THEDACARE MEDICAL CENTER-BERLIN INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- THEDACARE MEDICAL CENTER-BERLIN INC (EIN 39-0806359)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-14
- IRS object ID
- 201713189349302351
- Schema version
- 2016v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-11-14T08:45:11-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wipfli LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 12237 | AddressLine1Txt |
| City | Green Bay | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 543072237 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390806359 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ThedaCare Medical Center - Berlin Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | THED | BusinessNameControlTxt |
| Phone | 9203611313 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 MEMORIAL DR | AddressLine1Txt |
| City | BERLIN | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54923 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TIM A OLSON | PersonNm |
| Person Title | CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Phone | 9203611313 | PhoneNum |
| Signature | 2017-10-24 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Terri Rexrode CPA MST | PreparerPersonNm |
| PTIN | P00096513 | PTIN |
| Phone | 9206620016 | PhoneNum |
| Preparation | 2017-10-24 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 74.87.127.142 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-10-24 | IPDt |
| IP Tm | 12:54:27 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | A43ECD1EE6AF4781A69F6BFA161A98BDE8FA2C07 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2018-03-14 21:41:22Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TIM A OLSON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 MEMORIAL DR | AddressLine1Txt |
| City | BERLIN | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54923 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $62,736,822 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.thedacare.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1910 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | Improving the Health of our Community. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 92 | TotalVolunteersCnt |
| Total Gross UBI | $2,448,664 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$141,772 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $219,584 | PYContributionsGrantsAmt |
| CY Contributions Grants | $25,664 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $79,175,209 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $62,589,416 | CYProgramServiceRevenueAmt |
| PY Investment Income | $98,565 | PYInvestmentIncomeAmt |
| CY Investment Income | -$4,935 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,178,260 | PYOtherRevenueAmt |
| CY Other Revenue | $119,714 | CYOtherRevenueAmt |
| PY Total Revenue | $80,671,618 | PYTotalRevenueAmt |
| CY Total Revenue | $62,729,859 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $212,601 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $183,203 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $47,134,373 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $32,803,057 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $34,702,045 | PYOtherExpensesAmt |
| CY Other Expenses | $28,026,872 | CYOtherExpensesAmt |
| PY Total Expenses | $82,049,019 | PYTotalExpensesAmt |
| CY Total Expenses | $61,013,132 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,377,401 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,716,727 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $51,908,036 | TotalAssetsBOYAmt |
| Total Assets EOY | $41,918,485 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $24,504,228 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $12,935,835 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $27,403,808 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $28,982,650 | NetAssetsOrFundBalancesEOYAmt |
| Mission | To provide the highest quality health care, delivered in the most efficient and cost-effective ways, and accessible to all members of the community. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $59,339,940 | ExpenseAmt |
| Grant | $183,203 | GrantAmt |
| Revenue | $60,091,679 | RevenueAmt |
| Desc | 25-bed critical access hospital serving Green Lake, Marquette, and Waushara counties. Thedacare Medical Center - Berlin, Inc. provides patient care and support services including ER, diagnostic, lab, radiology, surgery, and therapy care and treatment to persons in need of medical attention. With corporate parent ThedaCare, Inc. we offer public awareness campaigns, charity care, support groups, and education programs targeted to local community needs. | Desc |
| Total Program Service Expenses | $59,339,940 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KRISTEN COGSWELL | PersonNm |
| Phone | 9207386471 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 122 EAST COLLEGE AVENUE | AddressLine1Txt |
| City | APPLETON | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54911 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| KUEHN RUSSELL | |||||||||
| BOARD CHAIR | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| WILLETT THOMAS DO | |||||||||
| BOARD SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| WISE LARRY | |||||||||
| BOARD TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| SHATTUCK P MICHAEL MD | |||||||||
