2014-11-14T13:48:48-06:00 2013-12-31 KPMG LLP 1212 North 96th Street Suite 300 Omaha NE 68114 990 2013-01-01 391028657 GUNDERSEN CLINIC LTD % DARA BARTELS GUND 6087827300 1836 SOUTH AVENUE Suite LA CROSSE WI 54601 KATHLEEN KLOCK SENIOR VICE PRESIDENT 6087756600 2014-10-27 true Donald Neal Jr P00798244 6087756600 2013 2015-11-30 17:44:51Z jeffrey thompson 1836 SOUTH AVENUE LA CROSSE WI 54601 193839094 false X www.gundersenhealth.org X 1963 WI SEE SCHEDULE O 10 0 0 0 288798 -52239 411665 150042 514739344 193405320 957872 205626 32352 25448 516141233 193786436 871536 10240929 0 0 285575653 179299817 0 0 0 257199107 224269808 543646296 413810554 -27505063 -220024118 401080849 171892241 402843261 393678771 -1762412 -221786530 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 339208740 10240614 193116522 SEE SCHEDULE O 339208740 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 10 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 Jeffrey Thompson MD Chief Executive Officer 2.0 44.0 X X 0 737331 56128 Julio Bird MD Board of Governors - Exec VP 2.0 44.0 X X 662971 53628 Frank Aberger MD Board of Governors - Member 2.0 44.0 X 384901 54228 Brian Sieck MD BOARD OF GOVERNORS- SEC/TREAS 2.0 44.0 X X 370447 56128 Stephen Shapiro MD Board of Governors - Member 2.0 47.0 X 437797 56128 Brian Mulrennan MD Board of Governors - Member 2.0 44.0 X 304377 54607 Jonathan Zlabek MD BOARD OF GOVERNORS - MEMBER 2.0 44.0 X 275155 54540 GREGORY THOMPSON MD CMO BOARD OF GOVERNORS - MEMBER 2.0 46.0 X X 355777 56128 Kelley Bahr MD Board of Governors - Member 2.0 44.25 X 247026 34940 William Agger MD Board of Governors - Member 2.0 44.0 X 244185 52926 Gordon Edwards Chief Financial Officer 0.0 40.0 X 96761 6925 Michael Allen Chief Financial Officer 0.0 40.0 X 106479 14196 MARY KUFFEL MD Medical Vice President 0.0 40.0 X 442987 37152 Michael J Dolan MD Medical Vice President 0.0 42.0 X 460015 54463 Marilu Bintz MD Medical Vice President 0.0 40.0 X 555076 44688 Scott Rathgaber MD Medical Vice President 0.0 40.0 X 499881 56128 Mary Lu Gerke Vice President 0.0 40.0 X 204064 37688 Janice DeHaan Vice President 0.0 41.5 X 275782 50490 Debra Rislow Vice President 0.0 42.0 X 302596 50652 Bryan Erdmann Vice President 0.0 42.8 X 176759 44373 Kelly Barton Vice President 0.0 41.5 X 177643 38659 Kathleen Klock Senior Vice President 0.0 40.0 X 423360 35700 Gerald Arndt Senior Vice President 0.0 41.0 X 387412 37152 Robert Trine Senior Vice President 0.0 40.0 X 372950 51515 Jeffrey Lawrence MD Medical Doctor 0.0 40.0 X 1145971 53628 Edward Riley MD Medical Doctor 0.0 40.0 X 1009957 56128 Jerry Davis MD Medical Doctor 0.0 40.0 X 947361 43428 Ronald Schneider DDS Dentist 0.0 40.0 X 895704 53628 Daniel Lange MD Medical Doctor 0.0 40.0 X 808271 55128 Daryl Applebury Former Chief of Corp. Ventures 0.0 40.0 X 224522 27458 0 13533518 1378560 0 true true false Gundersen Lutheran Admin Services 1910 South Avenue LA CROSSE WI 54601 Purchased Services 186782962 1 X 119438 17089 13515 150042 MEDICAL SERVICE PROVIDED 624100 193405320 193116522 288798 193405320 19566 19566 0 0 40869 15421 25448 0 25448 25448 223297 37237 186060 186060 186060 0 0 0 0 193786436 193116522 288798 231074 X 1606329 1606329 8634600 8634600 0 0 3765155 3765155 0 134201033 133067969 1133064 15897308 15755663 141645 17251210 16510390 740820 8185111 8100653 84458 0 3899 1799 2100 4900 175 4725 27765 27765 0 0 69505444 68688099 817345 0 37165450 37165450 766462 766462 0 7065985 3438190 3627795 631056 631056 0 0 71 71 85099078 24745288 60353790 9804223 4806780 4997443 2717885 49571 2668314 BAD DEBTS/COLLECTIONS 5340877 5340877 EMPLOYEE DEVEL. & TRAINING 2507094 2507094 PROFESSIONAL LIABILITY 1390674 1360430 30244 RECRUITING 1185871 1185871 1053074 1053074 413810554 339208740 74601814 0 X 0 0 1868455 2267952 0 0 55050740 7662035 0 0 0 0 0 0 2240870 2307165 721598 711927 315589766 167445547 154722407 148144219 8731731 6705810 20000 20000 0 0 0 0 177725048 4073133 401080849 171892241 36170032 16124053 0 0 0 0 0 0 0 0 0 0 0 0 0 0 366673229 377554718 402843261 393678771 X -1762412 -221786530 0 0 0 0 -1762412 -221786530 401080849 171892241 -220024118 X X false true X true true true X SUPPLEMENTAL INFORMATION THE CLINIC HAS OBTAINED TAX-EXEMPT STATUS AS AN ORGANIZATION WHOSE MAIN PURPOSE IS TO PROVIDE MEDICAL CARE. 