2026-08-13T18:54:56+00:00 2025-09-30 135565207 KPMG LLP 200 EAST RANDOLPH DRIVE SUITE 5500 CHICAGO IL 606016436 990 2024-10-01 390944012 MOUNDVIEW MEMORIAL HOSPITAL & CLINICS MOUN 6083393331 402 WEST LAKE STREET FRIENDSHIP WI 53934 LORI WITTIG ADMINISTRATOR 6083393331 2026-08-14 true true ZELIJKO POPOVIC P01795951 3126651000 2026-08-12 2024 2025-03-06 01:10:19Z GUNDERSEN MOUNDVIEW MEMORIAL HOSPITAL & CLINICS LORI WITTIG 402 WEST LAKE STREET FRIENDSHIP WI 53934 40201009 false X WWW.GUNDERSENHEALTH.ORG/MOUNDVIEW X 1959 WI TOGETHER, WE INSPIRE YOUR BEST LIFE BY RELENTLESSLY CARING, LEARNING AND INNOVATING. 9 5 177 75 0 122479 151158 35884432 39128512 699809 698756 194687 222583 36901407 40201009 600 1207221 0 0 18352667 19924849 0 0 0 16115872 17469712 34469139 38601782 2432268 1599227 24370099 33298110 3618761 10947545 20751338 22350565 X LEADING WITH LOVE, WE COURAGEOUSLY COMMIT TO A FUTURE OF HEALTHY PEOPLE AND THRIVING COMMUNITIES. true false 22663866 1207221 27284318 THE HOSPITAL IS A GENERAL MEDICAL CRITICAL ACCESS HOSPITAL LICENSED FOR 25 BEDS. DURING FISCAL YEAR 2025, THE HOSPITAL HAD 511 ACUTE INPATIENT DAYS AND 1,043 SWING-BED DAYS. THE HOSPITAL ALSO HAD 8,067 EMERGENCY ROOM/URGENT CARE AND 10,570 CLINIC VISITS. 11433844 12016630 THE HOSPITAL ALSO HAS AN OUTPATIENT PHARMACY THAT IS THE ONLY IN IT'S COUNTY (ADAMS, WI), AND IN 2025 FILLED 104,726 PRESCRIPTIONS. 34097710 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 true true false true true false false false false false false false false false false false false false false false true true true false false true 34 0 true 177 true false false false false false false false false false false false false X 9 5 false false false false true true true true true false false false true true true true true true false false false false WI X LORI WITTIG 6083393331 402 WEST LAKE STREET FRIENDSHIP WI 53934 PAUL FISCH BOARD OF DIRECTORS, VICE CHAIRMAN, DIRECTOR, MEDICAL MEDIA 2.0 2.0 X X 0 2599 0 SARAH ROSSMAN BOARD OF DIRECTORS, SECRETARY/TREASURER, CLINICAL OPERATIONS DIRECTOR, PEDIATRICS 2.0 48.0 X X 0 165646 27213 TADD WORMET BOARD OF DIRECTORS, CHAIRMAN 2.0 0 X X 0 0 0 BRYAN ERDMANN BOD, CHIEF OPERATING OFFICER 2.0 48.0 X 0 443670 76190 JENNIFER PARR BOARD OF DIRECTORS (BEG 1.1.25) 2.0 0 X 0 0 0 JOE THEISEN BOARD OF DIRECTORS 2.0 0 X 0 0 0 KAREN MILLER BOARD OF DIRECTORS, RN, CASE MANAGER - TWEETEN (END 12.31.24) 2.0 38.0 X 0 123519 29291 LAURIE INDA BOARD OF DIRECTORS 2.0 0 X 0 0 0 ROXANNE POTTS BOARD OF DIRECTORS, CLINICAL OPERATIONS DIRECTOR, IMAGING SERVICES 2.0 48.0 X 0 175720 48466 STEPHANIE CARROLL MD BOARD OF DIRECTORS, MD 2.0 48.0 X 0 322275 67169 CURTIS DOWDY FINANCE ADMINISTRATOR 50.0 0.0 X 0 182020 35296 FRANCISCO PEREZ-GUERRA ADMINISTRATOR 46.0 4.0 X 0 201120 66807 JOHN CEELEN CHIEF FINANCIAL OFFICER 1.0 49.0 X 0 728316 54052 KRISTY MILLERING FINANCE ADMINISTRATOR 16.0 34.0 X 0 131354 42400 LORI WITTIG ADMINISTRATOR 48.0 2.0 X 152201 0 24321 SCOTT RATHGABER MD CEO 1.0 49.0 X 0 1324275 73275 BRADLEY SHAW MANAGER, INPATIENT PHARMACY 50.0 0 X 202982 0 27954 DAVID BROWN PHARMACIST, OUTPATIENT 50.0 0 X 188852 0 26617 DEENA KEDROWSKI MANAGER, OUTPATIENT PHARMACY 50.0 0 X 197266 0 65752 NEAL DONNER PHARMACIST, OUTPATIENT 50.0 0 X 181812 0 60949 PRESTON PIETRZAK PHARMACIST, OUTPATIENT 50.0 0 X 155181 0 28615 STEVE LITTLE FORMER CHIEF FINANCIAL OFFICER 0.0 0.0 X 0 209856 0 1078294 4010370 754367 29 true true false SOUND CHOICE IMAGING LLC 36976 BRIDLEWOOD LANE OCONOMOWOC WI 53066 IMAGING SERVICES 471456 STAFFENCY 221 W COLLEGE AVE FLOOR 2 APPLETON WI 54911 REHAB/IMAGING SUPPORT SERVICES 316636 COSMIC HEALTHCARE LLC 23099 RED SUNSET PL ALDIE VA 20105 LAB CONTRACTOR SERVICES 224278 JAMES PIPER ANESTHESIA 1020 BRANDON STREET TOMAH WI 54660 ANESTHESIA SERVICES 218300 KAYNICK ANESTHESIA S C W9648 GEHRI ROAD WONEWOC WI 53968 ANESTHESIA SERVICES 201060 10 134674 16484 151158 NET PATIENT SERVICE REVENUE 621300 27056807 27056807 PHARMACY 456110 12016630 12016630 MEDICAL BUILDING RENT 531120 55075 55075 0 0 0 0 39128512 698756 698756 22675 22675 0 22675 22675 0 0 E.H.R. INCENTIVE 900099 126372 126372 CAFETERIA 722514 27472 27472 COMMUNITY EVENT REGISTRATIONS 900099 19252 19252 26812 26812 0 0 199908 40201009 39300948 0 748903 712 712 1206509 1206509 16216389 14466657 1749732 1355849 1260511 95338 1544457 1345435 199022 808154 713532 94622 990696 990696 31790 31790 15150 15150 2064078 1987371 76707 0 60836 1175 59661 11395 11395 369202 333137 36065 116927 111374 5553 27590 26590 1000 4573 4573 632011 376138 255873 72996 72996 PHARM DRUG & VACCINES 10885249 10885249 MEDICAL SUPPLIES 1035886 1015687 20199 BAD DEBT EXPENSE 633960 633960 EQUIP RENTAL AND MAINTENANCE 281435 272240 9195 235938 83998 151940 0 38601782 34097710 4504072 0 1065 1175 13432114 18432090 3687711 6985694 0 0 854301 972488 84246 67684 10466823 4709379 5527783 5757444 0 0 715000 715000 67879 366535 24370099 33298110 1890174 2530749 4058 3726 0 168775 134556 1555754 8278514 3618761 10947545 X 20137338 22350565 614000 0 20751338 22350565 24370099 33298110 1599227 0 X false true true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 15150 15150 false SCHEDULE C, PART II-B, LINE 1I MOUNDVIEW MEMORIAL HOSPITAL & CLINICS PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA) & AMERICAN HOSPITAL ASSOCIATION VIA WHA, AND THE RURAL WISCONSIN HEALTH COOPERATIVE. THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT BUT DISCUSSIONS WITH EACH ENTITY REVEAL A PERCENTAGE OF THEIR WORK, AND THUS A PERCENTAGE OF THE DUES EXPENSE IS DEDICATED TO LOBBYING SERVICES. 81500 81500 6515604 2129551 4386053 3487510 2199709 1287801 382209 380119 2090 5757444 FEDERAL INCOME TAXES INTERFACILITY LIABILITIES 7533996 DISCRETIONARY PENSION LIABILITY 744518 8278514 X 0 0 0 0 0 0 0 0 0 0 0 0 SCHEDULE D, PART X, LINE 2 FIN 48 (ASC 740) FOOTNOTE THE SYSTEM AND MOST OF ITS SUBSIDIARIES ARE CLASSIFIED AS TAX-EXEMPT ORGANIZATIONS AS DESCRIBED IN SECTIONS 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND ARE NOT SUBJECT TO FEDERAL AND STATE INCOME TAXES ON RELATED INCOME, PURSUANT TO SECTION 501(A) OF THE CODE. THESE ORGANIZATIONS ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES TO THE EXTENT THEY HAVE UNRELATED BUSINESS INCOME. THE SYSTEM HAS NO MATERIAL UNCERTAIN TAX POSITIONS. CERTAIN SUBSIDIARIES ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES. SOME OF THESE CORPORATIONS HAVE ACCUMULATED NET OPERATING LOSS CARRYFORWARDS THAT ARE AVAILABLE TO OFFSET FUTURE TAXABLE INCOME, IF ANY, AND HAVE BEEN FULLY RESERVED. true true X true X true X true true true false true true 666720 666720 0.01756 3893343 2692748 1200595 0.03162 0 0.0 0 0 4560063 2692748 1867315 0.04918 217713 11885 205828 0.00542 10982 10982 0.00029 7188112 5167233 2020879 0.05323 0 0.0 0 0.0 0 0 7416807 5179118 2237689 0.05894 0 0 11976870 7871866 4105004 0.10812 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 true 537324 1206509 5598445 5629231 -30786 X true true 1 1 MOUNDVIEW MEMORIAL HOSPITAL & CLINICS 402 WEST LAKE STREET PO BOX 40 FRIENDSHIP WI 53934 1014 X X X X MOUNDVIEW MEMORIAL HOSPITAL & CLINICS 1 false false true X X X X X X X X X 24 true true true true X HTTPS://WWW.GUNDERSENHEALTH.ORG/DOCUMENT/48911 X true 24 true HTTPS://WWW.GUNDERSENHEALTH.ORG/DOCUMENT/48906 false true X 200.0 400.0 X X X X X X X true true X X X X true X https://www.gundersenhealth.org/patients-visitors/financial-assistance X https://www.gundersenhealth.org/patients-visitors/financial-assistance X https://www.gundersenhealth.org/patients-visitors/financial-assistance X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 FACILITY , 1 FACILITY , 1 - MOUNDVIEW MEMORIAL HOSPITAL & CLINICS. MOUNDVIEW MEMORIAL HOSPITAL & CLINICS DID NOT CONDUCT A NEW SURVEY IN 2024. WE USED THE 52 QUESTION SURVEY THAT WAS PART OF THE CHNA THAT WE PARTICIPATED IN WITH ADAMS COUNTY HEALTH AND HUMAN SERVICES. THE SURVEY PRIMARILY INCLUDED A MIX OF RANKING QUESTIONS AND "CHECK ALL THAT APPLY" QUESTIONS. SOME EXAMPLES OF THE QUESTIONS INCLUDED: DEMOGRAPHICS, RATING OF THE COMMUNITY AND OPPORTUNITIES AVAILABLE IN THE COMMUNITY (JOBS, SOCIAL/RECREATIONS, SCHOOLS, CHILDCARE PROVIDERS, AFFORDABLE HOUSING, SAFETY, POLICE/SHERIFF, AVAILABLE RESOURCES) THE NEED FOR TRANSPORTATION, HEALTH SERVICES, FOOD; THEIR CONCERN FOR VARIOUS HEALTH ISSUES IN THE COMMUNITY SUCH AS MENTAL HEALTH, JOB LOSS, POVERTY, ALCOHOL AND DRUG USE), THEIR CONCERN FOR SAFETY RELATED ISSUES, WHAT THEY FELT WERE THE MOST IMPORTANT HEALTH PROBLEMS IN THE COMMUNITY. THE SURVEY TOOK PLACE THROUGHOUT THE SUMMER OF 2021 NOT 2024. WE USED THE 2021 SURVEY AS PART OF THE DATA FOR OUR 2024 NEEDS ASSESSMENT. WE THEN COLLECTED ADDITIONAL DATA IN 2024 THROUGH KEY INFORMANT INTERVIEWS, A COMMUNITY FOCUS GROUP AND KEY STAKEHOLDER MEETING WITH HEALTH NEEDS RANKINGS. SCHEDULE H, PART V, SECTION B, LINE 6A FACILITY , 1 FACILITY , 1 - MOUNDVIEW MEMORIAL HOSPITAL & CLINICS. THE CHNA WAS CONDUCTED IN JOINT EFFORT WITH THE FOLLOWING OTHER HOSPITAL: GUNDERSEN HEALTH SYSTEM SCHEDULE H, PART V, SECTION B, LINE 6B FACILITY , 1 FACILITY , 1 - MOUNDVIEW MEMORIAL HOSPITAL & CLINICS. THE CHNA WAS CONDUCTED IN JOINT EFFORT WITH THE FOLLOWING OTHER ORGANIZATIONS: ADAMS COUNTY HEALTH AND HUMAN SERVICES DIVISION OF PUBLIC HEALTH SCHEDULE H, PART V, SECTION B, LINE 11 FACILITY , 1 FACILITY , 1 - MOUNDVIEW MEMORIAL HOSPITAL & CLINICS. DEVELOP INITIATIVES TO IMPROVE THE MENTAL HEALTH OF AREA RESIDENTS. REDUCE THE AVERAGE NUMBER OF POOR MENTAL HEALTH DAYS IN THE LAST 30 DAYS TO LESS THAN THE 5.1 DAYS REPORTED IN THE 2024 COUNTY HEALTH RANKINGS. ACTION: MENTAL HEALTH SUPPORT FOR THOSE EXPERIENCING LOSS. PROGRAMS/INITIATIVES: ESTABLISH A STRUCTURED, RESEARCH BASED LOCAL GRIEF SUPPORT PROGRAM FOR THE DEATH OF LOVED ONE ACTION: RESILIENCY FOR DISADVANTAGED YOUTH PROGRAMS/INITIATIVES: GROW THE SCHOOL MENTOR PROGRAM TO INCLUDE STAFF FROM TWO COMMUNITY BUSINESSES OR AGENCIES THAT ARE NOT AFFILIATED WITH GUNDERSEN. ACTION: WORK WITH COMMUNITY PARTNERS ON MENTAL HEALTH INITIATIVES. CONTINUE TO SERVE ON AND PARTICIPATE IN THE COUNTY MENTAL HEALTH COMMUNITY ACTION TEAM AND RELATED INITIATIVES. ESTABLISH A ONESTOP LOCATION FOR AREA RESOURCES AND EVENTS FOR THE BENEFIT OF AREA RESIDENTS' OVERALL MENTAL AND PHYSICAL HEALTH. ACCESS TO CARE OVERALL GOAL: IMPROVE ACCESS TO HEALTHCARE PROVIDERS THROUGH RECRUITMENT AND RETENTION EFFORTS AND ENCOURAGING AREA YOUTH TO ENTER HEALTHCARE CAREERS. IMPROVE NUTRITION AND PHYSICAL ACTIVITY TO RESULT IN DECREASED CHRONIC ILLNESS, THEREBY REDUCING THE NEED FOR CARE. ACTION: IMPROVE ACCESS TO AREA RESOURCES AND SERVICES PROGRAMS/INITIATIVES: IMPROVE LOCAL TRANSPORTATION OPTIONS THROUGH A MULTIAGENCY APPROACH. CONTINUE SERVING ON THE TRANSPORTATION COMMUNITY ACTION TEAM. ACTION: IMPROVE NUTRITION AND PHYSICAL ACTIVITY TO DECREASE CHRONIC ILLNESS, THEREBY REDUCING THE NEED FOR CARE. PROGRAMS/INITIATIVES: -INCREASE AWARENESS AND ENCOURAGE USE OF LOCAL PHYSICAL ACTIVITY AND NUTRITION RESOURCES TO DECREASE OBESITY. DEVELOP TARGETED PROGRAMS/INITIATIVES THROUGH THE COMMUNITY ACTION TEAM ACTION: IMPROVE ACCESS TO HEALTHCARE SERVICES PROGRAMS/INITIATIVES: IMPLEMENT PEDIATRIC MOBILE CARE VAN PILOT PROGRAM IN FRIENDSHIP. CONTINUE RECRUITMENT OF SPECIALISTS AND PRIMARY CARE PHYSICIANS. IMPROVE ACCESS TO SURGICAL SERVICES.ACTION: ADDRESS CAREER SHORTAGE AREAS BY OFFERING JOB EXPLORATION, CLINICALS AND INTERNSHIP OPPORTUNITIES. PROGRAMS/INITIATIVES: GROW THE HEALTH CAREER ACADEMY AT AF HIGH SCHOOL OFFER 8TH GRADE CAREER TOURS AND ESTABLISH NEW CAREER EXPLORATION OPPORTUNITIES FOR YOUNGER STUDENTS. CONTINUE TO OFFER JOB SHADOWS, INTERNSHIPS AND SUBSTANCE ABUSE OVERALL GOAL: DECREASE THE DRUG OVERDOSE DEATHS TO LESS THAN THE 26 OVERDOSE DEATHS REPORTED FROM 20192023 BY THE ADAMS COUNTY SHERRIFF'S DEPARTMENT. ACTION: PARTNER WITH LOCAL AGENCIES ON TREATMENT PLANS FOR DRUG OFFENDERS PROGRAMS/INITIATIVES: LAB SUPPORT FOR DRUG COURT SCREENINGS - PROVIDE SPACE AND SUPPORT TO NOBLE COMMUNITY CLINIC (BEHAVIORAL HEALTH) ACTION: PARTICIPATE IN LOCAL EDUCATION AND DECREASE AVAILABILITY OF PRESCRIPTION DRUGS PROGRAMS/INITIATIVES: PARTICIPATE IN DRUG FREE ADAMS COUNTY PROGRAMS AND OTHER INITIATIVES. PROMOTE DRUG TAKE BACK PROGRAMS. MAINTAIN THE MEDICATION DROP BOX SPONSORED BY HOSPITAL PHARMACY. SOCIAL DETERMINANTS OF HEALTH (THAT SIMULTANEOUSLY IMPACT ECONOMIC HEALTH, PARTICULARLY HOUSING, WORKFORCE & ECONOMIC DEVELOPMENT, TRANSPORTATION, EDUCATION & CHILDCARE) OVERALL GOAL: IMPROVE THE HEALTH AND WELLBEING OF RESIDENTS AND THE COUNTY'S ECONOMY. THE ROOT CAUSE OF MANY HEALTH BEHAVIORS AND OUTCOMES CAN BE TIED TO POVERTY/LOW INCOME. IN ADAMS COUNTY THIS IS COMPOUNDED BY OVER HALF OF THE WORKFORCE NOT LIVING IN THE AREA, IMPACTING THE ECONOMY AND OVERALL HEALTH OUTCOMES. WE SEEK TO INCREASE THE COUNTY'S MEDIAN HOUSEHOLD INCOME ($55,223) AND DECREASE THE MEDIAN WORKFORCE AGE (55.1 YEARS) BY WORKING WITH OTHERS ON INITIATIVES TO ATTRACT/KEEP YOUNGER RESIDENTS AND FAMILIES AND ENCOURAGE BUSINESS DEVELOPMENT.ACTION: PARTNER WITH OTHERS IN THE COMMUNITY ON THE CREATION OF LOCAL ECONOMIC DEVELOPMENT PROGRAMS/INITIATIVES: SERVE ON THE RURAL PARTNERS NETWORK HOUSING COMMITTEE (GOAL OF INCREASING AVAILABLE, ATTRACTIVE WORKFORCE HOUSING AS OVER HALF OF THE COUNTY WORKFORCE DOES NOT LIVE IN THE AREA AND THEREFORE DOES NOT SUBSTANTIALLY CONTRIBUTE TO THE LOCAL ECONOMY) SERVE ON THE RURAL PARTNERS NETWORK DOWNTOWN IMPROVEMENT COMMITTEE (GOAL OF IMPROVING THE LOOK, FEEL, OFFERINGS AND ACTIVITIES OF DOWNTOWN ADAMS AND FRIENDSHIP TO MAKE THE CENTER OF THE COUNTY A MORE APPEALING PLACE TO HELP RETAIN AND RECRUIT WORKERS AND IMPROVE THE AREA ECONOMY) SERVE ON THE RURAL PARTNERS WORKFORCE DEVELOPMENT COMMITTEE (GOAL OF ATTRACTING NEW BUSINESSES TO THE AREA AND HELPING EXISTING BUSINESSES RECRUIT AND RETAIN QUALIFIED STAFF TO IMPROVE THE AREA ECONOMY) SERVE ON THE COUNTY ECONOMIC DEVELOPMENT BOARD AND/OR OTHER RELATED INITIATIVES. ACTION: ADDRESS THE CHILDCARE SHORTAGE PROGRAMS/INITIATIVES: SERVE ON THE ADAMS COUNTY CHILDCARE ALLIANCE COMMITTEE TO HELP IMPROVE THE AVAILABILITY OF LOCAL CHILDCARE OPTIONS ACTION: ADDRESS TRANSPORTATION NEEDS PROGRAMS/INITIATIVES: LISTED UNDER HEALTHCARE ACCESS ACTION: PROVIDE SUPPORT FOR LOCAL REFERENDUM COMMITTEES AS NEEDED. (SCHOOLS ARE ONE OF THE CORNERSTONES OF A SUCCESSFUL COMMUNITY) ACTION: OFFER INCENTIVES AND SCHOLARSHIPS WITH A FOCUS ON LOCAL, NONTRADITIONAL STUDENTS PURSUING HIGHNEED HEALTHCARE CAREERS PROGRAMS/INITIATIVES: PROVIDE HEALTHCARE SCHOLARSHIPS WITH THE CONTINGENCY THAT THE STUDENT WORKS LOCALLY. HOSPITAL PROVIDES PHYSICAL THERAPY SERVICES FOR SPECIAL NEEDS STUDENTS ON AN IEP. HOSPITAL ALSO PROVIDE PHYSICAL THERAPY SERVICES TO STUDENT ATHLETES AT SCHOOL TO AVOID LOSS OF ACADEMIC TIME. PROVIDE MENTORING FOR YOUTH RECEIVING SCHOLARSHIPS SCHEDULE H, PART V, SECTION B, LINE 13 FACILITY , 1 FACILITY , 1 - MOUNDVIEW MEMORIAL HOSPITAL & CLINICS. HOSPITAL PATIENTS NOT MEETING FINANCIAL ASSISTANCE ELIGIBILITY THRESHOLDS MAY BE ELIGIBLE FOR ASSISTANCE UNDER CIRCUMSTANCES WHEN HOSPITAL MEDICAL BILLS WOULD RESULT IN SEVERE FINANCIAL HARDSHIP. PATIENTS, OR THEIR GUARANTORS, MAY BE ELIGIBLE FOR CATASTROPHIC CARE ASSISTANCE IF THEY HAVE INCURRED OUTOFPOCKET OBLIGATIONS RESULTING FROM MEDICAL SERVICES PROVIDED BY GMV THAT EXCEED 25% OF FAMILY INCOME AND HAVE ASSETS BELOW THE EQUIVALENT OF 600% OF THE FPL THRESHOLD. 2 GUNDERSEN FRIENDSHIP CLINIC 402 WEST LAKE STREET PO BOX 40 FRIENDSHIP WI 53934 RURAL HEALTH CLINIC GUNDERSEN WESTFIELD CLINIC 207 NORTH PIONEER PARK ROAD WESTFIELD WI 53964 RURAL HEALTH CLINIC SCHEDULE H, PART I, LINE 3C PART I, LINE 3C: HOSPITAL PATIENTS NOT MEETING FINANCIAL ASSISTANCE ELIGIBILITY THRESHOLDS MAY BE ELIGIBLE FOR ASSISTANCE UNDER CIRCUMSTANCES WHEN HOSPITAL MEDICAL BILLS WOULD RESULT IN SEVERE FINANCIAL HARDSHIP. PATIENTS, OR THEIR GUARANTORS, MAY BE ELIGIBLE FOR CATASTROPHIC CARE ASSISTANCE IF THEY HAVE INCURRED OUTOF-POCKET OBLIGATIONS RESULTING FROM MEDICAL SERVICES PROVIDED BY GMV THAT EXCEED 25% OF FAMILY INCOME AND HAVE ASSETS BELOW THE EQUIVALENT OF 600% OF THE FPL THRESHOLD. SCHEDULE H, PART I, LINE 7 PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE. SCHEDULE H, PART I, LINE 7G SUBSIDIZED HEALTH SERVICES THE ORGANIZATION OPERATES 2 RURAL HEALTH CLINICS, AN OBSERVATION ROOM AND EMERGENCY ROOM WHERE THE COSTS EXCEED THE NET PATIENT SERVICE REVENUE. THESE SERVICES WOULD NOT BE PROVIDED TO THE COMMUNITY IF NOT FOR THE LEADERSHIP OF THE HOSPITAL. THE ORGANIZATION UTILIZED THEIR COST REPORT AND OTHER INTERNAL INFORMATION TO DETERMINE THE AMOUNTS TO BE RECORDED PER WORKSHEET 6 OF THE IRS FORM SCHEDULE H INSTRUCTIONS. AMOUNTS RECORDED HERE HAVE NOT BEEN DUPLICATED IN OTHER AREAS OF THE FORM, MEDICAID, BAD DEBT, FINANCIAL ASSISTANCE HAS BEEN REMOVED FROM THE AMOUNTS REPORTED AND THESE SERVICES WERE EXCLUDED FROM THE MEDICARE SURPLUS/SHORTFALL CALCULATION. SCHEDULE H, PART I, LINE 7 COSTING METHODOLOGY USED TO CALCULATE FINANCIAL ASSISTANCE THE RATIO OF PATIENT COST TO CHARGES WAS CALCULATED BY DIVIDING HOSPITAL EXPENSES NET OF NONPATIENT REVENUE AND IDENTIFIED COMMUNITY BENEFIT EXPENSE BY GROSS PATIENT REVENUE. THE PERCENTAGE WAS THEN MULTIPLIED BY THE GROSS REVENUES ON BAD DEBT ACCOUNTS. SCHEDULE H, PART II COMMUNITY BUILDING ACTIVITIES THE HOSPITAL'S COMMUNITY BUILDING ACTIVITIES PROMOTE HEALTH OF THE COMMUNITIES IT SERVES THROUGH LOCAL ADVERTISEMENTS, INVOLVEMENT WITH CHAMBER OF COMMERCE, DEPARTMENT OF AGING, AND OTHER COMMUNITY ORGANIZATIONS. THE AMOUNT OF SUPPORT IS DIFFICULT TO QUANTIFY. SCHEDULE H, PART III, LINE 2 BAD DEBT EXPENSE - METHODOLOGY USED TO ESTIMATE AMOUNT THE RATIO OF PATIENT COST TO CHARGES WAS CALCULATED BY DIVIDING HOSPITAL EXPENSES NET OF NONPATIENT REVENUE AND IDENTIFIED COMMUNITY BENEFIT EXPENSE BY GROSS PATIENT REVENUE. THE PERCENTAGE WAS THEN MULTIPLIED BY THE GROSS REVENUES ON BAD DEBT ACCOUNTS. SCHEDULE H, PART III, LINE 3 BAD DEBT EXPENSE METHODOLOGY IT IS CONSIDERED COMMUNITY BENEFIT AS THE HOSPITAL IS REIMBURSED ON MEDICARE ALLOWABLE COSTS. MEDICARE ALLOWABLE COSTS ARE DEFINED BY MEDICARE. THEY DO NOT NECESSARILY CAPTURE ALL COSTS OF THE HOSPITAL PROVIDING SERVICES TO THE COMMUNITY. CONSEQUENTLY, THERE ARE COSTS NOT REIMBURSED BY EITHER PATIENT OR THE PROGRAM. SCHEDULE H, PART III, LINE 4 BAD DEBT EXPENSE - FINANCIAL STATEMENT FOOTNOTE PATIENT ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS NET OF CONTRACTUAL ADJUSTMENTS AND AN ALLOWANCE FOR DOUBTFUL ACCOUNTS, THAT REFLECTS MANAGEMENT'S BEST ESTIMATE OF AMOUNTS THAT WILL NOT BE COLLECTED. MANAGEMENT PROVIDES FOR CONTRACTUAL ADJUSTMENTS UNDER TERMS OF THIRDPARTY REIMBURSEMENT AGREEMENTS THROUGH A REDUCTION OF GROSS PATIENT SERVICE REVENUE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. IN ADDITION, MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY FROM UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND CURRENT STATUS OF INDIVIDUAL ACCOUNTS.IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE ORGANIZATION ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRDPARTY COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRDPARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELFPAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRDPARTY COVERAGE. EXISTS FOR PART OF THE BILL). THE ORGANIZATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE BASED ON ITS EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. SCHEDULE H, PART III, LINE 8 COMMUNITY BENEFIT & METHODOLOGY FOR DETERMINING MEDICARE COSTS THE TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H TO THE FORM 990 IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE OF THE ORGANIZATION AND DOES NOT CONSIDER ALL CONTRACTUAL ADJUSTMENTS FOR SERVICES REIMBURSED BY THE MEDICARE PROGRAM. AMOUNTS LISTED FOR MEDICARE REVENUE DO NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE ORGANIZATION AS WELL AS ANESTHESIA PROFESSIONAL SERVICES, SURGICAL PHYSICIAN PROFESSIONAL SERVICES, AND REVENUE FOR ANY PATIENTS COVERED UNDER MEDICARE ADVANTAGE PLAN PROGRAMS. PHYSICIAN PROFESSIONAL SERVICES ARE REIMBURSED PRIMARILY ON FEE SCHEDULE REIMBURSEMENTS AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY, SURGICAL, AND CLINICAL PHYSICIAN SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELLBEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT MOUNDVIEW MEMORIAL HOSPITAL & CLINICS PROVIDES TO THE COMMUNITY AND SURROUNDING AREAS. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT, AND DOES NOT CONSIDER MEDICARE NONALLOWABLE EXPENSES, AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NONALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE).WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAXEXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. SCHEDULE H, PART III, LINE 9B COLLECTION PRACTICES FOR PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S COLLECTION AND CHARITY CARE POLICIES, MOUNDVIEW MEMORIAL HOSPITAL AND CLINICS MAKES EVERY ATTEMPT TO IDENTIFY AND PROMOTE CHARITY CARE TO PATIENTS. INCLUDED IN THE HOSPITAL'S CHARITY CARE POLICY IT IS NOTED THAT PATIENTS MAY QUALIFY FOR CHARITY CARE EITHER PRIOR TO ADMISSION OR FOLLOWING DISCHARGE. ALL INPATIENT SELF-PAY ADMISSIONS ARE SCREENED BY THE HOSPITAL'S PATIENT FINANCIAL COUNSELOR OR SOCIAL WORKERS TO ALLOW THESE PATIENTS THE ABILITY TO COMPLETE THEIR APPLICATION DURING THEIR STAY AT THE HOSPITAL, DEPENDING UPON THE PATIENT'S CONDITION, OR THE PATIENT'S RESPONSIBLE PARTY MAY BE CONTACTED TO COMPLETE AND RETURN THE FORMS AT A LATER TIME WHEN THEIR CARE ALLOWS THIS COMPLETION. DURING THE PATIENT ACCOUNT COLLECTION PROCESS, SELF-PAY PATIENTS ARE ALSO INFORMED OF THE HOSPITAL'S COLLECTION POLICIES AS WELL AS THE CHARITY CARE PROGRAM TO ALLOW PATIENTS THE OPPORTUNITY TO COMPLETE THE APPROPRIATE FORMS AND QUALIFY UNDER THE PROGRAM. SCHEDULE H, PART V, SECTION B, LINE 16A FAP WEBSITE - MOUNDVIEW MEMORIAL HOSPITAL & CLINICS: LINE 16A URL: HTTPS://WWW.GUNDERSENHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE; SCHEDULE H, PART V, SECTION B, LINE 16B FAP APPLICATION WEBSITE - MOUNDVIEW MEMORIAL HOSPITAL & CLINICS: LINE 16B URL: HTTPS://WWW.GUNDERSENHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE; SCHEDULE H, PART V, SECTION B, LINE 16C FAP PLAIN LANGUAGE SUMMARY WEBSITE - MOUNDVIEW MEMORIAL HOSPITAL & CLINICS: LINE 16C URL: HTTPS://WWW.GUNDERSENHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE; SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT THE HOSPITAL COMMUNICATES REGULARLY WITH PUBLIC HEALTH TO ADDRESS COMMUNITY HEALTH NEEDS. WE ANNUALLY REVIEW LOCAL, REGIONAL AND STATE DATA SOURCES. THE HOSPITAL COMPLETES REPORTS ON INFECTIOUS AND COMMUNICABLE DISEASE AND MONITORS FOR OUTBREAKS. ANNUAL RISK ASSESSMENTS ARE COMPLETED ON TB AND INFECTION CONTROL ISSUES. THE HOSPITAL MEASURES CHRONIC DISEASE SCREENING RATES. THE HOSPITAL REVIEWS DATA RELEVANT TO WORK BEING COMPLETED THROUGH THE LOCAL COMMUNITY ACTION TEAMS WHO ARE ADDRESSING THE PRIORITIZED HEALTH NEEDS. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE THE HOSPITAL ANNUALLY UPDATES THE AVAILABILITY OF ITS CHARITY PLAN AND QUALIFYING INCOME NEEDS TO QUALIFY ON THE HOSPITAL WEBSITE. THE EXISTENCE OF A CHARITY PLAN IS POSTED IN THE ADMITTING AREA. UPON REGISTRATION, THE PATIENT IS INFORMED OF THE HOSPITAL'S CHARITY PLAN, ELIGIBILITY, AND METHODS FOR APPLYING. ANYONE INTERESTED IN FURTHER INFORMATION IS REFERRED TO THE PATIENT ACCOUNT COORDINATOR FOR QUESTIONS AND ELIGIBILITY. THIS PERSON WORKS WITH THE PATIENT IN APPLICATION AS WELL AS EXPLORING THE POSSIBLE ELIGIBILITY OF ANY OTHER GOVERNMENT PROGRAM THAT MAY BE APPLICABLE, I.E. MEDICAID, BADGER CARE. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION GUNDERSEN MOUNDVIEW SERVES ALL RESIDENTS OF ADAMS COUNTY (POPULATION 21,226 PER CENSUS 2022 QUICK FACTS). WE ALSO SERVE WESTFIELD AREA RESIDENTS, LOCATED IN MARQUETTE COUNTY. HOWEVER, OUR PRIMARY SERVICE AREA IS THE CENTRAL PORTION OF ADAMS COUNTY INCLUDING THE ZIP CODES OF ADAMS, FRIENDSHIP, ARKDALE AND GRAND MARSH WHICH MAKE UP OVER 74% OF OUR REVENUE. THE MAJORITY OF ADAMS COUNTY RESIDENTS ARE WHITE (93.1%) AND A HIGH PERCENTAGE (31%) ARE AGE 65 AND OVER. THE MEDIAN HOUSEHOLD INCOME ($51,878) IS CONSIDERABLY LOWER THAN THE STATE. TOURISM AND AGRICULTURE ARE AMONG THE COUNTY'S LARGEST INDUSTRIES. THE COUNTY IS MEDICALLY UNDERSERVED AND HAS RANKED IN THE BOTTOM OF THE WI COUNTY HEALTH RANKINGS IN TERMS OF HEALTH OUTCOMES AND FACTORS. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH THE HOSPITAL IS A STRONG COMMUNITY PARTNER IN MANY LOCAL HEALTH EFFORTS. WE PROVIDE MONETARY AND INKIND SUPPORT TO SEVERAL INITIATIVES SUCH AS DONATIONS TO RECREATIONAL/WELLNESS PROGRAMS (EXAMPLEPROVIDING FREE BIKE HELMETS TO YOUTH AND FUNDING TENNIS RACKETS TO BE USED BY SCHOOL STUDENTS AND AT YMCA TENNIS CLASSES). WE ALSO HAVE A PHYSICIAN SERVING ON THE LOCAL HEALTH BOARD, STAFF SERVING ON NUMEROUS COMMUNITY COALITIONS, COLLECT DONATIONS FOR AREA FOOD PANTRIES AND MUCH MORE. THESE ARE JUST A FEW AREAS WE HAVE ASSISTED. THE HOSPITAL BOARD ALSO INCLUDES COMMUNITY MEMBERS WHO ARE UNPAID. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM THE ORGANIZATION IS A PART OF EMPLFY HEALTH WHICH IS THE COMBINATION OF GUNDERSEN HEALTH AND BELLIN HEALTH SYSTEMS. IT IS A NOT-FOR-PROFIT ORGANIZATION DEDICATED TO ENHANCING THE PHYSCIAL AND EMOTIONAL WELL-BEING OF INDIVIDUALS. IN COLLABORATION WITH COMMUNITIES, EMPLOYERS, SCHOOLS, AND GOVERNMENT OFFICIALS, WE SUPPORT INDIVIDUALS AND FAMILIES ON THEIR LIFELONG JOURNEY TOWARD OPTIMAL HEALTH. OUR COMMITMENT LIES IN DELIVERING SAFE, RELIABLE, AND COST-EFFECTIVE COMPREHENSIVE HEALTH SOLUTIONS, ALL WHILE UPHOLDING THE VALUES OF RESPECT AND COMPASSION. THROUGH OUR INNOVATIVE INITIATIVES, WE AIM TO TRANSFORM HEALTHCARE DELIVERY NOT ONLY IN OUR REGION BUT ALSO ON A GLOBAL SCALE. SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT WI true CHARITY CARE 1098 1206509 SCHEDULE I, PART I, LINE 2 PROCEDURES FOR MONITORING USE OF GRANT FUNDS THE FUNDS MADE TO INDIVIDUALS ARE GIVEN TO HELP PAY FOR MEDICAL BILLS OWED TO GUNDERSEN LUTHERAN MEDICAL CENTER THROUGH A CHARITY CARE APPLICATION PROCESS. false true false false false false false false false SARAH ROSSMAN BOARD OF DIRECTORS, SECRETARY/TREASURER, CLINICAL OPERATIONS DIRECTOR, PEDIATRICS 0 163776 0 0 0 1870 0 23318 0 3895 0 192859 0 0 STEPHANIE CARROLL MD BOARD OF DIRECTORS, MD 0 305920 0 15667 0 688 0 39470 0 27699 0 389444 0 0 BRYAN ERDMANN BOD, CHIEF OPERATING OFFICER 0 443062 0 0 0 608 0 48300 0 27890 0 519860 0 0 KAREN MILLER BOARD OF DIRECTORS, RN, CASE MANAGER - TWEETEN (END 12.31.24) 0 118741 0 2656 0 2122 0 17660 0 11631 0 152810 0 0 ROXANNE POTTS BOARD OF DIRECTORS, CLINICAL OPERATIONS DIRECTOR, IMAGING SERVICES 0 167073 0 0 0 8647 0 24799 0 23667 0 224186 0 0 STEVE LITTLE FORMER CHIEF FINANCIAL OFFICER 0 209856 0 0 0 0 0 0 0 0 0 209856 0 0 JOHN CEELEN CHIEF FINANCIAL OFFICER 0 598104 0 129468 0 744 0 29147 0 24905 0 782368 0 0 SCOTT RATHGABER MD CEO 0 1278368 0 0 0 45907 0 48300 0 24975 0 1397550 0 0 KRISTY MILLERING FINANCE ADMINISTRATOR 0 130279 0 0 0 1075 0 18798 0 23602 0 173754 0 0 FRANCISCO PEREZ-GUERRA ADMINISTRATOR 0 196856 0 0 0 4264 0 28988 0 37819 0 267927 0 0 LORI WITTIG ADMINISTRATOR 131318 0 14440 0 6443 0 21338 0 2983 0 176522 0 0 0 CURTIS DOWDY FINANCE ADMINISTRATOR 0 177185 0 2109 0 2726 0 25367 0 9929 0 217316 0 0 DAVID BROWN PHARMACIST, OUTPATIENT 183196 0 4501 0 1155 0 26278 0 339 0 215469 0 0 0 NEAL DONNER PHARMACIST, OUTPATIENT 176140 0 4501 0 1171 0 26278 0 34671 0 242761 0 0 0 DEENA KEDROWSKI MANAGER, OUTPATIENT PHARMACY 189343 0 4858 0 3065 0 28533 0 37219 0 263018 0 0 0 PRESTON PIETRZAK PHARMACIST, OUTPATIENT 154837 0 0 0 344 0 21738 0 6877 0 183796 0 0 0 BRADLEY SHAW MANAGER, INPATIENT PHARMACY 196768 0 4858 0 1356 0 27615 0 339 0 230936 0 0 0 SCHEDULE J, PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN CERTAIN INDIDVIDUALS LISTED IN SCHEDULE J, PART II, PARTICIPATE IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN TO WHICH THE ORGANIZATION MAKES ANNUAL CONTRIBUTIONS. THESE CONTRIBUTIONS ARE AT RISK AND DO NOT BECOME VESTED AND PAYABLE UNLESS AND UNTIL THE INDIVIDUAL SATISFIES A SUBSTANTIAL FUTUTE SERVICE REQUIREMENT. THE FOLLOWING INDIVIDUALS HAD CONTRIBUTIONS MADE TO THE PLAN FOR CALENDAR YEAR 2024: JOHN CEELEN SCHEDULE J, PART I, LINE 3 A RELATED ORGANIZATION OF THE FILING ORGANIZATION USES ONE OR MORE OF THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. FORM 990, PART III, LINE 2 NEW PROGRAM SERVICES EXPANSION OF GENERAL SURGERY PROGRAM WITH MORE AVAILABILITY ON A WEEKLY BASIS, INCLUDING SAME-DAY CONSULTS. THE FACILITY HAS ADDED NURSING FOOT CARE IN ITS SPECIALTY CLINIC. FORM 990, PART VI, LINE 15A COMPENSATION IS DETERMINED BY A RELATED ORGANIZATION. COMPENSATION FOR THE CEO AND KEY EXECUTIVES ARE SET BY THE EXECUTIVE COMMITTEE OF THE BOARD SUPPORTED BY MARKET DATA FROM SURVEYS AND AN INDEPENDENT CONSULTANTS REPORT. THE COMPENSATION IS DETERMINED BY MEMBERS OF THE EXECUTIVE COMMITTEE WITHOUT CONFLICT AND IS DOCUMENTED. FORM 990, PART VI, LINE 15B SENIOR LEADERS: COMPENSATION IS DETERMINED BY A RELATED ORGANIZATION. COMPENSATION FOR THOSE WHO REPORT TO THE CEO IS TAKEN TO THE EXECUTIVE COMMITTEE FOR DISCUSSION/APPROVAL. FORM 990, PART VI, LINE 6 CLASSES OF MEMBERS OR STOCKHOLDERS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION IS GUNDERSEN LUTHERAN HEALTH SYSTEM (GLHS) FORM 990, PART VI, LINE 7A MEMBERS OR STOCKHOLDERS ELECTING MEMBERS OF GOVERNING BODY PER THE ORGANIZATION'S BYLAWS THE BOARD SHALL CONSIST OF NINE DIRECTORS WHICH SHALL INCLUDE FIVE MEMBER REPRESENTATIVES AND FOUR COMMUNITY REPRESENTATIVES. THE SOLE CORPORATE MEMBER, GLHS, HAS THE AUTHORITY TO APPOINT/REMOVE THE FIVE MEMBER REPRESENTATIVES. FORM 990, PART VI, LINE 7B DECISIONS REQUIRING APPROVAL BY MEMBERS OR STOCKHOLDERS THE FOLLOWING ACTIONS ARE SUBJECT TO APPROVAL BY THE SOLE CORPORATE MEMBER, GLHS: THE INCURRENCE OF DEBT IN EXCESS OF $100,000 (OTHER THAN DEBT INCURRED FOR THE ACQUISITION OF GOODS THAT ARE ACQUIRED IN THE ORDINARY COURSE OF BUSINESS OR DEBT INCLUDED IN APPROVED BUDGETS) AND THE GRANT ANY SECURITY INTERESTS, PLACE ANY ENCUMBRANCES, ENTER INTO ANY COVENANTS, AND DIRECT THE EXECUTION OF ANY DOCUMENTS AND THE TAKING OF ANY ACTIONS NECESSARY OR APPROPRIATE IN CONNECTION WITH THE INCURRENCE OF SUCH DEBT; ANNUAL OPERATING BUDGET AND CAPITAL EXPENDITURES; AND STRATEGIC PLANS, MEDICAL STAFF PLANS, AND BUSINESS PLANS, GOALS, AND OBJECTIVES OF THE ORGANIZATION, AND ALL AMENDMENTS THERETO; INDIVIDUAL NEW PROGRAMS OR PROJECTS, OR CHANGES IN EXISTING PROGRAMS OR PROJECTS, THAT HAVE AN UNBUDGETED ANNUAL IMPACT ON INCOME FROM OPERATIONS AND/OR CAPITAL EXPENDITURES OF ONE HUNDRED THOUSAND DOLLARS ($100,000) OR GREATER; ANY PLAN TO CREATE A NEW AFFILIATE OF THE ORGANIZATION OR TO DISSOLVE, REORGANIZE, MERGE OR CONSOLIDATE THE ORGANIZATION; THE APPOINTMENT, EVALUATION AND REMOVAL OF THE CHIEF EXECUTIVE OFFICER; THE REPORT OF INDEPENDENT AUDITORS ON THE REASONABLENESS OF PHYSICIAN COMPENSATION, AS MAY BE REQUIRED; PROVIDED, HOWEVER, THAT ALL PHYSICIAN COMPENSATION SHALL BE SUBJECT TO REVIEW, APPROVAL AND EMPLOYMENT PRACTICES OF THE MEMBER; AMENDMENT OF THE ARTICLES OR BYLAWS OF THE CORPORATION; ANY CHANGE IN THE PAYOR CONTRACTING STRATEGY FOR THE ORGANIZATION THAT WOULD CHANGE THE ORGANIZATION'S ABILITY TO NEGOTIATE MANAGED CARE CONTRACTS WITH INSURANCE COMPANIES THAT ARE NOT UNDER CONTRACT WITH THE MEMBER AND THAT PERMITS THE ORGANIZATION TO BECOME A MEMBER OF PROVIDER NETWORKS OF THE MEMBER TO THE EXTENT PERMITTED BY THE APPLICABLE PAYERS. FORM 990, PART VI, LINE 11B REVIEW OF FORM 990 BY GOVERNING BODY THE FORM 990 IS REVIEWED BY THE ACCOUNTING MANAGER AND PRINCIPAL OFFICER. IT WILL BE MADE AVAILABLE FOR ALL BOARD MEMBERS BEFORE FILING. FORM 990, PART VI, LINE 12C CONFLICT OF INTEREST POLICY GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. (GLAS) ANNUALLY REQUIRES EXECUTIVE LEADERSHIP (VICE PRESIDENTS AND ABOVE), BOARD MEMBERS, MEDICAL GOVERNORS AND FOUNDATION BOARD MEMBERS TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT. COMPLETED DISCLOSURE STATEMENTS ARE REVIEWED BY A CONFLICT OF INTEREST REVIEW PANEL WHICH INCLUDES REPRESENTATIVES FROM LEGAL, COMPLIANCE, MEDICAL LEADERSHIP, HUMAN RESOURCES AND SUPPLY CHAIN. INDIVIDUALS REPORTING A POTENTIAL CONFLICT OF INTEREST ARE SENT A RESOLUTION THANKING THEM FOR THEIR SERVICE TO THE ORGANIZATION, ADVISING THEM OF ANY RESTRICTIONS RELATED TO THEIR CONFLICT (I.E. INDIVIDUALS WITH A RELATIONSHIP TO ANOTHER ORGANIZATION ARE ADVISED THAT THEY MUST ABSTAIN FROM DECISION MAKING THAT WOULD DIRECTLY AND SOLELY IMPACT GLAS) AND REMINDING THEM OF THEIR CONFIDENTIALITY OBLIGATIONS WITH RESPECT TO GLAS' HEALTHCARE, EMPLOYMENT AND PROPRIETARY INFORMATION. FORM 990, PART VI, LINE 19 REQUIRED DOCUMENTS AVAILABLE TO THE PUBLIC THE ORGANIZATION BELIEVES THE GOVERNING DOCUMENTS AND POLICIES ARE THE PROPERTY OF THE ORGANIZATION AND ARE NOT AVAILABLE FOR PUBLIC INSPECTION. THE AUDITED FINANCIAL STATEMENTS ARE NOW REQUIRED TO BE ATTACHED TO FORM 990. AUDITED FINANCIAL INFORMATION IS POSTED ANNUALLY ON THE HOSPITAL'S WEBSITE. FORM 990, PART VIII, LINE 11D OTHER MISCELLANEOUS REVENUE DONATION- PARTNERS OF MOUNDVIEW - TOTAL REVENUE: 8661, RELATED OR EXEMPT FUNCTION REVENUE: 8661, UNRELATED BUSINESS REVENUE: , REVENUE EXCLUDED FROM TAX UNDER SECTIONS 512, 513, OR 514: ; VENDOR REBATES - TOTAL REVENUE: 7213, RELATED OR EXEMPT FUNCTION REVENUE: 7213, UNRELATED BUSINESS REVENUE: , REVENUE EXCLUDED FROM TAX UNDER SECTIONS 512, 513, OR 514: ; OTHER - TOTAL REVENUE: 6167, RELATED OR EXEMPT FUNCTION REVENUE: 6167, UNRELATED BUSINESS REVENUE: , REVENUE EXCLUDED FROM TAX UNDER SECTIONS 512, 513, OR 514: ; LOAN FORGIVENESS INTEREST - PAYROLL - TOTAL REVENUE: 3868, RELATED OR EXEMPT FUNCTION REVENUE: 3868, UNRELATED BUSINESS REVENUE: , REVENUE EXCLUDED FROM TAX UNDER SECTIONS 512, 513, OR 514: ; VENDING MACHINE INCOME - TOTAL REVENUE: 903, RELATED OR EXEMPT FUNCTION REVENUE: 903, UNRELATED BUSINESS REVENUE: , REVENUE EXCLUDED FROM TAX UNDER SECTIONS 512, 513, OR 514: ; BELLIN GUNDERSEN HEALTH SYSTEM INC 1836 SOUTH AVENUE LA CROSSE WI 54601 920504278 SUPPORT ORG WI 501(C)(3) TYPE III-FI NA false GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1836 SOUTH AVE LA CROSSE WI 54601 391866425 SUPPORT ORG WI 501(C)(3) TYPE II BGHS false GUNDERSEN LUTHERAN MEDICAL CENTER INC 1910 SOUTH AVE LA CROSSE WI 54601 390813416 HEALTHCARE WI 501(C)(3) 3 GLHS false GUNDERSEN CLINIC LTD 1836 SOUTH AVENUE LA CROSSE WI 54601 391028657 HEALTHCARE WI 501(C)(3) 3 GLHS false GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES INC 1910 SOUTH AVE LA CROSSE WI 54601 391606449 SUPPORT ORG WI 501(C)(3) TYPE II GLHS false GUNDERSEN LUTHERAN MEDICAL FOUNDATION INC 1836 SOUTH AVENUE LA CROSSE WI 54601 391249705 FOUNDATION WI 501(C)(3) 7 GLHS false TRI-COUNTY MEMORIAL HOSPITAL INC 18601 LINCOLN STREET WHITEHALL WI 54773 390704510 HEALTHCARE WI 501(C)(3) 3 GLHS false HARMONY COUMMUNITY HEALTHCARE INC 815 MAIN AVE SOUTH HARMONY MN 55939 410711606 HEALTHCARE WI 501(C)(3) 10 GLHS false TWEETEN LUTHERAN HEALTHCARE CENTER INC 125 FIFTH AVE SE SPRING GROVE MN 55974 411565003 HEALTHCARE WI 501(C)(3) 10 GLHS false TRI STATE AMBULANCE INC 235 CAUSEWAY BOULEVARD LA CROSSE WI 54603 391965415 MEDICAL TRANSPORT WI 501(C)(3) 3 GLHS false TRI-STATE REGIONAL AMBULANCE INC 235 CAUSEWAY BOULEVARD LA CROSSE WI 54603 391962965 MEDICAL TRANSPORT WI 501(C)(3) 10 GLHS false LUTHERAN REAL ESTATE HOLDING CORPORATION 1910 SOUTH AVENUE LA CROSSE WI 54601 391480826 HOUSING WI 501(C)(3) TYPE III-FI GLHS false COMMUNITY HOUSING OF LA CROSSE INC 1900 SOUTH AVENUE LA CROSSE WI 54601 391586700 INDEPENDENT LIVING WI 501(C)(3) 10 LREH CORP false LUTHERAN HOUSING OF LA CROSSE INC 1900 SOUTH AVENUE LA CROSSE WI 54601 391751934 INDEPENDENT LIVING WI 501(C)(3) 10 LREH CORP false ST JOSEPH'S HEALTH SERVICES INC 400 WATER AVE HILLSBORO WI 54634 390929538 HEALTHCARE WI 501(C)(3) 3 GLHS false ST JOSEPH MEMORIAL FOUNDATION INC 400 WATER AVE HILLSBORO WI 54634 391455787 FOUNDATION WI 501(C)(3) TYPE I STJ HLTH SVC false TRI-COUNTY MEMORIAL FOUNDATION INC 18601 LINCOLN STREET WHITEHALL WI 54773 300093022 FOUNDATION WI 501(C)(3) TYPE I TCH false MEMORIAL HOSPITAL OF BOSCOBEL 205 PARKER STREET BOSCOBEL WI 53805 390845590 HEALTHCARE WI 501(C)(3) 3 GLHS false PALMER LUTHERAN HEALTH CENTER INC 112 JEFFERSON STREET WEST UNION IA 52175 421320763 HEALTHCARE WI 501(C)(3) 3 GLHS false MEMORIAL HEALTHCARE FOUNDATION INC (MOUNDVIEW) 402 WEST LAKE STREET FRIENDSHIP WI 53934 391775074 FOUNDATION WI 501(C)(3) TYPE I MDV HOSP true SAINT ELIZABETH'S HOSPITAL OF WABASHA INC WABASHA 1200 FIFTH GRANT BLVD WEST WABASHA MN 55981 410693877 HEALTHCARE WI 501(C)(3) 3 GLHS false BELLIN HEALTH SYSTEMS INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 391512904 SUPPORT ORG WI 501(C)(3) TYPE II BGHS false LAKE MICHIGAN HEALTH SERVICES INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 391512903 SUPPORT ORG WI 501(C)(3) TYPE II BHS false BELLIN COLLEGE INC 3201 EATON ROAD GREEN BAY WI 54311 391620530 EDUCATION WI 501(C)(3) 2 BHS false BELLIN PSYCHIATRIC CENTER INC PO BOX 23725 GREEN BAY WI 54301 391657627 HEALTHCARE WI 501(C)(3) 3 BHS false BELLIN MEMORIAL HOSPITAL INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 390884478 HEALTHCARE WI 501(C)(3) 3 BHS false THE BELLIN HEALTH FOUNDATION INC PO BOX 23400 GREEN BAY WI 54301 391809171 FOUNDATION WI 501(C)(3) 7 BHS false OCONTO HOSPITAL & MEDICAL CENTER INC 820 ARBUTUS AVENUE OCONTO WI 54153 061745397 HEALTHCARE WI 501(C)(3) 3 BMH false GUNDERSEN LUTHERAN ENVISION LLC 1836 SOUTH AVENUE LA CROSSE WI 54601 264706546 RENEWABLE ENERGY WI NA C CORPORATION false BEL-REGIONAL HOME MEDICAL INC 617 S ROOSEVELT GREEN BAY WI 54301 391504766 DURABLE MEDICAL EQUIPMENT, RETAIL WI NA C CORPORATION false GUNDERSEN EDGE LLC 1836 SOUTH AVENUE LA CROSSE WI 54601 921783811 INNOVATION WI NA C CORPORATION false BG ASSURANCE COMPANY SELF INSURANCE NA C CORPORATION false false false true false false false false false false true true false false false false false false true false MEMORIAL HEALTHCARE FOUNDATION INC C 111840 FMV