THEDACARE MEDICAL CENTER-BERLIN INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- THEDACARE MEDICAL CENTER-BERLIN INC (EIN 39-0806359)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-11-12
- IRS object ID
- 201813169349302866
- Schema version
- 2017v2.3
- 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 | 2018-11-12T11:33:04-06:00 | ReturnTs |
| Tax Period End | 2017-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 12237 | AddressLine1Txt |
| City | GREEN BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 543072237 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-01-01 | 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 | 225 MEMORIAL DR | AddressLine1Txt |
| City | BERLIN | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54923 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MARK THOMPSON | PersonNm |
| Person Title | CFO & COO | PersonTitleTxt |
| Phone | 9203611313 | PhoneNum |
| Signature | 2018-10-22 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | TERRI REXRODE CPA MST | PreparerPersonNm |
| PTIN | P00096513 | PTIN |
| Phone | 9206620016 | PhoneNum |
| Preparation | 2018-10-22 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 74.87.127.216 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-10-22 | IPDt |
| IP Tm | 15:43:35 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | A43ECD1EE6AF4781A69F6BFA161A98BDE8FA2C07 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MARK THOMPSON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 MEMORIAL DR | AddressLine1Txt |
| City | BERLIN | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54923 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $61,238,909 | 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 | 56 | TotalVolunteersCnt |
| Total Gross UBI | $872,121 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$40,747 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $25,664 | PYContributionsGrantsAmt |
| CY Contributions Grants | $32,224 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $62,589,416 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $60,830,860 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$4,935 | PYInvestmentIncomeAmt |
| CY Investment Income | $237,344 | CYInvestmentIncomeAmt |
| PY Other Revenue | $119,714 | PYOtherRevenueAmt |
| CY Other Revenue | $138,481 | CYOtherRevenueAmt |
| PY Total Revenue | $62,729,859 | PYTotalRevenueAmt |
| CY Total Revenue | $61,238,909 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $183,203 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $67,444 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $32,803,057 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $28,249,788 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $28,026,872 | PYOtherExpensesAmt |
| CY Other Expenses | $24,350,195 | CYOtherExpensesAmt |
| PY Total Expenses | $61,013,132 | PYTotalExpensesAmt |
| CY Total Expenses | $52,667,427 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,716,727 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $8,571,482 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $41,918,485 | TotalAssetsBOYAmt |
| Total Assets EOY | $38,359,780 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $12,935,835 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $805,648 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $28,982,650 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $37,554,132 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE THE HIGHEST QUALITY HEALTH CARE, DELIVERED IN THE MOST EFFICIENT AND COST-EFFECTIVE WAYS, AND ACCESSIBLE TO ALL MEMBERS OF THE COMMUNITY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $50,216,960 | ExpenseAmt |
| Grant | $67,444 | GrantAmt |
| Revenue | $59,854,309 | 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. THEDACARE REGIONAL 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 14,700 UNIQUE PATIENTS ACCOUNT FOR MORE THAN 45,000 VISITS ANNUALLY.IN ADDITON, WE OFFER CONVENIENT WALK-IN CARE, AND EVISITS 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. THDACARE 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 3,477 WITH 219 ADDITIONAL DAYS FOR NEWBORN CARE. THE UNREIMBURSED COST OF MEDICARE WAS APPROXIMATELY $29,078. THE COST OF CHARITY CARE PROVIDED DURING 2017 WAS APPROXIMATELY $226,998. | Desc |
