2019-11-13T13:56:54-06:00 2018-12-31 410746749 CLIFTONLARSONALLEN LLP 10401 W INNOVATION DRIVE SUITE 300 WAUWATOSA WI 53226 990 2018-01-01 390806359 THEDACARE MEDICAL CENTER - BERLIN INC THED 9203611313 PO BOX 8025 APPLETON WI 549128025 MARK THOMPSON CFO & COO 9203611313 2019-10-31 1 KURT BENNION P01469618 4144761880 2019-10-31 67.137.57.251 2019-10-31 12:49:45 PD P 8AB1EF77DE18A0C4413B49866C7FB8A65B600F09 72C56C6F533A7CAE8F7235CA15DC6DF10360C772 2018 2020-04-17 16:48:07Z X IMRAN ANDRABI MD PO BOX 8025 APPLETON WI 549128025 57874598 0 X WWW.THEDACARE.ORG X 1910 WI IMPROVING THE HEALTH OF OUR COMMUNITY. 12 6 0 80 0 0 32224 55011 60830860 57692890 237344 -94691 138481 126739 61238909 57779949 67444 310459 0 0 28249788 23847072 0 0 0 24350195 24268145 52667427 48425676 8571482 9354273 38359780 48965885 805648 945339 37554132 48020546 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. 1 0 47101379 310459 57576451 THEDACARE IS A TAX-EXEMPT, NON-PROFIT CORPORATION, AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE.THEDACARE MEDICAL CENTER-BERLIN IS A 25-BED CRITICAL ACCESS HOSPITAL SERVING BERLIN AND NEARBY COMMUNITIES. THERE ARE MORE THAN 300 EMPLOYEES LOCATED ON THE BERLIN CAMPUS. THEDACARE MEDICAL CENTER-BERLIN 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, NEUROLOGY, FAMILY BIRTH CARE, DIABETES, INTERNAL MEDICINE, EMERGENCY, OCCUPATIONAL HEALTH, PULMONOLOGY, WOMEN'S CARE, EAR, NOSE & THROAT, OUTPATIENT SURGERY AND THERAPY SERVICES.MORE THAN 15,000 UNIQUE PATIENTS ACCOUNT FOR MORE THAN 49,350 VISITS ANNUALLY.IN ADDITON, WE OFFER AND CONVENIENT WALK-IN CARE, AND E-VISITS FOR ENHANCED COMMUNITY ACCESS TO HEALTHCARE.WITH CORPORATE PARENT THEDACARE, INC. 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 (GREEN LAKE AND MARQUETTE) WHERE SERVICES ARE PROVIDED. EFFORTS INCLUDE PARTNERSHIPS WITH CITY OF BERLIN AMBULANCE SERVICES, BERLIN SCHOOL DISTRICT, GREEN LAKE SCHOOL DISTRICT, TRI-COUNTY BOYS AND GIRLS CLUB, GREEN LAKE COUNTY PUBLIC HEALTH. TOP PRIORITIES INCLUDE MENTAL HEALTH, INCLUDING A MENTORING PROGRAM AT THE TRI-COUNTY BOYS AND GIRLS CLUB TARGETED TO AGES 8TH GRADE THROUGH SENIORS IN HIGH SCHOOL. THEDACARE IS ALSO WORKING WITH COMMUNITY LEADERS TO BECOME A TRAUMA INFORMED COMMUNITY (DRIVING DIFFERENT APPROACHES TO IDENTIFYING ROOT CAUSES AND CONCERNS IN ADOLECENTS).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 3,562 WITH 214 ADDITIONAL DAYS FOR NEWBORN CARE. 47101379 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 1 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 12 6 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 PAUL KUJAWA CHAIR 1.00 0.00 X X 0 0 0 LARRY WISE VICE CHAIR 1.00 0.00 X X 0 0 0 KELLY WHITE DDS TREASURER 1.00 0.00 X X 0 0 0 CRAIG BATLEY MD SECRETARY / PHYSICIAN 1.00 40.00 X X 0 428990 33302 TAMMY BENDING BOARD MEMBER / VP OF CAH OPERATIONS 21.00 21.00 X 124172 124172 15408 JOHN BLAZEL BOARD