THEDACARE MEDICAL CENTER-WAUPACA INC: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- THEDACARE MEDICAL CENTER-WAUPACA INC (EIN 39-0871113)
- Tax period
- 2014-01-01 to 2014-12-31
- Filed
- 2015-11-12
- IRS object ID
- 201503169349301345
- Schema version
- 2014v5.0
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-11-12T10:44:40-06:00 | ReturnTs |
| Tax Period End | 2014-12-31 | 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 | 2014-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390871113 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RIVERSIDE MEDICAL CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | RIVE | BusinessNameControlTxt |
| Phone | 7152581000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 RIVERSIDE DR | AddressLine1Txt |
| City | WAUPACA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54981 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TIM A OLSON | PersonNm |
| Person Title | CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Phone | 7152581000 | PhoneNum |
| Signature | 2015-10-26 | 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 | 2015-10-26 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | 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 | 800 RIVERSIDE DR | AddressLine1Txt |
| City | WAUPACA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54981 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $37,374,466 | 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 | 1955 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | IMPROVING THE HEALTH OF OUR COMMUNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 251 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $59,212 | PYContributionsGrantsAmt |
| CY Contributions Grants | $28,967 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $37,474,070 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $36,457,206 | CYProgramServiceRevenueAmt |
| PY Investment Income | $941,178 | PYInvestmentIncomeAmt |
| CY Investment Income | $468,948 | CYInvestmentIncomeAmt |
| PY Other Revenue | $90,629 | PYOtherRevenueAmt |
| CY Other Revenue | $239,417 | CYOtherRevenueAmt |
| PY Total Revenue | $38,565,089 | PYTotalRevenueAmt |
| CY Total Revenue | $37,194,538 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $18,775,876 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $20,716,059 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $14,004,526 | PYOtherExpensesAmt |
| CY Other Expenses | $10,871,391 | CYOtherExpensesAmt |
| PY Total Expenses | $32,780,402 | PYTotalExpensesAmt |
| CY Total Expenses | $31,587,450 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $5,784,687 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $5,607,088 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $75,434,716 | TotalAssetsBOYAmt |
| Total Assets EOY | $79,709,092 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $4,765,360 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,821,081 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $70,669,356 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $75,888,011 | 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 | $28,822,328 | ExpenseAmt |
| Revenue | $36,378,772 | RevenueAmt |
| Desc | 25-BED CRITICAL ACCESS HOSPITAL SERVING WAUPACA AND NEARBY COMMUNITIES. RIVERSIDE MEDICAL CENTER, INC. PROVIDES PATIENT CARE AND SUPPORT SERVICES INCLUDING ER, DIAGNOSTIC, LAB, RADIOLOGY, SURGERY, AND THERAPY CARE AND TREATMENT 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 | $28,822,328 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | 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 | Yes (1) | 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 | Yes (1) | 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 | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | 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
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KRISTEN COGSWELL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 (20 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 |
|---|---|---|---|---|---|---|---|---|---|
| LARSON JIM | |||||||||
| BOARD CHAIR | 1.00 | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| POESCHL DAVID PHD | |||||||||
| BOARD VICE CHAIR | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JANSSEN GARY | |||||||||
| TREASURER | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| ANTHONY CHRIS | |||||||||
| SECRETARY | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| DENT ROBERT MD | |||||||||
| BOARD MEMBER/PHYSICIAN | 1.00 | 40.00 | Yes (X) | $0 | $180,327 | $25,232 | |||
| LONG GREGORY MD | |||||||||
| BOARD MEMBER/CMO | 5.00 | 36.00 | Yes (X) | $55,720 | $501,475 | $113,057 | |||
| BURMEISTER BRIAN | |||||||||
