APPLETON MEDICAL CENTER FOUNDATION INC: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- APPLETON MEDICAL CENTER FOUNDATION INC (EIN 39-1459276)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-11-10
- IRS object ID
- 201403149349302660
- Schema version
- 2013v3.0
- 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 D
- Schedule G
- Schedule I
- Schedule J
- Schedule N
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-11-10T15:30:01-06:00 | ReturnTs |
| Tax Period End | 2013-12-31 | 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 | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 12237 | AddressLine1 |
| City | GREEN BAY | City |
| State | WI | State |
| ZIP Code | 543072237 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391459276 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | APPLETON MEDICAL CENTER FOUNDATION INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | APPL | BusinessNameControlTxt |
| Phone | 9207386506 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1818 N MEADE STREET | AddressLine1 |
| City | APPLETON | City |
| State | WI | State |
| ZIP Code | 54911 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DEAN HIGH | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 9207386506 | PhoneNum |
| Signature | 2014-10-20 | 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 | 2014-10-20 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JEFF REISTER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1818 N MEADE STREET | AddressLine1 |
| City | APPLETON | City |
| State | WI | State |
| ZIP Code | 54911 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $7,503,728 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.AMCFOUNDATION.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1983 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | ENHANCE THE HEALTH OF OUR COMMUNITIES. | ActivityOrMissionDesc |
| Contract Termination | Yes (X) | ContractTerminationInd |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 46 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $790,656 | PYContributionsGrantsAmt |
| CY Contributions Grants | $382,612 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $317,747 | PYInvestmentIncomeAmt |
| CY Investment Income | $880,591 | CYInvestmentIncomeAmt |
| PY Other Revenue | $55,150 | PYOtherRevenueAmt |
| CY Other Revenue | -$10,025 | CYOtherRevenueAmt |
| PY Total Revenue | $1,163,553 | PYTotalRevenueAmt |
| CY Total Revenue | $1,253,178 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $143,984 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $739,950 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $279,378 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $322,208 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $277,943 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $88,134 | PYOtherExpensesAmt |
| CY Other Expenses | $82,074 | CYOtherExpensesAmt |
| PY Total Expenses | $511,496 | PYTotalExpensesAmt |
| CY Total Expenses | $1,144,232 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $652,057 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $108,946 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $12,041,669 | TotalAssetsBOYAmt |
| Total Assets EOY | $814,463 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $37,905 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $814,463 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $12,003,764 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $0 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $719,450 | ExpenseAmt |
| Grant | $719,450 | GrantAmt |
| Desc | 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. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $20,500 | ExpenseAmt |
| Grant | $20,500 | GrantAmt |
| Desc | 10 SCHOLARSHIPS WERE GRANTED TO INDIVIDUALS WHO ARE GOING INTO THE MEDICAL FIELD OF STUDY. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $739,950 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | 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 | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | 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 | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | 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 | Yes (1) | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | 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 | 0 | UnrelatedBusIncmOverLimitInd |
