2011-07-21T14:52:27-05:00 2010-12-31 RSM MCGLADREY INC PO BOX 5946 MADISON WI 537050946 990 2010-01-01 391459276 APPLETON MEDICAL CENTER FOUNDATION INC APPL 9207386506 1818 NORTH MEADE STREET APPLETON WI 54911 DEAN HIGH 9207386506 2011-07-06 1 JAMES G GRAHAM 6088333361 2010 2016-02-24 21:20:13Z DEAN HIGH 1818 NORTH MEADE STREET APLETON WI 54911 6041124 0 X WWW.AMCFOUNDATION.ORG X 1983 WI ENHANCE THE HEALTH OF OUR COMMUNITIES. 16 13 0 29 0 0 243392 1306897 0 0 235618 -1166440 38129 78896 517139 219353 776059 298700 0 0 227039 248609 0 0 232240 66015 90726 1069113 638035 -551974 -418682 9064943 10807039 122854 28782 8942089 10778257 ENHANCE THE HEALTH OF OUR COMMUNITIES. 0 0 283953 TO RAISE FUNDS AND CARRY OUT THE PURPOSES OF THE APPLETON MEDICAL CENTER, APPLETON, WI. THESE PURPOSES INCLUDE THE ENCOURAGEMENT OF EFFECTIVE SERVICES WITHIN AND AROUND APPLETON AND THE GREATER FOX VALLEY AREA BY PROVIDING SCHOLARSHIPS AND GRANTS TO ORGANIZATIONS THAT SUPPORT AMC'S PURPOSE. TO CREATE AND SUPPORT HOSPITAL HEALTH CARE INITIATIVES THROUGH FUNDING FOR THE APPLETON MEDICAL CENTER AND RELATED OTHER COMMUNITY HEALTH CARE PROVIDERS. 14747 12 SCHOLARSHIPS WERE GRANTED TO INDIVIDUALS WHO ARE GOING INTO THE MEDICAL FIELD OF STUDY. 298700 1 1 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 0 0 0 0 1 0 0 1 1 1 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 16 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X X JOSEPH W ENGELS 9208305971 122 E COLLEGE AVENUE PO BOX 8025 APPLETON WI 549128025 JOYCE BYTOF 1.00 X 0 0 0 STEVE DUNGAR MD 1.00 X 0 0 0 KATHRYN CORREIA 1.00 X 0 505245 89542 DAVID DUPPLER MD 1.00 X 0 0 0 JAY FULKERSON 1.00 X 0 0 0 WALTER RUGLAND 1.00 X 0 0 0 BARBARA UEHLING 1.00 X 0 0 0 CYRIL WALSH MD 1.00 X X 0 0 0 PETER SCHUBBE DC 1.00 X 0 0 0 DIANE ABRAHAM 16.00 X X 58418 58418 14262 C RAYMOND DURKEE 1.00 X 0 0 0 DEAN HIGH 1.00 X X 0 0 0 JEFF RIESTER 1.00 X X 0 0 0 JAMES R WILSON 1.00 X X 0 0 0 OSCAR BOLDT 1.00 X 0 0 0 RICHARD CALDER 1.00 X 0 0 0 PAULA CHANDLER 1.00 X 0 0 0 TIM OLSON 1.00 X 0 412161 100566 DAVID B ANDERLA MD 1.00 X 0 0 0 PASTOR ALAN SCHAFFMEYER 1.00 X 0 0 0 KIM BARNAS 10.00 X X 0 204482 14489 58418 1180306 218859 0 0 1 0 0 1095829 211068 8784 1306897 112227 112227 4514342 5793009 -1278667 -1278667 -1278667 107658 28762 78896 78896 219353 0 0 -1087544 270453 270453 28247 28247 58418 29209 29209 190191 32943 157248 11820 11820 3177 794 2383 2336 2336 SERVICES 25686 12843 12843 WEBSITE 13802 6901 6901 PRINTING 13028 13028 ASSET MANAGEMENT FEES 7518 7518 SUPPLIES 4159 1372 2787 9200 1359 7841 638035 298700 107095 232240 1118964 144727 135269 8920216 9552806 9064943 10807039 122854 28782 122854 28782 X 5231300 5872842 2137461 3328782 1573328 1576633 8942089 10778257 9064943 10807039 X -418682 2254850 X 0 1 1 X 0 X 4251759 273121 660549 243392 1306897 6735718 4251759 273121 660549 243392 1306897 6735718 6735718 978990 990640 247961 235618 112227 2565436 9301154 0.72420 0.68430 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5148663 3305 64028 27168 5188828 4876903 1370 287444 17054 5148663 5104609 7064 -234181 589 4876903 0.69610 0.30390 0 0 0 219353 638035 -418682 2254850 2254850 1836168 2502965 2254850 28762 2283612 219353 0 219353 666797 28762 28762 638035 0 638035 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. HIGH FLYING GOLF OUTING 78625 78625 15583 4862 LAUGHTER IS THE BEST MEDICINE 29033 29033 4358 3959 107658 107658 19941 8821 28762 78896 1 APPLETON MEDICAL CENTER INC 130 SECOND ST NEENAH WI 54956 390824015 3 211660 GENERAL APPLETON SCHOOL DISTRICT 122 EAST COLLEGE AVENUE SUITE 1A APPLETON WI 54911 3 25000 AASD AFTER SCHOOL RESEARCH PROJECT LIVING HEALTH COMMUNITY CLINIC 510 DOCTORS CT OSHKOSH WI 54901 391805963 3 30000 GENERAL SCHOLARSHIPS 13 28247 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: 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. X X X X 0 1 0 0 0 0 0 0 0 KATHRYN CORREIA 0 373218 0 122629 0 9398 0 75053 0 14489 0 594787 0 0 TIM OLSON 0 322102 0 67349 0 22710 0 87350 0 13216 0 512727 0 0 KIM BARNAS 0 183023 0 17844 0 3615 0 0 0 14489 0 218971 0 0 PART I, LINE 4A KATHRYN 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. FORM 990, PART VI, SECTION B, LINE 11 A DRAFT OF THE FORM 990 IS PROVIDED TO THE ORGANIZATION'S DESIGNATED COMMITTEE OF THE BOARD OF DIRECTORS FOR REVIEW AND DISCUSSION AT A BOARD MEETING. THE FINAL VERSION OF THE FORM 990 IS EMAILED TO THE ENTIRE BOARD BEFORE THE RETURN IS FILED. FORM 990, PART VI, SECTION B, LINE 12C ENFORCEMENT OF CONFLICTS POLICY IS REVIEWED AND SIGNED OFF BY EACH BOARD MEMBER ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 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 C, LINE 19 ALL ARE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 2,254,850. THEDACARE INC 122 EAST COLLEGE AVENUE APPLETON WI 54912 391509362 HEALTHCARE WI 501C3 LINE 11C, III-FI THEDACARE INC 0 APPLETON MEDICAL CENTER INC 1818 NORTH MEADE ST APPLETON WI 54911 390824015 HOSPITAL WI 501C3 LINE 3 THEDACARE INC 0 THEDA CLARK MEDICAL CENTER INC 130 SECOND ST NEENAH WI 54956 311550056 HOSPITAL WI 501C3 LINE 3 THEDACARE INC 0 GEORGE F PEABODY FOUNDATION INC PO BOX 2553 APPLETON WI 54912 391702534 FOUNDATION WI 501C3 LINE 11A, I THEDACARE INC 0 COMMUNITY HOSPICE FOUNDATION INC 1818 NORTH MEADE ST APPLETON WI 54911 391511977 FOUNDATION WI 501C3 LINE 7 THEDACARE INC 0 NEW LONDON FAMILY MEDICAL CENTER INC 1405 MILL ST NEW LONDON WI 54961 390869788 HSOPITAL WI 501C3 LINE 3 THEDACARE INC 0 RIVERSIDE MEDICAL CENTER INC 800 RIVERSIDE DRIVE WAUPACA WI 54891 390871113 HOSPITAL WI 501C3 LINE 3 THEDACARE INC 0 THEDA CLARK MEDICAL CENTER FOUNDATION INC 130 SECOND ST NEENAH WI 54956 390830664 FOUNDATION WI 501C3 LINE 11A, I THEDACARE INC 0 WOLF RIVER AREA HEALTHCARE FOUNDATION 1405 MILL ST NEW LONDON WI 54961 200049796 FOUNDATION WI 501C3 LINE 11B, II THEDACARE INC 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0