THEDACARE MEDICAL CENTER-WILD ROSE INC: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- THEDACARE MEDICAL CENTER-WILD ROSE INC (EIN 39-6089134)
- Tax period
- 2022-01-01 to 2022-12-31
- Filed
- 2023-11-13
- IRS object ID
- 202333179349312008
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-11-13T18:37:19+00:00 | ReturnTs |
| Tax Period End | 2022-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 440160260 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FORVIS LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 211 N Broadway Suite 600 | AddressLine1Txt |
| City | St Louis | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 631022733 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2022-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 396089134 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ThedaCare Medical Center - Wild Rose Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | THED | BusinessNameControlTxt |
| Phone | 9206223257 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 8025 | AddressLine1Txt |
| City | APPLETON | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 549128025 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | IMRAN ANDRABI MD | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 9206223257 | PhoneNum |
| Signature | 2023-11-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | WILLIAM | PersonFirstNm |
| Person Last | FLETT | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KRISTEN M HANKINS | PreparerPersonNm |
| PTIN | P01256574 | PTIN |
| Phone | 3142315544 | PhoneNum |
| Preparation | 2023-11-15 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | IMRAN ANDRABI MD | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 8025 | AddressLine1Txt |
| City | APPLETON | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 549128025 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $13,541,510 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.THEDACARE.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1956 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | IMPROVING THE HEALTH OF OUR COMMUNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 17 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $29,620 | PYContributionsGrantsAmt |
| CY Contributions Grants | $359,617 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $13,401,844 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $12,887,431 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $294,462 | CYOtherRevenueAmt |
| PY Total Revenue | $13,431,464 | PYTotalRevenueAmt |
| CY Total Revenue | $13,541,510 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $8,235,144 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,393,292 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,634,221 | PYOtherExpensesAmt |
| CY Other Expenses | $4,825,175 | CYOtherExpensesAmt |
| PY Total Expenses | $12,869,365 | PYTotalExpensesAmt |
| CY Total Expenses | $13,218,467 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $562,099 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $323,043 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $9,005,342 | TotalAssetsBOYAmt |
| Total Assets EOY | $9,611,199 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $4,579,981 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $4,862,795 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,425,361 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $4,748,404 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO 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 Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $10,821,237 | ExpenseAmt |
| Revenue | $12,887,431 | RevenueAmt |
| Desc | THEDACARE IS A TAX-EXEMPT, NON-PROFIT CORPORATION, AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THEDACARE MEDICAL CENTER-WILD ROSE IS A 25-BED CRITICAL ACCESS HOSPITAL SERVING WILD ROSE AND NEARBY COMMUNITIES. THERE ARE MORE THAN 90 TEAM MEMBERS LOCATED AT THE WILD ROSE LOCATION. THEDACARE MEDICAL CENTER-WILD ROSE 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. 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 (WAUSHARA) 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 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 | $10,821,237 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (true) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHRIS SANBORN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9204544184 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 8025 | AddressLine1Txt |
| City | APPLETON | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 549128025 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Carol Williams | ||||||||
| Secretary/Treasurer, Board Member | 1.0 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Dan Mielke | ||||||||
| Chair, Board Member | 1.0 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Mark Kjentvet | ||||||||
| Vice Chair, Board Member | 1.0 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Chandler Caves MD | ||||||||
| Board Member/Chief of Staff | 40.0 | 0 | Yes (X) | $0 | $530,052 | $52,907 | ||
| James Erdman | ||||||||
| Board Member | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | ||
| Karen West | ||||||||
| Board Member | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | ||
| Lynn Detterman | ||||||||
| Board Member/Senior VP-South Region | 20.0 | 20.0 | Yes (X) | $0 | $657,539 | $230,308 | ||
| Paul Smith | ||||||||
| Board Member | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | ||
| Sherry Brownlow | ||||||||
| Board Member | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | ||
