2026-08-13T16:59:41+00:00 2025-09-30 135565207 KPMG LLP 200 EAST RANDOLPH DRIVE SUITE 5500 CHICAGO IL 606016436 990 2024-10-01 390929538 ST JOSEPH'S HEALTH SERVICES INC STJO 6084898000 PO BOX 527 400 WATER AVENUE HILLSBORO WI 54634 HANNAH YOUNG ADMINISTRATOR 2026-08-13 true RILEY KOBRICK P02401884 3126651000 2026-08-12 2024 2025-03-06 01:10:19Z GUNDERSEN ST JOSEPH'S HOSPITAL AND CLINICS HANNAH YOUNG PO BOX 527 400 WATER AVENUE HILLSBORO WI 54634 51149838 false X WWW.GUNDERSENHEALTH.ORG/ST-JOSEPHS X 1949 WI TOGETHER, WE INSPIRE YOUR BEST LIFE BY RELENTLESSLY CARING, LEARNING, AND INNOVATING. 9 4 267 10 0 1637858 3969 42206201 50129640 583934 706141 177440 309153 44605433 51148903 0 1572800 0 0 22340031 25220633 0 0 0 15903799 18275831 38243830 45069264 6361603 6079639 75878392 86310920 28902794 33194453 46975598 53116467 LEADING WITH LOVE, WE COURAGEOUSLY COMMIT TO A FUTURE OF HEALTHY PEOPLE AND THRIVING COMMUNITIES. false false 33933623 1572800 44966647 ST. JOSEPH'S HEALTH SERVICES, INC. PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY HEALTH CARE SERVICES AND OTHER FINANCIAL SUPPORT THROUGH VARIOUS PROGRAMS THAT ARE DESIGNED, AMONG OTHER MATTERS, TO ENHANCE THE HEALTH OF THE COMMUNITY INCLUDING THE HEALTH OF LOW INCOME PATIENTS. THE ORGANIZATION OPERATES A 25-BED CRITICAL ACCESS HOSPITAL PROVIDING ACUTE CARE SERVICES TO THE HILLSBORO, WISCONSIN AREA. INPATIENT SERVICES INCLUDE ACUTE CARE FOR MEDICAL, SURGICAL, SWING BED, AND HOSPICE PATIENTS. ST. JOSEPH'S HEALTH SERVICES, INC. ALSO PROVIDES DIAGNOSTIC SERVICES TO PATIENTS, SUCH AS X-RAY, LAB, AND THERAPY SERVICES. THE HOSPITAL HAD 3,042 TOTAL INPATIENT DAYS DURING THE FISCAL YEAR. OF THOSE PATIENT DAYS 624 WERE RELATED TO ACUTE INPATIENT SERVICES AND 2,418 DAYS OF CARE PROVIDED TO SWING BED PATIENTS. THE HOSPITAL'S SWING BED PROGRAM PROVIDES CARE TO PATIENTS NEEDING EITHER SKILLED NURSING OR REHABILITATIVE PROGRAMS IN THE HOSPITAL SETTING. THE SWING BED PROGRAM IS A VITAL SERVICE TO THE COMMUNITY AS THERE CURRENTLY IS NO SKILLED NURSING FACILITY IN HILLSBORO, WISCONSIN, AND THIS PROGRAM ALLOWS MANY PATIENTS THE OPPORTUNITY TO BE CARED FOR IN THEIR COMMUNITY. ST. JOSEPH'S HEALTH SERVICES ALSO PROVIDES VARIOUS OUTPATIENT SERVICES INCLUDING EMERGENCY AND URGENT CARE SERVICES; DIAGNOSTIC PROCEDURES, SUCH AS X-RAYS, CT SCANS, MRI'S, AND LABORATORY TESTING; SURGICAL PROCEDURES; AND THERAPY PROGRAMS INCLUDING PHYSICAL, OCCUPATIONAL, SPEECH, AND RESPIRATORY THERAPY SERVICES ARE AMONG THE MANY SERVICES PROVIDED BY THE HOSPITAL. ST. JOSEPH'S HEALTH SERVICES, INC. PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS FINANCIAL ASSISTANCE POLICY WITH MINIMAL OR NO CHARGE. IN ADDITION, ST. JOSEPH'S IS A PROVIDER UNDER THE WISCONSIN MEDICAID PROGRAM. UNDER THIS PROGRAM, THE ORGANIZATION IS LEGALLY BOUND TO ACCEPT THE AMOUNT DETERMINED BY THE STATE AS PAYMENT IN FULL FOR EACH PATIENT'S CHARGES. (SEE ADDITIONAL INFORMATION ON THE COST OF PROVIDING THESE SERVICES INCLUDED IN SCHEDULE H OF THE FORM 990.) ST. JOSEPH'S PROVIDES THE MEALS FOR THE SENIOR MEAL SITE COMMUNITY MEMBERS. THESE MEALS ARE DELIVERED TO THE MEMBERS HOME. WE OFFERS ADULT FITNESS IN OUR REHABILITATION GYM. ST. JOSEPH'S IS VERY INVOLVED IN THE CARE OF THE SCHOOL AGE CHILDREN IN OUR SERVICE AREA. THROUGH CONTRACTS WITH THE AREA SCHOOLS WE PROVIDE THEM WITH NURSES, ATHLETIC TRAINERS, SOCIAL WORKER, AND BEHAVIORAL HEALTH THERAPISTS. WE PROVIDE ALL THE TRAINING, CME, AND EDUCATION TO SUPPORT THESE PROVIDERS IN THE SCHOOL SYSTEM. 6145682 5162993 ST. JOSEPH'S HEALTH SERVICES, INC. ALSO OPERATES THREE CLINICS LOCATED IN HILLSBORO, ELROY, AND WONEWOC, WISCONSIN. DURING THE FISCAL YEAR THESE THREE CLINICS PROVIDED A TOTAL OF 21,332 VISITS TO PATIENTS. ALL THREE OF THE CLINICS ARE DESIGNATED RURAL HEALTH CLINICS BY THE MEDICARE AND MEDICAID PROGRAMS AND AS SUCH BY DEFINITION ARE LOCATED IN DESIGNATED RURAL AND UNDERSERVED AREAS OF THE COUNTRY BY HEALTH CARE PRACTITIONERS. THESE CLINICS PROVIDE CARE TO A LARGE PORTION OF MEDICARE AND MEDICAID BENEFICIARIES WHO WITHOUT ACCESS TO CARE LOCALLY WOULD BE REQUIRED TO TRAVEL FURTHER DISTANCES FOR QUALITY HEALTHCARE. PATIENTS OF THE CLINICS ARE ALSO ELIGIBLE TO QUALIFY UNDER ST. JOSEPH'S HEALTH SERVICES FINANCIAL ASSISTANCE POLICY AS IT IS THE GOAL OF THE ORGANIZATION TO PROVIDE QUALITY HEALTHCARE TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. 