| BOARD MEMBER/CHIEF OF STAFF | 41.00 | Yes (X) | Yes (X) | $280,579 | $0 | $27,565 | |||
| FEENEY JOHN | |||||||||
| FORMER BOARD MEMBER/CEO | 41.00 | Yes (X) | Yes (X) | $365,102 | $0 | $28,445 | |||
| LONG GREGORY MD | |||||||||
| BOARD MEMBER/CMO | 5.00 | 36.00 | Yes (X) | $61,960 | $557,641 | $103,740 | |||
| BURMEISTERBRIAN | |||||||||
| BOARD MEMBER/VP SR AMC & TC | 5.00 | 38.00 | Yes (X) | $49,431 | $444,891 | $63,643 | |||
| BATLEY CRAIG DO | |||||||||
| BOARD MEMBER/PHYSICIAN | 41.00 | Yes (X) | $455,218 | $0 | $30,380 | ||||
| BUDDE DAVID DO | |||||||||
| BOARD MEMBER/PHYSICIAN | 41.00 | Yes (X) | $452,940 | $0 | $28,162 | ||||
| HOSTAK JOLENE | |||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| KUJAWA PAUL | |||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| WHITE KELLY DDS | |||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| OLSON TIM | |||||||||
| VP CFO SYSTEM | 4.00 | 37.00 | Yes (X) | $55,627 | $500,638 | $29,143 | |||
| GRUNER DEAN | |||||||||
| CEO - SYSTEM | 4.00 | 39.00 | Yes (X) | $129,688 | $1,167,188 | $215,288 | |||
| REED LAURA | |||||||||
| COO/CNE | 4.00 | 37.00 | $33,754 | $303,788 | $29,981 | Yes (X) | |||
| LIVINGSTON KEITH | |||||||||
| VP SR CIO | 4.00 | 37.00 | $53,701 | $483,310 | $109,713 | Yes (X) | |||
| PISTONE MAUREEN | |||||||||
| VP SR HR SERVICES | 4.00 | 36.00 | $46,289 | $416,602 | $101,774 | Yes (X) | |||
| ALVORD BRICE MD | |||||||||
| PHYSICIAN | 40.00 | $448,767 | $0 | $22,724 | Yes (X) | ||||
| KEITH PHILIP MD | |||||||||
| PHYSICIAN | 40.00 | $457,119 | $0 | $21,652 | Yes (X) | ||||
| LO HORACE MD | |||||||||
| PHYSICIAN | 40.00 | $611,892 | $0 | $35,194 | Yes (X) | ||||
| NELSON DARREN MD | |||||||||
| PHYSICIAN | 40.00 | $471,707 | $0 | $30,107 | Yes (X) | ||||
| VAISMAN URI MD | |||||||||
| PHYSICIAN | 40.00 | $1,842,398 | $0 | $21,857 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $5,816,172 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,874,058 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $899,368 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 30 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | shared medical services | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 209 limestone pass | AddressLine1Txt |
| City | cottage grove | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53527 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | medical services | ServicesDesc |
| Compensation | $593,204 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $25,664 | RelatedOrganizationsAmt |
| Total Contributions | $25,664 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|---|
| OUTPATIENT SERVICE REVENUE | 624100 | $41,553,983 | $41,553,983 | ||
| INPATIENT SERVICE REVENUE | 624100 | $18,507,494 | $18,507,494 | ||
| Pharmacy | 446110 | $2,448,664 | $2,448,664 | ||
| CAFETERIA REVENUE | 900099 | $49,073 | $49,073 | ||
| OTHER REVENUE | 624100 | $30,202 | $30,202 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $62,589,416 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,028 | TotalRevenueColumnAmt |
| Exclusion | $2,028 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $119,714 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $119,714 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $119,714 | TotalRevenueColumnAmt |
| Exclusion | $119,714 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $6,963 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$6,963 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$6,963 | TotalRevenueColumnAmt |
| Exclusion | -$6,963 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $62,729,859 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $60,091,679 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $2,448,664 | UnrelatedBusinessRevenueAmt |
| Exclusion | $163,852 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $183,203 | TotalAmt |
| Program Services | $183,203 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,164,169 | TotalAmt |
| Program Services | $966,700 | ProgramServicesAmt |
| Management And General | $1,197,469 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,194,040 | TotalAmt |
| Program Services | $23,194,040 | ProgramServicesAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $499,787 | TotalAmt |
| Program Services | $499,787 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,289,173 | TotalAmt |
| Program Services | $5,173,769 | ProgramServicesAmt |
| Management And General | $115,404 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,655,888 | TotalAmt |
| Program Services | $1,655,888 | ProgramServicesAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $960 | TotalAmt |
| Program Services | $960 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,841,497 | TotalAmt |
| Program Services | $4,499,229 | ProgramServicesAmt |
| Management And General | $342,268 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $94,267 | TotalAmt |
| Program Services | $94,267 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $470,125 | TotalAmt |
| Program Services | $455,835 | ProgramServicesAmt |
| Management And General | $14,290 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,405,265 | TotalAmt |
| Program Services | $2,401,504 | ProgramServicesAmt |
| Management And General | $3,761 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $101,522 | TotalAmt |
| Program Services | $101,522 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $127,805 | TotalAmt |
