THEDACARE MEDICAL CENTER-BERLIN INC: Form 990, tax year 2018
View the entire original 990 at ProPublica ↗
- Organization
- THEDACARE MEDICAL CENTER-BERLIN INC (EIN 39-0806359)
- Tax period
- 2018-01-01 to 2018-12-31
- Filed
- 2019-11-13
- IRS object ID
- 201933179349305913
- Schema version
- 2018v3.1
- 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 I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-11-13T13:56:54-06:00 | ReturnTs |
| Tax Period End | 2018-12-31 | 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 | 10401 W INNOVATION DRIVE SUITE 300 | AddressLine1Txt |
| City | WAUWATOSA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53226 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2018-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390806359 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THEDACARE MEDICAL CENTER - BERLIN INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | THED | BusinessNameControlTxt |
| Phone | 9203611313 | 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 | 9203611313 | PhoneNum |
| Signature | 2019-10-31 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KURT BENNION | PreparerPersonNm |
| PTIN | P01469618 | PTIN |
| Phone | 4144761880 | PhoneNum |
| Preparation | 2019-10-31 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 67.137.57.251 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-10-31 | IPDt |
| IP Tm | 12:49:45 | IPTm |
| IP Timezone | PD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 8AB1EF77DE18A0C4413B49866C7FB8A65B600F09 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 72C56C6F533A7CAE8F7235CA15DC6DF10360C772 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2018 | TaxYr |
| Build TS | 2020-04-17 16:48:07Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| 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 | $57,874,598 | 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 | 1910 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | IMPROVING THE HEALTH OF OUR COMMUNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 80 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $32,224 | PYContributionsGrantsAmt |
| CY Contributions Grants | $55,011 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $60,830,860 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $57,692,890 | CYProgramServiceRevenueAmt |
| PY Investment Income | $237,344 | PYInvestmentIncomeAmt |
| CY Investment Income | -$94,691 | CYInvestmentIncomeAmt |
| PY Other Revenue | $138,481 | PYOtherRevenueAmt |
| CY Other Revenue | $126,739 | CYOtherRevenueAmt |
| PY Total Revenue | $61,238,909 | PYTotalRevenueAmt |
| CY Total Revenue | $57,779,949 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $67,444 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $310,459 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $28,249,788 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $23,847,072 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $24,350,195 | PYOtherExpensesAmt |
| CY Other Expenses | $24,268,145 | CYOtherExpensesAmt |
| PY Total Expenses | $52,667,427 | PYTotalExpensesAmt |
| CY Total Expenses | $48,425,676 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $8,571,482 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $9,354,273 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $38,359,780 | TotalAssetsBOYAmt |
| Total Assets EOY | $48,965,885 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $805,648 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $945,339 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $37,554,132 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $48,020,546 | 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 | Yes (1) | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $47,101,379 | ExpenseAmt |
| Grant | $310,459 | GrantAmt |
