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TIN:
SCHEDULE O
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is atwww.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Inspection
Name of the organization
Gundersen Health Plan Inc
Employer identification number
39-1807071
39-1807071
| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6: | GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. IS THE SOLE CORPORATE MEMBER OF THIS ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 7A: | THE SOLE CORPORATE MEMBER, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. MAY ELECT THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION A, LINE 7B: | ANY DECISION BY THE CORPORATION TO DISAFFILIATE WITH THE GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., WHETHER THROUGH AMENDMENT TO THE ARTICLES OF INCORPORATION OR OTHERWISE; THE REPEAL OR AMENDMENT OF THE CORPORATION'S ARTICLES OF INCORPORATION OR BYLAWS; THE SELECTION, APPOINTMENT AND REMOVAL OF THE CORPORATION'S PRESIDENT AND CHIEF OPERATING OFFICER; THE GUARANTEE BY THE CORPORATION OF ANY INDEBTEDNESS IN EXCESS OF ONE HUNDRED THOUSAND DOLLARS ($100,000.00); THE ADOPTION OF THE CORPORATION'S ANNUAL OPERATING BUDGET; THE ELECTION, REMOVAL AND REPLACEMENT OF BOARD MEMBERS; AND THE MERGER, DISSOLUTION OR LIQUIDATION OF THE CORPORATION. |
| FORM 990, PART VI, SECTION B, LINE 11: | THE FORM 990 IS REVIEWED FOR COMPLETENESS AND ACCURACY BY MANAGEMENT. FOR THIS PURPOSE, MANAGEMENT INCLUDES THE Executive Director of Financial Operations FOR GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. AND THE TREASURER OF GUNDERSEN HEALTH PLAN, INC. THE ORGANIZATION PROVIDES A COPY OF THE FORM 990 TO ALL BOARD MEMBERS PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C: | ALL HEALTH PLAN EMPLOYEES AND COMMITTEE MEMBERS MUST REVIEW, COMPLETE, AND SIGN A CONFLICT OF INTEREST DISCLOSURE FORM ON AN ANNUAL BASIS AS PART OF THE MANDATORY EDUCATION PROCESS. BOARD MEMBERS ARE ALSO SENT A DISCLOSURE FORM TO COMPLETE ON AN ANNUAL BASIS ALONG WITH THE EMPLOYEES AND COMMITTEE MEMBERS. ALL DISCLOSURES ARE TRACKED AND HOUSED IN COMPLIANCE DEPARTMENT. FURTHER, IF AT ANY TIME AN INDIVIDUAL BECOMES AWARE OF AN ACTUAL, POTENTIAL OR PERCEIVED CONFLICT OF INTEREST, THE POLICY INDICATES THAT THE INDIVIDUAL SHALL IMMEDIATELY NOTIFY THE COMPLIANCE OFFICER, WHO THEN REIEWS ANY DISCLOSED CONFLICTS TO ASSESS ANY RISK AND/OR NEGATIVE INFLUENCE ON THE HEALTH PLAN AND DRAFTS PROPOSED RECOMMENDATIONS TO ANY DISCLOSED CONFLICTS OF INTEREST. THE COMPLIANCE OFFICER THEN PROVIDES THE DISCLOSED CONFLICTS OF INTEREST(S) AND PROPOSED RECOMMENDATION(S) TO A CONFLICT OF INTEREST REVIEW GROUP FOR FINAL REVIEW AND DETERMINATION REGARDING THE RECOMMENDATION. ONCE THE CONFLICT OF INTEREST REVIEW GROUP MAKES ITS FINAL DETERMINATION WITH RESPECT TO THE RECOMMENDATION, THE COMPLIANCE OFFICER SHALL COMMUNICATE THE RECOMMENDATION TO THE EMPLOYEE AND, WHEN APPLICABLE, TO THE CHAIRPERSON OF ANY COMMITTEE WHICH MAY BE REFERENCED IN THE RECOMMENDATION. |
| FORM 990, PART VI, SECTION B, LINE 15: | ALL PERSONNEL SERVICES FOR GUNDERSEN HEALTH PLAN, INC. 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 FOR GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., THE CONTROLLING MEMBER. THEIR DETERMINATION IS MADE AFTER A REVIEW OF MARKET DATA OBTAINED FROM SEVERAL ORGANIZATIONS AND CEO PERFORMANCE. MEETING MINUTES ARE TAKEN AND KEPT OF THE MEETINGS WHERE SUCH DISCUSSIONS TAKE PLACE. RECOMMENDATIONS FOR COMPENSATION FOR THE ORGANIZATIONS' KEY MANAGEMENT EMPLOYEES ARE DEVELOPED ANNUALLY BY THE CEO, AFTER A REVIEW OF PERFORMANCE AND COMPARABLE MARKET DATA. The proposed salaries are independently reviewed by an outside auditing firm. THE COMPENSATION RECOMMENDATIONS, audit reports, ALONG WITH THE MARKET DATA, ARE PRESENTED TO A COMMITTEE MADE UP OF THE COMMUNITY MEMBERS OF THE BOARD OF TRUSTEES OF THE GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., THE CONTROLLING MEMBER. THE COMPENSATION AMOUNTS ARE NOT EFFECTIVE UNTIL THE GUNDERSEN LUTHERAN HEALTH SYSTEM BOARD APPROVES THEM. MEETING MINUTES ARE TAKEN AND KEPT OF THE MEETINGS WHERE THE BOARD APPROVAL TAKES PLACE. |
| FORM 990, PART VI, SECTION C, LINE 19: | REQUESTS FOR ALL DOCUMENTS ARE MADE THROUGH THE LEGAL DEPARTMENT AND THEN APPROPRIATE DOCUMENTS ARE MADE AVAILABLE FOR INSPECTION IN THE LEGAL DEPARTMENT. |
| FORM 990, PART XI, LINE 9, CHANGES IN NET ASSETS: | PARTNERSHIP PASSTHROUGH ENTITY -40,725 |
| PART XII, LINE 2C | AUDIT PROCESS 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 PRIOR YEAR. |
| PART X, LINE 29 | FUND BALANCES THE ORGANIZATION DOES NOT FOLLOW SFAS 117. THE FINANCIAL STATEMENTS ARE PREPARED ON A STATUTORY BASIS WHICH DOES NOT FOLLOW GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. |
| PART IV, LINE 12A | AUDITED FINANCIAL STATEMENTS THE ORGANIZATION RECEIVED AN INDEPENDENT AUDITED FINANCIAL STATEMENT PREPARED ON A STATUTORY BASIS AND NOT ON A GENERALLY ACCEPTED ACCOUNTING PRINCIPLES BASIS. |
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2013
Additional Data
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