THEDACARE MEDICAL CENTER-WAUPACA INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- THEDACARE MEDICAL CENTER-WAUPACA INC (EIN 39-0871113)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-12
- IRS object ID
- 201203179349302145
- Schema version
- 2011v1.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-12T13:08:58-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420714325 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCGLADREY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 5946 | AddressLine1 |
| City | MADISON | City |
| State | WI | State |
| ZIP Code | 537050946 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390871113 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RIVERSIDE MEDICAL CENTER INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | RIVE | NameControl |
| Phone | 7152581000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 RIVERSIDE DRIVE | AddressLine1 |
| City | WAUPACA | City |
| State | WI | State |
| ZIP Code | 54981 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | CRAIG KANTOS | Name |
| Title | CHIEF EXECUTIVE OFFICER | Title |
| Phone | 7152581000 | Phone |
| Date Signed | 2012-11-08 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JAMES G GRAHAM | Name |
| PTIN | P00006111 | PTIN |
| Phone | 6088332612 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | CRAIG KANTOS | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 RIVERSIDE DRIVE | AddressLine1 |
| City | WAUPACA | City |
| State | WI | State |
| ZIP Code | 54981 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 48005957 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.THEDACARE.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1955 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | RIVERSIDE MEDICAL CENTER, IN PARTNERSHIP WITH THE MEDICAL STAFF AND OTHER HEALTH CARE PROVIDERS, SHALL PROVIDE ACCESS TO HEALTH CARE SERVICES FOR WAUPACA AND THE SURROUNDING AREAS THROUGH A STRATEGY EMPHASIZING THE VALUE OF HEALTHCARE ON THE WELLNESS CONTINUUM.RIVERSIDE MEDICAL CENTER SHALL PROVIDE QUALITY, CARING, AND COST EFFECTIVE SERVICES TO ADJUST OR IMPROVE THEIR HEALH STATUS WHILE RECOGNIZING THE INDIVIDUAL PATIENT'S RIGHTS AND RESPONSIBILITIES.WAUPACA WILL HAVE A MEDICAL COMMUNITY THAT FUNCTIONS AS A RESOURCE FOR THE HEALTH CARE DELIVERY SYSTEM. RIVERSIDE MEDICAL CENTER WILL PROVIDE LEADERSHIP FOR THE HEALTH CARE DELIVERY SYSTEM IN OUR COMMUNITY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 6 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 175 | TotalNbrVolunteers |
| Total Gross UBI | 3862 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 54606 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 329010 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 36078948 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 35579409 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 402759 | InvestmentIncomePriorYear |
| Investment Income Current Year | 862724 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | -213312 | OtherRevenuePriorYear |
| Other Revenue Current Year | 88040 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 36323001 | TotalRevenuePriorYear |
| Total Revenue Current Year | 36859183 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 19317531 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 19950777 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 13169704 | OtherExpensePriorYear |
| Other Expenses Current Year | 13304026 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 32487235 | TotalExpensesPriorYear |
| Total Expenses Current Year | 33254803 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 3835766 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 3604380 | RevenuesLessExpensesCY |
| Total Assets BOY | 59633154 | TotalAssetsBOY |
| Total Assets EOY | 62211853 | TotalAssetsEOY |
| Total Liabilities BOY | 7977012 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 7602627 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 51656142 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 54609226 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO PROVIDE THE HIGHEST QUALITY HEALTH CARE, DELIVERED IN THE MOST EFFICIENT AND COST-EFFECTIVE WAYS, AND ACCESIBLE TO ALL MEMBERS OF THE COMMUNITY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 31886530 | Expense |
| Revenue | 35660616 | Revenue |
| Description | RIVERSIDE MEDICAL CENTER PROVIDED MEDICAL CARE TO THE CITY OF WAUPACA AND ITS SURROUNDING COMMUNITIES AS A CRITICAL ACCESS FACILITY. INPATIENT ADMISSIONS WERE 1109 FOR THE PERIOD.THE AVERAGE LENGTH OF STAY (ALOS) WAS 2.9 DAYS PER STAY FOR THE PERIOD, COMPARED TO 3.0 DAYS PER STAY FOR THE PRIOR YEAR. THE MEDICAL CENTERS CASE MANAGEMENT PROGRAM CONTINUES T0 PLAY A MAJOR ROLE IN KEEPING RMC'S ALOS BELOW INDUSTRY LEVELS.THE PERIOD AVERAGE DAILY CENSUS WAS 8.9, OR 1.8 PATIENT PER DAY LOWER THAN LAST YEAR.RIVERSIDE MEDICAL CENTERS FINANCIAL SUCCESS CONTINUES TO RELY HEAVILY ON ITS OUTPATIENT BUSINESS. QUTPATIENT VISITS FOR PERIOD TOTALED 52,148 VISITS. THIS IS AN AVERAGE OF 142.87 PER DAY, UP 4.8% FROM 136.72 VISITS PER DAY LAST YEAR. THE OVERALL EMERGENCY ROOM/URGENT PATIENT VOLUMES TOTALED 12,585. THIS IS AN AVERAGE OF 34.5 PER DAY, COMPARED TO AN AVERAGE OF 32.6 LAST YEAR. TOTAL SURGERIES DURING THE PERIOD WERE 2,570. THIS IS AN AVERAGE OF 7.04 PER DAY COMPARED TO A TOTAL OF 2,731 DURING THE SAME PERIOD LAST YEAR.LABORATORY BILLED TESTS WERE 352,274 FOR THE PERIOD. THIS IS AN AVERAGE OF 965.13 PER DAY, COMPARED TO THE PREVIOUS YEARS DAILY AVERAGE OF 1,018.10 PER DAY.RIVERSIDE MEDICAL CENTER ALSO CONTINUES TO PROVIDE X-RAY, NUCLEAR MEDICINE, MRI, CT SCAN, ULTRASOUND, CARDIO SERVICES, CARDIAC REHAB, BONE DENSITY, VASCULAR ULTRASOUND AND REHABIITATION SERVICES.THE MEDICAL CENTER CONTINUED TO OFFER A VARIETY OF EDUCATIONAL PROGRAMS TO THE COMMUNITY. | Description |
| Total Program Service Expense | 31886530 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 6 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | WI | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KRISTEN COGSWELL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 9207386471 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 122 E COLLEGE AVENUE | AddressLine1 |
| City | APPLETON | City |
| State | WI | State |
| ZIP Code | 54911 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (20 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| ROSE CROW TERM EXP 2012 | ||||||||
| DIRECTOR | 2.00 | X | 99128 | 396511 | 18653 | |||
| ROBERT DENT MD TERM EXP 2012 | ||||||||
| DIRECTOR | 2.00 | X | 0 | 217441 | 22171 | |||
| GREGORY LONGMD TERM EXP 2012 | ||||||||
| DIRECTOR | 2.00 | X | 68561 | 388508 | 100460 | |||
| MARY ELLEN BOARIOTERM EX 2011 | ||||||||
| TREASURER | 2.00 | X | 0 | 0 | 0 | X | ||
| TOM JOHNSON TERM EXP 2013 | ||||||||
| SECRETARY | 2.00 | X | 0 | 0 | 0 | X | ||
| JIM LARSON TERM EXP 2014 | ||||||||
| VICE CHAIR | 2.00 | X | 0 | 0 | 0 | X | ||
| GARY JANSSEN TERM EXP 2014 | ||||||||
| CHAIR | 2.00 | X | 0 | 0 | 0 | X | ||
| DAVID POESCHL TERM EXP 2012 | ||||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | |||
| JERRY SALANRESIGNED 2011 | ||||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | |||
| CRAIG KANTOS | ||||||||
| CEO | 40.00 | 252790 | 0 | 20212 | X | |||
| KERRY LEE BLANKE | ||||||||
| CFO | 40.00 | 147838 | 0 | 18124 | X | |||
| DEAN GRUNER | ||||||||
| CEO - SYSTEM | 40.00 | 136493 | 773461 | 165240 | X | |||
| TIM OLSON | ||||||||
| VP, CFO - SYSTEM | 40.00 | 65042 | 368576 | 99753 | X | |||
| KEITH LIVINGSTON | ||||||||
| VP, SR., CIO | 40.00 | 56648 | 321003 | 80840 | X | |||
| MAUREEN PISTONE | ||||||||
| VP, SR., HUMAN RESOURCE SERVICES | 40.00 | 44702 | 253313 | 72532 | X | |||
| KATHRYN CORREIA | ||||||||
| VP, SR., HOSPITAL SERVICES | 40.00 | 52167 | 469506 | 96773 | X | |||
| GREGORY DEVINE | ||||||||
| VP, SR., PROVIDER STRATEGY AND SYSTEMS OF CARE | 40.00 | 69788 | 395462 | 81701 | X | |||
| WILLIAM HUNTER | ||||||||
| VP, SR., PLANNING & MARKETING | 40.00 | 59063 | 334690 | 75698 | X | |||
| JOHN POOLE | ||||||||
| VP, SR., THEDACARE IMPROVEMENT SYSTEM (TIS) | 40.00 | 56115 | 317983 | 78249 | X | |||
| ROBERT PETERSON MD | ||||||||
| PHYSICIAN | 40.00 | 315417 | 0 | 15307 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1423752 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 4236454 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 945713 | TotalOtherCompensation |
| Number Individuals GT100 K | 19 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (3 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| RICHARD VEIGA MD SC | |||||
| E2409 PEBBLE RUN RD | WAUPACA | WI | 54981 | PATHOLOGY | 373681 |
| AMER DIAGNOSTIC MEDICINE INC | |||||
| 167 OSWALT | BATAVIA | IL | 60510 | DIAGNOSTIC | 153674 |
| SHARED MEDICAL SERVICES | |||||
| PO BOX 330 | COTTAGE GROVE | WI | 53527 | PATIENT SCREENING SERVICES | 110046 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 3 | NumberOfContractorsGT100K |
| Related Organizations | 23974 | RelatedOrganizations |
| All Other Contributions | 305036 | AllOtherContributions |
| Total Contributions | 329010 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| OUTPATIENT REVENUE | 621400 | 26488132 | 26488132 | |
| INPATIENT REVENUE | 621990 | 8452006 | 8452006 | |
| OTHER MISC REVENUE | 621990 | 563916 | 563916 | |
| HERITAGE REVENUE | 621990 | 71493 | 71493 | |
| MEDICAL CARE | 900099 | 3862 | 3862 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 35579409 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 325851 | TotalRevenueColumn |
