COMMUNITY HOSPICE FOUNDATION INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HOSPICE FOUNDATION INC (EIN 39-1511977)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-13
- IRS object ID
- 201203189349303280
- Schema version
- 2011v1.2
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-13T14:22:37-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420714325 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCGLADREY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 5946 | AddressLine1 |
| City | MADISON | City |
| State | WI | State |
| ZIP Code | 537050946 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391511977 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPICE FOUNDATION INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | COMM | NameControl |
| Phone | 9208305963 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1534 | AddressLine1 |
| City | APPLETON | City |
| State | WI | State |
| ZIP Code | 54912 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DEBORAH BLEVONS WASCHER | Name |
| Title | TREASURER | Title |
| Phone | 9208305963 | Phone |
| Date Signed | 2012-11-08 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JAMES G GRAHAM | Name |
| PTIN | P00006111 | PTIN |
| Phone | 6088333361 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DEBORAH BLEVONS WASCHER | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1534 | AddressLine1 |
| City | APPLETON | City |
| State | WI | State |
| ZIP Code | 54912 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 239871 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.THEDACARE.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2003 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | 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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 11 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 25 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 215655 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 132900 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -23574 | InvestmentIncomePriorYear |
| Investment Income Current Year | 7702 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 30429 | OtherRevenuePriorYear |
| Other Revenue Current Year | 16443 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 222510 | TotalRevenuePriorYear |
| Total Revenue Current Year | 157045 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 406494 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 17388 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 55376 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 34644 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 37714 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 41196 | OtherExpensePriorYear |
| Other Expenses Current Year | 36849 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 503066 | TotalExpensesPriorYear |
| Total Expenses Current Year | 88881 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -280556 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 68164 | RevenuesLessExpensesCY |
| Total Assets BOY | 541278 | TotalAssetsBOY |
| Total Assets EOY | 592846 | TotalAssetsEOY |
| Total Liabilities BOY | 7227 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 3863 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 534051 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 588983 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 17388 | Expense |
| Grants | 17388 | Grants |
| Description | 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. | Description |
| Total Program Service Expense | 17388 | 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 | 0 | 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 | 0 | 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 |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| 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 | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 11 | 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 | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | 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 ENGELS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 9208305963 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 122 E COLLEGE AVENUE | AddressLine1 |
| City | APPLETON | City |
| State | WI | State |
| ZIP Code | 54912 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (13 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer |
|---|---|---|---|---|---|---|
| SCOTT ANDERSEN | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| DEBRA BLEVONS-WASCHER | ||||||
| TREASURER | 1.00 | X | 0 | 0 | 0 | X |
| KIM BEISER | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| CHRISTINE CORNELL | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| JEFFREY DRAKE | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| PAM GRUNER | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| JULIE HEINER | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| JOHN KELLER | ||||||
| PRESIDENT | 1.00 | X | 0 | 0 | 0 | X |
| SHANNON KENNEDY | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| JOHN LARSON | ||||||
| VICE PRESIDENT | 1.00 | X | 0 | 0 | 0 | X |
| MONICA RENKENS | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| DIANE ABRAHAM | ||||||
| EXECUTIVE DIRECTOR | 16.00 | X | 0 | 58567 | 1753 | X |
| MICHAEL FROHNA | ||||||
| EXECUTIVE DIRECTOR | 16.00 | X | 0 | 72831 | 8531 | X |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 131398 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 10284 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Related Organizations | 6700 | RelatedOrganizations |
| All Other Contributions | 126200 | AllOtherContributions |
| Total Contributions | 132900 | TotalContributions |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 7821 | TotalRevenueColumn |
| Exclusion | $7,821 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 72137 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 72256 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -119 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -119 | TotalRevenueColumn |
| Exclusion | -$119 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 27013 | GrossIncomeFundraisingEvents |
| Fundraising Direct Expenses | 10570 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 16443 | TotalRevenueColumn |
| Exclusion | $16,443 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 157045 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $24,145 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17388 | Total |
| Program Services | 17388 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 34644 | Total |
| Management And General | 12125 | ManagementAndGeneral |
| Fundraising | 22519 | Fundraising |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18036 | Total |
| Management And General | 18036 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1662 | Total |
| Management And General | 582 | ManagementAndGeneral |
| Fundraising | 1080 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 100 | Total |
| Management And General | 100 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|
| PURCHASED SERVICES | 7811 | 2734 | 5077 |
| PRINTING | 5657 | 5657 | |
| SUPPLIES | 2362 | 2362 | |
| DONOR CULTIVATION | 818 | 818 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 403 | Total |
| Management And General | 202 | ManagementAndGeneral |
| Fundraising | 201 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 88881 | Total |
| Program Services | 17388 | ProgramServices |
| Management And General | 33779 | ManagementAndGeneral |
| Fundraising | 37714 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 45321 | BOY |
| EOY | 104714 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24893 | BOY |
| EOY | 22597 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 470648 | BOY |
| EOY | 464921 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 416 | BOY |
| EOY | 614 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 541278 | BOY |
| EOY | 592846 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7227 | BOY |
| EOY | 3863 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7227 | BOY |
| EOY | 3863 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 406717 | BOY |
| EOY | 398700 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 127334 | BOY |
| EOY | 190283 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 534051 | BOY |
| EOY | 588983 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 541278 | BOY |
| EOY | 592846 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 68164 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -13232 | 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 |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Both | X | FinancialStatementBoth |
| 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 | 172243 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 222543 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 164480 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 215655 | CurrentTaxYearMinus1Year |
| Current Tax Year | 132900 | CurrentTaxYear |
| Total | 907821 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 172243 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 222543 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 164480 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 215655 | CurrentTaxYearMinus1Year |
| Current Tax Year | 132900 | CurrentTaxYear |
| Total | 907821 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amounts Subst Contributors Total | 92903 | AmountsSubstContributorsTotal |
| Public Support Total170 | 814918 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 41129 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 16660 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 13523 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 8452 | CurrentTaxYearMinus1Year |
| Current Tax Year | 7821 | CurrentTaxYear |
| Total | 87585 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 995406 | TotalSupport |
| Public Support Pertcentage170 | 0.81870 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.90670 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
| Total Revenue | 157045 | TotalRevenue |
| Total Expenses | 88881 | TotalExpenses |
| Excess Or Deficit For Year | 68164 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -13232 | NetUnrealizedGLOnInvestments |
| Total Adjustments | -13232 | TotalAdjustments |
| Excess Or Deficit Per FS | 54932 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 154383 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -13232 | NetUnrealizedGainsInvestments |
| Other Revenues | 10570 | OtherRevenues |
| Revenue Not Rptd F990 | -2662 | RevenueNotRptdF990 |
| Revenue Subtotal | 157045 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 157045 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 99451 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 10570 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 10570 | ExpensesNotRptdF990 |
| Expenses Subtotal | 88881 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 88881 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | THE FOUNDATION FOLLOWS FASB GUIDANCE ON INCOME TAXES, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, WHICH ADDRESSES THE DETERMINATION OF WHETHER TAX BENEFITS CLAIMED OR EXPECTED TO BE CLAIMED ON A TAX RETURN SHOULD BE RECORDED IN THE FINANCIAL STATEMENTS. UNDER THIS GUIDANCE, THE FOUNDATION MAY RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. EXAMPLES OF TAX POSITIONS INCLUDE THE TAX-EXEMPT STATUS OF THE FOUNDATION, AND VARIOUS POSITIONS RELATED TO THE POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME. THE TAX BENEFITS RECOGNIZED IN THE FINANCIAL STATEMENTS FROM SUCH A POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50 PERCENT LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. AT DECEMBER 31, 2011 AND 2010, THERE WERE NO UNRECOGNIZED TAX BENEFITS IDENTIFIED OR RECORDED AS LIABILITIES. THE FOUNDATION FILES FORM 990 IN THE U.S. FEDERAL JURISDICTION. TAX RETURNS FILED BY THE FOUNDATION ARE GENERALLY OPEN FOR EXAMINATION FOR THE YEARS 2008 THROUGH 2011. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | SPECIAL EVENT EXPENSE 10,570. | |
| PART XIII, LINE 2D - OTHER ADJUSTMENTS: | SPECIAL EVENT EXPENSE 10,570. |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | LIGHT UP THE NIGHT FOR HOSPICE | NameOfEvent1 |
| Gross Receipts Event1 | 27013 | GrossReceiptsEvent1 |
| Gross Revenue Event1 | 27013 | GrossRevenueEvent1 |
| Rent Facility Costs Event1 | 3258 | RentFacilityCostsEvent1 |
| Other Direct Expenses Event1 | 3946 | OtherDirectExpensesEvent1 |
| Gross Receipts Total | 27013 | GrossReceiptsTotal |
| Gross Revenue Total Events | 27013 | GrossRevenueTotalEvents |
| Rent Facility Costs Total Events | 3258 | RentFacilityCostsTotalEvents |
| Other Direct Expenses Total Events | 3946 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 7204 | DirectExpenseSummaryEvents |
| Net Income Summary | 19809 | NetIncomeSummary |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THEDACARE AT HOME | BusinessNameLine1 |
Address US AddressUS
| 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) |
|---|---|---|
| EIN Of Recipient | 391509362 | EINOfRecipient |
| IRC Section | 501(C)(3) | IRCSection |
| Amount Of Cash Grant | 17388 | AmountOfCashGrant |
| Purpose Of Grant | OPERATING EXPENSES | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | 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: PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS: 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. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | ORGANIZATION'S PROCESS USED TO REVIEW FORM 990: 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 | ENFORCEMENT OF CONFLICTS POLICY: 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 AND COMPARABILITY DATA PROVIDED BY HUMAN RESOURCES. NO OTHER OFFICERS OF THE ORGANIZATION RECEIVE ANY COMPENSATION. | |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS DISCLOSURE EXPLANATION: ALL ARE AVAILABLE UPON REQUEST. | |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED LOSSES ON INVESTMENTS: -13,232. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FROM 990, PART XII, LINE 2C | NO CHANGES 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 | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| THEDACARE INC | ||||||||||
| 122 E COLLEGE AVE | APPLETON | WI | 54912 | 391509362 | HEALTHCARE | WI | 501(C)(3) | LINE 11C, III-FI | THEDACARE INC | 0 |
| APPLETON MEDICAL CENTER INC | ||||||||||
| 1818 N MEADE ST | APPLETON | WI | 54911 | 390824015 | HOSPITAL | WI | 501(C)(3) | LINE 3 | THEDACARE INC | 0 |
| APPLETON MEDICAL CENTER FOUNDATION | ||||||||||
| 122 E COLLEGE AVE | APPLETON | WI | 54911 | 391459276 | FOUNDATION | WI | 501(C)(3) | LINE 7 | THEDACARE INC | 0 |
| GEORGE F PEABODY FOUNDATION INC | ||||||||||
| PO BOX 2553 | APPLETON | WI | 54912 | 391702534 | FOUNDATION | WI | 501(C)(3) | LINE 11A, I | THEDACARE INC | 0 |
| NEW LONDON FAMILY MEDICAL CENTER INC | ||||||||||
| 1405 MILL ST | NEW LONDON | WI | 54961 | 390869788 | HOSPITAL | WI | 501(C)(3) | LINE 3 | THEDACARE INC | 0 |
| THEDA CLARK MEDICAL CENTER INC | ||||||||||
| 130 SECOND ST | NEENAH | WI | 54956 | 390830664 | HOSPITAL | WI | 501(C)(3) | LINE 3 | THEDACARE INC | 0 |
| WOLF RIVER AREA HEALTHCARE FOUNDATION INC | ||||||||||
| 1405 MILL ST | NEW LONDON | WI | 54961 | 200049796 | FOUNDATION | WI | 501(C)(3) | LINE 11B, II | THEDACARE INC | 0 |
| THEDA CLARK MEDICAL CENTER FOUNDATION INC | ||||||||||
| 130 SECOND ST | NEENAH | WI | 54956 | 311550056 | FOUNDATION | WI | 501(C)(3) | LINE 11A, I | THEDACARE INC | 0 |
| RIVERSIDE MEDICAL CENTER INC | ||||||||||
| 800 RIVERSIDE DRIVE | WAUPACA | WI | 54981 | 390871113 | HOSPITAL | WI | 501(C)(3) | LINE 3 | THEDACARE INC | 0 |
| SHAWANO MEDICAL CENTER INC | ||||||||||
| 309 N BARTLETTE ST | SHAWANO | WI | 54166 | 390807068 | HOSPITAL | WI | 501(C)(3) | LINE 3 | THEDACARE INC | 0 |
| SHAWANO MEDICAL CENTER FOUNDATION INC | ||||||||||
| N6192 WOLF RIVER ROAD | SHAWANO | WI | 54166 | 391539117 | FOUNDATION | WI | 501(C)(3) | LINE 11D, III-O | THEDACARE INC | 0 |
| 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 | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| 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 | 0 | 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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