GUNDERSEN CLINIC LTD: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
GUNDERSEN CLINIC LTD (EIN 39-1028657)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-14
IRS object ID
201203199349301315
Schema version
2011v1.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-11-14T10:18:04-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN390758449EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1WIPFLI LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line12 COPELAND AVENUE SUITE 301AddressLine1
CityLA CROSSECity
StateWIState
ZIP Code54603ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN391028657EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1GUNDERSEN CLINIC LTDBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlGUNDNameControl
Phone6087827300Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11836 SOUTH AVENUEAddressLine1
CityLA CROSSECity
StateWIState
ZIP Code54601ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameGORDON T EDWARDSName
TitleCHIEF FINANCIAL OFFICERTitle
Phone6087827300Phone
Date Signed2012-11-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameMARY JO WERNER CPAName
PTINP00365167PTIN
Phone6087847300Phone
Date Prepared2012-11-13DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJEFFREY THOMPSONNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11836 SOUTH AVENUEAddressLine1
CityLA CROSSECity
StateWIState
ZIP Code54601ZIPCode
FieldValueIRS element (for citing)
Gross Receipts528278114GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.GUNDLUTH.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1963YearFormation
State Legal DomicileWIStateLegalDomicile
Activity Or Mission DescriptionTO 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.ActivityOrMissionDescription
Nbr Voting Members Governing Body9NbrVotingMembersGoverningBody
Nbr Independent Voting Members0NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI795TotalGrossUBI
Net Unrelated Business Txbl Income-51399NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year345239ContributionsGrantsPriorYear
Contributions Grants Current Year255358ContributionsGrantsCurrentYear
Program Service Revenue Prior Year500160057ProgramServiceRevenuePriorYear
Program Service Revenue CY524998801ProgramServiceRevenueCY
Investment Income Prior Year3206571InvestmentIncomePriorYear
Investment Income Current Year2857445InvestmentIncomeCurrentYear
Other Revenue Prior Year20859OtherRevenuePriorYear
Other Revenue Current Year26794OtherRevenueCurrentYear
Total Revenue Prior Year503732726TotalRevenuePriorYear
Total Revenue Current Year528138398TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year1290195GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY1448878GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year278168413SalariesEtcPriorYear
Salaries Etc Current Year277817880SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year238792547OtherExpensePriorYear
Other Expenses Current Year256470863OtherExpensesCurrentYear
Total Expenses Prior Year518251155TotalExpensesPriorYear
Total Expenses Current Year535737621TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-14518429RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-7599223RevenuesLessExpensesCY
Total Assets BOY378967775TotalAssetsBOY
Total Assets EOY403938911TotalAssetsEOY
Total Liabilities BOY345915921TotalLiabilitiesBOY
Total Liabilities EOY378486280TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY33051854NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY25452631NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTO 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense447195435Expense
Grants1448878Grants
Revenue524998006Revenue
DescriptionGUNDERSEN CLINIC, LTD. (THE CLINIC) HAS MORE THAN 450 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 1,023,000 PATIENT ENCOUNTERS FOR 2011. THE CLINIC PROVIDED UNCOMPENSATED CARE RELATED TO CHARITY, $2,078,687; MEDICARE, $88,696,480 AND MEDICAID, $26,522,795 FOR THE TOTAL AMOUNT OF $117,297,962 AT COST BASED ON POLICIES AND CONTRACTS ARRANGED TO HELP SUPPORT THE COMMUNITY'S NEEDS.THE $117,297,962 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.Description
Total Program Service Expense447195435TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org1TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees0NumberOfEmployees
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members9NbrVotingGoverningBodyMembers
Number Independent Voting Members0NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs1ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledWIStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1DARA BARTELSBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number6087759487TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11900 SOUTH AVENUE NCA1-01AddressLine1
