THEDACARE MEDICAL CENTER-WILD ROSE INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- THEDACARE MEDICAL CENTER-WILD ROSE INC (EIN 39-6089134)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-09-09
- IRS object ID
- 202132529349301108
- Schema version
- 2020v4.1
- 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 | 2021-09-09T09:54:33-05:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10700 NORTHUP WAY SUITE 200 | AddressLine1Txt |
| City | BELLEVUE | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98004 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | 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 | BusinessNameLine1Txt |
| Business Name Line2 | INC | BusinessNameLine2Txt |
| 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 | MARK THOMPSON | PersonNm |
| Person Title | CFO & COO | PersonTitleTxt |
| Phone | 9206223257 | PhoneNum |
| Signature | 2021-08-25 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | MARK | PersonFirstNm |
| Person Last | THOMPSON | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KURT BENNION CPA | PreparerPersonNm |
| PTIN | P01469618 | PTIN |
| Phone | 4252506100 | PhoneNum |
| Preparation | 2021-08-24 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | IMRAN ANDRABI MD | PrincipalOfficerNm |
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 | $11,745,110 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | 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 | 41 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $35,740 | PYContributionsGrantsAmt |
| CY Contributions Grants | $120,789 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $12,703,623 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $11,624,321 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $12,739,363 | PYTotalRevenueAmt |
| CY Total Revenue | $11,745,110 | 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 | $6,174,127 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $6,580,586 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,633,096 | PYOtherExpensesAmt |
| CY Other Expenses | $4,835,717 | CYOtherExpensesAmt |
| PY Total Expenses | $9,807,223 | PYTotalExpensesAmt |
| CY Total Expenses | $11,416,303 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,932,140 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $328,807 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $15,665,737 | TotalAssetsBOYAmt |
| Total Assets EOY | $14,490,837 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $11,825,094 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $10,627,577 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,840,643 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,863,260 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| 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 | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $8,673,288 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $11,624,321 | 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.WAS 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 NEEDS HEALTH ASSESSMENT IN COUNTIES (WAUSHARA) WHERE SERVICES ARE PROVIDED. EFFORTS INCLUDE PARTNERSHIPS WITH WAUSHARA COUNTY EMS SERVICES, WILD ROSE AND WAUTOMA SCHOOL DISTRICTS, FOX VALLEY TECHNICAL COLLEGE WAUTOMA, WAUSHARA COUNTY PUBLIC HEALTH. THE TOP PRIORITY IS MENTAL HEALTH AND WORKING ON A MENTORING PROJECT WHICH INVOLVES TARGETING K THROUGH 5TH GRADERS WITH SENIOR MENTORS/PARTNERS. NEXT UP WILL BE WORK ON ALCOHOL RELATED ISSUES.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 | $8,673,288 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | 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 | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NATHANIEL CHERNE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9207355560 | 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 (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|
| IMRAN ANDRABI MD | ||||||||
| PRESIDENT & CEO - SYSTEM | 4.00 | 36.00 | Yes (X) | $0 | $1,243,338 | $62,201 | ||
| MARK THOMPSON | ||||||||
| SENIOR VP, CFO & COO | 4.00 | 36.00 | Yes (X) | $0 | $748,076 | $64,671 | ||
| JAMES ALBIN | ||||||||
| CIO | 4.00 | 36.00 | Yes (X) | $0 | $429,869 | $84,171 | ||
| MAGGIE LUND | ||||||||
| CHRO | 4.00 | 36.00 | Yes (X) | $0 | $389,016 | $53,009 | ||
| CHANDLER CAVES MD | ||||||||
| BOARD MEMBER/CHIEF OF STAFF | 40.00 | 0.00 | $0 | $374,540 | $56,171 | Yes (X) | ||
| TAMMY BENDING | ||||||||
| BOARD MEMBER/VP OF CAH OPERATIONS | 20.00 | 20.00 | $0 | $231,090 | $27,009 | Yes (X) | ||
| BRIAN STERNS | ||||||||
| FORMER KEY EMPLOYEE | 4.00 | 36.00 | $0 | $172,483 | $58,171 | Yes (X) | ||
| DONALD WALDROP | ||||||||
| BOARD MEMBER/PRACTICE ADMINISTRATOR | 1.00 | 39.00 | $0 | $200,243 | $7,983 | Yes (X) | ||
| DAN MIELKE | ||||||||
| CHAIR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| MARK KJENTVET | ||||||||
| VICE CHAIR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| CAROL WILLIAMS | ||||||||
