2025-08-13T12:19:21-05:00 2024-09-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2023-10-01 390845590 MEMORIAL HOSPITAL OF BOSCOBEL MEMO 6083754112 205 PARKER STREET BOSCOBEL WI 53805 JENNIFER BOIGENZAHN FINANCE ADMINISTRATOR 6083754112 2025-08-13 1 1 MICHAEL J PETERSON CPA P01833529 2187224705 2025-08-06 2023 2025-03-06 01:10:19Z GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS JENNIFER BOIGENZAHN 205 PARKER STREET BOSCOBEL WI 53805 35650305 0 X WWW.GUNDERSENHEALTH.ORG/BOSCOBEL X 1952 WI TOGETHER, WE INSPIRE YOUR BEST LIFE BY RELENTLESSLY CARING, LEARNING AND INNOVATING. 9 4 206 50 0 0 57386 256555 24346084 34506649 303624 844080 81783 43021 24788877 35650305 4000 0 0 0 11426656 17080110 0 0 0 10207934 14297519 21638590 31377629 3150287 4272676 34589367 41476573 2290153 3528380 32299214 37948193 X LEADING WITH LOVE, WE COURAGEOUSLY COMMIT TO A FUTURE OF HEALTHY PEOPLE AND THRIVING COMMUNITIES. 0 0 19427888 0 28592185 GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS ("THE ORGANIZATION") PROVIDES INPATIENT, OUTPATIENT, EMERGENCY HEALTH CARE SERVICES AND OTHER FINANCIAL SUPPORT THROUGH VARIOUS PROGRAMS THAT ARE DESIGNED, AMONG OTHER MATTERS, TO ENHANCE THE HEALTH OF THE COMMUNITY INCLUDING THE HEALTH OF LOW-INCOME PATIENTS. SERVICES PROVIDED TO PATIENTS INCLUDE COLONOSCOPIES, LAPAROSCOPIC SURGERIES, AND KNEE REPLACEMENTS, AMONG OTHERS. THE ORGANIZATION IS AFFILIATED WITH GUNDERSEN HEALTH SYSTEM. THIS AFFILIATION PROVIDES LOCAL SERVICES IN CARDIOLOGY, NEUROLOGY, PODIATRY, DERMATOLOGY, UROLOGY, AND VASCULAR MEDICINE AS WELL AS MANY OTHER SERVICES. CONSISTENT WITH THE MISSION OF THE ORGANIZATION, CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY, INCLUDING PROVIDING SERVICES TO THOSE PERSONS WHO ARE EITHER UNDERINSURED OR WHO CANNOT AFFORD HEALTH INSURANCE BECAUSE OF INADEQUATE RESOURCES. HEALTH CARE SERVICES TO PATIENTS UNDER GOVERNMENT PROGRAMS, SUCH AS THE MEDICAID PROGRAM, ARE ALSO CONSIDERED PART OF THE ORGANIZATION'S BENEFIT PROVIDED TO THE COMMUNITY, SINCE A SUBSTANTIAL PORTION OF SUCH SERVICES ARE REIMBURSED AT AMOUNTS LESS THAN THE COSTS OF PROVIDING CARE. (SEE ADDITIONAL INFORMATION REGARDING THE COST OF PROVIDING SERVICES TO MEDICAID PATIENTS IN SCHEDULE H OF THE FORM 990.) PATIENTS WHO MEET CERTAIN CRITERIA FOR CHARITY CARE, GENERALLY BASED ON FEDERAL POVERTY GUIDELINES, ARE PROVIDED CARE AT A SIGNIFICANTLY REDUCED RATE, DETERMINED BASED ON QUALIFYING CRITERIA AS DEFINED IN THE ORGANIZATION'S CHARITY CARE POLICY AND FORM APPLICATIONS COMPLETED BY PATIENTS AND THEIR FAMILIES. (SEE ADDITIONAL INFORMATION REGARDING THE COST OF PROVIDING SERVICES TO CHARITY CARE RECIPIENTS IN SCHEDULE H OF THE FORM 990.) BENEFITS FOR SERVING THE COMMUNITY ALSO INCLUDE UNPAID COSTS OF TREATING THE ELDERLY, HEALTH SCREENINGS, COMMUNITY EDUCATION THROUGH SEMINARS AND CLASSES, AND OTHER HEALTH-RELATED SERVICES. DURING 2024, HOSPITAL PATIENT DAYS TOTALED 346. SOME OTHER KEY STATISTICS FOR FY2024 WERE 346 MEDICAL/SURGICAL INPATIENT DAYS, 1,240 SWING BED DAYS, 4,215 EMERGENCY ROOM VISITS, AND 461 SURGICAL OUTPATIENT VISITS. 7024056 0 5914464 THE ORGANIZATION OPERATES FAMILY PRACTICE CLINICS IN THREE LOCATIONS TO ENSURE COMMUNITY MEMBERS HAVE ACCESS TO CONVENIENT, QUALITY PRIMARY CARE. DURING 2024, TOTAL OUTPATIENT ENCOUNTERS AT THESE CLINICS TOTALED 13,622. THE THREE CLINICS ARE DESIGNATED AS RURAL HEALTH CLINICS BY THE MEDICARE AND MEDICAID PROGRAMS AND BY DEFINITION PROVIDE HEALTH CARE TO AREAS DESIGNATED AS MEDICAL PROFESSIONAL SHORTAGE AREAS WHERE WITHOUT THESE CLINICS THERE WOULD BE LIMITED ACCESS TO PRIMARY CARE CLINICAL SERVICES. IN ADDITION, THE ORGANIZATION'S CHARITY CARE PROGRAM IS ALSO AVAILABLE TO PATIENTS OF THE CLINICS AND IS INCLUDED IN THE CHARITY CARE AMOUNT REPORTED FOR THE HOSPITAL AS CHARITY CARE BENEFITS GIVEN TO CLINIC PATIENTS IN SCHEDULE H OF THE FORM 990. 