2011-11-04T15:59:20-05:00 2010-12-31 RSM MCGLADREY INC PO BOX 5946 MADISON WI 537050946 990 2010-01-01 390824015 APPLETON MEDICAL CENTER INC APPL 9207355560 PO BOX 8025 APPLETON WI 54912 TIM A OLSON 9207355560 2011-10-19 1 JAMES G GRAHAM 6088333361 2010 2016-03-07 17:11:31Z TIM A OLSON PO BOX 8025 APPLETON WI 54912 310565847 0 X WWW.THEDACARE.ORG X 1958 WI TO IMPROVE THE HEALTH OF OUR COMMUNITY 15 11 0 549 847006 0 626600 199225 209284453 194831296 995810 4916240 1243606 1077715 212150469 201024476 0 0 0 0 87385613 87244450 0 0 0 97790811 97895457 185176424 185139907 26974045 15884569 386474022 402509983 100554697 100706089 285919325 301803894 TO IMPROVE THE HEALTH OF OUR COMMUNITY 0 0 157211941 193984290 160-BED ACUTE CARE HOSPITAL, HEART, CANCER AND OUTPATIENT SURGERY CENTERS, & WELLNESS PROGRAMS. WITH CORPORATE PARENT THEDACARE, WE OFFER PUBLIC AWARENESS CAMPAIGNS, CHARITY CARE, SUPPORT GROUPS, AND EDUCATION PROGRAMS TARGETED TO LOCAL COMMUNITY NEEDS. 157211941 1 1 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 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 0 0 X X KRISTEN COGSWELL 9207386471 122 E COLLEGE AVE APPLETON WI 54911 OMAR ATTASSI 2.00 X 0 0 0 GINGER JONES 2.00 X 0 0 0 JIM LARSON 2.00 X 0 0 0 MARK RICHARDS 2.00 X 0 0 0 EILEEN CONNOLLY-KEESLER 2.00 X 0 0 0 MARK SCOTT 2.00 X 0 0 0 JEFFREY WHITESIDE MD 2.00 X 0 0 0 WALT RUGLAND 5.00 X X 0 0 0 JON STELLMACHER 2.00 X X 0 0 0 JACK SWANSON 2.00 X X 0 0 0 MIKE WELLER 2.00 X X 0 0 0 DEAN GRUNER 40.00 X X 174532 698126 166258 KATHLEEN QUALHEIM MD 40.00 X 0 343942 22049 DAVID ANDERLA MD 40.00 X 0 260906 22719 DOUGLAS MOARD MD 40.00 X 0 253454 22458 TIM OLSON 40.00 X 82432 329729 100566 KATHRYN CORREIA 40.00 X 252622 252622 96560 KEITH LIVINGSTON 40.00 X 74524 298094 75731 MAUREEN PISTONE 40.00 X 59843 239372 70643 GREGORY DEVINE 40.00 X 94527 378109 82239 GREGORY LONG MD 40.00 X 89584 358336 98137 JOHN POOLE 40.00 X 78425 313699 78629 WILLIAM HUNTER 40.00 X 79216 316862 73945 ROSE CROW 40.00 X 82639 330556 64311 1068344 4373807 974245 2 0 1 0 GROTH GROUP LLC 200 E WASHINGTON ST APPLETON WI 549121739 MANAGEMENT 814540 ALLIANCE HEALTHCARE SERVICES PO BOX 96485 CHICAGO IL 606936485 MEDICAL SERVICES 591924 FOX VALLEY PATHOLOGISTS 1818 N MEADE ST APPLETON WI 54956 MEDICAL SERVICES 378767 FRESENIUS MANAGEMENT SERVICES INC 16343 COLLECTION CENTER DR CHICAGO IL 60693 MANAGEMENT 363550 HEALTHPRO STAFFING & PLACEMENT 1602 HIDDEN HILL DRIVE VERONA WI 535937970 MEDICAL SERVICES 221635 6 198160 1065 199225 OUTPATIENT REVENUE 900099 106100297 106100297 INPATIENT REVENUE 900099 87883993 87883993 LAB REFERRAL REVENUE 621500 847006 847006 194831296 2795959 2795959 172140 172140 172140 172140 110717856 943796 109160042 381329 1557814 562467 2120281 2120281 CAFETERIA REVENUE 900099 776998 776998 OTHER MISC REVENUE 900099 128577 128577 905575 201024476 193984290 847006 5993955 643953 643953 65916340 51591158 14325182 4592832 4592832 11859443 9100069 2759374 4231882 4231882 814540 814540 353072 353072 28904596 20648831 8255765 2610447 2496704 113743 20349 20349 133719 133719 4864243 4864243 12147689 12147689 624261 624261 SUPPLIES 37638384 36622975 1015409 EQUIP RENTAL & MAINT 5342157 5342157 BAD DEBT EXPENSE 4442000 4442000 185139907 157211941 27927966 0 3300 3300 20744158 21009415 685634 994161 213273241 100508009 59324824 112765232 