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HOWEVER, THE CLINIC IS NOT REQUIRED TO BE LICENSED, REGISTERED, OR SIMILARLY RECOGNIZED BY THE STATE OF WISCONSIN AS A HOSPITAL AND IS NOT REQUIRED TO FILE SCHEDULE H. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6195 242027 6195 242027 271691930 2564277341 271698125 2564519368 1000000 1000000 250000 250000 0 0 0 0 1000000 1000000 1000000 1000000 4000000 6000000 22912 16182 22411 6195 67700 250000 250000 250000 250000 1000000 1500000 0 0 0 Schedule C, Part II-A AFFILIATED ORGANIZATIONS ORGANIZATION NAME: GUNDERSEN CLINIC, LTD. ADDRESS: 1836 SOUTH AVENUE LA CROSSE, WI 54601 EIN: 39-1028657 ORGANIZATION IS AN ELECTING ORGANIZATION. GRASSROOTS LOBBYING AMOUNT: NONE DIRECT LOBBYING AMOUNT: 6,195. TOTAL LOBBYING EXPENDITURES: 6,195. OTHER EXEMPT PURPOSE EXPENDITURES: 271,691,930. TOTAL EXEMPT PURPOSE EXPENDITURES: 271,698,125. LOBBYING NONTAXABLE AMOUNT: 1,000,000. GRASSROOTS NONTAXABLE AMOUNT: 250,000. TOTAL GRASSROOTS LESS NONTAXABLE AMOUNT: TOTAL EXPENDITURES LESS NONTAXABLE AMOUNT: SHARE OF EXCESS LOBBYING EXPENDITURES: NONE Schedule C, Part II-A AFFILIATED ORGANIZATIONS (CONT'D) ORGANIZATION NAME: GUNDERSEN LUTHERAN ADMIN. SERVICES, INC. ADDRESS: 1910 SOUTH AVENUE LA CROSSE, WI 54601 EIN: 39-1606449 ORGANIZATION IS AN ELECTING ORGANIZATION. GRASSROOTS LOBBYING AMOUNT: NONE DIRECT LOBBYING AMOUNT: 235,832. TOTAL LOBBYING EXPENDITURES: 235,832. OTHER EXEMPT PURPOSE EXPENDITURES: 1,001,055,088. TOTAL EXEMPT PURPOSE EXPENDITURES: 1,001,290,920. LOBBYING NONTAXABLE AMOUNT: 1,000,000. GRASSROOTS NONTAXABLE AMOUNT: 250,000. TOTAL GRASSROOTS LESS NONTAXABLE AMOUNT: TOTAL EXPENDITURES LESS NONTAXABLE AMOUNT: SHARE OF EXCESS LOBBYING EXPENDITURES: NONE Schedule C, Part II-A AFFILIATED ORGANIZATIONS (CONT'D) ORGANIZATION NAME: GUNDERSEN LUTHERAN MEDICAL CENTER, INC. ADDRESS: 1910 SOUTH AVENUE LA CROSSE, WI 54601 EIN: 39-0813416 ORGANIZATION IS AN ELECTING ORGANIZATION. GRASSROOTS LOBBYING AMOUNT: NONE DIRECT LOBBYING AMOUNT: NONE TOTAL LOBBYING EXPENDITURES: NONE OTHER EXEMPT PURPOSE EXPENDITURES: 1,291,530,323. TOTAL EXEMPT PURPOSE EXPENDITURES: 1,291,530,323. LOBBYING NONTAXABLE AMOUNT: 1,000,000. GRASSROOTS NONTAXABLE AMOUNT: 250,000. TOTAL GRASSROOTS LESS NONTAXABLE AMOUNT: TOTAL EXPENDITURES LESS NONTAXABLE AMOUNT: SHARE OF EXCESS LOBBYING EXPENDITURES: NONE Schedule C, Part II-A AFFILIATED ORGANIZATIONS (CONT'D) ORGANIZATION NAME: GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. ADDRESS: 1836 SOUTH AVENUE LA CROSSE, WI 54601 EIN: 39-1866425 ORGANIZATION IS AN ELECTING ORGANIZATION. GRASSROOTS