Form990


Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
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OMB No. 1545-0047
2021
Open to Public Inspection
A For the 2021 calendar year, or tax year beginning 01-01-2022 , and ending 12-31-2022
BCheck if applicable:
CName of organization
Gundersen Lutheran Administrative Services Inc
 
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
1910 SOUTH AVE
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
LA CROSSE, WI54601
D Employer identification number

39-1606449
E Telephone number

G Gross receipts $ 995,552,064
F Name and address of principal officer:
SCOTT RATHGABER MD
1910 SOUTH AVE
LA CROSSE,WI54601
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.GUNDERSENHEALTH.ORG
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. See instructions.
H(c)
Group exemption number MediumBullet  
K Form of organization:  
L Year of formation: 1987
M State of legal domicile: WI
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: TO SUPPORT GUNDERSEN HEALTH SYSTEM'S HEALTH CARE AND OTHER ORGS MISSIONS THROUGHOUT OUR SERVICES AREA, MANAGING THE LARGER PORTION OF BUISINESS SVCS, EDUCATION AND INVESTING.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 6
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 0
5 Total number of individuals employed in calendar year 2021 (Part V, line 2a) ...... 5 9,419
6 Total number of volunteers (estimate if necessary) ............. 6 310
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 3,997,310
b Net unrelated business taxable income from Form 990-T, Part I, line 11 ......... 7b 315,172
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 1,576,875 437,720
9 Program service revenue (Part VIII, line 2g) ......... 906,325,303 963,115,810
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 44,912,902 29,672,366
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 527,000 514,440
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 953,342,080 993,740,336
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 2,605,097 9,341,781
14 Benefits paid to or for members (Part IX, column (A), line 4).....   0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 786,360,513 851,847,734
16a Professional fundraising fees (Part IX, column (A), line 11e) .....   0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 123,427,142 140,101,405
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 912,392,752 1,001,290,920
19 Revenue less expenses. Subtract line 18 from line 12....... 40,949,328 -7,550,584
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 1,235,621,372 1,007,573,596
21 Total liabilities (Part X, line 26)............. 1,192,791,645 1,095,318,628
22 Net assets or fund balances. Subtract line 21 from line 20..... 42,829,727 -87,745,032
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
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Type or print name and title
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Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2021)
Form 990 (2021)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III..............
1
Briefly describe the organization’s mission: SEE SCHEDULE O.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 930,346,089 including grants of $ 9,341,781 ) (Revenue $ 963,115,810 )
GENERAL SERVICES PROVIDED TO GUNDERSEN CLINIC, LTD., GUNDERSEN LUTHERAN MEDICAL FOUNDATION, INC., GUNDERSEN LUTHERAN MEDICAL CENTER, INC. AND OTHER AFFILIATES: ADMINISTRATIVE, INFORMATION SYSTEMS, BILLING AND CODING, LAUNDRY, MEDICAL RECORDS, HUMAN RESOURCES, FINANCE, FACILITY OPERATIONS, CENTRAL SERVICES AND OTHER MISCELLANEOUS SERVICES.
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 expensesMediumBullet930,346,089
Form 990 (2021)
Form 990 (2021)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment
List of Attached Documents:
// Content
.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? See instructions. Click to see attachment
List of Attached Documents:
// Content
...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part I.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment
List of Attached Documents:
// Content
.........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Rev. Proc. 98-19? If "Yes," complete Schedule C, Part III..
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part I.........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part II....
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D, Part III..............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IV..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi endowments? If "Yes," complete Schedule D, Part V......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X, as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete
Schedule D, Part VI. Click to see attachment
List of Attached Documents:
// Content
...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VII.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIII.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IX............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
List of Attached Documents:
// Content
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
List of Attached Documents:
// Content
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI and XII......................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
List of Attached Documents:
// Content
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I. See instructions. ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....
20a
 
No
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....Click to see attachment
List of Attached Documents:
// Content
21
Yes
 
Form 990 (2021)
Form 990 (2021)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
List of Attached Documents:
// Content
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............Click to see list of attachments
List of Attached Documents:
// Content
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
No
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I ....
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I.......................
25b
 
No
26
Did the organization report any amount on Part X, line 5 or 22 for receivables from or payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part IIClick to see attachment
List of Attached Documents:
// Content
...........
26
Yes
 
27
Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons?
If "Yes," complete
Schedule L, Part III.........................
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see the Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If "Yes," complete Schedule L, Part IV......................
28a
 
No
b
A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV.....Click to see attachment
List of Attached Documents:
// Content
28b
Yes
 
c
A 35% controlled entity of one or more individuals and/or organizations described in line 28a or 28b? If "Yes," complete Schedule L, Part IV.....................
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .................
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II........................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I............Click to see attachment
List of Attached Documents:
// Content
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
List of Attached Documents:
// Content
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
 
No
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...
35b
 
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2.............
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VI
37
 
No
38
Did the organization complete Schedule O and provide explanations on Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in box 3 of Form 1096. Enter -0- if not applicable ..
1a
537
b
Enter the number of Forms W-2G included on line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
Form 990 (2021)
Form 990 (2021)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance (continued)
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
9,419
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. See instructions.
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? ........
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the sponsoring organization make any taxable distributions under section 4966?........
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources. (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state? .........
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? ....................
If "Yes," see the instructions and file Form 4720, Schedule N.
15
 
No
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income? ..
If "Yes," complete Form 4720, Schedule O.
16
 
No
17
Section 501(c)(21) organizations. Did the trust, any disqualified person, or mine operator engage in any activities that would result in the imposition of an excise tax under section 4951, 4952, or 4953? ..
If "Yes," complete Form 6069.
17
 
 
Form 990 (2021)
Form 990 (2021)
Page 6
Part VI
Governance, Management, and Disclosure. For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
6
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
0
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe on Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe on Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process on Schedule O. See instructions.
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the states with which a copy of this Form 990 is required to be filedMediumBullet
WI
18
Section 6104 requires an organization to make its Form 1023 (1024 or 1024-A, if applicable), 990, and 990-T (section 501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletSTEVE LITTLE1900 SOUTH AVENUE   NCA LA CROSSE,WI54601 (608) 782-7300
Form 990 (2021)
Form 990 (2021)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See the instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (box 5 of Form W-2, Form 1099-MISC, and/or box 1 of Form 1099-NEC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

See the instructions for the order in which to list the persons above.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(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) 		(D)
Reportable compensation from the organization (W-2/1099-MISC/1099-NEC) 		(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) ANDREA HAUSER
 
BOARD OF TRUSTEES-CNO, ADMIN VP NURSING & SYSTEM PRACTICES
 42.0
.................
5.0 		X   X       244,113 0 51,032
(2) BRYAN ERDMANN
 
BOARD OF TRUSTEES - CHIEF OPERATING OFFICER
 42.0
.................
6.5 		X   X       316,306 0 72,463
(3) DAN FLORNESS
 
BOARD OF TRUSTEES - TREASURER
 2.0
.................
4.0 		X   X       0 0 0
(4) GERALD ARNDT
 
BOARD OF TRUSTEES - CHAIR
 2.0
.................
7.0 		X   X       0 0 0
(5) GLENA TEMPLE PHD
 
BOARD OF TRUSTEES - SECRETARY
 2.0
.................
4.0 		X   X       0 0 0
(6) HEATHER SCHIMMERS
 
BOARD OF TRUSTEES - PRESIDENT
 42.0
.................
7.0 		X   X       514,939 0 58,135
(7) JOHN LYCHE
 
BOARD OF TRUSTEES - VICE CHAIR
 2.0
.................
4.0 		X   X       0 0 0
(8) ROBYN BORGE MD
 
BOARD OF TRUSTEES-CHIEF MEDICAL OFFICER
 42.0
.................
6.0 		X   X       306,023 0 46,630
(9) SCOTT RATHGABER MD
 
BOARD OF TRUSTEES - CEO, CHAIRMAN
 42.0
.................
6.0 		X   X       1,020,916 0 67,219
(10) TODD KOWALSKI MD
 
BOARD OF TRUSTEES - MEDICAL CHIEF OPERATING OFFICER
 42.0
.................
4.0 		X   X       473,806 0 72,811
(11) BENJAMIN JARMAN MD
 
BOARD OF TRUSTEES - MEMBER
 42.0
.................
6.0 		X           501,955 0 58,135
(12) CHRIS EBERLEIN MD
 
BOARD OF TRUSTEES - MEMBER
 42.0
.................
6.0 		X           387,958 0 67,719
(13) JENNIFER KLEVEN MD
 
BOARD OF TRUSTEES - MEMBER
 42.0
.................
6.0 		X           361,979 0 47,577
(14) MARK GLENDENNING
 
BOARD OF TRUSTEES - MEMBER
 2.0
.................
4.0 		X           0 0 0
(15) RICHARD RADCLIFFE
 
BOARD OF TRUSTEES - MEMBER
 2.0
.................
4.0 		X           0 0 0
(16) TITA YUTUC
 
BOARD OF TRUSTEES - MEMBER
 2.0
.................
4.0 		X           0 0 0
(17) CHRISTINE WALLER MD
 
MED VP, ACUTE CARE AND NURSING & SYSTEMS PRACTICES
 42.0
.................
6.0 		    X       520,081 0 77,227
Form 990 (2021)
Form 990 (2021)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(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) 		(D)
Reportable compensation from the organization (W-2/1099-MISC/1099-NEC) 		(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) DANIEL LILLY
 
SECRETARY
 42.0
.......................4.5 		    X       491,361 0 68,219
(19) GERALD OETZEL
 
CFO, TREASURER
 42.0
.......................7.0 		    X       615,642 0 52,651
(20) JONATHAN ZLABEK MD
 
MEDICAL VP, CROSS-FUNCTIONAL CARE
 42.0
.......................4.0 		    X       461,310 0 68,469
(21) KELLEY BAHR MD
 
MEDICAL VP, AMBULATORY SERVICES
 42.0
.......................4.0 		    X       393,507 0 44,275
(22) KRAIG SCHUSTER
 
ADMIN VP, COMMUNITY
 42.0
.......................6.0 		    X       284,169 0 53,972
(23) MARILU BINTZ MD
 
MED VP, COMM AND CMO-CRITICAL ACCESS HOSP
 42.0
.......................8.0 		    X       620,762 0 52,634
(24) MARY ELLEN MCCARTNEY
 
CHIEF HUMAN RESOURCES OFFICER
 42.0
.......................6.0 		    X       384,407 0 59,267
(25) MICHAEL DOLAN MD
 
EXEC VP, MEDICAL COO
 42.0
.......................6.0 		    X       636,281 0 71,911
(26) MICHAEL MCKEE
 
ADMIN VP, ACUTE CARE AND NURSING AND SYSTEMS
 42.0
.......................6.3 		    X       270,756 0 67,960
(27) PRAVEEN CHOPRA
 
CHIEF INFORMATION OFFICER
 42.0
.......................6.0 		    X       509,283 0 73,161
(28) RACHEL ALBRECHT
 
ADMIN VP, AMBULATORY SERVICES
 42.0
.......................4.8 		    X       151,435 0 46,902
(29) STEPHANIE NEUMAN MD
 
MEDICAL VP, AMBULATORY SERVICES
 42.0
.......................6.0 		    X       472,535 0 71,411
(30) STEPHEN SHAPIRO MD
 
CHIEF MEDICAL FOUNDATION OFFICER
 42.0
.......................10.0 		    X       498,943 0 71,269
(31) TINA LECHNIR
 
ADMIN VP, CROSS-FUNCTIONAL CARE
 42.0
.......................4.0 		    X       58,446 0 10,925
(32) WILLIAM FARRELL
 
CHIEF BUSINESS AND STRATEGY OFFICER
 42.0
.......................7.5 		    X       437,724 0 44,275
(33) ELLEN PEDRETTI-FENDT
 
VICE PRESIDENT APPLICATION SERVICES
 40.0
.......................0.0 		      X     203,686 0 54,866
(34) ERIC DEHN
 
VP ENTERPRISE ARCHITECTURE AND SOLUTION DESIGN
 40.0
.......................0.0 		      X     260,080 0 37,379
(35) JACK SCHWARTZ
 
