2024-08-15T10:50:31+00:00 2023-09-30 346565596 ERNST & YOUNG US LLP 155 N WACKER DRIVE CHICAGO IL 60606 990 2023-01-01 390813416 Gundersen Lutheran Medical Center Inc GUND 6087827300 1910 SOUTH AVE LA CROSSE WI 54601 SCOTT RATHGABER MD CEO 2024-08-15 true true Emily Upstrom P01765498 3128792000 2024-08-15 2023 2024-08-08 14:25:15Z SCOTT RATHGABER MD 1910 SOUTH AVE LA CROSSE WI 54601 1114936071 false X WWW.GUNDERSENHEALTH.ORG X 1899 WI SEE SCHEDULE O 6 0 0 0 922565 0 21943302 2513646 1344662213 1111127288 324889 339911 1607468 947565 1368537872 1114928410 23822814 42402715 0 0 0 0 0 0 0 1267707509 1063209332 1291530323 1105612047 77007549 9316363 1962166483 1973106299 12374567 13998020 1949791916 1959108279 SEE SCHEDULE O false false 1070891475 42402715 1111127288 SEE SCHEDULE O 1070891475 true true false true false false false false false true false false true true true false true false false false false false false false false true true true true false false false false false false false false false false false false false true true false false false true 0 0 0 true true false false false false false false false false false false false X 6 0 false true true false true true true true true false false true true true true true true true true false MN WI X JOHN CEELEN 6087827300 1900 SOUTH AVENUE NCA1-01 LA CROSSE WI 54601 X ANDREA HAUSER RN BOARD OF TRUSTEES - CHIEF NURSING OFFICER AND ADMIN VICE PRESIDENT 2.0 45.0 X X 0 0 0 BRYAN ERDMANN BOARD OF TRUSTEES - CHIEF OPERATING OFFICER 2.0 48.0 X X 0 0 0 HEATHER SCHIMMERS RN BOARD OF TRUSTEES - PRESIDENT 2.0 49.0 X X 0 0 0 SCOTT RATHGABER MD BOARD OF TRUSTEES, CEO, CHAIRMAN 2.0 46.0 X X 0 0 0 TODD KOWALSKI MD BOARD OF TRUSTEES -MEDICAL CHIEF OPERATING OFFICER 2.0 44.0 X X 0 0 0 JENNIFER KLEVEN MD BOARD OF TRUSTEES - CHIEF MEDICAL OFFICER 2.0 46.0 X 0 0 0 CHRISTINE WALLER MD MEDICAL VP, ACUTE CARE AND NURSING & SYSTEMS PRACTICE 0.0 40.0 X 0 0 0 DANIEL LILLY SECRETARY 0.0 48.0 X 0 0 0 GERALD OETZEL CHIEF FINANCIAL OFFICER AND TREASURER THRU 8/23 0.0 42.0 X 0 0 0 JONATHAN ZLABEK MD MEDICAL VP, CROSS-FUNCTIONAL CARE THRU 10/23 0.0 40.0 X 0 0 0 KELLEY BAHR MD MEDICAL VP, AMBULATORY SERVICES 0.0 40.0 X 0 0 0 KRAIG SCHUSTER ADMIN VICE PRESIDENT, COMMUNITY 0.0 43.5 X 0 0 0 MARILU BINTZ MD CHIEF POPULATION HEALTH OFFICER & CMO CRITICAL ACCESS HOSPITALS & ASSOCIATED CLINICS 0.0 43.8 X 0 0 0 MARY KUFFEL MD INTERIM MEDICAL VP, CROSS-FUNCTIONAL CARE BEGIN 9/23 0.0 40.0 X 0 0 0 MICHAEL MCKEE ADMIN VP, ACUTE CARE AND NURSING & SYSTEMS PRACTICE 0.0 42.3 X 0 0 0 RACHEL ALBRECHT ADMIN VP, AMBULATORY SERVICES 0.0 40.5 X 0 0 0 STEPHANIE NEUMAN MD MEDICAL VP, AMBULATORY SERVICES 0.0 40.0 X 0 0 0 STEVE LITTLE INTERIM CHIEF FINANCIAL OFFICER AND TREASURER BEGIN 8/23 0.0 42.0 X 0 0 0 TINA LECHNIR ADMIN VP, CROSS-FUNCTIONAL CARE 0.0 40.8 X 0 0 0 0 0 0 0 false false false GUNDERSEN LUTHERAN ADMIN SERVICES INC 1910 SOUTH AVENUE LA CROSSE WI 54601 SERVICES/SUPPLIES 0 1397605 1109867 6174 2513646 MEDICAL SERVICES PROVIDED 621500 1111127288 1111127288 0 0 0 0 1111127288 337297 337297 25000 25000 0 25000 25000 10275 7661 0 2614 2614 2614 LABORATORY SERVICES 621511 757650 757650 HELICOPTER DISPATCH SERVICES 561421 164915 164915 0 0 0 0 922565 1114928410 1111127288 922565 364911 X 7530168 7530168 34872547 34872547 0 0 229948581 201731767 28216814 265468 265468 134267960 134183944 84016 0 24015 23823 192 8257027 8161415 95612 994763 861352 133411 3288966 2736694 552272 392440 381383 11057 174207 162186 12021 20608092 18442632 2165460 999469 387892 611577 SUPPLIES 182995930 182995930 BAD DEBTS 22570430 22570430 LEASED EMPLOYEES 444597405 442055182 2542223 RECRUITING/EMPLOY. DEVEL/TAX 12510726 12501818 8908 1313853 1292312 21541 0 1105612047 1070891475 34720572 0 1531628 1448902 156454238 178727997 0 0 0 0 7575361 7349412 592122833 308404720 302939875 283718113 20000000 2000000 0 0 1473665381 1499861875 1962166483 1973106299 3599318 6220240 0 0 0 0 8775249 7777780 12374567 13998020 X 1949791916 1959108279 1949791916 1959108279 1962166483 1973106299 9316363 0 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 0 0 276873 0 276873 1105612047 2156545660 1105612047 2156822533 1000000 1000000 250000 250000 0 0 0 0 1000000 1000000 1000000 1000000 4000000 6000000 259182 380642 242027 276873 1158724 250000 250000 250000 250000 1000000 1500000 0 0 0 0 0 4370393 4370393 433620715 191143688 242477027 132872523 107039272 25833251 21259202 10221760 11037442 283718113 INTERCOMPANY RECEIVABLES 1475323816 RIGHT OF USE ASSETS 786542 OTHER RECEIVABLES AND ADJUSTMENT 23751517 1499861875 LEASE CONTRACT PAYABLE 5781877 OPERATING LEASE OBLIGATIONS 743598 MALPRACTICE CLAIM RESERVE 940745 ASSET RETIREMENT OBLIGATION 311560 7777780 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 AND GUNDERSEN EDGE, LLC, WHICH ARE FOR-PROFIT ENTITIES. AT SEPTEMBER 30, 2023 AND NOVEMBER 30, 2022, NET DEFERRED TAX ASSETS OF $7,057 AND $7,351, RESPECTIVELY, WHICH PRIMARILY ARE RELATED TO NET OPERATING LOSS CARRYFORWARDS, HAVE VALUATION ALLOWANCES OF $7,057 AND $7,351, RESPECTIVELY, RECORDED AGAINST THEM DUE TO THE UNCERTAINTY OF REALIZING THOSE BENEFITS IN THE FUTURE. AT SEPTEMBER 30, 2023, THE SYSTEM'S FEDERAL NET OPERATING LOSS CARRYFORWARDS WERE APPROXIMATELY $26,700, AND THE STATE NET OPERATING LOSS CARRYFORWARDS WERE APPROXIMATELY $24,600, WHICH WILL EXPIRE BETWEEN 2032 AND 2041. 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 true X true X true X true true true false true true 6886 12784602 0 12784602 0.0118 138220787 69512089 68708698 0.0634 0 0.0 0 6886 151005389 69512089 81493300 0.0752 463670 13159 450511 0.0004 15390977 4796043 10594934 0.0098 0 0.0 0 0.0 564082 0 564082 0.0005 0 0 16418729 4809202 11609527 0.0107 0 6886 167424118 74321291 93102827 0.0860 0 0.0 123636 123636 0.0001 12720 12720 0.0000 4500 4500 0.0000 0 0.0 0 0.0 0 0.0 17713 17713 0.0000 5607055 5607055 0.0052 0 0 5765624 0 5765624 0.0053 true 6950591 540494 112909924 150660247 -37750323 X true true 1 1 GUNDERSEN LUTHERAN MED CENTER INC 1910 SOUTH AVENUE LA CROSSE WI 54601 WWW.GUNDERSENHEALTH.ORG LICENSE #23 X X X X X GUNDERSEN LUTHERAN MED CENTER INC 1 false false true X X X X X X X X X X 21 true true true true X HTTPS://WWW.GUNDERSENHEALTH.ORG/DOCUMENT/22291 X HTTPS://WWW.GREATRIVERSUNITEDWAY.ORG/OUR-WORK/COMMUNITY-NEEDS-ASSESSMENT/ X X true 21 true HTTPS://WWW.GUNDERSENHEALTH.ORG/DOCUMENT/22316 false true X 200.0 400.0 X X X true true X X X X true X HTTPS://WWW.GUNDERSENHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE X HTTPS://WWW.GUNDERSENHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE X HTTPS://WWW.GUNDERSENHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE X X X X X X true X false X X X X X true X false false Schedule H, Part V, Section B, Line 3 Facility , 1 Facility , 1 - GUNDERSEN LUTHERAN MEDICAL CENTER INC. THE COMPASS NOW 2021 REPORT HTTPS://WWW.GREATRIVERSUNITEDWAY.ORG/OUR-WORK/COMMUNITY-NEEDS-ASSESSMENT/, INCLUDES 6 COUNTIES IN THE GUNDERSEN LUTHERAN MEDICAL CENTER'S SERVICE AREA. AT THAT TIME, THESE 6 COUNTIES REPRESENT APPROXIMATELY 70% OF OUR HOSPITAL SERVICE PATIENT POPULATION, AND 42% OF THE OVERALL POPULATION (261,591 OF 620,168) OF OUR 22-COUNTY SERVICE AREA. IT IS IMPORTANT TO NOTE THAT IN ADDITION TO THE COMPASS NOW 2021 REPORT, THE 22-COUNTY HEALTH INDICATOR REPORT WAS GENERATED, HTTPS://WWW.GUNDERSENHEALTH.ORG/DOCUMENT/22296. TO IDENTIFY THE HEALTH NEEDS OF THE BROADER GUNDERSEN HEALTH SYSTEM'S 22-COUNTY SERVICE AREA, ANALYSIS OF PUBLICLY AVAILABLE DATA WAS COMPLETED. SECONDARY DATA - INCLUDING POPULATION DEMOGRAPHICS, MORTALITY, MORBIDITY, HEALTH BEHAVIOR, AND CLINICAL CARE - WERE USED TO IDENTIFY AND PRIORITIZE SIGNIFICANT COMMUNITY HEALTH NEEDS IN EACH COUNTY. POPULATION CHARACTERISTICS, SOCIOECONOMIC, AND HEALTH STATUS DATA WERE ALSO EXAMINED. COMMUNITY-LEVEL DATA WERE COMPARED TO THE STATE, NATION, AND HEALTHY PEOPLE 2030 BENCHMARKS, WHEN AVAILABLE, TO HELP IDENTIFY KEY HEALTH ISSUES IN EACH COUNTY. A SUMMARY OF THE COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE FOUND HERE: HTTPS://WWW.GUNDERSENHEALTH.ORG/DOCUMENT/22291. STUDY METHODS FOR THE COMPASS NOW 2021 REPORT INCLUDED 1) ANALYSIS OF COMMUNITY INDICATORS FROM VARIOUS LOCAL, STATE, AND FEDERAL SOURCES (RELYING HEAVILY ON COUNTY HEALTH RANKINGS FROM THE UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTE). 