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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MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
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 Medical Center 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

39-0813416
E Telephone number

G Gross receipts $ 1,368,540,203
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: 1899
M State of legal domicile: WI
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: SEE SCHEDULE O
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 0
6 Total number of volunteers (estimate if necessary) ............. 6 0
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 1,582,468
b Net unrelated business taxable income from Form 990-T, Part I, line 11 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 11,909,564 21,943,302
9 Program service revenue (Part VIII, line 2g) ......... 1,276,404,314 1,344,662,213
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 85,555 324,889
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 994,567 1,607,468
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 1,289,394,000 1,368,537,872
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 14,533,410 23,822,814
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 0 0
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 1,198,959,278 1,267,707,509
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 1,213,492,688 1,291,530,323
19 Revenue less expenses. Subtract line 18 from line 12....... 75,901,312 77,007,549
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 1,900,711,582 1,962,166,483
21 Total liabilities (Part X, line 26)............. 27,927,215 12,374,567
22 Net assets or fund balances. Subtract line 21 from line 20..... 1,872,784,367 1,949,791,916
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
JumboBullet
Type or print name and title
Paid Preparer Use Only
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 $ 1,250,298,469 including grants of $ 23,822,814 ) (Revenue $ 1,344,662,213 )
SEE SCHEDULE O
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet1,250,298,469
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 IXClick to see attachment
List of Attached Documents:
// Content
............
11d
Yes
 
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....Click to see attachment
List of Attached Documents:
// Content
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
List of Attached Documents:
// Content
20b
Yes
 
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........Click to see attachment
List of Attached Documents:
// Content
22
Yes
 
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...............
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
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
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
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 II...........
26
 
No
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.....
28b
 
No
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
0
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
 
 
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
0
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
 
 
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
Yes
 
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
 
No
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
 
 
Section C. Disclosure
17
List the states with which a copy of this Form 990 is required to be filedMediumBullet
MN , 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 NCA1-01   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
 2.0
.................
45.0 		X   X       0 244,113 51,032
(2) BRYAN ERDMANN
 
BOARD OF TRUSTEES - CHIEF OPERATING OFFICER
 2.0
.................
46.5 		X   X       0 316,306 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
.................
6.0 		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
 2.0
.................
47.0 		X   X       0 514,939 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 - MEMBER, CHIEF OF MED. STAFF
 2.0
.................
46.0 		X   X       0 306,023 46,630
(9) SCOTT RATHGABER MD
 
BOARD OF TRUSTEES - CEO, CHAIRMAN
 2.0
.................
46.0 		X   X       0 1,020,916 67,219
(10) TODD KOWALSKI MD
 
BOARD OF TRUSTEES - MEDICAL CHIEF OPERATING OFFICER
 2.0
.................
44.0 		X   X       0 473,806 72,811
(11) BENJAMIN JARMAN MD
 
BOARD OF TRUSTEES - MEMBER
 2.0
.................
46.0 		X           0 501,955 58,135
(12) CHRIS EBERLEIN MD
 
BOARD OF TRUSTEES - MEMBER
 2.0
.................
46.0 		X           0 387,958 67,719
(13) JENNIFER KLEVEN MD
 
BOARD OF TRUSTEES - MEMBER
 2.0
.................
46.0 		X           0 361,979 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
 2.0
.................
46.0 		    X       0 520,081 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
 2.0
.......................44.0 		    X       0 491,361 68,219
(19) GERALD OETZEL
 
CFO, TREASURER
 2.0
.......................47.0 		    X       0 615,642 52,651
(20) JONATHAN ZLABEK MD
 
MEDICAL VP, CROSS-FUNCTIONAL CARE
 2.0
.......................44.0 		    X       0 461,310 68,469
(21) KELLEY BAHR MD
 
MEDICAL VP, AMBULATORY SERVICES
 2.0
.......................44.0 		    X       0 393,507 44,275
(22) KRAIG SCHUSTER
 
ADMIN VP, COMMUNITY
 2.0
.......................46.0 		    X       0 284,169 53,972
(23) MARILU BINTZ MD
 
MED VP, COMM AND CMO-CRITICAL ACCESS HOSP
 2.0
.......................48.0 		    X       0 620,762 52,634
(24) MARY ELLEN MCCARTNEY
 
CHIEF HUMAN RESOURCES OFFICER
 2.0
.......................46.0 		    X       0 384,407 59,267
(25) MICHAEL DOLAN MD
 
EXEC VP, MEDICAL COO
 2.0
.......................46.0 		    X       0 636,281 71,911
(26) MICHAEL MCKEE
 
ADMIN VP, ACUTE CARE AND NURSING AND SYSTEMS
 2.0
.......................46.3 		    X       0 270,756 67,960
(27) PRAVEEN CHOPRA
 
CHIEF INFORMATION OFFICER
 2.0
.......................46.0 		    X       0 509,283 73,161
(28) RACHEL ALBRECHT
 
ADMIN VP, AMBULATORY SERVICES
 2.0
.......................44.8 		    X       0 151,435 46,902
(29) STEPHANIE NEUMAN MD
 
MEDICAL VP, AMBULATORY SERVICES
 2.0
.......................46.0 		    X       0 472,535 71,411
(30) STEPHEN SHAPIRO MD
 
CHIEF MEDICAL FOUNDATION OFFICER
 2.0
.......................50.0 		    X       0 498,943 71,269
(31) TINA LECHNIR
 
ADMIN VP, CROSS-FUNCTIONAL CARE
 2.0
.......................44.0 		    X       0 58,446 10,925
(32) WILLIAM FARRELL
 
CHIEF BUSINESS AND STRATEGY OFFICER
 2.0
.......................47.5 		    X       0 437,724 44,275
(33) ELLEN PEDRETTI-FENDT
 
VICE PRESIDENT APPLICATION SERVICES
 0.0
.......................40.0 		      X     0 203,686 54,866
(34) ERIC DEHN
 
VP ENTERPRISE ARCHITECTURE AND SOLUTION DESIGN
 0.0
.......................40.0 		      X     0 260,080 37,379
(35) JACK SCHWARTZ
 
VICE PRESIDENT FOUNDATION
 0.0
.......................40.0 		      X     0 215,332 38,237
(36) JANINE LUZ
 
VICE PRESIDENT LEARNING
 0.0
.......................40.0 		      X     0 229,446 51,353
(37) KARI ADANK
 
VICE PRESIDENT COMPLIANCE
 0.0
.......................40.0 		      X     0 236,819 59,638
(38) KRISTER MATTSON
 
VICE PRESIDENT ENTERPRISE ANALYTICS
 0.0
.......................40.0 		      X     0 298,053 51,698
(39) MARY KUFFEL MD
 
MEDICAL VICE PRESIDENT
 0.0
.......................40.0 		      X     0 538,187 45,667
(40) P MICHAEL JACOBS DPM
 
MEDICAL VICE PRESIDENT
 0.0
.......................40.0 		      X     0 461,210 67,702
(41) PAMELA MAAS
 
VICE PRESIDENT BUSINESS SERVICES
 0.0
.......................40.0 		      X     0 274,453 32,393
(42) SHANNON MULLIGAN
 
VP HR & TOTAL REWARDS
 0.0
.......................40.0 		      X     0 264,842 35,571
(43) ASHLEY TAO
 
SENIOR PHYSICIST
 0.0
.......................40.0 		        X   0 196,021 37,833
(44) KATE SHEEHAN
 
RN, ACUTE HOSPITAL
 0.0
.......................40.0 		        X   0 207,931 38,637
(45) KIMBERLY SCHMIDT
 
SENIOR PHYSICIST
 0.0
.......................40.0 		        X   0 267,134 56,060
(46) PAULA STRAND
 
RN, ADMISSION REFERRAL COORDINATOR
 0.0
.......................40.0 		        X   0 214,019 48,397
(47) TINA PIKE
 
SENIOR PHYSICIST
 0.0
.......................40.0 		        X   0 230,039 59,885
(48) GREGORY THOMPSON MD
 
FORMER CHIEF MED OFF THRU 21
 0.0
.......................40.0 		          X 0 322,668 53,156
(49) STEPHANIE CARROLL MD
 
FORMER MEDICAL VP THRU 20
 0.0
.......................40.0 		          X 0 297,599 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 0 15,652,156 2,308,031
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 MediumBullet0
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
GUNDERSEN LUTHERAN ADMIN SERVICES INC

1910 SOUTH AVENUE
LA CROSSE,WI54601 		SERVICES/SUPPLIES 770,534,965
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet1
Form 990 (2021)
Form 990 (2021)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, Grants, and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d 959,830
e Government grants (contributions)1e 20,979,095
f All other contributions, gifts, grants, and similar amounts not included above1f 4,377
g Noncash contributions included in lines 1a - 1f:$ 1g  
h Total. Add lines 1a-1f.......MediumBullet 21,943,302
Program Service RevenueAmt Business Code
2a MEDICAL SERVICES PROVIDED 621500 1,344,662,213 1,344,662,213    
b
c
d
e
f All other program service revenue. 0 0 0 0
g Total. Add lines 2a–2f .....MediumBullet 1,344,662,213
OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ......MediumBullet 325,998     325,998
4 Income from investment of tax-exempt bond proceedsMediumBullet        
5 Royalties...........MediumBullet        
(ii) Personal (i) Real
6a Gross rents   25,000 6a
b Less: rental expenses     6b
c Rental income or (loss) 0 25,000 6c
d Net rental income or (loss).......MediumBullet 25,000     25,000
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory 1,222   7a
b Less: cost or other basis and sales expenses 2,331   7b
c Gain or (loss) -1,109 0 7c
d Net gain or (loss).........MediumBullet -1,109     -1,109
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 LABORATORY SERVICES 621511 1,350,968   1,350,968  
b HELICOPTER DISPATCH SERVICES 561421 231,500   231,500  
c            
d All other revenue .... 0 0 0 0
e Total. Add lines 11a–11d ...... MediumBullet 1,582,468
12 Total revenue. See instructions.....MediumBullet 1,368,537,872 1,344,662,213 1,582,468 349,889
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 .... 8,999,124 8,999,124
2 Grants and other assistance to domestic individuals. See Part IV, line 22 ........... 14,823,690 14,823,690
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. ............. 0 0
4 Benefits paid to or for members ....... 0 0
5 Compensation of current officers, directors, trustees, and key employees ...........        
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........        
7 Other salaries and wages........        
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....        
9 Other employee benefits .......        
10 Payroll taxes ...........        
11 Fees for services (non-employees):        
a Management ...... 214,679,361 184,680,573 29,998,788  
b Legal ......... 22,491   22,491  
c Accounting ...........        
d Lobbying ...........        
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ......        
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 182,421,129 181,939,735 481,394 0
12 Advertising and promotion .... 33,872 27,763 6,109  
13 Office expenses ....... 10,985,747 10,755,686 230,061  
14 Information technology ...... 1,774,451 1,750,451 24,000  
15 Royalties ..        
16 Occupancy ........... 4,628,373 3,932,507 695,866  
17 Travel ............ 573,740 532,325 41,415  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings .... 259,035 225,977 33,058  
20 Interest ...........        
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .. 27,464,838 24,415,709 3,049,129  
23 Insurance ... 1,416,691 648,636 768,055  
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 222,244,120 222,244,120    
b BAD DEBTS 28,263,531 28,263,531    
c LEASED EMPLOYEES 555,855,604 550,052,330 5,803,274  
d RECRUITING/EMPLOY. DEVEL/TAX 16,310,976 16,261,029 49,947  
e All other expenses 773,550 745,283 28,267 0
25 Total functional expenses. Add lines 1 through 24e 1,291,530,323 1,250,298,469 41,231,854 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 ........   1  
2 Savings and temporary cash investments ......... 1,466,968 2 1,531,628
3 Pledges and grants receivable, net ......   3  
4 Accounts receivable, net ............. 144,352,492 4 156,454,238
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 .......
0 5 0
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 ...........   7  
8 Inventories for sale or use ............ 6,787,866 8 7,575,361
9 Prepaid expenses and deferred charges ......   9  
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 594,929,560
b Less: accumulated depreciation 10b 291,989,685 306,783,049 10c 302,939,875
11 Investments—publicly traded securities . 20,000,000 11 20,000,000
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 ........... 1,421,321,207 15 1,473,665,381
16 Total assets. Add lines 1 through 15 (must equal line 33)... 1,900,711,582 16 1,962,166,483
Liabilities 17 Accounts payable and accrued expenses ..... 4,144,679 17 3,599,318
18 Grants payable ...   18  
19 Deferred revenue ......... 19,516,352 19 0
20 Tax-exempt bond liabilities .........   20  
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 4,266,184 25 8,775,249
26 Total liabilities. Add lines 17 through 25.. 27,927,215 26 12,374,567
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 .......... 1,872,784,367 27 1,949,791,916
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 ........... 1,872,784,367 32 1,949,791,916
33 Total liabilities and net assets/fund balances ........ 1,900,711,582 33 1,962,166,483
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
1,368,537,872
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
1,291,530,323
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
77,007,549
4
Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..
4
1,872,784,367
5
Net unrealized gains (losses) on investments ...............
5
 
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
0
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))
10
1,949,791,916
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 Medical Center Inc
 
Employer identification number

39-0813416
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 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 ...............................  
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
Total
 
   
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
 
 
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
 
 
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
 
 
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
 
 
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
 
 
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
 
 
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
 
 
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
 
 
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
 
 
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
 
 
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
 
 
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
 
 
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
 
 
b
A family member of a person described on 11a above?
11b
 
 
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
 
 
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
 
 
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 (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 Medical Center Inc
 
Employer identification number

39-0813416
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 Medical Center Inc
  		Employer identification number
39-0813416
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 Medical Center Inc
  		Employer identification number

39-0813416
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
Schedule B (Form 990) (2022)
Schedule B (Form 990) (2022)
Page 4
Name of organization
Gundersen Lutheran Medical Center Inc
  		Employer identification number

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

39-0813416
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

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) ........................ 0 242,027
c Total lobbying expenditures (add lines 1a and 1b) ............................................................ 0 242,027
d Other exempt purpose expenditures ............................................................................... 1,291,530,323 2,564,277,341
e Total exempt purpose expenditures (add lines 1c and 1d) .................................................. 1,291,530,323 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 0 0 0 0 0
d Grassroots nontaxable amount 250,000 250,000 250,000 250,000 1,000,000
e Grassroots ceiling amount
(150% of line 2d, column (e))		 1,500,000
f Grassroots lobbying expenditures 0 0 0 0 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 ORGANIZATION ORGANIZATION NAME: GUNDERSEN LUTHERAN ADMIN. SERVICES ADDRESS: 1910 SOUTH AVENUE LA CROSSE, WI 54601 EIN: 39-1606449 GRASSROOTS LOBBYING AMOUNT: NONE 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: NONE
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: NONE 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: NONE
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: NONE 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: NONE
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: NONE 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: NONE
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 Medical Center Inc
 
Employer identification number

39-0813416
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate value of contributions to (during year)    
3 Aggregate value of grants from (during year)    
4 Aggregate value at end of year ........    
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 .....   4,370,393 4,370,393
b Buildings ....   430,860,358 179,230,219 251,630,139
c Leasehold improvements   5,191,730 4,322,545 869,185
d Equipment ....   128,684,249 99,851,245 28,833,004
e Other .....   25,822,830 8,585,676 17,237,154
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 302,939,875
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)INTERCOMPANY RECEIVABLES 1,439,384,365
(2)RIGHT OF USE ASSETS 1,076,154
(3)OTHER RECEIVABLES AND ADJUSTMENT 33,204,862
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 1,473,665,381
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  
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 8,775,249
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 (DOLLARS 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




SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20a.
MediumBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2022
Open to Public Inspection
Name of the organization
Gundersen Lutheran Medical Center Inc
 
Employer identification number

39-0813416
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . . 		  5,671 5,155,682 0 5,155,682 0.41 %
b Medicaid (from Worksheet 3, column a) . . . . .     185,242,475 106,953,508 78,288,967 6.20 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .         0 0 %
d Total Financial Assistance and Means-Tested Government Programs . . . . . 0 5,671 190,398,157 106,953,508 83,444,649 6.61 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     570,499 12,381 558,118 0.04 %
f Health professions education (from Worksheet 5) . . .     18,019,966 4,649,289 13,370,677 1.06 %
g Subsidized health services (from Worksheet 6) . . . .         0 0 %
h Research (from Worksheet 7) .         0 0 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     767,243   767,243 0.06 %
j Total. Other Benefits . . 0 0 19,357,708 4,661,670 14,696,038 1.16 %
k Total. Add lines 7d and 7j . 0 5,671 209,755,865 111,615,178 98,140,687 7.77 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2022
Schedule H (Form 990) 2022
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing         0 0 %
2 Economic development     50,550   50,550 0 %
3 Community support     8,480   8,480 0 %
4 Environmental improvements     0   0 0 %
5 Leadership development and
training for community members		         0 0 %
6 Coalition building         0 0 %
7 Community health improvement advocacy         0 0 %
8 Workforce development     44,865   44,865 0 %
9 Other     6,741,336   6,741,336 0.53 %
10 Total 0 0 6,845,231 0 6,845,231 0.54 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
8,145,510
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
157,059
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
136,469,441
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
241,861,185
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-105,391,744
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2022
Schedule H (Form 990) 2022
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility) 		Licensed Hospital General Medical and Surgical Children's Hospital Teaching Hospital Critical Access Hospital Research Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 GUNDERSEN LUTHERAN MED CENTER INC
1910 SOUTH AVENUE
LA CROSSE,WI54601
WWW.GUNDERSENHEALTH.ORG
LICENSE #23 		X X   X   X X      
Schedule H (Form 990) 2022
Schedule H (Form 990) 2022
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
GUNDERSEN LUTHERAN MED CENTER INC
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 21
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 21
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): HTTPS://WWW.GUNDERSENHEALTH.ORG/DOCUMENT/22316
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2022
Schedule H (Form 990) 2022
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
GUNDERSEN LUTHERAN MED CENTER INC
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
HTTPS://WWW.GUNDERSENHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE
b
HTTPS://WWW.GUNDERSENHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2022
Schedule H (Form 990) 2022
Page 6
Part VFacility Information (continued)

