2018-11-14T14:49:17-06:00 2017-12-31 KPMG LLP 4200 WELLS FARGO CTR 90 S 7TH ST MINNEAPOLIS MN 55402 990 2017-01-01 391606449 Gundersen Lutheran Administrative Services Inc % Perry Breazeale GUND 6087827300 1910 SOUTH AVE LA CROSSE WI 54601 PERRY BREAZEALE Exec. Dir. Finance 6087754443 2018-11-08 true MONROE J GIERL P01413237 6123055000 2018-11-08 167.68.102.5 41438720183185000001 2018-11-14 P 80A177424C680C2DAD2A222932BC57697C814DAD 1AC817DA654FAC82C3A77F7D3F33864379930489 2017 2019-02-21 02:37:17Z GUNDERSEN ADMIN SERVICES INC SCOTT RATHGABER MD CEO 1910 SOUTH AVE LA CROSSE WI 54601 716893606 false X WWW.GUNDERSENHEALTH.ORG X 1987 WI TO SUPPORT GUNDERSEN HEALTH SYSTEM'S HEALTH CARE AND OTHER ORGS MISSIONS THROUGHOUT OUR SERVICE AREA, MANAGING THE LARGER PORTION OF BUSINESS SVCS, EDUCATION AND INVESTING. 13 4 9739 623 0 0 495719 441872 684153839 687179666 42699655 28033820 324066 476557 727673279 716131915 15949000 1494750 0 0 625140833 643652174 0 0 0 102177059 109464251 743266892 754611175 -15593613 -38479260 860542249 941583564 877494737 956164090 -16952488 -14580526 X See Schedule O. false false 742213233 373750 687179666 GENERAL SERVICES PROVIDED TO GUNDERSEN CLINIC, LTD., GUNDERSEN LUTHERAN MEDICAL FOUNDATION, INC., GUNDERSEN LUTHERAN MEDICAL CENTER, INC. AND OTHER AFFILIATES: ADMINISTRATIVE, INFORMATION SYSTEMS, BILLING AND CODING, LAUNDRY, MEDICAL RECORDS, HUMAN RESOURCES, FINANCE, FACILITY OPERATIONS, CENTRAL SERVICES AND OTHER MISCELLANEOUS SERVICES. 742213233 true true false true false false false false false false true false false false true true false true false false false false false false false false false true false true true false false false false false true false false true false false false false false false true true false false false true 567 0 true 9739 true false false false false false false false false false false X 13 4 true false false false true true true true true false false true true true true true true true true false WI X Perry Breazeale 6087754443 1910 SOUTH AVENUE NCA1-01 LA CROSSE WI 54601 X Scott Rathgaber MD Chief Executive Officer 42.0 6.0 X X 887280 0 63882 Wendy Lommen Board of Trustees - Chair 2.0 4.0 X X 0 0 0 John Lyche Board of Trustees - Secretary 2.0 4.0 X X 0 0 0 Gerald Arndt Board of Trustees - Member 2.0 6.0 X 0 0 0 Gerald Kember BOT - Member Thru 7-1-2017 2.0 6.0 X 0 0 0 Mark Glendenning Board of Trustees - Vice Chair 2.0 4.0 X X 0 0 0 Brad Sturm Board of Trustees - Treasurer 2.0 4.0 X X 0 0 0 Dan Florness Board of Trustees - Member 2.0 4.0 X 0 0 0 Rick Radcliffe Board of Trustees - Member 2.0 4.0 X 0 0 0 Stephen Shapiro MD Board of Trustees - Member 42.0 7.0 X 457596 0 64982 Brian Sieck MD Board of Trustees - Member 42.0 8.0 X 403930 0 64932 Kelley Bahr MD Board of Trustees - Member 42.0 6.0 X 362802 0 35510 Jonathan Zlabek MD Board of Trustees - Member 42.0 6.0 X 315951 0 64882 Greg Thompson MD BOT - Member, CMO 42.0 6.0 X X 443048 0 63132 Elizabeth Smith-Houskamp Vice President, Admin COO 42.0 8.0 X 410284 0 39150 Michael Dolan MD Exec VP, Medical COO 42.0 6.0 X 572038 0 62382 Marilu Bintz MD Senior Vice President, CMO 42.0 7.5 X 561138 0 49546 Rose Ann-Laureto Chief Information Officer 42.0 7.0 X 424937 0 48546 Dara Bartels Chief Financial Officer 42.0 6.0 X 366280 0 64382 P Michael Jacobs DPM Medical Vice President 40.0 2.0 X 363780 0 64882 Mary Kuffel MD Medical Vice President 40.0 1.0 X 491214 0 40542 Stephanie Carroll MD Medical Vice President 40.0 0.0 X 306262 0 54618 Todd Kowalski MD Medical Vice President 40.0 0.0 X 363014 0 63132 Lisa Wied Vice President 40.0 0.0 X 207042 0 55188 Mike McKee Vice President 40.0 2.5 X 204496 0 56182 Kraig Schuster Vice President 40.0 2.0 X 213834 0 54378 Bryan Erdmann Vice President 