2026-08-14T10:13:27+00:00 2025-09-30 135565207 KPMG LLP 200 EAST RANDOLPH DRIVE SUITE 5500 CHICAGO IL 606016436 990 2024-10-01 390813416 GUNDERSEN LUTHERAN MEDICAL CENTER INC GUND 6087827300 1910 SOUTH AVE LA CROSSE WI 54601 SCOTT RATHGABER M.D. 6087827300 2026-08-14 true true RILEY KOBRICK P02401884 3126651000 2026-08-14 2024 2025-03-06 01:10:19Z SCOTT RATHGABER MD 1910 SOUTH AVE LA CROSSE WI 54601 1731754213 false X WWW.GUNDERSENHEALTH.ORG X 1899 WI GUNDERSEN LUTHERAN MEDICAL CENTER (GLMC) ESTABLISHED IN 1899, PROVIDES ACUTE AND TERTIARY CARE FOR 21 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. 6 0 0 0 553523 0 6552264 2413386 1603269061 1728668868 128336 88646 929187 578523 1610878848 1731749423 45354040 49309265 0 0 0 0 0 0 1485588763 1553667111 1530942803 1602976376 79936045 128773047 2051865606 2183229728 12724717 12304539 2039140889 2170925189 GUNDERSEN LUTHERAN MEDICAL CENTER (GLMC) A PHYSICIAN LED, NOT-FOR-PROFIT HEALTHCARE SYSTEM, ESTABLISHED IN 1899, PROVIDES ACUTE AND TERTIARY CARE FOR 21 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 WELLBEING OF OUR COMMUNITIES WHILE ENRICHING EVERY LIFE WE TOUCH false false 1564497269 49309265 1728668868 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. FOR THE PERIOD OF OCTOBER 1, 2024 THROUGH SEPTEMBER 30, 2025, GLMC PROVIDED ASSISTANCE TO APPROXIMATELY 15,974 PATIENTS THAT RESULTED IN GLMC INCURRING ROUGHLY $36,835,797 IN UNCOMPENSATED COST ASSOCIATED WITH THIS PROGRAM. 1564497269 true true false true false false false false false false true false false true true true false true false false false false false false false false true true true true true false false false false false false false false false false false false false false true true false false false false true 0 0 0 true true false false false false false false false false false false false X 6 0 false true false false true true true true true false false false true true true true true true false false false false MN WI X JOHN CEELEN 6087827300 1900 SOUTH AVENUE NCA1-01 LA CROSSE WI 54601 ANDREA HAUSER RN BOARD OF TRUSTEES, VICE PRESIDENT, ACUTE CARE LA CROSSE & SYSTEM CNO 2.0 48.0 X X 0 289058 64092 BRYAN ERDMANN BOARD OF TRUSTEES, CHIEF OPERATING OFFICER 2.0 48.0 X X 0 443670 76190 HEATHER SCHIMMERS RN BOARD OF TRUSTEES, PRESIDENT 2.0 48.0 X X 0 841877 72275 SCOTT RATHGABER MD BOARD OF TRUSTEES, CHAIRMAN, CEO 2.0 48.0 X X 0 1324275 73275 TODD KOWALSKI MD BOARD OF TRUSTEES, MEDICAL CHIEF OPERATING OFFICER 2.0 48.0 X X 0 557485 77690 JENNIFER KLEVEN MD BOARD OF TRUSTEES 2.0 48.0 X 0 405613 52221 CHRISTINE WALLER MD MEDICAL VP, ACUTE CARE AND NURSING & SYSTEMS PRACTICES 2.0 48.0 X 0 560569 83319 DANIEL LILLY SECRETARY, CHIEF LEGAL OFFICER 2.0 48.0 X 0 617635 74467 JOHN CEELEN TREASURER, CHIEF FINANCIAL OFFICER 2.0 48.0 X 0 728316 54052 KELLEY BAHR MD MEDICAL VICE PRESIDENT, AMBULATORY SERVICES 2.0 48.0 X 0 442809 71967 KRAIG SCHUSTER VICE PRESIDENT 2.0 48.0 X 0 316352 58202 MICHAEL MCKEE VICE PRESIDENT 2.0 48.0 X 0 290401 71251 MICHELLE MICKA VICE PRESIDENT, FINANCE & ACCOUNTING 2.0 48.0 X 0 379411 72275 PETER VANDENHOUTEN SR VP LEGAL COUNSEL 2.0 48.0 X 0 629937 85132 RACHEL ALBRECHT VICE PRESIDENT 2.0 48.0 X 0 245331 56807 ROBERT HOLNESS MD MEDICAL VP, COMMUNITY AND CMO-CRITICAL ACCESS HOSPITALS 2.0 48.0 X 0 637179 64017 ROBYN BORGE MD MEDICAL VICE PRESIDENT, CROSS-FUNCTIONAL CARE 2.0 48.0 X 0 443350 48639 STEPHANIE NEUMAN MD MEDICAL VICE PRESIDENT, AMBULATORY SERVICES 2.0 48.0 X 0 578420 77190 TINA LECHNIR VICE PRESIDENT 2.0 48.0 X 0 245956 58682 ELLEN PEDRETTI-FENDT VICE PRESIDENT, BUSINESS PARTNERING AND SERVICE DELIVERY 0.0 0.0 X 0 228664 59128 ERIC DEHN VICE PRESIDENT, DIGITAL SOLUTIONS AND ENTERPRISE ARCHITECTURE 0.0 50.0 X 0 313406 65708 JANINE LUZ-JENSEN VICE PRESIDENT, TALENT ACQUISITION, TALENT DEVELOPMENT, & LEARNING 0.0 50.0 X 0 246063 52763 KARI ADANK VICE PRESIDENT, COMPLIANCE 0.0 50.0 X 0 269642 60140 KRISTER MATTSON VICE PRESIDENT, ENTERPRISE ANALYTICS AND DATA SCIENCE 0.0 50.0 X 0 305605 56203 MARILU BINTZ MD MEDICAL VP, COMMUNITY AND CMO-CRITICAL ACCESS HOSPITALS 0.0 2.0 X 0 261160 38627 SHANNON MULLIGAN VICE PRESIDENT, HR & TOTAL REWARDS 0.0 0.0 X 0 288578 19870 STEPHANIE CARROLL MD MEDICAL VICE PRESIDENT 0.0 50.0 X 0 322275 67169 STEPHEN SHAPIRO MD CHIEF MEDICAL FOUNDATION OFFICER 0.0 50.0 X 0 548480 63970 STEVE LITTLE FORMER CHIEF FINANCIAL OFFICER 0.0 0.0 X 0 209856 0 0 12971373 1775321 true true false 0 1512214 877681 23491 2413386 MEDICAL SERVICES PROVIDED 621500 1726555497 1726555497 CAFETERIA AND VENDING MACHINE 621500 2113371 2113371 0 0 0 0 1728668868 93436 93436 25000 25000 