| Program Services | $127,805 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $146,955 | TotalAmt |
| Program Services | $146,955 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,417,579 | TotalAmt |
| Program Services | $3,417,579 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $236,091 | TotalAmt |
| Program Services | $236,091 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| CLINIC & PATIENT SERVIC | $11,409,038 | $11,409,038 |
| PROVISION FOR BAD DEBTS | $3,259,659 | $3,259,659 |
| Equipment Rental and Ma | $1,516,109 | $1,516,109 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,013,132 | TotalAmt |
| Program Services | $59,339,940 | ProgramServicesAmt |
| Management And General | $1,673,192 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,816,298 | BOYAmt |
| EOY | $394,789 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,150,809 | BOYAmt |
| EOY | $6,707,196 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $763,497 | BOYAmt |
| EOY | $676,755 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,345,969 | BOYAmt |
| EOY | $5,722,434 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $67,837,635 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $39,420,324 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,251,381 | BOYAmt |
| EOY | $28,417,311 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,580,082 | BOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,908,036 | BOYAmt |
| EOY | $41,918,485 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $540,499 | BOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,963,729 | BOYAmt |
| EOY | $12,935,835 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,504,228 | BOYAmt |
| EOY | $12,935,835 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,403,808 | BOYAmt |
| EOY | $28,982,650 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,403,808 | BOYAmt |
| EOY | $28,982,650 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,908,036 | BOYAmt |
| EOY | $41,918,485 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,716,727 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$137,885 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule 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 | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $2,664 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $2,664 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | A portion of the WHA dues represent lobbying performed in regard to healthcare issues. The amount for 2016 was $2,664. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $843,214 | OtherCostOrOtherBasisAmt |
| Book Value | $843,214 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $37,785,067 | OtherCostOrOtherBasisAmt |
| Depreciation | $19,409,020 | DepreciationAmt |
| Book Value | $18,376,047 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,287,051 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,125,448 | DepreciationAmt |
| Book Value | $161,603 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $27,922,303 | OtherCostOrOtherBasisAmt |
| Depreciation | $18,885,856 | DepreciationAmt |
| Book Value | $9,036,447 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $28,417,311 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Deferred Employee benefits | Desc |
| Amt | $12,935,835 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $12,935,835 | TotalLiabilityAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | 0 | FinancialAssistanceBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $211,088 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $211,088 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00370 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,719,499 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,693,098 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,026,401 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03510 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,930,587 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,693,098 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,237,489 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03880 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 22 | ActivitiesOrProgramsCnt |
| Persons Served | 148670 | PersonsServedCnt |
| Total Community Benefit Expns | $313,163 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $313,163 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00540 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 218 | PersonsServedCnt |
| Total Community Benefit Expns | $132,156 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $132,156 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00230 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $5,101,762 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,101,762 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08830 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 75960 | PersonsServedCnt |
| Total Community Benefit Expns | $329,028 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $329,028 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00570 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 30 | ActivitiesOrProgramsCnt |
| Persons Served | 224848 | PersonsServedCnt |
| Total Community Benefit Expns | $5,876,109 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,876,109 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10170 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 30 | ActivitiesOrProgramsCnt |
