Gundersen Health Plan Minnesota Inc, Gundersen Lutheran Health Plan Mn in La Crosse, Wisconsin (WI)

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Table of contents:

• Overview
• Detailed Reports
  • Statements Regarding Other IRS Filings and Tax Compliance
  • Statement of Revenue
  • Statement of Functional Expenses
  • Balance Sheet
  • Reason for Public Charity Status
• Other organizations in Wisconsin

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Gundersen Health Plan Minnesota Inc, Gundersen Lutheran Health Plan Mn
Employer Identification Number (EIN)	452633920
Name of Organization	Gundersen Health Plan Minnesota Inc
Secondary Name	Gundersen Lutheran Health Plan Mn
In Care of Name	Dan Lilly
Address	1900 South Ave, La Crosse, WI 54601-5467
Subsection	Social Welfare Organization
Ruling Date	10/2014
Deductibility	Contributions are not deductible
Foundation	All organizations except 501(c)(3)
Organization	Corporation
Exempt Organization Status	Unconditional Exemption
Tax Period	12/2013
Assets	$1,000,000 to $4,999,999
Income	$1,000,000 to $4,999,999
Filing Requirement	990 (all other) or 990EZ return
Asset Amount	$1,866,546
Amount of Income	$2,174,372
Form 990 Revenue Amount	$2,174,372
National Taxonomy of Exempt Entities (NTEE)	Health - General and Rehabilitative: Health, General and Financing

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Financial snapshot ($)

Revenue for 2012

Statements Regarding Other IRS Filings and Tax Compliance (for 2012)
Did the organization have unrelated business gross income of $1,000 or more during the year?	No
Initiation fees and capital contributions	$0
Gross receipts for public use of club facilities	$0
Gross income from members or shareholders	$0
Gross income from other sources	$0

Statement of Revenue (for 2012)
Total revenue	$23,393
Contributions, Gifts, Grants and Other Similar Amounts	$0
Program Service Revenue	$22,490
Other Revenue
Investment income (including dividends, interest, and other similar amounts)	$903
Income from investment of tax-exempt bond proceeds	$0
Royalties	$0
Net rental income	$0
Net gain from sales of assets other than inventory	$0
Net income from fundraising events	$0
Net income from gaming activities	$0
Net income from sales of inventory	$0
Miscellaneous Revenue	$0

Statement of Functional Expenses (for 2012)
Total functional expenses	$40,595
Compensation of current officers, directors, trustees, and key employees	$0
Other salaries and wages	$0
Payroll taxes	$0
Professional fundraising services	$0
Other	$40,595

Balance Sheet (for 2012)
Total assets	$1,691,477
Total liabilities	$158,679
Tax-exempt bond liabilities	$0
Secured mortgages and notes payable to unrelated third parties	$0
Unsecured notes and loans payable to unrelated third parties	$0
Other	$158,679
Total net assets or fund balances	$1,532,798
Retained earnings, endowment, accumulated income, or other funds	$-17,202

Reason for Public Charity Status (for 2012)
The organization is not a private foundation because it is:	Not provided

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1	Alliance Of Health Insurers Ua	PO BOX 308, Madison, WI 53701-0308	WI	2013-09	$228,492
2	Amelia Reed Testamentary Trust	PO BOX 2043, Milwaukee, WI 53201-2043	WI		$6,225
3	American Federation Of Teachers, Univ Of Wi-Stevens Point Academic	2100 Main St, Stevens Point, WI 54481-3897	WI	1967-11	$70,926
4	Amery Community Club	PO BOX 211, Amery, WI 54001-0211	WI	2014-02	$144,540
5	Brown County Veba Health Savings Tr	305 E Walnut St 5th Flr, Green Bay, WI 54301-5027	WI	2014-09	$126,961
6	Center For Pharmacy Practice Accreditation	8517 Excelsior Dr Ste 205, Madison, WI 53717-1995	WI	2014-10	$2,000
7	Challenge Center Foundation Inc	1416 Cumming Ave, Superior, WI 54880-3757	WI	1946-03	$402,678
8	Funeral And Memorial Information Council Inc	13625 Bishops Dr, Brookfield, WI 53005-6600	WI	2013-12	$199,476
9	Gifford Pier Club Ltd	4635 Lake Club Cir, Oconomowoc, WI 53066-4016	WI	2014-02	$4,260
10	Greater Union Grove Area Chamber Of Commerce	PO BOX 44, Union Grove, WI 53182-0044	WI	2014-01	$65,011
11	Gundersen Health Plan Minnesota Inc, Gundersen Lutheran Health Plan Mn	1900 South Ave, La Crosse, WI 54601-5467	WI	2014-10	$2,174,372
12	Helen Bates Scholarship Fund, Ward P Bacon Ttee	345 Windward Rd, Green Bay, WI 54302-5204	WI		$590,182
13	International Association Of Fire Fighters, L1848 Oak Creek	PO BOX 123, Oak Creek, WI 53154-0123	WI	1959-03	$67,404
14	Johnson Controls Inc Non-Union Retiree Life Ins Tr	5757 N Green Bay Ave, Milwaukee, WI 53209-4408	WI	2014-04	$763,710
15	Johnson Controls Inc Non-Union Retiree Medical Tr	5757 N Green Bay Ave, Milwaukee, WI 53209-4408	WI	2014-04	$9,274,105
16	Johnson Controls Inc Union Retiree Life Ins Tr	5757 N Green Bay Ave, Milwaukee, WI 53209-4408	WI	2014-04	$289,139
17	Johnson Controls Inc Union Retiree Medical Tr	5757 N Green Bay Ave, Milwaukee, WI 53209-4408	WI	2014-04	$11,141,800
18	June Onefive Foundation Inc	1826 Gillette Pl, La Crosse, WI 54603-2303	WI		$5,002,165
19	Jwt Special Tr Dated September 17 2012	3913 W Prospect Ave Ste 201, Appleton, WI 54914-8797	WI		$192,144
20	Knights Of Columbus, Knights Of Columbus 3450 Bishop Griffin	895 Westbrook Drive, Plain, WI 53577	WI	1940-10	$10,165

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