SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
GUNDERSEN LUTHERAN MEDICAL CENTER INC
 
Employer identification number

39-0813416
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . . 		  9,805 2,780,414 0 2,780,414 0.270 %
b Medicaid (from Worksheet 3, column a) . . . . .     121,121,394 69,783,013 51,338,381 4.940 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .   9,805 123,901,808 69,783,013 54,118,795 5.210 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     539,299 70,170 469,129 0.050 %
f Health professions education (from Worksheet 5) . . .     15,407,129 10,656,292 10,656,292 1.030 %
g Subsidized health services (from Worksheet 6) . . . .            
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     657,321 0 657,321 0.060 %
j Total. Other Benefits . .     16,603,749 10,726,462 11,782,742 1.140 %
k Total. Add lines 7d and 7j .   9,805 140,505,557 80,509,475 65,901,537 6.350 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development     5,390   5,390 0 %
3 Community support            
4 Environmental improvements     2,475   2,475 0 %
5 Leadership development and
training for community members		            
6 Coalition building            
7 Community health improvement advocacy     14,382   14,382 0 %
8 Workforce development     2,976   2,976 0 %
9 Other     4,935,082   4,935,082 0.470 %
10 Total     4,960,305   4,960,305 0.470 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
7,328,547
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
2,166,355
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
142,065,118
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
197,799,933
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-55,734,815
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 GUNDERSEN LUTHERAN MED CENTER INC
1910 SOUTH AVENUE
LA CROSSE,WI54601
WWW.GUNDERSENHEALTH.ORG
WI License #23 		X X   X   X X      
Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
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Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
GUNDERSEN LUTHERAN MEDICAL CENTER INC
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 18
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 18
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): REFER TO SECTION C
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
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Part VFacility Information (continued)

Financial Assistance Policy (FAP)
GUNDERSEN LUTHERAN MEDICAL CENTER INC
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
REFER TO SECTION C
b
REFER TO SECTION C
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
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Part VFacility Information (continued)

Billing and Collections
GUNDERSEN LUTHERAN MEDICAL CENTER INC
Name of hospital facility or letter of facility reporting group  
Yes No
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
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Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
GUNDERSEN LUTHERAN MEDICAL CENTER INC
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
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Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
FORM 990 SCH H PART V LINE 3J THE COMPASS NOW 2018 PROCESS USED A VARIETY OF DATA COLLECTION METHODS TO CREATE AN OVERALL DEPICTION OF THE ISSUES FACING OUR COMMUNITIES. THESE METHODS INCLUDED A RANDOM HOUSEHOLD SURVEY, CONVENIENCE SURVEY, COMMUNITY CONVERSATIONS, AND AN EXTENSIVE REVIEW OF SOCIOECONOMIC INDICATORS, WHICH PROVIDES AN INVENTORY OF COMMUNITY RESOURCES. THE DATA COLLECTED DURING COMPASS NOW 2018 GUIDE FOUR PILLAR PROFILES. THESE ARE REFERRED TO AS PILLARS BECAUSE THEY CREATE THE BUILDING BLOCKS FOR A BETTER LIFE. THE PILLARS OF COMPASS NOW 2018 ARE COMMUNITY, EDUCATION, INCOME/ECONOMIC, AND HEALTH. THE PROFILES DESCRIBE OUR COMMUNITY WITH REGARDS TO THE KEY ISSUES OF EACH AREA. EACH PROFILE PULLS KEY INDICATOR DATA AND COMPASS SURVEY RESULTS INTO A NARRATIVE FORMAT THAT IS INTENDED TO PROVIDE A CONTEXT TO THE DATA FOUND IN THE INDICATOR REPORT, MAKING THE DATA EASY TO NAVIGATE.
FORM 990 SCH H PART V LINE 5 THE NEEDS ASSESSMENT PROCESS USED MANY SOURCES OF INFORMATION TO UNDERSTAND THE NEEDS OF THE REGION. THE KEY DATA SOURCE WAS THE RANDOM HOUSEHOLD SURVEY (RHS). THE RANDOM HOUSEHOLD SURVEY WAS MAILED TO A RANDOM SELECTION OF 5,450 HOUSEHOLDS THROUGHOUT THE REGION IN JULY AND AUGUST OF 2016. AFTER REVIEWING THE DEMOGRAPHICS OF THE RANDOM HOUSEHOLD SURVEY, THE STEERING COMMITTEE DETERMINED WHOSE VOICES WERE MISSING. A PLAN WAS DEVELOPED TO CONDUCT A CONVENIENCE SURVEY (CS) TO CAPTURE THE OPINIONS OF THE GROUPS OF PEOPLE WHO DID NOT RESPOND TO THE RANDOM HOUSEHOLD SURVEY TO ENSURE THAT THEIR VOICE WAS HEARD. STEERING COMMITTEE MEMBERS AND OTHER COMMUNITY PARTNERS COLLECTED RESPONSES TO THE CONVENIENCE SURVEY THROUGH ORGANIZATIONS THAT WERE ASKED TO REACH OUT TO AND SHARE THEIR EXPERTISE ABOUT POPULATIONS THAT MAY BE UNDER-REPRESENTED. THE FOLLOWING ORGANIZATIONS WERE ASKED TO PARTICIPATE IN THE PROCESS BY SOLICITING CONVENIENCE SURVEY RESPONSES, HOLDING FOCUS GROUPS, AND/OR ATTENDING STAKEHOLDER MEETINGS. ORGANIZATIONS INCLUDED IN THE CONVENIENCE SURVEY PROCESS INCLUDED THOSE REPRESENTING: PEOPLE WITH DISABILITIES; AGING POPULATION; LOW-INCOME POPULATION; CHILDREN-YOUTH-FAMILIES; RACIAL AND ETHNIC MINORITIES; VICTIMS OF DOMESTIC VIOLENCE, SEXUAL VIOLENCE, TRAFFICKING; AND, LGBTQ+ COMMUNITY. THE DATA WORKGROUP OVERSAW THE ANALYSIS OF THE DATA AND REVIEWED THE RESULTS UNDER THE GUIDANCE OF DR. LAURIE MILLER AT THE UNIVERSITY OF WISCONSIN-LA CROSSE. TO ADD TO THE SURVEY DATA, THE DATA WORKGROUP WAS TASKED WITH COLLECTING EXISTING DATA FROM FEDERAL, STATE, AND LOCAL SOURCES. THIS DATA INCLUDED INFORMATION ABOUT DEMOGRAPHICS, HEALTH, SOCIAL FACTORS, ECONOMIC FACTORS, AND MANY OTHER TOPICS. BECAUSE NUMBERS-BASED DATA ONLY TELLS PART OF A STORY, THE NEEDS ASSESSMENT PROCESS ALSO INCLUDED HOLDING COUNTY-BASED FOCUS GROUPS. FOCUS GROUPS ARE USUALLY