APPLETON MEDICAL CENTER FOUNDATION INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- APPLETON MEDICAL CENTER FOUNDATION INC (EIN 39-1459276)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-10-28
- IRS object ID
- 201343019349300149
- Schema version
- 2012v2.1
- 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 O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-10-28T13:52:52-05:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390758449 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| 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 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391459276 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | APPLETON MEDICAL CENTER FOUNDATION INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | APPL | NameControl |
| Phone | 9207386506 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1818 N MEADE STREET | AddressLine1 |
| City | APPLETON | City |
| State | WI | State |
| ZIP Code | 54911 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DEAN HIGH | Name |
| Title | VICE PRESIDENT | Title |
| Phone | 9207386506 | Phone |
| Date Signed | 2013-10-15 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TERRI REXRODE CPA MST | Name |
| PTIN | P00096513 | PTIN |
| Phone | 9206620016 | Phone |
| Date Prepared | 2013-10-15 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DEAN HIGH | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1818 N MEADE STREET | AddressLine1 |
| City | APPLETON | City |
| State | WI | State |
| ZIP Code | 54911 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 1196933 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.AMCFOUNDATION.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1983 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | ENHANCE THE HEALTH OF OUR COMMUNITIES. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 17 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 12 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 60 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 507834 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 790656 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -204930 | InvestmentIncomePriorYear |
| Investment Income Current Year | 317747 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 55113 | OtherRevenuePriorYear |
| Other Revenue Current Year | 55150 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 358017 | TotalRevenuePriorYear |
| Total Revenue Current Year | 1163553 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 172898 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 143984 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 245728 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 279378 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 244397 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 102504 | OtherExpensePriorYear |
| Other Expenses Current Year | 88134 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 521130 | TotalExpensesPriorYear |
| Total Expenses Current Year | 511496 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -163113 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 652057 | RevenuesLessExpensesCY |
| Total Assets BOY | 10645212 | TotalAssetsBOY |
| Total Assets EOY | 12041669 | TotalAssetsEOY |
| Total Liabilities BOY | 50428 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 37905 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 10594784 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 12003764 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO RAISE FUNDS AND CARRY OUT THE PURPOSES OF THE APPLETON MEDICAL CENTER, APPLETON, WI. THESE PURPOSES INCLUDE THE ENCOURAGEMENT OF EFFECTIVE SERVICES WITHIN AND AROUND APPLETON AND THE GREATER FOX VALLEY AREA BY PROVIDING SCHOLARSHIPS AND GRANTS TO ORGANIZATIONS THAT SUPPORT AMC'S PURPOSE. TO CREATE AND SUPPORT HOSPITAL HEALTH CARE INITIATIVES THROUGH FUNDING FOR THE APPLETON MEDICAL CENTER AND RELATED OTHER COMMUNITY HEALTH CARE PROVIDERS. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 139484 | Expense |
| Grants | 139484 | Grants |
| Description | TO RAISE FUNDS AND CARRY OUT THE PURPOSES OF THE APPLETON MEDICAL CENTER, APPLETON, WI. THESE PURPOSES INCLUDE THE ENCOURAGEMENT OF EFFECTIVE SERVICES WITHIN AND AROUND APPLETON AND THE GREATER FOX VALLEY AREA BY PROVIDING SCHOLARSHIPS AND GRANTS TO ORGANIZATIONS THAT SUPPORT AMC'S PURPOSE. TO CREATE AND SUPPORT HOSPITAL HEALTH CARE INITIATIVES THROUGH FUNDING FOR THE APPLETON MEDICAL CENTER AND RELATED OTHER COMMUNITY HEALTH CARE PROVIDERS. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 4500 | Expense |
