND ITASCA'S INTERPRETATION AND ED PATIENT TAXI CAB SERVICES ALLOW FOR THE CARE OF EACH AND EVERY PATIENT, NO MATTER THE INITIAL BARRIERS OR HARDSHIPS THAT MAY EXIST. THE NURSE ON-LINE PROGRAM, BY PROVIDING A 24 HOUR MEDICAL ADVICE HOTLINE, EMPOWERS PATIENTS TO MAKE EDUCATED DECISIONS ABOUT THEIR MEDICAL TREATMENT. TRIAGE CAN BE COMPLETED PRIOR TO A PATIENT'S ARRIVAL, ALLOWING MEDICAL RESOURCES TO BE ALLOCATED MORE EFFICIENTLY AND EFFECTIVELY.
SCHEDULE H, PART III, LINE 2	THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. THERE IS NO BAD DEBT EXPENSE INCLUDED IN FORM 990 PART IX AS AN EXPENSE. DUE TO THE ADOPTION OF NEW GAAP REPORTING, THE BAD DEBT EXPENSE HAS BEEN INCLUDED WITH "DISCOUNTS" NETTED AGAINST PATIENT SERVICE REVENUE ON PART VIII OF FORM 990.
SCHEDULE H, PART III, LINE 3	THE BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS THAT MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS.
SCHEDULE H, PART III, LINE 4	CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE. SEE NOTE 6 OF THE AUDITED FINANCIAL STATEMENTS FOR ADDITIONAL INFORMATION.
SCHEDULE H, PART III, LINE 8	IT IS PART OF THE ORGANIZATION'S MISSION THAT COMMUNITY BENEFIT ACTIVITY IS CARRIED OUT BY STAFF/LEADERSHIP AT EACH FACILITY BASED ON THE HEALTH CARE NEEDS IN THAT SERVICE AREA. THE MEDICARE COST TO CHARGE RATIO REPORTING IS CALCULATED SERVICE LINE BY SERVICE LINE. OTHER EXPENSES ARE CALCULATED USING THE OVERALL COST TO CHARGE RATIO. UNCOMPENSATED COSTS RESULTING FROM MEDICARE, MEDICAID AND STATE AND LOCAL INDIGENT CARE PROGRAMS ARE CONSIDERED A COMMUNITY BENEFIT BECAUSE OF THE SIGNIFICANT DIFFERENCES BETWEEN ACTUAL COSTS AND REIMBURSEMENT.
SCHEDULE H, PART III, LINE 9B	AFTER OUR PATIENTS HAVE RECEIVED SERVICES, IT IS THE POLICY OF THE ORGANIZATION TO BILL PATIENTS AND THEIR APPLICABLE PAYORS ON A TIMELY AND ACCURATE BASIS. DURING THIS BILLING AND COLLECTION PROCESS, STAFF IS COMMITTED TO PROVIDING QUALITY CUSTOMER SERVICE AND TIMELY FOLLOW UP ON ALL OUTSTANDING ACCOUNTS. BILLING: IT IS THE GOAL OF THE ORGANIZATION TO BILL ALL CLAIMS ACCURATELY AND ON A TIMELY BASIS. ALTHOUGH DEPENDENT ON INFORMATION AND COMMUNICATIONS FROM PATIENTS AND PAYORS, THE ORGANIZATION WILL PROVIDE SUFFICIENT FOLLOW UP SERVICE TO ENSURE THAT PATIENTS RECEIVE ACCURATE ACCOUNT AND BILLING INFORMATION AND HAVE THE OPPORTUNITY TO MAKE PAYMENT AND/OR APPLY FOR COMMUNITY CARE. THE ORGANIZATION HAS AGREED TO CERTAIN BILLING AND COLLECTION PRACTICES BY AN AGREEMENT WITH THE MINNESOTA ATTORNEY GENERAL'S OFFICE. THERE ARE FINANCIAL COUNSELORS AT EVERY ENTITY MONDAY THROUGH FRIDAY WHO INTERACT WITH THE PATIENTS IN PERSON AND OVER THE PHONE TO INFORM OF PROGRAMS AVAILABLE TO THEM AS WELL AS ASSIST THEM IN APPLYING FOR THE PROGRAMS. THE INFORMATION ABOUT NEEDING ASSISTANCE WITH PAYING THE BILL IS POSTED ON SIGNS IN THE HOSPITALS AND MATERIALS ARE DISTRIBUTED TO SELF-PAY PATIENTS BY REGISTRATION STAFF. THE STATEMENTS SENT OUT AFTER THE VISIT PROVIDE THIS INFORMATION AS WELL. IF A PATIENT/FAMILY MEMBER CALLS THE CENTRAL BUSINESS OFFICE CUSTOMER SERVICE STAFF TO ASK FOR ASSISTANCE WITH PAYING THEIR BILL, THEY ARE INFORMED ABOUT OPTIONS AT THAT TIME. THE ORGANIZATION PROVIDES AN INTERPRETER SERVICE THAT INTERPRETS CONVERSATIONS OVER THE PHONE. THIS SERVICE CAN BE USED EITHER AS A THREE-WAY PHONE CALL OR THE FINANCIAL COUNSELOR, IN A ROOM WITH THE PATIENT OR FAMILY CAN PLACE THE CALL TOGETHER TO THE INTERPRETER PHONE SERVICE. THE INTERPRETER SERVICES LINE ACCOMMODATES CLOSE TO 200 LANGUAGES. THE BILLING PROCESS WILL BE ASSISTED BY THE FOLLOWING GUIDELINES: 1) FOR ALL INSURED PATIENTS, THE ORGANIZATION WILL BILL ALL THIRD PARTY PAYOR INFORMATION (AS PROVIDED BY OR VERIFIED BY THE PATIENT) ON A TIMELY AND ACCURATE BASIS. 2) FOR ALL UNINSURED PATIENTS WITH MINNESOTA RESIDENCY RECEIVING HOSPITAL BASED SERVICES DEEMED MEDICALLY NECESSARY. THE ORGANIZATION WILL APPLY AN UNINSURED DISCOUNT EQUAL TO THE DISCOUNT PROVIDER TO OUR LARGEST CONTRACTED NON-GOVERNMENT PAYOR, ANY REMAINING BALANCE WILL BE BILLED TO THE PATIENT IN A TIMELY AND MANNER. 