COMMUNITY HOSPICE FOUNDATION INC: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HOSPICE FOUNDATION INC (EIN 39-1511977)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-11-10
- IRS object ID
- 201423149349302617
- 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 | 2014-11-10T15:30:58-06:00 | 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 | 391511977 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPICE FOUNDATION INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 9208305963 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1818 NORTH MEADE STREET | AddressLine1 |
| City | APPLETON | City |
| State | WI | State |
| ZIP Code | 54911 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOHN KELLER | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 9208305963 | PhoneNum |
| Signature | 2014-10-31 | 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 | 2014-10-31 | 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) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Final Return | Yes (X) | FinalReturnInd |
| Principal Officer | JOHN KELLER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1818 NORTH MEADE STREET | AddressLine1 |
| City | APPLETON | City |
| State | WI | State |
| ZIP Code | 54911 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $476,966 | 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 | 2003 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | THE COMMUNITY HOSPICE FOUNDATION HAS AS ITS PURPOSE TO RECEIVE & MAINTAIN GIFTS, BEQUESTS OR OTHER TRANSFERS TO BE USED FOR THE GENERAL SUPPORT, USE, MAINTENANCE, OPERATION, EXPANSION, AND OTHER SIMILAR PURPOSES OF THEDACARE AT HOME HOSPICE SERVICES. THEDACARE IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 23 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $104,436 | PYContributionsGrantsAmt |
| CY Contributions Grants | $153,072 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $7,180 | PYInvestmentIncomeAmt |
| CY Investment Income | $70,792 | CYInvestmentIncomeAmt |
| PY Other Revenue | $44,640 | PYOtherRevenueAmt |
| CY Other Revenue | -$1,555 | CYOtherRevenueAmt |
| PY Total Revenue | $156,256 | PYTotalRevenueAmt |
| CY Total Revenue | $222,309 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $26,884 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $97,332 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $23,711 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $25,674 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $35,989 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $40,302 | PYOtherExpensesAmt |
| CY Other Expenses | $43,777 | CYOtherExpensesAmt |
| PY Total Expenses | $90,897 | PYTotalExpensesAmt |
| CY Total Expenses | $166,783 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $65,359 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $55,526 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $698,215 | TotalAssetsBOYAmt |
| Total Assets EOY | $0 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $4,389 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $693,826 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $0 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE COMMUNITY HOSPICE FOUNDATION HAS AS ITS PURPOSE TO RECEIVE & MAINTAIN GIFTS, BEQUESTS OR OTHER TRANSFERS TO BE USED FOR THE GENERAL SUPPORT, USE, MAINTENANCE, OPERATION, EXPANSION, AND OTHER SIMILAR PURPOSES OF THEDACARE AT HOME HOSPICE SERVICES. THEDACARE IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $97,332 | ExpenseAmt |
| Grant | $97,332 | GrantAmt |
| Desc | SUBSIDIZED PATIENT CARE AND PROGRAMS OFFERED BY THEDACARE AT HOME WHERE PAY AND/OR GOVERNMENT REIMBURSEMENT IS INADEQUATE TO COVER COSTS. THIS INCLUDES HOSPICE RESIDENT AND NON-RESIDENT EXPENSES. | Desc |
| Total Program Service Expenses | $97,332 | 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 | 0 | 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 | 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 | Yes (1) | 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 | 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 | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | 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 (10 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 |
|---|---|---|---|---|---|---|---|
| ANDERSONSCOTT | |||||||
| TREASURER | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| BEISERKIM | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| CORNELLCHRISTINE | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| DRAKEJEFFREY | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| GRUNERPAM | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| HEINERJULIE | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| KELLERJOHN | |||||||
| PRESIDENT | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| LARSONJOHN | |||||||
| VICE PRESIDENT | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| RENKENSMONICA | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| FROHNAMICHAEL | |||||||
| EXECUTIVE DIRECTOR | 14.00 | 29.00 | Yes (X) | $64,887 | $134,763 | $22,012 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $64,887 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $134,763 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $22,012 | 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 | $46,833 | FundraisingAmt |
| All Other Contributions | $106,239 | AllOtherContributionsAmt |
| Total Contributions | $153,072 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,354 | TotalRevenueColumnAmt |
| Exclusion | $12,354 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $295,507 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $237,069 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $58,438 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $58,438 | TotalRevenueColumnAmt |
| Exclusion | $58,438 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $16,033 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $46,833 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $17,588 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$1,555 | TotalRevenueColumnAmt |
| Exclusion | -$1,555 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $222,309 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $69,237 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $97,332 | TotalAmt |
| Program Services | $97,332 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,674 | TotalAmt |
| Management And General | $8,986 | ManagementAndGeneralAmt |
| Fundraising | $16,688 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,036 | TotalAmt |
| Management And General | $18,036 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,275 | TotalAmt |
| Management And General | $4,996 | ManagementAndGeneralAmt |
| Fundraising | $9,279 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,245 | TotalAmt |
| Management And General | $555 | ManagementAndGeneralAmt |
| Fundraising | $4,690 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,678 | TotalAmt |
| Fundraising | $4,678 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $841 | TotalAmt |
| Management And General | $294 | ManagementAndGeneralAmt |
| Fundraising | $547 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $595 | TotalAmt |
| Management And General | $595 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DONOR CULTIVATION | Desc |
| Total | $107 | TotalAmt |
| Fundraising | $107 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $166,783 | TotalAmt |
| Program Services | $97,332 | ProgramServicesAmt |
| Management And General | $33,462 | ManagementAndGeneralAmt |
| Fundraising | $35,989 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $308,049 | BOYAmt |
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,556 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $380,026 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $584 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $698,215 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,389 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,389 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $415,342 | BOYAmt |
| EOY | $0 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $278,484 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $693,826 | BOYAmt |
| EOY | $0 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $698,215 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $55,526 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $11,442 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$760,794 | 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 | $164,480 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $215,655 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $132,900 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $104,436 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $153,072 | CurrentTaxYearAmt |
| Total | $770,543 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $164,480 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $215,655 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $132,900 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $104,436 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $153,072 | CurrentTaxYearAmt |
| Total | $770,543 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $770,543 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $13,523 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $8,452 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $7,821 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $7,429 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $12,354 | CurrentTaxYearAmt |
| Total | $49,579 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $820,122 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $207,790 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.93950 | PublicSupportCY170Pct |
| Public Support PY170 | 0.93970 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $251,339 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $11,442 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $11,442 | RevenueNotReportedAmt |
| Revenue Subtotal | $239,897 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$17,588 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$17,588 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $222,309 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $184,371 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $17,588 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $17,588 | ExpensesNotReportedAmt |
| Expenses Subtotal | $166,783 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $166,783 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 -17,588. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | FUNDRAISING EXPENSES 17,588. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | LIGHT UP THE NIGHT FOR HOSPICE | NameOfEvent1Amt |
| Gross Receipts Event1 | $23,881 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $17,717 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $6,164 | GrossRevenueEvent1Amt |
| Rent Facility Costs Event1 | $4,138 | RentFacilityCostsEvent1Amt |
| Other Direct Expenses Event1 | $4,930 | 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 | $625 | RentFacilityCostsEvent2Amt |
| Entertainment Event2 | $1,430 | EntertainmentEvent2Amt |
| Other Direct Expenses Event2 | $6,465 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $62,866 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $46,833 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $16,033 | GrossRevenueTotalEventsAmt |
| Rent Fclty Costs Total Events | $4,763 | RentFcltyCostsTotalEventsAmt |
| Entertainment Total Events | $1,430 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $11,395 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $17,588 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$1,555 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THEDACARE INC | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3000 E COLLEGE AVE | AddressLine1 |
| City | APPLETON | City |
| State | WI | State |
| ZIP Code | 54915 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 391509362 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $96,359 | CashGrantAmt |
| Purpose Of Grant | CHERRY MEADOWS RENOVATION, WAUPACA DOG SCREENING, TRAINING PROGRAM | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | 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 | THIS FOUNDATION ONLY PAYS OUT GRANTS TO ORGANIZATIONS AFTER THEY HAVE RECEIVED EITHER THE PRODUCT OR SERVICE AND INCURRED THE EXPENSE. THE ORGANIZATION'S PRIMARY PURPOSE IS TO SUPPORT THE HOSPITALS OF THEDACARE, WHICH PERFORM SERVICES EXCLUSIVELY IN WISCONSIN. | 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 | 0 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | FROHNAMICHAEL | PersonNm |
| Title | EXECUTIVE DIRECTOR | TitleTxt |
| Base Compensation Filing Org | $55,257 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $114,764 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $5,328 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $11,065 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $4,302 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $8,934 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $1,786 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $3,710 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $5,367 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $11,149 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $72,040 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $149,622 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Supplemental Information Detail SupplementalInformationDetail (2 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 COMMUNITY HOSPICE FOUNDATION'S EXECUTIVE DIRECTOR. |
Schedule N IRS990ScheduleN
Liquidation Of Assets Table LiquidationOfAssetsTableGrp
Liquidation Of Assets Detail LiquidationOfAssetsDetail (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 | |||||||||
| CASH | 2013-12-31 | $242,641 | ACTUAL COST | 464112255 | 1818 N MEADE ST PO BOX 1222 | APPLETON | WI | 549129974 | 501(C)(3) |
| THEDACARE FAMILY OF FOUNDATIONS | |||||||||
| INVESTMENTS | 2013-12-31 | $500,833 | FAIR MARKET VALUE | 464112255 | 1818 N MEADE ST PO BOX 1222 | APPLETON | WI | 549129974 | 501(C)(3) |
| THEDACARE FAMILY OF FOUNDATIONS | |||||||||
| OTHER ACCOUNTS RECEIVABLE | 2013-12-31 | $12,565 | BOOK VALUE | 464112255 | 1818 N MEADE ST PO BOX 1222 | APPLETON | WI | 549129974 | 501(C)(3) |
| THEDACARE FAMILY OF FOUNDATIONS | |||||||||
| PLEDGES RECEIVABLE | 2013-12-31 | $4,755 | BOOK VALUE | 464112255 | 1818 N MEADE ST PO BOX 1222 | APPLETON | WI | 549129974 | 501(C)(3) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor | Yes (1) | DirectorOfSuccessorInd |
| Employee Of Successor | Yes (1) | EmployeeOfSuccessorInd |
| Owner Of Successor | 0 | OwnerOfSuccessorInd |
| Receive Compensation | 0 | ReceiveCompensationInd |
| Assets Distributed | Yes (1) | AssetsDistributedInd |
| Required To Notify AG | Yes (1) | RequiredToNotifyAGInd |
| Attorney General Notified | Yes (1) | AttorneyGeneralNotifiedInd |
| Liabilities Paid | Yes (1) | LiabilitiesPaidInd |
| Bonds Outstanding | 0 | BondsOutstandingInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 2E: | EXPLANATION OF INVOLVEMENT: JOHN LARSON, VICE PRESIDENT OF COMMUNITY HOSPICE FOUNDATION BECAME A DIRECTOR OF THE TRANSFEREE ORGANIZATION, THEDACARE FAMILY OF FOUNDATIONS, INC.JOHN KELLER, PRESIDENT OF COMMUNITY HOSPICE FOUNDATION BECAME A DIRECTOR OF THE TRANSFEREE ORGANIZATION, THEDACARE FAMILY OF FOUNDATIONS, INC.MICHAEL FROHNA, EXECUTIVE DIRECTOR OF COMMUNITY HOSPICE 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, THE FOUNDATION'S BOARD OF DIRECTORS APPROVED A PLAN OF DISSOLUTION WHEREBY EFFECTIVE DECEMBER 31, 2013, IN WHICH THE FOUNDATION'S NET ASSETS WERE TRANSFERRED 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 | COMMUNITY HOSPICE FOUNDATION, 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 VOTING RIGHTS WITH RESPECT TO THE ELECTION OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7B | THEDACARE, INC. HAS VOTING RIGHTS WITH RESPECT TO: 1. AMENDMENT OF THE ARTICLES OF INCORPORATION 2. AMENDMENT OF THE BYLAWS OF THIS CORPORATION 3. DISSOLUTION OF THIS CORPORATION 4. ALTERATION OF ANY GIFT OR FUND RESTRICTION BY A TWO-THIRDS VOTE OF MEMBERS AND DIRECTORS |
| FORM 990, PART VI, SECTION B, LINE 11 | A DRAFT OF THE FORM 990 IS PROVIDED TO THE ORGANIZATION'S EXECUTIVE 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 | 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 THE ORGANIZATION'S EXECUTIVE DIRECTOR 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 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: | TRANSFER TO THEDACARE FAMILY OF FOUNDATIONS, INC. -760,794. |
| FORM 990, LINE XII, LINE 2C | OVERSIGHT OF THE AUDIT: 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 NORTH MEADE STREET | APPLETON | WI | 54911 | 311550056 | FOUNDATION | WI | 501(C)(3) | LINE 11A, I | Yes (1) | THEDACARE INC | |
| APPLETON MEDICAL CENTER FOUNDATION INC | |||||||||||
| 1818 NORTH MEADE STREET | APPLETON | WI | 54911 | 391459276 | FOUNDATION | WI | 501(C)(3) | LINE 7 | 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 | |
| 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 NORTH 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 |
|---|---|---|
| THEDACARE INC | ||
| B | $97,332 | FMV |
| TRANSFER OF NET ASSETS TO THEDACARE FAMILY FOUNDATIONS INC | ||
| R | $760,794 | FMV |
Comments