2015-11-12T10:44:40-06:00 2014-12-31 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2014-01-01 391459276 APPLETON MEDICAL CENTER FOUNDATION INC APPL 9207386506 1818 N MEADE STREET APPLETON WI 54911 DEAN HIGH PRESIDENT 9207386506 2015-10-26 1 TERRI REXRODE CPA MST P00096513 9206620016 2015-10-26 2014 2016-02-25 16:41:14Z X JEFF REISTER 1818 N MEADE STREET APPLETON WI 54911 0 0 X WWW.AMCFOUNDATION.ORG X 1983 WI ENHANCE THE HEALTH OF OUR COMMUNITIES. 16 13 0 16 0 0 382612 0 0 0 880591 0 -10025 0 1253178 0 739950 0 0 0 322208 0 0 0 0 82074 0 1144232 0 108946 0 814463 0 814463 0 0 0 X TO RAISE FUNDS AND CARRY OUT THE PURPOSES OF THE APPLETON MEDICAL CENTER, APPLETON, WI. THESE PURPOSES INCLUDE THE ENCOURAGEMENT OF EFFECTIVE SERVICES WITHIN AND AROUND APPLETON AND THE GREATER FOX VALLEY AREA BY PROVIDING SCHOLARSHIPS AND GRANTS TO ORGANIZATIONS THAT SUPPORT AMC'S PURPOSE. TO CREATE AND SUPPORT HOSPITAL HEALTH CARE INITIATIVES THROUGH FUNDING FOR THE APPLETON MEDICAL CENTER AND RELATED OTHER COMMUNITY HEALTH CARE PROVIDERS. 0 0 TO RAISE FUNDS AND CARRY OUT THE PURPOSES OF THE APPLETON MEDICAL CENTER, APPLETON, WI. THESE PURPOSES INCLUDE THE ENCOURAGEMENT OF EFFECTIVE SERVICES WITHIN AND AROUND APPLETON AND THE GREATER FOX VALLEY AREA BY PROVIDING SCHOLARSHIPS AND GRANTS TO ORGANIZATIONS THAT SUPPORT AMC'S PURPOSE. TO CREATE AND SUPPORT HOSPITAL HEALTH CARE INITIATIVES THROUGH FUNDING FOR THE APPLETON MEDICAL CENTER AND RELATED OTHER COMMUNITY HEALTH CARE PROVIDERS. 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 16 13 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 WI X KRISTEN COGSWELL 9207386471 122 EAST COLLEGE AVENUE APPLETON WI 54911 LAURIE ACKELL DIRECTOR 1.00 0.00 X 0 0 0 DAVID B ANDERLA MD DIRECTOR 1.00 40.00 X 0 343353 30437 CLARK BOREN JR MD VICE-CHAIRPERSON 1.00 40.00 X X 0 296131 9247 STEVE C DUNGAR MD DIRECTOR 1.00 0.00 X 0 0 0 JAY FULKERSON DIRECTOR 1.00 0.00 X 0 0 0 DEAN V HIGH CHAIRPERSON 1.00 1.00 X X 0 0 0 BILL HODGKISS DIRECTOR 1.00 0.00 X 0 0 0 BRENDA KLISTER DIRECTOR 1.00 0.00 X 0 0 0 ERICA MEYER MD DIRECTOR 1.00 0.00 X 0 0 0 TIM OLSON DIRECTOR 1.00 41.00 X 0 485946 108726 MICHAEL RAY MD DIRECTOR 1.00 0.00 X 0 0 0 JEFF RIESTER TREASURER/SECRETARY 1.00 0.00 X X 0 0 0 WALTER RUGLAND DIRECTOR 1.00 1.00 X 0 0 0 PASTOR ALAN SCHAFFMEYER DIRECTOR 1.00 0.00 X 0 0 0 PETER J SCHUBBE DC DIRECTOR 1.00 0.00 X 0 0 0 CYRIL P WALSH MD DIRECTOR 1.00 3.00 X 0 0 0 MICHAEL FROHNA EXECUTIVE DIRECTOR 1.00 40.00 X 0 217238 23268 0 1342668 171678 0 0 1 0 0 0 0 0 0 0 0 0 0 0 814463 0 0 0 0 0 0 0 0 0 0 0 0 0 0 814463 0 814463 814463 0 X 0 0 814463 0 0 X 0 0 0 X 1306897 507834 790656 382612 2987999 1306897 507834 790656 382612 2987999 1242485 1745514 112227 98740 140877 260797 612641 3600640 310118 0.48480 0.48990 X 0 1 0 0 0 0 0 0 0 DAVID B ANDERLA MD DIRECTOR 0 341783 0 404 0 1166 0 9800 0 20637 0 373790 0 0 CLARK BOREN JR MD VICE-CHAIRPERSON 0 278511 0 9774 0 7846 0 0 0 9247 0 305378 0 0 TIM OLSON DIRECTOR 0 409763 0 55001 0 21182 0 90400 0 18326 0 594672 0 0 MICHAEL FROHNA EXECUTIVE DIRECTOR 0 181485 0 12188 0 23565 0 5833 0 17435 0 240506 0 0 PART I, LINE 4B TIM OLSON IS ENTITLED TO AN ANNUAL FLEXIBLE BENEFIT EQUAL TO 20% OF HIS BASE COMPENSATION. THIS 457(F) SUPPLEMENTAL BENEFIT PLAN COMPLIES WITH THE FINAL REGULATIONS UNDER SECTIONS 409A AND 457(F) OF THE INTERNAL REVENUE CODE. PARTICIPANTS MAY ELECT THE BENEFIT TO BE USED TO PURCHASE PARTICULAR INSURANCE BENEFITS, INVESTED