| SECRETARY/TREASURER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| SHERRY BROWNLOW | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| JAMES ERDMAN | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| TERRY MARTZ | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| PAUL SMITH | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| KAREN WEST | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,788,655 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $413,386 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $19,803 | RelatedOrganizationsAmt |
| Government Grants | $100,986 | GovernmentGrantsAmt |
| Total Contributions | $120,789 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| OUTPATIENT REVENUE | 621990 | $9,191,944 | $9,191,944 |
| INPATIENT REVENUE | 621990 | $2,348,197 | $2,348,197 |
| ALL OTHER PROGRAM SERVICES | 621990 | $84,180 | $84,180 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $11,624,321 | TotalProgramServiceRevenueAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,745,110 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $11,624,321 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $932,750 | TotalAmt |
| Program Services | $859,305 | ProgramServicesAmt |
| Management And General | $73,445 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,728,934 | TotalAmt |
| Program Services | $3,931,412 | ProgramServicesAmt |
| Management And General | $797,522 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $918,902 | TotalAmt |
| Program Services | $535,107 | ProgramServicesAmt |
| Management And General | $383,795 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,693,474 | TotalAmt |
| Program Services | $419,857 | ProgramServicesAmt |
| Management And General | $1,273,617 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $412,974 | TotalAmt |
| Program Services | $412,974 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,518 | TotalAmt |
| Program Services | $18,518 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $203,234 | TotalAmt |
| Program Services | $203,234 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,135 | TotalAmt |
| Program Services | $20,135 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,596 | TotalAmt |
| Program Services | $1,596 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $457,450 | TotalAmt |
| Program Services | $327,129 | ProgramServicesAmt |
| Management And General | $130,321 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,427 | TotalAmt |
| Program Services | $32,427 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $1,126,626 | $1,042,311 | $84,315 |
| BAD DEBT EXPENSE | $507,393 | $507,393 | |
| EQUIPMENT MAINTENANCE | $361,890 | $361,890 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,416,303 | TotalAmt |
| Program Services | $8,673,288 | ProgramServicesAmt |
| Management And General | $2,743,015 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,325,946 | BOYAmt |
| EOY | $4,538,025 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,610,178 | BOYAmt |
| EOY | $1,569,189 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $170,108 | BOYAmt |
| EOY | $140,116 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $7,032,935 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,167,466 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,257,671 | BOYAmt |
| EOY | $3,865,469 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,301,834 | BOYAmt |
| EOY | $4,378,038 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,665,737 | BOYAmt |
| EOY | $14,490,837 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$152,366 | BOYAmt |
| EOY | $262,292 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $61 | BOYAmt |
| EOY | $12 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,977,399 | BOYAmt |
| EOY | $10,365,273 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,825,094 | BOYAmt |
| EOY | $10,627,577 | 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 | $3,840,643 | BOYAmt |
| EOY | $3,863,260 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,840,643 | BOYAmt |
| EOY | $3,863,260 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,665,737 | BOYAmt |
| EOY | $14,490,837 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $328,807 | ReconcilationRevenueExpnssAmt |
| Prior Period Adjustments | -$306,190 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | 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 (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | 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 | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $775 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $775 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | A PORTION OF THE WHA DUES REPRESENT LOBBYING PERFORMED IN REGARD TO HEALTHCARE ISSUES. TOTAL DUES PAID IN 2020 WERE $6,854. 11.3% 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 | $2,914,674 | OtherCostOrOtherBasisAmt |
| Depreciation | $974,931 | DepreciationAmt |
