2020-11-16T15:16:53-06:00 2019-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2019-01-01 390869788 THEDACARE MEDICAL CENTER - NEW LONDON INC THED 9205312000 PO BOX 8025 APPLETON WI 549128025 MARK THOMPSON CFO & COO 9205312000 2020-11-14 1 KURT BENNION CPA P01469618 4252506100 2020-11-14 67.137.57.251 2020-11-14 12:39:40 PS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 D6404CD6BDC62D55699D8FB81E5F5A720539BEA9 2019 2021-01-29 14:40:06Z IMRAN ANDRABI MD PO BOX 8025 APPLETON WI 549128025 35520895 0 X WWW.THEDACARE.ORG X 1975 WI IMPROVING THE HEALTH OF OUR COMMUNITY. 8 7 0 70 0 0 1000 50390 33839116 35460323 15251 10182 0 0 33855367 35520895 6725 723 0 0 13469380 12573192 0 0 0 12953185 16561114 26429290 29135029 7426077 6385866 112102191 118389916 1684798 1694286 110417393 116695630 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 1 28258093 723 35288149 THEDACARE IS A TAX-EXEMPT, NON-PROFIT CORPORATION, AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE.THEDACARE MEDICAL CENTER-NEW LONDON IS A 25-BED CRITICAL ACCESS HOSPITAL SERVING NEW LONDON AND NEARBY COMMUNITIES. THERE ARE MORE THAN 200 TEAM MEMBERS ON THE NEW LONDON CAMPUS. THEDACARE MEDICAL CENTER-NEW LONDON PROVIDES PATIENT CARE AND SUPPORT SERVICES INCLUDING DIAGNOSTIC SERVICES SUCH AS X-RAY, ULTRASOUND, MRI, CT SCAN, MAMMOGRAPHY, MEDICAL LABORATORY TESTING, AND SPECIALTY SERVICES INCLUDING CARDIOVASCULAR CARE, ORTHOPEDIC CARE, FAMILY BIRTH CARE, CANCER CARE, DIABETES, 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 NEEDS HEALTH ASSESSMENT IN COUNTIES (WAUPACA) 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), NEW LONDON SCHOOL DISTRICT, NEW LONDON PARKS AND RECREATION AND WAUPACA COUNTY PUBLIC HEALTH. TOP PRIORITIES INCLUDE ADVERSE CHILDHOOD EXPERIENCES AND TRAUMA INFORMED CARE (DRIVING DIFFERENT APPROACHES TO IDENTIFYING ROOT CAUSES AND CONCERNS IN ADOLECENTS) AND COMMUNITY OBESITY (IMPLEMENTATION OF TWO COMMUNITY GARDENS AND PURCHASING REFRIGERATION FOR ALL FOOD PANTRIES IN WAUPACA COUNTY).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. 28258093 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 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 8 7 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 ANDRABI MD PRESIDENT & CEO - SYSTEM 4.00 36.00 X 0 1184478 65868 MARK THOMPSON SENIOR VP, CFO & COO - SYSTEM 4.00 36.00 X 0 681900 62765 JAMES ALBIN CIO 4.00 36.00 X 0 433321 47350 MAGGIE LUND CHRO 4.00 36.00 X 0 360217 51584 BRIAN STERNS FORMER KEY EMPLOYEE 4.00 36.00 X 0 189442 57247 SCOTT BLECK CHAIR 1.00 0.00 X X 0 0 0 BRENDA HANSEN VICE CHAIR 1.00 0.00 X X 0 0 0 JEAN SKEWES SECRETARY/TREASURER 1.00 0.00 X X 0 0 0 SARAH HAROLDSON MD BOARD MEMBER 1.00 0.00 X 0 243696 0 JEFFREY SCHLUETER BOARD MEMBER 1.00 0.00 X 0 0 0 DEAN STEINGRABER BOARD MEMBER 1.00 0.00 X 0 0 0 MELISSA SYLTE BOARD MEMBER 1.00 0.00 X 0 0 0 LISA ZIEMER BOARD MEMBER 1.00 0.00 X 0 0 0 PAUL ZIEMER BOARD MEMBER (THROUGH APRIL 2019) 1.00 0.00 X 0 0 0 0 3093054 284814 0 1 1 0 TOTAL MSP LLC (STAFFENCY LLC) 221 W COLLEGE AVE 2ND FLOOR APPLETON WI 54911 MEDICAL STAFFING 881872 CHG COMPANIES INC PO BOX 972651 DALLAS TX 75397 MEDICAL STAFFING 686864 LOCUMTENENSCOM PO BOX 405547 ATLANTA GA 30384 MEDICAL STAFFING 426699 KRAJNIK EMERGENCY SERVICES LLC 5330 N ROSEMARY DR APPLETON WI 54913 MEDICAL STAFFING 329863 MUHANNAD KAYALI 1318 W PLAINFIELD RD COUNTRYSIDE IL 60525 MEDICAL STAFFING 214550 5 47610 2780 50390 OUTPATIENT REVENUE 624100 21455986 21455986 INPATIENT REVENUE 621990 13303580 13303580 OTHER REVENUE 900099 528583 528583 CAFETERIA REVENUE 900099 172174 172174 35460323 10182 10182 35520895 35288149 0 182356 X 723 723 551380 470113 81267 48998 48998 9902928 9419343 483585 2069886 1909256 160630 5372226 5239334 132892 2510 2510 439389 420827 18562 765381 765381 25343 25343 38780 38780 1473271 1473271 73922 73922 MEDICAL SUPPLIES 5972814 5972814 BAD DEBT EXPENSE 1711704 1711704 EQUIPMENT MAINTENANCE 685774 685774 29135029 28258093 876936 0 8447774 4690496 4255288 577044 577044 45829204 28009401 18379873 17819803 10000000 10000000 78454778 77290007 112102191 118389916 1684798 1694225 61 1684798 1694286 X 110417393 116695630 110417393 116695630 112102191 118389916 6385866 -107629 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 2410 2410 0 PART II-B, LINE 1: A PORTION OF THE WHA DUES REPRESENT LOBBYING PERFORMED IN REGARD TO HEALTHCARE ISSUES. TOTAL DUES PAID IN 2019 WERE $14,431. 16.7% OF THIS AMOUNT WAS SPENT ON LOBBYING. 1501954 1501954 26841834 12601210 14240624 17485416 15408191 2077225 17819803 DUE FROM AFFILIATES 77288857 OPERATING LEASE 1150 77290007 1 1 X 1 X 1 X 410.000000000000 1 0 1 1 364 167838 1 167837 0.00610 6116 3787907 3178540 609367 0.02220 6480 3955745 3178541 777204 0.02830 13 102375 137340 137340 0.00500 3 5401 61437 61437 0.00220 3 2 2459688 2459688 0.08970 6 677571 349734 349734 0.01280 25 785349 3008199 3008199 0.10970 25 791829 6963944 3178541 3785403 0.13800 1 13327 3715 3715 0.00010 1 203 7797 7797 0.00030 1 4 8 8 0.00000 1 13 1210 1210 0.00000 4 13547 12730 12730 0.00040 0 679819 0 6524070 5877749 646321 X 1 1 1 1 THEDACARE MEDICAL CENTER - NEW LONDON 1405 MILL STREET NEW LONDON WI 54961 WWW.THEDACARE.ORG 1029 X X X X THEDACARE MEDICAL CENTER - NEW LONDON 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 1 X 0 0 THEDACARE MEDICAL CENTER - NEW LONDON 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, SINGLE PARENTS, RURAL FARM FAMILIES, OLDER ADULTS, VETERANS, HISPANIC/LATINO POPULATION, AND HOMELESS. THEDACARE MEDICAL CENTER - NEW LONDON 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 MEDICAL CENTER - NEW LONDON PART V, SECTION B, LINE 7D: THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ONLINE AT:HTTPS://WWW.THEDACARE.ORG/HOSPITALS-AND-CLINICS/THEDACARE-MEDICAL-CENTER-NEW-LONDON.ASPX. THEDACARE MEDICAL CENTER - NEW LONDON PART V, SECTION B, LINE 11: THE THEDACARE COMMUNITY HEALTH IMPLEMENTATION STRATEGY WAS APPROVED BY THE THEDACARE BOARD OF TRUSTEES IN DECEMBER OF 2020.OBESITYOVERWEIGHT AND