2020-11-16T15:16:53-06:00 2019-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2019-01-01 391509362 THEDACARE INC THED 9207355560 PO BOX 8025 APPLETON WI 549128025 MARK THOMPSON CFO & COO 9207355560 2020-11-14 1 KURT BENNION CPA P01469618 4252506100 2020-11-14 67.137.57.251 2020-11-14 09:54:53 PS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 D6404CD6BDC62D55699D8FB81E5F5A720539BEA9 2019 2021-01-29 14:40:06Z IMRAN ANDRABI MD PO BOX 8025 APPLETON WI 549128025 398214250 0 X WWW.THEDACARE.ORG X 1985 WI IMPROVING THE HEALTH OF OUR COMMUNITY. 13 10 7820 11 0 1703259 1182180 1217022 289835897 307325985 33241893 76726566 14089448 12936221 338349418 398205794 1928475 328334 0 0 269492038 251208344 0 0 0 158691078 202108906 430111591 453645584 -91762173 -55439790 832833769 865028252 1376872636 1446524287 -544038867 -581496035 X TO PROVIDE THE HIGHEST QUALITY HEALTH CARE, DELIVERED IN THE MOST EFFICIENT AND COST-EFFECTIVE WAYS, AND ACCESSIBLE TO ALL MEMBERS OF THE COMMUNITY. 0 0 398825319 328334 307325985 FOR MORE THAN 110 YEARS, THEDACARE HAS BEEN COMMITTED TO IMPROVING THE HEALTH OF THE COMMUNITIES IT SERVES IN NORTHEAST AND CENTRAL WISCONSIN. THE ORGANIZATION DELIVERS CARE TO MORE THAN 600,000 RESIDENTS IN 18 COUNTIES AND EMPLOYS APPROXIMATELY 7,000 HEALTH CARE PROFESSIONALS. THEDACARE HAS 180 POINTS OF CARE, INCLUDING SEVEN HOSPITALS. AS AN ORGANIZATION COMMITTED TO BEING A LEADER IN POPULATION HEALTH, TEAM MEMBERS ARE DEDICATED TO EMPOWERING PEOPLE TO LIVE THEIR BEST LIVES THROUGH EASY ACCESS TO INDIVIDUALIZED CARE, SUPPORTING EACH PERSON'S OWN HEALTH AND WELLBEING. THEDACARE ALSO PARTNERS WITH COMMUNITIES TO UNDERSTAND UNIQUE NEEDS, FINDING SOLUTIONS TOGETHER, AND ENCOURAGING HEALTH AWARENESS AND ACTION. THEDACARE IS THE FIRST IN WISCONSIN TO BE A MAYO CLINIC CARE NETWORK MEMBER, GIVING SPECIALISTS THE ABILITY TO CONSULT WITH MAYO CLINIC EXPERTS ON A PATIENT'S CARE. THEDACARE IS A NOT-FOR-PROFIT HEALTH SYSTEM WITH A LEVEL II TRAUMA CENTER, COMPREHENSIVE CANCER TREATMENT, STROKE AND CARDIAC PROGRAMS, AS WELL AS PRIMARY CARE.THEDACARE OPERATES ONE OF NINE NATIONALLY VERIFIED LEVEL II TRAUMA CENTERS IN THE STATE OF WISCONSIN THEDACARE REGIONAL MEDICAL CENTER-NEENAH. A SIGNIFICANT FEATURE OF THE THEDACARE TRAUMA PROGRAM IS THEDASTAR. THE AIR MEDICAL PROGRAM PROVIDES IMMEDIATE MEDICAL CARE, HELICOPTER TRANSPORTS AND TRANSFERS FOR TRAUMA PATIENTS AND CRITICALLY ILL PATIENTS, INCLUDING TRANSPORT FROM OUR RURAL HOSPITALS. THIS COLLABORATION ALLOWS FOR OUR TEAMS, ACROSS THE ENTIRE REGION, TO WORK IN CONCERT WITH EACH OTHER. THERE ARE 17 COUNTIES SERVED WITHIN THE PRIMARY AND SECONDARY SERVICE AREAS. THEDACARE OFFERS A STRONG PRIMARY CARE NETWORK WITH MORE THAN 1,100 PROVIDERS DELIVERING CARE TO OUR 600,000 