26451944 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 51 0 1 206 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X KYLE STANEK 6083754112 205 PARKER STREET BOSCOBEL WI 53805 MARILU BINTZ MD BOARD MEMBER/MED VP BGHS (THRU 12/23) 2.00 48.00 X 0 539145 53893 ANDY NAHAS VP/BGHS OPTOMETRIST 2.00 48.00 X X 0 246128 62901 JAMES KLOCK BOARD MEMBER/DIR OF REG IS 2.00 48.00 X 0 189142 51419 ALAN EBER BOARD MEMBER/DIR OF BUSINESS SERVICES 2.00 48.00 X 0 160171 45529 KEITH FRYE SECRETARY/ADMIN DR LAB 2.00 48.00 X X 0 158638 45318 DAWN THORSTEN BOARD MEMBER/DIRECTOR OF QUALITY 2.00 48.00 X 0 126715 44299 JERRY BERGE PRESIDENT 2.00 X X 0 0 0 CYNDE LARSEN TREASURER/BOARD MEMBER 2.00 X X 0 0 0 PETE ESSER TREASURER/BOARD MEMBER (THRU 12/23) 2.00 X X 0 0 0 GARY BOUGHTON BOARD MEMBER 2.00 X 0 0 0 EMILY MCCORMICK BOARD MEMBER 2.00 X 0 0 0 SCOTT RATHGABER CEO-BGHS 2.00 48.00 X 0 1644221 68728 STEVE LITTLE INTERIM CFO-BGHS (THRU 02/24) 2.00 48.00 X 0 333317 0 THERESA BRAUDT ADMINISTRATOR 50.00 0.00 X 0 188533 49424 JENNIFER BOIGENZAHN FINANCE ADMINISTRATOR 50.00 X 0 161528 23533 JOHN CEELEN CFO-BGHS (BEG 02/24) 2.00 48.00 X 0 0 0 LISA WITTER PHARMACIST 40.00 X 171889 0 34074 TARA WOOD PHARMACIST 50.00 X 148061 0 14508 KELSEY LOMAS RN 40.00 X 126784 0 24565 KERRY CAMPBELL RN 40.00 X 131400 0 19744 JENNY DAX DIRECTOR, BUSINESS OPERATIONS 50.00 X 127475 0 21627 705609 3747538 559562 5 0 1 0 WAPITI MEDICAL STAFFING 107 FLYNN DR STE 600 MILBANK SD 57252 MEDICAL STAFFING 2080918 NUWEST GROUP HOLDINGS LLC 325 118TH AVE SE 300 BELLEVUE WA 98005 MEDICAL STAFFING 498893 NEXT GENERATION ANESTHESIA 1805 KENSINGTON DR WAUKESHA WI 53188 MEDICAL STAFFING 472077 STAFFENCY 221 W COLLEGE AVE FLR 2 APPLETON WI 54911 MEDICAL STAFFING 466110 COMPHEALTH 7259 BINGHAM JCT BLVD MIDVALE UT 84047 MEDICAL STAFFING 214691 12 2440 254115 159556 256555 HOSPITAL PATIENT REVENUE 621110 27735889 27735889 CLINIC REVENUE 621110 5914464 5914464 PHARMACY REVENUE 456110 809801 809801 46495 46495 34506649 844080 844080 43021 43021 43021 35650305 34506649 0 887101 X 13299658 10921454 2378204 1170446 961150 209296 1819414 1494072 325342 790592 649221 141371 925476 925476 152378 152378 3550 3550 664 664 6200277 6078309 121968 107131 107131 261846 179689 82157 44415 7032 37383 312180 286829 25351 99985 92914 7071 25534 16706 8828 12770 10088 2682 1123253 887370 235883 74441 74441 BILLABLE MEDICAL SUPPLI 2803939 2802029 1910 PROVISION FOR BAD DEBTS 1788831 1788831 EQUIPMENT RENTAL 144313 138472 5841 REPAIRS & MAINTENANCE 117266 114696 2570 99270 23082 76188 31377629 26451944 4925685 0 30478 43142 23481229 30227940 2544467 2943201 357790 463623 114060 90756 24941633 18065774 6990651 6875859 1405 0 1069287 832052 34589367 41476573 1861322 2793247 135904 135904 152578 265945 140349 333284 2290153 3528380 X 32299214 37948193 32299214 37948193 34589367 41476573 X 4272676 1413107 -36804 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3550 3550 0 PART II-B, LINE 1: GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS (THE ORGANIZATION") PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PAID PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING. THE WHA HAS NOTIFIED THE ORGANIZATION THAT $1,713 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTH CARE ENVIRONMENT. THE ORGANIZATION IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR THE ORGANIZATION PAYS MEMBERSHIP FEES TO RWHC. THE RWHC PROVIDES SUPPORT SERVICES FOR A NUMBER OF ITS MEMBER HOSPITALS THROUGHOUT THE STATE OF WISCONSIN. SOME OF THE MANY SERVICES PROVIDED TO MEMBER HOSPITALS INCLUDE PROVIDING ASSISTANCE TO ORGANIZATIONS IN FINDING GRANT FUNDING FOR NEW PROGRAMS, LEGAL SERVICES, REIMBURSEMENT REVIEW SERVICES, ACCOUNTING ASSISTANCE, CONTRACTING FOR THERAPIST COVERAGE, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, RWHC ALSO PROVIDES AN ANALYSIS OF CURRENT HEALTH CARE ISSUES IN AN EFFORT TO PROMOTE AND BETTER HEALTHCARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. ONE OF THESE EFFORTS ALSO INCLUDES A SMALL AMOUNT OF LOBBYING ON THE PART OF THE MEMBER HOSPITALS. THE RWHC DETERMINED THAT $1,837 OF THE FEES PAID BY THE ORGANIZATION IN FISCAL YEAR 2024 RELATED TO LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE HEALTH CARE ENVIRONMENT IN THE STATE OF WISCONSIN. 