2011-11-04T15:59:20-05:00 2010-12-31 RSM MCGLADREY INC PO BOX 5946 MADISON WI 537050946 990 2010-01-01 391509362 THEDACARE INC THED 9207355560 122 EAST COLLEGE AVENUE APPLETON WI 54911 TIM A OLSON 9207355560 2011-10-19 1 JAMES G GRAHAM 6088333361 2010 2016-03-07 17:11:31Z TIM A OLSON 122 EAST COLLEGE AVENUE APPLETON WI 54911 244661189 0 X WWW.THEDACARE.ORG X 1985 WI IMPROVING THE HEALTH OF OUR COMMUNITY. 15 11 6167 0 4148897 -83694 150912 530471 222261076 237423136 -639217 45900 5535237 5190724 227308008 243190231 10335604 2420009 0 0 166372783 169126713 0 0 0 77124157 84601210 253832544 256147932 -26524536 -12957701 486710014 241298868 719583169 459587454 -232873155 -218288586 X IMPROVING THE HEALTH OF OUR COMMUNITY. 0 0 111059764 112323724 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. 71424739 2420009 69892801 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. 34458386 42023504 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. 12665243 12261670 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. 12665243 12261670 229608132 1 1 0 1 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 1 438 0 1 6167 1 1 1 0 0 0 0 0 0 0 0 0 X 15 11 0 0 0 0 0 0 0 1 1 0 0 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 349063 523595 166258 KATHLEEN M QUALHEIM MD 40.00 X 343942 0 22049 DAVID ANDERLA MD 40.00 X 260906 0 22719 OMAR ATASSI MD 2.00 X 0 0 0 DOUGLAS MOARD MD 40.00 X 253454 0 22458 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 5.00 X 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 164864 247296 100567 ROSELLEN CROW 40.00 X 165279 247917 64311 BRIAN R BURMEISTER 40.00 X 284915 0 61721 KEITH J LIVINGSTON 40.00 X 149047 223571 75732 MAUREEN PISTONE 40.00 X 119686 179529 70643 TERRY DIETRICH MD 40.00 X 712446 0 24595 ERIC W ERICKSON MD 40.00 X 1165253 0 24415 TODD B SMITH MD 40.00 X 806871 0 24595 GREGORY DEVINE 40.00 X 189055 283581 82239 GREGORY LONG 40.00 X 179167 268752 98137 5143948 1974241 860439 14 0 1 0 GODFREY & KAHN SC 100 WEST LAWRENCE MILWAUKEE WI 532880318 LEGAL 854543 THE REVERE GROUP LTD 2166 PAYSPHERE CIRCLE CHICAGO IL 60674 BUSINESS ADVISOR 768373 VITALIZE CONSULTING SOL INC 248 MAIN ST STE 101 READING MA 01867 CONSULTING 645935 BOTTOM LINE MARKETING AND PUBLIC RELATIO 600 W VIRGINIA ST MILWAUKEE WI 532041556 MARKETING 330728 THIRSTY BOY LLC 223 N WATER ST STE 200 MILWAUKEE WI 53202 ADVERTISING 316529 23 476584 53887 530471 PATIENT/CLIENT REVENUE 900099 166345428 166345428 MANAGEMENT SERVICE FEE 900099 66928811 66928811 SOFTWARE SERVICES 541511 3994466 3994466 DURABLE MEDICAL EQUIP 621610 89893 89893 DURABLE MEDICAL EQUIP 621610 64538 64538 237423136 1689788 1426318 263470 263470 263470 90540 44640 45900 45900 45900 INFORMATION TECHNOLOGY 900099 1444244 1444244 OTHER MISC 900009 1365055 1365055 EQUITY GAIN IN AFFILIA 900099 598209 598209 1519746 1519746 4927254 243190231 236501699 4148897 2009164 2420009 2420009 2414338 858301 1556037 134556856 124653107 9903749 5534509 4325847 1208662 19097039 14118582 4978457 7523971 6452447 1071524 1097379 165666 931713 1130955 963543 167412 184848 184848 6152404 4461144 1691260 2135192 1769909 365283 1925703 1540081 385622 6680303 5344242 1336061 10809087 9972502 836585 1230274 1140933 89341 1035872 949216 86656 1349381 1349381 7396673 7106323 290350 1117657 990484 127173 SUPPLIES 12918871 12876552 42319 PURCHASED SERVICES 10171999 9758325 413674 COST OF GOODS SOLD 5587058 5587058 BAD DEBT EXPENSE 3149982 3144541 5441 HOSPICE PATIENT CARE 2314362 2314362 8213210 7345577 867633 256147932 229608132 26539800 0 40985307 34234031 22748730 23422156 898200 623666 12382560 10554542 210750953 107411407 138246729 103339546 51874903 42006440 219573585 27118487 486710014 241298868 58520139 55061075 1295216 1288067 255805000 249940000 10259778 14936629 393703036 138361683 719583169 459587454 X -232873155 -218288586 -232873155 -218288586 486710014 241298868 X -12957701 27542270 X X 0 1 1 X 0 X X X 0 0 0 THEDA CLARK MEDICAL CENTER INC 390830664 3 0 1 1 11300 APPLETON MEDICAL CENTER INC 390824015 3 0 1 1 1095829 NEW LONDON FAMILY MEDICAL CENTER INC 390869788 3 0 1 1 0 RIVERSIDE MEDICAL CENTER INC 390871113 3 0 1 1 0 4 1107129 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 26210 0 0 0 0 0 26210 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: 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 71179435 18813073 52366362 678348 226362 451986 118398690 88371972 30026718 12276877 12276877 103339546 CAPITAL FUNDS COMMITTED TO HOSPITAL 22309469 LICENSE FEES- NET OF AMORTIZATION 4809018 27118487 DUE TO AFFILIATES 90498498 DEFERRED EMPLOYEE BENEFITS 45425075 DEFERRED GAIN ON SALE OF BUILDING 1429238 LONG TERM DEBT-ARO ACCRETION 1008872 138361683 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, 2010 AND 2009, THERE WERE NO UNRECOGNIZED TAX BENEFITS IDENTIFIED OR RECORDED AS LIABILITIES. THEDACARE FILES FORMS 990 IN THE U.S. FEDERAL JURISDICTION. TAX RETURNS FILED BY THEDACARE ARE GENERALLY OPEN FOR EXAMINATION FOR THE YEARS 2007 THROUGH 2010. 0 THEDACARE CENTER FOR CREATING VALUE 100 W LAWRENCE ST APPLETON WI 54911 262795800 501 (C) (3) 1000000 GENERAL FOX CITIES COMMUNITY HEALTH CENTER 1814 APPLETON ROAD MENASHA WI 54952 202090446 501 (C) (3) 105000 GENERAL WISCONSIN HEALTH INFORMATION ORGANIZATION (WHIO) 200 WILLIAM STREET 303 DEPERE WI 54115 203493804 501 (C) (3) 10000 BUILDING THEDA CLARK MEDICAL CENTER FOUNDATION 130 SECOND ST NEENAH WI 54956 311550056 501 (C) (3) 11300 GENERAL WOLF RIVER AREA HEALTH CARE FOUNDATION 1405 MILL ST NEW LONDON WI 54961 200049796 501 (C) (3) 6000 GENERAL COMMUNITY HOSPICE FOUNDATION INC PO BOX 1534 APPLETON WI 54912 391511977 501 (C) (3) 7235 GENERAL APPLETON MEDICAL CENTER FOUNDATION INC 1818 NORTH MEADE STREET APPLETON WI 54911 391459276 501 (C) (3) 1095829 GENERAL GEORGE F PEABODY FOUNDATION PO BOX 1534 APPLETON WI 54912 391702534 501 (C) (3) 6000 GENERAL UNITED WAY OF THE FOX CITIES INC 1455 MIDWAY ROAD MENASHA WI 54952 390912895 501 (C) (3) 178645 GENERAL 9 X X 1 1 X X X X 0 1 0 0 0 0 0 1 0 DEAN A GRUNER MD 242352 363528 101347 152021 5364 8046 60540 90810 5963 8945 415566 623350 0 0 KATHLEEN M QUALHEIM MD 341645 0 1135 0 1162 0 9350 0 12699 0 365991 0 0 0 DAVID ANDERLA MD 258599 0 1135 0 1172 0 9350 0 13369 0 283625 0 0 0 DOUGLAS MOARD MD 236616 0 16135 0 703 0 9067 0 13391 0 275912 0 0 0 TIM A OLSON 128841 193261 26939 40409 9084 13626 34940 52410 5287 7930 205091 307636 0 0 ROSELLEN CROW 122269 183403 27436 41154 15574 23360 23186 34779 2538 3808 191003 286504 0 0 BRIAN R BURMEISTER 219678 0 48120 0 17117 0 48147 0 13574 0 346636 0 0 0 KEITH J LIVINGSTON 115594 173390 25374 38062 8079 12119 25100 37650 5193 7789 179340 269010 0 0 MAUREEN PISTONE 90872 136307 19905 29858 8909 13364 23197 34796 5060 7590 147943 221915 0 0 TERRY DIETRICH MD 466357 0 238565 0 7524 0 9350 0 15245 0 737041 0 0 0 ERIC W ERICKSON MD 504859 0 659368 0 1026 0 9350 0 15065 0 1189668 0 0 0 TODD B SMITH MD 499999 0 305846 0 1026 0 9350 0 15245 0 831466 0 0 0 GREGORY DEVINE 153044 229567 33494 50241 2517 3773 27100 40650 5796 8693 221951 332924 0 0 GREGORY LONG 140308 210463 30734 46101 8125 12188 33900 50850 5355 8032 218422 327634 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 PURPOSES OF DEVELOPING BUSINESS RELATIONSHIPS HAVE COMPANY PAID MEMBERSHIPS AT A LOCAL COUNTRY CLUB. 12 EMPLOYEES RECEIVED TAXABLE MEDICAL EXPENSE REIMBURSEMENTS AND 6 EMPLOYEES RECEIVED CLUB DUES REIMBURSEMENTS. PART I, LINE 4B 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 BONUS 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, 2009 TO DECEMBER 31, 2009) TO RECEIVE THEIR 2010 BONUSES. IF THE EMPLOYEE RETIRES, BECOMES DISABLED, MOVES TO A POSITION THAT IS ELIGIBLE UNDER THE BONUS PLAN OR MOVES TO A POSITION THAT IS NO LONGER ELIGIBLE FOR THE BONUS 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 BONUS 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 ACTUAL OPERATING PROFIT OVER BUDGET. ALL ELIGIBLE EMPLOYEES (ON THE PAYROLL AS OF JULY 1, 2010 AND STILL BE ON THE PAYROLL AS OF MARCH 15, 2011) 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 4436000 507610 53675584 2007 0 0 1 1 87896508 6037000 4729000 1018634 74093000 7167000 2010 0 0 0 1 36717948 1693000 425525 34599423 1 0 1 1 25345018 332397 25012621 1 0 1 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 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 BONUS 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 16,121,544. PENSION RELATED CHANGES 11,229,710. ASSETS RELEASED FROM RESTRICTION 191,016. TOTAL TO FORM 990, PART XI, LINE 5: 27,542,270. 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. EMPLOYEES WHOSE USUAL WORK LOCATION IS A FACILITY WHOSE FINANCIAL REPORTING IS INCLUDED IN THE THEDACARE INC. FORM 990. 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 GOLD CROSS AMBULANCE SERVICE INC 1055 WITTMAN DRIVE MENASHA WI 54952 391702433 AMBULANCE WI 501(C)(3) LINE 7 0 CRITICAL CARE SOLUTIONS LLC 9200 WEST WISCONSIN AVE MILWAUKEE WI 53226 202636740 EICU WI 501(C)(3) LINE 3 0 QUALITY HEALTH SOLUTIONS LLC N74 W12501 LEATHERWOOD COURT MENOMINEE FALLS WI 53051 202636686 HEALTHCARE WI 501(C)(3) LINE 3 0 APPLETON MEDICAL CENTER FOUNDATION 1818 N MEADE APPLETON WI 54911 391459276 FOUNDATION WI 501(C)(3) LINE 7 THEDACARE 0 THEDA CLARK FOUNDATION 130 SECOND STREET NEENAH WI 54956 391550056 FOUNDATION WI 501(C)(3) LINE 7 THEDACARE 0 WOLF RIVER FOUNDATION 1405 MILL STREET NEW LONDON WI 54961 200049796 FOUNDATION WI 501(C)(3) LINE 7 THEDACARE 0 COMMUNITY HOSPICE FOUNDATION 1818 N MEADE APPLETON WI 54911 391511977 FOUNDATION WI 501(C)(3) LINE 7 THEDACARE 0 GEORGE PEABODY FOUNDATION PO BOX 2553 APPLETON WI 54912 391702534 FOUNDATION WI 501(C)(3) LINE 7 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 AYLWARD CLINICAL SERVICES CO LLC PO BOX 2021 NEENAH WI 54956 204202274 MGMT SERVICE WI N/A RELATED 285317 947644 0 1 0.50000 GROTH CLINICAL SERVICES CO LLC 1818 N MEADE ST APPLETON WI 54911 204202228 MGMT SERVICE WI N/A RELATED 83871 912059 0 1 0.50000 PREMIUM HEALTHCARE INC PO BOX 8025 APPLETON WI 54912 200120381 CONT ADMIN WI N/A C 21501 56735 0.50000 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0