2019-11-13T13:56:38-06:00 2018-12-31 410746749 CLIFTONLARSONALLEN LLP 10401 W INNOVATION DRIVE SUITE 300 WAUWATOSA WI 53226 990 2018-01-01 390830664 THEDACARE REGIONAL MEDICAL CENTER - NEENAH INC THED 9207355560 PO BOX 8025 APPLETON WI 549128025 MARK THOMPSON CFO & COO 9207355560 2019-10-31 1 KURT BENNION P01469618 4144761880 2019-10-31 67.137.57.251 2019-10-31 05:04:42 PD P 33F877C3ABFBB78B8EF2964D67A95BC3B590144C 72C56C6F533A7CAE8F7235CA15DC6DF10360C772 2018 2020-03-31 21:24:44Z IMRAN ANDRABI MD PO BOX 8025 APPLETON WI 549128025 237747332 0 X WWW.THEDACARE.ORG X 1909 WI IMPROVING THE HEALTH OF OUR COMMUNITY. 14 11 0 262 1395145 274296 157262 138749 213778738 234679964 94769 216447 2700358 2712172 216731127 237747332 0 4299 0 0 80798745 82974684 0 0 0 100836021 98140905 181634766 181119888 35096361 56627444 394614293 459075023 830 74541 394613463 459000482 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 164628770 4299 233284819 THEDACARE IS A TAX-EXEMPT, NON-PROFIT CORPORATION, AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE.THEDACARE REGIONAL MEDICAL CENTER-NEENAH IS A 151-BED ACUTE CARE HOSPITAL, EMPLOYING MORE THAN 1,000 TEAM MEMBERS. THE CAMPUS OFFERS DIAGNOSTIC SERVICES SUCH AS X-RAY, ULTRASOUND, MRI, CAT SCAN, MAMMOGRAPHY AND MEDICAL LABORATORY TESTING. SPECIALTY PATIENT CARE SERVICES OFFERED INCLUDE CANCER, CARDIOVASCULAR, ORTHOPEDIC, SPINE, FAMILY BIRTH CARE, BARIATRIC WEIGHT LOSS, DIABETES, INTERNAL MEDICINE, EMERGENCY, OCCUPATIONAL HEALTH, PULMONOLOGY, UROLOGY, WOMEN'S CARE, NEPHROLOGY, THERAPY SERVICES, LEVEL II TRAUMA CENTER, NEUROLOGY, OUTPATIENT SURGERY CENTERS AND WELLNESS PROGRAMS. A SIGNIFICANT FEATURE OF THE THEDACARE TRAUMA PROGRAM IS THEDASTAR. THE AIR MEDICAL PROGRAM PROVIDES IMMEDIATE MEDICAL CARE, HELICOPTER TRANSPORTS AND TRANSFERS FOR TRAUMA PATIENTS AND CRITICALLY ILL PATIENTS, INCLUDING TRANSPORT FROM OUR RURAL HOSPITALS. THIS COLLABORATION ALLOWS FOR OUR TEAMS, ACROSS THE ENTIRE REGION, TO WORK IN CONCERT WITH EACH OTHER. THERE ARE 17 COUNTIES SERVED WITHIN THE PRIMARY AND SECONDARY SERVICE AREAS. CHILDREN'S HOSPITAL OF WISCONSIN-FOX VALLEY OPENED IN 2011 AND IS LOCATED WITHIN THEDACARE REGIONAL MEDICAL CENTER-NEENAH. THEDACARE AND CHW PARTNER TO ENSURE THE COMMUNITY HAS ACCESS TO HIGH LEVELS OF CARE. MORE THAN 109,740 UNIQUE PATIENTS ACCOUNT FOR MORE THAN 257,550 VISITS ANNUALLY.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 (WINNEBAGO) 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), REACH OUT AND READ (CHILDHOOD LITERACY).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 29,336 WITH 2,728 ADDITIONAL DAYS FOR NEWBORN CARE. AS PART OF THEDACARE, EMERGENCY MEDICAL HELICOPTER SERVICE IS PROVIDED THROUGHOUT THE 20 COUNTIES SERVED. THE HELICOPTER PROVIDES RAPID PATIENT TRANSPORT TO THE APPROPRIATE HEALTH CARE FACILITY ALONG WITH DELIVERING HIGH-LEVEL CRITICAL CARE. 164628770 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 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 1 1 0 0 0 0 0 0 0 0 0 0 0 X 14 11 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 