CityLA CROSSECity
StateWIState
ZIP Code54601ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (27 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerKey EmployeeKeyEmployeeReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
JULIO BIRD MD
EXECUTIVE VICE-PRESIDENT -2.00XXX071343855475
FRANK ABERGER MD
BOARD OF GOVERNORS - SECRE2.00XX044573260475
BRIAN SIECK MD
BOARD OF GOVERNORS - MEMBE2.00X035039260705
STEPHEN SHAPIRO MD
BOARD OF GOVERNORS - MEMBE2.00X042491758705
BRIAN MULRENNAN MD
BOARD OF GOVERNORS - MEMBE2.00X026436557975
JONATHAN ZLABEK MD
BOARD OF GOVERNORS - MEMBE2.00X025155360475
SCOTT RATHGABER MD
BOARD OF GOVERNORS - MEMBE2.00X051673255475
WILLIAM AGGER MD
BOARD OF GOVERNORS - MEMBE2.00X023806053588
MARY KUFFEL MD
BOARD OF GOVERNORS - MEMBE2.00X042776237235
JEFFREY THOMPSON MD
CHIEF EXECUTIVE OFFICER0.00X068457255475
SIGURD GUNDERSEN III MD
MEDICAL VICE-PRESIDENT0.00X043782255475
MICHAEL J DOLAN MD
MEDICAL VICE-PRESIDENT0.00X045377358705
MARILU BINTZ MD
MEDICAL VICE-PRESIDENT0.00X049063344423
MARY JO KLOS
VICE PRESIDENT0.00X019997251026
DEBRA RISLOW
VICE PRESIDENT0.00X027888251691
KATHLEEN KLOCK
SENIOR VICE PRESIDENT0.00X037198240465
GERALD ARNDT
SENIOR VICE PRESIDENT0.00X036131139781
JANICE DEHAAN
VICE PRESIDENT0.00X025890361521
MARY LU GERKE
VICE PRESIDENT0.00X019289838752
ROBERT TRINE
SENIOR VICE PRESIDENT0.00X035830452186
GORDON EDWARDS
CHIEF FINANCIAL OFFICER0.00X029412850542
DANIEL LANGE MD
MEDICAL DOCTOR0.00079204257475X
JEFFREY LAWRENCE MD
MEDICAL DOCTOR0.000107070255475X
EDWARD RILEY MD
MEDICAL DOCTOR0.00085498262705X
KURT MUELLER MD
MEDICAL DOCTOR0.00081056255475X
RONALD SCHNEIDER DDS
DENTIST0.00086194256020X
DARYL APPLEBURY
CHIEF OF CORPORATE VENTURES, PARTNERSHIPS40.00022297254672X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs12629333TotalReportableCompFrmRltdOrgs
Total Other Compensation1441972TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
GUNDERSEN LUTHERAN ADMINISTRATIVE SERVIC
1910 SOUTH AVENUELA CROSSEWI54601PURCHASED SERVICES433159643
GUNDERSEN LUTHERAN MEDICAL CENTER INC
1910 SOUTH AVENUELA CROSSEWI54601PURCHASED SERVICES112071043
FieldValueIRS element (for citing)
Number Of Contractors GT100 K2NumberOfContractorsGT100K
Related Organizations153072RelatedOrganizations
Government Grants102286GovernmentGrants
Total Contributions255358TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionMEDICAL SERV. PROVIDEDDescription
Business Code624100BusinessCode
Total Revenue Column524998801TotalRevenueColumn
Related Or Exempt Function Income524998006RelatedOrExemptFunctionIncome
Unrelated Business Revenue795UnrelatedBusinessRevenue
FieldValueIRS element (for citing)
Total Program Service Revenue524998801TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column2808201TotalRevenueColumn
Exclusion$2,808,201ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real63570Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real36776Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real26794Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column26794TotalRevenueColumn
Exclusion$26,794ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other152184Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other102940Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other49244Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column49244TotalRevenueColumn
Exclusion$49,244ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column528138398TotalRevenueColumn
Related Or Exempt Function Income524998006RelatedOrExemptFunctionIncome
Unrelated Business Revenue795UnrelatedBusinessRevenue
Exclusion$2,884,239ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total1448878Total
Program Services1448878ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total4796532Total
Program Services4796532ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total210552936Total
Program Services209396016ProgramServices
Management And General1156920ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total23998895Total
Program Services23847646ProgramServices
Management And General151249ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total27381604Total
Program Services26306859ProgramServices
Management And General1074745ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total11087913Total
Program Services10992356ProgramServices
Management And General95557ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total13309Total
Program Services3825ProgramServices
Management And General9484ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total6000Total
Program Services6000ProgramServices