| Revenue | $57,576,451 | 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-BERLIN IS A 25-BED CRITICAL ACCESS HOSPITAL SERVING BERLIN AND NEARBY COMMUNITIES. THERE ARE MORE THAN 300 EMPLOYEES LOCATED ON THE BERLIN CAMPUS. THEDACARE MEDICAL CENTER-BERLIN 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, NEUROLOGY, FAMILY BIRTH CARE, DIABETES, INTERNAL MEDICINE, EMERGENCY, OCCUPATIONAL HEALTH, PULMONOLOGY, WOMEN'S CARE, EAR, NOSE & THROAT, OUTPATIENT SURGERY AND THERAPY SERVICES.MORE THAN 15,000 UNIQUE PATIENTS ACCOUNT FOR MORE THAN 49,350 VISITS ANNUALLY.IN ADDITON, WE OFFER AND CONVENIENT WALK-IN CARE, AND E-VISITS FOR ENHANCED COMMUNITY ACCESS TO HEALTHCARE.WITH CORPORATE PARENT THEDACARE, INC. 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 (GREEN LAKE AND MARQUETTE) WHERE SERVICES ARE PROVIDED. EFFORTS INCLUDE PARTNERSHIPS WITH CITY OF BERLIN AMBULANCE SERVICES, BERLIN SCHOOL DISTRICT, GREEN LAKE SCHOOL DISTRICT, TRI-COUNTY BOYS AND GIRLS CLUB, GREEN LAKE COUNTY PUBLIC HEALTH. TOP PRIORITIES INCLUDE MENTAL HEALTH, INCLUDING A MENTORING PROGRAM AT THE TRI-COUNTY BOYS AND GIRLS CLUB TARGETED TO AGES 8TH GRADE THROUGH SENIORS IN HIGH SCHOOL. THEDACARE IS ALSO WORKING WITH COMMUNITY LEADERS TO BECOME A TRAUMA INFORMED COMMUNITY (DRIVING DIFFERENT APPROACHES TO IDENTIFYING ROOT CAUSES AND CONCERNS IN ADOLECENTS).THEDACARE PROVIDES SCHOLARSHIPS, CHARITY CARE, INTERPRETING AND EDUCATIONAL SERVICES, AND VARIOUS OTHER COMMUNITY BENEFITS.THEDACARE OPERATES ON A NON-DISCRIMINATORY BASIS REGARDLESS OF RACE, COLOR, SEX, RELIGION, OR NATIONAL ORIGIN. THEDACARE PROVIDES A VARIETY OF FINANCIAL ASSISTANCE OPTIONS TO PATIENTS WHO MEET ESTABLISHED CRITERIA. SERVICES ARE ALSO PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES.HOSPITAL INPATIENT DAYS TOTALED 3,562 WITH 214 ADDITIONAL DAYS FOR NEWBORN CARE. | Desc |
| Total Program Service Expenses | $47,101,379 | 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 |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| 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 | 0 | 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 | Yes (1) | 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 With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| 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 | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | NATHANIEL CHERNE | PersonNm |
| 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 (25 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| PAUL KUJAWA | ||||||||||
| CHAIR | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| LARRY WISE | ||||||||||
| VICE CHAIR | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| KELLY WHITE DDS | ||||||||||
| TREASURER | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| CRAIG BATLEY MD | ||||||||||
| SECRETARY / PHYSICIAN | 1.00 | 40.00 | Yes (X) | Yes (X) | $0 | $428,990 | $33,302 | |||
| TAMMY BENDING | ||||||||||
| BOARD MEMBER / VP OF CAH OPERATIONS | 21.00 | 21.00 | Yes (X) | $124,172 | $124,172 | $15,408 | ||||
| JOHN BLAZEL | ||||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| MARGARET BOSTELMANN | ||||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| DAVID BUDDE DO | ||||||||||
| BOARD MEMBER / PHYSICIAN | 1.00 | 40.00 | Yes (X) | $0 | $455,176 | $30,476 | ||||
| JAYSON DUFFY | ||||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| JARED KOHLENBERG DO | ||||||||||
| BOARD MEMBER / PHYSICIAN | 1.00 | 40.00 | Yes (X) | $0 | $489,635 | $30,214 | ||||
| JENNIFER REDMAN-SCHELL | ||||||||||
| BOARD MEMBER/SR VP, CLIN INTEG NTWRK | 2.00 | 38.00 | Yes (X) | $18,657 | $354,483 | $31,200 | ||||
| MARK THOMPSON | ||||||||||
| BOARD MEMBER / SR VP, CFO & COO - SYSTEM | 4.00 | 36.00 | Yes (X) | Yes (X) | $58,437 | $525,934 | $31,595 | |||
| IMRAN ANDRABI MD | ||||||||||
| PRESIDENT & CEO - SYSTEM | 4.00 | 36.00 | Yes (X) | $105,831 | $952,477 | $33,641 | ||||
| TIM OLSON | ||||||||||
| CFO - CLINICALLY INTEGRATED NETWORK | 4.00 | 36.00 | Yes (X) | $30,901 | $278,105 | $19,727 | ||||
| VICTORIA BARNTHOUSE | ||||||||||
| CNO | 4.00 | 36.00 | $32,842 | $295,585 | $18,954 | Yes (X) | ||||
| JAMES ALBIN | ||||||||||
| CIO | 4.00 | 36.00 | $37,439 | $336,952 | $31,617 | Yes (X) | ||||
| MAGGIE LUND | ||||||||||
| CHRO | 4.00 | 36.00 | $30,195 | $271,744 | $14,724 | Yes (X) | ||||
| BRIAN STERNS | ||||||||||
| CHIEF OF STAFF | 4.00 | 36.00 | $16,409 | $147,674 | $25,502 | Yes (X) | ||||
| WILLIAM MANN | ||||||||||
| SENIOR VP, STRATEGY | 4.00 | 36.00 | $48,432 | $435,890 | $19,124 | Yes (X) | ||||
| AMANDA HEIN MD | ||||||||||
| PHYSICIAN | 40.00 | 0.00 | $500,214 | $0 | $34,800 | Yes (X) | ||||
| HORACE LO MD | ||||||||||
| PHYSICIAN | 40.00 | 0.00 | $760,279 | $0 | $36,199 | Yes (X) | ||||
| DARREN NELSON MD | ||||||||||
| PHYSICIAN | 40.00 | 0.00 | $455,957 | $0 | $30,263 | Yes (X) | ||||
| DANIEL RESOP MD | ||||||||||
| PHYSICIAN | 40.00 | 0.00 | $442,763 | $0 | $37,466 | Yes (X) | ||||
| GREGORY LONG MD | ||||||||||