| Total Program Service Expenses | $50,216,960 | 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 | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 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 | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| 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 | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | 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 | KRISTEN COGSWELL | PersonNm |
| Phone | 9207386471 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 122 EAST COLLEGE AVENUE | AddressLine1Txt |
| City | APPLETON | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54911 | 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 |
|---|---|---|---|---|---|---|---|---|---|---|
| KUEHN RUSSELL | ||||||||||
| BOARD CHAIR | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| KUJAWA PAUL | ||||||||||
| VICE CHAIR | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| BATLEY CRAIG MD | ||||||||||
| SECRETARY/PHYSICIAN | 41.00 | 0.00 | Yes (X) | Yes (X) | $493,796 | $0 | $33,937 | |||
| WISE LARRY | ||||||||||
| TREASURER | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| BENDING TAMMY | ||||||||||
| BOARD MEMBER/VP OF CAH OPERATIONS | 41.00 | 1.00 | Yes (X) | Yes (X) | $181,672 | $0 | $15,555 | |||
| BUDDE DAVID DO | ||||||||||
| BOARD MEMBER/PHYSICIAN | 41.00 | 0.00 | Yes (X) | $526,044 | $0 | $31,320 | ||||
| DUFFY JAYSON | ||||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| HOSTAK JOLENE | ||||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| LONGGREGORY MD | ||||||||||
| BOARD MEMBER/PHYSICIAN | 5.00 | 36.00 | Yes (X) | $58,979 | $530,809 | $33,161 | ||||
| REDMAN-SCHELLJENNIFER | ||||||||||
| BOARD MEMBER/VP SR PHYS, BEHAV, TRANS | 3.00 | 38.00 | Yes (X) | $18,146 | $344,777 | $38,719 | ||||
| SHATTUCK P MICHAEL MD | ||||||||||
| BOARD MEMBER/CHIEF OF STAFF | 41.00 | 0.00 | Yes (X) | $249,110 | $0 | $29,214 | ||||
| WHITE KELLY DDS | ||||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| ANDRABI IMRAN MD | ||||||||||
| PRESIDENT AND CEO - SYSTEM | 4.00 | 39.00 | Yes (X) | $61,065 | $549,582 | $14,340 | ||||
| THOMPSON MARK | ||||||||||
| CFO & COO - SYSTEM | 4.00 | 36.00 | Yes (X) | $26,286 | $236,565 | $4,928 | ||||
| GRUNER DEAN | ||||||||||
| FORMER PRESIDENT AND CEO | 4.00 | 39.00 | Yes (X) | $82,012 | $738,103 | $21,472 | ||||
| OLSON TIM | ||||||||||
| FORMER CFO - SYSTEM | 4.00 | 36.00 | Yes (X) | $72,249 | $650,240 | $31,903 | ||||
| AUSLOOS JODI | ||||||||||
| INTERIM CIO | 4.00 | 36.00 | $27,625 | $248,619 | $16,502 | Yes (X) | ||||
| PISTONE MAUREEN | ||||||||||
| VP SR HR SERVICES | 4.00 | 36.00 | $42,720 | $384,476 | $30,869 | Yes (X) | ||||
| REED LAURA | ||||||||||
| FORMER COO/CHIEF NURSING EXEC | 4.00 | 37.00 | $27,727 | $249,541 | $22,139 | Yes (X) | ||||
| MANN WILLIAM | ||||||||||
| VP SR STRATEGY | 4.00 | 36.00 | $47,758 | $429,825 | $18,883 | Yes (X) | ||||
| NEWGENT ERIC DO | ||||||||||
| PHYSICIAN | 40.00 | 0.00 | $417,834 | $0 | $34,545 | Yes (X) | ||||
| NELSON DARREN MD | ||||||||||
| PHYSICIAN | 40.00 | 0.00 | $434,560 | $0 | $31,582 | Yes (X) | ||||
| LO HORACE MD | ||||||||||
| PHYSICIAN | 40.00 | 0.00 | $530,857 | $0 | $37,291 | Yes (X) | ||||
| RESOP DANIEL MD | ||||||||||
| PHYSICIAN | 40.00 | 0.00 | $405,165 | $0 | $38,651 | Yes (X) | ||||
| FEENEY JOHN | ||||||||||
| FORMER BOARD MEMBER AND CEO | 0.00 | 0.00 | $250,030 | $0 | $22,383 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,953,635 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $4,362,537 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $507,394 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 27 | 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 | $765,430 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $31,670 | RelatedOrganizationsAmt |
| All Other Contributions | $554 | AllOtherContributionsAmt |
| Total Contributions | $32,224 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|---|
| OUTPATIENT SERVICE REVENUE | 624100 | $39,377,063 | $39,377,063 | ||
| INPATIENT SERVICE REVENUE | 624100 | $20,477,246 | $20,477,246 | ||
| PHARMACY | 446110 | $872,121 | $872,121 | ||
| CAFETERIA REVENUE | 900099 | $104,430 | $104,430 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $60,830,860 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,643 | TotalRevenueColumnAmt |
