TY 2015 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) Jeffrey Thompson MD...................................................................... Chief Executive Officer	2.0 ................. 46.0	X	X	958,485	62,571
(2) Scott Rathgaber MD...................................................................... CEO, Med-VP	2.0 ................. 46.0	X	X	593,630	61,571
(3) Greg Prairie...................................................................... Board of Trustees - VP	2.0 ................. 4.0	X	X	0	0
(4) Wendy Lommen...................................................................... Board of Trustees - Treasurer	2.0 ................. 4.0	X	X	0	0
(5) Brian Rude...................................................................... Board of Trustees - Secretary	2.0 ................. 4.0	X	X	0	0
(6) Gerald Kember...................................................................... Board of Trustees - Member	2.0 ................. 6.0	X		0	0
(7) John Lyche...................................................................... Board of Trustees - Member	2.0 ................. 6.0	X		0	0
(8) Mark Glendenning...................................................................... Board of Trustees - Member	2.0 ................. 4.0	X		0	0
(9) Brad Sturm...................................................................... Board of Trustees - Chair	2.0 ................. 4.0	X	X	0	0
(10) Stephen Shapiro MD...................................................................... Board of Trustees - Member	2.0 ................. 49.0	X		441,572	62,571
(11) Brian Sieck MD...................................................................... Board of Trustees - Member	2.0 ................. 46.0	X		389,942	60,071
(12) Kelley Bahr MD...................................................................... Board of Trustees - Member	2.0 ................. 46.25	X		373,897	36,538
(13) Jonathan Zlabek MD...................................................................... Board of Trustees - Member	2.0 ................. 46.0	X		299,117	62,571
(14) P Michael Jacobs DPM...................................................................... Board of Trustees-Member, MVP	2.0 ................. 46.0	X		325,223	62,571
(15) Greg Thompson MD...................................................................... Chief Medical Officer	2.0 ................. 48.0		X	421,480	62,621
(16) Michael Dolan MD...................................................................... Med VP, Exec VP, Med COO	2.0 ................. 48.0		X	582,266	61,821
(17) Dara Bartels...................................................................... Interim CFO	2.0 ................. 49.0		X	225,050	55,319

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) Michael Allen........................................................................ Chief Financial Officer	2.0 .......................48.0	X				330,677	25,347
(19) Mary Kuffel MD........................................................................ Medical Vice President	0.0 .......................41.0		X			453,610	41,039
(20) Marilu Bintz MD........................................................................ Medical VP, Senior VP	0.0 .......................41.0		X			535,740	48,895
(21) Stephanie Carroll MD........................................................................ Medical Vice President	0.0 .......................40.0		X			242,912	51,160
(22) Kraig Schuster........................................................................ Vice President	0.0 .......................40.0		X			186,604	48,817
(23) Elizabeth Smith-Houskamp........................................................................ Vice President	0.0 .......................41.5		X			334,194	39,750
(24) Bryan Erdmann........................................................................ Vice President	0.0 .......................42.0		X			218,446	55,615
(25) Kelly Barton........................................................................ Vice President	0.0 .......................41.5		X			218,786	50,563
(26) Kathleen Klock........................................................................ Senior Vice President	0.0 .......................41.3		X			406,450	42,300
(27) Gerald Arndt........................................................................ Senior Vice President	0.0 .......................41.0		X			393,412	41,039
(28) Mark Platt........................................................................ Senior Vice President	0.0 .......................42.5		X			358,838	60,071
(29) Debra Rislow........................................................................ Senior Vice President	0.0 .......................42.0		X			368,380	54,179
(30) Mary Jafari........................................................................ Senior Physicist	0.0 .......................40.0			X		220,370	47,739
(31) John Wochos........................................................................ Senior Physicist	0.0 .......................40.0			X		206,867	54,591
(32) Allen Daus........................................................................ Senior Physicist	0.0 .......................40.0			X		206,034	51,599
(33) Kimberly Schmidt........................................................................ Senior Physicist	0.0 .......................40.0			X		181,939	44,213
(34) Ryan Holte........................................................................ Administrative Director	0.0 .......................40.0			X		176,246	34,852
(35) Mary Lu Gerke........................................................................ Nurse Executive	0.0 .......................40.0				X	198,932	39,091

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
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Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

Gundersen Lutheran Medical Center Inc

Employer identification number

39-0813416

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ))

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ..............

Provide the following information about the supported organization(s).

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10.

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2014. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2015. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the facts-and-circumstances test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2015

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513...
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2014. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2015

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2015 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Name of the organization

Gundersen Lutheran Medical Center Inc

Employer identification number

39-0813416

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2

Name of organization Gundersen Lutheran Medical Center Inc

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 3

Name of organization Gundersen Lutheran Medical Center Inc		Employer identification number 39-0813416

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 4


Name of organization Gundersen Lutheran Medical Center Inc			Employer identification number 39-0813416
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

Gundersen Lutheran Medical Center Inc

Employer identification number

39-0813416

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures ...................................................................................................................... SchCMd Bullet

Volunteer hours .............................................................................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2015

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures). Click to see attachment

B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(a) Filing organization's totals	(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ...............................................		0
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ...........................................		271,755
c	Total lobbying expenditures (add lines 1a and 1b) .......................................................................		271,755
d	Other exempt purpose expenditures .........................................................................................	858,901,665	1,746,355,332
e	Total exempt purpose expenditures (add lines 1c and 1d) ....................................................................	858,901,665	1,746,627,087
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.	1,000,000	1,000,000
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) ..........................................................................	250,000	250,000
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ..........................................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ...........................................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ..............................................................................................................		Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2012	(b) 2013	(c) 2014	(d) 2015	(e) Total

2a	Lobbying nontaxable amount	1,000,000	1,000,000	1,000,000	1,000,000	4,000,000

b	Lobbying ceiling amount (150% of line 2a, column(e))					6,000,000

c	Total lobbying expenditures	232,875	243,735	281,562	271,755	1,029,927

d	Grassroots nontaxable amount	250,000	250,000	250,000	250,000	1,000,000

e	Grassroots ceiling amount (150% of line 2d, column (e))					1,500,000

f	Grassroots lobbying expenditures	0	0	0		0

Schedule C (Form 990 or 990-EZ) 2015

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Total. Add lines 1c through 1i ....................................................................................................

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation

Schedule C (Form 990 or 990EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Gundersen Lutheran Medical Center Inc

Employer identification number

39-0813416

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

			(a) Donor advised funds	(b) Funds and other accounts

1	Total number at end of year ....
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ....

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ...........

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ............................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2015

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

Endowment Funds. Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations .................

3a(i)

(ii) related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land ...	4,015,571		4,015,571
b	Buildings	390,002,444	108,279,600	281,722,844
c	Leasehold improvements	5,007,956	3,547,131	1,460,825
d	Equipment ...	107,120,402	67,710,752	39,409,650
e	Other ...
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				326,608,890

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b)Book value	(c)Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) INTERCOMPANY RECEIVABLES				662,302,523
(2) OTHER RECEIVABLES				5,558,560
(3) ADJUSTMENT TO BALANCE				1,621
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				667,862,704

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
LEASE CONTRACT PAYABLE	619,819
LT MALPRACTICE CLAIMS RESERVE	993,360
ASSET RETIREMENT OBLIGATION	264,799
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	1,877,978
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
Income Tax Matters Part X, Line 2	THE OBLIGATED GROUP HAS REVIEWED ITS TAX POSITIONS FOR ALL OPEN YEARS AND HAS CONCLUDED THAT NO LIABILITIES EXIST FOR UNCERTAIN TAX POSITIONS AT DECEMBER 31, 2015 OR 2014. THE OBLIGATED GROUP'S INCOME TAX RETURNS ARE GENERALLY NO LONGER SUBJECT TO EXAMINATION FOR 2011 AND PRIOR YEARS.

Schedule D (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Gundersen Lutheran Medical Center Inc

Employer identification number

39-0813416

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	3,864,270		3,864,270	0.460 %
b	Medicaid (from Worksheet 3, column a) . . . . .	97,049,014	48,935,755	48,113,259	5.690 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	380,673	215,990	164,683	0.020 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	101,293,957	49,151,745	52,142,212	6.170 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	1,349,996	54,668	1,295,328	0.150 %
f	Health professions education (from Worksheet 5) . . .	10,871,238	4,763,928	6,107,310	0.720 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	541,665		541,665	0.060 %
j	Total. Other Benefits . .	12,762,899	4,818,596	7,944,303	0.930 %
k	Total. Add lines 7d and 7j .	114,056,856	53,970,341	60,086,515	7.100 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015

Schedule H (Form 990) 2015

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense
1	Physical improvements and housing	2,205		2,205
2	Economic development	5,760		5,760
3	Community support
4	Environmental improvements	1,733		1,733
5	Leadership development and training for community members
6	Coalition building	99,776	8,548	91,229
7	Community health improvement advocacy
8	Workforce development	48,568		48,568
9	Other	2,202,432		2,202,432
10	Total	2,360,474	8,548	2,351,927

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

5,330,324

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

115,469,569

Enter Medicare allowable costs of care relating to payments on line 5.....

148,210,909

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-32,741,340

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2015

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	GUNDERSEN LUTHERAN MED CENTER INC 1910 SOUTH AVENUE LA CROSSE,WI54601 WWW.GUNDERSENHEALTH.ORG 23	X	X	X	X	X

Schedule H (Form 990) 2015

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	GUNDERSEN LUTHERAN MEDICAL CENTERINC
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 15

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): REFER TO SECTION C

Other website (list url): REFER TO SECTION C

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 16

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): Refer to Section C

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	GUNDERSEN LUTHERAN MEDICAL CENTERINC
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.% and FPG family income limit for eligibility for discounted care of 400.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

Refer to Section C

The FAP application form was widely available on a website (list url):

Refer to Section C

A plain language summary of the FAP was widely available on a website (list url):
Refer to Section C