| Tammy Bending | ||||||||
| Board Member/Vice President-CAH Operations | 20.0 | 20.0 | Yes (X) | $0 | $283,952 | $73,416 | ||
| Terry Martz | ||||||||
| Board Member | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | ||
| Imran Andrabi MD | ||||||||
| President & CEO - System | 4.0 | 36.0 | Yes (X) | $0 | $1,808,832 | $654,639 | ||
| James Albin | ||||||||
| Chief Information Officer | 4.0 | 36.0 | Yes (X) | $0 | $494,205 | $49,169 | ||
| Maggie Lund | ||||||||
| Chief Human Resource Officer | 4.0 | 36.0 | Yes (X) | $0 | $534,688 | $165,995 | ||
| Mark Thompson | ||||||||
| Senior VP, CFO & COO - System | 4.0 | 36.0 | Yes (X) | $0 | $1,160,821 | $311,108 | ||
| Brian Sterns | ||||||||
| Chief Digital Health Officer | 4.0 | 36.0 | $0 | $266,613 | $135,716 | Yes (X) | ||
| Thomas Arquilla | ||||||||
| Chief Strategy Officer | 4.0 | 36.0 | $0 | $738,065 | $188,954 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $6,474,767 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,862,212 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| TOTAL MSP LLC | |||||
| 221 W COLLEGE AVE 2ND FLOOR | APPLETON | WI | 54911 | MEDICAL STAFFING | $547,274 |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES | |||||
| 12225 WILKINS AVE | ROCKVILLE | MD | 20852 | MEDICAL STAFFING | $228,336 |
| MAXIM HEALTHCARE STAFFING SERVICES INC | |||||
| 7227 LEE DEFOREST DR | COLUMBIA | MD | 21046 | MEDICAL STAFFING | $120,060 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $10,100 | RelatedOrganizationsAmt |
| Government Grants | $349,473 | GovernmentGrantsAmt |
| All Other Contributions | $44 | AllOtherContributionsAmt |
| Total Contributions | $359,617 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Net Patient Service Revenue | Desc |
| Business | 622110 | BusinessCd |
| Total Revenue Column | $12,887,431 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $12,887,431 | RelatedOrExemptFuncIncomeAmt |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $12,887,431 | TotalProgramServiceRevenueAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| Other operating revenue | 900099 | $276,476 | $276,476 |
| Cafeteria revenue | 722210 | $17,986 | $17,986 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $294,462 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,541,510 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $12,887,431 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $294,462 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,930,878 | TotalAmt |
| Program Services | $6,233,610 | ProgramServicesAmt |
| Management And General | $697,268 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $151,630 | TotalAmt |
| Program Services | $128,199 | ProgramServicesAmt |
| Management And General | $23,431 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $953,094 | TotalAmt |
| Program Services | $805,813 | ProgramServicesAmt |
| Management And General | $147,281 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $357,690 | TotalAmt |
| Program Services | $302,416 | ProgramServicesAmt |
| Management And General | $55,274 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $242,927 | TotalAmt |
| Management And General | $242,927 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,470,224 | TotalAmt |
| Program Services | $1,377,478 | ProgramServicesAmt |
| Management And General | $1,092,746 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,254 | TotalAmt |
| Program Services | $1,254 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $79,647 | TotalAmt |
| Program Services | $79,647 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $264,555 | TotalAmt |
| Program Services | $264,555 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,444 | TotalAmt |
| Program Services | $22,444 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,247 | TotalAmt |
| Program Services | $12,247 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $494,164 | TotalAmt |
| Program Services | $355,861 | ProgramServicesAmt |
| Management And General | $138,303 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,126 | TotalAmt |
| Program Services | $25,126 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| Medical Supplies | $764,568 | $764,568 |
| Equipment & Maintenance | $321,241 | $321,241 |
| Food/nutrition | $89,948 | $89,948 |
| Medicaid Assessment | $36,830 | $36,830 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,218,467 | TotalAmt |
| Program Services | $10,821,237 | ProgramServicesAmt |
| Management And General | $2,397,230 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,902,226 | BOYAmt |
| EOY | $1,865,586 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,857,717 | BOYAmt |
| EOY | $1,802,690 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $137,190 | BOYAmt |
| EOY | $143,226 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,621 | BOYAmt |
| EOY | $4,334 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $6,711,260 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,021,779 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,873,560 | BOYAmt |
| EOY | $3,689,481 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,226,028 | BOYAmt |
| EOY | $2,105,882 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,005,342 | BOYAmt |
| EOY | $9,611,199 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $242,456 | BOYAmt |
| EOY | $121,983 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $349,473 | BOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12 | BOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,988,040 | BOYAmt |
