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THEDACARE MEDICAL CENTER-WAUPACA INC: Form 990, tax year 2022

View the entire original 990 at ProPublica ↗

Organization
THEDACARE MEDICAL CENTER-WAUPACA INC (EIN 39-0871113)
Tax period
2022-01-01 to 2022-12-31
Filed
2023-11-13
IRS object ID
202333179349311583
Schema version
2022v5.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2023-11-13T18:32:18+00:00ReturnTs
Tax Period End2022-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN440160260PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1FORVIS LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1211 N Broadway Suite 600AddressLine1Txt
CitySt LouisCityNm
State AbbreviationMOStateAbbreviationCd
ZIP631022733ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2022-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN390871113EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ThedaCare Medical Center - Waupaca IncBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlTHEDBusinessNameControlTxt
Phone7152581000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 8025AddressLine1Txt
CityAPPLETONCityNm
State AbbreviationWIStateAbbreviationCd
ZIP549128025ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonIMRAN ANDRABI MDPersonNm
Person TitlePRESIDENTPersonTitleTxt
Phone7152581000PhoneNum
Signature2023-11-14SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstWILLIAMPersonFirstNm
Person LastFLETTPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKRISTEN M HANKINSPreparerPersonNm
PTINP01256574PTIN
Phone3142315544PhoneNum
Preparation2023-11-15PreparationDt
FieldValueIRS element (for citing)
Tax2022TaxYr
Build TS2023-04-26 12:10:37ZBuildTS

Form 990 IRS990

Principal Ofcr Business Name PrincipalOfcrBusinessName

FieldValueIRS element (for citing)
Business Name Line1IMRAN ANDRABI MDBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 8025AddressLine1Txt
CityAPPLETONCityNm
State AbbreviationWIStateAbbreviationCd
ZIP549128025ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$51,741,495GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.THEDACARE.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1955FormationYr
Legal Domicile StateWILegalDomicileStateCd
Activity Or MissionIMPROVING THE HEALTH OF OUR COMMUNITY.ActivityOrMissionDesc
Voting Members Governing Body10VotingMembersGoverningBodyCnt
Voting Members Independent7VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers34TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$53,082PYContributionsGrantsAmt
CY Contributions Grants$1,290,412CYContributionsGrantsAmt
PY Program Service Revenue$51,132,410PYProgramServiceRevenueAmt
CY Program Service Revenue$49,028,649CYProgramServiceRevenueAmt
PY Investment Income$1,694,280PYInvestmentIncomeAmt
CY Investment Income$587,991CYInvestmentIncomeAmt
PY Other Revenue$292,095PYOtherRevenueAmt
CY Other Revenue$834,443CYOtherRevenueAmt
PY Total Revenue$53,171,867PYTotalRevenueAmt
CY Total Revenue$51,741,495CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$20,138,199PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$19,838,640CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$23,877,855PYOtherExpensesAmt
CY Other Expenses$26,140,897CYOtherExpensesAmt
PY Total Expenses$44,016,054PYTotalExpensesAmt
CY Total Expenses$45,979,537CYTotalExpensesAmt
PY Revenues Less Expenses$9,155,813PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$5,761,958CYRevenuesLessExpensesAmt
Total Assets BOY$126,150,544TotalAssetsBOYAmt
Total Assets EOY$129,861,584TotalAssetsEOYAmt
Total Liabilities BOY$1,541,668TotalLiabilitiesBOYAmt
Total Liabilities EOY$1,978,500TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$124,608,876NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$127,883,084NetAssetsOrFundBalancesEOYAmt
MissionTO PROVIDE THE HIGHEST QUALITY HEALTH CARE, DELIVERED IN THE MOST EFFICIENT AND COST-EFFECTIVE WAYS, AND ACCESSIBLE TO ALL MEMBERS OF THE COMMUNITY.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$36,283,521ExpenseAmt
Revenue$49,028,649RevenueAmt
DescTHEDACARE IS A TAX-EXEMPT, NON-PROFIT CORPORATION, AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THEDACARE MEDICAL CENTER-WAUPACA IS A 25-BED CRITICAL ACCESS HOSPITAL SERVING WAUPACA AND NEARBY COMMUNITIES. THERE ARE MORE THAN 225 TEAM MEMBERS LOCATED AT THE WAUPACA CAMPUS. THEDACARE REGIONAL MEDICAL CENTER-WAUPACA PROVIDES PATIENT CARE AND SUPPORT SERVICES INCLUDING DIAGNOSTIC SERVICES SUCH AS X-RAY, ULTRASOUND, MRI, CT SCAN, MAMMOGRAPHY AND MEDICAL LABORATORY TESTING AND SPECIALTY SERVICES SUCH AS CANCER CARE, CARDIOVASCULAR CARE, ORTHOPEDIC CARE, SPINE, NEUROLOGY, FAMILY BIRTH CARE, INTERNAL MEDICINE, EMERGENCY, OCCUPATIONAL HEALTH, PULMONOLOGY, UROLOGY, WOMEN'S CARE, OUTPATIENT SURGERY AND THERAPY SERVICES. IN ADDITION, WE OFFER AND CONVENIENT WALK-IN CARE, AND E-VISITS FOR ENHANCED COMMUNITY ACCESS TO HEALTH CARE. AS PART OF THE THEDACARE SYSTEM, WE OFFER PUBLIC AWARENESS CAMPAIGNS, CHARITY CARE, SUPPORT GROUPS, AND EDUCATION PROGRAMS TARGETED TO LOCAL COMMUNITY NEEDS. THEDACARE IS COMMITTED TO COMMUNITY FOCUSED EFFORTS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT IN COUNTIES (WAUPACA) WHERE SERVICES ARE PROVIDED. EFFORTS INCLUDE PARTNERSHIPS WITH LOCAL GOVERNMENTS, COMMUNITY PARTNERS, AND AREA HEALTH ORGANIZATIONS TO ADDRESS THE TOP HEALTH PRIORITIES IDENTIFIED IN ITS MOST RECENT CHNA. THEDACARE PROVIDES SCHOLARSHIPS, CHARITY CARE, INTERPRETING AND EDUCATIONAL SERVICES AND VARIOUS OTHER COMMUNITY BENEFITS. THEDACARE OPERATES ON A NON-DISCRIMINATORY BASIS REGARDLESS OF RACE, COLOR, SEX, RELIGION, OR NATIONAL ORIGIN. THEDACARE PROVIDES A VARIETY OF FINANCIAL ASSISTANCE OPTIONS TO PATIENTS WHO MEET ESTABLISHED CRITERIA. SERVICES ARE ALSO PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES.Desc
Total Program Service Expenses$36,283,521TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntfalseTransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
Info In Schedule O Part VYes (X)InfoInScheduleOPartVInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee0EmployeeCnt
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members10GoverningBodyVotingMembersCnt
Independent Voting Member7IndependentVotingMemberCnt
Family Or Business RlnYes (true)FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (true)DelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CHRIS SANBORNBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone9204544184PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 8025AddressLine1Txt
CityAPPLETONCityNm
State AbbreviationWIStateAbbreviationCd
ZIP549128025ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
Christine Anthony
Secretary, Director1.00Yes (X)Yes (X)$0$0$0
Richard Phillipsen
Treasurer, Board Member1.00Yes (X)Yes (X)$0$0$0
Timothy Neuville
Vice Chair, Board Member1.00Yes (X)Yes (X)$0$0$0
William Zimmerman
Chair, Board Member1.00Yes (X)Yes (X)$0$0$0
Ellen Wenberg MD
Board Member/Physician40.00Yes (X)$0$272,520$44,411
Eric Hendrickson
Board Member1.00Yes (X)$0$0$0
Jackie Anhalt
Board Member/Chief Nursing Officer1.039.0Yes (X)$0$522,511$137,707
Jeremy Koehler
Board Member1.00Yes (X)$0$0$0
Suzanne Udoni
Board Member1.00Yes (X)$0$0$0
Thomas Arquilla
Board Member/Chief Strategy Officer4.036.0Yes (X)$0$738,065$188,954
Imran Andrabi MD
President & CEO - System4.036.0Yes (X)$0$1,808,832$654,639
James Albin
Chief Information Officer4.036.0Yes (X)$0$494,205$49,169
Maggie Lund
Chief Human Resource Officer4.036.0Yes (X)$0$534,688$165,995
Mark Thompson
Senior VP, CFO & COO - System4.036.0Yes (X)$0$1,160,821$311,108
Brian Sterns
Chief Digital Health Officer4.036.0$0$266,613$135,716Yes (X)
David Corso
Former Officer, VP - Orthopedic, Spine and Pain0.040.0$0$327,867$94,517Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$6,126,121TotReportableCompRltdOrgAmt
Total Other Compensation$1,782,216TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
TOTAL MSP LLC
221 W COLLEGE AVE 2ND FLOORAPPLETONWI54911MEDICAL STAFFING$2,138,105
CHG COMPANIES INC
PO BOX 972651DALLASTX75397MEDICAL STAFFING$276,987
WEATHERBY MEDICAL STAFFING
PO BOX 972633DALLASTX75397MEDICAL STAFFING$271,099
BURLINGTON HEALTHCARE PROVIDERS INC
W329 N4476 LAKELAND DR SUITE 140NASHOTAHWI53058MEDICAL STAFFING$222,520
ENCORE ONE LLC
6633 WEST NATIONAL AVEMILWAUKEEWI53214FACILITIES REPAIRS/MAINTENANCE$218,590
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K12CntrctRcvdGreaterThan100KCnt
Related Organizations$37,349RelatedOrganizationsAmt
Government Grants$1,250,063GovernmentGrantsAmt
All Other Contributions$3,000AllOtherContributionsAmt
Total Contributions$1,290,412TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescNet Patient Service RevenueDesc
Business622110BusinessCd
Total Revenue Column$49,028,649TotalRevenueColumnAmt
Related Or Exempt Func Income$49,028,649RelatedOrExemptFuncIncomeAmt