VICE PRESIDENT FOUNDATION
 40.0
.......................0.0 		      X     215,332 0 38,237
(36) JANINE LUZ
 
VICE PRESIDENT LEARNING
 40.0
.......................0.0 		      X     229,446 0 51,353
(37) KARI ADANK
 
VICE PRESIDENT COMPLIANCE
 40.0
.......................0.0 		      X     236,819 0 59,638
(38) KRISTER MATTSON
 
VICE PRESIDENT ENTERPRISE ANALYTICS
 40.0
.......................0.0 		      X     298,053 0 51,698
(39) MARY KUFFEL MD
 
MEDICAL VICE PRESIDENT
 40.0
.......................0.0 		      X     538,187 0 45,667
(40) P MICHAEL JACOBS DPM
 
MEDICAL VICE PRESIDENT
 40.0
.......................0.0 		      X     461,210 0 67,702
(41) PAMELA MAAS
 
VICE PRESIDENT BUSINESS SERVICES
 40.0
.......................0.0 		      X     274,453 0 32,393
(42) SHANNON MULLIGAN
 
VP HR & TOTAL REWARDS
 40.0
.......................0.0 		      X     264,842 0 35,571
(43) DOUGLAS HUGHES MD
 
MEDICAL DOCTOR
 40.0
.......................0.0 		        X   1,080,521 0 53,519
(44) JEFFREY LAWRENCE MD
 
MEDICAL DOCTOR
 40.0
.......................0.0 		        X   1,152,244 0 65,719
(45) JERRY DAVIS MD
 
MEDICAL DOCTOR
 40.0
.......................0.0 		        X   1,103,855 0 53,519
(46) KURT ZIEGELBEIN MD
 
MEDICAL DOCTOR
 40.0
.......................0.0 		        X   998,787 0 68,569
(47) MARK TOPOLSKI MD
 
MEDICAL DOCTOR
 40.0
.......................0.0 		        X   1,111,397 0 58,135
(48) GREGORY THOMPSON MD
 
FORMER CHIEF MED OFF THRU 21
 40.0
.......................0.0 		          X 322,668 0 53,156
(49) STEPHANIE CARROLL MD
 
FORMER MEDICAL VP THRU 20
 40.0
.......................0.0 		          X 297,599 0 63,310
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 19,983,816 0 2,366,680
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet69
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
KRAUS ANDERSON CONSTRUCTION CO

501 SOUTH EIGHTH STREET
MINNEAPOLIS,MN55404 		CONSTRUCTION CONTRACTOR 6,057,164
FOWLER AND HAMMER INC

313 MONITOR STREET
LA CROSSE,WI54603 		CONSTRUCTION CONTRACTOR 6,030,771
WIESER BROTHERS INC

200 TWILITE STREET
LA CRESCENT,MN55947 		CONSTRUCTION CONTRACTOR 5,230,523
SIRIUS COMPUTER SOLUTIONS INC

PO BOX 202289
DALLAS,TX753202289 		COMPUTER CONTRACTOR 4,259,378
HAYES LOCUMS LLC

POX BOX 88122
CHICAGO,IL606801122 		CONTRACTED DOCTOR 3,972,145
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet394
Form 990 (2021)
Form 990 (2021)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, Grants, and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d 56,330
e Government grants (contributions)1e 373,482
f All other contributions, gifts, grants, and similar amounts not included above1f 7,908
g Noncash contributions included in lines 1a - 1f:$ 1g  
h Total. Add lines 1a-1f.......MediumBullet 437,720
Program Service RevenueAmt Business Code
2a SERVICES PROVIDED TO GUNDERSEN 561000 959,863,687 959,863,687    
b ADMIN. AND TECHNICAL SUPPORT SERVICES 561499 3,252,123   3,252,123  
c
d
e
f All other program service revenue. 0 0 0 0
g Total. Add lines 2a–2f .....MediumBullet 963,115,810
OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ......MediumBullet 29,477,987   422,402 29,055,585
4 Income from investment of tax-exempt bond proceedsMediumBullet        
5 Royalties...........MediumBullet        
(ii) Personal (i) Real
6a Gross rents   1,791,723 6a
b Less: rental expenses   1,600,068 6b
c Rental income or (loss) 0 191,655 6c
d Net rental income or (loss).......MediumBullet 191,655     191,655
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory 406,039   7a
b Less: cost or other basis and sales expenses 211,660   7b
c Gain or (loss) 194,379 0 7c
d Net gain or (loss).........MediumBullet 194,379     194,379
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
8a  
b Less: direct expenses ... 8b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
9a  
b Less: direct expenses ... 9b  
c Net income or (loss) from gaming activities..MediumBullet        
10a Gross sales of inventory, less
returns and allowances ..
10a  
b Less: cost of goods sold .. 10b  
c Net income or (loss) from sales of inventory..MediumBullet        
Business Code Miscellaneous Revenue
11a HEALTH SHOP SALES 446199 322,785   322,785  
b            
c            
d All other revenue .... 0 0 0 0
e Total. Add lines 11a–11d ...... MediumBullet 322,785
12 Total revenue. See instructions.....MediumBullet 993,740,336 959,863,687 3,997,310 29,441,619
Form 990 (2021)
Form 990 (2021)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising
expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 .... 9,341,781 9,341,781
2 Grants and other assistance to domestic individuals. See Part IV, line 22 ...........    
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............    
4 Benefits paid to or for members .......    
5 Compensation of current officers, directors, trustees, and key employees ........... 8,883,451   8,883,451  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ......... 3,106,145 3,106,145    
7 Other salaries and wages........ 665,768,132 634,234,321 31,533,811  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 46,459,624 41,771,165 4,688,459  
9 Other employee benefits ....... 86,818,299 83,329,291 3,489,008  
10 Payroll taxes ........... 40,812,083 38,557,384 2,254,699  
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 2,214,117 256,212 1,957,905  
c Accounting ........... 372,113   372,113  
d Lobbying ........... 235,832 235,832 0  
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ...... 1,969,040 -22,220 1,991,260  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 30,515,908 24,374,831 6,141,077 0
12 Advertising and promotion .... 1,756,925 115,426 1,641,499  
13 Office expenses ....... 9,816,491 8,674,549 1,141,942  
14 Information technology ...... 37,110,108 35,389,133 1,720,975  
15 Royalties ..        
16 Occupancy ........... 10,692,328 8,817,137 1,875,191  
17 Travel ............ 648,221 491,249 156,972  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings .... 786,049 624,739 161,310  
20 Interest ........... 11,353,077 11,353,077 0  
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .. 19,010,579 18,660,231 350,348  
23 Insurance ... 1,060,282 1,053,877 6,405  
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 SUPPLIES/BAD DEBT 1,832,312 1,832,312    
b DUES/MEMBERSHIPS/LICENSES 2,142,885 1,484,332 658,553  
c RECRUITING/EMPLOYEE DEVELOPMENT/TAXES 3,967,473 3,260,023 707,450  
d CREDIT CARD EXPENSE 1,428,211 1,420,201 8,010  
e All other expenses 3,189,454 1,985,061 1,204,393 0
25 Total functional expenses. Add lines 1 through 24e 1,001,290,920 930,346,089 70,944,831 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 MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2021)
Form 990 (2021)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 17,055,873 1 18,339,297
2 Savings and temporary cash investments ......... 188,308,097 2 35,438,480
3 Pledges and grants receivable, net ......   3  
4 Accounts receivable, net .............   4  
5 Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
97,544 5 67,828
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
0 6 0
7 Notes and loans receivable, net ........... 23,757,402 7 28,471,988
8 Inventories for sale or use ............ 12,891,593 8 12,499,384
9 Prepaid expenses and deferred charges ...... 20,595,906 9 27,885,004
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 310,169,570
b Less: accumulated depreciation 10b 173,638,444 112,626,178 10c 136,531,126
11 Investments—publicly traded securities . 841,081,347 11 734,403,415
12 Investments—other securities. See Part IV, line 11 ..... 0 12  
13 Investments—program-related. See Part IV, line 11 .. 0 13  
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 19,207,432 15 13,937,074
16 Total assets. Add lines 1 through 15 (must equal line 33)... 1,235,621,372 16 1,007,573,596
Liabilities 17 Accounts payable and accrued expenses ..... 153,279,914 17 132,951,216
18 Grants payable ...   18  
19 Deferred revenue .........   19  
20 Tax-exempt bond liabilities ......... 352,255,000 20 343,535,000
21 Escrow or custodial account liability. Complete Part IV of Schedule D   21  
22 Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
0 22 0
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ..   24  
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 687,256,731 25 618,832,412
26 Total liabilities. Add lines 17 through 25.. 1,192,791,645 26 1,095,318,628
Net Assets or Fund Balance Organizations that follow FASB ASC 958, check here MediumBullet and complete lines 27, 28, 32, and 33.
27 Net assets without donor restrictions .......... 42,829,727 27 -87,745,032
28 Net assets with donor restrictions ...........   28  
Organizations that do not follow FASB ASC 958, check here MediumBullet and complete lines 29 through 33.
29 Capital stock or trust principal, or current funds .....   29  
30 Paid-in or capital surplus, or land, building or equipment fund ...   30  
31 Retained earnings, endowment, accumulated income, or other funds   31  
32 Total net assets or fund balances ........... 42,829,727 32 -87,745,032
33 Total liabilities and net assets/fund balances ........ 1,235,621,372 33 1,007,573,596
Form 990 (2021)
Form 990 (2021)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
993,740,336
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
1,001,290,920
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-7,550,584
4
Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..
4
42,829,727
5
Net unrealized gains (losses) on investments ...............
5
-120,718,868
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
0
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-2,305,307
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))
10
-87,745,032
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII.............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain on
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
Yes
 
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
Yes
 
Form 990 (2021)
Form 990 (2021)
Additional Data


Software ID: 22016089
Software Version: 2022v5.0
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990)

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.
right arrow Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2022
Open to Public
Inspection
Name of the organization
Gundersen Lutheran Administrative Services Inc
 
Employer identification number

39-1606449
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 12, check only one box.)
1
2
3
4
5
6
7
8
9
10
11
12
a
b
c
d
e
f
Enter the number of supported organizations ...............................19
g
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 10 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
(A) COMMUNITY HOUSING OF LA CROSSE INC
  		391586700 9   No 0 0
(B) GUNDERSEN CLINIC LTD
  		391028657 3 Yes   0 0
(C) GUNDERSEN LUTHERAN MEDICAL CENTER INC
  		390813416 3 Yes   0 0
(D) GUNDERSEN LUTHERAN MEDICAL FOUNDATION INC
  		391249705 7   No 0 0
(E) HARMONY COMMUNITY HEALTH CARE INC
  		410711606 7   No 0 0
(F) LUTHERAN HOUSING OF LA CROSSE INC
  		391751934 9   No 0 0
(G) MEMORIAL HOSPITAL OF BOSCOBEL
  		390845590 3   No 0 0
(H) PALMER LUTHERAN HEALTH CENTER INC
  		421320763 3   No 0 0
(I) ST JOSEPH HEALTH SERVICES INC
  		390929538 3   No 0 0
(J) TRI-COUNTY MEMORIAL HOSPITAL INC
  		390704510 3   No 0 0
(K) TRI-STATE AMBULANCE INC
  		391965415 3   No 0 0
(L) TRI-STATE REGIONAL AMBULANCE INC
  		391962965 9   No 0 0
(M) TWEETEN LUTHERAN HEALTHCARE CENTER INC
  		411565003 9   No 0 0
(N) MOUNDVIEW MEMORIAL HOSPITALS & CLINICS
  		390944012 3   No 0 0
(O) MEMORIAL HC FDTN OF ADAMS COUNTY INC
  		391775074 9   No 0 0
(P) SAINT ELIZABETH'S HOSPITAL OF WABASHA INC
  		410693877 3   No 0 0
(Q) BOSCOBEL AREA HEALTHCARE PARTNERS
  		450498844 7   No 0 0
(R) MEMORIAL HOSPITAL OF BOSCOBEL FOUNDATION INC
  		391688793 7   No 0 0
(S) PALMER MEMORIAL FOUNDATION
  		421032878 7   No 0 0
Total
19
 0 0
For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990) 2022

Schedule A (Form 990) 2022
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 failed to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2018 (b) 2019 (c) 2020 (d) 2021 (e) 2022 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..            
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) right arrow (a) 2018 (b) 2019 (c) 2020 (d) 2021 (e) 2022 (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  
12
12
 
13
First 5 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
14
14
 
15
15
 
16a
33 1/3% support test—2022. 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
b
33 1/3% support test—2021. 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—2022. 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
b
10%-facts-and-circumstances test—2021. 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
18
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) 2022