OBESITY ARE DRIVERS OF PREVENTABLE CHRONIC DISEASE AND REDUCED QUALITY AND LENGTH OF LIFE. IT WAS RANKED AMONG THE TOP 3 HEALTH PRIORITIES IN BOTH THE 2016 AND 2019 CHNAS.1. ALONG WITH UNITED WAY, CHAMPIONED TRANSFORMATION OF "WEIGHT OF THE FOX VALLEY" INTO MORE ROBUST "LIVEWELL FOX VALLEY" MODEL. RECEIVED COMMITMENT FROM 5 HEALTH SYSTEMS.2. ORGANIZATIONS OFFERING OBESITY-RELATED WORKSITE WELLNESS PROGRAMS INCREASED BY 233. EIGHT EARLY CARE & EDUCATION PROGRAMS ADDED STRATEGIES FOR SERVING WI GROWN FRUITS AND VEGETABLES4. BREASTFEEDING FRIENDLY DESIGNATIONS REGARDING EARLY CARE & EDUCATION PROGRAMS AND WORKSITES INCREASED BY EIGHT5. MAJOR SPONSOR OF AMERICAN HEART ASSOCIATION RESULTING IN $203,500 IN FUNDRAISING FROM HEART BALL, GO RED FOR WOMEN AND HEART & STROKE WALK; MORE THAN 2.6 MILLION IMPRESSIONS ON SOCIAL MEDIA AND TRADITIONAL MEDIA; 450 PEOPLE TRAINED IN HANDS ONLY CPR INCLUDING 35 STUDENTS FROM LITTLE CHUTE HIGH SCHOOL WHO CONTINUE TO TRAIN FOX CITIES COMMUNITY MEMBERS AT LOCAL BUSINESSES/SCHOOLS/CHURCHES/COMMUNITY EVENTS6. WAYFINDING SIGNAGE ON BICYCLE AND PEDESTRIAN TRAILS INCREASED BY 257. ATTAINED PRELIMINARY STATUS AS DIABETES PREVENTION PROGRAM PROVIDER BY CDC8. THOUGHOUT THE APPLICATION PHASE OF 2017-2019 ENROLLED 159 PEOPLE9. ON AVERAGE PARTICIPANTS REDUCED RISK OF DEVELOPING DIABETES BY 58%10. LIFESTYLE INTERVENTION PROGRAM ENROLLED 172 PEOPLE SINCE 2017 WITH AVERAGE WEIGHT LOSS OF 22 LBS11. HAT SCORE IMPROVEMENT OF 15 POINTS, REDUCTION OF PREDIABETES AMONG 53%, AND 44% REDUCTION IN METABOLIC SYNDROME. ENHANCING PROCESS TO ALLOW PROVIDERS TO MORE READILY REFER PEOPLE TO THE PROGRAM.12. THE CORONARY HEALTH IMPROVEMENT PROGRAM ENROLLED 308 PEOPLE SINCE 2017 WITH AN AVERAGE DROP IN BMI OF 5% AND 20% DROP IN LIPIDSFARMERS MARKETS: IN 2019, PROVIDED SPONSORSHIP AND SUPPORT TO THE NEW LONDON FARMER'S MARKET. THE MARKET PROMOTES PURCHASING AND PREPARING HEALTHY FOODS.MENTAL HEALTH/AODATHE STATE OF MENTAL HEALTH, ACCESS TO MENTAL HEALTH SERVICES AND DRUG ABUSE, IN PARTICULAR OPIOID ADDICTION, WERE NAMED AMONG TOP 3 HEALTH PROBLEMS ACROSS ALL MARKETS IN BOTH THE 2016 AND 2019 CHNAS.1. CATALPA HEALTH: IN 2019, THEDACARE PROVIDED IN-KIND LEADERSHIP AND FINANCIAL SUPPORT TO CATALPA HEALTH - CHILDREN'S MENTAL HEALTH PROVIDER WHICH PROVIDES MENTAL HEALTH SERVICES TO CHILDREN THROUGHOUT NORTHEAST WISCONSIN.2. NEW MH CONNECTION IS A COALITION OF 70+ MENTAL HEALTH AGENCIES TO ADDRESS ACCESS TO MENTAL HEALTH CARE. TC CHAIRS BOARD OF NEW MH CONNECTION AND PROVIDES IN-KIND OFFICE SPACE AT TCBH ETC. CONTRIBUTES $15,000 FUNDING ANNUALLY. - 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 - IN 2019, THERE WERE 143,000 PAGE VIEWS. 1400 (673 IN 2018) PEOPLE COMPLETED ONLINE SCREENING FOR DEPRESSION OR OTHER MENTAL HEALTH CONDITIONS. - TOP VIEWED PAGES: MENTAL HEALTH SERVICE DIRECTORY, EMERGENCY SERVICES PAGE, LIBRARY, CALENDAR; TOP LIBRARY SEARCHES: DEPRESSION, ANXIETY, OPIOID ADDICTION, ANOREXIA, EARLY SOCIAL EMOTIONAL DEVELOPMENT3. 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 SERVICES4. PROVIDED $190,000 IN SUBSIDIZED MENTAL HEALTH SERVICES5. IN THE FALL OF 2019, THEDACARE SPONSORED PARTY AT THE PAC FOR THOUSANDS OF AREA YOUTH TO EDUCATE ON THE PERILS OF RISKY BEHAVIOR WHILE TEXTING/DRINKING AND DRIVING6. OPIOID ABUSE PREVENTION: - DRUG TAKE BACK BOXES WERE PLACED IN 6 HOSPITALS THROUGHOUT SYSTEM - COMMUNITY AWARENESS CAMPAIGNS7. SEVENTEEN URBAN AND 6 RURAL SCHOOLS INITIATED SOURCES OF STRENGTH HIGH SCHOOL PROGRAM, A SCHOOL-BASED RESILIENCY PROGRAM. THEDACARE COMMITTED $300,000 OVER 3 YEARS TO IMPLEMENT THE SCHOOL BASED PROGRAM.8. CATALPA HEALTH LAUNCHED IN WAUPACA IN 20199. PROVIDED $5000 IN FINANCIAL SUPPORT OF STUDY REGARDING TEEN SUICIDE-RELATED BEHAVIORS IN PARTNERSHIP WITH MEDICAL COLLEGE OF WISCONSIN/NEW MENTAL HEALTH CONNECTION10. 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 0.11. 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.12. INPATIENT PSYCH WENT TO 7 DAYS ON/7 OFF FOR HOSPITALIST. FREES UP OUTPATIENT PSYCH TIME13. DEPRESSION SCREENING: DEPRESSION SCREENING IS TAKING PLACE IN 100% OF TC PEDIATRIC CLINICS AND FP CLINICS FOR PEOPLE AGE 12+14. CONDUCTING COLUMBIA SCREENING AT EVERY MENTAL HEALTH INITIAL APPOINTMENT15. CONDUCTING PHQ9 AT EVERY AODA INITIAL APPOINTMENTEARLY CHILDHOOD/FAMILY SUPPORTTHE WELL-BEING OF YOUNG CHILDREN WAS IDENTIFIED AS ONE OF TOP HEALTH CONCERNS IN 2016 AND 2019 CHNAS. IMPROVING EARLY CHILDHOOD ADDRESSES ROOT CAUSE OF MULTIPLE LONG-TERM PHYSICAL AND MENTAL HEALTH ISSUES.1. THEDACARE COMMITTED TO PROVIDING EVIDENCE-BASED REACH OUT AND READ EARLY CHILDHOOD READING PROGRAM IN ALL CLINICS BY 2019 - IN 2019, 23 OF 25 CLINICS WERE FULLY IMPLEMENTED AND TRAINED IN REACH OUT AND READ - 7,516 BOOKS WERE PROVIDED2. IMPROVED BIRTH CENTER ASSESSMENT AND REFERRAL PROCESS TO HOME VISITATION PROGRAMS - NUMBER OF HOSPITALS WITH HOME VISITATION REFERRAL INCREASED TO 4 FROM 2 - NUMBER OF ANNUAL HOME VISITATION ASSESSMENTS WERE 317 FROM 453. 2019 MAKE A DIFFERENCE DAY "MYSTERY BUSES" ENGAGED 300 TC AND PARTNER BUSINESS EMPLOYEES VOLUNTEERING AT 10 NON-PROFIT LOCATIONS ACROSS ALL HOSPITAL MARKETS FOCUSED ON EARLY CHILDHOOD AND YOUTH4. 2017 FOX CITIES CHAT PLUNGE ON EARLY CHILDHOOD PROMPTED EFFORT TO IMPROVE ASQ SCREENING PROCESS/RATE; PILOTED ASQ SCREENING PROCESS WITH WINNEBAGO COUNTY AND OSHKOSH TC CLINICHEALTH DISPARITIES/POVERTY: HEALTH DISPARITIES1. POINT - 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 CONDUCTED WITH 106 UNMANAGED HEALTH CONDITIONS IDENTIFIED. 266 REFERRALS WERE MADE TO HEALTH CARE PROVIDERS.2. THEDACARE IS A MAJOR SUPPORTER OF THE RURAL HEALTH INITIATIVE WHICH TAKES HEALTHCARE SERVICES TO THE FARM REACHING A SIGNIFICANT VULNERABLE POPULATION OF LOW-INCOME FARMERS AND MIGRANT WORKERS, MANY OF WHOM ARE UNINSURED. AS OF 10/21/2019, RHI HAS SERVED 190 FAMILIES. 116 REFERRALS WERE MADE TO HEALTH CARE PROVIDERS. THESE NUMBERS ARE DECREASING AS FARMS DECREASE DUE TO THE ECONOMYGENERAL1. MEDICAL STUDENTS AND ACCESS TO PRIMARY CARE AND MENTAL HEALTH SERVICES2. 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 SKILLS3. THEDACARE HOSPITALS PROVIDE FINANCIAL AS WELL AS DIAGNOSTIC AND LAB SUPPORT TO A PARTNERSHIP COMMUNITY HEALTH CENTER (FQHC) PROVIDING MEDICAL, BEHAVIORAL AND DENTAL CARE TO THE UNDERSERVED IN OUR SERVICE AREA4. CONTINUE SUPPORT OF CUIDATE LATINO TEEN PREGNANCY PREVENTION PROGRAM AT FQHC5. 2019 SPONSORSHIP OF LOCAL NON-PROFIT INITIATIVES RELATED TO DISPARITIES: $85,0006. 2017-2019 THEDACARE EMPLOYEE VOLUNTEER HOURS RELATED TO DISPARITIES: 8,7097. 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. THEDACARE MEDICAL CENTER - NEW LONDON 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 MEDICAL CENTER - NEW LONDON PART V, SECTION B, LINE 15E: CONTRACTED WITH ELIGIBILITY VENDOR (CARDON) TO WORK DIRECTLY WITH UNINSURED PATIENTS TO ASSIST THEM WITH INSURANCE ENROLLMENT AND EDUCATION. THEDACARE MEDICAL CENTER - NEW LONDON 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 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 ACOMBINATION OF AVERAGE COSTS AND ACTUAL COSTS PERTAINING TO SUPPLIES,WAGES, AND BENEFITS. FOR SUPPLIES, THE ACTUAL COST OF ITEMS USED FOR EACHEVENT IS APPLIED. IF NO ACTUAL COST IS AVAILABLE, WE THEN USE AN ESTIMATE.WAGES ARE CALCULATED BY MULTIPLYING THE AVERAGE WAGE RATE TIMES ACTUALHOURS WORKED. THE BENEFIT RATE USED INCLUDES A FRINGE RATIO OF ALLBENEFITS RELATED TO THE ABOVE WAGE CALCULATION. THE COST ACCOUNTING SYSTEMDOES 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 $ 1,711,704. 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 AT 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 CENTER-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" IN NOTE 1 ON PAGES 10-11 OF 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 ORGANIZATIONS 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 ASSISTANCE PROGRAM. IF ONLY A PORTION OF THE CHARGES ARE ELIGIBLE AND WRITTEN OFF THROUGH OUR CHARITY CARE/FINANCIAL ASSISTANCE 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 MEDICAL CENTER-NEW LONDON SERVICE AREA CONSISTS OF WAUPACA AND OUTAGAMIE 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.WAUPACA COUNTY:- THE PERCENTAGE OF RESIDENTS LIVING BELOW THE FEDERAL POVERTY LEVEL IS 11%.- ACCORDING TO UNITED WAY 36% OF WAUPACA 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%.- THE PERCENTAGE OF CHILDREN ELIGIBLE FOR FREE AND REDUCED LUNCH IN WAUPACA COUNTY IS 41%, ABOVE THE STATE AVERAGE OF 40%.- IN WAUPACA COUNTY 8% OF THE CHILDREN LIVE BELOW 100% OF THE FEDERAL POVERTY LEVEL.- WAUPACA COUNTY HAS 7% OF RESIDENTS WHO ARE UNINSURED.- WAUPACA COUNTY HIGH SCHOOL GRADUATION RATE IS 91%.- NINETY SIX PERCENT OF THE SERVICE AREA IS CAUCASIAN WITH HISPANIC POPULATION OF 2.6%. OUTAGAMIE COUNTY:- THE PERCENTAGE OF RESIDENTS LIVING BELOW THE FEDERAL POVERTY LEVEL IS 9%.- 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%.- THE PERCENTAGE OF CHILDREN ELIGIBLE FOR FREE AND REDUCED LUNCH IN OUTAGAMIE COUNTY IS 31%, BELOW THE STATE AVERAGE OF 40%.- IN OUTAGAMIE COUNTY 8% OF THE CHILDREN LIVE BELOW 100% OF THE FEDERAL POVERTY LEVEL.- OUTAGAMIE COUNTY HAS 3 % OF RESIDENTS WHO ARE UNINSURED.- OUTAGAMIE COUNTY HIGH SCHOOL GRADUATION RATE IS 91%.- IN COMPARISON TO MORE RURAL COUNTIES IN THE THEDACARE SERVICE AREA, OUTAGAMIE AND CALUMET COUNTIES CONTINUE TO HAVE A HIGHER PERCENTAGE OF CHILDREN.- 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%. PART VI, LINE 5: EACH YEAR THEDACARE SETS ASIDE A PERCENTAGE OF ANY 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 X 1 1 X X X X 0 1 0 0 0 0 0 1 0 IMRAN ANDRABI MD PRESIDENT & CEO - SYSTEM 0 881748 0 270005 0 32725 0 43518 0 22350 0 1250346 0 0 MARK THOMPSON SENIOR VP, CFO & COO - SYSTEM 0 557906 0 100979 0 23015 0 43518 0 19247 0 744665 0 0 JAMES ALBIN CIO 0 358040 0 55950 0 19331 0 25000 0 22350 0 480671 0 0 MAGGIE LUND CHRO 0 301356 0 39841 0 19020 0 44000 0 7584 0 411801 0 0 BRIAN STERNS FORMER KEY EMPLOYEE 0 158264 0 8161 0 23017 0 38000 0 19247 0 246689 0 0 SARAH HAROLDSON MD BOARD MEMBER 0 243696 0 0 0 0 0 0 0 0 0 243696 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, 2019 TO DECEMBER 31, 2019) TO RECEIVE A 2020 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 III, LINE 3 IN PARTNERSHIP WITH THEDACARE, WOMEN'S CARE OF WISCONSIN WILL BEGIN PROVIDING GYNECOLOGY AND OBSTETRICS CARE INCLUDING PRE- AND POST-NATAL SERVICES IN NEW LONDON ON NOVEMBER 1, 2019. THIS IS AN EVOLUTION OF A LONG-STANDING RELATIONSHIP BETWEEN THE TWO HEALTH ORGANIZATIONS AND COMPLEMENTS THEIR SHARED VISION OF PROVIDING HIGH-QUALITY CARE FOR PATIENTS. TO ALIGN CARE ACCESS TO PATIENT NEEDS IN THE NEW LONDON AREA, LABOR AND DELIVERY SERVICES AT THEDACARE MEDICAL CENTER-NEW LONDON ARE BEING DISCONTINUED AS OF DECEMBER 31, 2019. PATIENTS CAN BE CONFIDENT IN HAVING CONTINUED LOCAL ACCESS TO GYNECOLOGY AND OBSTETRICS CARE INCLUDING PRE- AND POST-DELIVERY. THAT CARE CAN BE COORDINATED WITH THE LABOR AND DELIVERY HOSPITAL OF THEIR CHOICE, INCLUDING THEDACARE HOSPITALS IN APPLETON, BERLIN, NEENAH, SHAWANO AND WAUPACA. THEDACARE HAS A LONG HISTORY OF SERVING THE PEOPLE OF THIS COMMUNITY AND IT'S IMPORTANT FOR OUR HOSPITAL TO GROW AND CHANGE TO PROVIDE THEM WITH THE BEST CARE. WE ARE COMMITTED TO ENHANCING ACCESS TO HEALTH CARE FOR THE NEW LONDON AREA. 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 MEDICAL CENTER - NEW LONDON, INC. FORM 990, PART VI, SECTION A, LINE 6 THEDACARE MEDICAL CENTER - NEW LONDON, INC.'S SOLE MEMBER 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. SELECTION, APPOINTMENT, AND REMOVAL OF A CHIEF OPERATING OFFICER; AND 5. APPROVAL OF THE PURCHASE OF ASSETS OVER $100,000. 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 MEDICAL CENTER - NEW LONDON, INC. DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND INTERNAL FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 5,239,334. MANAGEMENT AND GENERAL EXPENSES 132,892. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,372,226. 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