COMMUNITY MEMBERS, WHICH REPRESENTS MORE THAN 686,800 VISITS ANNUALLY. ADDITIONAL HEALTH AND CARE SERVICES THROUGH EMPLOYED AND AFFILIATED PROVIDER RELATIONSHIPS INCLUDE ORTHOPEDIC CARE, CARDIOVASCULAR CARE, CANCER CARE, HEMATOLOGY, BARIATRICS CARE, BEHAVIORAL HEALTH, DIABETES CARE, SPINE AND NEUROLOGICAL CARE, STROKE CARE, NEPHROLOGY, OPTHAMOLOGY, UROLOGY, PULMONARY, WOMEN'S HEALTH AND MORE. MOST CLINICS ALSO OFFER DIAGNOSTIC SERVICES SUCH AS X-RAY, ULTRASOUND, MRI, CAT SCAN, MAMMOGRAPHY AND MEDICAL LABORATORY TESTING. IN ADDITON, WE OFFER AND CONVENIENT WALK-IN CARE, FASTCARE AND E-VISITS FOR ENHANCED COMMUNITY ACCESS TO HEALTHCARE.CHILDREN'S HOSPITAL OF WISCONSIN-FOX VALLEY OPENED IN 2011 AND IS LOCATED WITHIN THEDACARE REGIONAL MEDICAL CENTER-NEENAH. THEDACARE AND CHW PARTNER TO ENSURE THE COMMUNITY HAS ACCESS TO HIGH LEVELS OF CARE. THEDACARE IS COMMITTED TO COMMUNITY FOCUSED EFFORTS IDENTIFIED IN THE COMMUNITY NEEDS HEALTH ASSESSMENT IN COUNTIES WHERE SERVICES ARE PROVIDED. SPECIFIC COMMUNITY EFFORTS ARE DETAILED FOR EACH COUNTY IN EACH INDIVIDUAL HOSPITAL REPORT ENCLOSED IN THIS SUBMISSION. 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.EVERY YEAR, THEDACARE PUBLISHES A COMMUNITY BENEFIT REPORT, WHICH HIGHLIGHTS OUR CONTRIBUTIONS TO OUR COMMUNITIES IN NORTHEAST AND CENTRAL WISCONSIN. WE TAKE INTO ACCOUNT WAYS IN WHICH OUR SYSTEM ADDRESSES UNMET HEALTH NEEDS IN THE COMMUNITY FOR WHICH REIMBURSEMENT IS NOT RECEIVED. IN 2019, THE TOTAL DOLLAR VALUE OF THAT DONATED COMMUNITY SUPPORT, CALLED COMMUNITY BENEFIT, AMOUNTED TO NEARLY $55 MILLION ACROSS THE SERVICE AREA. THE COMMUNITY BENEFIT TOTAL INCLUDES NON-HOSPITAL FINANCIAL ASSISTANCE AND MEDICAID. THE DOLLAR VALUE OF HOSPITAL-ONLY COMMUNITY BENEFIT IS $41,019,046.THEDACARE ADDRESSES UNMET HEALTH NEEDS THROUGH TRAINING MEN AND WOMEN TO BECOME DOCTORS AND NURSES, IMPROVING ACCESS TO BEHAVIORAL HEALTH CARE, SUPPORTING MEDICAL RESEARCH THROUGH CLINICAL TRIALS AND BY PROVIDING CARE TO THOSE WITHOUT THE FINANCIAL RESOURCES TO PAY, AS EXAMPLES. THEDACARE PROVIDES OPERATIONAL AND ADMINISTRATIVE SUPPORT SERVICES FOR HOSPITALS, MEDICAL CLINICS AND VARIOUS OTHER HEALTHCARE PROVIDERS. CENTRALIZING THESE SERVICES ALLOWS MEDICAL PROFESSIONALS TO CONCENTRATE ON GIVING THEIR PATIENTS THE BEST POSSIBLE CARE, WHILE ENJOYING THE BENEFITS OF EFFICIENT AND COST-EFFECTIVE BUSINESS MANAGEMENT.THEDACARE'S MAIN OPERATIONAL SERVICES INCLUDES A REFERENCE LABORATORY, TRANSCRIPTION SERVICES, BIOMEDICAL EQUIPMENT MAINTENANCE, PLUS A MEDICAL REFERENCE LIBRARY, STAFF EDUCATION AND PROFESSIONAL DEVELOPMENT PROGRAMS. MANY SENIOR CITIZENS SUBSCRIBE TO "LIFELINE," A MONITORED HELP/ALARM SYSTEM CONNECTED TO THEDACARE'S NURSE-STAFFED 24-HOUR CALL CENTER. THE CALL CENTER ALSO ANSWERS HEALTH QUESTIONS, HELPS PEOPLE LOCATE A PHYSICIAN, REFERS CALLERS TO ADDITIONAL SOURCES OF INFORMATION, AND ENROLLS CALLERS INTO COMMUNITY-FOCUSED CLASSES ON HEALTH-RELATED TOPICS. ADMINISTRATIVE SERVICES INCLUDE HUMAN RESOURCES, PAYROLL, PURCHASING, FINANCE AND ACCOUNTING, PRINTING, SERVICES FOR MEDICAL & ADMINISTRATIVE MATERIALS, ORGANIZATIONAL DEVELOPMENT, INTERNAL EDUCATION AND IMPROVEMENT SYSTEMS, QUALITY ASSURANCE FOR BOTH INTERNAL AND PUBLIC REPORTING, MARKETING, COMMUNITY OUTREACH AND EDUCATION PROGRAMS, COMMUNICATION SYSTEMS, SECURITY AND LEGAL COMPLIANCE, AND FULL-SPECTRUM INFORMATION TECHNOLOGY PLANNING & SUPPORT.THEDACARE OFFERS A VARIETY OF LONG-TERM CARE OPTIONS. THEDACARE AT HOME SERVES PEOPLE OF ALL AGES THROUGHOUT NORTHEAST AND CENTRAL WISCONSIN, INCLUDING ADULTS, CHILDREN, AND INFANTS. MOST HAVE SHORT-TERM SKILLED CARE OR REHABILITATION NEEDS FOLLOWING A HOSPITALIZATION OR ILLNESS. OTHERS NEED TEMPORARY OR ONGOING ASSISTANCE FOR CHRONIC CONDITIONS. THEDACARE ALSO OFFERS INDEPENDENT LIVING, ASSISTED LIVING, OR SKILLED CARE UNITS, AT THE HERITAGE, PEABODY MANOR AND JULIETTE MANOR COMMUNITIES. CHERRY MEADOWS HOSPICE PROVIDES CARE FOR END-OF-LIFE RESIDENTS IN A DIGNIFIED, COMPASSIONATE ENVIRONMENT. 398825319 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 0 0 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 705 0 7820 1 1 1 1 OC 0 0 0 0 0 0 0 0 1 0 X 13 10 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X NATHANIEL CHERNE 9207355560 PO BOX 8025 APPLETON WI 549128025 JOSHUA BLOMBERG MD PHYSICIAN 40.00 0.00 X 1464827 0 58345 ERIC ERICKSON MD PHYSICIAN 40.00 0.00 X 1310942 0 58350 IMRAN ANDRABI MD PRESIDENT & CEO - SYSTEM 12.00 28.00 X 1184478 0 65868 DEAN GRUNER MD PHYSICIAN 40.00 0.00 X 1052289 0 0 DAVID JONES MD PHYSICIAN 40.00 0.00 X 925775 0 47350 ANNA GILBERTSON MD PHYSICIAN 40.00 0.00 X 728205 0 26584 MARK THOMPSON SENIOR VP, CFO & COO - SYSTEM 12.00 28.00 X 681900 0 62765 THOMAS ARQUILLA FORMER KEY EMPLOYEE 12.00 28.00 X 509423 0 63247 GARY EDELMAN MD BOARD MEMBER / PHYSICIAN 41.00 2.00 X 493876 0 61247 NORMA TURK MD BOARD MEMBER / PHYSICIAN 1.00 42.00 X 434487 0 50790 JAMES ALBIN CIO 12.00 28.00 X 433321 0 47350 MAGGIE LUND CHRO 12.00 28.00 X 360217 0 51584 BRIAN STERNS FORMER KEY EMPLOYEE 12.00 28.00 X 189442 0 57247 TERRY TIMM CHAIR 1.00 2.00 X X 0 0 0 JIM KOTEK VICE CHAIR & SECRETARY 1.00 2.00 X X 0 0 0 TIM BERGSTROM BOARD MEMBER 1.00 3.00 X 0 0 0 PATRICK BRENNAN MD BOARD MEMBER 1.00 2.00 X 0 0 0 MARK BURSTEIN BOARD MEMBER 1.00 2.00 X 0 0 0 JOHN DAVIS BOARD MEMBER 1.00 2.00 X 0 0 0 DAVID KOEPER MD BOARD MEMBER 1.00 2.00 X 0 0 0 JIM MEYER BOARD MEMBER 1.00 3.00 X 0 0 0 KAREN TIMBERLAKE BOARD MEMBER 1.00 2.00 X 0 0 0 MARIA VAN LAANEN BOARD MEMBER 1.00 2.00 X 0 0 0 CYRIL WALSH MD BOARD MEMBER (THROUGH AUG 2019) 1.00 2.00 X 0 0 0 9769182 0 650727 566 1 1 0 ENSEMBLE RCM LLC PO BOX 639076 CINCINNATI OH 45263 BUSINESS SERVICES 18674061 WEATHERBY LOCUMS PO BOX 972633 DALLAS TX 75397 MEDICAL STAFFING 3540127 COMPHEALTH PO BOX 972651 DALLAS TX 75397 MEDICAL STAFFING 2705007 CARDIO SOLUTION PHYSICIANS 4675 CORNELL RD STE 100 CINCINNATI OH 45241 MEDICAL STAFFING 1785843 STAFFENCY LLC 221 W COLLEGE AVE 2ND FLOOR APPLETON WI 54911 MEDICAL STAFFING 1629109 5 1217022 1217022 PATIENT/CLIENT SERVICES 621110 274904623 274904623 MANAGEMENT SERVICE FEES 541900 26890618 26890618 INFORMATION TECHNOLOGY SERVICES 541511 5469611 5469611 TRANSCRIPTION SERVICES 541511 61133 61133 307325985 76735022 76735022 8456 -8456 -8456 -8456 OTHER REVENUE 900099 9509405 9509405 RISK SHARING PERFORMANCE REVENUE 900099 2013205 2013205 EARNINGS FROM EQUITY INVESTMENTS 900099 1413611 1413611 12936221 398205794 307325985 0 89662787 X 328334 328334 172261535 161824671 10436864 29797588 23838070 5959518 26476492 21676566 4799926 22672729 18138183 4534546 110000 88000 22000 71165621 66440149 4725472 3672996 2926340 746656 6387772 5671059 716713 18107712 14486718 3620994 42173275 37072465 5100810 1513870 999154 514716 5819548 3840902 1978646 12435759 8207601 4228158 19461174 12844375 6616799 1435265 1277886 157379 BAD DEBT EXPENSE 8800001 8800001 COST OF GOODS SOLD 6359723 6354828 4895 EQUIPMENT MAINTENANCE 2798262 2430737 367525 RECRUITMENT 1867928 1579280 288648 453645584 398825319 54820265 0 111459219 -121084388 48154392 36408569 906717 2034528 9079437 13766080 413021033 209907207 156347602 203113826 340228607 516698553 150190523 198941001 1770833 520833 14696439 14629250 832833769 865028252 87469796 86412335 97551688 108206849 271755445 326259895 7486254 44366496 912609453 881278712 1376872636 1446524287 X -544048867 -581506035 10000 10000 -544038867 -581496035 832833769 865028252 -55439790 17982622 0 X 0 1 X 1 0 X 624035 4865530 1007240 1182180 1217022 8896007 242383709 252609545 277431799 284057977 307325985 1363809015 243007744 257475075 278439039 285240157 308543007 1372705022 0 0 0 1372705022 7069362 7091228 7998243 12316183 76735022 111210038 7069362 7091228 7998243 12316183 76735022 111210038 883561 883561 5497729 8754152 29468854 13867324 98636221 156224280 255574835 273320455 315906136 312307225 483914250 1641022901 0.83650 0.92410 0.06780 0.03210 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME RISK SHARING PERFORMANCE REVENUE EQUITY INVESTMENT EARNINGS CHILD LEARNING CENTER REVENUE RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 1 107574 0 0 0 0 0 107574 0 PART II-B, LINE 1: LOBBYING ACTIVITIES WERE DONE TO INFLUENCE THE STATE OF WISCONSIN GOVERNING BODY. NO EFFORT WAS MADE TO INFLUENCE THE FEDERAL GOVERNMENT, OR TO SUPPORT ANY CANDIDATE. SEE DETAIL OF LOBBYING EXPENDITURES ONLINE AT HTTP://LOBBYING.WI.GOV. ITEMS THAT WERE LOBBIED INCLUDE LICENSURE OR CERTIFICATE RENEWAL FOR CERTAIN EMERGENCY MEDICAL SERVICES PERSONNEL AND AMBULANCE SERVICE PROVIDERS, AS WELL AS OTHER HEALTHCARE MATTERS. 