0 25000 25000 0 4790 0 -4790 -4790 -4790 LABORATORY SERVICES 621511 493523 493523 HELICOPTER DISPATCH SERVICES 561421 60000 60000 0 0 0 0 553523 1731749423 1726555497 553523 2227017 X 12473468 12473468 36835797 36835797 223966822 194892207 29074615 210104310 210104310 0 0 26394 26082 312 13383947 13365887 18060 1464213 1464213 4580948 4256042 324906 404473 393805 10668 140881 137444 3437 141326 140978 348 27685402 25519798 2165604 338372 338372 LEASED EMPLOYEES 655063774 648583517 6480257 SUPPLIES 356894726 356845693 49033 BAD DEBT 40037887 40037887 RECRUITING/EMPLOYEE DEVELOPMENT/TAXES 17595922 17591764 4158 1837714 1828377 9337 0 1602976376 1564497269 38479107 0 1946616 2410448 174203921 77102475 0 0 8298262 9726965 608770813 348586763 275245358 260184050 2000000 2000000 0 0 1590171449 1831805790 2051865606 2183229728 3036767 3068350 1650086 0 9687950 7586103 12724717 12304539 X 2039140889 2170925189 2039140889 2170925189 2051865606 2183229728 X 128773047 3011253 X false true true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 0 0 470625 0 470625 1602976376 3192999412 1602976376 3193470037 1000000 1000000 250000 250000 0 0 0 0 1000000 1000000 1000000 1000000 4000000 6000000 242027 276873 429679 470625 1419204 250000 250000 250000 250000 1000000 1500000 0 0 0 SCHEDULE C, PART II-A, LINE 2C, COLUMN (E) THE 4-YEAR AVERAGE PERIOD INCLUDES THE CURRENT AND 4 PRIOR TAX PERIODS, WHICH EXCLUDES A SHORT YEAR PERIOD FROM JANUARY 1, 2023, THROUGH SEPTEMBER 30, 2023. THE 4 PERIODS INCLUDED IN THE AVERAGE ARE 2022, SHORT YEAR 2023, FISCAL YEAR 2023, AND FISCAL YEAR 2024. 4239043 4239043 435792135 210750045 225042090 145930601 122562640 23367961 22809034 15274078 7534956 260184050 INTERCOMPANY RECEIVABLES 1810828952 OTHER RECEIVABLES 18323170 RIGHT OF USE ASSETS 2653668 1831805790 FEDERAL INCOME TAXES LEASE CONTRACT PAYABLE CURRENT AND LONG-TERM 4398380 OPERATING LEASE OBLIGATIONS 2589619 LONG-TERM MALPRACTICE CLAIMS RESERVE 264179 ASSET RETIREMENT OBLIGATION-FIN47 333925 7586103 X 0 0 0 0 0 0 0 0 0 0 0 0 SCHEDULE D, PART X, LINE 2 FIN 48 (ASC 740) FOOTNOTE THE SYSTEM AND MOST OF ITS SUBSIDIARIES ARE CLASSIFIED AS TAX-EXEMPT ORGANIZATIONS AS DESCRIBED IN SECTIONS 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND ARE NOT SUBJECT TO FEDERAL AND STATE INCOME TAXES ON RELATED INCOME, PURSUANT TO SECTION 501(A) OF THE CODE. THESE ORGANIZATIONS ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES TO THE EXTENT THEY HAVE UNRELATED BUSINESS INCOME. THE SYSTEM HAS NO MATERIAL UNCERTAIN TAX POSITIONS. CERTAIN SUBSIDIARIES ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES. SOME OF THESE CORPORATIONS HAVE ACCUMULATED NET OPERATING LOSS CARRYFORWARDS THAT ARE AVAILABLE TO OFFSET FUTURE TAXABLE INCOME, IF ANY, AND HAVE BEEN FULLY RESERVED. true true X true X true X true true true false true true 15974 22578793 0 22578793 0.01445 97908931 64305919 33603012 0.02150 0 0 0 0.0 0 15974 120487724 64305919 56181805 0.03595 494110 26137 467973 0.00030 19485655 6537429 12948226 0.00828 0 0 0 0.0 0 0 0 0.0 727100 0 727100 0.00047 0 0 20706865 6563566 14143299 0.00905 0 15974 141194589 70869485 70325104 0.04500 40840 40840 0.00003 29000 29000 0.00002 0 0 0.0 7000 7000 0.00000 0 0 0.0 0 0 0.0 0 0 0.0 105800 105800 0.00007 0 0 0.0 0 0 182640 0 182640 0.00012 true 12406752 0 166672578 232078510 -65405932 X true true 1 1 GUNDERSEN LUTHERAN MEDICAL CENTER INC 1910 SOUTH AVENUE LA CROSSE WI 54601 WWW.GUNDERSENHEALTH.ORG 23 X X X X X GUNDERSEN LUTHERAN MEDICAL CENTER INC 1 false false true X X X X X X X X X X 24 true true true true X https://www.gundersenhealth.org/document/46971 https://www.gundersenhealth.org/document/46971 X X true 24 true https://www.gundersenhealth.org/document/48471 false true X 200.0 400.0 X X X true true X X X X true X HTTPS://WWW.GUNDERSENHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE X HTTPS://WWW.GUNDERSENHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE X HTTPS://WWW.GUNDERSENHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE X X X X X X true X false X X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 3 FACILITY , 1 FACILITY , 1 - GUNDERSEN LUTHERAN MEDICAL CENTER, INC.. THE COMPASS NOW 2024 REPORT HTTPS://WWW.GREATRIVERSUNITEDWAY.ORG/WP-CONTENT/UPLOADS/2024/08/COMPASS-NOW-2024_WEB.PDF, INCLUDES 6 COUNTIES IN THE GUNDERSEN LUTHERAN MEDICAL CENTER'S SERVICE AREA. THESE 6 COUNTIES REPRESENT APPROXIMATELY 72% OF OUR HOSPITAL SERVICE PATIENT POPULATION, AND 43% OF THE OVERALL POPULATION (266,496 OF 615,362) OF OUR 21-COUNTY SERVICE AREA. IT IS IMPORTANT TO NOTE THAT IN ADDITION TO THE COMPASS NOW 2024 REPORT, THE 21- COUNTY HEALTH INDICATOR REPORT WAS GENERATED, HTTPS://WWW.GUNDERSENHEALTH.ORG/DOCUMENT/46971, TO IDENTIFY THE HEALTH NEEDS OF THE BROADER GUNDERSEN LUTHERAN MEDICAL CENTER'S 21-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/46971. STUDY METHODS FOR THE COMPASS NOW 2024 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 SUPPLEMENTAL CONVENIENCE SURVEY AND KEY INFORMANT INTERVIEWS; 3) PRIORITIZATION OF THE TOP NEEDS FACILITATED FOR THE 6 COUNTY STAKEHOLDER GROUPS. THE STUDY WAS CONDUCTED IN 2023 AND 2024 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. 