THEDACARE MEDICAL CENTER-WILD ROSE INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- THEDACARE MEDICAL CENTER-WILD ROSE INC (EIN 39-6089134)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-11-02
- IRS object ID
- 201643079349301219
- Schema version
- 2015v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-11-02T14:05:18-05:00 | ReturnTs |
| Tax Period End | 2015-12-31 | 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 | 2015-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 396089134 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ThedaCare Medical Center - WILD | BusinessNameLine1Txt |
| Business Name Line2 | ROSE Inc | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | THED | BusinessNameControlTxt |
| Phone | 9206223257 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 243 | AddressLine1Txt |
| City | Wild Rose | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 549840243 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | donald r caves | PersonNm |
| Person Title | CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Phone | 9206223257 | PhoneNum |
| Signature | 2016-10-19 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Terri Rexrode CPA | PreparerPersonNm |
| PTIN | P00096513 | PTIN |
| Phone | 9206620016 | PhoneNum |
| Preparation | 2016-10-19 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TIM A OLSON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 243 | AddressLine1Txt |
| City | Wild Rose | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 549840243 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $15,335,657 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.thedacare.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1956 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | Improving the Health of our Community. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 85 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $23,364 | PYContributionsGrantsAmt |
| CY Contributions Grants | $15,678 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $3,764,626 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $15,313,974 | CYProgramServiceRevenueAmt |
| PY Investment Income | $709 | PYInvestmentIncomeAmt |
| CY Investment Income | $6,005 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $3,788,699 | PYTotalRevenueAmt |
| CY Total Revenue | $15,335,657 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $2,075 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $1,894,062 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,452,297 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,633,837 | PYOtherExpensesAmt |
| CY Other Expenses | $5,320,572 | CYOtherExpensesAmt |
| PY Total Expenses | $3,527,899 | PYTotalExpensesAmt |
| CY Total Expenses | $14,774,944 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $260,800 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $560,713 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $6,222,585 | TotalAssetsBOYAmt |
| Total Assets EOY | $11,147,487 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $7,418,798 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $11,181,643 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$1,196,213 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$34,156 | NetAssetsOrFundBalancesEOYAmt |
| Mission | To provide the highest quality health care, delivered in the most efficient and cost-effective ways, and accessible to all members of the community. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $14,321,415 | ExpenseAmt |
| Grant | $2,075 | GrantAmt |
| Revenue | $15,313,974 | RevenueAmt |
| Desc | 25-bed critical access hospital serving Waushara county and the surrounding area. Thedacare Medical Center - Wild Rose, Inc. provides provides inpatient, emergency, diagnostic, rehabilitation and outpatient surgical services to persons in need of medical attention. With corporate parent ThedaCare, Inc. we offer public awareness campaigns, charity care, support groups, and education programs targeted to local community needs. | Desc |
| Total Program Service Expenses | $14,321,415 | 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 | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln 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 | 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | 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 |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| 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 (23 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| WILLIAMS ROGER | |||||||||
| BOARD CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| STEA ALLEN | |||||||||
| BOARD VICE CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| WILLIAMS CAROL | |||||||||