| Exclusion | $325,851 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 2935 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 2935 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2935 | TotalRevenueColumn |
| Exclusion | $2,935 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 11683647 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 11146738 | Securities |
| Other | 36 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 536909 | Securities |
| Other | -36 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 536873 | TotalRevenueColumn |
| Related Or Exempt Function Income | -36 | RelatedOrExemptFunctionIncome |
| Exclusion | $536,909 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | CAFETERIA REVENUE | Description |
| Business Code | 722210 | BusinessCode |
| Total Revenue Column | 85105 | TotalRevenueColumn |
| Related Or Exempt Function Income | 85105 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 85105 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 36859183 | TotalRevenueColumn |
| Related Or Exempt Function Income | 35660616 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 3862 | UnrelatedBusinessRevenue |
| Exclusion | $865,695 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 900973 | Total |
| Management And General | 900973 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14965400 | Total |
| Program Services | 14965400 | ProgramServices |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 675807 | Total |
| Program Services | 675807 | ProgramServices |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2444721 | Total |
| Program Services | 2444721 | ProgramServices |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 963876 | Total |
| Program Services | 963876 | ProgramServices |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 467266 | Total |
| Management And General | 467266 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 34 | Total |
| Management And General | 34 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 772062 | Total |
| Program Services | 772062 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30141 | Total |
| Program Services | 30141 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 903631 | Total |
| Program Services | 903631 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 52531 | Total |
| Program Services | 52531 | ProgramServices |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 71005 | Total |
| Program Services | 71005 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 309147 | Total |
| Program Services | 309147 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2823383 | Total |
| Program Services | 2823383 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 134464 | Total |
| Program Services | 134464 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| SUPPLIES | 3387590 | 3387590 |
| BAD DEBT EXPENSE | 1768961 | 1768961 |
| PURCHASED SERVICES | 1603867 | 1603867 |
| EQUIPMENT MAINTENANCE | 614872 | 614872 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 365072 | Total |
| Program Services | 365072 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 33254803 | Total |
| Program Services | 31886530 | ProgramServices |
| Management And General | 1368273 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 920 | BOY |
| EOY | 796 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12187371 | BOY |
| EOY | 13099772 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3939353 | BOY |
| EOY | 4848270 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 177907 | BOY |
| EOY | 180612 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 170665 | BOY |
| EOY | 0 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 53759542 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 22222309 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 33012723 | BOY |
| EOY | 31537233 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5332457 | BOY |
| EOY | 11905035 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4762001 | BOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 49757 | BOY |
| EOY | 640135 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 59633154 | BOY |
| EOY | 62211853 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 636797 | BOY |
| EOY | 590 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7340215 | BOY |
| EOY | 6454102 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 1147935 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7977012 | BOY |
| EOY | 7602627 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 51656142 | BOY |
| EOY | 54590615 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 18611 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 51656142 | BOY |
| EOY | 54609226 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 59633154 | BOY |