2) COMMUNITY INSIGHTS PROVIDED BY RESPONDENTS TO A RANDOM HOUSEHOLD SURVEY, SUPPLEMENTAL CONVENIENCE SURVEY AND KEY INFORMANT INTERVIEWS; 3) PRIORITIZATION OF THE TOP 5 NEEDS FACILITATED FOR THE 6 COUNTY STAKEHOLDER GROUPS. THE STUDY WAS CONDUCTED IN 2020 AND 2021 UNDER THE DIRECTION OF GREAT RIVERS UNITED WAY, WITH TECHNICAL SUPPORT FROM A CONTRACTED CONSULTANT (COMMUNITY HEALTH SOLUTIONS). THE STUDY WAS GUIDED BY A COMPASS NOW STEERING COMMITTEE COMPRISED OF STAKEHOLDERS FROM PUBLIC HEALTH, HEALTH CARE, AND OTHER COMMUNITY SECTORS. THE STEERING COMMITTEE MEMBERS PROVIDED GUIDANCE ON THE STUDY SCOPE AND METHODS, INCLUDING THE ADJUSTMENTS MADE IN RESPONSE TO COVID-19. THE STEERING COMMITTEE MEMBERS ALSO PROVIDED LIAISONS TO ENGAGE COMMUNITY ORGANIZATIONS IN PROMOTING PARTICIPATION IN THE CONVENIENCE SURVEY CONDUCTED FOR THE STUDY. HOSPITALS REPRESENTED ON THE STEERING COMMITTEE INCLUDED GUNDERSEN MEDICAL CENTER, MAYO CLINIC HEALTH SYSTEM, VERNON MEMORIAL HOSPITAL, GUNDERSEN ST JOSEPH'S HOSPITAL, GUNDERSEN TRI-COUNTY HOSPITAL. IN ADDITION, TOMAH MEMORIAL HOSPITAL WAS CONSULTED AND PARTICIPATED IN THE COMMUNITY STAKEHOLDER MEETINGS. OTHER COMMITTEE MEMBERS REPRESENTED THE SIX COUNTY HEALTH DEPARTMENTS FROM BUFFALO, TREMPEALEAU, LA CROSSE, VERNON, AND MONROE COUNTIES IN WISCONSIN, AND HOUSTON COUNTY IN MINNESOTA. COMMUNITY BASED ORGANIZATIONS REPRESENTED INCLUDED THE GREAT RIVERS UNITED WAY, APTIV, AND COULEECAP WITH ADDITIONAL CONSULTATION FROM LA CROSSE SCHOOL DISTRICT, LA CROSSE COMMUNITY FOUNDATION, LA CROSSE MEDICAL HEALTH SCIENCE CONSORTIUM AND UNIVERSITY OF WISCONSIN-LA CROSSE. ALL INDIVIDUALS ARE LISTED BY NAME IN THE REPORT. COMMUNITY DEMOGRAPHICS FOR THE COMPASS NOW 2021 REPORT WERE ANALYZED AND MAPPED USING DATA AND SOFTWARE FROM ESRI, A COMMERCIAL PROVIDER OF COMMUNITY DATA. DATA COMPILED INCLUDED A DEMOGRAPHIC PROFILE AND POPULATION ESTIMATES AND PROJECTIONS. A SUMMARY OF COUNTY HEALTH RANKINGS WAS DESCRIBED INCLUDING HEALTH OUTCOMES, LENGTH OF LIFE, QUALITY OF LIFE, HEALTH BEHAVIORS AND CONCERNS, CLINICAL/HEALTH CARE, SOCIAL/ECONOMIC FACTORS, AND PHYSICAL ENVIRONMENT. COMMUNITY SURVEY RESPONDENTS RATED VARIOUS ASPECTS OF THESE MODULES. Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - GUNDERSEN LUTHERAN MEDICAL CENTER, INC.. A RANDOM HOUSEHOLD SURVEY (RHS) OF COMMUNITY RESIDENTS WAS CONDUCTED IN JULY-SEPTEMBER OF 2020. THE SURVEY WAS MAILED TO 6,000 RANDOMLY SELECTED HOUSEHOLDS USING A SAMPLING STRATEGY DESIGNED TO PRODUCE A TARGET NUMBER OF AT LEAST 100 SURVEY RESPONSES FROM EACH OF THE SIX COUNTIES. IN ADDITION, WITHIN EACH COUNTY THE MAIL-OUT WAS DESIGNED TO OVER-SAMPLE FROM CENSUS TRACTS WITH RELATIVELY LOW INCOME TO HELP ASSURE THAT LOWER-INCOME COMMUNITY RESIDENTS WERE REPRESENTED. GREAT RIVERS UNITED WAY STAFF AND VOLUNTEERS ENTERED THE SURVEY DATA INTO A QUALTRICS SURVEY PORTAL PROVIDED BY COMMUNITY HEALTH SOLUTIONS. A TOTAL OF 713 RHS RESPONDENTS RETURNED THEIR SURVEYS, FOR A RESPONSE RATE OF 12%. FOCUSING ON RESPONSES BY COUNTY, AT LEAST 91 SURVEYS WERE RETURNED FOR EACH JURISDICTION. COMPARED TO POPULATION ESTIMATES FOR THE REGION AS A WHOLE, THE RHS RESPONSES INCLUDED A HIGHER PERCENTAGE OF OLDER ADULTS THAN THE POPULATION AS A WHOLE AND SKEWED TOWARD RESPONDENTS SELF-IDENTIFYING AS FEMALE AND OF WHITE RACE. THE HOUSEHOLD INCOME PROFILE FOR RHS RESPONDENTS WAS FAIRLY REPRESENTATIVE OF THE POPULATION AS A WHOLE, WITH SLIGHTLY MORE REPRESENTATION AT LOWER INCOME LEVELS. A SUPPLEMENTAL CONVENIENCE SURVEY (CS) WAS CONDUCTED IN OCTOBER-NOVEMBER 2020. THE PURPOSE OF THE CS WAS TO GENERATE ADDITIONAL SURVEY RESPONSES FROM POPULATIONS THAT MAY HAVE BEEN UNDER-REPRESENTED IN THE RHS. THE CS WAS PRIMARILY CONDUCTED USING MIXED METHODS, AND RESPONDENTS COULD EITHER COMPLETE THEIR SURVEY ONLINE OR SUBMIT A PAPER COPY OF THEIR SURVEY RESPONSE. ORGANIZATIONS INCLUDED IN THE CONVENIENCE SURVEY PROCESS INCLUDED THOSE REPRESENTING PEOPLE WITH DISABILITIES, LOW-INCOME POPULATION, CHILDREN-YOUTH-FAMILIES, RACIAL AND ETHNIC MINORITIES, VICTIMS OF DOMESTIC VIOLENCE AND LGBTQ+ COMMUNITY. GREAT RIVERS UNITED WAY STAFF AND VOLUNTEERS ENTERED PAPER SURVEY RESPONSES INTO A QUALTRICS SURVEY PORTAL PROVIDED BY COMMUNITY HEALTH SOLUTIONS. A TOTAL OF 510 CS RESPONSES WERE RECEIVED, WITH MORE THAN HALF COMING FROM LA CROSSE COUNTY. COMPARED TO THE RHS, THE CS YIELDED HIGHER REPRESENTATION OF ADULTS UNDER AGE 45, WOMEN, MINORITY POPULATIONS, AND MIDDLE-INCOME HOUSEHOLDS. THE CS RESULTS ARE PRESENTED ALONGSIDE THE RHS RESULTS THROUGHOUT THE REPORT TO PROVIDE A MULTI-METHOD PROFILE OF SURVEY RESPONSES. THE TWO SURVEYS WERE NOT COMBINED BECAUSE THEY ARE BASED ON TWO FUNDAMENTALLY DIFFERENT SAMPLING STRATEGIES. THE ASSESSMENT TEAM COLLABORATED WITH LOCAL PARTNERS TO ORGANIZE A SERIES OF COMMUNITY STAKEHOLDER VIRTUAL MEETINGS WITH STAKEHOLDERS FROM EACH OF THE SIX COUNTIES IN THE STUDY REGION. THE PURPOSE OF THE MEETINGS WAS TO GATHER ADDITIONAL INSIGHT ABOUT PRIORITY NEEDS AND ACTION IDEAS FROM A LOCAL PERSPECTIVE. THE INVITED PARTICIPANTS INCLUDED REPRESENTATIVES FROM LOCAL BUSINESSES, EDUCATION, FAITH, GOVERNMENT, HEALTH AND HUMAN SERVICES, AND NONPROFIT AGENCIES. THESE INDIVIDUALS HAVE FIRST-HAND KNOWLEDGE OF PUBLIC HEALTH AND SOCIAL NEEDS OF THE RESIDENTS OF THE COMMUNITIES. A TOTAL OF 191 INDIVIDUALS PARTICIPATED IN THE VARIOUS COUNTY MEETINGS. THE MEETINGS WERE FACILITATED VIRTUALLY SO THAT PARTICIPANTS COULD ATTEND WHILE MAINTAINING SOCIAL DISTANCING FOR THE PANDEMIC. DURING THE MEETINGS, PARTICIPANTS WERE INVITED TO SHARE THEIR INSIGHTS ABOUT PRESSING COMMUNITY NEEDS AS VIEWED FROM THEIR PERSPECTIVE. THE MEETING PARTICIPANTS WERE ALSO INVITED TO COMPLETE A POST-MEETING SURVEY TO PRIORITIZE AMONG THE AREAS OF NEED IDENTIFIED AT THE MEETING EVENT. Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - GUNDERSEN LUTHERAN MEDICAL CENTER, INC.. HOSPITALS REPRESENTED ON THE STEERING COMMITTEE INCLUDED GUNDERSEN MEDICAL CENTER, MAYO CLINIC HEALTH SYSTEM, VERNON MEMORIAL HOSPITAL, GUNDERSEN ST. JOSEPH'S HOSPITAL AND CLINICS, AND GUNDERSEN TRI-COUNTY HOSPITAL. IN ADDITION, TOMAH MEMORIAL HOSPITAL WAS CONSULTED AND PARTICIPATED IN THE COMMUNITY STAKEHOLDER MEETINGS. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - GUNDERSEN LUTHERAN MEDICAL CENTER, INC.. AJ FALKERS COUNSELING AND CONSULTING SERVICES, AMERICAN RED CROSS APTIV, INC., ARCADIA AMBULANCE SERVICE, ARCADIA MIDDLE SCHOOL, ARROW BEHAVIORAL HEALTH, AT HOME CARE OF WESTERN WISCONSIN, BIG BROTHERS BIG SISTERS OF THE 7 RIVERS REGION, BLAIR-TAYLOR HIGH SCHOOL, BRIDGES HEALTH, BUFFALO COUNTY HEALTH DEPARTMENT, CALEDONIA AREA PUBLIC SCHOOLS, CENTER FOR SPECIAL CHILDREN-LFMC, CHILDREN'S MUSEUM OF LA CROSSE, CIA SIAB, INC., CITY OF CALEDONIA, CITY OF FOUNTAIN CITY, CITY OF HILLSBORO, CITY OF LA CROSSE, COMMUNITY & ECONOMIC DEVELOPMENT, ASSOCIATES CO-OP CREDIT UNION, COULEE REGION RSVP, COULEECAP, INC., CROSS OF CHRIST LUTHERAN CHURCH, CROSSING RIVERS HEALTH, ESB BANK, FAMILIES FIRST OF MONROE COUNTY, INC., FAMILY & CHILDREN'S CENTER, FLOCKS GUARDIANS INC., GREAT RIVERS HUB, GREAT RIVERS UNITED WAY, HALE FIRE/FIRST RESPONDERS, HAMILTON COMMUNITY SCHOOL, HILLSBORO SCHOOL DISTRICT, HILLSBORO SENTRY-ENTERPRISE, HOUSTON COUNTY, HOUSTON COUNTY ECONOMIC DEVELOPMENT AUTHORITY, HOUSTON COUNTY PUBLIC HEALTH & HUMAN SERVICES, HOUSTON PUBLIC SCHOOLS, INCLUSA, INDEPENDENCE PUBLIC LIBRARY, INDEPENDENCE SCHOOL DISTRICT, INDEPENDENT LIVING RESOURCES, KWIK TRIP, LA CRESCENT AREA CHAMBER OF COMMERCE & TOURISM, LA CRESCENT MONTESSORI & STEM SCHOOL, LA CRESCENT-HOKAH PUBLIC SCHOOLS, LA CROSSE COMMUNITY FOUNDATION, LA CROSSE COUNTY, LA CROSSE COUNTY HEALTH DEPARTMENT, LA CROSSE COUNTY HISTORICAL SOCIETY, LA CROSSE COUNTY HUMAN SERVICES, LA CROSSE MEDICAL HEALTH SCIENCE CONSORTIUM, LA CROSSE MILLING COMPANY, LA FARGE SCHOOL DISTRICT, LIFESTYLE FITNESS, LOKENS SAWMILL INN & SUITES, MIENERGY COOPERATIVE, MOBILE MEALS, MONROE COUNTY DEPARTMENT OF HUMAN SERVICES, MONROE COUNTY GOVERNMENT, MONROE COUNTY HEALTH DEPARTMENT, MONROE COUNTY JUSTICE PROGRAMS, NEIGHBOR FOR NEIGHBOR, NEIGHBORS IN ACTION, NEXT CHAPTER, LA CROSSE NORWALK-ONTARIO-WILTON SCHOOL DISTRICT, OPTUM, PILGRIMS PRIDE ARCADIA WISCONSIN, ROYAL BANK, ROYAL CREDIT UNION, SCENIC BLUFFS COMMUNITY HEALTH CENTER, SECOND HARVEST FOODBANK OF SOUTHERN WISCONSIN, SEMCAC, SMOOTHTOE, SPARTA AREA CHAMBER OF COMMERCE, SPARTA AREA SCHOOL DISTRICT, SPARTA FREE LIBRARY, SPRING GROVE SCHOOL DISTRICT, ST. JOHN'S ALMA, ST. MICHAEL'S ASSISTED LIVING, STATE OF WISCONSIN DEPARTMENT OF MILITARY AFFAIRS, THE PARENTING PLACE, THE SALVATION ARMY OF LA CROSSE COUNTY, TOMAH AREA SCHOOL DISTRICT, TOMAH CHAMBER AND VISITORS CENTER, TOMAH POLICE DEPARTMENT, TOMAH VA MEDICAL CENTER, TREMPEALEAU COUNTY, TREMPEALEAU COUNTY BOARD, TREMPEALEAU COUNTY DEPARTMENT OF HUMAN SERVICES, TREMPEALEAU COUNTY HEALTH DEPARTMENT, TRI-COUNTY COMMUNICATIONS COOPERATIVE, TRIPLE BROOK FARMS, INC, UNIVERSITY OF WISCONSIN EXTENSION, UW-MADISON, UW-MADISON DIVISION OF EXTENSION MONROE COUNTY, UW-MADISON EXTENSION, VARC, INC. VERNON AREA REHABILITATION CENTER, VERNON COUNTY, VERNON COUNTY EMERGENCY MANAGEMENT, VERNON COUNTY HEALTH DEPARTMENT, VERNON ELECTRIC COOP, WESTERN WISCONSIN WOMEN'S BUSINESS CENTER, WISCONSIN STATE LEGISLATURE, WORKFORCE CONNECTIONS, INC., XCEL ENERGY, YWCA LA CROSSE. Schedule H, Part V, Section B, Line 7 Facility , 1 Facility , 1 - GUNDERSEN LUTHERAN MEDICAL CENTER, INC.. AVAILABLE BY CONTACTING SARAH HAVENS, PHONE 608-775-6580 OR 800-362-9567, EXT. 56580 OR EMAIL SJHAVENS@GUNDERSENHEALTH.ORG Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - GUNDERSEN LUTHERAN MEDICAL CENTER, INC.. OUR COMMUNITY HEALTH IMPLEMENTATION PLAN, INCLUDING GOALS, AND ACTION STEPS, RESOURCES, PARTNERS, AND OUTCOME MEASURES, ADDRESSES THE TOP PRIORITY NEEDS IDENTIFIED FOR THE COMPASS NOW 6 COUNTY REGION AND THE 22-COUNTY HEALTH INDICATOR REPORT. THE PRIORITIES ARE STATED DIRECTLY OR EMBEDDED AS AN ACTION STEP. IN ADDITION, THE IMPLEMENTATION PLAN SUPPORTS THE HEALTH SYSTEM'S POPULATION HEALTH INITIATIVES THAT SERVE TO STRENGTHEN OUR EFFORTS TO IMPROVE THE HEALTH OF OUR COMMUNITIES. THOSE PRIORITIES ARE SOCIAL DETERMINANTS OF HEALTH, MENTAL HEALTH, SUBSTANCE ABUSE, AND CHRONIC DISEASE. THE PLAN CAN BE FOUND HERE: HTTPS://WWW.GUNDERSENHEALTH.ORG/DOCUMENT/22316 COMPASS NOW 2021 PRIORITIES -MENTAL HEALTH -SUBSTANCE ABUSE -SAFE, AFFORDABLE HOUSING -POVERTY/FINANCIAL STABILITY 22-COUNTY HEALTH INDICATOR PRIORITIES -SUICIDE -POOR MENTAL HEALTH STATUS -PROVIDER ACCESS -EXCESSIVE ALCOHOL USE -DRUG OVERDOSE DEATH -OPIOID ABUSE AND DEATHS -HOUSING INSECURITY -FINANCIAL INSECURITY -POVERTY AND ALICE RATES -FOOD INSECURITY -TRANSPORTATION -ADVERSE CHILDHOOD EXPERIENCES -DIABETES -TOBACCO -OBESITY -PHYSICAL INACTIVITY GUNDERSEN POPULATION HEALTH PRIORITIES -MENTAL HEALTH -SUBSTANCE ABUSE (OPIOIDS) -SOCIAL DETERMINANTS OF HEALTH (INCLUDING POVERTY/FINANCIAL STABILITY, HOUSING, FOOD, AND TRASNPORTION INSECURITY) -ADVERSER CHILDHOOD EXPERIENCES AND TOXIC STRESS -CHRONIC ILLNESS OUR IMPLEMENTATION PLAN, INCLUDING GOALS, AND ACTION STEPS, RESOURCES, PARTNERS AND OUTCOME MEASURES, ADDRESSES THE TOP PRIORITY NEEDS IDENTIFIED FOR THE COMPASS NOW 6 COUNTY REGION AND THE 22-COUNTY HEALTH INDICATOR REPORT. THE PRIORITIES ARE STATED DIRECTLY OR EMBEDDED AS AN ACTION STEP. IN ADDITION, THE IMPLEMENTATION PLAN SUPPORTS THE HEALTH SYSTEM'S FOUR POPULATION HEALTH INITIATIVES THAT SERVE TO STRENGTHEN OUR EFFORTS TO IMPROVE THE HEALTH OF OUR COMMUNITIES: THE GOALS OF THE PLAN, WHICH IN SOME CASES CONNECT TO OUR ALREADY EXISTING ACTIVITY ARE STATED BELOW. EACH GOAL HAS SEVERAL ACTION STEPS THAT ENGAGE MULTI-DISCIPLINARY TEAMS FROM GUNDERSEN PLUS COMMUNITY PARTNERS AND HAVE MEASURABLE IMPACTS. -BY 2024, REDUCE NUMBER OF PATIENTS REPORTING HAVING FOOD, HOUSING , OR TRANSPORTATION INSECURITY BY 2% (BASELINE Q4 2022) -REDUCE NUMBER OF DEATHS DUE TO POOR MENTAL HEALTH AND SUBSTANCE ABUSE AND REDUCE THE NUMBER OF POOR MENTAL HEALTH DAYS BY 5% BY 2024 -REDUCE THE RATE OF DRUG OVERDOSE DEATHS TO LESS THAN 27.02/100,000 BY 2024 -SLOW THE RATE OF INCREASE OF ADULTS IN SERVICE AREA WILL REPORT FAIR/POOR HEALTH BY 2024 STATUS OF OUR GOALS AND ACTION STEPS ARE DOCUMENTED ANNUALLY AS OUR REPORT TO THE COMMUNITY. OUR COMMUNITY HEALTH SCORECARD IS REFERENCED AS OUR PRIMARY IN-HOUSE MONITORING TOOL. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - GUNDERSEN LUTHERAN MEDICAL CENTER, INC.. GHS PATIENTS NOT MEETING FINANCIAL ASSISTANCE ELIGIBILITY THRESHOLDS MAY BE ELIGIBLE FOR ASSISTANCE UNDER CIRCUMSTANCES WHEN GHS MEDICAL BILLS WOULD RESULT IN SEVERE FINANCIAL HARDSHIP. PATIENTS, OR THEIR GUARANTORS, MAY BE ELIGIBLE FOR CATASTROPHIC CARE ASSISTANCE IF THEY HAVE INCURRED OUT-OF-POCKET OBLIGATIONS RESULTING FROM MEDICAL SERVICES PROVIDED BY GHS THAT EXCEED 25% OF FAMILY INCOME AND HAVE ASSETS BELOW THE EQUIVALENT OF 600% OF THE FEDERAL POVERTY LEVEL THRESHOLD. PRESUMPTIVE ELIGIBILITY: GHS UNDERSTANDS THAT NOT ALL PATIENTS ARE ABLE TO COMPLETE A FINANCIAL ASSISTANCE APPLICATION OR COMPLY WITH REQUESTS FOR DOCUMENTATION. THERE MAY BE INSTANCES UNDER WHICH A PATIENT'S QUALIFICATION FOR FINANCIAL ASSISTANCE IS ESTABLISHED WITHOUT COMPLETING THE FORMAL FINANCIAL ASSISTANCE APPLICATION. OTHER INFORMATION MAY BE UTILIZED BY GHS TO DETERMINE WHETHER A PATIENT'S ACCOUNT IS UNCOLLECTIBLE AND THIS INFORMATION WILL BE USED TO DETERMINE PRESUMPTIVE ELIGIBILITY. PRESUMPTIVE ELIGIBILITY MAY BE GRANTED TO PATIENTS BASED ON THEIR ELIGIBILITY FOR OTHER PROGRAMS OR LIFE CIRCUMSTANCES SUCH AS: 1. PATIENTS OR GUARANTORS WHO HAVE DECLARED BANKRUPTCY. IN CASES INVOLVING BANKRUPTCY, ONLY THE ACCOUNT BALANCE AS OF THE DATE THE BANKRUPTCY IS FILED WILL BE WRITTEN OFF. 2. PATIENTS OR GUARANTORS WHO ARE DECEASED WITH NO ESTATE IN PROBATE. 3. PATIENTS OR GUARANTORS DETERMINED TO BE HOMELESS. 4. ACCOUNTS RETURNED BY THE COLLECTION AGENCY AS UNCOLLECTIBLE DUE TO ANY OF THE ABOVE REASONS. 