2012-11-12T13:21:35-06:00 2011-12-31 420714325 MCGLADREY LLP PO BOX 5946 MADISON WI 537050946 990 2011-01-01 391509362 THEDACARE INC THED 9207355560 122 EAST COLLEGE AVENUE APPLETON WI 54911 TIM A OLSON 9207355560 2012-11-08 1 JAMES G GRAHAM P00006111 6088332612 2011 2016-02-24 21:20:13Z TIM A OLSON 122 EAST COLLEGE AVENUE APPLETON WI 54911 506887782 0 X WWW.THEDACARE.ORG X 1985 WI IMPROVING THE HEALTH OF OUR COMMUNITY. 14 10 6579 0 4573312 -53384 530471 177349 237423136 247317178 45900 11302346 5190724 5724376 243190231 264521249 2420009 722750 0 0 169126713 178893522 0 0 0 84601210 87067913 256147932 266684185 -12957701 -2162936 241298868 433132372 459587454 696190372 -218288586 -263058000 X IMPROVING THE HEALTH OF OUR COMMUNITY. 0 0 117233504 117092143 THEDACARE OPERATES 23 MEDICAL CLINICS IN 13 COMMUNITIES THROUGHOUT THE FOX VALLEY AND SURROUNDING AREAS. THE SERVICES INCLUDE FAMILY & GENERAL PRACTICES, INTERNAL MEDICINE, ORTHOPEDICS, ALLERGY/IMMUNOLOGY, AND PEDIATRICS. ALONG WITH ROUTINE PHYSICIAN AND NURSING CARE, SOME LOCATIONS PROVIDE OFFICE HOURS WITH SPECIALTY MEDICAL PROVIDERS. MOST CLINICS ALSO OFFER DIAGNOSTIC SERVICES SUCH AS X-RAY, ULTRASOUND, MRI, CAT SCAN, MAMMOGRAPHY AND MEDICAL LABORATORY TESTING. 77642411 722750 74449640 THEDACARE PROVIDES OPERATIONAL AND ADMINISTRATIVE SUPPORT SERVICES FOR HOSPITALS, MEDICAL CLINICS AND VARIOUS OTHER HEALTHCARE PROVIDERS. CENTRALIZING THESE SERVICES ALLOWS MEDICAL PROFESSIONALS TO CONCENTRATE ON GIVING THEIR PATIENTS THE BEST POSSIBLE CARE, WHILE ENJOYING THE BENEFITS OF EFFICIENT AND COST-EFFECTIVE BUSINESS MANAGEMENT. THEDACARE'S MAIN OPERATIONAL SERVICES INCLUDE A REFERENCE LABORATORY, TRANSCRIPTION SERVICES, BIOMEDICAL EQUIPMENT MAINTENANCE, PLUS A MEDICAL REFERENCE LIBRARY, STAFF EDUCATION AND PROFESSIONAL DEVELOPMENT PROGRAMS. MANY SENIOR CITIZENS SUBSCRIBE TO "LIFELINE," A MONITORED HELP/ALARM SYSTEM CONNECTED TO THEDACARE'S NURSE-STAFFED 24-HOUR CALL CENTER. THE CALL CENTER ALSO ANSWERS HEALTH QUESTIONS, HELPS PEOPLE LOCATE A PHYSICIAN, REFERS CALLERS TO ADDITIONAL SOURCES OF INFORMATION, AND ENROLLS CALLERS INTO COMMUNITY-FOCUSED CLASSES ON HEALTH-RELATED TOPICS. ADMINISTRATIVE SERVICES INCLUDE HUMAN RESOURCES, PAYROLL, PURCHASING, FINANCE AND ACCOUNTING, PRINTING SERVICES FOR MEDICAL & ADMINISTRATIVE MATERIALS, ORGANIZATIONAL DEVELOPMENT, INTERNAL EDUCATION AND IMPROVEMENT SYSTEMS, QUALITY ASSURANCE FOR BOTH INTERNAL AND PUBLIC REPORTING, MARKETING, COMMUNITY OUTREACH AND EDUCATION PROGRAMS, COMMUNICATION SYSTEMS, SECURITY AND LEGAL COMPLIANCE, AND FULL-SPECTRUM INFORMATION TECHNOLOGY PLANNING & SUPPORT. 