Gundersen Clinic Ltd.

“Gundersen lutheran health system,inc. Is the sole member of this organization.”

“Gundersen lutheran health systems, inc.”

“The corporation's sole shareholder is gundersen lutheran health system, inc. The bylaws may be amended by the board with approval of the parent corporation, or by the vote of the sole shareholder. Also, the affairs of the corporation shall be managed under the direction of the corporation's board of governors, subject to certain approval powers of the board of governors and board of trustees of the parent corporation.”

“THE FORM 990 WILL BE AVAILABLE FOR ALL BOARD MEMBERS THROUGH THE DIRECTOR'S DESK WEBSITE and THE GUNDERSEN LUTHERAN HEALTH SYSTEM FINANCE COMMITTEE RECEIVES A COPY OF THE 990 BEFORE FILING AND UPON FURTHER REVIEW FROM THE INTERIM CFO THE 990S ARE APPROVED AND FILED.”

“Gundersen clinic, ltd. Monitors conflicts on an annual basis by reviewing disclosures on completed conflict of interest statements.”

“All personnel services for gundersen clinic, ltd. 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.”

“Requests for all documents are made through the legal department and the appropriate documents are made available for inspection in the legal department.”

“All personnel services for gundersen clinic, ltd. Are performed by employees of gundersen lutheran administrative services, inc.”

“All payments to vendors are made by gundersen lutheran administrative services, inc.”

“The provision of medical services in a manner beneficial to the community furthers gundersen clinic, ltd.'s charitable purpose of promotion of health.”

“Description of Organization Mission TO PROVIDE MEDICAL AND SURGICAL SERVICES, ENGAGE IN MEDICAL EDUCATION AND RESEARCH AND PROMOTE COMMUNITY HEALTH TO DELIVER THE HIGHEST QUALITY COMPREHENSIVE HEALTH CARE TO ALL PATIENTS WITHOUT REGARD TO THEIR ABILITY TO PAY.”

“SIGNIFICANT CHANGES TO PROGRAM SERVICES: IN 2013, THE CLINIC CONVERTED CLINIC BASED DEPARTMENTS TO HOSPITAL PROVIDER BASED DEPARTMENTS. 2014 WAS THE FIRST FULL YEAR REPORTING THE CONVERTED CLINIC BASED DEPARTMENTS AS HOSPITAL PROVIDER BASED DEPARTMENTS. Form 990, Part III, Line 4a Program Service Accomplishments: GUNDERSEN CLINIC, LTD. (THE CLINIC) HAS 510 PHYSICIANS REPRESENTING NEARLY EVERY SPECIALTY SERVING A 19 COUNTY REGION IN WESTERN WISCONSIN, NORTHEASTERN IOWA AND SOUTHEASTERN MINNESOTA. THE CLINIC PROVIDES MEDICAL CARE TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. CHARITY CARE AND/OR FINANCIAL ASSISTANCE IS DETERMINED BASED ON FINANCIAL INFORMATION PROVIDED BY THE PATIENT AND ANALYSIS OF OTHER RELEVANT INFORMATION. THERE WERE APPROXIMATELY 996,000 PATIENT ENCOUNTERS FOR 2014. THE CLINIC PROVIDED UNCOMPENSATED CARE RELATED TO CHARITY, $2,299,188; MEDICARE, $41,075,053; AND MEDICAID, $12,306,872 FOR THE TOTAL AMOUNT OF $55,681,114 AT A COST BASED ON POLICIES AND CONTRACTS ARRANGED TO HELP SUPPORT THE COMMUNITY'S NEEDS. THE $55,681,114 IS THE SUM OF UNREIMBURSED MEDICARE AND MEDICAID COST PLUS CHARITY AT COST. 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 ALLOCATING THE COST TO PROVIDE SERVICES TO A PATIENT BETWEEN ANY PAYMENTS, BAD DEBT, AND CHARITY WRITE-OFFS WHERE TOTAL PAYMENTS ARE LESS THAN THE COST OF SERVICES PROVIDED. 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.”

“Tax exempt bonds gundersen clinic,ltd. Is part of the obligated group (gundersen lutheran administrative services, inc., gundersen lutheran medical center, inc., gundersen clinic, ltd., and gundersen lutheran medical foundation, inc.) and tax-exempt debt resides on the balance sheet of gundersen lutheran administrative services, inc. Fein 39-1606449.”

“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.”

“Gundersen clinic, ltd. Operates in conjunction with a group of other affiliated corporations governed by gundersen lutheran health system, inc. As such, any federal awards to gundersen clinic, ltd. Undergo an audit as set forth in the single audit act and omb circular a-133. Single audit act and omb circular a-133.”