Schedule A (Form 990) 2022
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) right arrow (a) 2018 (b) 2019 (c) 2020 (d) 2021 (e) 2022 (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) right arrow (a) 2018 (b) 2019 (c) 2020 (d) 2021 (e) 2022 (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 on 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.)..            
14
First 5 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
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
33 1/3% support tests-2022. 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
b
33 1/3% support tests—2021. 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
20
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) 2022

Schedule A (Form 990) 2022
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
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.
1
 
No
2
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).
2
 
No
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.
3a
 
No
b
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.
3b
 
 
c
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.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.
4a
 
No
b
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.
4b
 
 
c
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.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c 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).
5a
 
No
b
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?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
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.
6
Yes
 
7
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) .
7
 
No
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).
8
 
No
9a
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.
9a
 
No
b
Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
No
c
Did a disqualified person (as defined on 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.
9c
 
No
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
 
No
b
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) 2022

Schedule A (Form 990) 2022
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?
11a
 
No
b
A family member of a person described on 11a above?
11b
 
No
c
A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.
11c
 
No
Section B. Type I Supporting Organizations
Yes
No
1
Did the officers, 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.
1
 
 
2
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.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
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).
1
Yes
 
Section D. All Type III Supporting Organizations
Yes
No
1
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?
1
 
 
2
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).
2
 
 
3
By reason of the relationship described in line 2 above, 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.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer lines 2a and 2b below.
Yes
No
a
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.
2a
 
 
b
Did the activities described on line 2a, above 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.
2b
 
 
3
Parent of Supported Organizations. Answer lines 3a and 3b below.
a
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?If "Yes" or "No", provide details in Part VI.
3a
 
 
b
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.
3b
 
 
Schedule A (Form 990) 2022

Schedule A (Form 990) 2022
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
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 0.015 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 0.035 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  
7
Schedule A (Form 990) 2022

Schedule A (Form 990) 2022
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 1  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity 		2  
3 Administrative expenses paid to accomplish exempt purposes of supported organizations 3  
4 Amounts paid to acquire exempt-use assets 4  
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) 5  
6 Other distributions (describe in Part VI). See instructions 6  
7Total annual distributions. Add lines 1 through 6. 7  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI). See instructions 		8  
9 Distributable amount for 2022 from Section C, line 6 9  
10 Line 8 amount divided by Line 9 amount 10  
Section E - Distribution Allocations (see instructions) (i)
Excess Distributions 		(ii)
Underdistributions
Pre-2022 		(iii)
Distributable
Amount for 2022
1 Distributable amount for 2022 from Section C, line 6  
2 Underdistributions, if any, for years prior to 2022 (reasonable cause required-- explain in Part VI).
See instructions.		  
3 Excess distributions carryover, if any, to 2022:
a From 2017.......  
b From 2018.......  
c From 2019.......  
d From 2020.......  
e From 2021.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2022 distributable amount  
i Carryover from 2017 not applied (see
instructions) 		 
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.  
4Distributions for 2022 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2022 distributable amount  
c Remainder. Subtract lines 4a and 4b from line 4.  
5 Remaining underdistributions for years prior to
2022, if any. Subtract lines 3g and 4a from line 2.
If the amount is greater than zero, explain in Part VI.
See instructions. 		 
6 Remaining underdistributions for 2022. Subtract
lines 3h and 4b from line 1. If the amount is greater
than zero, explain in Part VI. See instructions. 		 
7 Excess distributions carryover to 2023. Add lines
3j and 4c. 		 
8 Breakdown of line 7:
a Excess from 2018.....  
b Excess from 2019.....  
c Excess from 2020.....  
d Excess from 2021.....  
e Excess from 2022.....  
Schedule A (Form 990) (2022)

Schedule A (Form 990) 2022
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, Part I, Line 12g INFORMATION ON SUPPORTED ORGANIZATIONS GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES IS AN INTEGRAL PART OF THE GUNDERSEN LUTHERAN HEALTH SYSTEM AND PROVIDES SUPPORT TO EACH OF THE ORGANIZATIONS LISTED; HOWEVER, SUCH SERVICES CANNOT EASILY BE QUANTIFIED IN DOLLAR-BASED TERMS.
Schedule A, Part IV, Section A, Line 1 Supported Orgs Listed By Name THE ARTICLES OF INCORPORATION OF GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. (GLAS) PROVIDE THAT IT SHALL SUPPORT, OPERATE FOR THE BENEFIT OF, PERFORM THE FUNCTIONS OF, AND CARRY OUT SOME OR ALL OF THE CHARITABLE PURPOSES OF GUNDERSEN LUTHERAN, INC., GUNDERSEN CLINIC, LTD., GUNDERSEN LUTHERAN MEDICAL CENTER, INC. AND THEIR NONPROFIT AFFILIATES (HEREAFTER REFERRED TO AS THE GUNDERSEN LUTHERAN HEALTH SYSTEM) SO LONG AS THOSE ORGANIZATIONS ARE DESCRIBED IN SECTION 509(A)(1) OR 509(A)(2) OF THE INTERNAL REVENUE CODE, AND OTHER SECTION 501(C)(3) ORGANIZATIONS DESCRIBED IN SECTION 509(A)(1) OR 509(A)(2) OF THE INTERNAL REVENUE CODE WHICH ARE AFFILIATED WITH ANY OF THE AFORESAID ORGANIZATIONS. GLAS SUPPORTS THE THREE NAMED ENTITIES, TWO OF WHICH HAVE BEEN RECOGNIZED AS EXEMPT FROM TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND HAVE BEEN CLASSIFIED AS PUBLIC CHARITIES UNDER IRC SECTION 509(A)(1) OR (2) AND THE OTHER, GUNDERSEN LUTHERAN, INC., IS OPERATED, SUPERVISED, OR CONTROLLED BY OR CONNNECTION WITH THE NAMED SUPPORTED ORGANIZATIONS. FURTHER, PURSUANT TO THEIR BY-LAWS, THE GOVERNING BODY OF GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. (FORMALLY GUNDERSEN LUTHERAN, INC.) SERVES AS THE GOVERNING BODY OF GLAS, AS WELL AS GUNDERSEN CLINIC, LTD, AND GUNDERSEN LUTHERAN MEDICAL CENTER, INC. THUS, GLAS MEETS THE RELATIONSHIP TEST AS A TYPE II ORGANIZATION BECAUSE THERE IS COMMON SUPERVISION AND CONTROL BETWEEN GLAS AND ITS TWO NAMED SUPPORTED ORGANIZATIONS (TREAS. REGS. SECTION 1.509(A)-4(H)). GLAS ALSO SUPPORTS ORGANIZATIONS DESCRIBED IN IRC SECTION 509(A)(1) AND (2) WHICH ARE AFFILIATED WITH THE SUPPORTED ORGANIZATIONS OR ARE 501(C)(3) PUBLIC CHARITIES AFFILIATED WITH THESE AFFILIATED ENTITIES. THEY ARE DESCRIBED BY CLASS. TO QUALIFY AS A SECTION 509(A)(3) SUPPORTING ORGANIZATION, AN ORGANIZATION MUST SUPPORT ONE OR MORE SPECIFIED ORGANIZATIONS. FOR TYPE II SUPPORTING ORGANIZATIONS, SPECIFIED ORGANIZATIONS CAN BE EITHER SPECIFIED BY NAME IN THE SUPPORTING ORGANIZATION'S ARTICLES OF INCORPORATION, OR THE ARTICLES MUST DESIGNATE THE SUPPORTED ORGANIZATION(S) BY CLASS OR PURPOSE AND WHICH INCLUDE PUBLICLY SUPPORTED ORGANIZATIONS WHICH ARE CLOSELY RELATED IN PURPOSE OR FUNCTION TO THE PUBLICLY SUPPORTED ORGANIZATIONS SPECIFIED IN THE ARTICLES. (TREAS. REGS. SECTION 1.509(A)-4(D)(2)(B)(2). HEREFORE, THE LACK OF INCLUDING THE NAME OF THE AFFILIATED ORGANIZATIONS THAT GLAS WILL SUPPORT IN ITS ARTICLES OF INCORPORATION DOES NOT OTHERWISE DEFEAT GLAS'S STATUS AS A TYPE II SUPPORTING ORGANIZATION, BECAUSE ITS ARTICLES DESCRIBE THESE SUPPORTED ORGANIZATIONS BY CLASS (AFFILIATED WITH THE SPECIFIED SUPPORTED ORGANIZATION) AND REQUIRE THAT THEY BE EXEMPT FROM TAX UNDER IRC SECTION 501 (C) (3) AND DESCRIPBED IN IRC SECTION 509 (A) (1) OR (2).
Schedule A, Part IV, Section A, Line 6 Support to other supported orgs GENERAL SERVICES PROVIDED TO GUNDERSEN LUTHERAN MEDICAL FOUNDATION, INC. AND OTHER AFFILIATES: ADMINISTRATIVE, INFORMATION SYSTEMS, BILLING AND CODING, LAUNDRY, MEDICAL RECORDS, HUMAN RESOURCES, FINANCE, FACILITY OPERATIONS, CENTRAL SERVICES AND OTHER MISCELLANEOUS SERVICES. GLAS ALSO GIVES GRANTS TO QUALIFIED 501(C)(3) PUBLIC CHARITIES AND GOVERNMENTAL ENTITIES THAT SUPPORT THE MISSION OF GLAS AND THE ORGANIZATIONS THEY SUPPORT.
Schedule A (Form 990) 2022


Additional Data


Software ID: 22016089
Software Version: 2022v5.0
Schedule B
(Form 990)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors

Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2022
Name of the organization
Gundersen Lutheran Administrative Services Inc
 
Employer identification number

39-1606449
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ






Form 990-PF




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
Special Rules
......... Arrow Bullet $  
Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2022)
Schedule B (Form 990) (2022) Page 2
Name of organization
Gundersen Lutheran Administrative Services Inc
  		Employer identification number
39-1606449
Part I
Contributors
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


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990) (2022)
Schedule B (Form 990) (2022)
Page 3
Name of organization
Gundersen Lutheran Administrative Services Inc
  		Employer identification number

39-1606449
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) (2022)
Schedule B (Form 990) (2022)
Page 4
Name of organization
Gundersen Lutheran Administrative Services Inc
  		Employer identification number

39-1606449
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 $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No. from Part I		 (b) Purpose of gift (c) Use 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 (c) Use 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 (c) Use 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 (c) Use 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) (2022)
Additional Data


Software ID: 22016089
Software Version: 2022v5.0
SCHEDULE C
(Form 990)

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 BulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
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 Administrative Services Inc
 
Employer identification number

39-1606449
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

2
Political campaign activity expenditures. See instructions ....................................................................SchCMd Bullet
$  
3
Volunteer hours for political campaign activities. See instructions ..................................................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 ................................SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 .......................SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................
4a
Was a correction made? ......................................................................................................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b...........SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ...................................................................
5
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.
Cat. No. 50084S
Schedule C (Form 990) 2021

Schedule C (Form 990) 2021
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 Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
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 0
b Total lobbying expenditures to influence a legislative body (direct lobbying) ........................ 235,832 242,027
c Total lobbying expenditures (add lines 1a and 1b) ............................................................ 235,832 242,027
d Other exempt purpose expenditures ............................................................................... 1,001,055,088 2,564,277,341
e Total exempt purpose expenditures (add lines 1c and 1d) .................................................. 1,001,290,920 2,564,519,368
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-. ................................................ 0 0
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................ 0 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? ...................................................................................................................

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) 2018 (b) 2019 (c) 2020 (d) 2021 (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 219,416 243,000 358,231 235,832 1,056,479
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
Schedule C (Form 990) 2021


Schedule C (Form 990) 2021
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|No
(b)
Amount
1
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:
a
Volunteers? ...........................................................................................................
 
 
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
 
 
c
Media advertisements? ...................................................................................................
 
 
 
d
Mailings to members, legislators, or the public? .............................................................................
 
 
 
e
Publications, or published or broadcast statements? ...........................................................
 
 
 
f
Grants to other organizations for lobbying purposes? ..........................................................
 
 
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
 
 
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
 
 
i
Other activities? ...................................................................................................................
 
 
 
j
Total. Add lines 1c through 1i ....................................................................................................
 