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, AND MONROE COUNTIES IN WISCONSIN, AND HOUSTON COUNTY IN MINNESOTA. COMMUNITY BASED ORGANIZATIONS REPRESENTED INCLUDED THE GREAT RIVERS UNITED WAY, AMERICAN LUNG ASSOCIATION, ABLE INC, GREAT RIVERS HUB, AND COULEE CAP. ALL INDIVIDUALS ARE LISTED BY NAME IN THE REPORT. COMMUNITY DEMOGRAPHICS FOR THE COMPASS NOW 2024 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, HEALTH CARE ACCESS AND UTILIZATION, SOCIAL/ECONOMIC FACTORS, AND PHYSICAL ENVIRONMENT. COMMUNITY SURVEY RESPONDENTS RATED VARIOUS ASPECTS OF THESE MODULES. SUPPLEMENTAL INDICATORS INCLUDE LEADING CAUSES OF DEATH, MATERNAL AND INFANT HEALTH INDICATORS, YOUTH RISK INDICATORS, CHILD SERVICES CASES, 211 ASSISTANCE CALLS, ASSET-LIMITED, INCOME-CONSTRAINED, AND EMPLOYED (ALICE) HOUSEHOLDS. SCHEDULE H, PART V, SECTION B, LINE 5 FACILITY , 1 FACILITY , 1 - GUNDERSEN LUTHERAN MEDICAL CENTER, INC.. A COMMUNITY SURVEY, USING CONVENIENCE SAMPLING WAS CONDUCTED THROUGHOUT THE REGION FROM JUNE TO SEPTEMBER OF 2023. THE PURPOSE OF THE SURVEY WAS TO INVITE COMMUNITY INSIGHTS ABOUT HEALTH NEEDS IN THE REGION. THE SURVEY WAS CONDUCTED USING MIXED METHODS, AND RESPONDENTS COULD EITHER COMPLETE THEIR SURVEY ONLINE OR SUBMIT A PAPER COPY OF THEIR SURVEY RESPONSE. GREAT RIVERS UNITED WAY STAFF AND VOLUNTEERS ENTERED PAPER SURVEY RESPONSES INTO A QUALTRICS SURVEY PORTAL PROVIDED BY COMMUNITY HEALTH SOLUTIONS. THE SURVEY WAS CONDUCTED IN PARTNERSHIP WITH A WIDE RANGE OF COMMUNITY PARTNERS THAT HELPED RAISE AWARENESS AND ENCOURAGE COMMUNITY MEMBERS TO COMPLETE THE SURVEY. IN PLANNING THE SURVEY, THE PROJECT PARTNERS BEGAN WITH A COMMON AIM TO CONDUCT AN INCLUSIVE SURVEY WITH INSIGHTS FROM A WIDE ARRAY OF COMMUNITY MEMBERS. A TOTAL OF 1,238 INDIVIDUALS SUBMITTED A RESPONSE TO THE SURVEY. THE SURVEY RESPONDENTS WERE PREDOMINANTLY FEMALE (77%), AS IS COMMON IN COMMUNITY SURVEY OF THIS TYPE. BEYOND THE DIFFERENCE IN FEMALE VS. MALE RESPONDENTS, THE DEMOGRAPHIC PROFILE FOR SURVEY RESPONDENTS GENERALLY (THOUGH NOT PRECISELY) REFLECTS THE OVERALL DISTRIBUTION OF THE POPULATION BY SELECTED INDICATORS OF AGE, RACE, ETHNICITY, AND INCOME. IN ADDITION TO THE COMMUNITY SURVEY, THE PROJECT PARTNERS CONDUCTED A SERIES OF 'COMMUNITY INSIGHT EVENTS' WHERE COMMUNITY MEMBERS WERE INVITED TO SHARE THEIR INSIGHTS ABOUT COMMUNITY NEEDS IN A GROUP SETTING. PARTICIPANTS INCLUDED GENERAL COMMUNITY MEMBERS AND REPRESENTATIVES FROM LOCAL BUSINESSES, EDUCATION, FAITH, GOVERNMENT, HEALTH AND HUMAN SERVICES, AND NONPROFIT AGENCIES WITH FIRST-HAND KNOWLEDGE OF PUBLIC HEALTH AND SOCIAL NEEDS OF THE RESIDENTS OF THE COMMUNITIES. A TOTAL OF 20 COMMUNITY INSIGHT EVENTS WERE CONDUCTED IN THE AUGUST-OCTOBER TIME FRAME. WITHIN EACH EVENT THE PARTICIPANTS WERE INVITED TO SHARE THEIR INSIGHTS IN RESPONSE TO THESE QUESTIONS FOCUSING ON IMPORTANT HEALTH ISSUES OR CONCERNS FACING COMMUNITY, NEW OR EMERGING HEALTH ISSUES OR CONCERNS, VULNERABLE POPULATION GROUPS, AVAILABLE HEALTH RESOURCES AND IDEAS ON HOW ORGANIZATIONS CAN WORK BETTER TOGETHER TO PROMOTE BETTER HEALTH OR HEALTH CARE FOR THE COMMUNITY. 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.. ABLE, INC., ALLINA HEALTH, ARCADIA PUBLIC LIBRARY, ASHLEY WELLNESS CENTER, BLAIR-TAYLOR SCHOOL DISTRICT, BOYS AND GIRLS CLUBS OF GREATER LA CROSSE, BUFFALO COUNTY, BUFFALO COUNTY BOARD, BUFFALO COUNTY EMERGENCY MANAGEMENT, BUFFALO COUNTY HEALTH DEPARTMENT, BUFFALO COUNTY SHERIFF'S DEPARTMENT, CALEDONIA SCHOOL DISTRICT, CAMPBELL FAMILY GROUP HOME, CASA FOR KIDS, INC., CHILEDA, CITY OF CALEDONIA, CITY OF LA CROSSE - FIRE DEPARTMENT, CITY OF MONDOVI, COULEE RECOVERY CENTER, COULEECAP, INC., FAMILY AND CHILDREN'S CENTER, FIRST NATIONAL BANK & TRUST COMPANY. GALE-ETTRICK-TREMPEALEAU SCHOOL DISTRICT, GATEWAY AREA COUNCIL, BOY SCOUTS OF AMERICA, GREAT RIVERS 211, GREAT RIVERS UNITED WAY, GUNDERSEN HEALTH SYSTEM, GUNDERSEN ST. JOSEPH'S HOSPITAL & CLINICS, GUNDERSEN TRI-COUNTY HOSPITAL & CLINICS, HILLSBORO CITY COUNCIL, HOPE FLOATS, HOPE4U, HOUSTON COUNTY COMMISSIONERS, HOUSTON COUNTY PUBLIC HEALTH, HUNGER TASK FORCE, IMMANUEL LUTHERAN CHURCH, INDEPENDENCE SCHOOL DISTRICT, LA CROSSE AREA FAMILY YMCA, LA CROSSE COUNTY ADMINISTRATION, ECONOMIC & COMMUNITY DEVELOPMENT, LA CROSSE COUNTY BOARD, LA CROSSE COUNTY HEALTH DEPARTMENT, LA CROSSE COUNTY HUMAN SERVICES, LA CROSSE MEDICAL HEALTH SCIENCE CONSORTIUM, LEADERETHICS, MAYO CLINIC HEALTH SYSTEM, MINNESOTA DEPARTMENT OF HEALTH, MONROE COUNTY CHILD SUPPORT, MONROE COUNTY HEALTH DEPARTMENT, MONROE COUNTY HUMAN SERVICES, NEXT STEPS FOR CHANGE, ODCORP, OUTDOOR RECREATION ALLIANCE, PLANNED PARENTHOOD OF WISCONSIN, SCENIC BLUFFS COMMUNITY HEALTH CENTERS, SCENIC RIVERS AHEC, SCHOOL DISTRICT OF HILLSBORO, SCHOOL DISTRICT OF HOLMEN SCHOOL, DISTRICT OF LA CROSSE, SCHOOL DISTRICT OF MONDOVI, SCHOOL DISTRICT OF ONALASKA, SECOND HARVEST FOOD PANTRY, SEMCAC, ST. CLARE HEALTH MISSION, STATE OF WISCONSIN, OHS, THE NATURE PLACE, THE PARENTING PLACE, THE SALVATION ARMY, TOGETHER WITH VETERANS, TOMAH AREA SCHOOL DISTRICT, TOMAH HEALTH, TREMPEALEAU COUNTY, TREMPEALEAU COUNTY HEALTH DEPARTMENT, UNIVERSITY OF WISCONSIN - LA CROSSE, UW-MADISON EXTENSION - MONROE COUNTY, UW-MADISON EXTENSION - VERNON COUNTY, VERNON COUNTY HEALTH DEPARTMENT, VERNON COUNTY OVER 50, VERNON MEMORIAL HEALTHCARE, VIROQUA AREA SCHOOLS, VIROQUA VARIETY, VITERBO UNIVERSITY, WESTERN DAIRYLAND, HEAD START, WHITEHALL AREA CHAMBER OF COMMERCE, WINONA STATE UNIVERSITY DEPARTMENT OF NURSING. SCHEDULE H, PART V, SECTION B, LINE 7 FACILITY , 1 FACILITY , 1 - GUNDERSEN LUTHERAN MEDICAL CENTER, INC. AVAILABLE BY CONTACTING AMANDA WESTPHAL, PHONE 608-775-3412 OR 800-362-9567, EXT. 53412 OR EMAIL AJWESTPH@EMPLIFYHEALTH.ORG SCHEDULE H, PART V, SECTION B, LINE 11 FACILITY , 1 FACILITY , 1 - GUNDERSEN LUTHERAN MEDICAL CENTER, INC. EMPLIFY HEALTH ADDRESSED SIGNIFICANT COMMUNITY HEALTH NEEDS IN FY25 THROUGH SCREENING, REFERRAL, EDUCATION, DIRECT SERVICE, AND COMMUNITY PARTNERSHIPS. FOR MENTAL HEALTH AND ACCESS TO CARE, THE ORGANIZATION SCREENED PATIENTS AND WORKSITE PARTICIPANTS FOR DEPRESSION AND ANXIETY RISK, PROVIDED FOLLOW-UP RESOURCES, AND CONNECTED INDIVIDUALS TO PRIMARY CARE, EAP, AND COMMUNITY SUPPORTS. COMMUNITY RESOURCE CONNECTORS REVIEWED SOCIAL DRIVERS OF HEALTH SCREENINGS AND LINKED PATIENTS TO APPROPRIATE COMMUNITY RESOURCES. EMPLIFY HEALTH ALSO OFFERED STRESS MANAGEMENT COACHING AND SUPPORTED COMMUNITY-BASED MENTAL HEALTH INITIATIVES, INCLUDING SCHOOL-BASED EDUCATION, SCREEN TIME AWARENESS, AND PLANNING FOR ADDITIONAL COMMUNITY INTERVENTIONS. FOR SUBSTANCE USE, EMPLIFY HEALTH PROVIDED TOBACCO CESSATION INTERVENTIONS, QUITLINE REFERRALS, COACHING, AND VAPING PREVENTION EDUCATION. THE ORGANIZATION ALSO MONITORED OPIOID PRESCRIBING AND PARTICIPATED IN COMMUNITY COLLABORATIONS TO ADDRESS OPIOID USE DISORDER AND RELATED EMERGENCY DEPARTMENT UTILIZATION. FOR FOOD INSECURITY, EMPLIFY HEALTH CONTINUED SOCIAL DETERMINANTS OF HEALTH SCREENING AND REFERRAL WORKFLOWS, OPERATED THE COMMUNITY RESOURCE CONNECTOR PROGRAM, PROVIDED SUMMER MEALS TO CHILDREN, AND SUPPORTED FOOD ACCESS THROUGH COMMUNITY PARTNERSHIPS AND FOOD DONATIONS. SOME SIGNIFICANT NEEDS WERE NOT FULLY ADDRESSED IN FY25 AT THE ORIGINAL TARGET LEVELS BECAUSE EXISTING WORKFLOWS, STAFFING, AND REFERRAL CAPACITY DID NOT SUPPORT FULL IMPLEMENTATION AT SCALE. IN PARTICULAR, CERTAIN SOCIAL DRIVERS OF HEALTH REFERRAL GOALS WERE REVISED AFTER RE-EVALUATION TO REFLECT MORE REALISTIC OPERATIONAL CAPACITY AND TO IMPROVE THE QUALITY AND EFFECTIVENESS OF REFERRALS. FY25 EFFORTS FOCUSED ON BUILDING INFRASTRUCTURE, PILOTING NEW APPROACHES, STRENGTHENING COMMUNITY PARTNERSHIPS, AND DEVELOPING SUSTAINABLE STRATEGIES FOR FUTURE IMPLEMENTATION. ADDITIONAL DETAIL ON FY25 ACTIVITIES AND OUTCOMES IS AVAILABLE IN THE FY25 CHIP PROGRESS REPORT: HTTPS://GUNDERSEN.WIDEN.NET/S/DNHD2RPCDV/2025-2027-CHIP-PROGRESS-UPDATE 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. AN ASSET TEST IS NOT APPLICABLE TO FAMILIES WITH ANNUAL INCOME AT OR BELOW 200% OF THE MOST CURRENT FPG OR SERVICE AREAS THAT PARTICIPATE IN THE NATIONAL HEALTH SERVICE CORPS PROGRAM (NHSC). 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. AN ASSET TEST IS NOT APPLICABLE TO FAMILIES WITH ANNUAL INCOME AT OR BELOW 200% OF THE MOST CURRENT FPG OR SERVICE AREAS THAT PARTICIPATE IN THE NATIONAL HEALTH SERVICE CORPS PROGRAM (NHSC). 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 FOR THIRTY (30) DAYS (COPY OF MOST RECENT PAY STUBS OR OTHER DOCUMENTATION) 3. PROOF OF OTHER INCOME FOR THIRTY (30) DAYS, 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 (30) DAYS 2. SAVINGS ACCOUNTS (30) DAYS 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 9 WINONA MEDICAL CENTER 1122 W HIGHWAY 61 WINONA MN 559871957 MEDICAL SERVICES GL HOSPICE INDUSTRIAL REHAB BUILDING 1843 SIMS PL LA CROSSE WI 54601 HOSPICE SERVICES GL SATELLITE DIALYSIS-ONALASKA 3075 S KINNEY COULEE RD ONALASKA WI 54650 RENAL DIALYSIS CENTER UNITY HOUSE FOR WOMEN 1312 5TH AVE LA CROSSE WI 54601 ALCOHOL AND OTHER DRUG ABUSE UNITY HOUSE FOR MEN 1918-1924 MILLER ST LA CROSSE WI 54601 ALCOHOL AND OTHER DRUG ABUSE GL SATELLITE DIALYSIS-TOMAH 505 GOPHER DRIVE TOMAH WI 54650 RENAL DIALYSIS CENTER GL SATELLITE DIALYSIS-VIROQUA 407 S MAIN ST VIROQUA WI 54665 RENAL DIALYSIS CENTER GL SATELLITE DIALYSIS-PRAIRIE DU CHIEN 610 E TAYLOR ST PRAIRIE DU CHIEN WI 53821 RENAL DIALYSIS CENTER GL MENTAL HEALTH DAY TREAT BEHAV HEALTH 123 16TH AVE S ONALASKA WI 54650 OUTPATIENT PSYCHOLOGICAL 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-PARTY 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 40037887 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. IN FY2024, $974,406 WAS APPROVED THAT SUPPORTED REQUESTS THAT INCLUDED COMMUNITY ACTIVITIES RELATED TO THE 2022-2024 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, AS WELL AS ECONOMIC DEVELOPMENT, AND CORPORATE CITIZENSHIP. 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 EXPENSE OF $1,562,938,489. THE TOTAL HOSPITAL EXPENSES EXCLUDE THE BAD DEBT EXPENSE OF $40,037,887. SCHEDULE H, PART II COMMUNITY BUILDING ACTIVITIES THE EMPLIFY HEALTH SYSTEM, WHICH INCLUDES GUNDERSEN LUTHERN MEDICAL CENTER, IS COMMITTED TO OUR COMMUNITIES AS EXPRESSED IN OUR MISSION: WE INSPIRE YOUR BEST LIFE BY RELENTLESSLY CARING, LEARNING, AND INNOVATING. 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 EXPLICIT PRICE CONCESSIONS 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. THE SYSTEM GRANTS CREDIT WITHOUT COLLATERAL TO PATIENTS, MOST OF WHOM ARE LOCAL RESIDENTS AND ARE INSURED UNDER THIRD-PARTY PAYER AGREEMENTS. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR PRICE CONCESSIONS. THE ESTIMATES FOR IMPLICIT PRICE CONCESSIONS ARE BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL WRITE-OFFS AND EXPECTED NET COLLECTIONS; BUSINESS AND ECONOMIC CONDITIONS; TRENDS IN FEDERAL, STATE, AND PRIVATE EMPLOYER HEALTH CARE COVERAGE; AND OTHER COLLECTION INDICATORS. MANAGEMENT RELIES ON THE RESULTS OF DETAILED REVIEWS OF HISTORICAL WRITE-OFFS AND COLLECTIONS OF REVENUES AND ACCOUNTS RECEIVABLE AS A PRIMARY SOURCE OF INFORMATION IN ESTIMATING THE COLLECTABILITY OF ITS ACCOUNTS RECEIVABLE. MANAGEMENT UPDATES THE RETROSPECTIVE ANALYSIS AT LEAST QUARTERLY. CHANGES IN ESTIMATES HAVE NOT RESULTED IN SIGNIFICANT ADJUSTMENTS TO VALUATIONS OF ACCOUNTS RECEIVABLE OR PERIOD-TO-PERIOD COMPARISONS OF RESULTS OF OPERATIONS. AT SEPTEMBER 30, 2025 AND 2024, AMOUNTS DUE FROM MEDICARE REPRESENTED 30.7% AND 23.0%, RESPECTIVELY, OF THE SYSTEM'S PATIENT ACCOUNTS RECEIVABLE. 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 HARE 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 $42,542,741. THE MEDICARE COSTS ARE CALCULATED DIFFERENTLY THAN THE 990 UNREIMBURSED MEDICARE COSTS OF $65,405,932. 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 $42 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 $5.00 OR MORE. IN ACCORDANCE WITH THIS POLICY, FINANCIAL ASSISTANCE IS GENERALLY NOT EXTENDED FOR CO-PAYMENTS OR A BALANCE REMAINING AFTER THE INSURANCE COMPANY HAS PAID IF A PATIENT FAILS TO OBTAIN PROPER REFERRALS OR AUTHORIZATIONS, OR IF SUCH ASSISTANCE IS NOT IN ACCORDANCE WITH 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 MEDICAL 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 MEDICAL 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 MEDICAL CENTER, INC: LINE 16C URL: HTTPS://WWW.GUNDERSENHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE; SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT THE EMPLIFY HEALTH BY GUNDERSEN COMMUNITY HEALTH NEEDS ASSESSMENT UTILIZES THE COMPASS NOW COLLABORATIVE ASSESSMENT THAT INCLUDES 6 COUNTIES IN OUR SERVICE AREA. EMPLIFY HEALTH BY GUNDERSEN 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 (2025-2027 PLAN) ARE SUBSTANCE ABUSE, MENTAL HEALTH INCLUDING HEALTHCARE ACCESS, AND SOCIAL AND ECONOMIC ISSUES INCLUDING HEALTHY FOOD. 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 DRIVERS 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 EMPLIFY HEALTH SYSTEM. LOCATED IN LA CROSSE, WI, THE HOSPITAL SERVES PATIENTS FROM LA CROSSE AND SURROUNDING AREAS, INCLUDING 21 COUNTIES IN WESTERN WISCONSIN, SOUTHEASTERN MINNESOTA, AND NORTHEASTERN IOWA. LA CROSSE COUNTY, WITH A POPULATION OF APPROXIMATELY 121,637 PEOPLE, IS THE LARGEST COMMUNITY IN OUR SERVICE AREA. TOTAL 21 COUNTY SERVICE POPULATION IS APPROXIMATELY 605,618 WITH AN AVERAGE MEDIAN OF THE COUNTY INCOMES OF $69,131. 11% OF THE 21 COUNTY SERVICE AREA POPULATION IS COVERED BY MEDICAID. THE PROJECTED FIVE-YEAR POPULATION GROWTH IS .04%. 21% OF THE POPULATION ARE AGE 17 OR YOUNGER. THE SERVICE AREA POPULATION OF 65 AND OLDER ADULTS IS 23%. 5% 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, GUNDERSEN ST. ELIZABETH'S HOSPITAL IN WABASHA, MN, AND GUNDERSEN BOSCOBEL AREA HOSPITAL IN BOSCOBEL, WI ARE REGIONAL PARTNERS/AFFILIATES OF THE GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., MAKING UP THE SOUTHERN REGION OF EMPLIFY HEALTH. EACH OF THESE HOSPITALS CONDUCTS THEIR OWN COMMUNITY HEALTH NEEDS ASSESSMENT AND DEVELOPS A RESPONDING COMMUNITY HEALTH IMPROVEMENT PLAN. 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 FOLLOWS ITS FINANCIAL ASSISTANCE POLICY, PROVIDED CHARITY CARE AND OFFERED OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS. OUR HOSPITAL, LIKE MOST COMMUNITY HOSPITALS, WAS CREATED AND IS MAINTAINED SO THAT CARE CAN BE PROVIDED LOCALLY; CARE THAT WITHOUT OUR HOSPITAL MAY NOT BE AVAILABLE. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH IN 2024 THE GUNDERSEN LUTHERAN HEALTH SYSTEM BOARD APPROVED THE COMMUNITY HEALTH NEEDS ASSESSMENT AND THE COMMUNITY HEALTH IMPROVEMENT PLAN. THIS GROUP LEADS THE ORGANIZATION, 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 VAPING EDUCATION IN PARTNERSHIP WITH LOCAL SCHOOL DISTRICTS, CHILD RESILIENCE TRAINING 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 TO HELP US 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 GUNDERSEN HEALTH SYSTEM 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 $602,631,227. 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 $602,631,227. 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 $2, 216,661 MEDICARE UNREIMBURSED COST $470,613,243 MEDICAID UNREIMBURSED COST $129,801,322 SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT WI true GUNDERSEN LUTHERAN MEDICAL FOUNDATION INC 1836 SOUTH AVENUE LA CROSSE WI 54601 391249705 501 (C)(3) 12470494 OPERATING EXPENSE 1 0 CHARITY CARE 15974 36835797 BOOK CHARITY CARE 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 THE 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. true true false false false false false false false BRYAN ERDMANN BOARD OF TRUSTEES, CHIEF OPERATING OFFICER 0 443062 0 0 0 608 0 48300 0 27890 0 519860 0 0 ANDREA HAUSER RN BOARD OF TRUSTEES, VICE PRESIDENT, ACUTE CARE LA CROSSE & SYSTEM CNO 0 284754 0 0 0 4304 0 40425 0 23667 0 353150 0 0 TODD KOWALSKI MD BOARD OF TRUSTEES, MEDICAL CHIEF OPERATING OFFICER 0 556671 0 0 0 814 0 48300 0 29390 0 635175 0 0 SCOTT RATHGABER MD BOARD OF TRUSTEES, CHAIRMAN, CEO 0 1278368 0 0 0 45907 0 48300 0 24975 0 1397550 0 0 HEATHER SCHIMMERS RN BOARD OF TRUSTEES, PRESIDENT 0 638010 0 198913 0 4954 0 48300 0 23975 0 914152 0 0 JENNIFER KLEVEN MD BOARD OF TRUSTEES 0 404840 0 0 0 773 0 47659 0 4562 0 457834 0 0 STEVE LITTLE FORMER CHIEF FINANCIAL OFFICER 0 209856 0 0 0 0 0 0 0 0 0 209856 0 0 RACHEL ALBRECHT VICE PRESIDENT 0 236468 0 0 0 8863 0 34132 0 22675 0 302138 0 0 KELLEY BAHR MD MEDICAL VICE PRESIDENT, AMBULATORY SERVICES 0 438005 0 0 0 4804 0 48300 0 23667 0 514776 0 0 ROBYN BORGE MD MEDICAL VICE PRESIDENT, CROSS-FUNCTIONAL CARE 0 438000 0 0 0 5350 0 48300 0 339 0 491989 0 0 JOHN CEELEN TREASURER, CHIEF FINANCIAL OFFICER 0 598104 0 129468 0 744 0 29147 0 24905 0 782368 0 0 ROBERT HOLNESS MD MEDICAL VP, COMMUNITY AND CMO-CRITICAL ACCESS HOSPITALS 0 589004 0 0 0 48175 0 40350 0 23667 0 701196 0 0 TINA LECHNIR VICE PRESIDENT 0 236727 0 0 0 9229 0 33863 0 24819 0 304638 0 0 DANIEL LILLY SECRETARY, CHIEF LEGAL OFFICER 0 514649 0 97000 0 5986 0 48300 0 26167 0 692102 0 0 MICHAEL MCKEE VICE PRESIDENT 0 289289 0 0 0 1112 0 41410 0 29841 0 361652 0 0 MICHELLE MICKA VICE PRESIDENT, FINANCE & ACCOUNTING 0 374568 0 0 0 4843 0 48300 0 23975 0 451686 0 0 STEPHANIE NEUMAN MD MEDICAL VICE PRESIDENT, AMBULATORY SERVICES 0 575671 0 2500 0 249 0 48300 0 28890 0 655610 0 0 KRAIG SCHUSTER VICE PRESIDENT 0 309504 0 0 0 6848 0 43680 0 14522 0 374554 0 0 PETER VANDENHOUTEN SR VP LEGAL COUNSEL 0 407252 0 182656 0 40029 0 69350 0 15782 0 715069 0 39255 CHRISTINE WALLER MD MEDICAL VP, ACUTE CARE AND NURSING & SYSTEMS PRACTICES 0 555596 0 0 0 4973 0 48300 0 35019 0 643888 0 0 KARI ADANK VICE PRESIDENT, COMPLIANCE 0 268610 0 0 0 1032 0 37844 0 22296 0 329782 0 0 MARILU BINTZ MD MEDICAL VP, COMMUNITY AND CMO-CRITICAL ACCESS HOSPITALS 0 109201 0 100000 0 51959 0 36295 