2023-11-09T10:23:32-06:00 2022-12-31 346565596 ERNST & YOUNG US LLP 155 N WACKER DRIVE CHICAGO IL 60606 990 2022-01-01 453791176 SANFORD GROUP RETURN SANF 6053331000 PO BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 BILL MARLETTE EVP, CFO & TREASURER 6053331000 2023-11-09 1 BILL MARLETTE XXX-XX-XXXX 0 JESS WAGENER P01622613 3128792000 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z BILL GASSEN 2301 EAST 60TH ST SIOUX FALLS SD 57104 5327534915 1 1 5851 X WWW.SANFORDHEALTH.ORG X "DEDICATED TO SHARING GOD'S LOVE THROUGH THE WORK OF HEALTH, HEALING AND COMFORT." 13 6 3121 1254 102695945 2898047 173849939 100939514 5046555124 5209223752 5533720 9136742 2635171 2637006 5228573954 5321937014 47416673 44519605 0 0 2822078981 2907712001 0 0 0 1964536735 2208856104 4834032389 5161087710 394541565 160849304 3485607781 3581478897 1207557219 1069495687 2278050562 2511983210 X PART OF THE SANFORD HEALTH SYSTEM, SANFORD IS COMMITTED TO THE HEALTHCARE NEEDS OF COMMUNITIES THROUGHOUT SOUTH DAKOTA, NORTH DAKOTA, MINNESOTA AND IOWA. SANFORD PROVIDES A FULL RANGE OF PRIMARY AND SPECIALTY HEALTH CARE SERVICES. 0 0 4734788301 44519604 5064394241 SANFORD IS THE NATION'S LARGEST NOT-FOR-PROFIT INTEGRATED RURAL HEALTH SYSTEM PROVIDING MEDICAL SERVICES AT EVERY LEVEL FROM CRITICAL ACCESS HOSPITALS TO TERTIARY AND QUATERNARY CARE. THE SANFORD FOOTPRINT INCLUDES OVER 220,000 SQUARE MILES WITH A NINE STATE SERVICE AREA INCLUDING A NETWORK OF CHILDREN'S PRIMARY CARE CLINIC LOCATIONS ACROSS THE COUNTRY AND THE WORLD. SANFORD OPERATES FULL-TIME EMERGENCY CENTERS AND PROVIDES EMERGENCY CARE TO EVERYONE REGARDLESS OF THEIR ABILITY TO PAY. SANFORD FACILITIES AND CLINICS PROVIDE SERVICES TO REMOTE AND MEDICALLY UNDERSERVED AREAS THAT WOULD OTHERWISE NOT HAVE ACCESS TO EVEN PRIMARY CARE SERVICES. SANFORD FINANCIALLY SUPPORTS HEALTH AND WELLNESS, EDUCATION AND COMMUNITY DEVELOPMENT ACTIVITIES TO IMPROVE THE QUALITY OF LIFE AND STRENGTHEN COMMUNITIES THROUGHOUT THE REGION. EACH OF SANFORD'S FACILITIES PROMOTES HEALTH AND HEALING THAT RESPONDS TO THE UNIQUE NEEDS OF THE PATIENTS IN THE COMMUNITIES THAT SANFORD SERVES, ENSURING ACCESS TO COMPREHENSIVE AND SPECIALIZED SERVICES. THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT INDICATED THE IMPORTANT NEED FOR BEHAVIORAL HEALTH SERVICES FOR OUR COMMUNITY MEMBERS. SANFORD IS MEETING THIS NEED THROUGH AN INTEGRATED DELIVERY SYSTEM PROVIDING BEHAVIORAL HEALTH WITHIN THE MEDICAL HOME STRUCTURE.PLEASE SEE SCHEDULE H FOR A DESCRIPTION OF ADDITIONAL SERVICES, COMMUNITY BENEFIT ACTIVITIES, AND THE FULL SPECTRUM OF CHARITY CARE THAT SANFORD PROVIDES WITHIN THE COMMUNITY. 41001593 0 5322741 MEDICAL EDUCATION IS AN IMPORTANT SERVICE FOR SANFORD. SANFORD PROVIDES THE MEDICAL COMMUNITY WITH HIGH QUALITY EDUCATIONAL AND PROFESSIONAL DEVELOPMENT THAT IS EVIDENCE AND RESEARCH BASED; ACCREDITED FOR PHYSICIANS, NURSES, PHARMACISTS, AND ALLIED HEALTH PROFESSIONALS AND SCIENTISTS; INCLUSIVE OF CULTURAL DIVERSITY AND ADDRESSES THE NEED FOR SPECIALTY TRAINING.SANFORD IS DEDICATED TO PREPARING HEALTH CARE PROFESSIONALS FOR THE FUTURE. THE SANFORD PROMISE PROGRAM CONNECTS STUDENTS, EDUCATORS AND COMMUNITIES WITH SCIENCE AND RESEARCH IN HEALTH CARE AT A SECONDARY EDUCATION AGE. SANFORD WORKS IN PARTNERSHIP WITH THE UNIVERSITY OF SOUTH DAKOTA - SANFORD SCHOOL OF MEDICINE, AND THE UNIVERSITY OF NORTH DAKOTA - SCHOOL OF MEDICINE TO PROVIDE ROTATIONS FOR MEDICAL STUDENTS, RESIDENCIES AND FELLOWSHIPS. SANFORD WORKS IN PARTNERSHIP WITH AN EXTENSIVE GROUP OF HIGHER LEARNING ORGANIZATIONS TO PROVIDE STUDENT TRAINING AND LEARNING OPPORTUNITIES IN MANY VENUES ACROSS OUR REGION. 36091714 0 8433837 SANFORD RESEARCH AND SANFORD RESEARCH NORTH ARE BOTH NON-PROFIT HEALTH RESEARCH ORGANIZATIONS. COMBINED, BOTH ENTITIES HAVE MORE THAN 200 SCIENTISTS AND STAFF AS WELL AS CENTERS, INCLUDING: CHILDREN'S HEALTH, FOCUSED ON PEDIATRIC RARE DISEASES AND CANCER; THE SANFORD PROJECT, SEEKING A CURE FOR TYPE 1 DIABETES THROUGH THE BODY'S NATURAL ABILITY TO REGENERATE CELLS; HEALTH OUTCOMES AND PREVENTION FOCUSING ON SUDDEN INFANT DEATH SYNDROME AND BIRTH-RELATED DISORDERS AT STUDY SITES INCLUDING UNITED STATES NATIVE AMERICAN RESERVATIONS AND SOUTH AFRICA; GENOMIC AND MOLECULAR MEDICINE WITH AN EMPHASIS ON GENOMICS, MOLECULAR BIOLOGY, BIOBANKING AND IMMUNOTHERAPY; EDITH SANFORD BREAST CANCER FOCUSING ON ADVANCED MOLECULAR RESEARCH AND PERSONALIZED TREATMENT; NEUROSCIENCES, FOCUSED ON THE AREA OF EATING DISORDERS, OBESITY AND BARIATRIC SURGERY OUTCOMES AS WELL AS PHYSIOLOGICAL ASPECTS OF EATING AND ADDICTION AND CLINICAL RESEARCH INCLUDING PARTICIPATION IN DRUG AND DEVICE STUDIES, THE NATIONAL CANCER INSTITUTE COMMUNITY CLINICAL ONCOLOGY PROGRAM AND THE NATIONAL COMMUNITY CANCER CENTER PILOT PROJECT.SANFORD RESEARCH AND SANFORD RESEARCH NORTH OFFER EXCITING CHALLENGES FOR RESEARCHERS BOTH IN WELL-ESTABLISHED PROJECTS AND EVER EXPANDING RESEARCH OPPORTUNITIES. SANFORD OFFERS OPPORTUNITIES TO PARTICIPATE IN CLINICAL TRIALS AND TO BE A PART OF THE CHANGING FACE OF MEDICINE. 4811881608 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 1 1 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 1 1 0 1 0 1 X 4396 0 1 3121 1 1 1 1 CH GH GM 0 0 0 0 0 0 0 0 0 0 X 13 6 1 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 MN OR CA X BILL MARLETTE EVP CFO & TREASURER 6053331000 2301 EAST 60TH STREET SIOUX FALLS SD 57104 X WILLIAM BRUNNER MD PHYSICIAN 60.00 0.00 X 3406075 0 39142 BRYAN NERMOE PRESIDENT & CEO, FARGO-END 3/22 55.00 5.00 X 0 457274 37952 BRYAN NERMOE SEE SCH J, PART III, LINES 4A-4B 55.00 5.00 X 0 2719941 0 BILL GASSEN III TRUSTEE, PRESIDENT & CEO 49.64 10.36 X X 0 2683582 379583 TOMASZ STYS MD PHYSICIAN 60.00 0.00 X 2806912 0 39520 RANDY BURY FORMER CHIEF ADMIN OFFICER 0.00 0.00 X 0 56688 0 RANDY BURY SEE SCH J, PART III, LINES 4A-4B 0.00 0.00 X 0 2769572 0 ADAM STYS MD PHYSICIAN 60.00 0.00 X 2750489 0 42510 ERIC BELANGER MD PHYSICIAN 60.00 0.00 X 2545233 0 42926 MARIAN PETRASKO MD PHYSICIAN 60.00 0.00 X 2427171 0 34932 MATT HOCKS EVP, CHIEF OPERATING OFFICER 53.85 6.15 X 0 2164525 248300 MICHELLE BRUHN EVP, CFO & TREASURER 49.64 10.36 X 0 1530538 186998 JENNIFER GRENNAN EVP, CHIEF ADMIN OFFICER 55.00 5.00 X 0 1476061 183409 MICHAEL LEBEAU MD SVP, HEALTH SVC OPERATIONS 60.00 0.00 X 0 1420525 182111 PAUL HANSON PRESIDENT & CEO, SIOUX FALLS 60.00 0.00 X 0 1254502 154600 MARIA BELL MD TRUSTEE, PHYSICIAN 57.99 2.01 X 1143694 0 43942 TODD SCHAFFER PRESIDENT & CEO, BISMARCK 60.00 0.00 X 0 948736 110906 TIFFANY LAWRENCE PRESIDENT & CEO, FARGO-BEG 3/22 55.00 5.00 X 0 924767 132767 SUSAN JARVIS PRESIDENT & CEO, BEMIDJI 60.00 0.00 X 0 805036 122025 MICHELLE MICKA SVP, FINANCE, HEALTH SERVICES 55.00 5.00 X 0 615816 80707 MARK LUNDEEN MD TRUSTEE, PHYSICIAN 57.99 2.01 X 343914 0 13962 JOANN KUNKEL FORMER CFO-SCH J, PART III, LINES 4A-4B 0.00 0.00 X 0 339000 0 ANDY NORTH TRUSTEE, SECRETARY, INDEP CONTRACTOR 9.10 2.01 X X 316771 0 0 KIM PATRICK FORMER CLO-SCH J, PART III, LINES 4A-4B 0.00 0.00 X 0 315000 0 NATHAN WHITE FORMER COO-SCH J, PART III, LINES 4A-4B 0.00 0.00 X 0 300000 0 MARK PAULSON MD TRUSTEE, PHYSICIAN 57.99 2.01 X 239394 0 38669 ALLISON WIERDA-SUTTLE MD FORMER SVP, CMO-SCH J PT III, 4A-4B 0.00 0.00 X 0 264600 0 NEIL GULSVIG TRUSTEE, CHAIRPERSON 5.10 2.01 X X 75772 0 0 LAURIS MOLBERT TRUSTEE, VICE CHAIR 5.10 2.01 X X 35500 0 0 MARNIE HERMANN TRUSTEE 5.10 2.01 X 35500 0 0 DON JACOBS TRUSTEE 5.10 2.01 X 34500 0 0 JAMES CAIN TRUSTEE 5.10 2.01 X 34500 0 0 ROBIN SMITH TRUSTEE, TREASURER 5.10 2.01 X X 34000 0 0 WESLEY ENGBRECHT TRUSTEE 5.10 2.01 X 34000 0 0 BRENT TEIKEN TRUSTEE, PAST CHAIR 5.10 2.01 X X 33000 0 0 16296425 21046163 2114961 2308 1 1 0 FOCUSONE SOLUTIONS LLC 1010 N 102ND ST STE 300 OMAHA NE 68114 STAFFING SERVICES 300145941 MAYO CLINIC LABORATORIES 200 FIRST ST SOUTHWEST ROCHESTER MN 55905 LAB/MEDICAL SERVICES 10891161 MCGOUGH CONSTRUCTION CO LLC 2737 FAIRVIEW AVE N ST PAUL MN 55113 CONSTRUCTION SERVICES 7396303 LOCUMTENENSCOM LLC 2655 NORTHWINDS PKWY ALPHARETTA GA 30009 STAFFING SERVICES 4561600 WAPITI MEDICAL