21910879 21910879 138281013 46100827 92180186 49484162 12207652 37276510 186703871 151598728 35105143 16641108 16641108 203113826 108427468 F EQUITIES 90513533 F 198941001 DUE TO AFFILIATES 881278712 881278712 CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, 0 0 INVESTMENTS N/A 36653285 0 0 0 0 0 0 36653285 0 36653285 1 0 0 1 1 0 PART III ACCOUNTING METHOD: PART IV, LINE 4: THE ORGANIZATION IS AN EXEMPT ENTITY AND THERE IS NO UNRELATED BUSINESS INCOME GENERATED FROM THIS INVESTMENT. THEREFORE, FORM 8621 IS NOT REQUIRED. 1 COMMUNITY FOUNDATION PO BOX 563 APPLETON WI 54912 391548450 501(C)(3) 200000 GENERAL OPERATING SUPPORT HARBOR HOUSE 720 W 5TH STREET APPLETON WI 54914 391870927 501(C)(3) 33334 GENERAL OPERATING SUPPORT UNITED WAY FOX CITIES INC PO BOX 928 NEENAH WI 549570928 390912895 501(C)(3) 10000 GENERAL OPERATING SUPPORT MOSAIC FAMILY HEALTH 229 S MORRISON STREET APPLETON WI 54911 473298660 501(C)(3) 75000 GENERAL OPERATING SUPPORT BOYS AND GIRLS CLUB SHAWANO 1300 S UNION STREET SHAWANO WI 54166 396102943 501(C)(3) 10000 GENERAL OPERATING SUPPORT 5 0 PART I, LINE 2: IN ORDER FOR GRANT REQUESTS TO BE CONSIDERED, THEY MUST MEET THE FOLLOWING GUIDELINES: 1) DIRECTED TOWARD PROJECTS THAT SUPPORT THEDACARE'S MISSION AND VALUES; 2) BENEFIT THE COMMUNITES SERVED BY THEDACARE, INC.; OR 3) BENEFIT A 501(C)(3) NOT-FOR-PROFIT ORGANIZATION. CONVERSELY, REQUESTS MUST NOT BE FOR: 1) THE SOLE BENEFIT OF AN INDIVIDUAL; 2) POLITICAL ORGANIZATIONS OR CAMPAIGN COMMITTEES; 3) RELIGIOUS ORGANIZATIONS (FOR STRICTLY RELIGIOUS PURPOSES); 4) ORGANIZATIONS IN CONFLICT WITH THEDACARE'S MISSION AND VALUES; OR 5) STATE OR NATIONAL CAMPAIGNS. ALL ORGANIZATIONS REQUESTING GRANT FUNDS MUST APPLY THROUGH THE THEDACARE WEBSITE. REQUESTS ARE SCREENED, REVIEWED, AND APPROVED BY A COMMITTEE SIX TIMES THROUGHOUT THE FISCAL YEAR. A LETTER OF RESTRICTION IS ISSUED BY THEDACARE IN CONJUNCTION WITH ALL GRANT CHECKS. THIS LETTER OF RESTRICTION STATES THAT ALL GRANT FUNDS RECEIVED FROM THEDACARE MUST BE USED STRICTLY FOR THE PURPOSES FOR WHICH THEY WERE APPLIED. X 1 1 X X X X 0 1 0 0 0 0 0 1 0 JOSHUA BLOMBERG MD PHYSICIAN 1306915 0 120873 0 37039 0 35995 0 22350 0 1523172 0 0 0 ERIC ERICKSON MD PHYSICIAN 1259708 0 59958 0 -8724 0 36000 0 22350 0 1369292 0 0 0 IMRAN ANDRABI MD PRESIDENT & CEO - SYSTEM 881748 0 270005 0 32725 0 43518 0 22350 0 1250346 0 0 0 DEAN GRUNER MD PHYSICIAN 1052289 0 0 0 0 0 0 0 0 0 1052289 0 0 0 DAVID JONES MD