| Book Value | $1,939,743 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,893,130 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,192,535 | DepreciationAmt |
| Book Value | $700,595 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $19,585 | OtherCostOrOtherBasisAmt |
| Book Value | $19,585 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,865,469 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DUE FROM AFFILIATES | $4,339,039 |
| OPERATING LEASE | $38,999 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $4,378,038 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO AFFILIATES | Desc |
| Amt | $10,365,273 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $10,365,273 | TotalLiabilityAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 410.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | 0 | FinancialAssistanceBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $66,447 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $66,446 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00610 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1430 | PersonsServedCnt |
| Total Community Benefit Expns | $1,944,124 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,130,898 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $813,226 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07450 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1430 | PersonsServedCnt |
| Total Community Benefit Expns | $2,010,571 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,130,899 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $879,672 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08060 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 10 | ActivitiesOrProgramsCnt |
| Persons Served | 121117 | PersonsServedCnt |
| Total Community Benefit Expns | $331,419 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $331,419 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03040 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 46 | PersonsServedCnt |
| Total Community Benefit Expns | $91,250 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $91,250 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00840 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 1 | PersonsServedCnt |
| Total Community Benefit Expns | $55,367 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $55,367 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00510 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 164468 | PersonsServedCnt |
| Total Community Benefit Expns | $288,676 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $288,676 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02650 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 17 | ActivitiesOrProgramsCnt |
| Persons Served | 285632 | PersonsServedCnt |
| Total Community Benefit Expns | $766,712 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $766,712 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07040 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 17 | ActivitiesOrProgramsCnt |
| Persons Served | 287062 | PersonsServedCnt |
| Total Community Benefit Expns | $2,777,283 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,130,899 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,646,384 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.15100 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 12673 | PersonsServedCnt |
| Total Community Benefit Expns | $4,039 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,039 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 426 | PersonsServedCnt |
| Total Community Benefit Expns | $34,412 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $34,412 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00320 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 13099 | PersonsServedCnt |
| Total Community Benefit Expns | $38,451 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $38,451 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00360 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $238,499 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $2,278,172 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $2,396,530 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$118,358 | 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 (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | 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 | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | 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 | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE LINE 7D | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE LINE 7D | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 410.000000000000 | 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 (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | 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 (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://WWW.THEDACARE.ORG/POLICIES-AND-LEGAL-FORMS/PAYMENT-OPTIONS | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.THEDACARE.ORG/POLICIES-AND-LEGAL-FORMS/PAYMENT-OPTIONS | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.THEDACARE.ORG/POLICIES-AND-LEGAL-FORMS/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 (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | 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 (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| THEDACARE MEDICAL CENTER - WILD ROSE | PART V, SECTION B, LINE 5: AS PART OF THE NEEDS ASSESSMENT ADVISORY TEAM, THEDACARE CONSULTED WITH THE PUBLIC HEALTH DEPARTMENTS OF OUTAGAMIE COUNTY, WINNEBAGO COUNTY, CALUMET COUNTY, SHAWANO, GREEN LAKE, MARQUETTE, WAUSHARA, WAUPACA AND THE CITY OF APPLETON.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 THE HISPANIC POPULATION. |
| THEDACARE MEDICAL CENTER - WILD ROSE | PART V, SECTION B, LINE 6A: THEDACARE REGIONAL MEDICAL CENTER-WILD ROSE IS A MEMBER OF THE FOX VALLEY COMMUNITY HEALTH IMPROVEMENT COALITION WHOSE MEMBERS INCLUDE THE PUBLIC HEALTH DEPARTMENTS OF CALUMET, OUTAGAMIE AND WINNEBAGO COUNTIES AND THE HEALTH DEPARTMENTS OF THE CITY OF APPLETON AND CITY OF MENASHA. MEMBERSHIP ALSO INCLUDES REPRESENTATIVES FROM CHILDREN'S HOSPITAL OF WISCONSIN, PARTNERSHIP COMMUNITY HEALTH CENTER (FQHC), AURORA HEALTH IN OSHKOSH AND AFFINITY HEALTH IN APPLETON. THIS COALITION WAS PART OF A JOINT CHNA PROCESS DURING 2019. |
| THEDACARE MEDICAL CENTER - WILD ROSE | PART V, SECTION B, LINE 7D: THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ONLINE AT HTTPS://THEDACARE.ORG/ABOUT-US/COMMUNITY-HEALTH/NEEDS-ASSESSMENT-PLANS/. |
| THEDACARE MEDICAL CENTER - WILD ROSE | PART V, SECTION B, LINE 11: THE THEDACARE COMMUNITY HEALTH IMPLEMENTATION STRATEGY WAS APPROVED BY THE THEDACARE MEDICAL CENTER-WILD ROSE HOSPITAL BOARD AND THE THEDACARE BOARD OF TRUSTEES IN 2020.CHRONIC DISEASEESTABLISH A CULTURE THAT FOSTERS HEALTH AND WELLBEING AND REDUCES INCIDENCE OF CHRONIC DISEASE. VITAL CONDITIONS ADDRESSED: BASIC NEEDS, SOCIAL CONNECTION/BELONGING, ENVIRONMENT AND RELIABLE TRANSPORTATION.1. BE WELL FOX VALLEY IS A MULTI-SECTOR COLLABORATION WITH AREA HEALTH SYSTEMS TO ADVANCE A CULTURE OF HEALTH AND WELL-BEING. YEAR ONE STRATEGY CENTERED ON "EAT WELL FOX VALLEY," CONNECTING DIABETIC/PRE-DIABETIC RESIDENTS WITH HEALTHY FOODS. 2. BWFV IS CO-LED BY DR. JENNIFER FRANK, WITH DR. ANDRABI AND PAULA MORGEN SERVING ON THE ANCHOR LEADER GROUP AND PAULA ALSO SERVING ON THE LEADERSHIP TEAM. MULTIPLE TC STAFF ARE ENGAGED IN EAT WELL FOX VALLEY WORK TEAMS. TC PROVIDED $90,000 IN BOTH 2020 TO SUPPORT THIS WORK AS WELL AS $4900 TO SUPPORT AMERICORPS MEMBER.3. FARMERS MARKETS - IN 2020, THEDACARE DID PROVIDE MAJOR SPONSORSHIP AND SUPPORT TO THE DOWNTOWN APPLETON FARMER'S MARKET. HOWEVER, IN 2020 COVID MADE IT NECESSARY FOR THE MARKETS TO DEVELOP NEW POLICIES RELATED TO COVID AND THE MARKET WAS HELD IN A REDUCED CAPACITY. THE MARKET PROMOTES PURCHASING AND PREPARING HEALTHY FOODS.MENTAL HEALTH AND SUBSTANCE ABUSEYOUTH AND ADULTS HAVE SUPPORT NEEDED TO LEAD MENTALLY HEALTHY LIVES, FREE OF RELIANCE ON HARMFUL SUBSTANCES VITAL CONDITIONS ADDRESSED: SOCIAL CONNECTION/BELONGING AND BASIC NEEDS URGENT SERVICES ADDRESSED: ACUTE CARE FOR ILLNESS OR INJURY AND ADDICTION AND RECOVERY SERVICES.1. CATALPA HEALTH - A CHILDREN'S MENTAL HEALTH PROVIDER WHICH PROVIDES MENTAL HEALTH SERVICES TO CHILDREN THROUGHOUT NORTHEAST WISCONSIN. IN 2020, THEDACARE PROVIDED IN-KIND LEADERSHIP AND FINANCIAL SUPPORT IN EXCESS OF $200,000.2. NEW MH CONNECTION IS A COALITION OF 70+ MENTAL HEALTH AGENCIES TO ADDRESS ACCESS TO MENTAL HEALTH CARE.A. TC CHAIRS BOARD OF NEW MH CONNECTION AND PROVIDES IN-KIND OFFICE SPACE AT TCBH ETC. PROVIDED $30,000 FUNDING IN 2020. B. MYCONNECTIONNEW.ORG, SERVICE NAVIGATION SITE FOR ALL MENTAL HEALTH AND SUBSTANCE ABUSE PROVIDERS IN OUTAGAMIE, CALUMET, WINNEBAGO AND NOW BROWN COUNTY - IN PARTNERSHIP WITH UNITED WAY'S 2-1-1.3. FQHC SUPPORT: PROVIDED LEADERSHIP AND FUNDING FOR THE PARTNERSHIP COMMUNITY HEALTH CENTER WORKING TO IMPROVE THE HEALTH STATUS OF THE MEDICALLY UNDERSERVED BY PROVIDING COMPREHENSIVE PRIMARY CARE AND BEHAVIORAL HEALTH SERVICES.4. THEDACARE ADDED TWO OUTPATIENT PSYCHIATRISTS IN 2020; WAS AWARDED HRSA GRANT TO EXPAND ACCESS TO SUBSTANCE USE TREATMENT IN SHAWANO AND WAUPACA SU.5. THEDACARE BEHAVIORAL HEALTH WALK-IN CARE CLINIC NEENAH OPENED ON NOVEMBER 4, 2020.6. TWO COLLABORATIVE CARE MANAGERS (NEENAH AND OSHKOSH) SERVED 427 PATIENTS IN 2020. PLAN TO EXPAND COLLABORATIVE CARE MODEL TO SHAWANO AND WAUPACA EARLY 2021. GOAL IS ONE CC MANAGER IN EACH CALL GROUP.7. IN JANUARY 2020, TWO TELE-PSYCHIATRISTS JOINED TCBH FOR A TOTAL OF FOUR TELE-PSYCHIATRISTS.8. WITH THE ADVENT OF COVID-19, ALL SUD, MENTAL HEALTH, AND PSYCHIATRIC PROVIDERS OFFER VIRTUAL BASED CARE.9. 22,148 VISITS WERE PROVIDED VIA VIDEO IN 2020, FOR A PERCENTAGE OF 37% OF ALL CARE BEING VIDEO BASED. END 2020 85% TELEHEALTH .10. LED AN EFFORT TO ESTABLISH ED TO RECOVERY COACHING MODEL IN 3 EDS - STARTED DEC 5. PROVIDE RECOVERY COACH IN ED WITHIN 1 HOUR OF ADMISSION OF OPIOID/STIMULANT OVERDOSE PATIENT. USES LIVED EXPERIENCE TO SUPPORT PATIENT UP TO 18 MONTHS. METRICS INCLUDE READMISSION RATES, #/% IN TREATMENT, #/% REPORT REDUCED USE, #% REPORT STAYING SOBER. SECURED $190,000 IN GRANT FUNDING. 