| Grants | 4500 | Grants |
| Description | 7 SCHOLARSHIPS WERE GRANTED TO INDIVIDUALS WHO ARE GOING INTO THE MEDICAL FIELD OF STUDY. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 143984 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 0 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 17 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 12 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | WI | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOSEPH W ENGELS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 9208305971 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 8025 | AddressLine1 |
| City | APPLETON | City |
| State | WI | State |
| ZIP Code | 54911 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (17 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer |
|---|---|---|---|---|---|---|---|
| ANDERLADAVID MD | |||||||
| DIRECTOR | 1.00 | 43.00 | X | 0 | 308202 | 33534 | |
| BORENCLARK JR MD | |||||||
| DIRECTOR | 1.00 | 40.00 | X | 0 | 237312 | 23611 | |
| BYTOFJOYCE | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| DUNGAR STEVE C MD | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| FULKERSONJAY | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| HIGH DEAN V | |||||||
| VICE PRESIDENT | 1.00 | X | 0 | 0 | 0 | X | |
| OLSONTIM | |||||||
| DIRECTOR | 1.00 | 41.00 | X | 0 | 448909 | 119293 | |
| RAYMICHAEL MDPHD | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| RIESTERJEFF | |||||||
| DIRECTOR | 1.00 | 1.00 | X | 0 | 0 | 0 | |
| SCHAFFMEYER PASTOR ALAN | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| SCHUBBE PETER J | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| UEHLINGBARBARA | |||||||
| SECRETARY | 1.00 | X | 0 | 0 | 0 | X | |
| WALSH CYRIL P | |||||||
| PRESIDENT | 1.00 | X | 0 | 0 | 0 | X | |
| WILSON JAMES R | |||||||
| TREASURER | 1.00 | X | 0 | 0 | 0 | X | |
| HUNTERJEFF | |||||||
| DIRECTOR | 1.00 | 41.00 | X | 0 | 398506 | 139340 | |
| FROHNAMICHAEL | |||||||
| EXECUTIVE DIRECTOR | 15.00 | 28.00 | X | 87699 | 87702 | 21625 | X |
| RUGLANDWALTER | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 87699 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1480631 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 337403 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Related Organizations | 420192 | RelatedOrganizations |
| All Other Contributions | 370464 | AllOtherContributions |
| Total Contributions | 790656 | TotalContributions |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 140877 | TotalRevenueColumn |
| Exclusion | $140,877 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 176870 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 176870 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 176870 | TotalRevenueColumn |
| Exclusion | $176,870 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 88530 | GrossIncomeFundraisingEvents |
| Fundraising Direct Expenses | 33380 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 55150 | TotalRevenueColumn |
| Exclusion | $55,150 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1163553 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $372,897 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 139484 | Total |
| Program Services | 139484 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4500 | Total |
| Program Services | 4500 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 98511 | Total |
| Management And General | 24628 | ManagementAndGeneral |
| Fundraising | 73883 | Fundraising |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 180867 | Total |
| Management And General | 45217 | ManagementAndGeneral |
| Fundraising | 135650 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6865 | Total |
| Management And General | 6865 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18036 | Total |
| Management And General | 18036 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 877 | Total |
| Fundraising | 877 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6774 | Total |
| Fundraising | 6774 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -8228 | Total |
| Management And General | -4114 | ManagementAndGeneral |
| Fundraising | -4114 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3102 | Total |
| Management And General | 775 | ManagementAndGeneral |
| Fundraising | 2327 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1337 | Total |
| Management And General | 1337 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|
