4A (Expenses $ 233587650 including grants of $ 0) (Revenue $ 347943873)
THEDACARE IS A TAX-EXEMPT, NON-PROFIT CORPORATION, AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE.THEDACARE REGIONAL MEDICAL CENTER-APPLETON IS A 147-BED ACUTE CARE HOSPITAL, EMPLOYING MORE THAN 1,200 TEAM MEMBERS. THEDACARE REGIONAL MEDICAL CENTER-APPLETON OFFERS DIAGNOSTIC SERVICES SUCH AS X-RAY, ULTRASOUND, MRI, CAT SCAN, MAMMOGRAPHY AND MEDICAL LABORATORY TESTING, CANCER, CARDIOVASCULAR, ORTHOPEDIC, SPINE, NEUROLOGY, FAMILY BIRTH CARE, DIABETES, INTERNAL MEDICINE, EMERGENCY, OCCUPATIONAL HEALTH, PULMONOLOGY, WOMEN'S CARE, NEPHROLOGY, THERAPY SERVICES, OUTPATIENT SURGERY CENTERS AND WELLNESS PROGRAMS. THEDACARE REGIONAL MEDICAL CENTER-APPLETON HAS AN ACCREDITED CHEST PAIN AND RESUSCITATION CENTER ON CAMPUS.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 (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 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) AND REACH OUT AND READ (CHILDHOOD LITERACY).ADDITIONALLY, 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 31,304 WITH 1,489 ADDITIONAL DAYS FOR NEWBORN CARE.

THEDACARE REGIONAL MEDICAL CENTER - APPLETON
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 REGIONAL MEDICAL CENTER - APPLETON
PART V, SECTION B, LINE 6A: THEDACARE REGIONAL MEDICAL CENTER-APPLETON IS A MEMBER OF THE FOX VALLEY COMMUNITY HEALTH IMPROVEMENT COALITION WHOSE MEMBERS INCLUDE THE PUBLIC HEALTH DEPARTMENTS OF CALUMET, OUTAGAMIE AND WINNEBAGO COUNTIES AND THE HEALTH DEPARTMENTS OF THE CITY OF APPLETON AND CITY OF MENASHA. MEMBERSHIP ALSO INCLUDES REPRESENTATIVES FROM CHILDREN'S HOSPITAL OF WISCONSIN, PARTNERSHIP COMMUNITY HEALTH CENTER (FQHC), AURORA HEALTH IN OSHKOSH AND AFFINITY HEALTH IN APPLETON. THIS COALITION WAS PART OF A JOINT CHNA PROCESS DURING 2019.

THEDACARE REGIONAL MEDICAL CENTER - APPLETON
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 REGIONAL MEDICAL CENTER - APPLETON
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 IS 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 80+ 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. PROVIDED LEADERSHIP AND FUNDING FOR THE PARTNERSHIP COMMUNITY HEALTH CENTER (FQHC) 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.6. ED TO RECOVERY+ (ED2R+) 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 ALL SEVEN THEDACARE ED'S.7. 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 AND MIDDLE SCHOOLS WERE ENGAGED IN SOURCES OF STRENGTH. 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. FIVE OF THE HIGH SCHOOLS HOSTED ON-SITE ACTIVITIES WITH A HIGHLIGHT BEING THE CREATION OF 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. 8. 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.

THEDACARE REGIONAL MEDICAL CENTER - APPLETON
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 - APPLETON
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 - APPLETON
PART V, SECTION B, LINE 16J: THE FAP AND APPLICATION WERE AVAILABLE AT HOSPITAL CASHIER OFFICES, ON OUR WEB SITE AND OFFERED TO ALL PATIENTS THAT EXPRESSED A FINANCIAL HARDSHIP WHEN CALLING THE BILLING OFFICE. THE PLS WAS PRINTED ON EVERY STATEMENT AND A FOOTER WAS ADDED TO THE FRONT OF THE STATEMENT ADVISING PATIENT TO SEE REVERSE SIDE OF STATEMENT FOR FINANCIAL ASSISTANCE AND PAYMENT OPTIONS. NOTIFICATION OF FINANCIAL ASSISTANCE AVAILABILITY WAS ADDED TO THE INITIAL LETTER SENT BY THE THIRD PARTY COLLECTION AGENCY.

PART 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. GENERAL1. 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 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.4. 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. HEALTH 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 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 $ 7,879,696.

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 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"" OF NOTE 1 ON PAGE 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 ORGANIZATION'S 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 ASISTANCE PROGRAM. IF ONLY A PORTION OF THE CHARGES ARE ELIGIBLE AND WRITTEN OFF THROUGH OUR CHARITY CARE/FINANCIAL ASISSTANCE PROGRAM, THE REMAINING BALANCE WILL BE BILLED TO THE PATIENT AND COLLECTED IN ACCORDANCE WITH OUR NORMAL COLLECTION POLICY.

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 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 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.

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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.OUTAGAMIE COUNTY:1. THE PERCENTAGE OF RESIDENTS LIVING BELOW THE FEDERAL POVERTY LEVEL IS 9%.2. ACCORDING TO UNITED WAY 30% OF OUTAGAMIE HOUSEHOLDS LIVE BELOW THE ASSETS LIMITED, INCOME CONSTRAINED, EMPLOYED, (ALICE) AND POVERTY THRESHOLDS. ALICE REPRESENTS INDIVIDUALS AND FAMILIES WHO ARE WORKING BUT UNABLE TO AFFORD THE BASIC NECESSITIES OF HOUSING, FOOD, CHILDCARE, HEALTHCARE AND TRANSPORTATION. THIS IS BELOW THE STATE AVERAGE OF 37.5%.3. THE PERCENTAGE OF CHILDREN ELIGIBLE FOR FREE AND REDUCED LUNCH IN OUTAGAMIE COUNTY IS 31%, BELOW THE STATE AVERAGE OF 40%.5. IN OUTAGAMIE COUNTY 8% OF THE CHILDREN LIVE BELOW 100% OF THE FEDERAL POVERTY LEVEL.6. OUTAGAMIE COUNTY HAS % OF RESIDENTS WHO ARE UNINSURED.7. OUTAGAMIE COUNTY HIGH SCHOOL GRADUATION RATE IS 91%.8. IN COMPARISON TO MORE RURAL COUNTIES IN THE THEDACARE SERVICE AREA, OUTAGAMIE AND CALUMET COUNTIES CONTINUE TO HAVE A HIGHER PERCENTAGE OF CHILDREN.9. THE PERCENTAGE OF NON-CAUCASIAN POPULATION HAS GROWN FROM 9.3% TO 10.7%. EIGHTY NINE PERCENT OF THE SERVICE AREA IS CAUCASIAN WITH HISPANIC POPULATION OF 4.2%. THE LARGEST MINORITY POPULATIONS ARE LATINO (4.2%) AND ASIAN (3.4%). NATIVE AMERICANS ACCOUNT FOR APPROXIMATELY 1.9% OF THE POPULATION AND AFRICAN-AMERICANS REPRESENT 1.2%. CALUMET COUNTY:1. THE PERCENTAGE OF RESIDENTS LIVING BELOW THE FEDERAL POVERTY LEVEL IS 6%.2. ACCORDING TO UNITED WAY 29% OF CALUMET COUNTY HOUSEHOLDS LIVE BELOW THE ASSETS LIMITED, INCOME CONSTRAINED, EMPLOYED, (ALICE) AND POVERTY THRESHOLDS. ALICE REPRESENTS INDIVIDUALS AND FAMILIES WHO ARE WORKING BUT UNABLE TO AFFORD THE BASIC NECESSITIES OF HOUSING, FOOD, CHILDCARE, HEALTHCARE AND TRANSPORTATION. THIS IS BELOW THE STATE AVERAGE OF 37.5%.3. THE PERCENTAGE OF CHILDREN ELIGIBLE FOR FREE AND REDUCED LUNCH IN CALUMET COUNTY IS 30%, BELOW THE STATE AVERAGE OF 30%.4. IN CALUMET COUNTY 6% OF THE CHILDREN LIVE BELOW 100% OF THE FEDERAL POVERTY LEVEL.5. CALUMET COUNTY HAS 4% OF RESIDENTS WHO ARE UNINSURED.6. CALUMET COUNTY HIGH SCHOOL GRADUATION RATE IS 96%.7. IN COMPARISON TO MORE RURAL COUNTIES IN THE THEDACARE SERVICE AREA, OUTAGAMIE AND CALUMET COUNTIES CONTINUE TO HAVE A HIGHER PERCENTAGE OF CHILDREN.8. THE PERCENTAGE OF NON-CAUCASIAN POPULATION HAS GROWN FROM 9.3% TO 10.7%. NINETY ONE PERCENT OF THE SERVICE AREA IS CAUCASIAN WITH HISPANIC POPULATION OF 4.2%. THE LARGEST MINORITY POPULATIONS ARE LATINO (4.2%) AND ASIAN (2.4%). NATIVE AMERICANS ACCOUNT FOR APPROXIMATELY 0.5% OF THE POPULATION AND AFRICAN-AMERICANS REPRESENT 0.6%.

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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
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