| Persons Served | 224848 | PersonsServedCnt |
| Total Community Benefit Expns | $12,806,696 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,693,098 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,113,598 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.14050 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 1000 | PersonsServedCnt |
| Total Community Benefit Expns | $1,080 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,080 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 39 | PersonsServedCnt |
| Total Community Benefit Expns | $3,612 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,612 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 3 | PersonsServedCnt |
| Total Community Benefit Expns | $380 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $380 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 1042 | PersonsServedCnt |
| Total Community Benefit Expns | $5,072 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,072 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,285,688 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $218,526 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $9,604,189 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $9,333,372 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $270,817 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | thedacare medical center - berlin inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 Memorial Drive | AddressLine1Txt |
| City | Berlin | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54923 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | https://www.thedacare.org | WebsiteAddressTxt |
| State License | 1060 | 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 - berlin inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | see 7d | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | see 7d | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Other Method | Yes (X) | OtherMethodInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | https://www.thedacare.org/Policies-and-Legal-Forms/payment-options.aspx | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | https://www.thedacare.org/Policies-and-Legal-Forms/payment-options.aspx | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | https://www.thedacare.org/Policies-and-Legal-Forms/payment-options.aspx | 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 (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | 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 (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| thedacare medical center - berlin, inc. | Part V, Section B, Line 5: ThedaCare utilizes models created by the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation as the framework for the Community Health Needs Assessment. Over the course of a one year period, secondary data was collected, public health and key informant interviews were conducted, ThedaCare CHAT (Community Health Action Team) provided input and patient health data was studied. Vulnerable populations included those living in poverty, rural farm families, the elderly and Migrant Hispanic. Input was collected by representatives of:- Rural Health Initiative- Green Lake/Marquette Counties Aging and Disability Resource Center- Green Lake Public Health- HeadStart- Green Lake County Economic Support- Green Lake County UW-Extension |
| thedacare medical center - berlin, inc. | Part V, Section B, Line 7d: Hospital facility website: https://www.thedacare.org/Full chna & implementation strategy website: https://www.thedacare.org/Getting-Involved/Improving-Community-Health.aspx |
| thedacare medical center - berlin, inc. | Part V, Section B, Line 11: The ThedaCare Community Health Implementation Strategy was approved by the ThedaCare Medical Center-Berlin Board of Directors in October 2016 and the ThedaCare Board of Trustees in December of 2016.- ThedaCare provides support to the Center for Healthcare Value which is coordinating efforts across the country to share quality improvement and cost reduction learnings. - ThedaCare partners with Affinity Health System to sponsor Mosiac Health, providing hands on experience for medical students.- ThedaCare also partners with area nursing schools such as UW Oshkosh and Fox Valley Technical College to provide professional mentors for their nursing programs and venues for nursing students to practice their skills.- ThedaCare hospitals provide 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 supports the End of Life Coalition- ThedaCare 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. Obesity:- Provides funding to local Farmer's Markets including Berlin and Ripon.- ThedaCare partners with the local Boys and Girls Club to educate children about eating healthy and the benefits of being active.- Good to Go Week is an annual employee led initiative that takes place in 6 school districts throughout the ThedaCare system. Activities include healthy snacks, build a school garden, fats in foods, measure your drink, leading gym classes.Mental Health/AODA:- ThedaCaAre provides leadership and financial support for Catalpa Health, dedicated to pediatric mental health. - Provides leadership and funding for the Fox Valley Partnership Community Health Center working to improve the health status of the medically underserved by providing comprehensive primary care services.- Provided over $2,000,000 in subsidized mental health services. - Developed a protocol for screening patients for substance abuse and a policy for those on long-term opiate use. - Have gone live with the Wisconsin Prescription Drug Monitoring Program.- Have developed a policy for medical assisted treatment including Vivitrol. Early Childhood/Youth- ThedaCare is a supporter of the Reach out and Read Program.Identified but not addressed:- Transportation: Beyond the scope resources- Dental: Resources exist in region- Smoking: Being addressed by others- Housing: Beyond the scope resources |
| thedacare medical center - berlin, inc. | Part V, Section B, Line 15e: Contracted with 2 agencies to assist patients. First, Partnership Community Education Center - they provide the patient with free assistance with completing the financial assistance application and also assist patients in finding community funding that may be avaialable. Second, Cardon works directly with the uninsured patient to assist them with insurance enrollment and education. |
| thedacare medical center - berlin, inc. | Part V, Section B, Line 16j: The FAP and application were available at hospital cashier offices, on web site and offered to all patients that expressed a financial hardship when calling the billing office. The PLS was printed on every statement and a footer was added to the front of the statement advising patient to see reserve side of statement for financial assistance and payment options. Notification of financial assistance availability was added to the initial letter sent by the third party collection agency. |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | It is the organization's policy that no patient should be denied appropriate and necessary care on the basis of income. In response to this policy, the Caring Hearts Financial Assistance Program was set up to provide shelter to those patients who are unable to pay for their medical services. Medical service fees are written off under the financial assistance program that would otherwise have been sent to a collection agency. |
| Part I, Line 7: | The costing methodology used to calculate the amounts in the table is a combination of average costs and actual costs pertaining to supplies, wages, and benefits. For supplies, the actual cost of items used for each event is applied. If no actual cost is available, we then use an estimate. Wages are calculated by multiplying the average wage rate times actual hours worked. The benefit rate used includes a fringe ratio of all benefits related to the above wage calculation. The cost accounting system does not differentiate between different payer types and no cost-to-charge ratio is used. |
| Part I, Line 7g: | NO PHYSICIAN CLINICS ARE INCLUDED IN SUBSIDIZED HEALTH SERVICES. |
| Part I, Ln 7 Col(f): | The bad debt expense included on form 990 (Part IX, Line 25, Column A) but subtracted for purposes of calculating the percentage in this column is $3,259,659. |
| Part II, Community Building Activities: | Obesity:- Provides funding to local Farmer's Markets including Berlin and Ripon.- ThedaCare partners with the local Boys and Girls Club to educate children about eating healthy and the benefits of being active.- Good to Go Week is an annual employee led initiative that takes place in 6 school districts throughout the ThedaCare system. Activities include healthy snacks, build a school garden, fats in foods, measure your drink, leading gym classes.Mental Health/AODA:- ThedaCaAre provides leadership and financial support for Catalpa Health, dedicated to pediatric mental health. - Provides leadership and funding for the Fox Valley Partnership Community Health Center working to improve the health status of the medically underserved by providing comprehensive primary care services.- Provided over $2,000,000 in subsidized mental health services. - Developed a protocol for screening patients for substance abuse and a policy for those on long-term opiate use. - Have gone live with the Wisconsin Prescription Drug Monitoring Program.- Have developed a policy for medical assisted treatment including Vivitrol. Early Childhood/Youth- ThedaCare is a supporter of the Reach out and Read Program. |
| Part III, Line 4: | A cost-to-charge ratio was used to determine the amounts reported in Part III lines 2 and 3. Patient payments or discounts are applied prior to determining bad debt expense and are not included in the bad debt write-off reported on the audited financial statements. Deductibles and coinsurance amounts that are deemed uncollectible are written off either to bad debt expense or, if applicable, to charity care if the patient so qualifies for financial assistance. The financial statements do not contain a footnote but they account for bad debts based on gross charges to patients after reflecting any payments or discounts, or amounts determined to be eligible for charity care/financial assistance. |
| Part III, Line 8: | Hospitals must accept Medicare patients regardless of whether they make a surplus or deficit from providing services to those patients. We did not report any shortfall as a community benefit. The costing methodology used to determine the Medicare allowable costs reported in the organizations Medicare cost report is step down. |
| Part III, Line 9b: | Our policy is not to pursue patient accounts to the extent any charges are eligible and written off through our charity care/financial assistance program. If only a portion of the charges are eligible and written off through our charity care/financial assistance program, the remaining balance will be billed to the patient and collected in accordance with our normal collection policy. |