0 2332 0 299787 0 0 STEPHANIE CARROLL MD MEDICAL VICE PRESIDENT 0 305920 0 15667 0 688 0 39470 0 27699 0 389444 0 0 ERIC DEHN VICE PRESIDENT, DIGITAL SOLUTIONS AND ENTERPRISE ARCHITECTURE 0 312797 0 0 0 609 0 44118 0 21590 0 379114 0 0 JANINE LUZ-JENSEN VICE PRESIDENT, TALENT ACQUISITION, TALENT DEVELOPMENT, & LEARNING 0 241385 0 0 0 4678 0 34216 0 18547 0 298826 0 0 KRISTER MATTSON VICE PRESIDENT, ENTERPRISE ANALYTICS AND DATA SCIENCE 0 305177 0 0 0 428 0 38458 0 17745 0 361808 0 0 SHANNON MULLIGAN VICE PRESIDENT, HR & TOTAL REWARDS 0 232590 0 0 0 55988 0 9464 0 10406 0 308448 0 0 ELLEN PEDRETTI-FENDT VICE PRESIDENT, BUSINESS PARTNERING AND SERVICE DELIVERY 0 226752 0 0 0 1912 0 32340 0 26788 0 287792 0 0 STEPHEN SHAPIRO MD CHIEF MEDICAL FOUNDATION OFFICER 0 547371 0 0 0 1109 0 48300 0 15670 0 612450 0 0 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 I, LINE 4A SEVERANCE OR CHANGE-OF-CONTROL PAYMENT SHANNON MULLIGAN RECEIVED SEVERANCE PAYMENTS DURING THE CALENDAR YEAR PURSUANT TO A CONFIDENTIAL SEVERANCE AGREEMENT. THE PAYMENT IS INCLUDED IN PART VII, COLUMN D AND SCHEDULE J, PART II, COLUMN B(III). SCHEDULE J, PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN CERTAIN INDIDVIDUALS LISTED IN SCHEDULE J, PART II, PARTICIPATE IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN TO WHICH THE ORGANIZATION MAKES ANNUAL CONTRIBUTIONS. THESE CONTRIBUTIONS ARE AT RISK AND DO NOT BECOME VESTED AND PAYABLE UNLESS AND UNTIL THE INDIVIDUAL SATISFIES A SUBSTANTIAL FUTUTE SERVICE REQUIREMENT. THE FOLLOWING INDIVIDUALS HAD CONTRIBUTIONS MADE TO THE PLAN FOR CALENDAR YEAR 2024: PETER VANDENHOUTEN, JOHN CEELEN BELLIN MEMORIAL HOSPITAL, A RELATED PARTY, HAS A DEFERRED COMPENSATION PLAN FOR SELECTED EXECUTIVES. PETER VANDENHOUTEN PARTICIPATED IN THE 457(F) PLAN. THE FOLLOWING INDIVIDUAL, LISTED ON PART VII OF FORM 990, HAD THE FOLLOWING AMOUNTS DISTRIBUTED DURING CALENDAR YEAR 2024: PETER VANDENHOUTEN $39,255 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, INC. THEREFORE, THE AMOUNTS REPORTED ON SCHEDULE J REPRESENT REIMBURSEMENTS TO GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. FORM 990, PART VI, LINE 15A ALL PERSONNEL SERVICES FOR GUNDERSEN LUTHERAN MEDICAL CENTER, INC. ARE PERFORMED BY EMPLOYEES OF GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. THE COMPENSATION OF THE CEO IS 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 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 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 IS REVIEWED BY THE ACCOUNTING MANAGER AND PRINCIPAL OFFICER. IT WILL BE MADE AVAILABLE FOR ALL BOARD MEMBERS BEFORE FILING. FORM 990, PART VI, LINE 12C CONFLICT OF INTEREST POLICY GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. (GLAS) ANNUALLY REQUIRES EXECUTIVE LEADERSHIP (VICE PRESIDENTS AND ABOVE), BOARD MEMBERS, MEDICAL GOVERNORS AND FOUNDATION BOARD MEMBERS TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT. COMPLETED DISCLOSURE STATEMENTS ARE REVIEWED BY A CONFLICT OF INTEREST REVIEW PANEL WHICH INCLUDES REPRESENTATIVES FROM LEGAL, COMPLIANCE, MEDICAL LEADERSHIP, HUMAN RESOURCES AND SUPPLY CHAIN. INDIVIDUALS REPORTING A POTENTIAL CONFLICT OF INTEREST ARE SENT A RESOLUTION THANKING THEM FOR THEIR SERVICE TO THE ORGANIZATION, ADVISING THEM OF ANY RESTRICTIONS RELATED TO THEIR CONFLICT (I.E. INDIVIDUALS WITH A RELATIONSHIP TO ANOTHER ORGANIZATION ARE ADVISED THAT THEY MUST ABSTAIN FROM DECISION MAKING THAT WOULD DIRECTLY AND SOLELY IMPACT GLAS) AND REMINDING THEM OF THEIR CONFIDENTIALITY OBLIGATIONS WITH RESPECT TO GLAS' HEALTHCARE, EMPLOYMENT AND PROPRIETARY INFORMATION. FORM 990, PART VI, LINE 19 REQUIRED DOCUMENTS AVAILABLE TO THE PUBLIC 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 IX, LINE 11G OTHER FEES PURCHASED HEALTH SERVICES - TOTAL EXPENSE: XXX-XX-XXXX, PROGRAM SERVICE EXPENSE: XXX-XX-XXXX, MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; PURCHASED PROGRAM SERVICES - TOTAL EXPENSE: 22729787, PROGRAM SERVICE EXPENSE: 22729787, MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; CONSULTING - TOTAL EXPENSE: 4956730, PROGRAM SERVICE EXPENSE: 4956730, MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS OR FUND BALANCES EQUITY TRANSFER - 3011253; TOTAL - 3011253; 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. 