127437 ST. JOSEPH'S SPONSORS SEVERAL OPPORTUNITIES FOR THE COMMUNITY SENIOR STRENGTH TRAINING, CRP TRAINING, ADVANCED DIRECTIVES SEMINARS, CLUB SCRUB FOR MIDDLE SCHOOL STUDENTS, BLOOD DRIVES, EMPLOYEE EVENTS TO INCREASE VITALITY AT WORK, CAREER DAYS, ETC. WE ARE ADDING MORE AND MORE EVENTS IN THE COMMUNITY TO ADDRESS THE HEALTH OF OUR COMMUNITY. 40079305 true false false true false false false false false false true false false false true true false true false false false false false false false false true true false true true false false false false false false false false true false false false false false false true true false false false true 78 0 267 false false false false false false false false false false false false X 9 4 false false false false true true true true true false false false true true true true true true false false false false WI X JEN BOIGENZAHN 6084898000 PO BOX 527 400 WATER AVENUE HILLSBORO WI 54634 ANN BRANDAU HYNEK BOARD OF DIRECTORS, CHAIRMAN (BEG 12.1.24) 2.0 0 X X 0 0 0 JIM MLSNA BOARD OF DIRECTORS, CHAIRMAN, (END 11.21.24) 2.0 0 X X 0 0 0 MICHAEL MCKEE BOARD OF DIRECTORS, SECRETARY, VICE PRESIDENT 2.0 48.0 X X 0 290401 71251 STACIE CHRISTENSEN BOD, TREASURER, HOSPITAL & CLINICAL OPERATIONS DIRECTOR, HEART INSTITUTE AND LAB 2.0 48.0 X X 0 147871 46010 DANA MEYERS BOD, HOSPITAL & CLINICAL OPERATIONS DIRECTOR 2.0 48.0 X 0 179722 50071 HOLLY BOISEN BOARD OF DIRECTORS, DIRECTOR, QUALITY 2.0 48.0 X 0 117274 42673 JERI WEGER BOARD OF DIRECTORS, (BEG 4.16.25) 2.0 0 X 0 0 0 JONATHON WOOLEVER BOARD OF DIRECTORS 2.0 0 X 0 0 0 NATALIE ADAMS BOARD OF DIRECTORS 2.0 0 X 0 0 0 TINA LECHNIR BOARD OF DIRECTORS, VICE PRESIDENT 2.0 48.0 X 0 245956 58682 JENNIFER BOIGENZAHN FINANCE ADMINISTRATOR 25.0 25.0 X 0 157042 22084 JOHN CEELEN CHIEF FINANCIAL OFFICER 1.0 49.0 X 0 728316 54052 KRISTIE MCCOIC ADMINISTRATOR 25.0 25.0 X 0 189617 54043 ROBIN NELSON FINANCE ADMINISTRATOR (END 4.1.25) 50.0 0.0 X 0 166619 50829 SCOTT RATHGABER MD CEO 1.0 49.0 X 0 1324275 73275 ANDREA ANDERSON PHYSICIAN ASSISTANT - ST. JOSEPH - CLINIC 50.0 0 X 146569 0 34968 DENISE KROES RN, ACUTE HOSPITAL (NIGHTS) - ST. JOSEPH 36.0 0 X 144594 0 56050 JASON EISERMANN PHARMACIST (CASUAL) - ST. JOSEPH 40.0 0 X 143770 0 19963 SAMANTHA ERIE PHYSICIAN ASSISTANT - ST. JOSEPH - CLINIC 50.0 0 X 140310 0 43651 SCOTT LARSON MANAGER, PHARMACY - ST. JOSEPH 50.0 0 X 210624 0 39986 STEVE LITTLE FORMER CHIEF FINANCIAL OFFICER 0.0 0.0 X 0 209856 0 785867 3756949 717588 23 true true false REST EASY ANESTHESIA SERVICES 27349 COUNTY HWY V WONEWOC WI 53968 ANESTHESIA SERVICES 836462 WIESER BROTHERS INC 200 TWILITE STREET LA CRESCENT MN 55947 GENERAL CONTRACTOR 598068 SHARED IMAGING SERVICES 944 WATER ST SAUK CITY WI 53583 IMAGING 276377 STAFFENCY 221 W COLLEGE AVE FLOOR 2 APPLETON WI 54911 STAFFING 239426 SHARED MEDICAL SERVICES 209 LIMESTONE PASS COTTAGE GROVE WI 53527 MEDICAL SERVICES 183859 25 3969 3969 HOSPITAL PATIENT REVENUE 621110 36355445 36355445 CLINIC REVENUE 621110 5162993 5162993 PHARMACY REVENUE 456110 8457833 8457833 OTHER PROGRAM SERVICE REVENUE 900099 153369 153369 0 0 0 0 50129640 707076 707076 0 0 935 0 -935 -935 -935 DIETARY/CAFETERIA 722514 181716 181716 ALL OTHER REVENUE 900099 127437 127437 0 0 0 0 309153 51148903 50257077 0 887857 0 0 1572800 1572800 0 0 0 0 354557 354557 19904692 18256869 1647823 1684885 1555553 129332 2255532 1957841 297691 1020967 905793 115174 1153476 1153476 13820 13820 29075 29075 5790 5790 0 0 0 0 0 0 2695310 2685603 9707 0 85102 85102 732034 585197 146837 42593 42593 523052 515885 7167 122018 118969 3049 0 0 0 0 39318 30169 9149 857732 676298 181434 2749407 2295071 454336 93833 93833 PHARMACY EXPENSE 4842289 4842289 PROVISION FOR BAD DEBTS 1853740 1853740 MEDICAL SUPPLIES 1328984 1328984 REPAIRS AND MAINTENANCE 791067 787950 3117 317191 67701 249490 0 45069264 40079305 4989959 0 1050 1400 32214058 41379408 0 0 6404711 10526673 0 0 0 0 0 0 851927 883773 91663 103567 48436922 15835535 35060356 32601387 0 0 0 0 0 0 1254627 814712 75878392 86310920 4196019 4264028 0 0 0 0 0 0 0 0 0 22522893 21806375 0 0 2183882 7124050 28902794 33194453 X 46285781 52804577 689817 311890 X 0 0 0 0 0 0 46975598 53116467 75878392 86310920 X 6079639 61230 X false true true true true X false false false false false false false false true 5790 5790 false SCHEDULE C, PART II-B, LINE 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY ST. JOSEPH'S HEALTH SERVICES, INC. PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA) AND THE AMERICAN HOSPITAL ASSOCIATION (AHA). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING, HOWEVER, A PORTION OF THE ANNUAL DUES PAID TO THE WHA WAS USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. ST. JOSEPH'S HEALTH SERVICES, INC. IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR, THE ORGANIZATION PAYS MEMBERSHIP FEES TO THE RWHC. RWHC PROVIDES SUPPORT SERVICES FOR A NUMBER OF ITS MEMBER HOSPITALS THROUGHOUT THE STATE OF WISCONSIN. SOME OF THE MANY SERVICES PROVIDED TO MEMBER HOSPITALS INCLUDE PROVIDING ASSISTANCE TO ORGANIZATIONS IN FINDING GRANT FUNDING FOR NEW PROGRAMS, LEGAL SERVICES, REIMBURSEMENT REVIEW SERVICES, ACCOUNTING ASSISTANCE, CONTRACTING FOR THERAPIST AND EMERGENCY ROOM PATIENT CARE COVERAGE, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, THE RWHC ALSO PROVIDES AN ANALYSIS OF CURRENT HEALTHCARE ISSUES IN AN EFFORT TO PROMOTE AND IMPROVE HEALTHCARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. THESE EFFORTS ALSO INCLUDE LOBBYING ON THE PART OF MEMBER ORGANIZATIONS. 0 1470098 1470098 0 36666650 9013740 27652910 0 1512263 673270 838993 0 8700113 6148525 2551588 0 87798 87798 32601387 FEDERAL INCOME TAXES LEASE CONTRACTS PAYABLE 281669 CURRENT LEASES PAYABLE 85051 DUE TO/ FROM GLAS 5265942 OTHER REC 3RD PARTY SETTLEMENT 1491388 7124050 X 0 0 0 0 0 0 0 0 0 0 0 0 SCHEDULE D, PART X, LINE 2 FIN 48 (ASC 740) FOOTNOTE THE SYSTEM AND MOST OF ITS SUBSIDIARIES ARE CLASSIFIED AS TAX-EXEMPT ORGANIZATIONS AS DESCRIBED IN SECTIONS 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND ARE NOT SUBJECT TO FEDERAL AND STATE INCOME TAXES ON RELATED INCOME, PURSUANT TO SECTION 501(A) OF THE CODE. THESE ORGANIZATIONS ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES TO THE EXTENT THEY HAVE UNRELATED BUSINESS INCOME. THE SYSTEM HAS NO MATERIAL UNCERTAIN TAX POSITIONS. CERTAIN SUBSIDIARIES ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES. SOME OF THESE CORPORATIONS HAVE ACCUMULATED NET OPERATING LOSS CARRYFORWARDS THAT ARE AVAILABLE TO OFFSET FUTURE TAXABLE INCOME, IF ANY, AND HAVE BEEN FULLY RESERVED. true true X true X true X true true false true false 685429 0 685429 0.01586 4747398 6119256 0 0.0 0 0 0 0.0 0 0 5432827 6119256 685429 0.01586 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0 0 0 0 0 0 0.0 0 0 5432827 6119256 685429 0.01586 0 0 0.0 0 0 0.0 0 0 0.0 0 0 0.0 0 0 0.0 0 0 0.0 0 0 0.0 0 0 0.0 0 0 0.0 0 0 0 0 0 0.0 true 1572801 657906 9236013 9286689 -50676 X true true 1 1 ST JOSEPH'S HEALTH SERVICES INC PO BOX 527 400 WATER AVENUE HILLSBORO WI 54634 https://www.gundersenhealth.org/locations/st-josephs/hospital 1005 X X X X PROVIDER BASED PHYSICIAN CLINICS ST JOSEPH'S HEALTH SERVICES INC 1 false false true X X X X X X X X X 24 true true true true X https://www.gundersenhealth.org/locations/st-josephs/hospital https://www.gundersenhealth.org/community-assessment/ X true 24 true HTTPS://WWW.GUNDERSENHEALTH.ORG/COMMUNITY-ASSESSMENT/ false true X 200.0 400.0 X X X X true true X X X X true X https://www.gundersenhealth.org/patients-visitors/financial-assistance X https://www.gundersenhealth.org/patients-visitors/financial-assistance X https://www.gundersenhealth.org/patients-visitors/financial-assistance X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 FACILITY , 1 FACILITY , 1 - ST. JOSEPH'S HEALTH SERVICES, INC.. IN PREPARING THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), ST. JOSEPH'S HEALTH SERVICES, INC. GATHERED INFORMATION IN FOUR WAYS: - A RANDOM HOUSEHOLD SURVEY - CONVENIENCE SAMPLING OF IDENTIFIED GROUPS - AN ANALYSIS OF COUNTY HEALTH RANKINGS DATA - INPUT FROM COUNTY STAKEHOLDERS. THE COMPASS NOW SURVEY HAD 206 RESPONSES IN VERNON COUNTY. - CONVENIENCE SAMPLING OF IDENTIFIED GROUPS MEANS SPECIFIC OUTREACH WAS MADE TO HIGH NEED GROUPS SUCH AS WIC PARTICIPANTS AT THE COUNTY AND THE COUNTY DID OUTREACH WITH THE AMISH. - INPUT FROM COUNTY STAKEHOLDERS INCLUDES: - PATIENTS OR ST. JOE'S - COMMUNITY MEMBERS ON OUR HUNGERCARE PROGRAM - LOCAL SCHOOL REPRESENTATION - LIONS CLUB MEMBERS - WOMENS CIVIC CLUB MEMBERS - OLDER MEMBERS OF THE COMMUNITY - CHAMBER BOARD REPRESENTATION - HILLSBORO CITY COUNCIL - GREAT RIVERS UNITED WAY - CAMPBELL FAMILY GROUP HOMES - IMMANUEL LUTHERAN CHURCH - SCENIC BLUFFS HEALTH CENTER - VERNON COUNTY EXTENSION - VERNON COUNTY HEALTH DEPARTMENT - VERNON