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total53673575Total
Program Services53619207ProgramServices
Management And General54368ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total371798Total
Program Services331565ProgramServices
Management And General40233ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total50645371Total
Program Services49755130ProgramServices
Management And General890241ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total1190339Total
Program Services1185991ProgramServices
Management And General4348ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total8051340Total
Program Services3705857ProgramServices
Management And General4345483ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total1671337Total
Program Services1646071ProgramServices
Management And General25266ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total847174Total
Program Services847223ProgramServices
Management And General-49ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total3306Total
Management And General3306ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total104907011Total
Program Services34181576ProgramServices
Management And General70725435ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total13757719Total
Program Services8556293ProgramServices
Management And General5201426ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total5764925Total
Program Services1253837ProgramServices
Management And General4511088ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBT/COLLECTIONS1331268313312683
RECRUITING896911896169742
DUES/MEMBERSHIPS/LICENS8603268588351491
MISCELLANEOUS497739246886250853

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total535737621Total
Program Services447195435ProgramServices
Management And General88542186ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY6100008BOY
EOY7739471EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY57492493BOY
EOY69956508EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY51091BOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1991115BOY
EOY2080420EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY770671BOY
EOY695618EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis310839390LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec147115992LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY167853806BOY
EOY163723398EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY10057636BOY
EOY10678827EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY60000BOY
EOY60000EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY134590955BOY
EOY149004669EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY378967775BOY
EOY403938911EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY22832657BOY
EOY22381246EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY323083264BOY
EOY356105034EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY345915921BOY
EOY378486280EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY33051854BOY
EOY25452631EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY33051854BOY
EOY25452631EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY378967775BOY
EOY403938911EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-7599223ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii
General ExplanationSCHEDULE A, PART IV, 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.GeneralExplanation

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Org Belongs To Affiliated GroupXOrgBelongsToAffiliatedGroup

Total Direct Lobbying TotalDirectLobbying

FieldValueIRS element (for citing)
Filing Organizations Totals16803FilingOrganizationsTotals
Affiliated Group Totals216456AffiliatedGroupTotals

Total Lobbying Expenditures TotalLobbyingExpenditures

FieldValueIRS element (for citing)
Filing Organizations Totals16803FilingOrganizationsTotals
Affiliated Group Totals216456AffiliatedGroupTotals

Other Exempt Purpose Expenditures OtherExemptPurposeExpenditures

FieldValueIRS element (for citing)
Filing Organizations Totals447178632FilingOrganizationsTotals
Affiliated Group Totals1336911480AffiliatedGroupTotals

Total Exempt Purpose Expenditures TotalExemptPurposeExpenditures

FieldValueIRS element (for citing)
Filing Organizations Totals447195435FilingOrganizationsTotals
Affiliated Group Totals1337127936AffiliatedGroupTotals

Lobbying Nontaxable LobbyingNontaxableAmount

FieldValueIRS element (for citing)
Filing Organizations Totals1000000FilingOrganizationsTotals
Affiliated Group Totals1000000AffiliatedGroupTotals

Grassroots Nontaxable GrassrootsNontaxableAmount

FieldValueIRS element (for citing)
Filing Organizations Totals250000FilingOrganizationsTotals
Affiliated Group Totals250000AffiliatedGroupTotals

Tot Lobbying Grassroot Minus Non Tx TotLobbyingGrassrootMinusNonTx

FieldValueIRS element (for citing)
Filing Organizations Totals0FilingOrganizationsTotals
Affiliated Group Totals0AffiliatedGroupTotals

Tot Lobby Expend Mns Lobbying Nontx TotLobbyExpendMnsLobbyingNontx

FieldValueIRS element (for citing)
Filing Organizations Totals0FilingOrganizationsTotals
Affiliated Group Totals0AffiliatedGroupTotals

Lobbying Nontaxable Amount2 LobbyingNontaxableAmount2

FieldValueIRS element (for citing)
Current Year Minus31000000CurrentYearMinus3
Current Year Minus21000000CurrentYearMinus2
Current Year Minus11000000CurrentYearMinus1
Current Year1000000CurrentYear
Total4000000Total
FieldValueIRS element (for citing)
Lobbying Ceiling$6,000,000LobbyingCeilingAmount

Total Lobbying Expenditures2 TotalLobbyingExpenditures2

FieldValueIRS element (for citing)
Current Year Minus3222185CurrentYearMinus3
Current Year Minus2201660CurrentYearMinus2
Current Year Minus1258826CurrentYearMinus1
Current Year216456CurrentYear
Total899127Total