LOBBYING AMOUNT: NONE DIRECT LOBBYING AMOUNT: NONE TOTAL LOBBYING EXPENDITURES: NONE OTHER EXEMPT PURPOSE EXPENDITURES: NONE. TOTAL EXEMPT PURPOSE EXPENDITURES: NONE. LOBBYING NONTAXABLE AMOUNT: NONE. GRASSROOTS NONTAXABLE AMOUNT: NONE. TOTAL GRASSROOTS LESS NONTAXABLE AMOUNT: TOTAL EXPENDITURES LESS NONTAXABLE AMOUNT: SHARE OF EXCESS LOBBYING EXPENDITURES: NONE 8281788 8281788 257671547 134228570 123442977 115048936 85874369 29174567 1843932 1083879 760053 161659385 INTERCOMPANY PAYABLE 852662164 MALPRACTICE CLAIM RESERVE 8034609 ASSET RETIREMENT OBLIGATIONS 1231327 OPERATING LEASE OBLIGATIONS 4680862 LEASE CONTRACT PAYABLE 866608962 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote INCOME TAX MATTERS (DOLLARS IN THOUSANDS) THE SYSTEM QUALIFIES AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE), WITH THE EXCEPTION OF GUNDERSEN LUTHERAN ENVISION, LLC, WHICH IS A FOR-PROFIT ENTITY. AT NOVEMBER 30, 2022 AND DECEMBER 31, 2021, NET DEFERRED TAX ASSETS OF $7,351 AND $7,545, RESPECTIVELY, WHICH PRIMARILY ARE RELATED TO NET OPERATING LOSS CARRYFORWARDS, HAVE VALUATION ALLOWANCES OF $7,351 AND $7,545, RESPECTIVELY, RECORDED AGAINST THEM DUE TO THE UNCERTAINTY OF REALIZING THOSE BENEFITS IN THE FUTURE. AT NOVEMBER 30, 2022, THE SYSTEM'S FEDERAL NET OPERATING LOSS CARRYFORWARDS WERE APPROXIMATELY $27,800, AND THE STATE NET OPERATING LOSS CARRYFORWARDS WERE APPROXIMATELY $25,700, WHICH WILL EXPIRE BETWEEN 2031 AND 2040. THE SYSTEM HAS REVIEWED ITS TAX POSITIONS FOR ALL OPEN YEARS AND HAS CONCLUDED THAT NO LIABILITIES EXIST FOR UNCERTAIN TAX POSITIONS. THE SYSTEM'S INCOME TAX RETURNS ARE NO LONGER SUBJECT TO EXAMINATION FOR 2018 AND PRIOR YEARS. true GUNDERSEN LUTHERAN MEDICAL FOUNDATION INC 1836 SOUTH AVE LA CROSSE WI 54601 391249705 501(C)(3) 1305876 OPERATIONS SUPPORT 1 0 CHARITY CARE 4498 1153686 BOOK CHARITY CARE Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS ASSISTANCE WAS TO A RELATED ORGANIZATION, FUNDS ARE MONITORED BY MANAGEMENT AND THE BOARD OF GOVERNORS. false false false false false false false ROBYN BORGE MD BOARD OF GOVERNORS - MEMBER, CHIEF OF MED. STAFF 0 301500 0 100 0 4423 0 44080 0 2550 0 352653 0 0 BENJAMIN JARMAN MD BD OF GOVERNORS - MEMBR, SEC, TREAS 0 495141 0 0 0 6814 0 44225 0 13910 0 560090 0 0 SCOTT RATHGABER MD MEDICAL GOVERNORS - CEO, CHAIRMAN 0 1015579 0 180 0 5157 0 44225 0 22994 0 1088135 0 0 BRIAN SIECK MD FORMER SECRETARY/TREAS THRU 17 0 466325 0 0 0 4692 0 44225 0 13910 0 529152 0 0 EZANA AZENE MD BOARD OF GOVERNORS - MEMBER 0 960845 0 2000 0 5064 0 44225 0 29244 0 1041378 0 0 CHRIS EBERLEIN MD BOARD OF GOVERNORS - MEMBER 0 379772 0 3000 0 5186 0 44225 0 23494 0 455677 0 0 JENNIFER KLEVEN MD BOARD OF GOVERNORS - MEMBER 0 358763 0 3000 0 216 0 43395 0 4182 0 409556 0 0 STEPHANIE NEUMAN MD BOARD OF GOVERNORS - MEMBER 0 472163 0 0 0 372 0 44225 0 27186 0 543946 0 0 KURT OETTEL MD BOARD OF GOVERNORS - MEMBER 0 480829 0 0 0 4848 0 44225 0 21494 0 551396 0 0 BENJAMIN OROZCO MD BOARD OF GOVERNORS - MEMBER 0 385079 0 4680 0 319 0 44225 0 18602 0 452905 0 0 CHRISTINE WALLER MD BOARD OF GOVERNORS - MEMBER 0 511659 0 3000 0 5422 0 44225 0 33002 0 597308 0 0 GREGORY THOMPSON MD FORMER CHIEF MED OFF THRU 21 0 303070 0 0 0 19598 0 40620 0 12536 0 375824 0 0 MARILU BINTZ MD CHIEF POPULATION HEALTH OFFICER 0 614741 0 210 0 5811 0 44225 0 8409 0 673396 0 0 PRAVEEN CHOPRA CHIEF INFORMATION OFFICER 0 462246 0 0 0 47037 0 44225 0 28936 0 582444 0 0 MICHAEL DOLAN MD EXEC VP, MEDICAL COO 0 631023 0 4500 0 758 0 44225 0 27686 0 708192 0 0 WILLIAM FARRELL CHIEF BUSINESS AND STRATEGY OFFICER 0 432308 0 0 0 5416 0 44225 0 50 0 481999 0 0 MARY ELLEN MCCARTNEY CHIEF HUMAN RESOURCES OFFICER 0 383356 0 0 0 1051 0 44225 0 15042 0 443674 0 0 GERALD OETZEL CHIEF FINANCIAL OFFICER 0 609991 0 0 0 5651 0 44225 0 8426 0 668293 0 0 HEATHER SCHIMMERS ADMINISTRATIVE OPERATION OFFICER, CNO 0 509659 0 0 0 5280 0 44225 0 13910 0 573074 0 0 STEPHEN SHAPIRO MD CHIEF MEDICAL FOUNDATION OFFICER 0 493829 0 4650 0 464 0 44225 0 27044 0 570212 0 0 STEPHANIE CARROLL MD FORMER MEDICAL VP THRU 20 0 297576 0 0 0 23 0 37717 0 25593 0 360909 0 0 KARI ADANK VICE PRESIDENT COMPLIANCE 0 236696 0 0 0 123 0 34829 0 24809 0 296457 0 0 ERIC DEHN VP ENTERPRISE ARCHITECTURE AND SOLUTION DESIGN 0 239619 0 0 0 20461 0 25231 0 12148 0 297459 0 0 BRYAN ERDMANN ADMINISTRATIVE VICE PRESIDENT 0 312047 0 0 0 4259 0 44225 0 28238 0 388769 0 0 ANDREA HAUSER VP PATIENT EXPERIENCE & DEPT OF NURSING 0 240231 0 0 0 3882 0 33786 0 17246 0 295145 0 0 P MICHAEL JACOBS DPM MEDICAL VICE PRESIDENT 0 456496 0 0 0 4714 0 44225 0 23477 0 528912 0 0 TODD KOWALSKI MD MEDICAL VICE PRESIDENT 0 468479 0 4500 0 827 0 44225 0 28586 0 546617 0 0 MARY KUFFEL MD MEDICAL VICE PRESIDENT 0 529412 0 2000 0 6775 0 44225 0 1442 0 583854 0 0 DANIEL LILLY GENERAL COUNSEL 0 485361 0 0 0 6000 0 44225 0 23994 0 559580 0 0 JANINE LUZ VICE PRESIDENT LEARNING 0 225078 0 110 0 4258 0 33108 0 18245 0 280799 0 0 PAMELA MAAS VICE PRESIDENT BUSINESS SERVICES 0 223112 0 110 0 51231 0 32351 0 42 0 306846 0 0 KRISTER MATTSON VICE PRESIDENT ENTERPRISE ANALYTICS 0 277987 0 0 0 20066 0 36521 0 15177 0 349751 0 0 MICHAEL MCKEE ADMINISTRATIVE VICE PRESIDENT 0 270131 0 0 0 625 0 40054 0 27906 