| Exclusion | $4,643 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $138,481 | 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 | $138,481 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $138,481 | TotalRevenueColumnAmt |
| Exclusion | $138,481 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $232,701 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $232,701 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $232,701 | TotalRevenueColumnAmt |
| Exclusion | $232,701 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $61,238,909 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $59,854,309 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $872,121 | UnrelatedBusinessRevenueAmt |
| Exclusion | $480,255 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $67,444 | TotalAmt |
| Program Services | $67,444 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,009,207 | TotalAmt |
| Program Services | $1,167,474 | ProgramServicesAmt |
| Management And General | $841,733 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,778,871 | TotalAmt |
| Program Services | $19,070,510 | ProgramServicesAmt |
| Management And General | $708,361 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $613,068 | TotalAmt |
| Program Services | $613,068 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,493,503 | TotalAmt |
| Program Services | $4,190,700 | ProgramServicesAmt |
| Management And General | $302,803 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,355,139 | TotalAmt |
| Program Services | $1,355,139 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,096,428 | TotalAmt |
| Program Services | $4,557,300 | ProgramServicesAmt |
| Management And General | $539,128 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,707 | TotalAmt |
| Program Services | $36,707 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $425,750 | TotalAmt |
| Program Services | $373,192 | ProgramServicesAmt |
| Management And General | $52,558 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,171,281 | TotalAmt |
| Program Services | $2,165,397 | ProgramServicesAmt |
| Management And General | $5,884 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $97,713 | TotalAmt |
| Program Services | $97,713 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $102,727 | TotalAmt |
| Program Services | $102,727 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $182,970 | TotalAmt |
| Program Services | $182,970 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,294,441 | TotalAmt |
| Program Services | $4,294,441 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $218,303 | TotalAmt |
| Program Services | $218,303 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| CLINIC & PATIENT SERVIC | $9,184,539 | $9,184,539 |
| PROVISION FOR BAD DEBTS | $1,413,547 | $1,413,547 |
| EQUIPMENT RENTAL AND MA | $1,125,789 | $1,125,789 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,667,427 | TotalAmt |
| Program Services | $50,216,960 | ProgramServicesAmt |
| Management And General | $2,450,467 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $394,789 | BOYAmt |
| EOY | $68,907 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,707,196 | BOYAmt |
| EOY | $9,745,347 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $676,755 | BOYAmt |
| EOY | $343,333 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,722,434 | BOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $68,782,440 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $43,678,227 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,417,311 | BOYAmt |
| EOY | $25,104,213 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $3,097,980 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,918,485 | BOYAmt |
| EOY | $38,359,780 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,935,835 | BOYAmt |
| EOY | $805,648 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,935,835 | BOYAmt |
| EOY | $805,648 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,982,650 | BOYAmt |
| EOY | $37,554,132 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,982,650 | BOYAmt |
| EOY | $37,554,132 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,918,485 | BOYAmt |
| EOY | $38,359,780 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $8,571,482 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| 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