3) ALL BILLED PATIENTS HAVE THE OPPORTUNITY TO CONTACT THE ORGANIZATION REGARDING FINANCIAL ASSISTANCE FOR THEIR ACCOUNTS. FINANCIAL ASSISTANCE MAY INCLUDE COMMUNITY CARE, PAYMENT ARRANGEMENTS, MEDICAL ASSISTANCE OR OTHER APPLICABLE PROGRAMS. 4) IF A PATIENT CONTACTS THE ORGANIZATION REGARDING COMMUNITY CARE BEFORE THE ACCOUNT IS REFERRED TO A COLLECTION AGENCY OR ATTORNEY, AN APPLICATION AND REQUIRED DOCUMENTATION IS REQUESTED (INCOME VERIFICATION ETC.), THE ACCOUNT WILL THEN BE PROCESSED BASED ON THE OUTCOME OF THE COMMUNITY CARE DETERMINATION. 5) THE ORGANIZATION TAKES REASONABLE MEASURES TO AVOID REFERRING AN ACCOUNT TO COLLECTION UNLESS THERE ARE NO RESPONSES FROM THE PATIENT. IF A PATIENT CONTACTS THE ORGANIZATION REGARDING COMMUNITY CARE AFTER THEIR ACCOUNT HAS BEEN REFERRED TO A COLLECTION AGENCY OR ATTORNEY, THE ORGANIZATION WILL SEND AN APPLICATION TO THE PATIENT PROVIDED THE ACCOUNT MEETS THE COMMUNITY CARE REQUIREMENTS. IF THE COMPLETED APPLICATION ALONG WITH REQUIRED DOCUMENTATION (INCOME VERIFICATION, ETC.) IS SUBMITTED, ALL COLLECTION ACTION WILL BE SUSPENDED UNTIL THE PATIENT IS NOTIFIED OF THE ORGANIZATION'S DETERMINATION.
SCHEDULE H, PART VI, LINE 2	GRAND ITASCA REVIEWS APPLICABLE STATE AND COUNTY SURVEYS PERFORMED BY OTHER AGENCIES TO ASSESS THE NEEDS OF THE COMMUNITY. GRAND ITASCA WORKS WITH THESE AGENCIES TO PROVIDE THESE SERVICES WITHIN THE SCOPE OF THE MEDICAL FACILITY.
SCHEDULE H, PART VI, LINE 3	GRAND ITASCA HAS FINANCIAL ADVOCATES WORKING WITH UNINSURED PATIENTS TO ASSIST THEM IN COMPLETING APPLICATION FOR VARIOUS PROGRAMS THAT MAY PROVIDE THEM COVERAGE FOR MEDICAL SERVICES.
SCHEDULE H, PART VI, LINE 4	GRAND ITASCA SERVES THE PEOPLE OF GRAND RAPIDS AND THE SURROUNDING COMMUNITIES THROUGHOUT ITASCA COUNTY. THE COMMUNITY INCLUDES 15 ZIP CODES WHERE APPROXIMATELY 80 PERCENT OF ITS PATIENTS LIVE, THE CITY WHERE THE HOSPITAL RESIDES, GRAND RAPIDS, MN, AND THE COUNTY WHERE THE HOSPITAL RESIDES, ITASCA COUNTY. NINETY-FOUR PERCENT OF GRAND ITASCA EMPLOYEES LIVE WITHIN THE DEFINED COMMUNITY.
SCHEDULE H, PART VI, LINE 5	GRAND ITASCA PROMOTES HEALTH IN THE COMMUNITY BY SUPPORTING THE LOCAL FREE CLINIC, THROUGH THE PROVISION OF MEDICAL SUPPLIES, BASIC LAB TEST AND BASIC X-RAYS TO THE PATIENTS OF THIS CLINIC AT NO CHARGE. GRAND ITASCA ALSO WORKS WITH A COMMUNITY COALITION TO DETERMINE THE HEALTH NEEDS OF THE COMMUNITY SERVED BY GRAND ITASCA CLINIC & HOSPITAL.
SCHEDULE H, PART VI, LINE 6	GRAND ITASCA CLINIC AND HOSPITAL IS A COMMUNITY-FOCUSED, NON-PROFIT HEALTH CARE ORGANIZATION THAT IS PART OF FAIRVIEW HEALTH SERVICES. GRAND ITASCA CLINIC AND HOSPITAL PROVIDES INNOVATIVE TECHNOLOGY, COMPASSIONATE CARE, AND A FULL SPECTRUM OF FAMILY HEALTH SERVICES. ABOUT FAIRVIEW HEALTH SERVICES: FAIRVIEW HEALTH SERVICES (FAIRVIEW.ORG) IS A MINNEAPOLIS-BASED NONPROFIT HEALTH SYSTEM DRIVEN TO HEAL, DISCOVER, AND EDUCATE FOR LONGER, HEALTHIER LIVES. FOUNDED IN 1906, FAIRVIEW PROVIDES EXCEPTIONAL CARE TO PATIENTS AND COMMUNITIES AS ONE OF THE MOST COMPREHENSIVE AND GEOGRAPHICALLY ACCESSIBLE SYSTEMS IN MINNESOTA, SERVING THE GREATER TWIN CITIES METRO AREA AND NORTH-CENTRAL MINNESOTA. THROUGH A CLOSE RELATIONSHIP WITH THE UNIVERSITY OF MINNESOTA, FAIRVIEW OFFERS ACCESS TO BREAKTHROUGH MEDICAL RESEARCH AND SPECIALTY EXPERTISE AS PART OF A CONTINUUM OF CARE THAT REACHES ALL AGES AND HEALTH NEEDS. OUR MISSION: FAIRVIEW IS DRIVEN TO HEAL, DISCOVER, AND EDUCATE FOR LONGER, HEALTHIER LIVES. FAIRVIEW AT A GLANCE: 33,000+ EMPLOYEES 5,000+ SYSTEM PROVIDERS 11 HOSPITALS AND MEDICAL CENTERS 2,177 STAFFED BEDS 56+ PRIMARY CARE CLINICS 55+ SPECIALTY CLINICS 70+ SENIOR HOUSING LOCATIONS 40+ RETAIL AND SPECIALTY PHARMACIES FAIRVIEW HAS THE FOLLOWING HOSPITALS AND MEDICAL CENTERS: BETHESDA HOSPITAL (ST. PAUL) FAIRVIEW LAKES MEDICAL CENTER (WYOMING) FAIRVIEW NORTHLAND MEDICAL CENTER (PRINCETON) FAIRVIEW RANGE MEDICAL CENTER (HIBBING) FAIRVIEW RIDGES HOSPITAL (BURNSVILLE) FAIRVIEW SOUTHDALE HOSPITAL (EDINA) GRAND ITASCA CLINIC & HOSPITAL (GRAND RAPIDS) ST. JOHN'S HOSPITAL (MAPLEWOOD) ST. JOSEPH'S HOSPITAL (ST. PAUL) UNIVERSITY OF MINNESOTA MEDICAL CENTER AND UNIVERSITY OF MINNESOTA MASONIC CHILDREN'S HOSPITAL (MINNEAPOLIS) WOODWINDS HEALTH CAMPUS (WOODBURY)
SCHEDULE H, PART VI, LINE 7	MINNESOTA