STAFFING 107 FYNN DR SUITE 600 MILBANK SD 57252 STAFFING SERVICES 4343061 300 43258143 42975576 14705795 100939514 PATIENT SERVICES 621110 2359607636 2359607636 MEDICARE/MEDICAID 621400 1952624035 1952624035 PHARMACY 621300 521232020 513313609 7918411 RETAIL SALES 456199 187530621 166458066 21072555 SUPPORT SERVICES 561439 52033841 50766776 1267065 136195599 86147473 22938203 27109923 5209223752 5633495 5633495 3650 3650 4659382 2026026 2633356 2633356 2633356 1067175 6007947 1165159 2406716 -97984 3601231 3503247 3503247 5321937014 5078150819 102695945 40150736 44383028 44383028 126577 126577 10000 10000 21277779 19663681 1614098 4129859 4129859 2358340963 2183257619 175083344 96623894 88365800 8258094 274888369 244644216 30244153 152451137 139476853 12974284 2998111 294569 2703542 1196513 80195 1116318 1680186 1680186 233703 233703 439234857 407588646 31646211 20963774 7038078 13925696 57854805 38431076 19423729 120195962 46677250 73518712 109632057 99276820 10355237 20974164 18833612 2140552 5490097 4293797 1196300 24916005 24822949 93056 171958121 150461297 21496824 20230385 19840249 390136 MEDICAL SUPPLIES 1213605821 1206101877 7503944 CONTRACTED BIOMEDICAL S 29756264 29754082 2182 EMPLOYEE RECRUITMENT 12228358 8133417 4094941 OTHER TAXES 10560057 10340928 219129 -54853136 19751289 -74604425 5161087710 4811881608 349206102 0 X 87235347 5350099 281391844 230746569 220673 653343333 747066864 50879932 69083286 125839955 124928258 65070623 78225069 3815138177 2025007992 1751741875 1790130185 735389 433579 33508819 40467353 33414398 48008578 47957708 380893552 420413390 3485607781 3581478897 390495684 321632155 1595748 5118766 3159894 4018002 505134169 479072573 218589 174332 15455741 11901748 291497394 247578111 1207557219 1069495687 X 2278043512 2511976110 7050 7100 2278050562 2511983210 3485607781 3581478897 X 160849304 -7005023 80088367 X 0 1 X 1 1 1 X 19 19 LIST OF ORGANIZATIONS AND PUBLIC CHARITY STATUS: SANFORD HEALTH 509(A)(3) SANFORD MEDICAL CENTER 170(B)(1)(A)(III) SANFORD CLINIC 509(A)(2) SANFORD RESEARCH 170(B)(1)(A)(III) SANFORD RESEARCH NORTH 170(B)(1)(A)(III) SANFORD HOME HEALTH 509(A)(2) SANFORD HEALTH NETWORK 170(B)(1)(A)(III) SANFORD WORLD CLINICS 509(A)(2) SANFORD NORTH 509(A)(3) SANFORD MEDICAL CENTER FARGO 170(B)(1)(A)(III) SANFORD CLINIC NORTH 509(A)(2) SANFORD HEALTH NETWORK NORTH 170(B)(1)(A)(III) SANFORD HEALTH OF NORTHERN MINNESOTA 170(B)(1)(A)(III) BAKER PARK, INC. 509(A)(2) SANFORD WEST 509(A)(3) SANFORD BISMARCK 170(B)(1)(A)(III) SANFORD WORLD CLINICS-KLAMATH FALLS 509(A)(2) SANFORD VIRTUAL CARE 509(A)(2) SCHEDULE A, PART I PART I, LINE 12B - SANFORD HEALTH, SANFORD NORTH, AND SANFORD WEST ARE ALL TYPE II SUPPORTING ORGANIZATIONS. DETAIL FOR SCHEDULE A, PART I, LINE 12G LINE 12, COLUMN: (I) SANFORD MEDICAL CENTER; (II) 46-0227855; (III) 3; (IV) YES; (V) $37,525,246 LINE 12, COLUMN: (I) SANFORD CLINIC; (II) 46-0447693; (III) 10; (IV) YES; (V) $2,121,119 LINE 12, COLUMN: (I) SANFORD RESEARCH; (II) 46-0450378; (III) 4; (IV) YES; (V) $584,671 LINE 12, COLUMN: (I) SANFORD RESEARCH NORTH; (II) 45-0274828; (III) 4; (IV) YES; (V) $145,266 LINE 12, COLUMN: (I) SANFORD HOME HEALTH; (II) 46-0282134; (III) 10; (IV) YES; (V) $276,874 LINE 12, COLUMN: (I) SANFORD HEALTH NETWORK; (II) 46-0388596; (III) 3; (IV) YES; (V) $9,696,782 LINE 12, COLUMN: (I) SANFORD CLINIC NORTH; (II) 91-1770748; (III) 10; (IV) YES; (V) $4,364,111 LINE 12, COLUMN: (I) SANFORD MEDICAL CENTER FARGO; (II) 45-0226909; (III) 3; (IV) YES; (V) $46,504,965 LINE 12, COLUMN: (I) SANFORD WORLD CLINICS; (II) 26-2707628; (III) 10; (IV) YES; (V) $196,947 LINE 12, COLUMN: (I) SANFORD WORLD CLINICS-KLAMATH FALLS; (II) (92-0396212 (III) 10; (IV) YES; (V) $119,161 LINE 12, COLUMN: (I) SANFORD HEALTH OF NORTHERN MINNESOTA; (II) 41-1266009; (III) 3; (IV) YES; (V) $10,069,316 LINE 12, COLUMN: (I) BAKER PARK, INC.; (II) 41-1372480; (III) 10; (IV) YES; (V) $18,919 LINE 12, COLUMN: (I) SANFORD HEALTH FOUNDATION NORTH; (II) 45-0398104; (III) 7; (IV) YES; (V) $4,887,544 LINE 12, COLUMN: (I) SANFORD BISMARCK; (II) 45-0226700; (III) 3; (IV) YES; (V) $21,812,183 LINE 12, COLUMN: (I) SANFORD HEALTH FOUNDATION WEST; (II) 45-0397196; (III) 7; (IV) YES; (V) $80,201 LINE 12, COLUMN: (I) SANFORD VIRTUAL CARE; (II) 88-0976483; (III) 10; (IV) YES; (V) $7,634 LINE 12, COLUMN: (I) THE EVANGELICAL LUTHERAN GOOD SAMARITAN FOUNDATION; (II) 46-0422866; (III) 7; (IV) YES; (V) $214,007 LINE 12, COLUMN: (I) THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY; (II) 45-0228055; (III) 10; (IV) YES; (V) $27,607,528 LINE 12, COLUMN: (I) SANFORD HEALTH FOUNDATION OF NORTHERN MINNESOTA; (II) 41-1389317; (III) 7; (IV) YES; (V) $43,569 SCHEDULE A, PART I, LINE 12G, COLUMN (IV) WE HAVE ANSWERED YES THAT THE ORGANIZATIONS ARE LISTED IN OUR GOVERNING DOCUMENTS BECAUSE THE ARTICLES DESCRIBE THE SPECIFIED SUPPORTED ORGANIZATIONS AND THE OTHER SUPPORTED ORGANIZATIONS BY CLASS (AFFILIATED WITH THE SPECIFIED SUPPORTED ORGANIZATIONS). SCHEDULE A, PART III LINE 1 - COLUMN: (A) 133,275; (B) 429,804; (C) 9,415,179; (D) (3,426,082); (E) 2,951,560 ; (F) 9,503,736 LINE 2 - COLUMN: (A) 81,522,328; (B) 172,939,530; (C) 177,631,632; (D) 204,250,348; (E) 252,665,915; (F) 889,009,753 LINE 6 - COLUMN: (A) 81,655,603; (B) 173,369,334; (C) 187,046,811; (D) 200,824,266; (E) 255,617,475; (F) 898,513,489 LINE 8 - COLUMN: (F) 898,513,489 LINE 9 - COLUMN: (A) 81,655,603; (B) 173,369,334; (C) 187,046,811; (D) 200,824,266; (E) 255,617,475; (F) 898,513,489 LINE 10A - COLUMN: (A) 1,127,888; (B) 1,216,540; (C) 1,544,624; (D) 1,377,220; (E) 1,111,018; (F) 6,377,290 LINE 10C - COLUMN: (A) 1,127,888; (B) 1,216,540; (C) 1,544,624; (D) 1,377,220; (E) 1,111,018; (F) 6,377,290 LINE 11 - COLUMN: (A) 718,178; (B) 1,230,289; (C) 673,203; (D) 151,437; (E) 789,277; (F) 3,562,384 LINE 13 - COLUMN: (A) 83,501,669; (B) 175,816,163; (C) 189,264,638; (D) 202,352,923; (E) 257,517,770; (F) 908,453,163 LINE 15: 98.91% LINE 16: 98.71% LINE 17: 0.70% LINE 18: 0.85% LINE 19A: X LINE 19B: X PART IV, SECTION A LINE 1: NO LINE 2: NO LINE 3A: NO LINE 4A: NO LINE 5A: YES LINE 5B: YES LINE 5C: NO LINE 6: YES LINE 7: NO LINE 8: NO LINE 9A: NO LINE 9B: NO LINE 9C: NO LINE 10A: NO LINE 11A: NO LINE 11B: NO LINE 11C: NO SCHEDULE A, PART IV, SECTION A, LINE 1 THE ARTICLES OF INCORPORATION OF SANFORD HEALTH, SANFORD NORTH AND SANFORD BISMARCK PROVIDE THAT THEY SHALL PROVIDE OVERSIGHT, OPERATE FOR THE BENEFIT OF, TO SUPPORT THE FUNCTIONS OF, AND TO CARRY OUT SOME OR ALL OF THE CHARITABLE PURPOSES OF THE NAMED SUBSIDIARY ORGANIZATIONS WHICH ARE EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ALL OTHER 501(C)(3) ORGANIZATIONS OPERATED, SUPERVISED OR CONTROLLED BY OR SUPERVISED OR CONTROLLED IN CONNECTION WITH, SUCH ORGANIZATIONS. FURTHER, PURSUANT TO THEIR BY-LAWS, THE GOVERNING BODY OF SANFORD (PARENT), SERVES AS THE GOVERNING BODY OF SANFORD HEALTH, SANFORD NORTH AND SANFORD BISMARCK AS WELL AS ALL OF THE NAMED TAX-EXEMPT SUBSIDIARY ORGANIZATIONS. THUS, SANFORD HEALTH, SANFORD NORTH AND SANFORD BISMARCK MEET THE RELATIONSHIP TEST AS A TYPE II ORGANIZATIONS BECAUSE THERE IS COMMON SUPERVISION AND CONTROL BETWEEN SANFORD HEALTH, SANFORD NORTH AND SANFORD BISMARCK AND THEIR NAMED SUPPORTED ORGANIZATIONS. SANFORD HEALTH, SANFORD NORTH, AND SANFORD BISMARCK ALSO SUPPORT ORGANIZATIONS WHICH ARE 501(C)(3) ORGANIZATIONS AFFILIATED WITH THE SUPPORTED ORGANIZATIONS OR ARE 501(C)(3) PUBLIC CHARITIES AFFILIATED WITH THESE AFFILIATED ENTITIES. THEY ARE DESCRIBED BY CLASS. IN ADDITION, THE ARTICLES PROVIDE THAT IN FURTHERANCE OF THEIR PURPOSES, THESE CORPORATIONS MAY ENGAGE IN, ADVANCE, PROMOTE, SUPPORT, AND ADMINISTER CHARITABLE, SCIENTIFIC, AND EDUCATIONAL ACTIVITIES AND PROJECTS OF EVERY KIND AND NATURE WHATSOEVER IN ITS OWN BEHALF OR AS THE AGENT, TRUSTEE, OR REPRESENTATIVE OF OTHERS. THIS INCLUDES TO AID OR ASSIST OTHER ORGANIZATIONS WHOSE ACTIVITIES ARE SUCH AS TO FURTHER, ACCOMPLISH, FOSTER, OR ATTAIN ANY SUCH PURPOSES. ALL POWERS OF THESE CORPORATIONS SHALL BE EXERCISED ONLY SO THAT THESE CORPORATIONS' OPERATIONS SHALL BE EXCLUSIVELY