PHYSICIAN 764019 0 155177 0 6579 0 25000 0 22350 0 973125 0 0 0 ANNA GILBERTSON MD PHYSICIAN 542133 0 153463 0 32609 0 19000 0 7584 0 754789 0 0 0 MARK THOMPSON SENIOR VP, CFO & COO - SYSTEM 557906 0 100979 0 23015 0 43518 0 19247 0 744665 0 0 0 THOMAS ARQUILLA FORMER KEY EMPLOYEE 429017 0 53856 0 26550 0 44000 0 19247 0 572670 0 0 0 GARY EDELMAN MD BOARD MEMBER / PHYSICIAN 486784 0 2763 0 4329 0 42000 0 19247 0 555123 0 0 0 NORMA TURK MD BOARD MEMBER / PHYSICIAN 285839 0 89079 0 59569 0 42000 0 8790 0 485277 0 0 0 JAMES ALBIN CIO 358040 0 55950 0 19331 0 25000 0 22350 0 480671 0 0 0 MAGGIE LUND CHRO 301356 0 39841 0 19020 0 44000 0 7584 0 411801 0 0 0 BRIAN STERNS FORMER KEY EMPLOYEE 158264 0 8161 0 23017 0 38000 0 19247 0 246689 0 0 0 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, 2019 TO DECEMBER 31, 2019) TO RECEIVE A 2020 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. A WHEFA REV BOND 2010 391337855 97710BWA6 2010-05-25 25508288 REFUNDING 0 0 0 B WHEFA REV BOND 2012A 391337855 2012-10-19 49745000 REFUNDING 0 0 0 C WHEFA REV BOND 2014A 391337855 2014-08-06 11554244 REFUNDING 0 0 0 D WHEFA REV BOND 2015 391337855 97712DKC9 2015-01-07 140628056 REFUNDING AND FACILITY CONSTRUCTION 0 0 0 A 12420000 25508288 332397 25175981 1 0 1 1 B 49745000 279179 49465821 1 0 1 1 C 3384041 11554244 90600 11463643 1 0 1 1 D 9095000 140972887 1236782 93265202 46470904 0 1 0 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 D 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 0 B 0 0 0 1 1 0 0 0 1 C 0 1 0 0 1 0 0 0 1 D 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: WHEFA REV BOND 2010 DATE THE REBATE COMPUTATION WAS PERFORMED: 05/01/2015 ISSUER NAME: WHEFA REV BOND 2012A DATE THE REBATE COMPUTATION WAS PERFORMED: 10/01/2017 PART II, LINE 3B: FOR THE WHEFA REV BOND 2015, THE ISSUE PRICE VARIES FROM THE TOTAL PROCEEDS OF ISSUE DUE TO INVESTMENT EARNINGS OF $344,831. A WHEFA REV BOND 2019 391337855 97712D4U7 2019-12-20 152951126 REFUNDING AND FACILITY CONSTRUCTION 0 0 0 A 152951126 1234839 67624063 84092223 1 0 0 1 A 0 0 0 0 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 1 THE BOARD OF TRUSTEES HAS AN EXECUTIVE COMMITTEE CONSISTING OF THE BOARD'S CHAIR, VICE CHAIR, PRESIDENT, SECRETARY AND TREASURER. THE EXECUTIVE COMMITTEE HAS AND MAY EXERCISE, WHEN THE BOARD OF TRUSTEES IS NOT IN SESSION, THE POWER OF THE BOARD OF TRUSTEES IN THE MANAGEMENT OF THE ORGANIZATION'S AFFAIRS, EXCEPT ACTION WITH RESPECT TO ELECTION OF OFFICERS OR TRUSTEES. FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION'S BYLAWS WERE AMENDED IN AUGUST 2019 (A) TO INDICATE THAT BOARD TERMS ARE FOR THREE YEARS AND THAT A BOARD MEMBER MAY NOT SERVE MORE THAN THREE CONSECUTIVE TERMS; (B) TO CHANGE THE REQUIRED MAJORITY VOTE TO REMOVE A BOARD MEMBER FROM 3/4 AFFIRMATIVE TO 2/3 AFFIRMATIVE VOTES; (C) TO CONSOLIDATE THE 1ST VICE CHAIR AND 2ND VICE CHAIR POSITIONS INTO A SINGLE VICE CHAIR POSITION; (D) TO SHORTEN THE BOARD'S OFFICER TERMS FROM 2 YEARS TO 1 YEAR; AND (E) TO DECREASE THE REQUIRED MAJORITY VOTE FOR AMENDMENTS TO THE BYLAWS FROM 3/4 AFFIRMATIVE TO 2/3 AFFIRMATIVE VOTES. 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. 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 PARTICIPATE 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 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 66,440,149. MANAGEMENT AND GENERAL EXPENSES 4,725,472. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 71,165,621. THEDACARE ACO LLC PO BOX 8025 APPLETON WI 549128025 391509362 ACCOUNTABLE CARE ORGANIZATION WI 12512730 85489559 THEDACARE INC THEDACARE CORE ACO LLC PO BOX 8025 APPLETON WI 549128025 824621162 ACCOUNTABLE CARE ORGANIZATION WI 0 81318 THEDACARE INC THEDACARE REGIONAL MEDICAL CENTER - NEENAH INC PO BOX 8025 APPLETON WI 549128025 390830664 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 1 THEDACARE MEDICAL CENTER - NEW LONDON INC PO BOX 8025 APPLETON WI 549128025 390869788 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 1 THEDACARE MEDICAL CENTER - WAUPACA INC PO BOX 8025 APPLETON WI 549128025 390871113 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 1 THEDACARE REGIONAL MEDICAL CENTER - APPLETON INC PO BOX 8025 APPLETON WI 549128025 390824015 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 1 THEDACARE MEDICAL CENTER - SHAWANO INC PO BOX 8025 APPLETON WI 549128025 390807068 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 1 THEDACARE MEDICAL CENTER - BERLIN INC PO BOX 8025 APPLETON WI 549128025 390806359 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 1 THEDACARE MEDICAL CENTER - WILD ROSE INC PO BOX 8025 APPLETON WI 549128025 396089134 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 1 THEDACARE FAMILY OF FOUNDATIONS INC PO BOX 8025 APPLETON WI 549128025 464112255 FOUNDATION WI 501(C)(3) LINE 7 THEDACARE INC 1 N APPLETON AMBULATORY CARE CENTER BUILDING COMPANY LLC 2500 E CAPITOL DR APPLETON WI 54911 262497187 RENTAL WI N/A RELATED 187123 3831426 0 1 0.17330 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 THEDACARE FAMILY OF FOUNDATIONS INC C 1217022 CASH THEDACARE REGIONAL MEDICAL CENTER - APPLETON INC O 89382525 ACTUAL THEDACARE REGIONAL MEDICAL CENTER - NEENAH INC O 81853528 ACTUAL THEDACARE MEDICAL CENTER - BERLIN INC O 21861425 ACTUAL THEDACARE MEDICAL CENTER - NEW LONDON INC O 12573192 ACTUAL THEDACARE MEDICAL CENTER - SHAWANO INC O 22006371 ACTUAL THEDACARE MEDICAL CENTER - WAUPACA INC O 16049865 ACTUAL THEDACARE MEDICAL CENTER - WILD ROSE INC O 6174127 ACTUAL