| FORMER BOARD MEMBER / PHYSICIAN | 1.00 | 40.00 | $55,382 | $498,436 | $24,977 | Yes (X) | ||||
| MAUREEN PISTONE | ||||||||||
| FORMER KEY EMPLOYEE | 4.00 | 36.00 | $37,190 | $334,708 | $6,826 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,755,100 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $5,929,961 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $506,015 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 15 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHARED MEDICAL SERVICES | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 209 LIMESTONE PASS | AddressLine1Txt |
| City | COTTAGE GROVE | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53527 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | MEDICAL SERVICES | ServicesDesc |
| Compensation | $670,065 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $55,011 | RelatedOrganizationsAmt |
| Total Contributions | $55,011 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| INPATIENT SERVICE REVENUE | 624100 | $31,033,418 | $31,033,418 | |
| OUTPATIENT SERVICE REVENUE | 624100 | $26,521,856 | $26,521,856 | |
| CAFETERIA REVENUE | 900099 | $98,961 | $98,961 | |
| PHARMACY | 446110 | $21,177 | $21,177 | |
| MISCELLANEOUS INCOME | 900099 | $17,478 | $17,478 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $57,692,890 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$42 | TotalRevenueColumnAmt |
| Exclusion | -$42 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $126,739 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $126,739 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $126,739 | TotalRevenueColumnAmt |
| Exclusion | $126,739 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $94,649 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$94,649 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$94,649 | TotalRevenueColumnAmt |
| Exclusion | -$94,649 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $57,779,949 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $57,576,451 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $148,487 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $310,459 | TotalAmt |
| Program Services | $310,459 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $539,602 | TotalAmt |
| Program Services | $450,624 | ProgramServicesAmt |
| Management And General | $88,978 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,873 | TotalAmt |
| Program Services | $30,298 | ProgramServicesAmt |
| Management And General | $7,575 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,646,643 | TotalAmt |
| Program Services | $17,848,135 | ProgramServicesAmt |
| Management And General | $798,508 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,300 | TotalAmt |
| Program Services | $14,300 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,608,654 | TotalAmt |
| Program Services | $4,487,710 | ProgramServicesAmt |
| Management And General | $120,944 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,312,021 | TotalAmt |
| Program Services | $4,033,985 | ProgramServicesAmt |
| Management And General | $278,036 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $60,628 | TotalAmt |
| Program Services | $60,628 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $457,104 | TotalAmt |
| Program Services | $429,511 | ProgramServicesAmt |
| Management And General | $27,593 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,631 | TotalAmt |
| Program Services | $10,631 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,758,496 | TotalAmt |
| Program Services | $1,755,833 | ProgramServicesAmt |
| Management And General | $2,663 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71,247 | TotalAmt |
| Program Services | $71,247 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $98,573 | TotalAmt |
| Program Services | $98,573 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,225,052 | TotalAmt |
| Program Services | $3,225,052 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $93,439 | TotalAmt |
| Program Services | $93,439 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| CLINIC & PATIENT SERVIC | $9,842,570 | $9,842,570 |
| BAD DEBT EXPENSE | $3,384,037 | $3,384,037 |
| EQUIPMENT & MAINTENANCE | $954,347 | $954,347 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,425,676 | TotalAmt |
| Program Services | $47,101,379 | ProgramServicesAmt |
| Management And General | $1,324,297 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $68,907 | BOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,745,347 | BOYAmt |
| EOY | $6,315,029 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $343,333 | BOYAmt |
| EOY | $493,383 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $75,183,246 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $43,010,534 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,104,213 | BOYAmt |
| EOY | $32,172,712 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,097,980 | BOYAmt |
| EOY | $9,984,761 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,359,780 | BOYAmt |
| EOY | $48,965,885 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $805,648 | BOYAmt |
| EOY | $945,339 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $805,648 | BOYAmt |
| EOY | $945,339 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,554,132 | BOYAmt |
| EOY | $48,020,546 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,554,132 | BOYAmt |
| EOY | $48,020,546 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,359,780 | BOYAmt |
| EOY | $48,965,885 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $9,354,273 | ReconcilationRevenueExpnssAmt |
| Prior Period Adjustments | $1,112,141 | 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 | $3,056 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $3,056 | 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 2018 WERE $22,469. 13.6% OF THIS AMOUNT WAS SPENT ON LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,863,214 | OtherCostOrOtherBasisAmt |
| Book Value | $3,863,214 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $40,399,722 | OtherCostOrOtherBasisAmt |
| Depreciation | $17,660,139 | DepreciationAmt |
| Book Value | $22,739,583 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,215,316 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,090,951 | DepreciationAmt |
| Book Value | $124,365 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $29,704,994 | OtherCostOrOtherBasisAmt |
| Depreciation | $24,259,444 | DepreciationAmt |
| Book Value | $5,445,550 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $32,172,712 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE FROM AFFILIATES | Desc |
| Book Value | $9,984,761 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $9,984,761 | TotalBookValueOtherAssetsAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| Most Hospitals Policy | Yes (X) | MostHospitalsPolicyInd |
| 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) |
|---|---|---|
| Persons Served | 255 | PersonsServedCnt |
| Total Community Benefit Expns | $176,106 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $176,106 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00390 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 6579 | PersonsServedCnt |
| Total Community Benefit Expns | $4,499,129 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,468,584 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $30,545 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 6834 | PersonsServedCnt |
| Total Community Benefit Expns | $4,675,235 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,468,584 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $206,651 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00460 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 19 | ActivitiesOrProgramsCnt |
| Persons Served | 191317 | PersonsServedCnt |
| Total Community Benefit Expns | $199,191 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $199,191 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00440 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 139 | PersonsServedCnt |
| Total Community Benefit Expns | $81,771 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $81,771 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00180 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 110 | PersonsServedCnt |
| Total Community Benefit Expns | $731,320 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $731,320 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01620 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 87551 | PersonsServedCnt |
| Total Community Benefit Expns | $732,829 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $732,829 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01630 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 25 | ActivitiesOrProgramsCnt |