WITHIN THE CONTEMPLATION OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. TO QUALIFY AS A SECTION 509(A)(3) SUPPORTING ORGANIZATION, AN ORGANIZATION MUST SUPPORT ONE OR MORE SPECIFIED ORGANIZATIONS. FOR TYPE II SUPPORTING ORGANIZATION'S ARTICLES OF INCORPORATION, THE ARTICLES MUST DESIGNATE THE SUPPORTING ORGANIZATION(S) BY CLASS OR PURPOSE, AND WHICH INCLUDE PUBLICLY SUPPORTED ORGANIZATIONS WHICH ARE CLOSELY RELATED IN PURPOSE OR FUNCTION TO THE PUBLICLY SUPPORTED ORGANIZATION SPECIFIED IN THE ARTICLES. THEREFORE, THE LACK OF INCLUDING THE NAME OF THE AFFILIATED ORGANIZATIONS THAT SANFORD HEALTH, SANFORD NORTH, AND SANFORD WEST WILL SUPPORT IN THEIR ARTICLES OF INCORPORATION DOES NOT OTHERWISE DEFEAT THE ORGANIZATIONS STATUSES AS TYPE II SUPPORTING ORGANIZATIONS, BECAUSE THEIR ARTICLES DESCRIBE THESE SUPPORTED ORGANIZATIONS BY CLASS (AFFILIATED WITH THE SPECIFIED SUPPORTED ORGANIZATION) AND REQUIRE THAT THEY BE EXEMPT FROM TAX UNDER IRC SECTION 501(C)(3). SCHEDULE A, PART IV, SECTION A, LINE 5A (I) SANFORD WORLD CLINICS-KLAMATH FALLS, 92-0396212; (II) THE ORGANIZATION WAS ADDED BECAUSE IT WAS A NEW ORGANIZATION, AND IT WAS SUPPORTED BY THE SUPPORTING ORGANIZATIONS; (III) THE SUPPORTED ORGANIZATION WAS PART OF A CLASS ALREADY DESIGNATED IN THE ORGANIZATIONS ORGANIZING DOCUMENTS; (IV) NO ACTION NEEDED TO ACCOMPLISH (I) SANFORD VIRTUAL CARE, 88-0976483; (II) THE ORGANIZATION WAS ADDED BECAUSE IT WAS A NEW ORGANIZATION, AND IT WAS SUPPORTED BY THE SUPPORTING ORGANIZATIONS; (III) THE SUPPORTED ORGANIZATION WAS PART OF A CLASS ALREADY DESIGNATED IN THE ORGANIZATIONS ORGANIZING DOCUMENTS; (IV) NO ACTION NEEDED TO ACCOMPLISH (I) THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY, 45-0228055; (II) THE ORGANIZATION WAS ADDED BECAUSE IT WAS SUPPORTED BY THE SUPPORTING ORGANIZATIONS; (III) THE SUPPORTED ORGANIZATION WAS PART OF A CLASS ALREADY DESIGNATED IN THE ORGANIZATIONS ORGANIZING DOCUMENTS; (IV) NO ACTION NEEDED TO ACCOMPLISH (I) SANFORD HEALTH FOUNDATION OF NORTHERN MINNESOTA, 41-1389317; (II) THE ORGANIZATION WAS ADDED BECAUSE IT WAS SUPPORTED BY THE SUPPORTING ORGANIZATIONS; (III) THE SUPPORTED ORGANIZATION WAS PART OF A CLASS ALREADY DESIGNATED IN THE ORGANIZATIONS ORGANIZING DOCUMENTS; (IV) NO ACTION NEEDED TO ACCOMPLISH SCHEDULE A, PART IV, SECTION A, LINE 6 THE ORGANIZATIONS GIVE GRANTS AND PROVIDE SUPPORT TO QUALIFIED 501(C)(3) PUBLIC CHARITIES, GOVERNMENTAL ENTITIES AND VARIOUS LOCAL NONPROFIT ORGANIZATIONS THAT SUPPORT THE MISSIONS OF SANFORD HEALTH, SANFORD NORTH, AND SANFORD WEST AND THE ORGANIZATIONS THAT THEY SUPPORT. SCHEDULE A, PART IV, SECTION C, LINE 1 LINE 1: YES RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 1 753600 1 527817 0 1 398769 1680186 0 PART II-B, LINE 1: THE FILING ORGANIZATION HAS MEMBERSHIPS IN THE FOLLOWING ORGANIZATIONS: 340B HEALTH, AMERICAN ACADEMY OF FAMILY PHYSICIANS, AMERICAN ACADEMY OF OPTHALMOLOGY, AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS, AMERICAN ACADEMY OF SLEEP MEDICINE, AMERICAN COLLEGE OF HEALTHCARE EXECUTIVES, AMERICAN COLLEGE OF OB/GYN, AMERICAN COLLEGE OF OSTEOPATHIC SURGEONS, AMERICAN COLLEGE OF PHYSICIANS, AMERICAN COLLEGE OF SURGEONS PROFESSIONAL ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION, AMERICAN MEDICAL ASSOCIATION, AMERICAN MEDICAL GROUP ASSOCIATION, AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION, AMERICAN OSTEOPATHIC ASSOCIATION, AMERICAN PODIATRIC MEDICAL ASSOCIATION, AMERICAN SOCIETY FOR HEALTH CARE ENGINEERING, AIR MEDICAL OPERATORS ASSOCIATION, ASSOCIATION FOR ADVANCING PHYSICIAN & PROVIDER RECRUITMENT, ASSOCIATION OF COMMUNITY CANCER CENTERS, ASSOCIATION OF CRITICAL CARE TRANSPORT, CANTON ROTARY CLUB, CHAMBER OF COMMERCE GRAND FORKS, CHILDREN'S HOSPITAL ASSOCIATION, DOWNTOWN COMMUNITY PARTNERSHIP, FLORIDA PODIATRIC MEDICAL ASSOCIATION, GREATER ND CHAMBER, GREATER SF CHAMBER OF COMMERCE, HEALTHCARE INFORMATION AND MANAGEMENT SYSTEMS SOCIETY, HEALTH POLICY CONSORTIUM, IOWA HOSPITAL ASSOCIATION, IOWA MEDICAL SOCIETY, LEADINGAGE IA, MEDICAL GROUP MANAGEMENT ASSOCIATION, MIDWEST ASSOCIATION FOR MEDICAL EQUIPMENT & SUPPLIES, MINNESOTA HOSPITAL ASSOCIATION, NATIONAL ASSOCIATION FOR BIOMEDICAL RESEARCH, NATIONAL ASSOCIATION OF SOCIAL WORKERS, NATIONAL ASSOCIATION OF SPECIALTY PHARMACY, NATIONAL RURAL HEALTH ASSOCIATION, NORTH DAKOTA HOSPITAL ASSOCIATION, NORTH DAKOTA LONG TERM CARE ASSOCIATION, NORTH DAKOTA MOTOR CARRIERS ASSOCIATION, NORTH DAKOTA PETROLIUM COUNCIL, RENAL HEALTHCARE ASSOCIATION, SOUTH DAKOTA ASSOCIATION OF HEALTHCARE ORGANIZATION, SD BIOTECH ASSOCIATION, SD CHAMBER OF COMMERCE & INDUSTRY, SD HEALTH CARE ASSOCIATION, SOCIETY OF DIAGNOSTIC MEDICAL SONOGRAPHY, SOUTH DAKOTANS DECIDE HEALTHCARE, SOUTH DAKOTANS FOR FAIR ELECTIONS, AND TRAUMA CENTER ASSOCIATION OF AMERICA. A PERCENTAGE OF MEMBERSHIP DUES PAID TO THESE ORGANIZATIONS RELATE TO LOBBYING EXPENSES. IN ADDITION, THE ORGANIZATION EMPLOYS CERTAIN INDIVIDUALS, AND CONTRACTS WITH VARIOUS LOBBYISTS, TO MONITOR LEGISLATIVE ACTS IMPORTANT TO ALL SANFORD ENTITIES ON BOTH STATE AND NATIONAL LEVELS. OCCASIONALLY, SANFORD EMPLOYEES SEND MAILINGS TO LEGISLATORS ON ISSUES THAT MAY AFFECT HEALTHCARE. 0 1 X 95588573 3297480 -419011 180536 98286506 92002112 3586461 95588573 89216166 3360625 574611 67 92002112 84843272 4372894 89216166 63648688 21194584 84843272 0.00000 1.00000 0.00000 0 1 1 130555153 130555153 1704209799 775582059 928627740 93048174 57956978 35091196 1811002949 1157880386 653122563 76322102 33588569 42733533 1790130185 NON-OPERATING PROPERTY 94452433 DEFERRED COMPENSATION ASSETS HELD FOR INVESTMENT 160807939 OTHER ASSETS 81898286 RIGHT OF USE ASSET 83254732 420413390 DEFERRED COMPENSATION LIABILITY 160597727 OTHER NON-CURRENT LIABILITIES 20196146 LONG TERM OPERATING LEASE PAYABLE 66784238 247578111 X PART IV, LINE 2B: LONG TERM CARE FACILITIES HOLD SECURITY DEPOSITS FOR TENANTS. PART V, LINE 4: SANFORD HEALTH FOUNDATION, SANFORD HEALTH FOUNDATION NORTH, SANFORD HEALTH FOUNDATION OF NORTHERN MINNESOTA, AND SANFORD HEALTH FOUNDATION WEST HOLD ENDOWMENT FUNDS ON BEHALF OF THE FILING ORGANIZATION TO BE USED FOR ASSISTANCE IN ITS ACTIVITIES AND FOR PROVIDING HEALTH CARE, MEDICAL, OR EDUCATIONAL SERVICES. PART X, LINE 2: CERTAIN CONTROLLED ORGANIZATIONS ARE SUBJECT TO INCOME TAXES. DEFERRED INCOME TAX ASSETS AND LIABILITIES ARE RECOGNIZED FOR THE DIFFERENCES BETWEEN THE FINANCIAL AND INCOME TAX REPORTING BASIS OF ASSETS AND LIABILITIES BASED ON ENACTED TAX RATES AND LAWS. A TAX BENEFIT FROM AN UNCERTAIN TAX POSITION MAY BE RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION. THE DEFERRED INCOME TAX PROVISION OR BENEFIT GENERALLY REFLECTS THE NET CHANGE IN DEFERRED INCOME TAX ASSETS AND LIABILITIES DURING THE YEAR. THE CURRENT INCOME TAX PROVISION REFLECTS THE TAX CONSEQUENCES OF REVENUES AND EXPENSES CURRENTLY TAXABLE OR DEDUCTIBLE ON VARIOUS INCOME TAX RETURNS FOR THE YEAR REPORTED. SANFORD GROUP DID NOT HAVE A MATERIAL INCOME TAX LIABILITY AT DECEMBER 31, 2022; SOME RELATED ORGANIZATIONS HAVE ESTABLISHED RESERVES. 