11. DESPITE CHALLENGES OF VIRTUAL LEARNING AND SCHOOL DISRUPTION DUE TO COVID-19, ENGAGED FOUR ADDITIONAL RURAL HIGH SCHOOLS IN SOURCES OF STRENGTH, BRINGING TOTAL SCHOOLS TO NINE. SOURCES OF STRENGTH IS AN EVIDENCE-BASED PEER-LED MODEL ADDRESSING MENTAL HEALTH, SUBSTANCE USE AND SUICIDE AMONG TEENS.12. IN 2020, TCBH STARTED PROVIDING SUD SERVICES IN SHAWANO AND WAUPACA. THERE WERE 49 SUD VISITS IN SHAWANO IN 2020 AND 390 SUD VISITS OCCURRED IN WAUPACA IN 2020.13. BEHAVIORAL HEALTH OPERATIONS: INITIATED PRIMARY CARE CONSULT. DR. PANZER AND DR. BELD DO INITIAL REVIEW OF ALL REFERRALS AND IF URGENT, GET THEM INTO EXPEDITED CARE (PSYCH, MH OR AODA). OTHERWISE, CONSULT WITH PC. HELPS PCP MANAGE PATIENTS IF ON WAIT LIST. WAIT LIST FOR PSYCHIATRIC NEEDS DROPPED FROM 600+ TO 0. 14. INITIATED NPPP (NORTH PRIMARY CARE PSYCHIATRIC PARTNERSHIP) PROVIDER INTEGRATED IN PCP CLINIC. SEES PATIENTS ON WAIT LIST UP TO 4 TIMES. REFERS TO PSYCHIATRIST FOR INITIAL TRIAGE AND IF URGENT GETS THEM INTO PSYCH, MH OR AODA CARE RIGHT AWAY. EXPANDING TO NEENAH AND TRAINING ANOTHER PROVIDER. SHAWANO PSYCHIATRIST EMBEDDED IN PCP CLINIC.15. INPATIENT PSYCH WENT TO 7 DAYS ON/7 OFF FOR HOSPITALIST. FREES UP OUTPATIENT PSYCH TIME. 16. DEPRESSION SCREENING: DEPRESSION SCREENING IS TAKING PLACE IN 100% OF TC PEDIATRIC CLINICS AND FP CLINICS FOR PEOPLE AGE 12+. 17. CONDUCTING COLUMBIA SCREENING AT EVERY MENTAL HEALTH INITIAL APPOINTMENT.18. CONDUCTING PHQ9 AT EVERY AODA INITIAL APPOINTMENT.VULNERABLE POPULATIONSTHE MOST VULNERABLE POPULATIONS WITHIN THEDACARE SERVICE AREA HAVE THE OPPORTUNITY TO ACHIEVE OPTIMAL HEALTH AND WELLBEING VITAL CONDITIONS ADDRESSED: BASIC NEEDS, MEANINGFUL WORK/WEALTH, HUMANE HOUSING, LIFELONG LEARNING, RELIABLE TRANSPORTATION, BELONGING AND CIVIC MUSCLE.1. CONTINUE TO IMPROVED BIRTH CENTER ASSESSMENT AND REFERRAL PROCESS TO HOME VISITATION PROGRAMS. IN 2020, THEDACARE WORKED TO INCORPORATE PRE-NATAL ASSESSMENT IN A PARTNERSHIP WITH WOMEN'S HEALTH AND WOMEN'S CARE WHO DELIVER AT THEDACARE.2. NUMBER OF ANNUAL HOME VISITATION ASSESSMENTS WERE 457. 302 WERE ASSESSED; 69 WERE REFERRED TO HOME VISITATION WHICH IS MEANT FOR THE MOST AT RISK FAMILIES.3. WORK CONTINUES FROM FOX CITIES CHAT INITIATIVES ON EARLY CHILDHOOD WHICH PROMPTED EFFORT TO IMPROVE ASQ SCREENING PROCESS/RATE; PILOTED ASQ SCREENING PROCESS WITH WINNEBAGO COUNTY AND OSHKOSH TC CLINIC.4. DEVELOPED A WELCOME BABY MODEL FOR ALL NEW PARENTS IN COLLABORATION WITH AREA HEALTH SYSTEMS TO HELP ENSURE PARENTS HAVE ACCESS TO RESOURCES TO PROVIDE A STRONG START TO THEIR CHILD'S LIFE.5. 2020 MAKE A DIFFERENCE DAY ENGAGED 1698 PERSONS FROM THEDACARE AND PARTNER BUSINESS EMPLOYEES VOLUNTEERING AT SENIOR CARE FACILITIES THROUGHOUT ALL HOSPITAL MARKETS, ADDRESSING SOCIAL ISOLATION EXPERIENCED BY THESE ISOLATED SENIORS AND PROVIDING 238 HOURS OF VOLUNTEER SERVICE. 6. THEDACARE IS A PARTNER WITH THE POVERTY OUTCOMES & IMPROVEMENT TEAM (POINT), AN 18 MONTH INITIATIVE EQUIPPING THE ENTIRE FOX VALLEY REGION WITH CONTINUOUS IMPROVEMENT METHODOLOGIES FOCUSED ON POVERTY. POINT IS USING THESE PROCESSES TO STRENGTHEN EXISTING POVERTY REDUCTION EFFORTS, ADDRESS SERVICE GAPS, AND MEASURE PROGRESS ON REDUCING POVERTY IN NORTHEAST WISCONSIN. TC CONTRIBUTED $200,000 PLUS PRESENCE ON THE LEADERSHIP TEAM. POINT COLLABORATED WITH BOSTON-BASED INSTITUTE FOR HEALTHCARE IMPROVEMENT TO USE LEAN PROCESSES AND TOOLS TO HELP NON-PROFIT AGENCIES HELP PEOPLE BECOME SELF-SUFFICIENT. MORE THAN 40 NON-PROFIT AGENCIES ARE PARTICIPATING. THEDACARE PLAYS A LEADERSHIP ROLE IN PARTNERSHIP TO ALIGN LOCAL FUNDING BEHIND KEY DRIVERS OF POVERTY, INCLUDING SOCIAL CONNECTION, EMPLOYMENT, EDUCATION, AND HEALTH. 7. LAUNCHED DIVERSITY, INCLUSION AND BELONGING INTERNAL ADVISORY COUNCIL WITH HR AND PRIMARY CARE TO ENHANCE CULTURE THAT VALUES AND RESPECTS DIVERSITY ACROSS TEAM MEMBERS, PATIENTS AND COMMUNITY. FORMULATING RECOMMENDATIONS RE: PATIENT, TEAM MEMBER AND COMMUNITY STRATEGIES TO TAKE TO ELT IN MARCH. (METRICS TO INCLUDE PATIENT, AND TEAM MEMBER SATISFACTION SCORES).8. OPPORTUNITY GAP/STAR PROGRAM - FOLLOWING "BEING BLACK IN FOX CITIES" PLUNGE OCT 2015, TC LED A PROCESS WITH AFRICAN HERITAGE, INC., APPLETON/MENASHA SCHOOL DISTRICTS, BOYS & GIRLS CLUB, UNITED WAY, FOUR AREA COLLEGES AND OTHERS TO DEVELOP THE STAR PROGRAM (SCHOLARS ON TARGET TO ACHIEVE RESULTS) IN 2020, THEDACARE CONTINUED SUPPORT OF STAR PROGRAM WHICH ADDRESSES THE GRADUATION RATE DIFFERENTIAL BETWEEN BLACK AND WHITE HIGH SCHOOL STUDENTS IN MENASHA AND APPLETON. THE FOX CITIES COMMUNITY HEALTH ACTION TEAM FUNDED $30,000 PROGRAM DIRECTOR START-UP PERIOD WITH $50,000 PER YEAR FOR THREE YEARS FOR PROGRAM OPERATIONS. IN 2018-19 SCHOOL YEAR, 340 YOUTH WERE SERVED. CURRENT ENROLLMENT DURING 2020 IS 450 STUDENTS. |