IN A CAPITAL ACCUMULATION ACCOUNT, OR A COMBINATION OF THE TWO. BENEFITS ARE ACCRUED ON A MONTHLY BASIS AND ARE SUBJECT TO THE SUBSTANTIAL RISK OF FORFEITURE AGREEMENT SIGNED BY THE PARTICIPANTS. PLAN CONTRIBUTIONS ARE MADE ON A QUARTERLY BASIS. NOTHING WAS PAID OUT IN 2014. CASH - 12/31/13 LIABILITY PAID IN 2014 2014-12-31 814463 ACTUAL 464112255 THEDACARE FAMILY OF FOUNDATIONS INC 1818 N MEADE STREET APPLETON WI 54912 501 (C) (3) 1 1 0 0 1 1 1 1 0 PART I, LINE 2E: EXPLANATION OF INVOLVEMENT: DEAN HIGH, PRESIDENT OF APPLETON MEDICAL CENTER FOUNDATION BECAME A DIRECTOR OF THE TRANSFEREE ORGANIZATION, THEDACARE FAMILY OF FOUNDATIONS, INC.WALTER RUGLAND, DIRECTOR OF APPLETON MEDICAL CENTER FOUNDATION BECAME A DIRECTOR OF THE TRANSFEREE ORGANIZATION, THEDACARE FAMILY OF FOUNDATIONS, INC.MICHAEL FROHNA, EXECUTIVE DIRECTOR OF APPLETON MEDICAL CENTER FOUNDATION BECAME A DIRECTOR OF THE TRANSFEREE ORGANIZATION, THEDACARE FAMILY OF FOUNDATIONS, INC. FORM 990, PART VI, SECTION A, LINE 6 APPLETON MEDICAL CENTER FOUNDATION, INC.'S SOLE MEMBER OF THE SINGLE CLASS OF VOTING MEMBERS IS THEDACARE, INC. FORM 990, PART VI, SECTION A, LINE 7A THE ELECTION AND REMOVAL OF DIRECTORS REQUIRES THE APPROVAL OF THEDACARE,INC. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS SHALL NOT BE TAKEN WITHOUT THE APPROVAL OF THEDACARE, INC.: 1. AMENDMENT OF THE ARTICLES OF INCORPORATION 2. AMENDMENT OF THE BYLAWS 3. MERGER, CONSOLIDATION OR DISSOLUTION OF THIS CORPORATION 4. THE CREATION OF ANY SUBSIDIARIES OR AFFILIATES OF THIS CORPORATION FORM 990, PART VI, SECTION B, LINE 11 A DRAFT OF THE FORM 990 IS PROVIDED TO THE ORGANIZATION'S DESIGNATED COMMITTEE OF THE BOARD OF DIRECTORS FOR REVIEW AND DISCUSSION AT A BOARD MEETING. THE FINAL VERSION OF THE FORM 990 IS E-MAILED TO THE ENTIRE BOARD BEFORE THE RETURN IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY THROUGH SURVEYS, WHICH ARE REVIEWED BY THE COMPLIANCE OFFICER AND COMMITTEE. 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, SECTION C, LINE 19 ALL ARE AVAILABLE UPON REQUEST. THEDACARE INC 122 EAST COLLEGE AVENUE APPLETON WI 54911 391509362 HEALTHCARE WI 501(C)(3) LINE 11B, II N/A 0 THEDA CLARK MEDICAL CENTER INC PO BOX 8025 APPLETON WI 54912 390830664 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 1 THEDACARE MEDICAL CENTER - NEW LONDON INC 1405 MILL STREET NEW LONDON WI 54961 390869788 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 1 RIVERSIDE MEDICAL CENTER INC 800 RIVERSIDE DRIVE WAUPACA WI 54981 390871113 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 1 APPLETON MEDICAL CENTER INC PO BOX 8025 APPLETON WI 54912 390824015 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 1 SHAWANO MEDICAL CENTER INC 309 N BARTLETTE STREET SHAWANO WI 54166 390807068 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 1 COMMUNITY HEALTH NETWORK INC 225 MEMORIAL DRIVE BERLIN WI 54923 390806359 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 1 WILD ROSE COMMUNITY MEMORIAL HOSPITAL INC PO BOX 243 WILD ROSE WI 54984 396089134 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 1 THEDACARE FAMILY OF FOUNDATIONS INC 1818 NORTH MEADE STREET APPLETON WI 54912 464112255 FOUNDATION WI 501(C)(3) LINE 7 THEDACARE INC 1 NORTH APPLETON AMBULATORY CARE CENTER BUILDING COMPANY LLC 122 E COLLEGE AVENUE APPLETON WI 54911 262497187 RENTAL WI N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 THEDACARE FAMILY OF FOUNDATIONS INC R 814463 ACTUAL