Schedule H (Form 990) 2020

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
Graphic Arrow

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

Attach to Form 990.
Graphic Arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

GRAND ITASCA CLINIC AND HOSPITAL

Employer identification number

41-1865874

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 on 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 .....

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 on Line 1a? ....

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? .............

Yes

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

Yes

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 nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

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) 2020

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)
1JAMES HEREFORD PRES/CEO FAIRVIEW	(i) (ii)	------------- 1,655,996	------------- 250,000	-------------	------------- 675,788	------------- 39,645	------------- 2,621,429	-------------
2LAURA REED RN COO-FAIRIVEW	(i) (ii)	------------- 844,330	-------------	-------------	------------- 160,422	------------- 44,055	------------- 1,048,807	-------------
3LIZBETH THOMAS MD DIRECTOR-END 12-2020	(i) (ii)	115,433 -------------	-------------	523,126 -------------	99,018 -------------	77,704 -------------	815,281 -------------	-------------
4RYAN NOVAK MD PHYSICIAN	(i) (ii)	636,994 -------------	-------------	-------------	12,768 -------------	30,711 -------------	680,473 -------------	-------------
5DARIN SKAUDIS MD PHYSICIAN	(i) (ii)	415,005 -------------	-------------	-------------	12,768 -------------	30,447 -------------	458,220 -------------	-------------
6JONATHAN GERMSCHEID MD PHYSICIAN	(i) (ii)	406,207 -------------	-------------	-------------	12,768 -------------	30,541 -------------	449,516 -------------	-------------
7SHAWN OLSON MD PHYSICIAN	(i) (ii)	414,236 -------------	-------------	-------------	12,768 -------------	22,086 -------------	449,090 -------------	-------------
8JOHN KOLE MD PHYSICIAN	(i) (ii)	403,611 -------------	-------------	-------------	12,768 -------------	30,725 -------------	447,104 -------------	-------------
9KEVIN NELSON MD DIRECTOR	(i) (ii)	------------- 343,505	-------------	-------------	------------- 65,055	------------- 35,994	------------- 444,554	-------------
10BRIAN AMDAHL MD DIRECTOR-NEW 2-2020	(i) (ii)	------------- 375,214	-------------	-------------	------------- 26,000	------------- 39,880	------------- 441,094	-------------
11DANIEL SOULAR CMO-GICH	(i) (ii)	369,910 -------------	-------------	-------------	12,768 -------------	20,049 -------------	402,727 -------------	-------------
12KEITH MURPHY MD DIRECTOR- NEW1-2020	(i) (ii)	330,025 -------------	-------------	-------------	12,768 -------------	11,200 -------------	353,993 -------------	-------------
13SIMON LICK MD DIRECTOR- NEW1-2020	(i) (ii)	296,927 -------------	-------------	-------------	12,768 -------------	32,207 -------------	341,902 -------------	-------------
14DR JAMISON HARKER DIRECTOR-END 12-2020	(i) (ii)	293,510 -------------	-------------	-------------	12,768 -------------	32,207 -------------	338,485 -------------	-------------
15JEAN MACDONELL PRESIDENT & COO-GICH	(i) (ii)	------------- 275,787	-------------	------------- 410	------------- 19,305	------------- 24,651	------------- 320,153	-------------
16JANICE ROURK MD DIRECTOR-END 12-2020	(i) (ii)	198,573 -------------	-------------	-------------	8,863 -------------	21,004 -------------	228,440 -------------	-------------

Schedule J (Form 990) 2020

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
SCHEDULE J, PAGE 1, PART I, LINE 4	JAMES HEREFORD 0 630,288 0 LAURA REED, RN 0 114,922 0 LIZBETH THOMAS, MD 350,381 56,118 0 KEVIN NELSON, MD 0 44,119 0
SCHEDULE J, PAGE 1, PART I, LINE 7	FAIRVIEW HEALTH SERVICES PROVIDES LUMP SUM FINANCIAL AWARDS BASED ON SYSTEM-WIDE, BUSINESS UNIT AND/OR DEPARTMENTS FINANCIAL AND QUALITY MEASURES. ANNUAL GOALS, SPECIFICALLY TIED TO PRODUCTIVITY AND QUALITY INDICATORS, ARE SET FOR THE YEAR AND AN INCENTIVE PAID OUT ANNUALLY IF KEY GOALS AND MEASURES ARE ACHIEVED.
SCHEDULE J, PART III	THE NONQUALIFIED PLAN IS ONLY OPEN TO A SELECT GROUP OF HIGHLY COMPENSATED EMPLOYEES. THE PLAN CONTRIBUTES THE DIFFERENCE OF WHAT 403(B) EMPLOYER CONTRIBUTIONS WERE MISSED FOR PARTICIPANTS WHO EARN MORE THAN THE IRS LIMIT ON ELIGIBLE COMPENSATION FOR QUALIFIED RETIREMENT PLANS. THE CONTRIBUTION IS UNFUNDED. THE PLAN COMPLIES WITH SECTION 457(F) OF THE CODE.