| PURCHASED SERVICES | 35649 | 17825 | 17824 |
| SUPPLIES | 8971 | 2960 | 6011 |
| MEMBERSHIPS/SUBSCRIPTIO | 6094 | 3047 | 3047 |
| UNCOLLECTIBLE PLEDGES | 4693 | 4693 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3964 | Total |
| Management And General | 1846 | ManagementAndGeneral |
| Fundraising | 2118 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 511496 | Total |
| Program Services | 143984 | ProgramServices |
| Management And General | 123115 | ManagementAndGeneral |
| Fundraising | 244397 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1159318 | BOY |
| EOY | 1173565 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 238058 | BOY |
| EOY | 546981 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9247836 | BOY |
| EOY | 10321123 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10645212 | BOY |
| EOY | 12041669 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 50428 | BOY |
| EOY | 37905 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 50428 | BOY |
| EOY | 37905 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5510535 | BOY |
| EOY | 6249218 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3453019 | BOY |
| EOY | 4091410 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1631230 | BOY |
| EOY | 1663136 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10594784 | BOY |
| EOY | 12003764 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10645212 | BOY |
| EOY | 12041669 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 652057 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 756923 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Both | X | FinancialStatementBoth |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 660549 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 243392 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1306897 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 507834 | CurrentTaxYearMinus1Year |
| Current Tax Year | 790656 | CurrentTaxYear |
| Total | 3509328 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 660549 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 243392 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1306897 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 507834 | CurrentTaxYearMinus1Year |
| Current Tax Year | 790656 | CurrentTaxYear |
| Total | 3509328 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amounts Subst Contributors Total | 1888152 | AmountsSubstContributorsTotal |
| Public Support Total170 | 1621176 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 247961 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 235618 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 112227 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 98740 | CurrentTaxYearMinus1Year |
| Current Tax Year | 140877 | CurrentTaxYear |
| Total | 835423 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 4344751 | TotalSupport |
| Gross Receipts From Admissions Etc | 347095 | GrossReceiptsFromAdmissionsEtc |
| Public Support Pertcentage170 | 0.37310 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.30190 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
| Ten Percent Test Prior Year | X | TenPercentTestPriorYear |
| Facts And Circumstances Test | APPLETON MEDICAL CENTER FOUNDATION (THE FOUNDATION) DID NOT MEET THE 33 1/3% PUBLIC SUPPORT TEST IN THE PRIOR YEAR. HOWEVER, PURSUANT TO TREASURY REG. 1.170A-9(F)(3), IT SATISFIES THE 10% FACTS AND CIRCUMSTANCES TEST. THE FOUNDATION MAINTAINS A CONTINUOUS AND BONA FIDE PROGRAM FOR THE SOLICITATION OF FUNDS FROM THE GENERAL PUBLIC. HOWEVER, IT RECEIVED PERIODIC SIGNIFICANT CONTRIBUTIONS FROM A RELATED ORGANIZATION, THEDACARE, INC., THAT IS A SECTION 509(A)(3) SUPPORTING ORGANIZATION AND THEREFORE NOT AN EXCLUDED PUBLICALLY SUPPORTED ORGANIZATION. THESE SIGNIFICANT CONTRIBUTIONS MADE DURING 2008 AND 2010 HAVE NOT BEEN VIEWED AS UNUSUAL GRANTS. WITHOUT THESE CONTRIBUTIONS, THE FOUNDATION EASILY SATISFIES THE 33 1/3% TEST. FURTHERMORE, DURING 2009 THE FOUNDATION CONTRIBUTED BACK TO THEDACARE ALMOST $635,000. BASED ON THESE FACTORS, THE FOUNDATION BELIEVES THAT IT IS PUBLICALLY-SUPPORTED AS DEFINED BY THE INTERNAL REVENUE CODE AND REGULATIONS THEREUNDER. | FactsAndCircumstancesTest |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 5185470 | BeginningOfYearBalance |
| Contributions | 31906 | Contributions |
| Investment Earnings Or Losses | 71610 | InvestmentEarningsOrLosses |
| Other Expenditures | 31094 | OtherExpenditures |
| End Of Year Balance | 5257892 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 5188828 | BeginningOfYearBalance |
| Contributions | 54597 | Contributions |
| Investment Earnings Or Losses | -14882 | InvestmentEarningsOrLosses |
| Other Expenditures | 43073 | OtherExpenditures |
| End Of Year Balance | 5185470 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 5148663 | BeginningOfYearBalance |
| Contributions | 3305 | Contributions |
| Investment Earnings Or Losses | 64028 | InvestmentEarningsOrLosses |
| Other Expenditures | 27168 | OtherExpenditures |
| End Of Year Balance | 5188828 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 4876903 | BeginningOfYearBalance |
| Contributions | 1370 | Contributions |
| Investment Earnings Or Losses | 287444 | InvestmentEarningsOrLosses |
| Other Expenditures | 17054 | OtherExpenditures |
| End Of Year Balance | 5148663 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 5104609 | BeginningOfYearBalance |
| Contributions | 7064 | Contributions |
| Investment Earnings Or Losses | -234181 | InvestmentEarningsOrLosses |
| Other Expenditures | 589 | OtherExpenditures |
| End Of Year Balance | 4876903 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.68370 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.31630 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.00000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 1953856 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 756923 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 756923 | RevenueNotRptdF990 |
| Revenue Subtotal | 1196933 | RevenueSubtotal |
| Other Revenues Not Included | -33380 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | -33380 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 1163553 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 544876 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 33380 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 33380 | ExpensesNotRptdF990 |
| Expenses Subtotal | 511496 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 511496 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | THE FOUNDATION HAS ADOPTED INVESTMENT AND SPENDING POLICIES FOR ENDOWMENT ASSETS 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. ENDOWMENT ASSESTS INCLUDE THOSE ASSETS OF DONOR-RESTRICTED FUNDS THAT THE FOUNDATION MUST HOLD IN PERPETUITY OR FOR A DONOR-SPECIFIED PERIOD(S). UNDER THIS POLICY, AS APPROVED BY THE BOARD OF DIRECTORS, THE ENDOWMENT ASSETS ARE INVESTED IN A MANNER THAT IS INTENDED TO PRODUCE RESULTS THAT EXCEED THE PRICE AND YIELD RESULTS OF THE S & P 500 INDEX WHILE ASSUMING A MODERATE LEVEL OF INVESTMENT RISK. |
| 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 -33,380. | |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | FUNDRAISING EXPENSES 33,380. |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | HIGH FLYIN' GOLF OUTING | NameOfEvent1 |
| Gross Receipts Event1 | 52357 | GrossReceiptsEvent1 |
| Gross Revenue Event1 | 52357 | GrossRevenueEvent1 |
| Rent Facility Costs Event1 | 16752 | RentFacilityCostsEvent1 |
| Other Direct Expenses Event1 | 3824 | OtherDirectExpensesEvent1 |
| Name Of Event2 | LAUGHTER IS THE BEST MEDICINE | NameOfEvent2 |
| Gross Receipts Event2 | 36173 | GrossReceiptsEvent2 |
| Gross Revenue Event2 | 36173 | GrossRevenueEvent2 |
| Rent Facility Costs Event2 | 983 | RentFacilityCostsEvent2 |
| Food And Beverage Event2 | 2833 | FoodAndBeverageEvent2 |
| Entertainment Event2 | 3035 | EntertainmentEvent2 |
| Other Direct Expenses Event2 | 1202 | OtherDirectExpensesEvent2 |
| Gross Receipts Total | 88530 | GrossReceiptsTotal |
| Gross Revenue Total Events | 88530 | GrossRevenueTotalEvents |
| Rent Facility Costs Total Events | 17735 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 2833 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 3035 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 5026 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 28629 | DirectExpenseSummaryEvents |
| Net Income Summary | 59901 | NetIncomeSummary |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| RURAL HEALTH INITIATIVE | |||||||
| 100 COUNTY ROAD B | SHAWANO | WI | 54166 | 208635695 | 501(C)(3) | 46000 | GENERAL OPERATIONS |
| APPLETON MEDICAL CENTER INC | |||||||
| 1818 NORTH MEADE STREET | APPLETON | WI | 54911 | 390824015 | 501(C)(3) | 30071 | CANCER CARE SUPPORT, CARDIAC CARE SUPPORT, NURSING EDUCATION, AND COMMUNITY GARDENS |
| THEDACARE INC | |||||||
| PO BOX 8025 | APPLETON | WI | 54912 | 391509362 | 501(C)(3) | 16435 | CHILD LEARNING CENTER AND ADULT MENTAL HEALTH |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 3 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: THE ORGANIZATION ONLY WRITES CHECKS OUT FOR GRANTS TO ORGANIZATIONS ONCE THE ITEM OR SERVICE HAS ALREADY BEEN RECEIVED BY THE ORGANIZATION. SCHOLARSHIP CHECKS ARE WRITTEN OUT TO THE COLLEGE AND THE RECIPIENT. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 0 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Survey | X | CompensationSurvey |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ANDERLADAVID MD | ||||||||||||||
| DIRECTOR | 0 | 305861 | 0 | 511 | 0 | 1830 | 0 | 14500 | 0 | 19034 | 0 | 341736 | 0 | 0 |
| BORENCLARK JR MD | ||||||||||||||
| DIRECTOR | 0 | 237120 | 0 | 192 | 0 | 0 | 0 | 15816 | 0 | 7795 | 0 | 260923 | 0 | 0 |
| OLSONTIM | ||||||||||||||
| DIRECTOR | 0 | 381644 | 0 | 58695 | 0 | 8570 | 0 | 106269 | 0 | 13024 | 0 | 568202 | 0 | 0 |
| HUNTERJEFF | ||||||||||||||
| DIRECTOR | 0 | 331109 | 0 | 55333 | 0 | 12064 | 0 | 103929 | 0 | 35411 | 0 | 537846 | 0 | 0 |
| FROHNAMICHAEL | ||||||||||||||
| EXECUTIVE DIRECTOR | 79176 | 79177 | 3299 | 3300 | 5224 | 5225 | 2666 | 2667 | 8146 | 8146 | 98511 | 98515 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| 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 APPLETON MEDICAL CENTER FOUNDATION'S EXECUTIVE DIRECTOR. |
| PART I, LINE 4B | TIM OLSON IS ENTITLED TO AN ANNUAL FLEXIBLE BENEFIT EQUAL TO 20% OF HIS BASE COMPENSATION. THIS 457(F) SUPPLEMENTAL BENEFIT PLAN COMPLIES WITH THE FINAL REGULATIONS UNDER SECTIONS 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. NOTHING WAS PAID OUT IN 2012. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | APPLETON MEDICAL CENTER FOUNDATION, INC.'S SOLE MEMBER OF THE SINGLE CLASS OF VOTING MEMBERS IS THEDACARE, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE ELECTION AND REMOVAL OF DIRECTORS REQUIRES THE APPROVAL OF THEDACARE,INC. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE FOLLOWING ACTIONS SHALL NOT BE TAKEN WITHOUT THE APPROVAL OF THEDACARE, INC.: 1. AMENDMENT OF THE ARTICLES OF INCORPORATION 2. AMENDMENT OF THE BYLAWS 3. MERGER, CONSOLIDATION OR DISSOLUTION OF THIS CORPORATION 4. THE CREATION OF ANY SUBSIDIARIES OR AFFILIATES OF THIS CORPORATION |
| 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 AT A BOARD MEETING. THE FINAL VERSION OF THE FORM 990 IS E-MAILED 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 TOP OFFICIALS OF THE ORGANIZATION 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 AND 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. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (11 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | 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 | 0 | THEDACARE INC | |
| NEW LONDON FAMILY MEDICAL CENTER INC | |||||||||||
| 1405 MILL STREET | NEW LONDON | WI | 54961 | 390869788 | HOSPITAL | WI | 501(C)(3) | LINE 3 | 0 | THEDACARE INC | |
| RIVERSIDE MEDICAL CENTER INC | |||||||||||
| 800 RIVERSIDE DRIVE | WAUPACA | WI | 54981 | 390871113 | HOSPITAL | WI | 501(C)(3) | LINE 3 | 0 | THEDACARE INC | |
| APPLETON MEDICAL CENTER INC | |||||||||||
| PO BOX 8025 | APPLETON | WI | 54912 | 390824015 | HOSPITAL | WI | 501(C)(3) | LINE 3 | 0 | THEDACARE INC | |
| SHAWANO MEDICAL CENTER INC | |||||||||||
| 309 N BARTLETTE STREET | SHAWANO | WI | 54166 | 390807068 | HOSPITAL | WI | 501(C)(3) | LINE 3 | 0 | THEDACARE INC | |
| THEDA CLARK MEDICAL CENTER FOUNDATION INC | |||||||||||
| PO BOX 8025 | APPLETON | WI | 54912 | 311550056 | FOUNDATION | WI | 501(C)(3) | LINE 11A, I | 0 | THEDACARE INC | |
| WOLF RIVER AREA HEALTHCARE FOUNDATION INC | |||||||||||
| 1405 MILL STREET | NEW LONDON | WI | 54961 | 200049796 | FOUNDATION | WI | 501(C)(3) | LINE 11A, I | 0 | NEW LONDON FAMILY MEDICAL CENTER INC | |
| GEORGE F PEABODY FOUNDATION INC | |||||||||||
| PO BOX 2553 | APPLETON | WI | 54912 | 391702534 | FOUNDATION | WI | 501(C)(3) | LINE 11A, I | 0 | APPLETON MEDICAL CENTER INC | |
| COMMUNITY HOSPICE FOUNDATION INC | |||||||||||
| PO BOX 1534 | APPLETON | WI | 54912 | 391511977 | FOUNDATION | WI | 501(C)(3) | LINE 7 | 0 | THEDACARE INC | |
| SHAWANO MEDICAL CENTER FOUNDATION INC | |||||||||||
| 309 N BARTLETTE STREET | SHAWANO | WI | 54166 | 391539117 | FOUNDATION | WI | 501(C)(3) | LINE 11A, I | 0 | SHAWANO MEDICAL CENTER INC | |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTH APPLETON AMBULATORY CARE CENTER BUILDING COMPANY LLC | BusinessNameLine1 |
Address US AddressUS
| 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 Activity | RENTAL | PrimaryActivity |
| Legal Domicile State | WI | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
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