2014-11-10T15:30:58-06:00 2013-12-31 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2013-01-01 391511977 COMMUNITY HOSPICE FOUNDATION INC COMM 9208305963 1818 NORTH MEADE STREET APPLETON WI 54911 JOHN KELLER PRESIDENT 9208305963 2014-10-31 1 TERRI REXRODE CPA MST P00096513 9206620016 2014-10-31 2013 2015-11-30 17:44:51Z X X JOHN KELLER 1818 NORTH MEADE STREET APPLETON WI 54911 476966 0 X WWW.THEDACARE.ORG X 2003 WI 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. 9 9 0 23 0 0 104436 153072 0 0 7180 70792 44640 -1555 156256 222309 26884 97332 0 0 23711 25674 0 0 35989 40302 43777 90897 166783 65359 55526 698215 0 4389 0 693826 0 X 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. 0 0 97332 97332 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. 97332 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 WI X KRISTEN COGSWELL 9207386471 122 EAST COLLEGE AVENUE APPLETON WI 54911 ANDERSONSCOTT TREASURER 1.00 0.00 X X 0 0 0 BEISERKIM DIRECTOR 1.00 0.00 X 0 0 0 CORNELLCHRISTINE DIRECTOR 1.00 0.00 X 0 0 0 DRAKEJEFFREY DIRECTOR 1.00 0.00 X 0 0 0 GRUNERPAM DIRECTOR 1.00 0.00 X 0 0 0 HEINERJULIE DIRECTOR 1.00 0.00 X 0 0 0 KELLERJOHN PRESIDENT 1.00 1.00 X X 0 0 0 LARSONJOHN VICE PRESIDENT 1.00 1.00 X X 0 0 0 RENKENSMONICA DIRECTOR 1.00 0.00 X 0 0 0 FROHNAMICHAEL EXECUTIVE DIRECTOR 14.00 29.00 X 64887 134763 22012 64887 134763 22012 0 0 1 0 0 46833 106239 153072 12354 12354 295507 237069 58438 58438 58438 16033 46833 17588 -1555 -1555 222309 0 0 69237 97332 97332 25674 8986 16688 18036 18036 14275 4996 9279 5245 555 4690 4678 4678 841 294 547 595 595 DONOR CULTIVATION 107 107 166783 97332 33462 35989 0 308049 0 9556 0 0 0 0 0 0 0 0 380026 0 0 0 0 584 0 698215 0 4389 0 4389 0 X 415342 0 278484 0 693826 0 698215 0 X 55526 11442 -760794 X X 0 1 X 1 0 X 164480 215655 132900 104436 153072 770543 164480 215655 132900 104436 153072 770543 770543 13523 8452 7821 7429 12354 49579 820122 207790 0.93950 0.93970 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 X 251339 11442 11442 239897 -17588 -17588 222309 184371 17588 17588 166783 0 166783 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. LIGHT UP THE NIGHT FOR HOSPICE 23881 17717 6164 4138 4930 LAUGHTER IS THE BEST MEDICINE 38985 29116 9869 625 1430 6465 62866 46833 16033 4763 1430 11395 17588 -1555 1 THEDACARE INC 3000 E COLLEGE AVE APPLETON WI 54915 391509362 501(C)(3) 96359 CHERRY MEADOWS RENOVATION, WAUPACA DOG SCREENING, TRAINING PROGRAM 1 0 PART I, LINE 2: 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. X 0 1 X 0 0 0 0 0 0 0 0 0 FROHNAMICHAEL EXECUTIVE DIRECTOR 55257 114764 5328 11065 4302 8934 1786 3710 5367 11149 72040 149622 0 0 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. CASH 2013-12-31 242641 ACTUAL COST 464112255 THEDACARE FAMILY OF FOUNDATIONS 1818 N MEADE ST PO BOX 1222 APPLETON WI 549129974 501(C)(3) INVESTMENTS 2013-12-31 500833 FAIR MARKET VALUE 464112255 THEDACARE FAMILY OF FOUNDATIONS 1818 N MEADE ST PO BOX 1222 APPLETON WI 549129974 501(C)(3) OTHER ACCOUNTS RECEIVABLE 2013-12-31 12565 BOOK VALUE 464112255 THEDACARE FAMILY OF FOUNDATIONS 1818 N MEADE ST PO BOX 1222 APPLETON WI 549129974 501(C)(3) PLEDGES RECEIVABLE 2013-12-31 4755 BOOK VALUE 464112255 THEDACARE FAMILY OF FOUNDATIONS 1818 N MEADE ST PO BOX 1222 APPLETON WI 549129974 501(C)(3) 1 1 0 0 1 1 1 1 0 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. 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. 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 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 WOODS DRIVE APPLETON WI 54915 391702534 FOUNDATION WI 501(C)(3) LINE 11A, I APPLETON MEDICAL CENTER 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 INC 1818 NORTH MEADE STREET APPLETON WI 54915 464112255 FOUNDATION WI 501(C)(3) LINE 11A, I THEDACARE INC 1 NORTH APPLETON AMBULATORY CARE CENTER BUILDING COMPANY LLC 122 E COLLEGE AVENUE APPLETON WI 54911 262497187 RENTAL WI N/A 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 THEDACARE INC B 97332 FMV TRANSFER OF NET ASSETS TO THEDACARE FAMILY FOUNDATIONS INC R 760794 FMV