Schedule J (Form 990) 2020

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

GRAND ITASCA CLINIC AND HOSPITAL

Employer identification number

41-1865874

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 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 the 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
(1) LUKE SCHUMACHER	EMPLOYEE	COMPENSATION PACKAGE		X	20,000	12,629		No	Yes		Yes
(2) DANIELLE SMESTAD	EMPLOYEE	COMPENSATION PACKAGE		X	10,000	9,665		No	Yes		Yes
(3) TIFFANY AXTMAN	EMPLOYEE	COMPENSATION PACKAGE		X	10,000	6,649		No	Yes		Yes
(4) DAVID KELLERMAN	EMPLOYEE	COMPENSATION PACKAGE		X	10,000	3,501		No	Yes		Yes
(5) PATTI HOOPMAN	EMPLOYEE	COMPENSATION PACKAGE		X	5,000	2,263		No	Yes		Yes
(6) PATRICK NELSON	EMPLOYEE	COMPENSATION PACKAGE		X	10,000	2,001		No	Yes		Yes
Total ............... $						36,708

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) 2020

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) DR SHANNON R HARKER	WIFE OF DIRECTO	211,279	COMPENSATION		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) 2020

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization

GRAND ITASCA CLINIC AND HOSPITAL

Employer identification number

41-1865874

Return Reference	Explanation
FORM 990, PAGE 2, PART III, LINE 4A	GRAND ITASCA CLINIC AND HOSPITAL IS AN INTEGRATED MULTI-SPECIALTY CLINIC AND ACUTE-SURGICAL HOSPITAL. THE FACILITY IS LICENSED FOR 64 BEDS WHICH ARE COMPRISED OF 48 MEDICAL BEDS, 10 INTENSIVE CARE BEDS AND 6 OB BEDS. IN ADDITION TO PROVIDING TRADITIONAL HOSPITAL SERVICES, THE FACILITY HAS FOUR SURGERY SITES, A 24-HOUR EMERGENCY DEPARTMENT, OUTPATIENT MENTAL HEALTH SERVICES, OUTPATIENT REHABILITATION SERVICES, AND OUTPATIENT CLINIC SERVICES. THE FACILITY EMPLOYS OVER 750 PEOPLE INCLUDING OVER 60 HEALTHCARE PROVIDERS. THE FACILITY SERVED OVER 1,700 INPATIENTS AND OVER 230,000 OUTPATIENT ENCOUNTERS INCLUDING CLINIC, EMERGENCY ROOM, OUTPATIENT IMAGING AND OUTPATIENT SURGICAL PROCEDURE. GRAND ITASCA SERVES THE PATIENT REGARDLESS OF THE PERSON'S ABILITY TO PAY. DURING THE CALENDAR YEAR, THE FACILITY PROVIDED 1,121,590 OF CHARITY CARE, 789,689 OF DISCOUNTS TO THE UNINSURED AND ABSORBED 12,285,485 OF UNPAID MEDICARE AND MEDICAID COSTS. GRAND ITASCA ALSO PAID 1,696,583 IN PAYMENTS FOR MINNESOTA CARE TAX AND MEDICAID SURCHARGES, WHICH WERE USED TO FUND CARE FOR THE INDIGENT AND UNDERINSURED. GRAND ITASCA CLINIC AND HOSPITAL IS PART OF FAIRVIEW HEALTH SERVICES WHICH IS AN INDUSTRY-LEADING, AWARD-WINNING, NONPROFIT, INTEGRATED HEALTH SYSTEM PROVIDING EXCEPTIONAL HEALTH CARE ACROSS THE FULL SPECTRUM OF HEALTH CARE SERVICES. FOUNDED IN 1906, FAIRVIEW PROVIDES EXCEPTIONAL CARE TO PATIENTS AND COMMUNITIES AS ONE OF THE MOST COMPREHENSIVE AND GEOGRAPHICALLY ACCESSIBLE SYSTEMS IN MINNESOTA. FAIRVIEW IS PART OF M HEALTH FAIRVIEW, A JOINT CLINICAL ENTERPRISE. M HEALTH FAIRVIEW IS AN EXPANDED COLLABORATION AMONG THE UNIVERSITY OF MINNESOTA, UNIVERSITY OF MINNESOTA PHYSICIANS, AND FAIRVIEW HEALTH SERVICES, COMBINING THE BEST OF ACADEMIC AND COMMUNITY MEDICINE AND EXPANDING ACCESS TO WORLD-CLASS, BREAKTHROUGH CARE FOR OUR COMMUNITIES. IN MARCH 2020, THE WORLD HEALTH ORGANIZATION DECLARED THE CORONAVIRUS DISEASE 2019 ("COVID-19") OUTBREAK A PANDEMIC. THE PANDEMIC HAS HAD A SIGNIFICANT NEGATIVE EFFECT ON THE ECONOMY AND THE HEALTHCARE INDUSTRY. FAIRVIEW CONTINUES TO FOLLOW GUIDANCE FROM THE CENTER FOR DISEASE CONTROL AND PREVENTION ("CDC") AND THE MINNESOTA DEPARTMENT OF HEALTH AND CONTINUES COORDINATING ITS ACTIVITIES WITH STATE AND LOCAL GOVERNMENTS AS WELL AS OTHER HEALTH SYSTEMS IN THE STATE AND REGION. FIRST AND FOREMOST, OUR FOCUS IS ON CARING FOR OUR PATIENTS DURING THIS ONGOING PANDEMIC. IN MARCH 2020, MINNESOTA GOVERNOR TIM WALZ ISSUED EMERGENCY EXECUTIVE ORDER 20-09 DIRECTING DELAY OF ALL NON-ESSENTIAL OR ELECTIVE SURGERIES, PROCEDURES, AND CLINIC VISITS. IN ACCORDANCE WITH THE GOVERNOR'S ORDER, FAIRVIEW SUSPENDED ELECTIVE SURGERIES AND ELECTIVE PRIMARY AND SPECIALTY CARE VISITS TO PRESERVE ORGANIZATIONAL CAPACITY AND SUPPLIES TO MANAGE THE EXPECTED PATIENT VOLUMES FROM THE VIRUS. FAIRVIEW WAS ABLE TO START RAMPING UP ITS SURGICAL AND CLINIC VISITS IN MAY 2020, WHILE ENSURING ORGANIZATION CAPACITY AND SUPPLIES WERE APPROPRIATE FOR COVID-19 PATIENTS. FAIRVIEW EVOLVED ITS CARE MODELS TO TRANSITION OUR PATIENTS TO VIRTUAL CARE WHEREVER POSSIBLE VIA ONCARE. FAIRVIEW HAS BEEN ABLE TO ADAPT AND INNOVATE TO DELIVER CARE TO OUR PATIENTS IN OTHER WAYS AS WELL, FIRST CREATING DRIVE-UP COVID-19 TESTING AND THEN PIVOTING THAT CONCEPT TO LAUNCH CURBSIDE CARE AT SEVERAL OF OUR CLINICS, A NEW