Billing and Collections
GUNDERSEN LUTHERAN MED CENTER INC
Name of hospital facility or letter of facility reporting group  
Yes No
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2022
Schedule H (Form 990) 2022
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
GUNDERSEN LUTHERAN MED CENTER INC
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2022
Schedule H (Form 990) 2022
Page 8
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
Schedule H, Part V, Section B, Line 3 Facility , 1 Facility , 1 - GUNDERSEN LUTHERAN MEDICAL CENTER INC. THE COMPASS NOW 2021 REPORT HTTPS://WWW.GREATRIVERSUNITEDWAY.ORG/OUR-WORK/COMMUNITY-NEEDS-ASSESSMENT/, INCLUDES 6 COUNTIES IN THE GUNDERSEN LUTHERAN MEDICAL CENTER'S SERVICE AREA. THESE 6 COUNTIES REPRESENT APPROXIMATELY 70% OF OUR HOSPITAL SERVICE PATIENT POPULATION, AND 42% OF THE OVERALL POPULATION (261,591 OF 620,168) OF OUR 22-COUNTY SERVICE AREA. IT IS IMPORTANT TO NOTE THAT IN ADDITION TO THE COMPASS NOW 2021 REPORT, THE 22-COUNTY HEALTH INDICATOR REPORT WAS GENERATED, HTTPS://WWW.GUNDERSENHEALTH.ORG/DOCUMENT/22296. TO IDENTIFY THE HEALTH NEEDS OF THE BROADER GUNDERSEN HEALTH SYSTEM'S 22-COUNTY SERVICE AREA, ANALYSIS OF PUBLICLY AVAILABLE DATA WAS COMPLETED. SECONDARY DATA - INCLUDING POPULATION DEMOGRAPHICS, MORTALITY, MORBIDITY, HEALTH BEHAVIOR, AND CLINICAL CARE - WERE USED TO IDENTIFY AND PRIORITIZE SIGNIFICANT COMMUNITY HEALTH NEEDS IN EACH COUNTY. POPULATION CHARACTERISTICS, SOCIOECONOMIC, AND HEALTH STATUS DATA WERE ALSO EXAMINED. COMMUNITY-LEVEL DATA WERE COMPARED TO THE STATE, NATION, AND HEALTHY PEOPLE 2030 BENCHMARKS, WHEN AVAILABLE, TO HELP IDENTIFY KEY HEALTH ISSUES IN EACH COUNTY. A SUMMARY OF THE COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE FOUND HERE: HTTPS://WWW.GUNDERSENHEALTH.ORG/DOCUMENT/22291. STUDY METHODS FOR THE COMPASS NOW 2021 REPORT INCLUDED 1) ANALYSIS OF COMMUNITY INDICATORS FROM VARIOUS LOCAL, STATE, AND FEDERAL SOURCES (RELYING HEAVILY ON COUNTY HEALTH RANKINGS FROM THE UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTE). 2) COMMUNITY INSIGHTS PROVIDED BY RESPONDENTS TO A RANDOM HOUSEHOLD SURVEY, SUPPLEMENTAL CONVENIENCE SURVEY AND KEY INFORMANT INTERVIEWS; 3) PRIORITIZATION OF THE TOP 5 NEEDS FACILITATED FOR THE 6 COUNTY STAKEHOLDER GROUPS. THE STUDY WAS CONDUCTED IN 2020 AND 2021 UNDER THE DIRECTION OF GREAT RIVERS UNITED WAY, WITH TECHNICAL SUPPORT FROM A CONTRACTED CONSULTANT (COMMUNITY HEALTH SOLUTIONS). THE STUDY WAS GUIDED BY A COMPASS NOW STEERING COMMITTEE COMPRISED OF STAKEHOLDERS FROM PUBLIC HEALTH, HEALTH CARE, AND OTHER COMMUNITY SECTORS. THE STEERING COMMITTEE MEMBERS PROVIDED GUIDANCE ON THE STUDY SCOPE AND METHODS, INCLUDING THE ADJUSTMENTS MADE IN RESPONSE TO COVID-19. THE STEERING COMMITTEE MEMBERS ALSO PROVIDED LIAISONS TO ENGAGE COMMUNITY ORGANIZATIONS IN PROMOTING PARTICIPATION IN THE CONVENIENCE SURVEY CONDUCTED FOR THE STUDY. HOSPITALS REPRESENTED ON THE STEERING COMMITTEE INCLUDED GUNDERSEN MEDICAL CENTER, MAYO CLINIC HEALTH SYSTEM, VERNON MEMORIAL HOSPITAL, GUNDERSEN ST JOSEPH'S HOSPITAL, GUNDERSEN TRI-COUNTY HOSPITAL. IN ADDITION, TOMAH MEMORIAL HOSPITAL WAS CONSULTED AND PARTICIPATED IN THE COMMUNITY STAKEHOLDER MEETINGS. OTHER COMMITTEE MEMBERS REPRESENTED THE SIX COUNTY HEALTH DEPARTMENTS FROM BUFFALO, TREMPEALEAU, LA CROSSE, VERNON, MONROE, AND HOUSTON COUNTIES. COMMUNITY BASED ORGANIZATIONS REPRESENTED INCLUDED THE GREAT RIVERS UNITED WAY, APTIV, AND COULEECAP WITH ADDITIONAL CONSULTATION FROM LA CROSSE SCHOOL DISTRICT, LA CROSSE COMMUNITY FOUNDATION, LA CROSSE MEDICAL HEALTH SCIENCE CONSORTIUM AND UNIVERSITY OF WISCONSIN-LA CROSSE. ALL INDIVIDUALS ARE LISTED BY NAME IN THE REPORT. COMMUNITY DEMOGRAPHICS FOR THE COMPASS NOW 2021 REPORT WERE ANALYZED AND MAPPED USING DATA AND SOFTWARE FROM ESRI, A COMMERCIAL PROVIDER OF COMMUNITY DATA. DATA COMPILED INCLUDED A DEMOGRAPHIC PROFILE AND POPULATION ESTIMATES AND PROJECTIONS. A SUMMARY OF COUNTY HEALTH RANKINGS WAS DESCRIBED INCLUDING HEALTH OUTCOMES, LENGTH OF LIFE, QUALITY OF LIFE, HEALTH BEHAVIORS AND CONCERNS, CLINICAL/HEALTH CARE, SOCIAL/ECONOMIC FACTORS, AND PHYSICAL ENVIRONMENT. COMMUNITY SURVEY RESPONDENTS RATED VARIOUS ASPECTS OF THESE MODULES.
Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - GUNDERSEN LUTHERAN MEDICAL CENTER, INC.. A RANDOM HOUSEHOLD SURVEY (RHS) OF COMMUNITY RESIDENTS WAS CONDUCTED IN JULY-SEPTEMBER OF 2020. THE SURVEY WAS MAILED TO 6,000 RANDOMLY SELECTED HOUSEHOLDS USING A SAMPLING STRATEGY DESIGNED TO PRODUCE A TARGET NUMBER OF AT LEAST 100 SURVEY RESPONSES FROM EACH OF THE SIX COUNTIES. IN ADDITION, WITHIN EACH COUNTY THE MAIL-OUT WAS DESIGNED TO OVER-SAMPLE FROM CENSUS TRACTS WITH RELATIVELY LOW INCOME TO HELP ASSURE THAT LOWER-INCOME COMMUNITY RESIDENTS WERE REPRESENTED. GREAT RIVERS UNITED WAY STAFF AND VOLUNTEERS ENTERED THE SURVEY DATA INTO A QUALTRICS SURVEY PORTAL PROVIDED BY COMMUNITY HEALTH SOLUTIONS. A TOTAL OF 713 RHS RESPONDENTS RETURNED THEIR SURVEYS, FOR A RESPONSE RATE OF 12%. FOCUSING ON RESPONSES BY COUNTY, AT LEAST 91 SURVEYS WERE RETURNED FOR EACH JURISDICTION. COMPARED TO POPULATION ESTIMATES FOR THE REGION AS A WHOLE, THE RHS RESPONSES INCLUDED A HIGHER PERCENTAGE OF OLDER ADULTS THAN THE POPULATION AS A WHOLE AND SKEWED TOWARD RESPONDENTS SELF-IDENTIFYING AS FEMALE AND OF WHITE RACE. THE HOUSEHOLD INCOME PROFILE FOR RHS RESPONDENTS WAS FAIRLY REPRESENTATIVE OF THE POPULATION AS A WHOLE, WITH SLIGHTLY MORE REPRESENTATION AT LOWER INCOME LEVELS. A SUPPLEMENTAL CONVENIENCE SURVEY (CS) WAS CONDUCTED IN OCTOBER-NOVEMBER 2020. THE PURPOSE OF THE CS WAS TO GENERATE ADDITIONAL SURVEY RESPONSES FROM POPULATIONS THAT MAY HAVE BEEN UNDER-REPRESENTED IN THE RHS. THE CS WAS PRIMARILY CONDUCTED USING MIXED METHODS, AND RESPONDENTS COULD EITHER COMPLETE THEIR SURVEY ONLINE OR SUBMIT A PAPER COPY OF THEIR SURVEY RESPONSE. ORGANIZATIONS INCLUDED IN THE CONVENIENCE SURVEY PROCESS INCLUDED THOSE REPRESENTING PEOPLE WITH DISABILITIES, LOW-INCOME POPULATION, CHILDREN-YOUTH-FAMILIES, RACIAL AND ETHNIC MINORITIES, VICTIMS OF DOMESTIC VIOLENCE AND LGBTQ+ COMMUNITY. GREAT RIVERS UNITED WAY STAFF AND VOLUNTEERS ENTERED PAPER SURVEY RESPONSES INTO A QUALTRICS SURVEY PORTAL PROVIDED BY COMMUNITY HEALTH SOLUTIONS. A TOTAL OF 510 CS RESPONSES WERE RECEIVED, WITH MORE THAN HALF COMING FROM LA CROSSE COUNTY. COMPARED TO THE RHS, THE CS YIELDED HIGHER REPRESENTATION OF ADULTS UNDER AGE 45, WOMEN, MINORITY POPULATIONS, AND MIDDLE-INCOME HOUSEHOLDS. THE CS RESULTS ARE PRESENTED ALONGSIDE THE RHS RESULTS THROUGHOUT THE REPORT TO PROVIDE A MULTI-METHOD PROFILE OF SURVEY RESPONSES. THE TWO SURVEYS WERE NOT COMBINED BECAUSE THEY ARE BASED ON TWO FUNDAMENTALLY DIFFERENT SAMPLING STRATEGIES. THE ASSESSMENT TEAM COLLABORATED WITH LOCAL PARTNERS TO ORGANIZE A SERIES OF COMMUNITY STAKEHOLDER VIRTUAL MEETINGS WITH STAKEHOLDERS FROM EACH OF THE SIX COUNTIES IN THE STUDY REGION. THE PURPOSE OF THE MEETINGS WAS TO GATHER ADDITIONAL INSIGHT ABOUT PRIORITY NEEDS AND ACTION IDEAS FROM A LOCAL PERSPECTIVE. THE INVITED PARTICIPANTS INCLUDED REPRESENTATIVES FROM LOCAL BUSINESSES, EDUCATION, FAITH, GOVERNMENT, HEALTH AND HUMAN SERVICES, AND NONPROFIT AGENCIES. THESE INDIVIDUALS HAVE FIRST-HAND KNOWLEDGE OF PUBLIC HEALTH AND SOCIAL NEEDS OF THE RESIDENTS OF THE COMMUNITIES. A TOTAL OF 191 INDIVIDUALS PARTICIPATED IN THE VARIOUS COUNTY MEETINGS. THE MEETINGS WERE FACILITATED VIRTUALLY SO THAT PARTICIPANTS COULD ATTEND WHILE MAINTAINING SOCIAL DISTANCING FOR THE PANDEMIC. DURING THE MEETINGS, PARTICIPANTS WERE INVITED TO SHARE THEIR INSIGHTS ABOUT PRESSING COMMUNITY NEEDS AS VIEWED FROM THEIR PERSPECTIVE. THE MEETING PARTICIPANTS WERE ALSO INVITED TO COMPLETE A POST-MEETING SURVEY TO PRIORITIZE AMONG THE AREAS OF NEED IDENTIFIED AT THE MEETING EVENT.
Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - GUNDERSEN LUTHERAN MEDICAL CENTER, INC.. HOSPITALS REPRESENTED ON THE STEERING COMMITTEE INCLUDED GUNDERSEN MEDICAL CENTER, MAYO CLINIC HEALTH SYSTEM, VERNON MEMORIAL HOSPITAL, GUNDERSEN ST. JOSEPH'S HOSPITAL AND CLINICS, AND GUNDERSEN TRI-COUNTY HOSPITAL. IN ADDITION, TOMAH MEMORIAL HOSPITAL WAS CONSULTED AND PARTICIPATED IN THE COMMUNITY STAKEHOLDER MEETINGS.
Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - GUNDERSEN LUTHERAN MEDICAL CENTER, INC.. AJ FALKERS COUNSELING AND CONSULTING SERVICES, AMERICAN RED CROSS APTIV, INC., ARCADIA AMBULANCE SERVICE, ARCADIA MIDDLE SCHOOL, ARROW BEHAVIORAL HEALTH, AT HOME CARE OF WESTERN WISCONSIN, BIG BROTHERS BIG SISTERS OF THE 7 RIVERS REGION, BLAIR-TAYLOR HIGH SCHOOL, BRIDGES HEALTH, BUFFALO COUNTY HEALTH DEPARTMENT, CALEDONIA AREA PUBLIC SCHOOLS, CENTER FOR SPECIAL CHILDREN-LFMC, CHILDREN'S MUSEUM OF LA CROSSE, CIA SIAB, INC., CITY OF CALEDONIA, CITY OF FOUNTAIN CITY, CITY OF HILLSBORO, CITY OF LA CROSSE, COMMUNITY & ECONOMIC DEVELOPMENT, ASSOCIATES CO-OP CREDIT UNION, COULEE REGION RSVP, COULEECAP, INC., CROSS OF CHRIST LUTHERAN CHURCH, CROSSING RIVERS HEALTH, ESB BANK, FAMILIES FIRST OF MONROE COUNTY, INC., FAMILY & CHILDREN'S CENTER, FLOCKS GUARDIANS INC., GREAT RIVERS HUB, GREAT RIVERS UNITED WAY, HALE FIRE/FIRST RESPONDERS, HAMILTON COMMUNITY SCHOOL, HILLSBORO SCHOOL DISTRICT, HILLSBORO SENTRY-ENTERPRISE, HOUSTON COUNTY, HOUSTON COUNTY ECONOMIC DEVELOPMENT AUTHORITY, HOUSTON COUNTY PUBLIC HEALTH & HUMAN SERVICES, HOUSTON PUBLIC SCHOOLS, INCLUSA, INDEPENDENCE PUBLIC LIBRARY, INDEPENDENCE SCHOOL DISTRICT, INDEPENDENT LIVING RESOURCES, KWIK TRIP, LA CRESCENT AREA CHAMBER OF COMMERCE & TOURISM, LA CRESCENT MONTESSORI & STEM SCHOOL, LA CRESCENT-HOKAH PUBLIC SCHOOLS, LA CROSSE COMMUNITY FOUNDATION, LA CROSSE COUNTY, LA CROSSE COUNTY HEALTH DEPARTMENT, LA CROSSE COUNTY HISTORICAL SOCIETY, LA CROSSE COUNTY HUMAN SERVICES, LA CROSSE MEDICAL HEALTH SCIENCE CONSORTIUM, LA CROSSE MILLING COMPANY, LA FARGE SCHOOL DISTRICT, LIFESTYLE FITNESS, LOKENS SAWMILL INN & SUITES, MIENERGY COOPERATIVE, MOBILE MEALS, MONROE COUNTY DEPARTMENT OF HUMAN SERVICES, MONROE COUNTY GOVERNMENT, MONROE COUNTY HEALTH DEPARTMENT, MONROE COUNTY JUSTICE PROGRAMS, NEIGHBOR FOR NEIGHBOR, NEIGHBORS IN ACTION, NEXT CHAPTER, LA CROSSE NORWALK-ONTARIO-WILTON SCHOOL DISTRICT, OPTUM, PILGRIMS PRIDE ARCADIA WISCONSIN, ROYAL BANK, ROYAL CREDIT UNION, SCENIC BLUFFS COMMUNITY HEALTH CENTER, SECOND HARVEST FOODBANK OF SOUTHERN WISCONSIN, SEMCAC, SMOOTHTOE, SPARTA AREA CHAMBER OF COMMERCE, SPARTA AREA SCHOOL DISTRICT, SPARTA FREE LIBRARY, SPRING GROVE SCHOOL DISTRICT, ST. JOHN'S ALMA, ST. MICHAEL'S ASSISTED LIVING, STATE OF WISCONSIN DEPARTMENT OF MILITARY AFFAIRS, THE PARENTING PLACE, THE SALVATION ARMY OF LA CROSSE COUNTY, TOMAH AREA SCHOOL DISTRICT, TOMAH CHAMBER AND VISITORS CENTER, TOMAH POLICE DEPARTMENT, TOMAH VA MEDICAL CENTER, TREMPEALEAU COUNTY, TREMPEALEAU COUNTY BOARD, TREMPEALEAU COUNTY DEPARTMENT OF HUMAN SERVICES, TREMPEALEAU COUNTY HEALTH DEPARTMENT, TRI-COUNTY COMMUNICATIONS COOPERATIVE, TRIPLE BROOK FARMS, INC, UNIVERSITY OF WISCONSIN EXTENSION, UW-MADISON, UW-MADISON DIVISION OF EXTENSION MONROE COUNTY, UW-MADISON EXTENSION, VARC, INC. VERNON AREA REHABILITATION CENTER, VERNON COUNTY, VERNON COUNTY EMERGENCY MANAGEMENT, VERNON COUNTY HEALTH DEPARTMENT, VERNON ELECTRIC COOP, WESTERN WISCONSIN WOMEN'S BUSINESS CENTER, WISCONSIN STATE LEGISLATURE, WORKFORCE CONNECTIONS, INC., XCEL ENERGY, YWCA LA CROSSE.
Schedule H, Part V, Section B, Line 7 Facility , 1 Facility , 1 - GUNDERSEN LUTHERAN MEDICAL CENTER, INC.. AVAILABLE BY CONTACTING SARAH HAVENS, PHONE 608-775-6580 OR 800-362-9567, EXT. 56580 OR EMAIL SJHAVENS@GUNDERSENHEALTH.ORG
Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - GUNDERSEN LUTHERAN MEDICAL CENTER, INC.. OUR COMMUNITY HEALTH IMPLEMENTATION PLAN, INCLUDING GOALS, AND ACTION STEPS, RESOURCES, PARTNERS, AND OUTCOME MEASURES, ADDRESSES THE TOP PRIORITY NEEDS IDENTIFIED FOR THE COMPASS NOW 6 COUNTY REGION AND THE 22-COUNTY HEALTH INDICATOR REPORT. THE PRIORITIES ARE STATED DIRECTLY OR EMBEDDED AS AN ACTION STEP. IN ADDITION, THE IMPLEMENTATION PLAN SUPPORTS THE HEALTH SYSTEM'S POPULATION HEALTH INITIATIVES THAT SERVE TO STRENGTHEN OUR EFFORTS TO IMPROVE THE HEALTH OF OUR COMMUNITIES. THOSE PRIORITIES ARE SOCIAL DETERMINANTS OF HEALTH, MENTAL HEALTH, SUBSTANCE ABUSE, AND CHRONIC DISEASE. THE PLAN CAN BE FOUND HERE: HTTPS://WWW.GUNDERSENHEALTH.ORG/DOCUMENT/22316 COMPASS NOW 2021 PRIORITIES -MENTAL HEALTH -SUBSTANCE ABUSE -SAFE, AFFORDABLE HOUSING -POVERTY/FINANCIAL STABILITY 22-COUNTY HEALTH INDICATOR PRIORITIES -SUICIDE -POOR MENTAL HEALTH STATUS -PROVIDER ACCESS -EXCESSIVE ALCOHOL USE -DRUG OVERDOSE DEATH -OPIOID ABUSE AND DEATHS -HOUSING INSECURITY -FINANCIAL INSECURITY -POVERTY AND ALICE RATES -FOOD INSECURITY -TRANSPORTATION -ADVERSE CHILDHOOD EXPERIENCES -DIABETES -TOBACCO -OBESITY -PHYSICAL INACTIVITY GUNDERSEN POPULATION HEALTH PRIORITIES -MENTAL HEALTH -SUBSTANCE ABUSE (OPIOIDS) -SOCIAL DETERMINANTS OF HEALTH (INCLUDING POVERTY/FINANCIAL STABILITY, HOUSING, FOOD, AND TRASNPORTION INSECURITY) -ADVERSER CHILDHOOD EXPERIENCES AND TOXIC STRESS -CHRONIC ILLNESS OUR IMPLEMENTATION PLAN, INCLUDING GOALS, AND ACTION STEPS, RESOURCES, PARTNERS AND OUTCOME MEASURES, ADDRESSES THE TOP PRIORITY NEEDS IDENTIFIED FOR THE COMPASS NOW 6 COUNTY REGION AND THE 22-COUNTY HEALTH INDICATOR REPORT. THE PRIORITIES ARE STATED DIRECTLY OR EMBEDDED AS AN ACTION STEP. IN ADDITION, THE IMPLEMENTATION PLAN SUPPORTS THE HEALTH SYSTEM'S FOUR POPULATION HEALTH INITIATIVES THAT SERVE TO STRENGTHEN OUR EFFORTS TO IMPROVE THE HEALTH OF OUR COMMUNITIES: THE GOALS OF THE PLAN, WHICH IN SOME CASES CONNECT TO OUR ALREADY EXISTING ACTIVITY INCLUDE ARE STATED BELOW. EACH GOAL HAS SEVERAL ACTION STEPS THAT ENGAGE MULTI-DISCIPLINARY TEAMS FROM GUNDERSEN PLUS COMMUNITY PARTNERS AND HAVE MEASURABLE IMPACTS. -BY 2024, REDUCE NUMBER OF PATIENTS REPORTING HAVING FOOD, HOUSING , OR TRANSPORTATION INSECURITY BY 2% (BASELINE Q4 2022) -REDUCE NUMBER OF DEATHS DUE TO POOR MENTAL HEALTH AND SUBSTANCE ABUSE AND REDUCE THE NUMBER OF POOR MENTAL HEALTH DAYS BY 5% BY 2024 -REDUCE THE RATE OF DRUG OVERDOSE DEATHS TO LESS THAN 27.02/100,000 BY 2024 -SLOW THE RATE OF INCREASE OF ADULTS IN SERVICE AREA WILL REPORT FAIR/POOR HEALTH BY 2024 STATUS OF OUR GOALS AND ACTION STEPS ARE DOCUMENTED ANNUALLY AS OUR REPORT TO THE COMMUNITY. OUR COMMUNITY HEALTH SCORECARD IS REFERENCED AS OUR PRIMARY IN-HOUSE MONITORING TOOL. IT IS IMPORTANT TO NOTE THAT THE COVID-19 PANDEMIC IMPACTED OUR ENTIRE REGION, OUR COMMUNITIES, AND OUR HEALTH SYSTEM AND HOSPITAL. THE GOALS OF OUR PREVIOUS IMPLEMENTATION PLAN, 2019-2021, CONTINUED TO BE ADDRESSED BUT AT A MUCH SLOWER PACE DUE ADDRESSING UNEXPECTED NEEDS OF THOSE WE SERVE. COMMUNITY PARTNERS WITH LIMITED RESOURCES SHIFTED THEIR FOCUS. EFFORTS FOCUSED ON PATIENT CARE, INTERVENING IN DISEASE AND PREVENTING COMMUNITY SPREAD, AND ADDRESSING THE NEEDS OF OUR MOST VULNERABLE POPULATIONS. SOCIAL DETERMINANTS OF HEALTH BECAME AN EVEN MORE PROMINENT FACTOR IN HOW WE APPROACH OUR COMMUNITIES.
Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - GUNDERSEN LUTHERAN MEDICAL CENTER, INC.. GHS PATIENTS NOT MEETING FINANCIAL ASSISTANCE ELIGIBILITY THRESHOLDS MAY BE ELIGIBLE FOR ASSISTANCE UNDER CIRCUMSTANCES WHEN GHS MEDICAL BILLS WOULD RESULT IN SEVERE FINANCIAL HARDSHIP. PATIENTS, OR THEIR GUARANTORS, MAY BE ELIGIBLE FOR CATASTROPHIC CARE ASSISTANCE IF THEY HAVE INCURRED OUT-OF-POCKET OBLIGATIONS RESULTING FROM MEDICAL SERVICES PROVIDED BY GHS THAT EXCEED 25% OF FAMILY INCOME AND HAVE ASSETS BELOW THE EQUIVALENT OF 600% OF THE FEDERAL POVERTY LEVEL THRESHOLD. PRESUMPTIVE ELIGIBILITY: GHS UNDERSTANDS THAT NOT ALL PATIENTS ARE ABLE TO COMPLETE A FINANCIAL ASSISTANCE APPLICATION OR COMPLY WITH REQUESTS FOR DOCUMENTATION. THERE MAY BE INSTANCES UNDER WHICH A PATIENT'S QUALIFICATION FOR FINANCIAL ASSISTANCE IS ESTABLISHED WITHOUT COMPLETING THE FORMAL FINANCIAL ASSISTANCE APPLICATION. OTHER INFORMATION MAY BE UTILIZED BY GHS TO DETERMINE WHETHER A PATIENT'S ACCOUNT IS UNCOLLECTIBLE AND THIS INFORMATION WILL BE USED TO DETERMINE PRESUMPTIVE ELIGIBILITY. PRESUMPTIVE ELIGIBILITY MAY BE GRANTED TO PATIENTS BASED ON THEIR ELIGIBILITY FOR OTHER PROGRAMS OR LIFE CIRCUMSTANCES SUCH AS: 1. PATIENTS OR GUARANTORS WHO HAVE DECLARED BANKRUPTCY. IN CASES INVOLVING BANKRUPTCY, ONLY THE ACCOUNT BALANCE AS OF THE DATE THE BANKRUPTCY IS FILED WILL BE WRITTEN OFF. 2. PATIENTS OR GUARANTORS WHO ARE DECEASED WITH NO ESTATE IN PROBATE. 3. PATIENTS OR GUARANTORS DETERMINED TO BE HOMELESS. 4. ACCOUNTS RETURNED BY THE COLLECTION AGENCY AS UNCOLLECTIBLE DUE TO ANY OF THE ABOVE REASONS. 5. PATIENTS OR GUARANTORS WHO QUALIFY FOR STATE MEDICAID PROGRAMS WILL BE ELIGIBLE FOR ASSISTANCE FOR ANY COST-SHARING OBLIGATIONS ASSOCIATED WITH THE PROGRAM OR UNCOVERED SERVICES. GHS UNDERSTANDS THAT CERTAIN PATIENTS MAY BE NON-RESPONSIVE TO GHS'S APPLICATION PROCESS. UNDER THESE CIRCUMSTANCES, GHS MAY UTILIZE OTHER SOURCES OF INFORMATION TO MAKE AN INDIVIDUAL ASSESSMENT OF FINANCIAL NEED. THIS INFORMATION WILL ENABLE GHS TO MAKE AN INFORMED DECISION ON THE FINANCIAL NEED OF NON-RESPONSIVE PATIENTS UTILIZING THE BEST ESTIMATES AVAILABLE IN THE ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT. GHS MAY UTILIZE A THIRD-PARTY TO CONDUCT AN ELECTRONIC REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. THIS REVIEW UTILIZES A HEALTHCARE INDUSTRY-RECOGNIZED MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THIS PREDICTIVE MODEL INCORPORATES PUBLIC RECORD DATA TO CALCULATE A SOCIO-ECONOMIC AND FINANCIAL CAPACITY SCORE THAT INCLUDES ESTIMATES FOR INCOME, ASSETS AND LIQUIDITY. THE ELECTRONIC TECHNOLOGY IS DESIGNED TO ASSESS EACH PATIENT TO THE SAME STANDARDS AND IS CALIBRATED AGAINST HISTORICAL APPROVALS FOR GHS FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. THE ELECTRONIC TECHNOLOGY, WHEN UTILIZED, WILL BE DEPLOYED PRIOR TO BAD DEBT ASSIGNMENT AFTER ALL OTHER ELIGIBILITY AND PAYMENT SOURCES HAVE BEEN EXHAUSTED. THIS ALLOWS GHS TO SCREEN ALL PATIENTS FOR FINANCIAL ASSISTANCE PRIOR TO PURSUING ANY EXTRAORDINARY COLLECTION ACTIONS. THE DATA RETURNED FROM THIS ELECTRONIC ELIGIBILITY REVIEW WILL CONSTITUTE ADEQUATE DOCUMENTATION OF FINANCIAL NEED UNDER THIS POLICY. WHEN ELECTRONIC ENROLLMENT IS USED AS THE BASIS FOR PRESUMPTIVE ELIGIBILITY, THE HIGHEST DISCOUNT LEVELS WILL BE GRANTED FOR ELIGIBLE SERVICES FOR RETROSPECTIVE DATES OF SERVICE ONLY. IF A PATIENT DOES NOT QUALIFY UNDER THE ELECTRONIC ENROLLMENT PROCESS, THE PATIENT MAY STILL BE CONSIDERED UNDER THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS. GHS WILL PROVIDE PATIENTS NOT QUALIFYING FOR FINANCIAL ASSISTANCE THROUGH THIS PROCESS WITH A WRITTEN NOTICE INFORMING THEM THAT FINANCIAL ASSISTANCE IS AVAILABLE. THIS NOTICE WILL INCLUDE A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY AND ACTIONS TO BE TAKEN IF AN APPLICATION IS NOT SUBMITTED OR THE OUTSTANDING BALANCE PAID. PATIENT ACCOUNTS GRANTED PRESUMPTIVE ELIGIBILITY WILL BE RECLASSIFIED UNDER THE FINANCIAL ASSISTANCE POLICY. THEY WILL NOT BE SENT TO COLLECTION, WILL NOT BE SUBJECT TO FURTHER COLLECTION ACTIONS, AND WILL NOT BE INCLUDED IN THE HOSPITAL'S BAD DEBT EXPENSE.
Schedule H, Part V, Section B, Line 15 Facility , 1 Facility , 1 - GUNDERSEN LUTHERAN MEDICAL CENTER, INC.. APPLICATION REQUIREMENTS: ELIGIBILITY FOR FINANCIAL ASSISTANCE WILL BE BASED ON FINANCIAL NEED AT THE TIME OF APPLICATION. IN GENERAL, DOCUMENTATION IS REQUIRED TO SUPPORT AN APPLICATION FOR FINANCIAL ASSISTANCE. IF ADEQUATE DOCUMENTATION IS NOT PROVIDED, GHS MAY SEEK ADDITIONAL INFORMATION. RELIABLE EVIDENCE TO SUPPORT THE NEED FOR FINANCIAL ASSISTANCE IS REQUIRED. THE FOLLOWING INCOME DOCUMENTATION IS REQUIRED FROM PATIENTS, OR THEIR GUARANTORS, TO DETERMINE ELIGIBILITY: 1. COPY OF THE FEDERAL TAX RETURN, AND ALL ATTACHED SCHEDULES, FROM THE MOST RECENT TAX YEAR 2. CURRENT PROOF OF INCOME (COPY OF MOST RECENT PAY STUBS OR OTHER DOCUMENTATION) 3. PROOF OF OTHER INCOME, INCLUDING UNEMPLOYMENT, WORKERS' COMPENSATION, ALIMONY, TRUST INCOME, VETERAN'S BENEFITS 4. CURRENT BANK STATEMENTS THE FOLLOWING ASSET DOCUMENTATION IS REQUIRED FROM PATIENTS, OR THEIR GUARANTORS, TO DETERMINE ELIGIBILITY: 1. CHECKING ACCOUNTS 2. SAVINGS ACCOUNTS 3. MONEY MARKET ACCOUNTS 4. CERTIFICATES OF DEPOSIT 5. ANNUITIES 6. NON-RETIREMENT INVESTMENT ACCOUNTS 7. RETIREMENT ACCOUNTS, INCLUDING PENSIONS 8. REAL ESTATE 9. OTHER ASSETS
Schedule H, Part V, Section B, Line 20 Facility , 1 Facility , 1 - GUNDERSEN LUTHERAN MEDICAL CENTER, INC.. NOTIFICATION OF FINANCIAL ASSISTANCE: NOTIFICATIONS OF AVAILABILITY OF FINANCIAL ASSISTANCE ARE INCLUDED ON EVERY PATIENT STATEMENT, PROVIDED AT ADMISSION/CHECK-IN, ARE ANNOUNCED ON SIGNS AT EACH CHECK-IN AREA, AT BEDSIDE FOR PATIENTS DIRECTLY ADMITTED WHO MAY NOT HAVE MET WITH ADMISSIONS STAFF.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2022
Schedule H (Form 990) 2022
Page 9
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?9
Name and address Type of Facility (describe)
1 WINONA MEDICAL CENTER
1122 W HIGHWAY 61
WINONA,MN559871957 		MEDICAL SERVICES
2 GL HOSPICE INDUSTRIAL REHAB BUILDING
1843 SIMS PL
LA CROSSE,WI54601 		HOSPICE SERVICES
3 GL SATELLITE DIALYSIS - ONALASKA
3075 S KINNEY COULEE R
ONALASKA,WI54650 		RENAL DIALYSIS CENTER
4 GL SATELLITE DIALYSIS - TOMAH
505 GOPHER DRIVE
TOMAH,WI54660 		RENAL DIALYSIS CENTER
5 UNITY HOUSE FOR WOMEN
1312 5TH AVE
LA CROSSE,WI54601 		ALCOHOL AND OTHER DRUG ABUSE
6 UNITY HOUSE FOR MEN
1918-1924 MILLER ST
LA CROSSE,WI54601 		ALCOHOL AND OTHER DRUG ABUSE
7 GL SATELLITE DIALYSIS - VIROQUA
407 S MAIN ST
VIROQUA,WI54665 		RENAL DIALYSIS CENTER
8 GL SATELLITE DIALYSIS - PARARIE DU CHIEN
610 E TAYLOR ST
PRAIRE DU CHIEN,WI53821 		RENAL DIALYSIS CENTER
9 GL MENTAL HEALTH DAY TREAT BEHAV HLTH
123 16TH AVE S
ONALASKA,WI54650 		OUTPATIENT PSYCHOLOGICAL
10
Schedule H (Form 990) 2022
Schedule H (Form 990) 2022
Page 10
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
Schedule H, Part I, Line 3c CRITERIA FOR DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE CATASTROPHIC CARE ASSISTANCE: FINANCIAL ASSISTANCE PROVIDED TO ELIGIBLE PATIENTS WITH ANNUALIZED FAMILY INCOMES IN EXCESS OF 400% OF THE FEDERAL POVERTY LEVEL, AND ASSETS OF LESS THAN THE EQUIVALENT OF 600% OF THE FEDERAL POVERTY LEVEL, AND FINANCIAL OBLIGATIONS RESULTING FROM MEDICAL SERVICES PROVIDED BY GHS IN EXCESS OF 25% OF THE FAMILY INCOME. DISCOUNTED CARE: FINANCIAL ASSISTANCE THAT PROVIDES A DISCOUNT, FOR ELIGIBLE MEDICAL SERVICES PROVIDED BY GHS, BASED ON A SLIDING SCALE, FOR ELIGIBLE PATIENTS, OR PATIENT GUARANTORS, WITH ANNUALIZED FAMILY INCOMES BETWEEN 200-400% OF THE FEDERAL POVERTY LEVEL AND ASSETS AT OR BELOW SIX TIMES THE FEDERAL POVERTY LEVEL. 1. FAMILY INCOME ABOVE 200% FPL BUT EQUAL TO OR LESS THAN 225% FPL ARE ELIGIBLE TO RECEIVE A 80% DISCOUNT ON THE PATIENT BALANCE DUE. 2. FAMILY INCOME ABOVE 225% FPL BUT EQUAL TO OR LESS THAN 250% FPL ARE ELIGIBLE TO RECEIVE A 60% POLICY DISCOUNT ON THE PATIENT BALANCE DUE. 3. FAMILY INCOME ABOVE 250% FPL BUT EQUAL TO OR LESS THAN 275% FPL ARE ELIGIBLE TO RECEIVE A 40% DISCOUNT ON THE PATIENT BALANCE DUE. 4. FAMILY INCOME ABOVE 275% FPL BUT EQUAL TO OR LESS THAN 400% FPL ARE ELIGIBLE TO RECEIVE A 20% DISCOUNT ON THE PATIENT BALANCE DUE. FREE CARE: A 100% WAIVER OF PATIENT FINANCIAL OBLIGATION FOR ELIGIBLE MEDICAL SERVICES PROVIDED BY GHS FOR ELIGIBLE PATIENTS, OR THEIR GUARANTORS, WITH ANNUALIZED FAMILY INCOMES AT OR BELOW 200% OF THE FPL WITH ASSETS BELOW THE EQUIVALENT OF 600% OF THE FPL. UNINSURED DISCOUNT: PATIENTS WITH NO THIRD-PARTY COVERAGE WILL BE PROVIDED AN UNINSURED DISCOUNT, FOR ELIGIBLE SERVICES PROVIDED BY GHS UNDER THIS POLICY, AT THE TIME THAT THE UNDISCOUNTED CHARGES ARE RENDERED. SERVICES NOT ELIGIBLE FOR FINANCIAL ASSISTANCE INCLUDE THE FOLLOWING: 1. ELECTIVE PROCEDURES NOT MEDICALLY NECESSARY, AS WELL AS SERVICES TYPICALLY NOT COVERED BY MEDICARE OR DEFINED BY MEDICARE OR OTHER HEALTH INSURANCE COVERAGE AS NOT MEDICALLY NECESSARY. 2. LASIK SURGERY, CHIROPRACTIC CARE, FERTILITY SERVICES, CONTACTS/GLASSES, COSMETIC SURGERY/PLASTIC SERVICES, HEARING AIDS, ORTHODONTICS, DENTAL SERVICES. 3. SERVICES RECEIVED FROM CARE PROVIDERS NOT EMPLOYED BY GHS (E.G. PRIVATE AND/OR NON-GHS MEDICAL OR PHYSICIAN PROFESSIONALS, AMBULANCE TRANSPORT, ETC.). PATIENTS ARE ENCOURAGED TO CONTACT THESE PROVIDERS DIRECTLY TO INQUIRE INTO ANY AVAILABLE ASSISTANCE AND TO MAKE PAYMENT ARRANGEMENTS. SEE APPENDIX 3 FOR FULL LISTING OF PROVIDERS NOT COVERED UNDER THIS POLICY. 4. DEDUCTIBLES AND COINSURANCE ASSOCIATED WITH MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS OUT-OF-NETWORK AS DEFINED BY THEIR INSURERS. 5. Third- part requested exams (e.g. DOT physicals)
