2017-11-14T16:53:55-06:00 2016-12-31 KPMG LLP 4200 WELLS FARGO CTR 90 S 7TH ST MINNEAPOLIS MN 55402 990 2016-01-01 391028657 Gundersen Clinic Ltd % DARA BARTELS GUND 6087827300 1836 SOUTH AVENUE LA CROSSE WI 54601 DARA BARTELS CFO 2017-11-15 true Monroe J Gierl P01413237 6123055000 2017-11-15 167.68.102.5 41438720173185000004 2017-11-14 P CBDCF8A62BCD6705D428F3975F29828786D22771 30031D5E7EADAC179FA13A5C3B90D0218042D0DA 2016 2021-01-29 14:40:06Z SCOTT RATHGABER MD CE0 1836 SOUTH AVENUE LA CROSSE WI 54601 185529538 false X WWW.GUNDERSENHEALTH.ORG X 1963 WI SEE SCHEDULE O 9 0 0 0 255323 -39256 1620820 168597 168247129 185049835 -15032 -61595 -9750 119411 169843167 185276248 2760639 2512410 0 0 98736594 104161343 0 0 0 87835105 72471065 189332338 179144818 -19489171 6131430 176008200 188524543 452497081 458894390 -276488881 -270369847 X 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. false true 129257624 2512410 184794512 SEE SCHEDULE O 129257624 true true false true false false false false false false true false false false true true false true false false false false false false false false false true true true false false false false false false false false false false false false false true false true false true 0 0 0 true true false false false false false false false false false X 9 0 false false false false true true true true true false false true true true true true true true true false WI X DARA BARTELS 6087759487 1900 SOUTH AVENUE NCA1-01 LA CROSSE WI 54601 X Scott Rathgaber MD CEO, Board Chair 2.0 46.0 X X 0 849051 65310 Julio Bird MD Board of Governors - 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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 24087 219895 24087 219895 179120731 1847029847 179144818 1847249742 1000000 1000000 250000 250000 1000000 1000000 1000000 1000000 4000000 6000000 243735 281562 271755 219895 1016947 250000 250000 250000 250000 1000000 1500000 9290892 9290892 204920593 90240446 114680147 1766044 1292714 473330 91149022 70271511 20877511 145321880 0 ASSET RETIREMENT OBLIG-FIN47 1493460 INTERCOMPANY PAYABLE 431731263 RESERVE MALPRACTICE CLAIMS 1479499 LT MALPRACTICE CLAIMS RSV 6837115 441541337 X SCHEDULE 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 Health Plan, Inc. and Gundersen Health Plan Minnesota, Inc., which are tax-exempt organizations under 501(c)(4) of the Code, and Degen Berglund, Inc. and Gundersen Lutheran Envision, LLC, which are for-profit entities. At December 31, 2016 and 2015, net deferred tax assets of $3,493 and $3,083 , respectively, which primarily are related to net operating loss carryforwards, have valuation allowances of $2,766 and $2,205, respectively, recorded against them due to the uncertainty of realizing those benefits in the future. At December 31, 2016, the System's federal net operating loss carryforwards were approximately $27,109, and the state net operating loss carryforwards were approximately $22,902, which will expire between 2025 and 2034. 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 2012 and prior years. true Gundersen Lutheran Medical Foundation Inc 1836 South Avenue La Crosse WI 54601 391249705 501 (C) (3) 897684 Support of GLMF, Inc. LUTHERAN MEDICAL FOUNDATION, INC. 1 Charity Care 8039 1614726 BOOK CHARITY CARE SCHEDULE I, Part I, Line 2: ASSISTANCE WAS TO RELATED ORGANIZATIONS, FUNDS ARE MONITORED BY MANAGEMENT AND THE BOARD OF GOVERNORS. true false false false false false false false false Scott Rathgaber MD CEO, Board Chair 0 794496 0 50000 0 4555 0 39750 0 25614 0 914415 0 0 Julio Bird MD Board of Governors - Member 0 679496 0 0 0 62868 0 39750 0 23596 0 805710 0 0 Sigurd Gundersen III MD Board of Governors - Member 0 386496 0 0 0 4555 0 39750 0 23602 0 454403 0 0 Brian Sieck MD Secretary/Treasurer/BOG 0 391446 0 5000 0 333 0 39750 0 30346 0 466875 0 0 Stephen Shapiro MD Board of Governors - Member 0 442396 0 5000 0 373 0 39750 0 30296 0 517815 0 0 Brian Mulrennan MD Board of Governors - Member 0 298946 0 13000 0 3764 0 38232 0 26164 0 380106 0 0 Jonathan Zlabek MD Board of Governors - Member 0 296496 0 7500 0 4093 0 29150 0 26114 0 363353 0 0 Greg Thompson MD Board of Governors, CMO 0 429880 0 0 0 4555 0 39938 0 24614 0 498987 0 0 Kelley Bahr MD Board of Governors - Member 0 355000 0 0 0 4195 0 36250 0 54 0 395499 0 0 Todd Kowalski MD BOG - Member, Medical VP 0 308995 0 7500 0 13 0 33916 0 28915 0 379339 0 0 P Michael Jacobs DPM Medical Vice President 0 348996 0 3000 0 7455 0 39750 0 26114 0 425315 0 0 Mary Kuffel MD Medical Vice President 0 461912 0 0 0 4195 0 39750 