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AND GUNDERSEN LUTHERAN MEDICAL CENTER, INC. 0 0 576332736 646555684 GENERAL SERVICES PROVIDED TO GUNDERSEN CLINIC, LTD. 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OPERATES TO SUPPORT GUNDERSEN LUTHERAN HEALTH SYSTEM, INC.'S PROGRAMS OF HEALTH CARE, MEDICAL EDUCATION, MEDICAL RESEARCH AND COMMUNITY HEALTH PROMOTION ACTIVITIES WITHIN THE MEANING OF SECTION 509(A)(3) OF THE IRC, INCLUDING BORROWING AND LENDING OF FUNDS AND PROPERTY, ENGAGING IN FINANCING TRANSACTIONS WITH AND/OR ON BEHALF OF THE GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., ACQUIRING AND RECEIVING FUNDS AND PROPERTY OF EVERY KIND AND INVESTING IN, RECEIVING, HOLDING, USING AND DISPOSING OF ALL REAL/PERSONAL PROPERTY, ALONG WITH GENERAL SERVICES PROVIDED TO GUNDERSEN CLINIC, LTD. AND GUNDERSEN LUTHERAN MEDICAL CENTER, INC. SUCH AS ADMINISTRATIVE, INFORMATION SYSTEMS, BILLING AND CODING, LAUNDRY, MEDICAL RECORDS, HUMAN RESOURCES, FINANCE, FACILITY OPERATIONS, CENTRAL SERVICES, AND OTHER MISCELLANEOUS SERVICES. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 0 0 248391 258826 248391 258826 159753466 993318813 160001857 993577639 1000000 1000000 250000 250000 0 0 0 0 1000000 1000000 1000000 1000000 4000000 6000000 160921 222185 201660 258826 843592 250000 250000 250000 250000 1000000 1500000 PART IV, SUPPLEMENTAL INFORMATION: PART II-A LINE 1A-D: GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC., 1910 S. AVE, LA CROSSE, WI 54601, 39-1606449, LOBBYING EXPENSE - $248,391 OTHER EXEMPT PURPOSE EXPENSE - $159,753,466, GUNDERSEN CLINIC, LTD. 1836 S. AVE, LA CROSSE, WI 54601, 39-1028657 - LOBBYING EXPENSE - $10,435, OTHER EXEMPT PURPOSE EXPENSE - $435,688,034, GUNDERSEN LUTHERAN MEDICAL CENTER, INC., 1910 S. AVE, LA CROSSE, WI 54601 - 39-0813416 - LOBBYING EXPENSE - $0, OTHER EXEMPT PURPOSE EXPENSE - $397,877,313. 1222914 1222914 26581118 3204977 23376141 1390365 183612 1206753 142007716 89503941 52503775 78309583 STOCK PURCHASE OF LHI 90089788 C 90089788 GUNDERSEN CLINIC, LTD. AND GUNDERSEN LUTHERAN MEDICAL CENTER, INC. 295903151 UNAMORTIZED BOND ISSUE COSTS 3055403 ACCRUED INTEREST RECEIVABLE 1439570 OTHER RECEIVABLES 2697452 GUNDERSEN LUTHERAN MEDICAL FOUNDATION, INC. 1763843 GUNDERSEN LUTHERAN HEALTH PLAN, INC. 931152 UPPER MIDWEST CONSOLIDATED SERVICES CENTER 200000 305990571 GUNDERSEN LUTHERAN MEDICAL CENTER, INC. 472763395 LOSS ON SWAP CONTRACTS 20552917 DEFERRED COMPENSATION 822085 GUNDERSEN LUTHERAN MEDICAL FOUNDATION, INC. 291629 GUNDERSEN LUTHERAN HEALTH PLAN, INC. 4594 494434620 647277529 580406522 66871007 26147623 -77486 26070137 92941144 98641251 26147623 26147623 72493628 574783901 574783901 647277529 5597621 505223 505223 5092398 575314124 575314124 580406522 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, 2010 AND 2009. THE OBLIGATED GROUP'S INCOME TAX RETURNS ARE NO LONGER SUBJECT TO EXAMINATION FOR THE FISCAL YEARS ENDED DECEMBER 31, 2006, AND PRIOR. PART XI, LINE 8 - OTHER ADJUSTMENTS: MARKET ADJUSTMENT FOR SWAP CONTRACT -77,486. PART XII, LINE 4B - OTHER ADJUSTMENTS: GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. INVESTMENT ALLOCATION 158,958,245. RENTAL EXPENSES -505,223. INTERCOMPANY TRANSACTIONS WITH RELATED PARTIES 416,330,879. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 505,223. PART XIII, LINE 4B - OTHER ADJUSTMENTS: GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. INVESTMENT ALLOCATION 158,958,245. GUNDERSEN LUTHERAN MEDICAL FOUNDATION, INC. GRANTS 25,000. INTERCOMPANY TRANACTIONS WITH RELATED PARTIES 416,330,879. CENTRAL AMERICA AND THE CARIBBEAN 0 0 MEDICAL TEAM TRAVEL EXPENSES, RENTAL OF EQUIPMENT, PURCHASE OF MEDICATIONS AND TRAVEL INSURANCE APPROXIMATELY 300 PEOPLE REACHED BY VOLUNTEER TEAM WORKING IN THE HOSPITAL IN MATAGALPA AND THE COMMUNITY OF SANTA CELIA 5598 0 0 0 5598 0 5598 FUNDS CONTRIBUTED TO SUPPORT SPONSORSHIP OF SANTA CELIA COMMUNITY THROUGH NGO RAINBOW NETWORK, A 501(C)(3) ORGANIZATION. CENTRAL AMERICA AND THE CARIBBEAN 400 20000 FUND DONATED FOR THE PURCHASE OF ANESTHESIA MEDICATIONS SUB-SAHARAN AFRICA 70 1000 0 0 0 0 0 0 1 GUNDERSEN LUTHERAN COULEE TRAILS INC 126 1/2 W JEFFERSON VIROQUA WI 54665 391962965 501(C)(3) 25000 OPERATING CASH GUNDERSEN LUTHERAN MEDICAL FOUNDATION INC 1836 SOUTH AVENUE LA CROSSE WI 54601 391249705 501(C)(3) 667280 SUPPORT THE MISSION OF THE FOUNDATION THROUGH EDUCATION AND RESEARCH FUNDS 2 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: ASSISTANCE WAS MADE TO RELATED ORGANIZATIONS; THEREFORE, THE FUNDS ARE MONITORED BY MANAGEMENT AND THE BOARD OF TRUSTEES AND BOARD OF GOVERNORS. X X X 0 0 0 0 0 0 0 0 0 JEFFREY THOMPSON MD 674307 0 0 0 3608 0 35741 0 18946 0 732602 0 0 0 GARY LENTH MD 411388 0 0 0 228 0 35741 0 22884 0 470241 0 0 0 WILLIAM AGGER MD 234375 0 250 0 7253 0 35319 0 2974 0 280171 0 0 0 BRIAN MULRENNAN MD 234596 0 5250 0 21846 0 35741 0 22446 0 319879 0 0 0 JONATHAN ZLABEK MD 247846 0 1975 0 2762 0 35741 0 19196 0 307520 0 0 0 DARYL APPLEBURY 216869 0 0 0 0 0 32165 0 21983 0 271017 0 0 0 JULIO BIRD MD 655051 0 0 0 3248 0 35741 0 17446 0 711486 0 0 0 SIGURD GUNDERSEN III MD 478596 0 10050 0 3608 0 35741 0 17446 0 545441 0 0 0 MICHAEL J DOLAN MD 405396 0 10000 0 24260 0 35741 0 21876 0 497273 0 0 0 MARILU BINTZ MD 474929 0 10000 0 3608 0 35742 0 7665 0 531944 0 0 0 MARY JO KLOS 190307 0 0 0 0 0 27908 0 19302 0 237517 0 0 0 JANICE DEHAAN 244775 0 0 0 1562 0 35741 0 23585 0 305663 0 0 0 DEBRA RISLOW 255964 0 0 0 360 0 35741 0 14241 0 306306 0 0 0 KATHLEEN KLOCK 352423 0 10000 0 0 0 35741 0 4716 0 402880 0 0 0 GERALD ARNDT 348765 0 10000 0 0 0 35741 0 3816 0 398322 0 0 0 COLETTE LASACK 144882 0 10000 0 360 0 22700 0 18499 0 196441 0 0 0 DANIEL LILLY 248256 0 0 0 0 0 35741 0 22473 0 306470 0 0 0 ROGER ZIFF 212241 0 5000 0 360 0 31973 0 20187 0 269761 0 0 0 MARY LOU GERKE 188102 0 0 0 0 0 27473 0 9435 0 225010 0 0 0 MARY ELLEN MCCARTNEY 187681 0 0 0 360 0 27402 0 3250 0 218693 0 0 0 JEFFREY RICH 156711 0 22750 0 360 0 26314 0 18607 0 224742 0 0 0 WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY SERIES 2008A 391337855 97710BBF8 2008-05-29 27900000 REFUNDED THE 2006 SERIES A ISSUED 5/16/2006 0 0 0 WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY SERIES 2008B 391337855 97710BBG6 2008-05-29 61400000 REFUNDED THE 2006 SERIES B ISSUED 5/16/2006 0 0 0 WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY SERIES 2009 391337855 97710BHC9 2009-05-22 78715000 REFUNDED THE 2003 SERIES B AND C ISSUED 7/1/2003 0 0 0 WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY SERIES 20033B 391337855 97710VLT3 2003-07-23 34875000 REFUNDED THE 1993 SERIES A AND B 0 0 0 27075000 240754 1 0 1 1 61400000 565428 1 0 1 1 78715000 916999 1 0 1 1 12705000 668126 1 0 1 1 0 0 0 0 1 1 0 0 0 0 1 1 0 1 0 0 1 0.01600 0.01600 1 0 0 0 0 1 1 0 1 0 NA 0 0 0 0 1 0 NA 0 0 0 0 1 0 NA 0 0 1 0 0 0 NA 0 0 0 FORM 990, SCHEDULE K LINE D CUSIP NUMBERS: 97710VLT3 AND 97710VLU0 TAX EXEMPT BOND ISSUE FORM 990, PART IV, LINE 24A GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC IS A PART OF GUNDERSEN LUTHERAN'S 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 GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. RETURN. 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 B, LINE 11 THE 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 990S ARE APPROVED AND FILED. FORM 990, PART VI, SECTION B, LINE 12C GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. MONITORS CONFLICTS ON AN ANNUAL BASIS BY REVIEWING DISCLOSURES ON COMPLETED CONFLICT OF INTEREST STATEMENTS. FORM 990, PART VI, SECTION B, LINE 15 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 26,147,623. MARKET ADJUSTMENT FOR SWAP CONTRACT -77,486. TOTAL TO FORM 990, PART XI, LINE 5: 26,070,137. 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. 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