| BOARD SECRETARY AND TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| BROTEN WILLIAM | |||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| BURMEISTERBRIAN | |||||||||
| BOARD MEMBER/VP SR AMC & TC | 5.00 | Yes (X) | $47,560 | $428,044 | $61,298 | 38.00 | |||
| ERDMAN JAMES | |||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| KJENTVET MARK | |||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| MCGOVERN JAMES MD | |||||||||
| BOARD MEMBER | 41.00 | Yes (X) | $316,264 | $0 | $27,568 | ||||
| MIELKE DAN | |||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| SHUMAN DAWN | |||||||||
| BOARD MEMBER/CEO | 41.00 | Yes (X) | Yes (X) | $140,201 | $0 | $24,697 | |||
| STAUDINGER MICHAEL MD | |||||||||
| BOARD MEMBER | 41.00 | Yes (X) | $403,287 | $0 | $28,898 | ||||
| THURLEY DARLENE | |||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| WEST KAREN | |||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| MORROW PATRICK | |||||||||
| PRIOR BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| GRUNER DEAN | |||||||||
| CEO - SYSTEM | 4.00 | Yes (X) | $125,990 | $1,133,910 | $214,531 | 39.00 | |||
| OLSON TIM | |||||||||
| VP CFO SYSTEM | 4.00 | Yes (X) | $53,683 | $483,143 | $28,004 | 37.00 | |||
| LIVINGSTON KEITH | |||||||||
| VP SR CIO | 4.00 | $51,346 | $462,104 | $108,486 | 36.00 | Yes (X) | |||
| PISTONE MAUREEN | |||||||||
| VP SR HR SERVICES | 4.00 | $47,096 | $423,867 | $99,911 | 36.00 | Yes (X) | |||
| DEVINE GREGORY | |||||||||
| VP SR PROVIDER STRATEGY | 4.00 | $71,049 | $639,437 | $82,381 | 36.00 | Yes (X) | |||
| LONG GREGORY MD | |||||||||
| CMO | 4.00 | $61,539 | $553,851 | $99,179 | 38.00 | Yes (X) | |||
| HUNTER WILLIAM | |||||||||
| VP SR PLANNING & MARKETING | 4.00 | $41,500 | $373,502 | $14,764 | 36.00 | Yes (X) | |||
| MANN WILLIAM | |||||||||
| VP SR STRATEGY | 4.00 | $43,983 | $395,848 | $74,173 | 36.00 | Yes (X) | |||
| CAVES CHANDLER MD | |||||||||
| PHYSICIAN | 40.00 | $515,581 | $0 | $29,296 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,919,079 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $4,893,706 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $893,186 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 8 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $6,500 | GovernmentGrantsAmt |
| All Other Contributions | $9,178 | AllOtherContributionsAmt |
| Total Contributions | $15,678 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| OUTPATIENT REVENUE | 621990 | $9,489,594 | $9,489,594 |
| INPATIENT REVENUE | 621990 | $5,824,380 | $5,824,380 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $15,313,974 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,005 | TotalRevenueColumnAmt |
| Exclusion | $6,005 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,335,657 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $15,313,974 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $6,005 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,075 | TotalAmt |
| Program Services | $2,075 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $973,980 | TotalAmt |
| Program Services | $597,083 | ProgramServicesAmt |
| Management And General | $376,897 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,527,302 | TotalAmt |
| Program Services | $6,527,302 | ProgramServicesAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $196,018 | TotalAmt |
| Program Services | $196,018 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,281,756 | TotalAmt |
| Program Services | $1,276,406 | ProgramServicesAmt |
| Management And General | $5,350 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $473,241 | TotalAmt |
| Program Services | $473,241 | ProgramServicesAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $244 | TotalAmt |
| Program Services | $244 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,447,929 | TotalAmt |
| Program Services | $1,380,380 | ProgramServicesAmt |
| Management And General | $67,549 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,506 | TotalAmt |
| Program Services | $12,506 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,655,315 | TotalAmt |
| Program Services | $1,652,267 | ProgramServicesAmt |
| Management And General | $3,048 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $663,990 | TotalAmt |
| Program Services | $663,305 | ProgramServicesAmt |
| Management And General | $685 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,981 | TotalAmt |
| Program Services | $29,981 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,311 | TotalAmt |
| Program Services | $21,311 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,400 | TotalAmt |
| Program Services | $19,400 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $478,095 | TotalAmt |