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	GUNDERSEN LUTHERAN MEDICAL CENTERINC
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that
can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Form Sch H, Part V, Line 3j	THE COMPASS NOW 2015 PROCESS USED A VARIETY OF DATA COLLECTION METHODS TO CREATE AN OVERALL DEPICTION OF THE ISSUES FACING OUR COMMUNITIES. THESE METHODS INCLUDED A RANDOM HOUSEHOLD SURVEY, CONVENIENCE SURVEY, COMMUNITY CONVERSATIONS, AND AN EXTENSIVE REVIEW OF SOCIOECONOMIC INDICATORS, WHICH PROVIDES AN INVENTORY OF COMMUNITY RESOURCES. THE DATA COLLECTED DURING COMPASS NOW 2012 GUIDED THE DEVELOPMENT OF FOUR PILLAR PROFILES. THESE ARE REFERRED TO AS PILLARS BECAUSE THEY CREATE THE BUILDING BLOCKS FOR A BETTER LIFE. THE PILLARS OF COMPASS NOW 2015 ARE COMMUNITY, EDUCATION, INCOME/ECONOMIC, AND HEALTH. THE PROFILES DESCRIBE OUR COMMUNITY WITH REGARDS TO THE KEY ISSUES OF EACH AREA. EACH PROFILE PULLS KEY INDICATOR DATA AND COMPASS SURVEY RESULTS INTO A NARRATIVE FORMAT THAT IS INTENDED TO PROVIDE A CONTEXT TO THE DATA FOUND IN THE INDICATOR REPORT, MAKING THE DATA EASY TO NAVIGATE. COMPASS COUNCILS WERE ADVISORY GROUPS OF LOCAL EXPERTS IN THE FIELDS OF EDUCATION, INCOME, HEALTH, AND A VARIETY OF COMMUNITY ISSUES. THESE MEMBERS COLLECTED AND REVIEWED DATA, ANALYZED THE SURVEY RESULTS, AND OFFERED PROFESSIONAL INSIGHTS ABOUT TOPIC-SPECIFIC ISSUES IN THE GREAT RIVERS REGION. AFTER SIGNIFICANT REVIEW OF THE DATA AND SURVEY RESULTS, PRIORITY ISSUES WERE IDENTIFIED BY COMPASS COUNCIL MEMBERS. THESE ISSUES WERE THEN RANKED BY COUNCIL MEMBERS USING THE CRITERIA BELOW: 1. HOW WIDESPREAD IS THE ISSUE IN OUR COMMUNITY? 2. HOW SERIOUS ARE THE EFFECTS OF THE ISSUE IN OUR COMMUNITY? 3. HOW IMPORTANT IS THE ISSUE TO THE COMMUNITY? THE COMPASS NOW STEERING COMMITTEE THEN APPLIED ITS KNOWLEDGE OF THE ISSUES. THE COMBINATION OF COMPASS COUNCIL RECOMMENDATIONS AND THE INSIGHTS FROM THE COMPASS NOW STEERING COMMITTEE RESULTED IN THE IDENTIFICATION OF THREE TOP AREAS OF NEED FOR EACH OF THE FOUR GREAT RIVERS UNITED WAY PILLARS.
Form Sch H, Part V, Line 5	IN ADDITION TO THE RANDOM HOUSEHOLD SURVEY, THE COMPASS NOW 2015 COMMUNITY NEEDS ASSESSMENT ALSO INCLUDED A CONVENIENCE SAMPLE THAT FOCUSED ON SPECIFIC SUBGROUPS IN THE GREAT RIVERS REGION. THE OVERALL OBJECTIVE OF THIS SAMPLING WAS TO COLLECT FEEDBACK FROM POPULATIONS WITHIN THE COMMUNITY THAT WERE POTENTIALLY UNDERREPRESENTED IN THE RANDOM HOUSEHOLD SURVEY DUE TO THE SMALL NUMBER IN WHICH THEY EXIST IN THE COMMUNITY. THESE SMALLER POPULATIONS INCLUDED, BUT WERE NOT LIMITED TO, AFRICAN AMERICANS, HISPANICS, LGBT YOUTH, YOUTH AT-RISK, LOW-INCOME ADULTS, AND SENIOR CITIZENS. RESULTS FROM THIS SURVEY WERE COMPARED TO THE RESPONSES OF THE RANDOM HOUSEHOLD SURVEY RESPONDENTS IN AN ATTEMPT TO DETERMINE ANY SIGNIFICANT DIFFERENCES THAT EXISTED BETWEEN THE GENERAL POPULATION AND THOSE IN SMALLER SUBGROUPS WITHIN THE COMMUNITY. IN TOTAL, 753 COMMUNITY MEMBERS SHARED FEEDBACK THROUGH THE CONVENIENCE SAMPLE PROCESS. (OF THE 5,000 HOUSEHOLDS THAT RECEIVED THE RANDOM HOUSEHOLD SURVEY, 791 WERE RETURNED WITH RESPONSES ANALYZED.) ANOTHER WAY IN WHICH COMMUNITY FEEDBACK WAS GATHERED WAS THROUGH COMMUNITY CONVERSATIONS. THESE CONVERSATIONS WERE CONDUCTED IN LIEU OF THE FOCUS GROUPS THAT WERE CONDUCTED IN THE COMPASS NOW 2012 COMMUNITY NEEDS ASSESSMENT. THESE SMALL GROUP GATHERINGS WERE A SAFE SPACE IN WHICH COMMUNITY MEMBERS COULD COME TOGETHER AND SHARE THEIR THOUGHTS AND EXPERIENCES ABOUT LIVING IN THE GREAT RIVERS REGION. INDIVIDUALS CONSULTED: ANN KAPPAUF, NEW HORIZONS SHELTER & OUTREACH CENTERS; ANNA CARDARELLA, WESTERN DAIRYLAND; ASHLEY FOREMAN, MARINE CREDIT UNION; AUDRA MARTINE, AGING & DISABILITY RESOURCE CENTER OF WESTERN WISCONSIN; AUDRA WIESER, THE PARENTING PLACE; BEN CRENSHAW, MAYO CLINIC HEALTH SYSTEM; BETH HARTUNG, CONSULTANT, WFPRHA; BETH JOHNSON, VERNON COUNTY HEALTH DEPARTMENT; BETH THEEDE, LA CRESCENT-HOKAH PUBLIC SCHOOLS; BETTY JOREGENSON, MAYO CLINIC HEALTH SYSTEM; BRENDA ROONEY, GUNDERSEN HEALTH SYSTEM; BRIAN THEILER, GUNDERSEN TRI-COUNTY HOSPITAL & CLINICS; CAROL ABRAHAMZON, MISSISSIPPI VALLEY CONSERVANCY; CAROLINE NEILSEN, CITY OF LA CROSSE COMMUNITY DEVELOPMENT; CATHERINE EMMANUELLE, TREMPEALEAU COUNTY UW- EXTENSION; CATHERINE KOLKMEIER, LA CROSSE MEDICAL HEALTH SCIENCE CONSORTIUM; CECIL ADAMS, AFRICAN AMERICAN MUTUAL ASSISTANCE NETWORK; CHARLIE HANDY, LA CROSSE COUNTY PLANNING/COMMUNITY DEVELOPMENT; CHERYL RHODA, TREMPEALEAU COUNTY HEALTH DEPARTMENT; CHRISTINE DEAN, GUNDERSEN ST. JOSEPH'S HOSPITAL & CLINICS; ERIC PRISE, TOMAH MEMORIAL HOSPITAL; ERIN WALDHART, WAFER FOOD PANTRY; FAI DEMARK, CONSUMER CREDIT COUNSELING SERVICE OF LA CROSSE; GINA MERRELL, WORKFORCE CONNECTIONS; GREG FLOGSTAD, MISSISSIPPI RIVER REGIONAL PLANNING COMMISSION; GREG STANGL, LA CROSSE COUNTY LAND CONSERVATION; HEATHER MYHRE, HOUSTON COUNTY HEALTH DEPARTMENT; HEATHER QUACKENBOSS, LA CROSSE COMMUNITY FOUNDATION; JACKIE EASTWOOD, LA CROSSE COUNTY AREA PLANNING COMMITTEE; JAMIE SCHLOEGEL,
CONTINUED	FAMILY & CHILDREN'S CENTER; JASON LARSEN, LA CROSSE AREA FAMILY COLLABORATIVE; JASON WITT, LA CROSSE COUNTY HUMAN SERVICES DEPARTMENT; JENNIFER SLABAUGH, SEMCAC OUTREACH & EMERGENCY SERVICES PROGRAM; JENNY KUDERER, WISCONSIN ECONOMIC DEVELOPMENT CORPORATION; JERILYN DINSMOOR, LA CROSSE PROMISE; JESSIE CUNNINGHAM, VERNON MEMORIAL HEALTHCARE; JOAN MUELLER, MAYO CLINIC HEALTH SYSTEM; JOHN HENDRICKS, SPARTA AREA SCHOOL DISTRICT; JOSHUA WALDEN, CROSSFIRE; JULIE NELSON, THE SALVATION ARMY OF LA CROSSE; KAREN EHLE-TRAASTAD, VERNON COUNTY UW-EXTENSION; KAREN JOOS, COMMUNITY VOLUNTEER; KARI REYBURN, WESTERN TECHNICAL COLLEGE; KATE NOELKE, UNIVERSITY OF WISCONSIN-LA CROSSE; KAYLEIGH DAY, MONROE COUNTY HEALTH DEPARTMENT; KEITH LEASE, WESTERN TECHNICAL COLLEGE; KIM CABLE, COULEECAP; LAURA PETTERSEN, SCENIC BLUFFS AREA HEALTH EDUCATION CENTER; LAURIE STRANGMAN, UNIVERSITY OF WISCONSIN-LA CROSSE; LINDSEY MENARD, LA CROSSE COUNTY HUMAN SERVICES DEPARTMENT; LISA LUCKEY, LA CROSSE AREA FAMILY YMCA; LORI DUBCZAK, INDEPENDENT LIVING RESOURCES; LORI FREIT-HAMMES, MAYO CLINIC HEALTH SYSTEM; LORIE GRAFF, WESTERN REGION FOR ECONOMIC ASSISTANCE IM CONSORTIUM; MARI FREIBERG, SCENIC BLUFFS COMMUNITY HEALTH CENTER; MARY JACOBSON, CATHOLIC CHARITIES; MARY KAY WOLF, GREAT RIVERS UNITED WAY; MARY KOENIG, VERNON MEMORIAL HEALTHCARE; MARY MEEHAN-STRUB, LA CROSSE COUNTY UW-EXTENSION; MIKE DESMOND, BOYS & GIRLS CLUBS OF GREATER LA CROSSE; PAT KERRIGAN, VITERBO UNIVERSITY; PATRICIA MALONE, TREMPEALEAU COUNTY UW-EXTENSION; PAULINE BYOM, MAYO CLINIC HEALTH SYSTEM; ROBERT LYNN, GUNDERSEN HEALTH SYSTEM; SANDRA BREKKE, ST. CLARE HEALTH MISSION; SANDY GRAVES, LA CRESCENT AREA HEALTHY COMMUNITY PARTNERSHIP; SARA WROBEL, CAUSEWAY CAREGIVERS; SARAH HAVENS, GUNDERSEN HEALTH SYSTEM; SARAH SPAH, MAYO CLINIC HEALTH SYSTEM; SHARON NELSON, MONROE COUNTY HEALTH DEPARTMENT; SHELLY TEADT, COULEECAP; STEVE SALERNO, SCHOOL DISTRICT OF LA CROSSE; TERESA PIERCE, WORKFORCE CONNECTIONS; TJ BROOKS, UNIVERSITY OF WISCONSIN-LA CROSSE; TODD MANDEL, COULEECAP; TOM FAELLA, LA CROSSE COUNTY ADMINISTRATIVE CENTER; TONI ASHER, PUMP HOUSE REGIONAL ARTS CENTER; TRACY CRAKER, WESTERN TECHNICAL COLLEGE; TRACY HERLITZKE, COOPERATIVE EDUCATIONAL SERVICE AGENCY (CESA) #4; TRICIA WAVRA, WESTERN REGION FOR ECONOMIC ASSISTANCE IM CONSORTIUM; VALJEAN ADAMS, CLARA FIELDS MULTICULTURAL LITERACY PROGRAM; WES REVELS, GREAT RIVERS UNITED WAY BOARD OF DIRECTORS; WILLIAM COLCLOUGH, UNIVERSITY OF WISCONSIN-LA CROSSE. Form Sch H, Part V, Line 6a HOSPITALS INCLUDED ARE GUNDERSEN HEALTH SYSTEM, GUNDERSEN ST. JOSEPH'S HOSPITAL & CLINICS, GUNDERSEN TRI-COUNTY HOSPITAL & CLINICS, MAYO CLINIC HEALTH SYSTEM - LA CROSSE, MAYO CLINIC HEALTH SYSTEM-SPARTA, TOMAH MEMORIAL HOSPITAL, VERNON MEMORIAL HOSPITAL.
Form Sch H, Part V, Line 6b	OTHER ORGANIZATIONS INCLUDE GREAT RIVERS UNITED WAY, HOUSTON COUNTY (MN) HEALTH DEPARTMENT, LA CROSSE COMMUNITY FOUNDATION, LA CROSSE COUNTY (WI) HEALTH DEPARTMENT, MONROE COUNTY (WI) HEALTH DEPARTMENT, TREMPEALEAU COUNTY (WI) HEALTH DEPARTMENT, VERNON COUNTY (WI) HEALTH DEPARTMENT.
Form Sch H, Part V, Line 7A	HOSPITAL URL: HTTP://WWW.GUNDERSENHEALTH.ORG/WELLNESS/COMMUNITY-SUPPORT 7B: OTHER WEB SITE: HTTP://WWW.GREATRIVERSUNITEDWAY.ORG/OUR-WORK/COMMUNITY-NEEDS-ASSESSMENT/ 7C: PAPER COPY: AVAILABLE IN 5 MOONEY LIBRARIES LOCATED AT OUR LA CROSSE AND ONALASKA CAMPUS AND UPON REQUEST. 7D: AVAILABLE BY CONTACTING SARAH HAVENS, PHONE (608) 775-6580 OR (800) 362-9567, EXT. 56580 OR EMAIL SJHAVENS@GUNDERSENHEALTH.ORG. Part V, Section B, 10a: Implementation strategy url : http://www.gundersenhealth.org/wellness/community-support Form Sch H, Part V, Line 11: THE GUNDERSEN COMMUNITY HEALTH NEEDS ASSESSMENT UTILIZES THE COMPASS NOW COLLABORATIVE ASSESSMENT THAT INCLUDES 5 COUNTIES IN OUR SERVICE AREA REPRESENTING 77.6% OF OUR HOSPITAL SERVICE PATIENT POPULATION. THE COMPASS NOW ASSESSMENT HAS BEEN AN ONGOING COMMUNITY NEEDS ASSESSMENT IN COLLABORATION WITH THE UNITED WAY AND OTHER COMMUNITY PARTNERS SINCE 1995, WITH UPDATES EVERY THREE TO FIVE YEARS. TO EXPAND THE COMPASS NOW ASSESSMENT AND REPRESENTED POPULATION, WE HAVE ALSO COMPLETED A COMMUNITY HEALTH ASSESSMENT FOR THE 19-COUNTY SERVICE AREA AS A WHOLE, UTILIZING TOOLS GENERATED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION COMMUNITY HEALTH STATUS INDICATORS- 2015 CHSI 2015 AND COMMUNITY COMMONS. THE FIVE COUNTIES REPRESENTED IN COMPASS REFLECT 42% THE OVERALL POPULATION OF OUR 19 COUNTY SERVICE REGION. REVIEWING THE BROADER 19-COUNTY REGION NEEDS REVEALED NO SIGNIFICANT DIFFERENCES FOR THE TOP TWO CONCERNS MENTAL HEALTH AND/OR SUBSTANCE ABUSE (ADULT BINGE DRINKING, OLDER AND DEPRESSION) AND CHRONIC DISEASE AND CONTRIBUTING FACTORS (OBESITY, PHYSICAL INACTIVITY, SMOKING, DIABETES, STROKE, OVERALL HEALTH STATUS). THE NEED THAT WAS IDENTIFIED IN COMPASS NOW NOTED IN OUR BROADER SERVICE REGION ASSESSMENT IS ORAL HEALTH AND ALTERNATIVELY FEMALE PAP TESTS ARE INDICATED AS A NEED FOR THE BROADER 19-COUNTY SERVICE REGION BUT NOT IN COMPASS. SOCIAL FACTORS AND THE PHYSICAL ENVIRONMENT ARE ESPECIALLY IMPORTANT BECAUSE THEY REPRESENT THE CONDITIONS IN WHICH PEOPLE ARE BORN, WORK, AND PLAY. NEIGHBORHOODS WITH AFFORDABLE HEALTHY FOOD, SAFE AND ACCESSIBLE HOUSING, AND QUALITY EMPLOYMENT OPPORTUNITIES CAN POSITIVELY INFLUENCE BEHAVIORS AND HELP TO CREATE HEALTHY LIFESTYLES. THE WORLD HEALTH ORGANIZATION AND OTHERS CALL THE LIVING CONDITIONS THAT CAN AFFECT HEALTH AND QUALITY OF LIFE THE "SOCIAL DETERMINANTS OF HEALTH".
