THEDACARE MEDICAL CENTER-WILD ROSE INC: Form 990, tax year 2024
View the entire original 990 at ProPublica ↗
- Organization
- THEDACARE MEDICAL CENTER-WILD ROSE INC (EIN 39-6089134)
- Tax period
- 2024-07-01 to 2025-06-30
- Filed
- 2026-05-14
- IRS object ID
- 202611349349311711
- Schema version
- 2024v5.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2026-05-14T16:07:18+00:00 | ReturnTs |
| Tax Period End | 2025-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 440160260 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Forvis Mazars LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 Walnut Street Suite 1700 | AddressLine1Txt |
| City | Kansas City | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 641062246 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2024-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 396089134 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ThedaCare Medical Center - Wild Rose Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | THED | BusinessNameControlTxt |
| Phone | 9206223257 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 8025 | AddressLine1Txt |
| City | Appleton | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 549128025 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | William Flett | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Signature | 2026-05-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (true) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Kevin Ensminger | PreparerPersonNm |
| PTIN | P01310558 | PTIN |
| Phone | 8162216300 | PhoneNum |
| Preparation | 2026-05-14 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2024 | TaxYr |
| Build TS | 2025-03-06 01:10:19Z | BuildTS |
Form 990 IRS990
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | IMRAN ANDRABI MD | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 8025 | AddressLine1Txt |
| City | Appleton | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 549128025 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $14,163,268 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.THEDACARE.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1956 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | IMPROVING THE HEALTH OF OUR COMMUNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 6 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 4 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 30 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $14,785 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $6,667,909 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $14,121,630 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $13,699 | PYOtherRevenueAmt |
| CY Other Revenue | $26,853 | CYOtherRevenueAmt |
| PY Total Revenue | $6,681,608 | PYTotalRevenueAmt |
| CY Total Revenue | $14,163,268 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $4,488,994 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,657,590 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,208,901 | PYOtherExpensesAmt |
| CY Other Expenses | $4,312,756 | CYOtherExpensesAmt |
| PY Total Expenses | $6,697,895 | PYTotalExpensesAmt |
| CY Total Expenses | $13,970,346 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$16,287 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $192,922 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $5,423,295 | TotalAssetsBOYAmt |
| Total Assets EOY | $6,731,811 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $312,612 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,390,931 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $5,110,683 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,340,880 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE THE HIGHEST QUALITY HEALTH CARE, DELIVERED IN THE MOST EFFICIENT AND COST-EFFECTIVE WAYS, AND ACCESSIBLE TO ALL MEMBERS OF THE COMMUNITY. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $11,434,569 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $14,121,630 | RevenueAmt |
| Desc | THEDACARE IS A TAX-EXEMPT, NON-PROFIT CORPORATION, AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THEDACARE MEDICAL CENTER-WILD ROSE IS A 25-BED CRITICAL ACCESS HOSPITAL SERVING WILD ROSE AND NEARBY COMMUNITIES. THERE ARE MORE THAN 90 TEAM MEMBERS LOCATED AT THE WILD ROSE LOCATION. THEDACARE MEDICAL CENTER-WILD ROSE PROVIDES PATIENT CARE AND SUPPORT SERVICES INCLUDING DIAGNOSTIC SERVICES SUCH AS X-RAY, ULTRASOUND, MRI, CT SCAN, MAMMOGRAPHY AND MEDICAL LABORATORY TESTING AND SPECIALTY SERVICES SUCH AS CANCER CARE, CARDIOVASCULAR CARE, ORTHOPEDIC CARE, SPINE, NEUROLOGY, FAMILY BIRTH CARE, INTERNAL MEDICINE, EMERGENCY, OCCUPATIONAL HEALTH, PULMONOLOGY, UROLOGY, WOMEN'S CARE, OUTPATIENT SURGERY AND THERAPY SERVICES. EFFECTIVE JANUARY 1, 2024, THEDACARE MEDICAL CENTER - WILD ROSE IS PART OF FROEDTERT THEDACARE HEALTH, INC. CONTINUING ITS COMMITMENT TO PATIENT HEALTH AND COMMUNITY WELLBEING, WE OFFER PUBLIC AWARENESS CAMPAIGNS, CHARITY CARE, SUPPORT GROUPS, AND EDUCATION PROGRAMS TARGETED TO LOCAL COMMUNITY NEEDS. THEDACARE IS COMMITTED TO COMMUNITY FOCUSED EFFORTS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT IN COUNTIES (WAUSHARA) WHERE SERVICES ARE PROVIDED. EFFORTS INCLUDE PARTNERSHIPS WITH LOCAL GOVERNMENTS, COMMUNITY PARTNERS, AND AREA HEALTH ORGANIZATIONS TO ADDRESS THE TOP HEALTH PRIORITIES IDENTIFIED IN ITS MOST RECENT CHNA. THEDACARE OPERATES ON A NON-DISCRIMINATORY BASIS REGARDLESS OF RACE, COLOR, SEX, RELIGION, OR NATIONAL ORIGIN. THEDACARE PROVIDES A VARIETY OF FINANCIAL ASSISTANCE OPTIONS TO PATIENTS WHO MEET ESTABLISHED CRITERIA. SERVICES ARE ALSO PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. | Desc |
| Total Program Service Expenses | $11,434,569 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 6 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 4 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (true) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Policies Reference Chapters | false | PoliciesReferenceChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Written Policy Or Procedure | false | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | William Flett | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9206223257 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 8025 | AddressLine1Txt |
| City | APPLETON | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 549128025 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|---|
