2018-11-12T11:33:04-06:00 2017-12-31 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2017-01-01 390830664 THEDACARE REGIONAL MEDICAL CENTER - NEENAH INC THED 9207355560 PO BOX 8025 APPLETON WI 549128025 MARK THOMPSON CFO & COO 9207355560 2018-10-22 1 TERRI REXRODE CPA MST P00096513 9206620016 2018-10-22 74.87.127.216 2018-10-22 15:23:28 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 A43ECD1EE6AF4781A69F6BFA161A98BDE8FA2C07 2017 2019-02-21 02:37:17Z MARK THOMPSON PO BOX 8025 APPLETON WI 549128025 216731127 0 X WWW.THEDACARE.ORG X 1909 WI IMPROVING THE HEALTH OF OUR COMMUNITY. 16 12 0 270 1684824 191004 907306 157262 205670608 213778738 69170 94769 644400 2700358 207291484 216731127 0 0 0 0 81102628 80798745 0 0 0 89340515 100836021 170443143 181634766 36848341 35096361 359500709 394614293 707 830 359500002 394613463 X TO PROVIDE THE HIGHEST QUALITY HEALTH CARE, DELIVERED IN THE MOST EFFICIENT AND COST-EFFECTIVE WAYS, AND ACCESSIBLE TO ALL MEMBERS OF THE COMMUNITY. 0 0 167883842 211529056 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 250-BED ACUTE CARE HOSPITAL, OFFERING 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.MORE THAN 83,000 UNIQUE PATIENTS ACCOUNT FOR MORE THAN 184,000 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 (OUTAGAMIE) WHERE SERVICES ARE PROVIDED. EFFORTS INCLUDE PARTNERSHIPS WITH GOLD CROSS AMBULANCE SERVICE, CATALPA MENTAL HEALTH (MENTAL HEALTH AND WELLNESS FOR CHILDREN), MOSAIC (COMMUNITY PHYSICIAN TRAINING), UNITED WAY, THE WEIGHT OF THE FOX VALLEY (HEALTHY WEIGHT INITITAITVE) & 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 28,081 WITH 2,768 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. THE COST OF UNCOMPENSATED MEDICAID FOR 2017 WAS APPROXIMATELY $4,987,687. THE UNREIMBURSED COST OF MEDICARE WAS APPROXIMATELY $3,316,223. THE COST OF CHARITY CARE PROVIDED DURING 2017 WAS APPROXIMATELY $1,072,504. 167883842 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 1 1 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 X 16 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X KRISTEN COGSWELL 9207386471 122 EAST COLLEGE AVENUE APPLETON WI 54911 TIMM TERRY CHAIR 1.00 2.00 X X 0 0 0 KOTEK JIM VICE CHAIR & SECRETARY 1.00 2.00 X X 0 0 0 ANDRABI IMRAN MD PRESIDENT & CEO - SYSTEM 5.00 38.00 X X 61065 549582 14340 BERGSTROM TIM BOARD MEMBER 1.00 2.00 X 0 0 0 BRENNAN PATRICK MD BOARD MEMBER 1.00 2.00 X 0 0 0 BURSTEIN MARK BOARD MEMBER 1.00 2.00 X 0 0 0 EDELMANGARY MD BOARD MEMBER/PHYSICIAN 1.00 42.00 X 0 450350 31423 KOEPER DAVID MD BOARD MEMBER 1.00 2.00 X 0 0 0 LAMONTAGNE GRANT BOARD MEMBER 1.00 2.00 X 0 0 0 MEYERJIM BOARD MEMBER 1.00 3.00 X 0 0 0 MOARD DOUGLAS MD BOARD MEMBER/PHYSICIAN 1.00 42.00 X 0 295364 36169 TIMBERLAKEKAREN BOARD MEMBER 1.00 2.00 X 0 0 