2013-11-11T16:55:27-06:00 2012-12-31 KPMG LLP 1212 North 96th Street Suite 300 Omaha NE 68114 990 2012-01-01 391028657 GUNDERSEN CLINIC LTD % DARA BARTELS GUND 6087827300 1836 SOUTH AVENUE Suite LA CROSSE WI 54601 KATHLEEN KLOCK 6087756600 2013-11-11 true LORRAINE A EGGER 4023481450 2012 2016-02-24 21:20:13Z JEFFREY THOMPSON 1836 SOUTH AVENUE LA CROSSE WI 54601 516192586 false X www.gundersenhealth.org X 1963 WI SEE SCHEDULE O 10 0 0 0 272410 -87007 255358 411665 524998801 514739344 2857445 957872 26794 32352 528138398 516141233 1448878 871536 0 0 277817880 285575653 0 0 0 256470863 257199107 535737621 543646296 -7599223 -27505063 403938911 401080849 378486280 402843261 25452631 -1762412 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 false 454043024 871536 514466934 SEE SCHEDULE O 454043024 true true false true false false false false false false true false false true true true false true false false false false false false false false false true false 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 BRIAN SIECK MD 2.0 44.0 X X 0 359638 60496 STEPHEN SHAPIRO MD 2.0 46.0 X 0 432458 61084 BRIAN MULRENNAN MD 2.0 44.0 X 0 277381 62584 JONATHAN ZLABEK MD 2.0 44.0 X 0 258654 60084 WILLIAM AGGER MD 2.0 44.0 X 0 243914 58444 MARY KUFFEL MD 2.0 44.0 X X 0 435510 38940 JEFFREY THOMPSON MD 2.0 44.0 X X 0 711992 61084 JULIO BIRD MD 2.0 44.0 X X 0 664632 58584 FRANK ABERGER MD 2.0 44.0 X 0 486314 62584 GREGORY THOMPSON MD 2.0 46.0 X 0 343492 63584 GORDON EDWARDS 0.0 40.0 X 0 340689 59084 SCOTT RATHGABER MD 0.0 40.0 X 0 501122 60084 SIGURD GUNDERSEN III MD 0.0 42.8 X 0 442760 58584 MICHAEL J DOLAN MD 0.0 42.0 X 0 432568 58804 MARILU BINTZ MD 0.0 42.0 X 0 511944 46740 MARY JO KLOS 0.0 40.25 X 0 161086 20762 DEBRA RISLOW 0.0 41.0 X 0 287545 51648 KATHLEEN KLOCK 0.0 40.0 X 0 395360 37500 GERALD ARNDT 0.0 41.0 X 0 384412 38940 JANICE DEHAAN 0.0 41.5 X 0 266624 57004 MARY LU GERKE 0.0 40.0 X 0 199124 39240 ROBERT TRINE 0.0 40.0 X 0 365023 57537 KELLY BARTON 0.0 41.5 X 0 172998 26448 BRYAN ERDMANN 0.0 42.8 X 0 166557 47551 DANIEL LANGE MD 0.0 40.0 X 0 800830 59584 JEFFREY LAWRENCE MD 0.0 40.0 X 0 1057132 58584 EDWARD RILEY MD 0.0 40.0 X 0 889856 62584 KURT MUELLER MD 0.0 40.0 X 0 771632 58584 RONALD SCHNEIDER DDS 0.0 40.0 X 0 873198 63584 DARYL APPLEBURY 0.0 43.8 X 0 215893 53817 0 13450338 1604131 0 true true false GUNDERSEN LUTHERAN ADMIN SERVICES 1910 SOUTH AVENUE LA CROSSE WI 54601 PURCH SVCS/ SUPPLIES 448874038 GUNDERSEN LUTHERAN MEDICAL CENTER 1910 SOUTH AVENUE LA CROSSE WI 54601 PURCH SVCS/ SUPPLIES 108694731 2 351602 37146 22917 411665 MEDICAL SERVICE PROVIDED 624100 514739344 514466934 272410 514739344 947898 947898 0 0 47179 14827 32352 0 32352 32352 46500 36526 9974 9974 9974 0 0 0 0 516141233 514466934 272410 990224 871536 871536 0 0 0 4339746 4339746 0 218133050 217054608 1078442 24954850 24810884 143966 26785092 25815951 969141 11362915 11280356 82559 0 12133 5367 6766 176 176 10228 10228 0 6000 6000 43577826 43209988 367838 266 266 51298429 51050294 248135 1261143 1261143 0 10852444 7118022 3734422 1623676 1617117 6559 0 890153 888104 2049 0 111367067 36933243 74433824 13682219 8543661 5138558 4668488 1375629 3292859 BAD DEBTS/COLLECTIONS 15591201 15591201 RECRUITING 1043159 1042991 168 DUES/MEBERSHIPS/LICENSE 915057 914167 890 MISCELLANEOUS 399442 302346 97096 543646296 454043024 89603272 0 0 0 7739471 1868455 0 0 69956508 55050740 0 0 0 0 0 0 2080420 2240870 695618 721598 313213101 158490694 163723398 154722407 10678827 8731731 60000 20000 0 0 0 0 149004669 177725048 403938911 401080849 22381246 36170032 0 0 0 0 0 0 0 0 0 0 0 0 0 0 356105034 366673229 378486280 402843261 X 25452631 -1762412 0 0 0 0 25452631 -1762412 403938911 401080849 X -27505063 290020 X X false true X true true true X 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 10228 232875 10228 232875 543636068 1570265863 543646296 1570498738 1000000 1000000 250000 250000 1000000 1000000 1000000 1000000 4000000 6000000 201660 258826 216456 232875 909817 250000 250000 250000 250000 1000000 1500000 PART II-A LINE 1A-D GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC., 1910 S. AVE, LA CROSSE,WI 54601, 39-1606449 LOBBYING EXPENSE - $222,647 OTHER EXEMPT PURPOSE EXPENSE - $619,465,375 GUNDERSEN CLINIC, LTD. 1836 S. AVE, LA CROSSE, WI 54601, 39-1028657 LOBBYING EXPENSE - $10,228 OTHER EXEMPT PURPOSE EXPENSE - $543,636,068 GUNDERSEN LUTHERAN MEDICAL CENTER. INC.,1910 S. AVE, LA CROSSE, WI 54601, 39-0813416 LOBBYING EXPENSE - $0 OTHER EXEMPT PURPOSE EXPENSE - $407,164,420 GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. 1836 SOUTH AVE., LA CROSSE, WI 54601, 39-1866425 LOBBYING EXPENSE - $0 OTHER EXEMPT PURPOSE EXPENSE - $0 9374114 9374114 190683885 65995478 124688407 2613554 1759434 854120 110541548 90735782 19805766 154722407 ACCRUED INTEREST RECEIVABLE 15057 OTHER RECEIVABLES 1211015 OTHER RECEIVABLE NON-PATIENT 129717 OTHER RECEIVABLE AFFILIATES 1747309 AR TIF - CITY OF LA CROSSE 12796 INTERCOMPANY RECEIVABLE 174609154 177725048 0 INTERCOMPANY PAYABLE 355839406 RESERVE MALPRACTICE CLAIMS 3101877 LONG-TERM MALPRACTICE CLAIM RES 6195455 ASSET RETIREMENT OBLIGATION-FIN47 1536491 366673229 X PART X, LINE 2 THE OBLIGATED GROUP (GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC., GUNDERSEN LUTHERAN MEDICAL CENTER, INC., GUNDERSEN CLINIC, LTD., AND GUNDERSEN LUTHERAN MEDICAL FOUNDATION, INC.) ADOPTED THE PROVISIONS RELATING TO UNCERTAIN TAX POSITIONS OF THE FASB ACCOUNTING STANDARDS CODIFICATION ON JANUARY 1,2007. THE CODIFICATION CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS AND PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF AN INCOME TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE OBLIGATED GROUP HAS REVIEWED ITS TAX POSITIONS FOR ALL OPEN YEARS AND HAS CONCLUDED THAT NO LIABILITIES EXIST AS OF DECEMBER 31, 2012 AND 2011. THE OBLIGATED GROUP'S INCOME TAX RETURNS ARE NO LONGER SUBJECT TO EXAMINATION FOR THE FISCAL YEARS ENDED DECEMBER 31, 2006, 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. 1 0 SUPPLEMENTAL INFORMATION SCHEDULE I, PART I, LINE 2: ASSISTANCE WAS TO A RELATED ORGANIZATION. THE FUNDS ARE MONITORED BY MANAGEMENT AND THE BOARD OF GOVERNORS. 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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 MARY JO KLOS - $98,500 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 4A PROGRAM SERVICE ACCOMPLISHMENTS : GUNDERSEN CLINIC, LTD. (THE CLINIC) HAS MORE THAN 480 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 1,026,000 PATIENT ENCOUNTERS FOR 2012. THE CLINIC PROVIDED UNCOMPENSATED CARE RELATED TO CHARITY, $2,063,495; MEDICARE, $94,820,318; AND MEDICAID, $23,644,514 FOR THE TOTAL AMOUNT OF $120,528,327 AT COST BASED ON POLICIES AND CONTRACTS ARRANGED TO HELP SUPPORT THE COMMUNITY'S NEEDS. THE $120,528,327 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 GUNDERSEN LUTHERAN HEALTH SYSTEM FINANCE COMMITTEE RECEIVES A COpy OF THE 990 BEFORE FILING AND UPON FURTHER REVIEW FROM THE CONTROLLER THE 990 IS 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 COMPENSATION RECOMMENDATIONS, 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 XI, 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 XI - OTHER CHANGES IN NET ASSETS OTHER TRANSFERS ($ 730) CAPITATION AGREEMENT ADJ $290,750 TOTAL OTHER CHANGES IN NET ASSETS $290,020 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. ORG WI 501(C)(3) LINE 11B,II GLHS false GUNDERSEN LUTHERAN HEALTH PLAN INC 1836 SOUTH AVENUE LA CROSSE WI 54601 391807071 HEALTH INS. 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