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
 
b
If "Yes," enter the amount of any tax incurred under section 4912 ...........................................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................
 
d
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
No
1
Were substantially all (90% or more) dues received nondeductible by members? ...............................................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................
3
 
 
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."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year .............................................................................................................................
2a
 
b
Carryover from last year ............................................................................................................
2b
 
c
Total ...........................................................................................................................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
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? ......................................................................................................................
4
 
5
Taxable amount of lobbying and political expenditures. See Instructions .........................................
5
 
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, Part II-A AFFILIATED ORGANIZATIONS ORGANIZATION NAME: GUNDERSEN LUTHERAN ADMINISTRATIVE SVCS ADDRESS: 1910 S. AVE LA CROSSE, WI 54601 EIN: 39-1606449 GRASSROOTS LOBBYING AMOUNT: DIRECT LOBBYING AMOUNT: 235,832. TOTAL LOBBYING EXPENDITURES: 235,832. OTHER EXEMPT PURPOSE EXPENDITURES: 1,001,055,088. TOTAL EXEMPT PURPOSE EXPENDITURES: 1,001,290,920. LOBBYING NONTAXABLE AMOUNT: 1,000,000. GRASSROOTS NONTAXABLE AMOUNT: 250,000. TOTAL GRASSROOTS LESS NONTAXABLE AMOUNT: TOTAL EXPENDITURES LESS NONTAXABLE AMOUNT: SHARE OF EXCESS LOBBYING EXPENDITURES:
Schedule C, Part II-A AFFILIATED ORGANIZATIONS (CONT'D) ORGANIZATION NAME: GUNDERSEN CLINIC, LTD. ADDRESS: 1836 SOUTH AVENUE LA CROSSE, WI 54601 EIN: 39-1028657 GRASSROOTS LOBBYING AMOUNT: DIRECT LOBBYING AMOUNT: 6,195. TOTAL LOBBYING EXPENDITURES: 6,195. OTHER EXEMPT PURPOSE EXPENDITURES: 271,691,930. TOTAL EXEMPT PURPOSE EXPENDITURES: 271,698,125. LOBBYING NONTAXABLE AMOUNT: 1,000,000. GRASSROOTS NONTAXABLE AMOUNT: 250,000. TOTAL GRASSROOTS LESS NONTAXABLE AMOUNT: TOTAL EXPENDITURES LESS NONTAXABLE AMOUNT: SHARE OF EXCESS LOBBYING EXPENDITURES:
Schedule C, Part II-A AFFILIATED ORGANIZATIONS (CONT'D) ORGANIZATION NAME: GUNDERSEN LUTHERAN MEDICAL CENTER, INC. ADDRESS: 1910 SOUTH AVENUE LA CROSSE, WI 54601 EIN: 39-0813416 GRASSROOTS LOBBYING AMOUNT: DIRECT LOBBYING AMOUNT: NONE. TOTAL LOBBYING EXPENDITURES: NONE. OTHER EXEMPT PURPOSE EXPENDITURES: 1,291,530,323. TOTAL EXEMPT PURPOSE EXPENDITURES: 1,291,530,323. LOBBYING NONTAXABLE AMOUNT: 1,000,000. GRASSROOTS NONTAXABLE AMOUNT: 250,000. TOTAL GRASSROOTS LESS NONTAXABLE AMOUNT: TOTAL EXPENDITURES LESS NONTAXABLE AMOUNT: SHARE OF EXCESS LOBBYING EXPENDITURES:
Schedule C, Part II-A AFFILIATED ORGANIZATIONS (CONT'D) ORGANIZATION NAME: GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. ADDRESS: 1836 SOUTH AVENUE LA CROSSE, WI 54601 EIN: 39-1866425 GRASSROOTS LOBBYING AMOUNT: DIRECT LOBBYING AMOUNT: NONE. TOTAL LOBBYING EXPENDITURES: NONE. OTHER EXEMPT PURPOSE EXPENDITURES: NONE. TOTAL EXEMPT PURPOSE EXPENDITURES: NONE. LOBBYING NONTAXABLE AMOUNT: 1,000,000. GRASSROOTS NONTAXABLE AMOUNT: 250,000. TOTAL GRASSROOTS LESS NONTAXABLE AMOUNT: TOTAL EXPENDITURES LESS NONTAXABLE AMOUNT: SHARE OF EXCESS LOBBYING EXPENDITURES:
Schedule C (Form 990) 2021


Additional Data


Software ID: 22016089
Software Version: 2022v5.0

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet 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.
SchDMd Bullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
Gundersen Lutheran Administrative Services Inc
 
Employer identification number

39-1606449
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 ........    
5
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? ............
6
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? ...................................
Part II
Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
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.
Held at the End of the 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 7/25/06, and not on a historic structure listed in the National Register ... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet $  
8
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)? .............................
9
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.
1a
If the organization elected, as permitted under FASB 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.
b
If the organization elected, as permitted under FASB 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 $  
2
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 FASB ASC 958 relating to these items:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
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) 2021

Schedule D (Form 990) 2021
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
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):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
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?...
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.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
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  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...
b
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 ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Term endowment SchDMd Bullet  
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) Unrelated organizations .................
3a(i)
 
 
(ii) Related organizations .................
3a(ii)
 
 
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
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 .....   11,070,469 11,070,469
b Buildings ....   107,885,402 36,125,910 71,759,492
c Leasehold improvements   6,272,174 3,967,996 2,304,178
d Equipment ....   184,941,525 133,544,538 51,396,987
e Other .....        
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 136,531,126
Schedule D (Form 990) 2021

Schedule D (Form 990) 2021
Page 3
Part VII
Investments - Other 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.)Small Bullet  
Part VIII
Investments - Program 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.)Small Bullet  
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)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
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  
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 618,832,412
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) 2021

Schedule D (Form 990) 2021
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
Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote INCOME TAX MATTERS (IN THOUSANDS) THE SYSTEM QUALIFIES AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE), WITH THE EXCEPTION OF GUNDERSEN LUTHERAN ENVISION, LLC, WHICH IS A FOR-PROFIT ENTITY. AT NOVEMBER 30, 2022 AND DECEMBER 31, 2021, NET DEFERRED TAX ASSETS OF $7,351 AND $7,545, RESPECTIVELY, WHICH PRIMARILY ARE RELATED TO NET OPERATING LOSS CARRYFORWARDS, HAVE VALUATION ALLOWANCES OF $7,351 AND $7,545, RESPECTIVELY, RECORDED AGAINST THEM DUE TO THE UNCERTAINTY OF REALIZING THOSE BENEFITS IN THE FUTURE. AT NOVEMBER 30, 2022, THE SYSTEM'S FEDERAL NET OPERATING LOSS CARRYFORWARDS WERE APPROXIMATELY $27,800, AND THE STATE NET OPERATING LOSS CARRYFORWARDS WERE APPROXIMATELY $25,700, WHICH WILL EXPIRE BETWEEN 2031 AND 2040. THE SYSTEM HAS REVIEWED ITS TAX POSITIONS FOR ALL OPEN YEARS AND HAS CONCLUDED THAT NO LIABILITIES EXIST FOR UNCERTAIN TAX POSITIONS. THE SYSTEM'S INCOME TAX RETURNS ARE NO LONGER SUBJECT TO EXAMINATION FOR 2018 AND PRIOR YEARS.
Schedule D (Form 990) 2021


Additional Data


Software ID: 22016089
Software Version: 2022v5.0





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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 Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2022
Open to Public
Inspection
Name of the organization
Gundersen Lutheran Administrative Services Inc
 
Employer identification number
39-1606449
Part I
General Information on Grants and Assistance
1
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? ........................
2
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
noncash assistance		 (h) Purpose of grant
or assistance
(1) GREAT RIVERS UNITED WAY
1855 East Main St
Onalaska,WI54650 		39-0848188 501 (C)(3) 165,000       OPERATIONS SUPPORT
(2) SAINT CLARE HEALTH MISSION
916 Ferry Street
La Crosse,WI54601 		82-3903651 501 (C)(3) 100,000       OPERATIONS SUPPORT
(3) LA CROSSE MEDICAL HEALTH SCIENCE CONSORTIUM
1725 State Street
La Crosse,WI54601 		39-1804725 501 (C)(3) 83,484       OPERATIONS SUPPORT
(4) LA CROSSE AREA FAMILY YMCA
1140 Main Street
La Crosse,WI54601 		39-0806172 501 (C)(3) 50,000       OPERATIONS SUPPORT
(5) SUNFLOWER CHILD DEVELOPMENT CENTER
300 Iowa Highway 9
Decorah,IA52101 		42-1036817 501 (C)(3) 25,000       OPERATIONS SUPPORT
(6) ADULT & TEEN CHALLENGE OF WESTERN WISCONSIN INC
2507 Weston St
La Crosse,WI54601 		82-2144057 501 (C)(3) 25,000       OPERATIONS SUPPORT
(7) LA CROSSE COUNTY TREASURER
212 6th St N
La Crosse,WI54601 		39-6005709 GOV 25,000       OPERATIONS SUPPORT
(8) LA CROSSE ROTARY BRAIN GAME INC
PO Box 384
La Crosse,WI54602 		26-3035626 501 (C)(3) 24,300       OPERATIONS SUPPORT
(9) LA CROSSE AREA CHAMBER OF COMMERCE
601 7th St N
La Crosse,WI54601 		39-0414500 501 (C)(6) 21,250       OPERATIONS SUPPORT
(10) HILLSBORO EMERGENCY MEDICAL TECHNICIANS & ALLIES INC
PO Box 323
Hillsboro,WI54634 		88-2151437 501 (C)(3) 20,300       OPERATIONS SUPPORT
(11) ARCADIA AMBULANCE SERVICE
PO Box 156
Arcadia,WI54612 		46-1555439 501 (C)(3) 20,000       OPERATIONS SUPPORT
(12) LA CROSSE SYMPHONY ORCHESTRA
201 Main St Suite 230
La Crosse,WI54601 		39-1024330 501(c)(3) 14,000       OPERATIONS SUPPORT
(13) WAFER INC
403 Causeway Boulevard
La Crosse,WI54601 		39-1552632 501 (C)(3) 12,500       OPERATIONS SUPPORT
(14) LA CROSSE NEIGHBORHOODS INC
PO Box 1661
La Crosse,WI54601 		47-4445115 501 (C)(3) 11,000       OPERATIONS SUPPORT
(15) BOYS AND GIRLS CLUBS OF GREATER LA CROSSE
PO Box 91
La Crosse,WI54602 		39-6084791 501 (C)(3) 10,000       OPERATIONS SUPPORT
(16) ST JOSEPH'S FOUNDATION
400 Water Ave
Hillsboro,WI54634 		39-1455787 501 (C)(3) 10,000       OPERATIONS SUPPORT
(17) AMERICAN RED CROSS WI
4860 Sheboygan Ave
Madison,WI53705 		53-0196605 501 (C)(3) 10,000       OPERATIONS SUPPORT
(18) LA CROSSE CITY TREASURER
400 La Crosse St
La Crosse,WI54601 		39-6005490 GOV 10,000       OPERATIONS SUPPORT
(19) VIVENT HEALTH
648 N Plankinton Ave Suite 200
Milwaukee,WI53203 		39-1534049 501 (C)(3) 10,000       OPERATIONS SUPPORT
(20) SAFE FAMILIES FOR CHILDREN WI
PO Box 213
Elkhorn,WI53121 		47-2646525 501 (C)(3) 10,000       OPERATIONS SUPPORT
(21) VITERBO UNIVERSITY
900 Viterbo Drive
La Crosse,WI54601 		39-0978445 501 (C)(3) 9,000       OPERATIONS SUPPORT
(22) LA CROSSE MEDICAL HEALTH SCIENCE CONSORTIUM
1725 State Street
La Crosse,WI54601 		39-1805963 501 (C)(3) 8,160       OPERATIONS SUPPORT
(23) HABITAT FOR HUMANITY
3181 Berlin Dr
La Crosse,WI54601 		39-1706999 501 (C)(3) 7,500       OPERATIONS SUPPORT
(24) THE PARENTING PLACE
1500 Green Bay St
La Crosse,WI54601 		39-1676842 501 (C)(3) 7,500       OPERATIONS SUPPORT
(25) APTIVE FOUNDATION
3000 South Avenue
La Crosse,WI54601 		39-1366838 501 (C)(3) 7,500       OPERATIONS SUPPORT
(26) CITY OF CALEDONIA
231 East Main St PO Box 232
Caledonia,MN55921 		41-6005025 GOV 7,000       OPERATIONS SUPPORT
(27) YWCA LA CROSSE
3219 Commerce St
La Crosse,WI54603 		39-0810543 501 (C)(3) 7,000       OPERATIONS SUPPORT
(28) NORTHEAST IOWA FOOD BANK
1605 Lafayette St PO Box 2397
Waterloo,IA50704 		42-1169648 501 (C)(3) 6,000       OPERATIONS SUPPORT
(29) LA CROSSE AREA DEVELOPMENT CORPORATION
601 N 7th Street
La Crosse,WI54601 		39-1168327 501 (C)(6) 5,500       OPERATIONS SUPPORT
(30) 7 RIVERS ALLIANCE INC
601 Seventh St N Suite 400
La Crosse,WI54601 		01-0938132 501 (C)(3) 5,250       OPERATIONS SUPPORT
(31) GUNDERSEN LUTHERAN HEALTH SYSTEM INC
1836 SOUTH AVE
LA CROSSE,WI54601 		39-1866425 501 (C)(3) 8,411,785       OPERATIONS SUPPORT
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
31
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2022