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$49,028,649TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$587,991TotalRevenueColumnAmt
Exclusion$587,991ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$177,517RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$177,517RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$177,517TotalRevenueColumnAmt
Exclusion$177,517ExclusionAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt
Other$0OtherAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmt
Other operating revenue900099$568,378$568,378
Cafeteria722210$88,548$88,548

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$656,926OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$51,741,495TotalRevenueColumnAmt
Related Or Exempt Func Income$49,028,649RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$1,422,434ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$15,802,158TotalAmt
Program Services$12,991,091ProgramServicesAmt
Management And General$2,811,067ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$346,465TotalAmt
Program Services$267,779ProgramServicesAmt
Management And General$78,686ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$2,805,296TotalAmt
Program Services$2,168,179ProgramServicesAmt
Management And General$637,117ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$884,721TotalAmt
Program Services$683,790ProgramServicesAmt
Management And General$200,931ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$965,201TotalAmt
Management And General$965,201ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$29,509TotalAmt
Management And General$29,509ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$8,073,559TotalAmt
Program Services$5,831,147ProgramServicesAmt
Management And General$2,242,412ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$305TotalAmt
Program Services$305ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$192,827TotalAmt
Program Services$192,827ProgramServicesAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$5,192TotalAmt
Program Services$5,192ProgramServicesAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$3,044,758TotalAmt
Program Services$870,899ProgramServicesAmt
Management And General$2,173,859ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$37,310TotalAmt
Program Services$37,310ProgramServicesAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$57,379TotalAmt
Program Services$57,379ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,951,323TotalAmt
Program Services$1,394,089ProgramServicesAmt
Management And General$557,234ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$84,681TotalAmt
Program Services$84,681ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
Medical Supplies$10,464,234$10,464,234
Equipment & Maintenance$879,780$879,780
Food/nutrition$242,327$242,327
Medicaid Assessment$112,512$112,512

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$45,979,537TotalAmt
Program Services$36,283,521ProgramServicesAmt
Management And General$9,696,016ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$18,619,455BOYAmt
EOY$20,717,063EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$6,311,886BOYAmt
EOY$5,503,915EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$1,495,295BOYAmt
EOY$1,687,091EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$32,181BOYAmt
EOY$22,199EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$45,719,365LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$25,770,690LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$19,725,106BOYAmt
EOY$19,948,675EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$18,448,632BOYAmt
EOY$16,548,119EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$61,517,989BOYAmt
EOY$65,434,522EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$126,150,544BOYAmt
EOY$129,861,584EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$291,605BOYAmt
EOY$1,978,500EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$1,250,063BOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,541,668BOYAmt
EOY$1,978,500EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$124,608,876BOYAmt
EOY$127,883,084EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$124,608,876BOYAmt
EOY$127,883,084EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$126,150,544BOYAmt
EOY$129,861,584EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$5,761,958ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$2,487,750NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsYes (true)GrantsOtherOrganizationsInd
Grants Other Organizations$2,289GrantsOtherOrganizationsAmt
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesfalseOtherActivitiesInd
Total Lobbying Expenditures$2,289TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITYFormAndLineReferenceDesc
ExplanationA PORTION OF THE WHA DUES REPRESENT LOBBYING PERFORMED IN REGARD TO HEALTHCARE ISSUES. TOTAL DUES PAID IN 2022 WERE $20,626. 11.1% OF THIS AMOUNT WAS SPENT ON LOBBYING.ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,684,147OtherCostOrOtherBasisAmt
Book Value$2,684,147BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$29,557,128OtherCostOrOtherBasisAmt
Depreciation$15,074,488DepreciationAmt
Book Value$14,482,640BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$12,912,736OtherCostOrOtherBasisAmt
Depreciation$10,696,202DepreciationAmt
Book Value$2,216,534BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$565,354OtherCostOrOtherBasisAmt
Book Value$565,354BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$19,948,675TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (5 entries)

DescDescBook ValueBookValueAmt
DUE FROM AFFILIATES
OPERATING LEASE
Other assets$1,710,589
Due from affiliate$63,334,110
Estimated third-party receivable$389,823
FieldValueIRS element (for citing)
Total Book Value Other Assets$65,434,522TotalBookValueOtherAssetsAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule D, Part X, Line 2 EVALUATION OF UNCERTAIN TAX POSITIONSFormAndLineReferenceDesc
ExplanationMANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.ExplanationTxt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Percent400Yes (X)Percent400Ind
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetfalseFinancialAssistanceBudgetInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$293,512TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$293,512NetCommunityBenefitExpnsAmt
Total Expense0.0064TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Persons Served7382PersonsServedCnt
Total Community Benefit Expns$5,935,359TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$5,346,641DirectOffsettingRevenueAmt
Net Community Benefit Expns$588,718NetCommunityBenefitExpnsAmt
Total Expense0.0128TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Persons Served7382PersonsServedCnt
Total Community Benefit Expns$6,228,871TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$5,346,641DirectOffsettingRevenueAmt
Net Community Benefit Expns$882,230NetCommunityBenefitExpnsAmt
Total Expense0.0192TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Activities Or Programs8ActivitiesOrProgramsCnt
Persons Served49724PersonsServedCnt
Total Community Benefit Expns$249,419TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$135DirectOffsettingRevenueAmt
Net Community Benefit Expns$249,284NetCommunityBenefitExpnsAmt
Total Expense0.0054TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Activities Or Programs2ActivitiesOrProgramsCnt
Persons Served62PersonsServedCnt
Total Community Benefit Expns$211,624TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$211,624NetCommunityBenefitExpnsAmt
Total Expense0.0046TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Activities Or Programs2ActivitiesOrProgramsCnt
Persons Served1PersonsServedCnt
Total Community Benefit Expns$1,486,021TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,486,021NetCommunityBenefitExpnsAmt
Total Expense0.0323TotalExpensePct