1 EAST ASIA AND THE PACIFIC 0 0 INVESTMENTS CHINA INVESTMENTS, BEGINNING IN 2014 523000 EAST ASIA AND THE PACIFIC 0 0 PROGRAM SERVICES ADMINISTRATIVE EXPENSES (NEW ZEALAND) 106000 EUROPE (INCLUDING ICELAND & GREENLAND) 0 0 PROGRAM SERVICES ADMINISTRATIVE EXPENSES (GERMANY) 3000 SUB-SAHARAN AFRICA 0 0 PROGRAM SERVICES ADMINISTRATIVE EXPENSES (GHANA), INVESTIGATION OF POTENTIAL RESEARCH PARTNER (SOUTH AFRICA) 2681000 EUROPE (INCLUDING ICELAND & GREENLAND) 0 0 INVESTMENTS GERMANY INVESTMENTS, BEGINNING IN 2015 11945000 SUB-SAHARAN AFRICA 0 0 INVESTMENTS GHANA INVESTMENTS, BEGINNING IN 2012 2337000 CENTRAL AMERICA AND THE CARIBBEAN 0 0 PROGRAM SERVICES ADMINISTRATIVE EXPENSES (COSTA RICA) 2317000 MIDDLE EAST AND NORTH AFRICA 0 0 INVESTMENTS ISRAEL INVESTMENTS, BEGINNING IN 2018 1300000 EAST ASIA AND THE PACIFIC 0 0 INVESTMENTS NEW ZEALAND INVESTMENTS, BEGINNING IN 2019 1600000 CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENT COSTA RICA INVESTMENT, BEGINNING IN 2019 8000000 0 0 0 0 0 0 21212000 9600000 30812000 SUB-SAHARAN AFRICA GENERAL SUPPORT 10000 BANK TRANSFER 0 COST 0 1 1 0 1 0 0 0 PART I, LINE 2: PRIOR TO DISBURSEMENT ALL GRANT FUND REQUESTS ARE REVIEWED TO ENSURE THE RECEIVING ORGANIZATION AND PROPOSED USE OF FUNDS ALIGN WITH SANFORD'S MISSION. GRANTS ARE DISBURSED BY THE ORGANIZATION ONLY AFTER THE EXPENDITURE HAS BEEN MADE AND PROPERLY AUTHORIZED BY THE ORGANIZATION ALONG WITH RELATED DOCUMENTATION TO ENSURE THE FUNDS ARE NOT DIVERTED FOR NON-CHARITABLE USE. PART I, LINE 3: EXPENDITURES ARE ACCOUNTED FOR ON THE ACCRUAL BASIS OF ACCOUNTING. PART II, LINE 1 ACCOUNTING METHOD: GRANTS AND OTHER ASSISTANCE TO ORGANIZATIONS OR ENTITIES OUTSIDE THE UNITED STATES ARE ACCOUNTED FOR ON THE ACCRUAL BASIS OF ACCOUNTING. PART III ACCOUNTING METHOD: 1 1 X 1 X 225.000000000000 1 X 375.000000000000 1 1 0 1 1 84815767 0 84815767 0.01640 656748729 530138370 126610359 0.02450 0 0 741564496 530138370 211426126 0.04090 42943092 575297 42367795 0.00820 41001594 5322741 35678853 0.00690 1535999172 1303001747 232997425 0.04510 34480838 18248016 16232822 0.00310 24141891 0 24141891 0.00470 1678566587 1327147801 351418786 0.06800 2420131083 1857286171 562844912 0.10890 1335320 0 1335320 0.00030 915172 0 915172 0.00020 15482007 0 15482007 0.00300 2250 0 2250 0.00000 4789 0 4789 0.00000 10098 0 10098 0.00000 296695 0 296695 0.00010 4673493 0 4673493 0.00090 59366 0 59366 0.00000 22779190 22779190 0.00450 1 73533536 572478356 566666820 5811536 X 1 1 25 1 SANFORD MEDICAL CENTER 1305 W 18TH STREET SIOUX FALLS SD 57117 WWW.SANFORDHEALTH.ORG SD 10564 SANFORD MEDICAL CENTER 460227855 X X X X X A 2 SANFORD MEDICAL CENTER FARGO 5225 23RD AVENUE S FARGO ND 58104 WWW.SANFORDHEALTH.ORG ND 5070 SANFORD MEDICAL CENTER FARGO 450226909 X X X X X A 3 SANFORD BROADWAY MEDICAL CENTER FARGO 801 BROADWAY NORTH FARGO ND 58122 WWW.SANFORDHEALTH.ORG ND 5018A SANFORD MEDICAL CENTER FARGO 450226909 X X X X X A 4 SANFORD MEDICAL CENTER SOUTH UNIVERSITY 1720 SOUTH UNIVERSITY FARGO ND 58103 WWW.SANFORDHEALTH.ORG ND 5068A SANFORD MEDICAL CENTER FARGO 450226909 X X X A 5 SANFORD BISMARCK MEDICAL CENTER 300 N 7TH STREET BISMARCK ND 58501 WWW.SANFORDHEALTH.ORG ND 5003A SANFORD BISMARCK 450226700 X X X X A 6 SANFORD BEMIDJI MEDICAL CENTER 1300 ANNE STREET NW BEMIDJI MN 56601 WWW.SANFORDHEALTH.ORG MN 371073 SANFORD HEALTH OF NORTHERN MINNESOTA 411266009 X X X A 7 SANFORD MEDICAL CENTER THIEF RIVER FALLS 3001 SANFORD PARKWAY THIEF RIVER FALLS MN 56701 WWW.SANFORDHEALTH.ORG MN 371500 SANFORD HEALTH NETWORK NORTH 450409348 X X X X INPATIENT MENTAL HEALTH A 8 SANFORD ABERDEEN MEDICAL CENTER 2905 3RD AVENUE SE ABERDEEN SD 57401 WWW.SANFORDHEALTH.ORG SD 65089 SANFORD HEALTH NETWORK 460388596 X X X A 9 SANFORD WORTHINGTON MEDICAL CENTER 1018 6TH AVENUE WORTHINGTON MN 56187 WWW.SANFORDHEALTH.ORG MN 371449 SANFORD HEALTH NETWORK 460388596 X X X A 10 SANFORD SHELDON MEDICAL CENTER 118 N 7TH AVENUE SHELDON IA 51201 WWW.SANFORDHEALTH.ORG IA 161381 SANFORD HEALTH NETWORK 460388596 X X X X NURSING FACILITY A 11 SANFORD VERMILLION MEDICAL CENTER 20 S PLUM STREET VERMILLION SD 57069 WWW.SANFORDHEALTH.ORG SD 53082 SANFORD HEALTH NETWORK 460388596 X X X X NURSING FACILITY A 12 SANFORD CHAMBERLAIN MEDICAL CENTER 300 S BYRON BLVD CHAMBERLAIN SD 57325 WWW.SANFORDHEALTH.ORG SD 50302 SANFORD HEALTH NETWORK 460388596 X X X X NURSING FACILITY A 13 SANFORD LUVERNE MEDICAL CENTER 1600 N KNISS AVENUE LUVERNE MN 56156 WWW.SANFORDHEALTH.ORG MN 371352 SANFORD HEALTH NETWORK 460388596 X X X X A 14 SANFORD CANBY MEDICAL CENTER 112 ST OLAF AVENUE S CANBY MN 56220 WWW.SANFORDHEALTH.ORG MN 371019 SANFORD HEALTH NETWORK 460388596 X X X X NURSING FACILITY A 15 SANFORD JACKSON MEDICAL CENTER 1430 N HIGHWAY JACKSON MN 56143 WWW.SANFORDHEALTH.ORG MN 371002 SANFORD HEALTH NETWORK 460388596 X X X X A 16 SANFORD TRACY MEDICAL CENTER 251 5TH STREET E TRACY MN 56175 WWW.SANFORDHEALTH.ORG MN 371440 SANFORD HEALTH NETWORK 460388596 X X X X A 17 SANFORD HILLSBORO MEDICAL CENTER 12 3RD STREET SE HILLSBORO ND 58045 WWW.SANFORDHEALTH.ORG ND 5026A SANFORD HEALTH NETWORK NORTH 450409348 X X X X A 18 SANFORD MEDICAL CENTER MAYVILLE 42 6TH AVENUE SE MAYVILLE ND 58257 WWW.SANFORDHEALTH.ORG ND 5034A SANFORD HEALTH NETWORK NORTH 450409348 X X X X A 19 SANFORD WEBSTER MEDICAL CENTER 1401 W 1ST STREET WEBSTER SD 57274 WWW.SANFORDHEALTH.ORG SD 10573 SANFORD HEALTH NETWORK 460388596 X X X X A 20 SANFORD MEDICAL CENTER WHEATON 401 12TH STREET N WHEATON MN 56296 WWW.SANFORDHEALTH.ORG MN 371390 SANFORD HEALTH NETWORK NORTH 450409348 X X X X A 21 SANFORD BAGLEY MEDICAL CENTER 203 4TH STREET NW BAGLEY MN 56621 WWW.SANFORDHEALTH.ORG MN 371484 SANFORD HEALTH OF NORTHERN MINNESOTA 411266009 X X X X A 22 SANFORD CANTON-INWOOD MEDICAL CENTER 440 N HIAWATHA DRIVE CANTON SD 57013 WWW.SANFORDHEALTH.ORG SD 51569 SANFORD HEALTH NETWORK 460388596 X X X X A 23 SANFORD CLEAR LAKE MEDICAL CENTER 701 3RD AVENUE S CLEAR LAKE SD 57226 WWW.SANFORDHEALTH.ORG SD 10533 SANFORD HEALTH NETWORK 460388596 X X X X A 24 SANFORD WESTBROOK MEDICAL CENTER 920 BELL AVENUE WESTBROOK MN 56183 WWW.SANFORDHEALTH.ORG MN 371439 SANFORD HEALTH NETWORK 460388596 X X X X A 25 SANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTER 120 LA BREE AVENUE S THIEF RIVER FALLS MN 56701 WWW.SANFORDHEALTH.ORG MN 410505 SANFORD HEALTH NETWORK NORTH 450409348 X BEHAVIORAL HEALTH CENTER-INPATIENT MENTAL HEALTH A FACILITY REPORTING GROUP - A 0 0 1 X X X X X X X X X 21 1 1 0 1 X WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT X X 1 21 1 WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT 0 1 X 225.000000000000 375.000000000000 X X X X X X 1 1 X X X X 1 X SEE NARRATIVE FOR FULL URL X SEE NARRATIVE FOR FULL URL X SEE NARRATIVE FOR FULL URL X X X X X X X 1 X 0 X X X X 1 X 0 0 PART V, SECTION B FACILITY REPORTING GROUP A FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: SANFORD MEDICAL CENTER, - FACILITY 3: SANFORD BROADWAY MEDICAL CENTER FARGO, - FACILITY 4: SANFORD MEDICAL CENTER SOUTH UNIVERSITY, - FACILITY 5: SANFORD BISMARCK MEDICAL CENTER, - FACILITY 6: SANFORD BEMIDJI MEDICAL CENTER, - FACILITY 7: SANFORD MEDICAL CENTER THIEF RIVER FALLS, - FACILITY 8: SANFORD ABERDEEN MEDICAL CENTER, - FACILITY 9: SANFORD WORTHINGTON MEDICAL CENTER, - FACILITY 10: SANFORD SHELDON MEDICAL CENTER, - FACILITY 11: SANFORD VERMILLION MEDICAL CENTER, - FACILITY 12: SANFORD CHAMBERLAIN MEDICAL CENTER, - FACILITY 13: SANFORD LUVERNE MEDICAL CENTER, - FACILITY 14: SANFORD CANBY MEDICAL CENTER, - FACILITY 15: SANFORD JACKSON MEDICAL CENTER, - FACILITY 16: SANFORD TRACY MEDICAL CENTER, - FACILITY 17: SANFORD HILLSBORO MEDICAL CENTER, - FACILITY 18: SANFORD MEDICAL CENTER MAYVILLE, - FACILITY 19: SANFORD WEBSTER MEDICAL CENTER, - FACILITY 20: SANFORD MEDICAL CENTER WHEATON, - FACILITY 21: SANFORD BAGLEY MEDICAL CENTER, - FACILITY 22: SANFORD CANTON-INWOOD MEDICAL CENTER, - FACILITY 23: SANFORD CLEAR LAKE MEDICAL CENTER, - FACILITY 24: SANFORD WESTBROOK MEDICAL CENTER, - FACILITY 2: SANFORD MEDICAL CENTER FARGO, - FACILITY 25: SANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH C GROUP A-FACILITY 1 -- SANFORD MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 1 -- SANFORD MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 1 -- SANFORD MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 1 -- SANFORD MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO CAREACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE HEALTH CARE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET. SANFORD HAS MADE ACCESS TO CARE A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO INCREASE ACCESS TO AND AWARENESS OF AFFORDABLE CARE OPTIONS AND TO IMPROVE ACCESS THROUGH VIRTUAL CARE OPTIONS. IT IS SANFORD'S GOAL TO IMPROVE COMMUNITY ACCESS SO CARE IS AVAILABLE AND AFFORDABLE FOR ALL. PRIORITY 2: CHRONIC DISEASE PREVENTIONSANFORD MEDICAL CENTER TAKES AN INTEGRATED APPROACH TO DISEASE PREVENTION. SANFORD PROMOTES THE IMPORTANCE OF HAVING A PRIMARY CARE PROVIDER AND OFFERS SCREENING OPPORTUNITIES FOR EARLY DETECTION AND INTERVENTION OF CHRONIC DISEASE.SANFORD HAS MADE CHRONIC DISEASE PREVENTION A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO BROADEN COMMUNITY AWARENESS OF THE IMPORTANCE OF PRIMARY AND PREVENTIVE CARE AND IMPROVE CARE FOR CHILDREN AT RISK FOR OBESITY. IT IS SANFORD'S GOAL TO IMPROVE CHRONIC DISEASE MANAGEMENT AND REDUCTION OF OBESITY.PRIORITY 3: MENTAL HEALTH AND ADDICTIONMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH AND ADDICTION SIGNIFICANT PRIORITIES AND HAS DEVELOPED STRATEGIES TO EXPAND ACCESS TO TIMELY BEHAVIORAL HEALTH CARE AND REDUCE THE NEGATIVE IMPACT OF ADDICTION AND SUBSTANCE ABUSE ON THE COMMUNITY. IT IS SANFORD'S GOAL TO IMPROVE CARE MANAGEMENT FOR RESIDENTS SUFFERING FROM SUBSTANCE ABUSE AND MENTAL HEALTH ISSUES.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEAR:ACCESS TO CARESANFORD HEALTH WAS A MEMBER OF A COALITION OF PATIENT ADVOCATES, NURSES, HEALTH CARE PROVIDERS, FARMERS, FAITH LEADERS, AND EDUCATORS THAT WORKED TO PASS MEDICAID EXPANSION IN 2022, EXPANDING ELIGIBILITY TO 40,000 PEOPLE IN SD.HEALTH CARE LITERACY AND FINANCIAL ADVOCACY ARE ONGOING EFFORTS. WE COLLABORATE WITH SANFORD HEALTH PLAN TO HELP PATIENTS FIND AFFORDABLE COVERAGE. THE HOSPITAL ALSO HAS ONSITE FINANCIAL ADVOCATES WHO SPECIALIZE IN HEALTH CARE COVERAGE ENROLLMENT AND HELP PATIENTS NAVIGATE SANFORD'S FINANCIAL ASSISTANCE PROGRAM IF ELIGIBLE. WE CONTINUE TO ENHANCE ACCESS THROUGH VIDEO VISITS, TELEHEALTH, E-VISITS, REMOTE HOME MONITORING AND MY SANFORD NURSE. PCPS ARE ABLE TO REACH MORE PATIENTS TIMELY THROUGH VIRTUAL CARE OPTIONS. IN 2021, SANFORD HEALTH ANNOUNCED A VIRTUAL CARE INITIATIVE AS PART OF OUR COMMITMENT TO TRANSFORM HEALTH CARE FOR PATIENTS LIVING IN RURAL AND UNDERSERVED AREAS. VIRTUAL CARE SERVICES CONTINUED TO GROW IN 2022, BOTH AT THE MEDICAL CENTER AND THROUGHOUT THE REGION WITH 26 REGIONAL NETWORK FACILITIES WITH ACCESS TO VIRTUAL SERVICES FOR EMERGENCY SERVICES AS WELL AS TELE STROKE AND TELE BURN. GI, NEPHROLOGY, RHEUMATOLOGY AND PULMONARY WERE ADDED AS PEDIATRIC VIRTUAL OPTIONS IN 2022. CARESIGNAL HOME MONITORING EXPANDED WITH 7 PATIENTS ENROLLED IN 2022 FOR CONGESTIVE HEART FAILURE; 21 FOR DIABETES; AND 43 FOR DEPRESSION. TOTAL VIDEO VISITS IN THE SF REGION IN CY2022 WERE 24,000 AND E-VISITS WERE 12,800.OUR CALL CENTER, INCLUSIVE OF OUR ONE CALL SYSTEM, THE CLINICAL CALL CENTER, AND THE MY SANFORD NURSE LINE RESPONDS TO HUNDREDS OF THOUSANDS OF CALLS EACH YEAR. IN 2022, MY SANFORD NURSE HAD 47,743 CALLS AND THERE WERE 233,045 ONE CALL SYSTEM CALLS BRINGING THE 2022 TOTAL TO A QUARTER OF A MILLION CALLS.CHRONIC DISEASE PREVENTIONIN 2022, SANFORD MEDICAL CENTER (SMC) JOINED A NEW COLLABORATIVE INITIATED BY THE CITY OF SIOUX FALLS PUBLIC HEALTH DEPT. THIS COMMUNITY HEALTH IMPROVEMENT PLAN IS A COMPLEMENT TO THE CHNA BUT WITH A TARGETED FOCUS ON THE SIOUX FALLS METRO. THE CITY, SANFORD, AVERA, AND COMMUNITY PARTNERS DEVELOPED STRATEGIES TO ADDRESS GAPS IN PREVENTIVE CARE, SCREENINGS AND VACCINATIONS. IN 2022, WE LAUNCHED A MATCH WITH A DOCTOR QUIZ ON OUR WEBSITE TO HELP PEOPLE FIND THE RIGHT PROVIDER FOR THEIR NEEDS. WE ADDED COMMUNITY HEALTH WORKERS (CHWS) AT PRIMARY CARE CLINICS IN SIOUX FALLS. CHWS WORK WITH THE MEDICAID POPULATION TO ENSURE THEY RECEIVE APPROPRIATE CARE, INCLUDING PREVENTIVE CARE AND CONNECT THEM TO COMMUNITY RESOURCES AND SUPPORT SERVICES. IN 2022, CHWS LOGGED 658 ENCOUNTERS WITH THIS POPULATION.SMC DID MARKETING AND AWARENESS CAMPAIGNS IN FEBRUARY FOR HEART MONTH. OUR MOBILE HEART SCREENING TRUCK WAS OUT IN THE COMMUNITY FOR A TOTAL OF 31 DAYS IN 2022. OVERALL (IN CLINIC & MOBILE) WE DID 10,095 SCREENINGS IN 2022 (HEART: 5,509 WITH 1,599 POSITIVE SCREENS AND VASCULAR: 4,586 WITH 105 POSITIVE SCREENS).IN MARCH, WE PROMOTED COLORECTAL CANCER SCREENING AND HEALTHY LIFESTYLE HABITS TO DECREASE RISK. EDUCATIONAL INFORMATION WAS SHARED VIA DIRECT MAIL, SOCIAL MEDIA, OUR WEBSITE, AND OUR SANFORD HEALTH NEWS PODCAST SERIES. PRIMARY CARE STAFF ADVISED PATIENTS AS APPROPRIATE WHEN DUE FOR A SCREENING. SANFORD HEALTH ALSO ISSUED A GENERAL PRESS RELEASE NOTIFYING THE PUBLIC THAT THE SCREEN AGE WAS LOWERED FROM 50 TO 45. SMC SAW AN INCREASE IN COLORECTAL SCREENING RATE FROM 67.1% TO 68.2% IN 2022.LOCAL SCHOOLS HAVE ACCESS TO THE SANFORD FIT PROGRAM WHICH ENGAGES AND EMPOWERS CHILDREN AND FAMILIES TO MAKE HEALTHY LIFESTYLE CHOICES. STUDENTS LEARN ABOUT FOOD, PHYSICAL ACTIVITY, MOOD AND ENERGY NEEDS. IN 2022, OUR REGION HAD 3,700 FIT WEBSITE USERS AND 30,082 PAGE VIEWS. THE FIT TEAM CONDUCTED 35 EVENTS IN SIOUX FALLS TO 4,981 CHILDREN.MENTAL HEALTH AND ADDICTIONWE CONTINUE TO EXPAND BEHAVIORAL HEALTH SERVICES COMMENSURATE TO INCREASING DEMAND. EMBEDDING INTEGRATIVE HEALTH THERAPISTS WITHIN PRIMARY CARE CLINICS ENSURES BROADER ACCESS FOR OUR PATIENT POPULATION SEEKING OUTPATIENT CARE AND ENSURING REGULAR AND CONSISTENT SCREENING AND FOLLOW-UP. SMC HAS TWO PSYCHIATRY AND PSYCHOLOGY CLINIC LOCATIONS IN SIOUX FALLS. THE 49TH AND ELMWOOD LOCATION HAS TEN PROVIDERS. THE 84TH AND LOUISE LOCATION HOUSES PSYCHOLOGY AND NEUROPSYCHOLOGY PROVIDERS. WE CURRENTLY HAVE 5 PHYSICIANS, 5 PSYCHOLOGISTS, 2 NEUROPSYCHOLOGISTS, 7 APPS, 11 BEHAVIORAL HEALTH THERAPISTS. WE ARE ACTIVELY RECRUITING FOR ADDITIONAL PROVIDERS AT THE 49TH STREET LOCATION. WE ADDED 7 PROVIDERS IN 2022. WE HAD 36,505 TOTAL COMPLETED APPOINTMENTS INCLUDING OVER 5,000 NEW REFERRALS IN 2022. OF THE OVER 36,000 VISITS, 2,827 WERE MYCHART TELEMED HOME VISITS, 2,621 WERE TELEMED HOME VISITS (FACETIME), 13,301 WERE IN-CLINIC VISITS, AND OVER 11,000 WERE INDIVIDUAL THERAPY APPOINTMENTS. THE TOTAL ALSO INCLUDES A FEW OTHER VISIT TYPES OF LOWER VOLUMES INCLUDING GROUP THERAPY, MYCHART ADULT NURSE, AND NURSE VISITS FOR INJECTIONS OR BLOOD PRESSURE CHECKS.THE LINK, A COMMUNITY TRIAGE CENTER, IS THE RESULT OF A PARTNERSHIP BETWEEN SANFORD, THE CITY OF SIOUX FALLS, MINNEHAHA COUNTY, AND AVERA HEALTH TO CREATE A SAFE PLACE FOR PEOPLE EXPERIENCING NON-VIOLENT BEHAVIORAL HEALTH CRISIS OR NEEDING CARE FOR SUBSTANCE ABUSE. IT OFFERS ACCESS TO IMMEDIATE TREATMENT AND REFERRAL TO SUPPORT SERVICES FOR COMMUNITY RESIDENTS. SANFORD HEALTH ALSO HAS LICENSED ALCOHOL AND DRUG COUNSELORS AVAILABLE TO PROVIDE EVALUATION, RECOVERY SUPPORT, COUNSELING, AND OTHER RESOURCES. SMC STAFF AND PROVIDERS FOLLOW SANFORD ENTERPRISE BEST PRACTICES REGARDING OPIOID PRESCRIBING AND TREATMENT. THE EMR PROMPTS PROVIDERS TO CHECK PRESCRIPTION DRUG MONITORING PROGRAM BEFORE PRESCRIBING OPIOIDS, PERFORM ROUTINE YEARLY URINE DRUG SCREEN TESTS, PROVIDE EDUCATIONAL RESOURCES IN DEALING WITH PRESCRIBING OPIOIDS, AND GIVE CONTROLLED SUBSTANCE AGREEMENTS FOR PATIENTS USING OPIOIDS CHRONICALLY. THE ONECHART SYSTEM HAS AN OPIOID MANAGEMENT DASHBOARD WHERE PAIN AGREEMENTS, DRUG TESTS, AND NALOXONE COMPLIANCE ARE MONITORED. THERE IS ALSO A CHRONIC OPIOID USE REGISTRY TO SEE WHO HAS AN UPDATED OPIOID RISK TOOL ASSESSING RISK OF OPIOID ABUSE AND PAIN SCREENING TOOL. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE: LONG-TERM CAREPUBLIC TRANSPORTATIONAFFORDABLE HOUSINGSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 1 -- SANFORD MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 1 -- SANFORD MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 3 -- SANFORD BROADWAY MEDICAL CENTER FARGO PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 3 -- SANFORD BROADWAY MEDICAL CENTER FARGO PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 3 -- SANFORD BROADWAY MEDICAL CENTER FARGO PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 3 -- SANFORD BROADWAY MEDICAL CENTER FARGO PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO AFFORDABLE HEALTH CAREACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE HEALTH CARE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET. NDSU REPORTED HEALTH CARE ACCESSIBILITY AND COST AS TWO SEPARATE HEALTH NEEDS. THE CASS-CLAY WORKING GROUP DETERMINED THAT THE TWO TOPICS ARE MOST APPROPRIATELY ADDRESSED AS A COMBINED TOPIC FOR PURPOSES OF THE LOCAL CHNA PROCESS.SANFORD HAS MADE HEALTHCARE ACCESS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO EXPAND HEALTHCARE ACCESS AND ACCESS TO PRIMARY CARE SERVICES. IT IS SANFORD'S GOAL THAT THE COMMUNITY WOULD SEE THAT PATIENTS WILL HAVE GREATER EASE TO ACCESS PRIMARY CARE PROVIDERS FOR VIRTUAL OR IN-PERSON VISITS, HOME VISITS AND INCREASED EXPANDED HOURS. PATIENTS MAY EXPERIENCE LESS FREQUENT UTILIZATION OF EMERGENCY CARE, WHICH IS OFTEN MORE EXPENSIVE THAN PREVENTATIVE AND SCREENING SERVICES.PRIORITY 2: MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSEMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSE SIGNIFICANT PRIORITIES AND HAS DEVELOPED STRATEGIES TO RECRUIT PROVIDERS, INCREASE ACCESS TO CARE AND MENTAL HEALTH PROMOTION. IT IS SANFORD'S GOAL TO HAVE BETTER ACCESS TO AND UTILIZATION OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES DUE TO SERVICES BEING PROVIDED AT THE RIGHT TIME AND RIGHT PLACE. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEAR: ACCESS TO AFFORDABLE HEALTH CARESANFORD FARGO ESTABLISHED TWO GOALS IN SUPPORT OF THE PRIORITY, ACCESS TO AFFORDABLE HEALTH CARE. THE FIRST IS TO EXPAND HEALTHCARE ACCESS AND SUPPORT RESOURCES FOR VULNERABLE AND UNDERSERVED POPULATIONS. THE SECOND IS TO EXPAND PLATFORM AND ACCESS TO PRIMARY CARE SERVICES.ONE STRATEGY IDENTIFIED WITHIN THE COMMUNITY HEALTH NEEDS ASSESSMENT PROGRAM IS TO MAKE VIRTUAL VISITS AVAILABLE FOR ALL PRIMARY CARE PROVIDERS. AS OF THE END OF 2022, ACCESS TO TELEHEALTH IS AVAILABLE FOR ALL FAMILY MEDICINE PROVIDERS, WHICH ALLOWS PATIENTS TO RECEIVE CARE WITHIN THEIR HOMES IF THEY DO NOT HAVE ACCESS TO RELIABLE TRANSPORTATION OR CANNOT TRAVEL FOR APPOINTMENTS. TO INCREASE PRIMARY CARE AVAILABILITY, THE FAMILY MEDICINE RESIDENCY PROGRAM HAS BEGUN OUTREACH TO JEFFERSON ELEMENTARY (FARGO PUBLIC SCHOOLS) AND WILL BE EXPANDING TO YOUTHWORKS. JEFFERSON ELEMENTARY HAS APPROXIMATELY 288 STUDENTS, 231 OF WHICH ARE ELIGIBLE TO PARTICIPATE IN THE FREE LUNCH AND REDUCED-PRICE LUNCH PROGRAMS, ACCORDING TO THE NATIONAL CENTER FOR EDUCATION STATISTICS. YOUTHWORKS IS A "501C3 NON-PROFIT DEDICATED TO PROVIDING YOUTH AND FAMILY SERVICES THROUGHOUT NORTH DAKOTA. THEIR FOCUS AND EXPERTISE IS IN WORKING WITH TEENS, PARENTS, AND YOUNG ADULTS UNDER 22 YEARS OF AGE. OUR SERVICES INCLUDE PROGRAMS FOR RUNAWAY, HOMELESS AND STREET YOUTH; JUVENILE OFFENDERS; YOUTH FAILING IN SCHOOL; YOUTH SUSPENDED OR EXPELLED FROM SCHOOL; YOUNG PARENTS AND PREGNANT MOMS (UNDER 22); YOUTH ARRESTED AND UNABLE TO IMMEDIATELY RETURN HOME; YOUTH NEEDING EMERGENCY CARE; YOUTH NEEDING PEER SUPPORT OR CROSS-AGE MENTORING; AND YOUTH WITH ANGER ISSUES." THIS STRATEGY WILL HELP IMPROVE ACCESS FOR VULNERABLE AND UNDERSERVED RESIDENTS OF THE FARGO/MOORHEAD METRO AREA.A NEW PRIMARY CARE CLINIC IS UNDER CONSTRUCTION IN HORACE, ND AND IS SET TO OPEN IN 2023. THIS WILL SERVE THE NEEDS OF THE RAPIDLY GROWING TOWN OF HORACE AS WELL AS PORTIONS OF WEST FARGO TO ALLOW FOR INCREASED SPEED OF ACCESS TO INDIVIDUALS ACROSS ALL CLINICS. THREE NEW PROVIDERS WERE RECRUITED TO PRIMARY CARE. THE NEW PROVIDERS TOTALED 148 VISITS UPON STARTING IN THE FOURTH QUARTER OF 2022.MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSE THREE GOALS SUPPORT THE MENTAL HEALTH AND SUBSTANCE ABUSE GOAL. THE FIRST IS RECRUITING PROVIDERS AND INCREASING ACCESS TO CARE. THE SECOND IS TO DEVELOP A COMMUNITY STRATEGY FOR MENTAL HEALTH PROMOTION. THE THIRD IS TO DECREASE SUBSTANCE ABUSE.TO INCREASE ACCESS TO MENTAL HEALTH CARE, SANFORD FARGO EXPANDED ITS PARTNERSHIP WITH REGIONAL SCHOOLS TO PROVIDE STUDENT PLACEMENT FOR MASTER'S LEVEL THERAPISTS INTO THE INTERNAL MEDICINE DEPARTMENT. COORDINATION OF CARE WITH PRIMARY CARE, EMERGENCY DEPARTMENT, AND HOSPITAL CARE COORDINATION HAS RESULTED IN THE WAIT LIST FOR BEHAVIORAL HEALTH AND PSYCHIATRY APPOINTMENTS DECREASING FROM 2,000 PATIENTS TO 180 PATIENTS WAITING TO BE SCHEDULED. FURTHERMORE, ACCESS TO SUPPORTIVE BEHAVIORAL HEALTH SERVICES AND RESOURCES HAVE IMPROVED IN THE HOSPITAL WITH THE CREATION OF A DEDICATED UNIT AT THE SANFORD MEDICAL CENTER FARGO FOR PATIENTS ADMITTED FOR MEDICAL CARE WHO REQUIRE ADDITIONAL BEHAVIORAL HEALTH SUPPORT. IN 2022, SANFORD FARGO COMPLETED 10,083 COMPLETED VIDEO VISITS, 144 TRADITIONAL TELEMEDICINE AND 90 VERBAL VISITS.SANFORD FARGO CONDUCTED A DEPRESSION SCREENING INITIATIVE THROUGHOUT SANFORD-FARGO CLINICS TO SUPPORT COMMUNITY MENTAL HEALTH PROMOTION. THE PROMOTION RESULTED IN 40,000 DEPRESSION SCREENINGS COMPLETED BY INTERNAL MEDICINE, FAMILY MEDICINE, AND OB/GYN PROVIDERS AND RESIDENCY CLINICS. FOR ALL POSITIVE DEPRESSION SCREENINGS, THERE WAS A DOCUMENTED FOLLOW-UP PLAN WITHIN 14 DAYS OF THE SCREENING. SANFORD AMBULANCE REPORTED 1,200 PATIENTS RECEIVING CARE RELATED TO ALCOHOL USE, 1,350 RELATED TO BEHAVIORAL HEALTH/PSYCHIATRIC EPISODE. SANFORD FARGO IS ACTIVELY RECRUITING A NEW PROVIDER TO SUPPORT SUBOXONE CLINIC FOR PATIENTS WORKING ON ADDICTION AND RECOVERY TO DECREASE SUBSTANCE ABUSE. FURTHER SUPPORT IS PROVIDED THROUGH HOSPITAL PEER COACHING, WITH CONTINUED WORK WITH F5 AND THE LOTUS CENTER THROUGHOUT 2022 TO PROVIDE PEER COACHING IN THE HOSPITAL. SANFORD FARGO ALSO ENGAGES IN A PARTNERSHIP WITH CASS COUNTY'S WITHDRAWAL MANAGEMENT UNIT TO ENSURE COORDINATED UTILIZATION OF MEDICAL AND LAW ENFORCEMENT SUPPORT FOR INDIVIDUALS ACTIVELY IN DETOX.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:PHYSICAL ACTIVITY AND NUTRITIONSENIOR HOUSING AND LONG-TERM CAREPUBLIC TRANSPORTATIONAFFORDABLE HOUSING, EMPLOYMENT, ECONOMIC DEVELOPMENTDIVERSITY, INCLUSION, HEALTH EQUITYCHILDCAREHEALTH LITERACY AND NAVIGATIONSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 3 -- SANFORD BROADWAY MEDICAL CENTER FARGO PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 3 -- SANFORD BROADWAY MEDICAL CENTER FARGO PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 4 -- SANFORD MEDICAL CENTER SOUTH UNIVERSITY PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 4 -- SANFORD MEDICAL CENTER SOUTH UNIVERSITY PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 4 -- SANFORD MEDICAL CENTER SOUTH UNIVERSITY PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 4 -- SANFORD MEDICAL CENTER SOUTH UNIVERSITY PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO AFFORDABLE HEALTH CARE ACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE HEALTH CARE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET. NDSU REPORTED HEALTH CARE ACCESSIBILITY AND COST AS TWO SEPARATE HEALTH NEEDS. THE CASS-CLAY WORKING GROUP DETERMINED THAT THE TWO TOPICS ARE MOST APPROPRIATELY ADDRESSED AS A COMBINED TOPIC FOR PURPOSES OF THE LOCAL CHNA PROCESS.SANFORD HAS MADE HEALTHCARE ACCESS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO EXPAND HEALTHCARE ACCESS AND ACCESS TO PRIMARY CARE SERVICES. IT IS SANFORD'S GOAL THAT THE COMMUNITY WOULD SEE THAT PATIENTS WILL HAVE GREATER EASE TO ACCESS PRIMARY CARE PROVIDERS FOR VIRTUAL OR IN-PERSON VISITS, HOME VISITS AND INCREASED EXPANDED HOURS. PATIENTS MAY EXPERIENCE LESS FREQUENT UTILIZATION OF EMERGENCY CARE, WHICH IS OFTEN MORE EXPENSIVE THAN PREVENTATIVE AND SCREENING SERVICES.PRIORITY 2: MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSEMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSE SIGNIFICANT PRIORITIES AND HAS DEVELOPED STRATEGIES TO RECRUIT PROVIDERS, INCREASE ACCESS TO CARE AND MENTAL HEALTH PROMOTION. IT IS SANFORD'S GOAL TO HAVE BETTER ACCESS TO AND UTILIZATION OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES DUE TO SERVICES BEING PROVIDED AT THE RIGHT TIME AND RIGHT PLACE. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEAR: ACCESS TO AFFORDABLE HEALTH CARESANFORD FARGO ESTABLISHED TWO GOALS IN SUPPORT OF THE PRIORITY, ACCESS TO AFFORDABLE HEALTH CARE. THE FIRST IS TO EXPAND HEALTHCARE ACCESS AND SUPPORT RESOURCES FOR VULNERABLE AND UNDERSERVED POPULATIONS. THE SECOND IS TO EXPAND PLATFORM AND ACCESS TO PRIMARY CARE SERVICES.ONE STRATEGY IDENTIFIED WITHIN THE COMMUNITY HEALTH NEEDS ASSESSMENT PROGRAM IS TO MAKE VIRTUAL VISITS AVAILABLE FOR ALL PRIMARY CARE PROVIDERS. AS OF THE END OF 2022, ACCESS TO TELEHEALTH IS AVAILABLE FOR ALL FAMILY MEDICINE PROVIDERS, WHICH ALLOWS PATIENTS TO RECEIVE CARE WITHIN THEIR HOMES IF THEY DO NOT HAVE ACCESS TO RELIABLE TRANSPORTATION OR CANNOT TRAVEL FOR APPOINTMENTS. TO INCREASE PRIMARY CARE AVAILABILITY, THE FAMILY MEDICINE RESIDENCY PROGRAM HAS BEGUN OUTREACH TO JEFFERSON ELEMENTARY (FARGO PUBLIC SCHOOLS) AND WILL BE EXPANDING TO YOUTHWORKS. JEFFERSON ELEMENTARY HAS APPROXIMATELY 288 STUDENTS, 231 OF WHICH ARE ELIGIBLE TO PARTICIPATE IN THE FREE LUNCH AND REDUCED-PRICE LUNCH PROGRAMS, ACCORDING TO THE NATIONAL CENTER FOR EDUCATION STATISTICS. YOUTHWORKS IS A "501C3 NON-PROFIT DEDICATED TO PROVIDING YOUTH AND FAMILY SERVICES THROUGHOUT NORTH DAKOTA. THEIR FOCUS AND EXPERTISE IS IN WORKING WITH TEENS, PARENTS, AND YOUNG ADULTS UNDER 22 YEARS OF AGE. OUR SERVICES INCLUDE PROGRAMS FOR RUNAWAY, HOMELESS AND STREET YOUTH; JUVENILE OFFENDERS; YOUTH FAILING IN SCHOOL; YOUTH SUSPENDED OR EXPELLED FROM SCHOOL; YOUNG PARENTS AND PREGNANT MOMS (UNDER 22); YOUTH ARRESTED AND UNABLE TO IMMEDIATELY RETURN HOME; YOUTH NEEDING EMERGENCY CARE; YOUTH NEEDING PEER SUPPORT OR CROSS-AGE MENTORING; AND YOUTH WITH ANGER ISSUES." THIS STRATEGY WILL HELP IMPROVE ACCESS FOR VULNERABLE AND UNDERSERVED RESIDENTS OF THE FARGO/MOORHEAD METRO AREA.A NEW PRIMARY CARE CLINIC IS UNDER CONSTRUCTION IN HORACE, ND AND IS SET TO OPEN IN 2023. THIS WILL SERVE THE NEEDS OF THE RAPIDLY GROWING TOWN OF HORACE AS WELL AS PORTIONS OF WEST FARGO TO ALLOW FOR INCREASED SPEED OF ACCESS TO INDIVIDUALS ACROSS ALL CLINICS. THREE NEW PROVIDERS WERE RECRUITED TO PRIMARY CARE. THE NEW PROVIDERS TOTALED 148 VISITS UPON STARTING IN THE FOURTH QUARTER OF 2022.MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSETHREE GOALS SUPPORT THE MENTAL HEALTH AND SUBSTANCE ABUSE GOAL. THE FIRST IS RECRUITING PROVIDERS AND INCREASING ACCESS TO CARE. THE SECOND IS TO DEVELOP A COMMUNITY STRATEGY FOR MENTAL HEALTH PROMOTION. THE THIRD IS TO DECREASE SUBSTANCE ABUSE.TO INCREASE ACCESS TO MENTAL HEALTH CARE, SANFORD FARGO EXPANDED ITS PARTNERSHIP WITH REGIONAL SCHOOLS TO PROVIDE STUDENT PLACEMENT FOR MASTER'S LEVEL THERAPISTS INTO THE INTERNAL MEDICINE DEPARTMENT. COORDINATION OF CARE WITH PRIMARY CARE, EMERGENCY DEPARTMENT, AND HOSPITAL CARE COORDINATION HAS RESULTED IN THE WAIT LIST FOR BEHAVIORAL HEALTH AND PSYCHIATRY APPOINTMENTS DECREASING FROM 2,000 PATIENTS TO 180 PATIENTS WAITING TO BE SCHEDULED. FURTHERMORE, ACCESS TO SUPPORTIVE BEHAVIORAL HEALTH SERVICES AND RESOURCES HAVE IMPROVED IN THE HOSPITAL WITH THE CREATION OF A DEDICATED UNIT AT THE SANFORD MEDICAL CENTER FARGO FOR PATIENTS ADMITTED FOR MEDICAL CARE WHO REQUIRE ADDITIONAL BEHAVIORAL HEALTH SUPPORT. IN 2022, SANFORD FARGO COMPLETED 10,083 COMPLETED VIDEO VISITS, 144 TRADITIONAL TELEMEDICINE AND 90 VERBAL VISITS.SANFORD FARGO CONDUCTED A DEPRESSION SCREENING INITIATIVE THROUGHOUT SANFORD-FARGO CLINICS TO SUPPORT COMMUNITY MENTAL HEALTH PROMOTION. THE PROMOTION RESULTED IN 40,000 DEPRESSION SCREENINGS COMPLETED BY INTERNAL MEDICINE, FAMILY MEDICINE, AND OB/GYN PROVIDERS AND RESIDENCY CLINICS. FOR ALL POSITIVE DEPRESSION SCREENINGS, THERE WAS A DOCUMENTED FOLLOW-UP PLAN WITHIN 14 DAYS OF THE SCREENING. SANFORD AMBULANCE REPORTED 1,200 PATIENTS RECEIVING CARE RELATED TO ALCOHOL USE, 1,350 RELATED TO BEHAVIORAL HEALTH/PSYCHIATRIC EPISODE. SANFORD FARGO IS ACTIVELY RECRUITING A NEW PROVIDER TO SUPPORT SUBOXONE CLINIC FOR PATIENTS WORKING ON ADDICTION AND RECOVERY TO DECREASE SUBSTANCE ABUSE. FURTHER SUPPORT IS PROVIDED THROUGH HOSPITAL PEER COACHING, WITH CONTINUED WORK WITH F5 AND THE LOTUS CENTER THROUGHOUT 2022 TO PROVIDE PEER COACHING IN THE HOSPITAL. SANFORD FARGO ALSO ENGAGES IN A PARTNERSHIP WITH CASS COUNTY'S WITHDRAWAL MANAGEMENT UNIT TO ENSURE COORDINATED UTILIZATION OF MEDICAL AND LAW ENFORCEMENT SUPPORT FOR INDIVIDUALS ACTIVELY IN DETOX.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:PHYSICAL ACTIVITY AND NUTRITIONSENIOR HOUSING AND LONG-TERM CAREPUBLIC TRANSPORTATIONAFFORDABLE HOUSING, EMPLOYMENT, ECONOMIC DEVELOPMENTDIVERSITY, INCLUSION, HEALTH EQUITYCHILDCAREHEALTH LITERACY AND NAVIGATIONSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 4 -- SANFORD MEDICAL CENTER SOUTH UNIVERSITY PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 4 -- SANFORD MEDICAL CENTER SOUTH UNIVERSITY PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 5 -- SANFORD BISMARCK MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 5 -- SANFORD BISMARCK MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 5 -- SANFORD BISMARCK MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 5 -- SANFORD BISMARCK MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: IMPROVE ACCESS TO BEHAVIORAL HEALTH SERVICESMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE ACCESS TO BEHAVIORAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE AN IMPROVED CONTINUUM OF CARE APPROACH TO ADDRESSING MENTAL AND BEHAVIORAL HEALTH NEEDS AND SUBSTANCE USE DISORDERS. PRIORITY 2: IMPROVE ACCESS TO AFFORDABLE CAREACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE HEALTH CARE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET. SANFORD HAS MADE HEALTHCARE ACCESS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO PROMOTE AND IMPROVE ACCESS TO SERVICES. IMPROVING ACCESS TO HEALTHCARE SERVICES HAS BOTH FINANCIAL AND QUALITY OF LIFE IMPLICATIONS ON THE COMMUNITY. BY HELPING COMMUNITY MEMBERS ACCESS THE RIGHT CARE AT THE RIGHT TIME IN THE RIGHT PLACE, THEY ARE BETTER ABLE TO PREVENT AND MANAGE CHRONIC DISEASE AND ENJOY A BETTER QUALITY OF LIFE. FROM A FINANCIAL PERSPECTIVE, BETTER ACCESS TO CARE CAN BE MEASURED IN REDUCED UNNECESSARY EMERGENCY VISITS AND HOSPITALIZATIONS. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEAR IMPROVE ACCESS TO BEHAVIORAL HEALTH SERVICESTWO GOALS WERE IDENTIFIED THROUGH THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS TO IMPROVE ACCESS TO BEHAVIORAL HEALTH SERVICES, A VITAL NEED FOR THE COMMUNITIES SERVED BY SANFORD HEALTH. THE FIRST GOAL ADVANCES SCHOOL-BASED SERVICES FOR PEDIATRIC PATIENTS WHILE THE SECOND GOAL EXPANDS BEHAVIORAL HEALTH SERVICES AVAILABLE THROUGH THE EMERGENCY DEPARTMENT. SANFORD HEALTH HAS PARTNERED WITH NUMEROUS SCHOOLS IN THE BISMARCK PUBLIC SCHOOLS DISTRICT TO PROVIDE ONSITE BEHAVIORAL HEALTH SERVICES AS PART OF A COMPREHENSIVE TIERED-SYSTEM APPROACH TO PROVIDING RESILIENCY TRAINING AND INTERVENTIONS TO HELP STUDENTS BE SUCCESSFUL. FOR THOSE STUDENTS WHO MAY BENEFIT FROM SERVICES PROVIDED BY A LICENSED BEHAVIORAL HEALTH PROVIDER, SANFORD HEALTH'S ROLE IN THIS PARTNERSHIP IS TO PROVIDE ONSITE CARE. FURTHER, SANFORD'S THERAPIST MEETS WEEKLY WITH THE SCHOOLS' LEADERSHIP TEAMS TO BETTER COORDINATE SUPPORT SERVICES FOR HIGH-RISK STUDENTS. TO ENSURE ACCESS, SANFORD PROVIDED TELEHEALTH VISIT OPTIONS AND CONTINUED CARING FOR THE STUDENTS DURING THE SUMMER BREAK. THIS PROJECT BEGAN AS A PILOT PROGRAM WITH SIMLE MIDDLE SCHOOL. IN 2022, SANFORD PROVIDED 341 VISITS WITH SIMLE STUDENTS AND THEIR FAMILIES AND EXTENDED THE SERVICE EIGHT ADDITIONAL SCHOOLS, PROVIDING A TOTAL OF 989 VISITS IN 2022. SANFORD PARTNERS WITH HEARTVIEW FOUNDATION, A SUBSTANCE USE DISORDER TREATMENT CENTER, TO CO-LOCATE A COUNSELOR IN SANFORD'S EMERGENCY ROOM. THE COUNSELOR MET WITH 159 PATIENTS, 93 OF WHOM WERE REFERRED TO TREATMENT AT HEARTVIEW OR ELSEWHERE. HEARTVIEW OFFERS A 16-BED RESIDENTIAL FACILITY IN BISMARCK AMONG OTHER SERVICES. THE ORGANIZATION HAS ADDITIONAL RESIDENTIAL FACILITIES IN CANDO, ND, AND DICKINSON, ND.SANFORD EXPANDED ITS PARTNERSHIP WITH HEARTVIEW BY COLLABORATING WITH HEARTVIEW AND THE BISMARCK POLICE DEPARTMENT ON A GRANT APPLICATION TO PROVIDE TREATMENT FOR PATIENTS WITH CHRONIC SUD AND/OR OPIOID OVERDOSE. THE GRANT WAS APPROVED JANUARY 2022, AND THE PROGRAM BEGAN AUGUST 2022. SANFORD HAS REFERRED 13 PATIENTS TO HEARTVIEW FOR SUD MEDICATION-ASSISTED TREATMENT OPPORTUNITIES. AS PART OF THE PROGRAM TO HELP PATIENTS WHO EXPERIENCE AN OVERDOSE BE SUCCESSFUL IN SEEKING TREATMENT, SANFORD PHYSICIANS PRESCRIBE BUPRENORPHINE TO HELP PATIENTS SAFELY TRANSITION TO A MEDICATION-ASSISTED THERAPY PROGRAM. IMPROVE ACCESS TO AFFORDABLE CARESANFORD BISMARCK IS