| Part VI, Line 2: | ThedaCare covers a 9 county primary service area served by 7 hospitals. ThedaCare conducts a Community Needs Assessment every three years for each hospital gathering data pertinent to that community and the surrounding areas. Information collected includes data from the Wisconsin County Health Rankings, Fox Cities LIFE Study (Local Indicators for Excellence), the Behavioral Risk Factor Surveillance Survey, insights from interviews of Public Health Officials, insights from interviews with representatives of vulnerable populations, emergency department patient data and insights gathered from monthly meetings of the ThedaCare-led CHAT Team (Community Health Action Team) comprised of community leaders in business, non-profit, clergy, education, diverse population groups, healthcare, United Way, Public Health and the local Community Foundations. |
| Part VI, Line 3: | Patient education begins when a patient is admitted to a ThedaCare hospital. Admission specialists meet with each person individually to assess insurance status and financial need. If necessary, specialists refer patients to care management specialists who assist with the enrollment of patients in an applicable program. The hospital patient handbook is provided to all in-patients. Internal policies such as Discounted Services Policy, Caring Hearts Policy and Payment for Service Policy for Self-Pay Balances provide guidance.The ThedaCare website, www.thedacare.org, provides education regarding The Affordable Care Act in easy to understand language. It discusses options and where to go for assistance. |
| Part VI, Line 4: | ThedaCare Medical Center-Berlin service area consists of Green Lake County and Marquette Counties, Population is about 35,000 combined and is located in east-central Wisconsin. Green Lake County:-Green Lake County is among Wisconsin's slower growing counties. -Green Lake County graduation rate is 90%.-Green Lake's unemployment rate is significantly higher than the state. The top employers in Green Lake County are in Health, Education and Manufacturing. -Fourteen percent of Green Lake County lives below 100% of the Federal Poverty Level, 12% are uninsured.-The largest minority population is Hispanic/Latino at 4.9%. Native Americans account for approximately .6% of the population and African-Americans 7%. Marquette County:-Marquette County is among Wisconsin's slowest growing counties. -Marquette County graduation rate is 88%.-Marquette's unemployment rate is 8.4%. The top employers in Green Lake County are in Health, Education and Manufacturing. -Fourteen percent of Marquette County lives below 100% of the Federal Poverty Level, 14% are uninsured.-The largest minority population is Hispanic/Latino at 3.1%. Native Americans account for approximately .4% of the population and African-Americans .5%. |
| Part VI, Line 5: | Each year, ThedaCare Medical Center-Berlin'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 local community leaders who study systemic health issues outside the walls of our hospitals and clinics and work to identify innovative, collaborative solutions that draw upon the wide array of resources and strengths of our community. Through CHAT, such efforts as the Shawano County Rural Health Initiative have been developed. This Initiative takes basic health care and screening services to the farm. Each year hundreds of farm families living without insurance or only catastrophic coverage receive critical assistance. This initiative has now spread to Outagamie, Winnebago and Waupaca Counties ThedaCare provides funding and staff support to make CHAT and these community health efforts possible. A CHAT was implemented in Berlin in August 2016. |
| Part VI, Line 6: | ThedaCare, the parent organization, provides direction related to community health needs assessment for each hospital and surrounding communities within its service area. Plans are approved by local hospital boards. Each ThedaCare hospital, along with CHI staff and community members determine how best to meet local needs. Implementation of community programming occurs at the local level. |
| Part VI, Line 7, Reports Filed With States | WI |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| CITY OF BERLIN | |||||||
| 108 N CAPRON ST | BERLIN | WI | 54923 | 396005398 | government | $96,678 | ambulance |
| BOYS AND GIRLS CLUB | |||||||
| 501 E PARKWAY AVE PO BOX 411 | OSHKOSH | WI | 54903 | 396120658 | 501(c)(3) | $60,000 | GENERAL OPERATIONS |
| thedacare family of foundations | |||||||
| 1818 north meade street | appleton | WI | 54912 | 464112255 | 501(c)(3) | $22,239 | general |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 3 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | In order for grant requests to be considered they must meet the following guidelines: 1) Directed toward projects that support ThedaCare's mission and values 2) Benefit the communites served by ThedaCare, Inc. 3) Benefit a 501 (c)(3) not-for-profit organization Conversely, requests must NOT be for: 1) The sole benefit of an individual 2) Political organizations or campaign committees 3) Religious organizations (for strictly religious purposes) 4) Organizations in conflict with ThedaCare's mission and values 5) State or national campaigns All organizations requesting grant funds must apply through the ThedaCare website. Requests are screened, reviewed, and approved by committee six times throughout the fiscal year. A letter of restriction is issued by ThedaCare in conjunction with all grant checks. This letter of restriction states that all grant funds received from ThedaCare must be used strictly for the purposes for which they were applied. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Pmts | Yes (X) | IdemnificationGrossUpPmtsInd |
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (16 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SHATTUCK P MICHAEL MD | ||||||||||||||
| BOARD MEMBER/CHIEF OF STAFF | $224,386 | $0 | $414 | $0 | $55,779 | $0 | $8,531 | $0 | $19,034 | $0 | $308,144 | $0 | $0 | $0 |
| FEENEY JOHN | ||||||||||||||
| FORMER BOARD MEMBER/CEO | $270,398 | $0 | $24,300 | $0 | $70,404 | $0 | $6,060 | $0 | $22,385 | $0 | $393,547 | $0 | $0 | $0 |
| LONG GREGORY MD | ||||||||||||||
| BOARD MEMBER/CMO | $47,651 | $428,856 | $7,013 | $63,117 | $7,296 | $65,668 | $7,679 | $69,112 | $2,695 | $24,254 | $72,334 | $651,007 | $0 | $0 |
| BURMEISTERBRIAN | ||||||||||||||
| BOARD MEMBER/VP SR AMC & TC | $38,206 | $343,858 | $5,735 | $51,619 | $5,490 | $49,414 | $4,209 | $37,883 | $2,155 | $19,396 | $55,795 | $502,170 | $0 | $0 |
| BATLEY CRAIG DO | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | $368,936 | $0 | $414 | $0 | $85,868 | $0 | $9,078 | $0 | $21,302 | $0 | $485,598 | $0 | $0 | $0 |
| BUDDE DAVID DO | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | $368,131 | $0 | $414 | $0 | $84,395 | $0 | $9,431 | $0 | $18,731 | $0 | $481,102 | $0 | $0 | $0 |
| OLSON TIM | ||||||||||||||
| VP CFO SYSTEM | $46,522 | $418,697 | $6,918 | $62,261 | $2,187 | $19,680 | $795 | $7,155 | $2,119 | $19,074 | $58,541 | $526,867 | $0 | $0 |
| GRUNER DEAN | ||||||||||||||
| CEO - SYSTEM | $84,854 | $763,682 | $25,281 | $227,533 | $19,553 | $175,973 | $19,316 | $173,842 | $2,213 | $19,917 | $151,217 | $1,360,947 | $0 | $0 |
| REED LAURA | ||||||||||||||
| COO/CNE | $32,993 | $296,938 | $0 | $0 | $761 | $6,850 | $740 | $6,658 | $2,258 | $20,325 | $36,752 | $330,771 | $0 | $0 |
| LIVINGSTON KEITH | ||||||||||||||
| VP SR CIO | $37,839 | $340,554 | $5,774 | $51,968 | $10,088 | $90,788 | $8,892 | $80,025 | $2,080 | $18,716 | $64,673 | $582,051 | $0 | $0 |
| PISTONE MAUREEN | ||||||||||||||
| VP SR HR SERVICES | $32,468 | $292,209 | $4,970 | $44,731 | $8,851 | $79,662 | $8,018 | $72,163 | $2,159 | $19,434 | $56,466 | $508,199 | $0 | $0 |
| ALVORD BRICE MD | ||||||||||||||
| PHYSICIAN | $348,002 | $0 | $414 | $0 | $100,351 | $0 | $9,450 | $0 | $13,274 | $0 | $471,491 | $0 | $0 | $0 |
| KEITH PHILIP MD | ||||||||||||||
| PHYSICIAN | $351,391 | $0 | $414 | $0 | $105,314 | $0 | $9,732 | $0 | $11,920 | $0 | $478,771 | $0 | $0 | $0 |
| LO HORACE MD | ||||||||||||||
| PHYSICIAN | $454,901 | $0 | $414 | $0 | $156,577 | $0 | $9,950 | $0 | $25,244 | $0 | $647,086 | $0 | $0 | $0 |
| NELSON DARREN MD | ||||||||||||||
| PHYSICIAN | $417,460 | $0 | $52,453 | $0 | $1,794 | $0 | $9,950 | $0 | $20,157 | $0 | $501,814 | $0 | $0 | $0 |
| VAISMAN URI MD | ||||||||||||||
| PHYSICIAN | $364,752 | $0 | $414 | $0 | $1,477,232 | $0 | $9,950 | $0 | $11,907 | $0 | $1,864,255 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 1a | Executives receive reimbursement for personal medical expenses at an amount grossed-up for taxes. All executives in the senior management benefit category are eligible to have health or fitness club fees paid directly to the club, or reimbursed to them on evidence of payment. Senior executives whose duties include meeting with people outside the company for purposed of developing business relationships have company paid memberships at a local country club. 9 Employees received taxable medical expense reimbursements and 4 employees received club dues reimbursements. |
| Part I, Line 4b | Senior level executives of the company are entitled to an annual flexible benefit equal to 20% of the midpoint of their salary range. This 457(f) supplemental benefit plan complies with the final regulations under Section 409A and 457(f) of the Internal Revenue Code. Participants may elect the benefit to be used to purchase particular insurance benefits, invest in a capital accumulation account, or a combination of the two. Benefits are accrued on a monthly basis and are subject to the Substantial Risk of Forfeiture Agreement signed by the participants. Plan contributions are made on a quarterly basis. |
| Part I, 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 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 EXECUTIVE 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, 2015 TO DECEMBER 31, 2015) TO RECEIVE THEIR 2016 BONUSES. IF THE EMPLOYEE RETIRES, BECOMES DISABLED, 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 WILL BE FORFEITED. CARING FOR SUCCESS THE PLAN OBJECTIVES ARE TO PROVIDE INCENTIVE TO FOCUS THE ORGANIZATION'S RESOURCES, ENERGY AND ATTENTION ON THE FUFILLMENT OF THEDACARE'S MISSION. EMPLOYEE ELIGIBILITY IS BASED ON THE NUMBER OF HOURS WORKED. AND ALL ELIGIBLE EMPLOYEES SHARE IN THE PAYOUT. THE PAYOUT AMOUNT IS DETERMINED BASED ON BOTH FINANCIAL AND EMPLOYEE HEALTH AND SAFETY THRESHOLDS. THE AMOUNT PER EMPLOYEE IS DETERMINED BY DIVIDING THE TOTAL GAIN REALIZED (THE EMPLOYEE SHARE) BY HOURS PAID TO ALL ELIGIBLE EMPLOYEES. THE RESULTING DOLLAR UNIT PAYOUT IS MULTIPLIE BY AN INDIVIDUAL EMPLOYEE'S NUMBER OF HOURS PAID. THIS PLAN IS OVERSEEN BY AN ADMINISTRATIVE COMMITTEE. THE THEDACARE BOARD OF TRUSTEES MUST APPROVE THE PLAN. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part I, Line 5 | ThedaCare Inc. centralizes payroll and tax withholding functions for a number of affiliated entities, while all filing under ThedaCare's federal identification number. thedacare medical center - berlin,inc. (Berlin) reports "0" employees because employees are paid by ThedaCare, Inc., therefore, Berlin does not file any W-2 forms. ThedaCare Inc. is reimbursed by Berlin for salary expenses for the employees who are permanently assigned to Berlin. |