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 | $5,163 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $5,163 | 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. THE AMOUNT FOR 2017 22.98% OF $22,469 WHICH IS $5,163. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $843,214 | OtherCostOrOtherBasisAmt |
| Book Value | $843,214 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $37,661,099 | OtherCostOrOtherBasisAmt |
| Depreciation | $20,541,177 | DepreciationAmt |
| Book Value | $17,119,922 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,280,479 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,140,743 | DepreciationAmt |
| Book Value | $139,736 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $28,997,648 | OtherCostOrOtherBasisAmt |
| Depreciation | $21,996,307 | DepreciationAmt |
| Book Value | $7,001,341 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $25,104,213 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER ASSETS | Desc |
| Book Value | $3,097,980 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $3,097,980 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DEFERRED EMPLOYEE BENEFITS | Desc |
| Amt | $805,648 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $805,648 | TotalLiabilityAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent350 | Yes (X) | Percent350Ind |
| 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 | 264 | PersonsServedCnt |
| Total Community Benefit Expns | $226,998 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $226,998 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00440 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 6429 | PersonsServedCnt |
| Total Community Benefit Expns | $7,075,656 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,661,735 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 6693 | PersonsServedCnt |
| Total Community Benefit Expns | $7,302,654 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,661,735 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $226,998 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00440 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 19 | ActivitiesOrProgramsCnt |
| Persons Served | 74251 | PersonsServedCnt |
| Total Community Benefit Expns | $214,486 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $214,486 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00420 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 5524 | PersonsServedCnt |
| Total Community Benefit Expns | $155,962 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $155,962 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00300 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 110 | PersonsServedCnt |
| Total Community Benefit Expns | $1,654,687 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,654,687 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03230 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 58033 | PersonsServedCnt |
| Total Community Benefit Expns | $451,864 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $451,864 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00880 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 26 | ActivitiesOrProgramsCnt |
| Persons Served | 137918 | PersonsServedCnt |
| Total Community Benefit Expns | $2,476,999 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,476,999 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04830 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 26 | ActivitiesOrProgramsCnt |
| Persons Served | 144611 | PersonsServedCnt |
| Total Community Benefit Expns | $9,779,653 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,661,735 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,703,997 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05270 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 29223 | PersonsServedCnt |
| Total Community Benefit Expns | $1,360 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,360 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 121 | PersonsServedCnt |
| Total Community Benefit Expns | $6,214 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,214 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 8 | PersonsServedCnt |