| Persons Served | 279117 | PersonsServedCnt |
| Total Community Benefit Expns | $1,745,111 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,745,111 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03870 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 25 | ActivitiesOrProgramsCnt |
| Persons Served | 285951 | PersonsServedCnt |
| Total Community Benefit Expns | $6,420,346 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,468,584 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,951,762 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04330 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 24947 | PersonsServedCnt |
| Total Community Benefit Expns | $806 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $806 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 157 | PersonsServedCnt |
| Total Community Benefit Expns | $6,524 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,524 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 6 | PersonsServedCnt |
| Total Community Benefit Expns | $201 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $201 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 25110 | PersonsServedCnt |
| Total Community Benefit Expns | $7,531 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $7,531 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,161,952 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $10,619,118 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $12,161,551 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,542,433 | 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 - BERLIN | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 MEMORIAL DRIVE | AddressLine1Txt |
| City | BERLIN | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54923 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.THEDACARE.ORG | WebsiteAddressTxt |
| State License | 1060 | 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 - BERLIN INC | 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 | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | 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 | 16 | 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 (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| THEDACARE MEDICAL CENTER - BERLIN, INC. | PART V, SECTION B, LINE 5: THEDACARE UTILIZES MODELS CREATED BY THE UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTE AND THE ROBERT WOOD JOHNSON FOUNDATION AS THE FRAMEWORK FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. OVER THE COURSE OF A ONE YEAR PERIOD, SECONDARY DATA WAS COLLECTED, PUBLIC HEALTH AND KEY INFORMANT INTERVIEWS WERE CONDUCTED, THEDACARE CHAT (COMMUNITY HEALTH ACTION TEAM) PROVIDED INPUT AND PATIENT HEALTH DATA WAS STUDIED. VULNERABLE POPULATIONS INCLUDED THOSE LIVING IN POVERTY, RURAL FARM FAMILIES, THE ELDERLY AND MIGRANT HISPANIC. INPUT WAS COLLECTED BY REPRESENTATIVES OF:- RURAL HEALTH INITIATIVE- GREEN LAKE/MARQUETTE COUNTIES AGING AND DISABILITY RESOURCE CENTER- GREEN LAKE PUBLIC HEALTH- HEADSTART- GREEN LAKE COUNTY ECONOMIC SUPPORT- GREEN LAKE COUNTY UW-EXTENSION |
| THEDACARE MEDICAL CENTER - BERLIN, INC. | PART V, SECTION B, LINE 7D: THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ONLINE AT:HTTPS://WWW.THEDACARE.ORG/GETTING-INVOLVED/IMPROVING-COMMUNITY-HEALTH.ASPX |
| THEDACARE MEDICAL CENTER - BERLIN, INC. | PART V, SECTION B, LINE 11: THE THEDACARE COMMUNITY HEALTH IMPLEMENTATION STRATEGY WAS APPROVED BY THE THEDACARE BOARD OF TRUSTEES IN DECEMBER OF 2016.OBESITY:1. PROVIDED FUNDING TO LOCAL FARMER'S MARKETS.2. PARTNERED WITH THE LOCAL BOYS AND GIRLS CLUB TO EDUCATE CHILDREN ABOUT EATING HEALTHY AND THE BENEFITS OF BEING ACTIVE.MENTAL HEALTH/AODA:1. CATALPA HEALTH: IN 2018, THEDACARE PROVIDED IN-KIND LEADERSHIP AND FINANCIAL SUPPORT TO CATALPA HEALTH - CHILDREN'S MENTAL HEALTH PROVIDER WHICH PROVIDES MENTAL HEALTH SERVICES TO CHILDREN THROUGHOUT NORTHEAST WISCONSIN. 2. PROVIDES LEADERSHIP AND FUNDING FOR THE FOX VALLEY PARTNERSHIP COMMUNITY HEALTH CENTER WORKING TO IMPROVE THE HEALTH STATUS OF THE MEDICALLY UNDERSERVED BY PROVIDING COMPREHENSIVE PRIMARY CARE SERVICES.3. PROVIDED OVER $800,000 IN SUBSIDIZED MENTAL HEALTH SERVICES THROUGHOUT SERVICE AREA. 4. DEVELOPED A PROTOCOL FOR SCREENING PATIENTS FOR SUBSTANCE ABUSE AND A POLICY FOR THOSE ON LONG-TERM OPIATE USE. 5. OPIOID ABUSE PREVENTION: LAUNCHED OPIOID INITIATIVE TO ADDRESS ACADEMIC DETAILING, MAT EXPANSION, DRUG TAKE BACK BOXES THROUGHOUT SYSTEM, COMMUNITY AWARENESS CAMPAIGN, AND SCHOOL-BASED RESILIENCY PROGRAMMING CALLED SOURCES OF STRENGTH. THEDACARE COMMITTED $300,000 OVER 3 YEARS TO IMPLEMENT THE SCHOOL BASED PROGRAM.6. BEHAVIORAL HEALTH OPERATIONS: INITIATED PRIMARY CARE CONSULT. DR. PANZER AND DR. BELD DO INITIAL REVIEW OF ALL REFERRALS AND IF URGENT, GET THEM INTO CARE EXPEDITED (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. 