Mayo Clinic Health System – Red Cedar, Inc.

September 30, 2013

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Table of Contents Executive Summary ..................................................................................................................... 3

Our Community ............................................................................................................................ 6

Assessing the Needs of the Community .................................................................................... 9

Addressing the Needs of the Community ............................................................................... 13

Appendix A: Demographic Data ............................................................................................... 17

Appendix B: Individuals Involved in CHNA ........................................................................... 18

Appendix C: Data Sources ......................................................................................................... 21

Appendix D: Prioritization Matrix ........................................................................................... 23

Appendix E: County Health Rankings ..................................................................................... 24

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Executive Summary

Enterprise Overview: Mayo Clinic is a not-for-profit, worldwide leader in patient care, research and education. Each year Mayo Clinic serves more than one million patients from communities throughout the world, offering a full spectrum of care from health information, preventive and primary care to the most complex medical care possible. Mayo Clinic provides these services through many campuses and facilities, including 23 hospitals located in communities throughout the United States, including Arizona, Florida, Georgia, Minnesota, Wisconsin and Iowa. A significant benefit that Mayo Clinic provides to all communities, local to global, is through its education and research endeavors. Mayo Clinic reinvests its net operating income funds to advance breakthroughs in treatments and cures for all types of human disease, and bring this new knowledge to patient care quickly. Through its expertise and mission in integrated, multidisciplinary medicine and academic activities, Mayo Clinic is uniquely positioned to advance medicine and bring discovery to practice more efficiently and effectively. In addition, through its Centers for the Science of Health Care Delivery and Population Health Management, Mayo Clinic explores and advances affordable, effective health care models to improve quality, efficiency and accessibility in health care delivery to people everywhere.

Entity Overview: Mayo Clinic Health System – Red Cedar in Menomonie is a 25-bed critical access hospital located in Menomonie, Wis. Since 1980, the hospital has been dedicated to promoting health and meeting the health needs of our patients. Mayo Clinic Health System – Red Cedar in Menomonie is one of 17 hospitals within Mayo Clinic Health System. Red Cedar is part of the Northwest Wisconsin region of Mayo Clinic Health System, which also includes hospitals in Eau Claire, Bloomer, Barron and Osseo. Mayo Clinic Health System – Red Cedar in Menomonie supports the community through inpatient and outpatient services. The hospital had 1,956 admissions in 2012. The hospital has more than 700 employees. Mayo Clinic Health System is a family of clinics, hospitals and health care facilities serving more than 70 communities in Iowa, Georgia, Wisconsin and Minnesota. Mayo Clinic Health System includes more than 900 providers and serves more than half a million patients each year. As part of Mayo Clinic, a leading caregiver with nearly 150 years of patient care, research and medical education expertise, the organization provides a full spectrum of health care options to local neighborhoods, ranging from primary to highly specialized care. Mayo Clinic Health System is recognized as one of the most successful regional health care systems in the United States. Through the power of collaboration, Mayo Clinic Health System provides patients with access to cutting-edge research, technology and resources that comes from Mayo Clinic.

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By putting together integrated teams of local doctors and medical experts, we've created a new way of delivering health care and opened the door to sharing information in a way that allows us to keep our family, friends and neighbors healthier than ever before. Mayo Clinic's greatest strength is translating idealism into action. It's what our staff does every day for our patients, and it’s how we transform hope into healing. We call this power "the Mayo Effect." Mayo Clinic Health System was created to fulfill the commitment to bring Mayo Clinic quality health care to local communities. As part of this commitment, the health system has a long tradition of supporting community health and wellness. In 2012, Mayo Clinic Health System – Red Cedar in Menomonie provided more than $2.2 million in community benefit through uncompensated care. It provided more than $14,000 through philanthropic donations to the community to support such programs as American Cancer Society fundraising events, community events and causes that promote health, wellness and/or physical activity, Junior Achievement and first aid kits to local schools and coaches. Red Cedar also provides a wide range of wellness and prevention programs for the community, including free blood pressure/blood sugar screenings, a variety of support groups and classes, extensive programming for youth and families to promote physical activity and health eating, senior events, and women’s events. In 2012, Red Cedar reached more than 19,150 community members through community support and health and wellness activities. Mayo Clinic Health System’s community health needs assessment process will advance and strengthen our commitment to community health and wellness support activities by helping us focus on high-priority community needs and bringing additional needs to light.

Summary of Community Health Needs Assessment:

Mayo Clinic Health System – Red Cedar in Menomonie’s community assessment process was led by a regional Community Health Needs Assessment Committee (CHNAC.) That committee followed a systematic process to evaluate the health needs of our communities and determine the community health priorities. The primary input into the assessment and prioritization process was the Dunn County Community Health Needs Assessment 2011-2015. This assessment is a joint effort of Dunn County Health Department, Mayo Clinic Health System – Red Cedar in Menomonie, Marshfield Clinic, Mayo Clinic Health System – Chippewa Falls in Colfax, Dunn County Human Services, Head Start, city government representatives, the University of Wisconsin-Stout, Dunn County Board chair, WestCap, local schools and citizen coalition members with the goal of improving the quality of life for everyone in the community.

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The Wisconsin Department of Health Services’ most recent health agenda, Healthiest Wisconsin 2020, as well as County Health Rankings completed by the Centers for Disease Control also were taken into consideration. After completing an extensive analysis of the Dunn County Health Needs Assessment report, Healthiest Wisconsin 2020 and other quantitative and qualitative data, the top community health needs identified as MCHs – Red Cedar in Menomonie priorities are:

1. Chronic disease prevention and management

2. Physical activity

3. Adequate, appropriate and safe food and nutrition

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Our Community

Geographic Area: Mayo Clinic Health System – Red Cedar in Menomonie located in northwestern Wisconsin. The region is made up of the communities of Altoona, Chippewa Falls, Durand, Eau Claire and Menomonie. Mayo Clinic Health System – Red Cedar in Menomonie’s primary service area is Dunn County, and this report is based on the needs of its residents, who accounted for 72.6% of unique hospital inpatients in 2012.

Demographics: Menomonie has a population of 25,642. Dunn County has a population of 44,072 and is considered 98.6 percent rural. Most of the population growth in the county has been from natural population increase. The racial make-up of the county is predominately white, with the largest ancestry groups being German, Norwegian and Irish. The largest ethnic population is Asian, which grew from 2.1 percent in the 2000 Census to 2.7 percent in 2010. Additional demographic detail has been included as Appendix A. There are no additional hospitals in Dunn County. However, there are two hospitals in neighboring Eau Claire County that provide secondary and tertiary level care (Mayo Clinic Health System in Eau Claire and Sacred Heart Hospital), including level II trauma care (Mayo Clinic Health System in Eau Claire). As a member of Mayo Clinic Health System, Mayo Clinic Health System – Red Cedar in Menomonie has seamless access to the care offered in Eau Claire, as well as the world-renowned Mayo Clinic in Rochester, Minn. In addition, the residents of Dunn County have access to the following:

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General health clinics

Free Clinic of the Greater Menomonie Area, Menomonie

Marshfield Clinic, Menomonie

Mayo Clinic Health System – Chippewa Valley in Colfax Mental health clinics

Mayo Clinic Health System – Red Cedar in Menomonie

Dunn County Human Services Dental clinics

Colfax Dental Wellness Clinic

CVTC Rural Health Dental, Menomonie

Gentle Dental Care, Menomonie

Midwest Dental, Menomonie

Trimble Dental, Menomonie Nursing homes

Colfax Health & Rehabilitation Center, Colfax

Dunn County Health Care Center, Menomonie Assisted-living facilities

Above and Beyond Elderly Care, Boyceville

Agape Adult Family Home, Menomonie

Angel Care Adult Day Care, Menomonie

Arbor Place Inc., Menomonie

Aurora Residential Alternatives Inc., Menomonie

Autumn Village, Menomonie

Broadway Home, Menomonie

Care Partners Assisted Living, Menomonie

Clear View, Elk Mound

Comforts of Home, Menomonie

Country Terrace, Menomonie

Deerfield Adult Family Home, Menomonie

Gypsy Hill Country Home, Menomonie

Halverson Adult Family Home, Menomonie

Helping Hands of Dunn County, Menomonie

Journey Home, Elk Mound

Lambs Creek West Adult Family Home, Boyceville

Lifestyles Adult Family Homes Inc., Menomonie

Noreen Family Home, Menomonie

Northwest Pathways to Independence Inc., Menomonie

Our House Memory Care, Menomonie

Potters Country Home, Menomonie

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Safe Haven Adult Assisted Living, LLC., Boyceville

Serving Hands at South Ridge, Menomonie

Solomon Hill Adult Family Home, Menomonie

Spring of Life, Knapp

Tainter Adult Family Home, Colfax

Tara Place, Elk Mound

Triple Springs Country Home, Downing

Weimer Adult Family Home, Menomonie

Woodridge Court Home, Menomonie

Drug treatment centers

Arbor Place, Menomonie

Charlene Ovren, CSAC, Menomonie

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Assessing the Needs of the Community

Overview: Mayo Clinic Health System – Red Cedar in Menomonie identified and prioritized community health needs through a comprehensive process that included input from a cross section of community and organizational leadership, as well as direct input from the community. The assessment process particularly was aimed at understanding the needs of the traditionally underserved. The Mayo Clinic Health System regional CHNAC led the process of evaluating the health needs of our communities and determining our health priorities. The committee was chaired by the regional CEO and included leadership representation from the Northwest Wisconsin region of Mayo Clinic Health System, which is comprised of five hospitals located in Eau Claire, Barron, Bloomer, Menomonie and Osseo. Committee members were chosen for their expertise in directly providing services to meet the health needs of our communities and for their involvement in existing community programs and services. The committee was responsible for creating a thorough and organized needs assessment process, as well as developing an effective plan to meet the identified needs.

Process and Methods:

Dunn County health assessment survey 2011 process

The assessment process began with a thorough review of the Dunn County CHNA. The purpose of the county’s CHNA is to assess the needs in our community, identify community resources to address the most urgent needs and encourage action plans that solve local problems. The process also included the results of a comprehensive community survey conducted in 2012. In 2011, Dunn County Health Department led the process of evaluating the health needs of our communities and determining priorities. The Dunn County team followed the Centers for Disease Control’s (CDC) community health assessment and group evaluation (CHANGE) tool, which was designed to help community teams develop an action plan through assessment and prioritization. More information about this tool can be found at: http://www.cdc.gov/healthycommunitiesprogram/tools/change.htm The committee leading the county CHNA process was chaired by Wendy MacDougall, director of Dunn County Health Department, and included Hank Simpson, M.D., then CEO, of Mayo Clinic Health System – Red Cedar in Menomonie. The committee included individuals from a variety of organizations and agencies that provide support for the health needs of the county, many of whom were involved in existing community programs and services. This committee reviewed all five CHANGE sectors as determined by the CDC. For each sector, it assessed the areas of demographics, physical activity, nutrition, tobacco, chronic disease management

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and leadership. In addition, the school sector included questions related to the school district and after-school program. The CHANGE sectors are: 1. Community-at-large: includes community-wide efforts that impact the social and built

environments 2. Community institution/organization sector: includes entities in the community that provide a

broad range of human services and access to facilities 3. Health care sector: includes places where people go to receive preventive care or treatment or

emergency health care services 4. School sector: includes all primary and secondary learning institutions 5. Work-site sector: includes places of employment

The Dunn County CHNA 2011 process included a variety of data collection methods used to create an overall picture of the issues facing our communities. Finally, the team created an action plan and assigned responsible agencies and organizations to the various action items. Complete results from the Dunn County CHNA can be found at: http://www.dunncountywi.govoffice2.com/vertical/sites/%7B8D65D186-760D-414B-890C-7C4376A23107%7D/uploads/Health_assessment_2011-2015.pdf

Survey process The Mayo Clinic Health System – Red Cedar in Menomonie CHNA also took into consideration results from a random household survey. The objective of the survey was to increase the understanding of the community’s health needs and its perception of the main challenges facing the residents of Dunn County. During the design phase, the supplemental survey team ensured that the following target groups were represented:

Experienced people/senior citizens

Limited -resource individuals and families

Middle-class work force

General population

Diverse populations

People without health insurance The survey had three sections: ranking health concerns/risky behaviors, answering health care-related questions and providing demographic information.