Schedule H, Part I, Line 6b COMMUNITY BENEFIT REPORT AVAILABLE TO PUBLIC The community benefit data is filed with the Wisconsin Hospital Association (WHA). The WHA makes an aggregate summary available that includes all Wisconsin hospitals. In addition, the status of the community health implementation plan is updated annually and available on the Gundersen website.
Schedule H, Part I, Line 6a Community benefit report prepared by related organization GUNDERSEN LUTHERAN HEALTH SYSTEM, EIN: 39-1866425
Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation 28263531
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance SCHEDULE H, PART I, LINE 7A FINANCIAL ASSISTANCE AT COST IS FROM THE COST REPORT FOR CHARITY CARE AT COST. THIS IS BASED ON A COST TO CHARGE RATIO OF THE ACTUAL CHARITY CARE WRITTEN-OFF. COST TO CHARGE RATIO, AS CALCULATED USING WORKSHEET 2 METHODOLOGY TO DETERMINE THE COST OF SERVICES PROVIDED TO PATIENTS. MEDICAID AND OTHER MEANS TESTED PROGRAM COMMUNITY BENEFIT EXPENSES FOLLOWED THE CALCULATION METHODOLOGY ON WORKSHEET 3. SCHEDULE H, PART I, LINE 7B MEDICAID COMMUNITY BENEFIT EXPENSE IS CALCUATED USING COST TO CHARGE RATIO OF MEDICAID GROSS CHARGES DECREASED BY MEDICAID PROVIDER TAXES, FEES, AND DIRECT NET PATIENT SERVICE REVENUE. SCHEDULE H, PART I, LINE 7E Community health improvement services and community benefit operations are calculated on Worksheet 4 based on community health improvement cost and community benefit operations cost decreased by community health improvement service revenue. SCHEDULE H, PART I, LINE 7F HEALTH PROFESSIONALS EDUCATION COST IS CALCUATED ON WORKSHEET 5 TO REFLECT THE MEDICAL STUDENT, INTERNS, RESIDENTS, AND FELLOWS COST DECREASED BY REIMBURSEMENTS FROM MEDICARE, MEDICAID, AND TUITION REIMBURSEMENTS. SCHEDULE H, PART I, LINE 7I Community (cash) contributions are funds provided to non-profit organizations (including schools) that support activities, programs and services linked to Gundersen Lutheran's mission, supporting health improvement and overall quality of life for the region. This support serves or supports needs identified in the Community Health Needs Assessment, promote health and wellness, or provides for civic, community and economic development. A significant total is directly linked to our community health implementation plan and supportive of our population health community partners. The work is guided by the Community Benefit and Service Activity Policy. A committee representing the following departments - Administration, Office of Population Health, External Affairs, Business Health Services, The Gundersen Medical Foundation (includes Children's Miracle Network Hospitals), Corporate Communications, Marketing, Family Medicine, and Human Resources (Recruitment and Diversity, Equity and Inclusion) plus community members - meet bi-monthly to determine appropriate distribution of funds. Decisions are guided by established criteria that provide a framework for the committee to objectively determine the outcome of organizations' requests. $1,776,629 supports requests related the 2019-2021 community health implementation plan, that include social determinants of health including homelessness, ACES and RTIC (Adverse Child Experiences and Resilience and Trauma-Informed Care), chronic disease, mental health/substance abuse, and other support for vulnerable populations. Some approved requests are funded over a multi-year period. SCHEDULE H, PART I, LINE 7 COLUMN (F) THE PERCENT OF TOTAL EXPENSE WAS CALCULATED BY DIVIDING THE COMMUNITY BENEFIT COST BY TOTAL HOSPITAL EXPENSES OF $1,263,241,193. THE TOTAL HOSPITAL EXPENSES EXCLUDE THE BAD DEBT EXPENSE OF $28,263,531.
Schedule H, Part II Community Building Activities The Gundersen Health System, which includes Gundersen Lutheran medical Center, is committed to our communities as expressed in our mission: we distinguish ourselves through excellence in patient care, education, research, and improved health in the communities we serve. The community building activities are included in community service reporting which are programs or services that support our population health initiatives, benefiting communities by addressing identified need through effective health improvement programming, economic contribution, corporate citizenship, and volunteerism. Support is provided through contribution to other organizations, or through programming delivered by Gundersen. Whenever possible, this type of programming is evaluated to identify the impact on population health and quality of life. Verification of addressing community needs is documented in the implementation plan. As a larger system, community building activities encompass all corporations. Leadership in community health improvement is evidenced by our activity with several community coalitions and initiatives. As we consider our community needs identified in the compass report, it is evident that health is impacted by not only the traditional sense of provision of quality medical services, but the environment in which we live, the economic condition of our person and family and overall quality of life offered in the communities where we live.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount COST TO CHARGE RATIO WAS OUR STARTING POINT FOR DETERMINING THE COST OF BAD DEBTS. THE COST TO CHARGE RATIO WAS CALCULATED FOLLOWING THE METHODOLOGY ON WORKSHEET 2. BAD DEBT EXPENSE IS THE PRODUCT OF THE COST TO CHARGE RATIO AND THE NET PROVISION FOR BAD DEBTS FROM THE FINANCIAL STATEMENTS.
Schedule H, Part III, Line 3 Bad Debt Expense Methodology THE PATIENTS THAT EXCEED THE 400% FPG, WHEN ADDITIONAL CRITERIA SUCH AS CATASTROPHIC MEDICAL COSTS ARE CONSIDERED, HAPPENS WHEN ELIGIBLE PATIENTS WITH ANNUALIZED FAMILY INCOMES IN EXCESS OF 400% OF THE FEDERAL POVERTY LEVEL, ASSETS OF LESS THAN THE EQUIVALENT OF 600% OF THE FEDERAL POVERTY LEVEL, AND FINANCIAL OBLIGATIONS RESULTING FROM MEDICAL SERVICES PROVIDED BY GHS IN EXCESS OF 25% OF THE FAMILY INCOME. THE DATA USED IS FROM THE US CENSUS BUREAU, 2013-2017 AMERICAN COMMUNITY SURVEY (ACS) 5-YEAR DATA SET FOR THE WISCONSIN AND MINNESOTA COUNTIES. WE OBTAINED THE AVERAGE OF SEVERAL COUNTIES BY USING THE INFORMATION AT THE 3.00-3.99 (399%) OF FEDERAL POVERTY LEVEL (FPL) AND BELOW. THE NEXT RANGE WAS 4.00-4.99 RATIO OF INCOME TO POVERTY IN THE LAST 12 MONTHS. WE HAVE MULTIPLIED THE COUNTY AVERAGE AT 399% FPL TO THE BAD DEBT AT COST. WE DEDUCTED THE AMOUNT OF CHARITY CARE AT COST TO OBTAIN THE AMOUNT OF BAD DEBT AT COST TO PATIENTS ELIGIBLE UNDER FAP (BUT FOR WHOM INSUFFICIENT INFORMATION WAS OBTAINED TO DETERMINE THEIR ELIGIBILITY).
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote THE COLLECTION OF RECEIVABLES FROM THIRD-PARTY PAYERS AND PATIENTS IS THE SYSTEM'S PRIMARY SOURCE OF CASH FOR OPERATIONS. THE PRIMARY COLLECTION RISKS RELATE TO UNINSURED PATIENT ACCOUNTS AND PATIENT DEDUCTIBLES AND COINSURANCE ON INSURERS' ACCOUNTS. PATIENT RECEIVABLES, INCLUDING THE PORTION FOR WHICH A THIRD-PARTY PAYER IS RESPONSIBLE, ARE CARRIED AT NET REALIZABLE VALUE, DETERMINED BY THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED LESS AN ESTIMATE MADE FOR CONTRACTUAL ADJUSTMENTS OR DISCOUNTS PROVIDED TO THIRD-PARTY PAYERS. PATIENT RECEIVABLES DUE DIRECTLY FROM PATIENTS ARE CARRIED ON THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS AT THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED LESS AMOUNTS COVERED BY THIRD-PARTY PAYERS, ALLOWANCES FOR OTHER DISCOUNTS, AND AN ALLOWANCE FOR PRICE CONCESSIONS. THE SYSTEM DOES NOT CHARGE INTEREST ON PAST-DUE RECEIVABLES. RECEIVABLES ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE SYSTEM'S POLICIES. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE. ACCOUNTS RECEIVABLES ARE REDUCED BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE SYSTEM ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS ACCOUNTS AND PROVISION FOR BAD DEBTS. THE ANALYSIS IS PERFORMED USING A HINDSIGHT CALCULATION THAT UTILIZES WRITE-OFF DATA FOR ALL PAYOR CLASSES DURING A DETERMINED TIME PERIOD TO CALCULATE THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AT A POINT IN TIME. THE SYSTEM GRANTS CREDIT WITHOUT COLLATERAL TO PATIENTS, MOST OF WHOM ARE LOCAL RESIDENTS AND ARE INSURED UNDER THIRD-PARTY PAYOR AGREEMENTS. AT NOVEMBER 30, 2022 AND DECEMBER 31, 2021, THE SYSTEM'S ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS WAS $42,902 AND $39,305 (DOLLARS IN THOUSANDS), RESPECTIVELY. THE SYSTEM'S ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AS A PERCENTAGE OF ACCOUNTS RECEIVABLE WAS 15% AT NOVEMBER 30, 2022 AND 18% AT DECEMBER 31, 2021. AT NOVEMBER 30, 2022 AND DECEMBER 31, 2021, AMOUNTS DUE FROM MEDICARE REPRESENTED 16.7% AND 17.3%, RESPECTIVELY, OF THE SYSTEM'S NET PATIENT ACCOUNTS RECEIVABLE. MAJOR PAYOR SOURCES TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs THE MEDICARE COST REPORT IS USED TO DETERMINE ALLOWABLE COSTS. THE UNREIMBURSED MEDICARE COSTS ON PART III, SECTION B OF SCHEDULE H ARE ALLOWABLE COSTS PER THE MEDICARE COST REPORT. THIS CALCULATION IS LIMITED TO PATIENTS WHO ARE COVERED UNDER THE MEDICARE FEE FOR SERVICE PLAN AND DOES NOT INCLUDE THOSE COVERED BY THE MEDICARE ADVANTAGE PLANS. IT ALSO DOES NOT INCLUDE ALL SERVICES PROVIDED BY THE HOSPITAL TO PATIENTS COVERED UNDER THE MEDICARE FEE FOR SERVICE PLAN. IT EXCLUDES HOSPICE SERVICES, AMBULANCE SERVICES, CLINICAL LABORATORY SERVICES, AND A FEW OTHER MISCELLANEOUS SERVICES. INCORPORATING ALL SERVICES TO ALL MEDICARE BENEFICIARIES, THE UNREIMBURSED COST FOR MEDICARE IS $124,765,764. THE MEDICARE COSTS ARE CALCULATED DIFFERENTLY THAN THE 990 UNREIMBURSED MEDICARE COSTS OF $105,391,744. MEDICARE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT BECAUSE OUR MISSION IS TO PROMOTE HEALTH IN THE COMMUNITY AND WE DO NOT LIMIT THE CARE AVAILABLE TO ANY PATIENTS, INCLUDING THOSE COVERED BY MEDICARE. WE ARE RELIEVING A GOVERNMENT BURDEN BY PROVIDING CARE TO MEDICARE PATIENTS EVEN THOUGH COSTS EXCEED REIMBURSEMENTS BY $125 MILLION. TAX-EXEMPT HOSPITALS ARE EXPECTED TO PARTICIPATE IN THE MEDICARE PROGRAM.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance PURSUANT TO SELF-PAY BILLING & COLLECTION POLICY, NO EXTRAORDINARY COLLECTION ACTIONS WILL BE PURSUED AGAINST A PATIENT, OR PATIENT GUARANTOR, BEFORE REASONABLE EFFORTS HAVE BEEN MADE TO DETERMINE WHETHER THE PATIENT OR GUARANTOR IS ELIGIBLE FOR ASSISTANCE UNDER THE GHS FINANCIAL ASSISTANCE POLICY (FAP). NO ACCOUNT WILL BE SUBJECT TO BAD DEBT COLLECTION ACTIONS, OR ECA, WITHIN 120 DAYS OF THE FIRST POST-DISCHARGE STATEMENT BEFORE GHS HAS MADE REASONABLE EFFORTS TO DETERMINE WHETHER THAT PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE. THIS 120 DAY TIMEFRAME MAY BE ABBREVIATED IF A DETERMINATION HAS BEEN MADE ON FINANCIAL ASSISTANCE, A PAYMENT PLAN HAS BEEN ESTABLISHED AND AGREED TO BY THE PATIENT OR GUARANTOR, AND THE PATIENT OR GUARANTOR IS NO LONGER COMPLYING WITH THE PAYMENT PLAN. NO COLLECTION ACTIONS WILL BE PURSUED AGAINST A PATIENT IF THE PATIENT, OR GUARANTOR, HAS PROVIDED DOCUMENTATION SHOWING THAT HE OR SHE HAS APPLIED FOR COVERAGE UNDER MEDICAID, OR OTHER PUBLICLY SPONSORED HEALTH PROGRAMS, THAT MAY PAY THE OUTSTANDING CLAIM AND FOR WHICH AN ELIGIBILITY DETERMINATION IS STILL PENDING. PRIOR TO SENDING A PATIENT'S ACCOUNT TO A COLLECTION AGENCY GHS WILL MAKE REASONABLE EFFORTS TO PROVIDE INFORMATION ON FINANCIAL ASSISTANCE AND WILL MAIL A MINIMUM OF THREE (3) WRITTEN STATEMENTS TO THE PATIENT OR GUARANTOR. EACH STATEMENT WILL INCLUDE CONSPICUOUS NOTICE OF THE GHS FINANCIAL ASSISTANCE POLICY, TELEPHONE NUMBER TO CALL FOR HELP, AND DIRECT WEBSITE ADDRESS. IF ALL EFFORTS TO COMMUNICATE WITH THE PATIENT, OR PATIENT GUARANTOR, ARE UNSUCCESSFUL, AND A CORRECT ADDRESS FOR UNDELIVERABLE MAIL IS NOT FOUND, ACCOUNTS WILL BE SENT TO A COLLECTION AGENCY. WITHIN 240 DAYS FROM THE FIRST POST-DISCHARGE STATEMENT, IF A PATIENT, OR GUARANTOR, APPLIES FOR FINANCIAL ASSISTANCE, THE APPLICATION WILL BE ACCEPTED AND COLLECTION ACTIONS WILL CEASE WHILE AN ELIGIBILITY DETERMINATION IS BEING MADE. IF THE APPLICANT IS APPROVED FOR FREE CARE, NO FURTHER ACTIONS WILL BE TAKEN TO COLLECT ON THE AMOUNT. IF THE APPLICANT IS DENIED FINANCIAL ASSISTANCE OR IS APPROVED FOR DISCOUNTED CARE, STEPS WILL BE TAKEN TO RESOLVE THE OUTSTANDING OBLIGATION. IF THE ACCOUNT IS NOT RESOLVED OR ARRANGEMENTS TO RESOLVE THE ACCOUNT