7. INPATIENT PSYCH WENT TO 7 DAYS ON/7 OFF FOR HOSPITALIST. FREES UP OUTPATIENT PSYCH TIME. 8. DEPRESSION SCREENING: DEPRESSION SCREENING IS TAKING PLACE IN 100% OF THEDACARE PEDIATRIC AND FP CLINICS FOR PEOPLE AGE 12+. - CONDUCTING COLUMBIA SCREENING AT EVERY MENTAL HEALTH INITIAL APPOINTMENT.- CONDUCTING PHQ9 AT EVERY AODA INITIAL APPOINTMENT.EARLY CHILDHOOD/FAMILY SUPPORT:1. REACH OUT AND READ: CHI WORKED WITH PHYSICIAN SERVICES TO COMMIT TO EXPANDING ROAR THROUGHOUT TC WITH FUNDING COMING THROUGH OPERATIONS/FOUNDATION BY 2019. FOX CITIES LOCATIONS FUNDED THROUGH UNITED WAY GRANT THROUGH 2018. (A CHILD 1 YEAR BEHIND IN READING BY 3RD GRADE HAS 26% OF DROPPING OUT OF HIGH SCHOOL VS. 10% OF STUDENTS READING AT GRADE LEVEL.)2. HOSTED REACH OUT AND READ: THEDACARE EMPLOYEE VOLUNTEERISM EVENT IN 5 AREA SCHOOLS FOR 1 WEEK. READ TO ELEMENTARY STUDENTS AND ENCOURAGED CHILDREN TO READ. 3. THEDACARE MEDICAL CENTER-BERLIN HOSTED A PLUNGE ON EARLY CHILDHOOD. A PARTNERSHIP WITH CHILDREN'S HOSPITAL OF WI COMMUNITY SERVICES WAS FORMED. CHILDREN'S IS WORKING WITH THEDACARE AND COMMUNITY PARTNERS TO PROVIDE HOME VISITATION SERVICES AND PLAY BASE GROUP CLASSES TO GREEN LAKE AND MARQUETTE COUNTIES.4. HOSTED "KIDS IN CRISIS" PLUNGE IN MARCH 2017. THEDACARE PROVIDED $15,000/YEAR FOR 3 YEARS TO THE TRI-COUNTY BOYS AND GIRLS CLUB IN BERLIN TO LAUNCH A MENTORING PROGRAM TARGETED FOR GRADES 6TH - 12TH GRADE. PARTNERS INCLUDE 3 SCHOOL DISTRICTS, 2 COUNTY PH DEPARTMENTS, COUNTY BOARD. AGES 6TH-12TH GRADE. TARGET 15 ADULT MENTORS FIRST YEAR. TRACKING GRADUATION RATES, ACADEMIC OUTCOMES. PLAN TO REPLICATE THROUGHOUT 3 COUNTY AREA. 28 MATCHES IN PLACE. SUMMER PROGRAMMING INCLUDES WEEKLY MENTOR MEETINGS AS WELL AS MONTHLY FIELD TRIPS. FUNDING SECURED TO EXPAND MENTORING PROGRAM TO RIPON AND GREEN LAKE AREA SCHOOL DISTRICT IN FALL 2019.GENERAL:1. 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 HOSPITALS PROVIDE FINANCIAL AS WELL AS DIAGNOSTIC AND LAB SUPPORT TO A PARTNERSHIP COMMUNITY HEALTH CENTER (FQHC) PROVIDING MEDICAL, BEHAVIORAL AND DENTAL CARE TO THE UNDERSERVED IN OUR SERVICE AREA.IDENTIFIED BUT NOT ADDRESSED:1. TRANSPORTATION - BEYOND THE SCOPE OF RESOURCES2. DENTAL - RESOURCES EXIST IN REGION3. SMOKING - BEING ADDRESSED BY OTHERS4. HOUSING - BEYOND THE SCOPE OF RESOURCES |
| THEDACARE MEDICAL CENTER - BERLIN, INC. | 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 - BERLIN, INC. | PART V, SECTION B, LINE 15E: CONTRACTED WITH ELIGIBILITY VENDOR (CARDON)TO WORK DIRECTLY WITH THE UNINSURED PATIENT TO ASSIST THEM WITH INSURANCEENROLLMENT AND EDUCATION. |
| THEDACARE MEDICAL CENTER - BERLIN, INC. | PART V, SECTION B, LINE 16J: THE FAP AND APPLICATION WERE AVAILABLE AT HOSPITAL CASHIER OFFICES, ON 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. |
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 DENIEDAPPROPRIATE AND NECESSARY CARE ON THE BASIS OF INCOME. IN RESPONSE TO THISPOLICY, THE CARING HEARTS FINANCIAL ASSISTANCE PROGRAM WAS SET UP TOPROVIDE SHELTER TO THOSE PATIENTS WHO ARE UNABLE TO PAY FOR THEIR MEDICALSERVICES. MEDICAL SERVICE FEES ARE WRITTEN OFF UNDER THE FINANCIALASSISTANCE PROGRAM THAT WOULD OTHERWISE HAVE BEEN SENT TO A COLLECTIONAGENCY. |
| PART I, LINE 7: | THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS IN THE TABLE IS ACOMBINATION OF AVERAGE COSTS AND ACTUAL COSTS PERTAINING TO SUPPLIES,WAGES, AND BENEFITS. FOR SUPPLIES, THE ACTUAL COST OF ITEMS USED FOR EACHEVENT IS APPLIED. IF NO ACTUAL COST IS AVAILABLE, WE THEN USE AN ESTIMATE.WAGES ARE CALCULATED BY MULTIPLYING THE AVERAGE WAGE RATE TIMES ACTUALHOURS WORKED. THE BENEFIT RATE USED INCLUDES A FRINGE RATIO OF ALLBENEFITS RELATED TO THE ABOVE WAGE CALCULATION. THE COST ACCOUNTING SYSTEMDOES 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 $ 3,384,037. |
| 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 THE LOCAL CHAMBER OF COMMERCE AND 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 YOUR 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. |
| 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-BERLIN SERVICE AREA CONSISTS OF GREEN LAKE COUNTY AND MARQUETTE COUNTIES, POPULATION IS ABOUT 35,000 COMBINED AND IS LOCATED IN EAST-CENTRAL WISCONSIN. GREEN LAKE COUNTY:- GREEN LAKE COUNTY IS AMONG WISCONSIN'S SLOWER GROWING COUNTIES. - GREEN LAKE COUNTY GRADUATION RATE IS 92%.- GREEN LAKE'S UNEMPLOYMENT RATE IS SIGNIFICANTLY HIGHER THAN THE STATE. THE TOP EMPLOYERS IN GREEN LAKE COUNTY ARE IN HEALTH, EDUCATION AND MANUFACTURING. - SEVENTEEN PERCENT OF GREEN LAKE COUNTY CHILDREN LIVE BELOW 100% OF THE FEDERAL POVERTY LEVEL, 9% ARE UNINSURED.- THE LARGEST MINORITY POPULATION IS HISPANIC/LATINO AT 4.9%. NATIVE AMERICANS ACCOUNT FOR APPROXIMATELY 0.6% OF THE POPULATION AND AFRICAN-AMERICANS 7%. MARQUETTE COUNTY:- MARQUETTE COUNTY IS AMONG WISCONSIN'S SLOWEST GROWING COUNTIES. - MARQUETTE COUNTY GRADUATION RATE IS 85%.- MARQUETTE'S UNEMPLOYMENT RATE IS 5.2%. THE TOP EMPLOYERS IN GREEN LAKE COUNTY ARE IN HEALTH, EDUCATION AND MANUFACTURING. - NINETEENY PERCENT OF MARQUETTE COUNTY CHILDREN LIVE BELOW 100% OF THE FEDERAL POVERTY LEVEL, 8% ARE UNINSURED.- THE LARGEST MINORITY POPULATION IS HISPANIC/LATINO AT 3.1%. NATIVE AMERICANS ACCOUNT FOR APPROXIMATELY 0.4 % OF THE POPULATION AND AFRICAN-AMERICANS ACCOUNT FOR APPROXIMATELY 0.5%. |
| PART VI, LINE 5: | EACH YEAR, THEDACARE MEDICAL CENTER-BERLIN'S PARENT ORGANIZATION THEDACARE, SETS ASIDE A PERCENTAGE OF EXCESS NET BUDGETED INCOME TO FUND AN EFFORT CALLED CHAT (COMMUNITY HEALTH ACTION TEAM). CHAT IS A GROUP OF LOCAL 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. THROUGH CHAT, SUCH EFFORTS AS THE SHAWANO COUNTY RURAL HEALTH INITIATIVE HAVE BEEN DEVELOPED. THIS INITIATIVE TAKES BASIC HEALTH CARE AND SCREENING SERVICES TO THE FARM. EACH YEAR HUNDREDS OF FARM FAMILIES LIVING WITHOUT INSURANCE OR ONLY CATASTROPHIC COVERAGE RECEIVE CRITICAL ASSISTANCE. THIS INITIATIVE HAS NOW SPREAD TO OUTAGAMIE, WINNEBAGO AND WAUPACA COUNTIES THEDACARE PROVIDES FUNDING AND STAFF SUPPORT TO MAKE CHAT AND THESE COMMUNITY HEALTH EFFORTS POSSIBLE. A CHAT WAS IMPLEMENTED IN BERLIN IN AUGUST 2016. |
| 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 I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF BERLIN | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 108 N CAPRON STREET | AddressLine1Txt |
| City | BERLIN | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54923 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 396005398 | RecipientEIN |
| IRC Section | CITY OF BERLIN | IRCSectionDesc |
| Cash Grant | $302,958 | CashGrantAmt |
| Purpose Of Grant | AMBULANCE | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | 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 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. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Pmts | Yes (X) | IdemnificationGrossUpPmtsInd |
| 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 | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | Yes (1) | InitialContractExceptionInd |
| Rebuttable Presumption Proc | 0 | RebuttablePresumptionProcInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (19 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CRAIG BATLEY MD | ||||||||||||||
| SECRETARY / PHYSICIAN | $0 | $407,862 | $0 | $21,128 | $0 | $0 | $0 | $8,250 | $0 | $25,052 | $0 | $462,292 | $0 | $0 |
| TAMMY BENDING | ||||||||||||||
| BOARD MEMBER / VP OF CAH OPERATIONS | $100,563 | $100,563 | $4,714 | $4,714 | $18,895 | $18,895 | $3,156 | $3,156 | $4,548 | $4,548 | $131,876 | $131,876 | $0 | $0 |
| DAVID BUDDE DO | ||||||||||||||
| BOARD MEMBER / PHYSICIAN | $0 | $440,548 | $0 | $14,628 | $0 | $0 | $0 | $8,250 | $0 | $22,226 | $0 | $485,652 | $0 | $0 |
| JARED KOHLENBERG DO | ||||||||||||||
| BOARD MEMBER / PHYSICIAN | $0 | $471,507 | $0 | $18,128 | $0 | $0 | $0 | $8,250 | $0 | $21,964 | $0 | $519,849 | $0 | $0 |
| JENNIFER REDMAN-SCHELL | ||||||||||||||
| BOARD MEMBER/SR VP, CLIN INTEG NTWRK | $13,947 | $264,992 | $890 | $16,909 | $3,820 | $72,582 | $413 | $7,838 | $1,147 | $21,802 | $20,217 | $384,123 | $0 | $0 |
| MARK THOMPSON | ||||||||||||||
| BOARD MEMBER / SR VP, CFO & COO - SY | $55,688 | $501,192 | $144 | $1,294 | $2,605 | $23,448 | $905 | $8,142 | $2,255 | $20,293 | $61,597 | $554,369 | $0 | $0 |
| IMRAN ANDRABI MD | ||||||||||||||