| Program Services | $478,095 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $63,426 | TotalAmt |
| Program Services | $63,426 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | bad debt expense | Desc |
| Total | $928,375 | TotalAmt |
| Program Services | $928,375 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,774,944 | TotalAmt |
| Program Services | $14,321,415 | ProgramServicesAmt |
| Management And General | $453,529 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $502,889 | BOYAmt |
| EOY | $5,661,142 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,450,143 | BOYAmt |
| EOY | $1,506,650 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $244,965 | BOYAmt |
| EOY | $225,132 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,948 | BOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $6,133,576 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,123,700 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,823,300 | BOYAmt |
| EOY | $3,009,876 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $167,748 | BOYAmt |
| EOY | $195,975 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,592 | BOYAmt |
| EOY | $548,712 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,222,585 | BOYAmt |
| EOY | $11,147,487 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $315,633 | BOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $56,511 | BOYAmt |
| EOY | $46,361 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,046,654 | BOYAmt |
| EOY | $11,135,282 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,418,798 | BOYAmt |
| EOY | $11,181,643 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$1,196,213 | BOYAmt |
| EOY | -$34,156 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$1,196,213 | BOYAmt |
| EOY | -$34,156 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,222,585 | BOYAmt |
| EOY | $11,147,487 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $560,713 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $601,344 | 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
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 | $925 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $925 | 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 | WHA Dues: $925 | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $167,668 | OtherCostOrOtherBasisAmt |
| Book Value | $167,668 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,379,070 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,117,853 | DepreciationAmt |
| Book Value | $1,261,217 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,586,838 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,005,847 | DepreciationAmt |
| Book Value | $1,580,991 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,009,876 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO AFFILIATES | Desc |
| Amt | $11,135,282 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $11,135,282 | TotalLiabilityAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | 0 | FinancialAssistanceBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $194,448 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $194,448 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01400 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,781,014 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $660,942 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,120,072 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08090 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,975,462 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $660,942 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,314,520 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09490 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 23 | ActivitiesOrProgramsCnt |
| Persons Served | 99358 | PersonsServedCnt |
| Total Community Benefit Expns | $115,078 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $253 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $114,825 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00830 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 58 | PersonsServedCnt |
| Total Community Benefit Expns | $46,060 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $46,060 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00330 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $1,377,338 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,377,338 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09950 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 188452 | PersonsServedCnt |
| Total Community Benefit Expns | $22,811 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $22,811 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00160 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 30 | ActivitiesOrProgramsCnt |
| Persons Served | 287868 | PersonsServedCnt |
