2013-10-28T13:52:52-05:00 2012-12-31 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2012-01-01 391702534 GEORGE F PEABODY FOUNDATION INC GEOR 9207383000 PO BOX 2553 APPLETON WI 54912 JOHN LARSON 9207383000 2013-10-16 1 TERRI REXRODE CPA MST P00096513 9206620016 2013-10-16 2012 2016-03-07 17:11:31Z JOHN LARSON PO BOX 2553 APPLETON WI 54912 229373 0 X WWW.THEDACARE.ORG X 1991 WI SUPPORTING ORGANIZATIONS CONTROLLED BY ITS SOLE VOTING MEMBER, APPLETON MEDICAL CENTER, INC., A MEMBER OF THE THEDACARE, INC. GROUP, IN SUPPORT OF LONG-TERM HEALTH CARE. 10 10 0 10 0 0 8100 187777 0 0 -22796 41596 0 0 -14696 229373 52007 51037 0 0 0 0 0 0 0 10768 6133 62775 57170 -77471 172203 1249460 1518329 301 503 1249159 1517826 SUPPORTING ORGANIZATIONS CONTROLLED BY ITS SOLE VOTING MEMBER, APPLETON MEDICAL CENTER, INC., A MEMBER OF THE THEDACARE, INC. GROUP, IN SUPPORT OF LONG-TERM HEALTH CARE. 0 0 50037 50037 SUPPORT OF LONG-TERM CARE RESIDENTS AND RELATED FACILITY NEEDS (24 RESIDENTS). 1000 1000 CNA/EDUCATIONAL SCHOLARSHIPS (2 SCHOLARSHIPS). 51037 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 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 10 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 WI X MARY DIEDERICH 9207590614 N2118 SHAWN CT KAUKAUNA WI 54912 X LARSONJOHN 1.00 1.00 X X 0 0 0 STRANGEMARY 1.00 X X 0 0 0 BIELINSKIJOSEPH 1.00 X X 0 0 0 KELLERJOHN 1.00 1.00 X X 0 0 0 RIESTERJEFF 1.00 1.00 X 0 0 0 VALKCAROL 1.00 X 0 0 0 ARONSONDAVID 1.00 X 0 0 0 DIDERICH MARY K 1.00 X 0 0 0 VALENTINERYAN 1.00 X 0 0 0 BARKMEIERDIANE 1.00 X 0 0 0 0 0 0 0 0 0 0 0 187777 187777 38671 38671 2925 0 2925 2925 2925 229373 0 0 41596 50037 50037 1000 1000 4620 4620 1309 1309 204 204 57170 51037 6133 0 7589 134487 1047041 1191109 194830 192733 1249460 1518329 301 503 301 503 X -2452 176212 952641 1042644 298970 298970 1249159 1517826 1249460 1518329 172203 96464 0 X X 0 1 X 1 0 X X X 0 0 0 APPLETON MEDICAL CENTER INC 390824015 3 1 1 1 49015 1 49015 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1004927 138059 49015 1093971 1080017 -25083 50007 1004927 1009438 123856 53277 1080017 873406 136032 1009438 1194012 -320606 873406 0.72670 0.27330 0 0 0 ALTERNATIVE INVESTMENTS - OFFSHORE FEEDER 192733 F 192733 X 331837 96464 6000 102464 229373 0 229373 63170 6000 6000 57170 0 57170 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE FOUNDATION HAS ADOPTED INVESTMENT AND SPENDING POLICIES 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. ALL FUNDS ARE USED IN SUPPORT OF EFFECTIVE ELDERLY HEALTH CARE. 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. 1 THEDACARE INC 122 E COLLEGE AVE APPLETON WI 54912 391509362 501(C)(3) 49015 SUPPORT OF LONG TERM RESIDENTIAL CARE AT PEABODY MANOR, PART OF THE SENIOR CARE DIVISION OF THEDACARE, INC. 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: GRANTS ARE BASED ON CRITERIA ESTABLISHED BY THE BOARD OF DIRECTORS IN SUPPORT OF EFFECTIVE ELDERLY HEALTH CARE. FORM 990, PART VI, SECTION A, LINE 6 GEORGE PEABODY FOUNDATION, INC.'S SOLE MEMBER OF THE SINGLE CLASS OF VOTING MEMBERS IS APPLETON MEDICAL CENTER, INC. FORM 990, PART VI, SECTION A, LINE 7A APPLETON MEDICAL CENTER, INC. HAS VOTING RIGHTS WITH RESPECT TO THE ELECTION OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B APPLETON MEDICAL CENTER, 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 BOARD OF DIRECTORS REVIEWS FORM 990 DRAFT PRIOR TO FINAL SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED TO UPDATE AND SIGN CONFLICT OF INTEREST FORMS ANNUALLY. FORMS ARE REVIEWED ANNUALLY AT A BOARD MEETING. FORM 990, PART VI, SECTION C, LINE 19 FORM 990 AND RELATED DOCUMENTS ARE AVAILABLE TO ANY MEMBER OF THE PUBLIC 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 COMMUNITY HOSPICE FOUNDATION INC PO BOX 1534 APPLETON WI 54912 391511977 FOUNDATION WI 501(C)(3) LINE 7 THEDACARE 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 0 0 0 1 0 0