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HOWEVER, THE CLINIC IS NOT REQUIRED TO BE LICENSED, REGISTERED, OR SIMILARLY RECOGNIZED BY THE STATE OF WISCONSIN AS A HOSPITAL AND IS NOT REQUIRED TO FILE SCHEDULE H. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 0 16182 259182 16182 259182 269911343 2259539940 269927525 2259799122 1000000 1000000 250000 250000 1000000 1000000 1000000 1000000 4000000 6000000 243711 231180 242328 259182 976401 250000 250000 250000 250000 1000000 1500000 9215613 9215613 253650418 117365895 136284523 100694172 71911478 28782694 174282830 0 INTERCOMPANY PAYABLE 727274782 MALPRACTICE CLAIM RESERVE 8030549 ASSET RETIREMENT OBLIGATIONS 1149457 OPERATING LEASE OBLIGATIONS 5682903 LEASE CONTRACT PAYABLE 18342 742156033 X FORM 990, SCH D, PART X LINE 2 INCOME TAX MATTERS (DOLLARS IN THOUSANDS) THE SYSTEM QUALIFIES AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE), WITH THE EXCEPTION OF GUNDERSEN LUTHERAN ENVISION, LLC, WHICH IS A FOR-PROFIT ENTITY. AT DECEMBER 31, 2020 AND 2019, NET DEFERRED TAX ASSETS OF $7,948 AND $6,900, RESPECTIVELY, WHICH PRIMARILY ARE RELATED TO NET OPERATING LOSS CARRYFORWARDS, HAVE VALUATION ALLOWANCES OF $7,948 AND $6,900, RESPECTIVELY, RECORDED AGAINST THEM DUE TO THE UNCERTAINTY OF REALIZING THOSE BENEFITS IN THE FUTURE. AT DECEMBER 31, 2020, THE SYSTEM'S FEDERAL NET OPERATING LOSS CARRYFORWARDS WERE APPROXIMATELY $29,800, AND THE STATE NET OPERATING LOSS CARRYFORWARDS WERE APPROXIMATELY $27,900, WHICH WILL EXPIRE BETWEEN 2029 AND 2038. 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 2015 and prior years. true GUNDERSEN LUTHERAN MEDICAL FOUNDATION INC 1836 SOUTH AVENUE LA CROSSE WI 54601 391249705 501(C)(3) 1305876 OPERATIONS support 1 CHARITY CARE 3284 863420 BOOK CHARITY CARE FORM 990, SCHEDULE I, LINE 2 DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS ASSISTANCE WAS TO A RELATED ORGANIZATION, FUNDS ARE MONITORED BY MANAGEMENT AND THE BOARD OF GOVERNORS. false false false false false false false BENJAMIN JARMAN MD BOARD OF GOVERNORS - MEMBER 0 424409 0 2500 0 5192 0 41325 0 16134 0 489560 0 0 Brian Sieck MD FORMER OFFICER 0 389784 0 2500 0 4692 0 41325 0 16134 0 454435 0 0 Bryan Erdmann Administrative Vice President 0 262558 0 0 0 4611 0 38960 0 25841 0 331970 0 0 Douglas Hughes MD Medical Doctor 0 1005021 0 0 0 4692 0 29925 0 19350 0 1058988 0 0 Edward Riley II MD Medical Doctor 0 999100 0 0 0 0 0 41325 0 20826 0 1061251 0 0 Elizabeth Smith-Houskamp PhD RN Administrative Chief Operating 0 428058 0 80000 0 5011 0 41325 0 54 0 554448 0 0 Ellen Pedretti-Fendt Vice President Application Ser 0 176454 0 0 0 500 0 26166 0 22447 0 225567 0 0 Garith Steiner Former Vice President 0 192603 0 0 0 0 0 27232 0 2658 0 222493 0 0 Gerald Oetzel Chief Financial Officer 0 519912 0 0 0 14958 0 41325 0 19350 0 595545 0 0 Gregory Thompson MD Medical Governors - Member, Ch 0 449192 0 0 0 5192 0 41325 0 19850 0 515559 0 0 Janine Luz Vice President Learning 0 174099 0 0 0 3219 0 25680 0 15624 0 218622 0 0 Jeffrey Lawrence MD Medical Doctor 0 1041464 0 0 0 4692 0 41325 0 19350 0 1106831 0 0 Jennifer Kleven MD Medical Governors - Member 0 184125 0 0 0 2715 0 27092 0 2734 0 216666 0 0 Jerry Davis MD Medical Doctor 0 1053188 0 0 0 4692 0 29925 0 19350 0 1107155 0 0 Jonathan Zlabek MD BD OF GVNRS- MEMBR (END 7/20) 0 364979 0 0 0 5192 0 41325 0 21850 0 433346 0 0 Julio Bird MD Medical Governors - Member 0 471704 0 0 0 4692 0 41325 0 19326 0 537047 0 0 Kari Adank Vice President Compliance 0 206787 0 0 0 22 0 30493 0 22377 0 259679 0 0 Kelley Bahr MD Medical Governors - Member 0 347875 0 0 0 13384 0 41325 0 54 0 402638 0 0 Kraig Schuster Administrative Vice President 0 234492 0 0 0 2753 0 33473 0 25209 0 295927 0 0 Lisa Wied Administrative Vice President 0 227350 0 0 0 3992 0 33126 0 21350 0 285818 0 0 Marilu Bintz MD Chief Population Health Office 0 569125 0 0 0 5236 0 41325 0 7386 0 623072 0 0 Mary Ellen McCartney Chief Human Resources Officer 0 330056 0 0 0 545 0 41325 0 13602 0 385528 0 0 Mary Kuffel MD Medical Vice President 0 488762 0 0 0 4692 0 41325 0 1446 0 536225 0 0 Michael Dolan MD Exec VP, Medical Chief Operati 0 578153 0 0 0 42891 0 41325 0 25542 0 687911 0 0 Michael McKee Administrative Vice President 0 226650 0 0 0 500 0 33764 0 25399 0 286313 0 0 P Michael Jacobs DPM MEDICAL VICE PRESIDENT 0 383071 0 0 0 47961 0 41325 0 21832 0 494189 0 0 Pamela Maas Vice President Business SVCS 0 236563 0 0 0 3948 0 34302 0 54 0 274867 0 0 Daniel P Breazeale Vice President Finance 0 226059 0 0 0 14665 0 24104 0 19350 0 284178 0 0 Robyn Borge MD BD OF GVNRS -MEMBR(AS OF 6/20) 0 262717 0 0 0 4318 0 38002 0 2754 0 307791 0 0 Scott Rathgaber MD Chief Executive Officer, Medic 0 871829 0 0 0 5214 0 41325 0 20850 0 939218 0 0 Stephanie Carroll MD MED VICE PRESIDENT (END 7/20) 0 297121 0 2500 0 37306 0 35738 0 23676 0 396341 0 0 Todd Kowalski MD MEDICAL VICE PRESIDENT 0 380988 0 10000 0 44 0 41325 0 25042 0 457399 0 0 William Farrell Chief Business & Strategy Offi 0 380667 0 0 0 16439 0 29925 0 54 0 427085 0 0 Chris Eberlein MD BD OF GVNRS -MEMBR(AS OF 1/20) 0 359403 0 2500 0 15658 0 41325 0 26042 0 444928 0 0 Stephanie Neuman MD BD OF GVNRS -MEMBR(AS OF 1/20) 0 431238 0 0 0 500 0 41325 0 28842 0 501905 0 0 Kurt Oettel MD BD OF GVNRS -MEMBR(AS OF 1/20) 0 417934 0 2500 0 5214 0 41325 0 19350 0 486323 0 0 Todd Bille Vice President Growth, Strateg 0 139533 0 0 0 7175 0 19882 0 32 0 166622 0 0 Kurt Ziegelbein MD Medical Doctor 0 981324 0 0 0 60384 0 41325 0 22050 0 1105083 0 0 FORM 990, SCH J, PART I LINES 2 &3 ALL PERSONNEL SERVICES FOR GUNDERSEN CLINIC, LTD. ARE PERFORMED BY EMPLOYEES OF GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. FORM 990, SCH J, PART II GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. PROVIDES LEASED EMPLOYEES AND MANAGEMENT SERVICES TO GUNDERSEN CLINIC. THEREFORE, THE AMOUNTS REPORTED ON SCHEDULE J REPRESENT REIMBURSEMENTS TO GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. FORM 990, PART I LINE 1 TO PROVIDE MEDICAL AND SURGICAL SERVICES, ENGAGE IN MEDICAL EDUCATION AND RESEARCH, AND PROMOTE COMMUNITY HEALTH TO DELIVER