Research ResearchGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Activities Or Programs5ActivitiesOrProgramsCnt
Persons Served37353PersonsServedCnt
Total Community Benefit Expns$219,412TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$219,412NetCommunityBenefitExpnsAmt
Total Expense0.0048TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs17ActivitiesOrProgramsCnt
Persons Served87140PersonsServedCnt
Total Community Benefit Expns$2,166,476TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$135DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,166,341NetCommunityBenefitExpnsAmt
Total Expense0.0471TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs17ActivitiesOrProgramsCnt
Persons Served94522PersonsServedCnt
Total Community Benefit Expns$8,395,347TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$5,346,776DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,048,571NetCommunityBenefitExpnsAmt
Total Expense0.0663TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Economic Development EconomicDevelopmentGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Total Community Benefit Expns$2,544TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$2,544NetCommunityBenefitExpnsAmt
Total Expense0.0001TotalExpensePct

Community Support CommunitySupportGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Persons Served4365PersonsServedCnt
Total Community Benefit Expns$75,199TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$75,199NetCommunityBenefitExpnsAmt
Total Expense0.0016TotalExpensePct

Environmental Improvements EnvironmentalImprovementsGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Coalition Building CoalitionBuildingGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Other Communtity Building Acty OtherCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Activities Or Programs2ActivitiesOrProgramsCnt
Persons Served4365PersonsServedCnt
Total Community Benefit Expns$77,743TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$77,743NetCommunityBenefitExpnsAmt
Total Expense0.0017TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedfalseBadDebtExpenseReportedInd
Bad Debt Expense$2,597,246BadDebtExpenseAmt
Reimbursed By Medicare$8,545,418ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$7,534,322CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall$1,011,096MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1THEDACARE MEDICAL CENTER - WAUPACABusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1800 RIVERSIDE DRIVEAddressLine1Txt
CityWAUPACACityNm
State AbbreviationWIStateAbbreviationCd
ZIP54981ZIPCd
FieldValueIRS element (for citing)
Website AddressWWW.THEDACARE.ORGWebsiteAddressTxt
State License1038StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1THEDACARE MEDICAL CENTER - WAUPACABusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted22CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsfalseCHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsfalseCHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLHTTPS://THEDACARE.ORG/ABOUT-US/COMMUNITY-HEALTH/NEEDS-ASSESSMENT-PLANS/OwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt23ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLHTTPS://THEDACARE.ORG/ABOUT-US/COMMUNITY-HEALTH/NEEDS-ASSESSMENT-PLANS/StrategyWebsiteURLTxt
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care200.0FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care400.0FPGFamilyIncmLmtDscntCarePct
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Other CriteriaYes (X)OtherCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Other MethodYes (X)OtherMethodInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLhttps://thedacare.org/patients-and-visitors/billing-and-payment/payment-options/FAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLhttps://thedacare.org/patients-and-visitors/billing-and-payment/payment-options/FAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLhttps://thedacare.org/patients-and-visitors/billing-and-payment/payment-options/FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule H, Part V, Section B, Line 3ETHE HOSPITAL FACILITY ANALYZED SEVERAL HEALTH NEEDS OF THE COMMUNITY AND HAS PRIORITIZED THOSE OF MOST CONCERN. THE PRIORITIZATION OF TOP SIGNIFICANT COMMUNITY HEALTH NEEDS IS DESCRIBED IN THE CHNA.
Schedule H, Part V, Section B, Line 5 Facility , 1Facility , 1 - THEDACARE MEDICAL CENTER- WAUPACA. As part of the Needs Assessment Advisory Team, ThedaCare consulted with the Public Health Departments of Outagamie County, Winnebago County, Calumet County, Shawano, Menomonee, Green Lake, Marquette, Waushara, Waupaca and the City of Appleton. * Chuck Sepers, City of Appleton Public Health Officer * Bonnie Thelen RN, Calumet County Public Health Officer * Natalie Vandeveld, MS, REHS / WI RS * Doug Gieryn, Winnebago County Public Health Officer * Director Terri Harmala, MSN, RN, Shawano County Health Officer * Rachel Prellwitz, Green Lake County Public Health Officer * Jayme Sophe, Marquette County, Public Health Officer * Stefanie Eldredge, BSN, RN, Health Officer/Director * Jed Woldt, Waupaca County, Public Health Officer In addition, over the course of a one-year period, secondary data was collected, key informant interviews were conducted, ThedaCare CHAT Teams (Community Health Action Team) provided input and patient health data was studied. Vulnerable populations included low income, rural farm families, older adults and veterans. ThedaCare CHAT of Waupaca (Community Health Action Team) members: * Andy Behrendt, Trinity Lutheran Church Pastor * Brian Hoelzel, Chief of Police City of Waupaca Police Department * Garrett Colbert, First Weber Broker Associate * Gerry Hamm, ThedaCare Supervisor, Health Coach and Wellness * Gregory Grohman. Waupaca Chamber/Waupaca Schools, Grant Writer * Jed Woldt, Health Officer Waupaca County DHHS * Laura Colbert, Waupaca Parkes and Recreation Director * Laurie Schmidt, Waupaca Schools Director of Student Services * Patsy Servey, City of Waupaca Library, Adult Services * Rachel Lockwood, Waupaca Foundry, Health and Wellness Clinic RN * Shane Kohl, ThedaCare Family of Foundations * Shawna Hansen, WCDHHS Family & Community Services Manager * Tara Knaack, ThedaCare Outreach Health Specialist * Jeff Mirkowski, Waupaca County Economic Development Executive Director * Kellie Diedrick, VP ThedaCare Medical Waupaca * Tracey Ratzburg, ThedaCare CHI (facilitator) * Paula Morgen, ThedaCare CHI Director