| Total Community Benefit Expns | $66 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $66 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 29352 | PersonsServedCnt |
| Total Community Benefit Expns | $7,640 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $7,640 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $522,443 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $234,352 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $9,950,146 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $9,979,224 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$29,078 | 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 INC | 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 | HTTPS://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 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 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 | 350.000000000000 | 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 |
| 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: HOSPITAL FACILITY WEBSITE: HTTPS://WWW.THEDACARE.ORG/FULL CHNA & IMPLEMENTATION STRATEGY WEBSITE: HTTPS://WWW.THEDACARE.ORG/GETTING-INVOLVED/IMPROVING-COMMUNITY-HEALTH |
| THEDACARE MEDICAL CENTER - BERLIN, INC. | PART V, SECTION B, LINE 11: THE THEDACARE COMMUNITY HEALTH IMPLEMENTATION STRATEGY WAS APPROVED BY THE THEDACARE MEDICAL CENTER-BERLIN BOARD OF DIRECTORS IN OCTOBER 2016 AND THE THEDACARE BOARD OF TRUSTEES IN DECEMBER OF 2016.- THEDACARE PARTNERS WITH ASCENSION HEALTH SYSTEM TO SPONSOR MOSAIC FAMILY HEALTH RESIDENCY PROGRAM PROVIDING HANDS ON EXPERIENCE FOR MEDICAL STUDENTS AND ACCESS TO PRIMARY CARE AND MENTAL HEALTH SERVICES.- 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.- THEDACARE HOSPITALS PROVIDE FINANCIAL AS WELL AS DIAGNOSTIC AND LAB SUPPORT TO TWO AREA FQHC CLINICS PROVIDING MEDICAL, BEHAVIORAL AND DENTAL CARE TO THE UNDERSERVED IN OUR SERVICE AREA.OBESITY:- PROVIDED FUNDING TO LOCAL FARMER'S MARKETS.- PARTNERED WITH THE LOCAL BOYS AND GIRLS CLUB TO EDUCATE CHILDREN ABOUT EATING HEALTHY AND THE BENEFITS OF BEING ACTIVE.- HOSTED GOOD TO GO TC EMPLOYEE VOLUNTEERISM EVENT IN SCHOOL FOR 1 WEEK. BUILT SCHOOL GARDEN, EDUCATED ON FATS IN FOODS AND SUGARY BEVERAGES, LEAD GYM CLASSES.MENTAL HEALTH/AODA:- THEDACARE PROVIDES LEADERSHIP AND FINANCIAL SUPPORT FOR CATALPA HEALTH, DEDICATED TO PEDIATRIC MENTAL HEALTH SERVICES THROUGHOUT NORTHEAST WISCONSIN. - PROVIDES LEADERSHIP AND FUNDING FOR PARTNERSHIP COMMUNITY HEALTH CENTER FQHC WORKING TO IMPROVE THE HEALTH STATUS OF THE MEDICALLY UNDERSERVED BY PROVIDING COMPREHENSIVE PRIMARY CARE SERVICES.- PROVIDED OVER $900,000 IN SUBSIDIZED MENTAL HEALTH SERVICES THROUGHOUT ENTIRE TC SERVICE AREA. - OPIOID ABUSE PREVENTION: INTERNAL TEAMS ARE WORKING TO ADDRESS PAIN MANAGEMENT AGREEMENTS, PAIN ASSESSMENT STANDARDIZATION, PRESCRIPTION PATHWAYS, USE OF EPDMP, OPIOID RISK TOOL USE, USE OF EPDMP ANALGEIA, MAT AND EPDMP ANALGESIA. EARLY CHILDHOOD/YOUTH- REACH OUT AND READ: THEDACARE COMMITTED TO PROVIDING EVIDENCE-BASED REACH OUT AND READ EARLY CHILDHOOD READING PROGRAM IN ALL CLINICS BY 2019. - HOSTED "KIDS IN CRISIS" PLUNGE IN MARCH 2017, 60+ ATTENDEES. BERLIN BOYS & GIRLS CLUB LAUNCH MENTORING PROGRAM TO WHICH TC PROVIDED $15,000/YEAR FOR 3 YEARS. 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. HOPE TO REPLICATE THROUGHOUT 3 COUNTY AREA. IDENTIFIED BUT NOT ADDRESSED:- TRANSPORTATION: BEYOND THE SCOPE OF RESOURCES- DENTAL: RESOURCES EXIST IN REGION- SMOKING: BEING ADDRESSED BY OTHERS- HOUSING: BEYOND THE SCOPE OF RESOURCES |
| 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 INSURANCE ENROLLMENT 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. |
| PART V, LINE 13 | 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. |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | IT IS THE ORGANIZATION'S POLICY THAT NO PATIENT SHOULD BE DENIED APPROPRIATE AND NECESSARY CARE ON THE BASIS OF INCOME. IN RESPONSE TO THIS POLICY, THE CARING HEARTS FINANCIAL ASSISTANCE PROGRAM WAS SET UP TO PROVIDE SHELTER TO THOSE PATIENTS WHO ARE UNABLE TO PAY FOR THEIR MEDICAL SERVICES. MEDICAL SERVICE FEES ARE WRITTEN OFF UNDER THE FINANCIAL ASSISTANCE PROGRAM THAT WOULD OTHERWISE HAVE BEEN SENT TO A COLLECTION AGENCY. |