94297000 94297000 211419106 173440875 386474022 402509983 1662574 1891664 98892123 98814425 100554697 100706089 X 285919325 301803894 285919325 301803894 386474022 402509983 15884569 0 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2384215 2384215 134584257 47730201 86854056 598160 586324 11836 75706609 52191484 23515125 112765232 INTRACOMPANY- DUE FROM 173440875 173440875 BONDS DUE TO THEDACARE, INC. 98600000 MORTGAGES DUE AND LOANS PAYABLE 214425 98814425 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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, 2010 AND 2009, THERE WERE NO UNRECOGNIZED TAX BENEFITS IDENTIFIED OR RECORDED AS LIABILITIES. THEDACARE FILES FORMS 990 IN THE U.S. FEDERAL JURISDICTION. TAX RETURNS FILED BY THEDACARE ARE GENERALLY OPEN FOR EXAMINATION FOR THE YEARS 2007 THROUGH 2010. 1 1 X 1 X 300.000000000000 1 X 1 0 1 1 6333 1750759 1750759 0.00970 19354842 12307523 7047319 0.03900 6333 21105601 12307523 8798078 0.04870 28 1464763 1803295 17480 1785815 0.00990 3 758 1240993 4000 1236993 0.00680 4 2673143 2673143 0.01480 3 543981 538489 538489 0.00300 7 33282 1050310 1050310 0.00580 45 2042784 7306230 21480 7284750 0.04030 45 2049117 28411831 12329003 16082828 0.08900 1 2 2421 2421 0.00000 1 1187 1187 0.00000 1 236 1494 1494 0.00000 1 1164 6536 6536 0.00000 1 176017 3614 3614 0.00000 1 2 20046 20046 0.00010 1 592 42879 42879 0.00020 7 178013 78177 78177 0.00030 0 2236350 1795173 41296355 48492432 -7196077 X 1 1 2 1 APPLETON MEDICAL CENTER

PO BOX 8025 APPLETON WI 54912

X X X 2 GROTH SURGERY CENTER

PO BOX 8025 APPLETON WI 54912

OUTPATIENT SURGERY CENTER NA 1 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. EACH HOSPITAL HAS ITS OWN AVERAGE, WHICH WAS CALCULATED BY HR USING THE AVERAGE OF EVERYONE EMPLOYED BY THAT FACILITY. 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 $ 4442000. PART II: THE HEALTH OF THE COMMUNITY APPLETON MEDICAL CENTER SERVES IS PROMOTED THROUGH SEVERAL COMMUNITY BUILDING ACTIVITIES AS DESCRIBED BELOW. -APPLETON 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. -THEDA CARE BEHAVIORAL HEALTH HOSTED AN EDUCATIONAL BREAKFAST FOR THE HMONG ELDERS, CLAN LEADERS, ADULTS, AND COMMUNITY MEMBERS, TO EDUCATE THEM ON SERVICES AVAILABLE FOR MENTAL HEALTH AND SUBSTANCE ABUSE ISSUES, ALONG WITH INFORMATION ON ALZHEIMER'S & DEMENTIA. 34 MEMBERS OF THE HMONG COMMUNITY ATTENDED THE BREAKFAST. -THEDA CARE STAFF ATTENDED REGULAR MEETINGS OF COMMUNITY ACTION FOR HEALTHY LIVING COALTION, A STATEWIDE EFFORT TO ADVOCATE FOR LEGISLATION FOR SMOKE-FREE ENVIRONMENTS. -THEDA CARE STAFF PARTICIPATE IN LEADERSHIP FOX CITIES TO GROOM MIDDLE MANAGERS IN THE WORKINGS OF THE ENTIRE COMMUNITY, FROM EDUCATION SYSTEMS AND RECYCLING PROGRAMS TO GOVERNMENT AND JUSTICE SYSTEMS. -APPLETON 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. -APPLETON MEDICAL CENTER STAFF ARE INVOLVED IN STATEWIDE AND REGIONAL DISASTER READINESS PLANNING TO PREPARE OUR COMMUNITY FOR TIMES OF CRISIS. -APPLETON 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 TRUE SELF PAY ACCOUNT HAS THE SELF PAY DISCOUNT WRITTEN OFF TO THE ALLOWANCE ACCOUNT, AND THE REST THAT IS NOT COLLECTED FROM THE PATIENT IS WRITTEN OFF TO THE BAD DEBT ACCOUNT AT THE CHARGES THAT ARE LEFT ON THE ACCOUNT. DEDUCTIBLES AND COINSURANCE AMOUNTS THAT ARE DEEMED UNCOLLECTIBLE ARE WRITTEN OFF AS CHARGES EITHER TO CHARITY IF THE PATIENT QUALIFIES OR BAD DEBT EXPENSE. EVEN AFTER THE ACCOUNT IS WRITTEN OFF TO BAD DEBT, IT CAN STILL BE MOVED AFTER THE FACT IF THE PATIENT IS DETERMINED TO BE ELIGIBLE FOR CHARITY, SO A MAJORITY OF THE ACCOUNTS DO END UP IN THE CORRECT BUCKET. THE FINANCIAL STATEMENTS RECOGNIZE BAD DEBTS AT GROSS CHARGES FOR THE BALANCE REMAINING ON THE ACCOUNT. A COST TO CHARGE RATIO WAS USED TO DETERMINE THE AMOUNTS REPORTED IN PART III LINES 2 AND 3. THE FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE BUT THEY ACCOUNT FOR BAD DEBTS BASED ON CHARGES TO PATIENTS. 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: IF THE PATIENT QUALIFIES FOR A 100% WRITE OFF OF THEIR CHARGES THROUGH OUR CHARITY CARE/FINANCIAL ASSISTANCE, THOSE CHARGES WILL BE WRITTEN OFF TO SELF-PAY. IF THE PATIENT QUALIFIES FOR LESS THAN 50% WRITE OFF OF THEIR BALANCE, THE 50% WRITE OFF CHARGES WILL BE WRITTEN OFF TO SELF-PAY AND THE REMAINING BALANCE WILL BE BILLED TO THE PATIENT AS OUR COLLECTION POLICY STATES. PART VI, LINE 2: THEDACARE SERVES A 7 COUNTY PRIMARY SERVICE AREA. FOUR THEDACARE HOSPITALS PROVIDE SERVICE IN THIS AREA. THEDACARE CONDUCTS A COMMUNITY NEEDS ASSESSMENT 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, PRIMARY COMMUNITY INVOLVEMENT RESEARCH THEDACARE CONDUCTED WITH WEGGE RESEARCH OF 50 MOST INFLUENTIAL COMMUNITY LEADERS IN EACH MARKET, 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 (WHICH MIRRORS APPLETON MEDICAL CENTER'S SERVICE AREA) CONSISTS OF 7 COUNTIES INCLUDING OUTAGAMIE, WINNEBAGO, CALUMET, SHAWANO, WAUPACA, WAUSHARA AND GREEN LAKE. HIGHLIGHTS REGARDING THE COMMUNITIES WE SERVE INCLUDE: -TOTAL POPULATION OF THE SERVICE AREA IS 518,000. (CALUMET - 44,727; OUTAGAMIE - 174,993; WAUPACA - 51,858; WAUSHARA - 24,760; SHAWANO - 40,972; GREEN LAKE - 18,566; WINNEBAGO - 162,111.) -POPULATION OF OUR 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 FOX CITIES WILL GROW SLIGHTLY FASTER THAN THE REST OF NORTHEAST WISCONSIN -THE NUMBER OF UNINSURED IN OUR SERVICE AREA HAS INCREASED FROM 6% TO 8% -96% OF SERVICE AREA IS CAUCASIAN WITH HISPANIC POPULATION OF 2% SEEING THE FASTEST GROWTH; 2% OF POPULATION IS HMONG HAVING ARRIVED HERE AS REFUGEES IN NEED OF SIMULATION. -THE POVERTY RATE RANGES FROM 5.2% IN CALUMET COUNTY TO 11.7% IN WAUSHARA COUNTY. PART VI, LINE 6: EACH YEAR, APPLETON 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 LAUNCHED WITH SUPPORT FROM CHAT TO RAISE AWARENESS OF EVERYDAY BEHAVIORS OF MEN THAT CAN LEAD TO AN ACCEPTANCE OF VIOLENCE TOWARD WOMEN. THE PROJECTS ARISING FROM CHAT ARE NUMEROUS. 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 2010. HUNDREDS OF HEALTHCARE AND NON-HEALTHCARE VISITORS CAME FROM AS FAR AWAY AS AUSTRALIA AND RUSSIA TO OBSERVE. 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 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, SMOKING CESSATION, DIABETES IDENTIFICATION, AND CANCER PREVENTION. -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. -APPLETON 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. -APPLETON MEDICAL CENTER MAKES FINANCIAL AND IN-KIND DONATIONS TO NON-PROFIT ORGANIZATIONS INCLUDING UNITED WAY, AMERICAN HEART ASSOCIATION, AMERICAN CANCER SOCIETY AND REBUILDING TOGETHER. -THEDA CARE STAFF PARTICIPATE IN LEADERSHIP FOX CITIES TO GROOM MIDDLE