SMALL GROUPS OF PEOPLE WHOSE OPINIONS ARE GATHERED THROUGH A GUIDED DISCUSSION. FOCUS GROUPS WERE HELD IN ALL SIX COUNTIES AND WITH GENERAL COMMUNITY MEMBERS, STUDENTS, FAMILY ADVISORY COUNCILS, LATINO COMMUNITY MEMBERS, SERVICE PROVIDERS, AND HMONG COMMUNITY MEMBERS. THE STEERING COMMITTEE AND DATA WORKGROUP REVIEWED ALL OF THE DATA COLLECTED IN STEP 1 AND ORGANIZED INTO UNDERSTANDABLE PRESENTATIONS THAT WERE PRESENTED AT STAKEHOLDER MEETINGS. TO DETERMINE REGIONAL AND COUNTY-SPECIFIC NEEDS, THE NEEDS ASSESSMENT PROCESS INCLUDED STAKEHOLDER MEETINGS. EVERY COUNTY HELD AT LEAST ONE COUNTY STAKEHOLDER MEETING, EXCEPT FOR VERNON COUNTY, AND THE DATA WORKGROUP ALSO HOSTED A REGIONAL WEBINAR. THE MEETINGS PRESENTED DATA THAT HAD BEEN GATHERED ABOUT EACH COUNTY AND THE REGION. COMMUNITY MEMBERS AT THE MEETINGS GENERATED IDEAS OF THE TOP NEEDS OF THEIR COMMUNITY AND VOTED TO PRIORITIZE THE NEEDS BASED ON THE DATA PRESENTED AND THEIR PERSONAL KNOWLEDGE OF THE COMMUNITY. RESULTS WERE TABULATED AND THE TOP NEEDS WERE IDENTIFIED FOR EACH COUNTY AND THE REGION; THE REGIONAL PRIORITIES WERE DETERMINED BY COMBINING ALL OF THE COUNTY-LEVEL RESULTS AND THE RESULTS OF THE REGIONAL WEBINAR. THE GUNDERSEN COMMUNITY HEALTH NEEDS ASSESSMENT UTILIZES THE COMPASS NOW COLLABORATIVE ASSESSMENT THAT INCLUDES 6 COUNTIES IN OUR SERVICE AREA, REPRESENTING 74% OF OUR HOSPITAL SERVICE PATIENT POPULATION, AND 43% OF THE OVERALL POPULATION OF OUR 21-COUNTY SERVICE REGION. BECAUSE THE GUNDERSEN HEALTH SYSTEM SERVES A BROADER GEOGRAPHIC AREA THAN THE PRIMARY 6 COUNTY AREA INCLUDED IN THE COMPASS NOW 2018 REPORT, AN ADDITIONAL ANALYSIS, THE 21-COUNTY HEALTH INDICATOR ASSESSMENT WAS COMPLETED TO IDENTIFY UNIQUE CHARACTERISTICS AND NEEDS OF ITS COUNTIES SERVED CONSIDERED IN THE DEVELOPMENT OF THE COMMUNITY HEALTH IMPLEMENTATION PLAN. THE 21-COUNTY HEALTH INDICATOR REPORT CONCURRED WITH THE COMPASS ASSESSMENT PRIORITIES. HOWEVER, REVIEWING THE BROADER 21-COUNTY REGION ASSESSMENT REVEALED A SIGNIFICANT NEED NOT IDENTIFIED AS A PRIORITY WITHIN THE COMPASS PROCESS - OBESITY AND DIABETES. INDIVIDUALS CONSULTED: LINDSAY MENARD, MPH - LA CROSSE COUNTY HUMAN SERVICES; LIZ EVANS, GREAT RIVERS UNITED WAY; DR. LAURIE MILLER, UNIVERSITY OF WISCONSIN - LA CROSSE; ANDREA GROMOSKE, MSW, PHD - GROMOSKE CONSULTING, LLC; ADRIANNE OLSON; BARB BARCZAK - TREMPEALEAU COUNTY HEALTH DEPARTMENT; PAULINE BYAM - MAYO CLINIC HEALTH SYSTEM; JESSIE CUNNINGHAM - VERNON MEMORIAL HEALTHCARE; KAYLEIGH DAY - MONROE COUNTY HEALTH DEPARTMENT ; KAREN EHLE - TRAASTAD - VERNON COUNTY UW-EXTENSION; LIZ EVANS - GREAT RIVERS UNITED WAY; SARAH HAVENS - GUNDERSEN HEALTH SYSTEM; DAN HOWARD - GUNDERSEN ST. JOSEPH'S HOSPITAL AND CLINICS; BETH JOHNSON - VERNON COUNTY HEALTH DEPARTMENT ; MARY KESSENS - APTIV, INC.; CATHERINE KOLKMEIER - LA CROSSE MEDICAL HEALTH SCIENCE CONSORTIUM; JOE LARSON - LA CROSSE COUNTY HEALTH DEPARTMENT; APRIL LOEFFLER - BUFFALO COUNTY HEALTH DEPARTMENT; HEATHER MYHRE - HOUSTON COUNTY HEALTH DEPARTMENT; ERIC PRISE -TOMAH MEMORIAL HOSPITAL; JEN ROMBALSKI - LA CROSSE COUNTY HEALTH DEPARTMENT; SHELLY TEADT-COULEECAP; MARY KAY WOLF-GREAT RIVERS UNITED WAY; NOELLE GRIFFITHS - GREAT RIVERS UNITED WAY; MADISON NEECE - GREAT RIVERS UNITED WAY; SHELLY TEADT - COULEECAP; SARA THOMPSON - MAYO CLINIC HEALTH SYSTEM; CASEY MROZEK - BUFFALO COUNTY HEALTH DEPARTMENT; AMANDA SEBAL - GUNDERSEN HEALTH SYSTEM; JULIE ANDERSON - MONROE COUNTY HEALTH DEPARTMENT; PAT MALONE - TREMPEALEAU COUNTY HEALTH DEPART MENT ; JESSIE CUNNINGHAM - VERNON MEMORIAL HEALTHCARE; CHRISTINE DEAN - GUNDERSEN ST. JOSEPH'S HOSPITAL AND CLINICS.
FORM 990 SCH H PART V LINE 6A HOSPITALS INCLUDED ARE MAYO CLINIC HEALTH SYSTEM - LA CROSSE, TOMAH MEMORIAL HOSPITAL, VERNON MEMORIAL HOSPITAL, GUNDERSEN ST. JOSEPH'S HOSPITAL AND CLINICS, AND GUNDERSEN TRI-COUNTY HOSPITAL AND CLINICS.
FORM 990 SCH H PART V LINE 6B OTHER ORGANIZATIONS INCLUDE GREAT RIVERS UNITED WAY, LA CROSSE COUNTY HEALTH DEPARTMENT, BUFFALO COUNTY HEALTH DEPARTMENT, MONROE COUNTY HEALTH DEPARTMENT, VERNON COUNTY HEALTH DEPARTMENT, HOUSTON COUNTY HEALTH DEPARTMENT, TREMPEALEAU COUNTY HEALTH DEPARTMENT, 7 RIVERS ALLIANCE, INTERNATIONAL QUALITY HOMECARE, APTIV, INC., LA CRESCENT-HOKAH PUBLIC SCHOOLS, BIG BROTHERS BIG SISTERS OF THE 7 RIVERS REGION, LA CROSSE COMMUNITY FOUNDATION, BLUFF COUNTRY FAMILY RESOURCES, LA CROSSE COUNTY BOARD, CALEDONIA ARGUS NEWSPAPER, CALEDONIA BOY SCOUTS, LA CROSSE COUNTY HUMAN SERVICES DEPARTMENT; CALEDONIA ECONOMIC DEVELOPMENT AUTHORITY, LA CROSSE MEDICAL HEALTH SCIENCE CONSORTIUM, CALEDONIA PUBLIC SCHOOLS, LA CROSSE TASK FORCE TO ERADICATE MODERN SLAVERY, CITY OF CALEDONIA LIFESTYLE FITNESS, CITY OF HOUSTON, CITY OF LA CROSSE NEIGHBORS IN ACTION, COMMUNITY MEMBERS NEW BEGINNINGS CHRISTIAN FELLOWSHIP, COULEE REGION RSVP, ONALASKA PUBLIC SCHOOLS, CREST INN, RED CROSS, ESB BANK, SALVATION ARMY, ESSENTIAL HEALTH CLINIC, SCHOOL DISTRICT OF HOLMEN, FAMILIES FIRST OF MONROE COUNTY, SEMCAC, FAMILY & CHILDREN'S CENTER, SHERIFF'S OFFICE, GATEWAY AREA COUNCIL-BOY SCOUTS OF AMERICA, SPRING GROVE HERALD, GREAT RIVERS HUB, SPRING GROVE PUBLIC LIBRARY, THE PARENTING PLACE, HERMAN DENTAL, UNIVERSITY OF WISCONSIN-LA CROSSE, HMOOB CULTURAL & COMMUNITY AGENCY, VITERBO UNIVERSITY, HOUSTON PUBLIC SCHOOLS WAFER, HUNGER TASK FORCE OF LA CROSSE, WI DEPARTMENT OF HEALTH SERVICES, WKBT NEWS 8, IMMANUEL LUTHERAN CHURCH, WORKFORCE CONNECTIONS, LNCLUSA, AND YMCA, INDEPENDENT LIVING RESOURCES.
FORM 990 SCH H PART V LINE 7 7A: HTTPS://WWW.GUNDERSENHEALTH.ORG/APP/FILES/PUBLIC/10610/COMMUNITY-HEALTH-NE EDS-ASSESSMENT-SUMMARY-2018.PDF AND HTTPS://WWW.GUNDERSENHEALTH.ORG/APP/FILES/PUBLIC/10609/COMMUNITY-NEEDS-201 8-21-COUNTY-HEALTH-INDICATOR-ASSESSMENT.PDF 7B: OTHER WEBSITE HTTPS://WWW.GREATRIVERSUNITEDWAY.ORG/OUR-WORK/COMMUNITY-NEEDS-ASSESSMENT/ 7C: PAPER COPY: AVAILABLE IN 5 MOONEY LIBRARIES LOCATED AT OUR LA CROSSE AND ONALASKA CAMPUS AND UPON REQUEST 7D: AVAILABLE BY CONTACTING SARAH HAVENS, PHONE (608) 775-6580 OR (800) 362-9567, EXT. 56580 OR EMAIL SJHAVENS@GUNDERSENHEALTH.ORG.
