Tri County Memorial Hospital Inc

“As an affiliate of gundersen lutheran health system, inc., tri-county will routinely delegate various management or support functions to related entities. For example, the ceo and cfo of tri-county are employed by the home office of the parent organization, gundersen lutheran health system, inc. Several members of the board of directors are also employees of gundersen lutheran health system, inc. And its affiliated organizations, which are also tax-exempt organizations.”

“The articles of incorporation of tri-county provide for two classes of membership in the corporation. The first class of membership is a corporate member class, and the sole member of this class is gundersen lutheran health system, inc. The second class of membership is a public membership, which is made up of persons over the age of 18 who are interested in promoting aims, purposes, and welfare of tri-county.”

“The articles of incorporation of tri-county provide for two classes of membership. One class is held by a sole member, gundersen lutheran health system, inc., which may appoint seven of the twelve members of the board of directors. Gundersen also has the reserve right to approve or disapprove of the other five members of the board of directors.”

“Approval of tri-county's operating budget and plan, capital expenditures greater than $10,000, additional indebtedness over $10,000, disaffiliation, and amendments or changes to the articles of incorporation and bylaws is subject to approval by the board of directors of its member, gundersen lutheran health system, inc.”

“The return is reviewed by management and made available to the board of directors prior to filing.”

“Tri-county monitors conflicts on an annual basis by reviewing disclosures on completed conflict of interest statements. Any members with noted conflicts are asked to abstain from voting on any potentially conflicted matters.”

“For the purposes of determining compensation, tri-county relied on an affiliated organization within gundersen health system to establish compensation of the ceo, cfo, and other officers. Gundersen health system used the following practices for establishing compensation for such individuals: compensation survey or study, compensation committee, and approval by the board or compensation committee.”

“Tri-county makes its governing documents, conflict of interest policy, and financial statements available to the public upon request at its business location during normal business hours.”

“Patient billing services: program service expenses 0. Management and general expenses 16,718. Fundraising expenses 0. Total expenses 16,718. Clinic services: program service expenses 1,209,972. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,209,972. Emergency services: program service expenses 1,517,938. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,517,938. Anesthesia services: program service expenses 84,528. Management and general expenses 0. Fundraising expenses 0. Total expenses 84,528. Surgery services: program service expenses 104,457. Management and general expenses 0. Fundraising expenses 0. Total expenses 104,457. Other professional fees: program service expenses 2,313,241. Management and general expenses 829,258. Fundraising expenses 0. Total expenses 3,142,499.”

“Equity change in unconsolidated affiliates 8,846. Other change in net assets 1,675.”