| Total Community Benefit Expns | $1,561,287 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $253 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,561,034 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11270 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 30 | ActivitiesOrProgramsCnt |
| Persons Served | 287868 | PersonsServedCnt |
| Total Community Benefit Expns | $3,536,749 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $661,195 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,875,554 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.20760 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 14383 | PersonsServedCnt |
| Total Community Benefit Expns | $1,065 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,065 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 25 | PersonsServedCnt |
| Total Community Benefit Expns | $958 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $958 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 2 | PersonsServedCnt |
| Total Community Benefit Expns | $456 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $456 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $148 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $148 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $28 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $28 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 5 | ActivitiesOrProgramsCnt |
| Persons Served | 14410 | PersonsServedCnt |
| Total Community Benefit Expns | $2,655 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,655 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $514,321 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $224,821 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $3,170,602 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,727,849 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$557,247 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | thedacare medical center - wild rose inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 601 Grove Ave | AddressLine1Txt |
| City | Wild Rose | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54984 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | https://www.thedacare.org | WebsiteAddressTxt |
| State License | 1004 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | thedacare medical center - wild rose in | 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 |
| Information Gaps | Yes (X) | InformationGapsInd |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | 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 | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | see 7d | StrategyWebsiteURLTxt |
| Strategy Attached | Yes (1) | StrategyAttachedInd |
| 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 | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| 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 | www.thedacare.org/~/link.aspx?_id=206478F0E2874D2EAD353B71BC978623& | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | www.thedacare.org/~/link.aspx?_id=206478F0E2874D2EAD353B71BC978623& | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | www.thedacare.org/~/link.aspx?_id=206478F0E2874D2EAD353B71BC978623& | 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 |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| thedacare medical center - wild rose, inc. | Part V, Section B, Line 3j: ThedaCare Medical Center - Wild Rose's CHNA also identified owner expectations, mission/values, key components of our commitment, organizational support, advisory team guidance and the Health Improvement Model. |
| thedacare medical center - wild rose, inc. | Part V, Section B, Line 5: Public HealthThedaCare Medical Center - Wild Rose worked closely with Waushara and Green Lake County Public Health Departments throughout the entire needs assessment process. ThedaCare has representation on the Fox Valley Community Health Improvement Coalition which meets monthly with local health system representatives and public health officials from the Counties of Outagamie, Calumet and Winnebago and cities of Appleton and Menasha. Waushara and Green Lake public health officials are also invited to attend. Public Health is represented on ThedaCare's Needs Assessment Advisory Committee and also on the ThedaCare-led Community Health Action Team. In addition to these formal meetings, one-on-one interviews with public health officials were conducted either over the phone or in person. Sources: Sources: Kathryn Munsey,Green Lake Public Health Officer; Patti Wohlfiel, Waushara County Public Health OfficerCommunity Health Action Teams (CHAT) are the primary resources ThedaCare uses to engage the community in better understanding the local health needs and developing plans for action. ThedaCare's