537666 537666 15296480 10640534 4655946 7718149 6323560 1394589 1389338 1101680 287658 6875859 3RD PARTY SETTLEMENTS PAYABLE 218493 DUE TO RELATED PARTIES 114791 333284 X PART X, LINE 2: 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 2019 AND PRIOR YEARS. 1 1 X 1 X 1 X 1 1 0 1 1 385352 385352 0.01230 3927834 3828975 98859 0.00320 4313186 3828975 484211 0.01550 74876 74876 0.00240 74494 74494 0.00240 2958547 2815890 142657 0.00450 10260 10260 0.00030 3118177 2815890 302287 0.00960 7431363 6644865 786498 0.02510 5570 5570 0.00020 696 696 0.00000 6266 6266 0.00020 0 778470 389235 9299453 9348282 -48829 1 1 1 1 MEMORIAL HOSPITAL OF BOSCOBEL 205 PARKER STREET BOSCOBEL WI 53805 WWW.GUNDERSENHEALTH.ORG/BOSCOBEL 1048 X X X X MEMORIAL HOSPITAL OF BOSCOBEL 1 0 0 1 X X X X X X X X X 24 1 1 1 1 X SEE SUPPLEMENTAL INFORMATION X X 1 24 1 SEE SUPPLEMENTAL INFORMATION 0 1 X 201.000000000000 201.000000000000 X X X X X X 1 1 X X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X X 1 X 0 X X X X 1 X 0 0 MEMORIAL HOSPITAL OF BOSCOBEL PART V, SECTION B, LINE 5: INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY SERVED BY GBAHC WAS COLLECTED THROUGH ONLINE AND PAPER SURVEYS. THE SURVEY WAS ALSO MADE AVAILABLE IN SPANISH. THIS SURVEY MEASURED PERSPECTIVES ON HEALTHCARE AND HEALTH NEEDS, STRENGTHS, WEAKNESSES, OPPORTUNITIES, AND CHALLENGES. THE SURVEY WAS PROMOTED VIA THE COLLABORATIVE PARTNERS SOCIAL MEDIA PAGES, EMAIL, PUBLICITY EFFORTS, FAIRS, COUNTY HEALTH DEPARTMENTS AND DIRECT MAIL. A TOTAL OF 1,640 RESPONSES WERE COLLECTED. MEMORIAL HOSPITAL OF BOSCOBEL PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED IN JOINT EFFORT WITH THE FOLLOWING OTHER HOSPITALS:1. CROSSING RIVERS HEALTH2. GRANT REGIONAL HEALTH CENTER, INC. 3. SOUTHWEST HEALTH CENTER MEMORIAL HOSPITAL OF BOSCOBEL PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED IN JOINT EFFORT WITH THE FOLLOWING OTHER ORGANIZATIONS:1. CRAWFORD COUNTY PUBLIC HEALTH DEPARTMENT2. GRANT COUNTY PUBLIC HEALTH DEPARTMENT MEMORIAL HOSPITAL OF BOSCOBEL PART V, SECTION B, LINE 7D: PART V, SECTION B, LINES 7A AND 10A:HTTP://WWW.GUNDERSENHEALTH.ORG/COMMUNITY-ASSESSMENT/ MEMORIAL HOSPITAL OF BOSCOBEL PART V, SECTION B, LINE 11: BETWEEN THE CLOSE OF FY2024 (9/30/2024) AND FEBRUARY 15, 2025, GBAHC HAS DEVELOPED AND ADOPTED NEW SIGNIFICANT NEEDS OF WHICH HAS BEEN APPROVED BY OUR BOD ON FEBRUARY 14, 2025. THE CHIP ADDRESSES THE TOP THREE PRIORITIZED COMMUNITY HEALTH NEEDS AS NOTED IN OUR 2024 CHNA (BELOW), AND WILL INCLUDE GOALS, TACTICS, RESOURCES, PARTNERS, AND OUTCOME MEASURES FOR EACH. MENTAL HEALTH: 1). SYSTEM-WIDE EMPHASIS ON SCREENING PATIENTS ANNUALLY FOR DEPRESSION/RISK FOR DEPRESSION, 2). INVESTIGATE OPPORTUNITIES TO INCREASE SWCAP CARE COORDINATION NETWORK (CCN) REFERRALS FOR PATIENTS (INITIATED WITH SDOH SCREENING), 3). INCREASE AWARENESS OF COMMUNITY-BASED MENTAL HEALTH RESOURCES, 4). SUPPORT COMMUNITY INITIATIVES THAT IMPROVE MENTAL HEALTH OR ACCESS TO MENTAL HEALTH RESOURCES FOR ALL POPULATIONS.SUBSTANCE MISUSE: 1). CONTINUE TO OFFER TOBACCO CESSATION INTERVENTION TO PATIENTS, 2). PROVIDE OR SUPPORT EDUCATION AND RESOURCES THAT ENGAGE THE COMMUNITY (INCLUDING TOBACCO, VAPING, AND OTHER DRUG AND SUBSTANCE USE), 3). INVESTIGATE DRUG-RELATED EMERGENCY ROOM VISITS DUE TO OPIOID USE AND DEVELOP STRATEGIES TO ADDRESS FINDINGS, 4). MONITOR THE NUMBER OF PATIENTS EXPOSED TO OPIOIDS IN THE MANAGEMENT OF PAIN (ACTION/MEASURE MAY CHANGE BASED ON ORGANIZATIONAL STRATEGY).CHRONIC CONDITIONS: 1). EXPLORE GAPS IN CARE SPECIFIC TO CANCER SCREENING, 2). CONTINUED FOCUS ON CONTROLLING HIGH BLOOD PRESSURE, 3). MONITOR PATIENTS WHO FALL ON THE DIABETIC REGISTRY AND EXPLORE GAPS FOR THOSE WHOSE DIABETES IS NOT CONSIDERED OPTIMALLY CONTROLLED, 4). CONTINUE TO MAKE OUR MOVIN AND MORE PROGRAM ACCESSIBLE TO PATIENTS WHO PREVIOUSLY OPTED NOT TO ENROLL DUE TO COST. MOVIN' & MORE VOUCHERS CONTINUE TO BE FUNDED THROUGH THE HOSPITAL FOUNDATION TO SUPPORT ONE COMPLIMENTARY MONTH IN THE PROGRAM FOR ALL CARDIOPULMONARY REHABILITATION GRADUATES. OTHER: WILL CONTINUE TO PROVIDE LOW-COST OR FREE EDUCATIONAL SEMINARS AND TRAININGS FOR COMMUNITY MEMBERS, EMPLOYERS, AND LOCAL ENTITIES TO SUPPORT IMPROVED PHYSICAL AND MENTAL WELL-BEING. OTHER COMMUNITY HEALTH PRIORITIES WERE IDENTIFIED THROUGH THE ASSESSMENT PROCESS THAT WILL NOT BE ADDRESSED, BUT GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS WILL PROVIDE SUPPORT TO AREA ORGANIZATIONS AND PARTNERS WHEN REQUIRED, INCLUDE: 1). LACK OF PUBLIC TRANSPORTATION 2). NARROWING NETWORKS AND HIGH DEDUCTIBLE HEALTH PLANS 3). DENTAL SERVICES MEMORIAL HOSPITAL OF BOSCOBEL PART V, SECTION B, LINE 13H: GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINCS (GBAHC) 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 GBAHC 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 DISCHARGED 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.GBAHC UNDERSTANDS THAT CERTAIN PATIENTS MAY BE NON-RESPONSIVE TO GBAHC'S APPLICATION PROCESS. UNDER THESE CIRCUMSTANCES, GBAHC MAY UTILIZE OTHER SOURCES OF INFORMATION TO MAKE AN INDIVIDUAL ASSESSMENT OF FINANCIAL NEED. THIS INFORMATION WILL ENABLE GBAHC 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.GBAHC 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 GBAHC 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 GBAHC 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.PATIENT ACCOUNTS GRANTED PRESUMPTIVE ELIGIBILITY WILL BE RECLASSIFIED UNDER THE FINANCIAL ASSISTANCE POLICY. THEY WILL NOT BE SENT TO COLLECTION AND WILL NOT BE INCLUDED IN THE HOSPITAL'S BAD DEBT EXPENSE. PART V, SECTION B, LINE 10A HTTP://WWW.GUNDERSENHEALTH.ORG/COMMUNITY-ASSESSMENT/ 3 1 - GUNDERSEN BOSCOBEL CLINIC 208 PARKER STREET BOSCOBEL WI 53805 PROVIDER BASED RURAL HEALTH CLINIC 2 - GUNDERSEN FENNIMORE CLINIC 220 LINCOLN AVENUE FENNIMORE WI 53809 PROVIDER BASED RURAL HEALTH CLINIC 3 - GUNDERSEN MUSCODA CLINIC 525 NORTH WISCONSIN AVENUE MUSCODA WI 53573 PROVIDER BASED RURAL HEALTH CLINIC PART I, LINE 3C: THE HOSPITAL USES THE FEDERAL POVERTY GUIDELINES AS ONE MEANS OF DETERMINING ELIGIBILITY FOR CHARITY CARE. THE FEDERAL POVERTY GUIDELINES ARE UPDATED AND PUBLISHED ANNUALLY BY THE US DEPARTMENT OF HEALTH AND HUMAN SERVICES. AS A RULE, A PATIENT'S INCOME, BASED ON FAMILY SIZE, MUST BE AT OR BELOW 201% OF THE FEDERAL POVERTY GUIDELINES TO BE ELIGIBLE FOR THE CHARITY CARE PROGRAM. A SLIDING SCALE BASED ON THE PATIENT'S INCOME LEVEL UNDER THE FEDERAL POVERTY GUIDELINES WILL BE USED TO DETERMINE THE PRECISE AMOUNT OF CHARITY CARE FOR WHICH A PATIENT WILL BE ELIGIBLE. SOME PATIENTS MAY EXCEED 201% OF THE FEDERAL POVERTY GUIDELINES BUT MAY STILL BE ELIGIBLE FOR CHARITY CARE WHEN ADDITIONAL CRITERIA SUCH AS CATASTROPHIC MEDICAL COSTS ARE CONSIDERED. CATASTROPHIC MEDICAL CARE COSTS ARE DETERMINED ON A CASE-BY-CASE BASIS TO PATIENTS WHO DUE TO A SIGNIFICANT OR RECURRENCE OF MEDICAL BILLS MAY NEED ADDITIONAL COMMUNITY SUPPORT TO HELP A PATIENT OR THEIR FAMILY THROUGH A DIFFICULT TIME. PART I, LINE 7: THE COSTING METHOD USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST TO CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. THE COSTING METHODOLOGY FOR SUBSIDIZED HEALTH SERVICES IS BASED ON COST ALLOCATIONS FROM THE MEDICARE COST REPORT. THIS ALLOCATION METHOD AND PRINCIPLES OF ALLOCATION WERE USED TO DERIVE A SPECIFIC AMOUNT OF COST ALLOCATION TO THE VARIOUS PROGRAMS AND COST CENTERS OPERATED BY THE HOSPITAL. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES AT GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS INCLUDE THE OPERATION OF THREE RURAL HEALTH CLINICS. THE OPERATION OF THREE RURAL HEALTH CLINICS IS ALSO PROVIDED AS A SUBSIDIZED HEALTH SERVICE IN ORDER TO MEET HEALTH CARE NEEDS IN THE SURROUNDING COMMUNITIES. GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS CURRENTLY OPERATES RURAL HEALTH CLINICS IN BOSCOBEL, FENNIMORE, AND MUSCODA, WISCONSIN. IT IS THE GOAL OF THE HOSPITAL TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENT'S ABILITY TO PAY. PART II, COMMUNITY BUILDING ACTIVITIES: GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS, AS DEFINED BY THE IRS, AND IN ADDITION, THE HOSPITAL BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT BENEFIT WHICH IS NOT QUANTIFIED. GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS, LIKE MOST COMMUNITY HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY WHICH WITHOUT THE HOSPITAL, WOULD NOT BE AVAILABLE. BEYOND INPATIENT HOSPITALIZATIONS, THE HOSPITAL PROVIDES LOCAL ACCESS TO MANY SERVICES INCLUDING, BUT NOT LIMITED TO: DIAGNOSTICS, EMERGENCY SERVICES, INFUSION SERVICES, SWING BED SERVICES, CLINICAL SERVICES, LABORATORY SERVICES, REHABILITATION SERVICES, SPECIALTY MEDICINE, SPEECH PATHOLOGY, SURGICAL SERVICES, AND WOMEN'S SERVICES. PART III, LINE 2: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO, WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES EXCLUDING THE PROVISION FOR BAD DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF CARE OF PATIENTS WHO HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE EXCLUDED FROM GROSSPATIENT SERVICE REVENUE ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL. PART III, LINE 3: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND CREDIT TO ACCOUNTS RECEIVABLE. MANY TIMES, PATIENTS DO NOT COMPLETE THE REQUIRED CHARITY CARE APPLICATION AND ARE TRANSFERRED TO COLLECTION SERVICES EVEN THOUGH THE HOSPITAL PROVIDES THIS INFORMATION TO ALL PATIENTS AND ASSISTANCE WITH THE APPLICATIONS. DUE TO NO RESPONSES FROM SOME PATIENTS, A SIGNIFICANT AMOUNT OF BAD DEBTS COULD BE CONSIDERED AS CHARITY CARE. PART III, LINE 4: ACCOUNTS RECEIVABLE AND CREDIT POLICY: IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE ORGANIZATION ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY PAYOR COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ORGANIZATION RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE. PART III, LINE 8: THE TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H OF THE FORM 990 IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE OF THE HOSPITAL, AND ALSO DOES NOT CONSIDER ALL CONTRACTUAL ADJUSTMENTS FOR SERVICES REIMBURSED BY THE MEDICARE PROGRAM. AMOUNTS LISTED FOR MEDICARE REVENUES DO NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE HOSPITAL AS WELL AS HOSPITAL INPATIENT PHYSICIAN PROFESSIONAL SERVICES, RESPIRATORY THERAPY PROFESSIONAL SERVICES, RADIOLOGIST PROFESSIONAL SERVICES, SURGEON PROFESSIONAL SERVICES, AND REVENUES FOR ANY PATIENTS COVERED UNDER MEDICARE ADVANTAGE PLAN PROGRAMS. PHYSICIAN PROFESSIONAL SERVICES ARE REIMBURSED PRIMARILY ON FEE SCHEDULE REIMBURSEMENTS AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY AND PHYSICIAN SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT GUNDERSEN BOSCOBEL HOSPITAL AND CLINICS PROVIDES TO THE COMMUNITY AND SURROUNDING AREAS. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT FOR THE PERIOD ENDED SEPTEMBER 30, 2024 AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES, AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE). WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHO ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. PART III, LINE 9B: UNDER THE HOSPITAL'S COLLECTION AND CHARITY CARE POLICIES, GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS MAKES EVERY ATTEMPT TO IDENTIFY AND PROMOTE CHARITY CARE TO PATIENTS. INCLUDED IN THE HOSPITAL'S CHARITY CARE POLICY IT IS NOTED THAT PATIENTS MAY QUALIFY FOR CHARITY CARE EITHER PRIOR TO ADMISSION OR FOLLOWING DISCHARGE. ALL INPATIENT SELF-PAY ADMISSIONS ARE SCREENED BY THE HOSPITAL'S PATIENT FINANCIAL COUNSELOR OR SOCIAL WORKERS TO ALLOW THESE PATIENTS THE ABILITY TO COMPLETE THEIR APPLICATION DURING THEIR STAY AT THE HOSPITAL, DEPENDING UPON THE PATIENT'S CONDITION, OR THE PATIENT'S RESPONSIBLE PARTY MAY BE CONTACTED TO COMPLETE AND RETURN THE FORMS AT A LATER TIME WHEN THEIR CARE ALLOWS THIS COMPLETION. DURING THE PATIENT ACCOUNT COLLECTION PROCESS, SELF-PAY PATIENTS ARE ALSO INFORMED OF THE HOSPITAL'S COLLECTION POLICIES AS WELL AS THE CHARITY CARE PROGRAM TO ALLOW PATIENTS THE OPPORTUNITY TO COMPLETE THE APPROPRIATE FORMS AND QUALIFY UNDER THE PROGRAM. PART VI, LINE 2: GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES AND AREAS IT SERVES BY REVIEWING LOCAL DEMOGRAPHICS AND TRENDS IN PATIENT SERVICE UTILIZATION TO DETERMINE WHICH SERVICES COULD AND SHOULD BE MADE AVAILABLE TO THE COMMUNITY IN A COST-EFFECTIVE MANNER TO BE CONSISTENT WITH THE HOSPITAL'S MISSION IN THE COMMUNITY. GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS ALSO REVIEWS STATISTICS IN THE HOSPITAL, CLINIC, AND OTHER ORGANIZATIONAL DEPARTMENTS TO REVIEW THE CURRENT SERVICES BEING OFFERED AND ENSURE THAT RESOURCES ARE BEING APPROPRIATELY ALLOCATED TO AREAS IN NEED BY COMMUNITY MEMBERS AND PATIENTS. THE HOSPITAL ALSO MEETS WITH LOCAL COMMUNITY MEMBERS AND ITS PHYSICIAN GROUP TO DETERMINE WHICH SERVICES MAY BENEFIT THE COMMUNITY. DURING FISCAL YEAR 2024, THE HOSPITAL COLLABORATED WITH OTHER AREA HOSPITALS TO COMPLETE A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THROUGH THE CHNA PROCESS THE HOSPITAL CONSIDERED, COUNTY HEALTH STATISTICS, MEDICAL RESOURCES, SAFETY FACTORS, SOCIO-ECONOMIC INDICATORS, TRANSPORTATION ISSUES, ACCESS TO RESOURCES, AND ENVIRONMENTAL QUALITY. PART VI, LINE 3: PATIENTS IN NEED OF FINANCIAL ASSISTANCE CAN MEET WITH THE HOSPITAL'S FINANCIAL COUNSELOR EITHER AT THE TIME SERVICE IS PROVIDED OR WHEN THE PATIENT'S BILL IS GENERATED. THE FINANCIAL COUNSELOR EXPLAINS THE VARIOUS PAYMENT OPTIONS AVAILABLE TO THE PATIENT AS WELL AS THE HOSPITAL'S CHARITY CARE PROGRAM AND OFFERS THE CHARITY CARE APPLICATION WHEN APPROPRIATE. IF OTHER PROGRAMS ARE AVAILABLE TO THE PATIENT, SUCH AS THE WISCONSIN MEDICAID OR BADGERCARE PROGRAMS, THESE PATIENTS ARE REFERRED TO THE APPROPRIATE GOVERNMENT AGENCY FOR FURTHER ASSISTANCE. THE HOSPITAL ALSO PROVIDES CERTIFIED APPLICATION COUNSELORS FOR ASSISTING PATIENTS WITH OBTAINING COVERAGE THROUGH THE HEALTH INSURANCE MARKETPLACE. PART VI, LINE 4: THE PRIMARY SERVICE AREA FOR GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS ENCOMPASSES ALL PERSONS LIVING WITHIN A 20 TO 30 MILE RADIUS OF THE HOSPITAL. THE HOSPITAL ALSO DETERMINED THAT PRIMARY CLINICAL HEALTH CARE WAS A NEEDED SERVICE IN TWO SURROUNDING COMMUNITIES, SO THE HOSPITAL ALSO OPERATES PROVIDER-BASED RURAL HEALTH CLINICS IN FENNIMORE AND MUSCODA, WISCONSIN. PART VI, LINE 5: GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS OFFERS HEALTH SCREENINGS, EDUCATIONAL DISPLAYS, AND PRESENTATIONS ON A VARIETY OF TOPICS SUCH AS HEALTHY EATING, EXERCISE, HEART HEALTH, CHOLESTEROL, ETC. TO MEMBERS OF THE COMMUNITY. PROGRAMS AND SERVICES ARE ALSO CONSIDERED BY THE HOSPITAL'S BOARD OF DIRECTORS, WHICH INCLUDES FIVE LOCAL COMMUNITY MEMBERS WHO RESIDE WITHIN A THIRTY-MILE RADIUS OF THE HOSPITAL. THE HOSPITAL ALSO CONSIDERS A RELATIVELY OPEN MEDICAL STAFF POLICY ALLOWING PROPERLY CREDENTIALED PROVIDERS THE ABILITY TO PRACTICE MEDICINE AND FOLLOW-UP WITH PATIENTS UTILIZING