ARE NOT MADE, ADDITIONAL COLLECTION ACTIONS WILL BE PURSUED. IF AN INDIVIDUAL SUBMITS AN INCOMPLETE APPLICATION DURING THE APPLICATION PERIOD, GHS MUST (I) SUSPEND ALL COLLECTION ACTIONS, (II) PROVIDE THE INDIVIDUAL WITH A WRITTEN NOTICE THAT DESCRIBES THE ADDITIONAL INFORMATION AND/OR DOCUMENTATION REQUIRED UNDER THE FAP OR APPLICATION FORM THAT MUST BE SUBMITTED TO COMPLETE THE FAP APPLICATION AND (III) PROVIDE GHS'S CONTACT INFORMATION. THE APPLICATION WILL REMAIN ACTIVE FOR 30 DAYS FROM THE DATE THE LETTER WAS MAILED TO THE APPLICANT REQUESTING THIS INFORMATION. IF THE APPLICANT HAS NOT RESPONDED WITHIN THE 30 DAY TIMEFRAME, THE APPLICATION WILL BE DENIED. APPLICANTS APPROVED FOR FINANCIAL ASSISTANCE WILL BE REFUNDED PAYMENTS IN EXCESS OF THE AMOUNT DETERMINED OWED BY THE PATIENT OR PATIENT'S GUARANTOR ON ACCOUNTS FOR WHICH THEY HAVE BEEN GRANTED ASSISTANCE UNDER THE GHS FAP. REFUNDS APPLY TO EXCESS PAYMENTS OF $15.00 OR MORE. IN ACCORDANCE WITH THIS POLICY, FINANCIAL ASSISTANCE IS GENERALLY NOT EXTENDED FOR CO-PAYMENTS OR A BALANCE REMAINING AFTER THE INSURANCE COMPANY HAS PAID IF A PATIENT FAILS TO OBTAIN PROPER REFERRALS OR AUTHORIZATIONS, OR IF SUCH ASSISTANCE IS NOT IN ACCORDANCE WITH INSURER'S CONTRACTUAL AGREEMENT THEREFORE SUCH PAYMENTS RECEIVED WILL NOT BE REFUNDED. COLLECTION ACTIONS MAY BE UTILIZED BY GHS WHEN PURSUING PAYMENT FROM PATIENTS OR GUARANTORS (I) WITH BALANCES DUE THAT GO UNPAID FOR MORE THAN 120 DAYS WHO DO NOT APPLY FOR FINANCIAL ASSISTANCE, (II) PATIENTS OR GUARANTORS NOT IN CONFORMANCE WITH AN AGREED UPON PAYMENT PLAN, OR (III) PATIENTS OR GUARANTORS WHO ARE NO LONGER COOPERATING IN GOOD FAITH TO PAY OFF THE REMAINING BALANCE. AT LEAST 30 DAYS BEFORE INITIATING ONE OR MORE ECAS TO OBTAIN PAYMENT FOR THE CARE PROVIDED, GHS WILL PROVIDE A PATIENT OR PATIENT'S GUARANTOR WITH A WRITTEN NOTICE THAT INDICATES FINANCIAL ASSISTANCE IS AVAILABLE FOR ELIGIBLE INDIVIDUALS, HOW AN INDIVIDUAL CAN APPLY FOR FINANCIAL ASSISTANCE, AND WHERE THE FAP CAN BE OBTAINED. SUCH WRITTEN NOTICE WILL IDENTIFY THE ECAS THAT GHS OR OTHER AUTHORIZED PARTY INTENDS TO INITIATE TO OBTAIN PAYMENT FOR THE CARE AND INDICATE THE DEADLINE AFTER WHICH SUCH ECAS MAY BE INITIATED. THE DEADLINE WILL BE NO EARLIER THAN THIRTY (30) DAYS AFTER THE DATE THAT THE WRITTEN NOTICE IS PROVIDED TO THE PATIENT OR PATIENT'S GUARANTOR. A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY WILL BE INCLUDED WITH THE NOTICE GHS WILL ALSO MAKE REASONABLE EFFORTS TO ORALLY NOTIFY THE INDIVIDUAL ABOUT GHS FAP AND HOW THE PATIENT CAN OBTAIN ASSISTANCE WITH THE FAP PROCESS.
Schedule H, Part V, Section B, Line 16a FAP website - GUNDERSEN LUTHERAN MED CENTER, INC: Line 16a URL: HTTPS://WWW.GUNDERSENHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE;
Schedule H, Part V, Section B, Line 16b FAP Application website - GUNDERSEN LUTHERAN MED CENTER, INC: Line 16b URL: HTTPS://WWW.GUNDERSENHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website - GUNDERSEN LUTHERAN MED CENTER, INC: Line 16c URL: HTTPS://WWW.GUNDERSENHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE;
Schedule H, Part VI, Line 2 Needs assessment THE GUNDERSEN COMMUNITY HEALTH NEEDS ASSESSMENT UTILIZES THE COMPASS NOW COLLABORATIVE ASSESSMENT THAT INCLUDES 6 COUNTIES IN OUR SERVICE AREA. GUNDERSEN HEALTH SYSTEM DEFINES COMMUNITY BENEFIT AS PROGRAMS OR ACTIVITIES THAT PROVIDE TREATMENT AND/OR PROMOTE HEALTH AND HEALING AS A RESPONSE TO IDENTIFIED COMMUNITY NEEDS, REGARDLESS OF SOURCE OR AVAILABILITY OF PAYMENT. POPULATION HEALTH REFERS TO THE HEALTH AND WELL-BEING OF A POPULATION OR GROUP OF INDIVIDUALS MEASURED BY AGGREGATE HEALTH OUTCOMES (BROADER THAN HEALTH STATUS) OF HEALTH ADJUSTED LIFE EXPECTANCY (QUANTITY AND QUALITY) AS INFLUENCED BY SOCIAL, ECONOMIC, AND PHYSICAL ENVIRONMENTS, PERSONAL HEALTH PRACTICES, INDIVIDUAL CAPACITY AND COPING SKILLS, HUMAN BIOLOGY, EARLY CHILDHOOD DEVELOPMENT, AND HEALTH SERVICES. POPULATION HEALTH INITIATIVES (2022-2024 PLAN) ARE SUBSTANCE ABUSE, MENTAL HEALTH, CHRONIC DISEASE, AND SOCIAL DETERMINANTS OF HEALTH. COMMUNITY SERVICE ACTIVITIES ARE PROGRAMS OR ACTIVITIES THAT PROVIDE A MEASURABLE IMPROVEMENT IN POPULATION HEALTH. THE ACTIVITIES PROVIDED WITHIN OUR COMMUNITIES INCLUDE HEALTH IMPROVEMENT, ADVOCACY FOR PEOPLE WITH DISABILITIES, RECOGNITION OF DIVERSITY AND INCLUSION, MENTAL HEALTH, DOMESTIC VIOLENCE, WORKFORCE DEVELOPMENT, EDUCATION, AND SAFETY. ACTIVITIES ARE GUIDED BY COMMUNITY NEEDS ASSESSMENT AND AS APPROPRIATE, INCLUDED IN OUR IMPLEMENTATION PLAN. NEEDS CAN ALSO BE DOCUMENTED FROM OTHER GROUPS. AS A LARGER SYSTEM, COMMUNITY BUILDING ACTIVITIES ENCOMPASS ALL CORPORATIONS. LEADERSHIP IN COMMUNITY HEALTH IMPROVEMENT IS EVIDENCED BY OUR ACTIVITY WITH SEVERAL COMMUNITY COALITIONS AND INITIATIVES. PARTNERSHIPS ARE CRITICAL TO SUCCESSFUL COMMUNITY OUTCOMES. COMMUNITY SERVICE ACTIVITIES SUPPORT ONE OR MORE OF THE FOLLOWING IMPACT HEALTH STATUS 1. ACCESSIBLE TO THE ENTIRE COMMUNITY REGARDLESS OF ABILITY TO PAY 2. HEALTH PROMOTION 3. SOCIAL DETERMINANTS OF HEALTH CORPORATE CITIZENSHIP ACTIVITIES CAN BE: 1. DIRECT PROGRAM IMPLEMENTATION 2. IN-KIND SUPPORT/INVOLVEMENT (HUMAN RESOURCES) 3. FINANCIAL CONTRIBUTIONS 4. DONATION OF MATERIALS AND EQUIPMENT 5. EMPLOYEE VOLUNTEERISM IN THE COMMUNITY
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance EVERY PATIENT IS MADE AWARE OF THE AVAILABILITY OF FINANCIAL ASSISTANCE UPON CHECK-IN. SIGNS THAT ARE OF NOTICEABLE SIZE AND PLACEMENT ARE DISPLAYED IN EACH CHECK-IN AREA. PATIENTS ARE OFFERED A BROCHURE EXPLAINING THE FINANCIAL ASSISTANCE PROGRAM. PATIENTS THAT MEET WITH FINANCIAL COUNSELORS EITHER BY REFERRAL FROM A DEPARTMENT, OR SELF-REFERRAL ARE INFORMED OF THE FINANCIAL ASSISTANCE PROGRAM. FINANCIAL ASSISTANCE INFORMATION IS POSTED ON GLMC WEBSITE. INFORMATION IS ALSO POSTED IN NOT-FOR-PROFIT ORGANIZATIONS WHERE PATIENTS MIGHT SEEK ASSISTANCE FOR NON-MEDICAL FINANCIAL OBLIGATIONS.
Schedule H, Part VI, Line 4 Community information GUNDERSEN LUTHERAN MEDICAL CENTER INC. IS A MAJOR TERTIARY TEACHING HOSPITAL IN THE GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. LOCATED IN LA CROSSE, WI, THE HOSPITAL SERVES PATIENTS FROM THE LA CROSSE AND SURROUNDING AREAS INCLUDING THE 22 COUNTIES IN WESTERN WISCONSIN, SOUTHEASTERN MINNESOTA, AND NORTHEASTERN IOWA. LA CROSSE COUNTY, WITH A POPULATION OF APPROXIMATELY 122,029 PEOPLE, IS THE LARGEST COMMUNITY IN OUR SERVICE AREA. TOTAL 22 COUNTY SERVICE POPULATION IS APPROXIMATELY 609,591 WITH AN AVERAGE HOUSEHOLD INCOME OF $82,303. 24.38% OF THE 22 COUNTY SERVICE AREA POPULATION IS COVERED BY MEDICAID. THE PROJECTED FIVE-YEAR POPULATION GROWTH IS -0.11%. 20.24% OF THE POPULATION ARE AGE 17 OR YOUNGER. THE SERVICE AREA POPULATION OF 65 AND OLDER ADULTS IS 22.27%. 7.96% OF THE POPULATION IS NON-WHITE. SEVERAL CRITICAL ACCESS HOSPITALS ARE LOCATED THROUGHOUT THE REGION. GUNDERSEN TRI-COUNTY HOSPITAL IN WHITEHALL, WI, GUNDERSEN ST. JOSEPH'S HOSPITAL IN HILLSBORO, WI, GUNDERSEN PALMER LUTHERAN HEALTH CENTER IN WEST UNION, IA, ST. ELIZABETH'S HOSPITAL IN WABASHA, MN, AND GUNDERSEN BOSCOBEL AREA HOSPITAL IN BOSCOBEL, WI ARE PARTNERS/AFFILIATES OF THE GUNDERSEN HEALTH SYSTEM. SPECIALIZED SERVICES PERFORMED AT THE GUNDERSEN LUTHERAN MEDICAL CENTER AND IN MANY CASES, OUTREACH AT OUR REGIONAL CLINIC/HOSPITAL PARTNERS LOCATIONS MAY INCLUDE ALLERGY, AUDIOLOGY, BEHAVIORAL MEDICINE, CARDIOLOGY, CARDIO TESTING LAB, CATH LAB, DERMATOLOGY, ECHOCARDIOGRAPHY, ENDOCRINOLOGY, ENDODONTICS, EXERCISE PHYSIOLOGY, GASTROENTEROLOGY, HEMATOLOGY, HOSPITALIST, INFECTIOUS DISEASE, NEPHROLOGY, NEUROLOGY, NEUROPSYCHOLOGY, NUTRITION THERAPY, OB/GYN, OCCUPATIONAL SERVICES, ONCOLOGY, OPHTHALMOLOGY, OTOLARYNGOLOGY, PATHOLOGY, PEDIATRICS, PERIODONTICS, PHYSICAL MEDICINE AND REHAB, PHYSICAL THERAPY, PLASTIC SURGERY, PODIATRY, PROSTHODONTICS, PSYCHIATRIC, PULMONARY, RENAL DIALYSIS, RHEUMATOLOGY, SPEECH PATHOLOGY, SPORTS MEDICINE, SURGERY, AND UROLOGY. GUNDERSEN PROVIDED CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS. OUR HOSPITAL, LIKE MOST COMMUNITY HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY, CARE THAT WITHOUT OUR HOSPITAL MAY NOT BE AVAILABLE.
Schedule H, Part VI, Line 5 Promotion of community health GUNDERSEN'S BOARD OF TRUSTEES IS COMPRISED OF INDIVIDUALS FROM THE COMMUNITY WHO RESIDE HERE. THESE INDIVIDUALS ARE NOT EMPLOYEES OF THE HEALTH SYSTEM AND DO NOT RECEIVE COMPENSATION. THIS GROUP WORKS WITH THE BOARD OF GOVERNORS, MAKING DECISIONS THAT SUPPORT THE COMMUNITY-BASED MISSION AND VISION OF OUR ORGANIZATION. MANY OTHER EXAMPLES EXIST REFLECTING THE HEALTH SYSTEM'S SUPPORT AND PROMOTION OF THE HEALTH OF THE COMMUNITY. MANY PROGRAMS FOR THE COMMUNITY ARE PROVIDED AT NO COST SUCH AS A PHYSICAL ACTIVITY CHALLENGE, ACES TRAINING FOR COMMUNITY MEMBERS, CHILD RESILIENCE TRAINING FOR PARENTS, AND HEALTH SCREENINGS AT LOCAL EVENTS. A FREE NURSE ADVISOR LINE IS AVAILABLE FOR ALL TO ASSIST CALLERS. PRIORITY ONE DESIGNATION ASSURES HEART ATTACK PATIENTS SEEN IN HOSPITALS THROUGHOUT THE REGION ARE CARED FOR WITH PROVEN PROTOCOLS AND TIMELY PROCEDURES. GUNDERSEN STAFF ARE ENCOURAGED TO PARTICIPATE IN THEIR LOCAL COMMUNITY ORGANIZATIONS. STAFF LEND THEIR EXPERTISE IN LEADERSHIP POSITIONS TO ORGANIZATIONS SUCH AS UNITED WAY, ST. CLARE HEALTH MISSION, CHAMBER OF COMMERCE, COMMUNITY-BASED ORGANIZATIONS, HEALTH IMPROVEMENT INITIATIVES, AND HOMELESSNESS INITIATIVES. STAFF FROM GUNDERSEN HAVE BEEN INSTRUMENTAL IN ACCOMPLISHING COMMUNITY NEEDS ASSESSMENTS AND IMPLEMENTATION OF COMMUNITY INITIATIVES IN AREAS OF OBESITY, ALCOHOL USE, CHILD SAFETY, MENTAL HEALTH, DOMESTIC VIOLENCE, CHILD ABUSE AND ENVIRONMENTAL HEALTH. PATIENT ADVISORY GROUPS FROM VARIOUS SECTORS OF OUR COMMUNITY ARE COORDINATED IN ORDER FOR US TO BETTER MEET THE NEEDS OF OUR PATIENTS.
Schedule H, Part VI, Line 6 Affiliated health care system ALL AFFILIATES OF THE HEALTH SYSTEM HAVE A RESPONSIBILITY TO PROMOTE THE HEALTH OF THE COMMUNITIES WE SERVE. THE MAJORITY OF EMPLOYEES, BASED IN THE ADMINISTRATIVE CORPORATION, ARE ACTIVELY INVOLVED IN PROGRAMS AND SERVICES FOR THE COMMUNITY AS WELL AS MAINTAINING PARTNERSHIPS WITH A VARIETY OF ORGANIZATIONS, COALITIONS, INITIATIVES AND AGENCIES IN OUR COMMUNITIES THAT PROMOTE HEALTH. THE ADMINISTRATIVE CORPORATION ALSO PROVIDES THE FINANCIAL CORPORATE CONTRIBUTIONS TO VARIOUS ORGANIZATIONS AND COMMUNITY ACTIVITIES. OUR FOUNDATION PROVIDES SUPPORT FOR SOME COMMUNITY HEALTH PROMOTION PROGRAMS AS WELL, PROVIDED BY THE HEALTH SYSTEM OR OTHER ORGANIZATIONS IN OUR COMMUNITY. CLINICAL STAFF SUPPORT SCREENINGS AND VOLUNTEER AT THE HEALTH MISSION. OUR LOCAL RURAL HOSPITAL AFFILIATES PROVIDE SUPPORT TO THEIR RESPECTIVE COMMUNITIES. OUR CLINICS, LOCATED IN OVER 30 COMMUNITIES IN 3 STATES, PROVIDE SUPPORT UNIQUE TO THE NEEDS OF THAT COMMUNITY. THE MEDICAL CENTER, AS PART OF AN INTEGRATED HEALTH CARE DELIVERY SYSTEM, WORKS WITH AND IS RELATED TO GUNDERSEN CLINIC, LTD. WHICH PROVIDED UNCOMPENSATED CARE IN THE AMOUNT OF APPROXIMATELY $37,546,005. BASED ON POLICIES AND CONTRACTS ARRANGED TO HELP SUPPORT THE COMMUNITY'S NEEDS RELATED TO HEALTH CARE SERVICES, THE SUM OF UNREIMBURSED MEDICARE & MEDICAID COSTS PLUS CHARITY AT COST WAS $37,546,005. ALL OF THESE ARE CALCULATED USING THE SAME METHOD UTILIZED FOR THE HOSPITAL CALCULATION OF CHARITY COST AND UNREIMBURSED MEDICARE AND MEDICAID COSTS. THE COST OF CHARITY IS CALCULATED BY FOLLOWING THE METHODOLOGY ON WORKSHEET. 1. THE COST TO CHARGE RATIO IS CALCULATED FOLLOWING THE METHODOLOGY ON WORKSHEET. 2. THE UNREIMBURSED MEDICARE AND MEDICAID COSTS ARE CALCULATED BY COMPARING THE COST OF SERVICES TO MEDICARE AND MEDICAID PATIENTS TO THE NET REVENUE FOR THOSE SAME PATIENTS. UNREIMBURSED COST IS THE AMOUNT THE COST EXCEEDS THE NET REVENUE. AMOUNTS ARE REPORTED IN THE SEPARATE 990 FOR GUNDERSEN CLINIC, LTD. AFFILIATED ENTITY CHARITY CARE AN AFFILIATE OF GUNDERSEN LUTHERAN MEDICAL CENTER, INC., GUNDERSEN CLINIC LTD., IS NOT REQUIRED TO FILE SCHEDULE H OF FORM 990. GUNDERSEN CLINIC, LTD. PROVIDED COMMUNITY BENEFIT OF: CHARITY AT COST $728,462 MEDICARE UNREIMBURSED COST $25,400,969 MEDICAID UNREIMBURSED COST $11,416,574
Schedule H, Part VI, Line 7 State filing of community benefit report WI
Schedule H (Form 990) 2022
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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 Medical Center Inc
 
