Gundersen Clinic Ltd.

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

“Gundersen lutheran health system, 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 at a board meeting and the gundersen lutheran health system finance committee receives a copy of the 990 before filing. Upon further review from the cfo and/or the executive director finance, 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.”

“GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. PROVIDES LEASED EMPLOYEES AND MANAGEMENT SERVICES TO GUNDERSEN CLINIC. THEREFORE THE AMOUNTS REPORTED ON PART VII REPRESENT REIMBURSEMENTS TO GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. Form 990 Part VII GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. PAID AN INDEPENDENT EMPLOYMENT AGENCY $346,356 FOR MARK TERESIS SERVICES AS INTERIM CFO.”

“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. Form 990 Part III Line 4a PROGRAM SERVICE ACCOMPLISHMENTS: GUNDERSEN CLINIC, LTD. (THE CLINIC) HAS 557 PHYSICIANS REPRESENTING NEARLY EVERY SPECIALTY SERVING A 21 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 1,035,967 PATIENT ENCOUNTERS FOR 2018. THE CLINIC PROVIDED UNCOMPENSATED CARE RELATED TO CHARITY, $877,559; MEDICARE, $27,303,332; AND MEDICAID, $12,290,222 FOR THE TOTAL AMOUNT OF $40,471,113 AT COST BASED ON POLICIES AND CONTRACTS ARRANGED TO HELP SUPPORT THE COMMUNITY'S NEEDS. THE $40,471,113 IS THE SUM OF UNREIMBURSED MEDICARE & 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. THE UNREIMBURSED COST IS THE AMOUNT THE COST EXCEEDS THE NET REVENUE FOR THOSE SAME PATIENTS. MEDICARE AND MEDICAID PATIENTS TO THE NET REVENUE FOR THOSE SAME PATIENTS. THE UNREIMBURSED COST IS THE AMOUNT THE COST EXCEEDS THE NET REVENUE FOR THOSE SAME PATIENTS.”

“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. Form 990 Part V Lines 1 & 2 ALL PERSONNEL SERVICES FOR GUNDERSEN CLINIC, LTD. 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.”

“The information in the schedule is presented in accordance with the requirements of title 2 u.s. Code of federal regulations part 200, uniform administrative requirements, cost principles, and audit requirements for federal awards.”