| 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 | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | 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 | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| 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 | KRISTEN COGSWELL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9207386471 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 122 EAST COLLEGE AVENUE | AddressLine1 |
| City | APPLETON | City |
| State | WI | State |
| ZIP Code | 54911 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|
| ANDERLADAVID MD | |||||||
| DIRECTOR | 1.00 | 41.00 | Yes (X) | $0 | $317,507 | $28,818 | |
| BORENCLARK JR MD | |||||||
| SECRETARY (CURRENT) | 1.00 | 41.00 | Yes (X) | $0 | $294,287 | $7,968 | Yes (X) |
| BYTOFJOYCE | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| DUNGAR STEVE C MD | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| FULKERSONJAY | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| HIGH DEAN V | |||||||
| PRESIDENT | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| OLSONTIM | |||||||
| DIRECTOR | 1.00 | 40.00 | Yes (X) | $0 | $486,483 | $104,929 | |
| RAYMICHAEL MDPHD | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| RIESTERJEFF | |||||||
| TREASURER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| RUGLANDWALTER | |||||||
| VICE PRESIDENT | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| SCHAFFMEYER PASTOR ALAN | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| SCHUBBE PETER J DC | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| UEHLINGBARBARA | |||||||
| SECRETARY (FORMER) | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| WALSH CYRIL P | |||||||
| PRESIDENT | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | |
| HUNTER WILLIAM | |||||||
| DIRECTOR | 1.00 | 41.00 | Yes (X) | $0 | $419,674 | $76,222 | |
| FROHNAMICHAEL | |||||||
| EXECUTIVE DIRECTOR | 15.00 | 28.00 | $69,878 | $129,772 | $22,012 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $69,878 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,647,723 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $239,949 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $68,906 | FundraisingAmt |
| All Other Contributions | $313,706 | AllOtherContributionsAmt |
| Total Contributions | $382,612 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $260,797 | TotalRevenueColumnAmt |
| Exclusion | $260,797 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $6,836,672 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $6,216,878 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $619,794 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $619,794 | TotalRevenueColumnAmt |
| Exclusion | $619,794 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $23,647 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $68,906 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $33,672 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$10,025 | TotalRevenueColumnAmt |
| Exclusion | -$10,025 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,253,178 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $870,566 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $719,450 | TotalAmt |
| Program Services | $719,450 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,500 | TotalAmt |
| Program Services | $20,500 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $322,208 | TotalAmt |
| Management And General | $80,552 | ManagementAndGeneralAmt |
| Fundraising | $241,656 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,036 | TotalAmt |
| Management And General | $18,036 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,898 | TotalAmt |
| Management And General | $7,898 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,656 | TotalAmt |
| Management And General | $13,328 | ManagementAndGeneralAmt |
| Fundraising | $13,328 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,593 | TotalAmt |
| Fundraising | $8,593 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,429 | TotalAmt |
| Management And General | $1,714 | ManagementAndGeneralAmt |
| Fundraising | $1,715 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,766 | TotalAmt |
| Management And General | $692 | ManagementAndGeneralAmt |
| Fundraising | $2,074 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,019 | TotalAmt |
| Management And General | $2,019 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|
| SUPPLIES | $10,730 | $3,541 | $7,189 |
| MEALS AND CATERING | $3,811 | $1,906 | $1,905 |
| MEMBERSHIPS/SUBSCRIPTIO | $2,633 | $1,316 | $1,317 |
| DONOR CULTIVATION | $166 | $166 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -$4,663 | TotalAmt |
| Management And General | -$4,663 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,144,232 | TotalAmt |
| Program Services | $739,950 | ProgramServicesAmt |
| Management And General | $126,339 | ManagementAndGeneralAmt |
| Fundraising | $277,943 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,173,565 | BOYAmt |
| EOY | $814,463 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $546,981 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,321,123 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,041,669 | BOYAmt |
| EOY | $814,463 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,905 | BOYAmt |
| EOY | $814,463 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,905 | BOYAmt |
| EOY | $814,463 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,249,218 | BOYAmt |
| EOY | $0 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,091,410 | BOYAmt |
| EOY | $0 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,663,136 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,003,764 | BOYAmt |
| EOY | $0 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,041,669 | BOYAmt |
| EOY | $814,463 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $108,946 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $1,125,447 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$13,238,157 | 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) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| 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) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $243,392 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,306,897 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $507,834 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $790,656 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $382,612 | CurrentTaxYearAmt |
| Total | $3,231,391 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $243,392 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,306,897 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $507,834 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $790,656 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $382,612 | CurrentTaxYearAmt |
| Total | $3,231,391 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $1,232,905 | SubstantialContributorsTotAmt |
| Public Support Total170 | $1,998,486 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $235,618 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $112,227 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $98,740 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $140,877 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $260,797 | CurrentTaxYearAmt |
| Total | $848,259 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $4,079,650 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $370,742 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.48990 | PublicSupportCY170Pct |
| Public Support PY170 | 0.37310 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
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 D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $5,257,892 | BeginningYearBalanceAmt |
| Contributions | $47,322 | ContributionsAmt |
| Investment Earnings Or Losses | $129,975 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $5,395,434 | GrantsOrScholarshipsAmt |
| Other Expenditures | $39,755 | OtherExpendituresAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $5,185,470 | BeginningYearBalanceAmt |
| Contributions | $31,906 | ContributionsAmt |
| Investment Earnings Or Losses | $71,610 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $31,094 | OtherExpendituresAmt |
| End Year Balance | $5,257,892 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $5,188,828 | BeginningYearBalanceAmt |
| Contributions | $54,597 | ContributionsAmt |
| Investment Earnings Or Losses | -$14,882 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $43,073 | OtherExpendituresAmt |
| End Year Balance | $5,185,470 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $5,148,663 | BeginningYearBalanceAmt |
| Contributions | $3,305 | ContributionsAmt |
| Investment Earnings Or Losses | $64,028 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $27,168 | OtherExpendituresAmt |
| End Year Balance | $5,188,828 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,876,903 | BeginningYearBalanceAmt |
| Contributions | $1,370 | ContributionsAmt |
| Investment Earnings Or Losses | $287,444 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $17,054 | OtherExpendituresAmt |
| End Year Balance | $5,148,663 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $2,412,297 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $1,125,447 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $1,125,447 | RevenueNotReportedAmt |
| Revenue Subtotal | $1,286,850 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$33,672 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$33,672 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $1,253,178 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $1,177,904 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $33,672 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $33,672 | ExpensesNotReportedAmt |
| Expenses Subtotal | $1,144,232 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $1,144,232 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE FOUNDATION HAS ADOPTED INVESTMENT AND SPENDING POLICIES FOR ENDOWMENT ASSETS THAT ATTEMPT TO PROVIDE A PREDICTABLE STREAM OF FUNDING TO PROGRAMS SUPPORTED BY ITS ENDOWMENT WHILE SEEKING TO MAINTAIN THE PURCHASING POWER OF THE ENDOWMENT ASSETS. ENDOWMENT ASSESTS INCLUDE THOSE ASSETS OF DONOR-RESTRICTED FUNDS THAT THE FOUNDATION MUST HOLD IN PERPETUITY OR FOR A DONOR-SPECIFIED PERIOD(S). UNDER THIS POLICY, AS APPROVED BY THE BOARD OF DIRECTORS, THE ENDOWMENT ASSETS ARE INVESTED IN A MANNER THAT IS INTENDED TO PRODUCE RESULTS THAT EXCEED THE PRICE AND YIELD RESULTS OF THE S & P 500 INDEX WHILE ASSUMING A MODERATE LEVEL OF INVESTMENT RISK. |
| PART X, LINE 2: | IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE FOUNDATION DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THAT POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE FOUNDATION RECORDED NO ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS IN 2013 OR 2012. FEDERAL TAX RETURNS FOR THE YEARS ENDED 2010 AND BEYOND, REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | FUNDRAISING EXPENSES -33,672. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | FUNDRAISING EXPENSES 33,672. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | HIGH FLYIN' GOLF OUTING | NameOfEvent1Amt |
| Gross Receipts Event1 | $53,568 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $39,790 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $13,778 | GrossRevenueEvent1Amt |
| Rent Facility Costs Event1 | $17,162 | RentFacilityCostsEvent1Amt |
| Other Direct Expenses Event1 | $4,690 | OtherDirectExpensesEvent1Amt |
| Name Of Event2 | LAUGHTER IS THE BEST MEDICINE | NameOfEvent2Amt |
| Gross Receipts Event2 | $38,985 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $29,116 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $9,869 | GrossRevenueEvent2Amt |
| Rent Facility Costs Event2 | $2,026 | RentFacilityCostsEvent2Amt |
| Entertainment Event2 | $1,430 | EntertainmentEvent2Amt |
| Other Direct Expenses Event2 | $8,364 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $92,553 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $68,906 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $23,647 | GrossRevenueTotalEventsAmt |
| Rent Fclty Costs Total Events | $19,188 | RentFcltyCostsTotalEventsAmt |
| Entertainment Total Events | $1,430 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $13,054 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $33,672 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$10,025 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (10 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| COTS INC | |||||||
| 819 S WEST STREET | APPLETON | WI | 54915 | 391913179 | 501(C)(3) | $17,000 | SUPPORT OF AN AFTERCARE COORDINATOR |
| APPLETON MEDICAL CENTER INC | |||||||
| 1818 NORTH MEADE STREET | APPLETON | WI | 54911 | 390824015 | 501(C)(3) | $450,926 | CANCER CARE SUPPORT, NURSING EDUCATION, LEARNING CENTER FOR COLLABORATIVE CARE, NICONE EEG MACHINES |
| APPLETON AREA SCHOOL DISTRICT | |||||||
| 122 E COLLEGE AVE | APPLETON | WI | 54911 | 396000710 | APPLETON SCHOOL DIST | $25,000 | LAWRENCE UNIVERSITY RESEARCH PROJECT INVOLVING THE BUILDING FOR KIDS CHILDREN'S MUSEUM |
| LIVING HEALTHY COMMUNITY CLINIC | |||||||
| 510 DOCTORS COURT | OSHKOSH | WI | 54901 | 391805963 | 501(C)(3) | $90,000 | GENERAL OPERATIONS |
| FOX CITIES CHAMBER OF COMMERCE & INDUSTRY | |||||||
| 125 N SUPERIOR STREET | APPLETON | WI | 54911 | 391248133 | 501(C)(3) | $25,000 | ANNUAL ECONOMIC DEVELOPMENT GRANT |
| AMC VOLUNTEERS | |||||||
| 1818 NORTH MEADE STREET | APPLETON | WI | 54911 | 396062608 | 501(C)(3) | $17,500 | AVS SCHOLARSHIP AWARDS |
| CHAPS ACADEMY | |||||||
| N5367 MAYFLOWER ROAD | SHIOCTON | WI | 54170 | 450530019 | 501(C)(3) | $8,000 | SUPPORT STAFFING OF A RN |
| RIVERVIEW GARDENS | |||||||
| PO BOX 1645 | APPLETON | WI | 54911 | 391913179 | 501(C)(3) | $50,000 | HOOPHOUSES AND MAINTENANCE FOR 5 YEARS |
| REBUILDING TOGETHER FOR THE FOX VALLEY | |||||||
| 605 E HANCOCK STREET | APPLETON | WI | 54911 | 392013200 | 501(C)(3) | $10,000 | GENERAL OPERATING EXPENSES |
| BOYS & GIRLS CLUB | |||||||
| PO BOX 411 | OSHKOSH | WI | 549030411 | 396120658 | 501(C)(3) | $23,500 | DEVELOPMENT OF AN AT-RISK YOUTH CAREER MENTORING/LIFE SKILLS INITIATIVE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 10 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | SCHOLARSHIPS | GrantTypeTxt |
| Recipient | 10 | RecipientCnt |
| Cash Grant | $20,500 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION ONLY WRITES CHECKS OUT FOR GRANTS TO ORGANIZATIONS ONCE THE ITEM OR SERVICE HAS ALREADY BEEN RECEIVED BY THE ORGANIZATION. SCHOLARSHIP CHECKS ARE WRITTEN OUT TO THE COLLEGE AND THE RECIPIENT. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | 0 | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| 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 | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ANDERLADAVID MD | ||||||||||||||
| DIRECTOR | $0 | $273,015 | $0 | $43,387 | $0 | $1,105 | $0 | $9,064 | $0 | $19,754 | $0 | $346,325 | $0 | $0 |
| BORENCLARK JR MD | ||||||||||||||
| SECRETARY (CURRENT) | $0 | $276,294 | $0 | $10,373 | $0 | $7,620 | $0 | $0 | $0 | $7,968 | $0 | $302,255 | $0 | $0 |
| OLSONTIM | ||||||||||||||
| DIRECTOR | $0 | $387,286 | $0 | $75,178 | $0 | $24,019 | $0 | $87,550 | $0 | $17,379 | $0 | $591,412 | $0 | $0 |
| HUNTER WILLIAM | ||||||||||||||
| DIRECTOR | $0 | $330,851 | $0 | $77,288 | $0 | $11,535 | $0 | $58,415 | $0 | $17,807 | $0 | $495,896 | $0 | $0 |
| FROHNAMICHAEL | ||||||||||||||
| EXECUTIVE DIRECTOR | $59,508 | $110,514 | $5,738 | $10,655 | $4,632 | $8,603 | $1,924 | $3,573 | $5,780 | $10,735 | $77,582 | $144,080 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1B | CLUB DUES ARE A TAXABLE BENEFIT OFFERED INFREQUENTLY ON A CASE BY CASE BASIS. THEY NEED TO BE APPROVED UNANIMOUSLY BY THE HIRING VICE PRESIDENT, THE HUMAN RESOURCES VICE PRESIDENT, AND THE CEO. |
| PART I, LINE 3 | THE ORGANIZATION RELIES ON THEDACARE, INC., A RELATED 501(C)(3) ORGANIZATION, TO ESTABLISH THE COMPENSATION FOR ITS EXECUTIVE DIRECTOR. THEDACARE, INC. USES A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE, AS ITS METHODS FOR ESTABLISHING THE COMPENSATION FOR APPLETON MEDICAL CENTER FOUNDATION'S EXECUTIVE DIRECTOR. |
| 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 2013. |
Schedule N IRS990ScheduleN
Disposition Of Assets Detail DispositionOfAssetsDetail (4 entries)
| Assets Distri Or Expnss PaidAssetsDistriOrExpnssPaidDesc | DistributionDistributionDt | Fair Market Value Of AssetFairMarketValueOfAssetAmt | Method Of FMV DeterminationMethodOfFMVDeterminationTxt | EINEIN | Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | IRC SectionIRCSectionTxt |
|---|---|---|---|---|---|---|---|---|---|
| THEDACARE FAMILY OF FOUNDATIONS INC | |||||||||
| CASH | 2013-12-31 | $814,463 | ACTUAL COST | 464112255 | 1818 N MEADE ST PO BOX 1222 | APPLETON | WI | 549129974 | 501(C)(3) |
| THEDACARE FAMILY OF FOUNDATIONS INC | |||||||||
| OTHER ACCOUNTS RECEIVABLE | 2013-12-31 | -$74,297 | BOOK VALUE | 464112255 | 1818 N MEADE ST PO BOX 1222 | APPLETON | WI | 549129974 | 501(C)(3) |
| THEDACARE FAMILY OF FOUNDATIONS INC | |||||||||
| PLEDGES RECEIVABLE | 2013-12-31 | $103,673 | BOOK VALUE | 464112255 | 1818 N MEADE ST PO BOX 1222 | APPLETON | WI | 549129974 | 501(C)(3) |
| THEDACARE FAMILY OF FOUNDATIONS INC | |||||||||
| INVESTMENTS | 2013-12-31 | $12,394,318 | FAIR MARKET VALUE | 464112255 | 1818 N MEADE ST PO BOX 1222 | APPLETON | WI | 549129974 | 501(C)(3) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor2 | Yes (1) | DirectorOfSuccessor2Ind |
| Employee Of Successor2 | Yes (1) | EmployeeOfSuccessor2Ind |
| Owner Of Successor2 | 0 | OwnerOfSuccessor2Ind |
| Receive Compensation2 | 0 | ReceiveCompensation2Ind |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART II, 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, VICE PRESIDENT 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, SCHEDULE N | DURING 2013, THEDACARE, INC. FORMED A NEW FOUNDATION, THEDACARE FAMILY OF FOUNDATIONS, INC., IN ORDER TO CONSOLIDATE THE ACTIVITIES OF THEIR MULTIPLE FOUNDATIONS INTO ONE ORGANIZATION. ACCORDINGLY, AMC FOUNDATION'S BOARD OF DIRECTORS APPROVED A PLAN OF DISSOLUTION WHEREBY DURING 2013 THE FOUNDATION TRANSFERRED $13,238,157 OF NET ASSETS TO THEDACARE FAMILY OF FOUNDATIONS, INC. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 B, LINE 15A | THE COMPENSATION PROCESS FOR TOP OFFICIALS OF THE ORGANIZATION IS MANAGED BY THEIR EMPLOYER FOR PAYROLL PURPOSES, THEDACARE, INC., A RELATED ORGANIZATION. MANAGEMENT OF THEDACARE, INC. DETERMINES A FAIR AND REASONABLE COMPENSATION FOR THESE INDIVIDUALS BASED ON MARKET AND COMPARABILITY DATA PROVIDED BY HUMAN RESOURCES. NO OTHER OFFICERS OF THE ORGANIZATION RECEIVE ANY COMPENSATION. |
| FORM 990, PART VI, SECTION C, LINE 19 | ALL ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | NET ASSETS TRANSFERRED TO THEDACARE FAMILY OF FOUNDATIONS, INC. -13,238,157. |
| FORM 990, PART XII, LINE 2C: | THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (12 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| THEDACARE INC | |||||||||||
| 122 EAST COLLEGE AVENUE | APPLETON | WI | 54911 | 391509362 | HEALTHCARE | WI | 501(C)(3) | LINE 11C, III-FI | N/A | 0 | |
| THEDA CLARK MEDICAL CENTER 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 | |
| RIVERSIDE MEDICAL CENTER INC | |||||||||||
| 800 RIVERSIDE DRIVE | WAUPACA | WI | 54981 | 390871113 | HOSPITAL | WI | 501(C)(3) | LINE 3 | Yes (1) | THEDACARE INC | |
| APPLETON MEDICAL CENTER INC | |||||||||||
| PO BOX 8025 | APPLETON | WI | 54912 | 390824015 | HOSPITAL | WI | 501(C)(3) | LINE 3 | Yes (1) | THEDACARE INC | |
| SHAWANO MEDICAL CENTER INC | |||||||||||
| 309 N BARTLETTE STREET | SHAWANO | WI | 54166 | 390807068 | HOSPITAL | WI | 501(C)(3) | LINE 3 | Yes (1) | THEDACARE INC | |
| THEDA CLARK MEDICAL CENTER FOUNDATION INC | |||||||||||
| 1818 N MEADE STREET | APPLETON | WI | 54911 | 311550056 | FOUNDATION | WI | 501(C)(3) | LINE 11A, I | Yes (1) | THEDACARE INC | |
| WOLF RIVER AREA HEALTHCARE FOUNDATION INC | |||||||||||
| 1405 MILL STREET | NEW LONDON | WI | 54961 | 200049796 | FOUNDATION | WI | 501(C)(3) | LINE 11A, I | Yes (1) | NEW LONDON FAMILY MEDICAL CENTER INC | |
| GEORGE F PEABODY FOUNDATION INC | |||||||||||
| 2600 S HERITAGE WOODS DRIVE | APPLETON | WI | 54915 | 391702534 | FOUNDATION | WI | 501(C)(3) | LINE 11A, I | Yes (1) | APPLETON MEDICAL CENTER INC | |
| COMMUNITY HOSPICE FOUNDATION INC | |||||||||||
| 1818 N MEADE STREET | APPLETON | WI | 54911 | 391511977 | FOUNDATION | WI | 501(C)(3) | LINE 7 | Yes (1) | THEDACARE INC | |
| SHAWANO MEDICAL CENTER FOUNDATION INC | |||||||||||
| 309 N BARTLETTE STREET | SHAWANO | WI | 54166 | 391539117 | FOUNDATION | WI | 501(C)(3) | LINE 11A, I | Yes (1) | SHAWANO MEDICAL CENTER INC | |
| THEDACARE FAMILY OF FOUNDATIONS INC | |||||||||||
| 1818 N MEADE STREET | APPLETON | WI | 54915 | 464112255 | FOUNDATION | WI | 501(C)(3) | LINE 11A, I | 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 | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 122 E COLLEGE AVENUE | AddressLine1 |
| City | APPLETON | City |
| State | WI | State |
| ZIP Code | 54911 | ZIPCode |
| 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 | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | 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 | 0 | 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 | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| TRANSFER OF NET ASSETS TO THEDACARE FAMILY FOUNDATIONS INC | ||
| R | $13,238,157 | FMV |
| APPLETON MEDICAL CENTER INC | ||
| B | $739,950 | FMV |
Comments