40.0 2.0 X 250355 0 62331 Garith Steiner Vice President 40.0 0.0 X 250881 0 33125 Kathleen Klock Senior Vice President 40.0 1.3 X 446372 0 59174 Mary Ellen McCartney Senior Vice President 40.0 0.0 X 211514 0 41827 Jean Krause Senior Vice President 40.0 3.3 X 242400 0 45614 Daniel Lange MD Medical Doctor 40.0 0.0 X 855978 0 63882 Kurt Mueller MD Medical Doctor 40.0 0.0 X 831780 0 62382 Collin Driscoll MD Medical Doctor 40.0 0.0 X 802298 0 62382 Martin Koop MD Medical Doctor 40.0 0.0 X 780930 0 40542 Premnauth Rabindranauth MD Medical Doctor 40.0 0.0 X 725174 0 62382 Jeffrey Thompson MD Former CEO 40.0 0.0 X 251343 0 62626 Debra Rislow Former SVP, Admin COO 0.0 0.0 X 165445 0 3915 13169396 0 1610430 866 true true false GUNDERSEN LUTHERAN MEDICAL CENTER 1910 SOUTH AVENUE LA CROSSE WI 54601 SERVICES/SUPPLIES 472882048 FOWLER AND HAMMER INC 313 MONITOR STREET LA CROSSE WI 54603 BUILDING CONTRACTOR 10576699 FORSYTHE SOLUTIONS GROUP INC PO BOX 772951 CHICAGO IL 606770251 SOFTWARE CONSULTANTS 4494070 EPIC SYSTEM CORPORATION BOX 88314 MILWAUKEE WI 532880314 SOFTWARE CONSULTANTS 3913446 Metro Aviation Inc PO Box 7008 Shreveport LA 71137 Contracted Service 3708728 372 81321 350551 10000 441872 Service Provided to Gundersen 561000 687179666 687179666 687179666 28271279 28271279 0 0 1000789 524232 476557 0 476557 476557 237459 -237459 -237459 -237459 0 0 0 0 0 0 0 0 0 0 716131915 687179666 0 28510377 1494750 1494750 0 0 0 6176513 1631364 4545149 0 498964198 495169820 3794378 56594039 55717210 876829 51123939 51123939 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0 COMMUNITY HOUSING OF LA CROSSE INC 391586700 10 false 0 0 GUNDERSEN CLINIC LTD 391028657 3 true 0 0 GUNDERSEN LUTHERAN MEDICAL CENTER INC 390813416 3 true 0 0 GUNDERSEN LUTHERAN MEDICAL FOUNDATION 391249705 7 false 0 0 HARMONY COMMUNITY HEALTH CARE 410711606 7 false 0 0 LUTHERAN HOUSING OF LA CROSSE INC 391751934 10 false 0 0 MEMORIAL HOSPITAL OF BOSCOBEL 390845590 3 false 0 0 MEMORIAL HOSPITAL OF BOSCOBEL FOUNDATION INC 391688793 7 false 0 0 PALMER LUTHERAN HEALTH CENTER INC 421320763 3 false 0 0 Palmer Memorial Foundation 421032878 7 false 0 0 ST JOSEPH HEALTH SERVICES INC 390929538 3 false 0 0 TRI-COUNTY MEMORIAL HOSPITAL INC 390704510 3 false 0 0 TRI-STATE AMBULANCE INC 391965415 3 false 0 0 TRI-STATE REGIONAL AMBULANCE INC 391962965 10 false 0 0 TWEETEN LUTHERAN HEALTHCARE CENTER INC 411565003 10 false 0 0 Moundview Memorial Hospitals & Clinics 390944012 3 false 0 0 Memorial HC FDTN of Adams County Inc 391775074 10 false 0 0 18 false false false false true true true false false false false false false false false false true Sch A Part I Line 12g GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES IS AN INTEGRAL PART OF THE GUNDERSEN LUTHERAN HEALTH SYSTEM AND PROVIDES SUPPORT TO EACH OF THE ORGANIZATIONS LISTED; HOWEVER, SUCH SERVICES CANNOT EASILY BE QUANTIFIED IN DOLLAR-BASED TERMS. Sch A Part II Line 5a Supported Organizations new in 2017: Moundview Memorial Hospitals & Clinics EIN: 39-0944012 Memorial HC FDTN of Adams County, Inc. EIN: 39-1775074 Sch A Part IV Section A THE ARTICLES OF INCORPORATION OF GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. (GLAS) PROVIDE THAT IT SHALL "SUPPORT, OPERATE FOR THE BENEFIT OF, PERFORM THE FUNCTIONS OF, AND CARRY OUT SOME OR ALL OF THE CHARITABLE PURPOSES OF GUNDERSEN LUTHERAN, INC., GUNDERSEN CLINIC, LTD., GUNDERSEN LUTHERAN MEDICAL CENTER, INC. AND THEIR NONPROFIT AFFILIATES (HEREAFTER REFERRED TO AS THE "GUNDERSEN LUTHERAN HEALTH SYSTEM") SO LONG AS THOSE ORGANIZATIONS ARE DESCRIBED IN SECTION 509(A)(1) OR 509(A)(2) OF THE INTERNAL REVENUE CODE, AND OTHER SECTION 501(C)(3) ORGANIZATIONS DESCRIBED IN SECTION 509(A)(1) OR 509(A)(2) OF THE INTERNAL REVENUE CODE