2021-09-09T09:50:48-05:00 2020-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2020-01-01 390824015 THEDACARE REGIONAL MEDICAL CENTER - APPLETON INC THED 9207355560 PO BOX 8025 APPLETON WI 549128025 MARK THOMPSON CFO & COO 9207355560 2021-08-25 1 MARK THOMPSON 999009999 KURT BENNION CPA P01469618 4252506100 2021-08-25 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z IMRAN ANDRABI MD PO BOX 8025 APPLETON WI 549128025 324166970 0 X WWW.THEDACARE.ORG X 1958 WI IMPROVING THE HEALTH OF OUR COMMUNITY. 13 10 0 230 10302 0 277183 13498518 319830701 310668300 594 152 0 0 320108478 324166970 0 0 0 0 89382525 95747627 0 0 0 160802569 175358094 250185094 271105721 69923384 53061249 618710042 663046189 9966759 2028390 608743283 661017799 X TO PROVIDE THE HIGHEST QUALITY HEALTH CARE, DELIVERED IN THE MOST EFFICIENT AND COST-EFFECTIVE WAYS, AND ACCESSIBLE TO ALL MEMBERS OF THE COMMUNITY. 0 0 210788732 0 309381782 THEDACARE IS A TAX-EXEMPT, NON-PROFIT CORPORATION, AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE.THEDACARE REGIONAL MEDICAL CENTER-APPLETON IS A 147-BED ACUTE CARE HOSPITAL, EMPLOYING MORE THAN 1,200 TEAM MEMBERS. THEDACARE REGIONAL MEDICAL CENTER-APPLETON OFFERS DIAGNOSTIC SERVICES SUCH AS X-RAY, ULTRASOUND, MRI, CAT SCAN, MAMMOGRAPHY AND MEDICAL LABORATORY TESTING, CANCER, CARDIOVASCULAR, ORTHOPEDIC, SPINE, NEUROLOGY, FAMILY BIRTH CARE, DIABETES, INTERNAL MEDICINE, EMERGENCY, OCCUPATIONAL HEALTH, PULMONOLOGY, WOMEN'S CARE, NEPHROLOGY, THERAPY SERVICES, OUTPATIENT SURGERY CENTERS AND WELLNESS PROGRAMS. THEDACARE REGIONAL MEDICAL CENTER-APPLETON HAS AN ACCREDITED CHEST PAIN AND RESUSCITATION CENTER ON CAMPUS.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 NEEDS HEALTH ASSESSMENT IN COUNTIES (OUTAGAMIE) WHERE SERVICES ARE PROVIDED. EFFORTS INCLUDE PARTNERSHIPS WITH GOLD CROSS AMBULANCE SERVICE, CATALPA MENTAL HEALTH (MENTAL HEALTH AND WELLNESS FOR CHILDREN), MOSAIC (COMMUNITY PHYSICIAN TRAINING), UNITED WAY, THE WEIGHT OF THE FOX VALLEY (HEALTHY WEIGHT INITIATIVE) & PARTNERSHIP COMMUNITY HEALTH CENTER (AFFORDABLE MEDICAL, DENTAL AND BEHAVIORAL HEALTH SERVICES), STAR PROJECT (DIVERSITY), EARLY CHILDHOOD EDUCATION, VOICES OF MEN (SEXUAL ASSUALT AND DOMESTIC VIOLENCE) AND REACH OUT AND READ (CHILDHOOD LITERACY).ADDITIONALLY, THEDACARE PROVIDES SCHOLARSHIPS, CHARITY CARE, INTERPRETING AND EDUCATIONAL SERVICES AND VARIOUS OTHER COMMUNITY BENEFITS.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.HOSPITAL INPATIENT DAYS TOTALED 30,383 WITH 1,515 ADDITIONAL DAYS FOR NEWBORN CARE. 210788732 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 X 13 10 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X NATHANIEL CHERNE 9207355560 PO BOX 8025 APPLETON WI 549128025 IMRAN ANDRABIMD PRESIDENT & CEO - SYSTEM 4.00 36.00 X X 0 1243338 62201 MARK THOMPSON SENIOR VP, CFO & COO - SYSTEM 4.00 36.00 X 0 748076 64671 GARY EDELMAN MD BOARD MEMBER/PHYSICIAN 1.00 39.00 X 0 527205 62671 JAMES ALBIN CIO 4.00 36.00 X 0 429869 84171 MAGGIE LUND CHRO 4.00 36.00 X 0 389016 53009 NORMA TURK MD BOARD MEMBER/PHYSICIAN 1.00 39.00 X 0 308009 51009 BRIAN STERNS FORMER KEY EMPLOYEE 4.00 36.00 X 0 172483 58171 TERRY TIMM CHAIR 1.00 3.00 X X 0 0 0 JIM KOTEK VICE CHAIR/SECRETARY 1.00 3.00 X X 0 0 0 TIM BERGSTROM BOARD MEMBER 1.00 4.00 X 0 0 0 PATRICK BRENNAN MD BOARD MEMBER 1.00 3.00 X 0 0 0 MARK BURSTEIN BOARD MEMBER 1.00 3.00 X 0 0 0 JOHN DAVIS BOARD MEMBER 1.00 3.00 X 0 0 0 DAVID KOEPER MD BOARD MEMBER 1.00 3.00 X 0 0 0 JIM MEYER BOARD MEMBER 1.00 3.00 X 0 0 0 KAREN TIMBERLAKE BOARD MEMBER 1.00 3.00 X 0 0 0 MARIA VAN LAANAN BOARD MEMBER 1.00 3.00 X 0 0 0 0 3817996 435903 0 1 1 0 TOTAL MSP LLC 221 W COLLEGE AVENUE 2ND FLOOR APPLETON WI 54911 MEDICAL STAFFING 1607099 DAILY CARE LLC 323 N MORRISON STREET APPLETON WI 54911 MEDICAL STAFFING 1170943 TWEET GAROT MECHANICAL INC 2545 LARSEN RD GREEN BAY WI 543071767 FACILITIES REPAIRS/MAINTENANCE 883283 GE PRECISION HEALTHCARE LLC 3000 N GRANDVIEW BLVD WAUKESHA WI 53188 MEDICAL EQUIPMENT MAINTENANCE 565199 SPECIALTYCARE INC 3 MARYLAND FARMS STE 200 BRENTWOOD TN 37027 CONSULTING 515131 33 166796 13331722 13498518 INPATIENT REVENUE 621990 236899268 236899268 OUTPATIENT REVENUE 621400 72482514 72482514 CAFETERIA REVENUE 900099 900860 900860 OTHER MISCELLANEOUS REVENUE 900099 385658 10302 375356 310668300 152 152 324166970 309381782 10302 1276368 X 391554 318109 73445 77811201 58878105 18933096 17544872 8942943 8601929 30320595 14008161 16312434 16148 16148 834000 834000 9233 9233 4207251 4207251 93372 93372 73409 73409 16716 16716 13301262 10435292 2865970 364148 364148 CLIENT & PATIENT SERVIC 112613989 99083874 13530115 BAD DEBT EXPENSE 8487875 8487875 EQUIPMENT MAINTENANCE 5020096 5020096 271105721 210788732 60316989 0 81424765 72284618 39224471 42337778 4011603 5532963 1058681 459582 212128948 110076116 106080556 102052832 386909966 440378416 618710042 663046189 9741576 1180384 225183 848006 9966759 2028390 X 608743283 661017799 608743283 661017799 618710042 663046189 53061249 -786733 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7569 7569 0 PART II-B, LINE 1: A PORTION OF THE WHA DUES REPRESENT LOBBYING PERFORMED IN REGARD TO HEALTHCARE ISSUES. TOTAL DUES PAID IN 2020 WERE $66,981. 