CONTINUED	GUNDERSEN LUTHERAN MEDICAL CENTER'S 2016-2018 IMPLEMENTATION PLAN ADDRESSES THE IDENTIFIED NEEDS FROM COMPASS AND THE ADDITIONAL ISSUE REVEALED FROM THE GREATER 19-COUNTY ASSESSMENT. WE USED THE FOLLOWING PROCESS TO DETERMINE OUR IMPLEMENTATION STRATEGY: 1. CREATED SELECTION CRITERIA TO SELECT AREAS OF CONCERN FROM COMPASS (CHNA) THAT WE WOULD ADDRESS. THESE CRITERIA INCLUDE: a. MAGNITUDE - HOW WIDESPREAD IS THE ISSUE IN OUR COMMUNITY? b. SERIOUSNESS - HOW SERIOUS ARE THE EFFECTS OF THE ISSUE IN OUR COMMUNITY? c. IMPACT - HOW IMPORTANT IS THE ISSUE TO THE COMMUNITY? d. FEASIBILITY? DO WE HAVE THE ABILITY TO REASONABLY IMPACT THE ISSUE WITH AVAILABLE RESOURCES? NOTE: RESOURCES AVAILABLE TO ADDRESS THESE IDENTIFIED NEEDS VARY FROM COMMUNITY TO COMMUNITY, AND COUNTY TO COUNTY. AS A COMPONENT OF OUR IMPLEMENTATION PLAN, A GOAL WILL BE TO IDENTIFY RESOURCES ACROSS OUR SERVICE AREA. THIS WORK WILL INVOLVE OUR NETWORK OF REGIONAL PARTNERS (HOSPITAL AFFILIATES). e. CONSEQUENCES OF INACTION: WHAT IS THE RISK BY NOT ADDRESSING THE ISSUE? f. CURRENT SOLUTIONS: WHAT IS THE DEGREE TO WHICH OUR ACTIONS WILL ENHANCE CURRENT LEVELS OF INTERVENTIONS BY OTHERS? 2. INVENTORIED THE GUNDERSEN HEALTH SYSTEM FOR EXISTING PROGRAMS AND PROCESSES THAT ADDRESS THE IDENTIFIED NEED. 3. INCORPORATED FEEDBACK FROM COMMUNITY CONVERSATIONS AND SURVEY COMMENTS (FROM COMPASS PROCESS) 4. DETERMINED OPPORTUNITIES FOR NEW PROGRAMMING OR PARTNERSHIPS THAT COULD IMPACT AREAS NOT BEING ADDRESSED. 5. FORMALIZED GOALS AND ACTIVITIES THAT WILL DIRECTLY IMPACT IDENTIFIED PRIORITIES. 6. IDENTIFIED THOSE PRIORITIES NOT ADDRESSED IN OUR PLAN, BUT NOTE WE WILL MAINTAIN ACTIVE PARTNERSHIPS WITH AND REMAIN SUPPORTIVE OF THE LEAD ORGANIZATIONS ADDRESSING THOSE PRIORITIES. OUR IMPLEMENTATION PLAN, INCLUDING GOALS AND ACTION STEPS, HAS BEEN ESTABLISHED FOR THE THREE KEY ISSUES DETERMINED IN THE HEALTH CATEGORY (CHRONIC DISEASE AND CONTRIBUTING FACTORS, MENTAL HEALTH AND/OR SUBSTANCE ABUSE, ORAL HEALTH) AND ONE KEY ISSUE IN EACH OF THE OTHER CATEGORIES: INCOME- QUALITY HOUSING; EDUCATION- YOUTH RESILIENCE; AND COMMUNITY ADVERSE CHILDHOOD EXPERIENCES. THE SIX REMAINING ISSUES WILL BE ADDRESSED BY OUR COMMUNITY PARTNERS. ENGAGEMENT WITH KEY PARTNERS WILL ULTIMATELY LEAD TO COMMUNITY HEALTH IMPROVEMENT.
Form Sch H, Part V, Line 13C	GHS PATIENTS NOT MEETING FINANCIAL ASSISTANCE ELIGIBILITY THRESHOLDS MAY BE ELIGIBLE FOR ASSISTANCE UNDER CIRCUMSTANCES WHEN GHS MEDICAL BILLS WOULD RESULT IN SEVERE FINANCIAL HARDSHIP. PATIENTS, OR THEIR GUARANTORS, MAY BE ELIGIBLE FOR CATASTROPHIC CARE ASSISTANCE IF THEY HAVE INCURRED OUT-OF-POCKET OBLIGATIONS RESULTING FROM MEDICAL SERVICES PROVIDED BY GHS THAT EXCEED 25% OF FAMILY INCOME AND HAVE ASSETS BELOW THE EQUIVALENT OF 600% OF THE FPL THRESHOLD. PATIENTS, OR PATIENT GUARANTORS, MEETING ELIGIBILITY CRITERIA FOR CATASTROPHIC CARE WILL HAVE THEIR GHS CHARGES DISCOUNTED TO AN AMOUNT NOT TO EXCEED 25% OF FAMILY INCOME. FORM SCH H, PART V, LINE 13H PRESUMPTIVE ELIGIBILITY: GHS UNDERSTANDS THAT NOT ALL PATIENTS ARE ABLE TO COMPLETE A FINANCIAL ASSISTANCE APPLICATION OR COMPLY WITH REQUESTS FOR DOCUMENTATION. THERE MAY BE INSTANCES UNDER WHICH A PATIENTS QUALIFICATION FOR FINANCIAL ASSISTANCE IS ESTABLISHED WITHOUT COMPLETING THE FORMAL FINANCIAL ASSISTANCE APPLICATION. OTHER INFORMATION MAY BE UTILIZED BY GHS TO DETERMINE WHETHER A PATIENTS ACCOUNT IS UNCOLLECTIBLE AND THIS INFORMATION WILL BE USED TO DETERMINE PRESUMPTIVE ELIGIBILITY. PRESUMPTIVE ELIGIBILITY MAY BE GRANTED TO PATIENTS BASED ON THEIR ELIGIBILITY FOR OTHER PROGRAMS OR LIFE CIRCUMSTANCES SUCH AS: 1. PATIENTS OR GUARANTORS WHO HAVE DECLARED BANKRUPTCY. IN CASES INVOLVING BANKRUPTCY, ONLY THE ACCOUNT BALANCE AS OF THE DATE THE BANKRUPTCY IS DISCHARGED WILL BE WRITTEN OFF. 2. PATIENTS OR GUARANTORS WHO ARE DECEASED WITH NO ESTATE IN PROBATE. 3. PATIENTS OR GUARANTORS DETERMINED TO BE HOMELESS. 4. ACCOUNTS RETURNED BY THE COLLECTION AGENCY AS UNCOLLECTIBLE DUE TO ANY OF THE ABOVE REASONS. 5. PATIENTS OR GUARANTORS WHO QUALIFY FOR STATE MEDICAID PROGRAMS, WILL BE ELIGIBLE FOR ASSISTANCE FOR ANY COST-SHARING OBLIGATIONS ASSOCIATED WITH THE PROGRAM OR UNCOVERED SERVICES. GHS UNDERSTANDS THAT CERTAIN PATIENTS MAY BE NON-RESPONSIVE TO GHSS APPLICATION PROCESS. UNDER THESE CIRCUMSTANCES, GHS MAY UTILIZE OTHER SOURCES OF INFORMATION TO MAKE AN INDIVIDUAL ASSESSMENT OF FINANCIAL NEED. THIS INFORMATION WILL ENABLE GHS TO MAKE AN INFORMED DECISION ON THE FINANCIAL NEED OF NON- RESPONSIVE PATIENTS UTILIZING THE BEST ESTIMATES AVAILABLE IN THE ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT. GHS MAY UTILIZE A THIRD-PARTY TO CONDUCT AN ELECTRONIC REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. THIS REVIEW UTILIZES A HEALTHCARE INDUSTRY-RECOGNIZED MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THIS PREDICTIVE MODEL INCORPORATES PUBLIC RECORD DATA TO CALCULATE A SOCIO-ECONOMIC AND FINANCIAL CAPACITY SCORE THAT INCLUDES ESTIMATES FOR INCOME, ASSETS AND LIQUIDITY. THE ELECTRONIC TECHNOLOGY IS DESIGNED TO ASSESS EACH PATIENT TO THE SAME STANDARDS AND IS CALIBRATED AGAINST HISTORICAL APPROVALS FOR GHS FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS.
CONTINUED	THE ELECTRONIC TECHNOLOGY, WHEN UTILIZED, WILL BE DEPLOYED PRIOR TO BAD DEBT ASSIGNMENT AFTER ALL OTHER ELIGIBILITY AND PAYMENT SOURCES HAVE BEEN EXHAUSTED. THIS ALLOWS GHS TO SCREEN ALL PATIENTS FOR FINANCIAL ASSISTANCE PRIOR TO PURSUING ANY EXTRAORDINARY COLLECTION ACTIONS. THE DATA RETURNED FROM THIS ELECTRONIC ELIGIBILITY REVIEW WILL CONSTITUTE ADEQUATE DOCUMENTATION OF FINANCIAL NEED UNDER THIS POLICY. WHEN ELECTRONIC ENROLLMENT IS USED AS THE BASIS FOR PRESUMPTIVE ELIGIBILITY, THE HIGHEST DISCOUNT LEVELS WILL BE GRANTED FOR ELIGIBLE SERVICES FOR RETROSPECTIVE DATES OF SERVICE ONLY. IF A PATIENT DOES NOT QUALIFY UNDER THE ELECTRONIC ENROLLMENT PROCESS, THE PATIENT MAY STILL BE CONSIDERED UNDER THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS. GHS WILL PROVIDE PATIENTS NOT QUALIFYING FOR FINANCIAL ASSISTANCE THROUGH THIS PROCESS WITH A WRITTEN NOTICE INFORMING THEM THAT FINANCIAL ASSISTANCE IS AVAILABLE. THIS NOTICE WILL INCLUDE A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY AND ACTIONS TO BE TAKEN IF AN APPLICATION IS NOT SUBMITTED OR THE OUTSTANDING BALANCE PAID. PATIENT ACCOUNTS GRANTED PRESUMPTIVE ELIGIBILITY WILL BE RECLASSIFIED UNDER THE FINANCIAL ASSISTANCE POLICY. THEY WILL NOT BE SENT TO COLLECTION, WILL NOT BE SUBJECT TO FURTHER COLLECTION ACTIONS, WILL NOT BE SENT A WRITTEN NOTIFICATION OF THEIR ELECTRONIC ELIGIBILITY QUALIFICATION, AND WILL NOT BE INCLUDED IN THE HOSPITALS BAD DEBT EXPENSE. Form Sch H, Part V, Line 15c Contact info detailing phone number, physical location of financial counselors, and mailing address are included in the financial assistance policy, the financial assistance application, on the financial assistance website(http://www.gundersenhealth.org/pay-your-bill/financial-assistance) on every patient statement, and on brochures at all registration desks. Form Sch H, Part V, 15e APPLICATION REQUIREMENTS: ELIGIBILITY FOR FINANCIAL ASSISTANCE WILL BE BASED ON FINANCIAL NEED AT THE TIME OF APPLICATION. IN GENERAL, DOCUMENTATION IS REQUIRED TO SUPPORT AN APPLICATION FOR FINANCIAL ASSISTANCE. IF ADEQUATE DOCUMENTATION IS NOT PROVIDED, GHS MAY SEEK ADDITIONAL INFORMATION. RELIABLE EVIDENCE TO SUPPORT THE NEED FOR FINANCIAL ASSISTANCE IS REQUIRED. THE FOLLOWING INCOME DOCUMENTATION IS REQUIRED FROM PATIENTS, OR THEIR GUARANTORS, TO DETERMINE ELIGIBILITY: 1. COPY OF THE FEDERAL TAX RETURN, AND ALL ATTACHED SCHEDULES, FROM THE MOST RECENT TAX YEAR 2. CURRENT PROOF OF INCOME (COPY OF MOST RECENT PAY STUBS OR OTHER DOCUMENTATION) 3. PROOF OF OTHER INCOME, INCLUDING UNEMPLOYMENT, WORKERS COMPENSATION, ALIMONY, TRUST INCOME, VETERANS BENEFITS 4. CURRENT BANK STATEMENTS THE FOLLOWING ASSET DOCUMENTATION IS REQUIRED FROM PATIENTS, OR THEIR GUARANTORS, TO DETERMINE ELIGIBILITY: 1. CHECKING ACCOUNTS 2. SAVINGS ACCOUNTS 3. MONEY MARKET ACCOUNTS 4. CERTIFICATES OF DEPOSIT 5. ANNUITIES 6. NON-RETIREMENT INVESTMENT ACCOUNTS 7. RETIREMENT ACCOUNTS, INCLUDING PENSIONS 8. REAL ESTATE 9. OTHER ASSETS
PART V, SECTION B, LINE 16A, 16B, and 16C	THE FAP, FAP APPLICATION AND PLAIN LANGUAGE SUMMARY OF THE FAP WERE AVAILABLE ON A WEBSITE: WWW.GUNDERSENHEALTH.ORG/PAY-YOUR-BILL/FINANCIAL-ASSISTANCE
Form Sch H, Part V, Line 20e	NOTIFICATION OF FINANCIAL ASSISTANCE: NOTIFICATIONS OF AVAILABILITY OF FINANCIAL ASSISTANCE ARE INCLUDED ON EVERY PATIENT STATEMENT, PROVIDED AT ADMISSION/CHECK-IN, ARE ANNOUNCED ON SIGNS AT EACH CHECK-IN AREA, AT BEDSIDE FOR PATIENTS DIRECTLY ADMITTED WHO MAY NOT HAVE MET WITH ADMISSIONS STAFF.
Form Sch H, Part V, Line 22D	Amount Generally Billed (AGB): The amount generally billed is the expected payment for emergency or medically necessary services from patients, and/or a patients guarantor. For qualifying patients, this amount will not exceed a rate that will be determined utilizing a Look Back Method described in 1.501(r)-5(b)(3) of the Internal Revenue Code. The Look Back Method will be based on actual past claims paid to Gundersen by Medicare Fee-for-Service together with all private health insurers paying claims. The claims to be included in the AGB calculation will be claims allowed during the prior calendar year. The amounts for co-insurance, co-payments and deductibles will be included in the numerator along with the Medicare Fee-for-Service together with all allowed claims from private health insurers. The gross charges for said claims will be included in the denominator. The AGB will be calculated annually by the 45th day following the close of the prior calendar year, and implemented by the 120th day following the close of the calendar year.