| BOARD MEMBER/VP SR AMC & TC | 5.00 | 37.00 | Yes (X) | $43,961 | $395,650 | $73,139 | |||
| HALLETT MARK MD | |||||||||
| BOARD MEMBER/CHIEF CLINICAL OFFICER | 1.00 | 40.00 | Yes (X) | $0 | $385,943 | $20,369 | |||
| HANSEN KENLEY | |||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| ZIMMERMAN WILLIAM | |||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| KANTOS CRAIG | |||||||||
| CEO | 40.00 | 0.00 | Yes (X) | $264,550 | $0 | $25,338 | |||
| OLSON TIM | |||||||||
| VP CFO SYSTEM | 4.00 | 38.00 | Yes (X) | $48,594 | $437,352 | $108,726 | |||
| GRUNER DEAN | |||||||||
| CEO - SYSTEM | 4.00 | 39.00 | $120,869 | $1,087,821 | $176,335 | Yes (X) | |||
| LIVINGSTON KEITH | |||||||||
| VP SR CIO | 4.00 | 36.00 | $47,685 | $429,165 | $89,435 | Yes (X) | |||
| PISTONE MAUREEN | |||||||||
| VP SR HR SERVICES | 4.00 | 36.00 | $44,020 | $396,186 | $83,053 | Yes (X) | |||
| BARNAS KIM | |||||||||
| VP SR AMC & TC | 0.00 | 40.00 | $0 | $692,225 | $23,158 | Yes (X) | |||
| DEVINE GREGORY | |||||||||
| VP SR PROVIDER STRATEGY | 4.00 | 36.00 | $59,187 | $532,686 | $72,254 | Yes (X) | |||
| HUNTER WILLIAM | |||||||||
| VP SR PLANNING & MARKETING | 4.00 | 37.00 | $39,856 | $358,693 | $79,080 | Yes (X) | |||
| POOLE JOHN | |||||||||
| VP SR THEDACARE IMPROVE SYS | 4.00 | 36.00 | $49,159 | $442,425 | $83,079 | Yes (X) | |||
| PETERSON ROBERT MD | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $340,772 | $0 | $19,372 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,114,373 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $5,839,948 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $991,627 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 14 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| RICHARD VIEGA MD SC | |||||
| E2409 PEBBLE RUN RD | WAUPACA | WI | 54981 | MEDICAL SERVICES | $279,941 |
| AMER DIAGNOSTIC MEDICINE INC | |||||
| PO BOX 4210 | LISLE | IL | 60532 | MEDICAL SERVICES | $173,007 |
| SHARED MEDICAL SERVICES | |||||
| PO BOX 330 | COTTAGE GROVE | WI | 53527 | MEDICAL SERVICES | $132,233 |
| THE CLARO GROUP LLC | |||||
| 321 N CLARK STREET | CHICAGO | IL | 60654 | SOFTWARE SERVICES | $104,071 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $28,967 | AllOtherContributionsAmt |
| Total Contributions | $28,967 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| OUTPATIENT REVENUE | 621400 | $26,536,496 | $26,536,496 | |
| INPATIENT REVENUE | 621990 | $8,993,410 | $8,993,410 | |
| OTHER MISC REVENUE (EHR) | 621990 | $845,482 | $845,482 | |
| CAFETERIA REVENUE | 722210 | $78,434 | $78,434 | |
| AFFILIATE RENTAL REVENUE | 900099 | $3,384 | $3,384 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $36,457,206 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $648,876 | TotalRevenueColumnAmt |
| Exclusion | $648,876 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $239,417 | 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 | $239,417 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $239,417 | TotalRevenueColumnAmt |
| Exclusion | $239,417 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $179,928 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$179,928 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$179,928 | TotalRevenueColumnAmt |
| Exclusion | -$179,928 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $37,194,538 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $36,378,772 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $786,799 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $715,112 | TotalAmt |
| Program Services | $67,026 | ProgramServicesAmt |
| Management And General | $648,086 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,595,209 | TotalAmt |
| Program Services | $14,843,327 | ProgramServicesAmt |
| Management And General | $751,882 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $474,583 | TotalAmt |
| Program Services | $474,583 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,016,801 | TotalAmt |
| Program Services | $2,547,987 | ProgramServicesAmt |
| Management And General | $468,814 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $914,354 | TotalAmt |
| Program Services | $914,354 | ProgramServicesAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $41,334 | TotalAmt |
| Program Services | $41,334 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,409,255 | TotalAmt |
| Program Services | $1,636,459 | ProgramServicesAmt |
| Management And General | $772,796 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,959 | TotalAmt |
| Program Services | $3,959 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $414,064 | TotalAmt |
| Program Services | $340,723 | ProgramServicesAmt |
| Management And General | $73,341 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,018,780 | TotalAmt |
