2025-05-14T10:20:43+00:00 2024-06-30 440160260 Forvis Mazars LLP 211 N Broadway Suite 600 St Louis MO 631022733 990 2024-01-01 390871113 ThedaCare Medical Center - Waupaca Inc THED 7152581000 PO BOX 8025 APPLETON WI 549128025 William Flett CFO 2025-05-14 true Kristen Hankins P01256574 3142315544 2025-05-14 2024 2025-03-06 01:10:19Z IMRAN ANDRABI MD PO BOX 8025 APPLETON WI 549128025 28412561 false X WWW.THEDACARE.ORG X 1955 WI IMPROVING THE HEALTH OF OUR COMMUNITY. 9 6 0 53 0 39105 19230 55313924 27970000 686798 254707 359216 168624 56399043 28412561 0 0 0 0 21096201 11531782 0 0 0 25367754 14370946 46463955 25902728 9935088 2509833 140699082 155992236 1593288 1613820 139105794 154378416 TO PROVIDE THE HIGHEST QUALITY HEALTH CARE, DELIVERED IN THE MOST EFFICIENT AND COST-EFFECTIVE WAYS, AND ACCESSIBLE TO ALL MEMBERS OF THE COMMUNITY. false false 20245504 27970000 THEDACARE IS A TAX-EXEMPT, NON-PROFIT CORPORATION, AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THEDACARE MEDICAL CENTER-WAUPACA IS A 25-BED CRITICAL ACCESS HOSPITAL SERVING WAUPACA AND NEARBY COMMUNITIES. THERE ARE MORE THAN 225 TEAM MEMBERS LOCATED AT THE WAUPACA CAMPUS. THEDACARE REGIONAL MEDICAL CENTER-WAUPACA 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, SPINE, NEUROLOGY, FAMILY BIRTH CARE, INTERNAL MEDICINE, EMERGENCY, OCCUPATIONAL HEALTH, PULMONOLOGY, UROLOGY, WOMEN'S CARE, OUTPATIENT SURGERY AND THERAPY SERVICES. IN ADDITION, WE OFFER AND CONVENIENT WALK-IN CARE, AND E-VISITS FOR ENHANCED COMMUNITY ACCESS TO HEALTH CARE. EFFECTIVE JANUARY 1, 2024, THEDACARE MEDICAL CENTER - WAUPACA IS PART OF FROEDTERT THEDACARE HEALTH, INC. CONTINUING ITS COMMITMENT TO PATIENT HEALTH AND COMMUNITY WELLBEING, 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 HEALTH NEEDS ASSESSMENT IN COUNTIES (WAUPACA) WHERE SERVICES ARE PROVIDED. EFFORTS INCLUDE PARTNERSHIPS WITH LOCAL GOVERNMENTS, COMMUNITY PARTNERS, AND AREA HEALTH ORGANIZATIONS TO ADDRESS THE TOP HEALTH PRIORITIES IDENTIFIED IN ITS MOST RECENT CHNA. 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. 20245504 true true false false false false false false false false true false false true true false false true false false false false false false false false true true false false false false false false false false false false false false false false false false false false true false false false false true 0 0 0 false false false false false false false false false false false false X 9 6 true true false false true true true true true false false false true true true true true true true true false false X WILL FLETT 7152581000 PO BOX 8025 APPLETON WI 549128025 ERIC HENDRICKSON VICE CHAIR, BOARD MEMBER 1.0 0 X X 0 0 0 JEREMY KOEHLER SECRETARY, BOARD MEMBER 1.0 0 X X 0 0 0 RICHARD PHILLIPSEN CHAIRMAN, BOARD MEMBER 1.0 0 X X 0 0 0 SUZANNE UDONI TREASURER, BOARD MEMBER 1.0 0 X X 0 0 0 Dale Gisi SVP, TC-Central Region, Board Member 1.0 39.0 X 0 0 0 Ellen Wenberg MD PHYSICIAN, BOARD MEMBER 1.0 39.0 X 0 0 0 Jacqueline Anhalt Chief Nursing Officer, Board Member 4.0 36.0 X 0 0 0 LOU ANN MOKWA BOARD MEMBER 1.0 0 X 0 0 0 TIMOTHY NEUVILLE BOARD MEMBER 1.0 0 X 0 0 0 Brian Sterns Chief Digital Health Officer 4.0 36.0 X 0 0 0 Imran Andrabi MD President & CEO - System 4.0 36.0 X 0 0 0 Maggie Lund Chief Culture and Integration Officer 4.0 36.0 X 0 0 0 William Flett Chief Financial Officer 4.0 36.0 X 0 0 0 0 0 0 0 false false false 0 19230 19230 Net Patient Service Revenue 622110 27970000 27970000 0 0 0 0 27970000 254707 254707 79899 79899 0 79899 79899 0 0 0 Cafeteria Revenue 722210 85645 85645 Other Operating Revenue 900099 3080 3080 0 0 0 0 88725 28412561 27970000 0 423331 X 0 0 9290669 7260019 2030650 200485 162628 37857 1539939 1249158 290781 500689 406146 94543 877466 877466 13008 13008 3446145 2637905 808240 0 156 156 103119 103119 12129 12129 1466132 271871 1194261 21420 21420 23872 23872 1458055 1147793 310262 57645 57645 MEDICAL AND OTHER SUPPLIES 6524136 6524136 Equipment and Maintenance 136912 136912 Food and Nutrition 128809 128809 Medicaid Assessment 49643 49643 52299 52299 0 0 25902728 20245504 5657224 0 2161 31973611 6119452 6871357 0 0 0 0 1867882 1745207 37540 58140 35328912 1149128 19694653 34179784 18522463 19356683 0 0 62483481 93778904 140699082 155992236 1284888 1071118 0 0 308400 542702 1593288 1613820 X 139105794 154378416 139105794 154378416 140699082 155992236 X 2509833 579513 12183276 X false true true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1780619 1780619 25891175 612899 25278276 3983650 536229 3447421 3673468 3673468 34179784 Other Assets 1139123 Due from Affiliate 92639781 93778904 Federal Income Taxes Third Party Settlement 542702 542702 Schedule D, Part X, Line 2 EVALUATION OF UNCERTAIN TAX POSITIONS MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. true true X true X true X 249273 249273 0.00962 1879 2807125 2877362 0 0.0 0 0.0 0 1879 3056398 2877362 249273 0.00962 8 36929 119340 119340 0.00461 3 49 60621 60621 0.00234 3 1 982166 982166 0.03792 0 0.0 2 141417 220339 220339 0.00851 16 178396 1382466 0 1382466 0.05337 16 180275 4438864 2877362 1631739 0.06299 0 0.0 1 3773 3773 0.00015 1 130 206271 8108 198163 0.00765 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 130 210044 8108 201936 0.00780 false 1181107 662536 4048077 3693197 354880 X true true 1 1 THEDACARE MEDICAL CENTER - WAUPACA 800 RIVERSIDE DRIVE WAUPACA WI 54981 WWW.THEDACARE.ORG 1038 X X X X THEDACARE MEDICAL CENTER - WAUPACA 1 false false true X X X X X X X X X 22 true false false true X HTTPS://THEDACARE.ORG/ABOUT-US/COMMUNITY-HEALTH/NEEDS-ASSESSMENT-PLANS/ X true 23 true HTTPS://THEDACARE.ORG/ABOUT-US/COMMUNITY-HEALTH/NEEDS-ASSESSMENT-PLANS/ false true X 200.0 400.0 X X X X X true true X X X X X true X https://thedacare.org/PATIENTS-AND-VISITORS/BILLING-AND-PAYMENT/FINANCIAL-ASSISTANCE/ X https://thedacare.org/PATIENTS-AND-VISITORS/BILLING-AND-PAYMENT/FINANCIAL-ASSISTANCE/ X https://thedacare.org/PATIENTS-AND-VISITORS/BILLING-AND-PAYMENT/FINANCIAL-ASSISTANCE/ X X X X X X X true X false X X X true X false false Schedule H, Part V, Section B, Line 3E THE HOSPITAL FACILITY ANALYZED SEVERAL HEALTH NEEDS OF THE COMMUNITY AND HAS PRIORITIZED THOSE OF MOST CONCERN. THE PRIORITIZATION OF TOP SIGNIFICANT COMMUNITY HEALTH NEEDS IS DESCRIBED IN THE CHNA. Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - THEDACARE MEDICAL CENTER- WAUPACA. As part of the Needs Assessment Advisory Team, ThedaCare consulted with the Public Health Departments of Outagamie County, Winnebago County, Calumet County, Shawano, Menomonee, Green Lake, Marquette, Waushara, Waupaca and the City of Appleton. * Chuck Sepers, City of Appleton Public Health Officer * Bonnie Thelen RN, Calumet County Public Health Officer * Natalie Vandeveld, MS, REHS / WI RS *Doug Gieryn, Winnebago County Public Health Officer * Director Terri Harmala, MSN, RN, Shawano County Health Officer * Rachel Prellwitz, Green Lake County Public Health Officer * Jayme Sophe, Marquette County, Public Health Officer * Stefanie Eldredge, BSN, RN, Health Officer/Director * Jed Woldt, Waupaca County, Public Health Officer 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 and veterans. ThedaCare CHAT of Waupaca (Community Health Action Team) members: * Andy Behrendt, Trinity Lutheran Church Pastor * Brian Hoelzel, Chief of Police City of Waupaca Police Department * Garrett Colbert, First Weber Broker Associate * Gerry Hamm, ThedaCare Supervisor, Health Coach and Wellness * Gregory Grohman, Waupaca Chamber/Waupaca Schools, Grant Writer * Jed Woldt, Health Officer Waupaca County DHHS * Laura Colbert, Waupaca Parks and Recreation Director * Laurie Schmidt, Waupaca Schools Director of Student Services * Patsy Servey, City of Waupaca Library, Adult Services * Rachel Lockwood, Waupaca Foundry, Health and Wellness Clinic RN * Shane Kohl, ThedaCare Family of Foundations * Shawna Hansen, WCDHHS Family & Community Services Manager * Tara Knaack, ThedaCare Outreach Health Specialist * Jeff Mirkowski, Waupaca County Economic Development Executive Director * Kellie Diedrick, VP ThedaCare Medical Center Waupaca * Tracey Ratzburg, ThedaCare CHI (facilitator) * Paula Morgen, ThedaCare CHI Director Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - THEDACARE MEDICAL CENTER - WAUPACA. THE THEDACARE COMMUNITY HEALTH IMPLEMENTATION STRATEGY WAS APPROVED BY THE THEDACARE BOARD OF TRUSTEES IN 2023. THE FOLLOWING PRIORITIES WERE IDENTIFIED AS THE TOP COMMUNITY HEALTH NEEDS FOR THE 2023-2025 CHNA CYCLE: REGIONAL ALIGNMENT IN ORDER TO POSITIVELY AFFECT COMMUNITY HEALTH, HEALTH SYSTEMS, NOT-FOR-PROFIT ORGANIZATIONS, AND THE PUBLIC SECTOR MUST BE UNITED ON THEIR PRIORITIES AND COMMITMENTS. THEDACARE WILL WORK WITH PARTNERS TO ESTABLISH COMMON INFRASTRUCTURE NEEDED TO IMPROVE ALIGNMENT OF HEALTH PRIORITIES AND ACTIONS THROUGH THE FOLLOWING: 1) WORKING TO ESTABLISH COMMON COMMUNITY HEALTH NEEDS ASSESSMENT AND ALIGNED IMPROVEMENT PLANS ACROSS HEALTH SYSTEMS AND PUBLIC HEALTH PARTNERS. 2) DEVELOP COLLABORATIVE REGIONAL NETWORK AND INFRASTRUCTURE FOR ADDRESSING SOCIAL NEEDS. 3) DEVELOP ALIGNMENT AND SYNERGY ACROSS CHAT TEAMS. 4) SUPPORT IMAGINE FOX CITIES REGIONAL VISIONING INITIATIVE. 5) DEVELOP RELIABLE TRANSPORTATION ACROSS THE REGION. MENTAL AND BEHAVIORAL HEALTH CHALLENGES CONTINUE WITH THE MENTAL AND BEHAVIORAL HEALTH OF OUR COMMUNITY. ACCESS TO MENTAL HEALTH SERVICES IS NOT KEEPING UP WITH DEMAND, AND THERAPISTS AND HEALTH PROFESSIONALS ARE LACKING IN RURAL AREAS. ADDITIONALLY, ANXIETY AND DEPRESSION HAVE RISEN 20-30% IN RECENT YEARS WHILE SELF-MEDICATION AND SUBSTANCE ABUSE, INCLUDING ALCOHOL, METHAMPHETAMINE, AND VAPING ARE ON THE RISE. TO ADDRESS THIS HEALTH NEED, THE HOSPITAL FACILITY HAS IMPLEMENTED THE FOLLOWING TO ENSURE THAT PEOPLE HAVE THE SUPPORT NEEDED TO LEAD MENTALLY HEALTHY LIVES, FREE OF RELIANCE ON HARMFUL SUBSTANCES AND TO SUPPORT UPSTREAM EFFORTS THAT FOSTER MENTAL HEALTH: 1) PARTNER TO ESTABLISH REGIONAL DETOXIFICATION CAPACITY. 2) EXPAND ED2RECOVERY+ COACHING CAPACITY. 3) ADDRESS MENTAL HEALTH NEEDS OF LGBTQ+ COMMUNITY. 4) PARTNER TO SUPPORT SOCIAL CONNECTION AND BELONGING WORK. 5) SUPPORT CATALPA HEALTH AND CATALPA HEALTH "SEEDLINGS" PROGRAM ADDRESSING EARLY CHILDHOOD SOCIAL EMOTIONAL LEARNING. SOCIAL NEEDS AS THEDACARE SHIFTS ITS FOCUS UPSTREAM TO POPULATION HEALTH, IT IS IMPORTANT TO UNDERSTAND HOW VITAL CONDITIONS, SUCH AS CLEAN AIR, FAIR PAY, HOUSING, EDUCATION AND OTHER BASIC NECESSITIES CAN IMPACT AN INDIVIDUAL'S WELL-BEING. ADDITIONALLY, RELIABLE TRANSPORTATION, BELONGING AND CIVIC MUSCLE, AND PURPOSE ALL INFLUENCE HEALTH. TO ADDRESS THIS IDENTIFIED NEED, THE HOSPITAL FACILITY HAS IMPLEMENTED THE FOLLOWING TO ENSURE THAT THE BASIC NEEDS OF PATIENTS ARE MET: 1) ADDRESS SOCIAL NEEDS THROUGH EMPLOYEE VOLUNTEERING/GIVING EFFORTS. 2) IMPLEMENT CULTURAL COMPETENCY TRAINING OF THEDACARE TEAM MEMBERS. 3) SUPPORT EXPANSION OF STAR PROGRAM ADDRESSING "OPPORTUNITY GAP" BETWEEN BLACK AND WHITE HIGH SCHOOL STUDENTS. 4) SUPPORT BE WELL FOX VALLEY AND EAT WELL FOR LIFE INITIATIVES ADDRESSING DIABETES MANAGEMENT AMONG LOW-INCOME POPULATIONS. 5) SUPPORT BASIC NEEDS GIVING PARTNERSHIP AND US VENTURE GOLF OUTING TO END POVERTY. STRONG START TO LIFE GROWING UP HEALTHY AND STRONG STARTS AT THE BEGINNING OF AN INDIVIDUAL'S LIFE. IN PARTNERSHIP WITH CHILDREN'S WISCONSIN, THEDACARE SEEKS TO ADDRESS SOCIAL DETERMINANTS OF HEALTH, MENTAL, BEHAVIORAL AND INFANT HEALTH, AND SAFETY AND VIOLENCE IN CHILDREN THROUGH THE FOLLOWING: 1) SUPPORT REGIONAL FIRST 5 FOX VALLEY EARLY CHILDHOOD COALITION AND HELP ME GROW CENTRALIZED FAMILY SUPPORT ACCESS POINT. 2) ESTABLISH THEDACARE PEDIATRIC SDOH COMMUNITY RESOURCE NAVIGATION ASSISTANCE IN RURAL MARKETS THROUGH ADVANCING A HEALTHIER WISCONSIN GRANT AND EXPAND TO ENTIRE SERVICE AREA. 3) PARTNER TO ESTABLISH COMMUNITY RESOURCE NAVIGATION SUPPORT WITHIN CATALPA. 4) EXPLORE EXPANSION OF WELCOME BABY COMMUNITY MODEL IN RURAL MARKETS. 5) FACILITATE COLLABORATIVE REGIONAL ASSESSMENT OF AVAILABILITY AND ACCESSIBILITY OF PARENTING PROGRAMS AND SUPPORTS. SIGNIFICANT NEEDS IDENTIFIED THROUGH THE MOST RECENTLY CONDUCTED CHNA THAT WILL NOT BE ADDRESSED IN THE CURRENT THREE-YEAR PLAN ARE: 1) HIGH PAYING JOBS/ECONOMIC OPPORTUNITY - LIMITED RESOURCES TO ADDRESS. 2) INTERNET - BEING ADDRESSED BY OTHERS. 3) FOOD INSECURITY - BEING ADDRESSED BY OTHERS. 4) MOTOR VEHICLE CRASH DEATHS - LIMITED RESOURCES TO ADDRESS. 5) EXERCISE OPPORTUNITIES - LIMITED RESOURCES TO ADDRESS. WORK ON THESE NEEDS CONTINUES AS THEDACARE ADDRESSES PRIORITY ISSUES IN THE COMMUNITY HEALTH IMPROVEMENT PLAN. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - THEDACARE MEDICAL CENTER - WAUPACA. 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. Schedule H, Part V, Section B, Line 15 Facility , 1 Facility , 1 - THEDACARE MEDICAL CENTER - WAUPACA. CONTRACTED WITH ELIGIBILITY VENDOR (CARDON) TO WORK DIRECTLY WITH UNINSURED PATIENTS TO ASSIST THEM WITH INSURANCE ENROLLMENT AND EDUCATION. Schedule H, Part V, Section B, Line 16 Facility , 1 Facility , 1 - THEDACARE MEDICAL CENTER - WAUPACA. 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 THE PATIENT TO SEE THE REVERSE SIDE OF THE 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. 0 Schedule H, Part I, Line 3c DISCOUNTED CARE EXCEPTIONS SEE PART V, SECTION B, LINE 13 FOR THE LIST OF FACTORS USED IN THE ELIGIBILITY CRITERIA EXPLAINED IN THE FAP FOR PROVIDING FREE AND DISCOUNT CARE. Schedule H, Part I, Line 6a Community benefit report prepared by related organization THEDACARE, INC. 39-1509362 Schedule H, Part I, Line 7g Subsidized Health Services NO PHYSICIAN CLINIC COSTS ARE INCLUDED IN THE COMMUNITY BENEFIT EXPENSES. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance 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 RATION 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. Schedule H, Part II Community Building Activities THE HOSPITAL FACILITY PARTICIPATES IN NUMEROUS COMMUNITY BUILDING EFFORTS THROUGHOUT THE YEAR. SPECIFIC ACTIVITIES REPORTED ON SCHEDULE H, PART II INCLUDE: Economic Development: ThedaCare works together with local Chambers of Commerce in all of the communities it serves. The primary aim of the Chamber to promote and protect the interests of its members and the business community and work to improve the quality of life in their communities by building a healthy economy. Strong employment is a social determinant of health, reducing poverty and providing individual and family sustainability. 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. Community Support: SART/SANE Sexual Assault Response Team/Sexual Assault Nurse Examiner serves on a number of local, county, and state-wide coalitions to provide outreach and training to healthcare students, law enforcement, domestic violence shelters and agencies, child abuse response teams, Wisconsin Department of Justice trainings, and more. The program 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. Community Support: SHARPS and unused drug collection. Community SHARPS/unused drugs can be taken for collection and disposal to any of the seven ThedaCare Hospitals. Community Support: A 340B pharmacy is a pharmacy that participates in the 340B Drug Pricing Program, a federal program that requires drug manufacturers to sell outpatient drugs at discounted prices to eligible health care organizations. The 340B program helps health care organizations, known as covered entities, reduce the cost of drugs for their patients. Covered entities include hospitals, such as critical access hospitals, rural referral centers, and sole community hospitals, as well as federal grantee organizations. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount 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. Schedule H, Part III, Line 3 Bad Debt Expense Methodology THE HOSPITAL USES ACCOUNTING DATA, INCLUDING ACCOUNTS AND COST CENTERS, TO ESTIMATE THE PORTION OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. AS THIS IS A COST OF PROVIDING HEALTH CARE SERVICES TO THOSE IN THE COMMUNITY WHO FALL UNDER THE FAP, THE AMOUNT SHOULD BE CONSIDERED COMMUNITY BENEFIT. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote THE CONSOLIDATED FINANCIAL STATEMENTS DISCUSS PATIENT ACCOUNTS RECEIVABLE AND IMPLICIT PRICE CONCESSIONS IN NOTE 2(T) ON PAGE 14 OF THE ATTACHED FINANCIAL STATEMENTS. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO. SHORTFALLS ARISE FROM PAYMENTS THAT ARE LESS THAN THE COSTS TO PROVIDE THE SERVICES. THE SHORTFALLS SHOULD BE CONSIDERED COMMUNITY BENEFIT AS THEY MUST BE ABSORBED IN ORDER TO CONTINUE PROVIDING CARE TO OUR COMMUNITY. IT IS ALSO IMPLIED IN INTERNAL REVENUE SERVICE RULING 69-545 WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR TAX-EXEMPT HOSPITALS AND INDICATES THAT PARTICIPATION IN PUBLICLY-FINANCED PROGRAMS, SUCH AS MEDICARE, IS EVIDENCE THAT A HOSPITAL MEETS THE COMMUNITY BENEFIT STANDARD. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance 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. Schedule H, Part V, Section B, Line 16a FAP website - THEDACARE MEDICAL CENTER - WAUPACA: Line 16a URL: https://thedacare.org/PATIENTS-AND-VISITORS/BILLING-AND-PAYMENT/FINANCIAL-ASSISTANCE/; Schedule H, Part V, Section B, Line 16b FAP Application website - THEDACARE MEDICAL CENTER - WAUPACA: Line 16b URL: https://thedacare.org/PATIENTS-AND-VISITORS/BILLING-AND-PAYMENT/FINANCIAL-ASSISTANCE/; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - THEDACARE MEDICAL CENTER - WAUPACA: Line 16c URL: https://thedacare.org/PATIENTS-AND-VISITORS/BILLING-AND-PAYMENT/FINANCIAL-ASSISTANCE/; Schedule H, Part VI, Line 2 Needs assessment ThedaCare covers a nine-county primary service area served by seven 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. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance 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. Schedule H, Part VI, Line 4 Community information ThedaCare Medical Center-Waupaca service area consists of Waupaca County and is located in east-central Wisconsin. Waupaca County is largely rural. Waupaca County is home to 51,000. Waupaca County: * The percentage of residents living below the Federal Poverty Level is 11%. * In Waupaca County 8% of the children live below 100% of the Federal Poverty Level. * Waupaca County has 7% of residents who are uninsured. * Waupaca County high school graduation rate is 93%. * The vast majority of the service area is Caucasian at 96%, with Hispanic population of 2.6%. Schedule H, Part VI, Line 5 Promotion of community health 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 the 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. Schedule H, Part VI, Line 6 Affiliated health care system As of January 1, 2024, ThedaCare merged with Froedtert Health. To date, community health operations have not been integrated. ThedaCare continues to provide direction related to community health needs assessments for each hospital in the counties previously served by ThedaCare prior to the merger and surrounding communities within its service area. Plans are approved by local hospital boards and the ThedaCare North Region Board. Each ThedaCare hospital, along with COMMUNITY HEALTH IMPROVEMENT staff and community members determine how best to meet local needs. Implementation of community programming occurs at the local level. Schedule H, Part VI, Line 7 State filing of community benefit report WI Form 990, Part VI, Line 2 Family/business relationships amongst interested persons AN EMPLOYEE/EMPLOYER RELATIONSHIP EXISTS FOR INDIVIDUALS ON PART VII WHO ARE EMPLOYEES OF THEDACARE, INC. AND INDIVIDUALS LISTED ON PART VII WHO ALSO SERVE AS DIRECTORS OR OFFICERS OF THEDACARE, INC. - Business relationship Form 990, Part VI, Line 3 Delegation of management duties ALL MANAGEMENT AND ADMINISTRATIVE FUNCTIONS ARE PROVIDED BY EMPLOYEES OF THEDACARE, INC., THE SOLE MEMBER AND PARENT COMPANY OF THEDACARE MEDICAL CENTER - WAUPACA, INC. Form 990, Part VI, Line 6 Classes of members or stockholders THEDACARE MEDICAL CENTER - WAUPACA, INC.'S SOLE MEMBER IS THEDACARE, INC. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body THEDACARE, INC. HAS AUTHORITY IN THE CORPORATION TO VOTE AND TAKE ANY ACTION WITH RESPECT TO THE ELECTION OF DIRECTORS AND OFFICERS. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders THEDACARE, INC. HAS THE AUTHORITY WITH RESPECT TO THE FOLLOWING MATTERS: 1. AMENDMENT OF THE ARTICLES OF INCORPORATION; 2. ADOPTION AND AMENDMENT OF BYLAWS OF THE CORPORATION; 3. CONSOLIDATION, MERGER AND DISSOLUTION OF THE CORPORATION; 4. MONITORING COMPLIANCE WITH LAWS AND REGULATIONS; 5. SELECTION, APPOINTMENT, AND REMOVAL OF A CHIEF OPERATING OFFICER; 6. PROVISION FOR LONG-RANGE FINANCIAL STABILITY OF THE HOSPITAL AND PROVISION FOR THE CONTROL AND USE OF THE PHYSICAL AND FINANCIAL RESOURCES OF THE HOSPITAL; 7. ESTABLISHMENT OF A LONG-RANGE PLANNING MECHANISM; 8. APPROVAL OF A HOSPITAL ORGANIZATION AND MAJOR AUTHORITY DELEGATION PATTERNS; 9. APPROVAL OF FINANCIAL, CAPITAL, AND OTHER ITEMS; 10. APPROVAL OF DEBT OR LEASES; AND 11. CONSIDERATION AND ACTION UPON POLICIES CONCERNING RELATIONS WITH EXTERNAL GROUPS AND ORGANIZATIONS. Form 990, Part VI, Line 11b Review of form 990 by governing body THE FORM 990 IS MADE AVAILABLE TO THE BOARD OF DIRECTORS OF FROEDTERT THEDACARE HEALTH, INC., FOR REVIEW PRIOR TO FILING. Form 990, Part VI, Line 12c Conflict of interest policy 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, Line 15a Process to establish compensation of top management official 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, Line 15b Process to establish compensation of other employees 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, Line 19 Required documents available to the public THEDACARE MEDICAL CENTER - WAUPACA, 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 CONTRACT LABOR/AGENCY FEES - Total Expense: 1151414, Program Service Expense: 1151414, Management and General Expenses: , Fundraising Expenses: ; PHYSICIAN FEES - Total Expense: 5945, Program Service Expense: 5945, Management and General Expenses: , Fundraising Expenses: ; OTHER SERVICES - Total Expense: 2288786, Program Service Expense: 1480546, Management and General Expenses: 808240, Fundraising Expenses: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances ADJUSTMENTS FOR AFFILIATION REVALUATIONS - 12183276; THEDACARE INC PO BOX 8025 APPLETON WI 549128025 391509362 HEALTHCARE WI 501(c)(3) 10 NA false THEDACARE REGIONAL MEDICAL CENTER - NEENAH INC PO BOX 8025 APPLETON WI 549128025 390830664 HOSPITAL WI 501(c)(3) 3 THEDACARE INC false THEDACARE MEDICAL CENTER - NEW LONDON INC PO BOX 8025 APPLETON WI 549128025 390869788 HOSPITAL WI 501(c)(3) 3 THEDACARE INC false THEDACARE MEDICAL CENTER - WAUPACA INC PO BOX 8025 APPLETON WI 549128025 390871113 HOSPITAL WI 501(c)(3) 3 THEDACARE INC false THEDACARE REGIONAL MEDICAL CENTER -APPLETON INC PO BOX 8025 APPLETON WI 549128025 390824015 HOSPITAL WI 501(c)(3) 3 THEDACARE INC false THEDACARE MEDICAL CENTER - 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