5. PATIENTS OR GUARANTORS WHO QUALIFY FOR STATE MEDICAID PROGRAMS WILL BE ELIGIBLE FOR ASSISTANCE FOR ANY COST-SHARING OBLIGATIONS ASSOCIATED WITH THE PROGRAM OR UNCOVERED SERVICES. GHS UNDERSTANDS THAT CERTAIN PATIENTS MAY BE NON-RESPONSIVE TO GHS'S APPLICATION PROCESS. UNDER THESE CIRCUMSTANCES, GHS MAY UTILIZE OTHER SOURCES OF INFORMATION TO MAKE AN INDIVIDUAL ASSESSMENT OF FINANCIAL NEED. THIS INFORMATION WILL ENABLE GHS TO MAKE AN INFORMED DECISION ON THE FINANCIAL NEED OF NON-RESPONSIVE PATIENTS UTILIZING THE BEST ESTIMATES AVAILABLE IN THE ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT. GHS MAY UTILIZE A THIRD-PARTY TO CONDUCT AN ELECTRONIC REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. THIS REVIEW UTILIZES A HEALTHCARE INDUSTRY-RECOGNIZED MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THIS PREDICTIVE MODEL INCORPORATES PUBLIC RECORD DATA TO CALCULATE A SOCIO-ECONOMIC AND FINANCIAL CAPACITY SCORE THAT INCLUDES ESTIMATES FOR INCOME, ASSETS AND LIQUIDITY. THE ELECTRONIC TECHNOLOGY IS DESIGNED TO ASSESS EACH PATIENT TO THE SAME STANDARDS AND IS CALIBRATED AGAINST HISTORICAL APPROVALS FOR GHS FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. THE ELECTRONIC TECHNOLOGY, WHEN UTILIZED, WILL BE DEPLOYED PRIOR TO BAD DEBT ASSIGNMENT AFTER ALL OTHER ELIGIBILITY AND PAYMENT SOURCES HAVE BEEN EXHAUSTED. THIS ALLOWS GHS TO SCREEN ALL PATIENTS FOR FINANCIAL ASSISTANCE PRIOR TO PURSUING ANY EXTRAORDINARY COLLECTION ACTIONS. THE DATA RETURNED FROM THIS ELECTRONIC ELIGIBILITY REVIEW WILL CONSTITUTE ADEQUATE DOCUMENTATION OF FINANCIAL NEED UNDER THIS POLICY. WHEN ELECTRONIC ENROLLMENT IS USED AS THE BASIS FOR PRESUMPTIVE ELIGIBILITY, THE HIGHEST DISCOUNT LEVELS WILL BE GRANTED FOR ELIGIBLE SERVICES FOR RETROSPECTIVE DATES OF SERVICE ONLY. IF A PATIENT DOES NOT QUALIFY UNDER THE ELECTRONIC ENROLLMENT PROCESS, THE PATIENT MAY STILL BE CONSIDERED UNDER THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS. GHS WILL PROVIDE PATIENTS NOT QUALIFYING FOR FINANCIAL ASSISTANCE THROUGH THIS PROCESS WITH A WRITTEN NOTICE INFORMING THEM THAT FINANCIAL ASSISTANCE IS AVAILABLE. THIS NOTICE WILL INCLUDE A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY AND ACTIONS TO BE TAKEN IF AN APPLICATION IS NOT SUBMITTED OR THE OUTSTANDING BALANCE PAID. PATIENT ACCOUNTS GRANTED PRESUMPTIVE ELIGIBILITY WILL BE RECLASSIFIED UNDER THE FINANCIAL ASSISTANCE POLICY. THEY WILL NOT BE SENT TO COLLECTION, WILL NOT BE SUBJECT TO FURTHER COLLECTION ACTIONS, AND WILL NOT BE INCLUDED IN THE HOSPITAL'S BAD DEBT EXPENSE. Schedule H, Part V, Section B, Line 15 Facility , 1 Facility , 1 - GUNDERSEN LUTHERAN MEDICAL CENTER, INC.. APPLICATION REQUIREMENTS: ELIGIBILITY FOR FINANCIAL ASSISTANCE WILL BE BASED ON FINANCIAL NEED AT THE TIME OF APPLICATION. IN GENERAL, DOCUMENTATION IS REQUIRED TO SUPPORT AN APPLICATION FOR FINANCIAL ASSISTANCE. IF ADEQUATE DOCUMENTATION IS NOT PROVIDED, GHS MAY SEEK ADDITIONAL INFORMATION. RELIABLE EVIDENCE TO SUPPORT THE NEED FOR FINANCIAL ASSISTANCE IS REQUIRED. THE FOLLOWING INCOME DOCUMENTATION IS REQUIRED FROM PATIENTS, OR THEIR GUARANTORS, TO DETERMINE ELIGIBILITY: 1. COPY OF THE FEDERAL TAX RETURN, AND ALL ATTACHED SCHEDULES, FROM THE MOST RECENT TAX YEAR 2. CURRENT PROOF OF INCOME (COPY OF MOST RECENT PAY STUBS OR OTHER DOCUMENTATION) 3. PROOF OF OTHER INCOME, INCLUDING UNEMPLOYMENT, WORKERS' COMPENSATION, ALIMONY, TRUST INCOME, VETERAN'S BENEFITS 4. CURRENT BANK STATEMENTS THE FOLLOWING ASSET DOCUMENTATION IS REQUIRED FROM PATIENTS, OR THEIR GUARANTORS, TO DETERMINE ELIGIBILITY: 1. CHECKING ACCOUNTS 2. SAVINGS ACCOUNTS 3. MONEY MARKET ACCOUNTS 4. CERTIFICATES OF DEPOSIT 5. ANNUITIES 6. NON-RETIREMENT INVESTMENT ACCOUNTS 7. RETIREMENT ACCOUNTS, INCLUDING PENSIONS 8. REAL ESTATE 9. OTHER ASSETS Schedule H, Part V, Section B, Line 20 Facility , 1 Facility , 1 - GUNDERSEN LUTHERAN MEDICAL CENTER, INC.. NOTIFICATION OF FINANCIAL ASSISTANCE: NOTIFICATIONS OF AVAILABILITY OF FINANCIAL ASSISTANCE ARE INCLUDED ON EVERY PATIENT STATEMENT, PROVIDED AT ADMISSION/CHECK-IN, ARE ANNOUNCED ON SIGNS AT EACH CHECK-IN AREA, AT BEDSIDE FOR PATIENTS DIRECTLY ADMITTED WHO MAY NOT HAVE MET WITH ADMISSIONS STAFF. 9 WINONA MEDICAL CENTER 1122 W HIGHWAY 61 WINONA MN 559871957 MEDICAL SERVICES GL HOSPICE INDUSTRIAL REHAB BUILDING 1843 SIMS PL LA CROSSE WI 54601 HOSPICE SERVICES GL SATELLITE DIALYSIS - ONALASKA 3075 S KINNEY COULEE R ONALASKA WI 54650 RENAL DIALYSIS CENTER UNITY HOUSE FOR WOMEN 1312 5TH AVE LA CROSSE WI 54601 ALCOHOL AND OTHER DRUG ABUSE UNITY HOUSE FOR MEN 1918-1924 MILLER ST LA CROSSE WI 54601 ALCOHOL AND OTHER DRUG ABUSE GL SATELLITE DIALYSIS - TOMAH 505 GOPHER DRIVE TOMAH WI 54650 RENAL DIALYSIS CENTER GL SATELLITE DIALYSIS - VIROQUA 407 S MAIN ST VIROQUA WI 54665 RENAL DIALYSIS CENTER GL SATELLITE DIALYSIS - PRAIRIE DU CHIEN 610 E TAYLOR ST PRAIRE DU CHIEN WI 53821 RENAL DIALYSIS CENTER GL MENTAL HEALTH DAY TREAT BEHAV HLTH 123 16TH AVE S ONALASKA WI 54650 OUTPATIENT PSYCHOLOGICAL Schedule H, Part I, Line 3c CRITERIA FOR DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE CATASTROPHIC CARE ASSISTANCE: FINANCIAL ASSISTANCE PROVIDED TO ELIGIBLE PATIENTS WITH ANNUALIZED FAMILY INCOMES IN EXCESS OF 400% OF THE FEDERAL POVERTY LEVEL, AND ASSETS OF LESS THAN THE EQUIVALENT OF 600% OF THE FEDERAL POVERTY LEVEL, AND FINANCIAL OBLIGATIONS RESULTING FROM MEDICAL SERVICES PROVIDED BY GHS IN EXCESS OF 25% OF THE FAMILY INCOME. DISCOUNTED CARE: FINANCIAL ASSISTANCE THAT PROVIDES A DISCOUNT, FOR ELIGIBLE MEDICAL SERVICES PROVIDED BY GHS, BASED ON A SLIDING SCALE, FOR ELIGIBLE PATIENTS, OR PATIENT GUARANTORS, WITH ANNUALIZED FAMILY INCOMES BETWEEN 200-400% OF THE FEDERAL POVERTY LEVEL AND ASSETS AT OR BELOW SIX TIMES THE FEDERAL POVERTY LEVEL. 1. FAMILY INCOME ABOVE 200% FPL BUT EQUAL TO OR LESS THAN 225% FPL ARE ELIGIBLE TO RECEIVE A 80% DISCOUNT ON THE PATIENT BALANCE DUE. 2. FAMILY INCOME ABOVE 225% FPL BUT EQUAL TO OR LESS THAN 250% FPL ARE ELIGIBLE TO RECEIVE A 60% POLICY DISCOUNT ON THE PATIENT BALANCE DUE. 3. FAMILY INCOME ABOVE 250% FPL BUT EQUAL TO OR LESS THAN 275% FPL ARE ELIGIBLE TO RECEIVE A 40% DISCOUNT ON THE PATIENT BALANCE DUE. 4. FAMILY INCOME ABOVE 275% FPL BUT EQUAL TO OR LESS THAN 400% FPL ARE ELIGIBLE TO RECEIVE A 20% DISCOUNT ON THE PATIENT BALANCE DUE. FREE CARE: A 100% WAIVER OF PATIENT FINANCIAL OBLIGATION FOR ELIGIBLE MEDICAL SERVICES PROVIDED BY GHS FOR ELIGIBLE PATIENTS, OR THEIR GUARANTORS, WITH ANNUALIZED FAMILY INCOMES AT OR BELOW 200% OF THE FPL WITH ASSETS BELOW THE EQUIVALENT OF 600% OF THE FPL. UNINSURED DISCOUNT: PATIENTS WITH NO THIRD-PARTY COVERAGE WILL BE PROVIDED AN UNINSURED DISCOUNT, FOR ELIGIBLE SERVICES PROVIDED BY GHS UNDER THIS POLICY, AT THE TIME THAT THE UNDISCOUNTED CHARGES ARE RENDERED. SERVICES NOT ELIGIBLE FOR FINANCIAL ASSISTANCE INCLUDE THE FOLLOWING: 1. ELECTIVE PROCEDURES NOT MEDICALLY NECESSARY, AS WELL AS SERVICES TYPICALLY NOT COVERED BY MEDICARE OR DEFINED BY MEDICARE OR OTHER HEALTH INSURANCE COVERAGE AS NOT MEDICALLY NECESSARY. 2. LASIK SURGERY, CHIROPRACTIC CARE, FERTILITY SERVICES, CONTACTS/GLASSES, COSMETIC SURGERY/PLASTIC SERVICES, HEARING AIDS, ORTHODONTICS, DENTAL SERVICES. 3. SERVICES RECEIVED FROM CARE PROVIDERS NOT EMPLOYED BY GHS (E.G. PRIVATE AND/OR NON-GHS MEDICAL OR PHYSICIAN PROFESSIONALS, AMBULANCE TRANSPORT, ETC.). PATIENTS ARE ENCOURAGED TO CONTACT THESE PROVIDERS DIRECTLY TO INQUIRE INTO ANY AVAILABLE ASSISTANCE AND TO MAKE PAYMENT ARRANGEMENTS. SEE APPENDIX 3 FOR FULL LISTING OF PROVIDERS NOT COVERED UNDER THIS POLICY. 4. DEDUCTIBLES AND COINSURANCE ASSOCIATED WITH MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS OUT-OF-NETWORK AS DEFINED BY THEIR INSURERS. 