| Program Services | $968,577 | ProgramServicesAmt |
| Management And General | $50,203 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,361 | TotalAmt |
| Program Services | $64,361 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $82,083 | TotalAmt |
| Program Services | $82,083 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $209,652 | TotalAmt |
| Program Services | $209,652 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,283,172 | TotalAmt |
| Program Services | $2,283,172 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $138,579 | TotalAmt |
| Program Services | $138,579 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| CLIENT & PATIENT SERVIC | $3,461,492 | $3,461,492 |
| EQUIPMENT MAINTENANCE | $696,810 | $696,810 |
| BAD DEBT EXPENSE | $47,850 | $47,850 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,587,450 | TotalAmt |
| Program Services | $28,822,328 | ProgramServicesAmt |
| Management And General | $2,765,122 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,295 | BOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,756,454 | BOYAmt |
| EOY | $2,000,000 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,219,158 | BOYAmt |
| EOY | $4,733,477 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $229,797 | BOYAmt |
| EOY | $325,726 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $55,661,715 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $30,082,639 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,264,389 | BOYAmt |
| EOY | $25,579,076 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,825,624 | BOYAmt |
| EOY | $10,473,275 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,137,999 | BOYAmt |
| EOY | $36,597,538 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $75,434,716 | BOYAmt |
| EOY | $79,709,092 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $180,262 | BOYAmt |
| EOY | $221,566 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,585,098 | BOYAmt |
| EOY | $3,599,515 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,765,360 | BOYAmt |
| EOY | $3,821,081 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $70,661,170 | BOYAmt |
| EOY | $75,886,153 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,186 | BOYAmt |
| EOY | $1,858 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $70,669,356 | BOYAmt |
| EOY | $75,888,011 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $75,434,716 | BOYAmt |
| EOY | $79,709,092 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $5,607,088 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$388,433 | NetUnrlzdGainsLossesInvstAmt |
| 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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $3,708 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $3,708 | 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 | PORTION OF WHA DUES = $3,708. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,102,028 | OtherCostOrOtherBasisAmt |
| Book Value | $2,102,028 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $38,394,049 | OtherCostOrOtherBasisAmt |
| Depreciation | $17,325,751 | DepreciationAmt |
| Book Value | $21,068,298 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,025,201 | OtherCostOrOtherBasisAmt |
| Depreciation | $758,272 | DepreciationAmt |
| Book Value | $266,929 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $14,140,437 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,998,616 | DepreciationAmt |
| Book Value | $2,141,821 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $25,579,076 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE FROM AFFILIATE | Desc |
| Book Value | $36,597,538 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $36,597,538 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ALLOCABLE PORTION OF TAX-EXEMPT BONDS DUE TO AFFILIATE | Desc |
| Amt | $3,599,515 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $3,599,515 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THEDACARE DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THAT POSITION IS NOT RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS. THEDACARE RECORDED NO ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS IN 2014 AND 2013. TAX RETURNS FOR THE YEARS ENDED 2011 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. | ExplanationTxt |
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 | $179,900 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $179,900 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00570 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,861,683 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,806,814 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $54,869 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00170 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,041,583 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,806,814 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $234,769 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00740 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 24 | ActivitiesOrProgramsCnt |