Community Health Specialists help facilitate the CHAT efforts for four CHAT teams in the Fox Cities, New London, Shawano and Waupaca areas. Each CHAT team is comprised of local community leaders from business, education, public health, area health systems, faith communities, non-profit organizations and government. These leaders select issues to study, organize "plunge" experiences (day-long field trips) to gain in-depth understanding and collaborate in problem-solving initiatives. This results in sustainable, effective community-based solutions to systemic health issues. Thedacare medical center - Wild Rose providers and staff are integrated into a wide variety of initiatives. A CHAT team will be implemented in Wild Rose in April 2015.Key informant interviews were conducted with experts representing vulnerable or marginalized populations in our community including farm families, Latino population, Lesbian, Gay, Bisexual, Transgender (LGBT) Population, low income and seniors. |
| thedacare medical center - wild rose, inc. | Part V, Section B, Line 6a: Affinity Health System |
| thedacare medical center - wild rose, inc. | Part V, Section B, Line 7d: The CHNA was made available to local CHAT, ThedaCare boards and leadership teams.full chna & implementation strategy website: https://www.thedacare.org/Hospitals-and-Clinics/ThedaCare-medical-center-wild-rose.aspx |
| thedacare medical center - wild rose, inc. | Part V, Section B, Line 11: Identified and working on:Obesity:-In 2015, ThedaCare continued Good to Go Week, an employee led initiative that takes place in 6 school districts throughout the ThedaCare system. Activities include healthy snacks, build a school garden, fats in foods, measure your drink, leading gym classes.-Established Weight of the Fox Valley - a four healthcare system approach to tackling obesity, is in the process of forming work groups. ThedaCare supports this with financial contributions and participation on the leadership and core teams.-Provides funding to local Farmer's Markets to provide healthy food to the community -ThedaCare partners with local Boy's and Girl's Club to educate children about eating healthy and the benefits of being active-ThedaCare sponsors multiple family events that contribute to exercise and family activity and supports the YMCA Healthy Kids Campaign.Mental Health:-ThedaCare provides financial and in-kind support for the Primary Care/Mental Health Initiative aimed at improving PCP's ability to treat basic mental health issues,-Provides leadership and financial support for Catalpa Health - helping children and families obtain mental health and wellness-Provides leadership and funding for the Fox Valley Community Clinic-Provided over $1,000,000 in subsidized mental health services, provided leadership and financial support for the NEW Mental Health Connection-Supports the New Mental Health Connection, a coalition of mental health providers-Established No Wrong Door, a safety net system to detect kids in crisis-Provides leadership to the Suicide Prevention Task ForceSubstance Abuse:-Legislative work on laws related to substance abuse is included in Substance Abuse coalition efforts-Supported ReTHINK! An initiative to deter kids from using drugs and alcohol-Continues to host annually Party at the Pac - educating teens about the dangers of driving while drinking or textingAccess to Care:-Provide financial support to the Partnership Community Health Center-Provide 24/7 access to medical call advise via telephone-Provide leadership and financial support to the rural Health Initiative - an initiative that takes healthcare right to the farmer's door |
| thedacare medical center - wild rose, inc. | Part V, Section B, Line 15e: Contracted with 2 agencies to assist patients. First, Partnership Community Education Center - they provide the patient with free assistance with completing the financial assistance application and also assist patients in finding community funding that may be avaialable. Second, Cardon works directly with the uninsured patient to assist them with insurance enrollment and education. |
| thedacare medical center - wild rose, inc. | Part V, Section B, Line 16i: 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 reserve 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. |
| thedacare medical center - wild rose, inc. | Part V, Section B, Line 20e: ThedaCare and/or third party collection agency are placing a minimum of one outbound call to advise customer of payment options including FA prior to credit bureau reporting or legal judgement. Process adjusted to ensure no ECA until customer receives at least 4 billing statements after date of discharge. No ECA until at least 120 days after discharge. |
