Share Your LiveWELL Success Story Question Title * 1. What is your first and last name? OK Question Title * 2. I am a: Colleague Spouse/LDA OK Question Title * 3. I am a colleague/spouse/LDA of: St. Elizabeth’s Hospital – O’Fallon St. Joseph’s Hospital – Breese St. Mary’s Hospital – Decatur St. Anthony’s Memorial Hospital – Effingham St. Joseph’s Hospital – Highland St. Francis Hospital – Litchfield St. John’s Hospital – Springfield Holy Family Hospital– Greenville St. Joseph’s Hospital – Chippewa Falls Sacred Heart Hospital – Eau Claire St. Mary’s Hospital Medical Center – Green Bay St. Vincent Hospital – Green Bay St. Clare Memorial Hospital – Oconto Falls St. Nicholas Hospital – Sheboygan HSHS Medical Group, Inc. Prairie Cardiovascular Consultants, Ltd. Prairie Education and Research Cooperative Hospital Sisters Health System Good Shepherd Hospital - Shelbyville OK Question Title * 4. Current LiveWELL Level? Level 1 (1,000 to 2,499 points) Level 2 (2,500 to 4,999 points) Level 3 (5,000 points and above) OK Question Title * 5. What is your favorite LiveWELL challenge category so far? (select one) Physical Financial Emotional Work Well-being Why? OK Question Title * 6. Tell us what you have liked most about HSHS LiveWELL and/or share your success story. OK Question Title * 7. HSHS will highlight colleague stories on the HSHS Benefit website (Share Your Story examples) and/or in other publications. Are you interested in sharing your story publicly? Yes, I am willing to share my story! No, I do not want my story to be shared publicly. OK Question Title * 8. If you answered ‘yes’ to Question 7, please upload a photo of you “living well” to be used if your story is selected. DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only. Choose File Choose File No file chosen Remove File If you answered ‘yes’ to Question 7, please upload a photo of you “living well” to be used if your story is selected. OK Question Title * 9. What type of LiveWELL challenges would you like to see in the future? OK DONE