MEMBER 1.00 0.00 X 0 0 0 MARGARET BOSTELMANN BOARD MEMBER 1.00 0.00 X 0 0 0 DAVID BUDDE DO BOARD MEMBER / PHYSICIAN 1.00 40.00 X 0 455176 30476 JAYSON DUFFY BOARD MEMBER 1.00 0.00 X 0 0 0 JARED KOHLENBERG DO BOARD MEMBER / PHYSICIAN 1.00 40.00 X 0 489635 30214 JENNIFER REDMAN-SCHELL BOARD MEMBER/SR VP, CLIN INTEG NTWRK 2.00 38.00 X 18657 354483 31200 MARK THOMPSON BOARD MEMBER / SR VP, CFO & COO - SYSTEM 4.00 36.00 X X 58437 525934 31595 IMRAN ANDRABI MD PRESIDENT & CEO - SYSTEM 4.00 36.00 X 105831 952477 33641 TIM OLSON CFO - CLINICALLY INTEGRATED NETWORK 4.00 36.00 X 30901 278105 19727 VICTORIA BARNTHOUSE CNO 4.00 36.00 X 32842 295585 18954 JAMES ALBIN CIO 4.00 36.00 X 37439 336952 31617 MAGGIE LUND CHRO 4.00 36.00 X 30195 271744 14724 BRIAN STERNS CHIEF OF STAFF 4.00 36.00 X 16409 147674 25502 WILLIAM MANN SENIOR VP, STRATEGY 4.00 36.00 X 48432 435890 19124 AMANDA HEIN MD PHYSICIAN 40.00 0.00 X 500214 0 34800 HORACE LO MD PHYSICIAN 40.00 0.00 X 760279 0 36199 DARREN NELSON MD PHYSICIAN 40.00 0.00 X 455957 0 30263 DANIEL RESOP MD PHYSICIAN 40.00 0.00 X 442763 0 37466 GREGORY LONG MD FORMER BOARD MEMBER / PHYSICIAN 1.00 40.00 X 55382 498436 24977 MAUREEN PISTONE FORMER KEY EMPLOYEE 4.00 36.00 X 37190 334708 6826 2755100 5929961 506015 15 1 1 0 SHARED MEDICAL SERVICES 209 LIMESTONE PASS COTTAGE GROVE WI 53527 MEDICAL SERVICES 670065 1 55011 55011 INPATIENT SERVICE REVENUE 624100 31033418 31033418 OUTPATIENT SERVICE REVENUE 624100 26521856 26521856 CAFETERIA REVENUE 900099 98961 98961 PHARMACY 446110 21177 21177 MISCELLANEOUS INCOME 900099 17478 17478 57692890 -42 -42 126739 0 126739 126739 126739 94649 -94649 -94649 -94649 57779949 57576451 0 148487 310459 310459 539602 450624 88978 37873 30298 7575 18646643 17848135 798508 14300 14300 4608654 4487710 120944 4312021 4033985 278036 60628 60628 457104 429511 27593 10631 10631 1758496 1755833 2663 71247 71247 98573 98573 3225052 3225052 93439 93439 CLINIC & PATIENT SERVIC 9842570 9842570 BAD DEBT EXPENSE 3384037 3384037 EQUIPMENT & MAINTENANCE 954347 954347 48425676 47101379 1324297 0 68907 9745347 6315029 343333 493383 75183246 43010534 25104213 32172712 3097980 9984761 38359780 48965885 805648 945339 805648 945339 X 37554132 48020546 37554132 48020546 38359780 48965885 9354273 1112141 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 3056 3056 0 PART II-B, LINE 1: A PORTION OF THE WHA DUES REPRESENT LOBBYING PERFORMED IN REGARD TO HEALTHCARE ISSUES. TOTAL DUES PAID IN 2018 WERE $22,469. 13.6% OF THIS AMOUNT WAS SPENT ON LOBBYING. 