Schedule H (Form 990) 2015

Page 8

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?10
Name and address		Type of Facility (describe)
1	GL SATELLITE DIALYSIS-ONALASKA 3075 S KINNEY COULEE RD ONALASKA,WI54650	RENAL DIALYSIS CENTER
2	GL HOSPICE INDUSTRIAL REHAB BUILDING 1843 SIMS PL LA CROSSE,WI54601	HOSPICE SERVICES
3	UNITY HOUSE FOR WOMEN 1312 5th AVE LA CROSSE,WI54601	ALCOHOL AND OTHER DRUG ABUSE (AODA) SERVICES
4	UNITY HOUSE FOR MEN 1918-1924 Miller St LA CROSSE,WI54601	ALCOHOL AND OTHER DRUG ABUSE (AODA) SERVICES
5	GL SATELLITE DIALYSIS-VIROQUA 407 S MAIN ST VIROQUA,WI54665	RENAL DIALYSIS CENTER
6	GL SATELLITE DIALYSIS-PRAIRIE DU CHIEN 610 E Taylor St PRAIRIE DU CHIEN,WI53821	RENAL DIALYSIS CENTER
7	GL SATELLITE DIALYSIS-BLACK RVR FALLS 711 W ADAMS ST BLACK RIVER FALLS,WI54615	RENAL DIALYSIS CENTER
8	GL SATELLITE DIALYSIS-TOMAH 321 BUTTS AVE TOMAH,WI54660	RENAL DIALYSIS CENTER
9	GL SATELLITE DIALYSIS RICHLAND CENTER 1313 W SEMINARY ST RICHLAND CENTER,WI53581	RENAL DIALYSIS CENTER
10	GL MENTAL HEALTH DAY TREAT BEHAV HLTH 123 16th AVE S ONALASKA,WI54656	OUTPATIENT PSYCHOLOGICAL SERVICES