11.3% OF THIS AMOUNT WAS SPENT ON LOBBYING. 3394708 3394708 121656979 51552662 70104317 80594573 58523454 22071119 6482688 6482688 102052832 DUE FROM AFFILIATES 440378416 440378416 1 1 X 1 X 1 X 410.000000000000 1 0 1 1 1084986 1 1084985 0.00410 12770 23903107 17826464 6076643 0.02310 12770 24988093 17826465 7161628 0.02720 11 751257 2314827 2314827 0.00880 3 405 683207 683207 0.00260 3 1 2236082 2236082 0.00850 1 1104 1406381 1406381 0.00540 6 1360337 2310366 2310366 0.00880 24 2113104 8950863 8950863 0.03410 24 2125874 33938956 17826465 16112491 0.06130 1 93316 29474 29474 0.00010 1 3640 289145 289145 0.00110 1 750 245489 245489 0.00090 3 97706 564108 564108 0.00210 0 2838210 0 48090035 50093069 -2003034 X 1 1 1 1 THEDACARE REGIONAL MEDICAL CENTER - APPLETON 1818 NORTH MEADE STREET APPLETON WI 54911 WWW.THEDACARE.ORG 169 X X X THEDACARE REGIONAL MEDICAL CENTER - APPL 1 0 0 1 X X X X X X X X X 19 1 1 1 1 X SEE LINE 7D X X 1 19 1 SEE LINE 7D 0 1 X 200.000000000000 410.000000000000 X X X X X 1 1 X X X X X 1 X HTTPS://WWW.THEDACARE.ORG/POLICIES-AND-LEGAL-FORMS/PAYMENT-OPTIONS X HTTPS://WWW.THEDACARE.ORG/POLICIES-AND-LEGAL-FORMS/PAYMENT-OPTIONS X HTTPS://WWW.THEDACARE.ORG/POLICIES-AND-LEGAL-FORMS/PAYMENT-OPTIONS X X X X X X X 1 X 0 X X X 1 X 0 0 THEDACARE REGIONAL MEDICAL CENTER - APPLETON PART V, SECTION B, LINE 5: AS PART OF THE NEEDS ASSESSMENT ADVISORY TEAM, THEDACARE CONSULTED WITH THE PUBLIC HEALTH DEPARTMENTS OF OUTAGAMIE COUNTY, WINNEBAGO COUNTY, CALUMET COUNTY, SHAWANO, GREEN LAKE, MARQUETTE, WAUSHARA, WAUPACA AND THE CITY OF APPLETON.IN ADDITION, OVER THE COURSE OF A ONE YEAR PERIOD, SECONDARY DATA WAS COLLECTED, KEY INFORMANT INTERVIEWS WERE CONDUCTED, THEDACARE CHAT TEAMS (COMMUNITY HEALTH ACTION TEAM) PROVIDED INPUT AND PATIENT HEALTH DATA WAS STUDIED. VULNERABLE POPULATIONS INCLUDED LOW INCOME, RURAL FARM FAMILIES, OLDER ADULTS, VETERANS, HISPANIC/LATINO POPULATION, LESBIAN, GAY, BISEXUAL, TRANSGENDER (LGBT), HMONG POPULATION AND AFRICAN AMERICAN POPULATION. THEDACARE REGIONAL MEDICAL CENTER - APPLETON PART V, SECTION B, LINE 6A: THEDACARE REGIONAL MEDICAL CENTER-APPLETON IS A MEMBER OF THE FOX VALLEY COMMUNITY HEALTH IMPROVEMENT COALITION WHOSE MEMBERS INCLUDE THE PUBLIC HEALTH DEPARTMENTS OF CALUMET, OUTAGAMIE AND WINNEBAGO COUNTIES AND THE HEALTH DEPARTMENTS OF THE CITY OF APPLETON AND CITY OF MENASHA. MEMBERSHIP ALSO INCLUDES REPRESENTATIVES FROM CHILDREN'S HOSPITAL OF WISCONSIN, PARTNERSHIP COMMUNITY HEALTH CENTER (FQHC), AURORA HEALTH IN OSHKOSH AND AFFINITY HEALTH IN APPLETON. THIS COALITION WAS PART OF A JOINT CHNA PROCESS DURING 2019. THEDACARE REGIONAL MEDICAL CENTER - APPLETON PART V, SECTION B, LINE 7D: THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ONLINE AT HTTPS://THEDACARE.ORG/ABOUT-US/COMMUNITY-HEALTH/NEEDS-ASSESSMENT-PLANS/. THEDACARE REGIONAL MEDICAL CENTER - APPLETON PART V, SECTION B, LINE 11: THE THEDACARE COMMUNITY HEALTH IMPLEMENTATION STRATEGY WAS APPROVED BY THE THEDACARE BOARD OF TRUSTEES IN 2020.CHRONIC DISEASEESTABLISH A CULTURE THAT FOSTERS HEALTH AND WELLBEING AND REDUCES INCIDENCE OF CHRONIC DISEASE. VITAL CONDITIONS ADDRESSED: BASIC NEEDS, SOCIAL CONNECTION/BELONGING, ENVIRONMENT AND RELIABLE TRANSPORTATION.1. BE WELL FOX VALLEY IS A MULTI-SECTOR COLLABORATION WITH AREA HEALTH SYSTEMS TO ADVANCE A CULTURE OF HEALTH AND WELL-BEING. YEAR ONE STRATEGY CENTERED ON "EAT WELL FOX VALLEY," CONNECTING DIABETIC/PRE-DIABETIC RESIDENTS WITH HEALTHY FOODS. 2. BWFV IS CO-LED BY DR. JENNIFER FRANK, WITH DR. ANDRABI AND PAULA MORGEN SERVING ON THE ANCHOR LEADER GROUP AND PAULA ALSO SERVING ON THE LEADERSHIP TEAM. MULTIPLE TC STAFF ARE ENGAGED IN EAT WELL FOX VALLEY WORK TEAMS. TC PROVIDED $90,000 IN BOTH 2020 TO SUPPORT THIS WORK AS WELL AS $4900 TO SUPPORT AMERICORPS MEMBER.3. FARMERS MARKETS - IN 2020, THEDACARE DID PROVIDE MAJOR SPONSORSHIP AND SUPPORT TO THE DOWNTOWN APPLETON FARMER'S MARKET. HOWEVER, IN 2020 COVID MADE IT NECESSARY FOR THE MARKETS TO DEVELOP NEW POLICIES RELATED TO COVID AND THE MARKET WAS HELD IN A REDUCED CAPACITY. THE MARKET PROMOTES PURCHASING AND PREPARING HEALTHY FOODS.MENTAL HEALTH AND SUBSTANCE ABUSEYOUTH AND ADULTS HAVE SUPPORT NEEDED TO LEAD MENTALLY HEALTHY LIVES, FREE OF RELIANCE ON HARMFUL SUBSTANCES VITAL CONDITIONS ADDRESSED: SOCIAL CONNECTION/BELONGING AND BASIC NEEDS URGENT SERVICES ADDRESSED: ACUTE CARE FOR ILLNESS OR INJURY AND ADDICTION AND RECOVERY SERVICES.1. CATALPA HEALTH - A CHILDREN'S MENTAL HEALTH PROVIDER WHICH PROVIDES MENTAL HEALTH SERVICES TO CHILDREN THROUGHOUT NORTHEAST WISCONSIN. IN 2020, THEDACARE PROVIDED IN-KIND LEADERSHIP AND FINANCIAL SUPPORT IN EXCESS OF $200,000.2. NEW MH CONNECTION IS A COALITION OF 70+ MENTAL HEALTH AGENCIES TO ADDRESS ACCESS TO MENTAL HEALTH CARE.A. TC CHAIRS BOARD OF NEW MH CONNECTION AND PROVIDES IN-KIND OFFICE SPACE AT TCBH ETC. PROVIDED $30,000 FUNDING IN 2020. B. MYCONNECTIONNEW.ORG, SERVICE NAVIGATION SITE FOR ALL MENTAL HEALTH AND SUBSTANCE ABUSE PROVIDERS IN OUTAGAMIE, CALUMET, WINNEBAGO AND NOW BROWN COUNTY - IN PARTNERSHIP WITH UNITED WAY'S 2-1-1.3. FQHC SUPPORT: PROVIDED LEADERSHIP AND FUNDING FOR THE PARTNERSHIP COMMUNITY HEALTH CENTER WORKING TO IMPROVE THE HEALTH STATUS OF THE MEDICALLY UNDERSERVED BY PROVIDING COMPREHENSIVE PRIMARY CARE AND BEHAVIORAL HEALTH SERVICES.4. THEDACARE ADDED TWO OUTPATIENT PSYCHIATRISTS IN 2020; WAS AWARDED HRSA GRANT TO EXPAND ACCESS TO SUBSTANCE USE TREATMENT IN SHAWANO AND WAUPACA SU.5. THEDACARE BEHAVIORAL HEALTH WALK-IN CARE CINIC NEENAH OPENED ON NOVEMBER 4, 2020.6. TWO COLLABORATIVE CARE MANAGERS (NEENAH AND OSHKOSH) SERVED 427 PATIENTS IN 2020. PLAN TO EXPAND COLLABORATIVE CARE MODEL TO SHAWANO AND WAUPACA EARLY 2021. GOAL IS ONE CC MANAGER IN EACH CALL GROUP.7. IN JANUARY 2020, TWO TELE-PSYCHIATRISTS JOINED TCBH FOR A TOTAL OF FOUR TELE-PSYCHIATRISTS.8. WITH THE ADVENT OF COVID-19, ALL SUD, MENTAL HEALTH, AND PSYCHIATRIC PROVIDERS OFFER VIRTUAL BASED CARE.9. 22,148 VISITS WERE PROVIDED VIA VIDEO IN 2020, FOR A PERCENTAGE OF 37% OF ALL CARE BEING VIDEO BASED. END 2020 85% TELEHEALTH.10. LED AN EFFORT TO ESTABLISH ED TO RECOVERY COACHING MODEL IN 3 EDS - STARTED DEC 5. PROVIDE RECOVERY COACH IN ED WITHIN 1 HOUR OF ADMISSION OF OPIOID/STIMULANT OVERDOSE PATIENT. USES LIVED EXPERIENCE TO SUPPORT PATIENT UP TO 18 MONTHS. METRICS INCLUDE READMISSION RATES, #/% IN TREATMENT, #/% REPORT REDUCED USE, #% REPORT STAYING SOBER. SECURED $190,000 IN GRANT FUNDING. 11. DESPITE CHALLENGES OF VIRTUAL LEARNING AND SCHOOL DISRUPTION DUE TO COVID-19, ENGAGED FOUR ADDITIONAL RURAL HIGH SCHOOLS IN SOURCES OF STRENGTH, BRINGING TOTAL SCHOOLS TO NINE. SOURCES OF STRENGTH IS AN EVIDENCE-BASED PEER-LED MODEL ADDRESSING MENTAL HEALTH, SUBSTANCE USE AND SUICIDE AMONG TEENS.12. IN 2020, TCBH STARTED PROVIDING SUD SERVICES IN SHAWANO AND WAUPACA. THERE WERE 49 SUD VISITS IN SHAWANO IN 2020 AND 390 SUD VISITS OCCURRED IN WAUPACA IN 2020.13. BEHAVIORAL HEALTH OPERATIONS: INITIATED PRIMARY CARE CONSULT. DR. PANZER AND DR. BELD DO INITIAL REVIEW OF ALL REFERRALS AND IF URGENT, GET THEM INTO EXPEDITED CARE (PSYCH, MH OR AODA). OTHERWISE, CONSULT WITH PC. HELPS PCP MANAGE PATIENTS IF ON WAIT LIST. WAIT LIST FOR PSYCHIATRIC NEEDS DROPPED FROM 600+ TO 0. 14. INITIATED NPPP (NORTH PRIMARY CARE PSYCHIATRIC PARTNERSHIP) PROVIDER INTEGRATED IN PCP CLINIC. SEES PATIENTS ON WAIT LIST UP TO 4 TIMES. REFERS TO PSYCHIATRIST FOR INITIAL TRIAGE AND IF URGENT GETS THEM INTO PSYCH, MH OR AODA CARE RIGHT AWAY. EXPANDING TO NEENAH AND TRAINING ANOTHER PROVIDER. SHAWANO PSYCHIATRIST EMBEDDED IN PCP CLINIC.15. INPATIENT PSYCH WENT TO 7 DAYS ON/7 OFF FOR HOSPITALIST. FREES UP OUTPATIENT PSYCH TIME. 16. DEPRESSION SCREENING: DEPRESSION SCREENING IS TAKING PLACE IN 100% OF TC PEDIATRIC CLINICS AND FP CLINICS FOR PEOPLE AGE 12+. 17. CONDUCTING COLUMBIA SCREENING AT EVERY MENTAL HEALTH INITIAL APPOINTMENT.18. CONDUCTING PHQ9 AT EVERY AODA INITIAL APPOINTMENT.VULNERABLE POPULATIONSTHE MOST VULNERABLE POPULATIONS WITHIN THEDACARE SERVICE AREA HAVE THE OPPORTUNITY TO ACHIEVE OPTIMAL HEALTH AND WELLBEING VITAL CONDITIONS ADDRESSED: BASIC NEEDS, MEANINGFUL WORK/WEALTH, HUMANE HOUSING, LIFELONG LEARNING, RELIABLE TRANSPORTATION, BELONGING AND CIVIC MUSCLE.1. CONTINUE TO IMPROVED BIRTH CENTER ASSESSMENT AND REFERRAL PROCESS TO HOME VISITATION PROGRAMS. IN 2020, THEDACARE WORKED TO INCORPORATE PRE-NATAL ASSESSMENT IN A PARTNERSHIP WITH WOMEN'S HEALTH AND WOMEN'S CARE WHO DELIVER AT THEDACARE.2. NUMBER OF ANNUAL HOME VISITATION ASSESSMENTS WERE 457. 302 WERE ASSESSED; 69 WERE REFERRED TO HOME VISITATION WHICH IS MEANT FOR THE MOST AT RISK FAMILIES.3. WORK CONTINUES FROM FOX CITIES CHAT INITIATIVES ON EARLY CHILDHOOD WHICH PROMPTED EFFORT TO IMPROVE ASQ SCREENING PROCESS/RATE; PILOTED ASQ SCREENING PROCESS WITH WINNEBAGO COUNTY AND OSHKOSH TC CLINIC.4. DEVELOPED A WELCOME BABY MODEL FOR ALL NEW PARENTS IN COLLABORATION WITH AREA HEALTH SYSTEMS TO HELP ENSURE PARENTS HAVE ACCESS TO RESOURCES TO PROVIDE A STRONG START TO THEIR CHILD'S LIFE.5. 2020 MAKE A DIFFERENCE DAY ENGAGED 1698 PERSONS FROM THEDACARE AND PARTNER BUSINESS EMPLOYEES VOLUNTEERING AT SENIOR CARE FACILITIES THROUGHOUT ALL HOSPITAL MARKETS, ADDRESSING SOCIAL ISOLATION EXPERIENCED BY THESE ISOLATED SENIORS AND PROVIDING 238 HOURS OF VOLUNTEER SERVICE. 6. THEDACARE IS A PARTNER WITH THE POVERTY OUTCOMES & IMPROVEMENT TEAM (POINT), AN 18 MONTH INITIATIVE EQUIPPING THE ENTIRE FOX VALLEY REGION WITH CONTINUOUS IMPROVEMENT METHODOLOGIES FOCUSED ON POVERTY. POINT IS USING THESE PROCESSES TO STRENGTHEN EXISTING POVERTY REDUCTION EFFORTS, ADDRESS SERVICE GAPS, AND MEASURE PROGRESS ON REDUCING POVERTY IN NORTHEAST WISCONSIN. TC CONTRIBUTED $200,000 PLUS PRESENCE ON THE LEADERSHIP TEAM. POINT COLLABORATED WITH BOSTON-BASED INSTITUTE FOR HEALTHCARE IMPROVEMENT TO USE LEAN PROCESSES AND TOOLS TO HELP NON-PROFIT AGENCIES HELP PEOPLE BECOME SELF-SUFFICIENT. MORE THAN 40 NON-PROFIT AGENCIES ARE PARTICIPATING. THEDACARE PLAYS A LEADERSHIP ROLE IN PARTNERSHIP TO ALIGN LOCAL FUNDING BEHIND KEY DRIVERS OF POVERTY, INCLUDING SOCIAL CONNECTION, EMPLOYMENT, EDUCATION, AND HEALTH. 7. LAUNCHED DIVERSITY, INCLUSION AND BELONGING INTERNAL ADVISORY COUNCIL WITH HR AND PRIMARY CARE TO ENHANCE CULTURE THAT VALUES AND RESPECTS DIVERSITY ACROSS TEAM MEMBERS, PATIENTS AND COMMUNITY. FORMULATING RECOMMENDATIONS RE: PATIENT, TEAM MEMBER AND COMMUNITY STRATEGIES TO TAKE TO ELT IN MARCH. (METRICS TO INCLUDE PATIENT, AND TEAM MEMBER SATISFACTION SCORES).8. OPPORTUNITY GAP/STAR PROGRAM FOLLOWING "BEING BLACK IN FOX CITIES" PLUNGE OCT 2015, TC LED A PROCESS WITH AFRICAN HERITAGE, INC., APPLETON/MENASHA SCHOOL DISTRICTS, BOYS & GIRLS CLUB, UNITED WAY, FOUR AREA COLLEGES AND OTHERS TO DEVELOP THE STAR PROGRAM (SCHOLARS ON TARGET TO ACHIEVE RESULTS) IN 2020, THEDACARE CONTINUED SUPPORT OF STAR PROGRAM WHICH ADDRESSES THE GRADUATION RATE DIFFERENTIAL BETWEEN BLACK AND WHITE HIGH SCHOOL STUDENTS IN MENASHA AND APPLETON. THE FOX CITIES COMMUNITY HEALTH ACTION TEAM FUNDED $30,000 PROGRAM DIRECTOR START-UP PERIOD WITH $50,000 PER YEAR FOR THREE YEARS FOR PROGRAM OPERATIONS. IN 2018-19 SCHOOL YEAR, 340 YOUTH WERE SERVED. CURRENT ENROLLMENT DURING 2020 IS 450 STUDENTS. THEDACARE REGIONAL MEDICAL CENTER - APPLETON PART V, SECTION B, LINE 13H: PATIENTS ARE SENT AN OVERVIEW LETTER EXPLAINING THE PROCESS FOR APPLYING FOR OUR ASSISTANCE PROGRAM OR OUR STAFF WALKS THEM THROUGH THE PROCESS. THEY ARE ASKED TO COMPLETE AN APPLICATION THAT INCLUDES REQUESTS FOR INFORMATION. THIS INFORMATION IS NEEDED IN ORDER TO MAKE A DECISION AS TO WHETHER THE PATIENT MEETS THE CRITERIA FOR ACCEPTANCE, AND IF ACCEPTED, WHAT LEVEL OF ASSISTANCE WILL BE PROVIDED. ONCE THE DECISION IS MADE, WE WILL NOTIFY THE PATIENT AND IF ACCEPTABLE, WRITE OFF THE BALANCE AS DETERMINED. THEDACARE REGIONAL MEDICAL CENTER - APPLETON PART V, SECTION B, LINE 15E: CONTRACTED WITH ELIGIBILITY VENDOR (CARDON) TO WORK DIRECTLY WITH THE UNINSURED PATIENT TO ASSIST THEM WITH INSURANCE ENROLLMENT AND EDUCATION. THEDACARE REGIONAL MEDICAL CENTER - APPLETON PART V, SECTION B, LINE 16J: THE FAP AND APPLICATION WERE AVAILABLE AT HOSPITAL CASHIER OFFICES, ON OUR WEB SITE AND OFFERED TO ALL PATIENTS THAT EXPRESSED A FINANCIAL HARDSHIP WHEN CALLING THE BILLING OFFICE. THE PLS WAS PRINTED ON EVERY STATEMENT AND A FOOTER WAS ADDED TO THE FRONT OF THE STATEMENT ADVISING PATIENT TO SEE REVERSE SIDE OF STATEMENT FOR FINANCIAL ASSISTANCE AND PAYMENT OPTIONS. NOTIFICATION OF FINANCIAL ASSISTANCE AVAILABILITY WAS ADDED TO THE INITIAL LETTER SENT BY THE THIRD PARTY COLLECTION AGENCY. PART V, SECTION B, LINE 11 (CONTINUED): 9. THEDACARE IS A MAJOR SUPPORTER OF THE RURAL HEALTH INITIATIVE (RHI) WHICH TAKES HEALTHCARE SERVICES TO THE FARM TO REACH A SIGNIFICANT VULNERABLE POPULATION OF LOW-INCOME FARMERS AND MIGRANT WORKERS, MANY OF WHOM ARE UNINSURED. RHI ENHANCES RURAL ACCESS TO CARE, EARLY DETECTION AND MANAGEMENT OF CHRONIC DISEASE, HEALTHY LIFESTYLE EDUCATION, AND CONNECTION OF UNASSIGNED FREQUENT ED PATIENTS TO PRIMARY CARE HOME. REDUCTION OF CHRONIC DISEASE STARTS WITH AWARENESS OF HEALTH RISKS; 326 RURAL RESIDENTS FROM VULNERABLE POPULATIONS WERE SCREENED FOR OBESITY, CARDIOVASCULAR RISKS AND DIABETES. OF THE INDIVIDUALS SCREENED 35% (114) OF PEOPLE WERE DETECTED TO HAVE CHRONIC HEALTH CONDITIONS WITH THE HIGHEST LEVELS OF RISK BEING OBESITY AND CARDIOVASCULAR RISKS SUCH AS ELEVATED CHOLESTEROL LEVELS. 198 PEOPLE WERE EDUCATED ON MANAGING THOSE RISKS AND 185 INDIVIDUALS RECEIVED REFERRALS. REFERRALS INCLUDED HEALTHCARE PROVIDERS (133), MENTAL HEALTH, PRESCRIPTION DRUG ASSISTANCE, AND BENEFIT ASSISTANCE. 10. THE RURAL HEALTH INITIATIVE PROVIDED ASSISTANCE TO WAUPACA COUNTY PUBLIC HEALTH DEPARTMENT BY PROVIDING 43 FLU SHOTS AND 27 TETANUS SHOTS TO PREDOMINATELY LATINO WORKERS AT LARGE DAIRIES. 11. DESPITE COVID AND NOT BEING ABLE TO MAKE HOUSE CALLS FOR 2 MONTHS AND WITH LIMITED ACCESS FOR THE DURATION OF THE YEAR, THEDACARE RURAL HEALTH INITIATIVE ASSISTED THE THEDACARE MEDICAL CENTER-SHAWANO EMERGENCY DEPARTMENT WITH 552 FOLLOW UP PHONE CALLS TO PEOPLE WHO ARE FREQUENT UTILIZERS OF CARE. WE PROVIDED 178 REFERRALS OF WHICH 142 WERE ASSISTING IN ESTABLISHING WITH A PCP AND 33 FOR DENTAL ASSISTANCE. 12. IN 2020, RHI ALSO CONTRACTED WITH CALUMET COUNTY IN REPLICATING OUR MODEL OF OUTREACH CARE.GENERAL1. THEDACARE PARTNERS WITH ASCENSION HEALTH SYSTEM TO SPONSOR FOX VALLEY FAMILY RESIDENCY PROGRAM PROVIDING HANDS ON EXPERIENCE FOR MEDICAL STUDENTS AND ACCESS TO PRIMARY CARE AND MENTAL HEALTH SERVICES.2. THEDACARE ALSO PARTNERS WITH AREA NURSING SCHOOLS SUCH AS UW OSHKOSH AND FOX VALLEY TECHNICAL COLLEGE TO PROVIDE PROFESSIONAL MENTORS FOR THEIR NURSING PROGRAMS AND VENUES FOR NURSING STUDENTS TO PRACTICE THEIR SKILLS.3. THEDACARE PLAYED A CRITICAL ROLE IN THE DEVELOPMENT AND LAUNCH OF IMAGINE FOX CITIES VISIONING INITIATIVE WHICH ENGAGED THE ENTIRE FOX CITIES REGION IN A DISCOVERY AND DISCERNMENT PROCESS TO UNDERSTAND WHAT PEOPLE THINK ABOUT THEIR WELL-BEING TODAY, WHAT THEY EXPECT THEIR WELL-BEING TO BE IN THE FUTURE, AND ARTICULATE A VISION FOR GENERATIONS TO COME THAT WILL GUIDE LOCAL DECISION-MAKING. THIS VISION SETS THE LARGER CONTEXT FOR ADVANCING HEALTH AND WELL-BEING ACROSS THE REGION.4. THROUGH CONSULTANTS ENGAGED WITH IMAGINE FOX CITIES, BROUGHT LEADERS FROM RETHINK HEALTH TO FOX CITIES TO PARTICIPATE IN RWJF GRANT TO EXPLORE HOW LOCAL INSTITUTIONS CAN INVEST DIFFERENTLY TO PROPEL OUR COMMUNITY TOWARD THE NEW VISION. THEDACARE WILL PLAY A FUTURE LEAD ROLE.COVID 2020 1. LED VARIETY OF EFFORTS TO EASE THE IMPACT OF COVID-19 ON COMMUNITY.A. LED START-UP OF COMMUNITY SOLUTIONS TEAM OF UNITED WAY GATHERING 150+ COMMUNITY LEADERS TO ADDRESS EMERGING NEEDS RESULTING FROM PANDEMIC.B. SURVEYED AND ESTABLISHED COMMUNITY-BASED CHILD CARE RESOURCES FOR TEAM MEMBERS.C. ESTABLISHED ISOLATION HOUSING SUPPORT IN COMMUNITY FOR TEAM MEMBERS.D. ORGANIZED MASK SEWING EFFORT TO SECURE FABRIC MASKS FOR PATIENTS, TEAM MEMBERS.E. ASSISTED LEADERS WITH CONNECTIONS TO LOCAL MANUFACTURERS TO ASSIST WITH PPE.F. HELPED CHAMPION COLLABORATIVE EFFORTS RE: FOOD RELIEF, HOUSING, TRANSPORTATION, ACCESS TO PRESCRIPTIONS, SOCIAL ISOLATION PHONE PAL PROGRAM.G. SECURED MENTORS FOR SCHOOL AGE CHILDREN AS SCHOOLS WENT VIRTUAL.H. FOCUSED MAKE A DIFFERENCE DAY ON ISOLATED LTC RESIDENTS TO ADDRESS ISOLATION.I. WORKED WITH UNITED WAY TO ESTABLISH GIVE HELP GET HELP HUB AND FUNDED PROMOTION.J. CO-LED EFFORT TO ESTABLISH TRI-COUNTY MULTICULTURAL COMMUNICATION COALITION TO REACH MOST VULNERABLE POPULATIONS WITH EMERGENCY COMMUNICATIONS.K. HELPED CHAMPION EXPANSION OF NEIGHBORHOOD PARTNERS PROGRAM ACROSS FOX CITIES STRENGTHENING COMMUNITY AND BELONGING.L. FACILITATED HOUSING SUPPORT FOR TC INPATIENT HOMELESS PATIENTS UPON DISCHARGE AND SECURED $28,000 TO SUPPORT THIS EFFORT.M. ASSISTED EAST CENTRAL WISCONSIN PLANNING COMMISSION WITH GRANT TO EXPAND BROADBAND ACROSS RURAL MARKETS.N. HELPING LEAD EFFORT TO ADDRESS DISCHARGE DELAYS DUE TO TRANSPORTATION GAPS.O. PROVIDING VOLUNTEERS FOR FEEDING AMERICA FEDERAL FOOD DISTRIBUTION.HEALTH NEEDS IDENTIFIED BUT NOT ADDRESSED:1. ACES/EARLY CHILDHOOD - WORK ON THIS AREA HAS BEEN INITIATED AND IS ONGOING.2. ISOLATION/COMMUNITY CONNECTIONS - WORK ON THIS AREA HAS BEEN INITIATED AND IS ONGOING.3. FAMILIES STRUGGLING TO MAINTAIN STABLE HOME ENVIRONMENT/FINANCIAL SUSTAINABILITY - WORK ON THIS AREA HAS BEEN INITIATED AND IS ONGOING. 1 1 - GROTH SURGERY CENTER 1818 N MEADE STREET APPLETON WI 54911 OUTPATIENT SURGERY CENTER PART I, LINE 3C: IT IS THE ORGANIZATION'S POLICY THAT NO PATIENT SHOULD BE DENIED APPROPRIATE AND NECESSARY CARE ON THE BASIS OF INCOME. IN RESPONSE TO THIS POLICY, THE CARING HEARTS FINANCIAL ASSISTANCE PROGRAM WAS SET UP TO PROVIDE SHELTER TO THOSE PATIENTS WHO ARE UNABLE TO PAY FOR THEIR MEDICAL SERVICES. MEDICAL SERVICE FEES ARE WRITTEN OFF UNDER THE FINANCIAL ASSISTANCE PROGRAM THAT WOULD OTHERWISE HAVE BEEN SENT TO A COLLECTION AGENCY. PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS IN THE TABLE IS A COMBINATION OF AVERAGE COSTS AND ACTUAL COSTS PERTAINING TO SUPPLIES, WAGES, AND BENEFITS. FOR SUPPLIES, THE ACTUAL COST OF ITEMS USED FOR EACH EVENT IS APPLIED. IF NO ACTUAL COST IS AVAILABLE, WE THEN USE AN ESTIMATE. WAGES ARE CALCULATED BY MULTIPLYING THE AVERAGE WAGE RATE TIMES ACTUAL HOURS WORKED. THE BENEFIT RATE USED INCLUDES A FRINGE RATIO OF ALL BENEFITS RELATED TO THE ABOVE WAGE CALCULATION. THE COST ACCOUNTING SYSTEM DOES NOT DIFFERENTIATE BETWEEN DIFFERENT PAYER TYPES AND NO COST-TO-CHARGE RATIO IS USED. PART I, LINE 7G: NO PHYSICIAN CLINICS ARE INCLUDED IN SUBSIDIZED HEALTH SERVICES. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 8,487,875. PART II, COMMUNITY BUILDING ACTIVITIES: ECONOMIC DEVELOPMENT - THE PRIMARY AIM OF THE CHAMBER IS TO PROTECT THE INTEREST OF THE BUSINESS COMMUNITY AS A WHOLE. STRONG EMPLOYMENT IS A SOCIAL DETERMINANT OF HEALTH, REDUCING POVERTY AND PROVIDING INDIVIDUAL AND FAMILY SUSTAINABILITY. THEDACARE WORKS TOGETHER WITH LOCAL CHAMBERS OF COMMERCE IS IN ALL OF THE COMMUNITIES IT SERVES. COMMUNITY SUPPORT - CARING HEARTS IS A FINANCIAL ASSISTANCE PROGRAM DESIGNED FOR PATIENTS WHO ARE UNABLE TO PAY FOR MEDICALLY NECESSARY SERVICES PROVIDED BY ALL DIVISIONS WITHIN THEDACARE. THE CARING HEARTS PROGRAM COVERS SERVICES WHICH ARE DEEMED TO BE MEDICALLY NECESSARY AS DETERMINED BY THEIR PHYSICIAN. THIS COST IS FOR TIME AND EXPENSE NEEDED TO SUPPORT CARING HEARTS.THE CARING HEARTS FINANCIAL ASSISTANCE PROGRAM IS IN EFFECT AT ALL THEDACARE FACILITIES - THEDACARE REGIONAL MEDICAL CENTERS IN APPLETON AND NEENAH, THEDACARE MEDICAL CENTER- BERLIN, THEDACARE MEDICAL CENTER-NEW LONDON, THEDACARE MEDICAL CENTER-SHAWANO, THEDACARE MEDICAL CENTER-WAUPACA AND THEDACARE MEDICAL CENTER-WILD ROSE.ENVIRONMENTAL IMPROVEMENTS - SHARPS COLLECTION. COMMUNITY SHARPS CAN BE TAKEN FOR COLLECTION AND DISPOSAL TO ANY OF THE 7 THEDACARE HOSPITALS.COMMUNITY SHARPS CAN BE DISPOSED OF AT THEDACARE REGIONAL MEDICAL CENTER-APPLETON AND NEENAH, THEDACARE MEDICAL CENTER-BERLIN, THEDACARE MEDICAL CENTER-NEW LONDON, THEDACARE MEDICAL CENTER-SHAWANO, THEDACARE MEDICAL CENTER-WAUPACA AND THEDACARE MEDICAL CENTER-WILD ROSE.COMMUNITY OTHER: SART/SANE - THE SEXUAL ASSAULT RESPONSE TEAM WORKS WITH LOCAL LAW ENFORCEMENT, DOMESTIC ABUSE AGENCIES, SEXUAL ASSAULT AGENCIES, MENTAL HEALTH FACILITIES, LOCAL MEDICAL PROVIDERS TO IMPROVE IMMEDIATE RESPONSE TO VICTIMS OF SEXUAL ASSAULT. SART/SANE PROGRAMMING IS BASED AT THEDACARE REGIONAL MEDICAL CENTER-APPLETON AND SERVES THEDACARE REGIONAL MEDICAL CENTER-NEENAH, THEDACARE MEDICAL CENTER-BERLIN, THEDACARE MEDICAL CENTER-NEW LONDON, THEDACARE MEDICARE CENTER-SHAWANO, THEDACARE MEDICAL CNETER-WAUPACA AND THEDACARE MEDICAL CENTER-WILD ROSE. PART III, LINE 2: PATIENT ACCOUNTS RECEIVABLE ARE UNCOLLATERALIZED PATIENT OBLIGATIONS THAT ARE STATED AT THE AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH THEDACARE EXPECTS TO BE ENTITLED IN EXCHANGE FOR PROVIDING PATIENT CARE. THESE OBLIGATIONS ARE PRIMARILY FROM LOCAL RESIDENTS, MOST OF WHOM ARE INSURED UNDER THIRD-PARTY PAYOR AGREEMENTS. THEDACARE BILLS THIRD-PARTY PAYORS ON THE PATIENTS' BEHALF, OR IF A PATIENT IS UNINSURED, THE PATIENT IS BILLED DIRECTLY. ONCE CLAIMS ARE SETTLED WITH THE PRIMARY PAYOR, ANY SECONDARY INSURANCE IS BILLED, AND PATIENTS ARE BILLED FOR COPAY AND DEDUCTIBLE AMOUNTS THAT ARE THE PATIENTS' RESPONSIBILITY. PAYMENTS ON ACCOUNTS RECEIVABLE ARE APPLIED TO THE SPECIFIC CLAIM IDENTIFIED ON THE REMITTANCE ADVICE OR STATEMENTS. THEDACARE DOES NOT HAVE A POLICY TO CHARGE INTEREST ON PAST DUE ACCOUNTS.PATIENT ACCOUNTS RECEIVABLE ARE RECORDED AT NET REALIZABLE VALUE BASED ON CERTAIN ASSUMPTIONS. FOR THIRD-PARTY PAYORS, INCLUDING MEDICARE, MEDICAID, MANAGED CARE AND COMMERCIAL PAYORS, THE NET REALIZABLE VALUE IS BASED ON THE ESTIMATED CONTRACTUAL REIMBURSEMENT PERCENTAGE, WHICH IS BASED ON CURRENT CONTRACT PRICES OR HISTORICAL PAID CLAIMS DATA BY PAYOR. FOR UNINSURED PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR A PORTION OF THE BILL), THE NET REALIZABLE VALUE IS DETERMINED USING ESTIMATES OF HISTORICAL COLLECTION EXPERIENCE. THESE ESTIMATES ARE ADJUSTED FOR EXPECTED RECOVERIES AND ANY ANTICIPATED CHANGES IN TRENDS, INCLUDING SIGNIFICANT CHANGES IN PAYOR MIX, ECONOMIC CONDITIONS OR TRENDS IN FEDERAL AND STATE GOVERNMENTAL HEALTH CARE COVERAGE. PART III, LINE 3: THE HOSPITAL IS REPORTING $0 BECAUSE IT DOES NOT HAVE A METHOD OF REASONABLY ESTIMATING THE PORTION OF ITS BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE BUT WHO DID NOT COMPLETE A FINANCIAL ASSISTANCE APPLICATION. PART III, LINE 4: SEE "PATIENT ACCOUNTS RECEIVABLE AND CREDIT POLICY" OF NOTE 1 ON PAGES 10-11 IN THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: HOSPITALS MUST ACCEPT MEDICARE PATIENTS REGARDLESS OF WHETHER THEY MAKE A SURPLUS OR DEFICIT FROM PROVIDING SERVICES TO THOSE PATIENTS. WE DID NOT REPORT ANY SHORTFALL AS A COMMUNITY BENEFIT. THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT IS STEP DOWN. PART III, LINE 9B: OUR POLICY IS NOT TO PURSUE PATIENT ACCOUNTS TO THE EXTENT ANY CHARGES ARE ELIGIBLE AND WRITTEN OFF THROUGH OUR CHARITY CARE/FINANCIAL ASISTANCE PROGRAM. IF ONLY A PORTION OF THE CHARGES ARE ELIGIBLE AND WRITTEN OFF THROUGH OUR CHARITY CARE/FINANCIAL ASISSTANCE PROGRAM, THE REMAINING BALANCE WILL BE BILLED TO THE PATIENT AND COLLECTED IN ACCORDANCE WITH OUR NORMAL COLLECTION POLICY. PART VI, LINE 2: THEDACARE COVERS A 9 COUNTY PRIMARY SERVICE AREA SERVED BY 7 HOSPITALS. THEDACARE CONDUCTS A COMMUNITY NEEDS ASSESSMENT EVERY THREE YEARS FOR EACH HOSPITAL GATHERING DATA PERTINENT TO THAT COMMUNITY AND THE SURROUNDING AREAS. INFORMATION COLLECTED INCLUDES DATA FROM THE WISCONSIN COUNTY HEALTH RANKINGS, FOX CITIES LIFE STUDY (LOCAL INDICATORS FOR EXCELLENCE), THE BEHAVIORAL RISK FACTOR SURVEILLANCE SURVEY, INSIGHTS FROM INTERVIEWS OF PUBLIC HEALTH OFFICIALS, INSIGHTS FROM INTERVIEWS WITH REPRESENTATIVES OF VULNERABLE POPULATIONS, EMERGENCY DEPARTMENT PATIENT DATA AND INSIGHTS GATHERED FROM MONTHLY MEETINGS OF THE THEDACARE-LED CHAT TEAM (COMMUNITY HEALTH ACTION TEAM) COMPRISED OF COMMUNITY LEADERS IN BUSINESS, NON-PROFIT, CLERGY, EDUCATION, DIVERSE POPULATION GROUPS, HEALTHCARE, UNITED WAY, PUBLIC HEALTH AND THE LOCAL COMMUNITY FOUNDATIONS. PART VI, LINE 3: PATIENT EDUCATION BEGINS WHEN A PATIENT IS ADMITTED TO A THEDACARE HOSPITAL. ADMISSION SPECIALISTS MEET WITH EACH PERSON INDIVIDUALLY TO ASSESS INSURANCE STATUS AND FINANCIAL NEED. IF NECESSARY, SPECIALISTS REFER PATIENTS TO CARE MANAGEMENT SPECIALISTS WHO ASSIST WITH THE ENROLLMENT OF PATIENTS IN AN APPLICABLE PROGRAM. THE HOSPITAL PATIENT HANDBOOK IS PROVIDED TO ALL IN-PATIENTS. INTERNAL POLICIES SUCH AS DISCOUNTED SERVICES POLICY, CARING HEARTS POLICY AND PAYMENT FOR SERVICE POLICY FOR SELF-PAY BALANCES PROVIDE GUIDANCE.THE THEDACARE WEBSITE, WWW.THEDACARE.ORG, PROVIDES EDUCATION REGARDING THE AFFORDABLE CARE ACT IN EASY TO UNDERSTAND LANGUAGE. IT DISCUSSES OPTIONS AND WHERE TO GO FOR ASSISTANCE. PART VI, LINE 4: THEDACARE REGIONAL MEDICAL CENTER-APPLETON SERVICE AREA CONSISTS OF OUTAGAMIE AND CALUMET COUNTIES AND IS LOCATED IN EAST-CENTRAL WISCONSIN. THE TWO-COUNTY AREA HOSTS A POPULATION OF OVER 225,000 COMBINED WITH CONCENTRATION IN THE FOX CITIES URBAN AREA.OUTAGAMIE COUNTY:1. THE PERCENTAGE OF RESIDENTS LIVING BELOW THE FEDERAL POVERTY LEVEL IS 9%.2. ACCORDING TO UNITED WAY 30% OF OUTAGAMIE HOUSEHOLDS LIVE BELOW THE ASSETS LIMITED, INCOME CONSTRAINED, EMPLOYED, (ALICE) AND POVERTY THRESHOLDS. ALICE REPRESENTS INDIVIDUALS AND FAMILIES WHO ARE WORKING BUT UNABLE TO AFFORD THE BASIC NECESSITIES OF HOUSING, FOOD, CHILDCARE, HEALTHCARE AND TRANSPORTATION. THIS IS BELOW THE STATE AVERAGE OF 37.5%.3. THE PERCENTAGE OF CHILDREN ELIGIBLE FOR FREE AND REDUCED LUNCH IN OUTAGAMIE COUNTY IS 31%, BELOW THE STATE AVERAGE OF 40%.4. IN OUTAGAMIE COUNTY 8% OF THE CHILDREN LIVE BELOW 100% OF THE FEDERAL POVERTY LEVEL.5. OUTAGAMIE COUNTY HAS 6% OF RESIDENTS WHO ARE UNINSURED.6. OUTAGAMIE COUNTY HIGH SCHOOL GRADUATION RATE IS 91%.7. IN COMPARISON TO MORE RURAL COUNTIES IN THE THEDACARE SERVICE AREA, OUTAGAMIE AND CALUMET COUNTIES CONTINUE TO HAVE A HIGHER PERCENTAGE OF CHILDREN.8. THE PERCENTAGE OF NON-CAUCASIAN POPULATION HAS GROWN FROM 9.3% TO 10.7%. EIGHTY NINE PERCENT OF THE SERVICE AREA IS CAUCASIAN WITH HISPANIC POPULATION OF 4.2%. THE LARGEST MINORITY POPULATIONS ARE LATINO (4.2%) AND ASIAN (3.4%). NATIVE AMERICANS ACCOUNT FOR APPROXIMATELY 1.9% OF THE POPULATION AND AFRICAN-AMERICANS REPRESENT 1.2%. CALUMET COUNTY:1. THE PERCENTAGE OF RESIDENTS LIVING BELOW THE FEDERAL POVERTY LEVEL IS 6%.2. ACCORDING TO UNITED WAY 29% OF CALUMET COUNTY HOUSEHOLDS LIVE BELOW THE ASSETS LIMITED, INCOME CONSTRAINED, EMPLOYED, (ALICE) AND POVERTY THRESHOLDS. ALICE REPRESENTS INDIVIDUALS AND FAMILIES WHO ARE WORKING BUT UNABLE TO AFFORD THE BASIC NECESSITIES OF HOUSING, FOOD, CHILDCARE, HEALTHCARE AND TRANSPORTATION. THIS IS BELOW THE STATE AVERAGE OF 37.5%.3. THE PERCENTAGE OF CHILDREN ELIGIBLE FOR FREE AND REDUCED LUNCH IN CALUMET COUNTY IS 30%, BELOW THE STATE AVERAGE OF 30%.4. IN CALUMET COUNTY 6% OF THE CHILDREN LIVE BELOW 100% OF THE FEDERAL POVERTY LEVEL.5. CALUMET COUNTY HAS 4% OF RESIDENTS WHO ARE UNINSURED.6. CALUMET COUNTY HIGH SCHOOL GRADUATION RATE IS 96%.7. IN COMPARISON TO MORE RURAL COUNTIES IN THE THEDACARE SERVICE AREA, OUTAGAMIE AND CALUMET COUNTIES CONTINUE TO HAVE A HIGHER PERCENTAGE OF CHILDREN.8. THE PERCENTAGE OF NON-CAUCASIAN POPULATION HAS GROWN FROM 9.3% TO 10.7%. NINETY ONE PERCENT OF THE SERVICE AREA IS CAUCASIAN WITH HISPANIC POPULATION OF 4.2%. THE LARGEST MINORITY POPULATIONS ARE LATINO (4.2%) AND ASIAN (2.4%). NATIVE AMERICANS ACCOUNT FOR APPROXIMATELY 0.5% OF THE POPULATION AND AFRICAN-AMERICANS REPRESENT 0.6%. PART VI, LINE 5: EACH YEAR THEDACARE SETS ASIDE A PERCENTAGE OF EXCESS MARGIN AND DESIGNATES THESE FUNDS TO SUPPORT EFFORTS AND INITIATIVES COMING FROM CHAT (COMMUNITY HEALTH ACTION TEAM). CHAT IS A GROUP OF COMMUNITY LEADERS WHO STUDY SYSTEMIC HEALTH ISSUES OUTSIDE THE WALLS OF OUR HOSPITALS AND CLINICS AND WORK TO IDENTIFY INNOVATIVE, COLLABORATIVE SOLUTIONS THAT DRAW UPON THE WIDE ARRAY OF RESOURCES AND STRENGTHS OF OUR COMMUNITY. THERE ARE THEDACARE LED CHAT'S IN EACH HOSPITAL AREA WILD ROSE, WAUPACA, FOX CITIES, SHAWANO, BERLIN AND NEW LONDON. THEDACARE PROVIDES FUNDING AND DEDICATED STAFF TO MAKE CHAT COMMUNITY HEALTH EFFORTS POSSIBLE. PART VI, LINE 6: THEDACARE, THE PARENT ORGANIZATION, PROVIDES DIRECTION RELATED TO COMMUNITY HEALTH NEEDS ASSESSMENT FOR EACH HOSPITAL AND SURROUNDING COMMUNITIES WITHIN ITS SERVICE AREA. PLANS ARE APPROVED BY LOCAL HOSPITAL BOARDS. EACH THEDACARE HOSPITAL, ALONG WITH CHI STAFF AND COMMUNITY MEMBERS DETERMINE HOW BEST TO MEET LOCAL NEEDS. IMPLEMENTATION OF COMMUNITY PROGRAMMING OCCURS AT THE LOCAL LEVEL. PART VI, LINE 7, REPORTS FILED WITH STATES WI X 1 1 X X X X 0 1 0 0 0 0 0 1 0 IMRAN ANDRABIMD PRESIDENT & CEO - SYSTEM 0 902932 0 340406 0 0 0 43030 0 19171 0 1305539 0 0 MARK THOMPSON SENIOR VP, CFO & COO - SYSTEM 0 588076 0 160000 0 0 0 45500 0 19171 0 812747 0 0 GARY EDELMAN MD BOARD MEMBER/PHYSICIAN 0 514685 0 12520 0 0 0 43500 0 19171 0 589876 0 0 JAMES ALBIN CIO 0 329869 0 100000 0 0 0 65000 0 19171 0 514040 0 0 MAGGIE LUND CHRO 0 300016 0 89000 0 0 0 45500 0 7509 0 442025 0 0 NORMA TURK MD BOARD MEMBER/PHYSICIAN 0 300009 0 8000 0 0 0 43500 0 7509 0 359018 0 0 BRIAN STERNS FORMER KEY EMPLOYEE 0 147483 0 25000 0 0 0 39000 0 19171 0 230654 0 0 PART I, LINE 1A ALL EXECUTIVES AT A LEVEL OF VICE PRESIDENT AND ABOVE ARE ELIGIBLE TO HAVE HEALTH OR FITNESS CLUB FEES REIMBURSED TO THEM, AND TAXED UPON REIMBURSEMENT. 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, INVEST 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 LEADERS AND TO WORK TOGETHER AS A COHESIVE GROUP TOWARD COMMON GOALS. LEADERS FROM MANAGER 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, 2020 TO DECEMBER 31, 2020) TO RECEIVE A 2021 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. FORM 990, PART VI, SECTION A, LINE 1 THE BOARD OF TRUSTEES HAS AN EXECUTIVE COMMITTEE CONSISTING OF THE BOARD'S CHAIR, VICE CHAIR, PRESIDENT, SECRETARY AND TREASURER. THE EXECUTIVE COMMITTEE HAS AND MAY EXERCISE, WHEN THE BOARD OF TRUSTEES IS NOT IN SESSION, THE POWER OF THE BOARD OF TRUSTEES IN THE MANAGEMENT OF THE ORGANIZATION'S AFFAIRS, EXCEPT ACTION WITH RESPECT TO ELECTION OF OFFICERS OR TRUSTEES. FORM 990, PART VI, SECTION A, LINE 3 ALL MANAGEMENT AND ADMINISTRATIVE FUNCTIONS ARE PROVIDED BY EMPLOYEES OF THEDACARE, INC., THE SOLE MEMBER AND PARENT COMPANY OF THEDACARE REGIONAL MEDICAL CENTER - APPLETON, INC. FORM 990, PART VI, SECTION A, LINE 6 THEDACARE REGIONAL MEDICAL CENTER - APPLETON, INC.'S SOLE MEMBER OF THE SINGLE CLASS OF VOTING MEMBERS IS THEDACARE, INC. FORM 990, PART VI, SECTION A, LINE 7A THEDACARE, INC. HAS SOLE AUTHORITY IN THE CORPORATION TO VOTE AND TAKE ANY ACTION WITH RESPECT TO THE ELECTION OF DIRECTORS AND OFFICERS. FORM 990, PART VI, SECTION A, LINE 7B THEDACARE, INC. HAS THE SOLE AUTHORITY WITH RESPECT TO THE FOLLOWING MATTERS: 1. AMENDMENT OF THE ARTICLES OF INCORPORATION; 2. ADOPTION AND AMENDMENT OF BYLAWS OF THE CORPORATION; 3. CONSOLIDATION, MERGER, AND DISSOLUTION OF THE CORPORATION; 4. MONITORING COMPLIANCE WITH LAWS AND REGULATIONS; 5. SELECTION, APPOINTMENT, AND REMOVAL OF A CHIEF OPERATING OFFICER; 6. PROVISION FOR LONG-RANGE FINANCIAL STABILITY OF THE HOSPITAL AND PROVISION FOR THE CONTROL AND AND USE OF THE PHYSICAL AND FINANCIAL RESOURCES OF THE HOSPITAL; 7. ESTABLISHMENT OF A LONG-RANGE PLANNING MECHANISM; 8. APPROVAL OF A HOSPITAL ORGANIZATION AND MAJOR AUTHORITY DELEGATION PATTERNS; 9. APPROVAL OF FINANCIAL, CAPITAL, AND OTHER ITEMS; 10. APPROVAL OF DEBT OR LEASES; AND 11. CONSIDERATION AND ACTION UPON POLICIES CONCERNING RELATIONS WITH EXTERNAL GROUPS AND ORGANIZATIONS. FORM 990, PART VI, SECTION B, LINE 11B 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. ALL EMPLOYEES AND BOARD MEMBERS ARE COVERED UNDER THE CONFLICT OF INTEREST POLICY. THE CORPORATE COMPLIANCE COMMITTEE REVIEWS THE POTENTIAL CONFLICT AND THE CFO/BOARD OF TRUSTEES REVIEW ALL CONFLICTS. AFTER DISCLOSURE OF THE CONFLICT, THE EMPLOYEE SHALL NOT PARTICIPATE IN THE DECISION WHETHER TO ENGAGE IN THE TRANSACTION IN WHICH THE EMPLOYEE HAS AN INTEREST. 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. THE HUMAN RESOURCES AND GOVERNANCE COMMITTEE OF THE BOARD WAS FORMED IN DECEMBER, 2018. THE OUTSIDE CONSULTANT PRESENTED HIS FINDINGS TO THE CHIEF HUMAN RESOURCES OFFICER, THE PRESIDENT AND CEO. THE INFORMATION WAS THEN PRESENTED TO THE HUMAN RESOURCES AND GOVERNANCE COMMITTEE OF THE BOARD AND THEN TO THE EXECUTIVE COMMITTEE OF THE BOARD. BOTH COMMITTEES WERE PROVIDED THE INFORMATION FOR REVIEW, EDUCATION AND ACCEPTANCE IN DECEMBER, 2019 AND JANUARY, 2020. FORM 990, PART VI, SECTION C, LINE 19 THEDACARE REGIONAL MEDICAL CENTER - APPLETON, INC. DOES NOT MAKE ITS GOVERNING DOCUMENTS, OCNFLICT OF INTEREST POLICY AND INTERNAL FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 14,008,161. MANAGEMENT AND GENERAL EXPENSES 16,312,434. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 30,320,595. 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