INITIATIVE DESIGNED TO PROVIDE HIGH- QUALITY, ACCESSIBLE CARE FOR PATIENTS WHILE REDUCING POTENTIAL EXPOSURE TO COVID-19. THIS INNOVATION OFFERED A CONVENIENT WAY FOR PATIENTS TO RECEIVE MUCH-NEEDED PREVENTIVE CARE, NORMALLY PROVIDED IN A CLINIC SETTING, WITHOUT LEAVING THEIR CAR. THROUGH ITS PARTNERSHIP WITH THE UNIVERSITY OF MINNESOTA, FAIRVIEW ALSO CONTINUED TO FIND INNOVATIVE WAYS TO DELIVER CARE THROUGHOUT THIS CRISIS, INCLUDING THE DEVELOPMENT OF A LOW-COST VENTILATOR, THAT WAS APPROVED BY THE U.S. FOOD AND DRUG ADMINISTRATION, AND A PROTECTIVE DEVICE FOR HEALTHCARE WORKERS AGAINST COVID-19 EXPOSURE. COVID-19 VACCINE DISTRIBUTION IS LED BY THE STATE OF MINNESOTA. AS M HEALTH FAIRVIEW RECEIVED THEIR SUPPLY OF THE VACCINES, THEY WERE COMMITTED TO DISTRIBUTING THE DOSES AS FAST AS THEY WERE RECEIVED. FAIRVIEW DISTRIBUTED VACCINATIONS THROUGH SEVERAL OUTPATIENT CLINICS, AND THROUGH MASS VACCINATION EVENTS. IN 2020 FAIRVIEW PLAYED A CRITICAL ROLE IN MINNESOTA'S RESPONSE TO THE COVID-19 PANDEMIC. BEYOND CARING FOR CRITICALLY ILL AND HOSPITALIZED PATIENTS, FAIRVIEW PLAYED A KEY ROLE IN PROVIDING COVID-19 TESTING FOR THOUSANDS OF PATIENTS AND COMMUNITY MEMBERS OVER THE COURSE OF THE YEAR, CONDUCTING TARGETED OUTREACH FOR UNDERSERVED COMMUNITIES TOGETHER WITH LOCAL PARTNERS. THE FAIRVIEW SYSTEM CONSISTS OF 11 HOSPITALS, IT CONTROLS AND OPERATES UNIVERSITY OF MINNESOTA MEDICAL CENTER, THE ADULT AND PEDIATRIC TEACHING HOSPITAL OF THE UNIVERSITY OF MINNESOTA MEDICAL SCHOOL, HAS 10 COMMUNITY- BASED GENERAL ACUTE CARE HOSPITALS AND 1 LONG-TERM ACUTE CARE HOSPITAL; 56 PRIMARY CARE CLINICS; OVER 100 SPECIALTY CARE SERVICES; URGENT CARE CLINICS; OCCUPATIONAL HEALTH CLINICS; 36 RETAIL AND SPECIALTY PHARMACIES; PHARMACY BENEFIT MANAGEMENT SERVICES; REHABILITATION CENTERS; COUNSELING; HOME CARE AND HOSPICE SERVICES; 90+ OWNED AND MANAGED SENIOR CARE FACILITIES AND LONG-TERM CARE HOUSING FACILITIES (THROUGH EBENEZER SOCIETY, A FAIRVIEW SUBSIDIARY); EMERGENCY MEDICAL TRANSPORTATION; AN INTEGRATED PROVIDER NETWORK; AND HEALTH INSURER PREFERREDONE WITH OVER 360,000 HEALTH PLAN MEMBERS. FAIRVIEW'S 34,000+ EMPLOYEES AND NETWORK OF 5,000+ SYSTEM PROVIDERS EMBRACE INNOVATION AND NEW THINKING TO DRIVE A HEALTHIER FUTURE THROUGH HEALING, DISCOVERY AND EDUCATION. THE HEALTH CARE AND MEDICAL SERVICES WHICH FAIRVIEW PROVIDES TO THE COMMUNITY INCLUDE, BUT ARE NOT LIMITED TO: PRIMARY, SPECIALTY, TERTIARY, AND QUATERNARY CARE; HOSPITAL AND PHYSICIAN SERVICES; SENIOR SERVICES; ASSISTED LIVING; LONG-TERM CARE; URGENT CARE AND EMERGENCY SERVICES; PHARMACY; CARE OF MOTHERS AND CHILDREN; PHYSICAL THERAPY/SPORTS MEDICINE; REHABILITATION SERVICES; AND INPATIENT AND OUTPATIENT BEHAVIORAL HEALTH CARE AND CHEMICAL DEPENDENCY SERVICES. OUR VIRTUAL CARE OFFERINGS GREW DURING 2020. FAIRVIEW PROVIDES SPECIALIZED CARE FOR THE TREATMENT OF CANCER, HEART DISEASE, DIABETES, WOUND CARE, CHRONIC CONDITIONS, SOLID ORGAN TRANSPLANT, BLOOD AND MARROW TRANSPLANT, AND MANY OTHER SPECIALTIES. FAIRVIEW ALSO OFFERS SOCIAL WORK SERVICES, HEALTH EDUCATION AND SUPPORT GROUPS AND SERVICES FOR VARIOUS HEALTH ISSUES.
FORM 990, PART V	LINES 1A AND 2A: SECTION B: INDEPENDENT CONTRACTORS ALL FORM 1099'S AND FORM W-2'S WERE FILED BY A RELATED ORGANIZATION FAIRVIEW HEALTH SERVICES, A 501(C)(3) NON-PROFIT, TAX-EXEMPT ORGANIZATION.
FORM 990, PAGE 6, PART VI, LINE 11B	THE TAX DEPARTMENT CONDUCTS A DETAILED REVIEW OF THE COMPLETED RETURN. THE FORM 990 IS THEN REVIEWED BY THE GRAND ITASCA DIRECTOR OF FINANCE AND A COPY IS PROVIDED TO THE FINANCE COMMITTEE AND BOARD OF DIRECTORS FOR APPROVAL PRIOR TO FILING THE RETURN WITH THE IRS.
FORM 990, PAGE 6, PART VI, LINE 12C	BOARD MEMBERS SIGN THE CONFLICT OF INTEREST POLICY ANNUALLY.
FORM 990, PAGE 6, PART VI, LINE 15A	COMPENSATION IS DETERMINED BY ASSESSING THE MARKET THROUGH THE USE OF SURVEYS AND STUDIES AND DETERMINING PAY RATES AND RANGES FROM THE RESULTS OF THE ASSESSMENT. THE CEO COMPENSATION PACKAGE IS SUMMARIZED IN AN EMPLOYMENT AGREEMENT THAT IS APPROVED BY THE BOARD. THE COMPENSATION PACKAGE IS BASED UPON MARKET FOR THE POSITION.
FORM 990, PAGE 6, PART VI, LINE 15B	COMPENSATION IS DETERMINED BY ASSESSING THE MARKET THROUGH THE USE OF SURVEYS AND STUDIES AND DETERMINING PAY RATES AND RANGES FROM THE RESULTS OF THE ASSESSMENT. THE CEO COMPENSATION PACKAGE IS SUMMARIZED IN AN EMPLOYMENT AGREEMENT THAT IS APPROVED BY THE BOARD. THE COMPENSATION PACKAGE IS BASED UPON MARKET FOR THE POSITION.
FORM 990, PAGE 6, PART VI, LINE 19	FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D).
FORM 990, PART XI, LINE 9	OTHER FUND BALANCE ADJUSTMENTS 1,029

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2020

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

GRAND ITASCA CLINIC AND HOSPITAL

Employer identification number

41-1865874

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)FAIRVIEW HEALTH SERVICES 2450 RIVERSIDE AVENUE MINNEAPOLIS,MN55454 41-0991680	HOSPITAL	MN	501C3	3	N/A		No
(2)GRAND ITASCA FOUNDATION 1601 GOLF COURSE ROAD GRAND RAPIDS,MN55744 41-1560554	FOUNDATION	MN	501C3	12A	GICH GRAND ITASCA CLINIC & HOSPITSL	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2020

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	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(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?		(k) Percentage ownership
(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	(k) Percentage ownership
(1) CDI GRAND RAPIDS LLC 1601 GOLF COURSE ROAD GRAND ITASCA,MN55744 45-3783014	IMAGING SE	MN	N/A	RELATED	1,962,103	929,803		No			No	55.000 %

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	(h) Percentage ownership	(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	(h) Percentage ownership	Yes	No

Schedule R (Form 990) 2020

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) ............................

Yes

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) .....................

Yes

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

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

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

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) ............................

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
(1) GRAND ITASCA FOUNDATION	C	417,617	COST

Schedule R (Form 990) 2020

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?		(k) Percentage ownership
(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	(k) Percentage ownership

Schedule R (Form 990) 2020

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) 2020

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: PROVIDE QUALITY, ACCESSIBLE, AND VALUABLE HEALTH CARE SERVICES VIA A HOSPITAL, HOME HEALTH AGENCY, AND CLINIC TO THE SURROUNDING RURAL COMMUNITY.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	14
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	6
5	Total number of individuals employed in calendar year 2020 (Part V, line 2a) ......	5	816
6	Total number of volunteers (estimate if necessary) .............	6	82
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	37,803
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	496,160	5,619,077
9	Program service revenue (Part VIII, line 2g) .........	95,958,026	96,504,009
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	518,024	773,754
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	76,279	221,940
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	97,048,489	103,118,780
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...		0
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	58,221,467	61,250,728
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	35,988,874	35,554,974
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	94,210,341	96,805,702
19	Revenue less expenses. Subtract line 18 from line 12.......	2,838,148	6,313,078
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	60,436,620	71,663,098
21	Total liabilities (Part X, line 26).............	24,466,992	29,235,604
22	Net assets or fund balances. Subtract line 21 from line 20.....	35,969,628	42,427,494

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 86,707,797 including grants of $ ) (Revenue $ 94,727,336 )
	GRAND ITASCA CLINIC AND HOSPITAL IS AN INTEGRATED MULTI-SPECIALTY CLINIC AND ACUTE-SURGICAL HOSPITAL. THE FACILITY IS LICENSED FOR 64 BEDS WHICH ARE COMPRISED OF 48 MEDICAL BEDS, 10 INTENSIVE CARE BEDS AND 6 OB BEDS. IN ADDITION TO PROVIDING TRADITIONAL HOSPITAL SERVICES, THE FACILITY HAS FOUR SURGERY SITES, A 24-HOUR EMERGENCY DEPARTMENT, OUTPATIENT MENTAL HEALTH SERVICES, OUTPATIENT REHABILITATION SERVICES, AND OUTPATIENT CLINIC SERVICES. THE FACILITY EMPLOYS OVER 750 PEOPLE INCLUDING OVER 60 HEALTHCARE PROVIDERS. THE FACILITY SERVED OVER 1,700 INPATIENTS AND OVER 230,000 OUTPATIENT ENCOUNTERS INCLUDING CLINIC, EMERGENCY ROOM, OUTPATIENT IMAGING AND OUTPATIENT SURGICAL PROCEDURE. GRAND ITASCA SERVES THE PATIENT REGARDLESS OF THE PERSON'S ABILITY TO PAY. DURING THE CALENDAR YEAR, THE FACILITY PROVIDED 1,121,590 OF CHARITY CARE, 789,689 OF DISCOUNTS TO THE UNINSURED AND ABSORBED 12,285,485 OF UNPAID MEDICARE AND MEDICAID COSTS. GRAND ITASCA ALSO PAID 1,696,583 IN PAYMENTS FOR MINNESOTA CARE TAX AND MEDICAID SURCHARGES, WHICH WERE USED TO FUND CARE FOR THE INDIGENT AND UNDERINSURED. GRAND ITASCA CLINIC AND HOSPITAL IS PART OF FAIRVIEW HEALTH SERVICES WHICH IS AN INDUSTRY-LEADING, AWARD-WINNING, NONPROFIT, INTEGRATED HEALTH SYSTEM PROVIDING EXCEPTIONAL HEALTH CARE ACROSS THE FULL SPECTRUM OF HEALTH CARE SERVICES. FOUNDED IN 1906, FAIRVIEW PROVIDES EXCEPTIONAL CARE TO PATIENTS AND COMMUNITIES AS ONE OF THE MOST COMPREHENSIVE AND GEOGRAPHICALLY ACCESSIBLE SYSTEMS IN MINNESOTA. FAIRVIEW IS PART OF M HEALTH FAIRVIEW, A JOINT CLINICAL ENTERPRISE. M HEALTH FAIRVIEW IS AN EXPANDED COLLABORATION AMONG THE UNIVERSITY OF MINNESOTA, UNIVERSITY OF MINNESOTA PHYSICIANS, AND FAIRVIEW HEALTH SERVICES, COMBINING THE BEST OF ACADEMIC AND COMMUNITY MEDICINE AND EXPANDING ACCESS TO WORLD-CLASS, BREAKTHROUGH CARE FOR OUR COMMUNITIES. IN MARCH 2020, THE WORLD HEALTH ORGANIZATION DECLARED THE CORONAVIRUS DISEASE 2019 ("COVID-19") OUTBREAK A PANDEMIC. THE PANDEMIC HAS HAD A SIGNIFICANT NEGATIVE EFFECT ON THE ECONOMY AND THE HEALTHCARE INDUSTRY. FAIRVIEW CONTINUES TO FOLLOW GUIDANCE FROM THE CENTER FOR DISEASE CONTROL AND PREVENTION ("CDC") AND THE MINNESOTA DEPARTMENT OF HEALTH AND CONTINUES COORDINATING ITS ACTIVITIES WITH STATE AND LOCAL GOVERNMENTS AS WELL AS OTHER HEALTH SYSTEMS IN THE STATE AND REGION. FIRST AND FOREMOST, OUR FOCUS IS ON CARING FOR OUR PATIENTS DURING THIS ONGOING PANDEMIC. IN MARCH 2020, MINNESOTA GOVERNOR TIM WALZ ISSUED EMERGENCY EXECUTIVE ORDER 20-09 DIRECTING DELAY OF ALL NON-ESSENTIAL OR ELECTIVE SURGERIES, PROCEDURES, AND CLINIC VISITS. IN ACCORDANCE WITH THE GOVERNOR'S ORDER, FAIRVIEW SUSPENDED ELECTIVE SURGERIES AND ELECTIVE PRIMARY AND SPECIALTY CARE VISITS TO PRESERVE ORGANIZATIONAL CAPACITY AND SUPPLIES TO MANAGE THE EXPECTED PATIENT VOLUMES FROM THE VIRUS. FAIRVIEW WAS ABLE TO START RAMPING UP ITS SURGICAL AND CLINIC VISITS IN MAY 2020, WHILE ENSURING ORGANIZATION CAPACITY AND SUPPLIES WERE APPROPRIATE FOR COVID-19 PATIENTS. FAIRVIEW EVOLVED ITS CARE MODELS TO TRANSITION OUR PATIENTS TO VIRTUAL CARE WHEREVER POSSIBLE VIA ONCARE. FAIRVIEW HAS BEEN ABLE TO ADAPT AND INNOVATE TO DELIVER CARE TO OUR PATIENTS IN OTHER WAYS AS WELL, FIRST CREATING DRIVE-UP COVID-19 TESTING AND THEN PIVOTING THAT CONCEPT TO LAUNCH CURBSIDE CARE AT SEVERAL OF OUR CLINICS, A NEW INITIATIVE DESIGNED TO PROVIDE HIGH- QUALITY, ACCESSIBLE CARE FOR PATIENTS WHILE REDUCING POTENTIAL EXPOSURE TO COVID-19. THIS INNOVATION OFFERED A CONVENIENT WAY FOR PATIENTS TO RECEIVE MUCH-NEEDED PREVENTIVE CARE, NORMALLY PROVIDED IN A CLINIC SETTING, WITHOUT LEAVING THEIR CAR. THROUGH ITS PARTNERSHIP WITH THE UNIVERSITY OF MINNESOTA, FAIRVIEW ALSO CONTINUED TO FIND INNOVATIVE WAYS TO DELIVER CARE THROUGHOUT THIS CRISIS, INCLUDING THE DEVELOPMENT OF A LOW-COST VENTILATOR, THAT WAS APPROVED BY THE U.S. FOOD AND DRUG ADMINISTRATION, AND A PROTECTIVE DEVICE FOR HEALTHCARE WORKERS AGAINST COVID-19 EXPOSURE. COVID-19 VACCINE DISTRIBUTION IS LED BY THE STATE OF MINNESOTA. AS M HEALTH FAIRVIEW RECEIVED THEIR SUPPLY OF THE VACCINES, THEY WERE COMMITTED TO DISTRIBUTING THE DOSES AS FAST AS THEY WERE RECEIVED. FAIRVIEW DISTRIBUTED VACCINATIONS THROUGH SEVERAL OUTPATIENT CLINICS, AND THROUGH MASS VACCINATION EVENTS. IN 2020 FAIRVIEW PLAYED A CRITICAL ROLE IN MINNESOTA'S RESPONSE TO THE COVID-19 PANDEMIC. BEYOND CARING FOR CRITICALLY ILL AND HOSPITALIZED PATIENTS, FAIRVIEW PLAYED A KEY ROLE IN PROVIDING COVID-19 TESTING FOR THOUSANDS OF PATIENTS AND COMMUNITY MEMBERS OVER THE COURSE OF THE YEAR, CONDUCTING TARGETED OUTREACH FOR UNDERSERVED COMMUNITIES TOGETHER WITH LOCAL PARTNERS. THE FAIRVIEW SYSTEM CONSISTS OF 11 HOSPITALS, IT CONTROLS AND OPERATES UNIVERSITY OF MINNESOTA MEDICAL CENTER, THE ADULT AND PEDIATRIC TEACHING HOSPITAL OF THE UNIVERSITY OF MINNESOTA MEDICAL SCHOOL, HAS 10 COMMUNITY- BASED GENERAL ACUTE CARE HOSPITALS AND 1 LONG-TERM ACUTE CARE HOSPITAL; 56 PRIMARY CARE CLINICS; OVER 100 SPECIALTY CARE SERVICES; URGENT CARE CLINICS; OCCUPATIONAL HEALTH CLINICS; 36 RETAIL AND SPECIALTY PHARMACIES; PHARMACY BENEFIT MANAGEMENT SERVICES; REHABILITATION CENTERS; COUNSELING; HOME CARE AND HOSPICE SERVICES; 90+ OWNED AND MANAGED SENIOR CARE FACILITIES AND LONG-TERM CARE HOUSING FACILITIES (THROUGH EBENEZER SOCIETY, A FAIRVIEW SUBSIDIARY); EMERGENCY MEDICAL TRANSPORTATION; AN INTEGRATED PROVIDER NETWORK; AND HEALTH INSURER PREFERREDONE WITH OVER 360,000 HEALTH PLAN MEMBERS. FAIRVIEW'S 34,000+ EMPLOYEES AND NETWORK OF 5,000+ SYSTEM PROVIDERS EMBRACE INNOVATION AND NEW THINKING TO DRIVE A HEALTHIER FUTURE THROUGH HEALING, DISCOVERY AND EDUCATION. THE HEALTH CARE AND MEDICAL SERVICES WHICH FAIRVIEW PROVIDES TO THE COMMUNITY INCLUDE, BUT ARE NOT LIMITED TO: PRIMARY, SPECIALTY, TERTIARY, AND QUATERNARY CARE; HOSPITAL AND PHYSICIAN SERVICES; SENIOR SERVICES; ASSISTED LIVING; LONG-TERM CARE; URGENT CARE AND EMERGENCY SERVICES; PHARMACY; CARE OF MOTHERS AND CHILDREN; PHYSICAL THERAPY/SPORTS MEDICINE; REHABILITATION SERVICES; AND INPATIENT AND OUTPATIENT BEHAVIORAL HEALTH CARE AND CHEMICAL DEPENDENCY SERVICES. OUR VIRTUAL CARE OFFERINGS GREW DURING 2020. FAIRVIEW PROVIDES SPECIALIZED CARE FOR THE TREATMENT OF CANCER, HEART DISEASE, DIABETES, WOUND CARE, CHRONIC CONDITIONS, SOLID ORGAN TRANSPLANT, BLOOD AND MARROW TRANSPLANT, AND MANY OTHER SPECIALTIES. FAIRVIEW ALSO OFFERS SOCIAL WORK SERVICES, HEALTH EDUCATION AND SUPPORT GROUPS AND SERVICES FOR VARIOUS HEALTH ISSUES.