3863214 3863214 40399722 17660139 22739583 1215316 1090951 124365 29704994 24259444 5445550 32172712 DUE FROM AFFILIATES 9984761 9984761 1 1 X 1 X 1 X 410.000000000000 1 0 1 1 255 176106 176106 0.00390 6579 4499129 4468584 30545 0.00070 6834 4675235 4468584 206651 0.00460 19 191317 199191 199191 0.00440 2 139 81771 81771 0.00180 1 110 731320 731320 0.01620 3 87551 732829 732829 0.01630 25 279117 1745111 1745111 0.03870 25 285951 6420346 4468584 1951762 0.04330 1 24947 806 806 0.00000 1 157 6524 6524 0.00010 1 6 201 201 0.00000 3 25110 7531 7531 0.00010 0 1161952 0 10619118 12161551 -1542433 X 1 1 1 1 THEDACARE MEDICAL CENTER - BERLIN 225 MEMORIAL DRIVE BERLIN WI 54923 WWW.THEDACARE.ORG 1060 X X X X THEDACARE MEDICAL CENTER - BERLIN INC 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X SEE LINE 7D X X 1 16 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 MEDICAL CENTER - BERLIN, INC. PART V, SECTION B, LINE 5: THEDACARE UTILIZES MODELS CREATED BY THE UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTE AND THE ROBERT WOOD JOHNSON FOUNDATION AS THE FRAMEWORK FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. OVER THE COURSE OF A ONE YEAR PERIOD, SECONDARY DATA WAS COLLECTED, PUBLIC HEALTH AND KEY INFORMANT INTERVIEWS WERE CONDUCTED, THEDACARE CHAT (COMMUNITY HEALTH ACTION TEAM) PROVIDED INPUT AND PATIENT HEALTH DATA WAS STUDIED. VULNERABLE POPULATIONS INCLUDED THOSE LIVING IN POVERTY, RURAL FARM FAMILIES, THE ELDERLY AND MIGRANT HISPANIC. INPUT WAS COLLECTED BY REPRESENTATIVES OF:- RURAL HEALTH INITIATIVE- GREEN LAKE/MARQUETTE COUNTIES AGING AND DISABILITY RESOURCE CENTER- GREEN LAKE PUBLIC HEALTH- HEADSTART- GREEN LAKE COUNTY ECONOMIC SUPPORT- GREEN LAKE COUNTY UW-EXTENSION THEDACARE MEDICAL CENTER - BERLIN, INC. PART V, SECTION B, LINE 7D: THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ONLINE AT:HTTPS://WWW.THEDACARE.ORG/GETTING-INVOLVED/IMPROVING-COMMUNITY-HEALTH.ASPX THEDACARE MEDICAL CENTER - BERLIN, INC. PART V, SECTION B, LINE 11: THE THEDACARE COMMUNITY HEALTH IMPLEMENTATION STRATEGY WAS APPROVED BY THE THEDACARE BOARD OF TRUSTEES IN DECEMBER OF 2016.OBESITY:1. PROVIDED FUNDING TO LOCAL FARMER'S MARKETS.2. PARTNERED WITH THE LOCAL BOYS AND GIRLS CLUB TO EDUCATE CHILDREN ABOUT EATING HEALTHY AND THE BENEFITS OF BEING ACTIVE.MENTAL HEALTH/AODA:1. CATALPA HEALTH: IN 2018, 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. PROVIDES LEADERSHIP AND FUNDING FOR THE FOX VALLEY PARTNERSHIP COMMUNITY HEALTH CENTER WORKING TO IMPROVE THE HEALTH STATUS OF THE MEDICALLY UNDERSERVED BY PROVIDING COMPREHENSIVE PRIMARY CARE SERVICES.3. PROVIDED OVER $800,000 IN SUBSIDIZED MENTAL HEALTH SERVICES THROUGHOUT SERVICE AREA. 4. DEVELOPED A PROTOCOL FOR SCREENING PATIENTS FOR SUBSTANCE ABUSE AND A POLICY FOR THOSE ON LONG-TERM OPIATE USE. 5. OPIOID ABUSE PREVENTION: LAUNCHED OPIOID INITIATIVE TO ADDRESS ACADEMIC DETAILING, MAT EXPANSION, DRUG TAKE BACK BOXES THROUGHOUT SYSTEM, COMMUNITY AWARENESS CAMPAIGN, AND SCHOOL-BASED RESILIENCY PROGRAMMING CALLED SOURCES OF STRENGTH. THEDACARE COMMITTED $300,000 OVER 3 YEARS TO IMPLEMENT THE SCHOOL BASED PROGRAM.6. BEHAVIORAL HEALTH OPERATIONS: INITIATED PRIMARY CARE CONSULT. DR. PANZER AND DR. BELD DO INITIAL REVIEW OF ALL REFERRALS AND IF URGENT, GET THEM INTO CARE EXPEDITED (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. 7. INPATIENT PSYCH WENT TO 7 DAYS ON/7 OFF FOR HOSPITALIST. FREES UP OUTPATIENT PSYCH TIME. 8. DEPRESSION SCREENING: DEPRESSION SCREENING IS TAKING PLACE IN 100% OF THEDACARE PEDIATRIC AND FP CLINICS FOR PEOPLE AGE 12+. - CONDUCTING COLUMBIA SCREENING AT EVERY MENTAL HEALTH INITIAL APPOINTMENT.- CONDUCTING PHQ9 AT EVERY AODA INITIAL APPOINTMENT.EARLY CHILDHOOD/FAMILY SUPPORT:1. REACH OUT AND READ: CHI WORKED WITH PHYSICIAN SERVICES TO COMMIT TO EXPANDING ROAR THROUGHOUT TC WITH FUNDING COMING THROUGH OPERATIONS/FOUNDATION BY 2019. FOX CITIES LOCATIONS FUNDED THROUGH UNITED WAY GRANT THROUGH 2018. (A CHILD 1 YEAR BEHIND IN READING BY 3RD GRADE HAS 26% OF DROPPING OUT OF HIGH SCHOOL VS. 10% OF STUDENTS READING AT GRADE LEVEL.)2. HOSTED REACH OUT AND READ: THEDACARE EMPLOYEE VOLUNTEERISM EVENT IN 5 AREA SCHOOLS FOR 1 WEEK. READ TO ELEMENTARY STUDENTS AND ENCOURAGED CHILDREN TO READ. 3. THEDACARE MEDICAL CENTER-BERLIN HOSTED A PLUNGE ON EARLY CHILDHOOD. A PARTNERSHIP WITH CHILDREN'S HOSPITAL OF WI COMMUNITY SERVICES WAS FORMED. CHILDREN'S IS WORKING WITH THEDACARE AND COMMUNITY PARTNERS TO PROVIDE HOME VISITATION SERVICES AND PLAY BASE GROUP CLASSES TO GREEN LAKE AND MARQUETTE COUNTIES.4. HOSTED "KIDS IN CRISIS" PLUNGE IN MARCH 2017. THEDACARE PROVIDED $15,000/YEAR FOR 3 YEARS TO THE TRI-COUNTY BOYS AND GIRLS CLUB IN BERLIN TO LAUNCH A MENTORING PROGRAM TARGETED FOR GRADES 6TH - 12TH GRADE. PARTNERS INCLUDE 3 SCHOOL DISTRICTS, 2 COUNTY PH DEPARTMENTS, COUNTY BOARD. AGES 6TH-12TH GRADE. TARGET 15 ADULT MENTORS FIRST YEAR. TRACKING GRADUATION RATES, ACADEMIC OUTCOMES. PLAN TO REPLICATE THROUGHOUT 3 COUNTY AREA. 28 MATCHES IN PLACE. SUMMER PROGRAMMING INCLUDES WEEKLY MENTOR MEETINGS AS WELL AS MONTHLY FIELD TRIPS. FUNDING SECURED TO EXPAND MENTORING PROGRAM TO RIPON AND GREEN LAKE AREA SCHOOL DISTRICT IN FALL 2019.GENERAL:1. 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 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 AREA.IDENTIFIED BUT NOT ADDRESSED:1. TRANSPORTATION - BEYOND THE SCOPE OF RESOURCES2. DENTAL - RESOURCES EXIST IN REGION3. SMOKING - BEING ADDRESSED BY OTHERS4. HOUSING - BEYOND THE SCOPE OF RESOURCES THEDACARE MEDICAL CENTER - BERLIN, INC. PART V, SECTION B, LINE 13B: 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 - BERLIN, INC. PART V, SECTION B, LINE 15E: CONTRACTED WITH ELIGIBILITY VENDOR (CARDON)TO WORK DIRECTLY WITH THE UNINSURED PATIENT TO ASSIST THEM WITH INSURANCEENROLLMENT AND EDUCATION. THEDACARE MEDICAL CENTER - BERLIN, INC. PART V, SECTION B, LINE 16J: THE FAP AND APPLICATION WERE AVAILABLE AT HOSPITAL CASHIER OFFICES, ON 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 DENIEDAPPROPRIATE AND NECESSARY CARE ON THE BASIS OF INCOME. IN RESPONSE TO THISPOLICY, THE CARING HEARTS FINANCIAL ASSISTANCE PROGRAM WAS SET UP TOPROVIDE SHELTER TO THOSE PATIENTS WHO ARE UNABLE TO PAY FOR THEIR MEDICALSERVICES. MEDICAL SERVICE FEES ARE WRITTEN OFF UNDER THE FINANCIALASSISTANCE PROGRAM THAT WOULD OTHERWISE HAVE BEEN SENT TO A COLLECTIONAGENCY. 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 $ 3,384,037. 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 THE LOCAL CHAMBER OF COMMERCE AND 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 YOUR 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. 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-BERLIN SERVICE AREA CONSISTS OF GREEN LAKE COUNTY AND MARQUETTE COUNTIES, POPULATION IS ABOUT 35,000 COMBINED AND IS LOCATED IN EAST-CENTRAL WISCONSIN. GREEN LAKE COUNTY:- GREEN LAKE COUNTY IS AMONG WISCONSIN'S SLOWER GROWING COUNTIES. - GREEN LAKE COUNTY GRADUATION RATE IS 92%.- GREEN LAKE'S UNEMPLOYMENT RATE IS SIGNIFICANTLY HIGHER THAN THE STATE. THE TOP EMPLOYERS IN GREEN LAKE COUNTY ARE IN HEALTH, EDUCATION AND MANUFACTURING. - SEVENTEEN PERCENT OF GREEN LAKE COUNTY CHILDREN LIVE BELOW 100% OF THE FEDERAL POVERTY LEVEL, 9% ARE UNINSURED.- THE LARGEST MINORITY POPULATION IS HISPANIC/LATINO AT 4.9%. NATIVE AMERICANS ACCOUNT FOR APPROXIMATELY 0.6% OF THE POPULATION AND AFRICAN-AMERICANS 7%. MARQUETTE COUNTY:- MARQUETTE COUNTY IS AMONG WISCONSIN'S SLOWEST GROWING COUNTIES. - MARQUETTE COUNTY GRADUATION RATE IS 85%.- MARQUETTE'S UNEMPLOYMENT RATE IS 5.2%. THE TOP EMPLOYERS IN GREEN LAKE COUNTY ARE IN HEALTH, EDUCATION AND MANUFACTURING. - NINETEENY PERCENT OF MARQUETTE COUNTY CHILDREN LIVE BELOW 100% OF THE FEDERAL POVERTY LEVEL, 8% ARE UNINSURED.- THE LARGEST MINORITY POPULATION IS HISPANIC/LATINO AT 3.1%. NATIVE AMERICANS ACCOUNT FOR APPROXIMATELY 0.4 % OF THE POPULATION AND AFRICAN-AMERICANS ACCOUNT FOR APPROXIMATELY 0.5%. PART VI, LINE 5: EACH YEAR, THEDACARE MEDICAL CENTER-BERLIN'S PARENT ORGANIZATION THEDACARE, SETS ASIDE A PERCENTAGE OF EXCESS NET BUDGETED INCOME TO FUND AN EFFORT CALLED CHAT (COMMUNITY HEALTH ACTION TEAM). CHAT IS A GROUP OF LOCAL 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. THROUGH CHAT, SUCH EFFORTS AS THE SHAWANO COUNTY RURAL HEALTH INITIATIVE HAVE BEEN DEVELOPED. THIS INITIATIVE TAKES BASIC HEALTH CARE AND SCREENING SERVICES TO THE FARM. EACH YEAR HUNDREDS OF FARM FAMILIES LIVING WITHOUT INSURANCE OR ONLY CATASTROPHIC COVERAGE RECEIVE CRITICAL ASSISTANCE. THIS INITIATIVE HAS NOW SPREAD TO OUTAGAMIE, WINNEBAGO AND WAUPACA COUNTIES THEDACARE PROVIDES FUNDING AND STAFF SUPPORT TO MAKE CHAT AND THESE COMMUNITY HEALTH EFFORTS POSSIBLE. A CHAT WAS IMPLEMENTED IN BERLIN IN AUGUST 2016. 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 1 CITY OF BERLIN 108 N CAPRON STREET BERLIN WI 54923 396005398 CITY OF BERLIN 302958 AMBULANCE 1 0 PART I, LINE 2: IN ORDER FOR GRANT REQUESTS TO BE CONSIDERED THEY MUST MEET THE FOLLOWING GUIDELINES: 1) DIRECTED TOWARD PROJECTS THAT SUPPORT THEDACARE'S MISSION AND VALUES; 2) BENEFIT THE COMMUNITES SERVED BY THEDACARE, INC.; OR 3) BENEFIT A 501 (C)(3) NOT-FOR-PROFIT ORGANIZATION. CONVERSELY, REQUESTS MUST NOT BE FOR: 1) THE SOLE BENEFIT OF AN INDIVIDUAL; 2) POLITICAL ORGANIZATIONS OR CAMPAIGN COMMITTEES; 3) RELIGIOUS ORGANIZATIONS (FOR STRICTLY RELIGIOUS PURPOSES); 4) ORGANIZATIONS IN CONFLICT WITH THEDACARE'S MISSION AND VALUES; OR 5) STATE OR NATIONAL CAMPAIGNS. ALL ORGANIZATIONS REQUESTING GRANT FUNDS MUST APPLY THROUGH THE THEDACARE WEBSITE. REQUESTS ARE SCREENED, REVIEWED, AND APPROVED BY COMMITTEE SIX TIMES THROUGHOUT THE FISCAL YEAR. A LETTER OF RESTRICTION IS ISSUED BY THEDACARE IN CONJUNCTION WITH ALL GRANT CHECKS. THIS LETTER OF RESTRICTION STATES THAT ALL GRANT FUNDS RECEIVED FROM THEDACARE MUST BE USED STRICTLY FOR THE PURPOSES FOR WHICH THEY WERE APPLIED. X X 1 1 X X X X 0 1 0 0 0 0 0 0 1 0 CRAIG BATLEY MD SECRETARY / PHYSICIAN 0 407862 0 21128 0 0 0 8250 0 25052 0 462292 0 0 TAMMY BENDING BOARD MEMBER / VP OF CAH OPERATIONS 100563 100563 4714 4714 18895 18895 3156 3156 4548 4548 131876 131876 0 0 DAVID BUDDE DO BOARD MEMBER / PHYSICIAN 0 440548 0 14628 0 0 0 8250 0 22226 0 485652 0 0 JARED KOHLENBERG DO BOARD MEMBER / PHYSICIAN 0 471507 0 18128 0 0 0 8250 0 21964 0 519849 0 0 JENNIFER REDMAN-SCHELL BOARD MEMBER/SR VP, CLIN INTEG NTWRK 13947 264992 890 16909 3820 72582 413 7838 1147 21802 20217 384123 0 0 MARK THOMPSON BOARD MEMBER / SR VP, CFO & COO - SY 55688 501192 144 1294 2605 23448 905 8142 2255 20293 61597 554369 0 0 IMRAN ANDRABI MD PRESIDENT & CEO - SYSTEM 92048 828429 13597 122371 186 1677 825 7425 2539 22852 109195 982754 0 0 TIM OLSON CFO - CLINICALLY INTEGRATED NETWORK 22345 201104 13 115 8543 76886 680 6124 1292 11631 32873 295860 0 0 VICTORIA BARNTHOUSE CNO 30687 276186 0 0 2155 19399 825 7425 1070 9634 34737 312644 0 0 JAMES ALBIN CIO 35099 315890 1865 16785 475 4277 825 7425 2337 21030 40601 365407 0 0 MAGGIE LUND CHRO 24503 220523 3214 28923 2478 22298 761 6846 712 6405 31668 284995 0 0 BRIAN STERNS CHIEF OF STAFF 15633 140694 0 0 776 6980 371 3342 2179 19610 18959 170626 0 0 WILLIAM MANN SENIOR VP, STRATEGY 39646 356815 1983 17845 6803 61230 825 7425 1087 9787 50344 453102 0 0 AMANDA HEIN MD PHYSICIAN 452494 0 23128 0 24592 0 8010 0 26790 0 535014 0 0 0 HORACE LO MD PHYSICIAN 571027 0 156204 0 33048 0 8250 0 27949 0 796478 0 0 0 DARREN NELSON MD PHYSICIAN 416421 0 18878 0 20658 0 8250 0 22013 0 486220 0 0 0 DANIEL RESOP MD PHYSICIAN 413777 0 121 0 28865 0 11297 0 26169 0 480229 0 0 0 GREGORY LONG MD FORMER BOARD MEMBER / PHYSICIAN 299 2695 13 115 55070 495626 103 931 2394 21549 57879 520916 0 0 MAUREEN PISTONE FORMER KEY EMPLOYEE -155 -1396 13 115 37332 335989 0 0 683 6143 37873 340851 0 0 PART I, LINE 1A ALL EXECUTIVES AT THE LEVEL OF VICE PRESIDENT OR ABOVE RECEIVE REIMBURSEMENT FOR PERSONAL MEDICAL EXPENSES AT A MAXIMUM AMOUNT OF $6,800, THAT IS TAXED UPON REIMBURSEMENT. 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 8 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, 2018 TO DECEMBER 31, 2018) TO RECEIVE A 2019 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 2 ON JUNE 13, 2018, THEDACARE FINALIZED THE ACQUISITION OF THE ASSETS OF THE PHYSICIAN GROUP FOX VALLEY HEMATOLOGY & ONCOLOGY. THE ACQUISITION EXPANDS ACCESS TO ONCOLOGY EXCELLENCE FOR THE PATIENTS IN THE COMMUNITIES WHERE THEY LIVE AND WORK INCLUDING APPLETON, NEENAH AND OSHKOSH, AND ESPECIALLY IN THE RURAL AREAS INCLUDING BERLIN, SHAWANO, NEW LONDON AND WAUPACA WHERE THEDACARE IS NOW OFFERING CANCER CARE MULTIPLE DAYS PER WEEK. 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 - BERLIN, INC. FORM 990, PART VI, SECTION A, LINE 6 THEDACARE MEDICAL CENTER - BERLIN, 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. MERGE, CONSOLIDATE, OR CHANGE CONTROL OF THE ORGANIZATION; 2. SELL, LEASE, TRANSFER, OR DISPOSE OF MATERIAL ASSETS; 3. ENTER JOINT VENTURES OR AFFILIATIONS; 4. AMEND BYLAWS AND ARTICLES OF INCORPORATION; 5. DEVELOP AND APPROVE CAPITAL AND OPERATING BUDGETS; 6. AUTHORIZE AND MAKE CAPITAL EXPENDITURES; 7. APPROVE STRATEGIC PLANS, WITH MANAGEMENT AND BOARD OVERSIGHT; 8. APPROVE THE SAFETY AND QUALITY PLAN; 9. APPROVE THE DISSOLUTION OR LIQUIDATION; 10. APPOINT AUDITORS AND LEGAL COUNSEL; AND 11. RETAIN INVESTMENT ADVISORS AND ESTABLISH INVESTMENT POLICIES. 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, 2018 AND JANUARY, 2019. FORM 990, PART VI, SECTION C, LINE 19 THEDACARE MEDICAL CENTER - BERLIN, INC. DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND INTERNAL FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. THEDACARE INC PO BOX 8025 APPLETON WI 549128025 391509362 HEALTHCARE WI 501(C)(3) LINE 10 N/A 0 THEDACARE REGIONAL MEDICAL CENTER - NEENAH INC PO BOX 8025 APPLETON WI 549128025 390830664 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 0 THEDACARE MEDICAL CENTER - NEW LONDON INC PO BOX 8025 APPLETON WI 549128025 390869788 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 0 THEDACARE MEDICAL CENTER - WAUPACA INC PO BOX 8025 APPLETON WI 549128025 390871113 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 0 THEDACARE REGIONAL MEDICAL CENTER - APPLETON INC PO BOX 8025 APPLETON WI 549128025 390824015 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 0 THEDACARE MEDICAL CENTER - SHAWANO INC PO BOX 8025 APPLETON WI 549128025 390807068 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 0 THEDACARE MEDICAL CENTER - WILD ROSE INC PO BOX 8025 APPLETON WI 549128025 396089134 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 0 THEDACARE FAMILY OF FOUNDATIONS INC PO BOX 8025 APPLETON WI 549128025 464112255 FOUNDATION WI 501(C)(3) LINE 7 THEDACARE INC 0 N APPLETON AMBULATORY CARE CENTER BUILDING COMPANY LLC 122 E CAPITOL DR APPLETON WI 54911 262497187 RENTAL WI N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0