| thedacare medical center - wild rose, inc. | Part V, Section B, Line 22d: Lookback Method: For ER patients, take the 3 largest commercial insurers plus Medicare. Add all payments and all charges to arrive at a deduction percentage. Reduce the patient's bill by this percentage. For non-ER patients, take the 3 largest commercial insurers. Add all payments and all charges to arrive at a deduction percentage. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 4 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - WFP Wild Rose | ||||
| 701 Grove Ave | Wild Rose | WI | 54984 | Outpatient Physician Clinic |
| 2 - WFP Plainfield | ||||
| N6493 valley circle road | Plainfield | WI | 54966 | Outpatient Physician Clinic |
| 3 - WFP Wautoma | ||||
| N2934 Hwy 22 north | Wautoma | WI | 54982 | Outpatient Physician Clinic |
| 4 - WFP Coloma | ||||
| 141 FRONT STREET | COLOMA | WI | 54930 | Outpatient Physician Clinic |
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 $928,375. |
| Part II, Community Building Activities: | THE HEALTH OF THE COMMUNITY THEDACARE MEDICAL CENTER - Wild Rose IS PROMOTED THROUGH SEVERAL COMMUNITY BUILDING ACTIVITIES AS DESCRIBED BELOW:Chamber of Commerce Support - encourages economic development which in turn provides jobs and income, both contributors to health.Disaster Readiness - helps ensure the entire community is ready for potential emergencies. Rural Provider Recruitment - ensures quality of healthcare services in rural markets.Community Sharps Collection - reducing the risks of infectious waste.Community Garden - development of community gardens to provide fresh produce to community members and food pantry patrons.Farmer's Markets - provides fresh produce to area food pantries and community.United Way - working every day to improve the communitySexual Assault Nurse Examiner - working to end sexual and domestic violence.Emerging Leaders - making an impact in our community through dedication to service and philanthropy.Electronic Recycling Event - working to treat the Earth with the respect that it deserves.Wisconsin Sustainable Business Council - taking an active position on the role of climate change and building healthy communities by reducing or eliminating our energy waste and water footprint.Rural Health Initiative - addressing growing concerns regarding the health and safety issues facing today's farm families. Health and Economic Summit - wellness with health in mind.Working with local schools and business - to provide wellness activities.Waushara County Wellness Coalition |
| 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: | ThedaCare serves a 9 county primary service area. Seven ThedaCare hospitals provide service in this area. ThedaCare conducts a Community Needs Assessment every three years for the entire system gathering data pertinent to each community. 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 Foundation. |
| 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: | WILD ROSE MEDICAL CENTER'S SERVICE AREA CONSISTS OF WAUSHARA AND MARQUETTE COUNTY AND IS LOCATED EAST-CENTRAL WISCONSIN. THE TWO-COUNTY AREA HOSTS A POPULATION IS 39,379 AND IS ALMOST 100% RURAL.WAUSHARA COUNTY:-OVER THE COURSE OF THE PAST DECADE, WAUSHARA COUNTY HAS EXPERIENCED A POPULATION GROWTH OF 10.7%. -WAUSHARA COUNTY HIGH SCHOOL GRADUATION RATE IS 93%-HAS A MORE SEASONAL EMPLOYMENT BASE THAN THE STATE OR NATION. EDUCATION, HEALTH, TRADE, TRANSPORTATION AND UTILITIES AND PUBLIC ADMINISTRATION ARE THE LARGEST EMPLOYMENT SECTORS. WAUSHARA COUNTY'S AVERAGE ANNUAL WAGE ACROSS ALL INDUSTRY SECTORS IS BELOW THE STATE AVERAGE. -THE MEDIAN AGE OF WAUSHARA COUNTY'S POPULATION IS 46.2 YEARS.-THIRTEEN PERCENT OF WAUSHARA COUNTY LIVES BELOW 100% OF THE FEDERAL POVERTY LEVEL, 13% ARE UNINSURED.-THE LARGEST MINORITY POPULATIONS ARE LATINO AND ASIAN. NATIVE AMERICANS ACCOUNT FOR APPROXIMATELY 1% OF THE POPULATION AND AFRICAN-AMERICANS REPRESENTS LESS THAN 1%. THE LATINO POPULATION HAS A SIGNIFICANT AND GROWING PRESENCE AT 4.6%. |
| Part VI, Line 5: | Each year, Thedacare medical center - Wild Rose'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. Projects arising from CHAT are many. ThedaCare provides funding and staff support to make CHAT and these community health efforts possible. A Wild Rose CHAT was implemented in April 2016.Other ways that ThedaCare hospitals improve the health of the community include:-In 2015, ThedaCare shared its cutting edge application of Lean Production improvements with hundreds of healthcare and non-healthcare visitors from around the world. Most were visitors were from hospitals and health systems in the United States looking to improve quality and reduce costs.-ThedaCare hospitals provided support to the ThedaCare Center for Healthcare Value which is coordinating efforts across the country to share quality improvement and cost reduction learnings. -All ThedaCare hospitals provide health education programming for their respective communities focusing on such critical topics as proper nutrition, diabetes identification, and cancer prevention.-ThedaCare partners with Affinity Health System to sponsor Mosiac Health, providing hands on experience for medical students.-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 provided financial as well as diagnostic and lab support to two area clinics providing medical and dental care to the underserved in our service area.-ThedaCare hospital employees take part in Helping Hearts, an employee volunteerism program encouraging staff to give of their time in the community. ThedaCare provides paid staff to coordinate the program and identify and promote volunteerism opportunities. ThedaCare employees donated more than $1,707,253 in unpaid volunteer hours to local non-profits in 2015. -ThedaCare sponsors Party at the PAC for thousands of area youth to educate youth on the perils of risky behavior while driving. Hosted at Appleton Performing Arts Center, live dramatizations along with stories of youth disabled due to driving and risky behavior encourage teens to think twice before drinking or texting and driving. -Thedacare medical center - wild rose staff work with the area Chamber of Commerce and local high schools and colleges to inform youth about medical career opportunities and to help prepare our educational facilities to meet the healthcare staffing needs for the communities we serve.-Thedacare medical center - Wild Rose supports the American Cancer Society's Sole Burner Run and the American Heart Association Heart Walk events to help raise funds for the non-profit organizations.-Thedacare medical center - Wild Rose organizes support groups for cancer and diabetes and provides a telephone hotline for nutrition counseling.-Thedacare medical center - Wild Rose makes financial and in-kind donations to non-profit organizations including United Way, area schools, American Heart Association, American Cancer Society. -ThedaCare staff participates in Leadership Fox Cities to groom middle managers in the workings of the entire community, from education systems and recycling programs to government and justice systems. -Thedacare medical center - Wild Rose staff are involved in statewide and regional disaster readiness planning to prepare our community for times of crisis.-ThedaCare President and CEO is engaged in statewide Wisconsin Collaborative for Healthcare Quality making quality healthcare data transparent. |
| Part VI, Line 6: | ThedaCare, the parent organization, provides direction related to community needs assessment for all hospitals and markets within its service area. Each ThedaCare hospital, along with Community Health Improvement (CHI) staff and community members determine how best to meet local needs. Implementation of community programming occurs at the local level. |
| Part VI, Line 7, Reports Filed With States | WI |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (13 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BURMEISTERBRIAN | ||||||||||||||
| BOARD MEMBER/VP SR AMC & TC | $37,577 | $338,195 | $4,468 | $40,213 | $5,515 | $49,636 | $4,209 | $37,885 | $1,920 | $17,284 | $53,689 | $483,213 | $0 | $0 |
| MCGOVERN JAMES MD | ||||||||||||||
| BOARD MEMBER | $300,214 | $0 | $9,739 | $0 | $6,311 | $0 | $5,994 | $0 | $21,574 | $0 | $343,832 | $0 | $0 | $0 |
| SHUMAN DAWN | ||||||||||||||
| BOARD MEMBER/CEO | $139,508 | $0 | $216 | $0 | $477 | $0 | $4,337 | $0 | $20,360 | $0 | $164,898 | $0 | $0 | $0 |
| STAUDINGER MICHAEL MD | ||||||||||||||
| BOARD MEMBER | $297,606 | $0 | $0 | $0 | $105,681 | $0 | $9,950 | $0 | $18,948 | $0 | $432,185 | $0 | $0 | $0 |
| GRUNER DEAN | ||||||||||||||
| CEO - SYSTEM | $83,135 | $748,215 | $21,061 | $189,553 | $21,794 | $196,142 | $19,316 | $173,848 | $2,137 | $19,230 | $147,443 | $1,326,988 | $0 | $0 |
| OLSON TIM | ||||||||||||||
| VP CFO SYSTEM | $45,333 | $407,997 | $5,630 | $50,670 | $2,720 | $24,476 | $795 | $7,155 | $2,005 | $18,049 | $56,483 | $508,347 | $0 | $0 |
| LIVINGSTON KEITH | ||||||||||||||
| VP SR CIO | $37,782 | $340,035 | $4,656 | $41,900 | $8,908 | $80,169 | $8,892 | $80,025 | $1,957 | $17,612 | $62,195 | $559,741 | $0 | $0 |
| PISTONE MAUREEN | ||||||||||||||
| VP SR HR SERVICES | $32,446 | $292,018 | $4,049 | $36,438 | $10,601 | $95,411 | $8,018 | $72,164 | $1,973 | $17,756 | $57,087 | $513,787 | $0 | $0 |
| DEVINE GREGORY | ||||||||||||||
| VP SR PROVIDER STRATEGY | $47,894 | $431,044 | $14,711 | $132,401 | $8,444 | $75,992 | $6,243 | $56,190 | $1,995 | $17,953 | $79,287 | $713,580 | $0 | $0 |
| LONG GREGORY MD | ||||||||||||||
| CMO | $45,761 | $411,847 | $5,628 | $50,652 | $10,150 | $91,352 | $7,679 | $69,114 | $2,239 | $20,147 | $71,457 | $643,112 | $0 | $0 |