| DAN MIELKE | |||||||
| CHAIR, BOARD MEMBER END 10/24 | 1.0 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| KAREN WEST | |||||||
| SECRETARY, BOARD MEMBER | 1.0 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| TERRY MARTZ | |||||||
| VICE CHAIR, BOARD MEMBER | 1.0 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| KELLIE DIEDRICK | |||||||
| VP, CRITICAL ACCESS HOSPITALS, BOARD MEMBER | 1.0 | 49.0 | Yes (X) | $0 | $383,435 | $46,499 | |
| LYNN DETTERMAN | |||||||
| SR VP, THEDACARE SOUTH REGION, BOARD MEMBER | 1.0 | 49.0 | Yes (X) | $0 | $1,372,556 | $72,899 | |
| PAUL SMITH | |||||||
| BOARD MEMBER | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | |
| SHERRY BROWNLOW | |||||||
| BOARD MEMBER | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | |
| BRIAN STERNS | |||||||
| CHIEF DIGITAL HEALTH OFFICER | 4.0 | 46.0 | Yes (X) | $0 | $608,961 | $153,031 | |
| IMRAN ANDRABI MD | |||||||
| PRESIDENT & CEO - SYSTEM | 4.0 | 46.0 | Yes (X) | $0 | $4,591,338 | $647,039 | |
| MAGGIE LUND | |||||||
| CHIEF CULTURE AND INTEGRATION OFFICER | 4.0 | 46.0 | Yes (X) | $0 | $1,355,811 | $62,717 | |
| WILLIAM FLETT | |||||||
| CHIEF FINANCIAL OFFICER | 4.0 | 46.0 | Yes (X) | $0 | $623,899 | $178,131 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $8,936,000 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,160,316 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHARED MEDICAL SERVICES INC | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 209 Linestone Pass | AddressLine1Txt |
| City | Cottage Grove | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53527 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | Medical Staffing | ServicesDesc |
| Compensation | $102,884 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $14,785 | RelatedOrganizationsAmt |
| Total Contributions | $14,785 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SERVICE REVENUE | Desc |
| Business | 622110 | BusinessCd |
| Total Revenue Column | $14,121,630 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $14,121,630 | RelatedOrExemptFuncIncomeAmt |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $14,121,630 | TotalProgramServiceRevenueAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CAFETERIA REVENUE | 722210 | $26,320 | $26,320 |
| OTHER OPERATING REVENUE | 900099 | $533 | $533 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $26,853 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,163,268 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $14,121,630 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $26,853 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,006,064 | TotalAmt |
| Program Services | $7,175,106 | ProgramServicesAmt |
| Management And General | $830,958 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $165,852 | TotalAmt |
| Program Services | $145,190 | ProgramServicesAmt |
| Management And General | $20,662 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,061,817 | TotalAmt |
| Program Services | $929,533 | ProgramServicesAmt |
| Management And General | $132,284 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $423,857 | TotalAmt |
| Program Services | $371,052 | ProgramServicesAmt |
| Management And General | $52,805 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $374,280 | TotalAmt |
| Management And General | $374,280 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,221 | TotalAmt |
| Management And General | $1,221 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,521,896 | TotalAmt |
| Program Services | $531,887 | ProgramServicesAmt |
| Management And General | $990,009 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $106,845 | TotalAmt |
| Program Services | $106,845 | ProgramServicesAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $108 | TotalAmt |
| Program Services | $108 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $195,105 | TotalAmt |
| Program Services | $195,105 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,289 | TotalAmt |
| Program Services | $19,289 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,436 | TotalAmt |
| Program Services | $14,436 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $570,262 | TotalAmt |
| Program Services | $436,704 | ProgramServicesAmt |
| Management And General | $133,558 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,765 | TotalAmt |
| Program Services | $40,765 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| MEDICAL & OTHER SUPPLIES | $969,712 | $969,712 |
| EQUIPMENT & MAINTENANCE | $143,786 | $143,786 |
| FOOD & NUTRITION | $82,395 | $82,395 |
| MEDICAID ASSESSMENT | $32,136 | $32,136 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $240,520 | TotalAmt |
| Program Services | $240,520 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,970,346 | TotalAmt |
| Program Services | $11,434,569 | ProgramServicesAmt |
| Management And General | $2,535,777 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,559,851 | BOYAmt |
| EOY | $2,054,869 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $182,457 | BOYAmt |
| EOY | $152,599 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,138 | BOYAmt |
| EOY | $30,732 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $4,747,981 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $723,907 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,036,891 | BOYAmt |
| EOY | $4,024,074 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $626,958 | BOYAmt |
| EOY | $469,537 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,423,295 | BOYAmt |
| EOY | $6,731,811 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $162,612 | BOYAmt |
| EOY | $189,364 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $150,000 | BOYAmt |
| EOY | $1,201,567 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $312,612 | BOYAmt |
| EOY | $1,390,931 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,110,683 | BOYAmt |
| EOY | $5,340,880 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,110,683 | BOYAmt |
| EOY | $5,340,880 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,423,295 | BOYAmt |
| EOY | $6,731,811 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $192,922 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $37,275 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $1,221 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $1,221 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY | FormAndLineReferenceDesc |