Grassroots Nontaxable Amount2 GrassrootsNontaxableAmount2

FieldValueIRS element (for citing)
Current Year Minus3250000CurrentYearMinus3
Current Year Minus2250000CurrentYearMinus2
Current Year Minus1250000CurrentYearMinus1
Current Year250000CurrentYear
Total1000000Total
FieldValueIRS element (for citing)
Grassroots Ceiling$1,500,000GrassrootsCeilingAmount

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierPART IV, SUPPLEMENTAL INFORMATION:Identifier
ExplanationPART II-A LINE 1A-D: GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC., 1910 S. AVE, LA CROSSE, WI 54601, 39-1606449, LOBBYING EXPENSE - $199,653 OTHER EXEMPT PURPOSE EXPENSE - $583,725,083, GUNDERSEN CLINIC, LTD. 1836 S. AVE, LA CROSSE, WI 54601, 39-1028657 - LOBBYING EXPENSE - $216,456, OTHER EXEMPT PURPOSE EXPENSE - $447,178,632, GUNDERSEN LUTHERAN MEDICAL CENTER, INC., 1910 S. AVE, LA CROSSE, WI 54601 - 39-0813416 - LOBBYING EXPENSE - $0, OTHER EXEMPT PURPOSE EXPENSE - $306,007,765. GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. 1836 SOUTH AVE., LA CROSSE, WI 54601, 39-1866425- LOBBYING EXPENSE- $0, OTHER EXEMPT PURPOSE EXPENSE - $0.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis8772834OtherCostOrOtherBasis
Book Value8772834BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis189694481OtherCostOrOtherBasis
Depreciation59748541Depreciation
Book Value129945940BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis2596880OtherCostOrOtherBasis
Depreciation1643083Depreciation
Book Value953797BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis109775195OtherCostOrOtherBasis
Depreciation85724368Depreciation
Book Value24050827BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings163723398TotalOfBookValueLandBuildings

Other Assets OtherAssets (8 entries)

DescriptionDescriptionBook ValueBookValue
ACCRUED INTEREST RECEIVABLE22207
OTHER RECEIVABLES2484527
OTHER RECEIVABLE NON-PATIENT114714
OTHER RECEIVABLE AFFILIATES646948
ACCOUNTS RECEIVABLE TIF - CITY OF LA CROSSE1093921
RECEIVABLE FROM GUNDERSEN MEDICAL FOUNDATION50524
INTERCOMPANY RECEIVABLE - GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES37098102
INTERCOMPANY RECEIVABLE - GUNDERSEN LUTHERAN MEDICAL CENTER107493726
FieldValueIRS element (for citing)
Total Book Value Other Assets149004669TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (6 entries)