Schedule H, Part V, Section B, Line 11 Facility , 1Facility , 1 - THEDACARE MEDICAL CENTER - WAUPACA. THE THEDACARE COMMUNITY HEALTH IMPLEMENTATION STRATEGY WAS APPROVED BY THE THEDACARE BOARD OF TRUSTEES IN 2022. THE FOLLOWING PRIORITIES WERE IDENTIFIED AS THE TOP COMMUNITY HEALTH NEEDS FOR THE 2023-2025 CHNA CYCLE: MENTAL AND BEHAVIORAL HEALTH CHALLENGES CONTINUE WITH THE MENTAL AND BEHAVIORAL HEALTH OF OUR COMMUNITY. ACCESS TO MENTAL HEALTH SERVICES IS NOT KEEPING UP WITH DEMAND, AND THERAPISTS AND HEALTH PROFESSIONALS ARE LACKING IN RURAL AREAS. ADDITIONALLY, ANXIETY AND DEPRESSION HAVE RISEN 20-30% IN RECENT YEARS WHILE SELF-MEDICATION AND SUBSTANCE ABUSE, INCLUDING ALCOHOL, METHAMPHETAMINE, AND VAPING ARE ON THE RISE. TO ADDRESS THIS HEALTH NEED, THE HOSPITAL FACILITY HAS IMPLEMENTED THE FOLLOWING TO ENSURE THAT PEOPLE HAVE THE SUPPORT NEEDED TO LEAD MENTALLY HEALTHY LIVES, FREE OF RELIANCE ON HARMFUL SUBSTANCES AND TO SUPPORT UPSTREAM EFFORTS THAT FOSTER MENTAL HEALTH: 1) EXPAND THEDACARE BEHAVIORAL HEALTH TREATMENT CAPACITY a. EXPAND UTILIZATION OF/SERVICES OFFERED AT BEHAVIORAL HEALTH WALK-IN CARE CLINIC. ESTABLISH SAME-DAY ACCESS. b. EXPAND BEHAVIORAL HEALTH COLLABORATIVE CARE PROGRAM TO ALL PRIMARY CARE CLINICS BY 2026. c. INCREASE NUMBER OF MAT PROVIDERS. d. OPEN NEW BEHAVIORAL HEALTH CLINIC IN WAUPACA. e. ENHANCE RESOURCES OF PEDIATRIC PRIMARY CARE PROVIDERS TO ADDRESS COMMON BEHAVIORAL HEALTH NEEDS. 2) PARTNER TO ESTABLISH REGIONAL DETOXIFICATION CAPACITY, WORKING WITH COUNTY GOVERNMENTS, HEALTH SYSTEMS, PUBLIC HEALTH, LOCAL SUBSTANCE USE AGENCIES, AND LAW ENFORCEMENT. 3) STRENGTHEN, EXPAND AND DIVERSIFY BEHAVIORAL HEALTH WORKFORCE THROUGH: a. A REGIONAL TRAINING CENTER FOR NEW MENTAL HEALTH PRACTITIONERS NEEDING SUPERVISED CLINICAL HOURS. b. "JUST FOR ME" EMOTIONAL WELLNESS PROGRAMMING FOR MENTAL HEALTH PRACTITIONERS. 4) EXPAND ED2RECOVERY+ COACHING CAPACITY a. EXPAND TO INCLUDE REFERRALS FROM PRIMARY CARE AND COMMUNITY PARTNERS. b. ADDRESS ALL SUBSTANCES. 5) SUPPORT NEW MENTAL HEALTH CONNECTION. 6) ADDRESS MENTAL HEALTH NEEDS OF LGBTQ+ COMMUNITY a. SPONSOR LGBTQ+ MENTAL HEALTH SUMMIT. b. LGBTQ+ FRIENDLY MENTAL HEALTH RESOURCE DIRECTORY THROUGH NEW MENTAL HEALTH CONNECTION. c. PROVIDER LGBTQ+ CULTURAL COMPETENCY TRAINING. 7) PARTNER TO SUPPORT SOCIAL CONNECTION AND BELONGING WORK 8) SUPPORT CATALPA HEALTH AND CATALPA HEALTH "SEEDLINGS" PROGRAM ADDRESSING EARLY CHILDHOOD SOCIAL EMOTIONAL LEARNING. SOCIAL NEEDS AS THEDACARE SHIFTS ITS FOCUS UPSTREAM TO POPULATION HEALTH, IT IS IMPORTANT TO UNDERSTAND HOW VITAL CONDITIONS, SUCH AS CLEAN AIR, FAIR PAY, HOUSING, EDUCATION AND OTHER BASIC NECESSITIES CAN IMPACT AN INDIVIDUAL'S WELL-BEING. ADDITIONALLY, RELIABLE TRANSPORTATION, BELONGING AND CIVIC MUSCLE, AND PURPOSE ALL INFLUENCE HEALTH. TO ADDRESS THIS IDENTIFIED NEED, THE HOSPITAL FACILITY HAS IMPLEMENTED THE FOLLOWING TO ENSURE THAT THE BASIC NEEDS OF PATIENTS ARE MET: 1) ESTABLISH SYSTEMATIC SOCIAL NEEDS "CLOSED-LOOP" SCREENING AND REFERRAL OF THEDACARE PATIENTS. a. ACROSS INPATIENT, ED, AND PRIMARY CARE. b. PEDIATRICS. 2) IMPROVE ACCESS TO EMPLOYMENT TRANSPORTATION THROUGH WORKFORCE INNOVATION GRANT COLLABORATION. 3) ADDRESS SOCIAL NEEDS THROUGH EMPLOYEE VOLUNTEERING/GIVING EFFORTS THROUGH: a. HOUSING - HABITAT FOR HUMANITY b. FOOD INSECURITY - FEEDING AMERICA c. UNITED WAY CAMPAIGN 4) IMPLEMENT CULTURAL COMPETENCY TRAINING OF THEDACARE TEAM MEMBERS. 5) SUPPORT EXPANSION OF STAR PROGRAM ADDRESSING "OPPORTUNITY GAP" BETWEEN BLACK AND WHITE HIGH SCHOOL STUDENTS. 6) SUPPORT BE WELL FOX VALLEY AND EAT WELL FOR LIFE INITIATIVES ADDRESSING DIABETES MANAGEMENT AMONG LOW-INCOME POPULATIONS. 7) SUPPORT BASIC NEEDS GIVING PARTNERSHIP AND US VENTURE GOLF OUTING TO END POVERTY. STRONG START TO LIFE GROWING UP HEALTHY AND STRONG STARTS AT THE BEGINNING OF AN INDIVIDUAL'S LIFE. IN PARTNERSHIP WITH CHILDREN'S WISCONSIN, THEDACARE SEEKS TO ADDRESS SOCIAL DETERMINANTS OF HEALTH, MENTAL, BEHAVIORAL AND INFANT HEALTH, AND SAFETY AND VIOLENCE IN CHILDREN THROUGH THE FOLLOWING: 1) SUPPORT REGIONAL FIRST 5 FOX VALLEY EARLY CHILDHOOD COALITION AND HELP ME GROW CENTRALIZED FAMILY SUPPORT ACCESS POINT. 2) SUPPORT REGIONAL COLLEGE SAVINGS ACCOUNT INITIATIVE FOR LOW-INCOME FAMILIES. 3) ESTABLISH THEDACARE PEDIATRIC SDOH COMMUNITY RESOURCE NAVIGATION ASSISTANCE IN RURAL MARKETS THROUGH ADVANCING A HEALTHIER WISCONSIN GRANT AND EXPAND TO ENTIRE SERVICE AREA. 4) PARTNER TO ESTABLISH COMMUNITY RESOURCE NAVIGATION SUPPORT WITHIN CATALPA. 5) EXPLORE EXPANSION OF WELCOME BABY COMMUNITY MODEL IN RURAL MARKETS. 6) FACILITATE COLLABORATIVE REGIONAL ASSESSMENT OF AVAILABILITY AND ACCESSIBILITY OF PARENTING PROGRAMS AND SUPPORTS: a. COLLABORATE TO ADDRESS GAPS AND IMPROVE ACCESSIBILITY TO OFFERINGS. b. ADDRESS BASIC PARENTING AND GROWING OBESITY AND MENTAL HEALTH CONCERNS ACROSS INFANT TO TEEN SPECTRUM. REGIONAL ALIGNMENT IN ORDER TO POSITIVELY AFFECT COMMUNITY HEALTH, HEALTH SYSTEMS, NOT-FOR-PROFIT ORGANIZATIONS, AND THE PUBLIC SECTOR MUST BE UNITED ON THEIR PRIORITIES AND COMMITMENTS. THEDACARE WILL WORK WITH PARTNERS TO ESTABLISH COMMON INFRASTRUCTURE NEEDED TO IMPROVE ALIGNMENT OF HEALTH PRIORITIES AND ACTIONS THROUGH THE FOLLOWING: 1) ESTABLISH COMMON COMMUNITY HEALTH NEEDS ASSESSMENT AND ALIGNED IMPROVEMENT PLANS ACROSS HEALTH SYSTEMS AND PUBLIC HEALTH PARTNERS. 2) DEVELOP COLLABORATIVE REGIONAL NETWORK AND INFRASTRUCTURE FOR ADDRESSING SOCIAL NEEDS. 3) DEVELOP ALIGNMENT AND SYNERGY ACROSS CHAT TEAMS THROUGH IMPLEMENTATION OF CHAT 2.0 MODEL. 4) SUPPORT IMAGINE FOX CITIES REGIONAL VISIONING INITIATIVE. SIGNIFICANT NEEDS IDENTIFIED THROUGH THE MOST RECENTLY CONDUCTED CHNA THAT WILL NOT BE ADDRESS IN THE CURRENT THREE-YEAR PLAN ARE: 1) HIGH PAYING JOBS/ECONOMIC OPPORTUNITY - LIMITED RESOURCES TO ADDRESS 2) INTERNET - BEING ADDRESSED BY OTHERS 3) FOOD INSECURITY - BEING ADDRESS BY OTHERS 4) MOTOR VEHICLE CRASH DEATHS - LIMITED RESOURCES TO ADDRESS 5) EXERCISE OPPORTUNITIES - LIMITED RESOURCES TO ADDRESS.
Schedule H, Part V, Section B, Line 13 Facility , 1Facility , 1 - THEDACARE MEDICAL CENTER - WAUPACA. PATIENTS ARE SENT AN OVERVIEW LETTER EXPLAINING THE PROCESS FOR APPLYING FOR OUR ASSISTANCE PROGRAM OR OUR STAFF WALKS THEM THROUGH THE PROCESS. THEY ARE ASKED TO COMPLETE AN APPLICATION THAT INCLUDES REQUESTS FOR INFORMATION. THIS INFORMATION IS NEEDED IN ORDER TO MAKE A DECISION AS TO WHETHER THE PATIENT MEETS THE CRITERIA FOR ACCEPTANCE, AND IF ACCEPTED, WHAT LEVEL OF ASSISTANCE WILL BE PROVIDED. ONCE THE DECISION IS MADE, WE WILL NOTIFY THE PATIENT AND IF ACCEPTABLE, WRITE OFF THE BALANCE AS DETERMINED.
Schedule H, Part V, Section B, Line 15 Facility , 1Facility , 1 - THEDACARE MEDICAL CENTER - WAUPACA. CONTRACTED WITH ELIGIBILITY VENDOR (CARDON) TO WORK DIRECTLY WITH UNINSURED PATIENTS TO ASSIST THEM WITH INSURANCE ENROLLMENT AND EDUCATION.
Schedule H, Part V, Section B, Line 16 Facility , 1Facility , 1 - THEDACARE MEDICAL CENTER - WAUPACA. THE FAP AND APPLICATION WERE AVAILABLE AT HOSPITAL CASHIER OFFICES, ON OUR WEB SITE AND OFFERED TO ALL PATIENTS THAT EXPRESSED A FINANCIAL HARDSHIP WHEN CALLING THE BILLING OFFICE. THE PLS WAS PRINTED ON EVERY STATEMENT AND A FOOTER WAS ADDED TO THE FRONT OF THE STATEMENT ADVISING PATIENT TO SEE REVERSE SIDE OF STATEMENT FOR FINANCIAL ASSISTANCE AND PAYMENT OPTIONS. NOTIFICATION OF FINANCIAL ASSISTANCE AVAILABILITY WAS ADDED TO THE INITIAL LETTER SENT BY THE THIRD PARTY COLLECTION AGENCY.
FieldValueIRS element (for citing)
Facility0FacilityNum