| PART I, LINE 7: | THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS IN THE TABLE IS A COMBINATION OF AVERAGE COSTS AND ACTUAL COSTS PERTAINING TO SUPPLIES, WAGES, AND BENEFITS. FOR SUPPLIES, THE ACTUAL COST OF ITEMS USED FOR EACH EVENT IS APPLIED. IF NO ACTUAL COST IS AVAILABLE, WE THEN USE AN ESTIMATE. WAGES ARE CALCULATED BY MULTIPLYING THE AVERAGE WAGE RATE TIMES ACTUAL HOURS WORKED. THE BENEFIT RATE USED INCLUDES A FRINGE RATIO OF ALL BENEFITS RELATED TO THE ABOVE WAGE CALCULATION. THE COST ACCOUNTING SYSTEM DOES NOT DIFFERENTIATE BETWEEN DIFFERENT PAYER TYPES AND NO COST-TO-CHARGE RATIO IS USED. |
| PART I, LINE 7G: | NO PHYSICIAN CLINICS ARE INCLUDED IN SUBSIDIZED HEALTH SERVICES. |
| PART I, LN 7 COL(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 $1,413,547. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | ECONOMIC DEVELOPMENT: THE PRIMARY AIM OF THE CHAMBER IS TO PROTECT THE INTEREST OF THE BUSINESS COMMUNITY AS A WHOLE. STRONG EMPLOYMENT IS A SOCIAL DETERMINANT OF HEALTH, REDUCING POVERTY AND PROVIDING INDIVIDUAL AND FAMILY SUSTAINABILITY. THEDACARE WORKS TOGETHER WITH LOCAL CHAMBER OF COMMERCE AND ALL OF THE COMMUNITIES IT SERVES. |
| PART III, LINE 4: | A COST-TO-CHARGE RATIO WAS USED TO DETERMINE THE AMOUNTS REPORTED IN PART III LINES 2 AND 3. PATIENT PAYMENTS OR DISCOUNTS ARE APPLIED PRIOR TO DETERMINING BAD DEBT EXPENSE AND ARE NOT INCLUDED IN THE BAD DEBT WRITE-OFF REPORTED ON THE AUDITED FINANCIAL STATEMENTS. DEDUCTIBLES AND COINSURANCE AMOUNTS THAT ARE DEEMED UNCOLLECTIBLE ARE WRITTEN OFF EITHER TO BAD DEBT EXPENSE OR, IF APPLICABLE, TO CHARITY CARE IF THE PATIENT SO QUALIFIES FOR FINANCIAL ASSISTANCE. THE FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE BUT THEY ACCOUNT FOR BAD DEBTS BASED ON GROSS CHARGES TO PATIENTS AFTER REFLECTING ANY PAYMENTS OR DISCOUNTS, OR AMOUNTS DETERMINED TO BE ELIGIBLE FOR CHARITY CARE/FINANCIAL ASSISTANCE. |
| 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: | TO STAY GROUNDED IN THE NEEDS OF THE COMMUNITY IN THE TIMEFRAME BETWEEN OFFICIAL CHNA'S EVERY THREE YEARS, THEDACARE EMPLOYS SEVERAL STRATEGIES:1. COMMUNITY HEALTH ACTION TEAMS (CHAT TEAMS) - THEDACARE ORGANIZES AND LEADS CHAT TEAMS IN EACH HOSPITAL COMMUNITY. CHAT TEAMS ARE COMPRISED OF LEADERS FROM ALL SECTORS, INCLUDING EDUCATION, NON-PROFITS, BUSINESS, GOVERNMENT, HEALTHCARE, AND FAITH ORGANIZATIONS. THESE CHAT TEAMS MEET REGULARLY AND STAY ON TOP OF EMERGING TRENDS IN THE HEALTH OF THE COMMUNITY. 2. PUBLIC HEALTH RELATIONSHIPS THEDACARE COMMUNITY HEALTH STAFF MEET REGULARLY WITH PUBLIC HEALTH LEADERS IN EACH HOSPITAL MARKET. THE PUBLIC HEALTH OFFICIALS ALSO HAVE A THOROUGH UNDERSTANDING OF EMERGING HEALTH NEEDS AND WORK IN PARTNERSHIP WITH THEDACARE.3. IN COMMUNITIES THAT HAVE A UNITED WAY PRESENCE, THEDACARE MEETS REGULARLY WITH UNITED WAY OFFICIALS TO ALSO STAY ON TOP OF EMERGING NEEDS. THE NEEDS IDENTIFIED ABOVE ARE INCLUDED AS INPUTS TO THE ANNUAL STRATEGIC PLANNING WORK OF THE HEALTH SYSTEM. |
| 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 93%.- GREEN LAKE'S UNEMPLOYMENT RATE IS SIGNIFICANTLY HIGHER THAN THE STATE. THE TOP EMPLOYERS IN GREEN LAKE COUNTY ARE IN HEALTH, EDUCATION AND MANUFACTURING. - NINETEEN PERCENT OF GREEN LAKE COUNTY LIVES BELOW 100% OF THE FEDERAL POVERTY LEVEL, 10% ARE UNINSURED.- THE LARGEST MINORITY POPULATION IS HISPANIC/LATINO AT 4.9%. NATIVE AMERICANS ACCOUNT FOR APPROXIMATELY .6% OF THE POPULATION AND AFRICAN-AMERICANS 7%. MARQUETTE COUNTY:- MARQUETTE COUNTY IS AMONG WISCONSIN'S SLOWEST GROWING COUNTIES. - MARQUETTE COUNTY GRADUATION RATE IS 88%.- MARQUETTE'S UNEMPLOYMENT RATE IS 5.2%. THE TOP EMPLOYERS IN GREEN LAKE COUNTY ARE IN HEALTH, EDUCATION AND MANUFACTURING. - TWENTY PERCENT OF MARQUETTE COUNTY LIVES BELOW 100% OF THE FEDERAL POVERTY LEVEL, 7% ARE UNINSURED.- THE LARGEST MINORITY POPULATION IS HISPANIC/LATINO AT 3.1%. NATIVE AMERICANS ACCOUNT FOR APPROXIMATELY .4 % OF THE POPULATION AND AFRICAN-AMERICANS .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 ST | AddressLine1Txt |
| City | BERLIN | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54923 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 396005398 | RecipientEIN |
| IRC Section | GOVERNMENT | IRCSectionDesc |
| Cash Grant | $61,694 | 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. 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 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 | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BATLEY CRAIG MD | ||||||||||||||