5. Third-party requested exams (e.g. DOT physicals) Schedule H, Part I, Line 6b COMMUNITY BENEFIT REPORT AVAILABLE TO PUBLIC The community benefit data is filed with the Wisconsin Hospital Association (WHA). The WHA makes an aggregate summary available that includes all Wisconsin hospitals. In addition, the status of the community health implementation plan is updated annually and available on the Gundersen website. Schedule H, Part V, Section B LINE 15C - CONTACT INFORMATION OF HOSPITAL FACILITY CONTACT INFO DETAILING PHONE NUMBER, PHYSICAL LOCATION OF FINANCIAL COUNSELORS, AND MAILING ADDRESS ARE INCLUDED IN THE FINANCIAL ASSISTANCE POLICY, THE FINANCIAL ASSISTANCE APPLICATION, ON THE FINANCIAL ASSISTANCE WEBSITE, (HTTPS://WWW.GUNDERSENHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE) ON EVERY PATIENT STATEMENT, AND ON BROCHURE AT ALL REGISTRATION DESKS. Schedule H, Part I, Line 6a Community benefit report prepared by related organization GUNDERSEN LUTHERAN HEALTH SYSTEM, EIN: 39-1866425 Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation 22570430 Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance SCHEDULE H, PART I, LINE 7A FINANCIAL ASSISTANCE AT COST IS FROM THE COST REPORT FOR CHARITY CARE AT COST. THIS IS BASED ON A COST TO CHARGE RATIO OF THE ACTUAL CHARITY CARE WRITTEN-OFF. COST TO CHARGE RATIO, AS CALCULATED USING WORKSHEET 2 METHODOLOGY TO DETERMINE THE COST OF SERVICES PROVIDED TO PATIENTS. MEDICAID AND OTHER MEANS TESTED PROGRAM COMMUNITY BENEFIT EXPENSES FOLLOWED THE CALCULATION METHODOLOGY ON WORKSHEET 3. SCHEDULE H, PART I, LINE 7B MEDICAID COMMUNITY BENEFIT EXPENSE IS CALCUATED USING COST TO CHARGE RATIO OF MEDICAID GROSS CHARGES DECREASED BY MEDICAID PROVIDER TAXES, FEES, AND DIRECT NET PATIENT SERVICE REVENUE. SCHEDULE H, PART I, LINE 7E COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS ARE CALCULATED ON WORKSHEET 4 BASED ON COMMUNITY HEALTH IMPROVEMENT COST AND COMMUNITY BENEFIT OPERATIONS COST DECREASED BY COMMUNITY HEALTH IMPROVEMENT SERVICE REVENUE. SCHEDULE H, PART I, LINE 7F HEALTH PROFESSIONALS EDUCATION COST IS CALCUATED ON WORKSHEET 5 TO REFLECT THE MEDICAL STUDENT, INTERNS, RESIDENTS, AND FELLOWS COST DECREASED BY REIMBURSEMENTS FROM MEDICARE, MEDICAID, AND TUITION REIMBURSEMENTS. SCHEDULE H, PART I, LINE 7I COMMUNITY (CASH) CONTRIBUTIONS ARE FUNDS PROVIDED TO NON-PROFIT ORGANIZATIONS (INCLUDING SCHOOLS) THAT SUPPORT ACTIVITIES, PROGRAMS AND SERVICES LINKED TO GUNDERSEN LUTHERAN'S MISSION, SUPPORTING HEALTH IMPROVEMENT AND OVERALL QUALITY OF LIFE FOR THE REGION. THIS SUPPORT SERVES OR SUPPORTS NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT, PROMOTE HEALTH AND WELLNESS, OR PROVIDES FOR CIVIC, COMMUNITY AND ECONOMIC DEVELOPMENT. A SIGNIFICANT TOTAL IS DIRECTLY LINKED TO OUR COMMUNITY HEALTH IMPLEMENTATION PLAN AND SUPPORTIVE OF OUR POPULATION HEALTH COMMUNITY PARTNERS. THE WORK IS GUIDED BY THE COMMUNITY BENEFIT AND SERVICE ACTIVITY POLICY. A COMMITTEE REPRESENTING THE FOLLOWING DEPARTMENTS - ADMINISTRATION, OFFICE OF POPULATION HEALTH, EXTERNAL AFFAIRS, BUSINESS HEALTH SERVICES, THE GUNDERSEN MEDICAL FOUNDATION (INCLUDES CHILDREN'S MIRACLE NETWORK HOSPITALS), CORPORATE COMMUNICATIONS, MARKETING, FAMILY MEDICINE, AND HUMAN RESOURCES (RECRUITMENT AND DIVERSITY, EQUITY AND INCLUSION) PLUS COMMUNITY MEMBERS - MEET BI-MONTHLY TO DETERMINE APPROPRIATE DISTRIBUTION OF FUNDS. DECISIONS ARE GUIDED BY ESTABLISHED CRITERIA THAT PROVIDE A FRAMEWORK FOR THE COMMITTEE TO OBJECTIVELY DETERMINE THE OUTCOME OF ORGANIZATIONS' REQUESTS. IN 2023, $967,272 WAS APPROVED THAT SUPPORTED REQUESTS THAT INCLUDED COMMUNITY ACTIVITIES RELATED TO THE 2022-2024 COMMUNITY HEALTH IMPLEMENTATION PLAN, THAT INCLUDE SOCIAL DETERMINANTS OF HEALTH INCLUDING HOMELESSNESS, ACES AND RTIC (ADVERSE CHILD EXPERIENCES AND RESILIENCE AND TRAUMA-INFORMED CARE), CHRONIC DISEASE, MENTAL HEALTH/SUBSTANCE ABUSE, AND OTHER SUPPORT FOR VULNERABLE POPULATIONS. SOME APPROVED REQUESTS ARE FUNDED OVER A MULTI-YEAR PERIOD. SCHEDULE H, PART I, LINE 7 COLUMN (F) THE PERCENT OF TOTAL EXPENSE WAS CALCULATED BY DIVIDING THE COMMUNITY BENEFIT COST BY TOTAL HOSPITAL EXPENSES OF $1,083,041,617. THE TOTAL HOSPITAL EXPENSES EXCLUDE THE BAD DEBT EXPENSE OF $22,570,430. Schedule H, Part II Community Building Activities THE GUNDERSEN HEALTH SYSTEM, WHICH INCLUDES GUNDERSEN LUTHERAN MEDICAL CENTER, IS COMMITTED TO OUR COMMUNITIES AS EXPRESSED IN OUR MISSION: WE DISTINGUISH OURSELVES THROUGH EXCELLENCE IN PATIENT CARE, EDUCATION, RESEARCH, AND IMPROVED HEALTH IN THE COMMUNITIES WE SERVE. THE COMMUNITY BUILDING ACTIVITIES ARE INCLUDED IN COMMUNITY SERVICE REPORTING WHICH ARE PROGRAMS OR SERVICES THAT SUPPORT OUR POPULATION HEALTH INITIATIVES, BENEFITING COMMUNITIES BY ADDRESSING IDENTIFIED NEED THROUGH EFFECTIVE HEALTH IMPROVEMENT PROGRAMMING, ECONOMIC CONTRIBUTION, CORPORATE CITIZENSHIP, AND VOLUNTEERISM. SUPPORT IS PROVIDED THROUGH CONTRIBUTION TO OTHER ORGANIZATIONS, OR THROUGH PROGRAMMING DELIVERED BY GUNDERSEN. WHENEVER POSSIBLE, THIS TYPE OF PROGRAMMING IS EVALUATED TO IDENTIFY THE IMPACT ON POPULATION HEALTH AND QUALITY OF LIFE. VERIFICATION OF ADDRESSING COMMUNITY NEEDS IS DOCUMENTED IN THE IMPLEMENTATION PLAN. AS A LARGER SYSTEM, COMMUNITY BUILDING ACTIVITIES ENCOMPASS ALL CORPORATIONS. LEADERSHIP IN COMMUNITY HEALTH IMPROVEMENT IS EVIDENCED BY OUR ACTIVITY WITH SEVERAL COMMUNITY COALITIONS AND INITIATIVES. AS WE CONSIDER OUR COMMUNITY NEEDS IDENTIFIED IN THE COMPASS REPORT, IT IS EVIDENT THAT HEALTH IS IMPACTED BY NOT ONLY THE TRADITIONAL SENSE OF PROVISION OF QUALITY MEDICAL SERVICES, BUT THE ENVIRONMENT IN WHICH WE LIVE, THE ECONOMIC CONDITION OF OUR PERSON AND FAMILY AND OVERALL QUALITY OF LIFE OFFERED IN THE COMMUNITIES WHERE WE LIVE. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount COST TO CHARGE RATIO WAS OUR STARTING POINT FOR DETERMINING THE COST OF BAD DEBTS. THE COST TO CHARGE RATIO WAS CALCULATED FOLLOWING THE METHODOLOGY ON WORKSHEET 2. BAD DEBT EXPENSE IS THE PRODUCT OF THE COST TO CHARGE RATIO AND THE NET PROVISION FOR BAD DEBTS FROM THE FINANCIAL STATEMENTS. Schedule H, Part III, Line 3 Bad Debt Expense Methodology THE PATIENTS THAT EXCEED THE 400% FPG, WHEN ADDITIONAL CRITERIA SUCH AS CATASTROPHIC MEDICAL COSTS ARE CONSIDERED, HAPPENS WHEN ELIGIBLE PATIENTS WITH ANNUALIZED FAMILY INCOMES IN EXCESS OF 400% OF THE FEDERAL POVERTY LEVEL, ASSETS OF LESS THAN THE EQUIVALENT OF 600% OF THE FEDERAL POVERTY LEVEL, AND FINANCIAL OBLIGATIONS RESULTING FROM MEDICAL SERVICES PROVIDED BY GHS IN EXCESS OF 25% OF THE FAMILY INCOME. THE DATA USED IS FROM THE US CENSUS BUREAU, 2013-2017 AMERICAN COMMUNITY SURVEY (ACS) 5-YEAR DATA SET FOR THE WISCONSIN AND MINNESOTA COUNTIES. WE OBTAINED THE AVERAGE OF SEVERAL COUNTIES BY USING THE INFORMATION AT THE 3.00-3.99 (399%) OF FEDERAL POVERTY LEVEL (FPL) AND BELOW. THE NEXT RANGE WAS 4.00-4.99 RATIO OF INCOME TO POVERTY IN THE LAST 12 MONTHS. WE HAVE MULTIPLIED THE COUNTY AVERAGE AT 399% FPL TO THE BAD DEBT AT COST. WE DEDUCTED THE AMOUNT OF CHARITY CARE AT COST TO OBTAIN THE AMOUNT OF BAD DEBT AT COST TO PATIENTS ELIGIBLE UNDER FAP (BUT FOR WHOM INSUFFICIENT INFORMATION WAS OBTAINED TO DETERMINE THEIR ELIGIBILITY). Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote THE COLLECTION OF RECEIVABLES FROM THIRD-PARTY PAYERS AND PATIENTS IS THE SYSTEM'S PRIMARY SOURCE OF CASH FOR OPERATIONS. THE PRIMARY COLLECTION RISKS RELATE TO UNINSURED PATIENT ACCOUNTS AND PATIENT DEDUCTIBLES AND COINSURANCE ON INSURERS' ACCOUNTS. PATIENT RECEIVABLES, INCLUDING THE PORTION FOR WHICH A THIRD-PARTY PAYER IS RESPONSIBLE, ARE CARRIED AT NET REALIZABLE VALUE, DETERMINED BY THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED LESS AN ESTIMATE MADE FOR CONTRACTUAL ADJUSTMENTS OR DISCOUNTS PROVIDED TO THIRD-PARTY PAYERS. PATIENT RECEIVABLES DUE DIRECTLY FROM PATIENTS ARE CARRIED ON THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS AT THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED LESS AMOUNTS COVERED BY THIRD-PARTY PAYERS, ALLOWANCES FOR OTHER DISCOUNTS, AND AN ALLOWANCE FOR PRICE CONCESSIONS. THE SYSTEM DOES NOT CHARGE INTEREST ON PAST-DUE RECEIVABLES. RECEIVABLES ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE SYSTEM'S POLICIES. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE. ACCOUNTS RECEIVABLES ARE REDUCED BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE SYSTEM ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS ACCOUNTS AND PROVISION FOR BAD DEBTS. THE ANALYSIS IS PERFORMED USING A HINDSIGHT CALCULATION THAT UTILIZES WRITE-OFF DATA FOR ALL PAYOR CLASSES DURING A DETERMINED TIME PERIOD TO CALCULATE THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AT A POINT IN TIME. THE SYSTEM GRANTS CREDIT WITHOUT COLLATERAL TO PATIENTS, MOST OF WHOM ARE LOCAL RESIDENTS AND ARE INSURED UNDER THIRD-PARTY PAYOR AGREEMENTS. AT SEPTEMBER 30, 2023, AMOUNTS DUE FROM MEDICARE REPRESENTED 22.6% OF THE SYSTEM'S NET PATIENT ACCOUNTS RECEIVABLE. MAJOR PAYOR SOURCES TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs THE MEDICARE COST REPORT IS USED TO DETERMINE ALLOWABLE COSTS. THE UNREIMBURSED MEDICARE COSTS ON PART III, SECTION B OF SCHEDULE H ARE ALLOWABLE COSTS PER THE MEDICARE COST REPORT. THIS CALCULATION IS LIMITED TO PATIENTS WHO ARE COVERED UNDER THE MEDICARE FEE FOR SERVICE PLAN AND DOES NOT INCLUDE THOSE COVERED BY THE MEDICARE ADVANTAGE PLANS. IT ALSO DOES NOT INCLUDE ALL SERVICES PROVIDED BY THE HOSPITAL TO PATIENTS COVERED UNDER THE MEDICARE FEE FOR SERVICE PLAN. IT EXCLUDES HOSPICE SERVICES, AMBULANCE SERVICES, CLINICAL LABORATORY SERVICES, AND A FEW OTHER MISCELLANEOUS SERVICES. INCORPORATING ALL SERVICES TO ALL MEDICARE BENEFICIARIES, THE UNREIMBURSED COST FOR MEDICARE IS $141,873,642. THE MEDICARE COSTS ARE CALCULATED DIFFERENTLY THAN THE 990 UNREIMBURSED MEDICARE COSTS OF $37,750,323. MEDICARE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT BECAUSE OUR MISSION IS TO PROMOTE HEALTH IN THE COMMUNITY AND WE DO NOT LIMIT THE CARE AVAILABLE TO ANY PATIENTS, INCLUDING THOSE COVERED BY MEDICARE. WE ARE RELIEVING A GOVERNMENT BURDEN BY PROVIDING CARE TO MEDICARE PATIENTS EVEN THOUGH COSTS EXCEED REIMBURSEMENTS BY $142 MILLION. TAX-EXEMPT HOSPITALS ARE EXPECTED TO PARTICIPATE IN THE MEDICARE PROGRAM. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance PURSUANT TO SELF-PAY BILLING & COLLECTION POLICY, NO EXTRAORDINARY COLLECTION ACTIONS WILL BE PURSUED AGAINST A PATIENT, OR PATIENT GUARANTOR, BEFORE REASONABLE EFFORTS HAVE BEEN MADE TO DETERMINE WHETHER THE PATIENT OR GUARANTOR IS ELIGIBLE FOR ASSISTANCE UNDER THE GHS FINANCIAL ASSISTANCE POLICY (FAP). NO ACCOUNT WILL BE SUBJECT TO BAD DEBT COLLECTION ACTIONS, OR ECA, WITHIN 120 DAYS OF THE FIRST POST-DISCHARGE STATEMENT BEFORE GHS HAS MADE REASONABLE EFFORTS TO DETERMINE WHETHER THAT PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE. THIS 120 DAY TIMEFRAME MAY BE ABBREVIATED IF A DETERMINATION HAS BEEN MADE ON FINANCIAL ASSISTANCE, A PAYMENT PLAN HAS BEEN ESTABLISHED AND AGREED TO BY THE PATIENT OR GUARANTOR, AND THE PATIENT OR GUARANTOR IS NO LONGER COMPLYING WITH THE PAYMENT PLAN. NO COLLECTION ACTIONS WILL BE PURSUED AGAINST A PATIENT IF THE PATIENT, OR GUARANTOR, HAS PROVIDED DOCUMENTATION SHOWING THAT HE OR SHE HAS APPLIED FOR COVERAGE UNDER MEDICAID, OR OTHER PUBLICLY SPONSORED HEALTH PROGRAMS, THAT MAY PAY THE OUTSTANDING CLAIM AND FOR WHICH AN ELIGIBILITY DETERMINATION IS STILL PENDING. PRIOR TO SENDING A PATIENT'S ACCOUNT TO A COLLECTION AGENCY GHS WILL MAKE REASONABLE EFFORTS TO PROVIDE INFORMATION ON FINANCIAL ASSISTANCE AND WILL MAIL A MINIMUM OF THREE (3) WRITTEN STATEMENTS TO THE PATIENT OR GUARANTOR. EACH STATEMENT WILL INCLUDE CONSPICUOUS NOTICE OF THE GHS FINANCIAL ASSISTANCE POLICY, TELEPHONE NUMBER TO CALL FOR HELP, AND DIRECT WEBSITE ADDRESS. IF ALL EFFORTS TO COMMUNICATE WITH THE PATIENT, OR PATIENT GUARANTOR, ARE UNSUCCESSFUL, AND A CORRECT ADDRESS FOR UNDELIVERABLE MAIL IS NOT FOUND, ACCOUNTS WILL BE SENT TO A COLLECTION AGENCY. WITHIN 240 DAYS FROM THE FIRST POST-DISCHARGE STATEMENT, IF A PATIENT, OR GUARANTOR, APPLIES FOR FINANCIAL ASSISTANCE, THE APPLICATION WILL BE ACCEPTED AND COLLECTION ACTIONS WILL CEASE WHILE AN ELIGIBILITY DETERMINATION IS BEING MADE. IF THE APPLICANT IS APPROVED FOR FREE CARE, NO FURTHER ACTIONS WILL BE TAKEN TO COLLECT ON THE AMOUNT. IF THE APPLICANT IS DENIED FINANCIAL ASSISTANCE OR IS APPROVED FOR DISCOUNTED CARE, STEPS WILL BE TAKEN TO RESOLVE THE OUTSTANDING OBLIGATION. IF THE ACCOUNT IS NOT RESOLVED OR ARRANGEMENTS TO RESOLVE THE ACCOUNT ARE NOT MADE, ADDITIONAL COLLECTION ACTIONS WILL BE PURSUED. IF AN INDIVIDUAL SUBMITS AN INCOMPLETE APPLICATION DURING THE APPLICATION PERIOD, GHS MUST (I) SUSPEND ALL COLLECTION ACTIONS, (II) PROVIDE THE INDIVIDUAL WITH A WRITTEN NOTICE THAT DESCRIBES THE ADDITIONAL INFORMATION AND/OR DOCUMENTATION REQUIRED UNDER THE FAP OR APPLICATION FORM THAT MUST BE SUBMITTED TO COMPLETE THE FAP APPLICATION AND (III) PROVIDE GHS'S CONTACT INFORMATION. THE APPLICATION WILL REMAIN ACTIVE FOR 30 DAYS FROM THE DATE THE LETTER WAS MAILED TO THE APPLICANT REQUESTING THIS INFORMATION. IF THE APPLICANT HAS NOT RESPONDED WITHIN THE 30 DAY TIMEFRAME, THE APPLICATION WILL BE DENIED. APPLICANTS APPROVED FOR FINANCIAL ASSISTANCE WILL BE REFUNDED PAYMENTS IN EXCESS OF THE AMOUNT DETERMINED OWED BY THE PATIENT OR PATIENT'S GUARANTOR ON ACCOUNTS FOR WHICH THEY HAVE BEEN GRANTED ASSISTANCE UNDER THE GHS FAP. REFUNDS APPLY TO EXCESS PAYMENTS OF $5.00 OR MORE. IN ACCORDANCE WITH THIS POLICY, FINANCIAL ASSISTANCE IS GENERALLY NOT EXTENDED FOR CO-PAYMENTS OR A BALANCE REMAINING AFTER THE INSURANCE COMPANY HAS PAID IF A PATIENT FAILS TO OBTAIN PROPER REFERRALS OR AUTHORIZATIONS, OR IF SUCH ASSISTANCE IS NOT IN ACCORDANCE WITH INSURER'S CONTRACTUAL AGREEMENT THEREFORE SUCH PAYMENTS RECEIVED WILL NOT BE REFUNDED. COLLECTION ACTIONS MAY BE UTILIZED BY GHS WHEN PURSUING PAYMENT FROM PATIENTS OR GUARANTORS (I) WITH BALANCES DUE THAT GO UNPAID FOR MORE THAN 120 DAYS WHO DO NOT APPLY FOR FINANCIAL ASSISTANCE, (II) PATIENTS OR GUARANTORS NOT IN CONFORMANCE WITH AN AGREED UPON PAYMENT PLAN, OR (III) PATIENTS OR GUARANTORS WHO ARE NO LONGER COOPERATING IN GOOD FAITH TO PAY OFF THE REMAINING BALANCE. AT LEAST 30 DAYS BEFORE INITIATING ONE OR MORE ECAS TO OBTAIN PAYMENT FOR THE CARE PROVIDED, GHS WILL PROVIDE A PATIENT OR PATIENT'S GUARANTOR WITH A WRITTEN NOTICE THAT INDICATES FINANCIAL ASSISTANCE IS AVAILABLE FOR ELIGIBLE INDIVIDUALS, HOW AN INDIVIDUAL CAN APPLY FOR FINANCIAL ASSISTANCE, AND WHERE THE FAP CAN BE OBTAINED. SUCH WRITTEN NOTICE WILL IDENTIFY THE ECAS THAT GHS OR OTHER AUTHORIZED PARTY INTENDS TO INITIATE TO OBTAIN PAYMENT FOR THE CARE AND INDICATE THE DEADLINE AFTER WHICH SUCH ECAS MAY BE INITIATED. THE DEADLINE WILL BE NO EARLIER THAN THIRTY (30) DAYS AFTER THE DATE THAT THE WRITTEN NOTICE IS PROVIDED TO THE PATIENT OR PATIENT'S GUARANTOR. A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY WILL BE INCLUDED WITH THE NOTICE GHS WILL ALSO MAKE REASONABLE EFFORTS TO ORALLY NOTIFY THE INDIVIDUAL ABOUT GHS FAP AND HOW THE PATIENT CAN OBTAIN ASSISTANCE WITH THE FAP PROCESS. Schedule H, Part V, Section B, Line 16a FAP website - GUNDERSEN LUTHERAN MED CENTER, INC: Line 16a URL: HTTPS://WWW.GUNDERSENHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE; Schedule H, Part V, Section B, Line 16b FAP Application website - GUNDERSEN LUTHERAN MED CENTER, INC: Line 16b URL: HTTPS://WWW.GUNDERSENHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - GUNDERSEN LUTHERAN MED CENTER, INC: Line 16c URL: HTTPS://WWW.GUNDERSENHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE; Schedule H, Part VI, Line 2 Needs assessment THE