54912 TERRY TIMM CHAIR 1.00 2.00 X X 0 0 0 JIM KOTEK VICE CHAIR & SECRETARY 1.00 2.00 X X 0 0 0 IMRAN ANDRABI MD PRESIDENT & CEO - SYSTEM 4.00 36.00 X X 105831 952477 33641 TIM BERGSTROM BOARD MEMBER 1.00 3.00 X 0 0 0 PATRICK BRENNAN MD BOARD MEMBER 1.00 2.00 X 0 0 0 MARK BURSTEIN BOARD MEMBER 1.00 2.00 X 0 0 0 JOHN DAVIS BOARD MEMBER 1.00 2.00 X 0 0 0 GARY EDELMAN MD BOARD MEMBER / PHYSICIAN 1.00 42.00 X 0 499600 30264 DAVID KOEPER MD BOARD MEMBER 1.00 2.00 X 0 0 0 GRANT LAMONTAGNE BOARD MEMBER (THROUGH FEB 2018) 1.00 2.00 X 0 0 0 JIM MEYER BOARD MEMBER 1.00 3.00 X 0 0 0 DOUGLAS MOARD MD BOARD MEMBER / PHYSICIAN 1.00 42.00 X 0 320712 35726 KAREN TIMBERLAKE BOARD MEMBER 1.00 2.00 X 0 0 0 NORMA TURK MD BOARD MEMBER / PHYSICIAN 1.00 42.00 X 0 351579 20462 MARIA VAN LAANEN BOARD MEMBER 1.00 2.00 X 0 0 0 CYRIL WALSH MD BOARD MEMBER 1.00 2.00 X 0 0 0 MARK THOMPSON SENIOR VP, CFO & COO - SYSTEM 4.00 36.00 X 58437 525934 31595 TIM OLSON CFO - CLINICALLY INTEGRATED NETWORK 4.00 36.00 X 30901 278105 19727 VICTORIA BARNTHOUSE CNO 8.00 32.00 X 65686 262742 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 JENNIFER REDMAN-SCHELL SR VP, CLINICALLY INTEGRATED NETWORK 2.00 38.00 X 18657 354483 31200 GIANINA SIBLA MD PHYSICIAN 40.00 0.00 X 337692 0 29902 GREGORY LONG MD CMO 4.00 36.00 X 55382 498436 24977 NICKOLAS DEMARK MD PHYSICIAN 40.00 0.00 X 331627 0 18682 WILLIAM MANN SENIOR VP, MANAGED CARE 4.00 36.00 X 48432 435890 19124 BRIAN BURMEISTER FORMER KEY EMPLOYEE 8.00 32.00 X 93641 374563 21779 MAUREEN PISTONE FORMER KEY EMPLOYEE 4.00 36.00 X 37190 334708 6826 1267519 5945599 414702 45 1 1 0 MEDSPEED LLC 140 INDUSTRIAL DRIVE ELMHURST IL 60126 MEDICAL SERVICES 1051688 NEUROSCIENCE GROUP OF NE WISCONSIN 1305 W AMERICAN DRIVE NEENAH WI 54956 MEDICAL SERVICES 1009420 SURGICAL ASSOCIATES OF NEENAH 100 THEDA CLARK MED PLAZA STE 400 NEENAH WI 54956 MEDICAL SERVICES 882695 BIOFIRE DIAGNOSTICS LLC PO BOX 581463 SALT LAKE CITY UT 84158 MEDICAL SERVICES 504034 NEUROSPINE CENTER OF WISCONSIN 5320 W MICHAELS DRIVE APPLETON WI 54913 MEDICAL SERVICES 446742 9 98232 40517 138749 INPATIENT REVENUE 621990 200881168 200881168 OUTPATIENT REVENUE 621400 31633649 31633649 LAB REFERRAL REVENUE 621500 1395145 1395145 OTHER REVENUE 621990 770002 770002 234679964 213957 213957 2712172 0 2712172 2712172 2712172 2490 0 2490 2490 2490 237747332 233284819 1395145 2928619 4299 4299 358749 282397 76352 135870 128295 7575 66455916 56363695 10092221 16024149 13608298 2415851 8492898 5148631 3344267 145375 145375 1232865 801419 431446 5998894 5956618 42276 142244 142244 170125 170125 10353 10353 9217724 9217724 224663 224663 PATIENT & CLIENT SERVIC 64807802 64807802 EQUIPMENT MAINTENANCE 3893108 3893108 BAD DEBT EXPENSE 3723724 3723724 UBI TAXES 81130 81130 181119888 164628770 16491118 0 33044149 31974218 2330774 2795440 241627471 162891354 80843452 78736117 278395918 345569248 394614293 459075023 73931 830 610 830 74541 X 394613463 459000482 394613463 459000482 394614293 459075023 56627444 7759575 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 7550 7550 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 $55,514. 