Schedule I (Form 990) 2022
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
noncash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of noncash assistance
(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
Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS: THE FUNDS ARE MONITORED BY MANAGEMENT AND THE BOARD OF TRUSTEES
Schedule I (Form 990) 2022



Additional Data


Software ID: 22016089
Software Version: 2022v5.0


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 Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2022
Open to Public Inspection
Name of the organization
Gundersen Lutheran Administrative Services Inc
 
Employer identification number

39-1606449
Part I
Questions Regarding Compensation
Yes
No
1a
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.
b
If any of the boxes on 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 .....
1b
 
 
2
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 on Line 1a? ....
2
 
 
3
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.
4
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:
a
Receive a severance payment or change-of-control payment? .............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
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.
5
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:
a
The organization? ....................
5a
 
No
b
Any related organization? .......................
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
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:
a
The organization? ..................
6a
 
No
b
Any related organization? ......................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
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 ..........................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2022

Schedule J (Form 990) 2022
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, 1099-MISC compensation, and/or 1099-NEC (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
(i) Base
compensation 		(ii) Bonus & incentive
compensation 		(iii) Other reportable compensation
1ROBYN BORGE MD
 
BOARD OF TRUSTEES-CHIEF MEDICAL OFFICER 		(i)

(ii)		 301,500
-------------
0 		100
-------------
0 		4,423
-------------
0 		44,080
-------------
0 		2,550
-------------
0 		352,653
-------------
0 		0
-------------
0
2BRYAN ERDMANN
 
BOARD OF TRUSTEES - CHIEF OPERATING OFFICER 		(i)

(ii)		 312,047
-------------
0 		0
-------------
0 		4,259
-------------
0 		44,225
-------------
0 		28,238
-------------
0 		388,769
-------------
0 		0
-------------
0
3ANDREA HAUSER
 
BOARD OF TRUSTEES-CNO, ADMIN VP NURSING & SYSTEM PRACTICES 		(i)

(ii)		 240,231
-------------
0 		0
-------------
0 		3,882
-------------
0 		33,786
-------------
0 		17,246
-------------
0 		295,145
-------------
0 		0
-------------
0
4TODD KOWALSKI MD
 
BOARD OF TRUSTEES - MEDICAL CHIEF OPERATING OFFICER 		(i)

(ii)		 468,479
-------------
0 		4,500
-------------
0 		827
-------------
0 		44,225
-------------
0 		28,586
-------------
0 		546,617
-------------
0 		0
-------------
0
5SCOTT RATHGABER MD
 
BOARD OF TRUSTEES - CEO, CHAIRMAN 		(i)

(ii)		 1,015,579
-------------
0 		180
-------------
0 		5,157
-------------
0 		44,225
-------------
0 		22,994
-------------
0 		1,088,135
-------------
0 		0
-------------
0
6HEATHER SCHIMMERS
 
BOARD OF TRUSTEES - PRESIDENT 		(i)

(ii)		 509,659
-------------
0 		0
-------------
0 		5,280
-------------
0 		44,225
-------------
0 		13,910
-------------
0 		573,074
-------------
0 		0
-------------
0
7CHRIS EBERLEIN MD
 
BOARD OF TRUSTEES - MEMBER 		(i)

(ii)		 379,772
-------------
0 		3,000
-------------
0 		5,186
-------------
0 		44,225
-------------
0 		23,494
-------------
0 		455,677
-------------
0 		0
-------------
0
8BENJAMIN JARMAN MD
 
BOARD OF TRUSTEES - MEMBER 		(i)

(ii)		 495,141
-------------
0 		0
-------------
0 		6,814
-------------
0 		44,225
-------------
0 		13,910
-------------
0 		560,090
-------------
0 		0
-------------
0
9JENNIFER KLEVEN MD
 
BOARD OF TRUSTEES - MEMBER 		(i)

(ii)		 358,763
-------------
0 		3,000
-------------
0 		216
-------------
0 		43,395
-------------
0 		4,182
-------------
0 		409,556
-------------
0 		0
-------------
0
10GREGORY THOMPSON MD
 
FORMER CHIEF MED OFF THRU 21 		(i)

(ii)		 303,070
-------------
0 		0
-------------
0 		19,598
-------------
0 		40,620
-------------
0 		12,536
-------------
0 		375,824
-------------
0 		0
-------------
0
11RACHEL ALBRECHT
 
ADMIN VP, AMBULATORY SERVICES 		(i)

(ii)		 141,471
-------------
0 		100
-------------
0 		9,864
-------------
0 		22,658
-------------
0 		24,244
-------------
0 		198,337
-------------
0 		0
-------------
0
12KELLEY BAHR MD
 
MEDICAL VP, AMBULATORY SERVICES 		(i)

(ii)		 386,333
-------------
0 		2,110
-------------
0 		5,064
-------------
0 		44,225
-------------
0 		50
-------------
0 		437,782
-------------
0 		0
-------------
0
13MARILU BINTZ MD
 
MED VP, COMM AND CMO-CRITICAL ACCESS HOSP 		(i)

(ii)		 614,741
-------------
0 		210
-------------
0 		5,811
-------------
0 		44,225
-------------
0 		8,409
-------------
0 		673,396
-------------
0 		0
-------------
0
14PRAVEEN CHOPRA
 
CHIEF INFORMATION OFFICER 		(i)

(ii)		 462,246
-------------
0 		0
-------------
0 		47,037
-------------
0 		44,225
-------------
0 		28,936
-------------
0 		582,444
-------------
0 		0
-------------
0
15MICHAEL DOLAN MD
 
EXEC VP, MEDICAL COO 		(i)

(ii)		 631,023
-------------
0 		4,500
-------------
0 		758
-------------
0 		44,225
-------------
0 		27,686
-------------
0 		708,192
-------------
0 		0
-------------
0
16WILLIAM FARRELL
 
CHIEF BUSINESS AND STRATEGY OFFICER 		(i)

(ii)		 432,308
-------------
0 		0
-------------
0 		5,416
-------------
0 		44,225
-------------
0 		50
-------------
0 		481,999
-------------
0 		0
-------------
0
17DANIEL LILLY
 
SECRETARY 		(i)

(ii)		 485,361
-------------
0 		0
-------------
0 		6,000
-------------
0 		44,225
-------------
0 		23,994
-------------
0 		559,580
-------------
0 		0
-------------
0
18MARY ELLEN MCCARTNEY
 
CHIEF HUMAN RESOURCES OFFICER 		(i)

(ii)		 383,356
-------------
0 		0
-------------
0 		1,051
-------------
0 		44,225
-------------
0 		15,042
-------------
0 		443,674
-------------
0 		0
-------------
0
19MICHAEL MCKEE
 
ADMIN VP, ACUTE CARE AND NURSING AND SYSTEMS 		(i)

(ii)		 270,131
-------------
0 		0
-------------
0 		625
-------------
0 		40,054
-------------
0 		27,906
-------------
0 		338,716
-------------
0 		0
-------------
0
20STEPHANIE NEUMAN MD
 
MEDICAL VP, AMBULATORY SERVICES 		(i)

(ii)		 472,163
-------------
0 		0
-------------
0 		372
-------------
0 		44,225
-------------
0 		27,186
-------------
0 		543,946
-------------
0 		0
-------------
0
21GERALD OETZEL
 
CFO, TREASURER 		(i)

(ii)		 609,991
-------------
0 		0
-------------
0 		5,651
-------------
0 		44,225
-------------
0 		8,426
-------------
0 		668,293
-------------
0 		0
-------------
0
22KRAIG SCHUSTER
 
ADMIN VP, COMMUNITY 		(i)

(ii)		 281,574
-------------
0 		160
-------------
0 		2,435
-------------
0 		40,632
-------------
0 		13,340
-------------
0 		338,141
-------------
0 		0
-------------
0
23STEPHEN SHAPIRO MD
 
CHIEF MEDICAL FOUNDATION OFFICER 		(i)

(ii)		 493,829
-------------
0 		4,650
-------------
0 		464
-------------
0 		44,225
-------------
0 		27,044
-------------
0 		570,212
-------------
0 		0
-------------
0
24CHRISTINE WALLER MD
 
MED VP, ACUTE CARE AND NURSING & SYSTEMS PRACTICES 		(i)

(ii)		 511,659
-------------
0 		3,000
-------------
0 		5,422
-------------
0 		44,225
-------------
0 		33,002
-------------
0 		597,308
-------------
0 		0
-------------
0
25JONATHAN ZLABEK MD
 
MEDICAL VP, CROSS-FUNCTIONAL CARE 		(i)

(ii)		 451,746
-------------
0 		4,500
-------------
0 		5,064
-------------
0 		44,225
-------------
0 		24,244
-------------
0 		529,779
-------------
0 		0
-------------
0
26STEPHANIE CARROLL MD
 
FORMER MEDICAL VP THRU 20 		(i)

(ii)		 297,576
-------------
0 		0
-------------
0 		23
-------------
0 		37,717
-------------
0 		25,593
-------------
0 		360,909
-------------
0 		0
-------------
0
27KARI ADANK
 
VICE PRESIDENT COMPLIANCE 		(i)

(ii)		 236,696
-------------
0 		0
-------------
0 		123
-------------
0 		34,829
-------------
0 		24,809
-------------
0 		296,457
-------------
0 		0
-------------
0
28ERIC DEHN
 
VP ENTERPRISE ARCHITECTURE AND SOLUTION DESIGN 		(i)

(ii)		 239,619
-------------
0 		0
-------------
0 		20,461
-------------
0 		25,231
-------------
0 		12,148
-------------
0 		297,459
-------------
0 		0
-------------
0
29P MICHAEL JACOBS DPM
 
MEDICAL VICE PRESIDENT 		(i)

(ii)		 456,496
-------------
0 		0
-------------
0 		4,714
-------------
0 		44,225
-------------
0 		23,477
-------------
0 		528,912
-------------
0 		0
-------------
0
30MARY KUFFEL MD
 
MEDICAL VICE PRESIDENT 		(i)

(ii)		 529,412
-------------
0 		2,000
-------------
0 		6,775
-------------
0 		44,225
-------------
0 		1,442
-------------
0 		583,854
-------------
0 		0
-------------
0
31JANINE LUZ
 
VICE PRESIDENT LEARNING 		(i)

(ii)		 225,078
-------------
0 		110
-------------
0 		4,258
-------------
0 		33,108
-------------
0 		18,245
-------------
0 		280,799
-------------
0 		0
-------------
0
32PAMELA MAAS
 
VICE PRESIDENT BUSINESS SERVICES 		(i)

(ii)		 223,112
-------------
0 		110
-------------
0 		51,231
-------------
0 		32,351
-------------
0 		42
-------------
0 		306,846
-------------
0 		0
-------------
0
33KRISTER MATTSON
 
VICE PRESIDENT ENTERPRISE ANALYTICS 		(i)

(ii)		 277,987
-------------
0 		0
-------------
0 		20,066
-------------
0 		36,521
-------------
0 		15,177
-------------
0 		349,751
-------------
0 		0
-------------
0
34SHANNON MULLIGAN
 
VP HR & TOTAL REWARDS 		(i)

(ii)		 241,408
-------------
0 		20,000
-------------
0 		3,434
-------------
0 		31,502
-------------
0 		4,069
-------------
0 		300,413
-------------
0 		0
-------------
0
35ELLEN PEDRETTI-FENDT
 
VICE PRESIDENT APPLICATION SERVICES 		(i)