Schedule H (Form 990) 2015

Page 9

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
Form Sch H, Part I, Line 6a	GUNDERSEN LUTHERAN HEALTH SYSTEM, INC.
Form Sch H, Part I, Line 6b	THE COMMUNITY BENEFIT DATA IS FILED WITH THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THE WHA MAKES A COMBINED SUMMARY AVAILABLE THAT INCLUDES ALL WISCONSIN HOSPITALS.
Form Sch H, Part I, Line 7	COST TO CHARGE RATIO, AS CALCULATED USING WORKSHEET 2 METHODOLOGY TO DETERMINE THE COST OF SERVICES PROVIDED TO PATIENTS. MEDICAID AND OTHER MEANS TESTED PROGRAM COMMUNITY BENEFIT EXPENSES FOLLOWED THE CALCULATION METHODOLOGY ON WORKSHEET 3. PART I, LINE 7 COLUMN(F) THE PERCENT OF TOTAL EXPENSE WAS CALCULATED BY DIVIDING THE COMMUNITY BENEFIT COST BY TOTAL HOSPITAL EXPENSES OF $703,059,987.
Form Sch H, Part II	THE GUNDERSEN HEALTH SYSTEM, WHICH INCLUDES GUNDERSEN LUTHERAN MEDICAL CENTER, IS COMMITTED TO OUR COMMUNITIES AS EXPRESSED IN OUR MISSION: WE DISTINGUISH OURSELVES THROUGH EXCELLENCE IN PATIENT CARE, EDUCATION, RESEARCH AND IMPROVED HEALTH IN THE COMMUNITIES WE SERVE. THE COMMUNITY BUILDING ACTIVITIES ARE INCLUDED IN COMMUNITY SERVICE REPORTING WHICH ARE PROGRAMS OR SERVICES SUPPORT THAT OUR POPULATION HEALTH INITIATIVE, BENEFITING COMMUNITIES BY ADDRESSING IDENTIFIED NEED THROUGH EFFECTIVE HEALTH IMPROVEMENT PROGRAMMING, ECONOMIC CONTRIBUTION, CORPORATE CITIZENSHIP AND VOLUNTEERISM. SUPPORT IS PROVIDED THROUGH CONTRIBUTION TO OTHER ORGANIZATIONS, OR THROUGH PROGRAMMING DELIVERED BY GUNDERSEN. WHENEVER POSSIBLE, THIS TYPE OF PROGRAMMING IS EVALUATED TO IDENTIFY THE IMPACT ON POPULATION HEALTH AND QUALITY OF LIFE. VERIFICATION OF ADDRESSING COMMUNITY NEEDS IS DOCUMENTED IN THE IMPLEMENTATION PLAN. AS A LARGER SYSTEM, COMMUNITY BUILDING ACTIVITIES ENCOMPASS ALL CORPORATIONS. LEADERSHIP IN COMMUNITY HEALTH IMPROVEMENT IS EVIDENCED BY OUR ACTIVITY WITH SEVERAL COMMUNITY COALITIONS AND INITIATIVES. AS WE CONSIDER OUR COMMUNITY NEEDS IDENTIFIED IN THE COMPASS REPORT, IT IS EVIDENT THAT HEALTH IS IMPACTED BY NOT ONLY THE TRADITIONAL SENSE OF PROVISION OF QUALITY MEDICAL SERVICES, BUT THE ENVIRONMENT IN WHICH WE LIVE, THE ECONOMIC CONDITION OF OUR PERSON AND FAMILY AND OVERALL QUALITY OF LIFE OFFERED IN THE COMMUNITIES WHERE WE LIVE.
Form Sch H, Part III, Line 2	COST TO CHARGE RATIO WAS OUR STARTING POINT FOR DETERMINING THE COST OF BAD DEBTS. THE COST TO CHARGE RATIO WAS CALCULATED FOLLOWING THE METHODOLOGY ON WORKSHEET 2. BAD DEBT EXPENSE IS THE PRODUCT OF THE COST TO CHARGE RATIO AND THE NET PROVISION FOR BAD DEBTS FROM THE FINANCIAL STATEMENTS.
Form Sch H, Part III, Line 3	GUNDERSEN LUTHERAN'S FINANCIAL ASSISTANCE POLICY (FAP) PROVIDES FREE AND DISCOUNTED CARE UP TO 400% OF THE FEDERAL POVERTY GUIDELINES (FPG). SOME PATIENTS MAY EXCEED THE 400% FPG WHEN ADDITIONAL CRITERIA SUCH AS CATASTROPHIC MEDICAL COSTS ARE CONSIDERED. THE DATA USED IS FROM THE US CENSUS BUREAU, 2008-2010 AMERICAN COMMUNITY SURVEY (ACS) 3-YEAR DATA SET FOR THE WISCONSIN COUNTIES AND ACS 5-YEAR DATA SET FOR HOUSTON COUNTY. WE USED THE MINNESOTA STATE AVERAGE BECAUSE 200% VALUE WAS SO HIGH FOR HOUSTON COUNTY. WE OBTAINED THE AVERAGE OF THE FIVE COUNTIES BY USING THE INFORMATION AT THE 3.00-3.99 (399%) OF FEDERAL POVERTY LEVEL (FPL) AND BELOW. THE NEXT RANGE WAS 4.00-4.99 RATIO OF INCOME TO POVERTY IN THE LAST 12 MONTHS. WE MULTIPLIED THE FIVE COUNTY AVERAGE AT 399% OF FPL TO THE BAD DEBT AT COST. WE DEDUCTED THE AMOUNT OF CHARITY CARE AT COST TO OBTAIN THE AMOUNT OF BAD DEBT AT COST TO PATIENTS ELIGIBLE UNDER FAP (BUT FOR WHOM INSUFFICIENT INFORMATION WAS OBTAINED TO DETERMINE THEIR ELIGIBILITY).
Form Sch H, Part III, Line 4	THE COLLECTION OF RECEIVABLES FROM THIRD-PARTY PAYORS AND PATIENTS IS THE OBLIGATED GROUP'S PRIMARY SOURCE OF CASH FOR OPERATIONS. THE PRIMARY COLLECTION RISKS RELATE TO UNINSURED PATIENT ACCOUNTS AND PATIENT DEDUCTIBLES AND COINSURANCE ON INSURERS' ACCOUNTS. PATIENT RECEIVABLES, INCLUDING THE PORTION FOR WHICH A THIRD-PARTY PAYOR IS RESPONSIBLE, ARE CARRIED AT NET REALIZABLE VALUE, DETERMINED BY THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED LESS AN ESTIMATE MADE FOR CONTRACTUAL ADJUSTMENTS OR DISCOUNTS PROVIDED TO THIRD-PARTY PAYORS. PATIENT RECEIVABLES DUE DIRECTLY FROM THE PATIENTS ARE CARRIED ON THE ACCOMPANYING COMBINED BALANCE SHEETS AT THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED LESS AMOUNTS COVERED BY THIRD-PARTY PAYORS, ALLOWANCES FOR OTHER DISCOUNTS, AND AN ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. THE OBLIGATED GROUP DOES NOT CHARGE INTEREST ON PAST DUE RECEIVABLES. RECEIVABLES ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE OBLIGATED GROUP'S POLICIES. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE OBLIGATED GROUP ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. THE ANALYSIS IS PERFORMED USING A HINDSIGHT CALCULATION THAT UTILIZES WRITE-OFF DATA FOR ALL PAYOR CLASSES DURING A DETERMINED TIME PERIOD TO CALCULATE THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AT A POINT IN TIME. A FULL ALLOWANCE IS RECORDED FOR ACCOUNTS RECEIVABLE BALANCES, WITHOUT PAYMENT ARRANGEMENTS, OVER 365 DAYS OLD. AT DECEMBER 31, 2015 AND 2014, THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS WAS $24,275 AND $27,839 (DOLLARS IN THOUSANDS), RESPECTIVELY, WHICH AS A PERCENTAGE OF ACCOUNTS RECEIVABLE, NET OF CONTRACTUAL ADJUSTMENTS, WAS 16 % AND 19%, RESPECTIVELY.
Form Sch H, Part III, Line 8	THE MEDICARE COST REPORT IS USED TO DETERMINE ALLOWABLE COSTS. THE UNREIMBURSED MEDICARE COSTS ON PART III, SECTION B OF SCHEDULE H ARE ALLOWABLE COSTS PER THE MEDICARE COST REPORT. THIS CALCULATION IS LIMITED TO PATIENTS WHO ARE COVERED UNDER THE MEDICARE FEE FOR SERVICE PLAN AND DOES NOT INCLUDE THOSE COVERED BY THE MEDICARE ADVANTAGE PLANS. IT ALSO DOES NOT INCLUDE ALL SERVICES PROVIDED BY THE HOSPITAL TO PATIENTS COVERED UNDER THE MEDICARE FEE FOR SERVICE PLAN. IT EXCLUDES HOSPICE SERVICES, AMBULANCE SERVICES, CLINICAL LABORATORY SERVICES, AND A FEW OTHER MISCELLANEOUS SERVICES. INCORPORATING ALL SERVICES TO ALL MEDICARE BENEFICIARIES, THE UNREIMBURSED COST FOR MEDICARE IS $86,394,592. Form Sch H, Part III, Line 9b PURSUANT TO SELF-PAY BILLING & COLLECTION POLICY, NO EXTRAORDINARY COLLECTION ACTIONS WILL BE PURSUED AGAINST A PATIENT, OR PATIENT GUARANTOR, BEFORE REASONABLE EFFORTS HAVE BEEN MADE TO DETERMINE WHETHER THE PATIENT OR GUARANTOR IS ELIGIBLE FOR ASSISTANCE UNDER THE GHS FINANCIAL ASSISTANCE POLICY (FAP). NO ACCOUNT WILL BE SUBJECT TO BAD DEBT COLLECTION ACTIONS, OR ECA, WITHIN 120 DAYS OF THE FIRST POST-DISCHARGE STATEMENT BEFORE GHS HAS MADE REASONABLE EFFORTS TO DETERMINE WHETHER THAT PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE. THIS 120 DAY TIMEFRAME MAY BE ABBREVIATED IF A DETERMINATION HAS BEEN MADE ON FINANCIAL ASSISTANCE, A PAYMENT PLAN HAS BEEN ESTABLISHED AND AGREED TO BY THE PATIENT OR GUARANTOR, AND THE PATIENT OR GUARANTOR IS NO LONGER COMPLYING WITH THE PAYMENT PLAN. NO COLLECTION ACTIONS WILL BE PURSUED AGAINST A PATIENT IF THE PATIENT, OR GUARANTOR, HAS PROVIDED DOCUMENTATION SHOWING THAT HE OR SHE HAS APPLIED FOR COVERAGE UNDER MEDICAID, OR OTHER PUBLICLY SPONSORED HEALTH PROGRAMS, THAT MAY PAY THE OUTSTANDING CLAIM AND FOR WHICH AN ELIGIBILITY DETERMINATION IS STILL PENDING. PRIOR TO SENDING A PATIENTS ACCOUNT TO A COLLECTION AGENCY, GHS WILL MAKE REASONABLE EFFORTS TO PROVIDE INFORMATION ON FINANCIAL ASSISTANCE AND WILL MAIL A MINIMUM OF THREE(3) WRITTEN STATEMENTS TO THE PATIENT OR GUARANTOR. EACH STATEMENT WILL INCLUDE CONSPICUOUS NOTICE OF THE GHS FINANCIAL ASSISTANCE POLICY, TELEPHONE NUMBER TO CALL FOR HELP, AND DIRECT WEBSITE ADDRESS. IF ALL EFFORTS TO COMMUNICATE WITH THE PATIENT, OR PATIENT GUARANTOR, ARE UNSUCCESSFUL, AND A CORRECT ADDRESS FOR UNDELIVERABLE MAIL IS NOT FOUND, ACCOUNTS WILL BE SENT TO A COLLECTION AGENCY. WITHIN 240 DAYS FROM THE FIRST POST-DISCHARGE STATEMENT, IF A PATIENT, OR GUARANTOR, APPLIES FOR FINANCIAL ASSISTANCE, THE APPLICATION WILL BE ACCEPTED AND COLLECTION ACTIONS WILL CEASE WHILE AN ELIGIBILITY DETERMINATION IS BEING MADE.
CONTINUED	IF THE APPLICANT IS APPROVED FOR FREE CARE, NO FURTHER ACTIONS WILL BE TAKEN TO COLLECT ON THE AMOUNT. IF THE APPLICANT IS DENIED FINANCIAL ASSISTANCE OR IS APPROVED FOR DISCOUNTED CARE, STEPS WILL BE TAKEN TO RESOLVE THE OUTSTANDING OBLIGATION. IF THE ACCOUNT IS NOT RESOLVED OR ARRANGEMENTS TO RESOLVE THE ACCOUNT ARE NOT MADE, ADDITIONAL COLLECTION ACTIONS WILL BE PURSUED. IF AN INDIVIDUAL SUBMITS AN INCOMPLETE APPLICATION DURING THE APPLICATION PERIOD, GHS MUST (I) SUSPEND ALL COLLECTION ACTIONS, (II) PROVIDE THE INDIVIDUAL WITH A WRITTEN NOTICE THAT DESCRIBES THE ADDITIONAL INFORMATION AND/OR DOCUMENTATION REQUIRED UNDER THE FAP OR APPLICATION FORM THAT MUST BE SUBMITTED TO COMPLETE THE FAP APPLICATION AND (III) PROVIDE GHS'S CONTACT INFORMATION. THE APPLICATION WILL REMAIN ACTIVE FOR 30 DAYS FROM THE DATE THE LETTER WAS MAILED TO THE APPLICANT REQUESTING THIS INFORMATION. IF THE APPLICANT HAS NOT RESPONDED WITHIN THE 30 DAY TIMEFRAME, THE APPLICATION WILL BE DENIED. APPLICANTS APPROVED FOR FINANCIAL ASSISTANCE WILL BE REFUNDED PAYMENTS IN EXCESS OF THE AMOUNT DETERMINED OWED BY THE PATIENT OR PATIENTS GUARANTOR ON ACCOUNTS FOR WHICH THEY HAVE BEEN GRANTED ASSISTANCE UNDER THE GHS FAP. REFUNDS APPLY TO EXCESS PAYMENTS OF $5.00 OR MORE. IN ACCORDANCE WITH THIS POLICY, FINANCIAL ASSISTANCE IS GENERALLY NOT EXTENDED FOR CO-PAYMENTS OR A BALANCE REMAINING AFTER THE INSURANCE COMPANY HAS PAID IF A PATIENT FAILS TO OBTAIN PROPER REFERRALS OR AUTHORIZATIONS, OR IF SUCH ASSISTANCE IS NOT IN ACCORDANCE WITH INSURERS CONTRACTUAL AGREEMENT THEREFORE SUCH PAYMENTS RECEIVED WILL NOT BE REFUNDED. COLLECTION ACTIONS MAY BE UTILIZED BY GHS WHEN PURSUING PAYMENT FROM PATIENTS OR GUARANTORS (I) WITH BALANCES DUE THAT GO UNPAID FOR MORE THAN 120 DAYS WHO DO NOT APPLY FOR FINANCIAL ASSISTANCE, (II) PATIENTS OR GUARANTORS NOT IN CONFORMANCE WITH AN AGREED UPON PAYMENT PLAN, OR (III) PATIENTS OR GUARANTORS WHO ARE NO LONGER COOPERATING IN GOOD FAITH TO PAY OFF THE REMAINING BALANCE. AT LEAST 30 DAYS BEFORE INITIATING ONE OR MORE ECAS TO OBTAIN PAYMENT FOR THE CARE PROVIDED, GHS WILL PROVIDE A PATIENT OR PATIENTS GUARANTOR WITH A WRITTEN NOTICE THAT INDICATES FINANCIAL ASSISTANCE IS AVAILABLE FOR ELIGIBLE INDIVIDUALS, HOW AN INDIVIDUAL CAN APPLY FOR FINANCIAL ASSISTANCE, AND WHERE THE FAP CAN BE OBTAINED. SUCH WRITTEN NOTICE WILL IDENTIFY THE ECAS THAT GHS OR OTHER AUTHORIZED PARTY INTENDS TO INITIATE TO OBTAIN PAYMENT FOR THE CARE, AND INDICATE THE DEADLINE AFTER WHICH SUCH ECAS MAY BE INITIATED. THE DEADLINE WILL BE NO EARLIER THAN THIRTY (30) DAYS AFTER THE DATE THAT THE WRITTEN NOTICE IS PROVIDED TO THE PATIENT OR PATIENT'S GUARANTOR. A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY WILL BE INCLUDED WITH THE NOTICE GHS WILL ALSO MAKE REASONABLE EFFORTS TO ORALLY NOTIFY THE INDIVIDUAL ABOUT GHS FAP AND HOW THE PATIENT CAN OBTAIN ASSISTANCE WITH THE FAP PROCESS.
Form Sch H, Part VI, Line 2	IT IS THE POLICY OF GUNDERSEN HEALTH SYSTEM TO ENGAGE IN PRACTICES WHICH PROVIDE A BENEFIT TO THE COMMUNITY (GL-1820). THIS IS IN ACCORDANCE WITH OUR COMMUNITY SERVICE STATEMENT WHICH READS "WE SUPPORT AND STRENGTHEN THE COMMUNITIES WE SERVE WITH PARTNERSHIPS AND INVESTMENTS THROUGH EFFECTIVE HEALTH IMPROVEMENT PROGRAMMING, CORPORATE CITIZENSHIP, VOLUNTEERISM, AND ECONOMIC CONTRIBUTIONS." COMMUNITY BENEFIT PROGRAMS ARE THOSE PROGRAMS OR ACTIVITIES THAT PROVIDE TREATMENT AND /OR PROMOTE HEALTH AND HEALING AS A RESPONSE TO IDENTIFIED COMMUNITY NEEDS (I.E. CHNA, WORKSITE HEALTH RISK ASSESSMENTS, HEALTH SCORECARD, PATIENT AGGREGATE DATA, OTHER LOCAL, STATE, NATIONAL DATA SOURCES) REGARDLESS OF SOURCE OR AVAILABILITY OF PAYMENT. COMMUNITY SERVICE ACTIVITIES PROVIDE A MEASURABLE IMPROVEMENT IN POPULATION HEALTH. THE ACTIVITIES PROVIDED IN OUR COMMUNITIES INCLUDE HEALTH IMPROVEMENT, ADVOCACY FOR PEOPLE WITH DISABILITIES, RECOGNITION OF DIVERSITY AND INCLUSION, MENTAL HEALTH, DOMESTIC VIOLENCE, WORKFORCE DEVELOPMENT, EDUCATION AND SAFETY. ACTIVITIES ARE GUIDED BY COMMUNITY NEEDS ASSESSMENT AND AS APPROPRIATE, INCLUDED IN OUR IMPLEMENTATION PLAN. LEADERSHIP IN COMMUNITY HEALTH IMPROVEMENT IS EVIDENCED BY OUR ACTIVITY WITH SEVERAL COALITIONS AND INITIATIVES. GUNDERSEN HEALTH SYSTEM COMMUNITY SERVICES SUPPORT ONE OR MORE OF THE FOLLOWING ESTABLISHED CRITERIA: - SUPPORT GUNDERSEN HEALTH SYSTEM COMMUNITY-BASED MISSION THROUGH STRATEGIC COMMITMENT - TARGET POOR, MEDICALLY UNDERSERVED OR SPECIAL NEEDS POPULATION - IMPACT HEALTH STATUS - SUPPLY OR SUPPORT A SERVICE THAT WOULD BE DISCONTINUED IF DECISION MADE ON PURE FINANCIAL BASIS - ACCESSIBLE TO THE ENTIRE COMMUNITY REGARDLESS OF ABILITY TO PAY - STIMULATES EXTERNAL COMMUNITY PARTNERSHIPS, INCLUDING EMPLOYEE PARTICIPATION (VOLUNTEERISM) - CAN BE MEASURED IN TERMS OF FINANCIAL VALUE, EMPLOYEE CONTRIBUTIONS, THE NUMBER OF PEOPLE SERVED, AND IF THE GIVEN COMMUNITY BENEFITS ADDRESSES A HEALTH DISPARITY IN THE COMMUNITY. GUNDERSEN HEALTH SYSTEM FURTHER REFINES COMMUNITY SERVICE INTO THE FOLLOWING CATEGORIES: - ACCESS AND COVERAGE - HEALTH PROMOTION - SOCIAL AND BASIC NEEDS - CORPORATE CITIZENSHIP - ACTIVITIES: 1. FINANCIAL CONTRIBUTIONS 2. DONATION OF MATERIALS AND EQUIPMENT 3. EMPLOYEE VOLUNTEERISM IN THE COMMUNITY
Form Sch H, Part VI, Line 3	EVERY PATIENT IS MADE AWARE OF THE AVAILABILITY OF FINANCIAL ASSISTANCE UPON CHECK-IN. SIGNS THAT ARE OF NOTICEABLE SIZE AND PLACEMENT ARE DISPLAYED IN EACH CHECK-IN AREA. PATIENTS ARE OFFERED A BROCHURE EXPLAINING THE FINANCIAL ASSISTANCE PROGRAM. PATIENTS THAT MEET WITH FINANCIAL COUNSELORS EITHER BY REFERRAL FROM A DEPARTMENT, OR SELF-REFERRAL ARE INFORMED OF THE FINANCIAL ASSISTANCE PROGRAM. FINANCIAL ASSISTANCE INFORMATION IS POSTED ON GLMC WEBSITE. INFORMATION IS ALSO POSTED IN NOT-FOR-PROFIT ORGANIZATIONS WHERE PATIENTS MIGHT SEEK ASSISTANCE FOR NON-MEDICAL FINANCIAL OBLIGATIONS.
Form Sch H, Part VI, Line 4	GUNDERSEN LUTHERAN MEDICAL CENTER INC. IS A MAJOR TERTIARY TEACHING HOSPITAL IN THE GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. LOCATED IN LA CROSSE, WI, THE HOSPITAL SERVES PATIENTS FROM THE LA CROSSE AND SURROUNDING AREAS INCLUDING THE 19 COUNTIES IN WESTERN WISCONSIN, SOUTHEASTERN MINNESOTA AND NORTHEASTERN IOWA. LA CROSSE COUNTY, WITH A POPULATION OF APPROXIMATELY 116,250 PEOPLE, IS THE LARGEST COMMUNITY IN OUR SERVICE REGION. TOTAL 19 COUNTY SERVICE POPULATION IS APPROXIMATELY 568,300 WITH AN AVERAGE HOUSEHOLD INCOME OF 63,414. 11.8% OF THE 19 COUNTY SERVICE AREA POPULATION IS COVERED BY MEDICAID (ACCORDING TO WI AND IA DATA). PROJECTED POPULATION GROWTH IS MUCH SLOWER AT .9% COMPARED TO THE NATIONAL POPULATION GROWTH PROJECTION OF 3.5%. 21.9% OF THE POPULATION ARE AGE 17 OR UNDER COMPARED TO 23.2% NATIONALLY. THE SERVICE AREA POPULATION OF 65 AND OLDER ADULTS IS 17.6% COMPARED TO 14.7% NATIONALLY. 7.0% OF THE POPULATION IS NON-WHITE. SEVERAL SMALLER RURAL COMMUNITY HOSPITALS ARE LOCATED THROUGHOUT THE REGION. GUNDERSEN TRI-COUNTY HOSPITAL IN WHITEHALL, WI, GUNDERSEN ST. JOSEPHS HOSPITAL IN HILLSBORO, WI, PALMER LUTHERAN HEALTH CENTER IN WEST UNION, IA, AND GUNDERSEN BOSCOBEL AREA HOSPITAL IN BOSCOBEL, WI ARE PARTNERS/AFFILIATES OF THE GUNDERSEN HEALTH SYSTEM. SPECIALIZED SERVICES PERFORMED AT THE GUNDERSEN LUTHERAN MEDICAL CENTER AND IN MANY CASES, OUTREACH AT OUR REGIONAL CLINIC/HOSPITAL PARTNERS LOCATIONS INCLUDE ALLERGY, AUDIOLOGY, BEHAVIORAL MEDICINE, CARDIOLOGY, CARDIOTESTING LAB, CATH LAB, DERMATOLOGY, ECHOCARDIOGRAPHY, ENDOCRINOLOGY, ENDODONTICS, EXERCISE PHYSIOLOGY, GASTROENTEROLOGY, HEMATOLOGY, HOSPITALIST, INFECTIOUS DISEASE, NEPHROLOGY, NEUROLOGY, NEUROPSYCHOLOGY, NUTRITION THERAPY, OB/GYN, OCCUPATIONAL SERVICES, ONCOLOGY, OPHTHALMOLOGY, OTOLARYNGOLOGY, PATHOLOGY, PEDIATRICS, PERIODONTICS, PHYSICAL MEDICINE AND REHAB, PHYSICAL THERAPY, PLASTIC SURGERY, PODIATRY, PROSTHODONTICS, PSYCHIATRIC, PULMONARY, RENAL DIALYSIS, RHEUMATOLOGY, SPEECH PATHOLOGY, SPORTS MEDICINE, SURGERY, AND UROLOGY. GUNDERSEN PROVIDED SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS. WE PROVIDE A CRITICALLY IMPORTANT COMMUNITY BENEFIT, MUCH OF WHICH IS NOT QUALIFIED. OUR HOSPITAL, LIKE MOST COMMUNITY HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY, CARE THAT WITHOUT OUR HOSPITAL MAY NOT BE AVAILABLE.
Form Sch H, Part VI, Line 5	GUNDERSENS BOARD OF TRUSTEES IS COMPRISED OF INDIVIDUALS FROM THE COMMUNITY WHO RESIDE HERE. THESE INDIVIDUALS ARE NOT EMPLOYEES OF THE HEALTH SYSTEM. THIS GROUP WORKS WITH THE BOARD OF GOVERNORS, MAKING DECISIONS THAT SUPPORT THE COMMUNITYBASED MISSION AND VISION OF OUR ORGANIZATION. MANY OTHER EXAMPLES EXIST REFLECTING THE HEALTH SYSTEMS SUPPORT AND PROMOTION OF THE HEALTH OF THE COMMUNITY. MANY PROGRAMS FOR THE COMMUNITY ARE PROVIDED AT NO COST SUCH AS A PHYSICAL ACTIVITY CHALLENGE, HEALTHY MENU PLANNING AT LOCAL RESTAURANTS, CHILD RESILIENCE TRAINING FOR PARENTS, AND HEALTH SCREENINGS AT LOCAL EVENTS. A FREE NURSE ADVISOR LINE IS AVAILABLE FOR ALL TO ASSIST CALLERS. PRIORITY ONE DESIGNATION ASSURES HEART ATTACK PATIENTS SEEN IN HOSPITALS THROUGHOUT THE REGION ARE CARED FOR WITH PROVEN PROTOCOLS AND TIMELY PROCEDURES. GUNDERSEN STAFF ARE ENCOURAGED TO PARTICIPATE IN THEIR LOCAL COMMUNITY ORGANIZATIONS. STAFF LEND THEIR EXPERTISE IN LEADERSHIP POSITIONS TO ORGANIZATIONS SUCH AS UNITED WAY, HEALTH MISSION, CHAMBER OF COMMERCE, HUMAN SERVICE ORGANIZATIONS, AND HEALTH IMPROVEMENT INITIATIVES. STAFF FROM GUNDERSEN HAVE BEEN INSTRUMENTAL IN ACCOMPLISHING COMMUNITY NEEDS ASSESSMENTS AND IMPLEMENTATION OF COMMUNITY INITIATIVES IN AREAS OF OBESITY, ALCOHOL USE, CHILD SAFETY, MENTAL HEALTH, DOMESTIC VIOLENCE, CHILD ABUSE AND ENVIRONMENTAL HEALTH. PATIENT ADVISORY GROUPS FROM VARIOUS SECTORS OF OUR COMMUNITY ARE COORDINATED IN ORDER FOR US TO BETTER MEET THE NEEDS OF OUR PATIENTS.
Form Sch H, Part VI, Line 6	ALL AFFILIATES OF THE HEALTH SYSTEM HAVE A RESPONSIBILITY TO PROMOTE THE HEALTH OF THE COMMUNITIES WE SERVE. THE MAJORITY OF EMPLOYEES, BASED IN THE ADMINISTRATIVE CORPORATION, ARE ACTIVELY INVOLVED IN PROGRAMS AND SERVICES FOR THE COMMUNITY AS WELL AS MAINTAINING PARTNERSHIPS WITH A VARIETY OF ORGANIZATIONS, COALITIONS, INITIATIVES AND AGENCIES IN OUR COMMUNITIES THAT PROMOTE HEALTH. THE ADMINISTRATIVE CORPORATION ALSO PROVIDES THE FINANCIAL CORPORATE CONTRIBUTIONS TO VARIOUS ORGANIZATIONS AND COMMUNITY ACTIVITIES. OUR FOUNDATION PROVIDES SUPPORT FOR NUMEROUS COMMUNITY HEALTH PROMOTION PROGRAMS AS WELL, PROVIDED BY THE HEALTH SYSTEM OR OTHER ORGANIZATIONS IN OUR COMMUNITY. CLINICAL STAFF SUPPORT SCREENINGS AND THE HEALTH MISSION. OUR LOCAL RURAL HOSPITAL AFFILIATES PROVIDE SUPPORT TO THEIR RESPECTIVE COMMUNITIES. OUR CLINICS, LOCATED IN OVER 20 COMMUNITIES PROVIDE SUPPORT UNIQUE TO THE NEEDS OF THAT COMMUNITY. THE MEDICAL CENTER, AS PART OF AN INTEGRATED HEALTH CARE DELIVERY SYSTEM, WORKS WITH AND IS RELATED TO GUNDERSEN CLINIC, LTD. WHICH PROVIDED UNCOMPENSATED CARE IN THE AMOUNT OF APPROXIMATELY $56,876,005. BASED ON POLICIES AND CONTRACTS ARRANGED TO HELP SUPPORT THE COMMUNITYS NEEDS RELATED TO HEALTH CARE SERVICES, THE $56,876,005 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 FOLLOWING THE METHODOLOGY ON WORKSHEET 1. THE COST TO CHARGE RATIO IS CALCULATED FOLLOWING THE METHODOLOGY ON WORKSHEET 2. 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. AMOUNTS ARE REPORTED IN THE SEPARATE 990 FOR GUNDERSEN CLINIC, LTD. AFFILIATED ENTITY CHARITY CARE AN AFFILIATE OF GUNDERSEN LUTHERAN MEDICAL CENTER, INC., GUNDERSEN CLINIC LTD., IS NOT REQUIRED TO FILE SCHEDULE H OF FORM 990. GUNDERSEN CLINIC, LTD. PROVIDED COMMUNITY BENEFIT OF: CHARITY AT COST $1,392,637 MEDICARE UNREIMBURSED COST $41,036,319 MEDICAID UNREIMBURSED COST $14,447,049.
Form Sch H, Part VI, Line 7	LIST OF STATES RECEIVING COMMUNITY BENEFIT REPORT: WI

Schedule H (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
Gundersen Lutheran Medical Center Inc

Employer identification number
39-0813416

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section if applicable	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of non-cash assistance	(h) Purpose of grant or assistance

(1) GUNDERSEN LUTHERAN MEDICAL FOUNDATION INC
1836 SOUTH AVENUE
LA CROSSE,WI54601

39-1249705

501(C)(3)

10,027,815

SUPPORT OF THE GLMF CHARITY CARE FOR 3793 RECIPIENTS

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2015

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of non-cash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of non-cash assistance

(1) CHARITY CARE	3793	10,022,837	Book	CHARITY CARE
(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Return Reference	Explanation
PART I, LINE 2	ASSISTANCE WAS MADE TO A RELATED ORGANIZATION. THE FUNDS ARE MONITORED BY MANAGEMENT AND THE BOARD OF TRUSTEES.

Schedule I (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Gundersen Lutheran Medical Center Inc

Employer identification number

39-0813416

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization?

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization?

Any related organization? .........................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2015

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column(B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1Jeffrey Thompson MDChief Executive Officer	(i) (ii)	------------- 656,406	------------- 75,000	------------- 227,079	0 ------------- 39,750	0 ------------- 22,875	0 ------------- 1,021,110	0 ------------- 0
2Scott Rathgaber MDCEO, Med-VP	(i) (ii)	------------- 589,072	-------------	------------- 4,558	0 ------------- 39,750	0 ------------- 21,875	0 ------------- 655,255	0 ------------- 0
3Stephen Shapiro MDBoard of Trustees - Member	(i) (ii)	------------- 437,556	------------- 4,000	------------- 16	0 ------------- 39,750	0 ------------- 27,057	0 ------------- 508,379	0 ------------- 0
4Brian Sieck MDBoard of Trustees - Member	(i) (ii)	------------- 389,656	-------------	------------- 286	0 ------------- 39,750	0 ------------- 24,557	0 ------------- 454,249	0 ------------- 0
5Kelley Bahr MDBoard of Trustees - Member	(i) (ii)	------------- 343,000	------------- 2,500	------------- 28,397	------------- 36,538	------------- 54	------------- 410,489	0 ------------- 0
6Jonathan Zlabek MDBoard of Trustees - Member	(i) (ii)	------------- 286,156	------------- 9,000	------------- 3,961	0 ------------- 39,750	0 ------------- 22,875	0 ------------- 361,742	0 ------------- 0
7P Michael Jacobs DPMBoard of Trustees-Member, MVP	(i) (ii)	------------- 292,155	------------- 2,500	------------- 30,568	0 ------------- 39,750	0 ------------- 22,875	0 ------------- 387,848	0 ------------- 0
8Greg Thompson MDChief Medical Officer	(i) (ii)	------------- 415,606	------------- 1,316	------------- 4,558	0 ------------- 39,750	0 ------------- 22,925	0 ------------- 484,155	0 ------------- 0
9Michael Dolan MDMed VP, Exec VP, Med COO	(i) (ii)	------------- 530,558	------------- 6,500	------------- 45,208	------------- 39,750	------------- 26,307	------------- 648,323	-------------
10Mary Kuffel MDMedical Vice President	(i) (ii)	------------- 449,412	-------------	------------- 4,198	0 ------------- 39,750	0 ------------- 1,343	0 ------------- 494,703	0 ------------- 0
11Marilu Bintz MDMedical VP, Senior VP	(i) (ii)	------------- 531,182	-------------	------------- 4,558	0 ------------- 39,750	0 ------------- 9,145	0 ------------- 584,635	0 ------------- 0
12Stephanie Carroll MDMedical Vice President	(i) (ii)	------------- 231,580	------------- 11,316	------------- 16	0 ------------- 36,731	0 ------------- 17,343	0 ------------- 296,986	0 ------------- 0
13Kraig SchusterVice President	(i) (ii)	------------- 186,244	-------------	------------- 360	0 ------------- 28,285	0 ------------- 22,923	0 ------------- 237,812	0 ------------- 0
14Elizabeth Smith-HouskampVice President	(i) (ii)	------------- 274,000	-------------	------------- 60,194	0 ------------- 39,750	0 ------------- 54	0 ------------- 373,998	0 ------------- 0
15Bryan ErdmannVice President	(i) (ii)	------------- 214,861	-------------	------------- 3,585	0 ------------- 32,999	0 ------------- 25,376	0 ------------- 276,821	0 ------------- 0
16Kelly BartonVice President	(i) (ii)	------------- 215,720	-------------	------------- 3,066	0 ------------- 33,000	0 ------------- 17,617	0 ------------- 269,403	0 ------------- 0
17Kathleen KlockSenior Vice President	(i) (ii)	------------- 406,450	-------------	-------------	0 ------------- 39,750	0 ------------- 6,786	0 ------------- 452,986	0 ------------- 0
18Gerald ArndtSenior Vice President	(i) (ii)	------------- 393,412	-------------	-------------	0 ------------- 39,750	0 ------------- 5,507	0 ------------- 438,669	0 ------------- 0
19Mark PlattSenior Vice President	(i) (ii)	------------- 354,656	-------------	------------- 4,182	0 ------------- 39,750	0 ------------- 20,375	0 ------------- 418,963	0 ------------- 0
20Debra RislowSenior Vice President	(i) (ii)	------------- 368,020	-------------	------------- 360	0 ------------- 39,750	0 ------------- 18,665	0 ------------- 426,795	0 ------------- 0
21Dara BartelsInterim CFO	(i) (ii)	------------- 190,357	------------- 33,346	------------- 1,347	0 ------------- 32,998	0 ------------- 22,375	0 ------------- 280,423	0 ------------- 0
22Mary JafariSenior Physicist	(i) (ii)	------------- 220,370	-------------	-------------	0 ------------- 33,310	0 ------------- 14,483	0 ------------- 268,163	0 ------------- 0
23John WochosSenior Physicist	(i) (ii)	------------- 200,184	-------------	------------- 6,683	0 ------------- 31,770	0 ------------- 22,875	0 ------------- 261,512	0 ------------- 0
24Allen DausSenior Physicist	(i) (ii)	------------- 205,674	-------------	------------- 360	0 ------------- 31,278	0 ------------- 20,375	0 ------------- 257,687	0 ------------- 0
25Kimberly SchmidtSenior Physicist	(i) (ii)	------------- 181,579	-------------	------------- 360	0 ------------- 27,784	0 ------------- 16,483	0 ------------- 226,206	0 ------------- 0
26Ryan HolteAdministrative Director	(i) (ii)	------------- 168,465	------------- 6,250	------------- 1,531	0 ------------- 26,385	0 ------------- 8,521	0 ------------- 211,152	0 ------------- 0
27Mary Lu GerkeNurse Executive	(i) (ii)	------------- 198,932	-------------	-------------	0 ------------- 30,000	0 ------------- 11,605	0 ------------- 240,537	0 ------------- 0
28Michael AllenChief Financial Officer	(i) (ii)	------------- 249,771	-------------	------------- 80,906	0 ------------- 10,133	0 ------------- 18,038	0 ------------- 358,848	0 ------------- 0

Schedule J (Form 990) 2015

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
PART I, LINE 1 A, 2, AND 3	ALL PERSONNEL SERVICES FOR GUNDERSEN LUTHERAN MEDICAL CENTER, INC. ARE PERFORMED BY EMPLOYEES OF GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICE, INC. AND ALL PAYMENTS TO VENDORS ARE MADE BY GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC.

Schedule J (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(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 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

Gundersen Lutheran Medical Center Inc

Employer identification number

39-0813416

Return Reference	Explanation
Form 990, Part I, Line 1	GUNDERSEN LUTHERAN MEDICAL CENTER (GLMC) ESTABLISHED IN 1899, PROVIDES ACUTE AND TERTIARY CARE FOR 19 COUNTIES LOCATED THROUGHOUT WESTERN WISCONSIN, NORTHEASTERN IOWA AND SOUTHEASTERN MINNESOTA. GLMC IS A TEACHING HOSPITAL WITH 268 AVAILABLE BEDS AND A LEVEL II TRAUMA AND EMERGENCY CENTER. OUR MISSION IS TO DISTINGUISH OURSELVES THROUGH EXCELLENCE IN PATIENT CARE, EDUCATION, RESEARCH AND THROUGH IMPROVED HEALTH IN THE COMMUNITIES WE SERVE. WE WILL WORK AS A TEAM TO DEMONSTRATE OUR VALUES: INTEGRITY-PERFORM WITH HONESTY, RESPONSIBILITY AND TRANSPARENCY. EXCELLENCE-ACHIEVE EXCELLENCE IN ALL ASPECTS OF DELIVERING HEALTHCARE, RESPECT-TREAT PATIENTS, FAMILIES AND COWORKERS WITH DIGNITY, INNOVATION-EMBRACE CHANGE AND NEW IDEAS, COMPASSION-PROVIDE COMPASSIONATE CARE TO PATIENTS AND FAMILIES.
Form 990, Part III, Line 1	GUNDERSEN LUTHERAN MEDICAL CENTER (GLMC) ESTABLISHED IN 1899, PROVIDES ACUTE AND TERTIARY CARE FOR 19 COUNTIES LOCATED THROUGHOUT WESTERN WISCONSIN, NORTHEASTERN IOWA AND SOUTHEASTERN MINNESOTA. GLMC IS A TEACHING HOSPITAL WITH 268 AVAILABLE BEDS AND A LEVEL II TRAUMA AND EMERGENCY CENTER. OUR MISSION IS TO DISTINGUISH OURSELVES THROUGH EXCELLENCE IN PATIENT CARE, EDUCATION, RESEARCH AND THROUGH IMPROVED HEALTH IN THE COMMUNITIES WE SERVE. WE WILL WORK AS A TEAM TO DEMONSTRATE OUR VALUES: INTEGRITY-PERFORM WITH HONESTY, RESPONSIBILITY AND TRANSPARENCY, EXCELLENCE ACHIEVE EXCELLENCE IN ALL ASPECTS OF DELIVERING HEALTHCARE, RESPECT-TREAT PATIENTS, FAMILIES AND COWORKERS WITH DIGNITY, INNOVATION-EMBRACE CHANGE AND NEW IDEAS, COMPASSION-PROVIDE COMPASSIONATE CARE TO PATIENTS AND FAMILIES.
Form 990, Part III, Line 4a	GLMC PROVIDES A COMPREHENSIVE RANGE OF INPATIENT, CLINICAL AND DIAGNOSTIC SERVICES IN NUMEROUS MEDICAL SPECIALTIES AND SUBSPECIALTIES. GLMC IS A TEACHING HOSPITAL WITH 268 AVAILABLE BEDS WITH SPECIALTY SERVICES INCLUDING RENAL DIALYSIS, CANCER CARE, REHABILITATION SERVICES, AND CARDIAC SERVICES. IN 2013, GLMC OPENED AN NEW INPATIENT BEHAVIORAL HEALTH BUILDING, MEETING A TREMENDOUS NEED IN OUR REGION FOR ADDITIONAL BEDS AND SERVICES. WE ARE ABLE TO PROVIDE CARE LOCALLY FOR PATIENTS OF ALL AGES. THE FACILITY IS THE ONLY PLACE IN THE REGION OFFERING INPATIENT CARE FOR ADOLESCENTS AND TEENAGERS WITH BEHAVIORAL HEALTH NEEDS. GLMC VOLUNTARILY PROVIDES MEDICALLY NECESSARY PATIENT CARE SERVICE THAT IS DISCOUNTED OR FREE OF CHARGE TO PERSONS WHO HAVE INSUFFICIENT RESOURCES AND/OR WHO ARE UNINSURED. DURING 2015, GLMC PROVIDED FINANCIAL ASSISTANCE ON APPROXIMATELY 3,793 PATIENTS THAT RESULTED IN GLMC INCURRING ROUGHLY $6,066,700 IN UNCOMPENSATED COST ASSOCIATED WITH THIS PROGRAM. 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 THE BALANCE SHEET OF GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. FEIN 39-1606449.
Form 990, Part VI, Line 2	Mark Glendenning, Gerald Arndt and Greg Prairie Business Relationship.
Form 990, Part VI, Line 6	GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF THIS ORGANIZATION.
Form 990, Part VI, Line 7a	GUNDERSEN LUTHERAN HEALTH SYSTEM, INC.
Form 990, Part VI, Line 7b	GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. THE PARENT CORPORATION AND SOLE MEMBER OF THE CORPORATION, SHALL HAVE THE POWER TO RECOMMEND AND REVIEW, AS APPROPRIATE, AND APPROVE CERTAIN MATTERS. ARTICLES OF INCORPORATION MAY BE AMENDED BY VOTE OF THE SOLE MEMBER OF THE CORPORATION.
Form 990, Part VI, Line 11b	THE FORM 990 WILL BE AVAILABLE FOR ALL BOARD MEMBERS AT A BOARD MEETING AND THE GUNDERSEN LUTHERAN HEALTH SYSTEM FINANCE COMMITTEE RECEIVES A COPY OF THE 990 BEFORE FILING AND UPON FURTHER REVIEW FROM THE CFO THE 990S ARE APPROVED AND FILED.
Form 990, Part VI, Line 12c	GUNDERSEN LUTHERAN MEDICAL CENTER, INC. MONITORS CONFLICTS ON AN ANNUAL BASIS BY REVIEWING DISCLOSURES ON COMPLETED CONFLICT OF INTEREST STATEMENTS.
Form 990, Part VI, Line 15a	ALL PERSONNEL SERVICES FOR GUNDERSEN LUTHERAN MEDICAL CENTER, INC. ARE PERFORMED BY EMPLOYEES OF GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. THE COMPENSATION OF THE CEO IS DETERMINIED 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 PERFORIV1ANCE. 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 PROPOSED SALARIES ARE INDEPENDENTLY REVIWED BY AN OUTSIDE AUDITING FIRM. THE COMPENSATION RECOMMENDATIONS, AUDIT REPORTS, ALONG WITH THE MARKET DATA, ARE PRESENTED TO A COMMITTEE MADE OP 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, Line 19	REQUESTS FOR ALL DOCUMENTS ARE MADE THROUGH THE LEGAL DEPARTMENT AND THE APPROPRIATE DOCUMENTS ARE MADE AVAILABLE FOR INSPECTION IN THE LEGAL DEPARTMENT.
Form 990, Part VII, Line Section A, Line 1	ALL PERSONNEL SERVICES FOR GUNDERSEN LUTHERAN MEDICAL CENTER, INC. ARE PERFORMED BY EMPLOYEES OF GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC.
Form 990, Part VII, Line Section B, Line 1	ALL PAYMENTS TO VENDORS ARE MADE BY GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES,INC.
Form 990, Part XII, Line 2c	THE PROCESS ALLOWS THE AUDIT COMMITTEE OF GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. TO INDEPENDENTLY COMMUNICATE WITH THE EXTERNAL AUDIT FIRM THROUGHOUT THE YEAR, BUT FORMAL COMMUNICATION OCCURS BEFORE THE ENGAGEMENT AND UPON CONCLUSION. THE AUDIT COMMITTEE MEETS WITH THE AUDIT FIRM FOR PRESENTATION OF THE STATEMENTS. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.
Form 990, Part XII, Line 3a	GUNDERSEN LUTHERAN MEDICAL CENTER, INC. OPERATES IN CONJUNCTION WITH A GROUP OF OTHER AFFILIATED CORPORATIONS GOVERNED BY GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. AS SUCH, ANY FEDERAL AWARDS TO GUNDERSEN LUTHERAN MEDICAL CENTER, INC. UNDERGO AN AUDIT AS SET FORTH IN THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133.
FORM 990 PART IX LINE 11G	DESCRIPTION:Purchased Health Services TOTAL FEES:86662021
FORM 990 PART IX LINE 11G	DESCRIPTION:Purchased Program Services TOTAL FEES:10057354
FORM 990 PART IX LINE 11G	DESCRIPTION:Consulting TOTAL FEES:268295

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Gundersen Lutheran Medical Center Inc

Employer identification number

39-0813416

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1836 SOUTH AVENUE LA CROSSE,WI54601 39-1866425	SUPTNG. ORG	WI	501(C)(3)	LINE 11B,II	NA		No
(2)GUNDERSEN HEALTH PLAN INC 1836 SOUTH AVENUE LA CROSSE,WI54601 39-1807071	HEALTH INS.	WI	501(C)(4)		GLHS		No
(3)GUNDERSEN CLINIC LTD 1836 SOUTH AVENUE LA CROSSE,WI54601 39-1028657	HEALTH CARE	WI	501(C)(3)	LINE 3	GLHS		No
(4)GUNDERSEN LUTHERAN MEDICAL FNDTN INC 1836 SOUTH AVENUE LA CROSSE,WI54601 39-1249705	FOUNDATION	WI	501(C)(3)	LINE 7	GLHS		No
(5)GUNDERSEN LUTHERAN ADM SERVICES INC 1910 SOUTH AVENUE LA CROSSE,WI54601 39-1606449	SUPTNG. ORG.	WI	501(C)(3)	LINE 11B,II	GLHS		No
(6)GUNDERSEN LUTHERAN CREDENTIALING SVS INC 1910 SOUTH AVENUE LA CROSSE,WI54601 39-1856898	CREDENTIALING	WI	501(C)(3)	LN 11C,III	GLHS		No
(7)TRI-COUNTY MEMORIAL HOSPITAL INC 18601 LINCOLN STREET WHITEHALL,WI54773 39-0704510	HEALTH CARE	WI	501(C)(3)	LINE 3	GLHS		No
(8)TRI-STATE REGIONAL AMBULANCE INC 235 CAUSEWAY BLVD LA CROSSE,WI54603 39-1962965	MDCL TRANSPO.	WI	501(C)(3)	LINE 9	GLHS		No
(9)STJOSEPH'S HEALTH SERVICES INC 400 WATER AVENUE HILLSBORO,WI54634 39-0929538	HEALTH CARE	WI	501(C)(3)	LINE 3	GLHS		No
(10)ST JOSEPH MEMORIAL FOUNDATION INC 400 WATER AVENUE HILLSBORO,WI54634 39-1455787	FOUNDATION	WI	501(C)(3)	LINE 11A, I	S JOSEPH HS		No
(11)TRI-COUNTY MEMORIAL FOUNDATION INC 18601 LINCOLN STREET WHITEHALL,WI54773 30-0093022	FOUNDATION	WI	501(C)(3)	LINE 11A, I	TRI-COUNTY		No
(12)GUNDERSEN LUTHERAN EXPRESS CARE INC 1836 SOUTH AVE LA CROSSE,WI54601 90-0102388	HEALTH CARE	WI	501(C)(3)	LINE 11	GLHS		No
(13)GUNDERSEN HEALTH PLAN MN INC 1900 SOUTH AVE LA CROSSE,WI54601 45-2633920	HEALTH INS	MN	501(C)(4)		GHP		No
(14)MEMORIAL HOSPITAL OF BOSCOBEL 205 PARKER STREET BOSCOBEL,WI53805 39-0845590	HEALTH CARE	WI	501(C)(3)	LINE 3	GLHS		No
(15)MEMORIAL HOSPITAL OF BOSCOBEL FNDT INC 205 PARKER STREET BOSCOBEL,WI53805 39-1688793	FUNDRAISING	WI	501(C)(3)	LINE 7	NA		No
(16)BOSCOBEL AREA HEALTH CARE PARTNERS 205 PARKER STREET BOSCOBEL,WI53805 45-0498844	FUNDRAISING	WI	501(C)(3)	LINE 7	NA		No
(17)HARMONY COMMUNITY HEALTHCARE INC 815 MAIN AVENUE S HARMONY,MN55939 41-0711606	HEALTH CARE	MN	501(C)(3)	LINE 9	GLHS		No
(18)TWEETEN LUTHERAN HEALTHCARE CENTER INC 125 FIFTH AVENUE SE SPRING GROVE,MN55974 41-1565003	HEALTH CARE	MN	501(C)(3)	LINE 9	GLHS		No
(19)TRI-STATE AMBULANCE INC 235 CAUSEWAY BLVD LA CROSSE,WI54603 39-1965415	MDCL TRANSPO.	WI	501(C)(3)	LINE 3	GLHS		No
(20)LUTHERAN REAL ESTATE HOLDING CORPORATION 1910 SOUTH AVENUE LA CROSSE,WI54601 39-1480826	HOUSING	WI	501(C)(3)	LN 11C, III	GLHS		No
(21)LUTHERAN HOUSING OF LA CROSSE INC 1900 SOUTH AVENUE LA CROSSE,WI54601 39-1751934	INDP LIVING	WI	501(C)(3)	LINE 9	LRHC		No
(22)COMMUNITY HOUSING OF LA CROSSE INC 1900 SOUTH AVENUE LA CROSSE,WI54601 39-1586700	INDP LIVING	WI	501(C)(3)	LINE 9	LRHC		No
(23)PALMER LUTHERAN HEALTH CENTER INC 112 JEFFERSON STREET WEST UNION,IA52175 42-1320763	HEALTH CARE	IA	501(C)(3)	LINE 3	GLHS		No
(24)PALMER MEMORIAL FOUNDATION 112 JEFFERSON STREET WEST UNION,IA52175 42-1032878	FOUNDATION	IA	501(c)(3)	Line 7	PLHC		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2015

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) DEGEN BERGLUND INC 1709 LOSEY BLVD S LA CROSSE,WI54601 39-0971110	RTL PHARMACY	WI	GLHS	C Corp	0	0		No
(2) GUNDERSEN LUTHERAN ENVISION LLC 1836 SOUTH AVENUE LA CROSSE,WI54601 26-4706546	RENEW. ENERGY	WI	GLHS	C Corp	0	0		No

Schedule R (Form 990) 2015

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

Yes

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) GUNDERSEN HEALTH PLAN INC	p	95,001,896	FAIR VALUE
(2) GUNDERSEN HEALTH PLAN MN INC	p	1,816,901	FAIR VALUE

Schedule R (Form 990) 2015

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2015

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2015

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: See Schedule O
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	13
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	5
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	0
6	Total number of volunteers (estimate if necessary) .............	6	0
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	445,988
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	125,390

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	4,204,529	4,218,247
9	Program service revenue (Part VIII, line 2g) .........	889,202,712	928,711,210
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	14,357	29,290
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	707,178	435,764
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	894,128,776	933,394,511
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	25,233,301	20,050,652
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	360,158,499	372,340,882
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	413,981,084	466,510,131
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	799,372,884	858,901,665
19	Revenue less expenses. Subtract line 18 from line 12.......	94,755,892	74,492,846
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	1,053,873,078	1,129,322,051
21	Total liabilities (Part X, line 26).............	4,682,515	5,638,642
22	Net assets or fund balances. Subtract line 21 from line 20.....	1,049,190,563	1,123,683,409

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 718,872,703 including grants of $ 20,050,652 ) (Revenue $ 928,711,210 )
	See Schedule O

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses718,872,703

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	0	9,849,099	1,419,085

(A) Name and business address	(B) Description of services	(C) Compensation





2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 0

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	3,852,406
e	Government grants (contributions)		1e	295,885

f	All other contributions, gifts, grants, and similar amounts not included above		1f	69,956

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		4,218,247

			Business Code
2a	Medical Service Provided	621500	928,711,210	928,711,210
b
c
d
e
f	All other program service revenue.
g Total.Add lines 2a–2f.....			928,711,210

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			82,170			82,170
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		34,600
b	Less: rental expenses		44,824
c	Rental income or (loss)	0	-10,224
d	Net rental income or (loss)......			-10,224			-10,224
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses	52,880
c	Gain or (loss)	-52,880
d	Net gain or (loss).....			-52,880			-52,880
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	LABORATORY SERVICES		900099	445,988		445,988
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			445,988
12	Total revenue. See Instructions......			933,394,511	928,711,210	445,988	19,066

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	10,027,815	10,027,815
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	10,022,837	10,022,837
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	277,680,585	275,638,287	2,042,298
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	33,713,845	33,429,318	284,527
9	Other employee benefits .......	43,827,132	43,822,126	5,006
10	Payroll taxes ...........	17,119,320	16,977,499	141,821
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	9,983	9,983
c	Accounting ...........	0
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	96,987,670	96,930,379	57,291
12	Advertising and promotion ....	0
13	Office expenses .......	8,112,237	8,112,237
14	Information technology ......	1,875,876	1,875,876
15	Royalties ..	0
16	Occupancy ...........	1,434,002	1,100,041	333,961
17	Travel ............	618,135	597,583	20,552
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	0
20	Interest ...........	0
21	Payments to affiliates .......	191,889,513	58,117,707	133,771,806
22	Depreciation, depletion, and amortization ..	25,676,382	22,955,698	2,720,684
23	Insurance ...	314,478	12,063	302,415
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	Bad debts/collections	13,825,371	13,825,371
b	Employee Development	399,073	379,706	19,367
c	Supplies	110,300,473	110,300,473
d	ASSESSMENTS	14,416,005	14,260,156	155,849
e	All other expenses	650,933	477,548	173,385
25	Total functional expenses. Add lines 1 through 24e	858,901,665	718,872,703	140,028,962	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			0	1	0
2	Savings and temporary cash investments .........			188,096	2	217,732
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			108,974,642	4	110,177,678
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
				0	6	0
7	Notes and loans receivable, net ....			0	7	0
8	Inventories for sale or use ........			3,324,564	8	4,205,047
9	Prepaid expenses and deferred charges ......			0	9	0
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	506,146,373
b	Less: accumulated depreciation	10b	179,537,483	322,708,128	10c	326,608,890
11	Investments—publicly traded securities .			15,000,000	11	20,000,000
12	Investments—other securities. See Part IV, line 11 .....			250,000	12	250,000
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			603,427,648	15	667,862,704
16	Total assets. Add lines 1 through 15 (must equal line 34)...			1,053,873,078	16	1,129,322,051

17	Accounts payable and accrued expenses .....	3,022,731	17	3,760,664
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	0
20	Tax-exempt bond liabilities .........	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	0
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D	1,659,784	25	1,877,978
26	Total liabilities. Add lines 17 through 25..	4,682,515	26	5,638,642

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	1,049,190,563	27	1,123,683,409
28	Temporarily restricted net assets ...........	0	28	0
29	Permanently restricted net assets	0	29	0
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	1,049,190,563	33	1,123,683,409
34	Total liabilities and net assets/fund balances ........	1,053,873,078	34	1,129,322,051