| SECRETARY/PHYSICIAN | $454,121 | $0 | $9,150 | $0 | $30,525 | $0 | $10,100 | $0 | $23,837 | $0 | $527,733 | $0 | $0 | $0 |
| BENDING TAMMY | ||||||||||||||
| BOARD MEMBER/VP OF CAH OPERATIONS | $180,172 | $0 | $150 | $0 | $1,350 | $0 | $5,483 | $0 | $10,072 | $0 | $197,227 | $0 | $0 | $0 |
| BUDDE DAVID DO | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | $481,692 | $0 | $12,650 | $0 | $31,702 | $0 | $10,100 | $0 | $21,220 | $0 | $557,364 | $0 | $0 | $0 |
| LONGGREGORY MD | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | $49,036 | $441,324 | $15 | $135 | $9,928 | $89,350 | $810 | $7,290 | $2,506 | $22,555 | $62,295 | $560,654 | $0 | $0 |
| REDMAN-SCHELLJENNIFER | ||||||||||||||
| BOARD MEMBER/VP SR PHYS, BEHAV, TRAN | $15,802 | $300,235 | $7 | $142 | $2,337 | $44,400 | $405 | $7,695 | $1,531 | $29,088 | $20,082 | $381,560 | $0 | $0 |
| SHATTUCK P MICHAEL MD | ||||||||||||||
| BOARD MEMBER/CHIEF OF STAFF | $230,563 | $0 | $12,650 | $0 | $5,897 | $0 | $8,427 | $0 | $20,787 | $0 | $278,324 | $0 | $0 | $0 |
| ANDRABI IMRAN MD | ||||||||||||||
| PRESIDENT AND CEO - SYSTEM | $43,831 | $394,482 | $17,144 | $154,293 | $90 | $807 | $0 | $0 | $1,434 | $12,906 | $62,499 | $562,488 | $0 | $0 |
| THOMPSON MARK | ||||||||||||||
| CFO & COO - SYSTEM | $8,903 | $80,123 | $17,331 | $155,978 | $52 | $464 | $111 | $996 | $382 | $3,439 | $26,779 | $241,000 | $0 | $0 |
| GRUNER DEAN | ||||||||||||||
| FORMER PRESIDENT AND CEO | $46,701 | $420,307 | $15 | $135 | $35,296 | $317,661 | $609 | $5,480 | $1,538 | $13,845 | $84,159 | $757,428 | $0 | $0 |
| OLSON TIM | ||||||||||||||
| FORMER CFO - SYSTEM | $50,525 | $454,722 | $15 | $135 | $21,709 | $195,383 | $810 | $7,290 | $2,380 | $21,423 | $75,439 | $678,953 | $0 | $0 |
| AUSLOOS JODI | ||||||||||||||
| INTERIM CIO | $23,829 | $214,457 | $15 | $135 | $3,781 | $34,027 | $387 | $3,483 | $1,263 | $11,369 | $29,275 | $263,471 | $0 | $0 |
| PISTONE MAUREEN | ||||||||||||||
| VP SR HR SERVICES | $33,415 | $300,731 | $15 | $135 | $9,290 | $83,610 | $810 | $7,290 | $2,277 | $20,492 | $45,807 | $412,258 | $0 | $0 |
| REED LAURA | ||||||||||||||
| FORMER COO/CHIEF NURSING EXEC | $24,736 | $222,620 | $15 | $135 | $2,976 | $26,786 | $724 | $6,517 | $1,490 | $13,408 | $29,941 | $269,466 | $0 | $0 |
| MANN WILLIAM | ||||||||||||||
| VP SR STRATEGY | $39,210 | $352,894 | $15 | $135 | $8,533 | $76,796 | $810 | $7,290 | $1,078 | $9,705 | $49,646 | $446,820 | $0 | $0 |
| NEWGENT ERIC DO | ||||||||||||||
| PHYSICIAN | $368,859 | $0 | $20,150 | $0 | $28,825 | $0 | $10,100 | $0 | $24,445 | $0 | $452,379 | $0 | $0 | $0 |
| NELSON DARREN MD | ||||||||||||||
| PHYSICIAN | $423,171 | $0 | $150 | $0 | $11,239 | $0 | $10,100 | $0 | $21,482 | $0 | $466,142 | $0 | $0 | $0 |
| LO HORACE MD | ||||||||||||||
| PHYSICIAN | $469,351 | $0 | $12,043 | $0 | $49,463 | $0 | $10,100 | $0 | $27,191 | $0 | $568,148 | $0 | $0 | $0 |
| RESOP DANIEL MD | ||||||||||||||
| PHYSICIAN | $401,661 | $0 | $150 | $0 | $3,354 | $0 | $13,302 | $0 | $25,349 | $0 | $443,816 | $0 | $0 | $0 |
| FEENEY JOHN | ||||||||||||||
| FORMER BOARD MEMBER AND CEO | $0 | $0 | $0 | $0 | $250,030 | $0 | $2,000 | $0 | $20,383 | $0 | $272,413 | $0 | $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. ONE EXECUTIVE, NOT PART OF THE SENIOR LEADERSHIP TEAM, RECEIVED REIMBURSEMENT FOR A LOCAL COUNTRY CLUB MEMBERSHIP THAT ENDED 9/1/2017. 11 EMPLOYEES RECEIVED TAXABLE MEDICAL EXPENSE REIMBURSEMENTS AND 1 EMPLOYEE RECEIVED FITNESS CLUB DUES REIMBURSEMENTS. |
| PART I, LINES 4A-B | JOHN FEENEY RECEIVED $255,519 OF SEVERANCE PAY FROM THE ORGANIZATION DURING 2017. 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 KEY EXECUTIVES AND TO ENCOURAGE TOP-LEVEL EXECUTIVES TO WORK TOGETHER AS A COHESIVE GROUP TOWARD COMMON GOALS. THE PRESIDENT OF THEDACARE INC. DEVELOPS A LIST OF SENIOR LEVEL EXECUTIVES WHO ARE ELIGIBLE TO PARTICIPATE IN THIS PLAN, AS WELL AS THE PERFORMANCE LEVELS THE SENIOR EXECUTIVES MUST ACHIEVE AND THE BONUS AMOUNTS THAT THE EXECUTIVE WILL RECEIVE. THE PRESIDENT THEN SUBMITS THIS LIST TO THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES FOR FINAL APPROVAL. THESE EXECUTIVES MUST BE IN ACTIVE REGULAR SERVICE OF THEDACARE INC. FOR THE ENTIRE PLAN YEAR (JANUARY 1, 2016 TO DECEMBER 31, 2016) TO RECEIVE THEIR 2017 BONUSES. IF THE EMPLOYEE RETIRES, BECOMES DISABLED, MOVES TO A POSITION THAT IS