2024-05-10T09:21:57-05:00 2023-06-30 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2022-07-01 421446727 GREAT RIVER HEALTH FOUNDATION INC GREA 3197681000 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 JEREMY ALEXANDER CFO 3197681000 2024-05-08 1 JEREMY ALEXANDER XXX-XX-XXXX 1 KURT BENNION CPA P01469618 4252506100 2024-05-08 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z DR MICHAEL MCCOY 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 4487169 0 X WWW.GREATRIVERHEALTH.ORG X 1995 IA TO PROVIDE CONTINUING SUPPORT FOR SOUTHEAST IOWA REGIONAL MEDICAL CENTER THAT WILL PROVIDE FUNDING FOR FUTURE IMPROVEMENTS IN TECHNOLOGY, FACILITIES, AND QUALITY HEALTHCARE PROGRAMS AND SERVICES THAT IMPROVE THE HEALTHCARE FOR OUR COMMUNITY. 15 13 0 45 0 0 320066 2028900 0 0 -657463 269922 -2051 -12814 -339448 2286008 44385 2336542 0 0 0 0 0 0 0 1695 580 46080 2337122 -385528 -51114 4505423 4454309 80000 80000 4425423 4374309 TO SUPPORT THE MISSION OF SOUTHEAST IOWA REGIONAL MEDICAL CENTER TO PROVIDE SUSTAINABLE. QUALITY HEALTHCARE THROUGH EDUCATION, CHARITABLE DONATIONS, AND COMMUNITY RELATIONS. 0 0 2336542 2336542 0 THE PURPOSE FOR WHICH THE CORPORATION IS ORGANIZED AND OPERATED IS TO ENGAGE IN AND CONDUCT CHARITABLE, EDUCATIONAL, AND SCIENTIFIC ACTIVITIES EXCLUSIVELY FOR THE BENEFIT OF SOUTHEAST IOWA REGIONAL MEDICAL CENTER. THIS IS ACCOMPLISHED IN A VARIETY OF WAYS THROUGH THIS ORGANIZATION, INCLUDING SCHOLARSHIP FUNDING. 2336542 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 15 13 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X CHERYL ALBIN 3197681000 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 KERRY FLEMING DIRECTOR 1.00 40.00 X 0 146226 42448 HEATHER PERRY DPM DIRECTOR 1.00 40.00 X 0 233178 39825 CHRIS HUTSON DIRECTOR 1.00 40.00 X 0 69790 35271 CHUCK OSMANSKI CHAIRPERSON 1.00 0.00 X X 0 0 0 TAMMY MCCOY VICE CHAIRPERSON 1.00 0.00 X X 0 0 0 BOB HUFFMAN SECRETARY/TREASURER 1.00 1.00 X X 0 0 0 RACHAEL BENDA DIRECTOR 1.00 0.00 X 0 0 0 TERRY HOPE DIRECTOR 1.00 0.00 X 0 0 0 CHUCK KEMPKER DIRECTOR 1.00 0.00 X 0 0 0 MARCIA KRUSE DIRECTOR 1.00 0.00 X 0 0 0 DOUG MARTIN EX-OFFICIO-VOTING 1.00 1.00 X 0 0 0 ANN MENKE DIRECTOR 1.00 0.00 X 0 0 0 JAN MORRIS DIRECTOR 1.00 0.00 X 0 0 0 MIO SANTIAGO DIRECTOR 1.00 0.00 X 0 0 0 JENNY STEFFENSMEIER DIRECTOR 1.00 0.00 X 0 0 0 MATT WENZEL PRESIDENT/CEO (THROUGH 10/12/22) 1.00 42.00 X 0 1122540 53171 JEREMY ALEXANDER CFO 1.00 42.00 X 0 671653 51571 JASON HUTCHESON EXECUTIVE DIRECTOR 1.00 40.00 X 0 128734 23786 DR MICHAEL MCCOY PRESIDENT/CEO 1.00 42.00 X 0 624684 51091 0 2996805 297163 0 0 1 0 0 28547 2000353 588 2028900 107369 107369 2336542 2173989 162553 162553 162553 14358 28547 27172 -12814 -12814 2286008 0 0 257108 1849392 1849392 487150 487150 580 580 2337122 2336542 580 0 374539 682525 80000 80000 4050884 3691784 4505423 4454309 80000 80000 80000 80000 X 4092774 4041660 332649 332649 4425423 4374309 4505423 4454309 -51114 0 X X 0 1 X 1 0 X X X 2 SOUTHEAST IOWA REGIONAL MEDICAL CENTER INC 420680407 3 0 852457 0 HENRY COUNTY HEALTH CENTER INC 862701018 3 0 0 0 2 852457 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 PART IV, SECTION A, LINE 6: THE ORGANIZATION AWARDS SCHOLARSHIPS TO INDIVIDUALS PURSUING EDUCATION IN THE MEDICAL FIELD PURSUANT TO THE DONOR RESTRICTIONS PLACED ON THESE FUNDS. PART IV, SECTION A, LINE 1: GREAT HEALTH FOUNDATION, INC IDENTIFIES GREAT RIVER HEALTH SYSTEM, INC. (GRHS) AS ITS SUPPORTED ORGANIZATION WITHIN ITS GOVERNING DOCUMENTS. THIS IS PERMISSIBLE UNDER G.C.M. 39508,, WHICH SPECIFICALLY PROVIDES THAT AN ORGANIZATION CAN BE REGARDED AS "OPERATED EXCLUSIVELY" TO SUPPORT OR BENEFIT ONE OR MORE SPECIFIED PUBLICLY SUPPORTED ORGANIZATIONS EVEN IF IT SUPPORTS OR BENEFITS ANOTHER SUPPORTING ORGANIZATION, SO LONG AS THE PARENT ORGANIZATION IS A SUPPORTING ORGANIZATION DESCRIBED IN SECTION 501(C)(3) AND IS OPERATED, SUPERVISED, OR CONTROLLED DIRECTLY BY OR IN CONNECTION WITH SUCH PUBLICLY SUPPORTED ORGANIZATIONS. GRHS IS THE PARENT TO GREAT HEALTH FOUNDATION, INC., HENRY COUNTY HEALTH CENTER, INC. AND SOUTHEAST IOWA REGIONAL MEDICAL CENTER, INC. ALL ORGANIZATIONS ARE MANAGED BY COMMON EXECUTIVE LEADERSHIP AND THERE IS BOARD MEMBER OVERLAP. PART IV, SECTION A, LINE 2 GREAT RIVER HEALTH FOUNDATION, INC. IS A SUBSIDIARY OF GREAT RIVER HEALTH SYSTEM, INC. (GRHS). GRHS IS THE OVERALL PARENT COMPANY OF ALL ENTITIES AND AN INTEGRATED HEALTH CARE SYSTEM, ALL OF WHOM ULTIMATELY SUPPORT HENRY COUNTY HEALTH CENTER, INC. AND SOUTHEAST IOWA REGIONAL MEDICAL CENTER, INC. GREAT RIVER HEALTH FOUNDATION, INC. SUPPORTS HENRY COUNTY MEDICAL CENTER, A 501(C)(3) ORGANIZATION CLASSIFIED AS A PUBLIC CHARITY UNDER IRC SECTION 170(B)(1)(A)(III). GREAT RIVER HEALTH FOUNDATION, INC. COMPLETED THE CALCULATIONS FOR THE SECTION 509(A)(2) PUBLIC SUPPORT TEST FOR HENRY COUNTY MEDICAL CENTER FOR THE PERIOD 7/1/18 - 6/30/2023 AND DETERMINED THAT IT WOULD QUALIFY AS A PUBLICLY SUPPORTED ORGANIZATION UNDER IRC SECTION 509(A)(2). RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 25259 10500 3678 538 38899 29489 -3742 488 25259 25979 6331 2374 447 29489 23625 24155 2782 24155 428 25979 24226 1365 1100 866 23625 0.00000 1.00000 0.00000 1 0 0 X PART V, LINE 4: THE COMMUNITY FOUNDATION OF THE GREAT RIVER BEND HOLDS A FUND FOR THE GREAT RIVER HEALTH FOUNDATION. THE EARNINGS FROM THIS ENDOWMENT ARE TO PROVIDE FUNDS FOR THE GENERAL USE OF THE GREAT RIVER HEALTH FOUNDATION. PART X, LINE 2: THE ORGANIZATION IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. HOWEVER, THE ORGANIZATION IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE CONSOLIDATED FINANCIAL STATEMENTS. GOLF EVENT 42905 28547 14358 300 7118 7529 8304 3921 42905 28547 14358 300 7118 7529 8304 3921 27172 -12814 1 SOUTHEAST IOWA REGIONAL MEDICAL CENTER INC 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 420680407 501(C)(3) 852457 0 N/A N/A SUPPLIES/GENERAL SUPPORT SOUTHEASTERN COMMUNITY COLLEGE 1500 WEST AGENCY ROAD WEST BURLINGTON IA 52655 420926823 501(C)(3) 918316 0 N/A N/A NURSING PROGRAM SUPPORT GREAT RIVER HEALTH SYSTEM INC 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421193185 501(C)(3) 46489 0 N/A N/A SUPPLIES ABATE OF IOWA INC PO BOX 70 ELDORA IA 50627 421236906 501(C)(4) 8317 0 N/A N/A EDUCATION PROGRAMS KEOKUK AREA COMMUNITY FOUNDATION PO BOX 367 KEOKUK IA 52632 201838372 501(C)(3) 10000 0 N/A N/A ESTABLISH SOUTHEAST IOWA REGIONAL HOSPICE ENDOWMENT FUND 4 1 SCHOLARSHIPS 294 487150 0 N/A N/A PART I, LINE 2: GREAT RIVER HEALTH FOUNDATION PROVIDES FUNDS TO SOUTHEAST IOWA REGIONAL MEDICAL CENTER, INC. TO BE USED AT THEIR DISCRETION. THE EXECUTIVE DIRECTOR OF THE GREAT RIVER HEALTH FOUNDATION SHALL NOTIFY EACH STUDENT BY A LETTER. IF THEY RECEIVED OR DID NOT MEET THE CRITERIA NECESSARY TO RECEIVE THE SCHOLARSHIP AWARD. THE EXECUTIVE DIRECTOR OF THE GREAT RIVER HEALTH FOUNDATION SHALL NOTIFY THE TRUST OFFICER OF CONNECTION BANK OF RECIPIENTS THAT RECEIVED THE SCHOLARSHIPS. THE TRUST OFFICER OF CONNECTION BANK WILL SUBMIT A CHECK ALONG WITH A LETTER TO THE COLLEGE THE RECIPIENT IS ATTENDING. 1 0 0 0 0 0 0 0 0 MATT WENZEL PRESIDENT/CEO (THROUGH 10/12/22) 0 740784 0 213774 0 167982 0 15250 0 37921 0 1175711 0 0 JEREMY ALEXANDER CFO 0 552461 0 117896 0 1296 0 15250 0 36321 0 723224 0 0 DR MICHAEL MCCOY PRESIDENT/CEO 0 532528 0 80672 0 11484 0 15250 0 35841 0 675775 0 0 HEATHER PERRY DPM DIRECTOR 0 232698 0 0 0 480 0 8728 0 31097 0 273003 0 0 KERRY FLEMING DIRECTOR 0 145536 0 0 0 690 0 8000 0 34448 0 188674 0 0 JASON HUTCHESON EXECUTIVE DIRECTOR 0 128734 0 0 0 0 0 13950 0 9836 0 152520 0 0 PART I, LINE 3 THE COMPENSATION OF THE OFFICERS IS PAID BY RIVERVIEW SYSTEMS LTD., A RELATED ORGANIZATION, BUT DETERMINED BY GREAT RIVER HEALTH SYSTEM. THE FOLLOWING WERE USED BY GREAT RIVER HEALTH SYSTEM IN DETERMINING THE OFFICERS COMPENSATION: 1. COMPENSATION COMMITTEE 2. INDEPENDENT COMPENSATION CONSULTANT 3. FORM 990 OF OTHER ORGANIZATIONS 4. WRITTEN EMPLOYMENT CONTRACT 5. COMPENSATION SURVEY OR STUDY 6. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4A MATT WENZEL RECEIVED A SEVERANCE PAYMENT OF $164,442. THIS AMOUNT WAS INCLUDED IN W-2 WAGES. FORM 990, PART VI, SECTION A, LINE 2 DR. MICHAEL MCCOY, MATT WENZEL AND JEREMY ALEXANDER HAVE BUSINESS RELATIONSHIPS BY SERVING AS OFFICERS AND/OR BOARD MEMBERS OF FOR-PROFIT SUBSIDIARIES OF GREAT RIVER HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 3 ALL EXECUTIVE LEADERSHIP FUNCTIONS FOR GREAT RIVER HEALTH FOUNDATION, INC ARE PROVIDED BY MUTUAL CONSULTING AND MANAGEMENT SERVICES, INC. MUTUAL CONSULTING AND MANAGEMENT SERVICES IS A SUBSIDIARY OF RIVERVIEW SYSTEMS LTD, WHICH IS A SUBSIDIARY OF GREAT RIVER HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMEBER OF GREAT RIVER HEALTH FOUNDATION IS GREAT RIVER HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER, GREAT RIVER HEALTH SYSTEM, INC (GRHS), HAS THE SOLE POWER TO ELECT OR REMOVE ALL BOARD MEMBERS OF GREAT RIVER HEALTH FOUNDATION. THE NOMINATING COMMITTEE SHALL PRESENT A RECOMMENDATION FOR THE ELECTION OF DIRECTORS TO THE BOARD, WHICH UPON APPROVAL OF THE BOARD AND THE SUBSEQUENT APPROVAL OF GRHS, SHALL BE ELECTED TO THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B THE GRHS BOARD OF DIRECTORS HAS THE FOLLOWING SPECIFIC POWERS RELATED TO ALL SUBSIDIARY CORPORATIONS AND AFFILIATED ORGANIZATIONS: 1. ELECT OR REMOVE THE BOARD OF DIRECTORS, OR ANY OTHER MEMBER OF THE BOARD OF DIRECTORS; 2. AMEND THE ARTICLES OF INCORPORATION OR THE BYLAWS; 3. DISSOLVE OR APPROVE MERGER WITH ANY OTHER CORPORATE ENTITY; 4. APPROVE STRATEGIC OR OTHER BUSINESS PLANS; 5. APPROVE CAPITAL AND OPERATING BUDGETS; 6. APPROVAL OF ANY INDEBTEDNESS INCURRED; 7. TRANSFER, SELL OR CLOSE ANY FACILITY, DEPARTMENT OR FUNCTION; 8. APPROVE ANY CHARITABLE DISBURSEMENTS, WHETHER INTERNAL OR EXTERNAL, IN EXCESS OF ONE HUNDRED THOUSAND DOLLARS ($100,000.00) IN THE AGGREGATE DURING ANY FISCAL YEAR; 9. THE SALE, DISPOSITION OR ANY ENCUMBRANCE (OTHER THAN ROUTINE LEASE TRANSACTIONS) OF ANY REAL ESTATE; 10. ADOPT, AMEND, OR TERMINATE EMPLOYEE BENEFIT PROGRAMS OR PLANS; 11. APPOINT OR TERMINATE THE CHIEF EXECUTIVE OFFICER; 12. APPROVE THE ELECTION OF ANY OFFICER OR CHAIRPERSON OF THE BOARD OF DIRECTORS; AND 13. TO TAKE ANY OTHER ACTION NECESSARY DEEMED IN THE BEST INTERESTS OF GRHS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PREPARED BY AN EXTERNAL ACCOUNTANT. A DRAFT OF THE FORM 990 WAS REVIEWED IN DETAIL BY A MEMBER OF THE ACCOUNTING DEPARTMENT, DIRECTOR OF FINANCE AND CFO. ANY NECESSARY ADJUSTMENTS WERE MADE PRIOR TO FINALIZING THE FORM. A COPY OF THE FINAL FORM 990 WAS MADE AVAILABLE TO THE BOARD MEMBERS FOR THEIR REVIEW PRIOR TO FILING WITH THE IRS. ANY QUESTIONS OF THE BOARD MEMBERS WERE ADDRESSED THROUGH THE ACCOUNTING DEPARTMENT. FORM 990, PART VI, SECTION B, LINE 12C BOTH CORPORATE AND SUBSIDIARY BOARD MEMBERS ARE PROVIDED EDUCATION REGARDING CONFLICTS OF INTEREST. THIS EDUCATION IS PROVIDED BY THE CHIEF COMPLIANCE OFFICER. ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE FORM. RELATIONSHIPS NOTED ON THIS FORM MAY BE DISCUSSED WITH THE RESPECTIVE BOARD MEMBER IF THERE ARE QUESTIONS. IF AN INDIVIDUAL HAS A CONFLICT OF INTEREST, THEY MAY NOT PARTICIPATE IN DISCUSSIONS RELATING TO THE TRANSACTION IN QUESTION AND MAY NOT VOTE ON MATTERS RELATED TO THE TRANSACTION. CONFLICT OF INTEREST PROCEEDINGS ARISING FROM CONFLICTS OF INTEREST ARE DOCUMENTED IN THE BOARD MINUTES. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF THE OFFICERS OF GREAT RIVER HEALTH SYSTEM, INC. IS PAID BY A RELATED FOR-PROFIT SUBSIDIARY. THE COMPENSATION FOR THE CEO AND OTHER OFFICERS IS DETERMINED BY THE EXECUTIVE COMPENSATION COMMITTEE OF GREAT RIVER HEALTH SYSTEM, INC. THE ROLE OF THE COMPENSATION COMMITTEE IS TO ACT ON BEHALF OF THE BOARD IN ADOPTING, REVIEWING AND MAINTAINING AN EXECUTIVE COMPENSATION PHILOSOPHY. THE COMPENSATION COMMITTEE IS COMPRISED OF FIVE BOARD MEMBERS, ALL OF WHOM ARE INDEPENDENT FROM THE CEO AND OTHER OFFICERS. THE COMPENSATION COMMITTEE REVIEWS THE COMPENSATION OF THE CEO AND OTHER OFFICERS ON AN ANNUAL BASIS. THE DELIBERATIONS AND DECISIONS ARE DOCUMENTED IN MINUTES TAKEN AT THE MEETINGS. GREAT RIVER HEALTH SYSTEM, INC. PARTICIPATES IN AND UTILIZES THREE EXECUTIVE SALARY SURVEYS TO DETERMINE COMPENSATION RANGES. THE COMMITTEE REVIEWS PREVAILING MARKET DATA TO ENSURE CONTINUED MARKET COMPETITIVENESS. THE COMPENSATION COMMITTEE ALSO ENGAGES AN INDEPENDENT THIRD PARTY COMPENSATION CONSULTING GROUP BIANNIALLY TO ASSESS AND VALIDATE THE ENTIRETY OF THE EXECUTIVE COMPENSATION AND BENEFITS PACKAGES TO ENSURE REGULATORY COMPLIANCE, EXTERNAL COMPETITIVENESS, AND INTERNAL EQUITY. THE MOST RECENT YEAR OF AN INDEPENDENT THIRD PARTY REVIEW WAS 2023. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART XII, LINE 2C: THE PROCESS FOR OVERSIGHT AND SELECTION OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. GREAT RIVER HEALTH SYSTEM INC 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421193185 HEALTH CARE IA 501(C)(3) LINE 12C, III-FI N/A 0 SOUTHEAST IOWA REGIONAL MEDICAL CENTER 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 420680407 HOSPITAL IA 501(C)(3) LINE 3 GREAT RIVER HEALTH SYSTEM INC 0 GRHS HOLDINGS INC 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421193186 SUPPORT RELATED ORGANIZATIONS IA 501(C)(3) LINE 12B, II GREAT RIVER HEALTH SYSTEM INC 0 HENRY COUNTY HEALTH CENTER INC 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 862701018 HOSPITAL IA 501(C)(3) LINE 3 GREAT RIVER HEALTH SYSTEM INC 0 SOUTHEAST RENAL DIALYSIS LC 507 SOUTH WHITE STREET MOUNT PLEASANT IA 52641 391878280 MEDICAL SERVICES IA N/A 0 0 RIVERVIEW SYSTEM LTD 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421191960 MEDICAL SERVICES IA N/A C 0 GREAT RIVER MEDICAL SERVICES INC 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421493449 MEDICAL SERVICES IA N/A C 0 MUTUAL CONSULTING AND MANAGEMENT SERVICES 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421349668 MANAGEMENT SERVICES IA N/A C 0 HERITAGE PARK PHARMACY 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421191957 PHARMACY IA N/A C 0 HERITAGE MEDICAL EQUIPMENT AND SUPPLY 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 421191958 MEDICAL SUPPLY IA N/A C 0 RIGHTCHOICE INC 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 923383523 STAFFING AGENCY IA N/A C 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0