0 1318 0 507175 0 0 Stephanie Carroll MD Medical Vice President 0 297744 0 7000 0 13 0 39750 0 18868 0 363375 0 0 Lisa Wied Vice President 0 117528 0 0 0 8799 0 18488 0 54 0 144869 0 0 Mike McKee Vice President 0 116812 0 0 0 23552 0 21901 0 26961 0 189226 0 0 Kraig Schuster Vice President 0 200584 0 0 0 360 0 30033 0 26372 0 257349 0 0 Elizabeth Smith-Houskamp Vice President, Admin COO 0 365917 0 0 0 13435 0 39750 0 54 0 419156 0 0 Bryan Erdmann Vice President 0 231686 0 0 0 1501 0 35625 0 28845 0 297657 0 0 Kelly Barton Vice President 0 121266 0 0 0 1579 0 4908 0 1850 0 129603 0 0 Michael Dolan MD Executive VP, Medical COO 0 589058 0 5000 0 13 0 39750 0 27796 0 661617 0 0 Marilu Bintz MD Senior VP, Medical VP 0 572848 0 0 0 4542 0 39750 0 10156 0 627296 0 0 Kathleen Klock Senior Vice President 0 427000 0 0 0 120 0 39750 0 4236 0 471106 0 0 Mark Platt Senior Vice President 0 373996 0 0 0 4182 0 39750 0 23614 0 441542 0 0 Debra Rislow Senior VP, Admin COO 0 158366 0 0 0 231506 0 23925 0 14945 0 428742 0 0 Rose Ann-Laureto Chief Information Officer 0 197938 0 0 0 345 0 21827 0 5906 0 226016 0 0 Dara Bartels Chief Financial Officer 0 305237 0 25010 0 3686 0 39750 0 23614 0 397297 0 0 Frank Aberger MD Former BOG - Member 0 302326 0 0 0 3987 0 29150 0 26164 0 361627 0 0 William Agger MD Former BOG - Member 0 200784 0 5000 0 373 0 31500 0 26148 0 263805 0 0 Mary Lu Gerke Former Vice President 0 198836 0 0 0 0 0 30000 0 11616 0 240452 0 0 Jeffrey Thompson MD Former CEO, Board Chair 0 243996 0 0 0 3448 0 37500 0 26114 0 311058 0 0 Jeffrey Lawrence MD Medical Doctor 0 1051496 0 0 0 4195 0 39750 0 23614 0 1119055 0 0 Edward Riley II MD Medical Doctor 0 1219996 0 0 0 163 0 39750 0 30296 0 1290205 0 0 Jerry Davis MD Medical Doctor 0 1191496 0 0 0 4195 0 29150 0 23614 0 1248455 0 0 Patrick Conway MD Medical Doctor 0 966496 0 2500 0 13 0 39750 0 27796 0 1036555 0 0 Douglas Hughes MD Medical Doctor 0 1036496 0 0 0 39922 0 29150 0 23614 0 1129182 0 0 SCHEDULE J, PART I, LINE 1A, 2 AND 3: 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. SCHEDULE J, PART I, LINE 4A: 2016 Severance Payments: Debra Rislow $230,500 Form 990, Part I, Line 1: DESCRIPTION OF ORGANIZATION MISSION 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 3 Gundersen Clinic, Ltd. transferred three Iowa rural health clinics (Postville, West Union, and Fayette) to Palmer Lutheran Health Center, Inc. as part of a planned strategy and as Phase II of our affiliation on July 1, 2016. Form 990, Part III, Line 4a: PROGRAM SERVICE ACCOMPLISHMENTS GUNDERSEN CLINIC, LTD. (THE CLINIC) HAS 540 PHYSICIANS REPRESENTING NEARLY EVERY SPECIALTY SERVING A 19 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 998,100 PATIENT ENCOUNTERS FOR 2016. THE CLINIC PROVIDED UNCOMPENSATED CARE RELATED TO CHARITY, $1,104,804; MEDICARE, $32,792,397; AND MEDICAID, $12,362,141 FOR THE TOTAL AMOUNT OF $46,259,342 AT COST BASED ON POLICIES AND CONTRACTS ARRANGED TO HELP SUPPORT THE COMMUNITY'S NEEDS. THE $46,259,342 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. UNREIMBURSED COST IS THE AMOUNT THE COST EXCEEDS THE NET REVENUE. 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 VI, Section A, 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, Section A, 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, Section B, 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 THE 990S ARE APPROVED AND FILED. Form 990, Part VI, Section B, Line 12c: GUNDERSEN CLINIC, LTD. MONITORS CONFLICTS ON AN ANNUAL BASIS BY REVIEWING DISCLOSURES ON COMPLETED CONFLICT OF INTEREST STATEMENTS. Form 990, Part VI, Section B, Line 15a: 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, Section C, 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: ALL PERSONNEL SERVICES FOR GUNDERSEN CLINIC, LTD. ARE PERFORMED BY EMPLOYEES OF GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. Form 990, Part VII, Section B, Line 1: ALL PAYMENTS TO VENDORS ARE MADE BY 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 2c: THE PROCESS ALLOWS THE AUDIT COMMITTEE OF GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. TO INDEPENDENTLY COMMUNICATE WITH THE EXTERNAL AUDIT FIRM THROUGHOUT THE YEAR, BUT FORMAL COMMUNICATION OCCURS BEFORE THE ENGAGEMENT AND UPON CONCLUSION. THE AUDIT COMMITTEE MEETS WITH THE AUDIT FIRM FOR PRESENTATION OF THE STATEMENTS. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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 SYSTEM INC 1836 SOUTH AVENUE LA CROSSE WI 54601 391866425 SUPTNG. 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