Employer identification number
39-0813416
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) GUNDERSEN LUTHERAN MEDICAL FOUNDATION INC
1836 SOUTH AVENUE
LA CROSSE,WI54601 		39-1249705 501(C)(3) 8,999,124       OPERATING EXPENSE
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
1
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) CHARITY CARE 5671   14,823,690 BOOK CHARITY CARE
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.
Return Reference Explanation
Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. ASSISTANCE WAS MADE TO A RELATED ORGANIZATION AND INDIVIDUALS. THE FUNDS MADE TO RELATED ORGANIZATIONS ARE GIVEN TO HELP WITH OPERATING EXPENSES FOR EXPENSES RELATED TO RESIDENT DOCTORS, RESEARCH, AND FELLOWSHIPS. THE FUNDS MADE TO INDIVIDUALS ARE GIVEN TO HELP PAY FOR MEDICAL BILLS OWED TO GUNDERSEN LUTHERAN MEDICAL CENTER THROUGH A CHARITY CARE APPLICATION PROCESS. THESE FUNDS ARE MONITORED BY MANAGEMENT AND THE BOARD OF TRUSTEES.
Schedule I (Form 990) 2022



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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 Medical Center Inc
 
Employer identification number

39-0813416
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
 
 
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
 
 
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 - MEMBER, CHIEF OF MED. STAFF 		(i)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

(ii)		 0
-------------
212,018 		0
-------------
0 		0
-------------
3,314 		0
-------------
29,814 		0
-------------
8,423 		0
-------------
253,569 		0
-------------
0
37TINA PIKE
 
SENIOR PHYSICIST 		(i)

(ii)		 0
-------------
225,000 		0
-------------
150 		0
-------------
4,889 		0
-------------
31,591 		0
-------------
28,294 		0
-------------
289,924 		0
-------------
0
38KIMBERLY SCHMIDT
 
SENIOR PHYSICIST 		(i)

(ii)		 0
-------------
258,286 		0
-------------
8,180 		0
-------------
668 		0
-------------
38,814 		0
-------------
17,246 		0
-------------
323,194 		0
-------------
0
39KATE SHEEHAN
 
RN, ACUTE HOSPITAL 		(i)

(ii)		 0
-------------
206,108 		0
-------------
160 		0
-------------
1,663 		0
-------------
30,211 		0
-------------
8,426 		0
-------------
246,568 		0
-------------
0
40PAULA STRAND
 
RN, ADMISSION REFERRAL COORDINATOR 		(i)

(ii)		 0
-------------
207,659 		0
-------------
2,800 		0
-------------
3,560 		0
-------------
31,151 		0
-------------
17,246 		0
-------------
262,416 		0
-------------
0
41ASHLEY TAO
 
SENIOR PHYSICIST 		(i)

(ii)		 0
-------------
195,398 		0
-------------
160 		0
-------------
463 		0
-------------
28,607 		0
-------------
9,226 		0
-------------
233,854 		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, Part I, Line 3 Arrangement used to establish the top management official's compensation ALL PERSONNEL SERVICES FOR GUNDERSEN LUTHERAN MEDICAL CENTER, INC. ARE PERFORMED BY EMPLOYEES OF GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICE, INC. AND ALL PAYMENTS TO VENDORS ARE MADE BY GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC.
Schedule J, Part II LEASED EMPLOYEES AND MANAGEMENT SERVICES GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. PROVIDES LEASED EMPLOYEES AND MANAGEMENT SERVICES TO GUNDERSEN LUTHERAN MEDICAL CENTER. THEREFORE THE AMOUNTS REPORTED ON SCHEDULE J REPRESENT REIMBURSEMENTS TO GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC.
Schedule J (Form 990) 2022

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 Medical Center Inc
 
Employer identification number

39-0813416
Return Reference Explanation
Form 990, Part I, Line 1 ORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITES GUNDERSEN LUTHERAN MEDICAL CENTER (GLMC) ESTABLISHED IN 1899, PROVIDES ACUTE AND TERTIARY CARE FOR 22 COUNTIES LOCATED THROUGHOUT WESTERN WISCONSIN, NORTHEASTERN IOWA AND SOUTHEASTERN MINNESOTA. GLMC IS A TEACHING HOSPITAL WITH 325 LICENSED BEDS AND A LEVEL II TRAUMA AND EMERGENCY CENTER. OUR MISSION IS TO DISTINGUISH OURSELVES THROUGH EXCELLENCE IN PATIENT CARE, EDUCATION, RESEARCH AND IMPROVED HEALTH IN THE COMMUNITIES WE SERVE. WE WILL WORK AS A TEAM TO DEMONSTRATE OUR VALUES: INTEGRITY-PERFORM WITH HONESTY, RESPONSIBILITY AND TRANSPARENCY, EXCELLENCE-ACHIEVE EXCELLENCE IN ALL ASPECTS OF DELIVERING HEALTHCARE, RESPECT-TREAT PATIENTS, FAMILIES AND COWORKERS WITH DIGNITY, INNOVATION-EMBRACE CHANGE AND NEW IDEAS, COMPASSION-PROVIDE COMPASSIONATE CARE TO PATIENTS AND FAMILIES.
Form 990, Part III, Line 1 Organizations Mission GUNDERSEN LUTHERAN MEDICAL CENTER (GLMC) A PHYSICIAN-LED, NOT-FOR-PROFIT HEALTHCARE SYSTEM, ESTABLISHED IN 1899, PROVIDES ACUTE AND TERTIARY CARE FOR 22 COUNTIES LOCATED THROUGHOUT WESTERN WISCONSIN, NORTHEASTERN IOWA AND SOUTHEASTERN MINNESOTA. WE SERVE AS A REGIONAL REFERRAL CENTER. GLMC IS A TEACHING HOSPITAL WITH 325 LICENSED BEDS AND A LEVEL II TRAUMA AND EMERGENCY CENTER. OUR MISSION IS TO DISTINGUISH OURSELVES THROUGH EXCELLENCE IN PATIENT CARE, EDUCATION, RESEARCH AND IMPROVED HEALTH IN THE COMMUNITIES WE SERVE. WE WILL WORK AS A TEAM TO DEMONSTRATE OUR VALUES: INTEGRITY - PERFORM WITH HONESTY, RESPONSIBILITY AND TRANSPARENCY, EXCELLENCE - ACHIEVE EXCELLENCE IN ALL ASPECTS OF DELIVERING HEALTHCARE, RESPECT - TREAT PATIENTS, FAMILIES AND COWORKERS WITH DIGNITY, INNOVATION - EMBRACE CHANGE AND NEW IDEAS, COMPASSION - PROVIDE COMPASSIONATE CARE TO PATIENTS AND FAMILIES. OUR CURRENT VISION IS TO ENHANCE THE HEALTH AND WELL-BEING OF OUR COMMUNITIES WHILE ENRICHING EVERY LIFE WE TOUCH, INCLUDING PATIENTS, FAMILIES, AND STAFF.
Form 990, Part III, Line 4a Program Service Accomplishments GLMC PROVIDES A COMPREHENSIVE RANGE OF INPATIENT, CLINICAL AND DIAGNOSTIC SERVICES IN NUMEROUS MEDICAL SPECIALTIES AND SUBSPECIALTIES. GLMC IS A TEACHING HOSPITAL WITH 325 LICENSED BEDS WITH SPECIALTY SERVICES INCLUDING RENAL DIALYSIS, CANCER CARE, REHABILITATION SERVICES, AND CARDIAC SERVICES. IN 2013, GLMC OPENED A NEW INPATIENT BEHAVIORAL HEALTH BUILDING, MEETING A TREMENDOUS NEED IN OUR REGION FOR ADDITIONAL BEDS AND SERVICES. WE ARE ABLE TO PROVIDE CARE LOCALLY FOR PATIENTS OF ALL AGES. THE FACILITY IS THE ONLY PLACE IN THE REGION OFFERING INPATIENT CARE FOR ADOLESCENTS AND TEENAGERS WITH BEHAVIORAL HEALTH NEEDS. GLMC HAS REPEATEDLY BEEN NAMED ONE OF THE TOP 50 HOSPITALS IN THE NATION, PLACING US IN THE TOP ONE PERCENT. GLMC VOLUNTARILY PROVIDES MEDICALLY NECESSARY PATIENT CARE SERVICE THAT IS DISCOUNTED OR FREE OF CHARGE TO PERSONS WHO HAVE INSUFFICIENT RESOURCES AND/OR WHO ARE UNINSURED. DURING 2022, GLMC PROVIDED FINANCIAL ASSISTANCE TO APPROXIMATELY 5,671 PATIENTS THAT RESULTED IN GLMC INCURRING ROUGHLY $14,823,690 IN UNCOMPENSATED COST ASSOCIATED WITH THIS PROGRAM.
Form 990, Part IV, Line 24a GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. IS A PART OF GUNDERSEN LUTHERAN'S OBLIGATED GROUP (GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC., GUNDERSEN LUTHERAN MEDICAL CENTER, INC., GUNDERSEN CLINIC, LTD., AND GUNDERSEN LUTHERAN MEDICAL FOUNDATION, INC.) AND TAX-EXEMPT DEBT RESIDES ON THE BALANCE SHEET OF GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. FEIN 39-1606449
Form 990, Part V, Line 1a 1b, 1c, 2a, and 2b ALL PERSONNEL SERVICES FOR GUNDERSEN LUTHERAN MEDICAL CENTER, INC. ARE PERFORMED BY EMPLOYEES OF GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. AND ALL PAYMENTS TO VENDORS ARE MADE BY GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. HENCE LINES 1 & 2 INDICATE ZERO (0) FILINGS.
Form 990, Part VI, Line 2 Family/business relationships amongst interested persons MARK GLENDENNING AND GERALD ARNDT - Business relationship
Form 990, Part VI, Line 3 Delegation of management duties ALL MANAGEMENT AND PERSONNEL SERVICES FOR GUNDERSEN LUTHERAN MEDICAL CENTER ARE PERFORMED BY EMPLOYEES OF GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICE, INC.
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. THE 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 VICE PRESIDENT OF FINANCE, THE 990S ARE APPROVED AND FILED.
Form 990, Part VI, Line 12c Conflict of interest policy GUNDERSEN LUTHERAN MEDICAL CENTER, INC. MONITORS CONFLICTS ON AN ANNUAL BASIS BY REVIEWING DISCLOSURES ON COMPLETED CONFLICT OF INTEREST STATEMENTS.
Form 990, Part VI, Line 15a Process to establish compensation of top management official ALL PERSONNEL SERVICES FOR GUNDERSEN LUTHERAN MEDICAL CENTER, INC. ARE PERFORMED BY EMPLOYEES OF GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. THE COMPENSATION OF THE CEO IS 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 VII, Section A, Line 1a PART VI, SECTION A, LINE 3 GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. PROVIDES LEASED EMPLOYEES AND MANAGEMENT SERVICES TO GUNDERSEN LUTHERAN MEDICAL CENTER. THEREFOR THE AMOUNTS REPORTED ON PART VII REPRESENT REIMBURSEMENTS TO GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC.
Form 990, Part VII, Section B, Line 1 INDEPENDENT CONTRACTORS ALL PAYMENTS TO VENDORS ARE MADE BY GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC.
Form 990, Part IX, Line 11g Other Fees PURCHASED HEALTH SERVICES - Total Expense: XXX-XX-XXXX, Program Service Expense: XXX-XX-XXXX, Management and General Expenses: 0, Fundraising Expenses: ; PURCHASED PROGRAM SERVICE - Total Expense: 18309691, Program Service Expense: 18249413, Management and General Expenses: 60278, Fundraising Expenses: ; CONSULTING - Total Expense: 866523, Program Service Expense: 445407, Management and General Expenses: 421116, Fundraising Expenses: ;
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 Medical Center Inc
 
Employer identification number

39-0813416
Part I
Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity
(1) GUNDERSEN HEALTH ACCOUNTABLE CARE ORGANIZATION LLC
1910 SOUTH AVE
LA CROSSE,WI54601
39-0813416 		HEALTHCARE WI 0 1,068,002 GLMC
 










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 CLINIC LTD
1836 SOUTH AVENUE

LA CROSSE,WI54601
39-1028657 		HEALTHCARE WI 501(c)(3) 3 GLHS
 
 
No
(3)GUNDERSEN LUTHERAN ADM SERVICES INC
1910 SOUTH AVENUE

LA CROSSE,WI54601
39-1606449 		SUPPORTING ORG WI 501(c)(3) Type II 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
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
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
 
No
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
 
No
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
Yes
 
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 (Form 990) 2021

Additional Data


Software ID: 22016089
Software Version: 2022v5.0