COUNTY OVER 50 - VERNON MEMORIAL HEALTHCARE - VIROQUA AREA SCHOOLS SCHEDULE H, PART V, SECTION B, LINE 6A FACILITY , 1 FACILITY , 1 - ST. JOSEPH'S HEALTH SERVICES, INC.. THE CHNA WAS CONDUCTED IN JOINT EFFORT WITH THE FOLLOWING OTHER HOSPITALS: TRI-COUNTY MEMORIAL HOSPITAL; GUNDERSEN LUTHERAN HEALTH CENTER; MAYO CLINIC HEALTH SYSTEM; TOMAH MEMORIAL HOSPITAL; VERNON MEMORIAL HOSPITAL. SCHEDULE H, PART V, SECTION B, LINE 6B FACILITY , 1 FACILITY , 1 - ST. JOSEPH'S HEALTH SERVICES, INC.. THE CHNA WAS CONDUCTED IN JOINT EFFORT WITH THE FOLLOWING OTHER ORGANIZATIONS: GREAT RIVERS UNITED WAY; LA CROSSE COUNTY HEALTH DEPARTMENT; MONROE COUNTY HEALTH DEPARTMENT; VERNON COUNTY HEALTH DEPARTMENT; TREMPEALEAU COUNTY HEALTH DEPARTMENT; HOUSTON COUNTY HEALTH DEPARTMENT; BUFFALO COUNTY HEALTH DEPARTMENT; AMERICAN LUNG ASSOCIATION; ABLE INC.; GREAT RIVERS HUB; COULEECAP. SCHEDULE H, PART V, SECTION B, LINE 11 FACILITY , 1 FACILITY , 1 - ST. JOSEPH'S HEALTH SERVICES, INC.. THE COMMUNITY HEALTH NEEDS ASSESSMENT FOR GUNDERSEN ST. JOSEPH'S HOSPITAL AND CLINICS HIGHLIGHTS SEVERAL SIGNIFICANT HEALTH CONCERNS IN VERNON AND JUNEAU COUNTIES, FOCUSING PRIMARILY ON NUTRITION, MENTAL HEALTH AND SOCIAL ISOLATION, EXERCISE AND PHYSICAL ACTIVITY, AND ACCESS AND AFFORDABILITY OF CARE. KEY FINDINGS: NUTRITION: APPROXIMATELY ONE IN THREE ADULTS IN THE REGION ARE OBESE, WITH POOR ACCESS TO HEALTHY FOODS AND FOOD INSECURITY PREVALENT. COMMUNITY FEEDBACK IDENTIFIES OBESITY AS THE SECOND LEADING CONCERN, WITH 25% OF RESPONDENTS STRUGGLING TO AFFORD HEALTHY FOOD. THERE IS A STRONG DESIRE FOR NUTRITION EDUCATION, INCLUDING COOKING, MEAL PLANNING, AND GROWING PRODUCE. MENTAL HEALTH & SOCIAL ISOLATION: MENTAL HEALTH IS THE TOP CONCERN, WITH HIGH RATES OF MENTALLY UNHEALTHY DAYS AND SOCIAL ISOLATION, ESPECIALLY AMONG THE ELDERLY. TEEN MENTAL HEALTH ISSUES SUCH AS ANXIETY, PROLONGED SADNESS, AND SELF-HARM ARE NOTABLE. OPPORTUNITIES FOR SKILL DEVELOPMENT ARE LIMITED, AND 25% OF RESPONDENTS RATE THEIR MENTAL HEALTH AS FAIR OR POOR. EXERCISE & PHYSICAL ACTIVITY: OBESITY RATES ARE HIGH, AND ACCESS TO PARKS AND RECREATIONAL FACILITIES IS LIMITED. A SIGNIFICANT PORTION OF RESIDENTS REPORT NO PHYSICAL ACTIVITY, AND CONCERNS ABOUT UNSAFE OR INADEQUATE SIDEWALKS AND TRAFFIC HINDER OUTDOOR EXERCISE. ACCESS & AFFORDABILITY OF CARE: MANY HOUSEHOLDS STRUGGLE FINANCIALLY, WITH A HIGH RELIANCE ON EMERGENCY ROOMS FOR USUAL CARE, INDICATING POTENTIAL GAPS IN PRIMARY CARE ACCESS. APPOINTMENT SCHEDULING DIFFICULTIES AND TRANSPORTATION BARRIERS FURTHER LIMIT ACCESS TO HEALTHCARE SERVICES. HOSPITAL RESPONSE: GUNDERSEN ST. JOSEPH'S HOSPITAL AND CLINICS HAS DEVELOPED A COMPREHENSIVE IMPLEMENTATION PLAN TO ADDRESS THESE NEEDS, INCLUDING: - NUTRITION INITIATIVES SUCH AS IMPROVED NUTRITION LABELING AT ST. JOE'S HOSPITAL, GROCERY STORE TOURS, COOKING AND NUTRITION EDUCATION, HEALTHY FOOD SAMPLES AT FOOD PANTRIES, AND PRESENCE AT FARMERS' MARKETS. - EXERCISE PROGRAMS INCLUDING SENIOR STRENGTH CLASSES, COUCH TO 5K, WALKING CLUBS, DEVELOPMENT AND PROMOTION OF WALKABLE COMMUNITY ROUTES, AND EXPLORING FITNESS EQUIPMENT LOAN PROGRAMS. - MENTAL HEALTH EFFORTS FOCUSING ON STIGMA REDUCTION, SCHOOL-BASED PROGRAMS, MENTAL HEALTH FIRST AID TRAINING, DEMENTIA-FRIENDLY COMMUNITY EXPLORATION, AND EXPANDED FREE HEALTH SCREENINGS. - ACCESS IMPROVEMENTS THROUGH PATIENT TRANSPORTATION SERVICES, DIGITAL WELLNESS PROMOTION, AND PARTNERSHIPS FOR HEALTH PROMOTION. 3 GUNDERSEN ST JOSEPH'S HILLSBORO CLINIC 400 WATER AVENUE HILLSBORO WI 54634 PHYSICIAN CLINIC GUNDERSEN ST JOSEPH'S ELROY CLINIC 125 MAIN ST ELROY WI 53929 PHYSICIAN CLINIC GUNDERSEN ST JOSEPH'S WONEWOC CLINIC 301 RAILROAD STREET WONEWOC WI 53968 PHYSICIAN CLINIC SCHEDULE 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 AIDS, ORTHODONTICS, DENTAL SERVICES. 