| Explanation | A PORTION OF THE WHA DUES REPRESENT LOBBYING PERFORMED IN REGARD TO HEALTHCARE ISSUES. TOTAL DUES PAID IN 2024 WERE $7,714. 15.8% OF THIS AMOUNT WAS SPENT ON LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $235,400 | OtherCostOrOtherBasisAmt |
| Book Value | $235,400 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,558,709 | OtherCostOrOtherBasisAmt |
| Depreciation | $322,906 | DepreciationAmt |
| Book Value | $3,235,803 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $943,114 | OtherCostOrOtherBasisAmt |
| Depreciation | $401,001 | DepreciationAmt |
| Book Value | $542,113 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,758 | OtherCostOrOtherBasisAmt |
| Book Value | $10,758 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,024,074 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| OTHER ASSETS | $468,399 |
| DUE FROM AFFILIATE | |
| LEASE ASSET | $1,138 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $469,537 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| Federal Income Taxes | |
| THIRD PARTY SETTLEMENT | $500,000 |
| DUE TO AFFILIATE | $701,567 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,201,567 | TotalLiabilityAmt |
| Other Revenue | $0 | OtherRevenueAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $0 | RevenueSubtotalAmt |
| Other Revenues Not Included | $0 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $0 | TotalRevenuePerForm990Amt |
| Other Expenses Included | $0 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $0 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $0 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $0 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule D, Part X, Line 2 EVALUATION OF UNCERTAIN TAX POSITIONS | FormAndLineReferenceDesc |
| Explanation | MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $146,846 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $146,846 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01051 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 956 | PersonsServedCnt |
| Total Community Benefit Expns | $2,280,579 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,986,270 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $294,309 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02107 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 956 | PersonsServedCnt |
| Total Community Benefit Expns | $2,427,425 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,986,270 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $441,155 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03158 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 9 | ActivitiesOrProgramsCnt |
| Persons Served | 38114 | PersonsServedCnt |
| Total Community Benefit Expns | $1,251,110 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,251,110 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08955 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 1 | PersonsServedCnt |
| Total Community Benefit Expns | $1,281,074 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,281,074 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09170 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 100641 | PersonsServedCnt |
| Total Community Benefit Expns | $345,023 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $345,023 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02470 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 14 | ActivitiesOrProgramsCnt |
| Persons Served | 138756 | PersonsServedCnt |
| Total Community Benefit Expns | $2,877,207 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,877,207 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.20595 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 14 | ActivitiesOrProgramsCnt |
| Persons Served | 139712 | PersonsServedCnt |
| Total Community Benefit Expns | $5,304,632 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,986,270 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,318,362 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.23753 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 26585 | PersonsServedCnt |
| Total Community Benefit Expns | $6,721 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,721 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00048 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 278 | PersonsServedCnt |
| Total Community Benefit Expns | $26,830 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $26,830 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00192 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 26863 | PersonsServedCnt |
| Total Community Benefit Expns | $33,551 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $33,551 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00240 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $721,461 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $133,967 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $2,524,179 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $1,906,549 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $617,630 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THEDACARE MEDICAL CENTER - WILD ROSE INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 601 GROVE AVENUE | AddressLine1Txt |
| City | WILD ROSE | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54984 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.THEDACARE.ORG | WebsiteAddressTxt |
| State License | 1004 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THEDACARE MEDICAL CENTER - WILD ROSE INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 24 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTPS://THEDACARE.ORG/ABOUT-US/COMMUNITY-HEALTH/NEEDS-ASSESSMENT-PLANS/ | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 25 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTPS://THEDACARE.ORG/ABOUT-US/COMMUNITY-HEALTH/NEEDS-ASSESSMENT-PLANS/ | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.0 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.0 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Other Method | Yes (X) | OtherMethodInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://THEDACARE.ORG/PATIENTS-AND-VISITORS/BILLING-AND-PAYMENT/FINANCIAL-ASSISTANCE/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://THEDACARE.ORG/PATIENTS-AND-VISITORS/BILLING-AND-PAYMENT/FINANCIAL-ASSISTANCE/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://THEDACARE.ORG/PATIENTS-AND-VISITORS/BILLING-AND-PAYMENT/FINANCIAL-ASSISTANCE/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part V, Section B, Line 3E | THE HOSPITAL FACILITY ANALYZED SEVERAL HEALTH NEEDS OF THE COMMUNITY AND HAS PRIORITIZED THOSE OF MOST CONCERN. THE PRIORITIZATION OF THE TOP SIGNIFICANT COMMUNITY HEALTH NEEDS IS DESCRIBED IN THE CHNA. |