33619473 41147160 THEDACARE'S SENIOR SERVICES DIVISION FOCUSES ON HEALTH CARE FOR CITIZENS EXPERIENCING LONG-TERM HEALTH ISSUES. AT-HOME HEALTH CARE VISITS MAY COMBINE WITH MEDICAL EQUIPMENT RENTALS TO ALLOW SOME PATIENTS TO CONTINUE LIVING IN THEIR OWN HOMES. AN ADULT DAY PROGRAM ALLOWS A CAREGIVER TO WORK OUTSIDE THE HOME WHILE KNOWING THAT THEIR LOVED-ONE IS SAFE WHILE THEY ARE AWAY. INDIVIDUALS WITH GREATER NEEDS MAY UTILIZE OUR ASSISTED LIVING OR LONG-TERM NURSING CARE FACILITIES. CHERRY MEADOWS HOSPICE PROVIDES CARE FOR END-OF-LIFE RESIDENTS IN A DIGNIFIED, COMPASSIONATE ENVIRONMENT. 12796027 13770031 THEDACARE OFFERS A FULL RANGE OF BEHAVIORAL AND MENTAL HEALTH CARE IN BOTH INPATIENT AND OUTPATIENT SETTINGS. SERVICES INCLUDE PSYCHIATRY, PSYCHOLOGY, BEHAVIORAL MEDICINE, GROUP THERAPY, DAY TREATMENT, DRUG & ALCOHOL ABUSE PROGRAMS FOR BOTH ADULTS AND ADOLESCENTS, INDIVIDUAL OR FAMILY COUNSELING. PROFESSIONAL TREATMENT FOR ADHD, ALZHEIMER'S/DEMENTIA, AND OTHER BEHAVIORAL DISORDERS PROVIDES A RESOURCE FOR ALL SEGMENTS OF OUR COMMUNITY. THEDACARE WORKPLACE SOLUTIONS, A DIVISION OF THEDACARE, PROVIDES OCCUPATIONAL HEALTH SERVICES TO AREA BUSINESSES WITH THE GOAL OF HELPING TO CONTROL THE COST OF INSURING THEIR EMPLOYEES. INDENTIFYING AND MANAGING CHRONIC DISEASE HELPS KEEP A WORKFORCE HEALTHY AND PRODUCTIVE, BENEFITTING BOTH COMMUNITY AND EMPLOYER. EMPLOYEE ASSIST PROGRAMS, ON-SITE MEDICAL SERVICE PROVIDERS, ERGONOMICS, IMMUNIZATIONS AND SCREENINGS, SAFETY EDUCATION AND INJURY PREVENTION ALL CONTRIBUTE TO MAINTAINING THE HEALTH AND WELL-BEING OF INDIVIDUALS WHO MAKE UP OUR WORKFORCE. 12796027 13770031 241291415 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 428 0 1 6579 1 1 1 1 CJ 0 0 0 0 0 0 0 0 X 14 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X X KRISTEN COGSWELL 9207386471 122 E COLLEGE AVENUE APPLETON WI 54911 DEAN A GRUNER MD 40.00 X X 227488 682465 165240 KATHLEEN M QUALHEIM MD 40.00 X 436086 0 22397 DAVID ANDERLA MD 40.00 X 312073 0 23150 OMAR ATASSI MD 2.00 X 0 0 0 DOUGLAS MOARD MD 40.00 X 252753 0 21762 GINGER JONES 2.00 X 0 0 0 JIM LARSON 2.00 X 0 0 0 MARK RICHARDS 2.00 X 0 0 0 WALT RUGLAND 2.00 X 0 0 0 MARK SCOTT 2.00 X 0 0 0 JON STELLMACHER 2.00 X X 0 0 0 JACK SWANSON MD 2.00 X X 0 0 0 MIKE WELLER 2.00 X X 0 0 0 JEFFREY WHITESIDE MD 2.00 X 0 0 0 EILEEN CONNOLLY-KEESLER 2.00 X 0 0 0 TIM A OLSON 40.00 X 108404 325213 99752 ROSELLEN CROW 40.00 X 99128 396511 18653 BRIAN R BURMEISTER 40.00 X 148269 148269 52124 KEITH J LIVINGSTON 40.00 X 94412 283237 80840 MAUREEN PISTONE 40.00 X 74698 224097 72533 KATHRYN CORREIA 40.00 X 52167 469506 96773 ERIC W ERICKSON MD 40.00 X 1371308 0 23927 TODD B SMITH MD 40.00 X 788093 0 22777 KENNETH KLEIST 40.00 X 701029 0 22917 JEFFERY MINIKEL MD 40.00 X 468955 0 18618 5134863 2529298 741463 226 0 1 0 ENTERPRISE SYSTEMS SOFTWARE 5151 MONROE STREET 101 TOLEDO OH 43623 SOFTWARE 972926 BELLIN HEALTH SYSTEM PO BOX 23400 GREEN BAY WI 543053400 HEALTH 899256 GODFREY & KAHN SC 780 N WATER ST MILWAUKEE WI 532023590 LEGAL 675481 THE REVERE GROUP LTD 2166 PAYSPHERE CIRCLE CHICAGO IL 60674 BUSINESS ADVISOR 647979 E-FREIGHT COURIER LLP PO BOX 13885 WAUWATOSA WI 532130885 FREIGHT 412962 17 66881 110468 177349 PATIENT/CLIENT REVENUE 900099 171837973 171837973 MANAGEMENT SERVICE FEE 900099 70905893 70905893 SOFTWARE SERVICES 541511 4405804 4405804 DURABLE MEDICAL EQUIP 621610 97505 97505 DURABLE MEDICAL EQUIP 621610 70003 70003 247317178 4866400 4866400 1941287 1769920 171367 171367 171367 246985947 46612 240563258 33355 6422689 13257 6435946 6435946 OTHER MISC 900009 1826783 1826783 INFORMATION TECHNOLOGY 900099 1716958 1716958 EQUITY GAIN IN AFFILIA 900099 448538 448538 1560730 1560730 5553009 264521249 246458974 4573312 13311614 722750 722750 2513098 1000913 1512185 142262802 133134639 9128163 6723112 5266567 1456545 19611806 14454330 5157476 7782704 6658570 1124134 851334 80973 770361 777523 615389 162134 242143 242143 535582 535582 4571197 4388110 183087 2397991 1516809 881182 2081044 1662079 418965 8168774 6535019 1633755 12077739 11243687 834052 1160305 1100539 59766 1370909 1257475 113434 1402436 1402436 6809533 6714022 95511 1177206 1033944 143262 SUPPLIES 14280454 14236714 43740 PURCHASED SERVICES 10655285 10193762 461523 COST OF GOODS SOLD 6324591 6324591 BAD DEBT EXPENSE 4533027 4523506 9521 7650840 7224591 426249 266684185 241291415 25392770 0 34234031 60242270 23422156 22566778 623666 686851 10554542 11086141 204399793 113126252 103339546 91273541 42006440 222180786 27118487 25096005 241298868 433132372 55061075 64248434 1288067 2220885 249940000 242715000 14936629 13081131 138361683 373924922 459587454 696190372 X -218288586 -263058000 -218288586 -263058000 241298868 433132372 X -2162936 -42606478 X X 0 1 1 X 0 X X X 0 0 0 THEDA CLARK MEDICAL CENTER INC 390830664 3 0 1 1 0 APPLETON MEDICAL CENTER INC 390824015 3 0 1 1 0 NEW LONDON FAMILY MEDICAL CENTER INC 390869788 3 0 1 1 0 RIVERSIDE MEDICAL CENTER INC 390871113 3 0 1 1 0 SHAWANO MEDICAL CENTER INC 390807068 3 0 1 1 0 5 0 SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: SUPPLEMENTAL INFORMATION THEDACARE INC. PROVIDES FUNCTIONS SUCH AS PURCHASING, FINANCE, BILLING, BANKING, HUMAN RESOURCES, INFORMATION TECHNOLOGY, QUALITY ASSURANCE, EDUCATION AND REFERENCE LABORATORY TO THE SUPPORTED ORGANIZATIONS LISTED ON SCHEDULE A. CONSOLIDATED ACCOUNTING PROVIDES DIRECT REVENUE AND EXPENSE REPORTING BY ORGANIZATION, WITH ONGOING INTERCOMPANY BALANCES REPLACING THE USE OF CASH TRANSFERS TO REIMBURSE AFFILIATES. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 1 6859 0 0 0 0 0 6859 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: LOBBYING ACTIVITIES WERE DONE TO INFLUENCE THE STATE OF WI GOVERNING BODY. NO EFFORT WAS MADE TO THE FEDERAL GOVERNMENT, OR TO SUPPORT ANY CANDIDATE. SEE DETAIL OF LOBBYING EXPENDITURES ONLINE AT HTTP://ETHICS.STATE.WI.US ITEMS THAT WERE LOBBIED INCLUDE: -PROHIBITING REFUSAL TO HONOR ANATOMICAL GIFT DIRECTIVE -ASSISTED LIVING, NURSING HOME AND HOSPICE CARE POLICIES -CONSTRUCTION STANDARDS FOR HOSPITALS -GIFTS GIVEN OR OFFERED BY PRESCRIPTION DRUG MANUFACTURERS/DISTRIBUTORS -HEALTH AND FAMILY SERVICES: MEDICAL ASSISTANCE -HOSPITAL ASSESSMENT/TAX -HEALTH CARE RECORDS -HEALTH CARE REFORM, INCLUDING QUALITY OF CARE INITIATIVES -FEES FOR COPIES OF PATIENT HEALTH CARE RECORDS -HOSPITAL COSTS -ASSESSMENT ON GROSS PRIVATE PATIENT REVENUE OF HOSPITALS -MEDICAL ASSISTANCE AND BADGER CARE PAYMENT RATE FOR HOSPITALS -REGULATION OF HOSPITALS -ADVERTISING FOR PRESCRIPTION DRUGS -ELIMINATING AN ASSESSMENT ON THE GROSS PRIVATE PATIENT REVENUE OF HOSPITALS -THE ESTABLISHMENT OF THE HEALTHY WISCONSIN PLAN AND THE HEALTH WISCONSIN AUTHORITY, GRANTING RULE-MAKING AUTHORITY, AND MAKING AN APPROPRIATION 8217603 8217603 72033832 22805175 49228657 678348 267279 411069 116573205 90053798 26519407 6896805 6896805 91273541 CAPITAL FUNDS COMMITTED TO HOSPITAL 20977978 LICENSE FEES- NET OF AMORTIZATION 4118027 25096005 DUE TO AFFILIATES 303191467 DEFERRED EMPLOYEE BENEFITS 69674139 LONG TERM DEBT-ARO ACCRETION 1059316 373924922 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THEDACARE 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, THEDACARE 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 THEDACARE, AND VARIOUS POSITIONS RELATED TO THE POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME (UBIT). 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. THEDACARE FILES FORM 990 IN THE U.S. FEDERAL JURISDICTION. TAX RETURNS FILED BY THEDACARE ARE GENERALLY OPEN FOR EXAMINATION FOR THE YEARS 2008 THROUGH 2011. 1 THEDACARE CENTER FOR CREATING VALUE 100 W LAWRENCE ST APPLETON WI 54911 262795800 501 (C) (3) 625000 GENERAL FOX CITIES COMMUNITY HEALTH CENTER 1814 APPLETON ROAD MENASHA WI 54952 202090446 501 (C) (3) 52500 GENERAL THEDA CLARK MEDICAL CENTER FOUNDATION 130 SECOND ST NEENAH WI 54956 311550056 501 (C) (3) 11100 GENERAL WOLF RIVER AREA HEALTH CARE FOUNDATION 1405 MILL ST NEW LONDON WI 54961 200049796 501 (C) (3) 7000 GENERAL COMMUNITY HOSPICE FOUNDATION INC PO BOX 1534 APPLETON WI 54912 391511977 501 (C) (3) 6700 GENERAL APPLETON MEDICAL CENTER FOUNDATION INC 1818 NORTH MEADE STREET APPLETON WI 54911 391459276 501 (C) (3) 14450 GENERAL GEORGE F PEABODY FOUNDATION PO BOX 1534 APPLETON WI 54912 391702534 501 (C) (3) 6000 GENERAL 7 X X 1 1 X X X X 0 1 0 0 0 0 0 1 0 DEAN A GRUNER MD 166750 500250 58819 176457 1919 5758 37887 113662 3423 10268 268798 806395 0 0 KATHLEEN M QUALHEIM MD 433141 0 356 0 2589 0 9350 0 13047 0 458483 0 0 0 DAVID ANDERLA MD 311184 0 356 0 533 0 9350 0 13800 0 335223 0 0 0 DOUGLAS MOARD MD 252397 0 356 0 0 0 9350 0 12412 0 274515 0 0 0 TIM A OLSON 86162 258487 15635 46905 6607 19821 21638 64913 3300 9901 133342 400027 0 0 ROSELLEN CROW 62358 249431 11870 47480 24900 99600 2576 10304 1155 4618 102859 411433 0 0 BRIAN R BURMEISTER 116979 116979 21325 21325 9965 9965 19078 19078 6984 6984 174331 174331 0 0 KEITH J LIVINGSTON 75623 226869 13723 41169 5066 15199 16937 50812 3273 9818 114622 343867 0 0 MAUREEN PISTONE 60771 182314 11027 33082 2900 8701 14899 44697 3234 9703 92831 278497 0 0 KATHRYN CORREIA 39934 359409 10869 97825 1364 12272 8237 74135 1440 12961 61844 556602 0 0 ERIC W ERICKSON MD 582555 0 787728 0 1025 0 9350 0 14577 0 1395235 0 0 0 TODD B SMITH MD 499999 0 287068 0 1026 0 9350 0 13427 0 810870 0 0 0 KENNETH KLEIST 700003 0 0 0 1026 0 9350 0 13567 0 723946 0 0 0 JEFFERY MINIKEL MD 442299 0 20000 0 6656 0 7350 0 11268 0 487573 0 0 0 PART I, LINE 1A EXECUTIVES RECEIVE REIMBURSEMENT FOR PERSONAL MEDICAL EXPENSES AT AN AMOUNT GROSSED-UP FOR TAXES. ALL EXECUTIVES IN THE SENIOR MANAGEMENT BENEFIT CATEGORY ARE ELIGIBLE TO HAVE HEALTH OR FITNESS CLUB FEES PAID DIRECTLY TO THE CLUB, OR REIMBURSED TO THEM ON EVIDENCE OF PAYMENT. SENIOR EXECUTIVES WHOSE DUTIES INCLUDE MEETING WITH PEOPLE OUTSIDE THE COMPANY FOR PURPOSED OF DEVELOPING BUSINESS RELATIONSHIPS HAVE COMPANY PAID MEMBERSHIPS AT A LOCAL COUNTRY CLUB. 32 EMPLOYEES RECEIVED TAXABLE MEDICAL EXPENSE REIMBURSEMENTS AND 19 EMPLOYEES RECEIVED CLUB DUES REIMBURSEMENTS. PART I, LINE 4B NONQUALIFIED PLAN DESCRIPTION SENIOR LEVEL EXECUTIVES OF THE COMPANY ARE ENTITLED TO AN ANNUAL FLEXIBLE BENEFIT EQUAL TO 20% OF THE MIDPOINT OF THEIR SALARY RANGE. THIS 457(F) SUPPLEMENTAL BENEFIT PLAN COMPLIES WITH THE FINAL REGULATIONS UNDER SECTION 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. PART I, LINE 7 EXECUTIVE AT RISK COMPENSATION PLAN THE PLAN OBJECTIVES ARE TO ENHANCE THEDACARE INC'S ABILITY TO ACHIEVE ITS GOALS BY PROVIDING A TOOL FOR STIMULATING AND REWARDING SUPERIOR LEVELS OF PERFORMANCE AMONG KEY EXECUTIVES, IMPROVE THEDACARE INC'S ABILITY TO COMPETE WITH OTHER EMPLOYERS FOR HIGH TALENT EXECUTIVES AND TO ENCOURAGE TOP-LEVEL EXECUTIVES TO WORK TOGETHER AS A COHESIVE GROUP TOWARD COMMON GOALS. THE PRESIDENT OF THEDACARE INC. DEVELOPS A LIST OF SENIOR LEVEL EXECUTIVES WHO ARE ELIGIBLE TO PARTICIPATE IN THIS PLAN, AS WELL AS THE PERFORMANCE LEVELS THE SENIOR EXECUTIVES MUST ACHIEVE AND THE AT-RISK COMPENSATION AMOUNTS THAT THE EXECUTIVES WILL RECEIVE. THE PRESIDENT THEN SUBMITS THIS LIST TO THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES FOR FINAL APPROVAL. THESE EXECUTIVES MUST BE IN ACTIVE REGULAR SERVICE OF THEDACARE INC. FOR THE ENTIRE PLAN YEAR (JANUARY 1, 2011 TO DECEMBER 31, 2011) TO RECEIVE THEIR 2011 AT-RISK COMPENSATION. IF THE EMPLOYEE RETIRES, BECOMES DISABLED, MOVES TO A POSITION THAT IS ELIGIBLE UNDER THE AT-RISK COMPENSATION PLAN OR MOVES TO A POSITION THAT IS NO LONGER ELIGIBLE FOR THE AT-RISK COMPENSATION PLAN OR DIES THE PLAN WILL BE PRORATED FOR THE AMOUNT OF TIME THEY SERVED THE COMPANY. IF AN ELIGIBLE EMPLOYEE IS FIRED OR LEAVES THE COMPANY FOR ANY OTHER REASON THE PLAN AT-RISK COMPENSATION EARNED WILL BE FORFEITED. CARING FOR SUCCESS THE PLAN OBJECTIVES ARE TO PROVIDE INCENTIVE TO FOCUS THE ORGANIZATION'S RESOURCES, ENERGY AND ATTENTION ON THE FULFILLMENT OF THEDACARE'S MISSION. THE ORGANIZATIONAL MEASURE IS THEDACARE'S OPERATING PERFORMANCE AND EMPLOYEES HEALTH ASSESSMENT TOOL SCORE IMPROVEMENTS. ALL ELIGIBLE EMPLOYEES (ON THE PAYROLL AS OF JULY 1, 2011 AND STILL BE ON THE PAYROLL AS OF MARCH 15, 2012) SHARE IN THE GAIN. THE PAYOUT AMOUNT IS DETERMINED BASED ON THEDACARE'S OPERATING MARGIN AND REDUCTION IN OSHA RECORDABLE STRAINS AND SPRAINS. THE AMOUNT PER EMPLOYEE IS DETERMINED BY DIVIDING THE TOTAL GAIN REALIZED (THE EMPLOYEE SHARE) BY HOURS PAID TO ALL ELIGIBLE EMPLOYEES. THE RESULTING DOLLAR UNIT PAYOUT IS MULTIPLIED BY AN INDIVIDUAL EMPLOYEE'S NUMBER OF HOURS PAID. THIS PLAN IS OVERSEEN BY AN ADMINISTRATIVE COMMITTEE. THE THEDACARE BOARD OF TRUSTEES MUST APPROVE THE PLAN. WHEFA REV BOND 2005 391337895 97710VZH4 2005-12-22 59289833 FACILITY CONSTRUCTION 0 0 0 WHEFA REV BOND 2009A 391337855 97710BHY1 2009-06-16 87896508 FACILITY CONSTRUCTION RENOVATION AND REMODELING 0 0 0 WHEFA REV BOND 2009B 391337855 97710BJL7 2009-06-16 36717948 REFUNDING 0 0 0 WHEFA REV BOND 2010 391337855 97710BVM1 2010-05-25 25345018 REFUNDING 0 0 0 59289833 4350000 507610 53675584 2007 0 0 1 1 87896508 5373000 4916000 1018634 81260000 2010 0 0 1 1 36717948 1589000 425525 34599423 1 0 1 1 25345018 332397 25012621 1 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 1 FIFTH THIRD BANK 1.000000000000 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 DESIGNATED COMMITTEE OF THE BOARD OF DIRECTORS FOR REVIEW AND DISCUSSION AT A BOARD MEETING. 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 QUESTIONNAIRES ARE SENT TO ALL MANAGERS, TRUSTEES AND OFFICERS ANNUALLY. COMPLETED FORMS ARE RETURNED TO THE COMPLIANCE OFFICER. THE COMPLIANCE OFFICER REVIEWS THE QUESTIONNAIRES AND FOLLOWS UP WITH ANY QUESTIONS ABOUT THE MANAGERS' ANSWERS ON THE CONFLICT OF INTEREST FORMS. FORM 990, PART VI, SECTION B, LINE 15 THEDACARE HIRES AN OUTSIDE CONSULTING FIRM TO CONDUCT A THOROUGH MARKET REVIEW OF EXECUTIVE COMPENSATION EVERY OTHER YEAR. INTERNALLY, A COMPENSATION COMMITTEE REAFFIRMS THE COMPENSATION POLICY, REVIEWS DATA FROM CONSULTANTS, AND WITH INPUT FROM THE SR VP OF HUMAN RESOURCES, ADVISES, VALIDATES, AND APPROVES A RANGE FOR CEO COMPENSATION. THE COMMITTEE ALSO RATIFIES THE AT-RISK COMPENSATION PLAN. FORM 990, PART VI, SECTION C, LINE 19 THEDACARE INC. DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND INTERNAL FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. PART VI, SECTION B, LINE 16B: THEDACARE CONSULTS WITH LEGAL COUNSEL TO ENSURE SAFEGUARDING OF THE TAX-EXEMPT STATUS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -13,699,125. PENSION RELATED CHANGES -28,934,685. ASSETS RELEASED FROM RESTRICTION 27,332. TOTAL TO FORM 990, PART XI, LINE 5: -42,606,478. FROM 990, PART XII, LINE 2C: THE PROCESS DID NOT CHANGE DURING THE YEAR. NUMBER OF EMPLOYEES FROM 990, PART I, LINE 5: THEDACARE INC. CENTRALIZES PAYROLL AND TAX WITHHOLDING FUNCTIONS FOR A NUMBER OF AFFILIATED ENTITIES, WITH ALL FILINGS UNDER THEDACARE'S FEDERAL IDENTIFICATION NUMBER. APPLETON MEDICAL CENTER PO BOX 8025 APPLETON WI 54912 390824015 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE 0 THEDA CLARK MEDICAL CENTER PO BOX 8025 APPLETON WI 54912 390830664 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE 0 APPLETON MEDICAL CENTER FOUNDATION 1818 N MEADE APPLETON WI 54911 391459276 FOUNDATION WI 501(C)(3) LINE 7 THEDACARE 0 THEDA CLARK MEDICAL CENTER FOUNDATION 130 SECOND STREET NEENAH WI 54956 391550056 FOUNDATION WI 501(C)(3) LINE 7 THEDACARE 0 WOLF RIVER AREA HEALTHCARE FOUNDATION 1405 MILL STREET NEW LONDON WI 54961 200049796 FOUNDATION WI 501(C)(3) LINE 11B, II THEDACARE 0 COMMUNITY HOSPICE FOUNDATION 1818 N MEADE APPLETON WI 54911 391511977 FOUNDATION WI 501(C)(3) LINE 7 THEDACARE 0 GEORGE F PEABODY FOUNDATION PO BOX 2553 APPLETON WI 54912 391702534 FOUNDATION WI 501(C)(3) LINE 11A, I THEDACARE 0 NEW LONDON FAMILY MEDICAL CENTER 1405 MILL STREET NEW LONDON WI 54961 390869788 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE 0 RIVERSIDE MEDICAL CENTER INC 800 RIVERSIDE DRIVE WAUPACA WI 54891 390871113 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE 0 SHAWANO MEDICAL CENTER INC 309 N BARTLETTE STREET SHAWANO WI 54166 390807068 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE 0 SHAWANO MEDICAL CENTER FOUNDATION INC 309 N BARTLETTE STREET SHAWANO WI 54166 391539117 FOUNDATION WI 501(C)(3) LINE 11D, III-O THEDACARE 0 AYLWARD CLINICAL SERVICES CO LLC PO BOX 2021 NEENAH WI 54956 204202274 MGMT SERVICE WI N/A RELATED 114819 774857 0 1 0.50000 GROTH CLINICAL SERVICES CO LLC 1818 N MEADE ST APPLETON WI 54911 204202228 MGMT SERVICE WI N/A RELATED 644382 1484990 0 1 0.50000 PREMIUM HEALTHCARE INC PO BOX 8025 APPLETON WI 54912 200120381 CONT ADMIN WI N/A C -16751 42616 0.50000 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0