GUNDERSEN COMMUNITY HEALTH NEEDS ASSESSMENT UTILIZES THE COMPASS NOW COLLABORATIVE ASSESSMENT THAT INCLUDES 6 COUNTIES IN OUR SERVICE AREA. GUNDERSEN HEALTH SYSTEM DEFINES COMMUNITY BENEFIT AS PROGRAMS OR ACTIVITIES THAT PROVIDE TREATMENT AND/OR PROMOTE HEALTH AND HEALING AS A RESPONSE TO IDENTIFIED COMMUNITY NEEDS, REGARDLESS OF SOURCE OR AVAILABILITY OF PAYMENT. POPULATION HEALTH REFERS TO THE HEALTH AND WELL-BEING OF A POPULATION OR GROUP OF INDIVIDUALS MEASURED BY AGGREGATE HEALTH OUTCOMES (BROADER THAN HEALTH STATUS) OF HEALTH ADJUSTED LIFE EXPECTANCY (QUANTITY AND QUALITY) AS INFLUENCED BY SOCIAL, ECONOMIC, AND PHYSICAL ENVIRONMENTS, PERSONAL HEALTH PRACTICES, INDIVIDUAL CAPACITY AND COPING SKILLS, HUMAN BIOLOGY, EARLY CHILDHOOD DEVELOPMENT, AND HEALTH SERVICES. POPULATION HEALTH INITIATIVES (2022-2024 PLAN) ARE SUBSTANCE ABUSE, MENTAL HEALTH, CHRONIC DISEASE, AND SOCIAL DETERMINANTS OF HEALTH. COMMUNITY SERVICE ACTIVITIES ARE PROGRAMS OR ACTIVITIES THAT PROVIDE A MEASURABLE IMPROVEMENT IN POPULATION HEALTH. THE ACTIVITIES PROVIDED WITHIN OUR COMMUNITIES INCLUDE HEALTH IMPROVEMENT, ADVOCACY FOR PEOPLE WITH DISABILITIES, RECOGNITION OF DIVERSITY AND INCLUSION, MENTAL HEALTH, DOMESTIC VIOLENCE, WORKFORCE DEVELOPMENT, EDUCATION, AND SAFETY. ACTIVITIES ARE GUIDED BY COMMUNITY NEEDS ASSESSMENT AND AS APPROPRIATE, INCLUDED IN OUR IMPLEMENTATION PLAN. NEEDS CAN ALSO BE DOCUMENTED FROM OTHER GROUPS. AS A LARGER SYSTEM, COMMUNITY BUILDING ACTIVITIES ENCOMPASS ALL CORPORATIONS. LEADERSHIP IN COMMUNITY HEALTH IMPROVEMENT IS EVIDENCED BY OUR ACTIVITY WITH SEVERAL COMMUNITY COALITIONS AND INITIATIVES. PARTNERSHIPS ARE CRITICAL TO SUCCESSFUL COMMUNITY OUTCOMES. COMMUNITY SERVICE ACTIVITIES SUPPORT ONE OR MORE OF THE FOLLOWING IMPACT HEALTH STATUS 1. ACCESSIBLE TO THE ENTIRE COMMUNITY REGARDLESS OF ABILITY TO PAY 2. HEALTH PROMOTION 3. SOCIAL DETERMINANTS OF HEALTH CORPORATE CITIZENSHIP ACTIVITIES CAN BE: 1. DIRECT PROGRAM IMPLEMENTATION 2. IN-KIND SUPPORT/INVOLVEMENT (HUMAN RESOURCES) 3. FINANCIAL CONTRIBUTIONS 4. DONATION OF MATERIALS AND EQUIPMENT 5. EMPLOYEE VOLUNTEERISM IN THE COMMUNITY Schedule H, Part VI, Line 3 Patient education of eligibility for assistance EVERY PATIENT IS MADE AWARE OF THE AVAILABILITY OF FINANCIAL ASSISTANCE UPON CHECK-IN. SIGNS THAT ARE OF NOTICEABLE SIZE AND PLACEMENT ARE DISPLAYED IN EACH CHECK-IN AREA. PATIENTS ARE OFFERED A BROCHURE EXPLAINING THE FINANCIAL ASSISTANCE PROGRAM. PATIENTS THAT MEET WITH FINANCIAL COUNSELORS EITHER BY REFERRAL FROM A DEPARTMENT, OR SELF-REFERRAL ARE INFORMED OF THE FINANCIAL ASSISTANCE PROGRAM. FINANCIAL ASSISTANCE INFORMATION IS POSTED ON GLMC WEBSITE. INFORMATION IS ALSO POSTED IN NOT-FOR-PROFIT ORGANIZATIONS WHERE PATIENTS MIGHT SEEK ASSISTANCE FOR NON-MEDICAL FINANCIAL OBLIGATIONS. Schedule H, Part VI, Line 4 Community information GUNDERSEN LUTHERAN MEDICAL CENTER INC. IS A MAJOR TERTIARY TEACHING HOSPITAL IN THE GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. LOCATED IN LA CROSSE, WI, THE HOSPITAL SERVES PATIENTS FROM THE LA CROSSE AND SURROUNDING AREAS INCLUDING THE 21 COUNTIES IN WESTERN WISCONSIN, SOUTHEASTERN MINNESOTA, AND NORTHEASTERN IOWA. LA CROSSE COUNTY, WITH A POPULATION OF APPROXIMATELY 122,365 PEOPLE, IS THE MOST POPULATED IN OUR SERVICE AREA. TOTAL 21 COUNTY SERVICE POPULATION IS APPROXIMATELY 604,674 WITH AN AVERAGE HOUSEHOLD INCOME OF $81,710. 23.89% OF THE 21 COUNTY SERVICE AREA POPULATION IS COVERED BY MEDICAID. THE PROJECTED FIVE-YEAR POPULATION GROWTH IS -0.11%. 20.24% OF THE POPULATION ARE AGE 17 OR YOUNGER. THE SERVICE AREA POPULATION OF 65 AND OLDER ADULTS IS 22.27%. 7.96% OF THE POPULATION IS NON-WHITE. SEVERAL CRITICAL ACCESS HOSPITALS ARE LOCATED THROUGHOUT THE REGION. GUNDERSEN TRI-COUNTY HOSPITAL IN WHITEHALL, WI, GUNDERSEN ST. JOSEPH'S HOSPITAL IN HILLSBORO, WI, GUNDERSEN PALMER LUTHERAN HEALTH CENTER IN WEST UNION, IA, ST. ELIZABETH'S HOSPITAL IN WABASHA, MN, AND GUNDERSEN BOSCOBEL AREA HOSPITAL IN BOSCOBEL, WI ARE PARTNERS/AFFILIATES OF THE GUNDERSEN HEALTH SYSTEM. SPECIALIZED SERVICES PERFORMED AT THE GUNDERSEN LUTHERAN MEDICAL CENTER AND IN MANY CASES, OUTREACH AT OUR REGIONAL CLINIC/HOSPITAL PARTNERS LOCATIONS MAY INCLUDE ALLERGY, AUDIOLOGY, BEHAVIORAL MEDICINE, CARDIOLOGY, CARDIO TESTING LAB, CATH LAB, DERMATOLOGY, ECHOCARDIOGRAPHY, ENDOCRINOLOGY, ENDODONTICS, EXERCISE PHYSIOLOGY, GASTROENTEROLOGY, HEMATOLOGY, HOSPITALIST, INFECTIOUS DISEASE, NEPHROLOGY, NEUROLOGY, NEUROPSYCHOLOGY, NUTRITION THERAPY, OB/GYN, OCCUPATIONAL SERVICES, ONCOLOGY, OPHTHALMOLOGY, OTOLARYNGOLOGY, PATHOLOGY, PEDIATRICS, PERIODONTICS, PHYSICAL MEDICINE AND REHAB, PHYSICAL THERAPY, PLASTIC SURGERY, PODIATRY, PROSTHODONTICS, PSYCHIATRIC, PULMONARY, RENAL DIALYSIS, RHEUMATOLOGY, SPEECH PATHOLOGY, SPORTS MEDICINE, SURGERY, AND UROLOGY. GUNDERSEN PROVIDED CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS. OUR HOSPITAL, LIKE MOST COMMUNITY HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY, CARE THAT WITHOUT OUR HOSPITAL MAY NOT BE AVAILABLE. Schedule H, Part VI, Line 5 Promotion of community health Several critical access hospitals are located throughout the region. Gundersen Tri-County Hospital in Whitehall, WI, Gundersen St. Joseph's Hospital in Hillsboro, WI, Gundersen Palmer Lutheran Health Center in West Union, IA, St. Elizabeth's Hospital in Wabasha, MN, and Gundersen Boscobel Area Hospital in Boscobel, WI are partners/affiliates of the Gundersen Health System. Specialized services performed at the Gundersen Lutheran Medical Center and in many cases, outreach at our regional clinic/hospital partners locations may include allergy, audiology, behavioral medicine, cardiology, cardio testing lab, cath lab, dermatology, echocardiography, endocrinology, endodontics, exercise physiology, gastroenterology, hematology, hospitalist, infectious disease, nephrology, neurology, neuropsychology, nutrition therapy, ob/gyn, occupational services, oncology, ophthalmology, otolaryngology, pathology, pediatrics, periodontics, physical medicine and rehab, physical therapy, plastic surgery, podiatry, prosthodontics, psychiatric, pulmonary, renal dialysis, rheumatology, speech pathology, sports medicine, surgery, and urology. Gundersen follows its Financial Assistance Policy, provided charity care and offered other community benefits as defined by the IRS. Our hospital, like most community hospitals, was created and is maintained so that care can be provided locally; care that without our hospital may not be available. Schedule H, Part VI, Line 6 Affiliated health care system ALL AFFILIATES OF THE HEALTH SYSTEM HAVE A RESPONSIBILITY TO PROMOTE THE HEALTH OF THE COMMUNITIES WE SERVE. THE MAJORITY OF EMPLOYEES, BASED IN THE ADMINISTRATIVE CORPORATION, ARE ACTIVELY INVOLVED IN PROGRAMS AND SERVICES FOR THE COMMUNITY AS WELL AS MAINTAINING PARTNERSHIPS WITH A VARIETY OF ORGANIZATIONS, COALITIONS, INITIATIVES AND AGENCIES IN OUR COMMUNITIES THAT PROMOTE HEALTH. THE ADMINISTRATIVE CORPORATION ALSO PROVIDES THE FINANCIAL CORPORATE CONTRIBUTIONS TO VARIOUS ORGANIZATIONS AND COMMUNITY ACTIVITIES. OUR FOUNDATION PROVIDES SUPPORT FOR SOME COMMUNITY HEALTH PROMOTION PROGRAMS AS WELL, PROVIDED BY THE HEALTH SYSTEM OR OTHER ORGANIZATIONS IN OUR COMMUNITY. CLINICAL STAFF SUPPORT SCREENINGS AND VOLUNTEER AT THE HEALTH MISSION. OUR LOCAL RURAL HOSPITAL AFFILIATES PROVIDE SUPPORT TO THEIR RESPECTIVE COMMUNITIES. OUR CLINICS, LOCATED IN OVER 30 COMMUNITIES IN 3 STATES, PROVIDE SUPPORT UNIQUE TO THE NEEDS OF THAT COMMUNITY. THE MEDICAL CENTER, AS PART OF AN INTEGRATED HEALTH CARE DELIVERY SYSTEM, WORKS WITH AND IS RELATED TO GUNDERSEN CLINIC, LTD. WHICH PROVIDED UNCOMPENSATED CARE IN THE AMOUNT OF APPROXIMATELY $46,775,838. BASED ON POLICIES AND CONTRACTS ARRANGED TO HELP SUPPORT THE COMMUNITY'S NEEDS RELATED TO HEALTH CARE SERVICES, THE SUM OF UNREIMBURSED MEDICARE & MEDICAID COSTS PLUS CHARITY AT COST WAS $46,775,838. 