| Schedule H, Part V, Section B, Line 5 Facility , 1 | Facility , 1 - THEDACARE MEDICAL CENTER - WILD ROSE, INC.. AS PART OF THE NEEDS ASSESSMENT ADVISORY TEAM, THEDACARE CONSULTED WITH THE PUBLIC HEALTH DEPARTMENTS OF OUTAGAMIE COUNTY, WINNEBAGO COUNTY, CALUMET COUNTY, SHAWANO, MENOMONEE, GREEN LAKE, MARQUETTE, WAUSHARA, WAUPACA AND THE CITY OF APPLETON. * CHUCK SEPERS, CITY OF APPLETON PUBLIC HEALTH * KRISTENE HUTTER, CITY OF MENASHA PUBLIC HEALTH * KATHLEEN ELLIS, CALUMET COUNTY PUBLIC HEALTH * NATALIE VANDEVELD, OUTAGAMIE COUNTY PUBLIC HEALTH * DOUG GIERYN, WINNEBAGO COUNTY PUBLIC HEALTH * NICK MAU, SHAWANO MENOMINEE COUNTIES PUBLIC HEALTH * RACHEL PRELLWITZ, GREEN LAKE COUNTY PUBLIC HEALTH * JAYME SOPHE, MARQUETTE COUNTY PUBLIC HEALTH * STEFANIE ELDREDGE, WAUSHARA COUNTY PUBLIC HEALTH * JED WOLDT, WAUPACA COUNTY PUBLIC HEALTH |
| Schedule H, Part V, Section B, Line 11 Facility , 1 | Facility , 1 - THEDACARE MEDICAL CENTER - WILD ROSE, INC.. THE THEDACARE COMMUNITY HEALTH IMPLEMENTATION STRATEGY WAS APPROVED BY THE THEDACARE BOARD OF TRUSTEES IN 2024. THE FOLLOWING PRIORITIES WERE IDENTIFIED AS THE TOP COMMUNITY HEALTH NEEDS FOR THE 2026-2028 CHNA CYCLE: MENTAL HEALTH 1) DEVELOPMENT OF COMMUNITY-BASED APPROACH TO SETTING NORMS AROUND CELL PHONE USE. INITIATIVE IS CALLED SYNC: SUPPORTING YOUTH, NURTURING CONNECTION. 2) EXPANSION AND ADOPTION OF ED TO RECOVERY PROGRAM THROUGHOUT ALL THEDACARE FACILITIES. NUTRITION 1) ESTABLISH PARTNERSHIP WITH FEEDING AMERICA AND FORK FARMS TO PURCHASE HYDROPONIC GREENS WHEREBY THE PROCEEDS GO TO SUPPORT GROWING GREENS FOR THE HUNGER NETWORK OF EASTERN WISCONSIN. 2) TEAM MEMBER VOLUNTEER EVENTS TO BUILD FOOD BOXES FOR PATIENTS IN NEED AS THEY LEAVE OUR FACILITIES. ACCESS TO SUPPORTS FOR HEALTH AND WELLBEING 1) EXPAND SCREENING AND REFERRAL FOR SOCIAL NEEDS IN HOSPITAL AND CLINIC SETTINGS CONNECTING PEOPLE TO NEEDED SUPPORTS ADDRESSING UPSTREAM HEALTH BARRIERS. SIGNIFICANT NEEDS IDENTIFIED THROUGH THE MOST RECENTLY CONDUCTED CHNA THAT WILL NOT BE ADDRESSED IN THE CURRENT THREE-YEAR PLAN ARE: 1) EMPLOYMENT - LIMITED RESOURCES TO ADDRESS. 2) HOUSING - LIMITED RESOURCES TO ADDRESS. WORK ON THESE NEEDS CONTINUES AS THEDACARE ADDRESSES PRIORITY ISSUES IN THE COMMUNITY HEALTH IMPROVEMENT PLAN. |
| Schedule H, Part V, Section B, Line 13 Facility , 1 | Facility , 1 - THEDACARE MEDICAL CENTER - WILD ROSE, INC.. PATIENTS ARE SENT AN OVERVIEW LETTER EXPLAINING THE PROCESS FOR APPLYING FOR OUR ASSISTANCE PROGRAM OR OUR STAFF WALKS THEM THROUGH THE PROCESS. THEY ARE ASKED TO COMPLETE AN APPLICATION THAT INCLUDES REQUESTS FOR INFORMATION. THIS INFORMATION IS NEEDED IN ORDER TO MAKE A DECISION AS TO WHETHER THE PATIENT MEETS THE CRITERIA FOR ACCEPTANCE, AND IF ACCEPTED, WHAT LEVEL OF ASSISTANCE WILL BE PROVIDED. ONCE THE DECISION IS MADE, WE WILL NOTIFY THE PATIENT AND IF ACCEPTABLE, WRITE OFF THE BALANCE AS DETERMINED. |
| Schedule H, Part V, Section B, Line 15 Facility , 1 | Facility , 1 - THEDACARE MEDICAL CENTER - WILD ROSE, INC.. CONTRACTED WITH ELIGIBILITY VENDOR (CARDON) TO WORK DIRECTLY WITH UNINSURED PATIENTS TO ASSIST THEM WITH INSURANCE ENROLLMENT AND EDUCATION. |
| Schedule H, Part V, Section B, Line 16 Facility , 1 | Facility , 1 - THEDACARE MEDICAL CENTER - WILD ROSE, INC.. THE FAP AND APPLICATION WERE AVAILABLE AT HOSPITAL CASHIER OFFICES, ON OUR WEB SITE AND OFFERED TO ALL PATIENTS THAT EXPRESSED A FINANCIAL HARDSHIP WHEN CALLING THE BILLING OFFICE. THE PLS WAS PRINTED ON EVERY STATEMENT AND A FOOTER WAS ADDED TO THE FRONT OF THE STATEMENT ADVISING THE PATIENT TO SEE THE REVERSE SIDE OF THE STATEMENT FOR FINANCIAL ASSISTANCE AND PAYMENT OPTIONS. NOTIFICATION OF FINANCIAL ASSISTANCE AVAILABILITY WAS ADDED TO THE INITIAL LETTER SENT BY THE THIRD PARTY COLLECTION AGENCY. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 0 | FacilityNum |
Supplemental Information Detail SupplementalInformationDetail (20 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part I, Line 3 DISCOUNTED CARE EXCEPTIONS | SEE PART V, SECTION B, LINE 13 FOR THE LIST OF FACTORS USED IN THE ELIGIBILITY CRITERIA EXPLAINED IN THE FAP FOR PROVIDING FREE AND DISCOUNT CARE. |
| Schedule H, Part I, Line 7 COLUMN F | THE BAD DEBT EXPENSE IS NOT CONSIDERED A COMMUNITY BENEFIT EXPENSE AND IS NOT INCLUDED IN SCHEDULE H, PART I, LINE 7. THE AMOUNT EXCLUDED IS $721,461. |
| Schedule H, Part I, Line 6a Community benefit report prepared by related organization | THEDACARE, INC. 39-1509362 |
| Schedule H, Part I, Line 7g Subsidized Health Services | NO PHYSICIAN CLINIC COSTS ARE INCLUDED IN THE COMMUNITY BENEFIT EXPENSES. |
| Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance | THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS IN THE TABLE IS A COMBINATION OF AVERAGE COSTS AND ACTUAL COSTS PERTAINING TO SUPPLIES, WAGES, AND BENEFITS. FOR SUPPLIES, THE ACTUAL COST OF ITEMS USED FOR EACH EVENT IS APPLIED. IF NO ACTUAL COST IS AVAILABLE, WE THEN USE AN ESTIMATE. WAGES ARE CALCULATED BY MULTIPLYING THE AVERAGE WAGE RATE TIMES ACTUAL HOURS WORKED. THE BENEFIT RATE USED INCLUDES A FRINGE RATION 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. |