| Form 990, Part VI, Section A, line 2 | Russell Kuehn and Thomas Willett are members of the Board of Directors of 1st National Bank. |
| Form 990, Part VI, Section A, line 6 | thedacare medical center - berlin, INC.'S SOLE MEMBER OF THE SINGLE CLASS OF VOTING MEMBERS IS THEDACARE, INC. |
| Form 990, Part VI, Section A, line 7a | Thedacare, Inc. has sole authority in the corporation to vote and take any action with respect to the election of directors and officers. |
| Form 990, Part VI, Section A, line 7b | ThedaCare, Inc. has the sole authority with respect to the following matters: 1. Merge, consolidate, or change control of the organization 2. Sell, lease, transfer, or dispose of material assets 3. Enter joint ventures or affiliations 4. Amend bylaws and articles of incorporation 5. Develop and approve capital and operating budgets 6. Authorize and make capital expenditures 7. Approve strategic plans, with management and board oversight 8. Approve the safety and quality plan 9. Approve the dissolution or liquidation 10. Appoint auditors and legal counsel 11. Retain investment advisors and establish investment policies |
| Form 990, Part VI, Section B, line 11b | 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. 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 PARTCIPATE IN THE DECISION WHETHER TO ENGAGE IN THE TRANSACTION IN WHICH THE EMPLOYEE HAS AN INTEREST. |
| Form 990, Part VI, Section B, line 15 | THEDACARE HIRES AN OUTSIDE CONSULTING FIRM TO CONDUCT A THOROUGH MARKET REVIEW OF EXECUTIVE COMPENSATION EVERY OTHER YEAR. INTERNALLY, A COMPENSATION COMMITTEE REAFFIRMS THE COMPENSATION POLICY, REVIEWS DATA FROM CONSULTANTS, AND WITH INPUT FROM THE SENIOR VICE PRESIDENT OF HUMAN RESOURCES, ADVISES, VALIDATES, AND APPROVES A RANGE FOR CEO COMPENSATION. THE COMMITTEE ALSO RATIFIES THE AT-RISK COMPENSATION PLAN. |
| Form 990, Part VI, Section C, line 19 | The organization believes its governing documents, conflict of interest policy, and financial statements are the property of the organization and does not make them available to the public. |
| Form 990, Part XII, line 2c | Management provides oversight of the audit. The audit is presented to the Finance Committee of the Board of Directors. |
| Form 990, Part XI, line 2c | The process has not changed from the prior year. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY MEDICAL CENTER OF GREEN LAKE LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 670 COUNTY HWY A | AddressLine1Txt |
| City | GREEN LAKE | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54941 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 261424367 | EIN |
| Primary Activities | CLINIC | PrimaryActivitiesTxt |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Total Income | $0 | TotalIncomeAmt |
| End Of Year Assets | $0 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THEDACARE MEDICAL CENTER - BERLIN INC | BusinessNameLine1Txt |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| THEDACARE INC | |||||||||||
| 122 EAST COLLEGE AVENUE | APPLETON | WI | 54911 | 391509362 | HEALTHCARE | WI | 501(c)(3) | Line 10 | N/A | 0 | |
| ThedaCare Regional Medical Center - Neenah INC | |||||||||||
| PO BOX 8025 | APPLETON | WI | 54912 | 390830664 | HOSPITAL | WI | 501(c)(3) | Line 3 | Yes (1) | THEDACARE INC | |
| ThedaCare Medical Center - New London INC | |||||||||||
| 1405 MILL STREET | NEW LONDON | WI | 54961 | 390869788 | HOSPITAL | WI | 501(c)(3) | Line 3 | Yes (1) | THEDACARE INC | |
| ThedaCare Medical Center - Waupaca INC | |||||||||||
| 800 RIVERSIDE DRIVE | WAUPACA | WI | 54981 | 390871113 | HOSPITAL | WI | 501(c)(3) | Line 3 | Yes (1) | THEDACARE INC | |
| ThedaCare Regional Medical Center - Appleton INC | |||||||||||
| PO BOX 8025 | APPLETON | WI | 54912 | 390824015 | HOSPITAL | WI | 501(c)(3) | Line 3 | Yes (1) | THEDACARE INC | |
| ThedaCare Medical Center - Shawano INC | |||||||||||
| 100 COUNTY ROAD B | SHAWANO | WI | 54166 | 390807068 | HOSPITAL | WI | 501(c)(3) | Line 3 | Yes (1) | THEDACARE INC | |
| ThedaCare Medical Center - Wild Rose INC | |||||||||||
| PO BOX 243 | WILD ROSE | WI | 54984 | 396089134 | HOSPITAL | WI | 501(c)(3) | Line 3 | Yes (1) | THEDACARE INC | |
| THEDACARE FAMILY OF FOUNDATIONS INC | |||||||||||
| 1818 NORTH MEADE STREET | APPLETON | WI | 54912 | 464112255 | FOUNDATION | WI | 501(c)(3) | Line 7 | Yes (1) | THEDACARE INC | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTH APPLETON AMBULATORY CARE CENTER BUILDING COMPANY LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 122 E COLLEGE AVENUE | AddressLine1Txt |
| City | APPLETON | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54911 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 262497187 | EIN |
| Primary Activities | RENTAL | PrimaryActivitiesTxt |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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