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 FOLLOWING THE METHODOLOGY ON WORKSHEET. 1. THE COST TO CHARGE RATIO IS CALCULATED FOLLOWING THE METHODOLOGY ON WORKSHEET. 2. 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. UNREIMBURSED COST IS THE AMOUNT THE COST EXCEEDS THE NET REVENUE. AMOUNTS ARE REPORTED IN THE SEPARATE 990 FOR GUNDERSEN CLINIC, LTD. AFFILIATED ENTITY CHARITY CARE AN AFFILIATE OF GUNDERSEN LUTHERAN MEDICAL CENTER, INC., GUNDERSEN CLINIC LTD., IS NOT REQUIRED TO FILE SCHEDULE H OF FORM 990. GUNDERSEN CLINIC, LTD. PROVIDED COMMUNITY BENEFIT OF: CHARITY AT COST $1,793,991 MEDICARE UNREIMBURSED COST $29,169,515 MEDICAID UNREIMBURSED COST $15,812,332 Schedule H, Part VI, Line 7 State filing of community benefit report WI true Gundersen Lutheran Medical Foundation Inc 1836 SOUTH AVENUE La Crosse WI 54601 391249705 501(C)(3) 7529968 Operating Expense 1 0 CHARITY CARE 6886 34872547 Book Charity Care Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. ASSISTANCE WAS MADE TO A RELATED ORGANIZATION AND INDIVIDUALS. THE FUNDS MADE TO RELATED ORGANIZATIONS ARE GIVEN TO HELP WITH OPERATING EXPENSES FOR EXPENSES RELATED TO RESIDENT DOCTORS, RESEARCH, AND FELLOWSHIPS. THE FUNDS MADE TO INDIVIDUALS ARE GIVEN TO HELP PAY FOR MEDICAL BILLS OWED TO GUNDERSEN LUTHERAN MEDICAL CENTER THROUGH A CHARITY CARE APPLICATION PROCESS. THESE FUNDS ARE MONITORED BY MANAGEMENT AND THE BOARD OF TRUSTEES. Form 990, Part I, Line 1 ORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITES GUNDERSEN LUTHERAN MEDICAL CENTER (GLMC) ESTABLISHED IN 1899, PROVIDES ACUTE AND TERTIARY CARE FOR 21 COUNTIES LOCATED THROUGHOUT WESTERN WISCONSIN, NORTHEASTERN IOWA AND SOUTHEASTERN MINNESOTA. GLMC IS A TEACHING HOSPITAL WITH 325 LICENSED BEDS AND A LEVEL II TRAUMA AND EMERGENCY CENTER. OUR MISSION IS TO DISTINGUISH OURSELVES THROUGH EXCELLENCE IN PATIENT CARE, EDUCATION, RESEARCH AND IMPROVED HEALTH IN THE COMMUNITIES WE SERVE. WE WILL WORK AS A TEAM TO DEMONSTRATE OUR VALUES: INTEGRITY-PERFORM WITH HONESTY, RESPONSIBILITY AND TRANSPARENCY, EXCELLENCE-ACHIEVE EXCELLENCE IN ALL ASPECTS OF DELIVERING HEALTHCARE, RESPECT-TREAT PATIENTS, FAMILIES AND COWORKERS WITH DIGNITY, INNOVATION-EMBRACE CHANGE AND NEW IDEAS, COMPASSION-PROVIDE COMPASSIONATE CARE TO PATIENTS AND FAMILIES. Form 990, Part III, Line 1 Organizations Mission GUNDERSEN LUTHERAN MEDICAL CENTER (GLMC) A PHYSICIAN-LED, NOT-FOR-PROFIT HEALTHCARE SYSTEM, ESTABLISHED IN 1899, PROVIDES ACUTE AND TERTIARY CARE FOR 21 COUNTIES LOCATED THROUGHOUT WESTERN WISCONSIN, NORTHEASTERN IOWA AND SOUTHEASTERN MINNESOTA. WE SERVE AS A REGIONAL REFERRAL CENTER. GLMC IS A TEACHING HOSPITAL WITH 325 LICENSED BEDS AND A LEVEL II TRAUMA AND EMERGENCY CENTER. OUR MISSION IS TO DISTINGUISH OURSELVES THROUGH EXCELLENCE IN PATIENT CARE, EDUCATION, RESEARCH AND IMPROVED HEALTH IN THE COMMUNITIES WE SERVE. WE WILL WORK AS A TEAM TO DEMONSTRATE OUR VALUES: INTEGRITY - PERFORM WITH HONESTY, RESPONSIBILITY AND TRANSPARENCY, EXCELLENCE - ACHIEVE EXCELLENCE IN ALL ASPECTS OF DELIVERING HEALTHCARE, RESPECT - TREAT PATIENTS, FAMILIES AND COWORKERS WITH DIGNITY, INNOVATION - EMBRACE CHANGE AND NEW IDEAS, COMPASSION - PROVIDE COMPASSIONATE CARE TO PATIENTS AND FAMILIES. OUR CURRENT VISION IS TO ENHANCE THE HEALTH AND WELL-BEING OF OUR COMMUNITIES WHILE ENRICHING EVERY LIFE WE TOUCH, INCLUDING PATIENTS, FAMILIES, AND STAFF. Form 990, Part III, Line 4a Program Service Accomplishments GLMC PROVIDES A COMPREHENSIVE RANGE OF INPATIENT, CLINICAL AND DIAGNOSTIC SERVICES IN NUMEROUS MEDICAL SPECIALTIES AND SUBSPECIALTIES. GLMC IS A TEACHING HOSPITAL WITH 325 LICENSED BEDS WITH SPECIALTY SERVICES INCLUDING RENAL DIALYSIS, CANCER CARE, REHABILITATION SERVICES, AND CARDIAC SERVICES. IN 2013, GLMC OPENED A NEW INPATIENT BEHAVIORAL HEALTH BUILDING, MEETING A TREMENDOUS NEED IN OUR REGION FOR ADDITIONAL BEDS AND SERVICES. WE ARE ABLE TO PROVIDE CARE LOCALLY FOR PATIENTS OF ALL AGES. THE FACILITY IS THE ONLY PLACE IN THE REGION OFFERING INPATIENT CARE FOR ADOLESCENTS AND TEENAGERS WITH BEHAVIORAL HEALTH NEEDS. GLMC HAS REPEATEDLY BEEN NAMED ONE OF THE TOP 50 HOSPITALS IN THE NATION, PLACING US IN THE TOP ONE PERCENT. GLMC VOLUNTARILY PROVIDES MEDICALLY NECESSARY PATIENT CARE SERVICE THAT IS DISCOUNTED OR FREE OF CHARGE TO PERSONS WHO HAVE INSUFFICIENT RESOURCES AND/OR WHO ARE UNINSURED. FOR THE PERIOD OF JANUARY 1, 2023 THROUGH SEPTEMBER 30, 2023, GLMC PROVIDED FINANCIAL ASSISTANCE TO APPROXIMATELY 6,886 PATIENTS THAT RESULTED IN GLMC INCURRING ROUGHLY $34,872,547 IN UNCOMPENSATED COST ASSOCIATED WITH THIS PROGRAM. Form 990, Part VI, Line 15 A AND B - PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL ALL PERSONNEL SERVICES FOR GUNDERSEN LUTHERAN MEDICAL CENTER, INC. 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 LUTHERAN MEDICAL CENTER ARE PERFORMED BY EMPLOYEES OF GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICE, INC. Form 990, Part VI, Line 4 Significant changes to organizational documents IN JULY AND AUGUST 2023, THE BYLAWS AND ARTICLES OF INCORPORATION, RESPECTIVELY OF GUNDERSEN LUTHERAN MEDICAL CENTER, INC. ("CORPORATION") WERE AMENDED TO SPECIFY THE POWERS RETAINED BY GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. THE CHIEF EXECUTIVE OFFICER OF 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 GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. THE PARENT CORPORATION AND SOLE MEMBER OF THE CORPORATION, SHALL HAVE THE POWER TO RECOMMEND AND REVIEW, AS APPROPRIATE, AND APPROVE CERTAIN MATTERS. THE ARTICLES OF INCORPORATION MAY BE AMENDED BY VOTE OF THE SOLE MEMBER OF THE CORPORATION. Form 990, Part VI, Line 11b Review of form 990 by governing body THE FORM 990 WILL BE AVAILABLE FOR ALL BOARD MEMBERS BEFORE FILING AND UPON FURTHER REVIEW BY THE CFO, VICE-PRESIDENT OF FINANCE OR DIRECTOR OF FINANCE, THE 990S ARE APPROVED AND FILED. Form 990, Part VI, Line 12c Conflict of interest policy GUNDERSEN LUTHERAN MEDICAL CENTER, INC. 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 1a COMPENSATION REPORTING DUE TO THE SHORT YEAR RETURN IN WHICH THERE WAS NO CALENDAR YEAR THAT ENDS WITH OR WITHIN THE SHORT YEAR, NO REPORTABLE COMPENSATION IS SHOWN FOR INDIVIDUALS LISTED ON PART VII OF THE 990 RETURN. AS SUCH, NO KEY EMPLOYEES, HIGHEST COMPENSATED EMPLOYEES, OR INDEPENDENT CONTRACTORS ARE LISTED PER THE REPORTING INSTRUCTIONS. Form 990, Part IX, Line 11g Other Fees PURCHASED HEALTH SERVICES - Total Expense: XXX-XX-XXXX, Program Service Expense: XXX-XX-XXXX, Management and General Expenses: , Fundraising Expenses: ; PURCHASED PROGRAM SERVICE - Total Expense: 15026928, Program Service Expense: 15006835, Management and General Expenses: 20093, Fundraising Expenses: ; CONSULTING - Total Expense: 432805, Program Service Expense: 368882, Management and General Expenses: 63923, Fundraising Expenses: ; GUNDERSEN HEALTH ACCOUNTABLE CARE ORGANIZATION LLC 1910 SOUTH AVE LA CROSSE WI 54601 871018008 HEALTHCARE WI 0 1070218 GLMC GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1836 SOUTH AVENUE LA CROSSE WI 54601 391866425 SUPPORTING ORG WI 501(c)(3) Type II BGHS false GUNDERSEN CLINIC LTD 1836 SOUTH AVENUE LA CROSSE WI 54601 391028657 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 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