APPLETON MEDICAL CENTER FOUNDATION INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
APPLETON MEDICAL CENTER FOUNDATION INC (EIN 39-1459276)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-07-21
IRS object ID
201122029349301302
Schema version
2010v3.2
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

FieldValueIRS element (for citing)
Timestamp2011-07-21T14:52:27-05:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1RSM MCGLADREY INCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 5946AddressLine1
CityMADISONCity
StateWIState
ZIP Code537050946ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN391459276EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1APPLETON MEDICAL CENTER FOUNDATION INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlAPPLNameControl
Phone9207386506Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11818 NORTH MEADE STREETAddressLine1
CityAPPLETONCity
StateWIState
ZIP Code54911ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDEAN HIGHName
TitleTREASURERTitle
Phone9207386506Phone
Date Signed2011-07-06DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJAMES G GRAHAMName
Phone6088333361Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDEAN HIGHNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11818 NORTH MEADE STREETAddressLine1
CityAPLETONCity
StateWIState
ZIP Code54911ZIPCode
FieldValueIRS element (for citing)
Gross Receipts6041124GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.AMCFOUNDATION.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1983YearFormation
State Legal DomicileWIStateLegalDomicile
Activity Or Mission DescriptionENHANCE THE HEALTH OF OUR COMMUNITIES.ActivityOrMissionDescription
Nbr Voting Members Governing Body16NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers29TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year243392ContributionsGrantsPriorYear
Contributions Grants Current Year1306897ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year235618InvestmentIncomePriorYear
Investment Income Current Year-1166440InvestmentIncomeCurrentYear
Other Revenue Prior Year38129OtherRevenuePriorYear
Other Revenue Current Year78896OtherRevenueCurrentYear
Total Revenue Prior Year517139TotalRevenuePriorYear
Total Revenue Current Year219353TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year776059GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY298700GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year227039SalariesEtcPriorYear
Salaries Etc Current Year248609SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year232240TotalFundrsngExpCurrentYear
Other Expense Prior Year66015OtherExpensePriorYear
Other Expenses Current Year90726OtherExpensesCurrentYear
Total Expenses Prior Year1069113TotalExpensesPriorYear
Total Expenses Current Year638035TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-551974RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-418682RevenuesLessExpensesCY
Total Assets BOY9064943TotalAssetsBOY
Total Assets EOY10807039TotalAssetsEOY
Total Liabilities BOY122854TotalLiabilitiesBOY
Total Liabilities EOY28782TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY8942089NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY10778257NetAssetsOrFundBalancesEOY
Mission DescriptionENHANCE THE HEALTH OF OUR COMMUNITIES.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense283953Expense
DescriptionTO 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

FieldValueIRS element (for citing)
Expense14747Expense
Description12 SCHOLARSHIPS WERE GRANTED TO INDIVIDUALS WHO ARE GOING INTO THE MEDICAL FIELD OF STUDY.Description
FieldValueIRS element (for citing)
Total Program Service Expense298700TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip0ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members16NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledWIStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1JOSEPH W ENGELSBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number9208305971TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1122 E COLLEGE AVENUE PO BOX 8025AddressLine1
CityAPPLETONCity
StateWIState
ZIP Code549128025ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (21 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
JOYCE BYTOF
DIRECTOR1.00X000
STEVE DUNGAR MD
DIRECTOR1.00X000
KATHRYN CORREIA
DIRECTOR1.00X050524589542
DAVID DUPPLER MD
DIRECTOR1.00X000
JAY FULKERSON
DIRECTOR1.00X000
WALTER RUGLAND
DIRECTOR1.00X000
BARBARA UEHLING
DIRECTOR1.00X000
CYRIL WALSH MD
VICE PRESIDENT1.00X000X
PETER SCHUBBE DC
DIRECTOR1.00X000
DIANE ABRAHAM
EXECUTIVE DIRECTOR16.00X584185841814262X
C RAYMOND DURKEE
DIRECTOR EMERITUS1.00X000
DEAN HIGH
TREASURER1.00X000X
JEFF RIESTER
PRESIDENT1.00X000X
JAMES R WILSON
SECRETARY1.00X000X
OSCAR BOLDT
DIRECTOR EMERITUS1.00X000
RICHARD CALDER
DIRECTOR EMERITUS1.00X000
PAULA CHANDLER
DIRECTOR EMERITUS1.00X000
TIM OLSON
DIRECTOR1.00X0412161100566
DAVID B ANDERLA MD
DIRECTOR1.00X000
PASTOR ALAN SCHAFFMEYER
DIRECTOR1.00X000
KIM BARNAS
EXECUTIVE DIRECTOR10.00X020448214489X
FieldValueIRS element (for citing)
Total Reportable Comp From Org58418TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1180306TotalReportableCompFrmRltdOrgs
Total Other Compensation218859TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Related Organizations1095829RelatedOrganizations
All Other Contributions211068AllOtherContributions
Noncash Contributions8784NoncashContributions
Total Contributions1306897TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column112227TotalRevenueColumn
Exclusion$112,227ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities4514342Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities5793009Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-1278667Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-1278667TotalRevenueColumn
Exclusion-$1,278,667ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events107658GrossIncomeFundraisingEvents
Fundraising Direct Expenses28762FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column78896TotalRevenueColumn
Exclusion$78,896ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column219353TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion-$1,087,544ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total270453Total
Program Services270453ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total28247Total
Program Services28247ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total58418Total
Management And General29209ManagementAndGeneral
Fundraising29209Fundraising

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total190191Total
Management And General32943ManagementAndGeneral
Fundraising157248Fundraising

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total11820Total
Management And General11820ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total3177Total
Management And General794ManagementAndGeneral
Fundraising2383Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total2336Total
Management And General2336ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralFundraisingFundraising
SERVICES256861284312843
WEBSITE1380269016901
PRINTING1302813028
ASSET MANAGEMENT FEES75187518
SUPPLIES415913722787

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total9200Total
Management And General1359ManagementAndGeneral
Fundraising7841Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total638035Total
Program Services298700ProgramServices
Management And General107095ManagementAndGeneral
Fundraising232240Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
EOY1118964EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY144727BOY
EOY135269EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY8920216BOY
EOY9552806EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY9064943BOY
EOY10807039EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY122854BOY
EOY28782EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY122854BOY
EOY28782EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY5231300BOY
EOY5872842EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2137461BOY
EOY3328782EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1573328BOY
EOY1576633EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8942089BOY
EOY10778257EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY9064943BOY
EOY10807039EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-418682ReconcilationRevenueExpenses
Reconcilation Other Changes2254850ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years4251759CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years273121CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years660549CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year243392CurrentTaxYearMinus1Year
Current Tax Year1306897CurrentTaxYear
Total6735718Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years4251759CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years273121CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years660549CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year243392CurrentTaxYearMinus1Year
Current Tax Year1306897CurrentTaxYear
Total6735718Total
FieldValueIRS element (for citing)
Public Support Total1706735718PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years978990CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years990640CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years247961CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year235618CurrentTaxYearMinus1Year
Current Tax Year112227CurrentTaxYear
Total2565436Total
FieldValueIRS element (for citing)
Total Support9301154TotalSupport
Public Support Pertcentage1700.72420PublicSupportPertcentage170
Public Support Pertcent Prior Year0.68430PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance5148663BeginningOfYearBalance
Contributions3305Contributions
Investment Earnings Or Losses64028InvestmentEarningsOrLosses
Other Expenditures27168OtherExpenditures
End Of Year Balance5188828EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance4876903BeginningOfYearBalance
Contributions1370Contributions
Investment Earnings Or Losses287444InvestmentEarningsOrLosses
Other Expenditures17054OtherExpenditures
End Of Year Balance5148663EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance5104609BeginningOfYearBalance
Contributions7064Contributions
Investment Earnings Or Losses-234181InvestmentEarningsOrLosses
Other Expenditures589OtherExpenditures
End Of Year Balance4876903EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.69610BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.30390PermanentEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings
Total Revenue219353TotalRevenue
Total Expenses638035TotalExpenses
Excess Or Deficit For Year-418682ExcessOrDeficitForYear
Net Unrealized GL On Investments2254850NetUnrealizedGLOnInvestments
Total Adjustments2254850TotalAdjustments
Excess Or Deficit Per FS1836168ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt2502965TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments2254850NetUnrealizedGainsInvestments
Other Revenues28762OtherRevenues
Revenue Not Rptd F9902283612RevenueNotRptdF990
Revenue Subtotal219353RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form990219353TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt666797TotExpensesEtcAuditedFinclStmt
Other Expenses Included28762OtherExpensesIncluded
Expenses Not Rptd F99028762ExpensesNotRptdF990
Expenses Subtotal638035ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form990638035TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
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 ASSETS 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:INCOME TAXES - 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 (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, 2010 AND 2009 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 2007 THROUGH 2010.
PART XII, LINE 2D - OTHER ADJUSTMENTS:SPECIAL EVENT EXPENSE 28,762.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:SPECIAL EVENT EXPENSE 28,762.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1HIGH FLYING GOLF OUTINGNameOfEvent1
Gross Receipts Event178625GrossReceiptsEvent1
Gross Revenue Event178625GrossRevenueEvent1
Rent Facility Costs Event115583RentFacilityCostsEvent1
Other Direct Expenses Event14862OtherDirectExpensesEvent1
Name Of Event2LAUGHTER IS THE BEST MEDICINENameOfEvent2
Gross Receipts Event229033GrossReceiptsEvent2
Gross Revenue Event229033GrossRevenueEvent2
Rent Facility Costs Event24358RentFacilityCostsEvent2
Other Direct Expenses Event23959OtherDirectExpensesEvent2
Gross Receipts Total107658GrossReceiptsTotal
Gross Revenue Total Events107658GrossRevenueTotalEvents
Rent Facility Costs Total Events19941RentFacilityCostsTotalEvents
Other Direct Expenses Total Events8821OtherDirectExpensesTotalEvents
Direct Expense Summary Events28762DirectExpenseSummaryEvents
Net Income Summary78896NetIncomeSummary

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
APPLETON MEDICAL CENTER INC
130 SECOND STNEENAHWI549563908240153211660GENERAL
APPLETON SCHOOL DISTRICT
122 EAST COLLEGE AVENUE SUITE 1AAPPLETONWI54911325000AASD AFTER SCHOOL RESEARCH PROJECT
LIVING HEALTH COMMUNITY CLINIC
510 DOCTORS CTOSHKOSHWI54901391805963330000GENERAL

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantSCHOLARSHIPSTypeOfGrant
Number Of Recipients13NumberOfRecipients
Amount Of Cash Grant28247AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS: 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

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
KATHRYN CORREIA
0373218012262909398075053014489059478700
TIM OLSON
0322102067349022710087350013216051272700
KIM BARNAS
01830230178440361500014489021897100

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePART I, LINE 4AReturnReference
ExplanationKATHRYN CORREIA AND TIM OLSON ARE ENTITLED TO AN ANNUAL FLEXIBLE BENEFIT EQUAL TO 20% OF THEIR BASE COMPENSATION. THIS 457(F) SUPPLEMENTAL BENFIT 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. DURING 2010, $76,173 WAS PAID OUT PURSUANT TO THE PLAN'S TERMS FOR KATHRYN CORREIA AND $80,000 FOR TIM OLSON.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION B, LINE 11A 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.
ENFORCEMENT OF CONFLICTS POLICY IS REVIEWED AND SIGNED OFF BY EACH BOARD MEMBER ANNUALLY.FORM 990, PART VI, SECTION B, LINE 12C
THERE IS NO COMPENSATION FOR THESE PEOPLE PAID THROUGH THE ENTITY. WAGES ARE DETERMINED THROUGH THEDACARE, INC WHO IS THEIR EMPLOYER. HUMAN RESOURCES PROVIDES MARKET AND COMPARABILITY DATA TO MANAGEMENT.FORM 990, PART VI, SECTION B, LINE 15
ALL ARE AVAILABLE UPON REQUEST.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED GAINS ON INVESTMENTS: 2,254,850.FORM 990, PART XI, LINE 5:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (9 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
THEDACARE INC
122 EAST COLLEGE AVENUEAPPLETONWI54912391509362HEALTHCAREWI501C3LINE 11C, III-FITHEDACARE INC0
APPLETON MEDICAL CENTER INC
1818 NORTH MEADE STAPPLETONWI54911390824015HOSPITALWI501C3LINE 3THEDACARE INC0
THEDA CLARK MEDICAL CENTER INC
130 SECOND STNEENAHWI54956311550056HOSPITALWI501C3LINE 3THEDACARE INC0
GEORGE F PEABODY FOUNDATION INC
PO BOX 2553APPLETONWI54912391702534FOUNDATIONWI501C3LINE 11A, ITHEDACARE INC0
COMMUNITY HOSPICE FOUNDATION INC
1818 NORTH MEADE STAPPLETONWI54911391511977FOUNDATIONWI501C3LINE 7THEDACARE INC0
NEW LONDON FAMILY MEDICAL CENTER INC
1405 MILL STNEW LONDONWI54961390869788HSOPITALWI501C3LINE 3THEDACARE INC0
RIVERSIDE MEDICAL CENTER INC
800 RIVERSIDE DRIVEWAUPACAWI54891390871113HOSPITALWI501C3LINE 3THEDACARE INC0
THEDA CLARK MEDICAL CENTER FOUNDATION INC
130 SECOND STNEENAHWI54956390830664FOUNDATIONWI501C3LINE 11A, ITHEDACARE INC0
WOLF RIVER AREA HEALTHCARE FOUNDATION
1405 MILL STNEW LONDONWI54961200049796FOUNDATIONWI501C3LINE 11B, IITHEDACARE INC0
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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