Woods and Water Medical Center

1900 College Drive Rice Lake, WI 54868  715—234-7082 

meltonlj@my.witc.edu

September 19, 2018

Mr. Trent Gibson

429 Hillcreast Road
Rice Lake, WI 54868

Dear Mr. Gibson,

We have received your application for charity care from Woods & Water. In order to process your claim properly, we
will need the following documentation with your application for charity care.

Documentation needed:
 Completed financial form (enclosed).
 Photocopy or your 2012 Federal Income Tax Form.
 All adult W-2 forms used for filling 2012 Federal Income tax.
 Photocopies of last paycheck stubs for all working adults in household.
 Photocopies of last two months checking and saving account statements.
 Written denial from your county’s Social Service Department stating reason you did not qualify for state or
county assistance.

Please return all requested information to us in the enclosed envelope within 10 days. After receipt of all required
paperwork we will process your application and you will be notified by mail of our decision within 20 days.

Please contact Lesa Melton, Credit Department at 1-715-555-5552 if you have any questions or you may write us
at the above address.

Sincerely,

Lesa Melton
Credit Department

Enclosure
 Woods and Water Medical Center

1900 College Drive Rice Lake, WI 54868  715—234-7082 

meltonlj@my.witc.edu

September 19, 2018

Mr. Jacob Goreshek

19 Hummingbird Lane
Rice Lake, WI 54868

Dear Mr. Goreshek,

We have received your application for charity care from Woods & Water. In order to process your claim properly, we
will need the following documentation with your application for charity care.

Documentation needed:
 Completed financial form (enclosed).
 Photocopy or your 2012 Federal Income Tax Form.
 All adult W-2 forms used for filling 2012 Federal Income tax.
 Photocopies of last paycheck stubs for all working adults in household.
 Photocopies of last two months checking and saving account statements.
 Written denial from your county’s Social Service Department stating reason you did not qualify for state or
county assistance

Please return all requested information to us in the enclosed envelope within 10 days. After receipt of all required
paperwork we will process your application and you will be notified by mail of our decision within 20 days.

Please contact Lesa Melton, Credit Department at 1-715-555-5552 if you have any questions or you may write us at
the above address.

Sincerely,

Lesa Melton
Credit Department
Enclosure
 Woods and Water Medical Center

1900 College Drive Rice Lake, WI 54868  715—234-7082 

meltonlj@my.witc.edu

September 19, 2018

Mr. Steven Jones

2121 Linden Avenue
Rice Lake, WI 54868

Dear Mr. Jones,

We have received your application for charity care from Woods & Water. In order to process your claim properly, we
will need the following documentation with your application for charity care.

Documentation needed:
 Completed financial form (enclosed).
 Photocopy or your 2012 Federal Income Tax Form.
 All adult W-2 forms used for filling 2012 Federal Income tax.
 Photocopies of last paycheck stubs for all working adults in household.
 Photocopies of last two months checking and saving account statements.
 Written denial from your county’s Social Service Department stating reason you did not qualify for state or
county assistance.

Please return all requested information to us in the enclosed envelope within 10 days. After receipt of all required
paperwork we will process your application and you will be notified by mail of our decision within 20 days.

Please contact Lesa Melton, Credit Department at 1-715-555-5552 if you have any questions or you may write us
at the above address.

Sincerely,

Lesa Melton
Credit Department

Enclosures
 Woods and Water Medical Center

1900 College Drive Rice Lake, WI 54868  715—234-7082 

meltonlj@my.witc.edu

September 19, 2018

Ms. Linda Atelson

42 Wisconsin Avenue
Rice Lake, WI 54868

Dear Ms. Atelson,

We have received your application for charity care from Woods & Water. In order to process your claim properly, we will need the following
documentation with your application for charity care.

Documentation needed:
 Completed financial form (enclosed).
 Photocopy or your 2012 Federal Income Tax Form.
 All adult W-2 forms used for filling 2012 Federal Income tax.
 Photocopies of last paycheck stubs for all working adults in household.
 Photocopies of last two months checking and saving account statements.
 Written denial from your county’s Social Service Department stating reason you did not qualify for state or county assistance.

Please return all requested information to us in the enclosed envelope within 10 days. After receipt of all required paperwork we will process
your application and you will be notified by mail of our decision within 20 days.

Please contact Lesa Melton, Credit Department at 1-715-555-5552 if you have any questions or you may write us at the above address.

Sincerely,

Lesa Melton
Credit Department

Enclosures
 Woods and Water Medical Center

1900 College Drive Rice Lake, WI 54868  715—234-7082 

meltonlj@my.witc.edu

September 19, 2018

Ms. Regina Miller

2121 Main Street
Rice Lake, WI 54868

Dear Ms. Miller,

We have received your application for charity care from Woods & Water. In order to process your claim properly, we
will need the following documentation with your application for charity care.

Documentation needed:
 Completed financial form (enclosed).
 Photocopy or your 2012 Federal Income Tax Form.
 All adult W-2 forms used for filling 2012 Federal Income tax.
 Photocopies of last paycheck stubs for all working adults in household.
 Photocopies of last two months checking and saving account statements.
 Written denial from your county’s Social Service Department stating reason you did not qualify for state or
county assistance.

Please return all requested information to us in the enclosed envelope within 10 days. After receipt of all required
paperwork we will process your application and you will be notified by mail of our decision within 20 days.

Please contact Lesa Melton, Credit Department at 1-715-555-5552 if you have any questions or you may write us at
the above address.

Sincerely,

Lesa Melton
Credit Department

Enclosures
 Woods and Water Medical Center

1900 College Drive Rice Lake, WI 54868  715—234-7082 

meltonlj@my.witc.edu

September 19, 2018

Mr. Brady Lehman

8942 Western Avenue
Rice Lake, WI 54868

Dear Mr. Lehman,

We have received your application for charity care from Woods & Water. In order to process your claim properly, we
will need the following documentation with your application for charity care.

Documentation needed:
 Completed financial form (enclosed).
 Photocopy or your 2012 Federal Income Tax Form.
 All adult W-2 forms used for filling 2012 Federal Income tax.
 Photocopies of last paycheck stubs for all working adults in household.
 Photocopies of last two months checking and saving account statements.
 Written denial from your county’s Social Service Department stating reason you did not qualify for state or
county assistance.
Please return all requested information to us in the enclosed envelope within 10 days. After receipt of all required
paperwork we will process your application and you will be notified by mail of our decision within 20 days.

Please contact Lesa Melton, Credit Department at 1-715-555-5552 if you have any questions or you may write us
at the above address.

Sincerely,

Lesa Melton
Credit Department

Enclosures
 Woods and Water Medical Center

1900 College Drive Rice Lake, WI 54868  715—234-7082 

meltonlj@my.witc.edu

September 19, 2018

Ms. Bridget Hansen

1514 Rice Lake Road
Rice Lake, WI 54868

Dear Ms. Hansen,

We have received your application for charity care from Woods & Water. In order to process your claim properly, we
will need the following documentation with your application for charity care.

Documentation needed:
 Completed financial form (enclosed).
 Photocopy or your 2012 Federal Income Tax Form.
 All adult W-2 forms used for filling 2012 Federal Income tax.
 Photocopies of last paycheck stubs for all working adults in household.
 Photocopies of last two months checking and saving account statements.
 Written denial from your county’s Social Service Department stating reason you did not qualify for state or
county assistance.
Please return all requested information to us in the enclosed envelope within 10 days. After receipt of all required
paperwork we will process your application and you will be notified by mail of our decision within 20 days.

Please contact Lesa Melton, Credit Department at 1-715-555-5552 if you have any questions or you may write us
at the above address.

Sincerely,

Lesa Melton
Credit Department

Enclosures
 Woods and Water Medical Center

1900 College Drive Rice Lake, WI 54868  715—234-7082 

meltonlj@my.witc.edu

September 19, 2018

Mr. Michael Storbeck

2581 College Drive
Rice Lake, WI 54868

Dear Mr. Storbeck,

We have received your application for charity care from Woods & Water. In order to process your claim properly, we
will need the following documentation with your application for charity care.

Documentation needed:
 Completed financial form (enclosed).
 Photocopy or your 2012 Federal Income Tax Form.
 All adult W-2 forms used for filling 2012 Federal Income tax.
 Photocopies of last paycheck stubs for all working adults in household.
 Photocopies of last two months checking and saving account statements.
 Written denial from your county’s Social Service Department stating reason you did not qualify for state or
county assistance. Please return all requested information to us in the enclosed envelope within 10 days. After
receipt of all required paperwork we will process your application and you will be notified by mail of our
decision within 20 days.

Please contact Lesa Melton, Credit Department at 1-715-555-5552 if you have any questions or you may write us
at the above address.

Sincerely,

Lesa Melton
Credit Department

Enclosures
 Woods and Water Medical Center

1900 College Drive Rice Lake, WI 54868  715—234-7082 

meltonlj@my.witc.edu

September 19, 2018

Ms. Tracy Torkela

85 Augusta Avenue
Rice Lake, WI 54868

Dear Ms. Torkela,

We have received your application for charity care from Woods & Water. In order to process your claim properly, we
will need the following documentation with your application for charity care.

Documentation needed:
 Completed financial form (enclosed).
 Photocopy or your 2012 Federal Income Tax Form.
 All adult W-2 forms used for filling 2012 Federal Income tax.
 Photocopies of last paycheck stubs for all working adults in household.
 Photocopies of last two months checking and saving account statements.
 Written denial from your county’s Social Service Department stating reason you did not qualify for state or
county assistance. Please return all requested information to us in the enclosed envelope within 10 days. After
receipt of all required paperwork we will process your application and you will be notified by mail of our
decision within 20 days.

Please contact Lesa Melton, Credit Department at 1-715-555-5552 if you have any questions or you may write us
at the above address.

Sincerely,

Lesa Melton
Credit Department

Enclosures
 Woods and Water Medical Center

1900 College Drive Rice Lake, WI 54868  715—234-7082 

meltonlj@my.witc.edu

September 19, 2018

Mr. Bob Brazelton

25 Madison Street
Cameron, WI 54868

Dear Mr. Brazelton,

We have received your application for charity care from Woods & Water. In order to process your claim properly, we
will need the following documentation with your application for charity care.

Documentation needed:
 Completed financial form (enclosed).
 Photocopy or your 2012 Federal Income Tax Form.
 All adult W-2 forms used for filling 2012 Federal Income tax.
 Photocopies of last paycheck stubs for all working adults in household.
 Photocopies of last two months checking and saving account statements.
 Written denial from your county’s Social Service Department stating reason you did not qualify for state or
county assistance. Please return all requested information to us in the enclosed envelope within 10 days. After
receipt of all required paperwork we will process your application and you will be notified by mail of our
decision within 20 days.

Please contact Lesa Melton, Credit Department at 1-715-555-5552 if you have any questions or you may write us
at the above address.

Sincerely,

Lesa Melton
Credit Department

Enclosures
 Woods and Water Medical Center

1900 College Drive Rice Lake, WI 54868  715—234-7082 

meltonlj@my.witc.edu

September 19, 2018

Dear Sir or Madam,

We have received your application for charity care from Woods & Water. In order to process your claim properly, we
will need the following documentation with your application for charity care.

Documentation needed:
 Completed financial form (enclosed).
 Photocopy or your 2012 Federal Income Tax Form.
 All adult W-2 forms used for filling 2012 Federal Income tax.
 Photocopies of last paycheck stubs for all working adults in household.
 Photocopies of last two months checking and saving account statements.
 Written denial from your county’s Social Service Department stating reason you did not qualify for state or
county assistance.

Please return all requested information to us in the enclosed envelope within 10 days. After receipt of all required
paperwork we will process your application and you will be notified by mail of our decision within 20 days.

Please contact Lesa Melton, Credit Department at 1-715-555-5552 if you have any questions or you may write us
at the above address.

Sincerely,

Lesa Melton
Credit Department

Enclosures