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Nonprofiteer
← BELLIN GUNDERSEN HEALTH SYSTEM INC

Form 990 for tax year 2022

Filed by BELLIN GUNDERSEN HEALTH SYSTEM INC.

Totals

Total revenue
$0
Total expenses
$9,559,674
Contributions and grants received
$0
Grants paid
$0
Program services expenses (Part IX)
$9,559,674
Management and general expenses
$0
Fundraising expenses
$0
Program service expenses (Part III)
$9,559,674

Program services were 100.0% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • Gerald Arndt

    Board of Directors, Vice Chairman

    Total calculated
    $0
    Hours/week
    2

  • John Dykema

    Board of Directors - Chairman

    Total calculated
    $0
    Hours/week
    2

  • Barbara Gilling

    Board of Directors - Member

    Total calculated
    $0
    Hours/week
    2

  • Christopher Eberlein MD

    Board of Directors - Member

    Total calculated
    $455,677
    From this org
    $0
    From related orgs
    $387,958
    Other
    $67,719
    Hours/week
    2 + 43.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $379,772 related
    Bonus
    $0 + $3,000 related
    Other
    $0 + $5,186 related
    Deferred
    $0 + $44,225 related
    Nontaxable benefits
    $0 + $23,494 related
    Filer's total
    $0 + $455,677 related

  • Daniel Florness

    Board of Directors - Member

    Total calculated
    $0
    Hours/week
    2

  • Ezana Azene MD

    Board of Directors - Member

    Total calculated
    $1,041,378
    From this org
    $0
    From related orgs
    $967,909
    Other
    $73,469
    Hours/week
    2 + 42 related

    Schedule J breakdown matched by us

    Base
    $0 + $960,845 related
    Bonus
    $0 + $2,000 related
    Other
    $0 + $5,064 related
    Deferred
    $0 + $44,225 related
    Nontaxable benefits
    $0 + $29,244 related
    Filer's total
    $0 + $1,041,378 related

  • James Rider MD

    Board of Directors - Member

    Total calculated
    $868,046
    From this org
    $0
    From related orgs
    $825,447
    Other
    $42,599
    Hours/week
    2 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $704,177 related
    Bonus
    $0 + $121,000 related
    Other
    $0 + $270 related
    Deferred
    $0 + $14,739 related
    Nontaxable benefits
    $0 + $27,860 related
    Filer's total
    $0 + $868,046 related

  • John Lyche

    Board of Directors - Member

    Total calculated
    $0
    Hours/week
    2

  • Karl Schmidt

    Board of Directors - Member

    Total calculated
    $0
    Hours/week
    2

  • Richard Radcliffe

    Board of Directors - Member

    Total calculated
    $0
    Hours/week
    2

  • Robyn Borge MD

    Board of Directors - Member

    Total calculated
    $352,653
    From this org
    $0
    From related orgs
    $306,023
    Other
    $46,630
    Hours/week
    2 + 42 related

    Schedule J breakdown matched by us

    Base
    $0 + $301,500 related
    Bonus
    $0 + $100 related
    Other
    $0 + $4,423 related
    Deferred
    $0 + $44,080 related
    Nontaxable benefits
    $0 + $2,550 related
    Filer's total
    $0 + $352,653 related

  • Saied Assef MD

    Board of Directors - Member

    Total calculated
    $180,875
    From this org
    $0
    From related orgs
    $180,875
    Other
    $0
    Hours/week
    2 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $180,875 related
    Bonus
    $0
    Other
    $0
    Deferred
    $0
    Nontaxable benefits
    $0
    Filer's total
    $0 + $180,875 related

  • Sherri Hoyman DO

    Board of Directors - Member

    Total calculated
    $368,115
    From this org
    $0
    From related orgs
    $324,726
    Other
    $43,389
    Hours/week
    2 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $302,952 related
    Bonus
    $0 + $21,000 related
    Other
    $0 + $774 related
    Deferred
    $0 + $17,779 related
    Nontaxable benefits
    $0 + $25,610 related
    Filer's total
    $0 + $368,115 related