(ii)		 202,996
-------------
0 		160
-------------
0 		530
-------------
0 		30,015
-------------
0 		24,851
-------------
0 		258,552
-------------
0 		0
-------------
0
36JACK SCHWARTZ
 
VICE PRESIDENT FOUNDATION 		(i)

(ii)		 212,018
-------------
0 		0
-------------
0 		3,314
-------------
0 		29,814
-------------
0 		8,423
-------------
0 		253,569
-------------
0 		0
-------------
0
37JERRY DAVIS MD
 
MEDICAL DOCTOR 		(i)

(ii)		 1,099,163
-------------
0 		0
-------------
0 		4,692
-------------
0 		32,025
-------------
0 		21,494
-------------
0 		1,157,374
-------------
0 		0
-------------
0
38DOUGLAS HUGHES MD
 
MEDICAL DOCTOR 		(i)

(ii)		 1,075,829
-------------
0 		0
-------------
0 		4,692
-------------
0 		32,025
-------------
0 		21,494
-------------
0 		1,134,040
-------------
0 		0
-------------
0
39JEFFREY LAWRENCE MD
 
MEDICAL DOCTOR 		(i)

(ii)		 1,147,530
-------------
0 		0
-------------
0 		4,714
-------------
0 		44,225
-------------
0 		21,494
-------------
0 		1,217,963
-------------
0 		0
-------------
0
40MARK TOPOLSKI MD
 
MEDICAL DOCTOR 		(i)

(ii)		 1,106,659
-------------
0 		0
-------------
0 		4,738
-------------
0 		44,225
-------------
0 		13,910
-------------
0 		1,169,532
-------------
0 		0
-------------
0
41KURT ZIEGELBEIN MD
 
MEDICAL DOCTOR 		(i)

(ii)		 993,745
-------------
0 		0
-------------
0 		5,042
-------------
0 		44,225
-------------
0 		24,344
-------------
0 		1,067,356
-------------
0 		0
-------------
0
Schedule J (Form 990) 2022

Schedule J (Form 990) 2022
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
Schedule J (Form 990) 2022

Additional Data


Software ID: 22016089
Software Version: 2022v5.0

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax-Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet Attach to Form 990.
SchKMediumBulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
Gundersen Lutheran Administrative Services Inc
 
Employer identification number
39-1606449
Part Ⅰ
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer		 (i) Pool
financing
Yes No Yes No Yes No
A WHEFA SERIES 2021A ISSUANCE
  		39-1337855 97712JBU6 08-12-2021 117,839,194 SEE PART VI   X   X   X
B WHEFA SERIES 2016 ISSUANCE
  		39-1337855 000000000 02-12-2016 40,000,000 SEE PART VI   X   X   X
C WHEFA SERIES 2009 ISSUANCE
  		39-1337855 97710BE65 10-01-2012 78,715,000 SEE PART VI   X   X   X
D WHEFA SERIES 2008B ISSUANCE
  		39-1337855 97710BBG6 10-01-2012 61,400,000 SEE PART VI   X   X   X
WHEFA SEREIS 2012 ISSUANCE
  		39-1337855 97710B4B5 11-15-2022 68,505,000 SEE PART VI   X   X   X
WHEFA SERIES 2015 ISSUANCE
  		39-1337855 000000000 12-23-2015 12,000,000 SEE PART VI   X   X   X
WHEFA SERIES 2020A ISSUANCE
  		39-1337855 97712D654 03-24-2020 25,002,968 SEE PART VI   X   X   X
Part Ⅱ
Proceeds
A B C D
1 Amount of bonds retired .................. 0 8,160,000 21,070,000 9,900,000
2 Amount of bonds legally defeased .............. 0      
3 Total proceeds of issue .................. 117,893,194 40,000,000 78,715,000 61,400,000
4 Gross proceeds in reserve funds .............        
5 Capitalized interest from proceeds .............        
6 Proceeds in refunding escrows ...............        
7 Issuance costs from proceeds ............... 1,202,288      
8 Credit enhancement from proceeds .............        
9 Working capital expenditures from proceeds .............        
10 Capital expenditures from proceeds .............   12,044,550 25,003,152  
11 Other spent proceeds ............. 116,690,906 40,000,000 78,715,000 61,400,000
12 Other unspent proceeds .............        
13 Year of substantial completion ............. 2021 2016 2005 2008
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue of tax-exempt
bonds (or, if issued prior to 2020, a current refunding issue)? ........ 		X   X   X   X  
15 Were the bonds issued as part of an advance refunding issue of taxable
bonds (or, if issued prior to 2020, an advance refunding issue)? ........ 		  X   X   X   X
16 Has the final allocation of proceeds been made? .......... X   X   X   X  
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .................. X   X   X   X  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2021

Schedule K (Form 990) 2021
Page 2
Part Ⅲ
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............   X   X   X   X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ............... X     X X     X
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............   X   X   X   X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?                
c Are there any research agreements that may result in private business use of bond-financed property? .............   X   X   X   X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....SchKMediumBullet 0.14 %   0.07 %  
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government ......... SchKMediumBullet        
6 Total of lines 4 and 5 ............. 0.14 % 0 % 0.07 % 0 %
7 Does the bond issue meet the private security or payment test? ...   X   X   X   X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............   X   X X   X  
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..     0.51 % 0 %
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............         X   X  
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2? ........ 		X   X   X   X  
Part Ⅳ
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...   X   X   X   X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......   X   X   X   X
b Exception to rebate? ........ X   X   X   X  
c No rebate due? .........   X   X   X   X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate
computation was performed ......
3 Is the bond issue a variable rate issue? .....   X X   X   X  
Schedule K (Form 990) 2021

Schedule K (Form 990) 2021
Page 3
Part Ⅳ
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X X   X  
b Name of provider ..........  
  		 
  		PIPERMERRILL
  		MERRILL
 
c Term of hedge .........     2950 % 2700 %
d Was the hedge superintegrated? ......                
e Was the hedge terminated? ........                
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?   X   X   X   X
b Name of provider ..........  
  		 
  		 
  		 
 
c Term of GIC .........        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........                
6 Were any gross proceeds invested beyond an available temporary period?   X   X   X   X
7 Has the organization established written procedures to monitor the requirements of section 148? ... X   X   X   X  
Part Ⅴ
Procedures To Undertake Corrective Action
--------------------------------------------------------------------------------------------------------------- A B C D
Yes No Yes No Yes No Yes No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X   X   X   X  
Part Ⅵ
Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).
Return Reference Explanation
Schedule K, Part I, Column (a) DESCRIPTION OF PURPOSE BOND A: PROCEEDS OF THE SERIES 2021A BONDS WERE USED TO CURRENTLY REFUND THE 2011A SERIES ISSUED 9/29/2011 AND COSTS OF ISSUANCE. THE SERIES 2011A BOND PROCEEDS WERE USED TO CURRENTLY REFUND THE 2000 SERIES A AND B ISSUED 10/10/2000. 2008 SERIES A ISSUED 5/29/2008 AS NEW MONEY FOR CONSTRUCTION AND EQUIPPING OF HOSPITAL FACILITIES AND FOR COSTS OF ISSUANCE.
Schedule K, Part I, Column (b) DESCRIPTION OF PURPOSE BOND B: PROCEEDS OF THE SERIES 2016 BONDS WERE USED TO CURRENTLY REFUND, IN THEIR ENTIRETY, THE WISCONSIN HEALTH AND EDUCATIONAL FACILITY VARIABLE RATE REVENUE BONDS, SERIES 2011B (GUNDERSEN LUTHERAN).
Schedule K, Part I, Column (c) DESCRIPTION OF PURPOSE BOND C. CONVERSION AND REISSUANCE OF 2009 BONDS, ORIGINALLY ISSUED 5/22/2009 TO FINANCE CONSTRUCTION AND EQUIPPING OF HOSPITAL FACILITIES AND CURRENTLY REFUNDING THE SERIES 2003B/C BONDS.
Schedule K, Part I, Column (d) DESCRIPTION OF PURPOSE BOND D: CONVERSION AND REISSUANCE OF 2008 BONDS, ORIGINALLY ISSUED 5/29/2008 TO FINANCE THE REPAYMENT OF A LINE OF CREDIT USED TO REPAY THE SERIES 2006 BONDS, WHICH FINANCED THE CONSTRUCTION AND EQUIPPING OF HEALTH CARE FACILITIES AND COSTS OF ISSUANCE.
Schedule K, Part I, Column (e) DESCRIPTION OF PURPOSE BOND E: PROCEEDS OF THE SERIES 2022 BONDS WERE USED TO CURRENTLY REFUND THE 2012 SERIES ISSUED 9/27/2012 AND COSTS OF ISSUANCE. THE SERIES 2012 BONDS WERE USED TO CONSTRUCT AND EQUIP A CLINIC.
Schedule K, Part I, Column (f) DESCRIPTION OF PURPOSE BOND F: NEW MONEY FOR CONSTRUCTION AND EQUIPPING OF A CLINIC. INVESTMENT EARNINGS.
Schedule K, Part I, Column (g) DESCRIPTION OF PURPOSE BOND G: SERIES 2020A BONDS ARE FOR NEW MONEY FOR CONSTRUCTION AND EQUIPPING OF A CLINIC. INVESTMENT EARNINGS: THE DIFFERENCE BETWEEN THE ISUE PRICE AND THE TOTAL PROCEEDS OF THE ISSUE IS DUE TO 184.28 IN INVESTMENT EARNINGS.
Schedule K, Part II, Line 3 TOTAL PROCEEDS OF ISSUE BOND F: FOR SERIES 2015 BONDS, THE DIFFERENCE BETWEEN THE ISSUE PRICE AND THE TOTAL PROCEEDS OF THE ISSUE IS DUE TO $44,549.90 IN INVESTMENT EARNINGS (INTEREST).
Schedule K, Part II, Line 3 TOTAL PROCEEDS OF ISSUE BOND G: FOR SERIES 2020A BONDS, THE DIFFERENCE BETWEEN THE ISSUE PRICE ND TOTAL PROCEEDS OF THE ISSUE IS DUE TO $184.28 IN INVESTMENT EARNINGS (INTEREST).
Schedule K, Part III, Line 8a and 8c - SALE OF BOND-FINANCED PROPERTY GUNDERSEN HAD A SALE OF A BOND FINANCED LOADING DOC ASSET FROM THE 2008B ISSUANCE. BONDS ALLOCABLE TO THE SALE PROCEEDS OF THAT ASSET IN AN AMOUNT OF $800.00 WERE REDEEMED ON 7/15/15 IN ORDER TO REMEDIATE THAT SALE. IN 2019, GUNDERSEN SOLD A BOND-FINANED ASSET FROM THE 2003 ISSUANCE, LATER REFUNDED BY THE 2009 ISSUANCE, WHICH WAS SOLD AFTER ITS 15-YEAR USEFUL LIFE AND THEREFORE IS NOT REPORTED HERE.
Schedule K, Part III, Line 7 PRIVATE SECURITY OR PAYMENT TEST HISTORICALLY GUNDERSEN RESPONDED "YES" TO THIS QUESTION TO CONSERVATIVELY RESPOND AND TO REFLECT THAT IT DID MONITOR THE PRIVATE SECURITY TEST; GUNDERSEN IS NOW RESPONDING "NO" BECAUSE THERE IS NO PRIVATE USE WHICH GUNDERSEN CAREFULLY MONITORS AND MANAGES.
Schedule K (Form 990) 2021

Additional Data


Software ID: 22016089
Software Version: 2022v5.0


Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax-Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet Attach to Form 990.
SchKMediumBulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
Gundersen Lutheran Administrative Services Inc
 