0 338716 0 0 SHANNON MULLIGAN VP HR & TOTAL REWARDS 0 241408 0 20000 0 3434 0 31502 0 4069 0 300413 0 0 ELLEN PEDRETTI-FENDT VICE PRESIDENT APPLICATION SERVICES 0 202996 0 160 0 530 0 30015 0 24851 0 258552 0 0 KRAIG SCHUSTER ADMINISTRATIVE VICE PRESIDENT 0 281574 0 160 0 2435 0 40632 0 13340 0 338141 0 0 JACK SCHWARTZ VICE PRESIDENT FOUNDATION 0 212018 0 0 0 3314 0 29814 0 8423 0 253569 0 0 JONATHAN ZLABEK MD MEDICAL VICE PRESIDENT 0 451746 0 4500 0 5064 0 44225 0 24244 0 529779 0 0 JERRY DAVIS MD MEDICAL DOCTOR 0 1099163 0 0 0 4692 0 32025 0 21494 0 1157374 0 0 DOUGLAS HUGHES MD MEDICAL DOCTOR 0 1075829 0 0 0 4692 0 32025 0 21494 0 1134040 0 0 JEFFREY LAWRENCE MD MEDICAL DOCTOR 0 1147530 0 0 0 4714 0 44225 0 21494 0 1217963 0 0 MARK TOPOLSKI MD MEDICAL DOCTOR 0 1106659 0 0 0 4738 0 44225 0 13910 0 1169532 0 0 KURT ZIEGELBEIN MD MEDICAL DOCTOR 0 993745 0 0 0 5042 0 44225 0 24344 0 1067356 0 0 Schedule J, Part I LINES 2 & 3 ALL PERSONNEL SERVICES FOR GUNDERSEN CLINIC, LTD. ARE PERFORMED BY EMPLOYEES OF GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. Schedule J, Part II REIMBURSEMENTS GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. PROVIDES LEASED EMPLOYEES AND MANAGEMENT SERVICES TO GUNDERSEN CLINIC. THEREFORE, THE AMOUNTS REPORTED ON SCHEDULE J REPRESENT REIMBURSEMENTS TO GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. Form 990, Part I, Line 1 ORGANIZATION'S MISSION TO PROVIDE MEDICAL AND SURGICAL SERVICES, ENGAGE IN MEDICAL EDUCATION AND RESEARCH, AND PROMOTE COMMUNITY HEALTH TO DELIVER THE HIGHEST QUALITY COMPREHENSIVE HEALTH CARE TO ALL PATIENTS WITHOUT REGARD TO THEIR ABILITY TO PAY. Form 990, Part III, Line 4a PROGRAM SERVICE ACCOMPLISHMENTS GUNDERSEN CLINIC, LTD. (THE CLINIC) HAS 633 PHYSICIANS REPRESENTING NEARLY EVERY SPECIALTY SERVING A 22 COUNTY REGION IN WESTERN WISCONSIN, NORTHEASTERN IOWA AND SOUTHEASTERN MINNESOTA. THE CLINIC PROVIDES MEDICAL CARE TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. CHARITY CARE AND/OR FINANCIAL ASSISTANCE IS DETERMINED BASED ON FINANCIAL INFORMATION PROVIDED BY THE PATIENT AND ANALYSIS OF OTHER RELEVANT INFORMATION. THERE WERE APPROXIMATELY 1,034,268 PATIENT ENCOUNTERS FOR 2022. THE CLINIC PROVIDED UNCOMPENSATED CARE RELATED TO CHARITY AT COST, $728,462; MEDICARE, $25,400,969; AND MEDICAID, $11,416,574 FOR THE TOTAL AMOUNT OF $37,546,005 AT COST BASED ON POLICIES AND CONTRACTS ARRANGED TO HELP SUPPORT THE COMMUNITY'S NEEDS. THE $37,546,005 IS THE SUM OF UNREIMBURSED MEDICARE & MEDICAID COST PLUS CHARITY AT COST. ALL OF THESE ARE CALCULATED USING THE SAME METHOD UTILIZED FOR THE HOSPITAL CALCULATION OF CHARITY COST AND UNREIMBURSED MEDICARE AND MEDICAID COSTS. THE COST OF CHARITY IS CALCULATED BY ALLOCATING THE COST TO PROVIDE SERVICES TO A PATIENT BETWEEN ANY PAYMENTS, BAD DEBT, AND CHARITY WRITE-OFFS WHERE TOTAL PAYMENTS ARE LESS THAN THE COST OF SERVICES PROVIDED. THE UNREIMBURSED MEDICARE AND MEDICAID COSTS ARE CALCULATED BY COMPARING THE COST OF SERVICES TO MEDICARE AND MEDICAID PATIENTS TO THE NET REVENUE FOR THOSE SAME PATIENTS. THE UNREIMBURSED COST IS THE AMOUNT THE COST EXCEEDS THE NET REVENUE FOR THOSE SAME PATIENTS. MEDICARE AND MEDICAID PATIENTS TO THE NET REVENUE FOR THOSE SAME PATIENTS. THE UNREIMBURSED COST IS THE AMOUNT THE COST EXCEEDS THE NET REVENUE FOR THOSE SAME PATIENTS. Form 990, Part IV, Line 24a TAX-EXEMPT DEBT TAX EXEMPT BONDS GUNDERSEN CLINIC, LTD. IS PART OF THE OBLIGATED GROUP (GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC., GUNDERSEN LUTHERAN MEDICAL CENTER, INC., GUNDERSEN CLINIC, LTD., AND GUNDERSEN LUTHERAN MEDICAL FOUNDATION, INC.) AND TAX-EXEMPT DEBT RESIDES ON THE BALANCE SHEET OF GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. FEIN 39-1606449 Form 990, Part V, Line 1a AND LINE 2 ALL PERSONNEL SERVICES FOR GUNDERSEN CLINIC, LTD. ARE PERFORMED BY EMPLOYEES OF GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. AND ALL PAYMENTS TO VENDORS ARE MADE BY GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. HENCE LINES 1 & 2 INDICATE ZERO (0) FILINGS. Form 990, Part VI, Line 15 PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL ALL PERSONNEL SERVICES FOR GUNDERSEN CLINIC, LTD. ARE PERFORMED BY EMPLOYEES OF GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. THE COMPENSATION OF THE CEO IS DETERMINED ANNUALLY BY A COMMITTEE MADE UP OF THE COMMUNITY MEMBERS OF THE BOARD OF TRUSTEES. THEIR DETERMINATION IS MADE AFTER A REVIEW OF MARKET DATA OBTAINED FROM SEVERAL ORGANIZATIONS AND CEO PERFORMANCE. MEETING MINUTES ARE TAKEN AND KEPT AT THE MEETINGS WHERE SUCH DISCUSSIONS TAKE PLACE. RECOMMENDATIONS FOR COMPENSATION FOR THE ORGANIZATIONS' KEY MANAGEMENT EMPLOYEES ARE DEVELOPED ANNUALLY BY THE CEO, AFTER A REVIEW OF PERFORMANCE AND COMPARABLE MARKET DATA. THE PROPOSED SALARIES ARE INDEPENDENTLY REVIEWED BY AN OUTSIDE AUDITING FIRM. THE COMPENSATION RECOMMENDATIONS, AUDIT REPORTS, ALONG WITH THE MARKET DATA, ARE PRESENTED TO A COMMITTEE MADE UP OF THE COMMUNITY MEMBERS OF THE BOARD OF TRUSTEES. THE COMPENSATION AMOUNTS ARE NOT EFFECTIVE UNTIL THE BOARD COMMITTEE APPROVES THEM. MEETING MINUTES ARE TAKEN AND KEPT AT THE MEETINGS WHERE THE BOARD REVIEWS AND APPROVES THE COMPENSATION OF THE KEY EMPLOYEES. Form 990, Part VI, Line 3 Delegation of management duties ALL MANAGEMENT AND PERSONNEL SERVICES FOR GUNDERSEN CLINIC, LTD. ARE PERFORMED BY EMPLOYEES OF GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICE, INC. Form 990, Part VI, Line 4 Significant changes to organizational documents GUNDERSEN AND BELLIN HEALTH SYSTEMS, INC. (BELLIN), EACH A WISCONSIN NONPROFIT, NON-STOCK CORPORATION, ENTERED INTO A COMBINATION AGREEMENT DATED JULY 29, 2022 (THE AGREEMENT), TO ALIGN THEIR RESPECTIVE OPERATIONS AND TO FORM A SINGLE NONPROFIT HEALTH SYSTEM THROUGH THE CREATION OF BELLIN GUNDERSEN HEALTH SYSTEM, INC., A WISCONSIN NONPROFIT, NON-STOCK CORPORATION (BELLIN GUNDERSEN). ON DECEMBER 1, 2022, UPON CONSUMMATION OF THE ALIGNMENT OF THE TWO SYSTEMS (THE AFFILIATION), BELLIN GUNDERSEN BECAME THE SOLE CORPORATE MEMBER OF BOTH BELLIN AND GUNDERSEN. BELLIN AND GUNDERSEN AND THEIR RESPECTIVE AFFILIATES ARE EXPECTED TO MAINTAIN THEIR RESPECTIVE CORPORATE EXISTENCE. IN DECEMBER 2022, THE BYLAWS OF GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. WERE AMENDED AND RESTATED TO UPDATE THE SOLE CORPORATE MEMBER TO BELLIN GUNDERSEN HEALTH SYSTEM, INC. THE BYLAWS WERE ALSO UPDATED TO SPECIFY THE POWERS RETAINED BY GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. THE CHIEF EXECUTIVE OFFICER OF BELLIN GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. RETAINS AUTHORITY TO APPROVE ANY SIGNIFICANT CHANGES TO THE CORPORATION. SUBJECT TO THE RESERVED POWERS SPECIFIED IN THE BYLAWS, THE AFFAIRS OF THE CORPORATION SHALL BE MANAGED BY ITS BOARD OF TRUSTEES. Form 990, Part VI, Line 6 Classes of members or stockholders GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF THIS ORGANIZATION. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body THE CORPORATE MEMBER, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., HAS THE POWER TO APPOINT BOARD MEMBERS. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders THE CORPORATION'S SOLE SHAREHOLDER IS GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. THE BYLAWS MAY BE AMENDED BY THE BOARD WITH APPROVAL OF THE PARENT CORPORATION, OR BY THE VOTE OF THE SOLE SHAREHOLDER. ALSO, THE AFFAIRS OF THE CORPORATION SHALL BE MANAGED UNDER THE DIRECTION OF THE CORPORATION'S BOARD OF GOVERNORS, SUBJECT TO CERTAIN APPROVAL POWERS OF THE BOARD OF GOVERNORS AND BOARD OF TRUSTEES OF THE PARENT CORPORATION. Form 990, Part VI, Line 11b Review of form 990 by governing body THE FORM 990 WILL BE AVAILABLE FOR ALL BOARD MEMBERS AT A BOARD MEETING AND THE GUNDERSEN LUTHERAN HEALTH SYSTEM FINANCE COMMITTEE