| EOY | 62211853 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 3604380 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -651296 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $17,999 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 17999 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | PORTION OF WHA DUES = $17,999 | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2102028 | OtherCostOrOtherBasis |
| Book Value | 2102028 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 37597104 | OtherCostOrOtherBasis |
| Depreciation | 13682294 | Depreciation |
| Book Value | 23914810 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1025200 | OtherCostOrOtherBasis |
| Depreciation | 612253 | Depreciation |
| Book Value | 412947 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 13035210 | OtherCostOrOtherBasis |
| Depreciation | 7927762 | Depreciation |
| Book Value | 5107448 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 31537233 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE TO AFFILIATES | Description |
| Amount | $1,147,935 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1147935 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X: | ReturnReference |
| Explanation | FOOTNOTE FROM CONSOLIDATED FINANCIAL STATEMENTS: THEDACARE FOLLOWS FASB GUIDANCE ON INCOME TAXES, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, WHICH ADDRESSES THE DETERMINATION OF WHETHER TAX BENEFITS CLAIMED OR EXPECTED TO BE CLAIMED ON A TAX RETURN SHOULD BE RECORDED IN THE FINANCIAL STATEMENTS. UNDER THIS GUIDANCE, THEDACARE MAY RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. EXAMPLES OF TAX POSITIONS INCLUDE THE TAX-EXEMPT STATUS OF THEDACARE, AND VARIOUS POSITIONS RELATED TO THE POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME (UBIT). THE TAX BENEFITS RECOGNIZED IN THE FINANCIAL STATEMENTS FROM SUCH A POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50 PERCENT LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. AT DECEMBER 31, 2011 AND 2010, THERE WERE NO UNRECOGNIZED TAX BENEFITS IDENTIFIED OR RECORDED AS LIABILITIES. THEDACARE FILES FORM 990 IN THE U.S. FEDERAL JURISDICTION. TAX RETURNS FILED BY THEDACARE ARE GENERALLY OPEN FOR EXAMINATION FOR THE YEARS 2008 THROUGH 2011. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 300.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 0 | AmountsBudgetedForCharityCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 589 | PersonsServed |
| Total Community Benefit Expense | 161462 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 161462 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00510 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 5351 | PersonsServed |
| Total Community Benefit Expense | 3722829 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3133993 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 588836 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01870 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 5940 | PersonsServed |
| Total Community Benefit Expense | 3884291 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3133993 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 750298 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02380 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 25 | NumberOfActivitiesOrPrograms |
| Persons Served | 477777 | PersonsServed |
| Total Community Benefit Expense | 597407 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5317 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 592090 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01880 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 4 | NumberOfActivitiesOrPrograms |
| Persons Served | 601 | PersonsServed |
| Total Community Benefit Expense | 280985 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 280985 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00890 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 4 | NumberOfActivitiesOrPrograms |
| Persons Served | 3046 | PersonsServed |
| Total Community Benefit Expense | 2692658 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 695867 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1996791 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06340 | PercentOfTotalExpense |
Research Research
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 30 | PersonsServed |
| Total Community Benefit Expense | 1970 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1970 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 6 | NumberOfActivitiesOrPrograms |
| Persons Served | 9618 | PersonsServed |
| Total Community Benefit Expense | 278083 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 278083 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00880 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 40 | NumberOfActivitiesOrPrograms |