WHICH ARE AFFILIATED WITH ANY OF THE AFORESAID ORGANIZATIONS". GLAS SUPPORTS THE THREE NAMED ENTITIES, ALL OF WHICH HAVE BEEN RECOGNIZED AS EXEMPT FROM TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, AND HAVE BEEN CLASSIFIED AS PUBLIC CHARITIES UNDER IRC SECTION 509(A)(1) OR (2). FURTHER, PURSUANT TO THEIR BY-LAWS, THE GOVERNING BODY OF GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. (FORMALLY GUNDERSEN LUTHERAN, INC.) SERVES AS THE GOVERNING BODY OF GLAS, AS WELL AS GUNDERSEN CLINIC, LTD, AND GUNDERSEN LUTHERAN MEDICAL CENTER, INC., THUS, GLAS MEETS THE RELATIONSHIP TEST AS A TYPE II ORGANIZATION BECAUSE THERE IS COMMON SUPERVISION AND CONTROL BETWEEN GLAS AND ITS NAMED SUPPORTED ORGANIZATIONS (TREAS. REGS. SECTION 1.509(A)-4(H)). GLAS ALSO SUPPORTS ORGANIZATIONS DESCRIBED IN IRC SECTION 509(A)(1) AND (2) WHICH ARE AFFILIATED WITH THE SUPPORTED ORGANIZATIONS OR ARE 501(C)(3) PUBLIC CHARITIES AFFILIATED WITH THESE AFFILIATED ENTITIES. THEY ARE DESCRIBED BY CLASS. TO QUALIFY AS A SECTION 509(A)(3) SUPPORTING ORGANIZATION, AN ORGANIZATION MUST SUPPORT ONE OR MORE "SPECIFIED ORGANIZATIONS". FOR TYPE II SUPPORTING ORGANIZATIONS, "SPECIFIED" ORGANIZATIONS CAN BE EITHER SPECIFIED BY NAME IN THE SUPPORTING ORGANIZATION'S ARTICLES OF INCORPORATION, OR THE ARTICLES MUST DESIGNATE THE SUPPORTED ORGANIZATION(S) BY CLASS OR PURPOSE AND WHICH INCLUDE PUBLICLY SUPPORTED ORGANIZATIONS WHICH ARE CLOSELY RELATED IN PURPOSE OR FUNCTION TO THE PUBLICLY SUPPORTED ORGANIZATIONS SPECIFIED IN THE ARTICLES. (TREAS. REGS. SECTION 1.509(A)-4(D)(2)(B)(2)). THEREFORE, THE LACK OF INCLUDING THE NAME OF THE AFFILIATED ORGANIZATIONS THAT GLAS WILL SUPPORT IN ITS ARTICLES OF INCORPORATION DOES NOT OTHERWISE DEFEAT GLAS'S STATUS AS A TYPE II SUPPORTING ORGANIZATION, BECAUSE ITS ARTICLES DESCRIBE THESE SUPPORTED ORGANIZATIONS BY CLASS (AFFILIATED WITH THE SPECIFIED SUPPORTED ORGANIZATION) AND REQUIRE THAT THEY BE EXEMPT FROM TAX UNDER IRC SECTION 501(C)(3) AND DESCRIBED IN IRC SECTION 509(A)(1) OR (2). Sch A Part IV Section A Line 6 GENERAL SERVICES PROVIDED TO GUNDERSEN LUTHERAN MEDICAL FOUNDATION, INC. AND OTHER AFFILIATES: ADMINISTRATIVE, INFORMATION SYSTEMS, BILLING AND CODING, LAUNDRY, MEDICAL RECORDS, HUMAN RESOURCES, FINANCE, FACILITY OPERATIONS, CENTRAL SERVICES AND OTHER MISCELLANEOUS SERVICES. X 220565 243711 220565 243711 754390610 1907563731 754611175 1907807442 1000000 1000000 250000 250000 1000000 1000000 1000000 1000000 4000000 6000000 281562 271755 219895 243711 1016923 250000 250000 250000 250000 1000000 1500000 3869924 3869924 53121115 15041868 38079247 4420585 1607860 2812725 156056477 117904945 38151532 82913428 0 INTERCOMPANY PAYABLE 411136338 LOSS ON SWAP CONTRACTS 25971185 LT CIMP LIABILITY 4951019 LEASE CONTRACT PAYABLE 2466160 TEB PREM/(DISC) CURRENT AND LT 1696732 DEFERRED COMPENSATION 441987 DEFERRED REVENUE 3489 446666910 X Sch D Part X Line 2 INCOME TAX MATTERS (In Thousands) The System qualifies as a tax-exempt organization under Section 501(c)(3) of the Internal Revenue Code (the Code), with the exception of Degen Berglund, Inc. and Gundersen Lutheran Envision, LLC, which are for-profit entities. At December 31, 2017 and 2016, net deferred tax assets of $5,036 and $3,493, respectively, which primarily are related to net operating loss carryforwards, have valuation allowances of $4,000 and $2,766, respectively, recorded against them due to the uncertainty of realizing those benefits in the future. At December 31, 2017, the System's federal net operating loss carryforwards were approximately $28,600, and the state net operating loss carryforwards were approximately $25,200, which will expire between 2026 and 2035. 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 2013 and prior years. The Tax Cuts and Jobs Act (Act) was enacted on December 22, 2017. The Act reduces the U.S. federal corporate tax rate from 35% to 21%, requires companies to pay a one-time transition tax on earnings of certain foreign subsidiaries that was previously tax deferred, and creates new taxes on certain foreign sourced earnings. For tax-exempt entities, the Act also requires organizations to categorize certain fringe benefit expenses as a source of unrelated business income, pay an excise tax on remuneration above certain thresholds that is paid to executives by the organization, and report income or loss from unrelated business activities on an activity-by-activity basis, among other provisions. At December 31, 2017, the System has made a reasonable estimate of the tax effects of the enactment of the Act. Certain regulatory guidance provides for a measurement period of up to one year during which the accounting for the tax effects of the Act may be completed. The System may record further adjustments in future periods upon obtaining, preparing, or analyzing additional information about facts and circumstances that existed as of the date of enactment that would have affected the income tax effects initially reported. The System will continue to revise and refine the calculations as additional Internal Revenue Service guidance is issued. true GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1836 SOUTH AVENUE LA CROSSE WI 54601 391866425 501(C)(3) 1494750 General Support 1 Sch I Part I Line 2 THE FUNDS ARE MONITORED BY MANAGEMENT AND THE BOARD OF TRUSTEES. X X X true false false false false false false false false Scott Rathgaber MD Chief Executive Officer 832496 0 50000 0 4784 0 39150 0 24786 0 951216 0 0 0 Stephen Shapiro MD Board of Trustees - Member 452096 0 5000 0 500 0 39150 0 30170 0 526916 0 0 0 Brian Sieck MD Board of Trustees - Member 396446 0 3000 0 4484 0 39150 0 25836 0 468916 0 0 0 Kelley Bahr MD Board of Trustees - Member 355000 0 3000 0 4802 0 35510 0 54 0 398366 0 0 0 Jonathan Zlabek MD Board of Trustees - Member 306495 0 5000 0 4456 0 39150 0 25786 0 380887 0 0 0 Greg Thompson MD BOT - Member, CMO 438246 0 0 0 4802 0 39150 0 24036 0 506234 0 0 0 P Michael Jacobs DPM Medical Vice President 359496 0 0 0 4284 0 39150 0 25786 0 428716 0 0 0 Mary Kuffel MD Medical Vice President 478912 0 8000 0 4302 0 39150 0 1446 0 531810 0 0 0 Stephanie Carroll MD Medical Vice President 303244 0 3000 0 18 0 39150 0 19371 0 364783 0 0 0 Todd Kowalski MD Medical Vice President 357496 0 5000 0 518 0 39150 0 28320 0 430484 0 0 0 Lisa Wied Vice President 203896 0 0 0 3146 0 29356 0 25886 0 262284 0 0 0 Mike McKee Vice President 203996 0 0 0 500 0 30450 0 28432 0 263378 0 0 0 Kraig Schuster Vice President 213334 0 0 0 500 0 30538 0 26644 0 271016 0 0 0 Elizabeth Smith-Houskamp Vice President, Admin COO 406000 0 0 0 4284 0 39150 0 54 0 449488 0 0 0 Bryan Erdmann Vice President 247941 0 0 0 2414 0 36794 0 28788 0 315937 0 0 0 Garith Steiner Vice President 250000 0 0 0 881 0 33125 0 3204 0 287210 0 0 0 Michael Dolan MD Exec VP, Medical COO 566538 0 5000 0 500 0 39150 0 27570 0 638758 0 0 0 Marilu Bintz MD Senior Vice President, CMO 556336 0 0 0 4802 0 39150 0 10450 0 610738 0 0 0 Kathleen Klock Senior Vice President 441372 0 5000 0 0 0 39150 0 24344 0 509866 0 0 0 Mary Ellen McCartney Senior Vice President 211014 0 0 0 500 0 30907 0 13660 0 256081 0 0 0 Jean Krause Senior Vice President 209214 0 30000 0 3186 0 32894 0 12766 0 288060 0 0 0 Rose Ann-Laureto Chief Information Officer 389837 0 0 0 35100 0 39150 0 13734 0 477821 0 0 0 Dara Bartels Chief Financial Officer 361996 0 0 0 4284 0 39150 0 25286 0 430716 0 0 0 Daniel Lange MD Medical Doctor 850996 0 0 0 4982 0 39150 0 24786 0 919914 0 0 0 Kurt Mueller MD Medical Doctor 821996 0 5000 0 4784 0 39150 0 23286 0 894216 0 0 0 Collin Driscoll MD Medical Doctor 797496 0 0 0 4802 0 39150 0 23286 0 864734 0 0 0 Martin Koop MD Medical Doctor 774912 0 5500 0 518 0 39150 0 5730 0 825810 0 0 0 Premnauth Rabindranauth MD Medical Doctor 718996 0 0 0 6178 0 39150 0 23286 0 787610 0 0 0 Jeffrey Thompson MD Former CEO 247646 0 0 0 3697 0 36794 0 25875 0 314012 0 0 0 Debra Rislow Former SVP, Admin COO -485 0 0 0 165930 0 0 0 3915 0 169360 0 0 0 Sch J Part I Line 4a 2017 severance Payments: Debra Rislow - $162,500 A WHEFA SERIES 2011A ISSUANCE 391337855 97710BJ78 2011-09-29 132855000 SEE PART VI false false false B WHEFA SERIES 2016 ISSUANCE 391337855 2016-02-12 40000000 SEE PART VI false false false C WHEFA SERIES 2009 ISSUANCE 391337855 97710BE65 2011-03-17 76005000 SEE PART VI false false false D WHEFA SERIES 2008B ISSUANCE 391337855 97710BBG6 2010-09-01 61400000 SEE PART VI false false false A 34005000 0 162563462 0 0 0 1938652 0 0 70140245 90473803 0 2014 true false true true B 0 0 40000000 0 0 0 0 0 0 0 40000000 0 2016 true false true true C 5505000 0 78715000 0 0 0 0 0 0 0 78715000 0 2005 true false true true D 0 0 61400000 0 0 0 0 0 0 0 61400000 0 2008 true false true true A false false false false 0 true false false true B false false false false 0 true false false true C false true false false 0.02100 0.02100 true false false true D false false false false 0 true true true true A false true false false 0 false 0 false true B false true true false 0 false 0 false true C true true true PIPERMERRILL 0.295 false 0 false true D true true true MERRILL 0.27 false 0 false true A true B true C true D true A WHEFA SERIES 2012 ISSUANCE 391337855 97710B4B5 2012-09-27 69355000 SEE PART VI false false false B WHEFA Series 2015 Issuance 391337855 2015-12-23 10650000 SEE PART VI false false false A 815000 0 71875660 0 0 0 961054 0 0 70929112 0 0 2014 false false true true B 2410000 0 12041231 0 0 0 0 0 0 12094721 0 0 2017 false false true true A false false false false 0 true false false true B false false false false 0 true false false true A false true false false 0 false 0 false true B false true true false 0 false 0 false true A true B true Sch K PART I BOND ISSUES: LINE A (A) ISSUER NAME: WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY SERIES 2011A (F) DESCRIPTION OF PURPOSE: CURRENTLY REFUNDED THE 2000 SERIES A AND B ISSUED 10/10/2000. 2008 SERIES A ISSUED 5/29/2008 AND NEW MONEY FOR CONSTRUCTION AND EQUIPPING OF HOSPITAL FACILITIES AND COSTS OF ISSUANCE PART I BOND ISSUES: LINE B (A) ISSUER NAME: WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY SERIES 2016B (F) DESCRIPTION OF PURPOSE: PROCEEDS OF THE SERIES 2016 BONDS WERE USED TO CURRENTLY REFUND, IN THEIR ENTIRETY, THE WISCONSIN HEALTH AND EDUCATIONAL FACILITY VARIABLE RATE REVENUE BONDS, SERIES 2011B (GUNDERSEN LUTHERAN) PART I BOND ISSUES: LINE C (A) ISSUER NAME: WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY SERIES 2009 (C) CUSIP ID: 97710BE65/9910BE73 (F) DESCRIPTION OF PURPOSE: CONVERSION AND REISSUANCE OF 2009 BONDS, ORIGINALLY ISSUED 5/22/2009 TO FINANCE CONSTRUCTION AND EQUIPPING OF HOSPITAL FACILITIES AND CURRENTLY REFUND THE SERIES 2003B/C BONDS PART I BOND ISSUES: LINE D (A) ISSUER NAME: WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY SERIES 2008B (F) DESCRIPTION OF PURPOSE: CONVERSION AND REISSUANCE OF 2008 BONDS, ORIGINALLY ISSUED 5/29/2008 TO FINANCE THE REPAYMENT OF A LINE OF CREDIT USED TO REPAY THE SERIES 2006 BONDS, WHICH FINANCED THE CONSTRUCTION AND EQUIPPING OF HEALTH CARE FACILITIES AND COSTS OF ISSUANCE PART I BOND ISSUES: LINE E (A) ISSUER NAME: WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY SERIES 2012 (F) DESCRIPTION OF PURPOSE: NEW MONEY FOR CONSTRUCTION AND EQUIPPING OF HOSPITAL AND COSTS OF ISSUANCE PART I BOND ISSUES: LINE F (A) ISSUER NAME: WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY SERIES 2015 (F) DESCRIPTION OF PURPOSE: NEW MONEY FOR CONSTRUCTION AND EQUIPPING OF A CLINIC Sch K Part III Line 7 Gundersen monitors the private use of its bond-financed assets and routinely takes steps to limit private use. Gundersen manages compliance through its private use monitoring. Sch K Part Line 8a & 8c Gundersen had a sale of a bond financed asset from the 2008B issuance. 800.00 was reissued on 7/15/15 in order to remediate a sale. Rose Anne Laureto Employee - CIO Bonus/Relocation X 50000 17222 false true true 17222 Sean Agger SEE SUPPLEMENTAL INFO 217213 Employment false James Klock SEE SUPPLEMENTAL INFO 42185 Employment false Belinda Klock SEE SUPPLEMENTAL INFO 72432 Employment false James Klock SEE SUPPLEMENTAL INFO 120493 Employment false Brenda White SEE SUPPLEMENTAL INFO 41565 Employment false Samuel Thompson SEE SUPPLEMENTAL INFO 53931 Employment false Jonathan Klock SEE SUPPLEMENTAL INFO 110286 Employment false Tom Thompson SEE SUPPLEMENTAL INFO 54186 Employment false Margaret Webster MD SEE SUPPLEMENTAL INFO 149604 Employment false Ricardo Rivera SEE SUPPLEMENTAL INFO 99957 Employment false Megan Klock SEE SUPPLEMENTAL INFO 70853 Employment false Shannan Stephens MD SEE SUPPLEMENTAL INFO 317483 Employment false Ingri Gundersen Lombardi SEE SUPPLEMENTAL INFO 44406 Employment false John Houskamp MD SEE SUPPLEMENTAL INFO 313600 Employment false Rachel Thompson-Fleming MD SEE SUPPLEMENTAL INFO 44002 Employment false Nathan Fleming MD SEE SUPPLEMENTAL INFO 30200 Employment false Scott Wied SEE SUPPLEMENTAL INFO 102810 Employment false Karl Borge SEE SUPPLEMENTAL INFO 249823 Employment false Noel Radcliffe MD SEE SUPPLEMENTAL INFO 241810 Employment false Jeffrey Richards SEE SUPPLEMENTAL INFO 24123 Employment false Emma Westphal SEE SUPPLEMENTAL INFO 46185 Employment false Sch L Part IV BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: (A) NAME OF PERSON: SEAN AGGER (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF WILLIAM AGGER, M.D., FORMER DIRECTOR (A) NAME OF PERSON: JAMES KLOCK (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF KATHLEEN KLOCK, KEY EMPLOYEE (A) NAME OF PERSON: BELINDA KLOCK (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF KATHLEEN KLOCK, KEY EMPLOYEE (A) NAME OF PERSON: JAMES KLOCK (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF KATHLEEN KLOCK, KEY EMPLOYEE (A) NAME OF PERSON: BRENDA WHITE (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF GERALD ARNDT, KEY EMPLOYEE (A) NAME OF PERSON: SAMUEL THOMPSON (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF JEFFREY THOMPSON, M.D., Former DIRECTOR (A) NAME OF PERSON: JONATHAN KLOCK (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF KATHLEEN KLOCK, KEY EMPLOYEE (A) NAME OF PERSON: TOM THOMPSON (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF JEFFREY THOMPSON, M.D., Former DIRECTOR (A) NAME OF PERSON: MARGARET WEBSTER, M.D. (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF MARK GLENDENNING, DIRECTOR (A) NAME OF PERSON: RICARDO RIVERA (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF JULIO BIRD, M.D., DIRECTOR (A) NAME OF PERSON: MEGAN KLOCK (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF KATHLEEN KLOCK, KEY EMPLOYEE (A) NAME OF PERSON: SHANNaN STEPHENS, M.D. (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF KELLEY BAHR, M.D., DIRECTOR (A) NAME OF PERSON: INGRI GUNDERSEN LOMBARDI (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF SIGURD GUNDERSEN III, M.D., DIRECTOR (A) NAME OF PERSON: JOHN HOUSKAMP, M.D. (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF ElizaBETH SMITH-HOUSKAMP, Officer (A) NAME OF PERSON: RACHEL THOMPSON-FLEMING, M.D. (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF JEFFREY THOMPSON, M.D., FORMER DIRECTOR (A) NAME OF PERSON: NATHAN FLEMING, M.D. (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF JEFFREY THOMPSON, M.D., FORMER DIRECTOR (A) NAME OF PERSON: SCOTT WIED (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF LISA WIED, KEY EMPLOYEE (A) NAME OF PERSON: Karl Borge (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF Robyn Borge, Director (A) NAME OF PERSON: Noel Radcliffe, M.D. (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF Rick Radcliffe, Director (A) NAME OF PERSON: Jeffrey Richards (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF Dara Bartels, Officer (A) NAME OF PERSON: Emma Westphal (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF Deb Rislow, Former Key Employee Form 990 Part III Line 1 DESCRIPTION OF ORGANIZATION MISSION: TO SUPPORT GUNDERSEN LUTHERAN HEALTH SYSTEM, INC.'S PROGRAMS OF HEALTH CARE, MEDICAL EDUCATION, MEDICAL RESEARCH AND COMMUNITY HEALTH PROMOTION ACTIVITIES WITHIN THE MEANING OF SECTION 509(A)(3) OF THE IRC; BORROWING AND LENDING OF FUNDS AND PROPERTY, ENGAGING IN FINANCIAL TRANSACTIONS WITH AND/OR ON BEHALF OF THE GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., ALONG WITH GENERAL SERVICES PROVIDED TO GUNDERSEN CLINIC, LTD. AND GUNDERSEN LUTHERAN MEDICAL CENTER, INC. Form 990 Part VI Line 2 MARK GLENDENNING and GERALD ARNDT - BUSINESS RELATIONSHIP Form 990 Part VI Line 6 GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF THIS ORGANIZATION. Form 990 Part VI Line 7a GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. Form 990 Part VI Line 7b GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., THE PARENT CORPORATION AND SOLE MEMBER OF THE CORPORATION, SHALL HAVE THE POWER, TO RECOMMEND AND REVIEW, AS APPROPRIATE, AND APPROVE CERTAIN MATTERS. ARTICLES OF INCORPORATION MAY BE AMENDED BY VOTE OF THE SOLE MEMBER OF THE CORPORATION. Form 990 Part VI Line 11b THE FORM 990 WILL BE AVAILABLE FOR ALL BOARD MEMBERS AT A BOARD MEETING AND THE GUNDERSEN LUTHERAN HEALTH SYSTEM FINANCE COMMITTEE RECEIVES A COPY OF THE 990 BEFORE FILING AND UPON FURTHER REVIEW FROM THE CFO and/or the executive director finance, THE 990S ARE APPROVED AND FILED. Form 990 Part VI Line 12c GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. MONITORS CONFLICTS ON AN ANNUAL BASIS BY REVIEWING DISCLOSURES ON COMPLETED CONFLICT OF INTEREST STATEMENTS. Form 990 Part VI Line 15a 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 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 XII Line 2c THE PROCESS ALLOWS THE AUDIT COMMITTEE OF GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. TO INDEPENDENTLY COMMUNICATE WITH THE EXTERNAL AUDIT FIRM THROUGHOUT THE YEAR, BUT FORMAL COMMUNICATION OCCURS BEFORE THE ENGAGEMENT AND UPON CONCLUSION. THE AUDIT COMMITTEE MEETS WITH THE AUDIT FIRM FOR PRESENTATION OF THE STATEMENTS. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. Form 990 Part XII Line 3a GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. OPERATES IN CONJUNCTION WITH A GROUP OF OTHER AFFILIATED CORPORATIONS GOVERNED BY GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. AS SUCH, ANY FEDERAL AWARDS TO GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. UNDERGO AN AUDIT AS SET FORTH IN THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133. GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1836 SOUTH AVENUE LA CROSSE WI 54601 391866425 SUPTNG. ORG WI 501(C)(3) LINE 12B,II NA false GUNDERSEN LUTHERAN MEDICAL CENTER INC 1910 SOUTH AVENUE LA CROSSE WI 54601 390813416 HEALTH CARE WI 501(C)(3) LINE 3 GLHS false GUNDERSEN CLINIC LTD 1836 SOUTH AVENUE LA CROSSE WI 54601 391028657 HEALTH CARE WI 501(C)(3) LINE 3 GLHS false GUNDERSEN LUTHERAN MEDICAL FNDTN INC 1836 SOUTH AVENUE LA CROSSE WI 54601 391249705 FOUNDATION WI 501(C)(3) LINE 7 GLHS false GUNDERSEN LUTHERAN CREDENTIALING SVS INC 1910 SOUTH AVENUE LA CROSSE WI 54601 391856898 CREDENTIALING WI 501(C)(3) LN 12C,III GLHS false TRI-COUNTY MEMORIAL HOSPITAL INC 18601 LINCOLN STREET WHITEHALL WI 54773 390704510 HEALTH CARE WI 501(C)(3) LINE 3 GLHS false TRI-STATE REGIONAL AMBULANCE INC 235 CAUSEWAY BLVD LA CROSSE WI 54603 391962965 MDCL TRANSPO. WI 501(C)(3) LINE 10 GLHS false STJOSEPH'S HEALTH SERVICES INC 400 WATER AVENUE HILLSBORO WI 54634 390929538 HEALTH CARE WI 501(C)(3) LINE 3 GLHS false ST JOSEPH MEMORIAL FOUNDATION INC 400 WATER AVENUE HILLSBORO WI 54634 391455787 FOUNDATION WI 501(C)(3) LINE 12A, I S JOSEPH HS false TRI-COUNTY MEMORIAL FOUNDATION INC 18601 LINCOLN STREET WHITEHALL WI 54773 300093022 FOUNDATION WI 501(C)(3) LINE 12A, I TRI-COUNTY false MEMORIAL HOSPITAL OF BOSCOBEL 205 PARKER STREET BOSCOBEL WI 53805 390845590 HEALTH CARE WI 501(C)(3) LINE 3 GLHS false MEMORIAL HOSPITAL OF BOSCOBEL FNDT INC 205 PARKER STREET BOSCOBEL WI 53805 391688793 FUNDRAISING WI 501(C)(3) LINE 7 NA false BOSCOBEL AREA HEALTH CARE PARTNERS 205 PARKER STREET BOSCOBEL WI 53805 450498844 FUNDRAISING WI 501(C)(3) LINE 7 NA false HARMONY COMMUNITY HEALTHCARE INC 815 MAIN AVENUE S HARMONY MN 55939 410711606 HEALTH CARE MN 501(C)(3) LINE 10 GLHS false TWEETEN LUTHERAN HEALTHCARE CENTER INC 125 FIFTH AVENUE SE SPRING GROVE MN 55974 411565003 HEALTH CARE MN 501(C)(3) LINE 10 GLHS false TRI-STATE AMBULANCE INC 235 CAUSEWAY BLVD LA CROSSE WI 54603 391965415 MDCL TRANSPO. WI 501(C)(3) LINE 3 GLHS false LUTHERAN REAL ESTATE HOLDING CORPORATION 1910 SOUTH AVENUE LA CROSSE WI 54601 391480826 HOUSING WI 501(C)(3) LN 12C, III GLHS false LUTHERAN HOUSING OF LA CROSSE INC 1900 SOUTH AVENUE LA CROSSE WI 54601 391751934 INDP LIVING WI 501(C)(3) LINE 10 LRHC false COMMUNITY HOUSING OF LA CROSSE INC 1900 SOUTH AVENUE LA CROSSE WI 54601 391586700 INDP LIVING WI 501(C)(3) LINE 10 LRHC false PALMER LUTHERAN HEALTH CENTER INC 112 JEFFERSON STREET WEST UNION IA 52175 421320763 HEALTH CARE IA 501(C)(3) LINE 3 GLHS false PALMER MEMORIAL FOUNDATION 112 Jefferson Street West Union IA 52175 421032878 FOUNDATION IA 501(C)(3) LINE 7 PLHC false Moundview Memorial Hospitals & Clinics 402 West Lake Street Friendship WI 53934 390944012 Healthcare WI 501(C)(3) Line 3 GLHS false Memorial HC FDTN of Adams County Inc 402 West Lake Street Friendship WI 53934 391775074 Foundation WI 501(C)(3) Line 12A, I MMHC false DEGEN BERGLUND INC 1709 LOSEY BLVD S LA CROSSE WI 54601 390971110 RTL PHARMACY WI GLHS C Corp 0 0 true GUNDERSEN LUTHERAN ENVISION LLC 1836 SOUTH AVENUE LA CROSSE WI 54601 264706546 RENEWABLE ENERGY WI GLHS C Corp 0 0 true false true true true false false false false false true false true true false false true true true false Sch R Part IV Line 1 and 2 DEGEN BERGLUND, INC. AND GUNDERSEN LUTHERAN ENVISION, LLC ARE DIRECTLY OWNED BY GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. AND INDIRECTLY OWNED BY GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. Gundersen Lutheran Administr 1910 S AVE LA CROSSE WI 54601 391606449 0 220565 220565 754390610 754611175 1000000 250000 0 0 0 GUNDERSEN CLINIC 1836 S AVE LA CROSSE WI 54601 391028657 0 23146 23146 196420463 196443609 1000000 250000 0 0 0 Gundersen Lutheran Medical C 1910 S AVE LA CROSSE WI 54601 390813416 0 0 0 955174966 955174966 1000000 250000 0 0 0 Gundersen Lutheran Health Sy 1836 SOUTH AVE LA CROSSE WI 54601 391866425 0 0 0 1577692 1577692 228885 57221 0 0 0