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 0 27765 243735 27765 243735 413782789 1625668196 413810554 1625911931 1000000 1000000 250000 250000 1000000 1000000 1000000 1000000 4000000 6000000 258826 216456 232875 243735 951892 250000 250000 250000 250000 1000000 1500000 0 0 PART II-A LINE 1A-D GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC., 1910 S. AVE, LA CROSSE,WI 54601, 39-1606449 LOBBYING EXPENSE - $215,970 OTHER EXEMPT PURPOSE EXPENSE - $650,149,922 GUNDERSEN CLINIC, LTD. 1836 S. AVE, LA CROSSE, WI 54601, 39-1028657 LOBBYING EXPENSE - $27,765 OTHER EXEMPT PURPOSE EXPENSE - $413,782,789 GUNDERSEN LUTHERAN MEDICAL CENTER. INC.,1910 S. AVE, LA CROSSE, WI 54601, 39-0813416 LOBBYING EXPENSE - $0 OTHER EXEMPT PURPOSE EXPENSE - $561,735,485 GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. 1836 SOUTH AVE., LA CROSSE, WI 54601, 39-1866425 LOBBYING EXPENSE - $0 OTHER EXEMPT PURPOSE EXPENSE - $0 9339110 9339110 191384986 72229560 119155426 1743851 1068704 675147 113121819 94147283 18974536 148144219 0 INTERCOMPANY PAYABLE 368071398 RESERVE MALPRACTICE CLAIMS 3296990 LONG-TERM MALPRAC CLAIM RSV 4596062 ASSET RETIREMENT OBLIG-FIN47 1590268 377554718 X Income Tax Matters Part X, Line 2 THE OBLIGATED GROUP HAS REVIEWED ITS TAX POSITIONS FOR ALL OPEN YEARS AND HAS CONCLUDED THAT NO LIABILITIES EXIST AS OF DECEMBER 31, 2013 AND 2012. THE OBLIGATED GROUP'S INCOME TAX RETURNS ARE NO LONGER SUBJECT TO EXAMINATION FOR 2007, AND PRIOR. true GUNDERSEN LUTHERAN MEDICAL FOUNDATION INC 1836 SOUTH AVENUE LA CROSSE WI 54601 391249705 501(C)(3) 871536 EQUITY TRANSFER - SUPPORT OF THE GUNDERSEN LUTHERAN MEDICAL FOUNDATION, INC. Tri-County Memorial Hospital 18601 Lincoln St Whitehall WI 547 Whitehall WI 54773 390704510 501(C)(3) 734793 Equity Transfer - Operating Cash 2 Charity Care 1053 8634600 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 Jeffrey Thompson MD Chief Executive Officer 0 733516 0 0 0 3815 0 35700 0 20482 0 793513 0 0 Julio Bird MD Board of Governors - Exec VP 659516 3455 35700 17982 716653 0 0 Frank Aberger MD Board of Governors - Member 380916 3985 35700 18582 439183 0 0 Brian Sieck MD BOARD OF GOVERNORS- SEC/TREAS 370016 431 35700 23916 430063 0 0 Stephen Shapiro MD Board of Governors - Member 433416 4000 381 35700 23916 497413 0 0 Brian Mulrennan MD Board of Governors - Member 290017 11000 3360 34179 20482 359038 0 0 Jonathan Zlabek MD BOARD OF GOVERNORS - MEMBER 269017 3000 3138 35700 18894 329749 0 0 GREGORY THOMPSON MD CMO BOARD OF GOVERNORS - MEMBER 344016 2500 9261 35700 20482 411959 0 0 Kelley Bahr MD Board of Governors - Member 243000 1500 2526 29940 5054 282020 0 0 William Agger MD Board of Governors - Member 240804 3000 381 34650 20781 299616 0 0 MARY KUFFEL MD Medical Vice President 439412 0 3575 35700 1506 480193 0 0 Michael J Dolan MD Medical Vice President 459994 21 34785 23166 517966 0 0 Marilu Bintz MD Medical Vice President 517065 0 38011 35700 9042 599818 0 0 Scott Rathgaber MD Medical Vice President 496016 3865 35700 20482 556063 0 0 Mary Lu Gerke Vice President 199064 5000 28700 11062 243826 0 0 Janice DeHaan Vice President 266388 5000 4394 31022 22256 329060 0 0 Debra Rislow Vice President 302236 0 360 35700 18076 356372 0 0 Bryan Erdmann Vice President 173420 0 3339 24850 