| Persons Served | 491072 | PersonsServed |
| Total Community Benefit Expense | 3851103 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 701184 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3149919 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.10000 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 40 | NumberOfActivitiesOrPrograms |
| Persons Served | 497012 | PersonsServed |
| Total Community Benefit Expense | 7735394 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3835177 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3900217 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.12380 | PercentOfTotalExpense |
Physical Improvements And Housing PhysicalImprovementsAndHousing
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Building Expense | 929 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 929 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Building Expense | 102 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 102 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 37 | PersonsServed |
| Total Community Building Expense | 5 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 5 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Environmental Improvements EnvironmentalImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 300 | PersonsServed |
| Total Community Building Expense | 4841 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 4841 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Leadership Development LeadershipDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 19 | PersonsServed |
| Total Community Building Expense | 835 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 835 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 15036 | PersonsServed |
| Total Community Building Expense | 30436 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 30436 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00100 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Building Expense | 205 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 205 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 750 | PersonsServed |
| Total Community Building Expense | 19027 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 19027 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 1306 | PersonsServed |
| Total Community Building Expense | 19043 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 19043 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 9 | NumberOfActivitiesOrPrograms |
| Persons Served | 17448 | PersonsServed |
| Total Community Building Expense | 75423 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 75423 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00240 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $996,604 | BadDebtExpenseAmount |
| Amount Attributable To | 164493 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 8715203 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 8633325 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 81878 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RIVERSIDE MEDICAL CENTER INC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 RIVERSIDE DRIVE | AddressLine1 |
| City | WAUPACA | City |
| State | WI | State |
| ZIP Code | 54981 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| Critical Access Hospital | X | CriticalAccessHospital |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RIVERSIDE MEDICAL CENTER INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 300.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 300.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Permit Lawsuit | X | PermitLawsuit |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)
| ExplanationExplanation | Return ReferenceReturnReference | IdentifierIdentifier |
|---|---|---|
| PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS IN THE TABLE IS A COMBINATION OF AVERAGES AND ACTUAL COSTS OF 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 BASED ON ACTUAL COSTS. 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 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1768961. | ||
| PART II: THE HEALTH OF THE COMMUNITY RIVERSIDE MEDICAL CENTER SERVES IS PROMOTED THROUGH SEVERAL COMMUNITY BUILDING ACTIVITIES AS DESCRIBED BELOW. -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 STAFF WERE HEAVILY INVOLVED IN H1N1 COMMUNITY EDUCATION AND SET UP OF IMMUNIZATION CLINICS THAT HELPED PREVENT THE PANDEMIC FROM SPREADING. WE HAD REGIONAL INVOLVEMENT IN PLANNING AS WELL. -RIVERSIDE MEDICAL CENTER STAFF ARE INVOLVED IN STATEWIDE AND REGIONAL DISASTER READINESS PLANNING TO PREPARE OUR COMMUNITY FOR TIMES OF CRISIS. -RIVERSIDE MEDICAL CENTER STAFF PARTICIPATED IN A THEDACARE-WIDE REBUILDING TOGETHER EVENT WHERE STAFF SPENT THE DAY FIXING UP THE HOME OF A LOCAL FAMILY IN NEED. -THEDA CARE PRESIDENT AND CEO IS ENGAGED IN STATEWIDE WISCONSIN COLLABORATIVE FOR HEALTHCARE QUALITY MAKING QUALITY HEALTHCARE DATA TRANSPARENT. | ||