| Schedule H, Part II Community Building Activities | THE HOSPITAL FACILITY PARTICIPATES IN NUMEROUS COMMUNITY BUILDING EFFORTS THROUGHOUT THE YEAR. SPECIFIC ACTIVITIES REPORTED ON SCHEDULE H, PART II INCLUDE: ECONOMIC DEVELOPMENT: THEDACARE WORKS TOGETHER WITH LOCAL CHAMBERS OF COMMERCE IN ALL OF THE COMMUNITIES IT SERVES. THE PRIMARY AIM OF THE CHAMBER IS TO PROMOTE AND PROTECT THE INTERESTS OF ITS MEMBERS AND THE BUSINESS COMMUNITY AND WORK TO IMPROVE THE QUALITY OF LIFE IN THEIR COMMUNITIES BY BUILDING A HEALTHY ECONOMY. STRONG EMPLOYMENT IS A SOCIAL DETERMINANT OF HEALTH, REDUCING POVERTY AND PROVIDING INDIVIDUAL AND FAMILY SUSTAINABILITY. COMMUNITY SUPPORT: CARING HEARTS IS A FINANCIAL ASSISTANCE PROGRAM DESIGNED FOR PATIENTS WHO ARE UNABLE TO PAY FOR MEDICALLY NECESSARY SERVICES PROVIDED BY ALL DIVISIONS WITHIN THEDACARE. THE CARING HEARTS PROGRAM COVERS SERVICES WHICH ARE DEEMED TO BE MEDICALLY NECESSARY AS DETERMINED BY THEIR PHYSICIAN. THIS COST IS FOR TIME AND EXPENSE NEEDED TO SUPPORT CARING HEARTS. THE CARING HEARTS FINANCIAL ASSISTANCE PROGRAM IS IN EFFECT AT ALL THEDACARE FACILITIES - THEDACARE REGIONAL MEDICAL CENTERS IN APPLETON AND NEENAH, THEDACARE MEDICAL CENTER- BERLIN, THEDACARE MEDICAL CENTER-NEW LONDON, THEDACARE MEDICAL CENTER-SHAWANO, THEDACARE MEDICAL CENTER-WAUPACA AND THEDACARE MEDICAL CENTER-WILD ROSE. COMMUNITY SUPPORT: SART/SANE SEXUAL ASSAULT RESPONSE TEAM/SEXUAL ASSAULT NURSE EXAMINER SERVES ON A NUMBER OF LOCAL, COUNTY, AND STATE-WIDE COALITIONS TO PROVIDE OUTREACH AND TRAINING TO HEALTHCARE STUDENTS, LAW ENFORCEMENT, DOMESTIC VIOLENCE SHELTERS AND AGENCIES, CHILD ABUSE RESPONSE TEAMS, WISCONSIN DEPARTMENT OF JUSTICE TRAININGS, AND MORE. THE PROGRAM IS BASED AT THEDACARE REGIONAL MEDICAL CENTER-APPLETON AND SERVES THEDACARE REGIONAL MEDICAL CENTER-NEENAH, THEDACARE MEDICAL CENTER-BERLIN, THEDACARE MEDICAL CENTER-NEW LONDON, THEDACARE MEDICARE CENTER-SHAWANO, THEDACARE MEDICAL CENTER-WAUPACA AND THEDACARE MEDICAL CENTER-WILD ROSE. COMMUNITY SUPPORT: SHARPS AND UNUSED DRUG COLLECTION. COMMUNITY SHARPS/UNUSED DRUGS CAN BE TAKEN FOR COLLECTION AND DISPOSAL TO ANY OF THE SEVEN THEDACARE HOSPITALS. COMMUNITY SUPPORT: A 340B PHARMACY IS A PHARMACY THAT PARTICIPATES IN THE 340B DRUG PRICING PROGRAM, A FEDERAL PROGRAM THAT REQUIRES DRUG MANUFACTURERS TO SELL OUTPATIENT DRUGS AT DISCOUNTED PRICES TO ELIGIBLE HEALTH CARE ORGANIZATIONS. THE 340B PROGRAM HELPS HEALTH CARE ORGANIZATIONS, KNOWN AS COVERED ENTITIES, REDUCE THE COST OF DRUGS FOR THEIR PATIENTS. COVERED ENTITIES INCLUDE HOSPITALS, SUCH AS CRITICAL ACCESS HOSPITALS, RURAL REFERRAL CENTERS, AND SOLE COMMUNITY HOSPITALS, AS WELL AS FEDERAL GRANTEE ORGANIZATIONS. |
| Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount | PATIENT ACCOUNTS RECEIVABLE ARE UNCOLLATERALIZED PATIENT OBLIGATIONS THAT ARE STATED AT THE AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH THEDACARE EXPECTS TO BE ENTITLED IN EXCHANGE FOR PROVIDING PATIENT CARE. THESE OBLIGATIONS ARE PRIMARILY FROM LOCAL RESIDENTS, MOST OF WHOM ARE INSURED UNDER THIRD-PARTY PAYOR AGREEMENTS. THEDACARE BILLS THIRD-PARTY PAYORS ON THE PATIENTS' BEHALF, OR IF A PATIENT IS UNINSURED, THE PATIENT IS BILLED DIRECTLY. ONCE CLAIMS ARE SETTLED WITH THE PRIMARY PAYOR, ANY SECONDARY INSURANCE IS BILLED, AND PATIENTS ARE BILLED FOR COPAY AND DEDUCTIBLE AMOUNTS THAT ARE THE PATIENTS' RESPONSIBILITY. PAYMENTS ON ACCOUNTS RECEIVABLE ARE APPLIED TO THE SPECIFIC CLAIM IDENTIFIED ON THE REMITTANCE ADVICE OR STATEMENTS. THEDACARE DOES NOT HAVE A POLICY TO CHARGE INTEREST ON PAST DUE ACCOUNTS. PATIENT ACCOUNTS RECEIVABLE ARE RECORDED AT NET REALIZABLE VALUE BASED ON CERTAIN ASSUMPTIONS. FOR THIRD-PARTY PAYORS, INCLUDING MEDICARE, MEDICAID, MANAGED CARE AND COMMERCIAL PAYORS, THE NET REALIZABLE VALUE IS BASED ON THE ESTIMATED CONTRACTUAL REIMBURSEMENT PERCENTAGE, WHICH IS BASED ON CURRENT CONTRACT PRICES OR HISTORICAL PAID CLAIMS DATA BY PAYOR. FOR UNINSURED PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR A PORTION OF THE BILL), THE NET REALIZABLE VALUE IS DETERMINED USING ESTIMATES OF HISTORICAL COLLECTION EXPERIENCE. THESE ESTIMATES ARE ADJUSTED FOR EXPECTED RECOVERIES AND ANY ANTICIPATED CHANGES IN TRENDS, INCLUDING SIGNIFICANT CHANGES IN PAYOR MIX, ECONOMIC CONDITIONS OR TRENDS IN FEDERAL AND STATE GOVERNMENTAL HEALTH CARE COVERAGE. |
| Schedule H, Part III, Line 3 Bad Debt Expense Methodology | THE HOSPITAL USES ACCOUNTING DATA, INCLUDING ACCOUNTS AND COST CENTERS, TO ESTIMATE THE PORTION OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. AS THIS IS A COST OF PROVIDING HEALTH CARE SERVICES TO THOSE IN THE COMMUNITY WHO FALL UNDER THE FAP, THE AMOUNT SHOULD BE CONSIDERED COMMUNITY BENEFIT. |
| Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote | THE CONSOLIDATED FINANCIAL STATEMENTS DISCUSS PATIENT ACCOUNTS RECEIVABLE AND IMPLICIT PRICE CONCESSIONS IN NOTE 13 ON PAGE 29 OF THE ATTACHED FINANCIAL STATEMENTS. |
| Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs | MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO. SHORTFALLS ARISE FROM PAYMENTS THAT ARE LESS THAN THE COSTS TO PROVIDE THE SERVICES. THE SHORTFALLS SHOULD BE CONSIDERED COMMUNITY BENEFIT AS THEY MUST BE ABSORBED IN ORDER TO CONTINUE PROVIDING CARE TO OUR COMMUNITY. IT IS ALSO IMPLIED IN INTERNAL REVENUE SERVICE RULING 69-545 WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR TAX-EXEMPT HOSPITALS AND INDICATES THAT PARTICIPATION IN PUBLICLY-FINANCED PROGRAMS, SUCH AS MEDICARE, IS EVIDENCE THAT A HOSPITAL MEETS THE COMMUNITY BENEFITS STANDARD. |
| Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance | 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. |
| Schedule H, Part V, Section B, Line 16a FAP website | - THEDACARE MEDICAL CENTER - WILD ROSE, INC.: Line 16a URL: HTTPS://THEDACARE.ORG/PATIENTS-AND-VISITORS/BILLING-AND-PAYMENT/FINANCIAL-ASSISTANCE/; |
| Schedule H, Part V, Section B, Line 16b FAP Application website | - THEDACARE MEDICAL CENTER - WILD ROSE, INC.: Line 16b URL: HTTPS://THEDACARE.ORG/PATIENTS-AND-VISITORS/BILLING-AND-PAYMENT/FINANCIAL-ASSISTANCE/; |
| Schedule H, Part V, Section B, Line 16c FAP plain language summary website | - THEDACARE MEDICAL CENTER - WILD ROSE, INC.: Line 16c URL: HTTPS://THEDACARE.ORG/PATIENTS-AND-VISITORS/BILLING-AND-PAYMENT/FINANCIAL-ASSISTANCE/; |
| Schedule H, Part VI, Line 2 Needs assessment | IN ADDITION TO THE CHNA PROCESS CONDUCTED EVERY 3 YEARS, THEDACARE COMMUNITY HEALTH TEAM: * MEETS REGULARLY WITH LEADERS OF COMMUNITY ORGANIZATIONS REPRESENTING MARGINALIZED POPULATIONS. * FACILITATES COMMUNITY HEALTH ACTION TEAMS (CHAT TEAMS) IN EACH HOSPITAL COMMUNITY. CHAT TEAMS ARE COMPRISED OF 12-25 LOCAL COMMUNITY LEADERS/MEMBERS REPRESENTING DIVERSE COMMUNITY SECTORS WHO COME TOGETHER REGULARLY TO CREATE UNDERSTANDING OF LOCAL HEALTH NEEDS AND CO-CREATE SOLUTIONS TO SOME OF THE MOST PRESSING HEALTH NEEDS. * THEDACARE IS A MEMBER OF THE TRI-COUNTY COMMUNITY HEALTH IMPROVEMENT COALITION (TRI-CHIC) WHICH BRINGS TOGETHER AREA HEALTH SYSTEMS, PUBLIC HEALTH LEADERS, AND NONPROFIT ORGANIZATIONS TO PRIORITIZE AND ADDRESS LOCAL HEALTH ISSUES. |
| Schedule H, Part VI, Line 3 Patient education of eligibility for assistance | PATIENT EDUCATION BEGINS WHEN A PATIENT IS ADMITTED TO A THEDACARE HOSPITAL. ADMISSION SPECIALISTS MEET WITH EACH PERSON INDIVIDUALLY TO ASSESS INSURANCE STATUS AND FINANCIAL NEED. IF NECESSARY, SPECIALISTS REFER PATIENTS TO CARE MANAGEMENT SPECIALISTS WHO ASSIST WITH THE ENROLLMENT OF PATIENTS IN AN APPLICABLE PROGRAM. THE HOSPITAL PATIENT HANDBOOK IS PROVIDED TO ALL IN-PATIENTS. INTERNAL POLICIES SUCH AS DISCOUNTED SERVICES POLICY, CARING HEARTS POLICY AND PAYMENT FOR SERVICE POLICY FOR SELF-PAY BALANCES PROVIDE GUIDANCE. THE THEDACARE WEBSITE, WWW.THEDACARE.ORG PROVIDES EDUCATION REGARDING THE AFFORDABLE CARE ACT IN EASY TO UNDERSTAND LANGUAGE. IT DISCUSSES OPTIONS AND WHERE TO GO FOR ASSISTANCE. |
| Schedule H, Part VI, Line 4 Community information | THEDACARE MEDICAL CENTER-WILD ROSE SERVICE AREA IS BASED IN WAUSHARA COUNTY AND IS LOCATED IN EAST-CENTRAL WISCONSIN. THE WILD ROSE POPULATION HAS INCREASED IN SIZE SINCE 2020, WITH A SIZEABLE PORTION OF THE POPULATION BEING 65 OR OLDER. THE AREA IS SIMILAR IN DEMOGRAPHIC MAKE-UP TO THE REST OF WISCONSIN, WITH THE EXCEPTION OF HAVING MORE NON-HISPANIC WHITE PERSONS, FEWER FEMALES, AND A MUCH LOWER RATE OF PEOPLE PER SQUARE MILE. |
| Schedule H, Part VI, Line 5 Promotion of community health | THEDACARE COMMUNICATIONS TEAM IS CONSISTENTLY COMMUNICATING WITH THE PUBLIC ABOUT OPPORTUNITIES FOR HEALTH IMPROVEMENT INFORMATION. THEDACARE-LED COMMUNITY CHAT TEAMS (SEE ABOVE) CREATE A GRASSROOTS BASE OF ENGAGEMENT WORKING IN TANDEM WITH THEDACARE TEAM MEMBERS TO IMPROVE COMMUNITY HEALTH. THESE TEAMS STUDY SYSTEMIC HEALTH ISSUES OUTSIDE THE WALLS OF OUR HOSPITALS. CHAT IS THE FOUNDATION OF INNOVATIVE, COLLABORATIVE SOLUTIONS FOR COMMUNITY ISSUES THAT DRAW UPON THE WIDE ARRAY OF RESOURCES AND STRENGTHS OF OUR COMMUNITY. THERE ARE THEDACARE LED CHAT'S IN THE FOX CITIES OF APPLETON/MENASHA/NEENAH, BERLIN, NEW LONDON, SHAWANO, WAUPACA AND WILD ROSE. |
| Schedule H, Part VI, Line 6 Affiliated health care system | AS OF JANUARY 1, 2024, THEDACARE MERGED WITH FROEDTERT HEALTH. THEDACARE CONTINUES TO PROVIDE DIRECTION RELATED TO COMMUNITY HEALTH NEEDS ASSESSMENT FOR EACH HOSPITAL IN THE COUNTIES PREVIOUSLY SERVED BY THEDACARE PRIOR TO THE MERGER AND SURROUNDING COMMUNITIES WITHIN ITS SERVICE AREA. PLANS ARE APPROVED BY LOCAL HOSPITAL BOARDS AND THEDACARE NORTH REGION BOARD. EACH THEDACARE HOSPITAL, ALONG WITH CHI STAFF AND COMMUNITY MEMBERS DETERMINE HOW BEST TO MEET LOCAL NEEDS. IMPLEMENTATION OF COMMUNITY PROGRAMMING OCCURS AT THE LOCAL LEVEL. |
| Schedule H, Part VI, Line 7 State filing of community benefit report | WI |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (true) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LYNN DETTERMAN | ||||||||||||||
| SR VP, THEDACARE SOUTH REGION, BOARD MEMBER | $0 | $502,712 | $0 | $860,702 | $0 | $9,142 | $0 | $46,000 | $0 | $26,899 | $0 | $1,445,455 | $0 | $0 |
| KELLIE DIEDRICK | ||||||||||||||
| VP, CRITICAL ACCESS HOSPITALS, BOARD MEMBER | $0 | $281,314 | $0 | $94,643 | $0 | $7,478 | $0 | $19,600 | $0 | $26,899 | $0 | $429,934 | $0 | $0 |
| IMRAN ANDRABI MD | ||||||||||||||
| PRESIDENT & CEO - SYSTEM | $0 | $1,794,100 | $0 | $2,564,672 | $0 | $232,566 | $0 | $620,140 | $0 | $26,899 | $0 | $5,238,377 | $0 | $216,027 |
| WILLIAM FLETT | ||||||||||||||
| CHIEF FINANCIAL OFFICER | $0 | $478,381 | $0 | $134,891 | $0 | $10,627 | $0 | $151,232 | $0 | $26,899 | $0 | $802,030 | $0 | $0 |
| MAGGIE LUND | ||||||||||||||
| CHIEF CULTURE AND INTEGRATION OFFICER | $0 | $475,136 | $0 | $714,014 | $0 | $166,661 | $0 | $53,500 | $0 | $9,217 | $0 | $1,418,528 | $0 | $146,797 |
| BRIAN STERNS | ||||||||||||||
| CHIEF DIGITAL HEALTH OFFICER | $0 | $379,029 | $0 | $214,812 | $0 | $15,120 | $0 | $126,132 | $0 | $26,899 | $0 | $761,992 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation | THE PRESIDENT & CEO OF THE ORGANIZATION IS COMPENSATED BY A RELATED ORGANIZATION. THE RELATED ORGANIZATION USES THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF THE PRESIDENT: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. |
| Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan | 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 409(A) AND 457(F) OF THE INTERNAL REVENUE CODE. PARTICIPANTS MAY ELECT THE BENEFIT TO BE USED TO PURCHASE PARTICULAR INSURANCE BENEFITS, INVEST IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN, OR A COMBINATION OF THE TWO. BENEFITS ARE ACCRUED ON A MONTHLY BASIS AND ARE SUBJECT TO THE SUBSTANTIAL RISK OR FORFEITURE AGREEMENT SIGNED BY THE PARTICIPANTS. PLAN CONTRIBUTIONS ARE MADE ON A QUARTERLY BASIS. DURING THE YEAR, THE FOLLOWING INDIVIDUALS PARTICIPATED IN AND RECEIVED PAYMENT FROM THE PLAN: IMRAN ANDRABI, MD $216,027 MAGGIE LUND $146,797 DURING THE YEAR, THE FOLLOWING INDIVIDUALS ACCRUED AN AMOUNT FROM THE PLAN, WHICH IS INCLUDED IN DEFERRED COMPENSATION: IMRAN ANDRABI, MD $566,640 WILLIAM FLETT $105,232 BRIAN STERNS $72,632 |
| Schedule J, Part I, Line 7 Non-fixed payments | 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 LEADERS AND TO WORK TOGETHER AS A COHESIVE GROUP TOWARDS COMMON GOALS. LEADERS FROM MANAGER LEVEL TO THE PRESIDENT AND CEO ARE ELIGIBLE TO PARTICIPATE IN THIS PLAN. THE PERCENTAGE FOR WHICH AN INDIVIDUAL IS ELIGIBLE IS DETERMINED BY THE PARAMETERS LISTED FOR THE LEADERSHIP POSITION AND IN THE PLAN DOCUMENT ON FILE. LEADERS MAKE RECOMMENDATIONS FOR THEIR MANAGEMENT LEVEL DIRECT REPORTS TO THEIR EXECUTIVE LEADER BASED ON PERFORMANCE RESULTS. THE PRESIDENT AND CEO ALSO REVIEWS AND APPROVES. FOR SENIOR VICE PRESIDENTS, THE EXECUTIVE LEADERSHIP TEAM, AND THE PRESIDENT AND CEO, THE RECOMMENDATIONS ARE REVIEWED AND APPROVED BY THE HUMAN RESOURCES AND GOVERNANCE COMMITTEE OF THE BOARD AND THE EXECUTIVE COMMITTEE OF THE BOARD. THESE COMMITTEES ALSO REVIEW THE TOTAL SPEND FOR THE INCENTIVE PLANS. THESE LEADERS MUST BE IN ACTIVE REGULAR SERVICE OF THEDACARE, INC. FOR THE ENTIRE PLAN YEAR (JULY 1, 2024 TO JUNE 30, 2025) TO RECEIVE A 2025 BONUS. CARING FOR SUCCESS: THE PLAN OBJECTIVES ARE TO PROVIDE INCENTIVE TO FOCUS THE ORGANIZATION'S RESOURCES, ENERGY AND ATTENTION TO THE FULFILLMENT OF THEDACARE'S MISSION. EMPLOYEE ELIGIBILITY IS BASED ON THE NUMBER OF HOURS WORKED. ALL ELIGIBLE EMPLOYEES SHARE IN THE PAYOUT. THE PAYOUT AMOUNT IS A FLAT DOLLAR AMOUNT, DETERMINED BASED ON BOTH FINANCIAL AND QUALITY THRESHOLDS. THE AMOUNT PER EMPLOYEE IS DETERMINED BY DIVIDING THE TOTAL GAIN REALIZED (THE EMPLOYEE SHARE) BY HOURS PAID TO ALL ELIGIBLE EMPLOYEES. THE THEDACARE BOARD OF TRUSTEES APPROVES THE SPEND FOR THE PLAN. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part V, Line 1a 1099 AND 1096 FILINGS | ALL APPLICABLE 1099 AND 1096 IRS TAX FORMS ARE REPORTED AND FILED BY THE PARENT ORGANIZATION, FROEDTERT THEDACARE HEALTH INC, 39-2014409. |