| Persons Served | 48450 | PersonsServedCnt |
| Total Community Benefit Expns | $309,858 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $17,624 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $292,234 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00930 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 349 | PersonsServedCnt |
| Total Community Benefit Expns | $92,220 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $92,220 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00290 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 5 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $1,948,209 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,948,209 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06180 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $987 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $987 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 6 | ActivitiesOrProgramsCnt |
| Persons Served | 77424 | PersonsServedCnt |
| Total Community Benefit Expns | $197,169 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $197,169 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00630 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 39 | ActivitiesOrProgramsCnt |
| Persons Served | 126223 | PersonsServedCnt |
| Total Community Benefit Expns | $2,548,443 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $17,624 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,530,819 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08030 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 39 | ActivitiesOrProgramsCnt |
| Persons Served | 126223 | PersonsServedCnt |
| Total Community Benefit Expns | $6,590,026 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,824,438 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,765,588 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08770 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 10000 | PersonsServedCnt |
| Total Community Benefit Expns | $6,279 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,279 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 60 | PersonsServedCnt |
| Total Community Benefit Expns | $7,564 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $7,564 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 2096 | PersonsServedCnt |
| Total Community Benefit Expns | $3,568 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,568 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 37722 | PersonsServedCnt |
| Total Community Benefit Expns | $1,306 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,306 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 7 | PersonsServedCnt |
| Total Community Benefit Expns | $9,496 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $9,496 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 5 | ActivitiesOrProgramsCnt |
| Persons Served | 49885 | PersonsServedCnt |
| Total Community Benefit Expns | $28,213 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $28,213 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $721,244 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $179,406 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $9,423,155 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $9,614,507 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$191,352 | 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 | RIVERSIDE MEDICAL CENTER INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 RIVERSIDE DRIVE | AddressLine1Txt |
| City | WAUPACA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54981 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | HTTPS://WWW.THEDACARE.ORG | WebsiteAddressTxt |
| State License | 1038 | 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 | RIVERSIDE MEDICAL CENTER 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 |
| 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 App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | 0 | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| 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 (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| RIVERSIDE MEDICAL CENTER, INC. | PART V, SECTION B, LINE 3J: RIVERSIDE MEDICAL CENTER - WAUPACA CHNA ALSO IDENTIFIED OWNER EXPECTATIONS, MISSION/VALUES, KEY COMPONENTS OF OUR COMMITMENT, ORGANIZATIONAL SUPPORT, ADVISORY TEAM GUIDANCE AND THE HEALTH IMPROVEMENT MODEL. |
| RIVERSIDE MEDICAL CENTER, INC. | PART V, SECTION B, LINE 5: PUBLIC HEALTHTHEDACARE WORKED CLOSELY WITH WAUPACA COUNTY PUBLIC HEALTH DEPARTMENT 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. WAUPACA COUNTY PUBLIC HEALTH IS ALSO INVITED TO ATTEND. PUBLIC HEALTH IS REPRESENTED ON THEDACARE'S NEEDS ASSESSMENT ADVISORY COMMITTEE AND ALSO ON THE THEDACARE- LED WAUPACA 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: LINDA BEHM, WAUPACA COUNTY PUBLIC HEALTH NURSE.COMMUNITY 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. RIVERSIDE MEDICAL CENTER PROVIDERS AND STAFF ARE INTEGRATED INTO A WIDE VARIETY OF THESE INITIATIVES. THE WAUPACA CHAT TEAM INCLUDES LEADERS FROM PUBLIC HEALTH, NON-PROFITS, EDUCATION, MINISTRY AND HEALTH ORGANIZATIONS WHICH COLLECTIVELY REPRESENT THE BROAD INTERESTS OF THE COMMUNITY. 2014 WAUPACA COMMUNITY HEALTH ACTION TEAM ROSTERCRAIG KANTOS, RIVERSIDE MEDICAL CENTER CINDY OERTER, GREEN FOUNTAIN INN AND GARDEN PARK CBRFTERRI BROOKS, WAUPACA COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICESJAY KRCMAR, FARMER'S STATE BANKANGIE LANDSVERK, WAUPACA COUNTY POSTALLEN KRAEGER - WAUPACA COUNTY SHERIFF'S OFFICEAARON JENSON - WAUPACA PARKS AND RECREATIONMAUREEN MARKON - WAUPACA SCHOOL DISTRICTBETTY JO BALZAR, RIVERSIDE MEDICAL CENTER VICKI POESCHL - COMMUNITY MEMBERPAULA MORGEN, THEDACAREKAYE THOMPSON, THEDACAREKEY INFORMANT INTERVIEWS WERE CONDUCTED WITH EXPERTS REPRESENTING VULNERABLE OR MARGINALIZED POPULATIONS IN OUR COMMUNITY INCLUDING FARM FAMILIES, ELDERLY, SCHOOL COUNSELORS, POLICE LIAISON OFFICER, SADD DIRECTOR, SOCIAL WORKER AND PSYCHOLOGIST. SOURCES: PAT ENRIGHT, AGING AND DISABILITY RESOURCE CENTER WAUPACA COUNTY; KIM EBERT, NEW LONDON SENIOR SERVICES MANAGER; TERI MOE, WAUPACA SENIOR CENTER; GREG BLONDE AND CONNIE ABERT, UNIVERSITY OF WISCONSIN EXTENSION-WAUPACA COUNTY; RHONDA STREBEL, RURAL HEALTH INITIATIVE; PAT ENRIGHT, ADRC MANAGER; KIM EBERT WAUPACA COUNTY SENIOR SERVICES, BRIAN HOELZEL, WAUPACA CITY POLICE, FATHER JIM, ANNE COLLINS-REED, JEFF DOLSKI, JESSE RIEGERT, DENISE SAFFEIDT, SHANE DORNFELD; WAUPACA SCHOOLS COUNSELING GROUP. |
| RIVERSIDE MEDICAL CENTER, INC. | PART V, SECTION B, LINE 6A: AFFINITY HEALTH SYSTEM |
| RIVERSIDE MEDICAL CENTER, INC. | PART V, SECTION B, LINE 7D: THE CHNA WAS MADE AVAILABLE TO LOCAL CHAT, THEDACARE BOARDS AND LEADERSHIP TEAMS.FULL WEBSITE FOR CHNA & IMPENMENTATION STRATEGY: HTTPS://WWW.THEDACARE.ORG/HOSPITALS-AND-CLINICS/RIVERSIDE-MEDICAL-CENTER |
| RIVERSIDE MEDICAL CENTER, INC. | PART V, SECTION B, LINE 11: OBESITY:-SUPPORTED THE PURCHASED OF NEW REFRIGERATORS FOR WAUPACA COUNTY FOOD PANTRIES WHICH ALLOWED FOR FRESH FOOD STORAGE-WORKED WITH THE WAUPACA COUNTY NUTRITION AND ACTIVITY COALITION ON A RESTAURANT HEALTHY FOOD INITIATIVE-CONTRIBUTED FINANCIAL SUPPORT TO THE LOCAL FARMER'S MARKET-CONTRIBUTED SUPPORT TO PROJECT BACKPACK - SUPPLYING FOOD TO CHILDREN DURING WEEKENDS-SUPPORTED NUMEROUS YOUTH SPORTING TEAMS-PARKS AND RECREATION IS A MEMBER OF THE WAUPACA COMMUNITY HEALTH ACTION TEAM-SPONSORED MANY FAMILY RELATED ACTIVITY EVENTS-IN 2014, THEDACARE ESTABLISHED GOOD TO GO WEEK AN EMPLOYEE LED INITIATIVE THAT TOOK PLACE IN 6 SCHOOL DISTRICTS THROUGHOUT THE THEDACARE SYSTEM. ACTIVITIES WILL INCLUDE HEALTHY SNACKS, BUILD A SCHOOL GARDEN, FATS IN FOODS, MEASURE YOUR DRINK, LEADING GYM CLASSESMENTAL HEALTH: -THEDACARE HELD A DAY- LONG EVENT THAT BROUGHT TOGETHER 62 COMMUNITY MEMBERS INTERESTED IN LEARNING MORE ABOUT ISSUES OF 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 PROVIDERSSUBSTANCE ABUSE:-WITH THE THEDACARE LED COMMUNITY HEALTH ACTION TEAM, CONDUCTED TWO MAJOR DRUG TAKE BACK DAY INITIATIVES AND DOUBLES THE AMOUNT OF UNUSED DRUGS COLLECTED-PROVIDE LEADERSHIP TO THE WAUPACA COUNTY CRIMINAL JUSTICE COMMITTEEACCESS TO PRIMARY 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 DOORIDENTIFIED BUT NOT WORKING ON:1.POVERTY - BEYOND THE SCOPE OF OUR RESOURCES AT THIS TIME2.MOTOR VEHICLE CRASH RATE - BEYOND THE SCOPE OF OUR RESOURCES AT THIS TIME3.ACCESS TO DENTISTS - BEYOND THE SCOPE OF OUR RESOURCES AT THIS TIME4.SOME COLLEGE EDUCATION - BEYOND THE SCOPE OF OUR RESOURCES AT THIS TIME5.ACCESS TO RECREATIONAL FACILITIES - MAY BE INCLUDED IN THE OBESITY PRIORITY6.INDEPENDENT LIVING SUPPORT - BEYOND THE SCOPE OF OUR RESOURCES AT THIS TIME7.CHRONIC DISEASE PREVENTION - SIGNIFICANT EXISTING EFFORTS |
| RIVERSIDE MEDICAL CENTER, INC. | PART V, SECTION B, LINE 15E: OFFERED TO WORK DIRECTLY WITH PATIENTS TO COMPLETE THE APPLICATION IF NEEDED AND PROVIDED ASSISTANCE BEYOND THEDACARE ASSISTANCE FOR UNINSURED PATIENTS BY ASSISTING WITH THE FUNDING OF STAFF AT "PARTNERSHIP COMMUNITY EDUCATION CENTER". THEY ARE A NOT FOR PROFIT AGENCY THAT ASSISTS ANY MEMBER OF ANY COMMUNITY WITH MARKETPLACE INSURANCE ENROLLMENT AS WELL AS ASSESSING THE NEED FOR ADDITIONAL COMMUNITY BENEFITS THAT MAY BENEFIT THE PATIENT. |