| THEDACARE MEDICAL CENTER - WILD ROSE | PART V, SECTION B, LINE 13B: 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. |
| THEDACARE MEDICAL CENTER - WILD ROSE | PART V, SECTION B, LINE 15E: CONTRACTED WITH ELIGIBILITY VENDOR (CARDON) TO WORK DIRECTLY WITH UNINSURED PATIENTS TO ASSIST THEM WITH INSURANCE ENROLLMENT AND EDUCATION. |
| THEDACARE MEDICAL CENTER - WILD ROSE | PART V, SECTION B, LINE 16J: 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. |
| PART V, SECTION B, LINE 11 (CONTINUED): | 9. THEDACARE IS A MAJOR SUPPORTER OF THE RURAL HEALTH INITIATIVE (RHI) WHICH TAKES HEALTHCARE SERVICES TO THE FARM TO REACH A SIGNIFICANT VULNERABLE POPULATION OF LOW-INCOME FARMERS AND MIGRANT WORKERS, MANY OF WHOM ARE UNINSURED. RHI ENHANCES RURAL ACCESS TO CARE, EARLY DETECTION AND MANAGEMENT OF CHRONIC DISEASE, HEALTHY LIFESTYLE EDUCATION, AND CONNECTION OF UNASSIGNED FREQUENT ED PATIENTS TO PRIMARY CARE HOME. REDUCTION OF CHRONIC DISEASE STARTS WITH AWARENESS OF HEALTH RISKS; 326 RURAL RESIDENTS FROM VULNERABLE POPULATIONS WERE SCREENED FOR OBESITY, CARDIOVASCULAR RISKS AND DIABETES. OF THE INDIVIDUALS SCREENED 35% (114) OF PEOPLE WERE DETECTED TO HAVE CHRONIC HEALTH CONDITIONS WITH THE HIGHEST LEVELS OF RISK BEING OBESITY AND CARDIOVASCULAR RISKS SUCH AS ELEVATED CHOLESTEROL LEVELS. 198 PEOPLE WERE EDUCATED ON MANAGING THOSE RISKS AND 185 INDIVIDUALS RECEIVED REFERRALS. REFERRALS INCLUDED HEALTHCARE PROVIDERS (133), MENTAL HEALTH, PRESCRIPTION DRUG ASSISTANCE, AND BENEFIT ASSISTANCE. 10. THE RURAL HEALTH INITIATIVE PROVIDED ASSISTANCE TO WAUPACA COUNTY PUBLIC HEALTH DEPARTMENT BY PROVIDING 43 FLU SHOTS AND 27 TETANUS SHOTS TO PREDOMINATELY LATINO WORKERS AT LARGE DAIRIES. 11. DESPITE COVID AND NOT BEING ABLE TO MAKE HOUSE CALLS FOR 2 MONTHS AND WITH LIMITED ACCESS FOR THE DURATION OF THE YEAR, THEDACARE RURAL HEALTH INITIATIVE ASSISTED THE THEDACARE MEDICAL CENTER-SHAWANO EMERGENCY DEPARTMENT WITH 552 FOLLOW UP PHONE CALLS TO PEOPLE WHO ARE FREQUENT UTILIZERS OF CARE. WE PROVIDED 178 REFERRALS OF WHICH 142 WERE ASSISTING IN ESTABLISHING WITH A PCP AND 33 FOR DENTAL ASSISTANCE. 12. IN 2020, RHI ALSO CONTRACTED WITH CALUMET COUNTY IN REPLICATING OUR MODEL OF OUTREACH CARE.GENERAL1. THEDACARE PARTNERS WITH ASCENSION HEALTH SYSTEM TO SPONSOR FOX VALLEY FAMILY RESIDENCY PROGRAM PROVIDING HANDS ON EXPERIENCE FOR MEDICAL STUDENTS AND ACCESS TO PRIMARY CARE AND MENTAL HEALTH SERVICES.2. THEDACARE ALSO PARTNERS WITH AREA NURSING SCHOOLS SUCH AS UW OSHKOSH AND FOX VALLEY TECHNICAL COLLEGE TO PROVIDE PROFESSIONAL MENTORS FOR THEIR NURSING PROGRAMS AND VENUES FOR NURSING STUDENTS TO PRACTICE THEIR SKILLS.3. THEDACARE PLAYED A CRITICAL ROLE IN THE DEVELOPMENT AND LAUNCH OF IMAGINE FOX CITIES VISIONING INITIATIVE WHICH ENGAGED THE ENTIRE FOX CITIES REGION IN A DISCOVERY AND DISCERNMENT PROCESS TO UNDERSTAND WHAT PEOPLE THINK ABOUT THEIR WELL-BEING TODAY, WHAT THEY EXPECT THEIR WELL-BEING TO BE IN THE FUTURE, AND ARTICULATE A VISION FOR GENERATIONS TO COME THAT WILL GUIDE LOCAL DECISION-MAKING. THIS VISION SETS THE LARGER CONTEXT FOR ADVANCING HEALTH AND WELL-BEING ACROSS THE REGION.4. THROUGH CONSULTANTS ENGAGED WITH IMAGINE FOX CITIES, BROUGHT LEADERS FROM RETHINK HEALTH TO FOX CITIES TO PARTICIPATE IN RWJF GRANT TO EXPLORE HOW LOCAL INSTITUTIONS CAN INVEST DIFFERENTLY TO PROPEL OUR COMMUNITY TOWARD THE NEW VISION. THEDACARE WILL PLAY A FUTURE LEAD ROLE AND THIS WILL BENEFIT ALL AREAS THAT THEDACARE SERVES.COVID 2020 1. LED VARIETY OF EFFORTS TO EASE THE IMPACT OF COVID-19 ON COMMUNITY.A. LED START-UP OF COMMUNITY SOLUTIONS TEAM OF UNITED WAY GATHERING 150+ COMMUNITY LEADERS TO ADDRESS EMERGING NEEDS RESULTING FROM PANDEMIC.B. SURVEYED AND ESTABLISHED COMMUNITY-BASED CHILD CARE RESOURCES FOR TEAM MEMBERS.C. ESTABLISHED ISOLATION HOUSING SUPPORT IN COMMUNITY FOR TEAM MEMBERS.D. ORGANIZED MASK SEWING EFFORT TO SECURE FABRIC MASKS FOR PATIENTS, TEAM MEMBERS.E. ASSISTED LEADERS WITH CONNECTIONS TO LOCAL MANUFACTURERS TO ASSIST WITH PPE.F. HELPED CHAMPION COLLABORATIVE EFFORTS RE: FOOD RELIEF, HOUSING, TRANSPORTATION, ACCESS TO PRESCRIPTIONS, SOCIAL ISOLATION PHONE PAL PROGRAM.G. SECURED MENTORS FOR SCHOOL AGE CHILDREN AS SCHOOLS WENT VIRTUAL.H. FOCUSED MAKE A DIFFERENCE DAY ON ISOLATED LTC RESIDENTS TO ADDRESS ISOLATION.I. WORKED WITH UNITED WAY TO ESTABLISH GIVE HELP GET HELP HUB AND FUNDED PROMOTION.J. CO-LED EFFORT TO ESTABLISH TRI-COUNTY MULTICULTURAL COMMUNICATION COALITION TO REACH MOST VULNERABLE POPULATIONS WITH EMERGENCY COMMUNICATIONS.K. HELPED CHAMPION EXPANSION OF NEIGHBORHOOD PARTNERS PROGRAM ACROSS FOX CITIES STRENGTHENING COMMUNITY AND BELONGING.L. FACILITATED HOUSING SUPPORT FOR TC INPATIENT HOMELESS PATIENTS UPON DISCHARGE AND SECURED $28,000 TO SUPPORT THIS EFFORT.M. ASSISTED EAST CENTRAL WISCONSIN PLANNING COMMISSION WITH GRANT TO EXPAND BROADBAND ACROSS RURAL MARKETS.N. HELPING LEAD EFFORT TO ADDRESS DISCHARGE DELAYS DUE TO TRANSPORTATION GAPS.O. PROVIDING VOLUNTEERS FOR FEEDING AMERICA FEDERAL FOOD DISTRIBUTION.HEALTH NEEDS IDENTIFIED BUT NOT ADDRESSED1. ACES/EARLY CHILDHOOD - WORK ON THIS AREA HAS BEEN INITIATED AND IS ONGOING.2. ISOLATION/COMMUNITY CONNECTIONS - WORK ON THIS AREA HAS BEEN INITIATED AND IS ONGOING.3. FAMILIES STRUGGLING TO MAINTAIN STABLE HOME ENVIRONMENT/FINANCIAL SUSTAINABILITY - WORK ON THIS AREA HAS BEEN INITIATED AND IS ONGOING. |