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 expenses86,707,797

(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)	(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) STEVE BURGGRAF........................................................................ DIRECTOR	1.00 .......................0.00	X	0	0	0
(19) MIKE MISKOVICH DDS........................................................................ DIRECTOR- NE	1.00 .......................0.00	X	0	0	0
(20) DALE FUHRMAN........................................................................ DIRECTOR-NEW	1.00 .......................0.00	X	0	0	0
(21) MIKE IVES........................................................................ VICE CHAIR	1.00 .......................0.00	X	0	0	0
(22) CORY JACKSON........................................................................ DIRECTOR	1.00 .......................0.00	X	0	0	0
(23) KENT KOERBITZ........................................................................ DIRECTOR	1.00 .......................0.00	X	0	0	0
(24) ELIZABETH MISKOVICH........................................................................ DIRECTOR-END	1.00 .......................0.00	X	0	0	0
(25) COLLEEN NARDONE........................................................................ CHAIR - END	1.00 .......................0.00	X	0	0	0
(26) DENNIS ROY........................................................................ SECRETARY	1.00 .......................0.00	X	0	0	0
(27) JOSH SKELTON........................................................................ FINANCE COMM	1.00 .......................0.00	X	0	0	0

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	4,403,557	3,745,242	1,692,469

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	417,865
e	Government grants (contributions)		1e	5,201,212

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

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		5,619,077

		Business Code
2a	PATIENT SERVICES	621110	90,989,921	90,989,921
b	PHARMACY	446110	3,553,278	3,553,278
c	JOINT VENTURE- SURGERY CENTER	621400	1,960,810	1,960,810
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		96,504,009

3 Investment income (including dividends, interest, and othersimilar amounts) ......			396,921			396,921
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)			6c
d	Net rental income or (loss).......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		376,833	7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)		376,833	7c
d	Net gain or (loss).........			376,833			376,833
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a	394,706
b	Less: cost of goods sold ..		10b	356,903
c	Net income or (loss) from sales of inventory..			37,803		37,803
Business Code			Miscellaneous Revenue
11a	CAFETERIA & OTHER REVENUE		722514	184,137	184,137
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			184,137
12	Total revenue. See instructions.....			103,118,780	96,688,146	37,803	773,754

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	996,862	626,952	369,910
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........	49,084,875	44,922,562	4,162,313
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	2,048,881	1,793,937	254,944
9	Other employee benefits .......	6,121,138	4,870,866	1,250,272
10	Payroll taxes ...........	2,998,972	2,669,206	329,766
11	Fees for services (non-employees):
a	Management ......	229,732	173,208	56,524
b	Legal .........
c	Accounting ...........
d	Lobbying ...........	3,754		3,754
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)	5,944,292	4,425,162	1,519,130
12	Advertising and promotion ....	178,366	915	177,451
13	Office expenses .......	2,467,711	2,158,968	308,743
14	Information technology ......
15	Royalties ..
16	Occupancy ...........	1,304,034	1,302,933	1,101
17	Travel ............	66,074	58,969	7,105
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	227,163	214,598	12,565
20	Interest ...........	1,141,219	1,141,219
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	2,330,044	1,157,813	1,172,231
23	Insurance ...	30,908	30,908
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	18,270,648	17,895,283	375,365
b	MEDICARE & MEDICAID	1,696,583	1,696,583
c	SUPPLIES - OTHER	744,036	744,036
d	REPAIR & MAINTENANCE	638,057	634,395	3,662
e	All other expenses	282,353	189,284	93,069
25	Total functional expenses. Add lines 1 through 24e	96,805,702	86,707,797	10,097,905	0
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 ........			12,292,792	1	23,182,881
2	Savings and temporary cash investments .........				2
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			7,657,779	4	10,581,169
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				233,094	6	36,708
7	Notes and loans receivable, net ...........			95,866	7
8	Inventories for sale or use ............			2,271,579	8	1,785,838
9	Prepaid expenses and deferred charges ......			371,869	9	327,928
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	40,422,400
b	Less: accumulated depreciation	10b	8,190,437	32,976,013	10c	32,231,963
11	Investments—publicly traded securities .			1,398,958	11
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			3,138,670	15	3,516,611
16	Total assets. Add lines 1 through 15 (must equal line 33)...			60,436,620	16	71,663,098

17	Accounts payable and accrued expenses .....	5,569,843	17	9,136,680
18	Grants payable ...		18
19	Deferred revenue .........	70,350	19	10,519,822
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..	14,476,754	23	5,938,734
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	4,350,045	25	3,640,368
26	Total liabilities. Add lines 17 through 25..	24,466,992	26	29,235,604

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	33,838,786	27	39,800,492
28	Net assets with donor restrictions ...........	2,130,842	28	2,627,002
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	35,969,628	32	42,427,494
33	Total liabilities and net assets/fund balances ........	60,436,620	33	71,663,098