| RIVERSIDE MEDICAL CENTER, 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. |
| RIVERSIDE MEDICAL CENTER, 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. |
| RIVERSIDE MEDICAL CENTER, 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. |
| 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. |
| PART V, SECTION B, LINE 16 | FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY |
| RIVERSIDE MEDICAL CENTER, INC. PART V, SECTION B, LINE 16A WEBSITE: | WWW.THEDACARE.ORG/~/LINK.ASPX?_ID=206478F0E2874D2EAD353B71BC978623& |
| RIVERSIDE MEDICAL CENTER, INC. PART V, SECTION B, LINE 16B WEBSITE: | WWW.THEDACARE.ORG/~/LINK.ASPX?_ID=206478F0E2874D2EAD353B71BC978623& |
Supplemental Information Detail SupplementalInformationDetail (13 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 $47,850. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | THE HEALTH OF THE COMMUNITY RIVERSIDE MEDICAL CENTER SERVES 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.TEAMING FOR HEALTH & RESILIENCY IMPROVEMENT VIA EDUCATION AND SUPPORT (THRIVES) - ASSISTING PEOPLE WITH CHRONIC ILLNESS.CHAT - COMMUNITY LEADERS WORKING TOGETHER TO EXPLORE LOCAL AND REGIONAL HEALTH ISSUES.SEXUAL ASSAULT NURSE EXAMINER - WORKING TO END SEXUAL AND DOMESTIC VIOLENCE.EMERGING LEADERS - MAKING AN IMPACT IN OUR COMMUNITY THROUGH DEDICATION TO SERVICE/PHILANTHROPY.ELECTRONIC RECYCLING EVENT - WORKING TO TREAT THE EARTH WITH THE RESPECT THAT IT DESERVES.COMMUNITY SHARPS COLLECTION - REDUCING THE RISKS OF INFECTIOUS WASTE.COMMUNITY GARDEN/FARMER'S MARKETS - PROVIDES FRESH PRODUCE TO AREA FOOD PANTRIES/COMMUNITY.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.FOX VALLEY FAMILY MEDICINE RESIDENCY PROGRAM - TEACHING THE ART AND HEART OF CARE.THEDACARE CENTER FOR HEALTHCARE VALUE - OFFERS LEARNING EXPERIENCES THAT DEVELOP HEALTHCARE LEADERS WHO ARE CAPABLE OF CONFIDENTLY DRIVING THE LEAN TRANSFORMATION OF THEIR ORGANIZATIONS TO DELIVER MEASURABLY BETTER VALUE TO THE PATIENTS, FAMILIES AND COMMUNITIES THEY SERVE.COMMUNITY CHEST - WORKING EVERY DAY TO IMPROVE THE COMMUNITY.PLUNGE INTO ALCOHOL/DRUGS - A DAY-LONG EDUCATION LEARNING EVENT ABOUT THE EFFECTS OF DRUGS AND ALCOHOL ON LOCAL SCHOOLS, LAW ENFORCEMENT, LEGAL SYSTEM, HEALTHCARE AND THE COMMUNITY.DRUG TAKE BACK COLLECTION CAMPAIGN - A CAMPAIGN FOCUSED ON THE DANGERS OF PHARMACEUTICAL DRUGS AND HOW TO SAFELY DISPOSE OF THEM.CONCUSSION MANAGEMENT PROGRAM - EDUCATING STUDENTS, PARENTS AND COACHES TO RECOGNIZE THE VALUE OF REDUCING THE RISK OF INJURY. WAUPACA COUNTY NUTRITION AND ACTIVITY COALITION (NUACT) - CREATING ENVIRONMENTS THAT PROMOTE HEALTHY EATING AND PHYSICALLY ACTIVE LIFESTYLES. RURAL HEALTH INITIATIVE - ADDRESSING GROWING CONCERNS REGARDING THE HEALTH AND SAFETY ISSUES FACING TODAY'S FARM FAMILIES.PLUNGE INTO MENTAL HEALTH - A DAY-LONG EDUCATION LEARNING EVENT ABOUT MENTAL HEALTH ISSUES AND THE EFFECT ON LOCAL SCHOOLS, LAW ENFORCEMENT, LEGAL SYSTEM, HEALTHCARE AND THE COMMUNITY.MENTORING COMMITTEE - A COMMITTEE WORKING ON CREATING AN ON-SITE MENTORING PROGRAM FOR KIDS IN THE WAUPACA AREA.MISSION OF HOPE - PROVIDING BASIC SERVICES TO COMMUNITY IN NEED. |
| PART III, LINE 8: | WE DO 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. FIVE THEDACARE HOSPITALS PROVIDE SERVICE IN THIS AREA. THEDACARE CONDUCTS A COMMUNITY NEEDS ASSESSMENT EVERY TWO 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, AND INSIGHTS GATHERED FROM MONTHLY MEETINGS OF THE THEDACARE-LED CHAT TEAM (COMMUNITY HEALTH ACTION TEAM) COMPRISED OF 14 COMMUNITY LEADERS IN BUSINESS, NON-PROFIT, CLERGY, HEALTHCARE, EDUCATION, 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: | RIVERSIDE MEDICAL CENTER PROVIDES SERVICES PRIMARILY TO PEOPLE IN WAUPACA COUNTY. THE POPULATION OF WAUPACA COUNTY IS 52,410. COUNTY POPULATION IS CONCENTRATED IN THE WESTERN PORTION OF THE CITY OF NEW LONDON AND CITY OF WAUPACA. WAUPACA COUNTY IS MOSTLY RURAL WITH A LARGE FARMING POPULATION IN THE NORTHEAST REGION. WAUPACA COUNTY:-WAUPACA COUNTY POPULATION GROWTH RATE OVER THE LAST DECADE IS 5.5%.-WAUPACA COUNTY HIGH SCHOOL GRADUATION RATE IS 90%. -TOP INDUSTRIES IN WAUPACA COUNTY INCLUDE NURSING/RESIDENTIAL FACILITIES, FOOD/BEVERAGE SERVICES, EDUCATION, METAL FABRICATION AND SOCIAL ASSISTANCE. THE AREA HAS A STRONG INDUSTRIAL BASE AND STABLE GOVERNMENT. -THE MEDIAN AGE OF WAUPACA COUNTY RESIDENTS IS 43.-TWELVE PERCENT OF WAUPACA COUNTY POPULATION LIVES BELOW 100% OF THE FEDERAL POVERTY LEVEL. THE UNINSURED RATE IS 10%.-IN WAUPACA COUNTY, THE LARGEST MINORITY POPULATION IS ALSO LATINO. NATIVE AMERICAN, ASIAN, MULTI-RACIAL AND AFRICAN-AMERICAN ACCOUNT FOR LESS THAN 1% EACH. |