| PART III, LINE 4: A COST TO CHARGE RATIO WAS USED TO DETERMINE THE AMOUNTS REPORTED IN PART III LINES 2 AND 3. PATIENT PAYMENTS OR DISCOUNTS ARE APPLIED PRIOR TO DETERMINING BAD DEBT EXPENSE AND ARE NOT INCLUDED IN THE BAD DEBT WRITE-OFF REPORTED ON THE AUDITED FINANCIAL STATEMENTS. DEDUCTIBLES AND CONINSURANCE AMOUNTS THAT ARE DEEMED UNCOLLECTIBLE ARE WRITTEN OFF EITHER TO BAD DEBT EXPENSE OR, IF APPLICABLE, TO CHARITY CARE IF THE PATIENT SO QUALIFIES FOR FINANCIAL ASSISTANCE. THE FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE BUT THEY ACCOUNT FOR BAD DEBTS BASED ON GROSS CHARGES TO PATIENTS AFTER REFLECTING ANY PAYMENTS OR DISCOUNTS, OR AMOUNTS DETERMINED TO BE ELIGIBLE FOR CHARITY CARE/FINANCIAL ASSISTANCE. | ||
| PART III, LINE 8: WE DID NOT REPORT ANY SHORTFALL AS A COMMUNITY BENEFIT. THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATIONS MEDICARE COST REPORT IS STEP DOWN. | ||
| PART III, LINE 9B: OUR POLICY IS NOT TO PURSUE PATIENT ACCOUNTS TO THE EXTENT ANY CHARGES ARE ELIGIBLE AND WRITTEN OFF THROUGH OUR CHARITY CARE/FINANCIAL ASSISTANCE PROGRAM. IF ONLY A PORTION OF THE CHARGES ARE ELIGIBLE AND WRITTEN OFF THROUGH OUR CHARITY CARE/FINANCIAL ASSISTANCE PROGRAM, THE REMAINING BALANCE WILL BE BILLED TO THE PATIENT AND COLLECTED IN ACCORDANCE WITH OUR NORMAL COLLECTION POLICY. | ||
| 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 THAT WE NEED TO MAKE A DECISION AS TO WHETHER THE PATIENT MEETS THE CRITERIA FOR ACCEPTANCE AND THEN TO WHAT LEVEL. ONCE THE DECISION IS MADE, WE WILL NOTIFY THE PATIENT AND IF ACCEPTABLE, WRITE OFF THE BALANCE AS DETERMINED. | PART V, LINE 12 | |
| PART VI, LINE 2: THEDACARE SERVES AN 8 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 25 COMMUNITY LEADERS IN BUSINESS, NON-PROFIT, CLERGY, HEALTHCARE, UNITED WAY AND THE LOCAL COMMUNITY FOUNDATION. THE WISCONSIN STATE HEALTH PLAN IS ALSO TAKEN INTO CONSIDERATION. | ||
| PART VI, LINE 3: THERE ARE SEVERAL WAYS THIS OCCURS - THE MOST PROMINENT OF THOSE BEING THROUGH OUR PATIENT HANDBOOK THAT IS PROVIDED TO ALL PATIENTS, THROUGH CONVERSATION WITH OUR CARE MANAGEMENT/DISCHARGE PLANNERS AFTER ADMISSION TO OUR HOSPITALS, AND THROUGH CONVERSATION WITH OUR COLLECTION STAFF. | ||
| PART VI, LINE 4: THEDACARE'S SERVICE AREA CONSISTS OF 8 COUNTIES INCLUDING OUTAGAMIE, WINNEBAGO, CALUMET, SHAWANO, WAUPACA, WAUSHARA, MENOMINEE AND GREEN LAKE. RIVERSIDE MEDICAL CENTER PROVIDES SERVICES PRIMARILY TO PEOPLE IN WAUPACA COUNTY. HIGHLIGHTS REGARDING THE COMMUNITIES WE SERVE INCLUDE: -TOTAL POPULATION OF THE THEDACARE SERVICE AREA IS 518,000. RIVERSIDE MEDICAL CENTER'S SERVICE AREA TOTALS APPROXIMATELY 50,000. -POPULATION OF THE SERVICE AREA CONTINUES TO GROW BUT THE RATE OF GROWTH IS DECLINING -THE AVERAGE AGE OF THE POPULATION IS INCREASING; THE WORKING-AGE POPULATION IS DECLINING -THERE IS A TREND TOWARD SUBURBANIZATION; CORE CITIES AND TOWNS STAY FLAT WHILE CITIES SPRAWL INTO THE SUBURBS -THE NORTHEAST WISCONSIN WILL GROW SLIGHTLY SLOWER THAN THE FOX CITIES. -THE NUMBER OF UNINSURED IN RIVERSIDES SERVICE AREA IS SLIGHTLY HIGHER THAN THE FOX CITIES AT 10%. -98% OF SERVICE AREA IS CAUCASIAN WITH PRESENCE OF HISPANIC POPULATION. -THE POVERTY RATE IN RIVERSIDE MEDICAL CENTERS SERVICE AREA IS APPROXIMATELY 9%. | ||
| 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 25 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. ANOTHER INITIATIVE DEVELOPED THROUGH CHAT IS MAKING THE RIDE HAPPEN WHICH PROVIDES TRANSPORTATION TO OLDER ADULTS WHO OTHERWISE WOULD STAY COOPED UP IN APARTMENTS AND FIGHT DEPRESSION AND ISOLATION. PROJECT PROMISE IS A POVERTY INITIATIVE DEVELOPED THROUGH CHAT THAT BROUGHT TOGETHER MANY LOCAL AGENCIES AND BUSINESSES TO WORK TO ADDRESS POVERTY IN A COLLABORATIVE FASHION. VOICES OF MEN WAS LAUCHED WITH SUPPORT FROM CHAT TO RAISE AWARENESS OF EVERYDAY BEHAVIORS OF MEN THAT CAN LEAD TO AN ACCEPTANCE OF VIOLENCE TOWARD WOMEN. MOST RECENT INITIATIVES INCLUDE WORK AROUND HISPANIC TEEN PREGNANCY AND PREVENTING SUICIDE AMONG THE GAY, LESBIAN, BISEXUAL, TRANSGENDER POPULATION. THE PROJECTS ARISING FROM CHAT ARE MANY. THE LIVES TOUCHED ARE NUMEROUS. 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: -THEDACARE SHARED ITS CUTTING EDGE APPLICATION OF LEAN PRODUCTION IMPROVEMENTS WITH VISITORS ALMOST WEEKLY IN 2011. HUNDREDS OF HEALTHCARE AND NON-HEALTHCARE VISITORS CAME FROM AROUND THE COUNTRY. MOST VISITORS WERE FROM HOSPITALS AND HEALTH SYSTEMS IN THE UNITED STATES LOOKING TO IMPROVE QUALITY AND REDUCE COSTS. -THEDACARE HOSPITALS PROVIDED FUNDING 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 OSHKOSH AND FOX VALLEY TECHNICAL COLLEGE TO PROVIDE TEACHERS FOR THEIR NURSING PROGRAMS AND PROVIDES VENUES FOR NURSING STUDENTS TO PRACTICE THEIR SKILLS. -THEDACARE HOSPITALS LEADERSHIP PROVIDED MORE THAN $40,000 WORTH OF STAFF TIME PROVIDING LEADERSHIP TO LOCAL NON-PROFIT ORGANIZATIONS. -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. -ALL THEDACARE HOSPITALS PROVIDE HEALTH EDUCATION PROGRAMMING FOR THEIR RESPECTIVE COMMUNITIES FOCUSING ON SUCH CRITICAL TOPICS AS PROPER NUTRITION, DIABETES IDENTIFICATION, AND STRESS MANAGEMENT. -THEDACARE SPONSORS PARTY AT THE PAC FOR THOUSANDS OF AREA YOUTH TO EDUCATE YOUTH ON THE PERILS OF RISKY BEHAVIOR AND DRIVING. HOSTED AT OUR PERFORMING ARTS CENTER, LIVE DRAMATIZATIONS ALONG WITH STORIES OF YOUTH DISABLED DUE TO DRIVING AND RISKY BEHAVIOR ENCOURAGE TEENS TO THINK TWICE BEFORE DRINKING OR TEXTING AND DRIVING. -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 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 A FUN RUN FOR THE COMMUNITY TO ENCOURAGE FITNESS AND ACTIVITY. -RIVERSIDE MEDICAL CENTER STAFF PROVIDE FREE ATHLETIC TRAINING SERVICES TO AREA HIGH SCHOOL ATHLETIC EVENTS. -RIVERSIDE MEDICAL CENTER STAFF ARE INVOLVED IN STATEWIDE AND REGIONAL DISASTER READINESS PLANNING TO PREPARE OUR COMMUNITY FOR TIMES OF CRISIS. -RIVERSIDE MEDICAL CENTER STAFF PARTICIPATED IN A THEDACARE-WIDE REBUILDING TOGETHER EVENT WHERE STAFF SPENT THE DAY FIXING UP THE HOME OF A LOCAL FAMILY IN NEED. -THEDA CARE PRESIDENT AND CEO IS ENGAGED IN STATEWIDE WISCONSIN COLLABORATIVE FOR HEALTHCARE QUALITY MAKING QUALITY HEALTHCARE DATA TRANSPARENT. | ||
| PART VI, LINE 6: THEDACARE, THE PARENT ORGANIZATION, PROVIDES DIRECTION RELATED TO COMMUNITY NEEDS ASSESSMENT FOR ALL HOSPITALS AND MARKETS WITH ITS SERVICE AREA. EACH THEDACARE HOSPITAL DETERMINES HOW BEST TO MEET LOCAL NEEDS. IMPLEMENTATION OF COMMUNITY PROGRAMMING OCCURS AT THE HOSPITAL LEVEL. | ||
| WI | PART VI, LINE 7 | REPORTS FILED WITH STATES |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Payments | X | IdemnificationGrossUpPayments |
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 1 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (14 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROSE CROW TERM EXP 2012 | |||||||||||||
| 62358 | 249431 | 11870 | 47480 | 24900 | 99600 | 2576 | 10304 | 1155 | 4618 | 102859 | 411433 | 0 | 0 |
| ROBERT DENT MD TERM EXP 2012 | |||||||||||||
| 0 | 213895 | 0 | 356 | 0 | 3190 | 0 | 8428 | 0 | 13743 | 0 | 239612 | 0 | 0 |
| GREGORY LONGMD TERM EXP 2012 | |||||||||||||
| 54725 | 310106 | 10216 | 57890 | 3620 | 20512 | 12922 | 73227 | 2147 | 12164 | 83630 | 473899 | 0 | 0 |
| CRAIG KANTOS | |||||||||||||
| 214606 | 0 | 20425 | 0 | 17759 | 0 | 7350 | 0 | 12862 | 0 | 273002 | 0 | 0 | 0 |
| KERRY LEE BLANKE | |||||||||||||
| 139945 | 0 | 6705 | 0 | 1188 | 0 | 4400 | 0 | 13724 | 0 | 165962 | 0 | 0 | 0 |
| DEAN GRUNER | |||||||||||||
| 100050 | 566950 | 35291 | 199985 | 1152 | 6526 | 22732 | 128817 | 2054 | 11637 | 161279 | 913915 | 0 | 0 |
| TIM OLSON | |||||||||||||
| 51697 | 292952 | 9381 | 53160 | 3964 | 22464 | 12983 | 73568 | 1980 | 11222 | 80005 | 453366 | 0 | 0 |
| KEITH LIVINGSTON | |||||||||||||
| 45374 | 257119 | 8234 | 46658 | 3040 | 17226 | 10162 | 57587 | 1964 | 11127 | 68774 | 389717 | 0 | 0 |
| MAUREEN PISTONE | |||||||||||||
| 36463 | 206622 | 6616 | 37492 | 1623 | 9199 | 8939 | 50656 | 1941 | 10996 | 55582 | 314965 | 0 | 0 |
| KATHRYN CORREIA | |||||||||||||
| 39934 | 359409 | 10869 | 97825 | 1364 | 12272 | 8237 | 74135 | 1440 | 12961 | 61844 | 556602 | 0 | 0 |
| GREGORY DEVINE | |||||||||||||
| 57095 | 323536 | 10868 | 61587 | 1825 | 10339 | 10102 | 57247 | 2153 | 12199 | 82043 | 464908 | 0 | 0 |
| WILLIAM HUNTER | |||||||||||||
| 48738 | 276184 | 9278 | 52573 | 1047 | 5933 | 9382 | 53167 | 1972 | 11177 | 70417 | 399034 | 0 | 0 |
| JOHN POOLE | |||||||||||||
| 45749 | 259242 | 8708 | 49346 | 1658 | 9395 | 9773 | 55378 | 1965 | 11133 | 67853 | 384494 | 0 | 0 |
| ROBERT PETERSON MD | |||||||||||||
| 311105 | 0 | 302 | 0 | 4010 | 0 | 9350 | 0 | 5957 | 0 | 330724 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| 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. 32 EMPLOYEES RECEIVED TAXABLE MEDICAL EXPENSE REIMBURSEMENTS AND 19 EMPLOYEES RECEIVED CLUB DUES REIMBURSEMENTS. |
| PART I, LINE 3 | THE ORGANIZATION RELIES ON THEDACARE, INC., A RELATED 501(C)(3) ORGANIZATION, TO ESTABLISH THE COMPENSATION FOR ITS EXECUTIVE DIRECTOR. THEDACARE, INC. USES A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE, AS ITS METHODS FOR ESTABLISHING THE COMPENSATION FOR RIVERSIDE MEDICAL CENTER'S EXECUTIVE DIRECTOR. |
| 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 AT-RISK COMPENSATION 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 2011 AT-RISK COMPENSATION. IF THE EMPLOYEE RETIRES, BECOMES DISABLED, MOVES TO A POSITION THAT IS ELIGIBLE UNDER THE AT-RISK COMPENSATION PLAN OR MOVES TO A POSITION THAT IS NO LONGER ELIGIBLE FOR THE AT-RISK COMPENSATION 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 AT-RISK COMPENSATION 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. THE ORGANIZATIONAL MEASURE IS THEDACARE'S OPERATING PERFORMANCE AND EMPLOYES HEALTH ASSESSMENT TOOL SCORE IMPROVEMENTS. ALL ELIGIBLE EMPLOYEES (ON THE PAYROLL AS OF JULY 1, 2011 AND STILL BE ON THE PAYROLL AS OF MARCH 15, 2012) SHARE IN THE GAIN. THE PAYOUT AMOUNT IS DETERMINED BASED ON THEDACARE'S OPERATING MARGIN AND REDUCTION IN OSHA RECORDABLE STRAINS AND SPRAINS. 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
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE COMPLETE FORM 990 WAS MADE AVAILABLE TO THE BOARD MEMBERS AT A MONTHLY BOARD MEETING PRIOR TO ITS FILING. | |
| FORM 990, PART VI, SECTION B, LINE 12C | ON AN ANNUAL BASIS ALL RIVERSIDE MEDICAL CENTER EMPLOYEES ARE REQUIRED TO COMPLETE A COMPUTER BASED CORPORATE COMPLIANCE MODULE. WITHIN THIS MODULE, CONFLICT OF INTEREST IS ADDRESSED. AS PART OF COMPLETION OF THIS MODULE THE EMPLOYEE INDICATES THAT NO CONFLICT OF INTEREST EXISTS, OR DISCLOSES THE CONFLICT OF INTEREST. ANY DISCLOSURE OF A CONFLICT OF INTEREST IS INVESTIGATED. BOARD OF DIRECTORS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT ANNUALLY. AT THE TIME OF COMPLETION, THE BOARD MEMBER INDICATES IF NO CONFLICT OF INTEREST EXISTS, OR DISCLOSES THE CONFLICT OF INTEREST. ANY DISCLOSURE OF A CONFLICT OF INTEREST IS INVESTIGATED. IF INFORMATION IS RECEIVED AT ANY TIME DURING THE YEAR SUGGESTING THAT A CONFLICT OF INTEREST COULD POTENTIALLY EXIST WITH AN EMPLOYEE OR BOARD MEMBER, THIS IS IMMEDIATELY INVESTIGATED AND RESOLVED. | |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION IS ESTABLISHED BASED UPON MARKET SALARY SURVEY DATA. ADJUSTMENTS TO SALARY ARE BASED UPON THE SAME DATA AND APPROVED BY THE BOARD OF DIRECTORS. | |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC BY CONTACTING THE MEDICAL CENTER'S ADMINISTRATIVE ASSISTANT, CFO, OR CEO. | |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED LOSSES ON INVESTMENTS: -669,908. NET ASSETS RELEASED FROM RESTRICTIONS 18,612. TOTAL TO FORM 990, PART XI, LINE 5: -651,296. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2C | NO CHANGE FROM PRIOR YEAR | |
| FORM 990, PART I, LINE 5: | RIVERSIDE MEDICAL CENTER, INC. REPORTS "0" EMPLOYEES BECAUSE EMPLOYEES ARE ALL PAID BY THEDACARE INC., THEREFORE RIVERSIDE MEDICAL CENTER, INC. DOES NOT FILE ANY W-2 FORMS. THEDACARE INC. IS REIMBURSED BY RIVERSIDE MEDICAL CENTER, INC. FOR SALARY EXPENSES FOR ALL OF THE EMPLOYEES PERMANENTLY ASSIGNED TO RIVERSIDE MEDICAL CENTER, INC. | NUMBER OF EMPLOYEES |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (12 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| APPLETON MEDICAL CENTER | ||||||||||
| PO BOX 8025 | APPLETON | WI | 54912 | 390824015 | HOSPITAL | WI | 501(C)(3) | LINE 3 | THEDACARE | 0 |
| THEDA CLARK MEDICAL CENTER | ||||||||||
| PO BOX 8025 | APPLETON | WI | 54912 | 390830664 | HOSPITAL | WI | 501(C)(3) | LINE 3 | THEDACARE | 0 |
| APPLETON MEDICAL CENTER FOUNDATION | ||||||||||
| 1818 N MEADE | APPLETON | WI | 54911 | 391459276 | FOUNDATION | WI | 501(C)(3) | LINE 7 | THEDACARE | 0 |
| THEDA CLARK MEDICAL CENTER FOUNDATION | ||||||||||
| 130 SECOND STREET | NEENAH | WI | 54956 | 391550056 | FOUNDATION | WI | 501(C)(3) | LINE 7 | THEDACARE | 0 |
| WOLF RIVER AREA HEALTHCARE FOUNDATION | ||||||||||
| 1405 MILL STREET | NEW LONDON | WI | 54961 | 200049796 | FOUNDATION | WI | 501(C)(3) | LINE 11B, II | THEDACARE | 0 |
| COMMUNITY HOSPICE FOUNDATION | ||||||||||
| 1818 N MEADE | APPLETON | WI | 54911 | 391511977 | FOUNDATION | WI | 501(C)(3) | LINE 7 | THEDACARE | 0 |
| GEORGE F PEABODY FOUNDATION | ||||||||||
| PO BOX 2553 | APPLETON | WI | 54912 | 391702534 | FOUNDATION | WI | 501(C)(3) | LINE 11A, I | THEDACARE | 0 |
| NEW LONDON FAMILY MEDICAL CENTER | ||||||||||
| 1405 MILL STREET | NEW LONDON | WI | 54961 | 390869788 | HOSPITAL | WI | 501(C)(3) | LINE 3 | THEDACARE | 0 |
| THEDACARE INC | ||||||||||
| 122 E COLLEGE AVE | APPLETON | WI | 54912 | 391509362 | HEALTHCARE | WI | 501(C)(3) | LINE 11C, III-FI | 0 | |
| AUXILIARY OF RIVERSIDE MEDICAL CENTER | ||||||||||
| 800 RIVERSIDE DRIVE | WAUPACA | WI | 54981 | 900328881 | SUPPORT OF RIVERSIDE MEDICAL CENTER | WI | 501(C)(3) | LINE 11A, I | THEDACARE | 0 |
| SHAWANO MEDICAL CENTER FOUNDATION INC | ||||||||||
| 309 N BARTLETTE ST | SHAWANO | WI | 54166 | 391539117 | FOUNDATION | WI | 501(C)(3) | LINE 11D, III-O | THEDACARE | 0 |
| SHAWANO MEDICAL CENTER INC | ||||||||||
| 309 N BARTLETTE ST | SHAWANO | WI | 54166 | 390807068 | HOSPITAL | WI | 501(C)(3) | LINE 3 | THEDACARE | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |