2022-11-15T16:46:42-06:00 2021-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2021-01-01 390806359 THEDACARE MEDICAL CENTER - BERLIN INC THED 9203611313 PO BOX 8025 APPLETON WI 549128025 MARK THOMPSON CFO & COO 9203611313 2022-11-14 1 MARK THOMPSON 999009999 KURT BENNION CPA P01469618 4252506100 2022-11-14 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z IMRAN ANDRABI MD PO BOX 8025 APPLETON WI 549128025 62548873 0 X WWW.THEDACARE.ORG X 1910 WI IMPROVING THE HEALTH OF OUR COMMUNITY. 13 6 0 7 0 0 5838696 1042437 55188584 61506436 428 0 0 0 61027708 62548873 0 500 0 0 23592503 27403874 0 0 0 29181513 30710766 52774016 58115140 8253692 4433733 70832202 77299134 2347788 4380987 68484414 72918147 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 42934206 500 61377723 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.IN ADDITON, WE OFFER AND CONVENIENT WALK-IN CARE, AND E-VISITS FOR ENHANCED COMMUNITY ACCESS TO HEALTHCARE.AS PART OF THE THEDACARE SYSTEM. WE OFFER PUBLIC AWARENESS CAMPAIGNS, CHARITY CARE, SUPPORT GROUPS AND EDUCATION PROGRAMS TARGETED TO LOCAL COMMUNITY NEEDS. THEDACARE IS COMMITTED TO COMMUNITY FOCUSED EFFORTS IDENTIFIED IN THE COMMUNITY NEEDS HEALTH ASSESSMENT IN COUNTIES (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. THDACARE 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. 42934206 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 13 6 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X KRISTEN COGSWELL 9207355560 PO BOX 8025 APPLETON WI 549128025 IMRAN ANDRABIMD PRESIDENT & CEO - SYSTEM 4.00 36.00 X 0 1200893 67101 MARK THOMPSON SENIOR VP, CFO & COO - SYSTEM 4.00 36.00 X X 0 789686 67916 MARK COCKLEY MD PHYSICIAN & BOARD MEMBER 1.00 39.00 X 0 631582 62038 JAMES ALBIN CIO 4.00 36.00 X 0 609936 62038 LYNN DETTERMAN BOARD MEMBER/PHYSICIAN 1.00 39.00 X 0 469591 41916 MAGGIE LUND CHRO 4.00 36.00 X 0 380684 53181 DAVID BUDDE DO PHYSICIAN & BOARD MEMBER 1.00 39.00 X 0 371482 59466 CRAIG BATLEY DO PHYSICIAN, SECRETARY & BOARD MEMBER 1.00 39.00 X X 0 351005 59414 CYNTHIA FISHER DO PHYSICIAN & BOARD MEMBER 1.00 39.00 X 0 288711 54241 TAMMY BENDING BOARD MEMBER/VP OF CAH OPERATIONS 20.00 20.00 X 0 231760 27181 BRIAN STERNS FORMER KEY EMPLOYEE 4.00 36.00 X 0 187122 61416 JOHN BLAZEL ESQ CHAIR 1.00 0.00 X X 0 0 0 JAYSON DUFFY VICE CHAIR 1.00 0.00 X X 0 0 0 KELLY WHITE DDS TREASURER 1.00 0.00 X X 0 0 0 JARED ABBREDERIS BOARD MEMBER 1.00 0.00 X 0 0 0 MARGARET BOSTELMANN BOARD MEMBER 1.00 0.00 X 0 0 0 JULIE MCCARROLL BOARD MEMBER 1.00 0.00 X 0 0 0 0 5512452 615908 0 1 1 0 TOTAL MSP LLC 221 W COLLEGE AVENUE 2ND FLOOR APPLETON WI 54911 MEDICAL STAFFING 592619 SIEMENS MEDICAL SOLUTIONS USA INC 51 VALLEY STREAM PARKWAY MALVERN PA 19355 BIOMEDICAL REPAIRS/MAINTENANCE 189168 J&J INTERIOR CLEANING W2220 SPRING LAKE RD MARKESAN WI 53946 OUTSOURCED CLEANING 181153 AUGUST WINTER AND SONS INC 2323 N ROEMER ROAD APPLETON WI 54911 BUILDING REPAIRS/MAINTENANCE 117667 CANON MEDICAL SYSTEMS USA INC 2441 MICHELLE DR TUSTIN CA 92780 BIOMEDICAL REPAIRS/MAINTENANCE 107304 5 828034 212437 1966 1042437 INPATIENT SERVICE REVENUE 624100 35845757 35845757 OUTPATIENT SERVICE REVENUE 624100 25531966 25531966 CAFETERIA REVENUE 900099 120797 120797 MISCELLANEOUS INCOME 900099 7916 7916 61506436 62548873 61377723 0 128713 X 500 500 21110599 16400111 4710488 6293275 3890752 2402523 6511835 2698620 3813215 4034 4034 845467 206057 639410 705916 705916 36843 36843 36310 36310 4469816 3754046 715770 186634 186634 MEDICAL SUPPLIES 13360804 10461276 2899528 BAD DEBT EXPENSE 2193151 2193151 EQUIPMENT & MAINTENANCE 1907428 1907428 OTHER EXPENSES 246293 246293 206235 206235 58115140 42934206 15180934 0 5721543 6650831 8633756 2010732 1859263 67 27756 76379011 29861174 40463571 46517837 15985458 20260522 70832202 77299134 1310069 3452071 1000000 870379 37719 58537 2347788 4380987 X 68484414 72918147 68484414 72918147 70832202 77299134 4433733 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 3720 3720 0 PART II-B, LINE 1: A PORTION OF THE WHA DUES REPRESENT LOBBYING PERFORMED IN REGARD TO HEALTHCARE ISSUES. TOTAL DUES PAID IN 2021 WERE $24,315. 15.3% OF THIS AMOUNT WAS SPENT ON LOBBYING. 51224953 16305953 34919000 24944981 13555221 11389760 209077 209077 46517837 DUE FROM AFFILIATES 20260522 20260522 1 1 X 1 X 1 X 410.000000000000 1 0 1 1 309 351005 1 351004 0.00630 5769 7697553 7288743 408810 0.00730 6078 8048558 7288744 759814 0.01360 11 24541 216042 216042 0.00390 2 54 347605 347605 0.00620 4 3 577376 577376 0.01030 3 15800 550522 550522 0.00980 20 40398 1691545 1691545 0.03020 20 46476 9740103 7288744 2451359 0.04380 1 6284 6284 0.00010 1 194 53546 53546 0.00100 2 194 59830 59830 0.00110 0 1176178 285407 9990409 9257033 733376 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 19 1 1 1 1 X SEE LINE 7D X X 1 19 1 SEE LINE 7D 0 1 X 200.000000000000 410.000000000000 X X X X X 1 1 X X X X X 1 X HTTPS://WWW.THEDACARE.ORG/POLICIES-AND-LEGAL-FORMS/PAYMENT-OPTIONS X HTTPS://WWW.THEDACARE.ORG/POLICIES-AND-LEGAL-FORMS/PAYMENT-OPTIONS X HTTPS://WWW.THEDACARE.ORG/POLICIES-AND-LEGAL-FORMS/PAYMENT-OPTIONS X X X X X X X 1 X 0 X X X 1 X 0 0 THEDACARE MEDICAL CENTER - BERLIN, INC. PART V, SECTION B, LINE 5: AS PART OF THE NEEDS ASSESSMENT ADVISORY TEAM, THEDACARE CONSULTED WITH THE PUBLIC HEALTH DEPARTMENTS OF OUTAGAMIE COUNTY, WINNEBAGO COUNTY, CALUMET COUNTY, SHAWANO, GREEN LAKE, MARQUETTE, WAUSHARA, WAUPACA AND THE CITY OF APPLETON.IN ADDITION, OVER THE COURSE OF A ONE YEAR PERIOD, SECONDARY DATA WAS COLLECTED, KEY INFORMANT INTERVIEWS WERE CONDUCTED, THEDACARE CHAT TEAMS (COMMUNITY HEALTH ACTION TEAM) PROVIDED INPUT AND PATIENT HEALTH DATA WAS STUDIED. VULNERABLE POPULATIONS INCLUDED LOW INCOME, RURAL FARM FAMILIES, OLDER ADULTS, VETERANS, HISPANIC/LATINO POPULATION, LESBIAN, GAY, BISEXUAL, TRANSGENDER (LGBT), HMONG POPULATION AND AFRICAN AMERICAN POPULATION. THEDACARE MEDICAL CENTER - BERLIN, INC. PART V, SECTION B, LINE 6A: THEDACARE IS A MEMBER OF THE FOX VALLEY COMMUNITY HEALTH IMPROVEMENT COALITION WHOSE MEMBERS INCLUDE THE PUBLIC HEALTH DEPARTMENTS OF CALUMET, OUTAGAMIE AND WINNEBAGO COUNTIES AND THE HEALTH DEPARTMENTS OF THE CITY OF APPLETON AND CITY OF MENASHA. MEMBERSHIP ALSO INCLUDES REPRESENTATIVES FROM CHILDREN'S HOSPITAL OF WISCONSIN, PARTNERSHIP COMMUNITY HEALTH CENTER (FQHC), AURORA HEALTH IN OSHKOSH AND AFFINITY HEALTH IN APPLETON. THIS COALITION WAS PART OF A JOINT CHNA PROCESS DURING 2019. THEDACARE MEDICAL CENTER - BERLIN, INC. PART V, SECTION B, LINE 7D: THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ONLINE AT HTTPS://THEDACARE.ORG/ABOUT-US/COMMUNITY-HEALTH/NEEDS-ASSESSMENT-PLANS/. THEDACARE 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 2020.CHRONIC DISEASEESTABLISH A CULTURE THAT FOSTERS HEALTH AND WELLBEING AND REDUCES INCIDENCE OF CHRONIC DISEASE. VITAL CONDITIONS ADDRESSED: BASIC NEEDS, SOCIAL CONNECTION/BELONGING, ENVIRONMENT AND RELIABLE TRANSPORTATION.1. BE WELL FOX VALLEY (BWFV) ENVISIONS A PLACE WHERE ALL PEOPLE HAVE THE OPPORTUNITY TO LIVE LONGER, HEALTHIER AND HAPPIER LIVES. BWFV IS A MULTI-SECTOR COLLABORATION WITH AREA HEALTH SYSTEMS TO ADVANCE A CULTURE OF HEALTH AND WELL-BEING. DR. ANDRABI, CEO OF THEDACARE, AND PAULA MORGEN, DIRECTOR OF COMMUNITY HEALTH IMPROVEMENT, SERVE ON THE ANCHOR LEADER GROUP. THEDACARE PROVIDES FINANCIAL AND STAFF SUPPORT TO BE WELL FOX VALLEY AND EAT WELL FOX VALLEY ALONG WITH FUNDING FOR AN AMERICORPS MEMBER. 2. EAT WELL FOX VALLEY IS A STRATEGY OF BWFV CONNECTING LOW-INCOME, DIABETIC/PRE-DIABETIC RESIDENTS WITH HEALTHY FOODS AND LIFESTYLE EDUCATION. A COLLABORATION WITH FEEDING AMERICA EASTERN WISCONSIN ENABLES DISTRIBUTION OF DIABETIC-FRIENDLY FOOD BOXES TO PATIENTS. MEDICAL COLLEGE OF WISCONSIN IS THE RESEARCH PARTNER FOR THIS STUDY. 3. FARMERS MARKETS - FARMERS MARKETS PROMOTE THE PURCHASE AND PREPARATION OF HEALTHY FOODS. THEDACARE SUPPORTS FARMERS MARKETS IN APPLETON, NEENAH, BERLIN, NEW LONDON, WAUPACA AND SHAWANO. MENTAL HEALTH AND SUBSTANCE ABUSEYOUTH AND ADULTS HAVE SUPPORT NEEDED TO LEAD MENTALLY HEALTHY LIVES, FREE OF RELIANCE ON HARMFUL SUBSTANCES VITAL CONDITIONS ADDRESSED: SOCIAL CONNECTION/BELONGING AND BASIC NEEDS URGENT SERVICES ADDRESSED: ACUTE CARE FOR ILLNESS OR INJURY AND ADDICTION AND RECOVERY SERVICES.1. CATALPA HEALTH A CHILDREN'S MENTAL HEALTH PROVIDER WHICH PROVIDES MENTAL HEALTH SERVICES TO CHILDREN THROUGHOUT NORTHEAST WISCONSIN. IN 2021, THEDACARE PROVIDED IN-KIND LEADERSHIP AND FINANCIAL SUPPORT IN EXCESS OF $200,000.2. NEW MH CONNECTION IS A COALITION OF 70+ MENTAL HEALTH AGENCIES TO ADDRESS ACCESS TO MENTAL HEALTH CAREA. TC CHAIRS BOARD OF NEW MH CONNECTION AND PROVIDES IN-KIND OFFICE SPACE AT TCBH ETC. PROVIDED $30,000 FUNDING IN 2021. B. MYCONNECTIONNEW.ORG, SERVICE NAVIGATION SITE FOR ALL MENTAL HEALTH AND SUBSTANCE ABUSE PROVIDERS IN OUTAGAMIE, CALUMET, WINNEBAGO AND NOW BROWN COUNTY IN PARTNERSHIP WITH UNITED WAY'S 2-1-1.3. FQHC SUPPORT: PROVIDED LEADERSHIP AND FUNDING FOR THE PARTNERSHIP COMMUNITY HEALTH CENTER WORKING TO IMPROVE THE HEALTH STATUS OF THE MEDICALLY UNDERSERVED BY PROVIDING COMPREHENSIVE PRIMARY CARE AND BEHAVIORAL HEALTH SERVICES.4. THEDACARE BEHAVIORAL HEALTH WALK-IN CARE CLINIC NEENAH OPENED ON NOVEMBER 4, 2020.5. THEDACARE BEHAVIORAL HEALTH HAS EXPANDED COLLABORATIVE CARE TO INCLUDE SHAWANO, WAUPACA AND NEW LONDON. ED TO RECOVERY IS A COMMUNITY-CLINICAL PARTNERSHIP TO PROVIDE IMMEDIATE RECOVERY SUPPORT TO INDIVIDUALS IN OVERDOSE/CRISIS ENHANCING POSSIBILITY FOR ENROLLMENT IN TREATMENT AND/OR ACCESSING NEEDED SUPPORTS TO BECOME/STAY SUBSTANCE-FREE. A RECOVERY COACH IS IN ED WITHIN 1 HOUR OF ADMISSION OF OPIOID/STIMULANT OVERDOSE PATIENT. IN 2021, THE WI VOICES FOR RECOVERY GRANTED A 2ND YEAR FOR THE ED2R+ PROGRAM, WHICH BEGAN 9/1/21. ED TO RECOVERY IS IN THREE THEDACARE ED'S WITH PLANS TO EXPAND IN FUTURE YEARS. 6. SOURCES OF STRENGTH IS AN EVIDENCE-BASED PEER-LED MODEL ADDRESSING MENTAL HEALTH, SUBSTANCE USE AND SUICIDE AMONG TEENS. IN 2021, TWELVE RURAL HIGH SCHOOLS WERE ENGAGED IN SOURCES OF STRENGTH. THESE SCHOOLS INCLUDED HIGH SCHOOLS AND MIDDLE SCHOOLS. SOME STUDENTS ARE TRAINED AS PEER LEADERS.7. IN 2021, TCBH STARTED PROVIDING SUD SERVICES IN BERLIN WHILE MAINTAINING SERVICE IN SHAWANO AND WAUPACA. THERE WERE 49 SUD VISITS SHAWANO IN 2021 AND 390 SUD VISITS OCCURRED IN WAUPACA IN 2021.8. DEPRESSION SCREENING: DEPRESSION SCREENING IS TAKING PLACE IN 100% OF TC PEDIATRIC CLINICS AND FP CLINICS FOR PEOPLE AGE 12+. 9. CONDUCTING COLUMBIA SCREENING AND PHQ9 AT EVERY BEHAVIORAL HEALTH APPOINTMENT.VULNERABLE POPULATIONSTHE MOST VULNERABLE POPULATIONS WITHIN THEDACARE SERVICE AREA HAVE THE OPPORTUNITY TO ACHIEVE OPTIMAL HEALTH AND WELLBEING VITAL CONDITIONS ADDRESSED: BASIC NEEDS, MEANINGFUL WORK/WEALTH, HUMANE HOUSING, LIFELONG LEARNING, RELIABLE TRANSPORTATION, BELONGING AND CIVIC MUSCLE.1. IN 2021, THEDACARE CONTINUED TO EXTEND WECOME BABY ASSESSMENT BEYOND BIRTH CENTERS TO PRENATAL VISITS. THIS ASSESSMENT IDENTIFIES FAMILIES IN NEED OF ADDITIONAL SUPPORT AND HOME VISITATION. THEDACARE HAS WORKED TO INCORPORATE PRE-NATAL ASSESSMENT IN A PARTNERSHIP WITH WOMEN'S HEALTH AND WOMEN'S CARE WHO DELIVER BABIES AT THEDACARE. NUMBER OF ANNUAL HOME VISITATION ASSESSMENTS WERE 783. 2. WORKING IN COLLABORATION WITH AREA HEALTH SYSTEMS, THE WELCOME BABY MODEL IS FOR ALL NEW BIRTHS TO HELP ENSURE PARENTS HAVE ACCESS TO RESOURCES TO PROVIDE A STRONG START TO THEIR CHILD'S LIFE. IN 2021 NEW ENROLLMENT IN WELCOME BABY WAS 93.3. WORK CONTINUES ON FOX CITIES CHAT INITIATIVES ON EARLY CHILDHOOD RELATED TO 2 PROJECTS. FIRST, FUNDING OF $58,000 WAS GRANTED TO SUPPORT COMMUNITY HELP ME GROW (HMG) NAVIGATORS AND SECOND TO PARTNER ON ASQ REFERRALS WITH THEDACARE OSHKOSH PROVIDERS. IN 2021, HMG NAVIGATORS REACHED 1037 FAMILIES TO PROVIDE INFORMATION, REFERRALS TO RESOURCES AND FOLLOW UP. IN PARTNERSHIP WITH BIRTH TO THREE EARLY INTERVENTION, THEDACARE OSHKOSH ADMINISTERED 75 AGES AND STAGES (ASQ) DEVELOPMENTAL SCREENINGS. THIS PARTNERSHIPS AIM WAS TO IMPROVE ASQ SCREENING PROCESS/RATE.4. SOCIAL DETERMINANTS OF HEALTH - 663 PATIENTS SCREENED POSITIVE FOR SOCIAL NEEDS IN 2021.5. 2021 MAKE A DIFFERENCE DAY ENGAGED 370 THEDACARE TEAM MEMBERS, FAMILY AND FRIENDS VOLUNTEERING AT 7 HIGH SCHOOLS TO CREATE SOCIAL CONNECTIONS WITH 4,950 YOUTH AND FIVE OF THE HIGH SCHOOLS HOSTING ON-SITE ACTIVITIES WITH A HIGHLIGHT BEING THE SOURCES OF STRENGTH FLOWER GARDENS. SOURCES OF STRENGTH IS A NATIONAL PROGRAM DESIGNED TO BUILD RESILIENCY IN STUDENTS TO REDUCE UNHEALTHY BEHAVIORS AND SUICIDE. NEARLY 580 HOURS OF VOLUNTEER SERVICE WAS DONATED IN SEPTEMBER AND OCTOBER TO POSITIVELY IMPACT SOCIAL CONNECTIONS OF AREA YOUTH.6. THEDACARE IS A PARTNER WITH THE POVERTY OUTCOMES & IMPROVEMENT TEAM (POINT), AN 18 MONTH INITIATIVE EQUIPPING THE ENTIRE FOX VALLEY REGION WITH CONTINUOUS IMPROVEMENT METHODOLOGIES FOCUSED ON POVERTY. POINT IS USING THESE PROCESSES TO STRENGTHEN EXISTING POVERTY REDUCTION EFFORTS, ADDRESS SERVICE GAPS, AND MEASURE PROGRESS ON REDUCING POVERTY IN NORTHEAST WISCONSIN. TC CONTRIBUTED $200,000 PLUS PRESENCE ON THE LEADERSHIP TEAM. POINT COLLABORATED WITH BOSTON-BASED INSTITUTE FOR HEALTHCARE IMPROVEMENT TO USE LEAN PROCESSES AND TOOLS TO HELP NON-PROFIT AGENCIES HELP PEOPLE BECOME SELF-SUFFICIENT. MORE THAN 40 NON-PROFIT AGENCIES ARE PARTICIPATING. THEDACARE PLAYS A LEADERSHIP ROLE IN PARTNERSHIP TO ALIGN LOCAL FUNDING BEHIND KEY DRIVERS OF POVERTY, INCLUDING SOCIAL CONNECTION, EMPLOYMENT, EDUCATION, AND HEALTH. 7. LAUNCHED DIVERSITY, INCLUSION AND BELONGING INTERNAL ADVISORY COUNCIL WITH HR AND PRIMARY CARE TO ENHANCE CULTURE THAT VALUES AND RESPECTS DIVERSITY ACROSS TEAM MEMBERS, PATIENTS AND COMMUNITY. FORMULATING RECOMMENDATIONS RE: PATIENT, TEAM MEMBER AND COMMUNITY STRATEGIES TO TAKE TO ELT IN MARCH. (METRICS TO INCLUDE PATIENT, AND TEAM MEMBER SATISFACTION SCORES).8. OPPORTUNITY GAP/STAR PROGRAM FOLLOWING "BEING BLACK IN FOX CITIES" PLUNGE OCT 2015, TC LED A PROCESS WITH AFRICAN HERITAGE, INC., APPLETON/MENASHA SCHOOL DISTRICTS, BOYS & GIRLS CLUB, UNITED WAY, FOUR AREA COLLEGES AND OTHERS TO DEVELOP THE STAR PROGRAM (SCHOLARS ON TARGET TO ACHIEVE RESULTS). THE STAR PROGRAM ADDRESSES THE GRADUATION RATE DIFFERENTIAL BETWEEN BLACK AND WHITE HIGH SCHOOL STUDENTS IN MENASHA AND APPLETON. THE FOX CITIES COMMUNITY HEALTH ACTION TEAM FUNDED $30,000 PROGRAM DIRECTOR START-UP PERIOD WITH $50,000 PER YEAR FOR THREE YEARS FOR PROGRAM OPERATIONS. IN THE 2021/2022 SCHOOL YEAR, 347 YOUTH WERE SERVED, 26 WERE SENIORS AND 96 GRADUATED. 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 INSURANCE ENROLLMENT 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 V, SECTION B, LINE 11 (CONTINUED): 9. THE RURAL HEALTH INITIATIVE (RHI) TAKES HEALTHCARE SERVICES TO THE FARM TO REACH A SIGNIFICANT VULNERABLE POPULATION OF LOW-INCOME FARMERS AND MIGRANT WORKERS, MANY OF WHOM ARE UNINSURED. RHI ENHANCES RURAL ACCESS TO CARE, EARLY DETECTION AND MANAGEMENT OF CHRONIC DISEASE, HEALTHY LIFESTYLE EDUCATION, AND CONNECTION OF UNASSIGNED FREQUENT ED PATIENTS TO PRIMARY CARE HOME. IN 2021, RURAL HEALTH INITIATIVE BECAME PART OF THEDACARE AND IS NOW FUNDED BY A GRANT. REDUCTION OF CHRONIC DISEASE STARTS WITH AWARENESS OF HEALTH RISKS. DURING 2021, 326 RURAL RESIDENTS FROM VULNERABLE POPULATIONS WERE SCREENED FOR OBESITY, CARDIOVASCULAR RISKS AND DIABETES. OF THE INDIVIDUALS SCREENED 35% (114) OF PEOPLE WERE DETECTED TO HAVE CHRONIC HEALTH CONDITIONS WITH THE HIGHEST LEVELS OF RISK BEING OBESITY AND CARDIOVASCULAR RISKS SUCH AS ELEVATED CHOLESTEROL LEVELS. 198 PEOPLE WERE EDUCATED ON MANAGING THOSE RISKS AND 185 INDIVIDUALS RECEIVED REFERRALS. REFERRALS INCLUDED HEALTHCARE PROVIDERS (133), MENTAL HEALTH, PRESCRIPTION DRUG ASSISTANCE, AND BENEFIT ASSISTANCE. 326 RURAL RESIDENTS FROM VULNERABLE POPULATIONS WERE SCREENED FOR OBESITY, CARDIOVASCULAR RISKS AND DIABETES. OF THE INDIVIDUALS SCREENED 35% (114) OF PEOPLE WERE DETECTED TO HAVE CHRONIC HEALTH CONDITIONS WITH THE HIGHEST LEVELS OF RISK BEING OBESITY AND CARDIOVASCULAR RISKS SUCH AS ELEVATED CHOLESTEROL LEVELS. 198 PEOPLE WERE EDUCATED ON MANAGING THOSE RISKS AND 185 INDIVIDUALS RECEIVED REFERRALS. REFERRALS INCLUDED HEALTHCARE PROVIDERS (133), MENTAL HEALTH, PRESCRIPTION DRUG ASSISTANCE, AND BENEFIT ASSISTANCE. GENERALTHEDACARE 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.1. 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.2. THEDACARE PLAYED A CRITICAL ROLE IN THE DEVELOPMENT AND LAUNCH OF IMAGINE FOX CITIES VISIONING INITIATIVE WHICH ENGAGED THE ENTIRE FOX CITIES REGION IN A DISCOVERY AND DISCERNMENT PROCESS TO UNDERSTAND WHAT PEOPLE THINK ABOUT THEIR WELL-BEING TODAY, WHAT THEY EXPECT THEIR WELL-BEING TO BE IN THE FUTURE, AND ARTICULATE A VISION FOR GENERATIONS TO COME THAT WILL GUIDE LOCAL DECISION-MAKING. THIS VISION SETS THE LARGER CONTEXT FOR ADVANCING HEALTH AND WELL-BEING ACROSS THE REGION.3. THROUGH CONSULTANTS ENGAGED WITH IMAGINE FOX CITIES, BROUGHT LEADERS FROM RETHINK HEALTH TO FOX CITIES TO PARTICIPATE IN RWJF GRANT TO EXPLORE HOW LOCAL INSTITUTIONS CAN INVEST DIFFERENTLY TO PROPEL OUR COMMUNITY TOWARD THE NEW VISION. THEDACARE WILL PLAY A FUTURE LEAD ROLE AND THIS WILL BENEFIT ALL AREAS THAT THEDACARE SERVES.NEEDS IDENTIFIED BUT NOT ADDRESSED1. ACES/EARLY CHILDHOOD - WORK ON THIS AREA HAS BEEN INITIATED AND IS ONGOING.2. ISOLATION/COMMUNITY CONNECTIONS - WORK ON THIS AREA HAS BEEN INITIATED AND IS ONGOING.3. FAMILIES STRUGGLING TO MAINTAIN STABLE HOME ENVIRONMENT/FINANCIAL SUSTAINABILITY - WORK ON THIS AREA HAS BEEN INITIATED AND IS ONGOING. 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 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 $ 2,193,151. PART II, COMMUNITY BUILDING ACTIVITIES: ECONOMIC DEVELOPMENT THE PRIMARY AIM OF THE CHAMBER IS TO PROTECT THE INTEREST OF THE BUSINESS COMMUNITY AS A WHOLE. STRONG EMPLOYMENT IS A SOCIAL DETERMINANT OF HEALTH, REDUCING POVERTY AND PROVIDING INDIVIDUAL AND FAMILY SUSTAINABILITY. THEDACARE WORKS TOGETHER WITH LOCAL CHAMBERS OF COMMERCE IS IN ALL OF THE COMMUNITIES IT SERVES. COMMUNITY SUPPORT CARING HEARTS IS A FINANCIAL ASSISTANCE PROGRAM DESIGNED FOR PATIENTS WHO ARE UNABLE TO PAY FOR MEDICALLY NECESSARY SERVICES PROVIDED BY ALL DIVISIONS WITHIN THEDACARE. THE CARING HEARTS PROGRAM COVERS SERVICES WHICH ARE DEEMED TO BE MEDICALLY NECESSARY AS DETERMINED BY THEIR PHYSICIAN. THIS COST IS FOR TIME AND EXPENSE NEEDED TO SUPPORT CARING HEARTS.THE CARING HEARTS FINANCIAL ASSISTANCE PROGRAM IS IN EFFECT AT ALL THEDACARE FACILITIES THEDACARE REGIONAL MEDICAL CENTERS IN APPLETON AND NEENAH, THEDACARE MEDICAL CENTER- BERLIN, THEDACARE MEDICAL CENTER-NEW LONDON, THEDACARE MEDICAL CENTER-SHAWANO, THEDACARE MEDICAL CENTER-WAUPACA AND THEDACARE MEDICAL CENTER-WILD ROSE.ENVIRONMENTAL IMPROVEMENTS SHARPS AND UNUSED DRUG COLLECTION. COMMUNITY SHARPS/UNUSED DRUGS CAN BE TAKEN FOR COLLECTION AND DISPOSAL TO ANY OF THE 7 THEDACARE HOSPITALS.COMMUNITY SHARPS/UNUSED DRUGS CAN BE DISPOSED OF AT THEDACARE REGIONAL MEDICAL CENTER-APPLETON AND NEENAH, THEDACARE MEDICAL CENTER-BERLIN, THEDACARE MEDICAL CENTER-NEW LONDON, THEDACARE MEDICAL CENTER-SHAWANO, THEDACARE MEDICAL CENTER-WAUPACA AND THEDACARE MEDICAL CENTER WILD ROSE.COMMUNITY OTHER: SART/SANE THE SEXUAL ASSAULT RESPONSE TEAM WORKS WITH LOCAL LAW ENFORCEMENT, DOMESTIC ABUSE AGENCIES, SEXUAL ASSAULT AGENCIES, MENTAL HEALTH FACILITIES, LOCAL MEDICAL PROVIDERS TO IMPROVE IMMEDIATE RESPONSE TO VICTIMS OF SEXUAL ASSAULT.SART/SANE PROGRAMMING IS BASED AT THEDACARE REGIONAL MEDICAL CENTER-APPLETON AND SERVES THEDACARE REGIONAL MEDICAL CENTER-NEENAH, THEDACARE MEDICAL CENTER-BERLIN, THEDACARE MEDICAL CENTER-NEW LONDON, THEDACARE MEDICARE CENTER-SHAWANO, THEDACARE MEDICAL CENTER-WAUPACA AND THEDACARE MEDICAL CENTER-WILD ROSE. PART III, LINE 2: PATIENT ACCOUNTS RECEIVABLE ARE UNCOLLATERALIZED PATIENT OBLIGATIONS THAT ARE STATED AT THE AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH THEDACARE EXPECTS TO BE ENTITLED IN EXCHANGE FOR PROVIDING PATIENT CARE. THESE OBLIGATIONS ARE PRIMARILY FROM LOCAL RESIDENTS, MOST OF WHOM ARE INSURED UNDER THIRD-PARTY PAYOR AGREEMENTS. THEDACARE BILLS THIRD-PARTY PAYORS ON THE PATIENTS' BEHALF, OR IF A PATIENT IS UNINSURED, THE PATIENT IS BILLED DIRECTLY. ONCE CLAIMS ARE SETTLED WITH THE PRIMARY PAYOR, ANY SECONDARY INSURANCE IS BILLED, AND PATIENTS ARE BILLED FOR COPAY AND DEDUCTIBLE AMOUNTS THAT ARE THE PATIENTS' RESPONSIBILITY. PAYMENTS ON ACCOUNTS RECEIVABLE ARE APPLIED TO THE SPECIFIC CLAIM IDENTIFIED ON THE REMITTANCE ADVICE OR STATEMENTS. THEDACARE DOES NOT HAVE A POLICY TO CHARGE INTEREST ON PAST DUE ACCOUNTS.PATIENT ACCOUNTS RECEIVABLE ARE RECORDED AT NET REALIZABLE VALUE BASED ON CERTAIN ASSUMPTIONS. FOR THIRD-PARTY PAYORS, INCLUDING MEDICARE, MEDICAID, MANAGED CARE AND COMMERCIAL PAYORS, THE NET REALIZABLE VALUE IS BASED ON THE ESTIMATED CONTRACTUAL REIMBURSEMENT PERCENTAGE, WHICH IS BASED ON CURRENT CONTRACT PRICES OR HISTORICAL PAID CLAIMS DATA BY PAYOR. FOR UNINSURED PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR A PORTION OF THE BILL), THE NET REALIZABLE VALUE IS DETERMINED USING ESTIMATES OF HISTORICAL COLLECTION EXPERIENCE. THESE ESTIMATES ARE ADJUSTED FOR EXPECTED RECOVERIES AND ANY ANTICIPATED CHANGES IN TRENDS, INCLUDING SIGNIFICANT CHANGES IN PAYOR MIX, ECONOMIC CONDITIONS OR TRENDS IN FEDERAL AND STATE GOVERNMENTAL HEALTH CARE COVERAGE. PART III, LINE 3: THE HOSPITAL IS REPORTING $0 BECAUSE IT DOES NOT HAVE A METHOD OF REASONABLY ESTIMATING THE PORTION OF ITS BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE BUT WHO DID NOT COMPLETE A FINANCIAL ASSISTANCE APPLICATION. PART III, LINE 4: SEE "PATIENT ACCOUNTS RECEIVABLE AND CREDIT POLICY" IN NOTE 1 ON PAGE 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 REGIONAL MEDICAL CENTER-APPLETON SERVICE AREA CONSISTS OF OUTAGAMIE AND CALUMET COUNTIES AND IS LOCATED IN EAST-CENTRAL WISCONSIN. THE TWO-COUNTY AREA HOSTS A POPULATION OF OVER 225,000 COMBINED WITH CONCENTRATION IN THE FOX CITIES URBAN AREA.GREEN LAKE COUNTY:1. THE PERCENTAGE OF RESIDENTS LIVING BELOW THE FEDERAL POVERTY LEVEL IS 11%.2. THE PERCENTAGE OF CHILDREN ELIGIBLE FOR FREE AND REDUCED LUNCH IN GREEN LAKE COUNTY IS 38%, BELOW THE STATE AVERAGE OF 40%.3. IN GREEN LAKE COUNTY 18% OF THE CHILDREN LIVE BELOW 100% OF THE FEDERAL POVERTY LEVEL.4. GREEN LAKE COUNTY HAS 8% OF RESIDENTS WHO ARE UNINSURED.5. GREEN LAKE COUNTY HIGH SCHOOL GRADUATION RATE IS 92%.6. NINETY TWO PERCENT OF THE SERVICE AREA IS CAUCASIAN, HISPANIC POPULATION IS 2.6%. MARQUETTE COUNTY:1. THE PERCENTAGE OF RESIDENTS LIVING BELOW THE FEDERAL POVERTY LEVEL IS 7%.2. THE PERCENTAGE OF CHILDREN ELIGIBLE FOR FREE AND REDUCED LUNCH IN MARQUETTE COUNTY IS 45%, ABOVE THE STATE AVERAGE OF 40%.3. IN MARQUETTE COUNTY 9% OF THE CHILDREN LIVE BELOW 100% OF THE FEDERAL POVERTY LEVEL.4. MARQUETTE COUNTY HAS 7% OF RESIDENTS WHO ARE UNINSURED.5. MARQUETTE COUNTY HIGH SCHOOL GRADUATION RATE IS 85%.6. NINETY FIVE PERCENT OF THE SERVICE AREA IS CAUCASIAN 93.7 WITH THE HISPANIC POPULATION OF 2.8%. PART VI, LINE 5: THE FOUNDATION OF COMMUNITY HEALTH WITHIN THEDACARE IS COMMUNITY HEALTH IMPROVEMENT. THEDACARE COMMUNITY HEALTH IMPROVEMENT IS FUNDED THROUGH OPERATING BUDGET, GRANTS, AND THE THEDACARE FAMILY OF FOUNDATION SUPPORT. THEDACARE PROVIDES FUNDING AND DEDICATED STAFF TO MAKE CHAT COMMUNITY HEALTH EFFORTS POSSIBLE. THE COMMUNITY HEALTH TEAM WORKS WITH LOCAL COMMUNITY HEALTH ACTION TEAM (CHAT), GROUPS OF COMMUNITY LEADERS WHO STUDY SYSTEMIC HEALTH ISSUES OUTSIDE THE WALLS OF OUR HOSPITALS. CHAT IS THE FOUNDATION OF INNOVATIVE, COLLABORATIVE SOLUTIONS FOR COMMUNITY ISSUES THAT DRAW UPON THE WIDE ARRAY OF RESOURCES AND STRENGTHS OF OUR COMMUNITY. THERE ARE THEDACARE LED CHAT'S IN THE FOX CITIES OF APPLETON/MENASHA/NEENAH, BERLIN, NEW LONDON, SHAWANO, WAUPACA AND WILD ROSE. PART VI, LINE 6: THEDACARE, THE PARENT ORGANIZATION, PROVIDES DIRECTION RELATED TO COMMUNITY HEALTH NEEDS ASSESSMENT FOR EACH HOSPITAL AND SURROUNDING COMMUNITIES WITHIN ITS SERVICE AREA. PLANS ARE APPROVED BY LOCAL HOSPITAL BOARDS. EACH THEDACARE HOSPITAL, ALONG WITH CHI STAFF AND COMMUNITY MEMBERS DETERMINE HOW BEST TO MEET LOCAL NEEDS. IMPLEMENTATION OF COMMUNITY PROGRAMMING OCCURS AT THE LOCAL LEVEL. PART VI, LINE 7, REPORTS FILED WITH STATES WI X 1 1 X X X X 0 1 0 0 0 0 0 0 1 0 IMRAN ANDRABIMD PRESIDENT & CEO - SYSTEM 0 1016274 0 184619 0 0 0 44685 0 22416 0 1267994 0 0 MARK THOMPSON SENIOR VP, CFO & COO - SYSTEM 0 699158 0 90528 0 0 0 45500 0 22416 0 857602 0 0 MARK COCKLEY MD PHYSICIAN & BOARD MEMBER 0 554237 0 77345 0 0 0 45500 0 16538 0 693620 0 0 JAMES ALBIN CIO 0 555409 0 54527 0 0 0 45500 0 16538 0 671974 0 0 LYNN DETTERMAN BOARD MEMBER/PHYSICIAN 0 430578 0 39013 0 0 0 19500 0 22416 0 511507 0 0 MAGGIE LUND CHRO 0 333237 0 47447 0 0 0 45500 0 7681 0 433865 0 0 DAVID BUDDE DO PHYSICIAN & BOARD MEMBER 0 357982 0 13500 0 0 0 37050 0 22416 0 430948 0 0 CRAIG BATLEY DO PHYSICIAN, SECRETARY & BOARD MEMBER 0 338005 0 13000 0 0 0 36998 0 22416 0 410419 0 0 CYNTHIA FISHER DO PHYSICIAN & BOARD MEMBER 0 276211 0 12500 0 0 0 31825 0 22416 0 342952 0 0 TAMMY BENDING BOARD MEMBER/VP OF CAH OPERATIONS 0 213424 0 18336 0 0 0 19500 0 7681 0 258941 0 0 BRIAN STERNS FORMER KEY EMPLOYEE 0 170436 0 16686 0 0 0 39000 0 22416 0 248538 0 0 PART I, LINE 1A ALL EXECUTIVES AT A LEVEL OF VICE PRESIDENT AND ABOVE ARE ELIGIBLE TO HAVE HEALTH OR FITNESS CLUB FEES REIMBURSED TO THEM, AND TAXED UPON REIMBURSEMENT. PART I, LINE 4B SENIOR LEVEL EXECUTIVES OF THE COMPANY ARE ENTITLED TO AN ANNUAL FLEXIBLE BENEFIT EQUAL TO 20% OF THE MIDPOINT OF THEIR SALARY RANGE. THIS 457(F) SUPPLEMENTAL BENEFIT PLAN COMPLIES WITH THE FINAL REGULATIONS UNDER SECTION 409A AND 457(F) OF THE INTERNAL REVENUE CODE. PARTICIPANTS MAY ELECT THE BENEFIT TO BE USED TO PURCHASE PARTICULAR INSURANCE BENEFITS, INVEST IN A CAPITAL ACCUMULATION ACCOUNT, OR A COMBINATION OF THE TWO. BENEFITS ARE ACCRUED ON A MONTHLY BASIS AND ARE SUBJECT TO THE SUBSTANTIAL RISK OF FORFEITURE AGREEMENT SIGNED BY THE PARTICIPANTS. PLAN CONTRIBUTIONS ARE MADE ON A QUARTERLY BASIS. PART I, LINE 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, 2021 TO DECEMBER 31, 2021) TO RECEIVE A 2022 BONUS. CARING FOR SUCCESS: THE PLAN OBJECTIVES ARE TO PROVIDE INCENTIVE TO FOCUS THE ORGANIZATION'S RESOURCES, ENERGY AND ATTENTION ON THE FULFILLMENT OF THEDACARE'S MISSION. EMPLOYEE ELIGIBILITY IS BASED ON THE NUMBER OF HOURS WORKED. ALL ELIGIBLE EMPLOYEES SHARE IN THE PAYOUT. THE PAYOUT AMOUNT IS A FLAT DOLLAR AMOUNT, DETERMINED BASED ON BOTH FINANCIAL AND QUALITY THRESHOLDS. THE AMOUNT PER EMPLOYEE IS DETERMINED BY DIVIDING THE TOTAL GAIN REALIZED (THE EMPLOYEE SHARE) BY HOURS PAID TO ALL ELIGIBLE EMPLOYEES. THE THEDACARE BOARD OF TRUSTEES APPROVES THE SPEND FOR THE PLAN. FORM 990, PART VI, SECTION A, LINE 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 2021. 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. FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 2,698,620. MANAGEMENT AND GENERAL EXPENSES 3,813,215. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,511,835. 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