| PRESIDENT & CEO - SYSTEM | $92,048 | $828,429 | $13,597 | $122,371 | $186 | $1,677 | $825 | $7,425 | $2,539 | $22,852 | $109,195 | $982,754 | $0 | $0 |
| TIM OLSON | ||||||||||||||
| CFO - CLINICALLY INTEGRATED NETWORK | $22,345 | $201,104 | $13 | $115 | $8,543 | $76,886 | $680 | $6,124 | $1,292 | $11,631 | $32,873 | $295,860 | $0 | $0 |
| VICTORIA BARNTHOUSE | ||||||||||||||
| CNO | $30,687 | $276,186 | $0 | $0 | $2,155 | $19,399 | $825 | $7,425 | $1,070 | $9,634 | $34,737 | $312,644 | $0 | $0 |
| JAMES ALBIN | ||||||||||||||
| CIO | $35,099 | $315,890 | $1,865 | $16,785 | $475 | $4,277 | $825 | $7,425 | $2,337 | $21,030 | $40,601 | $365,407 | $0 | $0 |
| MAGGIE LUND | ||||||||||||||
| CHRO | $24,503 | $220,523 | $3,214 | $28,923 | $2,478 | $22,298 | $761 | $6,846 | $712 | $6,405 | $31,668 | $284,995 | $0 | $0 |
| BRIAN STERNS | ||||||||||||||
| CHIEF OF STAFF | $15,633 | $140,694 | $0 | $0 | $776 | $6,980 | $371 | $3,342 | $2,179 | $19,610 | $18,959 | $170,626 | $0 | $0 |
| WILLIAM MANN | ||||||||||||||
| SENIOR VP, STRATEGY | $39,646 | $356,815 | $1,983 | $17,845 | $6,803 | $61,230 | $825 | $7,425 | $1,087 | $9,787 | $50,344 | $453,102 | $0 | $0 |
| AMANDA HEIN MD | ||||||||||||||
| PHYSICIAN | $452,494 | $0 | $23,128 | $0 | $24,592 | $0 | $8,010 | $0 | $26,790 | $0 | $535,014 | $0 | $0 | $0 |
| HORACE LO MD | ||||||||||||||
| PHYSICIAN | $571,027 | $0 | $156,204 | $0 | $33,048 | $0 | $8,250 | $0 | $27,949 | $0 | $796,478 | $0 | $0 | $0 |
| DARREN NELSON MD | ||||||||||||||
| PHYSICIAN | $416,421 | $0 | $18,878 | $0 | $20,658 | $0 | $8,250 | $0 | $22,013 | $0 | $486,220 | $0 | $0 | $0 |
| DANIEL RESOP MD | ||||||||||||||
| PHYSICIAN | $413,777 | $0 | $121 | $0 | $28,865 | $0 | $11,297 | $0 | $26,169 | $0 | $480,229 | $0 | $0 | $0 |
| GREGORY LONG MD | ||||||||||||||
| FORMER BOARD MEMBER / PHYSICIAN | $299 | $2,695 | $13 | $115 | $55,070 | $495,626 | $103 | $931 | $2,394 | $21,549 | $57,879 | $520,916 | $0 | $0 |
| MAUREEN PISTONE | ||||||||||||||
| FORMER KEY EMPLOYEE | -$155 | -$1,396 | $13 | $115 | $37,332 | $335,989 | $0 | $0 | $683 | $6,143 | $37,873 | $340,851 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | ALL EXECUTIVES AT THE LEVEL OF VICE PRESIDENT OR ABOVE RECEIVE REIMBURSEMENT FOR PERSONAL MEDICAL EXPENSES AT A MAXIMUM AMOUNT OF $6,800, THAT IS TAXED UPON REIMBURSEMENT. 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 8 | 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, 2018 TO DECEMBER 31, 2018) TO RECEIVE A 2019 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 III, LINE 2 | ON JUNE 13, 2018, THEDACARE FINALIZED THE ACQUISITION OF THE ASSETS OF THE PHYSICIAN GROUP FOX VALLEY HEMATOLOGY & ONCOLOGY. THE ACQUISITION EXPANDS ACCESS TO ONCOLOGY EXCELLENCE FOR THE PATIENTS IN THE COMMUNITIES WHERE THEY LIVE AND WORK INCLUDING APPLETON, NEENAH AND OSHKOSH, AND ESPECIALLY IN THE RURAL AREAS INCLUDING BERLIN, SHAWANO, NEW LONDON AND WAUPACA WHERE THEDACARE IS NOW OFFERING CANCER CARE MULTIPLE DAYS PER WEEK. |
| 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 - BERLIN, INC. |
| FORM 990, PART VI, SECTION A, LINE 6 | THEDACARE MEDICAL CENTER - BERLIN, 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. MERGE, CONSOLIDATE, OR CHANGE CONTROL OF THE ORGANIZATION; 2. SELL, LEASE, TRANSFER, OR DISPOSE OF MATERIAL ASSETS; 3. ENTER JOINT VENTURES OR AFFILIATIONS; 4. AMEND BYLAWS AND ARTICLES OF INCORPORATION; 5. DEVELOP AND APPROVE CAPITAL AND OPERATING BUDGETS; 6. AUTHORIZE AND MAKE CAPITAL EXPENDITURES; 7. APPROVE STRATEGIC PLANS, WITH MANAGEMENT AND BOARD OVERSIGHT; 8. APPROVE THE SAFETY AND QUALITY PLAN; 9. APPROVE THE DISSOLUTION OR LIQUIDATION; 10. APPOINT AUDITORS AND LEGAL COUNSEL; AND 11. RETAIN INVESTMENT ADVISORS AND ESTABLISH INVESTMENT POLICIES. |
| 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 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, 2018 AND JANUARY, 2019. |
| FORM 990, PART VI, SECTION C, LINE 19 | THEDACARE MEDICAL CENTER - BERLIN, INC. DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND INTERNAL FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. |
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 | 390871113 | 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 - WILD ROSE INC | |||||||||||
| PO BOX 8025 | APPLETON | WI | 549128025 | 396089134 | 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 |
| 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 | 0 | 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 |