  • Susan Finco

    Board of Directors - Member

    Total calculated
    $0
    Hours/week
    2

  • Teresita Yutuc

    Board of Directors - Member

    Total calculated
    $0
    Hours/week
    2

  • Terry Fulwiler

    Board of Directors - Member

    Total calculated
    $0
    Hours/week
    2

  • Andrea Werner

    Chief Population Health Officer

    Total calculated
    $281,576
    From this org
    $0
    From related orgs
    $258,297
    Other
    $23,279
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $218,619 related
    Bonus
    $0 + $33,000 related
    Other
    $0 + $6,678 related
    Deferred
    $0 + $13,321 related
    Nontaxable benefits
    $0 + $9,958 related
    Filer's total
    $0 + $281,576 related

  • Christine Woleske

    Executive Vice President, Northern Counties Regional President

    Total calculated
    $1,353,876
    From this org
    $0
    From related orgs
    $1,323,496
    Other
    $30,380
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $918,647 related
    Bonus
    $0 + $250,000 related
    Other
    $0 + $154,849 related
    Deferred
    $0 + $19,922 related
    Nontaxable benefits
    $0 + $10,458 related
    Filer's total
    $0 + $1,353,876 related

  • Daniel Lilly

    Secretary

    Total calculated
    $559,580
    From this org
    $0
    From related orgs
    $491,361
    Other
    $68,219
    Hours/week
    0 + 48 related

    Schedule J breakdown matched by us

    Base
    $0 + $485,361 related
    Bonus
    $0
    Other
    $0 + $6,000 related
    Deferred
    $0 + $44,225 related
    Nontaxable benefits
    $0 + $23,994 related
    Filer's total
    $0 + $559,580 related

  • Gerald Oetzel

    CHIEF FINANCIAL OFFICER AND TREASURER (THRU 8/23)

    Total calculated
    $668,293
    From this org
    $0
    From related orgs
    $615,642
    Other
    $52,651
    Hours/week
    0 + 42 related

    Schedule J breakdown matched by us

    Base
    $0 + $609,991 related
    Bonus
    $0
    Other
    $0 + $5,651 related
    Deferred
    $0 + $44,225 related
    Nontaxable benefits
    $0 + $8,426 related
    Filer's total
    $0 + $668,293 related

  • Heather Schimmers RN

    Southern Counties Regional President

    Total calculated
    $573,074
    From this org
    $0
    From related orgs
    $514,939
    Other
    $58,135
    Hours/week
    0 + 51 related

    Schedule J breakdown matched by us

    Base
    $0 + $509,659 related
    Bonus
    $0
    Other
    $0 + $5,280 related
    Deferred
    $0 + $44,225 related
    Nontaxable benefits
    $0 + $13,910 related
    Filer's total
    $0 + $573,074 related

  • Julie Graceffa

    Assistant Treasurer

    Total calculated
    $200,652
    From this org
    $0
    From related orgs
    $164,852
    Other
    $35,800
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $144,667 related
    Bonus
    $0 + $20,005 related
    Other
    $0 + $180 related
    Deferred
    $0 + $11,031 related
    Nontaxable benefits
    $0 + $24,769 related
    Filer's total
    $0 + $200,652 related

  • LeAnne Andersen

    Chief People Officer

    Total calculated
    $0
    Hours/week
    0 + 40 related

  • Lisa Harton

    Chief Quality Officer

    Total calculated
    $275,781
    From this org
    $0
    From related orgs
    $250,970
    Other
    $24,811
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $215,556 related
    Bonus
    $0 + $35,000 related
    Other
    $0 + $414 related
    Deferred
    $0 + $15,337 related
    Nontaxable benefits
    $0 + $9,474 related
    Filer's total
    $0 + $275,781 related

  • Peter Vandenhouten

    Assistant Secretary

    Total calculated
    $517,568
    From this org
    $0
    From related orgs
    $487,169
    Other
    $30,399
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $367,216 related
    Bonus
    $0 + $88,375 related
    Other
    $0 + $31,578 related
    Deferred
    $0 + $19,728 related
    Nontaxable benefits
    $0 + $10,671 related
    Filer's total
    $0 + $517,568 related

  • Praveen Chopra

    Chief Digital and Information Officer

    Total calculated
    $582,444
    From this org
    $0
    From related orgs
    $509,283
    Other
    $73,161
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $462,246 related
    Bonus
    $0
    Other
    $0 + $47,037 related
    Deferred
    $0 + $44,225 related
    Nontaxable benefits
    $0 + $28,936 related
    Filer's total
    $0 + $582,444 related

  • Scott Rathgaber MD

    Chief Executive Officer

    Total calculated
    $1,088,135
    From this org
    $0
    From related orgs
    $1,020,916
    Other
    $67,219
    Hours/week
    0 + 48 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,015,579 related
    Bonus
    $0 + $180 related
    Other
    $0 + $5,157 related
    Deferred
    $0 + $44,225 related
    Nontaxable benefits
    $0 + $22,994 related
    Filer's total
    $0 + $1,088,135 related

  • STEVE LITTLE

    INTERIM CFO & TREASURER (BEGIN 8/23)

    Total calculated
    $0
    Hours/week
    0 + 42 related

  • William Farrell

    Chief Innovation & Strategy Officer

    Total calculated
    $481,999
    From this org
    $0
    From related orgs
    $437,724
    Other
    $44,275
    Hours/week
    0 + 41 related

    Schedule J breakdown matched by us

    Base
    $0 + $432,308 related
    Bonus
    $0
    Other
    $0 + $5,416 related
    Deferred
    $0 + $44,225 related
    Nontaxable benefits
    $0 + $50 related
    Filer's total
    $0 + $481,999 related

  • CINDY LASEKI MD

    NORTHERN CHIEF CLINICAL OFFICER

    Total calculated
    $398,183
    From this org
    $0
    From related orgs
    $378,442
    Other
    $19,741
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $347,501 related
    Bonus
    $0 + $30,167 related
    Other
    $0 + $774 related
    Deferred
    $0 + $15,961 related
    Nontaxable benefits
    $0 + $3,780 related
    Filer's total
    $0 + $398,183 related

  • MICHAEL DOLAN MD

    SOUTHERN CHIEF CLINICAL OFFICER

    Total calculated
    $708,192
    From this org
    $0
    From related orgs
    $636,281
    Other
    $71,911
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $631,023 related
    Bonus
    $0 + $4,500 related
    Other
    $0 + $758 related
    Deferred
    $0 + $44,225 related
    Nontaxable benefits
    $0 + $27,686 related
    Filer's total
    $0 + $708,192 related

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 4b · Supplemental nonqualified retirement plan

Answered no

  • 4a · Severance or change-of-control payment
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings

The filer's explanations (Part III)

Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan
BELLIN MEMORIAL HOSPITAL, A RELATED PARTY, HAS A DEFERRED COMPENSATION PLAN FOR SELECTED EXECUTIVES. PETER VANDENHOUTEN AND CHRISTINE WOLESKE PARTICIPATED IN THE 457(F) PLAN. THERE WERE NO DISTRIBUTIONS DURING CALENDAR YEAR 2021. THE FOLLOWING INDIVIDUALS, LISTED ON PART VII OF FORM 990, HAD THE FOLLOWING AMOUNTS ACCRUED DURING CALENDAR YEAR 2022: CHRISTINE WOLESKE $141,843 PETER VANDEHOUTEN $30,804
Schedule J, Part I Lines 2 and 3
ALL PERSONNEL SERVICES FOR BELLING GUNDERSEN HEALTH SERVICES, INC. ARE PERFORMED BY EMPLOYEES OF GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. AND BELLING HEALTH SYSTEMS, INC.
Schedule J, Part II REIMBURSEMENTS
GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. AND BELLING HEALTH SYSTEMS, INC. PROVIDE LEASE EMPLOYEES AND MANAGEMENT SERVICES TO BELLIN GUNDERSEN HEALTH SYSTEM, INC. THEREFORE, THE AMOUNTS REPORTED REPRESENT REIMBURSEMENTS TO GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. AND BELLING HEALTH SYSTEMS, INC.

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

No itemized grants to organizations on this return.

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Provenance

Return type
form_990
Tax year
2022
Filed
15 August 2024
IRS schema version
2022v5.0
Source object
202422289349302062

Check it against the return as filed: the GivingTuesday Data Lake hosts a public copy of the original XML.

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