2012-11-13T14:22:37-06:00 2011-12-31 420714325 MCGLADREY LLP PO BOX 5946 MADISON WI 537050946 990 2011-01-01 391511977 COMMUNITY HOSPICE FOUNDATION INC COMM 9208305963 PO BOX 1534 APPLETON WI 54912 DEBORAH BLEVONS WASCHER 9208305963 2012-11-08 1 JAMES G GRAHAM P00006111 6088333361 2011 2016-02-24 21:20:13Z DEBORAH BLEVONS WASCHER PO BOX 1534 APPLETON WI 54912 239871 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. 12 11 0 25 0 0 215655 132900 0 0 -23574 7702 30429 16443 222510 157045 406494 17388 0 0 55376 34644 0 0 37714 41196 36849 503066 88881 -280556 68164 541278 592846 7227 3863 534051 588983 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 17388 17388 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. 17388 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 12 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 WI X JOSEPH ENGELS 9208305963 122 E COLLEGE AVENUE APPLETON WI 54912 SCOTT ANDERSEN 1.00 X 0 0 0 DEBRA BLEVONS-WASCHER 1.00 X X 0 0 0 KIM BEISER 1.00 X 0 0 0 CHRISTINE CORNELL 1.00 X 0 0 0 JEFFREY DRAKE 1.00 X 0 0 0 PAM GRUNER 1.00 X 0 0 0 JULIE HEINER 1.00 X 0 0 0 JOHN KELLER 1.00 X X 0 0 0 SHANNON KENNEDY 1.00 X 0 0 0 JOHN LARSON 1.00 X X 0 0 0 MONICA RENKENS 1.00 X 0 0 0 DIANE ABRAHAM 16.00 X X 0 58567 1753 MICHAEL FROHNA 16.00 X X 0 72831 8531 0 131398 10284 0 0 0 0 0 6700 126200 132900 7821 7821 72137 72256 -119 -119 -119 27013 10570 16443 16443 157045 0 0 24145 17388 17388 34644 12125 22519 18036 18036 1662 582 1080 100 100 PURCHASED SERVICES 7811 2734 5077 PRINTING 5657 5657 SUPPLIES 2362 2362 DONOR CULTIVATION 818 818 403 202 201 88881 17388 33779 37714 45321 104714 24893 22597 470648 464921 416 614 541278 592846 7227 3863 7227 3863 X 406717 398700 127334 190283 534051 588983 541278 592846 X 68164 -13232 X X 0 1 1 X 0 X 172243 222543 164480 215655 132900 907821 172243 222543 164480 215655 132900 907821 92903 814918 41129 16660 13523 8452 7821 87585 995406 0.81870 0.90670 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 157045 88881 68164 -13232 -13232 54932 154383 -13232 10570 -2662 157045 0 157045 99451 10570 10570 88881 0 88881 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. LIGHT UP THE NIGHT FOR HOSPICE 27013 27013 3258 3946 27013 27013 3258 3946 7204 19809 1 THEDACARE AT HOME 3000 E COLLEGE AVE APPLETON WI 54915 391509362 501(C)(3) 17388 OPERATING EXPENSES 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: 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. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -13,232. FROM 990, PART XII, LINE 2C NO CHANGES FROM THE PRIOR YEAR. 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 0 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0