0 TURK NORMA MD BOARD MEMBER/PHYSICIAN 1.00 42.00 X 0 391788 22328 VAN LAANEN MARIA BOARD MEMBER 1.00 2.00 X 0 0 0 WALSH CYRIL P MD BOARD MEMBER 1.00 2.00 X 0 0 0 DAVIS JOHN BOARD MEMBER 1.00 2.00 X 0 0 0 GRUNERDEAN FORMER BOARD MEMBER/CEO 5.00 38.00 X X 82012 738103 21472 HENSON PAMELA FORMER BOARD MEMBER 1.00 2.00 X 0 0 0 KLISTER PAUL FORMER BOARD MEMBER 1.00 2.00 X 0 0 0 THOMPSON MARK CFO & COO - SYSTEM 4.00 36.00 X 26286 236565 4928 OLSON TIM FORMER CFO - SYSTEM 4.00 36.00 X 72249 650240 31903 BURMEISTER BRIAN VP SR AMC & TC 8.00 34.00 X 87223 348895 30774 AUSLOOS JODI INTERIM CIO 4.00 36.00 X 27625 248619 16502 REED LAURA FORMER COO/CHIEF NURSING EXEC 8.00 33.00 X 55454 221814 22139 PISTONE MAUREEN VP SR HR SERVICES 4.00 36.00 X 42720 384476 30869 REDMAN-SCHELL JENNIFER VP SR PHYS, BEHAV, TRANS 2.00 39.00 X 18146 344777 38719 ARORA MAYANK MD PHYSICIAN 40.00 0.00 X 295116 0 20454 LONG GREGORY MD CMO 4.00 37.00 X 58979 530809 33161 HALLETT MARK MD PHYSICIAN 20.00 21.00 X 235274 235274 41696 MANN WILLIAM VP SR STRATEGY 4.00 36.00 X 47758 429825 18883 1109907 6056481 415760 50 0 1 0 NEUROSCIENCE GROUP OF NE WI 1305 W AMERICAN DRIVE NEENAH WI 54956 MEDICAL SERVICES 1118267 MEDSPEED LLC 655 W GRAND AVE SUITE 320 ELMHURST IL 60126 MEDICAL SERVICES 995423 SURGICAL ASSOCIATES NEENAH SC 100 THEDA CLARK MED PLAZA STE 400 NEENAH WI 54956 MEDICAL SERVICES 846070 NEUROSPINE CENTER OF WI 5320 W MICHAELS DRIVE APPLETON WI 54913 MEDICAL SERVICES 392150 SPECIALTYCARE MISS SERVICES DEPT 1614 PO BOX 11407 BIRMINGHAM AL 35246 MEDICAL SERVICES 269815 10 130562 26700 157262 OUTPATIENT REVENUE 621400 106462327 106462327 INPATIENT REVENUE 621990 104750368 104750368 LAB REFERRAL REVENUE 621500 1684824 1684824 OTHER REVENUE 621990 564858 564858 AFFILIATE RENTAL REVENUE 900099 316361 316361 213778738 94769 94769 2700358 0 2700358 2700358 2700358 216731127 211529056 1684824 3359985 496192 496192 62162918 53671549 8491369 1991382 1991382 11882023 11273216 608807 4266230 4266230 16395975 12693057 3702918 26796 26796 1641704 1230800 410904 5987633 5946899 40734 43751 43751 129349 129349 2283145 2283145 11397048 11397048 442757 442757 CLIENT & PATIENT SERVIC 49078449 49078449 BAD DEBT EXPENSE 9946304 9946304 EQUIPMENT MAINTENANCE 3463110 3463110 181634766 167883842 13750924 0 33801838 33044149 2264537 2330774 234837934 153994482 84060434 80843452 239373900 278395918 359500709 394614293 707 830 707 830 X 359500002 394613463 359500002 394613463 359500709 394614293 X 35096361 17100 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 12757 12757 0 PART II-B, LINE 1: A PORTION OF THE WHA DUES REPRESENT LOBBYING PERFORMED IN REGARD TO HEALTHCARE ISSUES. THE AMOUNT FOR 2017 22.98% OF $55,514 WHICH IS $12,757. 6271775 6271775 151947184 91188912 60758272 2674963 1987030 687933 73944012 60818540 13125472 80843452 DUE FROM AFFILIATES 278395918 278395918 OTHER LIABILITIES 830 830 1 1 X 1 X 1 X 1 0 1 1 926 1072504 1072504 0.00620 34257 23289800 18302113 4987687 0.02910 35183 24362304 18302113 6060191 0.03530 21 841656 1487136 1487136 0.00870 4 37954 995631 995631 0.00580 4 1723 3476108 3476108 0.02020 6 631915 1764539 1764539 0.01030 35 1513248 7723414 7723414 0.04500 35 1548431 32085718 18302113 13783605 0.08030 1 1 1 239442 5704 5704 0.00000 1 854 40733 40733 0.00020 1 55 422 422 0.00000 1 1000 8050 8050 0.00000 5 241352 54909 54909 0.00020 0 4243720 1113377 23657070 26973293 -3316223 X 1 1 1 1 THEDACARE REGIONAL MEDICAL CENTER - NEENAH INC 120 SECOND STREET NEENAH WI 54956 HTTPS://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 7D X X 1 16 1 SEE 7D 0 1 X 200.000000000000 350.000000000000 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, 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, VETERANS, HISPANICS/LATINO'S, LGBT, HMONG AND AFRICAN AMERICAN. INPUT WAS COLLECTED BY REPRESENTATIVES OF:- RURAL HEALTH INITIATIVE- CASA HISPANA- AGING AND DISABILITY RESOURCE CENTER OF OUTAGAMIE COUNTY- HMONG-AMERICAN PARTNERSHIP- OUTAGAMIE COUNTY VETERANS' SERVICE - AFRICAN HERITAGE, INC.- LGBT PARTNERSHIP THEDACARE REGIONAL MEDICAL CENTER - NEENAH, INC. PART V, SECTION B, LINE 6A: AFFINITY HEALTH SYSTEM & AURORA HEALTH THEDACARE REGIONAL MEDICAL CENTER - NEENAH, INC. PART V, SECTION B, LINE 6B: THEDACARE REGIONAL MEDICAL CENTER-NEENAH IS A MEMBER OF THE FOX VALLEY COMMUNITY HEALTH 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. MEMBER ALSO INCLUDES REPRESENTATIVES FROM AURORA HEALTH IN OSHKOSH AND AFFINITY HEALTH IN APPLETON. THIS COALITION WAS PART OF A JOINT CHNA DURING 2015/2016. THEDACARE REGIONAL MEDICAL CENTER - NEENAH, INC. PART V, SECTION B, LINE 7D: HOSPITAL FACILITY WEBSITE: HTTPS://WWW.THEDACARE.ORG/ FULL CHNA & IMPLEMENTATION STRATEGY WEBSITE: HTTPS://WWW.THEDACARE.ORG/GETTING-INVOLVED/IMPROVING-COMMUNITY-HEALTH THEDACARE REGIONAL MEDICAL CENTER - NEENAH, 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.- THEDACARE PARTNERS WITH ASCENSION HEALTH SYSTEM TO SPONSOR MOSAIC FAMILY HEALTH RESIDENCY PROGRAM PROVIDING HANDS ON EXPERIENCE FOR MEDICAL STUDENTS AND ACCESS TO PRIMARY CARE AND MENTAL HEALTH SERVICES.- 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.- THEDACARE HOSPITALS PROVIDE FINANCIAL AS WELL AS DIAGNOSTIC AND LAB SUPPORT TO TWO AREA FQHC CLINICS PROVIDING MEDICAL, BEHAVIORAL AND DENTAL CARE TO THE UNDERSERVED IN OUR SERVICE AREA.OBESITY- WEIGHT OF THE FOX VALLEY INITIATIVE - CONTRIBUTED $20,000 TO WOTFV, WITH PRESENCE ON LEADERSHIP AND CORE TEAMS - TC PRODUCED FIRST SET OF AGGREGATE PATIENT BMI DATA FROM 3 HEALTH SYSTEMS; 91,000 ADULT PATIENTS, 28,000 PEDIATRIC PTS. (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 - PARTNERSHIP WITH HEALTHTIDE STATE OBESITY NETWORK, APPLIED FOR $50,000 GRANT) - WORKSITE SUPPORTED MAINTAIN DON'T GAIN CHALLENGE WITH 18 ORGANIZATIONS AND 1,130 WORKERS PARTICIPATING. 247 COMPLETED POST SURVEY WITH 90% MAINTAINING OR LOSING WEIGHT OVER HOLIDAYS. - ACTIVE COMMUNITIES SUPPORTED ADVOCACY WORK TO IMPLEMENT COMPLETE STREETS POLICIES; WAYFARING SIGNAGE ON TRAILS - LAUNCHING SCHOOLS AND HEALTHCARE ACTION TEAMS TC PROVIDERS HELPING TO DETERMINE FOCUS POTENTIALLY ADDRESSING SUGARY BEVERAGE CONSUMPTION IN CLINIC VISIT - VISIBLE AT 63 COMMUNITY EVENTS WITH 5000+ INDIVIDUAL CONNECTIONS- HOSTED GOOD TO GO TC EMPLOYEE VOLUNTEERISM EVENT IN 5 AREA SCHOOLS FOR 1 WEEK - 96% TC EMPLOYEES AGREED/STRONGLY AGREED THEIR VOLUNTEERISM THROUGH GOOD TO GO MADE THEM FEEL GOOD ABOUT THEDACARE (96% SAID THEY WOULD VOLUNTEER AGAIN)- SPONSOR HEALTHY KIDS EVENTS - $6000 SPONSORSHIP WITH YMCA HELD AT 6 LOCATIONS WITH 3000 CHILDREN ATTENDING, FOCUS ON HEALTHY COOKING PROVIDES FUNDING TO LOCAL FARMER'S MARKETS INCLUDING NEENAH.- FARMERS MARKETS - PROVIDED FUNDING TO LOCAL FARMER'S MARKETS INCLUDING NEENAH.MENTAL HEALTH/AODA: - CATALPA HEALTH: THEDACARE PROVIDED IN-KIND LEADERSHIP AND FINANCIAL SUPPORT TO CATALPA HEALTH - CHILDREN'S MENTAL HEALTH PROVIDER. - NEW MH CONNECTION SUPPORT - TC CHAIRS BOARD OF NEW MH CONNECTION; PROVIDES IN-KIND OFFICE SPACE AT TCBH ETC. CONTRIBUTE $15,000 FUNDING ANNUALLY - LAUNCH OF WEBSITE: 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 - WEBSITE LAUNCHED MAY 2017; TOTAL VISITS 28, 835, PAGE VIEWS 52,076; AVERAGE VISITS PER DAY 117; TOP VIEWED PAGES: MENTAL HEALTH SERVICE DIRECTORY, EMERGENCY SERVICES PAGE, LIBRARY, CALENDAR; TOP LIBRARY SEARCHES: DEPRESSION, ANXIETY, OPIOID ADDICTION, ANOREXIA, EARLY SOCIAL EMOTIONAL DEVELOPMENT- 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.- PROVIDED OVER $2,000,000 IN SUBSIDIZED MENTAL HEALTH SERVICES. - THEDACARE ANNUALLY SPONSORS PARTY AT THE PAC FOR THOUSANDS OF AREA YOUTH TO EDUCATE ON THE PERILS OF RISKY BEHAVIOR WHILE TEXTING/DRINKING AND DRIVING. - OPIOID ABUSE PREVENTION: INTERNAL TEAMS ARE WORKING TO ADDRESS PAIN MANAGEMENT AGREEMENTS, PAIN ASSESSMENT STANDARDIZATION, PRESCRIPTION PATHWAYS, USE OF EPDMP, OPIOID RISK TOOL USE, USE OF EPDMP ANALGEIA, MAT AND EPDMP ANALGESIA.- 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. SIGNIFICANTLY DROPPED # ON WAIT LIST. - 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.- INPATIENT PSYCH WENT TO 7 DAYS ON/7 OFF FOR HOSPITALIST. FREES UP OUTPATIENT PSYCH TIME. - DEPRESSION SCREENING: AS OF 6/1/2017, DEPRESSION SCREENING IS TAKING PLACE IN 100% OF TC PEDS AND FP CLINICS FOR PEOPLE AGE 12+. (12-18 YR. OLD ARE ASKED 4 QUESTIONS; 18+ COMPLETE PHQ2) - 53.56% OF PATIENT BASE IN THOSE CLINICS HAVE BEEN SCREENED AS OF OCTOBER 2017; 60.54% SCREENED AS OF DEC 31 2017- IN ADDITION - CONDUCTING COLUMBIA SCREENING AT EVERY MENTAL HEALTH INITIAL APPOINTMENT - CONDUCTING PHQ9 AT EVERY AODA INITIAL APPOINTMENTEARLY CHILDHOOD/YOUTH- REACH OUT AND READ: THEDACARE COMMITTED TO PROVIDING EVIDENCE-BASED REACH OUT AND READ EARLY CHILDHOOD READING PROGRAM IN ALL CLINICS BY 2019. IN 2017, 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.)- 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 WITH MODEL PROPOSAL DUE APRIL 2018.- GREAT FUTURES START HERE MENTORING: TC IN LAST YEAR OF TWO-YEAR FUNDING COMMITMENT WITH PROGRAM THROUGH OSHKOSH BOYS & GIRLS CLUB WHICH TC HELPED LAUNCH AFTER POVERTY PLUNGE. ($23,000). 70 AT-RISK YOUTH MENTORED IN 2017 WITH 93% HAVING NO CONTACT WITH LAW ENFORCEMENT. 1 TEEN PREGNANCY. NO SUICIDES. 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:- OPPORTUNITY GAP FOLLOWING "BEING BLACK IN FOX CITIES" PLUNGE OCT 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. 190 YOUTH TO BE SERVED YEAR 1. ADDITIONAL METRICS INCLUDE "ON-TRACK TO GRADUATE" SCORES, POST-SECONDARY ENROLLMENT AND FAMILY ENGAGEMENT.- DIVERSITY AND INCLUSION TC LEADERSHIP HAS PARTICIPATED IN COMMUNITY EFFORT TO ESTABLISH A DIVERSE AND INCLUSIVE BUSINESS COUNCIL THROUGH THE FOX CITIES CHAMBER. ALSO, WORKING TO ESTABLISH A MORE WELCOMING DOWNTOWN APPLETON FOR PEOPLE OF COLOR. END OF LIFE:- 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. - SURVEY OF PROVIDER ATTITUDES TOWARD END OF LIFE CONVERSATIONS, PALLIATIVE CARE AND HOSPICE TAKING PLACE SPRING 2018. - TC HIRING ADVANCE CARE PLANNING COORDINATOR IDENTIFIED BUT NOT ADDRESSED:- SMOKING: EXISTING EFFORTS ARE UNDER WAY- HOMELESSNESS: BEYOND SCOPE OF RESOURCES- STD'S: BEYOND SCOPE OF RESOURCES THEDACARE REGIONAL MEDICAL CENTER - NEENAH, INC. PART V, SECTION B, LINE 15E: CONTRACTED WITH ELIGIBILITY VENDOR (CARDON) TO WORK DIRECTLY WITH THE UNINSURED PATIENT TO ASSIST THEM WITH INSURANCE ENROLLMENT AND EDUCATION. THEDACARE REGIONAL MEDICAL CENTER - NEENAH, 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 V, LINE 13 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. 2 1 - AYLWARD SURGERY CENTER 120 SECOND STREET NEENAH WI 54956 OUTPATIENT SURGERY CENTER 2 - RENAISSANCE 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, LN 7 COL(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 $9,946,304. 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 CHAMBER OF COMMERCE AND ALL OF THE COMMUNITIES IT SERVES. 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 4: A COST-TO-CHARGE RATIO WAS USED TO DETERMINE THE AMOUNTS REPORTED IN PART III LINES 2 AND 3. PATIENT PAYMENTS OR DISCOUNTS ARE APPLIED PRIOR TO DETERMINING BAD DEBT EXPENSE AND ARE NOT INCLUDED IN THE BAD DEBT WRITE-OFF REPORTED ON THE AUDITED FINANCIAL STATEMENTS. DEDUCTIBLES AND COINSURANCE AMOUNTS THAT ARE DEEMED UNCOLLECTIBLE ARE WRITTEN OFF EITHER TO BAD DEBT EXPENSE OR, IF APPLICABLE, TO CHARITY CARE IF THE PATIENT SO QUALIFIES FOR FINANCIAL ASSISTANCE. THE FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE BUT THEY ACCOUNT FOR BAD DEBTS BASED ON GROSS CHARGES TO PATIENTS AFTER REFLECTING ANY PAYMENTS OR DISCOUNTS, OR AMOUNTS DETERMINED TO BE ELIGIBLE FOR CHARITY CARE/FINANCIAL ASSISTANCE. 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: TO STAY GROUNDED IN THE NEEDS OF THE COMMUNITY IN THE TIMEFRAME BETWEEN OFFICIAL CHNA'S EVERY THREE YEARS, THEDACARE EMPLOYS SEVERAL STRATEGIES:1. COMMUNITY HEALTH ACTION TEAMS (CHAT TEAMS) - THEDACARE ORGANIZES AND LEADS CHAT TEAMS IN EACH HOSPITAL COMMUNITY. CHAT TEAMS ARE COMPRISED OF LEADERS FROM ALL SECTORS, INCLUDING EDUCATION, NON-PROFITS, BUSINESS, GOVERNMENT, HEALTHCARE, AND FAITH ORGANIZATIONS. THESE CHAT TEAMS MEET REGULARLY AND STAY ON TOP OF EMERGING TRENDS IN THE HEALTH OF THE COMMUNITY. 2. PUBLIC HEALTH RELATIONSHIPS THEDACARE COMMUNITY HEALTH STAFF MEET REGULARLY WITH PUBLIC HEALTH LEADERS IN EACH HOSPITAL MARKET. THE PUBLIC HEALTH OFFICIALS ALSO HAVE A THOROUGH UNDERSTANDING OF EMERGING HEALTH NEEDS AND WORK IN PARTNERSHIP WITH THEDACARE.3. IN COMMUNITIES THAT HAVE A UNITED WAY PRESENCE, THEDACARE MEETS REGULARLY WITH UNITED WAY OFFICIALS TO ALSO STAY ON TOP OF EMERGING NEEDS. THE NEEDS IDENTIFIED ABOVE ARE INCLUDED AS INPUTS TO THE ANNUAL STRATEGIC PLANNING WORK OF THE HEALTH SYSTEM. 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 SERVICE AREA CONSISTS OF WINNEBAGO COUNTY AND IS LOCATED IN NORTHEAST WISCONSIN. POPULATION OF WINNEBAGO COUNTY IS SLIGHTLY OVER 170,000.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. - FOURTEEN PERCENT OF WINNEBAGO COUNTY LIVE BELOW 100% OF THE FEDERAL POVERTY LEVEL, 5% PERCENT OF WINNEBAGO COUNTY POPULATION IS UNINSURED.- THE LARGEST MINORITY POPULATIONS ARE LATINO AND ASIAN (4.1%). NATIVE AMERICANS ACCOUNT FOR APPROXIMATELY .7% OF THE POPULATION AND AFRICAN-AMERICANS REPRESENTS 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 ANDRABI IMRAN MD PRESIDENT & CEO - SYSTEM 43831 394482 17144 154293 90 807 0 0 1434 12906 62499 562488 0 0 EDELMANGARY MD BOARD MEMBER/PHYSICIAN 0 444717 0 2150 0 3483 0 10100 0 21323 0 481773 0 0 MOARD DOUGLAS MD BOARD MEMBER/PHYSICIAN 0 291666 0 150 0 3548 0 10100 0 26069 0 331533 0 0 TURK NORMA MD BOARD MEMBER/PHYSICIAN 0 317618 0 70075 0 4095 0 10059 0 12269 0 414116 0 0 GRUNERDEAN FORMER BOARD MEMBER/CEO 46701 420307 15 135 35296 317661 609 5480 1538 13845 84159 757428 0 0 THOMPSON MARK CFO & COO - SYSTEM 8903 80123 17331 155978 52 464 111 996 382 3439 26779 241000 0 0 OLSON TIM FORMER CFO - SYSTEM 50525 454722 15 135 21709 195383 810 7290 2380 21423 75439 678953 0 0 BURMEISTER BRIAN VP SR AMC & TC 79449 317797 30 120 7744 30978 1620 6480 4535 18139 93378 373514 0 0 AUSLOOS JODI INTERIM CIO 23829 214457 15 135 3781 34027 387 3483 1263 11369 29275 263471 0 0 REED LAURA FORMER COO/CHIEF NURSING EXEC 49471 197884 30 120 5953 23810 1448 5793 2980 11918 59882 239525 0 0 PISTONE MAUREEN VP SR HR SERVICES 33415 300731 15 135 9290 83610 810 7290 2277 20492 45807 412258 0 0 REDMAN-SCHELL JENNIFER VP SR PHYS, BEHAV, TRANS 15802 300235 7 142 2337 44400 405 7695 1531 29088 20082 381560 0 0 ARORA MAYANK MD PHYSICIAN 265293 0 18150 0 11673 0 7531 0 12923 0 315570 0 0 0 LONG GREGORY MD CMO 49036 441324 15 135 9928 89350 810 7290 2506 22555 62295 560654 0 0 HALLETT MARK MD PHYSICIAN 191934 191934 75 75 43265 43265 3975 3975 16873 16873 256122 256122 0 0 MANN WILLIAM VP SR STRATEGY 39210 352894 15 135 8533 76796 810 7290 1078 9705 49646 446820 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. ONE EXECUTIVE, NOT PART OF THE SENIOR LEADERSHIP TEAM, RECEIVED REIMBURSEMENT FOR A LOCAL COUNTRY CLUB MEMBERSHIP THAT ENDED 9/1/2017. 12 EMPLOYEES RECEIVED TAXABLE MEDICAL EXPENSE REIMBURSEMENTS AND 2 EMPLOYEES RECEIVED FITNESS CLUB DUES REIMBURSEMENTS. 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 KEY EXECUTIVES AND TO ENCOURAGE TOP-LEVEL EXECUTIVES TO WORK TOGETHER AS A COHESIVE GROUP TOWARD COMMON GOALS. THE PRESIDENT OF THEDACARE INC. DEVELOPS A LIST OF SENIOR LEVEL EXECUTIVES WHO ARE ELIGIBLE TO PARTICIPATE IN THIS PLAN, AS WELL AS THE PERFORMANCE LEVELS THE SENIOR EXECUTIVES MUST ACHIEVE AND THE BONUS AMOUNTS THAT THE EXECUTIVE WILL RECEIVE. THE PRESIDENT THEN SUBMITS THIS LIST TO THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES FOR FINAL APPROVAL. THESE EXECUTIVES MUST BE IN ACTIVE REGULAR SERVICE OF THEDACARE INC. FOR THE ENTIRE PLAN YEAR (JANUARY 1, 2016 TO DECEMBER 31, 2016) TO RECEIVE THEIR 2017 BONUSES. IF THE EMPLOYEE RETIRES, BECOMES DISABLED, MOVES TO A POSITION THAT IS NO LONGER ELIGIBLE FOR THE BONUS PLAN OR DIES, THE PLAN WILL BE PRORATED FOR THE AMOUNT OF TIME THEY SERVED THE COMPANY. IF AN ELIGIBLE EMPLOYEE IS FIRED OR LEAVES THE COMPANY FOR ANY OTHER REASON THE PLAN BONUS WILL BE FORFEITED. CARING FOR SUCCESS THE PLAN OBJECTIVES ARE TO PROVIDE INCENTIVE TO FOCUS THE ORGANIZATION'S RESOURCES, ENERGY AND ATTENTION ON THE FUFILLMENT OF THEDACARE'S MISSION. EMPLOYEE ELIGIBILITY IS BASED ON THE NUMBER OF HOURS WORKED. AND ALL ELIGIBLE EMPLOYEES SHARE IN THE PAYOUT. THE PAYOUT AMOUNT IS DETERMINED BASED ON BOTH FINANCIAL AND EMPLOYEE HEALTH AND SAFETY THRESHOLDS. THE AMOUNT PER EMPLOYEE IS DETERMINED BY DIVIDING THE TOTAL GAIN REALIZED (THE EMPLOYEE SHARE) BY HOURS PAID TO ALL ELIGIBLE EMPLOYEES. THE RESULTING DOLLAR UNIT PAYOUT IS MULTIPLIED BY AN INDIVIDUAL EMPLOYEE'S NUMBER OF HOURS PAID. THIS PLAN IS OVERSEEN BY AN ADMINISTRATIVE COMMITTEE. THE THEDACARE BOARD OF TRUSTEES MUST APPROVE THE PLAN. FORM 990, PART 1, LINE 5 NUMBER OF EMPLOYEES: THEDACARE INC. CENTRALIZES PAYROLL AND TAX WITHHOLDING FUNCTIONS FOR A NUMBER OF AFFILIATED ENTITIES, WHILE ALL FILING UNDER THEDACARE'S FEDERAL IDENTIFICATION NUMBER. THEDACARE REGIONAL MEDICAL CENTER - NEENAH, INC. (NEENAH) REPORTS "0" EMPLOYEES BECAUSE EMPLOYEES ARE PAID BY THEDACARE, INC., THEREFORE, NEENAH DOES NOT FILE ANY W-2 FORMS. THEDACARE INC. IS REIMBURSED BY NEENAH FOR SALARY EXPENSES FOR THE EMPLOYEES WHO ARE PERMANENTLY ASSIGNED TO TC. 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 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 HIRED AN OUTSIDE CONSULTING FIRM TO CONDUCT A THOROUGH MARKET REVIEW OF EXECUTIVE COMPENSATION EVERY OTHER YEAR. INTERNALLY, A COMPENSATION COMMITTEE REAFFIRMED THE COMPENSATION POLICY, REVIEWED DATA FROM CONSULTANTS, AND WITH INPUT FROM THE SR VP OF HUMAN RESOURCES, ADVISED, VALIDATED, AND APPROVED A RANGE FOR CEO COMPENSATION. THE COMMITTEE ALSO RATIFIED THE BONUS PLAN. 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. FORM 990, PART XI, LINE 9: NET ASSETS RELEASED TO OR FROM RESTRICTION 17,100. FORM 990, PART XII, LINE 2C: OVERSIGHT OF THE AUDIT: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. THEDACARE INC 122 EAST COLLEGE AVENUE APPLETON WI 54911 391509362 HEALTHCARE WI 501(C)(3) LINE 10 N/A 0 THEDACARE MEDICAL CENTER - NEW LONDON INC 1405 MILL STREET NEW LONDON WI 54961 390869788 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 1 THEDACARE MEDICAL CENTER - WAUPACA INC 800 RIVERSIDE DRIVE WAUPACA WI 54981 390871113 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 1 THEDACARE REGIONAL MEDICAL CENTER - APPLETON INC PO BOX 8025 APPLETON WI 54912 390824015 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 1 THEDACARE MEDICAL CENTER - SHAWANO INC 100 COUNTY ROAD B SHAWANO WI 54166 390807068 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 1 THEDACARE MEDICAL CENTER - BERLIN INC 225 MEMORIAL DRIVE BERLIN WI 54923 390806359 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 1 THEDACARE MEDICAL CENTER - WILD ROSE INC PO BOX 243 WILD ROSE WI 54984 396089134 HOSPITAL WI 501(C)(3) LINE 3 THEDACARE INC 1 THEDACARE FAMILY OF FOUNDATIONS INC 1818 NORTH MEADE STREET APPLETON WI 54912 464112255 FOUNDATION WI 501(C)(3) LINE 7 THEDACARE INC 1 NORTH APPLETON AMBULATORY CARE CENTER BUILDING COMPANY LLC 122 E COLLEGE AVENUE 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 THEDACARE FAMILY OF FOUNDATIONS INC C 130562 ACTUAL