MANAGERS IN THE WORKINGS OF THE ENTIRE COMMUNITY, FROM EDUCATION SYSTEMS AND RECYCLING PROGRAMS TO GOVERNMENT AND JUSTICE SYSTEMS. -APPLETON MEDICAL CENTER STAFF ARE INVOLVED IN STATEWIDE AND REGIONAL DISASTER READINESS PLANNING TO PREPARE OUR COMMUNITY FOR TIMES OF CRISIS. -APPLETON 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 7: THEDACARE, THE PARENT ORGANIZATION, PROVIDES DIRECTION RELATED TO COMMUNITY NEEDS ASSESSMENT FOR ALL HOSPITALS AND MARKETS WITHIN ITS SERVICE AREA. EACH THEDACARE HOSPITAL DETERMINES HOW BEST TO MEET LOCAL NEEDS. IMPLEMENTATION OF COMMUNITY PROGRAMMING OCCURS AT THE HOSPITAL LEVEL. REPORTS FILED WITH STATES PART VI, LINE 7 WI X X 1 1 X X X X 0 1 0 0 0 0 0 1 0 DEAN GRUNER 121176 484704 50674 202694 2682 10728 30270 121080 2982 11926 207784 831132 0 0 KATHLEEN QUALHEIM MD 0 341645 0 1135 0 1162 0 9350 0 12699 0 365991 0 0 DAVID ANDERLA MD 0 258599 0 1135 0 1172 0 9350 0 13369 0 283625 0 0 DOUGLAS MOARD MD 0 236616 0 16135 0 703 0 9067 0 13391 0 275912 0 0 TIM OLSON 64420 257682 13470 53879 4542 18168 17470 69880 2643 10573 102545 410182 0 0 KATHRYN CORREIA 186609 186609 61314 61314 4699 4699 41035 41035 7245 7245 300902 300902 0 0 KEITH LIVINGSTON 57797 231187 12687 50749 4040 16158 12550 50200 2596 10385 89670 358679 0 0 MAUREEN PISTONE 45436 181743 9953 39810 4454 17819 11599 46394 2530 10120 73972 295886 0 0 GREGORY DEVINE 76522 306089 16747 66988 1258 5032 13550 54200 2898 11591 110975 443900 0 0 GREGORY LONG MD 70154 280617 15367 61468 4063 16251 16950 67800 2677 10710 109211 436846 0 0 JOHN POOLE 59802 239208 13419 53676 5204 20815 13110 52440 2616 10463 94151 376602 0 0 WILLIAM HUNTER 63710 254840 14296 57184 1210 4838 12150 48600 2639 10556 94005 376018 0 0 ROSE CROW 61134 244537 13718 54872 7787 31147 11593 46372 1269 5077 95501 382005 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. 12 EMPLOYEES RECEIVED TAXABLE MEDICAL EXPENSE REIMBURSEMENTS AND 6 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, 2009 TO DECEMBER 31, 2009) TO RECEIVE THEIR 2010 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. THE ORGANIZATIONAL MEASURE IS THEDACARE'S ACTUAL OPERATING PROFIT OVER BUDGET. ALL ELIGIBLE EMPLOYEES (ON THE PAYROLL AS OF JULY 1, 2010 AND STILL BE ON THE PAYROLL AS OF MARCH 15, 2011) 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. FORM 990, PART VI, SECTION B, LINE 11 ORGANIZATION'S PROCESS USED TO REVIEW FORM 990: 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 15A 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 SR VP OF HUMAN RESOURCES, ADVISES, VALIDATES, AND APPROVES A RANGE FOR CEO COMPENSATION. THE COMMITTEE ALSO RATIFIES THE BONUS PLAN. FORM 990, PART VI, SECTION C, LINE 19 APPLETON MEDICAL CENTER INC. DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND INTERNAL FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART XII, LINE 2C: THE PROCESS DID NOT CHANGE DURING THE YEAR NUMBER OF EMPLOYEES FORM 990, PART I, LINE 5: APPLETON MEDICAL CENTER INC. REPORTS "0" EMPLOYEES BECAUSE EMPLOYEES ARE ALL PAID BY THEDACARE INC., THEREFORE APPLETON MEDICAL CENTER INC. DOES NOT FILE ANY W-2 FORMS. THEDACARE INC. IS REIMBURSED BY APPLETON MEDICAL CENTER INC. FOR SALARY EXPENSES FOR ALL OF THE EMPLOYEES PERMANENTLY ASSIGNED TO APPLETON MEDICAL CENTER INC. 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