FORM 990 SCH H PART V, SECTION B 10A: IMPLEMENTATION STRATEGY URL: https://www.gundersenhealth.org/app/files/public/10611/community-health-ne eds-implementation-plan-2019-2021.pdf
FORM 990 SCH H PART V LINE 11 THE COMPASS NOW 2018 PRIORITIZED NEEDS ARE: - MORE LIVABLE WAGE JOBS (INCORPORATES SOCIAL DETERMINANTS OF HEALTH) - IMPROVED MENTAL HEALTH AND INCREASED ACCESS TO MENTAL HEALTHCARE SERVICES - REDUCED DRUG AND ALCOHOL MISUSE AND ABUSE - INCREASED WRAPAROUND SUPPORT THROUGHOUT THE LIFESPAN - INCREASED INCLUSION OF SOCIALLY DIVERSE PEOPLE THE ABOVE PRIORITIZED NEEDS, ALONG WITH THE ADDITIONAL OBESITY AND DIABETES ISSUE ARE ADDRESSED IN OUR COMMUNITY HEALTH IMPLEMENTATION PLAN (WE ARE STRIVING TO IMPACT EACH OF THESE IDENTIFIED NEEDS.) HTTPS://WWW.GUNDERSENHEALTH.ORG/APP/FILES/PUBLIC/10611/COMMUNITY-HEALTH-NE EDS-IMPLEMENTATIONPLAN-2019-2021.PDF IN ADDITION, GUNDERSEN HEALTH SYSTEM HAS ESTABLISHED 4 POPULATION HEALTH INITIATIVES THAT INTERSECT OR MIRROR THE IDENTIFIED NEED PRIORITIES. THESE INITIATIVES ARE: 1. ADVERSE CHILDHOOD EXPERIENCES (ACES)/ TRAUMA INFORMED CARE (TIC) 2. HOMELESSNESS (AND OTHER SOCIAL DETERMINANTS OF HEALTH) 3. SUBSTANCE ABUSE/MENTAL HEALTH 4. CHRONIC ILLNESS (POPULATION MEDICINE) OUR PLAN INCORPORATES 4 OVERARCHING GOALS THAT BLEND THE COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED PRIORITIES AND OUR POPULATION HEALTH INITIATIVES: - AUGMENT AND DISSEMINATE WRAP AROUND SERVICES FOR CHILDREN AND ADULTS THAT WILL IMPROVE SELECTED OUTCOMES (INCLUDES ACTION STEPS TO INCREASE INCLUSION OF SOCIALLY DIVERSE PEOPLE) - REDUCE NUMBER OF DEATHS DUE TO POOR MENTAL HEALTH AND SUBSTANCE ABUSE AND REDUCE THE NUMBER OF POOR MENTAL HEALTH DAYS - LEVERAGE COMMUNITY PARTNERSHIPS TO ADDRESS OBESITY AND IMPROVE OUTCOMES AMONG PATIENTS WITH DIABETES - REDUCE THE IMPACT OF POVERTY ON POOR HEALTH BY PARTNERING WITH COMMUNITIES TO ADDRESS SOCIAL DETERMINANTS OF HEALTH
FORM 990 SCH H PART V LINE 13C GHS PATIENTS NOT MEETING FINANCIAL ASSISTANCE ELIGIBILITY THRESHOLDS MAY BE ELIGIBLE FOR ASSISTANCE UNDER CIRCUMSTANCES WHEN GHS MEDICAL BILLS WOULD RESULT IN SEVERE FINANCIAL HARDSHIP. PATIENTS, OR THEIR GUARANTORS, MAY BE ELIGIBLE FOR CATASTROPHIC CARE ASSISTANCE IF THEY HAVE INCURRED OUT-OF-POCKET OBLIGATIONS RESULTING FROM MEDICAL SERVICES PROVIDED BY GHS THAT EXCEED 25% OF FAMILY INCOME AND HAVE ASSETS BELOW THE EQUIVALENT OF 600% OF THE FEDERAL POVERTY LEVEL THRESHOLD. PATIENTS, OR PATIENT GUARANTORS, MEETING ELIGIBILITY CRITERIA FOR CATASTROPHIC CARE WILL HAVE THEIR GHS CHARGES DISCOUNTED TO AN AMOUNT NOT TO EXCEED 25% OF FAMILY INCOME.
FORM 990 SCH H PART V LINE 13H GHS PATIENTS NOT MEETING FINANCIAL ASSISTANCE ELIGIBILITY THRESHOLDS MAY BE ELIGIBLE FOR ASSISTANCE UNDER CIRCUMSTANCES WHEN GHS MEDICAL BILLS WOULD RESULT IN SEVERE FINANCIAL HARDSHIP. PATIENTS, OR THEIR GUARANTORS, MAY BE ELIGIBLE FOR CATASTROPHIC CARE ASSISTANCE IF THEY HAVE INCURRED OUT-OF-POCKET OBLIGATIONS RESULTING FROM MEDICAL SERVICES PROVIDED BY GHS THAT EXCEED 25% OF FAMILY INCOME AND HAVE ASSETS BELOW THE EQUIVALENT OF 600% OF THE FEDERAL POVERTY LEVEL THRESHOLD. PRESUMPTIVE ELIGIBILITY: GHS UNDERSTANDS THAT NOT ALL PATIENTS ARE ABLE TO COMPLETE A FINANCIAL ASSISTANCE APPLICATION OR COMPLY WITH REQUESTS FOR DOCUMENTATION. THERE MAY BE INSTANCES UNDER WHICH A PATIENT'S QUALIFICATION FOR FINANCIAL ASSISTANCE IS ESTABLISHED WITHOUT COMPLETING THE FORMAL FINANCIAL ASSISTANCE APPLICATION. OTHER INFORMATION MAY BE UTILIZED BY GHS TO DETERMINE WHETHER A PATIENT'S ACCOUNT IS UNCOLLECTIBLE AND THIS INFORMATION WILL BE USED TO DETERMINE PRESUMPTIVE ELIGIBILITY. PRESUMPTIVE ELIGIBILITY MAY BE GRANTED TO PATIENTS BASED ON THEIR ELIGIBILITY FOR OTHER PROGRAMS OR LIFE CIRCUMSTANCES SUCH AS: 1. PATIENTS OR GUARANTORS WHO HAVE DECLARED BANKRUPTCY. IN CASES INVOLVING BANKRUPTCY, ONLY THE ACCOUNT BALANCE AS OF THE DATE THE BANKRUPTCY IS DISCHARGED WILL BE WRITTEN OFF. 2. PATIENTS OR GUARANTORS WHO ARE DECEASED WITH NO ESTATE IN PROBATE. 3. PATIENTS OR GUARANTORS DETERMINED TO BE HOMELESS. 4. ACCOUNTS RETURNED BY THE COLLECTION AGENCY AS UNCOLLECTIBLE DUE TO ANY OF THE ABOVE REASONS. 5. PATIENTS OR GUARANTORS WHO QUALIFY FOR STATE MEDICAID PROGRAMS, WILL BE ELIGIBLE FOR ASSISTANCE FOR ANY COST-SHARING OBLIGATIONS ASSOCIATED WITH THE PROGRAM OR UNCOVERED SERVICES. GHS UNDERSTANDS THAT CERTAIN PATIENTS MAY BE NON-RESPONSIVE TO GHS'S APPLICATION PROCESS. UNDER THESE CIRCUMSTANCES, GHS MAY UTILIZE OTHER SOURCES OF INFORMATION TO MAKE AN INDIVIDUAL ASSESSMENT OF FINANCIAL NEED. THIS INFORMATION WILL ENABLE GHS TO MAKE AN INFORMED DECISION ON THE FINANCIAL NEED OF NON-RESPONSIVE PATIENTS UTILIZING THE BEST ESTIMATES AVAILABLE IN THE ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT. GHS MAY UTILIZE A THIRD-PARTY TO CONDUCT AN ELECTRONIC REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. THIS REVIEW UTILIZES A HEALTHCARE INDUSTRY-RECOGNIZED MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THIS PREDICTIVE MODEL INCORPORATES PUBLIC RECORD DATA TO CALCULATE A SOCIO-ECONOMIC AND FINANCIAL CAPACITY SCORE THAT INCLUDES ESTIMATES FOR INCOME, ASSETS AND LIQUIDITY. THE ELECTRONIC TECHNOLOGY IS DESIGNED TO ASSESS EACH PATIENT TO THE SAME STANDARDS AND IS CALIBRATED AGAINST HISTORICAL APPROVALS FOR GHS FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. THE ELECTRONIC TECHNOLOGY, WHEN UTILIZED, WILL BE DEPLOYED PRIOR TO BAD DEBT ASSIGNMENT AFTER ALL OTHER ELIGIBILITY AND PAYMENT SOURCES HAVE BEEN EXHAUSTED. THIS ALLOWS GHS TO SCREEN ALL PATIENTS FOR FINANCIAL ASSISTANCE PRIOR TO PURSUING ANY EXTRAORDINARY COLLECTION ACTIONS. THE DATA RETURNED FROM THIS ELECTRONIC ELIGIBILITY REVIEW WILL CONSTITUTE ADEQUATE DOCUMENTATION OF FINANCIAL NEED UNDER THIS POLICY. WHEN ELECTRONIC ENROLLMENT IS USED AS THE BASIS FOR PRESUMPTIVE ELIGIBILITY, THE HIGHEST DISCOUNT LEVELS WILL BE GRANTED FOR ELIGIBLE SERVICES FOR RETROSPECTIVE DATES OF SERVICE ONLY. IF A PATIENT DOES NOT QUALIFY UNDER THE ELECTRONIC ENROLLMENT PROCESS, THE PATIENT MAY STILL BE CONSIDERED UNDER THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS. GHS WILL PROVIDE PATIENTS NOT QUALIFYING FOR FINANCIAL ASSISTANCE THROUGH THIS PROCESS WITH A WRITTEN NOTICE INFORMING THEM THAT FINANCIAL ASSISTANCE IS AVAILABLE. THIS NOTICE WILL INCLUDE A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY AND ACTIONS TO BE TAKEN IF AN APPLICATION IS NOT SUBMITTED OR THE OUTSTANDING BALANCE PAID. PATIENT ACCOUNTS GRANTED PRESUMPTIVE ELIGIBILITY WILL BE RECLASSIFIED UNDER THE FINANCIAL ASSISTANCE POLICY. THEY WILL NOT BE SENT TO COLLECTION, WILL NOT BE SUBJECT TO FURTHER COLLECTION ACTIONS, WILL NOT BE SENT A WRITTEN NOTIFICATION OF THEIR ELECTRONIC ELIGIBILITY QUALIFICATION, AND WILL NOT BE INCLUDED IN THE HOSPITAL'S BAD DEBT EXPENSE.
FORM 990 SCH H PART V LINE 15C CONTACT INFO DETAILING PHONE NUMBER, PHYSICAL LOCATION OF FINANCIAL COUNSELORS, AND MAILING ADDRESS ARE INCLUDED IN THE FINANCIAL ASSISTANCE POLICY, THE FINANCIAL ASSISTANCE APPLICATION, ON THE FINANCIAL ASSISTANCE WEBSITE (https://www.gundersenhealth.org/pay-my-bill/financial-assistance/), ON EVERY PATIENT STATEMENT, AND ON BROCHURES AT ALL REGISTRATION DESKS.
FORM 990 SCH H PART V LINE 15E APPLICATION REQUIREMENTS: ELIGIBILITY FOR FINANCIAL ASSISTANCE WILL BE BASED ON FINANCIAL NEED AT THE TIME OF APPLICATION. IN GENERAL, DOCUMENTATION IS REQUIRED TO SUPPORT AN APPLICATION FOR FINANCIAL ASSISTANCE. IF ADEQUATE DOCUMENTATION IS NOT PROVIDED, GHS MAY SEEK ADDITIONAL INFORMATION. RELIABLE EVIDENCE TO SUPPORT THE NEED FOR FINANCIAL ASSISTANCE IS REQUIRED. THE FOLLOWING INCOME DOCUMENTATION IS REQUIRED FROM PATIENTS, OR THEIR GUARANTORS, TO DETERMINE ELIGIBILITY: 1. COPY OF THE FEDERAL TAX RETURN, AND ALL ATTACHED SCHEDULES, FROM THE MOST RECENT TAX YEAR 2. CURRENT PROOF OF INCOME (COPY OF MOST RECENT PAY STUBS OR OTHER DOCUMENTATION) 3. PROOF OF OTHER INCOME, INCLUDING UNEMPLOYMENT, WORKERS' COMPENSATION, ALIMONY, TRUST INCOME, VETERAN'S BENEFITS 4. CURRENT BANK STATEMENTS THE FOLLOWING ASSET DOCUMENTATION IS REQUIRED FROM PATIENTS, OR THEIR GUARANTORS, TO DETERMINE ELIGIBILITY: 1. CHECKING ACCOUNTS 2. SAVINGS ACCOUNTS 3. MONEY MARKET ACCOUNTS 4. CERTIFICATES OF DEPOSIT 5. ANNUITIES 6. NON-RETIREMENT INVESTMENT ACCOUNTS 7. RETIREMENT ACCOUNTS, INCLUDING PENSIONS 8. REAL ESTATE 9. OTHER ASSETS
FORM 990 SCH H PART V LINE 16A, 16B, AND 16C THE FAP: FAP APPLICATION AND PLAIN LANGUAGE SUMMARY OF THE FAP WERE AVAILABLE ON A WEBSITE: https://www.gundersenhealth.org/pay-my-bill/financial-assistance/
FORM 990 SCH H PART V LINE 20E NOTIFICATION OF FINANCIAL ASSISTANCE: NOTIFICATIONS OF AVAILABILITY OF FINANCIAL ASSISTANCE ARE INCLUDED ON EVERY PATIENT STATEMENT, PROVIDED AT ADMISSION/CHECK-IN, ARE ANNOUNCED ON SIGNS AT EACH CHECK-IN AREA, AT BEDSIDE FOR PATIENTS DIRECTLY ADMITTED WHO MAY NOT HAVE MET WITH ADMISSIONS STAFF.
SCHEDULE H, PART V, LINE 22B AMOUNT GENERALLY BILLED (AGB): THE AMOUNT GENERALLY BILLED IS THE EXPECTED PAYMENT FOR EMERGENCY OR MEDICALLY NECESSARY SERVICES FROM PATIENTS, AND/OR A PATIENT'S GUARANTOR. FOR QUALIFYING PATIENTS, THIS AMOUNT WILL NOT EXCEED A RATE THAT WILL BE DETERMINED UTILIZING A LOOK BACK METHOD DESCRIBED IN SECTION 1.501(R)-5(B)(3) OF THE INTERNAL REVENUE CODE. THE LOOK BACK METHOD WILL BE BASED ON ACTUAL PAST CLAIMS PAID TO GUNDERSEN BY MEDICARE FEE-FOR-SERVICE TOGETHER WITH ALL PRIVATE HEALTH INSURERS PAYING CLAIMS. THE CLAIMS TO BE INCLUDED IN THE AGB CALCULATION WILL BE CLAIMS ALLOWED DURING THE PRIOR CALENDAR YEAR. THE AMOUNTS FOR CO-INSURANCE, CO-PAYMENTS AND DEDUCTIBLES WILL BE INCLUDED IN THE NUMERATOR ALONG WITH THE MEDICARE FEE-FOR-SERVICE TOGETHER WITH ALL ALLOWED CLAIMS FROM PRIVATE HEALTH INSURERS. THE GROSS CHARGES FOR PAID CLAIMS WILL BE INCLUDED IN THE DENOMINATOR. THE AGB WILL BE CALCULATED ANNUALLY BY THE 45TH DAY FOLLOWING THE CLOSE OF THE PRIOR CALENDAR YEAR AND IMPLEMENTED BY THE 120TH DAY FOLLOWING THE CLOSE OF THE CALENDAR YEAR.
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2019
Page 9
Schedule H (Form 990) 2019
Page 9
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?10
Name and address Type of Facility (describe)
1 GL HOSPICE INDUSTRIAL REHAB BUILDING
1843 SIMS PL
LA CROSSE,WI54601 		HOSPICE SERVICES
2 GL SATELLITE DIALYSIS-ONALASKA
3075 S KINNEY COULEE RD
ONALASKA,WI54650 		RENAL DIALYSIS CENTER
3 UNITY HOUSE FOR WOMEN
1312 5TH AVE
LA CROSSE,WI54601 		ALCOHOL AND OTHER DRUG ABUSE (AODA) SERVICES
4 GL SATELLITE DIALYSIS-VIROQUA
407 S MAIN ST
VIROQUA,WI54665 		RENAL DIALYSIS CENTER
5 GL SATELLITE DIALYSIS-TOMAH
505 GOPHER DRIVE
TOMAH,WI54660 		RENAL DIALYSIS CENTER
6 GL SATELLITE DIALYSIS- PRAIRIE DU CHIEN
610 E TAYLOR ST
PRAIRIE DU CHIEN,WI53821 		RENAL DIALYSIS CENTER
7 GL SATELLITE DIALYSIS-BLACK RVR FALLS
711 W ADAMS ST
BLACK RIVER FALLS,WI54615 		RENAL DIALYSIS CENTER
8 GL SATELLITE DIALYSIS-RICHLAND CENTER
1313 W SEMINARY ST
RICHLAND CENTER,WI53581 		RENAL DIALYSIS CENTER
9 GL MENTAL HEALTH DAY TREAT BEHAV HLTH
123 16TH AVE S
ONALASKA,WI54650 		OUTPATIENT PSYCHOLOGICAL SERVICES
10 UNITY HOUSE FOR MEN
1918-1924 MILLER ST
LA CROSSE,WI54601 		ALCOHOL AND OTHER DRUG ABUSE (AODA) SERVICES
Schedule H (Form 990) 2019
Page 10
Schedule H (Form 990) 2019
Page 10
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
FORM 990 SCH H PART I LINE 3C CATASTROPHIC CARE ASSISTANCE: FINANCIAL ASSISTANCE PROVIDED TO ELIGIBLE PATIENTS WITH ANNUALIZED FAMILY INCOMES IN EXCESS OF 400% OF THE FEDERAL POVERTY LEVEL, AND ASSETS OF LESS THAN THE EQUIVALENT OF 600% OF THE FEDERAL POVERTY LEVEL, AND FINANCIAL OBLIGATIONS RESULTING FROM MEDICAL SERVICES PROVIDED BY GHS IN EXCESS OF 25% OF THE FAMILY INCOME. DISCOUNTED CARE: FINANCIAL ASSISTANCE THAT PROVIDES A DISCOUNT, FOR ELIGIBLE MEDICAL SERVICES PROVIDED BY GHS, BASED ON A SLIDING SCALE, FOR ELIGIBLE PATIENTS, OR PATIENT GUARANTORS, WITH ANNUALIZED FAMILY INCOMES BETWEEN 200-400% OF THE FEDERAL POVERTY LEVEL AND ASSETS AT OR BELOW SIX TIMES THE FEDERAL POVERTY LEVEL. 1. FAMILY INCOME ABOVE 200% FPL BUT EQUAL TO OR LESS THAN 225% FPL ARE ELIGIBLE TO RECEIVE A 80% DISCOUNT ON THE PATIENT BALANCE DUE. 2. FAMILY INCOME ABOVE 225% FPL BUT EQUAL TO OR LESS THAN 250% FPL ARE ELIGIBLE TO RECEIVE A 60% POLICY DISCOUNT ON THE PATIENT BALANCE DUE. 3. FAMILY INCOME ABOVE 250% FPL BUT EQUAL TO OR LESS THAN 275% FPL ARE ELIGIBLE TO RECEIVE A 40% DISCOUNT ON THE PATIENT BALANCE DUE. 4. FAMILY INCOME ABOVE 275% FPL BUT EQUAL TO OR LESS THAN 400% FPL ARE ELIGIBLE TO RECEIVE A 20% DISCOUNT ON THE PATIENT BALANCE DUE. FREE CARE: A 100% WAIVER OF PATIENT FINANCIAL OBLIGATION FOR ELIGIBLE MEDICAL SERVICES PROVIDED BY GHS FOR ELIGIBLE PATIENTS, OR THEIR GUARANTORS, WITH ANNUALIZED FAMILY INCOMES AT OR BELOW 200% OF THE FPL WITH ASSETS BELOW THE EQUIVALENT OF 600% OF THE FPL. UNINSURED DISCOUNT: PATIENTS WITH NO THIRD-PARTY COVERAGE WILL BE PROVIDED AN UNINSURED DISCOUNT, FOR ELIGIBLE SERVICES PROVIDED BY GHS UNDER THIS POLICY, AT THE TIME THAT THE UNDISCOUNTED CHARGES ARE RENDERED. SERVICES NOT ELIGIBLE FOR FINANCIAL ASSISTANCE INCLUDE THE FOLLOWING: 1. ELECTIVE PROCEDURES NOT MEDICALLY NECESSARY, AS WELL AS SERVICES TYPICALLY NOT COVERED BY MEDICARE OR DEFINED BY MEDICARE OR OTHER HEALTH INSURANCE COVERAGE AS NOT MEDICALLY NECESSARY. 2. LASIK SURGERY, CHIROPRACTIC CARE, FERTILITY SERVICES, CONTACTS/GLASSES, COSMETIC SURGERY/PLASTIC SERVICES, HEARING AIDES, ORTHODONTICS, DENTAL SERVICES, OPTOMETRY. 3. SERVICES RECEIVED FROM CARE PROVIDERS NOT EMPLOYED BY GHS (E.G. PRIVATE AND/OR NON-GHS MEDICAL OR PHYSICIAN PROFESSIONALS, AMBULANCE TRANSPORT, ETC.). PATIENTS ARE ENCOURAGED TO CONTACT THESE PROVIDERS DIRECTLY TO INQUIRE INTO ANY AVAILABLE ASSISTANCE AND TO MAKE PAYMENT ARRANGEMENTS. SEE APPENDIX 3 FOR FULL LISTING OF PROVIDERS NOT COVERED UNDER THIS POLICY. 4. DEDUCTIBLES AND COINSURANCE ASSOCIATED WITH MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS OUT-OF-NETWORK AS DEFINED BY THEIR INSURERS.
FORM 990 SCH H PART I LINE 6A GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. (EIN: 39-1866425)
FORM 990 SCH H PART I LINE 6B THE COMMUNITY BENEFIT DATA IS FILED WITH THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THE WHA MAKES A COMBINED SUMMARY AVAILABLE THAT INCLUDES ALL WISCONSIN HOSPITALS.
FORM 990 SCH H PART I LINE 7 SCHEDULE H, PART I, LINE 7A FINANCIAL ASSISTANCE AT COST IS FROM THE COST REPORT FOR CHARITY CARE AT COST. THIS IS BASED ON A COST TO CHARGE RATIO OF THE ACTUAL CHARITY CARE WRITTEN-OFF. COST TO CHARGE RATIO, AS CALCULATED USING WORKSHEET 2 METHODOLOGY TO DETERMINE THE COST OF SERVICES PROVIDED TO PATIENTS. MEDICAID AND OTHER MEANS TESTED PROGRAM COMMUNITY BENEFIT EXPENSES FOLLOWED THE CALCULATION METHODOLOGY ON WORKSHEET 3. SCHEDULE H, PART I, LINE 7B MEDICAID COMMUNITY BENEFIT EXPENSE IS CALCUATED USEING COST TO CHARGE RATIO OF MEDICAID GROSS CHARGES DECREASED BY MEDICAID PROVIDER TAXES, FEES, AND DIRECT NET PATIENT SERVICE REVENUE. SCHEDULE H, PART I, LINE 7E COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFITS OPERATIONS IS CACULATED ON WORKSHEET 4 BASED ON COMMUNITY HEALTH IMPROVEMENT SERVICES COST AND COMMUNITY BENEFIT OPERATIONS COST DECREASED BY COMMUNITY HEALTH IMPROVEMENT SERVICE REVENUE. SCHEDULE H, PART I, LINE 7F HEALTH PROFESSIONALS EDUCATION COST IS CALCUATED ON WORKSHEET 5 TO REFLECT THE MEDICAL STUDENT, INTERNS, RESIDENTS, AND FELLOWS COST DECREASED BY REIMBURSMENTS FROM MEDICARE, MEDICAID, AND TUITION REIMBURSMENTS.
SCHEDULE H, PART I, LINE 7 COLUMN (F) THE PERCENT OF TOTAL EXPENSE WAS CALCULATED BY DIVIDING THE COMMUNITY BENEFIT COST BY TOTAL HOSPITAL EXPENSES OF $1,039,108,234. THE TOTAL HOSPITAL EXPENSES EXCLUDE THE BAD DEBT EXPENSE OF $19,921,502.
FORM 990 SCH H PART II THE GUNDERSEN HEALTH SYSTEM, WHICH INCLUDES GUNDERSEN LUTHERAN MEDICAL CENTER, IS COMMITTED TO OUR COMMUNITIES AS EXPRESSED IN OUR MISSION: WE DISTINGUISH OURSELVES THROUGH EXCELLENCE IN PATIENT CARE, EDUCATION, RESEARCH AND IMPROVED HEALTH IN THE COMMUNITIES WE SERVE. THE COMMUNITY BUILDING ACTIVITIES ARE INCLUDED IN COMMUNITY SERVICE REPORTING WHICH ARE PROGRAMS OR SERVICES THAT SUPPORT OUR POPULATION HEALTH INITIATIVE, BENEFITING COMMUNITIES BY ADDRESSING IDENTIFIED NEED THROUGH EFFECTIVE HEALTH IMPROVEMENT PROGRAMMING, ECONOMIC CONTRIBUTION, CORPORATE CITIZENSHIP AND VOLUNTEERISM. SUPPORT IS PROVIDED THROUGH CONTRIBUTION TO OTHER ORGANIZATIONS, OR THROUGH PROGRAMMING DELIVERED BY GUNDERSEN. WHENEVER POSSIBLE, THIS TYPE OF PROGRAMMING IS EVALUATED TO IDENTIFY THE IMPACT ON POPULATION HEALTH AND QUALITY OF LIFE. VERIFICATION OF ADDRESSING COMMUNITY NEEDS IS DOCUMENTED IN THE IMPLEMENTATION PLAN. AS A LARGER SYSTEM, COMMUNITY BUILDING ACTIVITIES ENCOMPASS ALL CORPORATIONS. LEADERSHIP IN COMMUNITY HEALTH IMPROVEMENT IS EVIDENCED BY OUR ACTIVITY WITH SEVERAL COMMUNITY COALITIONS AND INITIATIVES. AS WE CONSIDER OUR COMMUNITY NEEDS IDENTIFIED IN THE COMPASS REPORT, IT IS EVIDENT THAT HEALTH IS IMPACTED BY NOT ONLY THE TRADITIONAL SENSE OF PROVISION OF QUALITY MEDICAL SERVICES, BUT THE ENVIRONMENT IN WHICH WE LIVE, THE ECONOMIC CONDITION OF OUR PERSON AND FAMILY AND OVERALL QUALITY OF LIFE OFFERED IN THE COMMUNITIES WHERE WE LIVE.
FORM 990 SCH H PART III LINE 2 COST TO CHARGE RATIO WAS OUR STARTING POINT FOR DETERMINING THE COST OF BAD DEBTS. THE COST TO CHARGE RATIO WAS CALCULATED FOLLOWING THE METHODOLOGY ON WORKSHEET 2. BAD DEBT EXPENSE IS THE PRODUCT OF THE COST TO CHARGE RATIO AND THE NET PROVISION FOR BAD DEBTS FROM THE FINANCIAL STATEMENTS.
FORM 990 SCH H PART III LINE 3 THE PATIENTS THAT EXCEED THE 400% FPG, WHEN ADDITIONAL CRITERIA SUCH AS CATASTROPHIC MEDICAL COSTS ARE CONSIDERED, HAPPENS WHEN ELIGIBLE PATIENTS WITH ANNUALIZED FAMILY INCOMES IN EXCESS OF 400% OF THE FEDERAL POVERTY LEVEL, ASSETS OF LESS THAN THE EQUIVALENT OF 600% OF THE FEDERAL POVERTY LEVEL, AND FINANCIAL OBLIGATIONS RESULTING FROM MEDICAL SERVICES PROVIDED BY GHS IN EXCESS OF 25% OF THE FAMILY INCOME. THE DATA USED IS FROM THE US CENSUS BUREAU, 2013-2017 AMERICAN COMMUNITY SURVEY (ACS) 5-YEAR DATA SET FOR THE WISCONSIN AND MINNESOTA COUNTIES. WE OBTAINED THE AVERAGE OF SEVERAL COUNTIES BY USING THE INFORMATION AT THE 3.00-3.99 (399%) OF FEDERAL POVERTY LEVEL (FPL) AND BELOW. THE NEXT RANGE WAS 4.00-4.99 RATIO OF INCOME TO POVERTY IN THE LAST 12 MONTHS. WE HAVE MULTIPLIED THE COUNTY AVERAGE AT 399% FPL TO THE BAD DEBT AT COST. WE DEDUCTED THE AMOUNT OF CHARITY CARE AT COST TO OBTAIN THE AMOUNT OF BAD DEBT AT COST TO PATIENTS ELIGIBLE UNDER FAP (BUT FOR WHOM INSUFFICIENT INFORMATION WAS OBTAINED TO DETERMINE THEIR ELIGIBILITY).
FORM 990 SCH H PART III LINE 4 THE COLLECTION OF RECEIVABLES FROM THIRD-PARTY PAYORS AND PATIENTS IS THE SYSTEM'S PRIMARY SOURCE OF CASH FOR OPERATIONS. THE PRIMARY COLLECTION RISKS RELATE TO UNINSURED PATIENT ACCOUNTS AND PATIENT DEDUCTIBLES AND COINSURANCE ON INSURERS' ACCOUNTS. PATIENT RECEIVABLES, INCLUDING THE PORTION FOR WHICH A THIRD-PARTY PAYOR IS RESPONSIBLE, ARE CARRIED AT NET REALIZABLE VALUE, DETERMINED BY THE ORIGINAL CHARGE FOR THE SERVICEPROVIDED LESS AN ESTIMATE MADE FOR CONTRACTUAL ADJUSTMENTS OR DISCOUNTS PROVIDED TO THIRD-PARTY PAYORS. PATIENT RECEIVABLES DUE DIRECTLY FROM THE PATIENTS ARE CARRIED ON THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS AT THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED LESS AMOUNTS COVERED BY THIRD-PARTY PAYORS, ALLOWANCES FOR OTHER DISCOUNTS, AND AN ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. THE SYSTEM DOES NOT CHARGE INTEREST ON PAST-DUE RECEIVABLES. RECEIVABLES ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE SYSTEM'S POLICIES. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE SYSTEM ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS ACCOUNTS AND PROVISION FOR BAD DEBTS. THE ANALYSIS IS PERFORMED USING A HINDSIGHT CALCULATION THAT UTILIZES WRITE-OFF DATA FOR ALL PAYOR CLASSES DURING A DETERMINED TIME PERIOD TO CALCULATE THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AT A POINT IN TIME. THE SYSTEM GRANTS CREDIT WITHOUT COLLATERAL TO PATIENTS, MOST OF WHOM ARE LOCAL RESIDENTS AND ARE INSURED UNDER THIRD-PARTY PAYOR AGREEMENTS. AT DECEMBER 31, 2019 AND 2018, THE SYSTEMS ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS WAS $15,156 AND $14,674 (DOLLARS IN THOUSANDS), RESPECTIVELY. THE SYSTEMS ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AS A PERCENTAGE OF ACCOUNTS RECEIVABLE WAS 8% AT DECEMBER 31, 2019 AND 2018. AT DECEMBER 31, 2019 AND 2018, AMOUNTS DUE FROM MEDICARE REPRESENTED 12% AND 15% OF THE SYSTEM'S NET PATIENT ACCOUNTS RECEIVABLE. MAJOR PAYOR SOURCES TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL.
FORM 990 SCH H PART III LINE 8 THE MEDICARE COST REPORT IS USED TO DETERMINE ALLOWABLE COSTS. THE UNREIMBURSED MEDICARE COSTS ON PART III, SECTION B OF SCHEDULE H ARE ALLOWABLE COSTS PER THE MEDICARE COST REPORT. THIS CALCULATION IS LIMITED TO PATIENTS WHO ARE COVERED UNDER THE MEDICARE FEE FOR SERVICE PLAN AND DOES NOT INCLUDE THOSE COVERED BY THE MEDICARE ADVANTAGE PLANS. IT ALSO DOES NOT INCLUDE ALL SERVICES PROVIDED BY THE HOSPITAL TO PATIENTS COVERED UNDER THE MEDICARE FEE FOR SERVICE PLAN. IT EXCLUDES HOSPICE SERVICES, AMBULANCE SERVICES, CLINICAL LABORATORY SERVICES, AND A FEW OTHER MISCELLANEOUS SERVICES. INCORPORATING ALL SERVICES TO ALL MEDICARE BENEFICIARIES, THE UNREIMBURSED COST FOR MEDICARE IS $59,236,843. THE MEDICARE COSTS ARE CALCULATED DIFFERENTLY THAN THE 990 UNREIMBURSED MEDICARE COSTS OF $55,734,815. MEDICARE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT BECAUSE OUR MISSION IS TO PROMOTE HEALTH IN THE COMMUNITY AND WE DO NOT LIMIT THE CARE AVAILABLE TO ANY PATIENTS, INCLUDING THOSE COVERED BY MEDICARE. WE ARE RELIEVING A GOVERNMENT BURDEN BY PROVIDING CARE TO MEDICARE PATIENTS EVEN THOUGH COSTS EXCEED REIMBURSEMENTS BY $59 MILLION. TAX-EXEMPT HOSPITALS ARE EXPECTED TO PARTICIPATE IN THE MEDICARE PROGRAM.
FORM 990 SCH H PART III LINE 9B PURSUANT TO SELF-PAY BILLING & COLLECTION POLICY, NO EXTRAORDINARY COLLECTION ACTIONS WILL BE PURSUED AGAINST A PATIENT, OR PATIENT GUARANTOR, BEFORE REASONABLE EFFORTS HAVE BEEN MADE TO DETERMINE WHETHER THE PATIENT OR GUARANTOR IS ELIGIBLE FOR ASSISTANCE UNDER THE GHS FINANCIAL ASSISTANCE POLICY (FAP). NO ACCOUNT WILL BE SUBJECT TO BAD DEBT COLLECTION ACTIONS, OR ECA, WITHIN 120 DAYS OF THE FIRST POST-DISCHARGE STATEMENT BEFORE GHS HAS MADE REASONABLE EFFORTS TO DETERMINE WHETHER THAT PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE. THIS 120 DAY TIMEFRAME MAY BE ABBREVIATED IF A DETERMINATION HAS BEEN MADE ON FINANCIAL ASSISTANCE, A PAYMENT PLAN HAS BEEN ESTABLISHED AND AGREED TO BY THE PATIENT OR GUARANTOR, AND THE PATIENT OR GUARANTOR IS NO LONGER COMPLYING WITH THE PAYMENT PLAN. NO COLLECTION ACTIONS WILL BE PURSUED AGAINST A PATIENT IF THE PATIENT, OR GUARANTOR, HAS PROVIDED DOCUMENTATION SHOWING THAT HE OR SHE HAS APPLIED FOR COVERAGE UNDER MEDICAID, OR OTHER PUBLICLY SPONSORED HEALTH PROGRAMS, THAT MAY PAY THE OUTSTANDING CLAIM AND FOR WHICH AN ELIGIBILITY DETERMINATION IS STILL PENDING. PRIOR TO SENDING A PATIENT'S ACCOUNT TO A COLLECTION AGENCY GHS WILL MAKE REASONABLE EFFORTS TO PROVIDE INFORMATION ON FINANCIAL ASSISTANCE AND WILL MAIL A MINIMUM OF THREE (3) WRITTEN STATEMENTS TO THE PATIENT OR GUARANTOR. EACH STATEMENT WILL INCLUDE CONSPICUOUS NOTICE OF THE GHS FINANCIAL ASSISTANCE POLICY, TELEPHONE NUMBER TO CALL FOR HELP, AND DIRECT WEBSITE ADDRESS. IF ALL EFFORTS TO COMMUNICATE WITH THE PATIENT, OR PATIENT GUARANTOR, ARE UNSUCCESSFUL, AND A CORRECT ADDRESS FOR UNDELIVERABLE MAIL IS NOT FOUND, ACCOUNTS WILL BE SENT TO A COLLECTION AGENCY. WITHIN 240 DAYS FROM THE FIRST POST-DISCHARGE STATEMENT, IF A PATIENT, OR GUARANTOR, APPLIES FOR FINANCIAL ASSISTANCE, THE APPLICATION WILL BE ACCEPTED AND COLLECTION ACTIONS WILL CEASE WHILE AN ELIGIBILITY DETERMINATION IS BEING MADE. IF THE APPLICANT IS APPROVED FOR FREE CARE, NO FURTHER ACTIONS WILL BE TAKEN TO COLLECT ON THE AMOUNT. IF THE APPLICANT IS DENIED FINANCIAL ASSISTANCE OR IS APPROVED FOR DISCOUNTED CARE, STEPS WILL BE TAKEN TO RESOLVE THE OUTSTANDING OBLIGATION. IF THE ACCOUNT IS NOT RESOLVED OR ARRANGEMENTS TO RESOLVE THE ACCOUNT ARE NOT MADE, ADDITIONAL COLLECTION ACTIONS WILL BE PURSUED. IF AN INDIVIDUAL SUBMITS AN INCOMPLETE APPLICATION DURING THE APPLICATION PERIOD, GHS MUST (I) SUSPEND ALL COLLECTION ACTIONS, (II) PROVIDE THE INDIVIDUAL WITH A WRITTEN NOTICE THAT DESCRIBES THE ADDITIONAL INFORMATION AND/OR DOCUMENTATION REQUIRED UNDER THE FAP OR APPLICATION FORM THAT MUST BE SUBMITTED TO COMPLETE THE FAP APPLICATION AND (III) PROVIDE GHS'S CONTACT INFORMATION. THE APPLICATION WILL REMAIN ACTIVE FOR 30 DAYS FROM THE DATE THE LETTER WAS MAILED TO THE APPLICANT REQUESTING THIS INFORMATION. IF THE APPLICANT HAS NOT RESPONDED WITHIN THE 30 DAY TIMEFRAME, THE APPLICATION WILL BE DENIED. APPLICANTS APPROVED FOR FINANCIAL ASSISTANCE WILL BE REFUNDED PAYMENTS IN EXCESS OF THE AMOUNT DETERMINED OWED BY THE PATIENT OR PATIENT'S GUARANTOR ON ACCOUNTS FOR WHICH THEY HAVE BEEN GRANTED ASSISTANCE UNDER THE GHS FAP. REFUNDS APPLY TO EXCESS PAYMENTS OF $15.00 OR MORE. IN ACCORDANCE WITH THIS POLICY, FINANCIAL ASSISTANCE IS GENERALLY NOT EXTENDED FOR CO-PAYMENTS OR A BALANCE REMAINING AFTER THE INSURANCE COMPANY HAS PAID IF A PATIENT FAILS TO OBTAIN PROPER REFERRALS OR AUTHORIZATIONS, OR IF SUCH ASSISTANCE IS NOT IN ACCORDANCE WITH INSURER'S CONTRACTUAL AGREEMENT THEREFORE SUCH PAYMENTS RECEIVED WILL NOT BE REFUNDED. COLLECTION ACTIONS MAY BE UTILIZED BY GHS WHEN PURSUING PAYMENT FROM PATIENTS OR GUARANTORS (I) WITH BALANCES DUE THAT GO UNPAID FOR MORE THAN 120 DAYS WHO DO NOT APPLY FOR FINANCIAL ASSISTANCE, (II) PATIENTS OR GUARANTORS NOT IN CONFORMANCE WITH AN AGREED UPON PAYMENT PLAN, OR (III) PATIENTS OR GUARANTORS WHO ARE NO LONGER COOPERATING IN GOOD FAITH TO PAY OFF THE REMAINING BALANCE. AT LEAST 30 DAYS BEFORE INITIATING ONE OR MORE ECAS TO OBTAIN PAYMENT FOR THE CARE PROVIDED, GHS WILL PROVIDE A PATIENT OR PATIENT'S GUARANTOR WITH A WRITTEN NOTICE THAT INDICATES FINANCIAL ASSISTANCE IS AVAILABLE FOR ELIGIBLE INDIVIDUALS, HOW AN INDIVIDUAL CAN APPLY FOR FINANCIAL ASSISTANCE, AND WHERE THE FAP CAN BE OBTAINED. SUCH WRITTEN NOTICE WILL IDENTIFY THE ECAS THAT GHS OR OTHER AUTHORIZED PARTY INTENDS TO INITIATE TO OBTAIN PAYMENT FOR THE CARE AND INDICATE THE DEADLINE AFTER WHICH SUCH ECAS MAY BE INITIATED. THE DEADLINE WILL BE NO EARLIER THAN THIRTY (30) DAYS AFTER THE DATE THAT THE WRITTEN NOTICE IS PROVIDED TO THE PATIENT OR PATIENT'S GUARANTOR. A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY WILL BE INCLUDED WITH THE NOTICE GHS WILL ALSO MAKE REASONABLE EFFORTS TO ORALLY NOTIFY THE INDIVIDUAL ABOUT GHS FAP AND HOW THE PATIENT CAN OBTAIN ASSISTANCE WITH THE FAP PROCESS.
FORM 990 SCH H PART VI LINE 2 The Gundersen Community Health Needs Assessment utilizes the COMPASS Now collaborative assessment that includes 6 counties in our service area, representing 74% of our hospital service patient population, and 43% of the overall population of our 21-county service region. The COMPASS Now assessment has been an ongoing community needs assessment in collaboration with the United Way and other community partners since 1995, with updates every three years. The 21-county Health Indicator Report concurred with the COMPASS assessment priorities. However, reviewing the broader 21 county region assessment revealed a significant need not identified as a priority within the COMPASS process - obesity and diabetes. ACCORDING TO GUNDERSEN POLICY GL-1820, GUNDERSEN HEALTH SYSTEM ENGAGES IN PRACTICES WHICH PROVIDE A BENEFIT TO THE COMMUNITY. THIS IS IN ACCORDANCE WITH ITS COMMUNITY SERVICE AND POPULATION HEALTH PHILOSOPHY TO SUPPORT AND STRENGTHEN THE COMMUNITIES WE SERVE WITH PARTNERSHIPS AND INVESTMENT THROUGH EFFECTIVE HEALTH IMPROVEMENT PROGRAMING, CORPORATE CITIZENSHIP, VOLUNTEERISM, AND ECONOMIC CONTRIBUTIONS. GUNDERSEN HEALTH SYSTEM DEFINES COMMUNITY BENEFIT AS PROGRAMS OR ACTIVITIES THAT PROVIDE TREATMENT AND/OR PROMOTE HEALTH AND HEALING AS A RESPONSE TO IDENTIFIED COMMUNITY NEEDS, REGARDLESS OF SOURCE OR AVAILABILITY OF PAYMENT. POPULATION HEALTH REFERS TO THE HEALTH AND WELL-BEING OF A POPULATION OR GROUP OF INDIVIDUALS MEASURED BY AGGREGATE HEALTH OUTCOMES (BROADER THAN HEALTH STATUS) OF HEALTH ADJUSTED LIFE EXPECTANCY (QUANTITY AND QUALITY) AS INFULUENCED BY SOCIAL, ECONCOMIC, AND PHYSICAL ENVIRONMENTS, PERSONAL HEALTH PRACTICES, INDIVIDUAL CAPACITY AND COPING SKILLS, HUMAN BIOLOGY, EARLY CHILDHOOD DEVELOPMENT, AND HEALTH SERVICES. POPULATION HEALTH INITIATIVES ARE SUBSTANCE ABUSE/MENTAL HEALTH, ADVERSE CHILDHOOD EXPERIENCES/RESILIENCE, CHRONIC DISEASE AND SOCIAL DETERMINANTS OF HEALTH INCLUDING HOMELESSNESS. COMMUNITY SERVICE ACTIVITIES ARE PROGRAMS OR ACTIVIITIES THAT PROVIDE A MEASURABLE IMPROVEMENT IN POPULATION HEALTH. THE ACTIVITIES PROVIDED WITHIN OUR COMMUNITIES INCLUDE HEALTH IMPROVEMENT, ADVOCACY FOR PEOPLE WITH DISABILITIES, RECOGNITION OF DIVERSITY AND INCLUSION, MENTAL HEALTH, DOMESTIC VIOLENCE, WORKFORCE DEVELOPMENT, EDUCATION AND SAFETY. ACTIVITIES ARE GUIDED BY COMMUNITY NEEDS ASSESSMENT AND AS APPROPRIATE, INCLUDED IN OUR IMPLEMENTATION PLAN. NEEDS CAN ALSO BE DOCUMENTED FROM OTHER GROUPS. AS A LARGER SYSTEM, COMMUNITY BUILDING ACTIVITIES ENCOMPASS ALL CORPORATIONS. LEADERSHIP IN COMMUNITIY HEALTH IMPROVEMENT IS EVIDENCED BY OUR ACTIVITY WITH SEVERAL COMMUNITY COALITIONS AND INITIATIVES. PARTNERSHIPS ARE CRITICAL TO SUCCESSFUL COMMUNITY OUTCOMES. COMMUNITY SERVICE ACTIVITIES SUPPORT ONE OR MORE OF THE FOLLOWING: - IMPACT HEALTH STATUS 1. ACCESSIBLE TO THE ENTIRE COMMUNITY REGARDLESS OF ABILITY TO PAY 2. HEALTH PROMOTION 3. SOCIAL DETERMINANTS OF HEALTH - CORPORATE CITIZENSHIP - ACTIVITIES CAN BE: 1. DIRECT PROGRAM IMPLEMENTATION 2. IN-KIND SUPPORT/INVOLMENT (HUMAN RESOURCES) 3. FINANCIAL CONTRIBUTIONS 4. DONATION OF MATERIALS AND EQUIPMENT 5. EMPLOYEE VOLUNTEERISM IN THE COMMUNITY
FORM 990 SCH H PART VI LINE 3 EVERY PATIENT IS MADE AWARE OF THE AVAILABILITY OF FINANCIAL ASSISTANCE UPON CHECK-IN. SIGNS THAT ARE OF NOTICEABLE SIZE AND PLACEMENT ARE DISPLAYED IN EACH CHECK-IN AREA. PATIENTS ARE OFFERED A BROCHURE EXPLAINING THE FINANCIAL ASSISTANCE PROGRAM. PATIENTS THAT MEET WITH FINANCIAL COUNSELORS EITHER BY REFERRAL FROM A DEPARTMENT, OR SELF-REFERRAL ARE INFORMED OF THE FINANCIAL ASSISTANCE PROGRAM. FINANCIAL ASSISTANCE INFORMATION IS POSTED ON GLMC WEBSITE. INFORMATION IS ALSO POSTED IN NOT-FOR-PROFIT ORGANIZATIONS WHERE PATIENTS MIGHT SEEK ASSISTANCE FOR NON-MEDICAL FINANCIAL OBLIGATIONS.
FORM 990 SCH H PART VI LINE 4 GUNDERSEN LUTHERAN MEDICAL CENTER INC. IS A MAJOR TERTIARY TEACHING HOSPITAL IN THE GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. LOCATED IN LA CROSSE, WI, THE HOSPITAL SERVES PATIENTS FROM THE LA CROSSE AND SURROUNDING AREAS INCLUDING THE 21 COUNTIES IN WESTERN WISCONSIN, SOUTHEASTERN MINNESOTA, AND NORTHEASTERN IOWA. LA CROSSE COUNTY, WITH A POPULATION OF APPROXIMATELY 120,955 PEOPLE, IS THE LARGEST COMMUNITY IN OUR SERVICE AREA. TOTAL 21 COUNTY SERVICE POPULATION IS APPROXIMATELY 611,658 WITH AN AVERAGE HOUSEHOLD INCOME OF $69,076. 13.7% OF THE 21 COUNTY SERVICE AREA POPULATION IS COVERED BY MEDICAID. THE PROJECTED FIVE-YEAR POPULATION GROWTH IS .96%. 20.3% OF THE POPULATION ARE AGE 17 OR YOUNDER. THE SERVICE AREA POPULATION OF 65 AND OLDER ADULTS IS 19.8%. 7.98% OF THE POPULATION IS NON-WHITE. SEVERAL SMALLER RURAL COMMUNITY HOSPITALS ARE LOCATED THROUGHOUT THE REGION. GUNDERSEN TRI-COUNTY HOSPITAL IN WHITEHALL, WI, GUNDERSEN ST. JOSEPH'S HOSPITAL IN HILLSBORO, WI, GUNDERSEN PALMER LUTHERAN HEALTH CENTER IN WEST UNION, IA, AND GUNDERSEN BOSCOBEL AREA HOSPITAL IN BOSCOBEL, WI ARE PARTNERS/AFFILIATES OF THE GUNDERSEN HEALTH SYSTEM. SPECIALIZED SERVICES PERFORMED AT THE GUNDERSEN LUTHERAN MEDICAL CENTER AND IN MANY CASES, OUTREACH AT OUR REGIONAL CLINIC/HOSPITAL PARTNERS LOCATIONS INCLUDE ALLERGY, AUDIOLOGY, BEHAVIORAL MEDICINE, CARDIOLOGY, CARDIO TESTING LAB, CATH LAB, DERMATOLOGY, ECHOCARDIOGRAPHY, ENDOCRINOLOGY, ENDODONTICS, EXERCISE PHYSIOLOGY, GASTROENTEROLOGY, HEMATOLOGY, HOSPITALIST, INFECTIOUS DISEASE, NEPHROLOGY, NEUROLOGY, NEUROPSYCHOLOGY, NUTRITION THERAPY, OB/GYN, OCCUPATIONAL SERVICES, ONCOLOGY, OPHTHALMOLOGY, OTOLARYNGOLOGY, PATHOLOGY, PEDIATRICS, PERIODONTICS, PHYSICAL MEDICINE AND REHAB, PHYSICAL THERAPY, PLASTIC SURGERY, PODIATRY, PROSTHODONTICS, PSYCHIATRIC, PULMONARY, RENAL DIALYSIS, RHEUMATOLOGY, SPEECH PATHOLOGY, SPORTS MEDICINE, SURGERY, AND UROLOGY. GUNDERSEN PROVIDED CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS. OUR HOSPITAL, LIKE MOST COMMUNITY HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY, CARE THAT WITHOUT OUR HOSPITAL MAY NOT BE AVAILABLE.
FORM 990 SCH H PART VI LINE 5 GUNDERSEN'S BOARD OF TRUSTEES IS COMPRISED OF INDIVIDUALS FROM THE COMMUNITY WHO RESIDE HERE. THESE INDIVIDUALS ARE NOT EMPLOYEES OF THE HEALTH SYSTEM. THIS GROUP WORKS WITH THE BOARD OF GOVERNORS, MAKING DECISIONS THAT SUPPORT THE COMMUNITY-BASED MISSION AND VISION OF OUR ORGANIZATION. MANY OTHER EXAMPLES EXIST REFLECTING THE HEALTH SYSTEM'S SUPPORT AND PROMOTION OF THE HEALTH OF THE COMMUNITY. MANY PROGRAMS FOR THE COMMUNITY ARE PROVIDED AT NO COST SUCH AS A PHYSICAL ACTIVITY CHALLENGE, ACES TRAINING FOR COMMUNITY MEMBERS, CHILD RESILIENCE TRAINING FOR PARENTS, AND HEALTH SCREENINGS AT LOCAL EVENTS. A FREE NURSE ADVISOR LINE IS AVAILABLE FOR ALL TO ASSIST CALLERS. PRIORITY ONE DESIGNATION ASSURES HEART ATTACK PATIENTS SEEN IN HOSPITALS THROUGHOUT THE REGION ARE CARED FOR WITH PROVEN PROTOCOLS AND TIMELY PROCEDURES. GUNDERSEN STAFF ARE ENCOURAGED TO PARTICIPATE IN THEIR LOCAL COMMUNITY ORGANIZATIONS. STAFF LEND THEIR EXPERTISE IN LEADERSHIP POSITIONS TO ORGANIZATIONS SUCH AS UNITED WAY, HEALTH MISSION, CHAMBER OF COMMERCE, HUMAN SERVICE ORGANIZATIONS, HEALTH IMPROVEMENT INITIATIVES, AND HOMELESSNESS INITIATIVES. STAFF FROM GUNDERSEN HAVE BEEN INSTRUMENTAL IN ACCOMPLISHING COMMUNITY NEEDS ASSESSMENTS AND IMPLEMENTATION OF COMMUNITY INITIATIVES IN AREAS OF OBESITY, ALCOHOL USE, CHILD SAFETY, MENTAL HEALTH, DOMESTIC VIOLENCE, CHILD ABUSE AND ENVIRONMENTAL HEALTH. PATIENT ADVISORY GROUPS FROM VARIOUS SECTORS OF OUR COMMUNITY ARE COORDINATED IN ORDER FOR US TO BETTER MEET THE NEEDS OF OUR PATIENTS.
FORM 990 SCH H PART VI LINE 6 ALL AFFILIATES OF THE HEALTH SYSTEM HAVE A RESPONSIBILITY TO PROMOTE THE HEALTH OF THE COMMUNITIES WE SERVE. THE MAJORITY OF EMPLOYEES, BASED IN THE ADMINISTRATIVE CORPORATION, ARE ACTIVELY INVOLVED IN PROGRAMS AND SERVICES FOR THE COMMUNITY AS WELL AS MAINTAINING PARTNERSHIPS WITH A VARIETY OF ORGANIZATIONS, COALITIONS, INITIATIVES AND AGENCIES IN OUR COMMUNITIES THAT PROMOTE HEALTH. THE ADMINISTRATIVE CORPORATION ALSO PROVIDES THE FINANCIAL CORPORATE CONTRIBUTIONS TO VARIOUS ORGANIZATIONS AND COMMUNITY ACTIVITIES. OUR FOUNDATION PROVIDES SUPPORT FOR SOME COMMUNITY HEALTH PROMOTION PROGRAMS AS WELL, PROVIDED BY THE HEALTH SYSTEM OR OTHER ORGANIZATIONS IN OUR COMMUNITY. CLINICAL STAFF SUPPORT SCREENINGS AND VOLUNTEER AT THE HEALTH MISSION. OUR LOCAL RURAL HOSPITAL AFFILIATES PROVIDE SUPPORT TO THEIR RESPECTIVE COMMUNITIES. OUR CLINICS, LOCATED IN OVER 30 COMMUNITIES IN 3 STATES, PROVIDE SUPPORT UNIQUE TO THE NEEDS OF THAT COMMUNITY. THE MEDICAL CENTER, AS PART OF AN INTEGRATED HEALTH CARE DELIVERY SYSTEM, WORKS WITH AND IS RELATED TO GUNDERSEN CLINIC, LTD. WHICH PROVIDED UNCOMPENSATED CARE IN THE AMOUNT OF APPROXIMATELY $36,690,512. BASED ON POLICIES AND CONTRACTS ARRANGED TO HELP SUPPORT THE COMMUNITY'S NEEDS RELATED TO HEALTH CARE SERVICES, THE SUM OF UNREIMBURSED MEDICARE & MEDICAID COSTS PLUS CHARITY AT COST WAS $36,690,512. 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 FOLLOWING THE METHODOLOGY ON WORKSHEET 1. THE COST TO CHARGE RATIO IS CALCULATED FOLLOWING THE METHODOLOGY ON WORKSHEET 2. 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. AMOUNTS ARE REPORTED IN THE SEPARATE 990 FOR GUNDERSEN CLINIC, LTD. AFFILIATED ENTITY CHARITY CARE AN AFFILIATE OF GUNDERSEN LUTHERAN MEDICAL CENTER, INC., GUNDERSEN CLINIC LTD., IS NOT REQUIRED TO FILE SCHEDULE H OF FORM 990. GUNDERSEN CLINIC,LTD. PROVIDED COMMUNITY BENEFIT OF: CHARITY AT COST $567,584 MEDICARE UNREIMBURSED COST $25,238,751 MEDICAID UNREIMBURSED COST $10,884,177
FORM 990 SCH H PART VI LINE 7 LIST OF STATES RECEIVING COMMUNITY BENEFIT REPORT: WI
Schedule H (Form 990) 2019
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