2024-08-12T09:14:09-05:00 2023-09-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2023-01-01 410711606 HARMONY COMMUNITY HEALTHCARE HARM 5078866544 815 MAIN AVENUE S HARMONY MN 55939 BRENDA MOSER FINANCE ADMINISTRATOR 5078866544 2024-07-31 1 1 MICHAEL J PETERSON CPA P01833529 2187224705 2024-07-30 2023 2024-08-08 14:25:15Z GUNDERSEN HARMONY CARE CENTER BRENDA MOSER 815 MAIN AVENUE S HARMONY MN 55939 3264313 0 X HTTPS://WWW.GUNDERSENHEALTH.ORG/LOCATIONS/GUNDERS X 1948 MN TO PROVIDE CARE TO THE ELDERLY. 7 3 0 5 0 0 359256 37263 3341514 3222703 3886 4347 0 0 3704656 3264313 0 0 0 0 3294639 2285725 0 0 0 1149052 931666 4443691 3217391 -739035 46922 1579135 2059124 553104 979268 1026031 1079856 HARMONY COMMUNITY HEALTHCARE IS COMMITTED TO ENHANCING THE QUALITY OF LIFE OF THOSE WE SERVICE. 0 0 2813724 0 3222703 THE ORAGNIZATION PROVIDES HOUSING AND NURSING CARE TO THE ELDERLY BY OPERATING A 42-BED NURSING FACILITY IN HARMONY, MN. FROM JANUARY 1 - SEPTEMBER 30, 2023, THERE WERE 8,502 RESIDENT DAYS. 2813724 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 7 3 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 0 MN X BRENDA MOSER 5078866544 815 MAIN AVENUE S HARMONY MN 55939 X X SCOTT RATHGABER CEO-GHS 1.00 40.00 X 0 0 0 GERALD OETZEL CFO-GHS (THRU 08/23) 1.00 40.00 X 0 0 0 STEVE LITTLE CFO-GHS (BEG 08/23) 1.00 40.00 X 0 0 0 MICHELLE BORRESON ADMINISTRATOR/CEO 20.00 20.00 X 0 0 0 BRENDA MOSER FINANCE ADMINISTRATOR 4.00 36.00 X 0 0 0 VICKI BAKALARS PRESIDENT 0.50 39.50 X X 0 0 0 CHUCK JOHNSON VICE PRESIDENT 0.50 39.50 X X 0 0 0 CHRIS SKAALEN SECRETARY/TREASURER 0.50 X X 0 0 0 JEN BERENDES DIRECTOR 0.50 39.50 X 0 0 0 MICHELLE GATZKE DIRECTOR (THRU 4/2023) 0.50 X 0 0 0 MANDI PERICAK DIRECTOR 0.50 39.50 X 0 0 0 DONNA SCHEEVEL DIRECTOR 0.50 X 0 0 0 ERIC SLINDE DIRECTOR (THRU 9/2023) 0.50 X 0 0 0 0 0 0 0 0 0 0 0 36478 785 37263 RESIDENT SERVICE REVEN 623000 3151738 3151738 RENTAL REVENUE 900099 62316 62316 8649 8649 3222703 4347 4347 3264313 3222703 0 4347 1966111 1824195 141916 26102 24429 1673 181511 177440 4071 112001 109125 2876 74655 74655 50 50 7350 7350 227885 227300 585 3716 1390 2326 24707 15463 9244 154374 149891 4483 2949 2392 557 13016 11656 1360 8852 7082 1770 97873 78298 19575 10396 10396 FOOD EXPENSE 99590 99590 DHS SURCHARGE 90784 90784 MEDICAL SUPPLIES 67509 67509 MINR EQUIPMENT 2286 2286 45674 15678 29996 3217391 2813724 403667 0 142471 651404 234070 265015 36866 21877 3226309 2163180 1136189 1063129 29539 57699 1579135 2059124 288770 304815 5848 198855 6636 3169 200000 300000 51850 172429 553104 979268 X 996492 1043413 29539 36443 1026031 1079856 1579135 2059124 X 46922 6903 X 0 1 X 1 1 1 X 14596 339334 110302 359256 37263 860751 3795367 3402808 3170925 3341514 3222703 16933317 3809963 3742142 3281227 3700770 3259966 17794068 0 1534247 1571306 1365479 1042839 1109953 6623824 1534247 1571306 1365479 