DescriptionDescriptionAmountAmount
INTERCOMPANY PAYABLE - GUNDERSEN MEDICAL FOUNDATION$9,317
INTERCOMPANY PAYABLE - GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES$295,012,957
INTERCOMPANY PAYABLE - GUNDERSEN LUTHERAN MEDICAL CENTER$48,663,339
RESERVE MALPRACTICE CLAIMS$9,218,319
LONG-TERM MALPRACTICE CLAIM RESERVE$1,716,570
ASSET RETIREMENT OBLIGATION-FIN47$1,484,532
FieldValueIRS element (for citing)
Total Of Amounts356105034TotalOfAmounts
Total Revenue528138398TotalRevenue
Total Expenses535737621TotalExpenses
Excess Or Deficit For Year-7599223ExcessOrDeficitForYear
Excess Or Deficit Per FS-7599223ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt514014419TotRevenueEtcAuditedFinclStmt
Other Revenues223390OtherRevenues
Revenue Not Rptd F990223390RevenueNotRptdF990
Revenue Subtotal513791029RevenueSubtotal
Other Revenues Not Included14347369OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt14347369RevenueNotRptdOnFinStmt
Total Revenue Per Form990528138398TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt524415842TotExpensesEtcAuditedFinclStmt
Other Expenses Included36776OtherExpensesIncluded
Expenses Not Rptd F99036776ExpensesNotRptdF990
Expenses Subtotal524379066ExpensesSubtotal
Other Expenses Not Included11358555OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt11358555ExpensesNotRptdOnFinStmt
Total Expenses Per Form990535737621TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X: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, 2011 AND 2010. THE OBLIGATED GROUP'S INCOME TAX RETURNS ARE NO LONGER SUBJECT TO EXAMINATION FOR THE FISCAL YEARS ENDED DECEMBER 31, 2007, AND PRIOR.
PART XII, LINE 2D - OTHER ADJUSTMENTS:RENTAL REVENUE 63,570. GRANT REVENUE 102,286. GAIN ON ASSET DISPOSAL 49,244. CONTRIBUTIONS 8,290.
PART XII, LINE 4B - OTHER ADJUSTMENTS:GUNDERSEN LUTHERAN MEDICAL FOUNDATION, INC. GRANTS 153,072. INTEREST INCOME 2,808,201. GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. INVESTMENT ALLOCATION 11,207,772. GAIN ON ASSET DISPOSAL 49,244. OTHER GRANTS AND CONTRIBUTIONS 102,286. NET RENTAL INCOME 26,794.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:RENTAL EXPENSES 36,776.
PART XIII, LINE 4B - OTHER ADJUSTMENTS:INVESTMENT EXPENSES 6,000. GUNDERSEN LUTHERAN MEDICAL FOUNDATION, INC. GRANTS 144,783. GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. INVESTMENT ALLOCATION 11,207,772.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1GUNDERSEN LUTHERAN MEDICAL FOUNDATION INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11836 SOUTH AVENUEAddressLine1
CityLA CROSSECity
StateWIState
ZIP Code54601ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient391249705EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant1448877AmountOfCashGrant
Purpose Of GrantSUPPORT OF THE GUNDERSEN LUTHERAN MEDICAL FOUNDATION, INC.PurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: ASSISTANCE WAS TO A RELATED ORGANIZATION. THE FUNDS ARE MONITORED BY MANAGEMENT AND THE BOARD OF GOVERNORS.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (27 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
JULIO BIRD MD
065351700059921035741019734076891300
FRANK ABERGER MD
04419720003760035741024734050620700
BRIAN SIECK MD
0349972000420035741024964041109700
STEPHEN SHAPIRO MD
0424547000370035741022964048362200
BRIAN MULRENNAN MD
024547200018893035741022234032234000
JONATHAN ZLABEK MD
02439720007581035741024734031202800
SCOTT RATHGABER MD
05129720003760035741019734057220700
WILLIAM AGGER MD
02368000001260035043018545029164800
MARY KUFFEL MD
0424412000335003574101494046499700
JEFFREY THOMPSON MD
06809720003600035741019734074004700
SIGURD GUNDERSEN III MD
041547200022350035741019734049329700
MICHAEL J DOLAN MD
041347200040301035741022964051247800
MARILU BINTZ MD
0487033000360003574108682053505600
MARY JO KLOS
01949720500000029420021606025099800
DEBRA RISLOW
0278512000370035741015950033057300
KATHLEEN KLOCK
03719120007003574104724041244700
GERALD ARNDT
036119100012003574104040040109200
JANICE DEHAAN
02572610001642035741025780032042400
MARY LU GERKE
01928980000028194010558023165000
ROBERT TRINE
0323476020000014828035741016445041049000
GORDON EDWARDS
027386400020264035741014801034467000
DANIEL LANGE MD
07879720004070035741021734084951700
JEFFREY LAWRENCE MD
0106747200032300357410197340112617700
EDWARD RILEY MD
085497200010035741026964091768700
KURT MUELLER MD
08069720003590035741019734086603700
RONALD SCHNEIDER DDS
082119700040745035741020279091796200
DARYL APPLEBURY
02229720000032801021871027764400