| Form 990, Part V, Line 2a W-2 AND W-3 FILINGS | ALL APPLICABLE W-2 AND W-3 IRS TAX FORMS ARE REPORTED AND FILED BY THE PARENT ORGANIZATION, FROEDTERT THEDACARE HEALTH INC, 39-2014409. |
| Form 990, Part VI, Line 2 Family/business relationships amongst interested persons | AN EMPLOYEE/EMPLOYER RELATIONSHIP EXISTS FOR INDIVIDUALS ON PART VII WHO ARE EMPLOYEES OF THEDACARE, INC. AND INDIVIDUALS LISTED ON PART VII WHO ALSO SERVE AS DIRECTORS OR OFFICERS OF THEDACARE, INC. - Business relationship |
| Form 990, Part VI, Line 3 Delegation of management duties | ALL MANAGEMENT AND ADMINISTRATIVE FUNCTIONS ARE PROVIDED BY EMPLOYEES OF THEDACARE, INC., THE SOLE MEMBER AND PARENT COMPANY OF THEDACARE MEDICAL CENTER - WILD ROSE, INC. |
| Form 990, Part VI, Line 6 Classes of members or stockholders | THEDACARE MEDICAL CENTER - WILD ROSE, INC.'S SOLE MEMBER IS THEDACARE, INC. |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | THEDACARE, INC. HAS SOLE AUTHORITY IN THE CORPORATION TO VOTE AND TAKE ANY ACTION WITH RESPECT TO THE ELECTION OF DIRECTORS AND OFFICERS. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | THEDACARE, INC. HAS THE SOLE AUTHORITY WITH RESPECT TO THE FOLLOWING MATTERS: 1. DEVELOP AND APPROVE ANNUAL CAPITAL AND OPERATING TARGETS; 2. AUTHORIZE AND MAKE CAPITAL EXPENDITURES; 3. APPROVE STRATEGIC PLANS, WITH MANAGEMENT AND BOARD OVERSIGHT; 4. APPROVE THE SAFETY AND QUALITY PLAN; 5. APPROVE THE DISSOLUTION OR LIQUIDATION; 6. HIRE OR TERMINATE THE PRESIDENT AND CEO; 7. BORROW OR INCUR DEBT; 8. APPOINT AUDITORS AND LEGAL COUNSEL; AND 9. RETAIN INVESTMENT ADVISORS AND ESTABLISH INVESTMENT POLICIES. THE BOARD OF TRUSTEES MAY NOT DO THE FOLLOWING WITHOUT RECEIVING THE CONSENT OF THEDACARE, INC. 1. MERGE, CONSOLIDATE, OR CHANGE CONTROL OF THE ORGANIZATION; 2. SELL, LEASE, OR TRANSFER MATERIAL ASSETS; 3. ENTER JOINT VENTURES OR AFFILIATIONS; AND 4. AMEND THE ARTICLES OF INCORPORATION OR BYLAWS. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | THE FORM 990 IS MADE AVAILABLE TO THE BOARD OF DIRECTORS OF FROEDTERT THEDACARE HEALTH, INC., FOR REVIEW PRIOR TO FILING. |
| Form 990, Part VI, Line 12c Conflict of interest policy | QUESTIONNAIRES ARE SENT TO ALL MANAGERS, TRUSTEES, AND OFFICERS ANNUALLY. COMPLETED FORMS ARE RETURNED TO THE COMPLIANCE OFFICER. THE COMPLIANCE OFFICER REVIEWS THE QUESTIONNAIRES AND FOLLOWS UP WITH ANY QUESTIONS ABOUT THE MANAGERS' ANSWERS ON THE CONFLICT OF INTEREST FORMS. ALL EMPLOYEES AND BOARD MEMBERS ARE COVERED UNDER THE CONFLICT OF INTEREST POLICY. THE CORPORATE COMPLIANCE COMMITTEE REVIEWS THE POTENTIAL CONFLICT AND THE CFO/BOARD OF TRUSTEES REVIEW ALL CONFLICTS. AFTER DISCLOSURE OF THE CONFLICT, THE EMPLOYEE SHALL NOT PARTICIPATE IN THE DECISION WHETHER TO ENGAGE IN THE TRANSACTION IN WHICH THE EMPLOYEE HAS AN INTEREST. |
| Form 990, Part VI, Line 15a Process to establish compensation of top management official | THEDACARE HIRES AN OUTSIDE CONSULTING FIRM TO CONDUCT A THOROUGH MARKET REVIEW OF EXECUTIVE COMPENSATION EVERY OTHER YEAR. THE HUMAN RESOURCES AND GOVERNANCE COMMITTEE OF THE BOARD WAS FORMED IN DECEMBER, 2018. THE OUTSIDE CONSULTANT PRESENTED HIS FINDINGS TO THE CHIEF HUMAN RESOURCES OFFICER, THE PRESIDENT AND CEO. THE INFORMATION WAS THEN PRESENTED TO THE HUMAN RESOURCES AND GOVERNANCE COMMITTEE OF THE BOARD AND THEN TO THE EXECUTIVE COMMITTEE OF THE BOARD. BOTH COMMITTEES WERE PROVIDED THE INFORMATION FOR REVIEW, EDUCATION AND ACCEPTANCE IN 2021. |
| Form 990, Part VI, Line 15b Process to establish compensation of other employees | THEDACARE HIRES AN OUTSIDE CONSULTING FIRM TO CONDUCT A THOROUGH MARKET REVIEW OF EXECUTIVE COMPENSATION EVERY OTHER YEAR. THE HUMAN RESOURCES AND GOVERNANCE COMMITTEE OF THE BOARD WAS FORMED IN DECEMBER, 2018. THE OUTSIDE CONSULTANT PRESENTED HIS FINDINGS TO THE CHIEF HUMAN RESOURCES OFFICER, THE PRESIDENT AND CEO. THE INFORMATION WAS THEN PRESENTED TO THE HUMAN RESOURCES AND GOVERNANCE COMMITTEE OF THE BOARD AND THEN TO THE EXECUTIVE COMMITTEE OF THE BOARD. BOTH COMMITTEES WERE PROVIDED THE INFORMATION FOR REVIEW, EDUCATION AND ACCEPTANCE IN 2021. |
| Form 990, Part VI, Line 19 Required documents available to the public | THEDACARE MEDICAL CENTER - WILD ROSE, INC. DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND INTERNAL FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. |
| Form 990, Part IX, Line 11g Other Fees | CONTRACT LABOR - Total Expense: 45251, Program Service Expense: 45251, Management and General Expenses: , Fundraising Expenses: ; PHYSICIAN FEES - Total Expense: 1795, Program Service Expense: 1795, Management and General Expenses: , Fundraising Expenses: ; OTHER SERVICES - Total Expense: 1474850, Program Service Expense: 484841, Management and General Expenses: 990009, Fundraising Expenses: ; |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | ASSET VALUATION ADJUSTMENT - 37275; Total - 37275; |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (18 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| THEDACARE INC | ||||||||||
| PO BOX 8025 | APPLETON | WI | 549128025 | 391509362 | HEALTHCARE | WI | 501(c)(3) | 10 | NA | false |
| THEDACARE REGIONAL MEDICAL CENTER - NEENAH INC | ||||||||||
| PO BOX 8025 | APPLETON | WI | 549128025 | 390830664 | HOSPITAL | WI | 501(c)(3) | 3 | THEDACARE INC | false |
| THEDACARE MEDICAL CENTER - NEW LONDON INC | ||||||||||
| PO BOX 8025 | APPLETON | WI | 549128025 | 390869788 | HOSPITAL | WI | 501(c)(3) | 3 | THEDACARE INC | false |
| THEDACARE MEDICAL CENTER - WAUPACA INC | ||||||||||
| PO BOX 8025 | APPLETON | WI | 549128025 | 390871113 | HOSPITAL | WI | 501(c)(3) | 3 | THEDACARE INC | false |
| THEDACARE REGIONAL MEDICAL CENTER - APPLETON INC | ||||||||||
| PO BOX 8025 | APPLETON | WI | 549128025 | 390824015 | HOSPITAL | WI | 501(c)(3) | 3 | THEDACARE INC | false |
| THEDACARE MEDICAL CENTER - SHAWANO INC | ||||||||||