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. GUNDERSEN HEALTH ACCOUNTABLE CARE ORGANIZATION LLC 1910 SOUTH AVE LA CROSSE WI 54601 871018008 HEALTHCARE WI 0 1458470 GLMC BELLIN GUNDERSEN HEALTH SYSTEM INC 1836 SOUTH AVENUE LA CROSSE WI 54601 920504278 SUPPORT ORG WI 501(C)(3) TYPE III-FI NA false GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1836 SOUTH AVE LA CROSSE WI 54601 391866425 SUPPORT ORG WI 501(C)(3) TYPE II BGHS false GUNDERSEN CLINIC LTD 1836 SOUTH AVENUE LA CROSSE WI 54601 391028657 HEALTHCARE WI 501(C)(3) 3 GLHS false GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES INC 1910 SOUTH AVE LA CROSSE WI 54601 391606449 SUPPORT ORG WI 501(C)(3) TYPE II GLHS false GUNDERSEN LUTHERAN MEDICAL FOUNDATION INC 1836 SOUTH AVENUE LA CROSSE WI 54601 391249705 FOUNDATION WI 501(C)(3) 7 GLHS false TRI-COUNTY MEMORIAL HOSPITAL INC 18601 LINCOLN STREET WHITEHALL WI 54773 390704510 HEALTHCARE WI 501(C)(3) 3 GLHS false HARMONY COUMMUNITY HEALTHCARE INC 815 MAIN AVE SOUTH HARMONY MN 55939 410711606 HEALTHCARE MN 501(C)(3) 10 GLHS false TWEETEN LUTHERAN HEALTHCARE CENTER INC 125 FIFTH AVE SE SPRING GROVE MN 55974 411565003 HEALTHCARE MN 501(C)(3) 10 GLHS false TRI STATE AMBULANCE INC 235 CAUSEWAY BOULEVARD LA CROSSE WI 54603 391965415 MEDICAL TRANSPORT WI 501(C)(3) 3 GLHS false TRI-STATE REGIONAL AMBULANCE INC 235 CAUSEWAY BOULEVARD LA CROSSE WI 54603 391962965 MEDICAL TRANSPORT WI 501(C)(3) 10 GLHS false LUTHERAN REAL ESTATE HOLDING CORPORATION 1910 SOUTH AVENUE LA CROSSE WI 54601 391480826 HOUSING WI 501(C)(3) TYPE III-FI GLHS false COMMUNITY HOUSING OF LA CROSSE INC 1900 SOUTH AVENUE LA CROSSE WI 54601 391586700 INDEPENDENT LIVING WI 501(C)(3) 10 LREH CORP false LUTHERAN HOUSING OF LA CROSSE INC 1900 SOUTH AVENUE LA CROSSE WI 54601 391751934 INDEPENDENT LIVING WI 501(C)(3) 10 LREH CORP false ST JOSEPH'S HEALTH SERVICES INC 400 WATER AVE HILLSBORO WI 54634 390929538 HEALTHCARE WI 501(C)(3) 3 GLHS false ST JOSEPH MEMORIAL FOUNDATION INC 400 WATER AVE HILLSBORO WI 54634 391455787 FOUNDATION WI 501(C)(3) TYPE I STJ HLTH SVC false TRI-COUNTY MEMORIAL FOUNDATION INC 18601 LINCOLN STREET WHITEHALL WI 54773 300093022 FOUNDATION WI 501(C)(3) TYPE I TCH false MEMORIAL HOSPITAL OF BOSCOBEL 205 PARKER STREET BOSCOBEL WI 53805 390845590 HEALTHCARE WI 501(C)(3) 3 GLHS false PALMER LUTHERAN HEALTH CENTER INC 112 JEFFERSON STREET WEST UNION IA 52175 421320763 HEALTHCARE IA 501(C)(3) 3 GLHS false MOUNDVIEW MEMORIAL HOSPITALS AND CLINICS 402 WEST LAKE STREET FRIENDSHIP WI 53934 390944012 HEALTHCARE WI 501(C)(3) 3 GLHS false MEMORIAL HEALTHCARE FOUNDATION INC 402 WEST LAKE STREET FRIENDSHIP WI 53934 391775074 FOUNDATION WI 501(C)(3) TYPE I MDV HOSP false SAINT ELIZABETH'S HOSPITAL OF WABASHA INC 1200 FIFTH GRANT BLVD WEST WABASHA MN 55981 410693877 HEALTHCARE MN 501(C)(3) 3 GLHS false BELLIN HEALTH SYSTEMS INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 391512904 SUPPORT ORG WI 501(C)(3) TYPE II BGHS false LAKE MICHIGAN HEALTH SERVICES INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 391512903 SUPPORT ORG WI 501(C)(3) TYPE II BHS false BELLIN COLLEGE INC 3201 EATON ROAD GREEN BAY WI 54311 391620530 EDUCATION WI 501(C)(3) 2 BHS false BELLIN PSYCHIATRIC CENTER INC PO BOX 23725 GREEN BAY WI 54301 391657627 HEALTHCARE WI 501(C)(3) 3 BHS false BELLIN MEMORIAL HOSPITAL INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 390884478 HEALTHCARE WI 501(C)(3) 3 BHS false THE BELLIN HEALTH FOUNDATION INC PO BOX 23400 GREEN BAY WI 54301 391809171 FOUNDATION WI 501(C)(3) 7 BHS false OCONTO HOSPITAL & MEDICAL CENTER INC 820 ARBUTUS AVENUE OCONTO WI 54153 061745397 HEALTHCARE WI 501(C)(3) 3 BMH false GUNDERSEN LUTHERAN ENVISION LLC 1836 SOUTH AVENUE LA CROSSE WI 54601 264706546 RENEWABLE ENERGY WI NA C CORPORATION false BEL-REGIONAL HOME MEDICAL INC 617 S ROOSEVELT GREEN BAY WI 54301 391504766 DURABLE MEDICAL EQUIPMENT, RETAIL WI NA C CORPORATION false GUNDERSEN EDGE LLC 1836 SOUTH AVENUE LA CROSSE WI 54601 921783811 INNOVATION WI NA C CORPORATION false BG ASSURANCE COMPANY 20 GENESIS CLOSE PO BOX 30600 GEORGE TOWN GRAND CAYMAN CJ KY11203 SELF INSURANCE CJ NA C CORPORATION false false true true false false false false false false false true true true true true true true true true GUNDERSEN LUTHERAN MEDICAL CENTER INC 1910 SOUTH AVE LA CROSSE WI 54601 390813416 X 0 0 0 1602976376 1602976376 1000000 250000 0 0 0 GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES INC 1910 SOUTH AVENUE LA CROSSE WI 54601 391606449 X 0 437650 437650 1205516671 1205954321 1000000 250000 0 0 0 GUNDERSEN LUTHERAN MEDICAL CENTER INC 1910 SOUTH AVENUE LA CROSSE WI 54601 390813416 X 0 0 0 1602976376 1602976376 1000000 250000 0 0 0 GUNDERSEN CLINIC LTD 1836 SOUTH AVENUE LA CROSSE WI 54601 391028657 X 0 32975 32975 384506365 384539340 1000000 250000 0 0 0 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1836 SOUTH AVENUE LA CROSSE WI 54601 391866425 X 0 0 0 0 0 0 0 0 0 0