| HUNTER WILLIAM | ||||||||||||||
| VP SR PLANNING & MARKETING | $18,622 | $167,594 | $4,553 | $40,980 | $18,325 | $164,928 | $635 | $5,713 | $841 | $7,575 | $42,976 | $386,790 | $0 | $0 |
| MANN WILLIAM | ||||||||||||||
| VP SR STRATEGY | $34,416 | $309,746 | $4,199 | $37,787 | $5,368 | $48,315 | $6,459 | $58,128 | $959 | $8,627 | $51,401 | $462,603 | $0 | $0 |
| CAVES CHANDLER MD | ||||||||||||||
| PHYSICIAN | $384,337 | $0 | $0 | $0 | $131,244 | $0 | $9,950 | $0 | $19,346 | $0 | $544,877 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 1a | Executives receive reimbursement for personal medical expenses at an amount grossed-up for taxes. All executives in the senior management benefit category are eligible to have health or fitness club fees paid directly to the club, or reimbursed to them on evidence of payment. Senior executives whose duties include meeting with people outside the company for purposes of developing business relationships have company paid memberships at a local country club. |
| Part I, Line 4b | Nonqualified plan description: 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, improve ThedaCare Inc's ability to compete with other employers for high talent 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 executives 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, 2014 to December 31, 2014) to receive their 2015 bonuses. If the employee retires, becomes disabled, moves to a position that is eligible under the bonus plan or 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 earned will be forfeited. 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, 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 - wild rose,inc. (Wild Rose) reports "0" employees because employees are paid by ThedaCare, Inc., therefore, Wild Rose does not file any W-2 forms. ThedaCare Inc. is reimbursed by Wild Rose for salary expenses for the employees who are permanently assigned to Wild Rose. |
| Form 990, Part VI, Section A, line 6 | thedacare medical center - wild rose, inc., 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. Develop and approve annual capital and operating targets 2. Authorize and make capital expenditures 3. Approve strategic plans, with management and board oversight 4. Approve the safety and quality plan 5. Approve the dissolution or liquidation 6. Hire or terminate the president and ceo 7. Borrow or incur debt 8. Appoint auditors and legal counsel 9. Retain investment advisors and establish investment policies The board of trustees may not do the following without receiving the consent of ThedaCare,Inc. 1. Merge, consolidate, or change control of the organization 2. Sell, lease, or transfer material assets 3. Enter joint ventures or affiliations 4. Amend the articles of incorporation or bylaws |
| Form 990, Part VI, Section B, line 11 | A DRAFT OF THE FORM 990 IS PROVIDED TO THE ORGANIZATION'S DESIGNATED COMMITTEE OF THE BOARD OF DIRECTORS FOR REVIEW AND DISCUSSION AT A BOARD MEETING. THE FINAL VERSION OF THE FORM 990 IS EMAILED TO THE ENTIRE BOARD BEFORE THE RETURN IS FILED. |
| Form 990, Part VI, Section B, line 12c | QUESTIONNAIRES ARE SENT TO ALL MANAGERS, TRUSTEES, AND OFFICERS ANNUALLY. COMPLETED FORMS ARE RETURNED TO THE COMPLIANCE OFFICER. THE COMPLIANCE OFFIcER REVIEWS THE QUESTIONNAIRES AND FOLLOWS UP WITH ANY QUESTIONS ABOUT THE MANAGERS' ANSWERS ON THE CONFLICT OF INTEREST FORMS. ALL EMPLOYEES AND BOARD MEMBERS ARE COVERED UNDER THE CONFLICT OF INTEREST POLICY. THE CORPORATE COMPLIANCE COMMITTEE REVIEWS THE POTENTIAL CONFLICT AND THE CFO/BOARD OF TRUSTEES REVIEW ALL CONFLICTS. AFTER DISCLOSURE OF THE CONFLICT, THE EMPLOYEE SHALL NOT PARTCIPATE IN THE DECISION WHETHER TO ENGAGE IN THE TRANSACTION IN WHICH THE EMPLOYEE HAS AN INTEREST. |
| Form 990, Part VI, Section B, line 15 | THEDACARE HIRES AN OUTSIDE CONSULTING FIRM TO CONDUCT A THOROUGH MARKET REVIEW OF EXECUTIVE COMPENSATION EVERY OTHER YEAR. INTERNALLY, A COMPENSATION COMMITTEE REAFFIRMS THE COMPENSATION POLICY, REVIEWS DATA FROM CONSULTANTS, AND WITH INPUT FROM THE SENIOR VICE PRESIDENT OF HUMAN RESOURCES, ADVISES, VALIDATES, AND APPROVES A RANGE FOR CEO COMPENSATION. THE COMMITTEE ALSO RATIFIES THE AT-RISK COMPENSATION 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 9: | Equity relcassifications 601,344. |
| Form 990, PART XI, LINE 2C | This process did not change 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 11b, II | 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 - Berlin INC | |||||||||||
| 225 MEMORIAL DRIVE | BERLIN | WI | 54923 | 390806359 | 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 | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | 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 |