21370 222979 0 0 Kelly Barton Vice President 175490 0 2153 24850 13863 216356 0 0 Kathleen Klock Senior Vice President 398000 25000 360 35700 3488 462548 0 0 Gerald Arndt Senior Vice President 387412 0 0 35700 4932 428044 0 0 Robert Trine Senior Vice President 369516 3434 32587 18982 424519 0 0 Jeffrey Lawrence MD Medical Doctor 1142516 3455 35700 17982 1199653 0 0 Edward Riley MD Medical Doctor 1009516 441 35700 23915 1069572 0 0 Jerry Davis MD Medical Doctor 850527 96834 25500 17982 990843 0 0 Ronald Schneider DDS Dentist 895683 21 35700 21416 952820 0 0 Daniel Lange MD Medical Doctor 804016 4255 35700 19482 863453 0 0 Daryl Applebury Former Chief of Corp. Ventures 79514 145008 11082 17145 252749 0 0 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. PART I, LINE 4A SEVERANCE PAYMENT Daryl Applebury - $145,008 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 SIGNIFICANT CHANGES TO PROGRAM SERVICES: In 2013, the Clinic converted clinic based departments to hospital provider based departments. FORM 990, PART III, LINE 4A PROGRAM SERVICE ACCOMPLISHMENTS: GUNDERSEN CLINIC, LTD. (THE CLINIC) HAS MORE THAN 520 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 994,000 PATIENT ENCOUNTERS FOR 2013. THE CLINIC PROVIDED UNCOMPENSATED CARE RELATED TO CHARITY, $6,067,353; MEDICARE, $71,968,379; AND MEDICAID, $5,593,096 FOR THE TOTAL AMOUNT OF $83,628,828 AT COST BASED ON POLICIES AND CONTRACTS ARRANGED TO HELP SUPPORT THE COMMUNITY'S NEEDS. THE $83,628,828 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, SECTION A, LINE 7A GUNDERSEN LUTHERAN HEALTH SYSTEMS, 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 11 THE FORM 990 WILL BE AVAILABLE FOR ALL BOARD MEMBERS THROUGH THE DIRECTOR'S DESK WEBSITE and THE GUNDERSEN LUTHERAN HEALTH SYSTEM FINANCE COMMITTEE RECEIVES A COPY OF THE 990 BEFORE FILING AND UPON FURTHER REVIEW FROM THE EXECUTIVE DIRECTOR OF FINANCIAL OPERATIONS THE 990S ARE APPROVED AND FILED. FORM 990, PART VI, SECTIONB, 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 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, 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 ALL PERSONNEL SERVICES FOR GUNDERSEN CLINIC, LTD. ARE PERFORMED BY EMPLOYEES OF GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. FORM 990, PART VII, SECTION B 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 X, Line 15 IN 2013, GUNDERSEN LUTHERAN HEALTH SYSTEM CHANGED THEIR PROCESS WHERE INTER-COMPANY ACCOUNTS ARE NETTED INTO ONE ACCOUNT. Form 990, Part X, Line 27 SIGNFICANT CHANGE IN NET ASSETS THE DECREASE IN NET ASSETS IS A RESULT OF THE TRANSITION TO HOSPITAL (PROVIDER) BASED BILLING. In 2013, the Clinic converted clinic based departments to hospital provider based departments. 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 GUNDERSEN CLINIC, LTD. OPERATES IN CONJUNCTION WITH A GROUP OF OTHER AFFILIATED CORPORATIONS GOVERNED BY GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. AS SUCH, ANY FEDERAL AWARDS TO GUNDERSEN CLINIC, LTD. UNDERGO AN AUDIT AS SET FORTH IN THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133. SINGLE AUDIT ACT AND OMB CIRCULAR A-133. FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED HEALTH SERVICES TOTAL FEES:62108505 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED PROGRAM SERVICES TOTAL FEES:7311480 FORM 990 PART IX LINE 11G DESCRIPTION:CONSULTING TOTAL FEES:85459 GUNDERSEN LUTHERAN MEDICAL CENTER INC 1910 SOUTH AVENUE LA CROSSE WI 54501 390813416 HEALTH CARE WI 501(C)(3) LINE 3 GLHS false GUNDERSEN LUTHERAN MEDICAL FNDTN INC 1836 SOUTH AVENUE LA CROSSE WI 54601 391249705 FOUNDATION WI 501(C)(3) LINE 7 GLHS false GUNDERSEN LUTHERAN ADMINISTRATIVE SRVC 1910 SOUTH AVENUE LA CROSSE WI 54601 391606449 SUPTNG. 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