THE HOSPITAL'S FACILITIES. PART VI, LINE 6: THE ORGANIZATION IS A PART OF EMPLIFY HEALTH WHICH IS THE COMBINATION OF GUNDERSEN HEALTH AND BELLIN HEALTH SYSTEMS. IT IS A NOT-FOR-PROFIT ORGANIZATION DEDICATED TO ENHANCING THE PHYSICAL AND EMOTIONAL WELL-BEING OF INDIVIDUALS IN. IN COLLABORATION WITH COMMUNITIES, EMPLOYERS, SCHOOLS, AND GOVERNMENT OFFICIALS, WE SUPPORT INDIVIDUALS AND FAMILIES ON THEIR LIFELONG JOURNEY TOWARD OPTIMAL HEALTH. OUR COMMITMENT LIES IN DELIVERING SAFE, RELIABLE, AND COST-EFFECTIVE COMPREHENSIVE HEALTH SOLUTIONS, ALL WHILE UPHOLDING THE VALUES OF RESPECT AND COMPASSION. THROUGH OUR INNOVATIVE INITIATIVES, WE AIM TO TRANSFORM HEALTHCARE DELIVERY NOT ONLY IN OUR REGION BUT ALSO ON A GLOBAL SCALE. PART VI, LINE 7, REPORTS FILED WITH STATES WI 0 0 0 0 0 0 0 0 0 SCOTT RATHGABER CEO-BGHS 0 1274504 0 200000 0 169717 0 45225 0 23503 0 1712949 0 0 MARILU BINTZ MD BOARD MEMBER/MED VP BGHS (THRU 12/23 0 501037 0 0 0 38108 0 45225 0 8668 0 593038 0 0 STEVE LITTLE INTERIM CFO-BGHS (THRU 02/24) 0 258317 0 75000 0 0 0 0 0 0 0 333317 0 0 ANDY NAHAS VP/BGHS OPTOMETRIST 0 241137 0 4000 0 991 0 36298 0 26603 0 309029 0 0 JAMES KLOCK BOARD MEMBER/DIR OF REG IS 0 184909 0 1800 0 2433 0 27916 0 23503 0 240561 0 0 THERESA BRAUDT ADMINISTRATOR 0 185112 0 3421 0 0 0 27421 0 22003 0 237957 0 0 LISA WITTER PHARMACIST 159481 0 11772 0 636 0 6922 0 27152 0 205963 0 0 0 ALAN EBER BOARD MEMBER/DIR OF BUSINESS SERVICE 0 155096 0 0 0 5075 0 23539 0 21990 0 205700 0 0 KEITH FRYE SECRETARY/ADMIN DR LAB 0 156862 0 0 0 1776 0 23324 0 21994 0 203956 0 0 JENNIFER BOIGENZAHN FINANCE ADMINISTRATOR 0 149318 0 11000 0 1210 0 23246 0 287 0 185061 0 0 DAWN THORSTEN BOARD MEMBER/DIRECTOR OF QUALITY 0 125637 0 0 0 1078 0 19145 0 25154 0 171014 0 0 TARA WOOD PHARMACIST 141907 0 5850 0 304 0 0 0 14508 0 162569 0 0 0 KELSEY LOMAS RN 94174 0 32610 0 0 0 0 0 24565 0 151349 0 0 0 KERRY CAMPBELL RN 93827 0 37143 0 430 0 0 0 19744 0 151144 0 0 0 PART I, LINE 3 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. X 1 159556 FMV 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE ARTICLES OF INCORPORATION OF GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS PROVIDES FOR ONE MEMBER OF THE CORPORATION. THE SOLE CORPORATE MEMBER OF GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS IS GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7A AS THE SOLE CORPORATE MEMBER AND UNDER THE TERMS OF THE AFFILIATION AGREEMENT, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. MAY APPOINT, REMOVE, OR ELECT CERTAIN OFFICERS AND/OR MEMBERS OF THE BOARD OF DIRECTORS OF GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS. GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. MAY APPOINT SIX MEMBERS OF THE BOARD OF DIRECTORS OF GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. HAS THE FOLLOWING RESERVE RIGHTS OF APPROVAL: THE INCURRENCE OF DEBT (OTHER THAN DEBT INCURRED FOR THE ACQUISITION OF GOODS THAT ARE ACQUIRED IN THE ORDINARY COURSE OF BUSINESS OR DEBT INCLUDED IN APPROVED BUDGETS) AND THE GRANT OF ANY SECURITY INTEREST, PLACE ANY ENCUMBRANCES, ENTER INTO ANY COVENANTS, AND DIRECT EXECUTION OF ANY DOCUMENTS AND THE TAKING OF ANY ACTIONS NECESSARY OR APPROPRIATE IN CONNECTION WITH THE INCURRENCE OF SUCH DEBT: AND THE ANNUAL OPERATING BUDGET AND CAPITAL EXPENDITURES. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM AND THEN REVIEWED BY THE ORGANIZATION'S MANAGEMENT. A FINAL COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS DISCLOSES ANY CONFLICTS OF INTEREST BY COMPLETING A QUESTIONNAIRE AND DISCLOSURE FORM ANNUALLY. EMPLOYEES ARE REQUIRED TO REVIEW THE CONFLICT OF INTEREST POLICY UPON HIRE AND AT ANNUAL INTERVALS. IF ANY SIGNIFICANT CONFLICTS ARISE WITH MEMBERS OF THE BOARD OF DIRECTORS, MANAGEMENT, OR KEY EMPLOYEES, IT IS PROPERLY DOCUMENTED AND FOLLOWED UP ON BY THE APPROPRIATE GOVERNING GROUP OR DEPARTMENT WITHIN THE ORGANIZATION ACCORDING TO THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 FOR THE PURPOSES OF DETERMINING COMPENSATION, GUNDERSEN AREA BOSCOBEL HOSPITAL AND CLINICS RELIED ON ITS AFFILIATED ORGANIZATION, GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC., TO ESTABLISH COMPENSATION OF THE CEO, CFO, AND OTHER OFFICERS. GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. USED THE FOLLOWING PRACTICES FOR ESTABLISHING COMPENSATION FOR SUCH INDIVIDUALS: COMPENSATION SURVEY OR STUDY, COMPENSATION COMMITTEE, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 THE ABBREVIATED FINANCIAL STATEMENTS ARE MADE PUBLICLY AVAILABLE THROUGH THE WISCONSIN HOSPITAL ASSOCIATION AND THE COMPLETE AUDITED FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE ALSO AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G ADMINISTRATIVE/MANAGEMENT FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 84,585. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 84,585. CLINIC PHYSICIAN COVERAGE: PROGRAM SERVICE EXPENSES 9,644. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,644. ER PHYSICIAN COVERAGE: PROGRAM SERVICE EXPENSES 2,148,602. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,148,602. INFORMATION SYSTEMS PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 37,383. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 37,383. LAB SERVICES: PROGRAM SERVICE EXPENSES 736,070. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 736,070. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 441,743. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 441,743. RADIOLOGY PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,649,039. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,649,039. SPECIALTY SERVICES: PROGRAM SERVICE EXPENSES 571,997. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 571,997. SURGICAL SERVICES: PROGRAM SERVICE EXPENSES 521,214. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 521,214. FORM 990, PART XI, LINE 9: NET CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION -36,804. 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 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 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 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 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 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 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 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 HARMONY COMMUNITY HEALTHCARE INC 815 MAIN AVENUE S HARMONY MN 55939 410711606 HEALTH CARE MN 501(C)(3) LINE 10 GUNDERSEN LUTHERAN HEALTH SYSTEM 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 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 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 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 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 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 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 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 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 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 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-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 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 BEL-REGIONAL HOME MEDICAL INC 617 S ROOSEVELT GREEN BAY WI 54301 391504766 DURABLE MEDICAL EQUIPMENT, RETAIL PHARMACY, FITNESS WI N/A C 0 BG ASSURANCE COMPANY 20 GENESIS CLOSE PO BOX 30600 GEORGE TOWN GRAND CAYMAN, KY1 CJ SELF INSURANCE CJ N/A C 0 GUNDERSEN EDGE LLC 1836 SOUTH AVENUE LA CROSSE WI 54601 921783811 INNOVATION WI N/A C 0 GUNDERSEN LUTHERAN ENVISION LLC 1836 SOUTH AVENUE LA CROSSE WI 54601 264706546 RENEWABLE ENERGY WI N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0