Section 1: Rank 33 health concerns/risky behaviors as “not a problem,” “minor problem,” “major problem” and “no opinion.” These covered major areas of community life including health, public safety, violence, wellness education, environmental safety and community concerns. Participants also were asked to order the top four health concerns/risky behaviors.

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Section 2: Provide information about their own health, health insurance coverage and health care patterns

Section 3: Provide demographic information related to gender, age, ethnicity, marital status, employment and income

The community survey was available on Mayo Clinic Health System’ public website and in a paper version. An invitation to take the survey was announced through a newspaper article and ad. The following targeted groups were personally invited to provide feedback:

Assisted living facilities: Autumn Village, Comforts of Home and The Oaks

Businesses: 3M, Cardinal Glass, CEVA Logistics

City of Menomonie

Free Clinic of the Greater Menomonie Area patients

Hmong Alliance Church congregation

Mayo Clinic Health System – Red Cedar in Menomonie employees and volunteers

Mayo Clinic Health System – Red Cedar in Menomonie Hmong patients, through interpreter

Menomonie School District

Shirley Doane Senior Center patrons

Stepping Stones patrons

Rural/ag community through UW-Extension

Partnership for Youth The survey was completed by more than 540 community members. Obesity, unprotected sex, poor eating habits and drug use/abuse were the top issues of concern for the county. After completing a review of the Dunn County CHNA report, the CHNAC thoroughly reviewed Healthiest Wisconsin 2020, the statewide public health improvement plan completed by the Wisconsin Department of Health Services. Healthiest Wisconsin is a collaborative process that taps the wisdom of Wisconsin communities. It contains 23 focus areas that provide a menu for action by partners from many sectors. These focus areas encompass the most important aspects of health across the life span. The focus areas and their objectives are based on science, evidence and the input from Wisconsin communities. The complete Healthiest Wisconsin 2020 plan can be found at: http://www.dhs.wisconsin.gov/hw2020/index.htm The CHNAC also reviewed a wide range of secondary data sources, including health, demographic and socio-economic qualitative data. A full citation of data sources is included as Appendix C. One of the main data sources used in the assessment was County Health Rankings provided by the Centers for Disease Control. Launched in 2010, the County Health Rankings program aimed to produce county-level health rankings for all 50 states.

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The County Health Rankings identify the multiple health factors that determine a county’s health status. These rankings show that our health status can be impacted by where we live. A number of factors may determine the health status of a community, including the environment, education and jobs, individual behaviors, access to services and health care quality. A Dunn County Health Rankings report can be found as Appendix E. Prioritization The CHNAC used these data sources and the county CHNA to compile a thorough listing of community health needs. Identified needs were evaluated using a matrix called the CHNA Process to Identify & Prioritize Needs. This process measured each need on a set of criteria, which were given a ranking of high, medium or low for each criteria. The criteria used were: comparison to state and national goals, community impact, the organization’s ability to impact change, community readiness for change, gaps in community resources and the voice of local customer. The prioritization matrix is included as Appendix D.

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Addressing the Needs of the Community

Overview: After completing an extensive analysis of the Dunn County Community Health Assessment, community survey results, Healthiest Wisconsin 2020, County Health Rankings and other quantitative and qualitative data, the top community health needs identified in Dunn County priorities are:

1. Chronic disease prevention and management

2. Physical activity

3. Adequate, Appropriate and Safe Food and Nutrition

Chronic disease prevention and management

Much of the information in this section was originally included in the Healthiest Wisconsin 2020 Health Focus Areas report which can be found here: www.dhs.wisconsin.gov/hw2020/pdf/chronicdisease.pdf According to Healthiest Wisconsin 2020, the goals of chronic disease prevention and management are “to prevent disease occurrence, delay the onset of disease and disability, lessen the severity of disease and improve the health-related quality and duration of the individual's life.” Four modifiable health risk behaviors— unhealthy diet, insufficient physical activity, tobacco use and second-hand smoke exposure, and excessive alcohol use — are responsible for much of the illness, suffering, and early death related to chronic diseases. Chronic disease prevention isn’t always possible, so it’s important that effective management of chronic disease is also part of the health care system. Although chronic diseases usually become clinically apparent in adulthood, the exposures and risk factors that precede disease onset occur at every stage of life. Childhood and adolescence are critical times to deliver and reinforce health education messages. Data highlights Chronic diseases – such as heart disease, stroke, cancer, diabetes, asthma and arthritis – are among the most common and costly of all health problems in the United States. Currently, seven of the 10 leading causes of death in Wisconsin and the United States as a whole are due to chronic diseases, accounting for approximately two out of every three deaths annually.

Cardiovascular disease is consistently the leading cause of mortality for Wisconsin residents, accounting for more than 16,000 deaths annually, or 35 percent of all deaths.

Each year from 2002 through 2006, an annual average of 27,256 cancers were diagnosed among Wisconsin residents. The average age-adjusted incidence rate for all cancers was 470.3 per 100,000 Wisconsin residents.

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From 2004 to 2007, diabetes-related hospitalizations increased nearly 11 percent, from 85,113 to 94,331. Diabetes prevalence among adults increased more than 27 percent, from 329,460 to 419,870.

In 2005, more than 5,500 Wisconsin residents were hospitalized for asthma and more than 22,000 sought emergency room care.

More than 27 percent of Wisconsin adults aged 18 years and older (1.1 million) reported they had some form of arthritis during 2003–2007.

In a study conducted in 2008, 17 percent of Dunn County residents were uninsured for part or all of the past year. Being uninsured prohibits people from seeking needed health care services and contributes to the ability to prevent and manage chronic disease. http://www.dhs.wisconsin.gov/publications/P0/P00406/p00406b-Dunn-2012.pdf

In 2010, 16 percent of pregnant women smoked during pregnancy. Not only does this contribute to the mother’s overall health and pregnancy health, it also exposes the baby to dangerous chemicals that can lessen the amount of oxygen it receives, which can hinder growth and development and damage baby's lungs. http://www.dhs.wisconsin.gov/localdata/pdf/10pubhlth/dunn10.pdf

According to County Health Rankings & Roadmaps, 16 percent of adults smoke. According to the CDC, smoking causes coronary heart disease, the leading cause of death in the United States. It also causes reduced circulation and puts smokers at risk of developing peripheral vascular disease and aortic aneurysm.

In 2010, the underlying causes of death in Dunn County were heart disease (22 percent), cancer (26 percent) and diabetes (1.6 percent, while tobacco use was the underlying or contributing cause of death for 18 percent of deaths. http://www.dhs.wisconsin.gov/localdata/pdf/10pubhlth/dunn10.pdf

Physical activity Much of the information in this section was originally included in the Healthiest Wisconsin 2020 Health Focus Areas report which can be found here: www.dhs.wisconsin.gov/hw2020/pdf/physicalactivity.pdf Limited physical activity is linked closely to obesity (a major risk factor for cardiovascular disease, certain types of cancer, type 2 diabetes and other chronic diseases). Obesity is defined by the Centers for Disease Control and Prevention as “a body mass index (BMI) of 30 or greater. BMI is calculated from a person's weight and height and provides a reasonable indicator of body fatness and weight categories that may lead to health problems.” U.S. and Wisconsin rates of obesity have risen steadily over the past 20 years, with a leveling off in recent years. Behavioral Risk Factor Surveillance System results for 2008 indicate that 26.7 percent of the U.S. population and 26.1 percent of the Wisconsin population were obese. Obesity, the second leading cause of death in the U.S., has increased significantly from 2000 to 2010. This increase has occurred nationally, as well as in Minnesota, Wisconsin and Dunn County.

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• Levels of physical activity in Wisconsin have shown a slight increase since 2001. The proportion of residents meeting the minimum physical activity recommendations rose from 52 percent (2001) to 55 percent (2007.) Nearly half the population of Wisconsin doesn’t meet the recommendations for physical activity.

• Twenty-six percent of Wisconsin adults are obese and 64 percent are overweight or obese. • Twenty-three percent of high school students are overweight or obese.

According to County Health Rankings & Roadmaps, 29 percent of adults are obese and 24 percent are physical inactive.

In addition, a study conducted from 2005 to 2007 found that neighboring counties with the highest percent of residents reporting obesity are Dunn, Clark, Rusk and Jackson at 40 percent, 38 percent, 37 percent and 33 percent, respectively. These counties, along with Chippewa and Barron counties, exceed the 2009 national average of 27 percent obesity.

Adequate, appropriate and safe food and nutrition

Much of the information in this section was originally included in the Healthiest Wisconsin 2020 Health Focus Areas report which can be found here: www.dhs.wisconsin.gov/hw2020/pdf/nutrition.pdf According to Healthiest Wisconsin 2020, adequate, appropriate and safe food and nutrition means the regular and sufficient consumption of nutritious foods across the life span, including breastfeeding, to support normal growth and development of children and promote physical, emotional and social well-being for all people. Good nutritional practices also can reduce the risk for a number of chronic diseases that are major public health problems, including conditions such as obesity, type 2 diabetes, cancer, heart disease and stroke. Obesity is one of the most critical health issues of our time. Overweight and obesity describe ranges of weight for a certain height that are higher than that considered healthy. Obesity is a paramount health concern for Wisconsin and the nation because of its strong relationship to many negative health conditions and outcomes, such as type 2 diabetes, cardiovascular disease, certain cancers, arthritis, asthma, depression and negative pregnancy and birth outcomes. Obese youth are also much more likely to become obese adults, putting them at risk of having lifelong health consequences. Poverty in Wisconsin rose substantially during the 2000s. In 2009, 12.4 percent of the state’s population was living in poverty, increasing to 13.2 percent in 2010. Data about the prevalence of obesity have been included under physical activity. Along with those statistics, about 14 percent of adults and 7 percent of high school students eat fruit at least twice per day and vegetables at least three times per day.

Fifteen and a half percent of Dunn County residents are at or below poverty level; limited resources make it more difficult to purchase healthful foods, such as fresh fruits and vegetables.

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In 2010, 446 pregnant or postpartum women and 298 infants (468 live births) qualified for Dunn County WIC services. http://www.dhs.wisconsin.gov/localdata/pdf/10pubhlth/dunn10.pdf

According to County Health Rankings & Roadmaps, 38 percent of restaurants in Dunn County are fast-food restaurants.

Adequate and appropriate nutrition is a cornerstone for preventing chronic disease and promoting vibrant health. One key issue for this focus area is food security — assured access to enough food to lead an active and healthy life.

Health Needs Not Addressed:

Through our assessment process, the CHNAC identified other community health needs that have not been addressed in this health improvement plan. In prioritizing health needs the CHNAC took into consideration other organizations addressing the need in question, the core competencies of Mayo Clinic Health System and our ability to impact change, as well as the readiness of the community for interventions. Access to dental care: This is outside the expertise and resources available at the hospital. Deaths caused by motor vehicle accidents: Mayo Clinic Health System does address this need through our bi-annual teen car control class, however this issue is most effectively addressed through other community agencies. Alcohol and drug use/abuse: Others agencies in the county are addressing these issues, and they are generally out of scope for Mayo Clinic Health System. Tobacco. We will continue to support the decrease of tobacco use through patient education. Mental health: This is a core service of Mayo Clinic Health System that we will continue to address to meet the needs of our patients. Access to health care: Mayo Clinic Health System will continue to focus on increasing access to care for our patients. Reproductive/sexual health: This is a focus for Dunn County Public Health and University Health Services, whose efforts are supported by Mayo Clinic Health System – Red Cedar in Menomonie.

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Appendix A: Demographic Data

Dunn County Population: 43,534 Population in poverty: 15.5%

Unemployment rate: 6.3% Uninsured ages 18-64: 8.1% Uninsured under 18: 0.7% Adults 25+ years with high school education or less: 45.5%

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Appendix B: Individuals Involved in CHNA

Dunn County Community Health Assessment 2011

Participants

Patrick Beilfuss, senior planner, Cedar Corporation

Laura Bundy, combination family resource provider, Menomonie Head Start

Katherine Dutton, executive director, Stepping Stones Shelter, Dunn County

Randy Eide, public works director, City of Menomonie

Jill Gamez, executive director, Arbor Place

Jody Graese, RN, district nurse, Boyceville School District

Linda Halvorson, manager, Dunn County Economic Support

Julie Harmon, lead CMA, Mayo Clinic Health System - Chippewa Valley in Colfax

Dawn Hase, RN, Elk Mound School District

Vicki Holden, manager, Dunn County Aging and Disability Resource Center

Heidi Hooten, shelter coordinator, Stepping Stones of Dunn County

Cheri Jacobson, director, Menomonie Head Start

Gary Johnson, school social worker, Menomonie School District

Kari Kallio, physical education and health teacher, Elk Mound School District

Charles Kell, chair, Community Foundation Board

Becky Kneer, member/nurse, Health Watch Dunn County Mental Health Coalition

Kate Konkle, consultant, Wisconsin Population Health Institute

Deb Lindemann, director, Mayo Clinic Health System

Michael Lockheart, D.O., Mayo Clinic Health System

Wendy MacDougall, director/health officer, Dunn County Public Health Department

Maltee McMahon, non-profit resource specialist, Bremer Bank

Ramie McMahon, RN, school nurse, Menomonie School Disrict

Christine McMasters, director of student services, Menomonie School District

Trevor Peterson, AmeriCorps assistant coordinator, Farm to School

Lowell Prange, city administrator, City of Menomonie

Janice Lawrence-Ramaeker, director, Student Health Services, UW-Stout

Steve Rasmussen, chair, Dunn County Board

Dennis Shaw, assistant dean of students, UW-Stout

Hank Simpson, M.D., CEO, Mayo Clinic Health System

Tina Tharp, community wellness supervisor, Mayo Clinic Health System

Robyn Thibado, social assets director, West CAP Community Action Agency

Joan Thomas, dean of students, UW-Stout

James Uhlir, safety and risk management executive director, UW-Stout Linda Walsh, steering committee member, Sustainable Dunn

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Persons with special knowledge and expertise in public health

Wendy Mac Dougall, director/health officer, Dunn County Public Health Department

Vicki Holden, manager, Aging and Disability Resource Center, Dunn County

Dr. Henry Simpson, Mayo Clinic Health System

Tina Tharp, Mayo Clinic Health System

Dr. Michael Lockheart, Mayo Clinic Health System

Julie Harmon, Mayo Clinic Health System

Becky Kneer, Health Watch, parish nurse Government agencies with knowledge of relevant health needs of the community

Wendy Mac Dougall, director/health officer, Dunn County Public Health Department

Vicki Holden, manager, Aging and Disability Resource Center, Dunn County

Linda Halvorson, economic support manager, Dunn County

Lowell Prange, city manager, Menomonie

Steve Rasmussen, chair, Dunn County Board

Randy Eide, City of Menomonie Medically underserved representatives

Wendy Mac Dougall, Director Health Department

Heidi Hooten, director, Stepping Stones Shelter

Katherine Dutton, director, Stepping Stones Shelter

Kate Konkle, Wisconsin Population Health Institute Minority populations

Wendy MacDougall, director, Public Health Department

Heidi Hooten, Stepping Stones Shelter

Katherine Dutton, Stepping Stones Shelter Low-income representatives

Cheri Jacobson, Menomonie Head Start

Laura Bundy, Menomonie Head Start

Robyn Thibado, WestCap Community Action Agency Health care consumer advocates

Jill Gamez, Arbor Place (AODA Treatment Center)

Linda Walsh, Sustainable Dunn

Maltee McMahon, non-profit resource manager, Bremer Foundation Academic experts

Joan Thomas, UW-Stout Dean of Students

James Uhlir, UW-Stout

Christine McMasters, Menomonie School District (MSD)

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Gary Johnson, MSD

Ramie McMahan, MSD

Jody Graese, Boyceville School District

Dawn Hase, Elk Mound School District

Kari Kallio, Elk Mound School District Private businesses

Charles Kell, Community Foundation Board, private business owner

Patrick Beilfuss, Cedar Corporation Health insurance and managed care organizations Vicki Holden, Aging and Disability Resource Center Linda Halvorson, Economic Support Mayo Clinic Health System Community Health Needs Assessment Committee

Susan Albee, RN

Mary Bygd, assistant administrator

Jay Edenborg, public affairs director

Dean Eide, vice president

Jerome Garrett, primary care support director

Randall Linton, MD, CEO

Andra Palmer, legal Counsel

Daniel Paulmier, CPA

Dennis Pope, vice president

Benjamin Rindone, corporate health services

Lynn Salter, public affairs

Rita Sullivan, vice president

Edward Wittrock, vice president

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Appendix C: Data Sources

S Bureau of Labor Statistics, April 2013, Sources: Market Planner Plus, Market Expert 21st Edition of America's Health Rankings®: A Call to Action for Individuals and Their Communities. http://www.americashealthrankings.org/. County Health Rankings, Mobilizing Action Toward Community Health. www.countyhealthrankings.org/

Dunn County Community Health Assessment http://www.dunncountywi.govoffice2.com/vertical/sites/%7B8D65D186-760D-414B-890C-7C4376A23107%7D/uploads/Health_assessment_2011-2015.pdf Wisconsin State Health Plan:Healthiest Wisconsin 2020 http://www.dhs.wisconsin.gov/hw2020/index.htm United Way Community Conversations. http://www.uwgcv.org/yourvoicematters Wisconsin Hospital Association Wisconsin Hospitals 2012 WHA Community Benefit Survey http://www.wiservepoint.org Centers for Disease Control and Prevention (CDC.)Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Available at: http://apps.nccd.cdc.gov/BRFSS/. Accessed on 9/16/2011 Wisconsin Department of Private Instruction http://sspw.dpi.wi.gov/sspw_yrbsindx University of Wisconsin Extension http://apl.wisc.edu/pfs_profiles/Eau_Claire_Poverty_and_Food_Insecurity.pdf State Indicator on Fruits and Vegetables http://www.cdc.gov/nutrition/downloads/StateIndicatorReport2009.pdf Local Data on Poverty Status and Health Insurance Coverage in Wisconsin — Dunn County http://www.dhs.wisconsin.gov/publications/P0/P00406/p00406b-Dunn-2012.pdf www.cdc.gov/chronicdisease/overview/index.htm www.cdc.gov/std/stats09/trends.htm. www.cdc.gov/pertussis/about/causes-transmission.html.

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http://www.cdc.gov/lyme/. www.nimh.nih.gov/statistics/1ANYDIS_ADULT.shtml. The Burden of Suicide in Wisconsin, 2008. Available at http://www.mcw.edu/IRC/Research/BurdenofSuicideinWisconsinReport.htm. Wisconsin Department of Health Services.2010 Burden of Oral Disease in Wisconsin. Available at: http://www.dhs.wisconsin.gov/publications/P0/P00209.pdf. Voskuil KR, Palmersheim KA, Glysch RL, Jones NR. Burden of Tobacco in Wisconsin: 2010 Edition. University of Wisconsin Carbone Cancer Center. Madison, Wis.: March, 2010.

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Appendix D: Prioritization Matrix

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Appendix E: County Health Rankings