RECEIVES A COPY OF THE 990 BEFORE FILING. UPON FURTHER REVIEW FROM THE CFO AND/OR THE EXECUTIVE DIRECTOR FINANCE, THE 990S ARE APPROVED AND FILED. Form 990, Part VI, Line 12c Conflict of interest policy GUNDERSEN CLINIC, LTD. MONITORS CONFLICTS ON AN ANNUAL BASIS BY REVIEWING DISCLOSURES ON COMPLETED CONFLICT OF INTEREST STATEMENTS. Form 990, Part VI, Line 19 Required documents available to the public REQUESTS FOR ALL DOCUMENTS ARE MADE THROUGH THE LEGAL DEPARTMENT AND THE APPROPRIATE DOCUMENTS ARE MADE AVAILABLE FOR INSPECTION IN THE LEGAL DEPARTMENT. Form 990, Part VII, Section A LINE 1 & PART VI SECTION A LINE 3 GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. PROVIDES LEASED EMPLOYEES AND MANAGEMENT SERVICES TO GUNDERSEN CLINIC. THEREFORE, THE AMOUNTS REPORTED ON PART VII REPRESENT REIMBURSEMENTS TO GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. Form 990, Part VIII, Line 2a PROGRAM SERVICE REVENUE THE PROVISION OF MEDICAL SERVICES IN A MANNER BENEFICIAL TO THE COMMUNITY FURTHERS GUNDERSEN CLINIC, LTD.'S CHARITABLE PURPOSE OF PROMOTION OF HEALTH GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1836 SOUTH AVENUE LA CROSSE WI 54601 391866425 SUPPORTING ORG WI 501(c)(3) Type II BGHS false GUNDERSEN LUTHERAN MEDICAL CENTER INC 1910 SOUTH AVENUE LA CROSSE WI 54601 390813416 HEALTHCARE WI 501(c)(3) 3 GLHS false GUNDERSEN LUTHERAN ADM SERVICES INC 1910 SOUTH AVENUE LA CROSSE WI 54601 391606449 SUPPORTING ORG WI 501(c)(3) Type II GLHS false GUNDERSEN LUTHERAN MEDICAL FOUNDATION INC 1836 SOUTH AVENUE LA CROSSE WI 54601 391249705 FOUNDATION WI 501(c)(3) 7 GLHS false GUNDERSEN LUTHERAN CREDENTIALING SVS INC 1910 SOUTH AVENUE LA CROSSE WI 54601 391856898 CREDENTIALING WI 501(c)(3) Type III-FI GLHS false TRI-COUNTY MEMORIAL HOSPITAL INC 18601 LINCOLN STREET WHITEHALL WI 54773 390704510 HEALTHCARE WI 501(c)(3) 3 GLHS false HARMONY COMMUNITY HEALTHCARE INC 815 MAIN AVENUE HARMONY MN 55939 410711606 HEALTHCARE MN 501(c)(3) 10 GLHS false TWEETEN LUTHERAN HEALTHCARE CENTER INC 125 FIFTH AVENUE SE SPRING GROVE MN 55974 411565003 HEALTHCARE MN 501(c)(3) 10 GLHS false TRI-STATE AMBULANCE INC 235 CAUSEWAY BLVD LA CROSSE WI 54603 391965415 MEDICAL TRANSPORT WI 501(c)(3) 3 GLHS false TRI-STATE REGIONAL AMBULANCE INC 235 CAUSEWAY BLVD LA CROSSE WI 54603 391962965 MEDICAL TRANSPORT WI 501(c)(3) 10 GLHS false LUTHERAN REAL ESTATE HOLDING CORPORATION 1910 SOUTH AVENUE LA CROSSE WI 54601 391480826 HOUSING WI 501(c)(3) Type III-FI GLHS false COMMUNITY HOUSING OF LA CROSSE INC 1900 SOUTH AVENUE LA CROSSE WI 54601 391586700 INDEPENDENT LIVING WI 501(c)(3) 10 LREH CORP false LUTHERAN HOUSING OF LA CROSSE INC 1900 SOUTH AVENUE LA CROSSE WI 54601 391751934 INDEPENDENT LIVING WI 501(c)(3) 10 LREH CORP false ST JOSEPH'S HEALTH SERVICES INC 400 WATER AVENUE HILLSBORO WI 54634 390929538 HEALTHCARE WI 501(c)(3) 3 GLHS false ST JOSEPH'S MEMORIAL FOUNDATION INC 400 WATER AVENUE HILLSBORO WI 54634 391455787 FOUNDATION WI 501(c)(3) Type I ST JO HTH SV false TRI-COUNTY MEMORIAL FOUNDATION INC 18601 LINCOLN STREET WHITEHALL WI 54773 300093022 FOUNDATION WI 501(c)(3) Type I TRI CTY HSPT false MEMORIAL HOSPITAL OF BOSCOBEL 205 PARKER STREET BOSCOBEL WI 53805 390845590 HEALTHCARE WI 501(c)(3) 3 GLHS false PALMER LUTHERAN HEALTH CENTER INC 112 JEFFERSON STREET WEST UNION IA 52175 421320763 HEALTHCARE IA 501(c)(3) 3 GLHS false MOUNDVIEW MEMORIAL HOSPITALS & CLINICS 402 WEST LAKE STREET FRIENDSHIP WI 53934 390944012 HEALTHCARE WI 501(c)(3) 3 GLHS false MEMORIAL HC FDN OF ADAMS COUNTY INC 402 WEST LAKE STREET FRIENDSHIP WI 53934 391775074 FOUNDATION WI 501(c)(3) Type I MDVW MEM HOS false SAINT ELIZABETH'S HOSP OF WABASHA INC 1200 5TH GRANT BOULEVARD WEST WABASHA MN 55981 410693877 HEALTHCARE MN 501(c)(3) 3 GLHS false BELLIN GUNDERSEN HEALTH SYSTEM INC 1836 SOUTH AVENUE LA CROSSE WI 54601 920504278 SUPPORTING ORG WI 501(c)(3) Type II NA false BELLIN HEALTH SYSTEMS INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 391512904 SUPPORTING ORG WI 501(c)(3) Type II BGHS false LAKE MICHIGAN HEALTH SERVICES INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 391512903 SUPPORTING ORG WI 501(c)(3) Type II BHS false BELLIN COLLEGE INC 3201 EATON ROAD GREEN BAY WI 54311 391620530 EDUCATION WI 501(c)(3) 2 BHS false BELLIN PSYCHIATRIC CENTER INC PO BOX 23725 GREEN BAY WI 54301 391657627 HEALTHCARE WI 501(c)(3) 3 BHS false BELLIN MEMORIAL HOSPITAL INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 390884478 HEALTHCARE WI 501(c)(3) 3 BHS false THE BELLIN HEALTH FOUNDATION INC PO BOX 23400 GREEN BAY WI 54301 391809171 FOUNDATION WI 501(c)(3) 7 BHS false OCONTO HOSPITAL & MEDICAL CENTER INC 820 ARBUTUS AVENUE OCONTO WI 54153 061745397 HEALTHCARE WI 501(c)(3) 3 BMH false GUNDERSEN LUTHERAN ENVISION LLC 1836 SOUTH AVENUE LA CROSSE WI 54601 264706546 RENEWABLE ENERGY WI GLHS C Corporation false BEL-REGIONAL HOME MEDICAL INC 617 S ROOSEVELT GREEN BAY WI 54301 391504766 DURABLE MEDICAL EQUIPMENT, RETAIL WI NA C Corporation false BELLIN INVESTMENTS INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 391564939 OTHER WI NA C Corporation false false true true false false false false false false true true true true false false true true false false