Employer identification number
39-1606449
Part Ⅰ
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer		 (i) Pool
financing
Yes No Yes No Yes No
A WHEFA SERIES 2021A ISSUANCE
  		39-1337855 97712JBU6 08-12-2021 117,839,194 SEE PART VI   X   X   X
B WHEFA SERIES 2016 ISSUANCE
  		39-1337855 000000000 02-12-2016 40,000,000 SEE PART VI   X   X   X
C WHEFA SERIES 2009 ISSUANCE
  		39-1337855 97710BE65 10-01-2012 78,715,000 SEE PART VI   X   X   X
D WHEFA SERIES 2008B ISSUANCE
  		39-1337855 97710BBG6 10-01-2012 61,400,000 SEE PART VI   X   X   X
WHEFA SEREIS 2012 ISSUANCE
  		39-1337855 97710B4B5 11-15-2022 68,505,000 SEE PART VI   X   X   X
WHEFA SERIES 2015 ISSUANCE
  		39-1337855 000000000 12-23-2015 12,000,000 SEE PART VI   X   X   X
WHEFA SERIES 2020A ISSUANCE
  		39-1337855 97712D654 03-24-2020 25,002,968 SEE PART VI   X   X   X
Part Ⅱ
Proceeds
A B C D
1 Amount of bonds retired .................. 0 8,160,000 21,070,000 9,900,000
2 Amount of bonds legally defeased .............. 0      
3 Total proceeds of issue .................. 117,893,194 40,000,000 78,715,000 61,400,000
4 Gross proceeds in reserve funds .............        
5 Capitalized interest from proceeds .............        
6 Proceeds in refunding escrows ...............        
7 Issuance costs from proceeds ............... 1,202,288      
8 Credit enhancement from proceeds .............        
9 Working capital expenditures from proceeds .............        
10 Capital expenditures from proceeds .............   12,044,550 25,003,152  
11 Other spent proceeds ............. 116,690,906 40,000,000 78,715,000 61,400,000
12 Other unspent proceeds .............        
13 Year of substantial completion ............. 2021 2016 2005 2008
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue of tax-exempt
bonds (or, if issued prior to 2020, a current refunding issue)? ........ 		X   X   X   X  
15 Were the bonds issued as part of an advance refunding issue of taxable
bonds (or, if issued prior to 2020, an advance refunding issue)? ........ 		  X   X   X   X
16 Has the final allocation of proceeds been made? .......... X   X   X   X  
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .................. X   X   X   X  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2021

Schedule K (Form 990) 2021
Page 2
Part Ⅲ
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............   X   X   X   X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ............... X     X X     X
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............   X   X   X   X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?                
c Are there any research agreements that may result in private business use of bond-financed property? .............   X   X   X   X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....SchKMediumBullet 0.14 %   0.07 %  
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government ......... SchKMediumBullet        
6 Total of lines 4 and 5 ............. 0.14 % 0 % 0.07 % 0 %
7 Does the bond issue meet the private security or payment test? ...   X   X   X   X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............   X   X X   X  
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..     0.51 % 0 %
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............         X   X  
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2? ........ 		X   X   X   X  
Part Ⅳ
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...   X   X   X   X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......   X   X   X   X
b Exception to rebate? ........ X   X   X   X  
c No rebate due? .........   X   X   X   X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate
computation was performed ......
3 Is the bond issue a variable rate issue? .....   X X   X   X  
Schedule K (Form 990) 2021

Schedule K (Form 990) 2021
Page 3
Part Ⅳ
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X X   X  
b Name of provider ..........  
  		 
  		PIPERMERRILL
  		MERRILL
 
c Term of hedge .........     2950 % 2700 %
d Was the hedge superintegrated? ......                
e Was the hedge terminated? ........                
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?   X   X   X   X
b Name of provider ..........  
  		 
  		 
  		 
 
c Term of GIC .........        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........                
6 Were any gross proceeds invested beyond an available temporary period?   X   X   X   X
7 Has the organization established written procedures to monitor the requirements of section 148? ... X   X   X   X  
Part Ⅴ
Procedures To Undertake Corrective Action
--------------------------------------------------------------------------------------------------------------- A B C D
Yes No Yes No Yes No Yes No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X   X   X   X  
Part Ⅵ
Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).
Return Reference Explanation
Schedule K, Part I, Column (a) DESCRIPTION OF PURPOSE BOND A: PROCEEDS OF THE SERIES 2021A BONDS WERE USED TO CURRENTLY REFUND THE 2011A SERIES ISSUED 9/29/2011 AND COSTS OF ISSUANCE. THE SERIES 2011A BOND PROCEEDS WERE USED TO CURRENTLY REFUND THE 2000 SERIES A AND B ISSUED 10/10/2000. 2008 SERIES A ISSUED 5/29/2008 AS NEW MONEY FOR CONSTRUCTION AND EQUIPPING OF HOSPITAL FACILITIES AND FOR COSTS OF ISSUANCE.
Schedule K, Part I, Column (b) DESCRIPTION OF PURPOSE BOND B: PROCEEDS OF THE SERIES 2016 BONDS WERE USED TO CURRENTLY REFUND, IN THEIR ENTIRETY, THE WISCONSIN HEALTH AND EDUCATIONAL FACILITY VARIABLE RATE REVENUE BONDS, SERIES 2011B (GUNDERSEN LUTHERAN).
Schedule K, Part I, Column (c) DESCRIPTION OF PURPOSE BOND C. CONVERSION AND REISSUANCE OF 2009 BONDS, ORIGINALLY ISSUED 5/22/2009 TO FINANCE CONSTRUCTION AND EQUIPPING OF HOSPITAL FACILITIES AND CURRENTLY REFUNDING THE SERIES 2003B/C BONDS.
Schedule K, Part I, Column (d) DESCRIPTION OF PURPOSE BOND D: CONVERSION AND REISSUANCE OF 2008 BONDS, ORIGINALLY ISSUED 5/29/2008 TO FINANCE THE REPAYMENT OF A LINE OF CREDIT USED TO REPAY THE SERIES 2006 BONDS, WHICH FINANCED THE CONSTRUCTION AND EQUIPPING OF HEALTH CARE FACILITIES AND COSTS OF ISSUANCE.
Schedule K, Part I, Column (e) DESCRIPTION OF PURPOSE BOND E: PROCEEDS OF THE SERIES 2022 BONDS WERE USED TO CURRENTLY REFUND THE 2012 SERIES ISSUED 9/27/2012 AND COSTS OF ISSUANCE. THE SERIES 2012 BONDS WERE USED TO CONSTRUCT AND EQUIP A CLINIC.
Schedule K, Part I, Column (f) DESCRIPTION OF PURPOSE BOND F: NEW MONEY FOR CONSTRUCTION AND EQUIPPING OF A CLINIC. INVESTMENT EARNINGS.
Schedule K, Part I, Column (g) DESCRIPTION OF PURPOSE BOND G: SERIES 2020A BONDS ARE FOR NEW MONEY FOR CONSTRUCTION AND EQUIPPING OF A CLINIC. INVESTMENT EARNINGS: THE DIFFERENCE BETWEEN THE ISUE PRICE AND THE TOTAL PROCEEDS OF THE ISSUE IS DUE TO 184.28 IN INVESTMENT EARNINGS.
Schedule K, Part II, Line 3 TOTAL PROCEEDS OF ISSUE BOND F: FOR SERIES 2015 BONDS, THE DIFFERENCE BETWEEN THE ISSUE PRICE AND THE TOTAL PROCEEDS OF THE ISSUE IS DUE TO $44,549.90 IN INVESTMENT EARNINGS (INTEREST).
Schedule K, Part II, Line 3 TOTAL PROCEEDS OF ISSUE BOND G: FOR SERIES 2020A BONDS, THE DIFFERENCE BETWEEN THE ISSUE PRICE ND TOTAL PROCEEDS OF THE ISSUE IS DUE TO $184.28 IN INVESTMENT EARNINGS (INTEREST).
Schedule K, Part III, Line 8a and 8c - SALE OF BOND-FINANCED PROPERTY GUNDERSEN HAD A SALE OF A BOND FINANCED LOADING DOC ASSET FROM THE 2008B ISSUANCE. BONDS ALLOCABLE TO THE SALE PROCEEDS OF THAT ASSET IN AN AMOUNT OF $800.00 WERE REDEEMED ON 7/15/15 IN ORDER TO REMEDIATE THAT SALE. IN 2019, GUNDERSEN SOLD A BOND-FINANED ASSET FROM THE 2003 ISSUANCE, LATER REFUNDED BY THE 2009 ISSUANCE, WHICH WAS SOLD AFTER ITS 15-YEAR USEFUL LIFE AND THEREFORE IS NOT REPORTED HERE.
Schedule K, Part III, Line 7 PRIVATE SECURITY OR PAYMENT TEST HISTORICALLY GUNDERSEN RESPONDED "YES" TO THIS QUESTION TO CONSERVATIVELY RESPOND AND TO REFLECT THAT IT DID MONITOR THE PRIVATE SECURITY TEST; GUNDERSEN IS NOW RESPONDING "NO" BECAUSE THERE IS NO PRIVATE USE WHICH GUNDERSEN CAREFULLY MONITORS AND MANAGES.
Schedule K (Form 990) 2021

Additional Data


Software ID: 22016089
Software Version: 2022v5.0

Schedule L
(Form 990)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ.
MediumBulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
Gundersen Lutheran Administrative Services Inc
 
Employer identification number

39-1606449
Part I
Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No
2
Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e) Original principal amount (f) Balance due (g) In default? (h) Approved by board or committee? (i) Written agreement?
To From Yes No Yes No Yes No
(1) Daniel Breazeale
  		Employee - VP Finance Bonus/Relocation   X 30,000 6,762 Yes   Yes   Yes  
(2) Praveen Chopra
  		Employee - Chief Information Officer Bonus/Relocation   X 125,000 49,971   No Yes   Yes  
(3) Tina Lechnir
  		Employee - Vice President Bonus/Relocation   X 12,000 11,095   No Yes   Yes  
(4) Nathan Franklin
  		Director Bonus/Relocation   X 5,000 0   No Yes   Yes  
Total ...............Small Bullet $ 67,828
Part III
Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990) 2021
Schedule L (Form 990) 2021
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) Alexander Lilly
  		See Supplemental Info 4,515 Employment   No
(2) April Farrell MD
  		See Supplemental Info 788,000 Employment   No
(3) Brenda White
  		See Supplemental Info 27,093 Employment   No
(4) Caitlin Zlabek
  		See Supplemental Info 5,551 Employment   No
(5) Cassandra Zlabek
  		See Supplemental Info 56,005 Employment   No
(6) Deborah Schwartz
  		See Supplemental Info 93,273 Employment   No
(7) Emily Dolan MD
  		See Supplemental Info 295,928 Employment   No
(8) Evan Dolan
  		See Supplemental Info 55,713 Employment   No
(9) James Kleven MD
  		See Supplemental Info 501,263 Employment   No
(10) Kaleb Schuster
  		See Supplemental Info 19,493 Employment   No
(11) Karl Borge MD
  		See Supplemental Info 272,043 Employment   No
(12) Margaret Webster MD
  		See Supplemental Info 11,658 Employment   No
(13) Noel Radcliffe MD
  		See Supplemental Info 347,757 Employment   No
(14) Parker Schimmers
  		See Supplemental Info 5,910 Employment   No
(15) Ricardo Rivera (Ricky)
  		See Supplemental Info 126,043 Employment   No
(16) Shannan Stephens MD
  		See Supplemental Info 373,038 Employment   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
Schedule L (Form 990) 2021


Additional Data


Software ID: 22016089
Software Version: 2022v5.0




SCHEDULE O
(Form 990)

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 Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
Gundersen Lutheran Administrative Services Inc
 