Supplemental Information Detail SupplementalInformationDetail (20 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule H, Part I, Line 3c DISCOUNTED CARE EXCEPTIONSSEE PART V, SECTION B, LINE 13 FOR THE LIST OF FACTORS USED IN THE ELIGIBILITY CRITERIA EXPLAINED IN THE FAP FOR PROVIDING FREE AND DISCOUNT CARE.
Schedule H, Part I, Line 7 COLUMN FThe bad debt expense is not considered a community benefit expense and is not included in Schedule H, Part I, Line 7. The amount excluded is $2,597,246.
Schedule H, Part I, Line 7gNo physician clinic costs are included in the Community Benefit expenses.
Schedule H, Part I, Line 6a Community benefit report prepared by related organizationTHEDACARE, INC. 39-1509362
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistanceTHE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS IN THE TABLE IS A COMBINATION OF AVERAGE COSTS AND ACTUAL COSTS PERTAINING TO SUPPLIES, WAGES, AND BENEFITS. FOR SUPPLIES, THE ACTUAL COST OF ITEMS USED FOR EACH EVENT IS APPLIED. IF NO ACTUAL COST IS AVAILABLE, WE THEN USE AN ESTIMATE. WAGES ARE CALCULATED BY MULTIPLYING THE AVERAGE WAGE RATE TIMES ACTUAL HOURS WORKED. THE BENEFIT RATE USED INCLUDES A FRINGE RATIO OF ALL BENEFITS RELATED TO THE ABOVE WAGE CALCULATION. THE COST ACCOUNTING SYSTEM DOES NOT DIFFERENTIATE BETWEEN DIFFERENT PAYER TYPES AND NO COST-TO-CHARGE RATIO IS USED.
Schedule H, Part II Community Building ActivitiesTHE HOSPITAL FACILITY PARTICIPATES IN NUMEROUS COMMUNITY BUILDING EFFORTS THROUGHOUT THE YEAR. SPECIFIC ACTIVITIES REPORTED ON SCHEDULE H, PART II INCLUDE: Economic Development - The primary aim of the chamber is to protect the interest of the business community as a whole. Strong employment is a social determinant of health, reducing poverty and providing individual and family sustainability. ThedaCare works together with local Chambers of Commerce in all of the communities it serves. Community Support - Caring Hearts is a financial assistance program designed for patients who are unable to pay for medically necessary services provided by all divisions within ThedaCare. The Caring Hearts Program covers services which are deemed to be medically necessary as determined by their physician. This cost is for time and expense needed to support Caring Hearts. The Caring Hearts financial assistance program is in effect at all ThedaCare facilities - ThedaCare Regional Medical Centers in Appleton and Neenah, ThedaCare Medical Center- Berlin, ThedaCare Medical Center-New London, ThedaCare Medical Center-Shawano, ThedaCare Medical Center-Waupaca and ThedaCare Medical Center-Wild Rose.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amountPATIENT ACCOUNTS RECEIVABLE ARE UNCOLLATERALIZED PATIENT OBLIGATIONS THAT ARE STATED AT THE AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH THEDACARE EXPECTS TO BE ENTITLED IN EXCHANGE FOR PROVIDING PATIENT CARE. THESE OBLIGATIONS ARE PRIMARILY FROM LOCAL RESIDENTS, MOST OF WHOM ARE INSURED UNDER THIRD-PARTY PAYOR AGREEMENTS. THEDACARE BILLS THIRD-PARTY PAYORS ON THE PATIENTS' BEHALF, OR IF A PATIENT IS UNINSURED, THE PATIENT IS BILLED DIRECTLY. ONCE CLAIMS ARE SETTLED WITH THE PRIMARY PAYOR, ANY SECONDARY INSURANCE IS BILLED, AND PATIENTS ARE BILLED FOR COPAY AND DEDUCTIBLE AMOUNTS THAT ARE THE PATIENTS' RESPONSIBILITY. PAYMENTS ON ACCOUNTS RECEIVABLE ARE APPLIED TO THE SPECIFIC CLAIM IDENTIFIED ON THE REMITTANCE ADVICE OR STATEMENTS. THEDACARE DOES NOT HAVE A POLICY TO CHARGE INTEREST ON PAST DUE ACCOUNTS. PATIENT ACCOUNTS RECEIVABLE ARE RECORDED AT NET REALIZABLE VALUE BASED ON CERTAIN ASSUMPTIONS. FOR THIRD-PARTY PAYORS, INCLUDING MEDICARE, MEDICAID, MANAGED CARE AND COMMERCIAL PAYORS, THE NET REALIZABLE VALUE IS BASED ON THE ESTIMATED CONTRACTUAL REIMBURSEMENT PERCENTAGE, WHICH IS BASED ON CURRENT CONTRACT PRICES OR HISTORICAL PAID CLAIMS DATA BY PAYOR. FOR UNINSURED PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR A PORTION OF THE BILL), THE NET REALIZABLE VALUE IS DETERMINED USING ESTIMATES OF HISTORICAL COLLECTION EXPERIENCE. THESE ESTIMATES ARE ADJUSTED FOR EXPECTED RECOVERIES AND ANY ANTICIPATED CHANGES IN TRENDS, INCLUDING SIGNIFICANT CHANGES IN PAYOR MIX, ECONOMIC CONDITIONS OR TRENDS IN FEDERAL AND STATE GOVERNMENTAL HEALTH CARE COVERAGE.
Schedule H, Part III, Line 3 Bad Debt Expense MethodologyTHE HOSPITAL IS REPORTING $0 BECAUSE IT DOES NOT HAVE A METHOD OF REASONABLY ESTIMATING THE PORTION OF ITS BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE BUT WHO DID NOT COMPLETE A FINANCIAL ASSISTANCE APPLICATION.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnoteSEE "PATIENT ACCOUNTS RECEIVABLE AND CREDIT POLICY" IN NOTE 1 ON PAGE 11 OF THE ATTACHED FINANCIAL STATEMENTS.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costsMEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO. SHORTFALLS ARISE FROM PAYMENTS THAT ARE LESS THAN THE COSTS TO PROVIDE THE SERVICES. THE SHORTFALLS SHOULD BE CONSIDERED COMMUNITY BENEFIT AS THEY MUST BE ABSORBED IN ORDER TO CONTINUE PROVIDING CARE TO OUR COMMUNITY. IT IS ALSO IMPLIED IN INTERNAL REVENUE SERVICE RULING 69-545 WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR TAX-EXEMPT HOSPITALS AND INDICATES THAT PARTICIPATION IN PUBLICLY-FINANCED PROGRAMS, SUCH AS MEDICARE, IS EVIDENCE THAT A HOSPITAL MEETS THE COMMUNITY BENEFIT STANDARD.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistanceOUR POLICY IS NOT TO PURSUE PATIENT ACCOUNTS TO THE EXTENT ANY CHARGES ARE ELIGIBLE AND WRITTEN OFF THROUGH OUR CHARITY CARE/FINANCIAL ASSISTANCE PROGRAM. IF ONLY A PORTION OF THE CHARGES ARE ELIGIBLE AND WRITTEN OFF THROUGH OUR CHARITY CARE/FINANCIAL ASSISTANCE PROGRAM, THE REMAINING BALANCE WILL BE BILLED TO THE PATIENT AND COLLECTED IN ACCORDANCE WITH OUR NORMAL COLLECTION POLICY.