THE HIGHEST QUALITY COMPREHENSIVE HEALTH CARE TO ALL PATIENTS WITHOUT REGARD TO THEIR ABILITY TO PAY. FORM 990, PART III LINE 4A PROGRAM SERVICE ACCOMPLISHMENTS: GUNDERSEN CLINIC, LTD. (THE CLINIC) HAS 625 PHYSICIANS REPRESENTING NEARLY EVERY SPECIALTY SERVING A 22 COUNTY REGION IN WESTERN WISCONSIN, NORTHEASTERN IOWA AND SOUTHEASTERN MINNESOTA. THE CLINIC PROVIDES MEDICAL CARE TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. CHARITY CARE AND/OR FINANCIAL ASSISTANCE IS DETERMINED BASED ON FINANCIAL INFORMATION PROVIDED BY THE PATIENT AND ANALYSIS OF OTHER RELEVANT INFORMATION. THERE WERE APPROXIMATELY 900,314 PATIENT ENCOUNTERS FOR 2020. THE CLINIC PROVIDED UNCOMPENSATED CARE RELATED TO CHARITY AT COST, $698,187; MEDICARE, $27,153,494; AND MEDICAID, $11,864,711 FOR THE TOTAL AMOUNT OF $39,716,392 AT COST BASED ON POLICIES AND CONTRACTS ARRANGED TO HELP SUPPORT THE COMMUNITY'S NEEDS. THE $39,716,392 IS THE SUM OF UNREIMBURSED MEDICARE & MEDICAID COST PLUS CHARITY AT COST. ALL OF THESE ARE CALCULATED USING THE SAME METHOD UTILIZED FOR THE HOSPITAL CALCULATION OF CHARITY COST AND UNREIMBURSED MEDICARE AND MEDICAID COSTS. THE COST OF CHARITY IS CALCULATED BY ALLOCATING THE COST TO PROVIDE SERVICES TO A PATIENT BETWEEN ANY PAYMENTS, BAD DEBT, AND CHARITY WRITE-OFFS WHERE TOTAL PAYMENTS ARE LESS THAN THE COST OF SERVICES PROVIDED. THE UNREIMBURSED MEDICARE AND MEDICAID COSTS ARE CALCULATED BY COMPARING THE COST OF SERVICES TO MEDICARE AND MEDICAID PATIENTS TO THE NET REVENUE FOR THOSE SAME PATIENTS. THE UNREIMBURSED COST IS THE AMOUNT THE COST EXCEEDS THE NET REVENUE FOR THOSE SAME PATIENTS. MEDICARE AND MEDICAID PATIENTS TO THE NET REVENUE FOR THOSE SAME PATIENTS. THE UNREIMBURSED COST IS THE AMOUNT THE COST EXCEEDS THE NET REVENUE FOR THOSE SAME PATIENTS. FORM 990, PART IV LINE 24A TAX EXEMPT BONDS GUNDERSEN CLINIC, LTD. IS PART OF THE OBLIGATED GROUP (GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC., GUNDERSEN LUTHERAN MEDICAL CENTER, INC., GUNDERSEN CLINIC, LTD., AND GUNDERSEN LUTHERAN MEDICAL FOUNDATION, INC.) AND TAX-EXEMPT DEBT RESIDES ON THE BALANCE SHEET OF GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. FEIN 39-1606449. FORM 990, PART V LINES 1 & 2 ALL PERSONNEL SERVICES FOR GUNDERSEN CLINIC, LTD. ARE PERFORMED BY EMPLOYEES OF GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. AND ALL PAYMENTS TO VENDORS ARE MADE BY GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. HENCE LINES 1 & 2 INDICATE ZERO (0) FILINGS. FORM 990, PART VI LINE 3 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 6 GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF THIS ORGANIZATION. FORM 990, PART VI LINE 7A GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. FORM 990 PART VI LINE 7B THE CORPORATION'S SOLE SHAREHOLDER IS GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. THE BYLAWS MAY BE AMENDED BY THE BOARD WITH APPROVAL OF THE PARENT CORPORATION, OR BY THE VOTE OF THE SOLE SHAREHOLDER. ALSO, THE AFFAIRS OF THE CORPORATION SHALL BE MANAGED UNDER THE DIRECTION OF THE CORPORATION'S BOARD OF GOVERNORS, SUBJECT TO CERTAIN APPROVAL POWERS OF THE BOARD OF GOVERNORS AND BOARD OF TRUSTEES OF THE PARENT CORPORATION. FORM 990, PART VI LINE 11B THE FORM 990 WILL BE AVAILABLE FOR ALL BOARD MEMBERS AT A BOARD MEETING AND THE GUNDERSEN LUTHERAN HEALTH SYSTEM FINANCE COMMITTEE RECEIVES A COPY OF THE 990 BEFORE FILING. UPON FURTHER REVIEW FROM THE CFO AND/OR THE EXECUTIVE DIRECTOR FINANCE, THE 990S ARE APPROVED AND FILED. FORM 990, PART VI LINE 12C GUNDERSEN CLINIC, LTD. MONITORS CONFLICTS ON AN ANNUAL BASIS BY REVIEWING DISCLOSURES ON COMPLETED CONFLICT OF INTEREST STATEMENTS. FORM 990, PART VI LINE 15 ALL PERSONNEL SERVICES FOR GUNDERSEN CLINIC, LTD. ARE PERFORMED BY EMPLOYEES OF GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. THE COMPENSATION OF THE CEO IS DETERMINED ANNUALLY BY A COMMITTEE MADE UP OF THE COMMUNITY MEMBERS OF THE BOARD OF TRUSTEES. THEIR DETERMINATION IS MADE AFTER A REVIEW OF MARKET DATA OBTAINED FROM SEVERAL ORGANIZATIONS AND CEO PERFORMANCE. MEETING MINUTES ARE TAKEN AND KEPT AT THE MEETINGS WHERE SUCH DISCUSSIONS TAKE PLACE. RECOMMENDATIONS FOR COMPENSATION FOR THE ORGANIZATIONS' KEY MANAGEMENT EMPLOYEES ARE DEVELOPED ANNUALLY BY THE CEO, AFTER A REVIEW OF PERFORMANCE AND COMPARABLE MARKET DATA. THE PROPOSED SALARIES ARE INDEPENDENTLY REVIEWED BY AN OUTSIDE AUDITING FIRM. THE COMPENSATION RECOMMENDATIONS, AUDIT REPORTS, ALONG WITH THE MARKET DATA, ARE PRESENTED TO A COMMITTEE MADE UP OF THE COMMUNITY MEMBERS OF THE BOARD OF TRUSTEES. THE COMPENSATION AMOUNTS ARE NOT EFFECTIVE UNTIL THE BOARD COMMITTEE APPROVES THEM. MEETING MINUTES ARE TAKEN AND KEPT AT THE MEETINGS WHERE THE BOARD REVIEWS AND APPROVES THE COMPENSATION OF THE KEY EMPLOYEES. FORM 990, PART VI LINE 19 REQUESTS FOR ALL DOCUMENTS ARE MADE THROUGH THE LEGAL DEPARTMENT AND THE APPROPRIATE DOCUMENTS ARE MADE AVAILABLE FOR INSPECTION IN THE LEGAL DEPARTMENT. FORM 990, PART VII, SECTION A, LINE 1 & PART VI SECTION A LINE 3 GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. PROVIDES LEASED EMPLOYEES AND MANAGEMENT SERVICES TO GUNDERSEN CLINIC. THEREFORE, THE AMOUNTS REPORTED ON PART VII REPRESENT REIMBURSEMENTS TO GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. FORM 990, PART VIII LINE 2A THE PROVISION OF MEDICAL SERVICES IN A MANNER BENEFICIAL TO THE COMMUNITY FURTHERS GUNDERSEN CLINIC, LTD.'S CHARITABLE PURPOSE OF PROMOTION OF HEALTH. FORM 990, PART XII LINE 3A THE INFORMATION IN THE SCHEDULE IS PRESENTED IN ACCORDANCE WITH THE REQUIREMENTS OF TITLE 2 U.S. CODE OF FEDERAL REGULATIONS PART 200, UNIFORM ADMINISTRATIVE REQUIREMENTS, COST PRINCIPLES, AND AUDIT REQUIREMENTS FOR FEDERAL AWARDS. GUNDERSEN LUTHERAN HEALTH SYSTEMS INC 1836 SOUTH AVENUE LA CROSSE WI 54601 391866425 SUPTNG ORG. WI 501(C)(3) LINE 12B II NA false GUNDERSEN LUTHERAN MEDICAL CENTER INC 1910 SOUTH AVENUE LA CROSSE WI 54601 390813416 HEALTHCARE WI 501(C)(3) Line 3 GLHS false GUNDERSEN LUTHERAN ADMINISTRATIVE SVC 1910 SOUTH AVENUE LA CROSSE WI 54061 391606449 SUPTNG ORG. 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