13.6% OF THIS AMOUNT WAS SPENT ON LOBBYING. 6271775 6271775 154642562 95907245 58735317 2674963 2169654 505309 78038171 64814455 13223716 78736117 DUE FROM AFFILIATES 345569248 345569248 OTHER LIABILITIES 610 610 1 1 X 1 X 1 X 410.000000000000 1 0 1 1 1266 1095992 1095992 0.00620 34367 24630286 23590420 1039866 0.00590 35633 25726278 23590420 2135858 0.01210 19 773924 1540823 1540823 0.00870 4 1829 650439 650439 0.00370 3 1380 1059024 1059024 0.00600 6 668814 2048343 2048343 0.01150 32 1445947 5298629 5298629 0.02990 32 1481580 31024907 23590420 7434487 0.04200 1 87633 3479 3479 0.00000 1 1772 55757 2500 53257 0.00030 1 47 1512 1512 0.00000 1 100 9685 9685 0.00010 4 89552 70433 2500 67933 0.00040 0 1406926 0 28068403 28028224 40179 X 1 1 1 1 THEDACARE REGIONAL MEDICAL CENTER - NEENAH 120 SECOND STREET NEENAH WI 54956 WWW.THEDACARE.ORG 32 X X X THEDACARE REGIONAL MEDICAL CENTER - NEEN 1 0 0 1 X X X X X X X X X 16 1 1 1 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 REGIONAL MEDICAL CENTER - NEENAH PART V, SECTION B, LINE 5: THEDACARE CONSULTED WITH THE PUBLIC HEALTH DEPARTMENTS OF OUTAGAMIE COUNTY, WINNEBAGO COUNTY AND CALUMET COUNTY. 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 THOSE LIVING IN POVERTY, RURAL FARM FAMILIES, THE ELDERLY, GRANDPARENTS AS CARETAKERS, SINGLE-PARENTS, HOMELESS, VETERANS AND HEADSTART POPULATION. INPUT WAS COLLECTED FROM REPRESENTATIVES OF:- RURAL HEALTH/FARM FAMILIES- LESBIAN GAY BISEXUAL TRANSGENDER (LGBT)- SENIORS/ELDERLY- LATINO- IMPOVERISHED- HMONG- YOUTH- AFRICAN AMERICAN THEDACARE REGIONAL MEDICAL CENTER - NEENAH PART V, SECTION B, LINE 6A: THEDACARE REGIONAL MEDICAL CENTER-NEENAH 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 2015/2016. THEDACARE REGIONAL MEDICAL CENTER - NEENAH 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 REGIONAL MEDICAL CENTER - NEENAH PART V, SECTION B, LINE 11: THE THEDACARE COMMUNITY HEALTH IMPLEMENTATION STRATEGY WAS APPROVED BY THE THEDACARE BOARD OF TRUSTEES IN DECEMBER OF 2016.OBESITY1. WEIGHT OF THE FOX VALLEY INITIATIVE:- CONTRIBUTED $20,000 TO WOTFV, WITH PRESENCE ON LEADERSHIP AND CORE TEAMS. LEADING EFFORT TO REFOCUS WOTFV ON HEALTHY LIFESTYLE AND WELLBEING VS. OBESITY.- THEDACARE PRODUCED AGGREGATE PATIENT BMI DATA FROM 3 HEALTH SYSTEMS; 91,000 ADULT PATIENTS, 29,000 PEDIATRIC PATIENTS (30% OF POPULATION).- SUPPORTED SECURING $75,000 AMERICORPS PLANNING GRANT TO BRING 20 AMERICORPS VOLUNTEERS IN 2018-19 TO WORK ON OBESITY GOALS.- WOTFV ACTION TEAMS: - KICKED OFF EARLY CARE/EDUCATION ACTION TEAM - FOCUS ON INCREASING FRUIT AND VEG CONSUMPTION AND BREASTFEEDING AGE BIRTH - 5 (WORKING ON HEALTHY SIDES AND BEVERAGES IN KIDS MEALS IN RESTAURANTS. - WORKSITE - ENGAGED 21 ADDITIONAL WORKSITES TO HOST WORKSITE WELLNESS PROGRAMS. GAINED 12 WORKSITES/EARLY CARE PROGRAMS PROVIDING BREASTFEEDING FRIENDLY DESIGNATIONS. SUPPORTED MAINTAIN DON'T GAIN CHALLENGE. - ACTIVE COMMUNITIES - GAINED ACCEPTANCE OF COMPLETE STREETS POLICIES IN FIVE MUNICIPALITIES; ADDED 40 WAYFARING SIGNS AND 3.2 MILES OF TRAILS. - LAUNCHING SCHOOLS AND HEALTHCARE ACTION TEAMS - THEDACARE PROVIDERS HELPING TO DETERMINE FOCUS. 2. SPONSOR HEALTHY KIDS EVENTS - $6000 SPONSORSHIP WITH YMCA HELD AT 6 LOCATIONS WITH 4000 CHILDREN ATTENDING. IN 2018 THE EVENTS FOCUSED ON HEALTHY COOKING. 3. FARMERS MARKETS - IN 2018, PROVIDED SPONSORSHIP TO LOCAL FARMER'S MARKET. THE MARKET PROMOTES PURCHASING AND PREPARING HEALTHY FOODS.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. NEW MH CONNECTION SUPPORT- THEDACARE CHAIRS THE BOARD OF NEW MH CONNECTION, A COALITION OF 70+ MENTAL HEALTH AGENCIES, TO ADDRESS ACCESS TO MENTAL HEALTH CARE; 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 2018, THERE WERE 52,076 PAGE VIEWS. 673 PEOPLE COMPLETED ONLINE SCREENING FOR DEPRESSION OR OTHER MENTAL HEALTH CONDITIONS. 65% INDICATED FURTHER EVALUATION WAS NEEDED. - TOP VIEWED PAGES: MENTAL HEALTH SERVICE DIRECTORY, EMERGENCY SERVICES PAGE, LIBRARY, CALENDAR; TOP LIBRARY SEARCHES: DEPRESSION, ANXIETY, OPIOID ADDICTION, ANOREXIA, EARLY SOCIAL EMOTIONAL DEVELOPMENT.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. PROVIDED OVER $800,000 IN SUBSIDIZED MENTAL HEALTH SERVICES. 5. IN THE FALL OF 2018, THEDACARE SPONSORED PARTY AT THE PAC FOR THOUSANDS OF AREA YOUTH TO EDUCATE ON THE PERILS OF RISKY BEHAVIOR WHILE TEXTING/DRINKING AND DRIVING. 6. 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. 7. 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. 8. 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.9. INPATIENT PSYCH WENT TO 7 DAYS ON/7 OFF FOR HOSPITALIST. FREES UP OUTPATIENT PSYCH TIME. 10. DEPRESSION SCREENING: DEPRESSION SCREENING IS TAKING PLACE IN 100% OF TC PEDS AND FP CLINICS FOR PEOPLE AGE 12+. 11. IN ADDITION:- CONDUCTING COLUMBIA SCREENING AT EVERY MENTAL HEALTH INITIAL APPOINTMENT; AND- CONDUCTING PHQ9 AT EVERY AODA INITIAL APPOINTMENT.EARLY CHILDHOOD/FAMILY SUPPORT:1. REACH OUT AND READ: THEDACARE COMMITTED TO PROVIDING EVIDENCE-BASED REACH OUT AND READ EARLY CHILDHOOD READING PROGRAM IN ALL CLINICS BY 2019. IN 2018, TCP SHAWANO, DARBOY, TIGERTON, NEENAH/MENASHA PEDS PROVIDED BOOKS TO 4000 KIDS. (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 TC EMPLOYEE VOLUNTEERISM EVENT IN 5 AREA SCHOOLS FOR 1 WEEK. READ TO ELEMENTARY STUDENTS AND ENCOURAGED CHILDREN TO READ. 3. IMPROVED BIRTH CENTER ASSESSMENT AND REFERRAL PROCESS TO HOME VISITATION PROGRAMS. TRIPLED THE NUMBER OF REFERRALS FOR PARENTS AS TEACHERS IN HOME SUPPORT. 4. HOSTED EARLY CHILDHOOD PLUNGE APRIL 28, 2017: 60+ COMMUNITY LEADERS ATTENDED. TWO FOLLOW-UP DEBRIEFING MEETINGS RESULTING IN TOP PRIORITY OF DEVELOPING COMMUNITY-WIDE UMBRELLA MODEL THAT CREATES COMMON VISION, ALIGNED PRIORITIES, FACILITATES ACCESS TO ALL EC SERVICES IN THE COMMUNITY AND PROVIDES CONSISTENT MEASUREMENT AND CONDUIT TO RESOURCES, LOCAL, STATE AND NATIONAL. CHAT RESEARCH TEAM EXPLORING NATIONAL MODELS.5. GREAT FUTURES START HERE MENTORING: TC HELPED LAUNCH AND PROVIDED 5 YEARS OF SUPPORT FOR GREAT FUTURES THROUGH OSHKOSH BOYS & GIRLS CLUB. 191 AT-RISK YOUTH MENTORED SINCE PROGRAM START UP.POVERTY: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 PARTICIPATINGHEALTH DISPARITIES:1. OPPORTUNITY GAP - FOLLOWING "BEING BLACK IN FOX CITIES" PLUNGE OCTOBER 2015, TC LED PROCESS WITH AFRICAN HERITAGE, INC., APPLETON/MENASHA SCHOOL DISTRICTS, BOYS & GIRLS CLUB, UNITED WAY, FOUR AREA COLLEGES AND OTHERS TO DEVELOP STAR PROGRAM (SCHOLARS ON TARGET TO ACHIEVE RESULTS) TO HELP REDUCE GRADUATION GAP BETWEEN BLACK AND WHITE STUDENTS. CHAT 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. ADDITIONAL METRICS INCLUDE "ON-TRACK TO GRADUATE" SCORES, POST-SECONDARY ENROLLMENT AND FAMILY ENGAGEMENT.2. RURAL HEALTH INITIATIVE - 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. RHI HAS SERVED 420 FAMILIES IN 2018 WITH 100 BEING LATINO. 572 HEALTH SCREENINGS WERE CONDUCTED WITH 106 UNMANAGED HEALTH CONDITIONS IDENTIFIED. 266 REFERRALS WERE MADE TO HEALTH CARE PROVIDERS. END OF LIFE:1. FOX VALLEY ADVANCE CARE PLANNING PARTNERSHIP: TC LEADERS SERVED ON FV ADVANCE CARE PLANNING PARTNERSHIP LEADERSHIP TEAM. CHAT COMMITTED $160,000 OVER THREE YEARS TO SUPPORT START-UP OF PARTNERSHIP WHICH INCLUDES THEDACARE, ASCENSION, MOSAIC AND END OF LIFE COALITION. STRATEGIC PLAN DEVELOPED TO INCLUDE COMMUNITY-BASED AND HEALTH-SYSTEM BASED GOALS. TC HIRED AN ADVANCE CARE PLANNING COORDINATOR. SURVEY OF PROVIDER ATTITUDES TOWARD END OF LIFE CONVERSATIONS, PALLIATIVE CARE AND HOSPICE COMPLETED SPRING 2018. 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 COMMUNTIY HEALTH CENTER (FQHC) PROVIDING MEDICAL, BEHAVIORAL AND DENTAL CARE TO THE UNDERSERVED IN OUR SERVICE AREA.IDENTIFIED BUT NOT ADDRESSED:1. SMOKING - EXISTING EFFORTS ARE UNDER WAY2. HOMELESSNESS - BEYOND SCOPE OF RESOURCES3. STD'S - BEYOND SCOPE OF RESOURCES THEDACARE REGIONAL MEDICAL CENTER - NEENAH 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 - NEENAH 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. 2 1 - AYLWARD SURGERY CENTER 120 SECOND STREET NEENAH WI 54956 OUTPATIENT SURGERY CENTER 2 - RENAIISANCE SURGERY CENTER 2400 WITZEL AVENUE OSHKOSH WI 54904 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 $ 3,723,724. 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.COMMUNITY SUPPORT: CISM DEBRIEFING - CRITICAL INCIDENT STRESS MANAGEMENT IS AN ADAPTIVE, SHORT-TERM PSYCHOLOGICAL HELPING-PROCESS THAT FOCUSES SOLELY ON AN IMMEDIATE AND IDENTIFIABLE PROBLEM. IT CAN INCLUDE PRE-INCIDENT PREPAREDNESS TO ACUTE CRISIS MANAGEMENT TO POST-CRISIS FOLLOW-UP. ITS PURPOSE IS TO ENABLE PEOPLE TO RETURN TO THEIR DAILY ROUTINE MORE QUICKLY AND WITH LESS LIKELIHOOD OF EXPERIENCING POST-TRAUMATIC STRESS DISORDER. THEDACARE WORKS WITH THE LOCAL COMMUNITY IN CASES OF DEATH, SEVERE INJURY AND INFANT DEATH.OTHER: TRAUMA INJURY PREVENTION OUTREACH - THEDACARE WORKS WITH THE LOCAL COMMUNITY TO PROVIDE INJURY PREVENTION TACTICS INCLUDING HOW TO STOP SEVERE BLEEDING, HOW TO RESPOND TO AN EMERGENCY SUCH AS CARDIAC ARREST OR STROKE. 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 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 REGIONAL MEDICAL CENTER - NEENAH'S SERVICE AREA CONSISTS OF WINNEBAGO COUNTY AND IS LOCATED IN EAST-CENTRAL WISCONSIN. THE COUNTY HOSTS A POPULATION OF OVER 170,000 COMBINED WITH CONCENTRATION IN THE FOX CITIES URBAN AREA.WINNEBAGO COUNTY: - WINNEBAGO COUNTY HIGH SCHOOL GRADUATION RATE IS 91%.- HAS HAD A LOWER UNEMPLOYMENT RATE THAN THE STATE OR NATION PRIMARILY DUE TO A STRONG MANUFACTURING BASE. TRADE/TRANSPORTATION/UTILITIES, EDUCATION/HEALTH AND MANUFACTURING EMPLOY THE MOST PEOPLE IN THE COUNTY. - SIX PERCENT OF WINNEBAGO COUNTY LIVE BELOW 100% OF THE FEDERAL POVERTY LEVEL. 13% PERCENT OF WINNEBAGO COUNTY CHILDREN ARE UNINSURED.- THE LARGEST MINORITY POPULATIONS ARE LATINO AND ASIAN (4.1%). NATIVE AMERICANS ACCOUNT FOR APPROXIMATELY 0.7% OF THE POPULATION AND AFRICAN-AMERICANS REPRESENT 2.1%. 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 92048 828429 13597 122371 186 1677 825 7425 2539 22852 109195 982754 0 0 GARY EDELMAN MD BOARD MEMBER / PHYSICIAN 0 461856 0 37744 0 0 0 8250 0 22014 0 529864 0 0 DOUGLAS MOARD MD BOARD MEMBER / PHYSICIAN 0 320584 0 128 0 0 0 8250 0 27476 0 356438 0 0 NORMA TURK MD BOARD MEMBER / PHYSICIAN 0 257047 0 94532 0 0 0 8250 0 12212 0 372041 0 0 MARK THOMPSON SENIOR VP, CFO & COO - SYSTEM 55688 501192 144 1294 2605 23448 905 8142 2255 20293 61597 554369 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 61375 245498 0 0 4311 17244 1650 6600 2141 8563 69477 277905 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 JENNIFER REDMAN-SCHELL SR VP, CLINICALLY INTEGRATED NETWORK 13947 264992 890 16909 3820 72582 413 7838 1147 21802 20217 384123 0 0 GIANINA SIBLA MD PHYSICIAN 267535 0 70157 0 0 0 8250 0 21652 0 367594 0 0 0 GREGORY LONG MD CMO 299 2695 13 115 55070 495626 103 931 2394 21549 57879 520916 0 0 NICKOLAS DEMARK MD PHYSICIAN 267651 0 63976 0 0 0 8046 0 10636 0 350309 0 0 0 WILLIAM MANN SENIOR VP, MANAGED CARE 39646 356815 1983 17845 6803 61230 825 7425 1087 9787 50344 453102 0 0 BRIAN BURMEISTER FORMER KEY EMPLOYEE 2164 8656 26 103 91451 365804 235 940 4121 16483 97997 391986 0 0 MAUREEN PISTONE FORMER KEY EMPLOYEE -155 -1396 13 115 37332 335989 683 6143 0 0 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 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, 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 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 - NEENAH, INC. FORM 990, PART VI, SECTION A, LINE 6 THEDACARE REGIONAL MEDICAL CENTER - NEENAH, 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 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 2018 AND JANUARY 2019. FORM 990, PART VI, SECTION C, LINE 19 THEDACARE REGIONAL MEDICAL CENTER - NEENAH, 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 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 - BERLIN INC PO BOX 8025 APPLETON WI 549128025 390806359 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 NORTH APPLETON AMBULATORY CARE CENTER BUILDING COMPANY LLC 2500 E CAPITOL DR APPLETON WI 54911 262497187 RENTAL WI N/A 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0