| EOY | $4,740,812 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,579,981 | BOYAmt |
| EOY | $4,862,795 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,425,361 | BOYAmt |
| EOY | $4,748,404 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,425,361 | BOYAmt |
| EOY | $4,748,404 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,005,342 | BOYAmt |
| EOY | $9,611,199 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $323,043 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (true) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $807 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | false | OtherActivitiesInd |
| Total Lobbying Expenditures | $807 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY | FormAndLineReferenceDesc |
| Explanation | A PORTION OF THE WHA DUES REPRESENT LOBBYING PERFORMED IN REGARD TO HEALTHCARE ISSUES. TOTAL DUES PAID IN 2022 WERE $7,271. 11.1% OF THIS AMOUNT WAS SPENT ON LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,205,546 | OtherCostOrOtherBasisAmt |
| Book Value | $1,205,546 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,322,549 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,288,628 | DepreciationAmt |
| Book Value | $2,033,921 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,183,165 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,733,151 | DepreciationAmt |
| Book Value | $450,014 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,689,481 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DUE FROM AFFILIATES | |
| OPERATING LEASE | |
| Other assets | $754,407 |
| Due from affiliate | $1,351,475 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $2,105,882 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO AFFILIATES | |
| Third Party Settlement | $377,562 |
| Intercompany Accounts Payable | $4,363,250 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $4,740,812 | TotalLiabilityAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule D, Part X, Line 2 EVALUATION OF UNCERTAIN TAX POSITIONS | FormAndLineReferenceDesc |
| Explanation | MANAGEMENT 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | false | FinancialAssistanceBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $100,892 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $100,892 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0076 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2121 | PersonsServedCnt |
| Total Community Benefit Expns | $2,345,111 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,342,961 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,002,150 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0758 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 2121 | PersonsServedCnt |
| Total Community Benefit Expns | $2,446,003 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,342,961 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,103,042 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0834 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 10 | ActivitiesOrProgramsCnt |
| Persons Served | 49711 | PersonsServedCnt |
| Total Community Benefit Expns | $244,886 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $244,886 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0185 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 62 | PersonsServedCnt |
| Total Community Benefit Expns | $211,624 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $211,624 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0160 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $68,684 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $68,684 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0052 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 34850 | PersonsServedCnt |
| Total Community Benefit Expns | $182,825 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $182,825 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0138 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 16 | ActivitiesOrProgramsCnt |
| Persons Served | 84623 | PersonsServedCnt |
| Total Community Benefit Expns | $708,019 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $708,019 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0536 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 16 | ActivitiesOrProgramsCnt |
| Persons Served | 86744 | PersonsServedCnt |
| Total Community Benefit Expns | $3,154,022 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,342,961 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,811,061 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.1370 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $2,544 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,544 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0002 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 4368 | PersonsServedCnt |
| Total Community Benefit Expns | $116,343 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $116,343 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0088 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 4368 | PersonsServedCnt |
| Total Community Benefit Expns | $118,887 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $118,887 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0090 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $901,486 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $2,885,124 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $2,029,167 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $855,957 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THEDACARE MEDICAL CENTER - WILD ROSE | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 601 GROVE AVENUE | AddressLine1Txt |