Employer identification number

39-1606449
Return Reference Explanation
Form 990, Part III, Line 1 ORGANIZATION'S MISSION TO SUPPORT GUNDERSEN LUTHERAN HEALTH SYSTEM, INC.'S PROGRAMS OF HEALTH CARE, MEDICAL EDUCATION, MEDICAL RESEARCH AND COMMUNITY HEALTH PROMOTION ACTIVITIES WITHIN THE MEANING OF SECTION 509(A)(3) OF THE IRC; BORROWING AND LENDING OF FUNDS AND PROPERTY, ENGAGING IN FINANCIAL TRANSACTIONS WITH AND/OR ON BEHALF OF THE GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., ALONG WITH GENERAL SERVICES PROVIDED TO GUNDERSEN CLINIC, LTD. AND GUNDERSEN LUTHERAN MEDICAL CENTER, INC.
Form 990, Part VI, Line 2 Family/business relationships amongst interested persons MARK GLENDENNING AND GERALD ARNDT - Business relationship
Form 990, Part VI, Line 4 Significant changes to organizational documents GUNDERSEN AND BELLIN HEALTH SYSTEMS, INC. (BELLIN), EACH A WISCONSIN NONPROFIT, NON-STOCK CORPORATION, ENTERED INTO A COMBINATION AGREEMENT DATED JULY 29, 2022 (THE AGREEMENT), TO ALIGN THEIR RESPECTIVE OPERATIONS AND TO FORM A SINGLE NONPROFIT HEALTH SYSTEM THROUGH THE CREATION OF BELLIN GUNDERSEN HEALTH SYSTEM, INC., A WISCONSIN NONPROFIT, NON-STOCK CORPORATION (BELLIN GUNDERSEN). ON DECEMBER 1, 2022, UPON CONSUMMATION OF THE ALIGNMENT OF THE TWO SYSTEMS (THE AFFILIATION), BELLIN GUNDERSEN BECAME THE SOLE CORPORATE MEMBER OF BOTH BELLIN AND GUNDERSEN. BELLIN AND GUNDERSEN AND THEIR RESPECTIVE AFFILIATES ARE EXPECTED TO MAINTAIN THEIR RESPECTIVE CORPORATE EXISTENCE. IN DECEMBER 2022, THE BYLAWS OF GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. WERE AMENDED AND RESTATED TO UPDATE THE SOLE CORPORATE MEMBER TO BELLIN GUNDERSEN HEALTH SYSTEM, INC. THE BYLAWS WERE ALSO UPDATED TO SPECIFY THE POWERS RETAINED BY GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. THE CHIEF EXECUTIVE OFFICER OF BELLIN GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. RETAINS AUTHORITY TO APPROVE ANY SIGNIFICANT CHANGES TO THE CORPORATION. SUBJECT TO THE RESERVED POWERS SPECIFIED IN THE BYLAWS, THE AFFAIRS OF THE CORPORATION SHALL BE MANAGED BY ITS BOARD OF TRUSTEES.
Form 990, Part VI, Line 6 Classes of members or stockholders GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF THIS ORGANIZATION.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body THE CORPORATE MEMBER, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., HAS THE POWER TO APPOINT BOARD MEMBERS
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders 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 Review of form 990 by governing body 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 AND/OR THE EXECUTIVE DIRECTOR FINANCE, THE 990S ARE APPROVED AND FILED.
Form 990, Part VI, Line 12c Conflict of interest policy GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. MONITORS CONFLICTS ON AN ANNUAL BASIS BY REVIEWING DISCLOSURES ON COMPLETED CONFLICT OF INTEREST STATEMENTS.
Form 990, Part VI, Line 15a Process to establish compensation of top management official THE COMPENSATION OF THE CEO IS DETERMINED ANNUALLY BY A COMMITTEE MADE UP OF THE COMMUNITY MEMBERS OF THE BOARD OF TRUSTEES. THEIR DETERMINATION IS MADE AFTER A REVIEW OF MARKET DATA OBTAINED FROM SEVERAL ORGANIZATIONS AND CEO PERFORMANCE. MEETING MINUTES ARE TAKEN AND KEPT AT THE MEETINGS WHERE SUCH DISCUSSIONS TAKE PLACE. RECOMMENDATIONS FOR COMPENSATION FOR THE ORGANIZATIONS' KEY MANAGEMENT EMPLOYEES ARE DEVELOPED ANNUALLY BY THE CEO, AFTER A REVIEW OF PERFORMANCE AND COMPARABLE MARKET DATA. THE PROPOSED SALARIES ARE INDEPENDENTLY REVIEWED BY AN OUTSIDE AUDITING FIRM. THE COMPENSATION RECOMMENDATIONS, AUDIT REPORTS, ALONG WITH THE MARKET DATA, ARE PRESENTED TO A COMMITTEE MADE UP OF THE COMMUNITY MEMBERS OF THE BOARD OF TRUSTEES. 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 Required documents available to the public 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 XI, Line 9 OTHER CHANGES $100K ABOUTNHEALTH - ON 2.25.22, WE WITHDREW AS A MEMBER IN ABOUTHEALTH AND FORFEITED OUR RIGHT TO ANY MONEY DUE AS A MEMBER.
Form 990, Part XI, Line 9 Other changes in net assets or fund balances EQUITY TRANSFERS TO AFFILIATES - -2202369; ABOUTHEALTH CONTRACT FORFEITURE - -100000; SWAP MARKET ADJ - -2938;
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990) 2021


Additional Data


Software ID: 22016089
Software Version: 2022v5.0
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
Gundersen Lutheran Administrative Services Inc
 
Employer identification number

39-1606449
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
(1) 3 REALESTATE LLC
1900 SOUTH AVENUE
LA CROSSE,WI54601
39-1606449 		RENTAL WI 247,400 5,545,295 GLAS
 










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?
Yes No
(1)GUNDERSEN LUTHERAN HEALTH SYSTEM INC
1836 SOUTH AVENUE

LA CROSSE,WI54601
39-1866425 		SUPPORTING ORG WI 501(c)(3) Type II BGHS
 
 
No
(2)GUNDERSEN LUTHERAN MEDICAL CENTER INC
1910 SOUTH AVENUE

LA CROSSE,WI54601
39-0813416 		HEALTHCARE WI 501(c)(3) 3 GLHS
 
 
No
(3)GUNDERSEN CLINIC LTD
1836 SOUTH AVENUE

LA CROSSE,WI54601
39-1028657 		HEALTHCARE WI 501(c)(3) 3 GLHS
 
 
No
(4)GUNDERSEN LUTHERAN MEDICAL FOUNDATION INC
1836 SOUTH AVENUE

LA CROSSE,WI54601
39-1249705 		FOUNDATION WI 501(c)(3) 7 GLHS
 
 
No
(5)GUNDERSEN LUTHERAN CREDENTIALING SVS INC
1910 SOUTH AVENUE

LA CROSSE,WI54601
39-1856898 		CREDENTIALING WI 501(c)(3) Type III-FI GLHS
 
 
No
(6)TRI-COUNTY MEMORIAL HOSPITAL INC
18601 LINCOLN STREET

WHITEHALL,WI54773
39-0704510 		HEALTHCARE WI 501(c)(3) 3 GLHS
 
 
No
(7)HARMONY COMMUNITY HEALTHCARE INC
815 MAIN AVENUE

HARMONY,MN55939
41-0711606 		HEALTHCARE MN 501(c)(3) 10 GLHS
 
 
No
(8)TWEETEN LUTHERAN HEALTHCARE CENTER INC
125 FIFTH AVENUE SE

SPRING GROVE,MN55974
41-1565003 		HEALTHCARE MN 501(c)(3) 10 GLHS
 
 
No
(9)TRI-STATE AMBULANCE INC
235 CAUSEWAY BLVD

LA CROSSE,WI54603
39-1965415 		MEDICAL TRANSPORT WI 501(c)(3) 3 GLHS
 
 
No
(10)TRI-STATE REGIONAL AMBULANCE INC
235 CAUSEWAY BLVD

LA CROSSE,WI54603
39-1962965 		MEDICAL TRANSPORT WI 501(c)(3) 10 GLHS
 
 
No
(11)LUTHERAN REAL ESTATE HOLDING CORPORATION
1910 SOUTH AVENUE

LA CROSSE,WI54601
39-1480826 		HOUSING WI 501(c)(3) Type III-FI GLHS
 
 
No
(12)COMMUNITY HOUSING OF LA CROSSE INC
1900 SOUTH AVENUE

LA CROSSE,WI54601
39-1586700 		INDEPENDENT LIVING WI 501(c)(3) 10 LREH CORP
 
 
No
(13)LUTHERAN HOUSING OF LA CROSSE INC
1900 SOUTH AVENUE

LA CROSSE,WI54601
39-1751934 		INDEPENDENT LIVING WI 501(c)(3) 10 LREH CORP
 
 
No
(14)ST JOSEPH'S HEALTH SERVICES INC
400 WATER AVENUE

HILLSBORO,WI54634
39-0929538 		HEALTHCARE WI 501(c)(3) 3 GLHS
 
 
No
(15)ST JOSEPH'S MEMORIAL FOUNDATION INC
400 WATER AVENUE

HILLSBORO,WI54634
39-1455787 		FOUNDATION WI 501(c)(3) Type I ST JO HTH SV
 
 
No
(16)TRI-COUNTY MEMORIAL FOUNDATION INC
18601 LINCOLN STREET

WHITEHALL,WI54773
30-0093022 		FOUNDATION WI 501(c)(3) Type I TRI CTY HSPT
 
 
No
(17)MEMORIAL HOSPITAL OF BOSCOBEL
205 PARKER STREET

BOSCOBEL,WI53805
39-0845590 		HEALTHCARE WI 501(c)(3) 3 GLHS
 
 
No
(18)PALMER LUTHERAN HEALTH CENTER INC
112 JEFFERSON STREET

WEST UNION,IA52175
42-1320763 		HEALTHCARE IA 501(c)(3) 3 GLHS
 
 
No
(19)MOUNDVIEW MEMORIAL HOSPITALS & CLINICS
402 WEST LAKE STREET

FRIENDSHIP,WI53934
39-0944012 		HEALTHCARE WI 501(c)(3) 3 GLHS
 
 
No
(20)MEMORIAL HC FDN OF ADAMS COUNTY INC
402 WEST LAKE STREET

FRIENDSHIP,WI53934
39-1775074 		FOUNDATION WI 501(c)(3) Type I MDVW MEM HOS
 
 
No
(21)SAINT ELIZABETH'S HOSP OF WABASHA INC
1200 5TH GRANT BOULEVARD WEST

WABASHA,MN55981
41-0693877 		HEALTHCARE MN 501(c)(3) 3 GLHS
 
 
No
(22)BELLIN GUNDERSEN HEALTH SYSTEM INC
1836 SOUTH AVENUE

LA CROSSE,WI54601
92-0504278 		SUPPORTING ORG WI 501(c)(3) Type II NA
 
 
No
(23)BELLIN HEALTH SYSTEMS INC
744 SOUTH WEBSTER AVE

GREEN BAY,WI54301
39-1512904 		SUPPORTING ORG WI 501(c)(3) Type II BGHS
 
 
No
(24)LAKE MICHIGAN HEALTH SERVICES INC
744 SOUTH WEBSTER AVE

GREEN BAY,WI54301
39-1512903 		SUPPORTING ORG WI 501(c)(3) Type II BHS
 
 
No
(25)BELLIN COLLEGE INC
3201 EATON ROAD

GREEN BAY,WI54311
39-1620530 		EDUCATION WI 501(c)(3) 2 BHS
 
 
No
(26)BELLIN PSYCHIATRIC CENTER INC
PO BOX 23725

GREEN BAY,WI54301
39-1657627 		HEALTHCARE WI 501(c)(3) 3 BHS
 
 
No
(27)BELLIN MEMORIAL HOSPITAL INC
744 SOUTH WEBSTER AVE

GREEN BAY,WI54301
39-0884478 		HEALTHCARE WI 501(c)(3) 3 BHS
 
 
No
(28)THE BELLIN HEALTH FOUNDATION INC
PO BOX 23400

GREEN BAY,WI54301
39-1809171 		FOUNDATION WI 501(c)(3) 7 BHS
 
 
No
(29)OCONTO HOSPITAL & MEDICAL CENTER INC
820 ARBUTUS AVENUE

OCONTO,WI54153
06-1745397 		HEALTHCARE WI 501(c)(3) 3 BMH
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
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



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(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?



 		(k)
Percentage
ownership
Yes No 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
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) GUNDERSEN LUTHERAN ENVISION LLC

1836 SOUTH AVENUE
LA CROSSE,WI54601
26-4706546 		RENEWABLE ENERGY WI GLHS
  		C Corporation         No
(2) BEL-REGIONAL HOME MEDICAL INC

617 S ROOSEVELT
GREEN BAY,WI54301
39-1504766 		DURABLE MEDICAL EQUIPMENT, RETAIL WI NA
  		C Corporation         No
(3) BELLIN INVESTMENTS INC

744 SOUTH WEBSTER AVE
GREEN BAY,WI54301
39-1564939 		OTHER WI NA
  		C Corporation         No








Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
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
No
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 .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) ............................
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) ............................
1d
Yes
 
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
 
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
 
No
o Sharing of paid employees with related organization(s) ............................
1o
 
No
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
r Other transfer of cash or property to related organization(s) ............................
1r
Yes
 
s Other transfer of cash or property from related organization(s) ............................
1s
 
No
2
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





Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
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) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(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? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R. See instructions.
Return Reference Explanation
Schedule R, Part IV SCH R, PART IV, LINE 1 GUNDERSEN LUTHERAN ENVISION, LLC IS DIRECTLY OWNED BY GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. AND INDIRECTLY OWNED BY GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC.
Schedule R (Form 990) 2021

Additional Data


Software ID: 22016089
Software Version: 2022v5.0