Schedule H, Part V, Section B, Line 16a FAP website- THEDACARE MEDICAL CENTER - WAUPACA: Line 16a URL: https://thedacare.org/patients-and-visitors/billing-and-payment/payment-options/;
Schedule H, Part V, Section B, Line 16b FAP Application website- THEDACARE MEDICAL CENTER - WAUPACA: Line 16b URL: https://thedacare.org/patients-and-visitors/billing-and-payment/payment-options/;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website- THEDACARE MEDICAL CENTER - WAUPACA: Line 16c URL: https://thedacare.org/patients-and-visitors/billing-and-payment/payment-options/;
Schedule H, Part VI, Line 2 Needs assessmentTHEDACARE COVERS A 9-COUNTY PRIMARY SERVICE AREA SERVED BY 7 HOSPITALS. THEDACARE CONDUCTS A COMMUNITY NEEDS ASSESSMENT EVERY THREE YEARS FOR EACH HOSPITAL GATHERING DATA PERTINENT TO THAT COMMUNITY AND THE SURROUNDING AREAS. INFORMATION COLLECTED INCLUDES DATA FROM THE WISCONSIN COUNTY HEALTH RANKINGS, FOX CITIES LIFE STUDY (LOCAL INDICATORS FOR EXCELLENCE), THE BEHAVIORAL RISK FACTOR SURVEILLANCE SURVEY, INSIGHTS FROM INTERVIEWS OF PUBLIC HEALTH OFFICIALS, INSIGHTS FROM INTERVIEWS WITH REPRESENTATIVES OF VULNERABLE POPULATIONS, EMERGENCY DEPARTMENT PATIENT DATA AND INSIGHTS GATHERED FROM MONTHLY MEETINGS OF THE THEDACARE-LED CHAT TEAM (COMMUNITY HEALTH ACTION TEAM) COMPRISED OF COMMUNITY LEADERS IN BUSINESS, NON-PROFIT, CLERGY, EDUCATION, DIVERSE POPULATION GROUPS, HEALTHCARE, UNITED WAY, PUBLIC HEALTH AND THE LOCAL COMMUNITY FOUNDATIONS.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistancePATIENT EDUCATION BEGINS WHEN A PATIENT IS ADMITTED TO A THEDACARE HOSPITAL. ADMISSION SPECIALISTS MEET WITH EACH PERSON INDIVIDUALLY TO ASSESS INSURANCE STATUS AND FINANCIAL NEED. IF NECESSARY, SPECIALISTS REFER PATIENTS TO CARE MANAGEMENT SPECIALISTS WHO ASSIST WITH THE ENROLLMENT OF PATIENTS IN AN APPLICABLE PROGRAM. THE HOSPITAL PATIENT HANDBOOK IS PROVIDED TO ALL IN-PATIENTS. INTERNAL POLICIES SUCH AS DISCOUNTED SERVICES POLICY, CARING HEARTS POLICY AND PAYMENT FOR SERVICE POLICY FOR SELF-PAY BALANCES PROVIDE GUIDANCE. THE THEDACARE WEBSITE, WWW.THEDACARE.ORG PROVIDES EDUCATION REGARDING THE AFFORDABLE CARE ACT IN EASY-TO-UNDERSTAND LANGUAGE. IT DISCUSSES OPTIONS AND WHERE TO GO FOR ASSISTANCE.
Schedule H, Part VI, Line 4 Community informationTHEDACARE MEDICAL CENTER - WAUPACA DEFINES ITS PRIMARY HOSPITAL SERVICE AREA (HSA) AS WAUPACA COUNTY IN WISCONSIN. THE TOTAL POPULATION FOR THE HSA WAS 50,664 ACCORDING TO THE MOST RECENT AVAILABLE DATA. THE POPULATION IS PREDOMINANTLY RURAL WITH MORE THAN 21% AGE 65 AND OLDER. IN THE LAST DECADE, THE HISPANIC/LATINO POPULATION HAS HAD THE MOST GROWTH IN BOTH COUNTIES; HOWEVER, THE POPULATION IS PRIMARILY NON-HISPANIC WHITE. APPROXIMATELY ONE-THIRD OF HOUSEHOLDS ARE LIVING BELOW THE ALICE THRESHOLD, WHICH INDICATES A HOUSEHOLD EITHER ABOVE OR BELOW THE FEDERAL POVERTY LEVEL BUT STILL NOT EARNING ENOUGH TO AFFORD BASIC NECESSITIES.
Schedule H, Part VI, Line 5 Promotion of community healthTHE FOUNDATION OF COMMUNITY HEALTH WITHIN THEDACARE IS COMMUNITY HEALTH IMPROVEMENT. THEDACARE COMMUNITY HEALTH IMPROVEMENT IS FUNDED THROUGH OPERATING BUDGET, GRANTS, AND THE THEDACARE FAMILY OF FOUNDATION SUPPORT. THEDACARE PROVIDES FUNDING AND DEDICATED STAFF TO MAKE CHAT COMMUNITY HEALTH EFFORTS POSSIBLE. THE COMMUNITY HEALTH TEAM WORKS WITH LOCAL COMMUNITY HEALTH ACTION TEAM (CHAT), GROUPS OF COMMUNITY LEADERS WHO STUDY SYSTEMIC HEALTH ISSUES OUTSIDE THE WALLS OF OUR HOSPITALS. CHAT IS THE FOUNDATION OF INNOVATIVE, COLLABORATIVE SOLUTIONS FOR COMMUNITY ISSUES THAT DRAW UPON THE WIDE ARRAY OF RESOURCES AND STRENGTHS OF OUR COMMUNITY. THERE ARE THEDACARE LED CHAT'S IN THE FOX CITIES OF APPLETON/MENASHA/NEENAH, BERLIN, NEW LONDON, SHAWANO, WAUPACA AND WILD ROSE.
Schedule H, Part VI, Line 6 Affiliated health care systemTHEDACARE, INC., THE PARENT ORGANIZATION, PROVIDES DIRECTION RELATED TO COMMUNITY HEALTH NEEDS ASSESSMENT FOR EACH HOSPITAL AND SURROUNDING COMMUNITIES WITHIN ITS SERVICE AREA. PLANS ARE APPROVED BY LOCAL HOSPITAL BOARDS. EACH THEDACARE HOSPITAL, ALONG WITH CHI STAFF AND COMMUNITY MEMBERS DETERMINE HOW BEST TO MEET LOCAL NEEDS. IMPLEMENTATION OF COMMUNITY PROGRAMMING OCCURS AT THE LOCAL LEVEL.
Schedule H, Part VI, Line 7 State filing of community benefit reportWI

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (true)AnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Thomas Arquilla
Board Member/Chief Strategy Officer$0$479,252$0$200,574$0$58,239$0$171,313$0$17,641$0$927,019$0$0
Jackie Anhalt
Board Member/Chief Nursing Officer$0$364,169$0$145,517$0$12,825$0$113,796$0$23,911$0$660,218$0$0
Ellen Wenberg MD
Board Member/Physician$0$249,675$0$22,005$0$841$0$20,500$0$23,911$0$316,931$0$0
David Corso
Former Officer, VP - Orthopedic, Spine and Pain$0$240,670$0$79,059$0$8,138$0$94,517$0$0$0$422,384$0$0
Maggie Lund
Chief Human Resource Officer$0$370,127$0$157,543$0$7,018$0$157,901$0$8,094$0$700,683$0$0
Imran Andrabi MD
President & CEO - System$0$1,069,773$0$625,104$0$113,954$0$654,639$0$0$0$2,463,471$0$0
Mark Thompson
Senior VP, CFO & COO - System$0$823,122$0$321,783$0$15,916$0$287,197$0$23,911$0$1,471,929$0$0
James Albin
Chief Information Officer$0$219,539$0$170,014$0$104,652$0$38,878$0$10,291$0$543,374$0$0
Brian Sterns
Chief Digital Health Officer$0$200,386$0$59,016$0$7,210$0$111,805$0$23,911$0$402,329$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule J, Part I, Line 4b Supplemental nonqualified retirement planSENIOR LEVEL EXECUTIVES OF THE COMPANY ARE ENTITLED TO AN ANNUAL FLEXIBLE BENEFIT EQUAL TO 20% OF THE MIDPOINT OF THEIR SALARY RANGE. THIS 457(F) SUPPLEMENTAL BENEFIT PLAN COMPLIES WITH THE FINAL REGULATIONS UNDER SECTION 409(A) AND 457(F) OF THE INTERNAL REVENUE CODE. PARTICIPANTS MAY ELECT THE BENEFIT TO BE USED TO PURCHASE PARTICULAR INSURANCE BENEFITS, INVEST IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN, OR A COMBINATION OF THE TWO. BENEFITS ARE ACCRUED ON A MONTHLY BASIS AND ARE SUBJECT TO THE SUBSTANTIAL RISK OF FORFEITURE AGREEMENT SIGNED BY THE PARTICIPANTS. PLAN CONTRIBUTIONS ARE MADE ON A QUARTERLY BASIS. DURING THE YEAR, THE FOLLOWING INDIVIDUALS PARTICIPATED IN AND RECEIVED PAYMENT FROM THE PLAN: IMRAN ANDRABI, MD $102,463 THOMAS ARQUILLA $45,524 JAMES ALBIN $95,700 DURING THE YEAR, THE FOLLOWING INDIVIDUALS ACCRUED AN AMOUNT FROM THE PLAN, WHICH IS INCLUDED IN DEFERRED COMPENSATION: IMRAN ANDRABI, MD $162,871
Schedule J, Part I, Line 7 Non-fixed paymentsEXECUTIVE AT-RISK COMPENSATION PLAN: THE PLAN OBJECTIVES ARE TO ENHANCE THEDACARE INC'S ABILITY TO ACHIEVE ITS GOALS BY PROVIDING A TOOL FOR STIMULATING AND REWARDING SUPERIOR LEVELS OF PERFORMANCE AMONG LEADERS AND TO WORK TOGETHER AS A COHESIVE GROUP TOWARD COMMON GOALS. LEADERS FROM MANAGER LEVEL TO THE PRESIDENT AND CEO ARE ELIGIBLE TO PARTICIPATE IN THIS PLAN. THE PERCENTAGE FOR WHICH AN INDIVIDUAL IS ELIGIBLE IS DETERMINED BY THE PARAMETERS LISTED FOR THE LEADERSHIP POSITION AND IN THE PLAN DOCUMENT ON FILE. LEADERS MAKE RECOMMENDATIONS FOR THEIR MANAGEMENT LEVEL DIRECT REPORTS TO THEIR EXECUTIVE LEADER BASED ON PERFORMANCE RESULTS. THE PRESIDENT AND CEO ALSO REVIEWS AND APPROVES. FOR SENIOR VICE PRESIDENTS, THE EXECUTIVE LEADERSHIP TEAM, AND THE PRESIDENT AND CEO, THE RECOMMENDATIONS ARE REVIEWED AND APPROVED BY THE HUMAN RESOURCES AND GOVERNANCE COMMITTEE OF THE BOARD AND THE EXECUTIVE COMMITTEEE OF THE BOARD. THESE COMMITTEES ALSO REVIEW THE TOTAL SPEND FOR THE INCENTIVE PLANS. THESE LEADERS MUST BE IN ACTIVE REGUALR SERVICE OF THEDACARE, INC. FOR THE ENTIRE PLAN YEAR (JANUARY 1, 2022, TO DECEMBER 31, 2022) TO RECEIVE A 2023 BONUS. CARING FOR SUCCESS: THE PLAN OBJECTIVES ARE TO PROVIDE INCENTIVE TO FOCUS THE ORGANIZATION'S RESOURCES, ENERGY AND ATTENTION ON THE FULFILLMENT OF THEDACARE'S MISSION. EMPLOYEE ELIGIBILITY IS BASED ON THE NUMBER OF HOURS WORKED. ALL ELIGIBLE EMPLOYEES SHARE IN THE PAYOUT. THE PAYOUT AMOUNT IS A FLAT DOLLAR AMOUNT, DETERMINED BASED ON BOTH FINANCIAL AND QUALITY THRESHOLDS. THE AMOUNT PER EMPLOYEE IS DETERMINED BY DIVIDING THE TOTAL GAIN REALIZED (THE EMPLOYEE SHARE) BY HOURS PAID TO ALL ELIGIBLE EMPLOYEES. THE THEDACARE BOARD OF TRUSTEES APPROVES THE SPEND FOR THE PLAN.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part V, Line 1aALL APPLICABLE 1099 AND 1096 IRS TAX FORMS ARE REPORTED AND FILED BY THE PARENT ORGANIZATION, THEDACARE, INC., EIN 39-1509362.
Form 990, Part V, Line 2aALL APPLICABLE W-2 AND W-3 IRS TAX FORMS ARE REPORTED AND FILED BY THE PARENT ORGANIZATION, THEDACARE, INC., EIN 39-1509362.
Form 990, Part VI, Line 2 Family/business relationships amongst interested personsAn employee/employer relationship exists for individuals on Part VII who are employees of ThedaCare, Inc. and individuals listed on Part VII who also serve as Directors or Officers of ThedaCare, Inc. - Business relationship
Form 990, Part VI, Line 3 Delegation of management dutiesALL MANAGEMENT AND ADMINISTRATIVE FUNCTIONS ARE PROVIDED BY EMPLOYEES OF THEDACARE, INC., THE SOLE MEMBER AND PARENT COMPANY OF THEDACARE MEDICAL CENTER - WAUPACA, INC.
Form 990, Part VI, Line 6 Classes of members or stockholdersTHEDACARE MEDICAL CENTER - WAUPACA, INC.'S SOLE MEMBER IS THEDACARE, INC.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing bodyTHEDACARE, INC. HAS SOLE AUTHORITY IN THE CORPORATION TO VOTE AND TAKE ANY ACTION WITH RESPECT TO THE ELECTION OF DIRECTORS AND OFFICERS.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholdersTHEDACARE, INC. HAS THE SOLE AUTHORITY WITH RESPECT TO THE FOLLOWING MATTERS: 1. AMENDMENT OF THE ARTICLES OF INCORPORATION; 2. ADOPTION AND AMENDMENT OF BYLAWS OF THE CORPORATION; 3. CONSOLIDATION, MERGER AND DISSOLUTION OF THE CORPORATION; 4. MONITORING COMPLIANCE WITH LAWS AND REGULATIONS; 5. SELECTION, APPOINTMENT, AND REMOVAL OF A CHIEF OPERATING OFFICER; 6. PROVISION FOR LONG-RANGE FINANCIAL STABILITY OF THE HOSPITAL AND PROVISION FOR THE CONTROL AND USE OF THE PHYSICAL AND FINANCIAL RESOURCES OF THE HOSPITAL; 7. ESTABLISHMENT OF A LONG-RANGE PLANNING MECHANISM; 8. APPROVAL OF A HOSPITAL ORGANIZATION AND MAJOR AUTHORITY DELEGATION PATTERNS; 9. APPROVAL OF FINANCIAL, CAPITAL, AND OTHER ITEMS; 10. APPROVAL OF DEBT OR LEASES; AND 11. CONSIDERATION AND ACTION UPON POLICIES CONCERNING RELATIONS WITH EXTERNAL GROUPS AND ORGANIZATIONS.
Form 990, Part VI, Line 11b Review of form 990 by governing bodyA DRAFT OF THE FORM 990 IS PROVIDED TO THE ORGANIZATION'S DESIGNATED COMMITTEE OF THE BOARD OF DIRECTORS FOR REVIEW AND DISCUSSION AT A BOARD MEETING. THE FINAL VERSION OF THE FORM 990 IS EMAILED TO THE ENTIRE BOARD BEFORE THE RETURN IS FILED.
Form 990, Part VI, Line 12c Conflict of interest policyQUESTIONNAIRES ARE SENT TO ALL MANAGERS, TRUSTEES, AND OFFICERS ANNUALLY. COMPLETED FORMS ARE RETURNED TO THE COMPLIANCE OFFICER. THE COMPLIANCE OFFICER REVIEWS THE QUESTIONNAIRES AND FOLLOWS UP WITH ANY QUESTIONS ABOUT THE MANAGERS' ANSWERS ON THE CONFLICT OF INTEREST FORMS. ALL EMPLOYEES AND BOARD MEMBERS ARE COVERED UNDER THE CONFLICT OF INTEREST POLICY. THE CORPORATE COMPLIANCE COMMITTEE REVIEWS THE POTENTIAL CONFLICT AND THE CFO/BOARD OF TRUSTEES REVIEW ALL CONFLICTS. AFTER DISCLOSURE OF THE CONFLICT, THE EMPLOYEE SHALL NOT PARTCIPATE IN THE DECISION WHETHER TO ENGAGE IN THE TRANSACTION IN WHICH THE EMPLOYEE HAS AN INTEREST.
Form 990, Part VI, Line 15a Process to establish compensation of top management officialTHEDACARE HIRES AN OUTSIDE CONSULTING FIRM TO CONDUCT A THOROUGH MARKET REVIEW OF EXECUTIVE COMPENSATION EVERY OTHER YEAR. THE HUMAN RESOURCES AND GOVERNANCE COMMITTEE OF THE BOARD WAS FORMED IN DECEMBER, 2018. THE OUTSIDE CONSULTANT PRESENTED HIS FINDINGS TO THE CHIEF HUMAN RESOURCES OFFICER, THE PRESIDENT AND CEO. THE INFORMATION WAS THEN PRESENTED TO THE HUMAN RESOURCES AND GOVERNANCE COMMITTEE OF THE BOARD AND THEN TO THE EXECUTIVE COMMITTEE OF THE BOARD. BOTH COMMITTEES WERE PROVIDED THE INFORMATION FOR REVIEW, EDUCATION AND ACCEPTANCE IN 2021.
Form 990, Part VI, Line 19 Required documents available to the publicTHEDACARE MEDICAL CENTER - WAUPACA, INC. DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND INTERNAL FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC.
Form 990, Part IX, Line 11g Other FeesContract labor/agency fees - Total Expense: 3494675, Program Service Expense: 2254509, Management and General Expenses: 1240166, Fundraising Expenses: ; Physician/professional fees - Total Expense: 33698, Program Service Expense: 21739, Management and General Expenses: 11959, Fundraising Expenses: ; Fees for other services - Total Expense: 4545186, Program Service Expense: 3554899, Management and General Expenses: 990287, Fundraising Expenses: ;

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (8 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
THEDACARE INC
PO BOX 8025APPLETONWI549128025391509362HEALTHCAREWI501(c)(3)10NAfalse
THEDACARE REGIONAL MEDICAL CENTER - NEENAH INC
PO BOX 8025APPLETONWI549128025390830664HOSPITALWI501(c)(3)3THEDACARE INCYes (true)
THEDACARE MEDICAL CENTER - NEW LONDON INC
PO BOX 8025APPLETONWI549128025390869788HOSPITALWI501(c)(3)3THEDACARE INCYes (true)
THEDACARE REGIONAL MEDICAL CENTER -APPLETON INC
PO BOX 8025APPLETONWI549128025390824015HOSPITALWI501(c)(3)3THEDACARE INCYes (true)
THEDACARE MEDICAL CENTER - SHAWANO INC
PO BOX 8025APPLETONWI549128025390807068HOSPITALWI501(c)(3)3THEDACARE INCYes (true)
THEDACARE MEDICAL CENTER - BERLIN INC
PO BOX 8025APPLETONWI549128025390806359HOSPITALWI501(c)(3)3THEDACARE INCYes (true)
THEDACARE MEDICAL CENTER - WILD ROSE INC
PO BOX 8025APPLETONWI549128025396089134HOSPITALWI501(c)(3)3THEDACARE INCYes (true)
THEDACARE FAMILY OF FOUNDATIONS INC
PO BOX 8025APPLETONWI549128025464112255FOUNDATIONWI501(c)(3)7THEDACARE INCYes (true)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtPredominant Income TypePredominantIncomeTypeTxt
N APPLETON AMBULATORY CARE CENTER BUILDING COMPANY LLC
122 E CAPITOL DRAPPLETONWI54911262497187RENTALWINAN/A
ENCIRCLE REALCO LLC
65 HIDDEN RAVINES DRIVE SUITE 100POWELLOH43065853472736PROPERTY HOLDINGOHTHEDACARE REGIONAL MEDICAL CENTER - APPLETON INCExcluded
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd