2013-10-24T14:23:50-05:00 2012-12-31 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2012-01-01 391509362 THEDACARE INC THED 9207355560 122 EAST COLLEGE AVENUE APPLETON WI 54911 TIM A OLSON 9207355560 2013-10-16 1 TERRI REXRODE CPA MST P00096513 9206620016 2013-10-16 2012 2016-02-24 21:20:13Z TIM A OLSON 122 EAST COLLEGE AVENUE APPLETON WI 54911 569132345 0 X WWW.THEDACARE.ORG X 1985 WI IMPROVING THE HEALTH OF OUR COMMUNITY. 15 11 6558 0 4184729 -66917 177349 347089 247317178 264028806 11302346 8776832 5724376 3338100 264521249 276490827 722750 784070 0 0 178893522 185853643 0 0 0 87067913 92964047 266684185 279601760 -2162936 -3110933 433132372 486244062 696190372 760776189 -263058000 -274532127 X TO PROVIDE THE HIGHEST QUALITY HEALTH CARE, DELIVERED IN THE MOST EFFICIENT AND COST-EFFECTIVE WAYS, AND ACCESSIBLE TO ALL MEMBERS OF THE COMMUNITY. 0 0 122886997 127606051 THEDACARE OPERATES 23 MEDICAL CLINICS IN 13 COMMUNITIES THROUGHOUT THE FOX VALLEY AND SURROUNDING AREAS. THE SERVICES INCLUDE FAMILY AND GENERAL PRACTICES, INTERNAL MEDICINE, ORTHOPEDICS, ALLERGY/IMMUNOLOGY, AND PEDIATRICS. ALONG WITH ROUTINE PHYSICIAN AND NURSING CARE, SOME LOCATIONS PROVIDE OFFICE HOURS WITH SPECIALTY MEDICAL PROVIDERS. MOST CLINICS ALSO OFFER DIAGNOSTIC SERVICES SUCH AS X-RAY, ULTRASOUND, MRI, CAT SCAN, MAMMOGRAPHY AND MEDICAL LABORATORY TESTING. 81050936 784070 78891345 THEDACARE PROVIDES OPERATIONAL AND ADMINISTRATIVE SUPPORT SERVICES FOR HOSPITALS, MEDICAL CLINICS AND VARIOUS OTHER HEALTHCARE PROVIDERS. CENTRALIZING THESE SERVICES ALLOWS MEDICAL PROFESSIONALS TO CONCENTRATE ON GIVING THEIR PATIENTS THE BEST POSSIBLE CARE, WHILE ENJOYING THE BENEFITS OF EFFICIENT AND COST-EFFECTIVE BUSINESS MANAGEMENT. THEDACARE'S MAIN OPERATIONAL SERVICES INCLUDES A REFERENCE LABORATORY, TRANSCRIPTION SERVICES, BIOMEDICAL EQUIPMENT MAINTENANCE, PLUS A MEDICAL REFERENCE LIBRARY, STAFF EDUCATION AND PROFESSIONAL DEVELOPMENT PROGRAMS. MANY SENIOR CITIZENS SUBSCRIBE TO "LIFELINE," A MONITORED HELP/ALARM SYSTEM CONNECTED TO THEDACARE'S NURSE-STAFFED 24-HOUR CALL CENTER. THE CALL CENTER ALSO ANSWERS HEALTH QUESTIONS, HELPS PEOPLE LOCATE A PHYSICIAN, REFERS CALLERS TO ADDITIONAL SOURCES OF INFORMATION, AND ENROLLS CALLERS INTO COMMUNITY-FOCUSED CLASSES ON HEALTH-RELATED TOPICS. ADMINISTRATIVE SERVICES INCLUDE HUMAN RESOURCES, PAYROLL, PURCHASING, FINANCE AND ACCOUNTING, PRINTING, SERVICES FOR MEDICAL & ADMINISTRATIVE MATERIALS, ORGANIZATIONAL DEVELOPMENT, INTERNAL EDUCATION AND IMPROVEMENT SYSTEMS, QUALITY ASSURANCE FOR BOTH INTERNAL AND PUBLIC REPORTING, MARKETING, COMMUNITY OUTREACH AND EDUCATION PROGRAMS, COMMUNICATION SYSTEMS, SECURITY AND LEGAL COMPLIANCE, AND FULL-SPECTRUM INFORMATION TECHNOLOGY PLANNING & SUPPORT. 36312618 37585812 THEDACARE'S SENIOR SERVICES DIVISION FOCUSES ON HEALTH CARE FOR CITIZENS EXPERIENCING LONG-TERM HEALTH ISSUES. AT-HOME HEALTH CARE VISITS MAY COMBINE WITH MEDICAL EQUIPMENT RENTALS TO ALLOW SOME PATIENTS TO CONTINUE LIVING IN THEIR OWN HOMES. AN ADULT DAY PROGRAM ALLOWS A CAREGIVER TO WORK OUTSIDE THE HOME WHILE KNOWING THAT THEIR LOVED-ONE IS SAFE WHILE THEY ARE AWAY. INDIVIDUALS WITH GREATER NEEDS MAY UTILIZE OUR ASSISTED LIVING OR LONG-TERM NURSING CARE FACILITIES. CHERRY MEADOWS HOSPICE PROVIDES CARE FOR END-OF-LIFE RESIDENTS IN A DIGNIFIED, COMPASSIONATE ENVIRONMENT. 13250948 13880016 THEDACARE OFFERS A FULL RANGE OF BEHAVIORAL AND MENTAL HEALTH CARE IN BOTH INPATIENT AND OUTPATIENT SETTINGS. SERVICES INCLUDE PSYCHIATRY, PSYCHOLOGY, BEHAVIORAL MEDICINE, GROUP THERAPY, DAY TREATMENT, DRUG & ALCOHOL ABUSE PROGRAMS FOR BOTH ADULTS AND ADOLESCENTS, INDIVIDUAL OR FAMILY COUNSELING. PROFESSIONAL TREATMENT FOR ADHD, ALZHEIMER'S/DEMENTIA, AND OTHER BEHAVIORAL DISORDERS PROVIDES A RESOURCE FOR ALL SEGMENTS OF OUR COMMUNITY.THEDACARE WORKPLACE SOLUTIONS, A DIVISION OF THEDACARE, PROVIDES OCCUPATIONAL HEALTH SERVICES TO AREA BUSINESSES WITH THE GOAL OF HELPING TO CONTROL THE COST OF INSURING THEIR EMPLOYEES. IDENTIFYING AND MANAGING CHRONIC DISEASE HELPS KEEP A WORKFORCE HEALTHY AND PRODUCTIVE, BENEFITTING BOTH COMMUNITY AND EMPLOYER. EMPLOYEE ASSIST PROGRAMS, ON-SITE MEDICAL SERVICE PROVIDERS, ERGONOMICS, IMMUNIZATIONS AND SCREENINGS, SAFETY EDUCATION AND INJURY PREVENTION ALL CONTRIBUTE TO MAINTAINING THE HEALTH AND WELL-BEING OF INDIVIDUALS WHO MAKE UP OUR WORKFORCE. 13250948 13880016 253501499 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 652 0 1 6558 1 1 1 0 0 0 0 0 0 0 0 0 X 15 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X KRISTEN COGSWELL 9207386471 122 EAST COLLEGE AVENUE APPLETON WI 54911 STELLMACHERJON 1.00 2.00 X X 0 0 0 MALANOWSKIJOHN 1.00 2.00 X X 0 0 0 SWANSONJACK MD 1.00 2.00 X X 0 0 0 WELLERMIKE 1.00 2.00 X X 0 0 0 GRUNERDEAN 11.00 32.00 X X 235351 706052 202823 ANDERLADAVID MD 41.00 3.00 X 308202 0 33534 ATTASSIOMAR MD 1.00 3.00 X 0 0 0 CONNOLLY-KEESLEREILEEN 1.00 2.00 X 0 0 0 DAVISJOHN 1.00 2.00 X 0 0 0 EDELMANGARY MD 41.00 2.00 X 414561 0 36509 JONESGINGER 1.00 2.00 X 0 0 0 LARSONJIM 1.00 4.00 X 0 0 0 MEYERJIM 1.00 3.00 X 0 0 0 MOARD DOUGLAS MD 41.00 2.00 X 289772 0 37000 TIMBERLAKEKAREN 1.00 2.00 X 0 0 0 WHITESIDEJEFFREY MD 1.00 2.00 X 0 0 0 OLSONTIM 10.00 32.00 X 112227 336681 109293 BARNASKIM 8.00 32.00 X 70067 280269 115579 BURMEISTERBRIAN 8.00 34.00 X 66470 265880 86035 CROWROSE 8.00 33.00 X 99356 397423 30785 LIVINGSTONKEITH 10.00 30.00 X 95060 285181 96813 PISTONEMAUREEN 10.00 30.00 X 79405 238212 87635 DIETRICHTERRY MD 40.00 0.00 X 498126 0 32228 ERICKSON ERIC MD 40.00 0.00 X 1611714 0 32682 KLIEST KENNETH MD 40.00 0.00 X 1113465 0 33498 MINIKEL JEFFERY MD 40.00 0.00 X 536186 0 20289 SMITH TODD MD 40.00 0.00 X 720688 0 31735 6250650 2509698 986438 255 0 1 0 E-FREIGHT COURIER LLP PO BOX 13885 WAUWATOSA WI 53213 FREIGHT SERVICES 682116 GODFREY & KAHN SC PO BOX 2728 APPLETON WI 54912 LEGAL SERVICES 593438 AVASTONE TECHNOLOGIES LLC PO BOX 78103 MILWAUKEE WI 53278 SOFTWARE SERVICES 539669 MEDISYNC HEALTHCARE SOLUTIONS 4700 SMITH RD STE A CINCINNATI OH 45212 MANAGEMENT SERVICES 515148 MORGAN HUNTER HEALTHCARE INC 7600 W 110TH ST OVERLAND PARK KS 66210 SOFTWARE SERVICES 385807 27 108747 238342 347089 PATIENT/CLIENT SERVICE 900099 179071878 179071878 MANAGEMENT SERVICE FEES 900099 73971116 73971116 OTHER OPERATING REVENUE 900099 4920230 4920230 SOFTWARE SERVICES 541519 4125157 4125157 INFORMATION TECHNOLOGY SERVICES 900099 1880853 1880853 59572 59572 264028806 5051183 5051183 2224417 821223 1403194 1403194 1403194 295451522 94422 291609659 210636 3841863 -116214 3725649 3725649 OTHER REVENUE 900099 1745608 1745608 EQUITY GAIN IN AFFILIATE 900099 189298 189298 1934906 276490827 257963224 4184729 13995785 784070 784070 7272034 1021384 6250650 144273700 140251232 4022468 6045080 5101817 943263 20243340 14798396 5444944 8019489 6875702 1143787 1221725 1221725 647269 532435 114834 397135 397135 555385 555385 17971802 17217736 754066 2605111 1768127 836984 20448986 19803966 645020 9785756 7828605 1957151 13129871 12222855 907016 1133516 1072032 61484 1722563 1474093 248470 1360005 1360005 6315153 6212762 102391 882149 844043 38106 COST OF GOODS SOLD 6339169 6339169 BAD DEBT EXPENSE 4411690 4401694 9996 EQUIPMENT MAINTENANCE 3462941 3208484 254457 RECRUITMENT 573821 382892 190929 279601760 253501499 26100261 0 4610654 1491979 55631616 55874825 22566778 30712131 686851 602452 11086141 10169383 204813226 124089079 91273541 80724147 222180786 228484988 52673294 1106 996756 25096005 24513001 433132372 486244062 64248434 66611432 2220885 1844113 242715000 235920000 13081131 10787189 373924922 445613455 696190372 760776189 X -263058000 -274532127 -263058000 -274532127 433132372 486244062 X -3110933 15457957 -23821151 X X 0 1 X 1 0 X X X 0 0 0 THEDA CLARK MEDICAL CENTER 390830664 3 0 1 1 0 APPLETON MEDICAL CENTER 390824015 3 0 1 1 0 NEW LONDON MEDICAL CENTER 390869788 3 0 1 1 0 RIVERSIDE MEDICAL CENTER 390871113 3 0 1 1 0 SHAWANO MEDICAL CENTER 390807068 3 0 1 1 0 5 0 SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: THEDACARE INC. PROVIDES FUNCTIONS SUCH AS PURCHASING, FINANCE, BILLING, BANKING, HUMAN RESOURCES, INFORMATION TECHNOLOGY, QUALITY ASSURANCE, EDUCATION AND REFERENCE LABORATORY TO THE SUPPORTED ORGANIZATIONS LISTED ON SCHEDULE A. CONSOLIDATED ACCOUNTING PROVIDES DIRECT REVENUE AND EXPENSE REPORTING BY THE ORGANIZATION, WITH ONGOING INTERCOMPANY BALANCES REPLACING THE USE OF CASH TRANSFERS TO REIMBURSE AFFILIATES. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 1 4859 0 0 0 0 0 4859 0 PART IV, SUPPLEMENTAL INFORMATION: PART II-B, LINE 1, LOBBYING ACTIVITIES: LOBBYING ACTIVITIES WERE DONE TO INFLUENCE THE STATE OF WISCONSIN GOVERNING BODY. NO EFFORT WAS MADE TO THE FEDERAL GOVERNMENT, OR TO SUPPORT ANY CANDIDATE. SEE DETAIL OF LOBBYING EXPENDITURES ONLINE AT HTTP://LOBBYING.WI.GOV. ITEMS THAT WERE LOBBIED INCLUDE: - DIETITIAN'S LICENSING LEGISLATION - MEDICAID PAYMENT REFORMS - ASSISTED LIVING, NURSING HOME AND HOSPICE CARE POLICIES - COLORECTAL CANCER SCREENING - CONSTRUCTION STANDARDS FOR HOSPITALS - DRUG DISPENSING TECHNOLOGY - HEALTH CARE COSTS AND FINANCING - HEALTH CARE FUNDING - HEALTH CARE MANPOWER NEEDS - HEALTH CARE QUALITY REPORTING - HEALTH CARE RECORDS - HEALTH CARE REFORM - HEALTH CARE REFORM, INCLUDING QUALITY OF CARE INITIATIVES - HOSPITAL ASSESSMENT/TAX - HOSPITAL COSTS - PROPOSED HOSPITAL ASSESSMENT - PROPOSED HOSPITAL ASSESSMENT - SUPPORT - REGULATION OF HOSPITALS 8217603 8217603 72428337 26510303 45918034 678348 306754 371594 120105652 97272022 22833630 3383286 3383286 80724147 45695504 F EQUITIES 6977790 F 52673294 CAPITAL FUNDS COMMITTED TO HOSPITAL 19694851 LICENSE FEES - NET OF AMORTIZATION 4818150 24513001 DUE TO AFFILIATES 353950400 DEFERRED EMPLOYEE BENEFITS 91663055 445613455 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: 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 2012 AND 2011. TAX RETURNS FOR THE YEARS ENDED 2009 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. 1 APPLETON MEDICAL CENTER FOUNDATION INC 1818 N MEADE ST APPLETON WI 54911 391459276 501(C)(3) 404692 GENERAL THEDACARE CENTER FOR CREATING VALUE 100 W LAWRENCE ST APPLETON WI 54911 262795800 501(C)(3) 208333 GENERAL FOX CITIES COMMUNITY HEALTH CENTER 1814 APPLETON RD MENASHA WI 54952 202090446 501(C)(3) 87500 GENERAL UNITED WAY OF THE FOX CITIES 1455 MIDWAY RD MENASHA WI 54952 390912895 501(C)(3) 63615 GENERAL THEDA CLARK MEDICAL CENTER FOUNDATION 130 SECOND ST NEENAH WI 54956 311550056 501(C)(3) 6200 GENERAL WOLF RIVER AREA HEALTH CARE FOUNDATION 1405 MILL ST LONDON WI 54961 200049796 501(C)(3) 7250 GENERAL COMMUNITY HOSPICE FOUNDATION INC PO BOX 1534 APPLETON WI 54912 391511977 501(C)(3) 6470 GENERAL 7 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: IN ORDER FOR GRANT REQUESTS TO BE CONSIDERED THEY MUST MEET THE FOLLOWING GUIDELINES: 1) DIRECTED TOWARD PROJECTS THAT SUPPORT THEDACARE'S MISSION AND VALUES 2) BENEFIT THE COMMUNITES SERVED BY THEDACARE, INC. 3) BENEFIT A 501 (C)(3) NOT-FOR-PROFIT ORGANIZATION CONVERSELY, REQUESTS MUST NOT BE FOR: 1) THE SOLE BENEFIT OF AN INDIVIDUAL 2) POLITICAL ORGANIZATIONS OR CAMPAIGN COMMITTEES 3) RELIGIOUS ORGANIZATIONS (FOR STRICTLY RELIGIOUS PURPOSES) 4) ORGANIZATIONS IN CONFLICT WITH THEDACARE'S MISSION AND VALUES 5) STATE OR NATIONAL CAMPAIGNS ALL ORGANIZATIONS REQUESTING GRANT FUNDS MUST APPLY THROUGH THE THEDACARE WEBSITE. REQUESTS ARE SCREENED, REVIEWED, AND APPROVED BY COMMITTEE SIX TIMES THROUGHOUT THE FISCAL YEAR. A LETTER OF RESTRICTION IS ISSUED BY THEDACARE IN CONJUNCTION WITH ALL GRANT CHECKS. THIS LETTER OF RESTRICTION STATES THAT ALL GRANT FUNDS RECEIVED FROM THEDACARE MUST BE USED STRICTLY FOR THE PURPOSES FOR WHICH THEY WERE APPLIED. X X 1 1 X X X X 0 1 0 0 0 0 0 1 0 GRUNERDEAN 174876 524627 56795 170384 3680 11041 45800 137400 4906 14717 286057 858169 0 0 ANDERLADAVID MD 305861 0 511 0 1830 0 14500 0 19034 0 341736 0 0 0 EDELMANGARY MD 355742 0 47877 0 10942 0 12000 0 24509 0 451070 0 0 0 MOARD DOUGLAS MD 289261 0 511 0 0 0 19500 0 17500 0 326772 0 0 0 OLSONTIM 91653 274959 14674 44021 5900 17701 22850 68550 4473 13420 139550 418651 0 0 BARNASKIM 63206 252822 3360 13441 3501 14006 19180 76720 3936 15743 93183 372732 0 0 BURMEISTERBRIAN 55903 223613 7969 31875 2598 10392 13242 52967 3965 15861 83677 334708 0 0 CROWROSE 18289 73155 10620 42479 70447 281789 5500 22000 657 2628 105513 422051 0 0 LIVINGSTONKEITH 77028 231085 12879 38636 5153 15460 19875 59625 4328 12985 119263 357791 0 0 PISTONEMAUREEN 64417 193250 10350 31049 4638 13913 17465 52395 4444 13331 101314 303938 0 0 DIETRICHTERRY MD 483648 0 0 0 14478 0 10750 0 21478 0 530354 0 0 0 ERICKSON ERIC MD 719751 0 890937 0 1026 0 10750 0 21932 0 1644396 0 0 0 KLIEST KENNETH MD 796679 0 288033 0 28753 0 9500 0 23998 0 1146963 0 0 0 MINIKEL JEFFERY MD 495188 0 33141 0 7857 0 9500 0 10789 0 556475 0 0 0 SMITH TODD MD 491450 0 220057 0 9181 0 10750 0 20985 0 752423 0 0 0 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 PURPOSED OF DEVELOPING BUSINESS RELATIONSHIPS HAVE COMPANY PAID MEMBERSHIPS AT A LOCAL COUNTRY CLUB. 7 EMPLOYEES RECEIVED TAXABLE MEDICAL EXPENSE REIMBURSEMENTS AND 4 EMPLOYEES RECEIVED CLUB DUES REIMBURSEMENTS. PART I, LINE 4B SENIOR LEVEL EXECUTIVES OF THE COMPANY ARE ENTITLED TO AN ANNUAL FLEXIBLE BENEFIT EQUAL TO 20% OF THE MIDPOINT OF THEIR SALARY RANGE. THIS 457(F) SUPPLEMENTAL BENEFIT PLAN COMPLIES WITH THE FINAL REGULATIONS UNDER SECTION 409A AND 457(F) OF THE INTERNAL REVENUE CODE. PARTICIPANTS MAY ELECT THE BENEFIT TO BE USED TO PURCHASE PARTICULAR INSURANCE BENEFITS, INVESTED 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, 2011 TO DECEMBER 31, 2011) TO RECEIVE THEIR 2012 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. A WHEFA REV BOND 2005 391337895 97710VZH4 2005-12-22 59289833 FACILITY CONSTRUCTION 0 0 0 B WHEFA REV BOND 2009A 391337855 97710BHY1 2009-06-16 87896508 FACILITY CONSTRUCTION RENOVATION AND REMODELING 0 0 0 C WHEFA REV BOND 2009B 391337855 97710BJL7 2009-06-16 36717948 REFUNDING 0 0 0 D WHEFA REV BOND 2010 391337855 97710BVM1 2010-05-25 25345018 REFUNDING 0 0 0 A 6789833 59289833 4350000 507610 53675584 2007 0 0 1 1 B 981508 87896508 5373000 4916000 1018634 81260000 2010 0 0 1 1 C 11712948 36717948 1589000 425525 34599423 1 0 1 1 D 3590018 25345018 332397 25012621 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 1 0 0 0 0 1 FIFTH THIRD BANK 1.000000000000 1 0 1 B 0 1 0 0 0 0 0 1 C 0 1 0 0 0 0 0 0 0 D 0 1 0 0 0 0 0 0 0 A 0 B 0 C 0 D 0 A WHEFA REV BOND 2012A 391337855 NONEAVAIL 2012-10-19 49745000 REFUNDING 0 0 0 A 49745000 280323 49745000 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 1 0 0 0 0 0 0 0 A 1 NUMBER OF EMPLOYEES FORM 990, PART I, LINE 5: THEDACARE INC. CENTRALIZES PAYROLL AND TAX WITHHOLDING FUNCTIONS FOR A NUMBER OF AFFILIATED ENTITIES, WITH ALL FILINGS UNDER THEDACARE'S FEDERAL IDENTIFICATION NUMBER. 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. 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 THEDACARE INC. DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND INTERNAL FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: PENSION RELATED CHANGES -31,437,614. FUNDS RELEASED FROM RESTRICTIONS -12,478. INVESTMENT RECLASS FROM THEDA CLARK MEDICAL CENTER, INC. 3,719,225. INVESTMENT RECLASS FROM APPLETON MEDICAL CENTER, INC. 3,909,716. OVERSIGHT OF AUDIT FORM 990, PART XII, LINE 2C: THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. THEDA CLARK MEDICAL CENTER INC PO BOX 8025 APPLETON WI 54912 390830664 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 1 NEW LONDON FAMILY MEDICAL CENTER INC 1405 MILL STREET NEW LONDON WI 54961 390869788 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 1 RIVERSIDE MEDICAL CENTER INC 800 RIVERSIDE DRIVE WAUPACA WI 54981 390871113 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 1 APPLETON MEDICAL CENTER INC PO BOX 8025 APPLETON WI 54912 390824015 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 1 SHAWANO MEDICAL CENTER INC 309 N BARTLETTE STREET SHAWANO WI 54166 390807068 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 1 THEDA CLARK MEDICAL CENTER FOUNDATION INC PO BOX 8025 APPLETON WI 54912 311550056 FOUNDATION WI 501(C)(3) LINE 11A, I THEDACARE INC 1 APPLETON MEDICAL CENTER FOUNDATION INC 1818 NORTH MEADE STREET APPLETON WI 54911 391459276 FOUNDATION WI 501(C)(3) LINE 7 THEDACARE INC 1 WOLF RIVER AREA HEALTHCARE FOUNDATION INC 1405 MILL STREET NEW LONDON WI 54961 200049796 FOUNDATION WI 501(C)(3) LINE 11A, I NEW LONDON FAMILY MEDICAL CENTER INC 1 GEORGE F PEABODY FOUNDATION INC PO BOX 2553 APPLETON WI 54912 391702534 FOUNDATION WI 501(C)(3) LINE 11A, I APPLETON MEDICAL CENTER INC 1 COMMUNITY HOSPICE FOUNDATION INC PO BOX 1534 APPLETON WI 54912 391511977 FOUNDATION WI 501(C)(3) LINE 7 THEDACARE INC 1 SHAWANO MEDICAL CENTER FOUNDATION INC 309 N BARTLETTE STREET SHAWANO WI 54166 391539117 FOUNDATION WI 501(C)(3) LINE 11A, I SHAWANO MEDICAL CENTER INC 1 NORTH APPLETON AMBULATORY CARE CENTER BUILDING COMPANY LLC 122 E COLLEGE AVENUE APPLETON WI 54911 262497187 RENTAL WI N/A RELATED -102541 330328 0 1 0.17330 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 NEW LONDON FAMILY MEDICAL CENTER INC D 7818175 ACTUAL RIVERSIDE MEDICAL CENTER INC D 4585099 ACTUAL THEDA CLARK MEDICAL CENTER INC N 1332258 ACTUAL APPLETON MEDICAL CENTER INC N 3369072 ACTUAL NEW LONDON FAMILY MEDICAL CENTER INC N 174613 ACTUAL RIVERSIDE MEDICAL CENTER INC N 208292 ACTUAL SHAWANO MEDICAL CENTER INC N 244832 ACTUAL THEDA CLARK MEDICAL CENTER INC O 79140049 ACTUAL APPLETON MEDICAL CENTER INC O 107238431 ACTUAL NEW LONDON FAMILY MEDICAL CENTER INC O 15065241 ACTUAL RIVERSIDE MEDICAL CENTER INC O 19396132 ACTUAL SHAWANO MEDICAL CENTER INC O 21000923 ACTUAL APPLETON MEDICAL CENTER FOUNDATION INC O 280000 ACTUAL THEDA CLARK MEDICAL CENTER FOUNDATION INC O 286000 ACTUAL