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. SCHEDULE H, PART I, LINE 7 COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25(A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1,853,740. SCHEDULE H, PART I, LINE 7G SUBSIDIZED HEALTH SERVICES SUBSIDIZED HEALTH SERVICES AT ST. JOSEPH'S HEALTH SERVICES, INC. INCLUDE THE OPERATION OF THE INPATIENT UNIT, EMERGENCY ROOM, AND RURAL HEALTH CLINICS. THE HOSPITAL AND CLINICS ARE OPERATED TO PROVIDE SUPPORT TO THE COMMUNITY BY PROVIDING HOSPITALIZATION, EMERGENCY, AND CLINICAL SERVICES TO THE SURROUNDING RURAL AREAS, WHICH WOULD OTHERWISE BE UNDERSERVED. IT IS THE GOAL OF ST. JOSEPH'S HEALTH SERVICES, INC. TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENT'S ABILITY TO PAY. THE COSTING METHOD FOR SUBSIDIZED HEALTH SERVICES IS BASED ON THE COSTING METHODS USED IN THE HOSPITAL'S MEDICARE COST REPORT WHICH PROVIDES FOR A DIRECT ALLOCATION OF EXPENSES AS WELL AS PROVIDING THE SAME DATA TO THE MEDICARE PROGRAM AS WELL AS TO THE IRS FOR 990 PURPOSES. SCHEDULE H, PART I, LINE 7 BAD DEBT EXPENSE EXCLUDED FROM FINANCIAL ASSISTANCE CALCULATION 1853740 SCHEDULE H, PART I, LINE 7 COSTING METHODOLOGY USED TO CALCULATE FINANCIAL ASSISTANCE THE COSTING METHOD USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST TO CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. THE COSTING METHODOLOGY FOR SUBSIDIZED HEALTH SERVICES IS BASED ON COST ALLOCATIONS FROM THE MEDICARE COST REPORT. THIS ALLOCATION METHOD AND PRINCIPLES OF ALLOCATION WERE USED TO DERIVE A SPECIFIC AMOUNT OF COST ALLOCATION TO THE VARIOUS PROGRAMS AND COST CENTERS OPERATED BY THE HOSPITAL. SCHEDULE H, PART III, LINE 2 BAD DEBT EXPENSE - METHODOLOGY USED TO ESTIMATE AMOUNT THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO, WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES EXCLUDING THE PROVISION FOR BAD DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF CARE OF PATIENTS WHO HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE EXCLUDED FROM GROSS PATIENT SERVICE REVENUE ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL. SCHEDULE H, PART III, LINE 3 BAD DEBT EXPENSE METHODOLOGY MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. MANY TIMES, PATIENTS DO NOT COMPLETE THE REQUIRED CHARITY CARE APPLICATION AND ARE TRANSFERRED TO COLLECTION SERVICES EVEN THOUGH THE HOSPITAL PROVIDES THIS INFORMATION TO ALL PATIENTS AND ASSISTANCE WITH THE APPLICATIONS. DUE TO NO RESPONSES FROM SOME PATIENTS, A SIGNIFICANT AMOUNT OF BAD DEBTS COULD BE CONSIDERED AS CHARITY CARE. SCHEDULE H, PART III, LINE 4 BAD DEBT EXPENSE - FINANCIAL STATEMENT FOOTNOTE ACCOUNTS RECEIVABLE AND CREDIT POLICY: IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE ORGANIZATION ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY PAYOR COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ORGANIZATION RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE. SCHEDULE H, PART III, LINE 8 COMMUNITY BENEFIT & METHODOLOGY FOR DETERMINING MEDICARE COSTS THE TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H TO THE FORM 990 IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE OF THE ORGANIZATION AND DOES NOT CONSIDER ALL CONTRACTUAL ADJUSTMENTS FOR SERVICES REIMBURSED BY THE MEDICARE PROGRAM. AMOUNTS LISTED FOR MEDICARE REVENUE DO NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE ORGANIZATION AS WELL AS ANESTHESIA PROFESSIONAL SERVICES, SURGICAL PHYSICIAN PROFESSIONAL SERVICES, AND REVENUE FOR ANY PATIENTS COVERED UNDER MEDICARE ADVANTAGE PLAN PROGRAMS. PHYSICIAN PROFESSIONAL SERVICES ARE REIMBURSED PRIMARILY ON FEE SCHEDULE REIMBURSEMENTS AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY, SURGICAL, AND CLINICAL PHYSICIAN SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT ST. JOSEPH'S HEALTH SERVICES, INC. PROVIDES TO THE COMMUNITY AND SURROUNDING AREAS. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT, AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES, AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE). WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. SCHEDULE H, PART III, LINE 9B COLLECTION PRACTICES FOR PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE THE ORGANIZATION FOLLOWS GUNDERSEN HEALTH SYSTEM'S GUIDELINES FOR COLLECTION PRACTICES RELATED TO PATIENTS QUALIFYING FOR CHARITY OR FINANCIAL ASSISTANCE. A PATIENT CAN APPLY FOR CHARITY OR FINANCIAL ASSISTANCE AT ANY TIME DURING THE COLLECTION CYCLE. ONCE QUALIFYING DOCUMENTATION IS RECEIVED THE PATIENT'S ACCOUNT IS ADJUSTED. PATIENT ACCOUNTS FOR THE QUALIFYING PATIENT IN THE PREVIOUS SIX MONTHS MAY ALSO BE CONSIDERED FOR CHARITY OR FINANCIAL ASSISTANCE. ONCE A PATIENT QUALIFIES FOR CHARITY OR FINANCIAL ASSISTANCE, ALL COLLECTION ACTIVITY IS SUSPENDED. SCHEDULE H, PART V, SECTION B, LINE 16A FAP WEBSITE - ST. JOSEPH'S HEALTH SERVICES, INC.: LINE 16A URL: HTTPS://WWW.GUNDERSENHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE; SCHEDULE H, PART V, SECTION B, LINE 16B FAP APPLICATION WEBSITE - ST. JOSEPH'S HEALTH SERVICES, INC.: LINE 16B URL: HTTPS://WWW.GUNDERSENHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE; SCHEDULE H, PART V, SECTION B, LINE 16C FAP PLAIN LANGUAGE SUMMARY WEBSITE - ST. JOSEPH'S HEALTH SERVICES, INC.: LINE 16C URL: HTTPS://WWW.GUNDERSENHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE; SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT THE HOSPITAL REVIEWS THE UTILIZATION OF SERVICES THAT ARE CURRENTLY AVAILABLE AT THE HOSPITAL. AN EVALUATION OF THE AREA DEMOGRAPHIC IS USED TO DETERMINE WHAT NEW SERVICES MAYBE APPROPRIATE TO PROVIDE. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE FINANCIAL ASSISTANCE INFORMATION IS AVAILABLE AT ALL CHECK IN AREAS OF OUR HOSPITAL AND CLINICS. INFORMATION IS INCLUDED WITH THE BILLING STATEMENT, AVAILABLE ON THE HOSPITAL'S WEBSITE, OR BY CALLING THE PATIENT ACCOUNTS DEPARTMENT. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION WE HAVE A 30 MILE SERVICE THAT INCLUDES THE SEVERAL COUNTIES, VERNON, SAUK, MONROE, JUNEAU AND RICHLAND. OUR PATIENT POPULATION IS MADE UP LARGELY OF MEDICARE & MEDICAID PATIENTS. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH DRIVE THROUGH VACCINATION CLINICS WERE HELD IN EACH OF OUR LOCAL COMMUNITIES, HILLSBORO, ELROY, AND WONEWOC TO FACILITATE EASY ACCESS FOR FLU AND COVID VACCINES. WE PROVIDE THE MEALS FOR THE COMMUNITY MEMBERS SIGNED UP FOR THE MEAL SITE. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM THE ORGANIZATION IS A PART OF EMPLIFY HEALTH WHICH IS THE COMBINATION OF GUNDERSEN HEALTH AND BELLIN HEALTH SYSTEMS. IT IS A NOT-FOR-PROFIT ORGANIZATION DEDICATED TO ENHANCING THE PHYSICAL AND EMOTIONAL WELL-BEING OF INDIVIDUALS IN. IN COLLABORATION WITH COMMUNITIES, EMPLOYERS, SCHOOLS, AND GOVERNMENT OFFICIALS, WE SUPPORT INDIVIDUALS AND FAMILIES ON THEIR LIFELONG JOURNEY TOWARD OPTIMAL HEALTH. OUR COMMITMENT LIES IN DELIVERING SAFE, RELIABLE, AND COST-EFFECTIVE COMPREHENSIVE HEALTH SOLUTIONS, ALL WHILE UPHOLDING THE VALUES OF RESPECT AND COMPASSION. THROUGH OUR INNOVATIVE INITIATIVES, WE AIM TO TRANSFORM HEALTHCARE DELIVERY NOT ONLY IN OUR REGION BUT ALSO ON A GLOBAL SCALE. SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT WI true CHARITY CARE 71 1572800 COST SCHEDULE I, PART I, LINE 2 PROCEDURES FOR MONITORING USE OF GRANT FUNDS WHEN A PATIENT HAS INDICATED OR DEMONSTRATED AN "INABILITY TO PAY", A ST. JOSEPH'S HEALTH SERVICES REVENUE CYCLE REPRESENTATIVE WILL PROVIDE THE PATIENT WITH A FINANCIAL HARDSHIP APPLICATION (FHA) AND EXPLICIT INSTRUCTIONS FOR ITS COMPLETION ALONG WITH A REQUEST FOR ANY DOCUMENTS NECESSARY TO VERIFY POTENTIAL PATIENT ASSETS AND LIABILITIES. AFTER RECEIPT OF THE PACKET IT IS THEN REVIEWED AS COMPILED AND PUT ONTO A SLIDING POVERTY DETERMINATION SCALE. AN ANNUAL COMPLIANCE AUDIT IS COMPLETED TO ENSURE ALL POLICY STANDARDS ARE BEING FOLLOWED. false true false false false false false false false MICHAEL MCKEE BOARD OF DIRECTORS, SECRETARY, VICE PRESIDENT 0 289289 0 0 0 1112 0 41410 0 29841 0 361652 0 0 STACIE CHRISTENSEN BOD, TREASURER, HOSPITAL & CLINICAL OPERATIONS DIRECTOR, HEART INSTITUTE AND LAB 0 147338 0 0 0 533 0 21229 0 24781 0 193881 0 0 TINA LECHNIR BOARD OF DIRECTORS, VICE PRESIDENT 0 236727 0 0 0 9229 0 33863 0 24819 0 304638 0 0 HOLLY BOISEN BOARD OF DIRECTORS, DIRECTOR, QUALITY 0 116115 0 0 0 1159 0 17096 0 25577 0 159947 0 0 DANA MEYERS BOD, HOSPITAL & CLINICAL OPERATIONS DIRECTOR 0 172980 0 1280 0 5462 0 25420 0 24651 0 229793 0 0 STEVE LITTLE FORMER CHIEF FINANCIAL OFFICER 0 209856 0 0 0 0 0 0 0 0 0 209856 0 0 JOHN CEELEN CHIEF FINANCIAL OFFICER 0 598104 0 129468 0 744 0 29147 0 24905 0 782368 0 0 ROBIN NELSON FINANCE ADMINISTRATOR (END 4.1.25) 0 164294 0 0 0 2325 0 23896 0 26933 0 217448 0 0 SCOTT RATHGABER MD CEO 0 1278368 0 0 0 45907 0 48300 0 24975 0 1397550 0 0 JENNIFER BOIGENZAHN FINANCE ADMINISTRATOR 0 155482 0 0 0 1560 0 21767 0 317 0 179126 0 0 KRISTIE MCCOIC ADMINISTRATOR 0 188634 0 0 0 983 0 27617 0 26426 0 243660 0 0 ANDREA ANDERSON PHYSICIAN ASSISTANT - ST. JOSEPH - CLINIC 146091 0 0 0 478 0 20559 0 14409 0 181537 0 0 0 JASON EISERMANN PHARMACIST (CASUAL) - ST. JOSEPH 143678 0 0 0 92 0 19963 0 0 0 163733 0 0 0 SAMANTHA ERIE PHYSICIAN ASSISTANT - ST. JOSEPH - CLINIC 139081 0 0 0 1229 0 20031 0 23620 0 183961 0 0 0 DENISE KROES RN, ACUTE HOSPITAL (NIGHTS) - ST. JOSEPH 138835 0 4928 0 831 0 21163 0 34887 0 200644 0 0 0 SCOTT LARSON MANAGER, PHARMACY - ST. JOSEPH 204744 0 5000 0 880 0 29527 0 10459 0 250610 0 0 0 SCHEDULE J, PART I, LINE 3 ARRANGEMENT USED TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION A RELATED ORGANIZATION OF THE FILING ORGANIZATION USES ONE OR MORE OF THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION SURVEY OR STUDY, AND -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PLEASE REFER TO THE FORM 990, PART VI, LINE 15A DISCLOSURE IN SCHEDULE O FOR ADDITIONAL DETAILS ON HOW COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL IS ESTABLISHED. SCHEDULE J, PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN CERTAIN INDIDVIDUALS LISTED IN SCHEDULE J, PART II, PARTICIPATE IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN TO WHICH THE ORGANIZATION MAKES ANNUAL CONTRIBUTIONS. THESE CONTRIBUTIONS ARE AT RISK AND DO NOT BECOME VESTED AND PAYABLE UNLESS AND UNTIL THE INDIVIDUAL SATISFIES A SUBSTANTIAL FUTUTE SERVICE REQUIREMENT. THE FOLLOWING INDIVIDUALS HAD CONTRIBUTIONS MADE TO THE PLAN FOR CALENDAR YEAR 2024: JOHN CEELEN ANGIE NOVY SISTER OF OFFICER 46533 SALARY false FORM 990, PART VI, LINE 15A COMPENSATION IS DETERMINED BY A RELATED ORGANIZATION. COMPENSATION FOR THE CEO AND KEY EXECUTIVES ARE SET BY THE EXECUTIVE COMMITTEE OF THE BOARD SUPPORTED BY MARKET DATA FROM SURVEYS AND AN INDEPENDENT CONSULTANTS REPORT. THE COMPENSATION IS DETERMINED BY MEMBERS OF THE EXECUTIVE COMMITTEE WITHOUT CONFLICT AND IS DOCUMENTED. CEO COMPENSATION: CEO PRESENTS RESULTS OF PERFORMANCE OBJECTIVES TO THE EXECUTIVE COMMITTEE IN JANUARY OF EACH YEAR. THE CHAIR APPLIES A FORMULA TO THE RESULTS AND COMES UP WITH A RECOMMENDATION. THE CHAIR FACILITIES GETTING APPROVAL FROM OTHER MEMBERS OF THE EXECUTIVE COMMITTEE. FORM 990, PART VI, LINE 15B SENIOR LEADERS: COMPENSATION IS DETERMINED BY A RELATED ORGANIZATION. COMPENSATION FOR THOSE WHO REPORT TO THE CEO IS TAKEN TO THE EXECUTIVE COMMITTEE FOR DISCUSSION/APPROVAL. FORM 990, PART VI, LINE 6 CLASSES OF MEMBERS OR STOCKHOLDERS THE ARTICLES OF INCORPORATION OF ST. JOSEPH'S HEALTH SERVICES, INC. PROVIDES FOR ONE MEMBER OF THE CORPORATION. THE SOLE MEMBER OF ST. JOSEPH'S HEALTH SERVICES, INC. IS GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. FORM 990, PART VI, LINE 7A MEMBERS OR STOCKHOLDERS ELECTING MEMBERS OF GOVERNING BODY AS THE SOLE 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 ST. JOSEPH'S HEALTH SERVICES, INC. GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. MAY APPOINT FIVE MEMBERS OF THE BOARD OF DIRECTORS OF ST. JOSEPH'S HEALTH SERVICES, INC. FORM 990, PART VI, LINE 7B DECISIONS REQUIRING APPROVAL BY MEMBERS OR STOCKHOLDERS 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 INTERESTS, 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. FORM 990, PART VI, LINE 11B REVIEW OF FORM 990 BY GOVERNING BODY THE FORM 990 IS REVIEWED BY THE ACCOUNTING MANAGER AND PRINCIPAL OFFICER. IT WILL BE MADE AVAILABLE FOR ALL BOARD MEMBERS BEFORE FILING. FORM 990, PART VI, LINE 12C CONFLICT OF INTEREST POLICY GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. (GLAS) ANNUALLY REQUIRES EXECUTIVE LEADERSHIP (VICE PRESIDENTS AND ABOVE), BOARD MEMBERS, MEDICAL GOVERNORS AND FOUNDATION BOARD MEMBERS TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT. COMPLETED DISCLOSURE STATEMENTS ARE REVIEWED BY A CONFLICT OF INTEREST REVIEW PANEL WHICH INCLUDES REPRESENTATIVES FROM LEGAL, COMPLIANCE, MEDICAL LEADERSHIP, HUMAN RESOURCES AND SUPPLY CHAIN. INDIVIDUALS REPORTING A POTENTIAL CONFLICT OF INTEREST ARE SENT A RESOLUTION THANKING THEM FOR THEIR SERVICE TO THE ORGANIZATION, ADVISING THEM OF ANY RESTRICTIONS RELATED TO THEIR CONFLICT (I.E. INDIVIDUALS WITH A RELATIONSHIP TO ANOTHER ORGANIZATION ARE ADVISED THAT THEY MUST ABSTAIN FROM DECISION MAKING THAT WOULD DIRECTLY AND SOLELY IMPACT GLAS) AND REMINDING THEM OF THEIR CONFIDENTIALITY OBLIGATIONS WITH RESPECT TO GLAS' HEALTHCARE, EMPLOYMENT AND PROPRIETARY INFORMATION. FORM 990, PART VI, LINE 19 REQUIRED DOCUMENTS AVAILABLE TO THE PUBLIC THE ORGANIZATION CURRENTLY DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. FORM 990 IS MADE AVAILABLE TO THE PUBLIC AT ITS MAIN BUSINESS OFFICE DURING NORMAL BUSINESS HOURS. FORM 990 INCLUDES MUCH OF THE INFORMATION CONTAINED WITHIN THE ORGANIZATION'S GOVERNING DOCUMENTS. CONFLICTS OF INTEREST ARE ALSO NOTED ON FORM 990. THE AUDITED FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC AS THEY ARE REQUIRED TO BE ATTACHED TO THE FORM 990. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS OR FUND BALANCES CHANGE IN INTEREST IN UNRESTRICTED NET ASSETS OF FOUNDATION - 61230; TOTAL - 61230; BELLIN GUNDERSEN HEALTH SYSTEM INC 1836 SOUTH AVENUE LA CROSSE WI 54601 920504278 SUPPORT ORG WI 501(C)(3) TYPE III-FI NA false GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1836 SOUTH AVE LA CROSSE WI 54601 391866425 SUPPORT ORG WI 501(C)(3) TYPE II BGHS false GUNDERSEN LUTHERAN MEDICAL CENTER INC 1910 SOUTH AVE LA CROSSE WI 54601 390813416 HEALTHCARE WI 501(C)(3) 3 GLHS false GUNDERSEN CLINIC LTD 1836 SOUTH AVENUE LA CROSSE WI 54601 391028657 HEALTHCARE WI 501(C)(3) 3 GLHS false GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES INC 1910 SOUTH AVE LA CROSSE WI 54601 391606449 SUPPORT ORG WI 501(C)(3) TYPE II GLHS false GUNDERSEN LUTHERAN MEDICAL FOUNDATION INC 1836 SOUTH AVENUE LA CROSSE WI 54601 391249705 FOUNDATION WI 501(C)(3) 7 GLHS false TRI-COUNTY MEMORIAL HOSPITAL INC 18601 LINCOLN STREET WHITEHALL WI 54773 390704510 HEALTHCARE WI 501(C)(3) 3 GLHS false HARMONY COUMMUNITY HEALTHCARE INC 815 MAIN AVE SOUTH HARMONY MN 55939 410711606 HEALTHCARE MN 501(C)(3) 10 GLHS false TWEETEN LUTHERAN HEALTHCARE CENTER INC 125 FIFTH AVE SE SPRING GROVE MN 55974 411565003 HEALTHCARE MN 501(C)(3) 10 GLHS false TRI STATE AMBULANCE INC 235 CAUSEWAY BOULEVARD LA CROSSE WI 54603 391965415 MEDICAL TRANSPORT WI 501(C)(3) 3 GLHS false TRI-STATE REGIONAL AMBULANCE INC 235 CAUSEWAY BOULEVARD LA CROSSE WI 54603 391962965 MEDICAL TRANSPORT WI 501(C)(3) 10 GLHS false LUTHERAN REAL ESTATE HOLDING CORPORATION 1910 SOUTH AVENUE LA CROSSE WI 54601 391480826 HOUSING WI 501(C)(3) TYPE III-FI GLHS false COMMUNITY HOUSING OF LA CROSSE INC 1900 SOUTH AVENUE LA CROSSE WI 54601 391586700 INDEPENDENT LIVING WI 501(C)(3) 10 LREH CORP false LUTHERAN HOUSING OF LA CROSSE INC 1900 SOUTH AVENUE LA CROSSE WI 54601 391751934 INDEPENDENT LIVING WI 501(C)(3) 10 LREH CORP false ST JOSEPH MEMORIAL FOUNDATION INC 400 WATER AVE HILLSBORO WI 54634 391455787 FOUNDATION WI 501(C)(3) TYPE I STJ HLTH SVC true TRI-COUNTY MEMORIAL FOUNDATION INC 18601 LINCOLN STREET WHITEHALL WI 54773 300093022 FOUNDATION WI 501(C)(3) TYPE I TCH false MEMORIAL HOSPITAL OF BOSCOBEL 205 PARKER STREET BOSCOBEL WI 53805 390845590 HEALTHCARE WI 501(C)(3) 3 GLHS false PALMER LUTHERAN HEALTH CENTER INC 112 JEFFERSON STREET WEST UNION IA 52175 421320763 HEALTHCARE IA 501(C)(3) 3 GLHS false MOUNDVIEW MEMORIAL HOSPITALS AND CLINICS 402 WEST LAKE STREET FRIENDSHIP WI 53934 390944012 HEALTHCARE WI 501(C)(3) 3 GLHS false MEMORIAL HEALTHCARE FOUNDATION INC 402 WEST LAKE STREET FRIENDSHIP WI 53934 391775074 FOUNDATION WI 501(C)(3) TYPE I MDV HOSP false SAINT ELIZABETH'S HOSPITAL OF WABASHA INC 1200 FIFTH GRANT BLVD WEST WABASHA MN 55981 410693877 HEALTHCARE MN 501(C)(3) 3 GLHS false BELLIN HEALTH SYSTEMS INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 391512904 SUPPORT ORG WI 501(C)(3) TYPE II BGHS false LAKE MICHIGAN HEALTH SERVICES INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 391512903 SUPPORT ORG WI 501(C)(3) TYPE II BHS false BELLIN COLLEGE INC 3201 EATON ROAD GREEN BAY WI 54311 391620530 EDUCATION WI 501(C)(3) 2 BHS false BELLIN PSYCHIATRIC CENTER INC PO BOX 23725 GREEN BAY WI 54301 391657627 HEALTHCARE WI 501(C)(3) 3 BHS false BELLIN MEMORIAL HOSPITAL INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 390884478 HEALTHCARE WI 501(C)(3) 3 BHS false THE BELLIN HEALTH FOUNDATION INC PO BOX 23400 GREEN BAY WI 54301 391809171 FOUNDATION WI 501(C)(3) 7 BHS false OCONTO HOSPITAL & MEDICAL CENTER INC 820 ARBUTUS AVENUE OCONTO WI 54153 061745397 HEALTHCARE WI 501(C)(3) 3 BMH false BEL-REGIONAL HOME MEDICAL INC 617 S ROOSEVELT GREEN BAY WI 54301 391504766 DURABLE MEDICAL EQUIPMENT, RETAIL PHARMACY, FITNESS WI NA C CORPORATION false BG ASSURANCE COMPANY 20 GENESIS CLOSE PO BOX 30600 GEORGE TOWN GRAND CAYMAN CJ KY11203 SELF INSURANCE CJ NA C CORPORATION false GUNDERSEN EDGE LLC 1836 SOUTH AVENUE LA CROSSE WI 54601 921783811 INNOVATION WI GUNDERSEN LUTHERAN HEALTH SYSTEM INC C CORPORATION false GUNDERSEN LUTHERAN ENVISION LLC 1836 SOUTH AVENUE LA CROSSE WI 54601 264706546 RENEWABLE ENERGY WI GUNDERSEN LUTHERAN HEALTH SYSTEM INC C CORPORATION false false false true false false false false false false false false false true true false true false false