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSUPPLEMENTAL INFORMATIONIdentifier
Return ReferencePART IIIReturnReference
ExplanationPART 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.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (14 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
TAX EXEMPT BONDSFORM 990, PART IV, LINE 24AGUNDERSEN 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 4AMENDED AND RESTATED BYLAWS EFFECTIVE AS OF NOVEMBER 2011. CHANGED SOME TYPOGRAPHICAL AND SECTION REFERENCE, REMOVED PROXY VOTING BY DIRECTORS, ADDITION OF THE "EXECUTIVE VICE PRESIDENT" ROLE.
FORM 990, PART VI, SECTION A, LINE 6GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF THIS ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7AGUNDERSEN LUTHERAN HEALTH SYSTEMS, INC.
FORM 990, PART VI, SECTION A, LINE 7BTHE 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 11THE GUNDERSEN LUTHERAN HEALTH SYSTEM FINANCE COMMITTEE RECEIVES A COPY OF THE 990 BEFORE FILING AND UPON FURTHER REVIEW FROM THE ACCOUNTING MANAGER, CONTROLLER AND CFO THE 990 IS APPROVED AND FILED.
FORM 990, PART VI, SECTION B, LINE 12CGUNDERSEN CLINIC, LTD. MONITORS CONFLICTS ON AN ANNUAL BASIS BY REVIEWING DISCLOSURES ON COMPLETED CONFLICT OF INTEREST STATEMENTS.
FORM 990, PART VI, SECTION B, LINE 15ALL 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 19REQUESTS 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 AALL PERSONNEL SERVICES FOR GUNDERSEN CLINIC, LTD. ARE PERFORMED BY EMPLOYEES OF GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC.
FORM 990, PART VII, SECTION BALL PAYMENTS TO VENDORS ARE MADE BY GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC.
FORM 990, PART VII, SECTION AHOURS WORKED BY OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES BY ENTITY: JEFFREY THOMPSON - WORKS 40 HOURS FOR RELATED ORGANIZATIONS JULIO BIRD - WORKS 40 HOURS FOR RELATED ORGANIZATIONS MARILU BINTZ - WORKS 40 HOURS FOR RELATED ORGANIZATIONS MICHAEL DOLAN - WORKS 40 HOURS FOR RELATED ORGANIZATIONS SIGURD GUNDERSEN III - WORKS 40 HOURS FOR RELATED ORGANIZATIONS MARY LU GERKE - WORKS 40 HOURS FOR RELATED ORGANIZATIONS JOHN ZLABEK - WORKS 40 HOURS FOR RELATED ORGANIZATIONS MARY JO KLOS - WORKS 40 HOURS FOR RELATED ORGANIZATIONS DEBRA RISLOW - WORKS 40 HOURS FOR RELATED ORGANIZATIONS KATHLEEN KLOCK - WORKS 40 HOURS FOR RELATED ORGANIZATIONS GERALD ARNDT - WORKS 40 HOURS FOR RELATED ORGANIZATIONS JANICE DEHAAN - WORKS 40 HOURS FOR RELATED ORGANIZATIONS ROBERT TRINE - WORKS 40 HOURS FOR RELATED ORGANIZATIONS GORDON EDWARDS - WORKS 40 HOURS FOR RELATED ORGANIZATIONS FRANK ABERGER - WORKS 40 HOURS FOR RELATED ORGANIZATIONS BRIAN SIECK - WORKS 40 HOURS FOR RELATED ORGANIZATIONS STEPHEN SHAPIRO - WORKS 40 HOURS FOR RELATED ORGANIZATIONS BRIAN MULRENNAN - WORKS 40 HOURS FOR RELATED ORGANIZATIONS SCOTT RATHGABER - WORKS 40 HOURS FOR RELATED ORGANIZATIONS WILLIAM AGGER - WORKS 40 HOURS FOR RELATED ORGANIZATIONS DANIEL LANGE - WORKS 40 HOURS FOR RELATED ORGANIZATIONS JEFFREY LAWRENCE - WORKS 40 HOURS FOR RELATED ORGANIZATIONS EDWARD RILEY - WORKS 40 HOURS FOR RELATED ORGANIZATIONS KURT MUELLER - WORKS 40 HOURS FOR RELATED ORGANIZATIONS RONALD SCHNEIDER - WORKS 40 HOURS FOR RELATED ORGANIZATIONS MARY KUFFEL - WORKS 40 HOURS FOR RELATED ORGANIZATIONS
FORM 990, PART XI, LINE 2CTHE 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 VIII, LINE 2ATHE PROVISION OF MEDICAL SERVICES IN A MANNER BENEFICIAL TO THE COMMUNITY FURTHERS GUNDERSEN CLINIC, LTD.'S CHARITABLE PURPOSE OF PROMOTION OF HEALTH.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (16 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodePrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
GUNDERSEN LUTHERAN HEALTH SYSTEM INC - 39-1866425
1836 SOUTH AVENUELA CROSSEWI54601SUPPORTING ORGWI501(C)(3)LINE 11B, IIN/A0
GUNDERSEN LUTHERAN MEDICAL CENTER INC-39-0813416
1910 SOUTH AVENUELA CROSSEWI54601HEALTH CAREWI501(C)(3)LINE 30GUNDERSEN LUTHERAN HEALTH SYSTEM INC
GUNDERSEN LUTHERAN MEDICAL FOUNDATION INC -39-1249705
1836 SOUTH AVENUELA CROSSEWI54601FOUNDATIONWI501(C)(3)LINE 70GUNDERSEN LUTHERAN HEALTH SYSTEM INC
GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES INC -39-1606449
1910 SOUTH AVENUELA CROSSEWI54601SUPPORTING ORGWI501(C)(3)LINE 11B, II0GUNDERSEN LUTHERAN HEALTH SYSTEM INC
GUNDERSEN LUTHERAN HEALTH PLAN INC -39-1807071
1836 SOUTH AVENUELA CROSSEWI54601HEALTH INSURANCEWI501(C)(4)0GUNDERSEN LUTHERAN HEALTH SYSTEM INC
GUNDERSEN LUTHERAN CREDENTIALING SERVICES INC -39-1856898
1910 SOUTH AVENUELA CROSSEWI54601CREDENTIALING SERVICESWI501(C)(3)LINE 11A, I0GUNDERSEN LUTHERAN HEALTH SYSTEM INC
TRI-COUNTY MEMORIAL HOSPITAL INC -39-0704510
18601 LINCOLN STREETWHITEHALLWI54773HEALTH CAREWI501(C)(3)LINE 30GUNDERSEN LUTHERAN HEALTH SYSTEM INC
HARMONY COMMUNITY HEALTHCARE INC -41-0711606
815 MAIN AVENUE SHARMONYMN55939HEALTH CAREMN501(C)(3)LINE 30GUNDERSEN LUTHERAN HEALTH SYSTEM INC
TWEETEN LUTHERAN HEALTHCARE CENTER INC -41-1565003
125 FIFTH AVENUE SESPRING GROVEMN55974HEALTH CAREMN501(C)(3)LINE 30GUNDERSEN LUTHERAN HEALTH SYSTEM INC
TRI-STATE AMBULANCE INC - 39-1965415
235 CAUSEWAY BLVDLA CROSSEWI54603MEDICAL TRANSPORTATIONWI501(C)(3)LINE 90GUNDERSEN LUTHERAN HEALTH SYSTEM INC
TRI-STATE REGIONAL AMBULANCE INC - 39-1962965
235 CAUSEWAY BLVDLA CROSSEWI54603MEDICAL TRANSPORTATIONWI501(C)(3)LINE 90GUNDERSEN LUTHERAN HEALTH SYSTEM INC
LUTHERAN REAL ESTATE HOLDING CORPORATION -39-1480826
1910 SOUTH AVENUELA CROSSEWI54601HOUSINGWI501(C)(3)LINE 90GUNDERSEN LUTHERAN HEALTH SYSTEM INC
LUTHERAN HOUSING OF LA CROSSE INC -39-1751934
1900 SOUTH AVENUELA CROSSEWI54601INDEPENDENT LIVINGWI501(C)(3)LINE 90LUTHERAN REAL ESTATE HOLDING CORPORATION
COMMUNITY HOUSING OF LA CROSSE INC -39-1586700
1900 SOUTH AVENUELA CROSSEWI54601INDEPENDENT LIVINGWI501(C)(3)LINE 70LUTHERAN REAL ESTATE HOLDING CORPORATION
OPTIONS IN REPRODUCTIVE CARE INC -39-1166634
1201 CALEDONIA STREETLA CROSSEWI54603HEALTH CAREWI501(C)(3)LINE 30GUNDERSEN LUTHERAN HEALTH SYSTEM INC
ST JOSEPH'S HEALTH SERVICES INC 39-0929538
400 WATER AVENUEHILLSBOROWI54634HEALTH CAREWI501(C)(3)LINE 30GUNDERSEN LUTHERAN HEALTH SYSTEM INC

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntity
DEGEN BERGLUND INC
1709 LOSEY BLVD SLA CROSSEWI54601390971110RETAIL PHARMACYWIN/AC
GUNDERSEN LUTHERAN ENVISION LLC
1836 SOUTH AVENUELA CROSSEWI54601264706546RENEWABLE ENERGYWIN/AC
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org1SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
GUNDERSEN LUTHERAN HEALTH PLAN INC
Q76252612FAIR VALUE
(no name)
D

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