| PART VI, LINE 5: | EACH YEAR, RIVERSIDE MEDICAL CENTER'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 14 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. IN 2014, WAUPACA TOOK A PLUNGE INTO MENTAL HEALTH. THEDACARE PROVIDES FUNDING AND STAFF SUPPORT TO MAKE CHAT AND THESE COMMUNITY HEALTH EFFORTS POSSIBLE. OTHER WAYS THAT THEDACARE HOSPITALS IMPROVE THE HEALTH OF THE COMMUNITY INCLUDE:-IN 2014, 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. -THEDACARE PARTNERS WITH THE FOX CITIES/UW RESIDENCY CENTER TO PROVIDE HANDS ON EXPERIENCE FOR MEDICAL STUDENTS.-THEDACARE ALSO PARTNERS WITH AREA NURSING SCHOOLS SUCH AS UW STEVEN'S POINT 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 $1,434,000 IN UNPAID VOLUNTEER HOURS TO LOCAL NON-PROFITS IN 2014. -RIVERSIDE MEDICAL CENTER STAFF ARE ENGAGED IN WAUPACA COUNTY NUACT COALITION, A COMMUNITY-WIDE MULTI-DISCIPLINARY TEAM ADDRESSING COMMUNITY HEALTH AND WELLNESS NEEDS-RIVERSIDE MEDICAL CENTER HOSTS SUPPORT GROUPS FOR DIABETES, LIVING WITH LOSS AND NEW BABY.-RIVERSIDE MEDICAL CENTER 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.-RIVERSIDE MEDICAL CENTER REACHES OUT TO THE COMMUNITY TO HOST SCREENINGS AND HEALTH FAIRS.-RIVERSIDE MEDICAL CENTER HOSTS AN ANNUAL FUN RUN FOR THE COMMUNITY AND ALSO SPONSORS AN ANNUAL AREA TRIATHLON TO ENCOURAGE FITNESS AND ACTIVITY. RIVERSIDE MEDICAL CENTER STAFF PROVIDE FREE ATHLETIC TRAINING SERVICES TO AREA HIGH SCHOOL ATHLETIC EVENTS.-RIVERSIDE MEDICAL CENTER STAFF SUPPORT THE AMERICAN HEART ASSOCIATION'S GO RED FOR WOMEN EVENT.-RIVERSIDE MEDICAL CENTER STAFF ARE INVOLVED IN STATEWIDE AND REGIONAL DISASTER READINESS PLANNING TO PREPARE OUR COMMUNITY FOR TIMES OF CRISIS.-THEDA CARE PRESIDENT AND CEO IS ENGAGED IN STATEWIDE WISCONSIN COLLABORATIVE FOR HEALTHCARE QUALITY MAKING QUALITY HEALTHCARE DATA TRANSPARENT. -A PLUNGE INTO SUBSTANCE RESULTED WITH THE WAUPACA CHAT WORKING WITH WAUPACA COUNTY TO PARTNER ON DRUG TAKE BACK DAYS. COLLECTED DRUGS WERE DOUBLED.-BECAUSE OF A PLUNGE INTO MENTAL HEALTH AN ON-SITE MENTORING PROJECT WILL BE LAUNCHED THIS FALL OF 2015. |
| 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 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 | 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 (14 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DENT ROBERT MD | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | $0 | $174,670 | $0 | $311 | $0 | $5,346 | $0 | $7,362 | $0 | $17,870 | $0 | $205,559 | $0 | $0 |
| LONG GREGORY MD | ||||||||||||||
| BOARD MEMBER/CMO | $48,286 | $434,570 | $5,496 | $49,461 | $1,938 | $17,444 | $9,161 | $82,449 | $2,145 | $19,302 | $67,026 | $603,226 | $0 | $0 |
| BURMEISTER BRIAN | ||||||||||||||
| BOARD MEMBER/VP SR AMC & TC | $37,908 | $341,173 | $4,114 | $37,024 | $1,939 | $17,453 | $5,444 | $48,995 | $1,870 | $16,830 | $51,275 | $461,475 | $0 | $0 |
| HALLETT MARK MD | ||||||||||||||
| BOARD MEMBER/CHIEF CLINICAL OFFICER | $0 | $342,924 | $0 | $23,249 | $0 | $19,770 | $0 | $7,800 | $0 | $12,569 | $0 | $406,312 | $0 | $0 |
| KANTOS CRAIG | ||||||||||||||
| CEO | $233,839 | $0 | $16,208 | $0 | $14,503 | $0 | $7,654 | $0 | $17,684 | $0 | $289,888 | $0 | $0 | $0 |
| OLSON TIM | ||||||||||||||
| VP CFO SYSTEM | $40,976 | $368,787 | $5,500 | $49,501 | $2,118 | $19,064 | $9,040 | $81,360 | $1,833 | $16,493 | $59,467 | $535,205 | $0 | $0 |
| GRUNER DEAN | ||||||||||||||
| CEO - SYSTEM | $98,643 | $887,783 | $21,136 | $190,227 | $1,090 | $9,811 | $15,606 | $140,459 | $2,027 | $18,243 | $138,502 | $1,246,523 | $0 | $0 |
| LIVINGSTON KEITH | ||||||||||||||
| VP SR CIO | $42,177 | $379,589 | $4,627 | $41,643 | $881 | $7,933 | $7,083 | $63,746 | $1,861 | $16,745 | $56,629 | $509,656 | $0 | $0 |
| PISTONE MAUREEN | ||||||||||||||
| VP SR HR SERVICES | $38,287 | $344,585 | $3,958 | $35,623 | $1,775 | $15,978 | $6,445 | $58,009 | $1,860 | $16,739 | $52,325 | $470,934 | $0 | $0 |
| BARNAS KIM | ||||||||||||||
| VP SR AMC & TC | $0 | $304,636 | $0 | $47,079 | $0 | $340,510 | $0 | $21,331 | $0 | $1,827 | $0 | $715,383 | $0 | $0 |
| DEVINE GREGORY | ||||||||||||||
| VP SR PROVIDER STRATEGY | $46,547 | $418,927 | $10,129 | $91,160 | $2,511 | $22,599 | $5,360 | $48,236 | $1,866 | $16,792 | $66,413 | $597,714 | $0 | $0 |
| HUNTER WILLIAM | ||||||||||||||
| VP SR PLANNING & MARKETING | $34,094 | $306,845 | $4,708 | $42,360 | $1,054 | $9,488 | $6,070 | $54,628 | $1,838 | $16,544 | $47,764 | $429,865 | $0 | $0 |
| POOLE JOHN | ||||||||||||||
| VP SR THEDACARE IMPROVE SYS | $44,224 | $398,017 | $4,542 | $40,875 | $393 | $3,533 | $6,415 | $57,731 | $1,893 | $17,040 | $57,467 | $517,196 | $0 | $0 |
| PETERSON ROBERT MD | ||||||||||||||
| PHYSICIAN | $320,505 | $0 | $11,947 | $0 | $8,320 | $0 | $7,800 | $0 | $11,572 | $0 | $360,144 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (4 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. 12 EMPLOYEES RECEIVED TAXABLE MEDICAL EXPENSE REIMBURSEMENTS AND 7 EMPLOYEE RECEIVED CLUB DUES REIMBURSEMENTS. |
| PART I, LINE 3 | 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, LINES 4A-B | DURING 2014, KIM BARNAS RECEIVED A SEVERANCE PAYMENT OF $219,735. |
| 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, 2013 TO DECEMBER 31, 2013) TO RECEIVE THEIR 2014 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: | NUMBER OF EMPLOYEES: THEDACARE INC., A RELATED ORGANIZATION, CENTRALIZES PAYROLL AND TAX WITHHOLDING FUNCTIONS FOR A NUMBER OF AFFILIATED ENTITIES, WHILE ALL FILING UNDER THEDACARE'S FEDERAL IDENTIFICATION NUMBER. RIVERSIDE MEDICAL CENTER (RMC) REPORTS "0" EMPLOYEES BECAUSE EMPLOYEES ARE PAID BY THEDACARE, INC., THEREFORE, RMC DOES NOT FILE ANY W-2 FORMS. THEDACARE INC. IS REIMBURSED BY RMC FOR SALARY EXPENSES FOR THE EMPLOYEES WHO ARE PERMANENTLY ASSIGNED TO RMC. |
| FORM 990, PART VI, SECTION A, LINE 6 | RIVERSIDE MEDICAL CENTER, INC.'S SOLE CORPORATE MEMBER IS THEDACARE, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | THEDACARE, INC. HAS SOLE AUTHORITY IN THE CORPORATION TO VOTE AND TAKE ANY ACTION WITH RESPECT TO THE ELECTION OF DIRECTORS AND OFFICERS. |
| FORM 990, PART VI, SECTION A, LINE 7B | THEDACARE, INC. HAS THE SOLE AUTHORITY WITH RESPECT TO THE FOLLOWING MATTERS: 1. AMENDMENT OF THE ARTICLES OF INCORPORATION 2. ADOPTION AND AMENDMENT OF BYLAWS OF THE CORPORATION 3. CONSOLIDATION, MERGER AND DISSOLUTION OF THE CORPORATION 4. MONITORING COMPLIANCE WITH LAWS AND REGULATIONS 5. SELECTION, APPOINTMENT, AND REMOVAL OF A CHIEF OPERATING OFFICER 6. PROVISION FOR LONG-RANGE FINANCIAL STABILITY OF THE HOSPITAL AND PROVISION FOR THE CONTROL AND USE OF THE PHYSICAL AND FINANCIAL RESOURCES OF THE HOSPITAL 7. ESTABLISHMENT OF A LONG-RANGE PLANNING MECHANISM 8. APPROVAL OF A HOSPITAL ORGANIZATION AND MAJOR AUTHORITY DELEGATION PATTERNS 9. APPROVAL OF FINANCIAL, CAPITAL, AND OTHER ITEMS 10. APPROVAL OF DEBT OR LEASES 11. CONSIDERATION AND ACTION UPON POLICIES CONCERNING RELATIONS WITH EXTERNAL GROUPS AND ORGANIZATIONS |
| 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 | ON AN ANNUAL BASIS, ALL EMPLOYEES WHO MAKE PURCHASES ON BEHALF OF THE COMPANY REVIEW THE CONFLICT OF INTEREST POLICY AND COMPLETE A FORM TO DISCLOSE PERSONAL INTEREST AS STATED IN THE POLICY. ALL EMPLOYEES AND BOARD MEMBERS ARE COVERED UNDER THE CONFLICT OF INTEREST POLICY. THE CORPORATE COMPLIANCE COMMITTEE REVIEWS THE POTENTIAL CONFLICT AND THE CFO/BOARD OF TRUSTEES REVIEW ALL CONFLICTS. AFTER DISCLOSURE OF THE CONFLICT, THE EMPLOYEE SHALL NOT PARTICIPATE IN THE DECISION WHETHER TO ENGAGE IN THE TRANSACTION IN WHICH THE EMPLOYEE HAS AN INTEREST. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO, OFFICERS AND KEY EMPLOYEES INVOLVES A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. |
| FORM 990, PART VI, SECTION C, LINE 19 | RIVERSIDE MEDICAL CENTER DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND INTERNAL FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. |
| FORM 990, PART XI, LINE 2C: | OVERSIGHT OF AUDIT AND SELECTION PROCESS: THIS PROCESS DID NOT CHANGE FROM THE PRIOR YEAR. |
| FORM 990, PART V, LINE 3A | AFTER THE EXTENSION WAS FILED, IT WAS DETERMINED THAT THERE WERE NOT GROSS RECEIPTS OF AT LEAST $1,000 FROM UNRELATED BUSINESS ACTIVITIES. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (9 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 | |
| THEDA CLARK MEDICAL CENTER 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 | |
| APPLETON MEDICAL CENTER INC | |||||||||||
| PO BOX 8025 | APPLETON | WI | 54912 | 390824015 | HOSPITAL | WI | 501(C)(3) | LINE 3 | Yes (1) | THEDACARE INC | |
| SHAWANO MEDICAL CENTER INC | |||||||||||
| 309 N BARTLETTE STREET | SHAWANO | WI | 54166 | 390807068 | HOSPITAL | WI | 501(C)(3) | LINE 3 | Yes (1) | THEDACARE INC | |
| COMMUNITY HEALTH NETWORK INC | |||||||||||
| 225 MEMORIAL DRIVE | BERLIN | WI | 54923 | 380806359 | HOSPITAL | WI | 501(C)(3) | LINE 3 | Yes (1) | THEDACARE INC | |
| WILD ROSE COMMUNITY MEMORIAL HOSPITAL INC | |||||||||||
| PO BOX 243 | WILD ROSE | WI | 54984 | 396089134 | HOSPITAL | WI | 501(C)(3) | LINE 3 | Yes (1) | THEDACARE INC | |
| APPLETON MEDICAL CENTER FOUNDATION INC | |||||||||||
| 1818 NORTH MEADE STREET | APPLETON | WI | 54911 | 391459276 | FOUNDATION | WI | 501(C)(3) | LINE 7 | 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 | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| THEDACARE INC | ||
| D | $3,599,515 | ACTUAL |
| THEDACARE INC | ||
| N | $230,948 | ACTUAL |
| RIVERSIDE MEDICAL CENTER INC | ||
| O | $20,716,059 | ACTUAL |