| City | WILD ROSE | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54984 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWWW.THEDACARE.ORG | WebsiteAddressTxt |
| State License | 1004 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THEDACARE MEDICAL CENTER - WILD ROSE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 22 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTPS://THEDACARE.ORG/ABOUT-US/COMMUNITY-HEALTH/NEEDS-ASSESSMENT-PLANS/ | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 23 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTPS://THEDACARE.ORG/ABOUT-US/COMMUNITY-HEALTH/NEEDS-ASSESSMENT-PLANS/ | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.0 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.0 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Other Method | Yes (X) | OtherMethodInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | https://thedacare.org/patients-and-visitors/billing-and-payment/payment-options/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | https://thedacare.org/patients-and-visitors/billing-and-payment/payment-options/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | https://thedacare.org/patients-and-visitors/billing-and-payment/payment-options/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part V, Section B, Line 3E | THE HOSPITAL FACILITY ANALYZED SEVERAL HEALTH NEEDS OF THE COMMUNITY AND HAS PRIORITIZED THOSE OF MOST CONCERN. THE PRIORITIZATION OF THE TOP SIGNIFICANT COMMUNITY HEALTH NEEDS IS DESCRIBED IN THE CHNA. |
| Schedule H, Part V, Section B, Line 5 Facility , 1 | Facility , 1 - THEDACARE MEDICAL CENTER - WILD ROSE. 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, veterans, Hispanic/Latino population, Lesbian, Gay, Bisexual, Transgender (LGBT), Hmong population and African American population. ThedaCare Medical Center-Wild Rose CHAT: * Amanda Williams, ThedaCare Family of Foundations, Regional Coordinator * Allen Luchini, Wild Rose Emergency Management Director * Chris Langenfeld, Waushara County Prevention Coordinator * Allen Ruetten, Farmer's Bank of Waupaca * Colin Mitchell, Family Health LaClinica, Director of Business Development * Craig Hayes, Wild Rose School District * Deborah Walworth, ThedaCare Outreach Health Specialist * Denise Klusmeyer, Waushara County Chamber of Commerce Executive Director * Mary Ann Shilling, University of Wisconsin Extension * Sharon Woodruff, Whauars County Shines Coordinator * Mary O'Baram Population Health Coordinator * Mary Kunasch, Waushara Argus * Tammy Bending, ThedaCare Medical Center -Wild Rose * Tracey Ratzburg, ThedaCare Community Health Improvement |
| Schedule H, Part V, Section B, Line 11 Facility , 1 | Facility , 1 - THEDACARE MEDICAL CENTER - WILD ROSE. 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 , 1 | Facility , 1 - THEDACARE MEDICAL CENTER - WILD ROSE. 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 , 1 | Facility , 1 - THEDACARE MEDICAL CENTER - WILD ROSE. 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 , 1 | Facility , 1 - THEDACARE MEDICAL CENTER - WILD ROSE. 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. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 0 | FacilityNum |
Supplemental Information Detail SupplementalInformationDetail (20 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part I, Line 3 DISCOUNTED CARE EXCEPTIONS | SEE 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 F | The 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 $901,486. |
| Schedule H, Part I, Line 7g | No physician clinic costs are included in the Community Benefit expenses. |
| Schedule H, Part I, Line 6a Community benefit report prepared by related organization | THEDACARE, INC. 39-1509362 |
| Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance | THE 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 OT 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 Activities | THE HOSPITAL FACILITY PARTICIPATES IN NUMEROUS COMMUNITY BUILDING ACTIVITIES 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 amount | PATIENT 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 Methodology | THE 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 footnote | SEE "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 costs | MEDICARE 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 BENEFITS STANDARD. |
| Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance | OUR 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 - WILD ROSE: 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 - WILD ROSE: 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 - WILD ROSE: Line 16c URL: https://thedacare.org/patients-and-visitors/billing-and-payment/payment-options/; |
| Schedule H, Part VI, Line 2 Needs assessment | THEDACARE 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 assistance | PATIENT 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 information | THEDACARE MEDICAL CENTER - WILD ROSE DEFINES ITS PRIMARY HOSPITAL SERVICE AREA (HSA) AS WAUSHARA COUNTY IN WISCONSIN. THE TOTAL POPULATION FOR THE HSA WAS 50,209 ACCORDING TO THE MOST RECENT AVAILABLE DATA. THE POPULATION IS PREDOMINANTLY RURAL WITH MORE THAN 25% 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 TWO-FIFTHS 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 health | THE 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 system | THEDACARE, 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 report | WI |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (true) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Lynn Detterman | ||||||||||||||
