Memorial Hospital of Boscobel

“The articles of incorporation of gundersen boscobel area hospital and clinics provides for one member of the corporation. The sole corporate member of gundersen boscobel area hospital and clinics is gundersen lutheran health system, inc.”

“As the sole corporate member and under the terms of the affiliation agreement, gundersen lutheran health system, inc. May appoint, remove, or elect certain officers and/or members of the board of directors of gundersen boscobel area hospital and clinics. Gundersen lutheran health system, inc. May appoint six members of the board of directors of gundersen boscobel area hospital and clinics.”

“The sole member, gundersen lutheran health system, inc. Has the following reserve rights of approval: the incurrence of debt (other than debt incurred for the acquisition of goods that are acquired in the ordinary course of business or debt included in approved budgets) and the grant of any security interest, place any encumbrances, enter into any covenants, and direct execution of any documents and the taking of any actions necessary or appropriate in connection with the incurrence of such debt: and the annual operating budget and capital expenditures.”

“The form 990 is prepared by an independent accounting firm and then reviewed by the organization's management. A final copy of the form 990 is provided to the board of directors prior to submission.”

“The board of directors discloses any conflicts of interest by completing a questionnaire and disclosure form annually. Employees are required to review the conflict of interest policy upon hire and at annual intervals. If any significant conflicts arise with members of the board of directors, management, or key employees, it is properly documented and followed up on by the appropriate governing group or department within the organization according to the conflict of interest policy.”

“For the purposes of determining compensation, gundersen area boscobel hospital and clinics relied on its affiliated organization, gundersen lutheran administrative services, inc., to establish compensation of the ceo, cfo, and other officers. Gundersen lutheran administrative services, inc. Used the following practices for establishing compensation for such individuals: compensation survey or study, compensation committee, and approval by the board or compensation committee.”

“The abbreviated financial statements are made publicly available through the wisconsin hospital association and the complete audited financial statements are available upon request. Governing documents and the conflict of interest policy are also available to the public upon request.”

“Administrative/management fees: program service expenses 0. Management and general expenses 84,585. Fundraising expenses 0. Total expenses 84,585. Clinic physician coverage: program service expenses 9,644. Management and general expenses 0. Fundraising expenses 0. Total expenses 9,644. Er physician coverage: program service expenses 2,148,602. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,148,602. Information systems purchased services: program service expenses 0. Management and general expenses 37,383. Fundraising expenses 0. Total expenses 37,383. Lab services: program service expenses 736,070. Management and general expenses 0. Fundraising expenses 0. Total expenses 736,070. Other purchased services: program service expenses 441,743. Management and general expenses 0. Fundraising expenses 0. Total expenses 441,743. Radiology purchased services: program service expenses 1,649,039. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,649,039. Specialty services: program service expenses 571,997. Management and general expenses 0. Fundraising expenses 0. Total expenses 571,997. Surgical services: program service expenses 521,214. Management and general expenses 0. Fundraising expenses 0. Total expenses 521,214.”

“Net change in interest in net assets of foundation -36,804.”