2014-11-10T15:29:10-06:00 2013-12-31 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2013-01-01 391509362 THEDACARE INC THED 9207355560 122 EAST COLLEGE AVENUE APPLETON WI 54911 TIM A OLSON CHIEF FINANCIAL OFFICER 9207355560 2014-10-20 1 TERRI REXRODE CPA MST P00096513 9206620016 2014-10-20 2013 2015-11-30 17:44:51Z TIM A OLSON 122 EAST COLLEGE AVENUE APPLETON WI 54911 397776707 0 X WWW.THEDACARE.ORG X 1985 WI IMPROVING THE HEALTH OF OUR COMMUNITY. 15 11 6486 0 2894583 -85337 347089 156204 264028806 276948840 8776832 11717647 3338100 3447617 276490827 292270308 784070 251299 0 0 185853643 197635232 0 0 0 92964047 96506795 279601760 294393326 -3110933 -2123018 486244062 539996111 760776189 740845487 -274532127 -200849376 X TO PROVIDE THE HIGHEST QUALITY HEALTH CARE, DELIVERED IN THE MOST EFFICIENT AND COST-EFFECTIVE WAYS, AND ACCESSIBLE TO ALL MEMBERS OF THE COMMUNITY. 0 0 130913339 126730737 THEDACARE OPERATES 23 MEDICAL CLINICS IN 13 COMMUNITIES THROUGHOUT THE FOX VALLEY AND SURROUNDING AREAS. THE SERVICES INCLUDE FAMILY AND GENERAL PRACTICES, INTERNAL MEDICINE, ORTHOPEDICS, ALLERGY/IMMUNOLOGY, AND PEDIATRICS. ALONG WITH ROUTINE PHYSICIAN AND NURSING CARE, SOME LOCATIONS PROVIDE OFFICE HOURS WITH SPECIALTY MEDICAL PROVIDERS. MOST CLINICS ALSO OFFER DIAGNOSTIC SERVICES SUCH AS X-RAY, ULTRASOUND, MRI, CAT SCAN, MAMMOGRAPHY AND MEDICAL LABORATORY TESTING. 84026997 251299 95331963 THEDACARE PROVIDES OPERATIONAL AND ADMINISTRATIVE SUPPORT SERVICES FOR HOSPITALS, MEDICAL CLINICS AND VARIOUS OTHER HEALTHCARE PROVIDERS. CENTRALIZING THESE SERVICES ALLOWS MEDICAL PROFESSIONALS TO CONCENTRATE ON GIVING THEIR PATIENTS THE BEST POSSIBLE CARE, WHILE ENJOYING THE BENEFITS OF EFFICIENT AND COST-EFFECTIVE BUSINESS MANAGEMENT. THEDACARE'S MAIN OPERATIONAL SERVICES INCLUDES A REFERENCE LABORATORY, TRANSCRIPTION SERVICES, BIOMEDICAL EQUIPMENT MAINTENANCE, PLUS A MEDICAL REFERENCE LIBRARY, STAFF EDUCATION AND PROFESSIONAL DEVELOPMENT PROGRAMS. MANY SENIOR CITIZENS SUBSCRIBE TO "LIFELINE," A MONITORED HELP/ALARM SYSTEM CONNECTED TO THEDACARE'S NURSE-STAFFED 24-HOUR CALL CENTER. THE CALL CENTER ALSO ANSWERS HEALTH QUESTIONS, HELPS PEOPLE LOCATE A PHYSICIAN, REFERS CALLERS TO ADDITIONAL SOURCES OF INFORMATION, AND ENROLLS CALLERS INTO COMMUNITY-FOCUSED CLASSES ON HEALTH-RELATED TOPICS. ADMINISTRATIVE SERVICES INCLUDE HUMAN RESOURCES, PAYROLL, PURCHASING, FINANCE AND ACCOUNTING, PRINTING, SERVICES FOR MEDICAL & ADMINISTRATIVE MATERIALS, ORGANIZATIONAL DEVELOPMENT, INTERNAL EDUCATION AND IMPROVEMENT SYSTEMS, QUALITY ASSURANCE FOR BOTH INTERNAL AND PUBLIC REPORTING, MARKETING, COMMUNITY OUTREACH AND EDUCATION PROGRAMS, COMMUNICATION SYSTEMS, SECURITY AND LEGAL COMPLIANCE, AND FULL-SPECTRUM INFORMATION TECHNOLOGY PLANNING & SUPPORT. 39069834 39193028 THEDACARE'S SENIOR SERVICES DIVISION FOCUSES ON HEALTH CARE FOR CITIZENS EXPERIENCING LONG-TERM HEALTH ISSUES. AT-HOME HEALTH CARE VISITS MAY COMBINE WITH MEDICAL EQUIPMENT RENTALS TO ALLOW SOME PATIENTS TO CONTINUE LIVING IN THEIR OWN HOMES. AN ADULT DAY PROGRAM ALLOWS A CAREGIVER TO WORK OUTSIDE THE HOME WHILE KNOWING THAT THEIR LOVED-ONE IS SAFE WHILE THEY ARE AWAY. INDIVIDUALS WITH GREATER NEEDS MAY UTILIZE OUR ASSISTED LIVING OR LONG-TERM NURSING CARE FACILITIES. CHERRY MEADOWS HOSPICE PROVIDES CARE FOR END-OF-LIFE RESIDENTS IN A DIGNIFIED, COMPASSIONATE ENVIRONMENT. 13333987 12816374 "THEDACARE OFFERS A FULL RANGE OF BEHAVIORAL AND MENTAL HEALTH CARE IN BOTH INPATIENT AND OUTPATIENT SETTINGS. SERVICES INCLUDE PSYCHIATRY, PSYCHOLOGY, BEHAVIORAL MEDICINE, GROUP THERAPY, DAY TREATMENT, DRUG & ALCOHOL ABUSE PROGRAMS FOR BOTH ADULTS AND ADOLESCENTS, INDIVIDUAL OR FAMILY COUNSELING. PROFESSIONAL TREATMENT FOR ADHD, ALZHEIMER'S/DEMENTIA, AND OTHER BEHAVIORAL DISORDERS PROVIDES A RESOURCE FOR ALL SEGMENTS OF OUR COMMUNITY.THEDACARE WORKPLACE SOLUTIONS, A DIVISION OF THEDACARE, PROVIDES OCCUPATIONAL HEALTH SERVICES TO AREA BUSINESSES WITH THE GOAL OF HELPING TO CONTROL THE COST OF INSURING THEIR EMPLOYEES. IDENTIFYING AND MANAGING CHRONIC DISEASE HELPS KEEP A WORKFORCE HEALTHY AND PRODUCTIVE, BENEFITTING BOTH COMMUNITY AND EMPLOYER. EMPLOYEE ASSIST PROGRAMS, ON-SITE MEDICAL SERVICE PROVIDERS, ERGONOMICS, IMMUNIZATIONS AND SCREENINGS, SAFETY EDUCATION AND INJURY PREVENTION ALL CONTRIBUTE TO MAINTAINING THE HEALTH AND WELL-BEING OF INDIVIDUALS WHO MAKE UP OUR WORKFORCE." 13333987 12816374 267344157 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 452 0 6486 1 1 1 0 0 0 0 0 0 0 0 0 X 15 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X KRISTEN COGSWELL 9207386471 122 EAST COLLEGE AVENUE APPLETON WI 54911 ANDERLA DAVID MD BOARD MEMBER 41.00 1.00 X 317507 0 28818 ATTASSI OMAR MD BOARD MEMBER 1.00 3.00 X 0 0 0 DALEY-ULLEM BETH BOARD MEMBER 1.00 2.00 X 0 0 0 DAVIS JOHN BOARD MEMBER 1.00 2.00 X 0 0 0 EDELMAN GARY MD BOARD MEMBER 41.00 2.00 X 432258 0 31028 JONES GINGER BOARD MEMBER 1.00 2.00 X 0 0 0 LARSON JIM BOARD MEMBER 1.00 3.00 X 0 0 0 MOARD DOUGLAS MD BOARD MEMBER 41.00 2.00 X 289271 0 27239 TIMBERLAKE KAREN BOARD MEMBER 1.00 2.00 X 0 0 0 WALSH CYRIL P BOARD MEMBER 1.00 2.00 X 0 0 0 STELLMACHER JON BOARD CHAIRMAN 1.00 2.00 X X 0 0 0 MALANOWSKI JOHN BOARD VICE-CHAIRMAN 1.00 2.00 X X 0 0 0 WELLER MIKE BOARD TREASURER 1.00 2.00 X X 0 0 0 WHITESIDE JEFFREY MD BOARD SECRETARY 1.00 2.00 X X 0 0 0 GRUNER DEAN CEO-SYSTEM 11.00 32.00 X X 259852 779557 175676 OLSON TIM VP, CFO-SYSTEM 10.00 31.00 X 121621 364862 104931 BURMEISTER BRIAN VP SR, PHYSICIAN & RURAL SERVICES 8.00 34.00 X 72498 289991 80071 BARNAS KIM VP SR AMC & THEDA CLARK HOSPITAL 8.00 32.00 X 83088 332354 99280 LIVINGSTON KEITH VP SR CIO 10.00 30.00 X 102602 307806 86106 PISTONE MAUREEN VP SR TALENT MANAGEMENT 10.00 30.00 X 87765 263297 80998 DEVINE GREGORY VP SR PROVIDER STRATEGIES AND SYSTEMS OF CARE 10.00 30.00 X 121777 365328 78875 DIETRICH TERRY MD PHYSICIAN 40.00 0.00 X 509766 0 31267 ERICKSON ERIC MD PHYSICIAN 40.00 0.00 X 1703734 0 30626 KLEIST KENNETH MD PHYSICIAN 40.00 0.00 X 1097655 0 31907 MINIKEL JEFFERY MD PHYSICIAN 40.00 0.00 X 510158 0 30541 CROW ROSE FORMER KEY EMPLOYEE 0.00 0.00 X 102281 0 413 5811833 2703195 917776 255 1 1 0 FOX VALLEY ROOFING & SIDING W650 APATHA FREMONT WI 54940 CONSTRUCTION SERVICES 1849162 GODFREY & KAHN SC PO BOX 2728 APPLETON WI 54912 LEGAL SERVICES 705188 MORGAN HUNTER HEALTHCARE INC 7600 W 110TH ST OVERLAND PARK KS 66210 SOFTWARE SERVICES 457741 APEX PRINT TECHNOLOGIES 100 S OWASSO BLVD WEST ST PAUL MN 55117 PRINTING SERVICES 428199 THE CLARO GROUP 321 N CLARK STREET CHICAGO IL 06054 SOFTWARE SERVICES 424255 27 156204 156204 PATIENT/CLIENT SERVICES 900099 194668956 194668956 MANAGEMENT SERVICE FEES 900099 74532672 74532672 OTHER OPERATING REVENUE 900099 4870474 4870474 INFORMATION TECHNOLOGY SERVICES 900099 2876738 2876738 276948840 4948264 4948264 2427942 864741 1563201 1563201 5106 1558095 110091616 1306641 104112712 516162 5978904 790479 6769383 6769383 25523 12784 12739 12739 OTHER REVENUE 900099 1745325 1745325 EQUITY GAIN IN AFFILIATE 900099 126352 126352 1871677 292270308 274072102 2894583 15147419 251299 251299 5809006 5809006 155002892 149582558 5420334 6466390 5450414 1015976 22010289 15943793 6066496 8346655 7139599 1207056 1195976 876328 319648 758447 575848 182599 147528 118022 29506 734032 734032 24055710 22226312 1829398 3103278 2417581 685697 19116891 18336796 780095 9376929 7501543 1875386 11876977 10786356 1090621 1047302 972769 74533 1331330 1211299 120031 1311407 1293153 18254 5993478 5884700 108778 981956 915697 66259 COST OF GOODS SOLD 6595236 6595236 BAD DEBT EXPENSE 5018300 4995248 23052 EQUIPMENT MAINTENANCE 3661537 3388895 272642 RECRUITMENT 200481 146679 53802 294393326 267344157 27049169 0 1491979 3436792 55874825 31449986 30712131 28776043 602452 582850 10169383 11831555 217468746 134323071 80724147 83145675 228484988 274621805 52673294 80209120 1106 9296 996756 1305836 24513001 24627153 486244062 539996111 66611432 72787261 1844113 1323632 235920000 228080000 10787189 8101714 445613455 430552880 760776189 740845487 X -274532127 -200849376 -274532127 -200849376 486244062 539996111 X -2123018 30461739 45344030 X X 0 1 X 1 0 X X X 0 0 0 THEDA CLARK MEDICAL CENTER 390830664 3 0 1 1 0 APPLETON MEDICAL CENTER 390824015 3 0 1 1 0 NEW LONDON MEDICAL CENTER 390869788 3 0 1 1 0 RIVERSIDE MEDICAL CENTER 390871113 3 0 1 1 0 SHAWANO MEDICAL CENTER 390807068 3 0 1 1 0 5 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 1 32173 0 0 0 0 0 32173 0 PART II-B, LINE 1 PART II-B, LINE 1, LOBBYING ACTIVITIES: LOBBYING ACTIVITIES WERE DONE TO INFLUENCE THE STATE OF WISCONSIN GOVERNING BODY. NO EFFORT WAS MADE TO THE FEDERAL GOVERNMENT, OR TO SUPPORT ANY CANDIDATE. SEE DETAIL OF LOBBYING EXPENDITURES ONLINE AT HTTP://LOBBYING.WI.GOV. ITEMS THAT WERE LOBBIED INCLUDE: - DIETITIAN'S LICENSING LEGISLATION - MEDICAID PAYMENT REFORMS - ASSISTED LIVING, NURSING HOME AND HOSPICE CARE POLICIES - COLORECTAL CANCER SCREENING - CONSTRUCTION STANDARDS FOR HOSPITALS - DRUG DISPENSING TECHNOLOGY - HEALTH CARE COSTS AND FINANCING - HEALTH CARE FUNDING - HEALTH CARE MANPOWER NEEDS - HEALTH CARE QUALITY REPORTING - HEALTH CARE RECORDS - HEALTH CARE REFORM - HEALTH CARE REFORM, INCLUDING QUALITY OF CARE INITIATIVES - HOSPITAL ASSESSMENT/TAX - HOSPITAL COSTS - PROPOSED HOSPITAL ASSESSMENT - PROPOSED HOSPITAL ASSESSMENT - SUPPORT - REGULATION OF HOSPITALS 8217603 8217603 74050127 30190082 43860045 678347 345924 332423 124196552 103787065 20409487 10326117 10326117 83145675 75639784 F EQUITIES 4569336 F 80209120 DUE TO AFFILIATES 381860677 DEFERRED EMPLOYEE BENEFITS 48406930 UNRECOGNIZED LOSS ON SALE OF BUILDING 285273 430552880 X PART X, LINE 2: IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THEDACARE 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 CONSOLIDATED FINANCIAL STATEMENTS. THEDACARE RECORDED NO ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS IN 2013 AND 2012. TAX RETURNS FOR THE YEARS ENDED 2010 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. 1 UNITED WAY OF THE FOX CITIES PO BOX 928 NEENAH WI 549570928 390912895 501(C)(3) 155103 GENERAL FOX COMMUNITIES HEALTH CENTER 5337 W GRANDE MARKET DRIVE APPLETON WI 54913 202090446 501(C)(3) 35000 GENERAL PARTNERSHIP COMMUNITY HEALTH CENTER 5337 W GRANDE MARKET DRIVE APPLETON WI 54913 202090446 501(C)(3) 35000 GENERAL WELL CITY FOX CITIES W6390 QUALITY DRIVE GREENVILLE WI 54942 390912895 501(C)(3) 5000 GENERAL 4 0 PART I, LINE 2: 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. X X 1 1 X X X X 1 1 0 0 0 0 0 1 0 ANDERLA DAVID MD BOARD MEMBER 273015 0 43387 0 1105 0 9064 0 19754 0 346325 0 0 0 EDELMAN GARY MD BOARD MEMBER 55507 0 60349 0 316402 0 12000 0 19028 0 463286 0 0 0 MOARD DOUGLAS MD BOARD MEMBER 272885 0 15907 0 479 0 9350 0 17889 0 316510 0 0 0 GRUNER DEAN CEO-SYSTEM 186754 560265 71424 214271 1674 5021 39042 117127 4877 14630 303771 911314 0 0 OLSON TIM VP, CFO-SYSTEM 96822 290465 18794 56383 6005 18014 21888 65663 4345 13035 147854 443560 0 0 BURMEISTER BRIAN VP SR, PHYSICIAN & RURAL SERVICES 57734 230934 11552 46209 3212 12848 12488 49953 3526 14104 88512 354048 0 0 BARNAS KIM VP SR AMC & THEDA CLARK HOSPITAL 65906 263624 13220 52880 3962 15850 15790 63160 4066 16264 102944 411778 0 0 LIVINGSTON KEITH VP SR CIO 81312 243935 15811 47433 5479 16438 17095 51284 4432 13295 124129 372385 0 0 PISTONE MAUREEN VP SR TALENT MANAGEMENT 69392 208179 13287 39860 5086 15258 15847 47542 4402 13207 108014 324046 0 0 DEVINE GREGORY VP SR PROVIDER STRATEGIES AND SYSTEM 96928 290781 22634 67903 2215 6644 15085 45254 4634 13902 141496 424484 0 0 DIETRICH TERRY MD PHYSICIAN 495506 0 309 0 13951 0 10750 0 20517 0 541033 0 0 0 ERICKSON ERIC MD PHYSICIAN 716582 0 986163 0 989 0 9350 0 21276 0 1734360 0 0 0 KLEIST KENNETH MD PHYSICIAN 794474 0 275855 0 27326 0 9350 0 22557 0 1129562 0 0 0 MINIKEL JEFFERY MD PHYSICIAN 494636 0 10374 0 5148 0 9350 0 21191 0 540699 0 0 0 CROW ROSE FORMER KEY EMPLOYEE 98207 0 4074 0 0 0 0 0 413 0 102694 0 0 0 PART I, LINE 1A EXECUTIVES RECEIVE REIMBURSEMENT FOR PERSONAL MEDICAL EXPENSES AT AN AMOUNT GROSSED-UP FOR TAXES. ALL EXECUTIVES IN THE SENIOR MANAGEMENT BENEFIT CATEGORY ARE ELIGIBLE TO HAVE HEALTH OR FITNESS CLUB FEES PAID DIRECTLY TO THE CLUB, OR REIMBURSED TO THEM ON EVIDENCE OF PAYMENT. SENIOR EXECUTIVES WHOSE DUTIES INCLUDE MEETING WITH PEOPLE OUTSIDE THE COMPANY FOR PURPOSES OF DEVELOPING BUSINESS RELATIONSHIPS HAVE COMPANY PAID MEMBERSHIPS AT A LOCAL COUNTRY CLUB. 24 EMPLOYEES RECEIVED TAXABLE MEDICAL EXPENSE REIMBURSEMENTS AND 17 EMPLOYEES RECEIVED CLUB DUES REIMBURSEMENTS. PART I, LINES 4A-B ROSE CROW WAS A FORMER KEY EMPLOYEE WHOM WAS PREVIOUSLY REPORTED EVENLY AMONGST THEDA CLARK MEDICAL CENTER, SHAWANO MEDICAL CENTER, RIVERSIDE MEDICAL CENTER, NEW LONDON FAMILY MEDICAL CENTER, AND THEDACARE. CROW DID NOT WORK ANY HOURS DURING 2013 BUT RECEIVED SEVERANCE PAY OF $103,107. SENIOR LEVEL EXECUTIVES OF THE COMPANY ARE ENTITLED TO AN ANNUAL FLEXIBLE BENEFIT EQUAL TO 20% OF THE MIDPOINT OF THEIR SALARY RANGE. THIS 457(F) SUPPLEMENTAL BENEFIT PLAN COMPLIES WITH THE FINAL REGULATIONS UNDER SECTION 409A AND 457(F) OF THE INTERNAL REVENUE CODE. PARTICIPANTS MAY ELECT THE BENEFIT TO BE USED TO PURCHASE PARTICULAR INSURANCE BENEFITS, INVESTED IN A CAPITAL ACCUMULATION ACCOUNT, OR A COMBINATION OF THE TWO. BENEFITS ARE ACCRUED ON A MONTHLY BASIS AND ARE SUBJECT TO THE SUBSTANTIAL RISK OF FORFEITURE AGREEMENT SIGNED BY THE PARTICIPANTS. PLAN CONTRIBUTIONS ARE MADE ON A QUARTERLY BASIS. PART I, LINE 7 EXECUTIVE AT RISK COMPENSATION PLAN THE PLAN OBJECTIVES ARE TO ENHANCE THEDACARE INC'S ABILITY TO ACHIEVE ITS GOALS BY PROVIDING A TOOL FOR STIMULATING AND REWARDING SUPERIOR LEVELS OF PERFORMANCE AMONG KEY EXECUTIVES, IMPROVE THEDACARE INC'S ABILITY TO COMPETE WITH OTHER EMPLOYERS FOR HIGH TALENT EXECUTIVES AND TO ENCOURAGE TOP-LEVEL EXECUTIVES TO WORK TOGETHER AS A COHESIVE GROUP TOWARD COMMON GOALS. THE PRESIDENT OF THEDACARE INC. DEVELOPS A LIST OF SENIOR LEVEL EXECUTIVES WHO ARE ELIGIBLE TO PARTICIPATE IN THIS PLAN, AS WELL AS THE PERFORMANCE LEVELS THE SENIOR EXECUTIVES MUST ACHIEVE AND THE BONUS AMOUNTS THAT THE EXECUTIVES WILL RECEIVE. THE PRESIDENT THEN SUBMITS THIS LIST TO THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES FOR FINAL APPROVAL. THESE EXECUTIVES MUST BE IN ACTIVE REGULAR SERVICE OF THEDACARE INC. FOR THE ENTIRE PLAN YEAR (JANUARY 1, 2012 TO DECEMBER 31, 2012) TO RECEIVE THEIR 2013 BONUSES. IF THE EMPLOYEE RETIRES, BECOMES DISABLED, MOVES TO A POSITION THAT IS ELIGIBLE UNDER THE BONUS PLAN OR MOVES TO A POSITION THAT IS NO LONGER ELIGIBLE FOR THE BONUS PLAN OR DIES, THE PLAN WILL BE PRORATED FOR THE AMOUNT OF TIME THEY SERVED THE COMPANY. IF AN ELIGIBLE EMPLOYEE IS FIRED OR LEAVES THE COMPANY FOR ANY OTHER REASON THE PLAN BONUS EARNED WILL BE FORFEITED. CARING FOR SUCCESS THE PLAN OBJECTIVES ARE TO PROVIDE INCENTIVE TO FOCUS THE ORGANIZATION'S RESOURCES, ENERGY AND ATTENTION ON THE FULFILLMENT OF THEDACARE'S MISSION. 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 MULTIPLIED BY AN INDIVIDUAL EMPLOYEE'S NUMBER OF HOURS PAID. THIS PLAN IS OVERSEEN BY AN ADMINISTRATIVE COMMITTEE. THE THEDACARE BOARD OF TRUSTEES MUST APPROVE THE PLAN. A WHEFA REV BOND 2005 391337895 97710VZH4 2005-12-22 59289833 FACILITY CONSTRUCTION 0 0 0 B WHEFA REV BOND 2009A 391337855 97710BHY1 2009-06-16 87896508 FACILITY CONSTRUCTION RENOVATION AND REMODELING 0 0 0 C WHEFA REV BOND 2009B 391337855 97710BJL7 2009-06-16 36717948 REFUNDING 0 0 0 D WHEFA REV BOND 2010 391337855 97710BVM1 2010-05-25 25508288 REFUNDING 0 0 0 A 8624832 59289833 4510000 507610 1319209 52948513 2007 0 0 1 1 B 2631508 87896508 5549000 4916000 1018634 80554000 2010 0 0 1 1 C 15032948 36717948 1616000 425525 34558000 1 0 1 1 D 4788288 25508288 332397 25175981 1 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 A 0 1 0 0 0 0 1 FIFTH THIRD BANK 1.000000000000 1 0 1 B 0 1 0 0 0 0 0 1 C 0 1 0 0 0 0 0 0 0 D 0 1 0 0 0 0 0 0 0 A 0 B 0 C 0 D 0 A WHEFA REV BOND 2012A 391337855 NONEAVAIL 2012-10-19 49745000 REFUNDING 0 0 0 A 49745000 279179 49465821 1 0 1 1 A 0 0 0 0 0 0 0 A 0 1 0 0 0 0 0 0 0 A 1 FORM 990, PART I, LINE 5: NUMBER OF EMPLOYEES: THEDACARE INC. CENTRALIZES PAYROLL AND TAX WITHHOLDING FUNCTIONS FOR A NUMBER OF AFFILIATED ENTITIES, WITH ALL FILINGS UNDER THEDACARE'S FEDERAL IDENTIFICATION NUMBER. 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. 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 PARTICIPATE 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 THEDACARE INC. DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND INTERNAL FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: PENSION RELATED CHANGES 45,378,871. FUNDS RELEASED FROM RESTRICTIONS -34,841. FORM 990, PART XII, LINE 2C: OVERSIGHT OF AUDIT: THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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 THEDA CLARK MEDICAL CENTER FOUNDATION INC 1818 NORTH MEADE STREET APPLETON WI 54911 311550056 FOUNDATION WI 501(C)(3) LINE 11A, I THEDACARE INC 1 APPLETON MEDICAL CENTER FOUNDATION INC 1818 NORTH MEADE STREET APPLETON WI 54911 391459276 FOUNDATION WI 501(C)(3) LINE 7 THEDACARE INC 1 WOLF RIVER AREA HEALTHCARE FOUNDATION INC 1405 MILL STREET NEW LONDON WI 54961 200049796 FOUNDATION WI 501(C)(3) LINE 11A, I NEW LONDON FAMILY MEDICAL CENTER INC 1 GEORGE F PEABODY FOUNDATION INC 2600 S HERITAGE WOOD DRIVE APPLETON WI 54915 391702534 FOUNDATION WI 501(C)(3) LINE 11A, I APPLETON MEDICAL CENTER INC 1 COMMUNITY HOSPICE FOUNDATION INC 1818 NORTH MEADE STREET APPLETON WI 54911 391511977 FOUNDATION WI 501(C)(3) LINE 7 THEDACARE INC 1 SHAWANO MEDICAL CENTER FOUNDATION INC 309 N BARTLETTE STREET SHAWANO WI 54166 391539117 FOUNDATION WI 501(C)(3) LINE 11A, I SHAWANO MEDICAL CENTER INC 1 THEDACARE FAMILY OF FOUNDATIONS 1818 NORTH MEADE STREET APPLETON WI 54911 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 RELATED -86869 128389 0 1 0.17330 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 THEDACARE MEDICAL CENTER - NEW LONDON INC D 7763308 ACTUAL RIVERSIDE MEDICAL CENTER INC D 4585097 ACTUAL THEDA CLARK MEDICAL CENTER INC N 1355762 ACTUAL APPLETON MEDICAL CENTER INC N 3401537 ACTUAL THEDACARE MEDICAL CENTER - NEW LONDON INC N 229205 ACTUAL RIVERSIDE MEDICAL CENTER INC N 310536 ACTUAL SHAWANO MEDICAL CENTER INC N 287699 ACTUAL THEDA CLARK MEDICAL CENTER INC O 83603653 ACTUAL APPLETON MEDICAL CENTER INC O 113055200 ACTUAL THEDACARE MEDICAL CENTER - NEW LONDON INC O 15301402 ACTUAL RIVERSIDE MEDICAL CENTER INC O 18775877 ACTUAL SHAWANO MEDICAL CENTER INC O 20958157 ACTUAL APPLETON MEDICAL CENTER FOUNDATION INC O 323000 ACTUAL THEDA CLARK MEDICAL CENTER FOUNDATION INC O 323000 ACTUAL