Supplemental Information Detail SupplementalInformationDetail (16 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | IT IS THE ORGANIZATION'S POLICY THAT NO PATIENT SHOULD BE DENIED APPROPRIATE AND NECESSARY CARE ON THE BASIS OF INCOME. IN RESPONSE TO THIS POLICY, THE CARING HEARTS FINANCIAL ASSISTANCE PROGRAM WAS SET UP TO PROVIDE SHELTER TO THOSE PATIENTS WHO ARE UNABLE TO PAY FOR THEIR MEDICAL SERVICES. MEDICAL SERVICE FEES ARE WRITTEN OFF UNDER THE FINANCIAL ASSISTANCE PROGRAM THAT WOULD OTHERWISE HAVE BEEN SENT TO A COLLECTION AGENCY. |
| PART I, LINE 7: | 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 TO THE ABOVE WAGE CALCULATION. THE COST ACCOUNTING SYSTEM DOES NOT DIFFERENTIATE BETWEEN DIFFERENT PAYER TYPES AND NO COST-TO-CHARGE RATIO IS USED. |
| PART I, LINE 7G: | NO PHYSICIAN CLINICS ARE INCLUDED IN SUBSIDIZED HEALTH SERVICES. |
| PART I, LINE 7, COLUMN (F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 507,393. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | 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 IS 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.ENVIRONMENTAL IMPROVEMENTS - SHARPS COLLECTION. COMMUNITY SHARPS CAN BE TAKEN FOR COLLECTION AND DISPOSAL TO ANY OF THE 7 THEDACARE HOSPITALS.COMMUNITY SHARPS CAN BE DISPOSED OF AT THEDACARE REGIONAL MEDICAL CENTER-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.COMMUNITY OTHER: SART/SANE - THE SEXUAL ASSAULT RESPONSE TEAM WORKS WITH LOCAL LAW ENFORCEMENT, DOMESTIC ABUSE AGENCIES, SEXUAL ASSAULT AGENCIES, MENTAL HEALTH FACILITIES, LOCAL MEDICAL PROVIDERS TO IMPROVE IMMEDIATE RESPONSE TO VICTIMS OF SEXUAL ASSAULT. SART/SANE PROGRAMMING IS BASED AT THEDACARE REGIONAL MEDICAL CENTER-APPLETON AND SERVES THEDACARE REGIONAL MEDICAL CENTER-NEENAH, THEDACARE MEDICAL CENTER-BERLIN, THEDACARE MEDICAL CENTER-NEW LONDON, THEDACARE MEDICARE CENTER-SHAWANO, THEDACARE MEDICAL CENTER-WAUPACA AND THEDACARE MEDICAL CENTER-WILD ROSE. |
| PART III, LINE 2: | 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. |
| PART III, LINE 3: | 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. |
| PART III, LINE 4: | SEE "PATIENT ACCOUNTS RECEIVABLE AND CREDIT POLICY" IN NOTE 1 ON PAGES 10-11 OF THE ATTACHED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | HOSPITALS MUST ACCEPT MEDICARE PATIENTS REGARDLESS OF WHETHER THEY MAKE A SURPLUS OR DEFICIT FROM PROVIDING SERVICES TO THOSE PATIENTS. WE DID NOT REPORT ANY SHORTFALL AS A COMMUNITY BENEFIT. THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATIONS MEDICARE COST REPORT IS STEP DOWN. |
| PART III, LINE 9B: | 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. |
| PART VI, LINE 2: | 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. |
| PART VI, LINE 3: | 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. |
| PART VI, LINE 4: | THEDACARE MEDICAL CENTER-WILD ROSE SERVICE AREA CONSISTS OF WAUSHARA COUNTY AND IS LOCATED IN EAST-CENTRAL WISCONSIN. POPULATION OF WAUSHARA COUNTY IS 47,000 PLUS.WAUSHARA COUNTY:- THE PERCENTAGE OF RESIDENTS LIVING BELOW THE FEDERAL POVERTY LEVEL IS 11%.- THE PERCENTAGE OF CHILDREN ELIGIBLE FOR FREE AND REDUCED LUNCH IN WAUSHARA COUNTY IS 52%, ABOVE THE STATE AVERAGE OF 40%.- IN WAUSHARA COUNTY 16% OF THE CHILDREN LIVE BELOW 100% OF THE FEDERAL POVERTY LEVEL.- WAUSHARA COUNTY HAS 7% OF RESIDENTS WHO ARE UNINSURED.- WAUSHARA COUNTY HIGH SCHOOL GRADUATION RATE IS 90%.- NINETY ONE PERCENT OF THE SERVICE AREA IS CAUCASIAN WITH HISPANIC POPULATION OF 5.9%.THEDACARE MEDICAL CENTER-WAUSHARA SERVICE AREA CONSISTS OF WAUSHARA COUNTY AND IS LOCATED IN EAST-CENTRAL WISCONSIN. WAUSHARA COUNTY IS HOME TO 24,386. |
| PART VI, LINE 5: | EACH YEAR THEDACARE SETS ASIDE A PERCENTAGE OF ANY MARGIN AND DESIGNATES THESE FUNDS TO SUPPORT EFFORTS AND INITIATIVES COMING FROM CHAT (COMMUNITY HEALTH ACTION TEAM). CHAT IS A GROUP OF COMMUNITY LEADERS WHO STUDY SYSTEMIC HEALTH ISSUES OUTSIDE THE WALLS OF OUR HOSPITALS AND CLINICS AND WORK TO IDENTIFY INNOVATIVE, COLLABORATIVE SOLUTIONS THAT DRAW UPON THE WIDE ARRAY OF RESOURCES AND STRENGTHS OF OUR COMMUNITY. THERE ARE THEDACARE LED CHAT'S IN EACH HOSPITAL AREA WILD ROSE, WAUPACA, FOX CITIES, SHAWANO, BERLIN AND NEW LONDON. THEDACARE PROVIDES FUNDING AND DEDICATED STAFF TO MAKE CHAT COMMUNITY HEALTH EFFORTS POSSIBLE. |
| PART VI, LINE 6: | THEDACARE, 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. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | WI |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| IMRAN ANDRABI MD | ||||||||||||||
| PRESIDENT & CEO - SYSTEM | $0 | $902,932 | $0 | $340,406 | $0 | $0 | $0 | $43,030 | $0 | $19,171 | $0 | $1,305,539 | $0 | $0 |
| MARK THOMPSON | ||||||||||||||
| SENIOR VP, CFO & COO | $0 | $588,076 | $0 | $160,000 | $0 | $0 | $0 | $45,500 | $0 | $19,171 | $0 | $812,747 | $0 | $0 |
| JAMES ALBIN | ||||||||||||||
| CIO | $0 | $329,869 | $0 | $100,000 | $0 | $0 | $0 | $65,000 | $0 | $19,171 | $0 | $514,040 | $0 | $0 |
| MAGGIE LUND | ||||||||||||||
| CHRO | $0 | $300,016 | $0 | $89,000 | $0 | $0 | $0 | $45,500 | $0 | $7,509 | $0 | $442,025 | $0 | $0 |
| CHANDLER CAVES MD | ||||||||||||||
| BOARD MEMBER/CHIEF OF STAFF | $0 | $374,540 | $0 | $0 | $0 | $0 | $0 | $37,000 | $0 | $19,171 | $0 | $430,711 | $0 | $0 |
| TAMMY BENDING | ||||||||||||||
| BOARD MEMBER/VP OF CAH OPERATIONS | $0 | $195,182 | $0 | $35,908 | $0 | $0 | $0 | $19,500 | $0 | $7,509 | $0 | $258,099 | $0 | $0 |
| BRIAN STERNS | ||||||||||||||
| FORMER KEY EMPLOYEE | $0 | $147,483 | $0 | $25,000 | $0 | $0 | $0 | $39,000 | $0 | $19,171 | $0 | $230,654 | $0 | $0 |
| DONALD WALDROP | ||||||||||||||
| BOARD MEMBER/PRACTICE ADMINISTRATOR | $0 | $168,096 | $0 | $32,147 | $0 | $0 | $0 | $5,468 | $0 | $2,515 | $0 | $208,226 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | ALL EXECUTIVES AT A LEVEL OF VICE PRESIDENT AND ABOVE ARE ELIGIBLE TO HAVE HEALTH OR FITNESS CLUB FEES REIMBURSED TO THEM, AND TAXED UPON REIMBURSEMENT. |
| PART I, LINE 4B | 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 409A AND 457(F) OF THE INTERNAL REVENUE CODE. PARTICIPANTS MAY ELECT THE BENEFIT TO BE USED TO PURCHASE PARTICULAR INSURANCE BENEFITS, INVEST IN A CAPITAL ACCUMULATION ACCOUNT, 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. |
| PART I, LINE 7 | 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 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 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, 2020 TO DECEMBER 31, 2020) TO RECEIVE A 2021 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 (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | 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, SECTION A, LINE 6 | THEDACARE MEDICAL CENTER - WILD ROSE, INC.'S SOLE MEMBER IS THEDACARE, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | 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, SECTION A, LINE 7B | 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 IWTHOUT 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 VENTURE SOR AFFILIATIONS; AND 4. AMEND THE ARTICLES OF INCORPORATION OR BYLAWS. |
| FORM 990, PART VI, SECTION B, LINE 11B | 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, SECTION B, LINE 12C | 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 PARTCIPATE IN THE DECISION WHETHER TO ENGAGE IN THE TRANSACTION IN WHICH THE EMPLOYEE HAS AN INTEREST. |
| FORM 990, PART VI, SECTION B, LINE 15 | 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 DECEMBER, 2019 AND JANUARY, 2020. |
| FORM 990, PART VI, SECTION C, LINE 19 | 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: PROGRAM SERVICE EXPENSES 419,857. MANAGEMENT AND GENERAL EXPENSES 1,273,617. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,693,474. |
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 | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| THEDACARE INC | |||||||||||
| PO BOX 8025 | APPLETON | WI | 549128025 | 391509362 | HEALTHCARE | WI | 501(C)(3) | LINE 10 | N/A | 0 | |
| THEDACARE REGIONAL MEDICAL CENTER - NEENAH INC | |||||||||||
| PO BOX 8025 | APPLETON | WI | 549128025 | 390830664 | HOSPITAL | WI | 501(C)(3) | LINE 3 | 0 | THEDACARE INC | |
| THEDACARE MEDICAL CENTER - NEW LONDON INC | |||||||||||
| PO BOX 8025 | APPLETON | WI | 549128025 | 390869788 | HOSPITAL | WI | 501(C)(3) | LINE 3 | 0 | THEDACARE INC | |
| THEDACARE MEDICAL CENTER - WAUPACA INC | |||||||||||
| PO BOX 8025 | APPLETON | WI | 549128025 | 398711113 | HOSPITAL | WI | 501(C)(3) | LINE 3 | 0 | THEDACARE INC | |
| THEDACARE REGIONAL MEDICAL CENTER - APPLETON INC | |||||||||||
| PO BOX 8025 | APPLETON | WI | 549128025 | 390824015 | HOSPITAL | WI | 501(C)(3) | LINE 3 | 0 | THEDACARE INC | |
| THEDACARE MEDICAL CENTER - SHAWANO INC | |||||||||||
| PO BOX 8025 | APPLETON | WI | 549128025 | 390807068 | HOSPITAL | WI | 501(C)(3) | LINE 3 | 0 | THEDACARE INC | |
| THEDACARE MEDICAL CENTER - BERLIN INC | |||||||||||
| PO BOX 8025 | APPLETON | WI | 549128025 | 390806359 | HOSPITAL | WI | 501(C)(3) | LINE 3 | 0 | THEDACARE INC | |
| THEDACARE FAMILY OF FOUNDATIONS INC | |||||||||||
| PO BOX 8025 | APPLETON | WI | 549128025 | 464112255 | FOUNDATION | WI | 501(C)(3) | LINE 7 | 0 | THEDACARE INC | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | N APPLETON AMBULATORY CARE CENTER BUILDING COMPANY LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 122 E CAPITOL DR | AddressLine1Txt |
| City | APPLETON | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54911 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 262497187 | EIN |
| Primary Activities | RENTAL | PrimaryActivitiesTxt |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | 0 | GeneralOrManagingPartnerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |