2013-10-28T13:52:52-05:00 2012-12-31 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2012-01-01 391511977 COMMUNITY HOSPICE FOUNDATION INC COMM 9208305963 PO BOX 1534 APPLETON WI 54912 DEBORAH BLEVONS WASCHER 9208305963 2013-10-15 1 TERRI REXRODE CPA MST P00096513 9206620016 2013-10-10 2012 2016-03-07 17:11:31Z DEBORAH BLEVONS WASCHER PO BOX 1534 APPLETON WI 54912 171128 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. 11 10 0 23 0 0 132900 104436 0 0 7702 7180 16443 44640 157045 156256 17388 26884 0 0 34644 23711 0 0 31923 36849 40302 88881 90897 68164 65359 592846 698215 3863 4389 588983 693826 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 26884 26884 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. 26884 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 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 WI X JOSEPH W ENGELS 9208305963 PO BOX 8025 APPLETON WI 54912 ANDERSONSCOTT 1.00 X 0 0 0 BEISERKIM 1.00 X 0 0 0 BLEVONS-WASCHERDEBORAH 1.00 X 0 0 0 CORNELLCHRISTINE 1.00 X 0 0 0 DRAKEJEFFREY 1.00 X 0 0 0 GRUNERPAM 1.00 X 0 0 0 HEINERJULIE 1.00 X 0 0 0 KELLERJOHN 1.00 X 0 0 0 LARSONJOHN 1.00 X 0 0 0 RENKENSMONICA 1.00 X 0 0 0 FROHNAMICHAEL 14.00 29.00 X 0 175401 21625 0 175401 21625 0 0 1 0 0 6470 97966 104436 7429 7429 249 -249 -249 -249 59263 14623 44640 44640 156256 0 0 51820 26884 26884 23711 8299 15412 18036 18036 4475 4287 188 7929 129 7800 7774 7774 823 288 535 1051 1051 DONOR CULTIVATION 214 214 90897 26884 32090 31923 229473 308049 22597 9556 340162 380026 614 584 592846 698215 3863 4389 3863 4389 X 398700 415342 190283 278484 588983 693826 592846 698215 65359 39484 0 X X 0 1 X 1 0 X 222543 164480 215655 132900 104436 840014 222543 164480 215655 132900 104436 840014 840014 16660 13523 8452 7821 7429 53885 893899 191757 0.93970 0.81870 X X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 X 210363 39484 39484 170879 -14623 -14623 156256 105520 14623 14623 90897 0 90897 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE FOUNDATION IS A TAX-EXEMPT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE FOUNDATION IS ALSO EXEMPT FROM STATE INCOME TAXES ON RELATED INCOME. 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 2012 OR 2011. FEDERAL TAX RETURNS FOR THE YEARS ENDED 2009 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES -14,623. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 14,623. LIGHT UP THE NIGHT FOR HOSPICE 23090 23090 3763 2783 LAUGHTER IS THE BEST MEDICINE 36173 36173 983 2833 3035 1226 59263 59263 4746 2833 3035 4009 14623 44640 1 THEDACARE INC 3000 E COLLEGE AVE APPLETON WI 54915 391509362 501(C)(3) 26884 THEDACARE AT HOME OPERATING EXPENSES 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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. 0 0 0 0 0 0 0 0 0 FROHNAMICHAEL 0 158353 0 6599 0 10449 0 5333 0 16292 0 197026 0 0 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. 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 XII, LINE 2C: 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 0 NEW LONDON FAMILY MEDICAL CENTER INC 1405 MILL STREET NEW LONDON WI 54961 390869788 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 0 RIVERSIDE MEDICAL CENTER INC 800 RIVERSIDE DRIVE WAUPACA WI 54981 390871113 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 0 APPLETON MEDICAL CENTER INC PO BOX 8025 APPLETON WI 54912 390824015 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 0 SHAWANO MEDICAL CENTER INC 309 N BARTLETTE STREET SHAWANO WI 54166 390807068 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 0 THEDA CLARK MEDICAL CENTER FOUNDATION INC PO BOX 8025 APPLETON WI 54912 311550056 FOUNDATION WI 501(C)(3) LINE 11A, I THEDACARE INC 0 APPLETON MEDICAL CENTER FOUNDATION INC 1818 NORTH MEADE STREET APPLETON WI 54911 391459276 FOUNDATION WI 501(C)(3) LINE 7 THEDACARE INC 0 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 0 GEORGE F PEABODY FOUNDATION INC PO BOX 2553 APPLETON WI 54912 391702534 FOUNDATION WI 501(C)(3) LINE 11A, I APPLETON MEDICAL CENTER INC 0 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 0 NORTH APPLETON AMBULATORY CARE CENTER BUILDING COMPANY LLC 122 E COLLEGE AVENUE APPLETON WI 54911 262497187 RENTAL WI N/A 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0