| Board Member/Senior VP-South Region | $0 | $453,427 | $0 | $196,369 | $0 | $7,742 | $0 | $206,397 | $0 | $23,911 | $0 | $887,847 | $0 | $0 |
| Chandler Caves MD | ||||||||||||||
| Board Member/Chief of Staff | $0 | $527,808 | $0 | $450 | $0 | $1,794 | $0 | $38,443 | $0 | $14,464 | $0 | $582,959 | $0 | $0 |
| Tammy Bending | ||||||||||||||
| Board Member/Vice President-CAH Operations | $0 | $218,799 | $0 | $62,614 | $0 | $2,540 | $0 | $65,222 | $0 | $8,194 | $0 | $357,368 | $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 |
| Thomas Arquilla | ||||||||||||||
| Chief Strategy Officer | $0 | $479,252 | $0 | $200,574 | $0 | $58,239 | $0 | $171,313 | $0 | $17,641 | $0 | $927,019 | $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 ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan | SENIOR 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 LYNN DETTERMAN $45,363 |
| Schedule J, Part I, Line 7 Non-fixed payments | EXECUTIVE 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 MANAGEMENT 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 COMMITTEE OF THE BOARD. THESE COMMITTEES ALSO REVIEW THE TOTAL SPEND FOR THE INCENTIVE PLANS. THESE LEADERS MUST BE IN ACTIVE REGULAR 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 ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part V, Line 1a | ALL 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 2a | ALL 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 persons | An 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 duties | ALL MANAGEMENT AND ADMINISTRATIVE FUNCTIONS ARE PROVIDED BY EMPLOYEES OF THEDACARE, INC., THE SOLE MEMBER AND PARENT COMPANY OF THEDACARE MEDICAL CENTER - WILD ROSE, INC. |
| Form 990, Part VI, Line 6 Classes of members or stockholders | THEDACARE MEDICAL CENTER - WILD ROSE, INC.'S SOLE MEMBER IS THEDACARE, INC. |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | THEDACARE, 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 stockholders | THEDACARE, INC. HAS THE SOLE AUTHORITY WITH RESPECT TO THE FOLLOWING MATTERS: 1. DEVELOP AND APPROVE ANNUAL CAPITAL AND OPERATING TARGETS; 2. AUTHORIZE AND MAKE CAPITAL EXPENDITURES; 3. APPROVE STRATEGIC PALNS, WITH MANAGEMENT AND BOARD OVERSIGHT; 4. APPROVE THE SAFETY AND QUALITY PLAN; 5. APPROVE THE DISSOLUTION OR LIQUIDATION; 6. HIRE OR TERMINATE THE PRESIDENT AND CEO; 7. BORROW OR INCUR DEBT; 8. APPOINT AUDITORS AND LEGAL COUNSEL; AND 9. RETAIN INVESTMENT ADVISORS AND ESTABLISH INVESTMENT POLICIES. THE BOARD OF TRUSTEES MAY NOT DO THE FOLLOWING WITHOUT RECEIVING THE CONSENT OF THEDACARE, INC. 1. MERGE, CONSOLIDATE, OR CHANGE CONTROL OF THE ORGANIZATION; 2. SELL, LEASE, OR TRANSFER MATERIAL ASSETS; 3. ENTER JOINT VENTURES OR AFFILIATIONS; AND 4. AMEND THE ARTICLES OF INCORPORATION OR BYLAWS. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | A 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 policy | QUESTIONNAIRES 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 PARTICIPATE 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 official | THEDACARE 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 public | THEDACARE MEDICAL CENTER - WILD ROSE, 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 Fees | Contract labor/agency fees - Total Expense: 918291, Program Service Expense: 466220, Management and General Expenses: 452071, Fundraising Expenses: ; Physician/professional fees - Total Expense: 19641, Program Service Expense: 9947, Management and General Expenses: 9694, Fundraising Expenses: ; Fees for other services - Total Expense: 1532292, Program Service Expense: 901311, Management and General Expenses: 630981, Fundraising Expenses: ; |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| THEDACARE INC | ||||||||||
| PO BOX 8025 | APPLETON | WI | 549128025 | 391509362 | HEALTHCARE | WI | 501(c)(3) | 10 | NA | false |
| THEDACARE REGIONAL MEDICAL CENTER - NEENAH INC | ||||||||||
| PO BOX 8025 | APPLETON | WI | 549128025 | 390830664 | HOSPITAL | WI | 501(c)(3) | 3 | THEDACARE INC | Yes (true) |
| THEDACARE MEDICAL CENTER - NEW LONDON INC | ||||||||||
| PO BOX 8025 | APPLETON | WI | 549128025 | 390869788 | HOSPITAL | WI | 501(c)(3) | 3 | THEDACARE INC | Yes (true) |
| THEDACARE MEDICAL CENTER - WAUPACA INC | ||||||||||
| PO BOX 8025 | APPLETON | WI | 549128025 | 390871113 | HOSPITAL | WI | 501(c)(3) | 3 | THEDACARE INC | Yes (true) |
| THEDACARE REGIONAL MEDICAL CENTER -APPLETON INC | ||||||||||
| PO BOX 8025 | APPLETON | WI | 549128025 | 390824015 | HOSPITAL | WI | 501(c)(3) | 3 | THEDACARE INC | Yes (true) |
| THEDACARE MEDICAL CENTER - SHAWANO INC | ||||||||||
| PO BOX 8025 | APPLETON | WI | 549128025 | 390807068 | HOSPITAL | WI | 501(c)(3) | 3 | THEDACARE INC | Yes (true) |
| THEDACARE MEDICAL CENTER - BERLIN INC | ||||||||||
| PO BOX 8025 | APPLETON | WI | 549128025 | 390806359 | HOSPITAL | WI | 501(c)(3) | 3 | THEDACARE INC | Yes (true) |
| THEDACARE FAMILY OF FOUNDATIONS INC | ||||||||||
| PO BOX 8025 | APPLETON | WI | 549128025 | 464112255 | FOUNDATION | WI | 501(c)(3) | 7 | THEDACARE INC | Yes (true) |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt |
|---|---|---|---|---|---|---|---|---|
| N APPLETON AMBULATORY CARE CENTER BUILDING COMPANY LLC | ||||||||
| 122 E CAPITOL DR | APPLETON | WI | 54911 | 262497187 | RENTAL | WI | NA | N/A |
| ENCIRCLE REALCO LLC | ||||||||
| 65 HIDDEN RAVINES DRIVE SUITE 100 | POWELL | OH | 43065 | 853472736 | PROPERTY HOLDING | OH | THEDACARE REGIONAL MEDICAL CENTER - APPLETON INC | Excluded |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |