2018-11-14T13:37:38-06:00 2017-12-31 390758449 WIPFLI LLP 4890 OWEN AYRES COURT SUITE 200 EAU CLAIRE WI 54701 990 2017-01-01 390845590 MEMORIAL HOSPITAL OF BOSCOBEL MEMO 6083754112 205 PARKER STREET BOSCOBEL WI 53805 DAVID HARTBERG CEO CEO 6083754112 2018-09-17 1 PAUL M TRACZEK CPA P01368830 7158323407 2018-08-14 216.54.158.12 2018-09-17 12:33:25 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 9EE82A27147B19BA1493F570C01C41C476B4566D 2017 2019-02-21 02:37:17Z GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS DAVID HARTBERG 205 PARKER STREET BOSCOBEL WI 53805 20148183 0 X WWW.GUNDERSENHEALTH.ORG/BOSCOBEL X 1952 WI WE WILL MEET THE PRIMARY AND IMMEDIATE HEALTH CARE NEEDS OF AREA RESIDENTS BY PROVIDING HIGH QUALITY SERVICES DELIVERED IN A COMPASSIONATE, PROFESSIONAL MANNER. 11 5 161 45 0 0 65561 47062 20067671 20065622 -27838 15531 20887 14245 20126281 20142460 0 0 0 0 7564801 7773349 0 0 0 10108770 9747808 17673571 17521157 2452710 2621303 15827857 17505139 6698024 5670185 9129833 11834954 X WE WILL MEET THE PRIMARY AND IMMEDIATE HEALTH CARE NEEDS OF AREA RESIDENTS BY PROVIDING HIGH QUALITY SERVICES DELIVERED IN A COMPASSIONATE, PROFESSIONAL MANNER. 0 0 10991370 16369186 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 FROM 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 2017, HOSPITAL PATIENT DAYS TOTALED 736 AND TOTAL OUTPATIENT ENCOUNTERS WERE 13,359. KEY STATISTICS INCLUDED IN THESE TOTALS WERE 439 MEDICAL/SURGICAL INPATIENT DAYS, 297 SWING BED DAYS, 4,241 EMERGENCY ROOM VISITS, AND 439 SURGICAL OUTPATIENT VISITS. 3118432 3015868 THE ORGANIZATION OPERATES FAMILY PRACTICE CLINICS IN THREE LOCATIONS TO ENSURE COMMUNITY MEMBERS HAVE ACCESS TO CONVENIENT, QUALITY PRIMARY CARE. DURING 2017, TOTAL OUTPATIENT ENCOUNTERS AT THESE CLINICS TOTALED 13,191. 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. 14109802 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 55 0 161 1 0 0 0 0 0 0 0 0 0 0 X 11 5 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 WI X RONDA FOSTERLING 6083754112 205 PARKER STREET BOSCOBEL WI 53805 X MARILU BINTZ MD BOARD MEMBER/MED VP GHS 0.50 40.00 X 0 561138 51877 PETE ESSER BOARD MEMBER 0.50 X 0 0 0 MICHELLE MUELLER BOARD MEMBER 0.50 X 0 0 0 JAMES KLOCK BOARD MEMBER/DIR OF REG IS 0.50 40.00 X 0 120493 21918 JEAN KRAUSE BOARD MEMBER/CHIEF QUALITY 0.50 40.00 X 0 242400 39945 CYNDE LARSEN BOARD MEMBER 0.50 X 0 0 0 KRAIG SCHUSTER BOARD MEMBER/VP GHS 0.50 40.00 X 0 213834 36444 JERRY BERGE PRESIDENT 0.50 0.30 X X 0 0 0 SCOTT KNIPRATH VICE PRESIDENT/EXEC DIR GH 0.50 40.00 X X 0 156158 24173 LORI BARRY TREASURER 0.50 X X 0 0 0 KEITH FRYE SECRETARY/ADMIN DIR - LAB 0.50 40.00 X X 0 111054 19695 DAVID HARTBERG CONTRACTED EE CEO 40.00 0.30 X 0 205746 52603 MELISSA USELMAN CONTRACTED EE CFO 40.00 X 0 89728 29289 DOUGLAS KNOBLE PHARMACIST 40.00 X 132767 0 25335 MICHELLE PETERSON APNP FAMILY MEDICINE 40.00 X 116958 0 6018 249725 1700551 307297 2 0 1 0 SOUTHERN WISCONSIN EMERGENCY PHYSICIANS PO BOX 674579 DETROIT MI 49685 ER PHYSICIAN COVERAGE 1477214 BEINBORN ANESTHESIA SC 62598 BLUFFS OF WILDERNESS PRAIRIE DU CHIEN WI 53821 CRNA PROFESSIONAL SERVICES 341484 MEDICAL SOLUTIONS 1010 N 102ND STREET SUITE 300 OMAHA NE 68114 CONTRACTED SURGICAL TECH 109289 3 38486 8576 47062 HOSPITAL PATIENT REVENUE 621110 16369186 16369186 CLINIC REVENUE 621110 3015868 3015868 680568 680568 20065622 15531 15531 19968 5723 14245 14245 14245 20142460 19385054 0 710344 X 377366 377366 5545455 4358549 1186906 124762 98059 26703 1334683 1049018 285665 391083 306427 84656 5086 5086 27933 27933 5551103 4523324 1027779 158646 158646 559300 377781 181519 459328 459328 97613 48517 49096 812250 812250 62954 62954 BILLABLE MEDICAL SUPPLI 1279780 1279780 REPAIRS & MAINTENANCE 321399 321399 PROVISION FOR BAD DEBTS 231613 231613 EQUIPMENT RENTAL 180803 180803 17521157 14109802 3411355 0 171211 171464 6143137 7344810 1940650 1892082 323498 361379 116621 139550 19160515 12520340 6672757 6640175 459983 955679 15827857 17505139 1706226 1570514 469541 381107 3962357 3686664 559900 31900 6698024 5670185 X 8709201 11330504 420632 504450 9129833 11834954 15827857 17505139 X 2621303 83818 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 4925 4925 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 $1,788 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 $3,137 OF THE FEES PAID BY THE ORGANIZATION IN 2017 RELATED TO LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE HEALTH CARE ENVIRONMENT IN THE STATE OF WISCONSIN. 348441 348441 12065962 7660217 4405745 6460177 4860123 1600054 285935 285935 6640175 GOODWILL 33729 INTEREST IN NET ASSETS OF FOUNDATION 504450 AMOUNTS RECEIVABLE TO THIRD-PARTY REIMBURSEMENT PROGRAMS 417500 955679 ASSET RETIREMENT OBLIGATION 31900 31900 19916570 5723 5723 19910847 231613 231613 20142460 17295267 5723 5723 17289544 231613 231613 17521157 PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE 5,723. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 231,613. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE 5,723. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 231,613. 1 1 1 X 1 X 1 1 0 1 1 209989 209989 0.01200 2301902 1910671 391231 0.02230 2511891 1910671 601220 0.03430 35305 35305 0.00200 5699534 4276448 1423086 0.08120 5734839 4276448 1458391 0.08320 8246730 6187119 2059611 0.11750 0 102635 51318 5816251 5849611 -33360 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 16 1 1 1 1 X HTTP://WWW.GUNDERSENHEALTH.ORG/COMMUNITY-ASSESSMENT/ X 1 16 1 HTTP://WWW.GUNDERSENHEALTH.ORG/COMMUNITY-ASSESSMENT/ 0 1 X 200.000000000000 400.000000000000 X X X X X X 1 1 X X X X 1 X HTTPS://WWW.GUNDERSENHEALTH.ORG/BOSCOBEL X HTTPS://WWW.GUNDERSENHEALTH.ORG/BOSCOBEL X HTTPS://WWW.GUNDERSENHEALTH.ORG/BOSCOBEL 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: INDIVIDUALS AND COMMUNITY MEMBERS REPRESENTING THEIR OWN INTERESTS WERE REACHED IN TWO WAYS: A GENERAL SURVEY COMPLETED AT PUBLIC EVENTS (COUNTY FAIRS, LOCAL FESTIVALS) AND FOCUS GROUPS. COMMUNITY MEMBERS COMPLETING THE WRITTEN SURVEY IDENTIFIED THEMSELVES BY AGE AND NUMBER OF CHILDREN IN HOUSEHOLD. FOCUS GROUPS PARTICIPANT WERE IDENTIFIED BY GENDER. 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. 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 DEPARTMENT3. CRAWFORD COUNTY UNIVERSITY OF WISCONSIN - EXTENSION4. GRANT COUNTY UNIVERSITY OF WISCONSIN - EXTENSION5. AGING AND DISABILITY RESOURCE CENTER - CRAWFORD AND GRANT COUNTIES MEMORIAL HOSPITAL OF BOSCOBEL PART V, SECTION B, LINE 11: THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS REVEALED A NUMBER OF NEEDS IN OUR COMMUNITIES THAT CAN BE SUMMARIZED AS: 1. THE NEED TO EMPOWER PEOPLE TO IMPROVE THEIR HEALTH2. THE NEED TO CONNECT PEOPLE TO SERVICES AND RESOURCES3. THE NEED TO CREATE A HEALTHY ENVIRONMENT AND A CULTURE OF WELLNESSTHE ACTION PLAN GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS HAS IMPLEMENTED ATTEMPTS TO TACKLE THESE ISSUES FROM A NUMBER OF DIFFERENT APPROACHES. TO EMPOWER PEOPLE TO IMPROVE THEIR HEALTH, WE HAVE PUT TOGETHER A NUMBER OF PROGRAMS AND SPECIALTY OUTREACHES THAT OFFER GREATER ABILITY FOR COMMUNITY MEMBERS TO IMPROVE THEIR OWN HEALTH. FOR EXAMPLE, WE HAVE ADDED A DIABETES EDUCATION PROGRAM THAT OFFERS GREATER EDUCATIONAL TRAINING AND CONNECTIVITY FOR THOSE MANAGING THEIR DIABETES. WE ALSO HAVE OFFERED EDUCATIONAL SEMINARS AND TRAINING FOR COMMUNITY MEMBERS, EMPLOYERS, AND LOCAL ENTITIES. SOME OF THOSE SEMINARS INCLUDE: MEDICATION RECONCILIATION, EMS TRAININGS, CPR, ETC. SECONDLY, WE HAVE HELPED CONNECT PEOPLE TO SERVICES AND RESOURCES BY SIGNIFICANTLY IMPROVING ACCESS TO SPECIALTY PROVIDERS IN OUR RURAL AREA. THIS HAS ALLOWED LOCAL RESIDENTS, MANY OF WHOM ARE LOW-INCOME OR ELDERLY, ACCESS TO SPECIALTY PROVIDERS THAT MAY HAVE BEEN DIFFICULT TO ACCESS WITH TRAVEL RESTRAINTS. A SPECIFIC PROGRAM THAT WAS NOTED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT AS NEEDED IS CANCER CARE. WE HAVE RECENTLY ADDED THAT TO OUR GROWING SPECIALTY SERVICES PROGRAM. ALSO, WE HAVE IMPLEMENTED TELEMEDICINE CAPABILITIES THAT ALLOWS GREAT ACCESS FOR FOLLOW-UP CARE WITH SPECIALTY PROVIDERS AND SERVICES NOT OFFERED AT OUR LOCATION. LASTLY, WE HAVE ENCOURAGED A HEALTHY ENVIRONMENT AND CULTURE OF WELLNESS BY HOSTING EDUCATIONAL SEMINARS AND CLASSES TO ENCOURAGE THESE BEHAVIORS. THIS INCLUDES EVENTS LIKE COOKING CLASSES, BLOOD PRESSURE SCREENINGS, CONCUSSION PREVENTION, AND MORE. WE HAVE ALSO DEVELOPED A GRIEF SUPPORT PROGRAM THAT SEEKS TO IMPROVE SOME OF THE MENTAL HEALTH SUPPORT LACKING IN OUR AREA. 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 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. AS A GENERAL RULE, A PATIENT'S INCOME, BASED ON FAMILY SIZE, MUST BE AT OR BELOW 200% 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 200% 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 THE EMERGENCY DEPARTMENT AND THE OPERATION OF THREE RURAL HEALTH CLINICS. THE EMERGENCY DEPARTMENT IS STAFFED 24-HOURS PER DAY TO PROVIDE NEEDED ACCESS TO EMERGENCY CARE IN THE BOSCOBEL, WISCONSIN, COMMUNITY OR AS REQUIRED BY REGULATIONS TO BE ON-CALL AND AVAILABLE TO PROVIDE ACCESS TO EMERGENCY CARE AS A PART OF OPERATING A HOSPITAL IN THE STATE OF WISCONSIN. 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: WHILE THERE IS GROWING AGREEMENT IN THE UNITED STATES ABOUT WHAT CONSTITUTES A NON-PROFIT HOSPITAL'S "COMMUNITY BENEFIT," THESE EFFORTS CONTINUE TO BE A WORK IN PROGRESS. 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 GROSS PATIENT 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 COLLECTIBILITY 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 DECEMBER 31, 2017, 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 2015, 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: GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS IS AFFILIATED WITH GUNDERSEN HEALTH SYSTEM. THIS AFFILIATION PROVIDES LOCAL SERVICES IN CARDIOLOGY, NEUROLOGY, PODIATRY, DERMATOLOGY, UROLOGY, GYNECOLOGY, ENDOCRINOLOGY, HEMATOLOGY/ONCOLOGY, AND VASCULAR MEDICINE AS WELL AS LAPAROSCOPIC AND ORTHOPEDIC SURGERY. PART VI, LINE 7, REPORTS FILED WITH STATES WI 0 0 0 0 0 0 0 0 0 MARILU BINTZ MD BOARD MEMBER/MED VP GHS 0 556800 0 0 0 4338 39150 0 12727 0 51877 561138 0 0 JEAN KRAUSE BOARD MEMBER/CHIEF QUALITY 0 239668 0 0 0 2732 32894 0 7051 0 39945 242400 0 0 KRAIG SCHUSTER BOARD MEMBER/VP GHS 0 211030 0 0 0 2804 30539 0 5905 0 36444 213834 0 0 SCOTT KNIPRATH VICE PRESIDENT/EXEC DIR GH 0 154982 0 0 0 1176 19929 0 4244 0 24173 156158 0 0 DAVID HARTBERG CONTRACTED EE CEO 0 202430 0 0 0 3316 29559 0 23044 0 52603 205746 0 0 DOUGLAS KNOBLE PHARMACIST 131568 0 0 0 1199 0 5448 0 19887 0 158102 0 0 0 SCHEDULE J, PART 1, LINE 3 FOR THE PURPOSE OF DETERMINING EXECUTIVE COMPENSATION, GUNDERSEN 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. A CITY OF BOSCOBEL WI 396005403 2007-07-26 4200000 EMERGENCY ROOM CONSTRUCTION AND REMODEL 0 0 0 B CITY OF BOSCOBEL WI 396005403 2003-03-01 2719054 PROVIDE FUNDS TO REFUND A PRIOR BOND ISSUE AND PURCHASE EQUIPMENT 0 0 0 A 1432889 4200000 84000 4116000 2007 0 0 1 1 B 1732162 2719054 54381 297952 2366721 2003 1 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 0 1 0 0 0 0 0 0 B 0 0 1 0 0 0 0 0 0 A 0 B 0 FORM 990, PART VI, SECTION A, LINE 3 AS AN AFFILIATE OF GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS WILL ROUTINELY DELEGATE VARIOUS MANAGEMENT OR SUPPORT FUNCTIONS TO RELATED ENTITIES. FOR EXAMPLE, THE CEO AND CFO OF GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS, AS WELL AS SEVERAL MEMBERS OF THE BOARD OF DIRECTORS, ARE EMPLOYEES OF GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. AND ITS AFFILIATED ORGANIZATIONS WHICH ARE ALSO TAX-EXEMPT ORGANIZATIONS. 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 GUNERSEN 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 INTERESTS, 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 INCURRANCE 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 VII, LINE 1A, EXPLANATION OF HOURS WORKED: SOME OFFICERS AND BOARD MEMBERS ARE EMPLOYED BY GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. AND ITS AFFILIATES. GUNDERSEN LUTHERAN HEALTH SYSTEM, INC.'S PURPOSE IS TO SERVE AS A SUPPORTING ORGANIZATION TO MULTIPLE SUBSIDIARY ORGANIZATIONS AS LISTED IN SCHEDULE R AND THESE OFFICERS AND BOARD MEMBERS OFTEN WORK IN EXCESS OF 40 HOURS PER WEEK PROVIDING SERVICES TO AFFILIATED ORGANIZATIONS. THESE HOURS ARE REFLECTED IN LINE 2 OF COLUMN B. FORM 990, PART IX, LINE 11G ER PHYSICIAN COVERAGE: PROGRAM SERVICE EXPENSES 1,485,757. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,485,757. CLINIC PHYSICIAN COVERAGE: PROGRAM SERVICE EXPENSES 918,349. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 918,349. RADIOLOGY PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 583,297. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 583,297. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,535,921. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,535,921. ADMINISTRATIVE/MANAGEMENT FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 455,867. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 455,867. INFORMATION SYSTEMS PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 571,912. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 571,912. FORM 990, PART XI, LINE 9: NET CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 83,818. FORM 990, PART XII, LINE 2C, SELECTION OF INDEPENDENT ACCOUNTANT: THE BOARD OF DIRECTORS OF GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS IS RESPONSIBLE FOR THE SELECTION OF THE INDEPENDENT ACCOUNTANT AND OVERSIGHT OF THE ANNUAL AUDIT. THE BOARD OF DIRECTORS MEETS WITH THE INDEPENDENT AUDITORS ON AN ANNUAL BASIS AND APPROVES THE AUDIT REPORT. THIS PROCESS HAS NOT CHANGED IN THE PAST YEAR. TRI-COUNTY MEMORIAL FOUNDATION INC 18601 LINCOLN STREET WHITEHALL WI 54773 300093022 FOUNDATION WI 501(C)(3) LINE 12B, II TRI-COUNTY MEMORIAL HOSPITAL INC 1 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1836 SOUTH AVENUE LA CROSSE WI 54601 391866425 SUPPORTING ORGANIZATION WI 501(C)(3) LINE 12B, II N/A 0 GUNDERSEN LUTHERAN MEDICAL CENTER INC 1910 SOUTH AVENUE LA CROSSE WI 54601 390813416 HEALTH CARE WI 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 GUNDERSEN CLINIC LTD 1836 SOUTH AVENUE LA CROSSE WI 54601 391028657 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 GUNDERSEN LUTHERAN CREDENTIALING SERVICES INC 1910 SOUTH AVENUE LA CROSSE WI 54601 391856898 CREDENTIALING SERVICES WI 501(C)(3) LINE 12D, III-O GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 GUNDERSEN ADMINISTRATIVE SERVICES INC 1910 SOUTH AVENUE LA CROSSE WI 54601 391606449 SUPPORTING ORGANIZATION WI 501(C)(3) LINE 12C, III-FI 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 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 11 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 TRI-STATE AMBULANCE INC 235 CAUSEWAY BLVD LA CROSSE WI 54603 391965415 MEDICAL TRANSPORTATION WI 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 LUTHERAN REAL ESTATE HOLDING CORPORATION 1910 SOUTH AVENUE LA CROSSE WI 56401 391480826 HOUSING WI 501(C)(3) LINE 12D, III-O GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 LUTHERAN HOUSING OF LA CROSSE INC 1900 SOUTH AVENUE LA CROSSE WI 54601 391751934 INDEPENDENT LIVING WI 501(C)(3) LINE 11 LUTHERAN REAL ESTATE HOLDING CORP 1 COMMUNITY HOUSING OF LA CROSSE INC 1900 SOUTH AVENUE LA CROSSE WI 54601 391586700 INDEPENDENT LIVING WI 501(C)(3) LINE 11 LUTHERAN REAL ESTATE HOLDING CORP 1 OPTIONS IN REPRODUCTIVE CARE INC 1201 CALEDONIA STREET LA CROSSE WI 54603 391166634 HEALTH CARE 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 ST JOSEPH'S HEALTH SERVICES INC 400 WATER AVENUE HILLSBORO WI 54634 390929538 HEALTH CARE WI 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEM 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 MEMORIAL HOSPITAL OF BOSCOBEL FOUNDATION INC 205 PARKER STREET BOSCOBEL WI 53805 391688793 FOUNDATION WI 501(C)(3) LINE 7 MEMORIAL HOSPITAL OF BOSCOBEL 1 GUNDERSEN EXPRESS CARE INC 1836 SOUTH AVENUE LA CROSSE WI 54601 900102388 HEALTH CARE WI 501(C)(3) LINE 12B, II GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 ST JOSEPH'S MEMORIAL FOUNDATION INC 400 WATER AVENUE HILLSBORO WI 54634 391455787 FOUNDATION WI 501(C)(3) LINE 12B, II ST JOSEPH'S HEALTH SERVICES 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 PALMER MEMORIAL FOUNDATION 112 JEFFERSON STREET WEST UNION IA 52175 421032878 FOUNDATION IA 501(C)(3) LINE 7 PALMER LUTHERAN HEALTH CENTER 1 MOUNDVIEW MEMORIAL HOSPITAL & CLINICS INC 402 W LAKE STREET FRIENDSHIP WI 53934 390944012 HEALTH CARE WI 501(C)(3) LINE 3 GUNDERSEN LUTERHAN 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 DEGEN BERGLUND INC 1709 LOSEY BLVD S LA CROSSE WI 54601 390971110 RETAIL PHARMACY WI GUNDERSEN LUTHERAN HEALTH SYSTEM INC C 1 GUNDERSEN ENVISION LLC 1836 SOUTH AVENUE LA CROSSE WI 54601 264706546 RENEWABLE ENERGY WI GUNDERSEN LUTHERAN HEALTH SYSTEM INC C 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0