| PO BOX 8025 | APPLETON | WI | 549128025 | 390807068 | HOSPITAL | WI | 501(c)(3) | 3 | THEDACARE INC | false |
| THEDACARE MEDICAL CENTER - BERLIN INC | ||||||||||
| PO BOX 8025 | APPLETON | WI | 549128025 | 390806359 | HOSPITAL | WI | 501(c)(3) | 3 | THEDACARE INC | false |
| THEDACARE FAMILY OF FOUNDATIONS INC | ||||||||||
| PO BOX 8025 | APPLETON | WI | 549128025 | 464112255 | FOUNDATION | WI | 501(c)(3) | 7 | THEDACARE INC | false |
| FROEDTERT MEMORIAL LUTHERAN HOSPITAL | ||||||||||
| 9200 W WISCONSIN AVE | MILWAUKEE | WI | 53226 | 396105970 | HOSPITAL | WI | 501(c)(3) | 3 | FROEDTERT THEDACARE HEALTH | false |
| COMMUNITY MEMORIAL HOSPITAL OF MF | ||||||||||
| W180 N8085 TOWN HALL ROAD | MENOMONEE FALLS | WI | 53051 | 390987025 | HOSPITAL | WI | 501(c)(3) | 3 | FROEDTERT THEDACARE HEALTH | false |
| ST JOSEPH'S COMMUNITY HOSPITAL OF WB | ||||||||||
| 3200 PLEASANT VALLEY ROAD | WEST BEND | WI | 53095 | 390806302 | HOSPITAL | WI | 501(c)(3) | 3 | FROEDTERT THEDACARE HEALTH | false |
| FROEDTERT WEST BEND HOSPITAL FOUNDATION | ||||||||||
| 3200 PLEASANT VALLEY ROAD | WEST BEND | WI | 53095 | 392034296 | HEALTH/WELFARE | WI | 501(c)(3) | 7 | ST JOSEPH'S | false |
| FROEDTERT HOSPITAL FOUNDATION INC | ||||||||||
| 9200 W WISCONSIN AVE | MILWAUKEE | WI | 53226 | 391431192 | HEALTH/WELFARE | WI | 501(c)(3) | 7 | FROEDTERT THEDACARE HEALTH | false |
| FROEDTERT MENOMONEE FALLS HOSPITAL FOUNDATION | ||||||||||
| W180 N8085 TOWN HALL ROAD | MENOMONEE FALLS | WI | 53051 | 391635057 | HEALTH/WELFARE | WI | 501(c)(3) | 10 | COMM MEM HOSP | false |
| COMMUNITY OUTPATIENT HEALTH SERVICES | ||||||||||
| W180 N8085 TOWN HALL ROAD | MENOMONEE FALLS | WI | 53051 | 391743056 | MED/DENT SVCS | WI | 501(c)(3) | 3 | COMM MEM HOSP | false |
| FH ENTERPRISE SERVICES HOLDINGS INC | ||||||||||
| 9200 W WISCONSIN AVE | MILWAUKEE | WI | 53226 | 202636686 | HEALTHCARE SVCS | WI | 501(c)(3) | Type I | FROEDTERT THEDACARE HEALTH | false |
| HOLY FAMILY MEMORIAL INC | ||||||||||
| 2300 WESTERN AVE | MANITOWOC | WI | 54221 | 390806395 | HOSPITAL | WI | 501(c)(3) | 3 | FROEDTERT THEDACARE HEALTH | false |
| FROEDTERT THEDACARE HEALTH INC | ||||||||||
| 9200 W WISCONSIN AVE | MILWAUKEE | WI | 53226 | 392014409 | MGMNT SVCS | WI | 501(c)(3) | Type III-FI | NA | false |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (14 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt | Address Line2USAddress/AddressLine2Txt |
|---|---|---|---|---|---|---|---|---|---|
| N APPLETON AMBULATORY CARE CENTER BUILDING COMPANY LLC | |||||||||
| 122 E CAPITOL DR | APPLETON | WI | 54911 | 262497187 | RENTAL | WI | NA | N/A | |
| ENCIRCLE REALCO LLC | |||||||||
| 65 HIDDEN RAVINES DRIVE | POWELL | OH | 43065 | 853472736 | PROPERTY HOLDING | OH | THEDACARE REGIONAL MEDICAL CENTER - APPLETON INC | Excluded | SUITE 100 |
| FROEDTERT SURGERY CENTER LLC | |||||||||
| 9200 W WISCONSIN AVE | MILWAUKEE | WI | 53226 | 201499345 | SURGERY CENTER | WI | FROEDTERT THEDACARE HEALTH | Related | |
| FMLH MCW REAL ESTATE VENTURES LLC | |||||||||
| 9200 W WISCONSIN AVE | MILWAUKEE | WI | 53226 | 260629591 | REAL ESTATE | WI | FROEDTERT THEDACARE HEALTH | Related | |
| WISCONSIN DIAGNOSTIC LABORATORIES LLC | |||||||||
| 9200 W WISCONSIN AVE | MILWAUKEE | WI | 53226 | 391896819 | LAB SERVICES | WI | FROEDTERT THEDACARE HEALTH | Related | |
| DREXEL TOWN SQUARE SURGERY CENTER LLC | |||||||||
| 7901 S 6TH STREET | OAK CREEK | WI | 53154 | 814904300 | SURGERY CENTER | WI | FROEDTERT THEDACARE HEALTH | Related | |
| MENOMONEE FALLS AMBULATORY SURGERY CTR | |||||||||
| W180 N8045 TOWN HALL ROAD | MENOMONEE FALLS | WI | 53051 | 391745697 | SURGERY CENTER | WI | FROEDTERT THEDACARE HEALTH | Related | |
| FROEDTERT & THE MCW NETWORK LLC | |||||||||
| 9200 W WISCONSIN AVE | MILWAUKEE | WI | 53226 | 814382585 | HEALTH CARE | WI | NA | N/A | |
| FROEDTERT & THE MCW ACO LLC | |||||||||
| 8710 WATERTOWN PLANK RD | MILWAUKEE | WI | 53226 | 833159534 | HEALTH CARE | WI | NA | N/A | |
| WEST BEND SURGERY CENTER LLC | |||||||||
| 3212 PLEASANT VALLEY ROAD | WEST BEND | WI | 53095 | 391954169 | HEALTHCARE SERVICES | WI | FROEDTERT THEDACARE HEALTH | Related | |
| NATIONAL LABORATORY NETWORK LLC | |||||||||
| 9200 W WISCONSIN AVE | MILWAUKEE | WI | 53226 | 883305667 | LABORATORY SVCS | WI | FROEDTERT THEDACARE HEALTH | Related | |
| D1 SPORTS TRAINING OF MILWAUKEE LLC | |||||||||
| 9200 W WISCONSIN AVE | MILWAUKEE | WI | 53226 | 473322294 | SPORTS MEDICINE | WI | FROEDTERT THEDACARE HEALTH | Related | |
| THP-FROEDTERT HEALTH VENTURES LLC | |||||||||
| 1415 LOUISIANA STREET | HOUSTON | TX | 77002 | 823559342 | HEALTH CARE | TX | FROEDTERT THEDACARE HEALTH | Related | |
| FHHP LLC | |||||||||
| 9200 W WISCONSIN AVE | MILWAUKEE | WI | 53226 | 452221564 | HEALTH CARE | WI | FROEDTERT THEDACARE HEALTH | Related | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (6 entries)
| Address Line1ForeignAddress/AddressLine1Txt | Address Line2ForeignAddress/AddressLine2Txt | CityForeignAddress/CityNm | Province Or StateForeignAddress/ProvinceOrStateNm | CountryForeignAddress/CountryCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Legal Domicile StateLegalDomicileStateCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| HART'S MILL INSURANCE COMPANY | |||||||||||||||
| 62 FORUM LANE | 3RD FLOOR | GRAND CAYMAN | CAYMAN ISLANDS | CJ | 981311808 | SELF-INSURANCE | CJ | FROEDTERT THEDACARE HEALTH | C Corporation | false | |||||
| FH INVESTMENT HOLDINGS INC | |||||||||||||||
| 991422017 | INVST HOLD CO | FROEDTERT THEDACARE HEALTH | C Corporation | false | 9200 W WISCONSIN AVE | MILWAUKEE | WI | 53226 | WI | ||||||
| NETWORK HEALTH INC | |||||||||||||||
| 462966177 | HEALTHCARE ADMIN | FROEDTERT THEDACARE HEALTH | C Corporation | false | 1570 MIDWAY PLACE | MENASHA | WI | 54952 | WI | ||||||
| NETWORK HEALTH INSURANCE CORP | |||||||||||||||
| 392020474 | SERVICE INSURANCE | NETWORK HEALTH INC | C Corporation | false | 1570 MIDWAY PLACE | MENASHA | WI | 54952 | WI | ||||||
| NETWORK HEALTH PLAN | |||||||||||||||
| 391442058 | HEALTH INSURANCE | NETWORK HEALTH INC | C Corporation | false | 1570 MIDWAY PLACE | MENASHA | WI | 54952 | WI | ||||||
| HOLY FAMILY HEALTH SERVICES INC | |||||||||||||||
| 391572253 | HEALTH CARE | FROEDTERT THEDACARE HEALTH | C Corporation | false | 1600 SOUTH 41ST STREET | MANITOWOC | WI | 54220 | WI | ||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |