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← THEDACARE MEDICAL CENTER-WILD ROSE INC

Form 990 for tax year 2022

Filed by THEDACARE MEDICAL CENTER-WILD ROSE INC.

Totals

Total revenue
$13,541,510
Total expenses
$13,218,467
Contributions and grants received
$359,617
Grants paid
$0
Program service revenue
$12,887,431
Investment income
$0
Other revenue
$294,462
Total assets, end of year
$9,611,199
Total liabilities, end of year
$4,862,795
Net assets or fund balances, end of year
$4,748,404
Program services expenses (Part IX)
$10,821,237
Management and general expenses
$2,397,230
Fundraising expenses
$0
Program service expenses (Part III)
$10,821,237

Program services were 81.9% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 1d · Related organizations

    $10,100

  • 1e · Government grants (contributions)

    $349,473

  • 1f · All other contributions, gifts and grants

    $44

  • 2a · Program service revenue: Net Patient Service Revenue

    total $12,887,431 · related or exempt $12,887,431

  • 2f · All other program service revenue

    total $0 · related or exempt $0 · unrelated business $0 · excluded $0

  • 6c · Rental income or loss

    real property $0 · personal property $0

  • 7c · Gain or loss

    securities $0 · other assets $0

  • 11a · Other revenue: Other operating revenue

    total $276,476 · excluded $276,476

  • 11b · Other revenue: Cafeteria revenue

    total $17,986 · excluded $17,986

  • 11d · All other revenue

    total $0 · related or exempt $0 · unrelated business $0 · excluded $0

  • 11e · Other revenue, total

    $294,462

Functional expenses

Part IX, the statement of functional expenses.

  • 7 · Other salaries and wages

    total $6,930,878 · program services $6,233,610 · management and general $697,268

  • 8 · Pension plan contributions

    total $151,630 · program services $128,199 · management and general $23,431

  • 9 · Other employee benefits

    total $953,094 · program services $805,813 · management and general $147,281

  • 10 · Payroll taxes

    total $357,690 · program services $302,416 · management and general $55,274

  • 11a · Fees: management

    total $242,927 · management and general $242,927

  • 11g · Fees: other

    total $2,470,224 · program services $1,377,478 · management and general $1,092,746 · fundraising $0

  • 12 · Advertising and promotion

    total $1,254 · program services $1,254

  • 13 · Office expenses

    total $79,647 · program services $79,647

  • 16 · Occupancy

    total $264,555 · program services $264,555

  • 17 · Travel

    total $22,444 · program services $22,444

  • 19 · Conferences, conventions and meetings

    total $12,247 · program services $12,247

  • 22 · Depreciation, depletion and amortization

    total $494,164 · program services $355,861 · management and general $138,303

  • 23 · Insurance

    total $25,126 · program services $25,126

  • 24a · Other expenses: Medical Supplies

    total $764,568 · program services $764,568

  • 24b · Other expenses: Equipment & Maintenance

    total $321,241 · program services $321,241

  • 24c · Other expenses: Food/nutrition

    total $89,948 · program services $89,948

  • 24d · Other expenses: Medicaid Assessment

    total $36,830 · program services $36,830

  • 24e · All other expenses

    total $0 · program services $0 · management and general $0 · fundraising $0

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $1,902,226 · end of year $1,865,586

  • 4 · Accounts receivable

    beginning of year $1,857,717 · end of year $1,802,690

  • 5 · Loans and receivables from officers and key people

    beginning of year $0 · end of year $0

  • 6 · Loans and receivables from disqualified persons

    beginning of year $0 · end of year $0

  • 8 · Inventories for sale or use

    beginning of year $137,190 · end of year $143,226

  • 9 · Prepaid expenses and deferred charges

    beginning of year $8,621 · end of year $4,334

  • 10a · Land, buildings and equipment: cost or other basis

    $6,711,260

  • 10b · Land, buildings and equipment: accumulated depreciation

    $3,021,779

  • 10c · Land, buildings and equipment, net

    beginning of year $3,873,560 · end of year $3,689,481

  • 12 · Investments: other securities

    beginning of year $0

  • 13 · Investments: program-related

    beginning of year $0

  • 15 · Other assets

    beginning of year $1,226,028 · end of year $2,105,882

  • 17 · Accounts payable and accrued expenses

    beginning of year $242,456 · end of year $121,983

  • 19 · Deferred revenue

    beginning of year $349,473

  • 22 · Loans and payables to officers and key people

    beginning of year $0 · end of year $0

  • 23 · Secured mortgages and notes payable

    beginning of year $12

  • 25 · Other liabilities

    beginning of year $3,988,040 · end of year $4,740,812

  • 27 · Net assets without donor restrictions

    beginning of year $4,425,361 · end of year $4,748,404

Mission and programs · 2022

Mission

TO PROVIDE THE HIGHEST QUALITY HEALTH CARE, DELIVERED IN THE MOST EFFICIENT AND COST-EFFECTIVE WAYS, AND ACCESSIBLE TO ALL MEMBERS OF THE COMMUNITY.

Activities or mission (Part I)

IMPROVING THE HEALTH OF OUR COMMUNITY.

  • THEDACARE IS A TAX-EXEMPT, NON-PROFIT CORPORATION, AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THEDACARE MEDICAL CENTER-WILD ROSE IS A 25-BED CRITICAL ACCESS HOSPITAL SERVING WILD ROSE AND NEARBY COMMUNITIES. THERE ARE MORE THAN 90 TEAM MEMBERS LOCATED AT THE WILD ROSE LOCATION. THEDACARE MEDICAL CENTER-WILD ROSE PROVIDES PATIENT CARE AND SUPPORT SERVICES INCLUDING DIAGNOSTIC SERVICES SUCH AS X-RAY, ULTRASOUND, MRI, CT SCAN, MAMMOGRAPHY AND MEDICAL LABORATORY TESTING AND SPECIALTY SERVICES SUCH AS CANCER CARE, CARDIOVASCULAR CARE, ORTHOPEDIC CARE, SPINE, NEUROLOGY, FAMILY BIRTH CARE, INTERNAL MEDICINE, EMERGENCY, OCCUPATIONAL HEALTH, PULMONOLOGY, UROLOGY, WOMEN'S CARE, OUTPATIENT SURGERY AND THERAPY SERVICES. AS PART OF THE THEDACARE SYSTEM, WE OFFER PUBLIC AWARENESS CAMPAIGNS, CHARITY CARE, SUPPORT GROUPS AND EDUCATION PROGRAMS TARGETED TO LOCAL COMMUNITY NEEDS. THEDACARE IS COMMITTED TO COMMUNITY FOCUSED EFFORTS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT IN COUNTIES (WAUSHARA) WHERE SERVICES ARE PROVIDED. EFFORTS INCLUDE PARTNERSHIPS WITH LOCAL GOVERNMENTS, COMMUNITY PARTNERS, AND AREA HEALTH ORGANIZATIONS TO ADDRESS THE TOP HEALTH PRIORITIES IDENTIFIED IN ITS MOST RECENT CHNA. THEDACARE OPERATES ON A NON-DISCRIMINATORY BASIS REGARDLESS OF RACE, COLOR, SEX, RELIGION, OR NATIONAL ORIGIN. THEDACARE PROVIDES A VARIETY OF FINANCIAL ASSISTANCE OPTIONS TO PATIENTS WHO MEET ESTABLISHED CRITERIA. SERVICES ARE ALSO PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES.

    Expenses $10,821,237 · Revenue $12,887,431

As filed on the 2022 return.

Listed in Part VII

  • Carol Williams

    Secretary/Treasurer, Board Member

    Total calculated
    $0
    Hours/week
    1

  • Dan Mielke

    Chair, Board Member

    Total calculated
    $0
    Hours/week
    1

  • Mark Kjentvet

    Vice Chair, Board Member

    Total calculated
    $0
    Hours/week
    1

  • Chandler Caves MD

    Board Member/Chief of Staff

    Total calculated
    $582,959
    From this org
    $0
    From related orgs
    $530,052
    Other
    $52,907
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $0 + $527,808 related
    Bonus
    $0 + $450 related
    Other
    $0 + $1,794 related
    Deferred
    $0 + $38,443 related
    Nontaxable benefits
    $0 + $14,464 related
    Filer's total
    $0 + $582,959 related

  • James Erdman

    Board Member

    Total calculated
    $0
    Hours/week
    1

  • Karen West

    Board Member

    Total calculated
    $0
    Hours/week
    1

  • Lynn Detterman

    Board Member/Senior VP-South Region

    Total calculated
    $887,847
    From this org
    $0
    From related orgs
    $657,539
    Other
    $230,308
    Hours/week
    20 + 20 related

    Schedule J breakdown matched by us

    Base
    $0 + $453,427 related
    Bonus
    $0 + $196,369 related
    Other
    $0 + $7,742 related
    Deferred
    $0 + $206,397 related
    Nontaxable benefits
    $0 + $23,911 related
    Filer's total
    $0 + $887,847 related

  • Paul Smith

    Board Member

    Total calculated
    $0
    Hours/week
    1

  • Sherry Brownlow

    Board Member

    Total calculated
    $0
    Hours/week
    1

  • Tammy Bending

    Board Member/Vice President-CAH Operations

    Total calculated
    $357,368
    From this org
    $0
    From related orgs
    $283,952
    Other
    $73,416
    Hours/week
    20 + 20 related

    Schedule J breakdown matched by us

    Base
    $0 + $218,799 related
    Bonus
    $0 + $62,614 related
    Other
    $0 + $2,540 related
    Deferred
    $0 + $65,222 related
    Nontaxable benefits
    $0 + $8,194 related
    Filer's total
    $0 + $357,368 related

  • Terry Martz

    Board Member

    Total calculated
    $0
    Hours/week
    1

  • Imran Andrabi MD

    President & CEO - System

    Total calculated
    $2,463,471
    From this org
    $0
    From related orgs
    $1,808,832
    Other
    $654,639
    Hours/week
    4 + 36 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,069,773 related
    Bonus
    $0 + $625,104 related
    Other
    $0 + $113,954 related
    Deferred
    $0 + $654,639 related
    Nontaxable benefits
    $0
    Filer's total
    $0 + $2,463,471 related

  • James Albin

    Chief Information Officer

    Total calculated
    $543,374
    From this org
    $0
    From related orgs
    $494,205
    Other
    $49,169
    Hours/week
    4 + 36 related

    Schedule J breakdown matched by us

    Base
    $0 + $219,539 related
    Bonus
    $0 + $170,014 related
    Other
    $0 + $104,652 related
    Deferred
    $0 + $38,878 related
    Nontaxable benefits
    $0 + $10,291 related
    Filer's total
    $0 + $543,374 related

  • Maggie Lund

    Chief Human Resource Officer

    Total calculated
    $700,683
    From this org
    $0
    From related orgs
    $534,688
    Other
    $165,995
    Hours/week
    4 + 36 related

    Schedule J breakdown matched by us

    Base
    $0 + $370,127 related
    Bonus
    $0 + $157,543 related
    Other
    $0 + $7,018 related
    Deferred
    $0 + $157,901 related
    Nontaxable benefits
    $0 + $8,094 related
    Filer's total
    $0 + $700,683 related

  • Mark Thompson

    Senior VP, CFO & COO - System

    Total calculated
    $1,471,929
    From this org
    $0
    From related orgs
    $1,160,821
    Other
    $311,108
    Hours/week
    4 + 36 related

    Schedule J breakdown matched by us

    Base
    $0 + $823,122 related
    Bonus
    $0 + $321,783 related
    Other
    $0 + $15,916 related
    Deferred
    $0 + $287,197 related
    Nontaxable benefits
    $0 + $23,911 related
    Filer's total
    $0 + $1,471,929 related

  • Brian Sterns

    Chief Digital Health Officer

    Total calculated
    $402,329
    From this org
    $0
    From related orgs
    $266,613
    Other
    $135,716
    Hours/week
    4 + 36 related

    Schedule J breakdown matched by us

    Base
    $0 + $200,386 related
    Bonus
    $0 + $59,016 related
    Other
    $0 + $7,210 related
    Deferred
    $0 + $111,805 related
    Nontaxable benefits
    $0 + $23,911 related
    Filer's total
    $0 + $402,329 related

  • Thomas Arquilla

    Chief Strategy Officer

    Total calculated
    $927,019
    From this org
    $0
    From related orgs
    $738,065
    Other
    $188,954
    Hours/week
    4 + 36 related

    Schedule J breakdown matched by us

    Base
    $0 + $479,252 related
    Bonus
    $0 + $200,574 related
    Other
    $0 + $58,239 related
    Deferred
    $0 + $171,313 related
    Nontaxable benefits
    $0 + $17,641 related
    Filer's total
    $0 + $927,019 related

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 3 · Compensation committee
  • 3 · Independent compensation consultant
  • 3 · Compensation survey or study
  • 3 · Approval by the board or compensation committee
  • 4b · Supplemental nonqualified retirement plan
  • 7 · Other non-fixed payments

Answered no

  • 4a · Severance or change-of-control payment
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan
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 409(A) AND 457(F) OF THE INTERNAL REVENUE CODE. PARTICIPANTS MAY ELECT THE BENEFIT TO BE USED TO PURCHASE PARTICULAR INSURANCE BENEFITS, INVEST IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN, 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 THE YEAR, THE FOLLOWING INDIVIDUALS PARTICIPATED IN AND RECEIVED PAYMENT FROM THE PLAN: IMRAN ANDRABI, MD $102,463 THOMAS ARQUILLA $45,524 JAMES ALBIN $95,700 DURING THE YEAR, THE FOLLOWING INDIVIDUALS ACCRUED AN AMOUNT FROM THE PLAN, WHICH IS INCLUDED IN DEFERRED COMPENSATION: IMRAN ANDRABI, MD $162,871 LYNN DETTERMAN $45,363
Schedule J, Part I, Line 7 Non-fixed payments
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 LEADERS AND TO WORK TOGETHER AS A COHESIVE GROUP TOWARD COMMON GOALS. LEADERS FROM MANAGEMENT LEVEL TO THE PRESIDENT AND CEO ARE ELIGIBLE TO PARTICIPATE IN THIS PLAN. THE PERCENTAGE FOR WHICH AN INDIVIDUAL IS ELIGIBLE IS DETERMINED BY THE PARAMETERS LISTED FOR THE LEADERSHIP POSITION AND IN THE PLAN DOCUMENT ON FILE. LEADERS MAKE RECOMMENDATIONS FOR THEIR MANAGEMENT LEVEL DIRECT REPORTS TO THEIR EXECUTIVE LEADER BASED ON PERFORMANCE RESULTS. THE PRESIDENT AND CEO ALSO REVIEWS AND APPROVES. FOR SENIOR VICE PRESIDENTS, THE EXECUTIVE LEADERSHIP TEAM, AND THE PRESIDENT AND CEO, THE RECOMMENDATIONS ARE REVIEWED AND APPROVED BY THE HUMAN RESOURCES AND GOVERNANCE COMMITTEE OF THE BOARD AND THE EXECUTIVE COMMITTEE OF THE BOARD. THESE COMMITTEES ALSO REVIEW THE TOTAL SPEND FOR THE INCENTIVE PLANS. THESE LEADERS MUST BE IN ACTIVE REGULAR SERVICE OF THEDACARE, INC. FOR THE ENTIRE PLAN YEAR (JANUARY 1, 2022, TO DECEMBER 31, 2022) TO RECEIVE A 2023 BONUS. 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. EMPLOYEE ELIGIBILITY IS BASED ON THE NUMBER OF HOURS WORKED. ALL ELIGIBLE EMPLOYEES SHARE IN THE PAYOUT. THE PAYOUT AMOUNT IS A FLAT DOLLAR AMOUNT, DETERMINED BASED ON BOTH FINANCIAL AND QUALITY THRESHOLDS. THE AMOUNT PER EMPLOYEE IS DETERMINED BY DIVIDING THE TOTAL GAIN REALIZED (THE EMPLOYEE SHARE) BY HOURS PAID TO ALL ELIGIBLE EMPLOYEES. THE THEDACARE BOARD OF TRUSTEES APPROVES THE SPEND FOR THE PLAN.

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

No itemized grants to organizations on this return.

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Related partnerships

Part III: related organizations taxable as a partnership, with the filer's share.

Provenance

Return type
form_990
Tax year
2022
Filed
14 November 2023
IRS schema version
2022v5.0
Source object
202333179349312008

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