1042839 1109953 6623824 11170244 2858 2935 2564 3886 4347 16590 2858 2935 2564 3886 4347 16590 3812821 3745077 3283791 3704656 3264313 17810658 0.62720 0.61700 0.00090 0.00080 X PART III, SHORT YEAR EXPLANATION: THE ORGANIZATION WAS INCLUDED IN A SHORT YEAR CONSOLIDATED AUDIT FOR THE 10-MONTH PERIOD DECEMBER 1, 2022 THROUGH SEPTEMBER 30, 2023. THE ANSWERS FOR PART IV, LINE 12B AND PART XII, LINES 2A-2C HAVE BEEN ANSWERED YES EVEN THOUGH THE FORM 990 COVERS THE 9-MONTH PERIOD JANUARY 1, 2023 THROUGH SEPTEMBER 30, 2023. THE REASON FOR THIS CHANGE IS DUE TO A MERGER WITH THE BELLIN GUNDERSEN HEALTH SYSTEM. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 24650 24650 2579466 1611303 968163 622193 551877 70316 1063129 DUE TO AFFILIATES 161385 ADVANCE COVID PAYMENTS 11044 172429 X PART X, LINE 2: THE SYSTEM HAS REVIEWED 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. X 0 0 0 0 0 0 0 0 0 PART I, LINE 3 PURSUANT TO IRS FORM 990 INSTRUCTIONS, THIS SHORT PERIOD RETURN COVERS THE DATES 01/01/2023 THROUGH 09/30/2023 AND THERE IS NO CALENDAR YEAR ENDING WITHIN THE PERIOD AND THUS NO REPORTABLE COMPENSATION. A RELATED ORGANIZATION OF THE FILING ORGANIZATION USES ONE OR MORE OF THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION SURVEY OR STUDY, AND -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PLEASE REFER TO THE FORM 990, PART VI, LINE 15A DISCLOSURE IN SCHEDULE O FOR ADDITIONAL DETAILS ON HOW COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL IS ESTABLISHED. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE VOTING MEMBER OF HARMONY COMMUNITY HEALTHCARE, INC. IS GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7A FOUR OUT OF THE SEVEN DIRECTORS SHALL BE ELECTED BY GUNDERSEN LUTHERAN HEALTH SYSTEM, INC.'S BOARD OF GOVERNORS AND BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B GUNDERSEN LUTHERAN HEALTH SYSTEM, INC.'S FINANCE COMMITTEE APPROVES THE BUDGET AND CAPITAL BUDGET. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 11B THE DRAFT FORM 990 WILL FIRST BE REVIEWED BY THE CEO/ADMINISTRATOR AND FINANCE ADMINISTRATOR. THE RETURN WILL THEN BE PROVIDED TO THE BOARD OF DIRECTORS AFTER FILING. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY COVERS BOARD MEMBERS AND OFFICERS. BOARD MEMBERS ARE ASKED TO DISCLOSE ANY POTENTIAL CONFLICTS AS THEY ARISE. IF THE BOARD OF DIRECTORS DETERMINES THERE IS A CONFLICT THE BOARD MEMBER WITH THE CONFLICT MUST REFRAIN FROM VOTING. A STATEMENT OF CONFLICT OF INTEREST DISCLOSURE IS MADE ON AN ANNUAL BASIS BY OFFICERS AND DIRECTORS. THE DISCLOSURE FORMS ARE REVIEWED BY HARMONY COMMUNITY HEALTHCARE'S COMPLIANCE COMMITTEE ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15A THE ADMINISTRATOR IS COMPENSATED BY GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. THE HARMONY BOARD OF DIRECTORS APPROVES THE COMPENSATION FOR THE ADMINISTRATOR AND USES THE AGING SERVICE OF MINNESOTA SALARY SURVEY. THERE IS A WRITTEN CONTRACT IN PLACE FOR THE ADMINISTRATOR. COMPENSATION IS REVIEWED ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE UPON REQUESTS. FORM 990, PART VII, SECTION A PURSUANT TO IRS FORM 990 INSTRUCTIONS, THIS SHORT PERIOD RETURN COVERS THE DATES 01/01/2023 THROUGH 09/30/2023 AND THERE IS NO CALENDAR YEAR ENDING WITHIN THE PERIOD AND THUS NO REPORTABLE COMPENSATION. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN FOUNDATION 6,903. FORM 990, PART IV, LINE 12B AND PART XIII, LINE 2 THE ORGANIZATION WAS INCLUDED IN A SHORT YEAR CONSOLIDATED AUDIT FOR THE 10-MONTH PERIOD DECEMBER 1, 2022 THROUGH SEPTEMBER 30, 2023. THE ANSWERS FOR PART IV, LINE 12B AND PART XII, LINES 2A-2C HAVE BEEN ANSWERED YES EVEN THOUGH THE FORM 990 COVERS THE 9-MONTH PERIOD JANUARY 1, 2023 THROUGH SEPTEMBER 30, 2023. THE REASON FOR THIS CHANGE IS DUE TO A MERGER WITH THE BELLIN GUNDERSEN HEALTH SYSTEM. BELLIN GUNDERSEN HEALTH SYSTEM INC 1836 SOUTH AVENUE LA CROSSE WI 54601 920504278 PARENT WI 501(C)(3) LINE 12B, II N/A 0 BELLIN HEALTH SYSTEMS INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 391512904 SUPPORT OF HEALTHCARE ORGANIZATIONS WI 501(C)(3) LINE 12B, II BELLIN GUNDERSEN HEALTH SYSTEMS INC 1 BELLIN COLLEGE INC 3201 EATON ROAD GREEN BAY WI 54311 391620530 NURSING AND RADIOLOGIC SCIENCE COLLEGE WI 501(C)(3) LINE 2 BELLIN HEALTH SYSTEMS INC 1 LAKE MICHIGAN HEALTH SERVICES INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 391512903 SUPPORT PURPOSES OF BELLIN MEMORIAL HOSPITAL WI 501(C)(3) LINE 12B, II BELLIN HEALTH SYSTEMS INC 1 THE BELLIN HEALTH FOUNDATION INC PO BOX 23400 GREEN BAY WI 54301 391809171 FOUNDATION WI 501(C)(3) LINE 7 BELLIN HEALTH SYSTEMS INC 1 BELLIN PSYCHIATRIC CENTER INC PO BOX 23725 GREEN BAY WI 54305 391657627 PSYCHIATRIC HOSPITAL WI 501(C)(3) LINE 3 BELLIN HEALTH SYSTEMS INC 1 BELLIN MEMORIAL HOSPITAL INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 390884478 HEALTH CARE WI 501(C)(3) LINE 3 BELLIN HEALTH SYSTEMS INC 1 OCONTO HOSPITAL & MEDICAL CENTER INC 820 ARBUTUS AVENUE OCONTO WI 54153 061745397 HEALTH CARE WI 501(C)(3) LINE 3 BELLIN MEMORIAL HOSPITAL INC 1 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1836 SOUTH AVENUE LA CROSSE WI 54601 391866425 SUPPORTING ORGANIZATION WI 501(C)(3) LINE 12B, II BELLIN GUNDERSEN HEALTH SYSTEMS INC 1 GUNDERSEN LUTHERAN MEDICAL CENTER INC 1910 SOUTH AVENUE LA CROSSE WI 54601 390813416 HEALTH CARE WI 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 GUNDERSEN CLINIC LTD 1910 SOUTH AVENUE LA CROSSE WI 54601 391028657 HEALTH CARE WI 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES INC 1910 SOUTH AVENUE LA CROSSE WI 54601 391606449 SUPPORTING ORGANIZATION WI 501(C)(3) LINE 12B, II GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 GUNDERSEN LUTHERAN MEDICAL FOUNDATION INC 1836 SOUTH AVENUE LA CROSSE WI 54601 391249705 FOUNDATION WI 501(C)(3) LINE 7 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 TWEETEN LUTHERAN HEALTHCARE CENTER INC 125 FIFTH AVENUE SE SPRING GROVE MN 55974 411565003 HEALTH CARE MN 501(C)(3) LINE 10 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 TRI-STATE AMBULANCE INC 235 CAUSEWAY BLVD LA CROSSE WI 54601 391965415 MEDICAL TRANSPORTATION WI 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 TRI-STATE REGIONAL AMBULANCE INC 235 CAUSEWAY BLVD LA CROSSE WI 54603 391962965 MEDICAL TRANSPORTATION WI 501(C)(3) LINE 11 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 LUTHERAN REAL ESTATE HOLDING CORP 1910 SOUTH AVENUE LA CROSSE WI 54601 391480826 HOUSING WI 501(C)(3) LINE 12C, III-FI GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 COMMUNITY HOUSING OF LA CROSSE INC 1900 SOUTH AVENUE LA CROSSE WI 54601 391586700 INDEPENDENT LIVING WI 501(C)(3) LINE 10 LUTHERAN REAL ESTATE HOLDING CORP 1 LUTHERAN HOUSING OF LA CROSSE INC 1900 SOUTH AVENUE LA CROSSE WI 54601 391751934 INDEPENDENT LIVING WI 501(C)(3) LINE 10 LUTHERAN REAL ESTATE HOLDING CORP 1 ST JOSEPH'S MEMORIAL FOUNDATION INC 400 WATER AVE HILLSBORO WI 54634 391455787 FOUNDATION WI 501(C)(3) LINE 12A, I ST JOSEPH'S HEALTH SERVICES INC 1 TRI-COUNTY MEMORIAL HOSPITAL INC 18601 LINCOLN STREET WHITEHALL WI 54773 390704510 HEALTH CARE WI 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 TRI-COUNTY MEMORIAL FOUNDATION INC 18601 LINCOLN STREET WHITEHALL WI 54773 300093022 FOUNDATION WI 501(C)(3) LINE 12A, I TRI-COUNTY MEMORIAL HOSPITAL INC 1 MEMORIAL HOSPITAL OF BOSCOBEL 205 PARKER STREET BOSCOBEL WI 53805 390845590 HEALTH CARE WI 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 PALMER LUTHERAN HEALTH CENTER 112 JEFFERSON STREET WEST UNION IA 52175 421320763 HEALTH CARE IA 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 MEMORIAL HEALTHCARE FOUNDATION INC PO BOX 40 FRIENDSHIP WI 53934 391775074 FOUNDATION WI 501(C)(3) LINE 12A, I MOUNDVIEW MEMORIAL HOSPITAL & CLINICS INC 1 MOUNDVIEW MEMORIAL HOSPITAL & CLINICS INC 402 W LAKE STREET FRIENDSHIP WI 53934 390944012 HEALTH CARE WI 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 SAINT ELIZABETH'S HOSPITAL OF WABASHA 1200 GRANT BLVD WEST WABASHA MN 55981 410693877 HEALTH CARE MN 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 ST JOSEPH'S HEALTH SERVICES PO BOX 527 400 WATER AVENUE HILLSBORO WI 54634 390929538 HEALTH CARE WI 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 GUNDERSEN LUTHERAN ENVISION LLC 1836 SOUTH AVENUE LA CROSSE WI 54601 264706546 RENEWABLE ENERGY WI N/A C 0 BEL-REGIONAL HOME MEDICAL INC 617 S ROOSEVELT GREEN BAY WI 54301 391504766 DURABLE MEDICAL EQUIPMENT, RETAIL PHARMACY, FITNESS WI N/A C 0 GUNDERSEN EDGE LLC 1836 SOUTH AVENUE LA CROSSE WI 54601 921783811 INNOVATION WI N/A C 0 0 0 0 0 1 0 0 0 0 1 1 1 1 1 1 1 1 0 0