NO LONGER ELIGIBLE FOR THE BONUS PLAN OR DIES, THE PLAN WILL BE PRORATED FOR THE AMOUNT OF TIME THEY SERVED THE COMPANY. IF AN ELIGIBLE EMPLOYEE IS FIRED OR LEAVES THE COMPANY FOR ANY OTHER REASON THE PLAN BONUS WILL BE FORFEITED. CARING FOR SUCCESS THE PLAN OBJECTIVES ARE TO PROVIDE INCENTIVE TO FOCUS THE ORGANIZATION'S RESOURCES, ENERGY AND ATTENTION ON THE FUFILLMENT OF THEDACARE'S MISSION. EMPLOYEE ELIGIBILITY IS BASED ON THE NUMBER OF HOURS WORKED. AND ALL ELIGIBLE EMPLOYEES SHARE IN THE PAYOUT. THE PAYOUT AMOUNT IS DETERMINED BASED ON BOTH FINANCIAL AND EMPLOYEE HEALTH AND SAFETY THRESHOLDS. THE AMOUNT PER EMPLOYEE IS DETERMINED BY DIVIDING THE TOTAL GAIN REALIZED (THE EMPLOYEE SHARE) BY HOURS PAID TO ALL ELIGIBLE EMPLOYEES. THE RESULTING DOLLAR UNIT PAYOUT IS MULTIPLIED BY AN INDIVIDUAL EMPLOYEE'S NUMBER OF HOURS PAID. THIS PLAN IS OVERSEEN BY AN ADMINISTRATIVE COMMITTEE. THE THEDACARE BOARD OF TRUSTEES MUST APPROVE THE PLAN. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART I, LINE 5 | THEDACARE INC. CENTRALIZES PAYROLL AND TAX WITHHOLDING FUNCTIONS FOR A NUMBER OF AFFILIATED ENTITIES, WHILE ALL FILING UNDER THEDACARE'S FEDERAL IDENTIFICATION NUMBER. THEDACARE MEDICAL CENTER - BERLIN,INC. (BERLIN) REPORTS "0" EMPLOYEES BECAUSE EMPLOYEES ARE PAID BY THEDACARE, INC., THEREFORE, BERLIN DOES NOT FILE ANY W-2 FORMS. THEDACARE INC. IS REIMBURSED BY BERLIN FOR SALARY EXPENSES FOR THE EMPLOYEES WHO ARE PERMANENTLY ASSIGNED TO BERLIN. |
| FORM 990, PART VI, SECTION A, LINE 2 | RUSSELL KUEHN IS A MEMBER OF THE BOARD OF DIRECTORS OF FORTIFI BANK (FORMERLY KNOWN AS 1ST NATIONAL BANK). |
| FORM 990, PART VI, SECTION A, LINE 6 | THEDACARE MEDICAL CENTER - BERLIN, INC.'S SOLE MEMBER OF THE SINGLE CLASS OF VOTING MEMBERS 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 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 PARTCIPATE IN THE DECISION WHETHER TO ENGAGE IN THE TRANSACTION IN WHICH THE EMPLOYEE HAS AN INTEREST. |
| FORM 990, PART VI, SECTION B, LINE 15 | THEDACARE HIRED AN OUTSIDE CONSULTING FIRM TO CONDUCT A THOROUGH MARKET REVIEW OF EXECUTIVE COMPENSATION EVERY OTHER YEAR. INTERNALLY, A COMPENSATION COMMITTEE REAFFIRMED THE COMPENSATION POLICY, REVIEWED DATA FROM CONSULTANTS, AND WITH INPUT FROM THE SR VP OF HUMAN RESOURCES, ADVISED, VALIDATED, AND APPROVED A RANGE FOR CEO COMPENSATION. THE COMMITTEE ALSO RATIFIED THE BONUS PLAN. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION BELIEVES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE THE PROPERTY OF THE ORGANIZATION AND DOES NOT MAKE THEM AVAILABLE TO THE PUBLIC. |
| FORM 990, PART XI, LINE 2C | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
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 | |||||||||||
| 122 EAST COLLEGE AVENUE | APPLETON | WI | 54911 | 391509362 | HEALTHCARE | WI | 501(C)(3) | LINE 10 | N/A | 0 | |
| THEDACARE REGIONAL MEDICAL CENTER - NEENAH INC | |||||||||||
| PO BOX 8025 | APPLETON | WI | 54912 | 390830664 | HOSPITAL | WI | 501(C)(3) | LINE 3 | Yes (1) | THEDACARE INC | |
| THEDACARE MEDICAL CENTER - NEW LONDON INC | |||||||||||
| 1405 MILL STREET | NEW LONDON | WI | 54961 | 390869788 | HOSPITAL | WI | 501(C)(3) | LINE 3 | Yes (1) | THEDACARE INC | |
| THEDACARE MEDICAL CENTER - WAUPACA INC | |||||||||||
| 800 RIVERSIDE DRIVE | WAUPACA | WI | 54981 | 390871113 | HOSPITAL | WI | 501(C)(3) | LINE 3 | Yes (1) | THEDACARE INC | |
| THEDACARE REGIONAL MEDICAL CENTER - APPLETON INC | |||||||||||
| PO BOX 8025 | APPLETON | WI | 54912 | 390824015 | HOSPITAL | WI | 501(C)(3) | LINE 3 | Yes (1) | THEDACARE INC | |
| THEDACARE MEDICAL CENTER - SHAWANO INC | |||||||||||
| 100 COUNTY ROAD B | SHAWANO | WI | 54166 | 390807068 | HOSPITAL | WI | 501(C)(3) | LINE 3 | Yes (1) | THEDACARE INC | |
| THEDACARE MEDICAL CENTER - WILD ROSE INC | |||||||||||
| PO BOX 243 | WILD ROSE | WI | 54984 | 396089134 | HOSPITAL | WI | 501(C)(3) | LINE 3 | Yes (1) | THEDACARE INC | |
| THEDACARE FAMILY OF FOUNDATIONS INC | |||||||||||
| 1818 NORTH MEADE STREET | APPLETON | WI | 54912 | 464112255 | FOUNDATION | WI | 501(C)(3) | LINE 7 | Yes (1) | THEDACARE INC | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTH APPLETON AMBULATORY CARE CENTER BUILDING COMPANY LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 122 E COLLEGE AVENUE | 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 |