ADDRESSING THE PRIORITY THROUGH TWO GOALS: REDUCING HEALTHCARE COSTS BY REDUCING AVOIDABLE VISITS AND INCREASING HEALTHCARE COVERAGE IN THE COMMUNITY. RESIDENTS OF THE CHNA AREA CONDUCTED 3,378 SEARCHES ON THE FINDHELP PLATFORM IN 2022. A QUARTER OF THEM WERE HEALTH RELATED.COMMUNITY HEALTH WORKERS (CHWS) ARE ONE OF THE STRATEGIES DEPLOYED BY THE REGION TO REDUCE AVOIDABLE VISITS. CHWS ARE TRAINED PUBLIC HEALTH WORKERS WHO SERVE AS A BRIDGE BETWEEN COMMUNITIES AND THE HEALTHCARE SYSTEM. THEY ARE NON-LICENSED PROVIDERS WITH SPECIFIC TRAINING TO HELP PATIENTS ADDRESS THEIR SOCIAL DETERMINANTS OF HEALTH OUTSIDE THE CLINIC SETTING.SANFORD HEALTH BISMARCK ADDED A COMMUNITY HEALTH WORKER TO HELP ADDRESS PATIENT NEEDS OUTSIDE THE FOUR WALLS OF A CLINIC OR A HOSPITAL. THE CHW WORKS WITH PATIENTS TO IMPROVE HEALTH OUTCOMES BY HELPING THOSE WHO MIGHT OTHERWISE HAVE TROUBLE ACCESSING THE HEALTH SYSTEM AND BY CONNECTING PATIENTS TO COMMUNITY SERVICES SUCH AS HOUSING, TRANSPORTATION, AND FOOD. THE CHW PLAYS AN IMPORTANT ROLE WITH HEALTH SYSTEM CARE TEAMS AND HAS A UNIQUE KNOWLEDGE OF BARRIERS TO ACCESS AND ARE EXPERTS IN OVERCOMING THOSE BARRIERS.IN 2022, SANFORD BISMARCK'S CHW HELPED 164 PATIENTS. BY HELPING PATIENTS CONNECT TO NEEDED COMMUNITY SERVICES AND OTHER HEALTH-RELATED LIVING FACTORS, THE CHW HELPED REDUCE AVOIDABLE ER VISITS AND AVOIDABLE HOSPITALIZATIONS FOR THESE PATIENTS BY 56 PERCENT AND 68 PERCENT, RESPECTIVELY. BOTH THE HEALTH IMPROVEMENT AND COST SAVINGS FOR BOTH THE PATIENT AND THE HEALTHCARE SYSTEM ARE TREMENDOUS. TO INCREASE HEALTHCARE COVERAGE IN THE COMMUNITY, SANFORD HEALTH HAS INTEGRATED FULLTIME, ONSITE FINANCIAL ADVOCATES WHO SPECIALIZE IN HEALTHCARE COVERAGE ENROLLMENT TO HELP COMMUNITY MEMBERS WHO ARE UNINSURED AND UNDERINSURED SECURE ACCESS TO HEALTHCARE SERVICES. THEY HELP SANFORD PATIENTS AS WELL AS COMMUNITY REFERRALS.HEALTH INSURANCE COVERAGE: SANFORD BISMARCK'S FINANCIAL ADVOCATES HELPED 3,363 UNINSURED AND UNDERINSURED PATIENTS AND THEIR FAMILIES SECURE HEALTH CARE COVERAGE, HELPING PATIENTS PAY FOR MUCH-NEEDED HEALTHCARE SERVICES AND ONGOING CARE.THE SANFORD HEALTH FOUNDATION ALSO SUPPORTS PATIENTS THAT MAY BE TEMPORARILY UNABLE TO AFFORD THE MEDICATIONS THEY NEED DUE TO EXTENUATING CIRCUMSTANCES, E.G., SUDDEN LOSS OF EMPLOYMENT, SANFORD'S FOUNDATION ESTABLISHED A FUND TO HELP COMMUNITY MEMBERS. ESTABLISHED INTERNAL WORKFLOW PROCESSES TO HELP INDIVIDUALS UNABLE TO AFFORD PRESCRIPTIONS RECEIVE THE MEDICATION FREE OF CHARGE.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:HEALTHY LIVING ACCESS TO HEALTH CARE PROVIDERSLONG-TERM CARE PUBLIC TRANSPORTATIONAFFORDABLE HOUSINGSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 5 -- SANFORD BISMARCK MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 5 -- SANFORD BISMARCK MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 6 -- SANFORD BEMIDJI MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 6 -- SANFORD BEMIDJI MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 6 -- SANFORD BEMIDJI MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 6 -- SANFORD BEMIDJI MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO HEALTH CARE: MENTAL HEALTHMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO ADD ADDITIONAL BEHAVIORAL HEALTH PROVIDERS, PROGRAMS, IMPROVED ACCESS, AND ALTERNATE WAYS TO ENGAGE WITH BEHAVIORAL HEALTH PROVIDERS. IT IS SANFORD'S GOAL TO PROVIDE ACCESS TO QUALITY AND TIMELY HEALTH CARE RELATED TO MENTAL HEALTH AND SUBSTANCE ABUSE. PRIORITY 2: HEALTHY LIVINGIN THE UNITED STATES, MANY OF THE LEADING CAUSES OF DEATH AND DISEASE ARE ATTRIBUTED TO UNHEALTHY BEHAVIORS. FOR EXAMPLE, POOR NUTRITION AND LOW LEVELS OF PHYSICAL ACTIVITY ARE ASSOCIATED WITH HIGHER RISK OF CARDIOVASCULAR DISEASE, TYPE 2 DIABETES, AND OBESITY. TOBACCO USE IS ASSOCIATED WITH HEART DISEASE, CANCER, AND POOR PREGNANCY OUTCOMES IF THE MOTHER SMOKES DURING PREGNANCY. EXCESSIVE ALCOHOL USE IS ASSOCIATED WITH INJURIES, CERTAIN TYPES OF CANCERS, AND CIRRHOSIS. SANFORD HAS MADE HEALTHY LIVING A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE AN INCREASE IN OPTIONS AND ASSISTANCE FOR HEALTHY LIVING. IT IS SANFORD'S GOAL TO FOCUS ON HEALTHY LIVING TO INCLUDE ASSESSMENT AND TREATMENT OF CHRONIC HEALTH ISSUES, LEVELS OF PHYSICAL ACTIVITY AND FOOD INSECURITY.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARACCESS TO HEALTH CARE: MENTAL HEALTHWE IDENTIFIED FOUR GOALS TO ADDRESS MENTAL HEALTH ACCESS. THE FIRST IS TO DEVELOP A FULLY INTEGRATED BEHAVIORAL HEALTH SYSTEM, RESULTING IN INCREASED ACCESS AND QUALITY CARE AND BECOME A CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINIC (CCBHC). THE SECOND GOAL IS TO INCREASE ACCESS TO URGENT AND EMERGENT BEHAVIORAL HEALTH SERVICES FOR COMMUNITY MEMBERS IN BEHAVIORAL HEALTH CRISIS. SANFORD BEMIDJI ALSO SEEKS THE GOALS OF INCREASING ACCESS TO CULTURALLY SENSITIVE SUBSTANCE ABUSE PREVENTION AND TREATMENT AND INCREASING ACCESS TO CHILDREN'S BEHAVIORAL HEALTH SERVICES. WE ANTICIPATE BECOMING A CCBHC, CERTIFIED BY THE MINNESOTA DEPARTMENT OF HEALTH, IN MARCH 2023. A 2-YEAR FEDERAL GRANT FOR CCBHC IMPLEMENTATION WILL END IN FEBRUARY 2023 AND INCLUDED 1,360 PATIENT INTAKES. SANFORD IS RECRUITING FOR ADDITIONAL PROVIDERS, WHICH RESULTED IN SIGNING TWO PSYCHIATRISTS AND THREE APPS. ADDITIONAL NEEDS WERE SUPPORTED THROUGH FURTHER DEVELOPMENT OF SCHOLARSHIPS AND INTERNSHIPS PROGRAMMING WITH EIGHT INTERNS ADDED IN 2022. THIS SUPPORTS THE NEEDS OF BOTH THE SYSTEM AND THE STUDENTS SEEKING A CAREER IN THE MEDICAL FIELD.IN ADDITION TO THE NEEDS WITHIN THE CHNA COMMUNITY, SANFORD IS EXPLORING THE EXPANSION OF BEHAVIORAL HEALTH SERVICES INTO SECONDARY MARKETS IN MULTIPLE COMMUNITIES ADJACENT TO THE CURRENT SERVICE FOOTPRINT. BEHAVIORAL HEALTH SERVICES WERE EXPANDED INTO PARK RAPIDS THROUGH THE ACQUISITION OF A BETTER CONNECTION COMPLETED 12/2021. THE ADDITION TO THE SANFORD ORGANIZATION INCREASED SERVICES BY 20% WITH A 1.0 CARE COORDINATOR, AND 1.0 BHC.HEARTLAND LAKES DEVELOPMENT (HLD) HAS SECURED THE LAND TO BUILD A SUPPORTIVE HOUSING COMPLEX. NEXT STEPS IN THE PLANNING/CONSTRUCTION HAVE NOT STARTED. WE CONTINUE TO COMMUNICATE WITH HLD AS PLANS ARE DEVELOPED.CONSTRUCTION WAS COMPLETED ON THE BEHAVIORAL HEALTH CRISIS CENTER HOSPITAL AND EMPATH UNITS. A SOFT ROLL-OUT FOR EMPATH STARTED DECEMBER 2022 AND THE IP UNIT OPENED IN FEBRUARY 2023. ACCESS TO MOBILE CRISIS SERVICES WAS EXPANDED BY INCREASING FULL-TIME FTES.TO INCREASE ACCESS TO CULTURALLY SENSITIVE SUBSTANCE ABUSE PREVENTION AND TREATMENT, BEHAVIORAL HEALTH'S SUD PROGRAM BECAME A WELLBRIETY CERTIFIED TREATMENT CENTER IN 2022. MEETING THIS CRITERIA ENSURES ALL COUNSELORS ARE TRAINED IN AND INCORPORATE CULTURALLY BASED CURRICULUM, PROVIDES ACCESS TO A NATIVE AMERICAN ELDER WHO CONDUCTS CEREMONIES AND PROVIDES TEACHINGS, AND INCORPORATES TRADITIONAL NATIVE AMERICAN HEALING PRACTICES (SMUDGING, PIPE CEREMONY, SWEAT LODGE, ETC.) INTO THE PROGRAM.THE MEDICATION ASSISTED TREATMENT PROGRAM MOVED TO THE 1705 CLINIC AND TRANSITIONED TO THE BH UMBRELLA.EXPANDING BH SERVICES INTO SECONDARY IS BEING EXPLORED IN MULTIPLE COMMUNITIES ADJACENT TO THE CURRENT SERVICE FOOTPRINT TO INCREASE ACCESS TO CHILDREN'S BH SERVICES.CHILDREN'S THERAPEUTIC SERVICES AND SUPPORTS EXPANDED WITH CONTINUED PLANNING FOR MORE IN-HOME SERVICES. HOWEVER, IN-SCHOOL SERVICE NEEDS HAVE DRAMATICALLY INCREASED. THE SCHOOL LINKED MENTAL HEALTH GRANT REQUEST WAS INCREASED BY $300,000, TO SUPPORT AN INCREASE OF FIVE FTES TO SERVE ADDITIONAL SCHOOLS. WE WILL BE OFFERING CHILDREN'S THERAPEUTIC SERVICES AND SUPPORTS TO ALL BEMIDJI SCHOOLS.HEALTHY LIVINGWE ESTABLISHED FOUR GOALS WITHIN THE PRIORITY: ASSESSMENT AND TREATMENT OF CHRONIC HEALTH ISSUES, ASSESSMENT AND TREATMENT OF CHRONIC HEALTH ISSUES, FOOD INSECURITY, AND EXPAND SUPPORT OF HUBBARD COUNTY AND PARK RAPIDS THROUGH LOCAL COMMUNITY PARTNERS AND FOCUS ON THE ISSUES OF HEALTHY LIFESTYLES, BEHAVIORAL HEALTH, AFFORDABLE HOUSING, AND WORKFORCE DEVELOPMENT.WE STARTED 2022 COMMITTED TO IMPROVING DEPRESSION SCREENING IN PRIMARY CARE. DURING THE YEAR, WE ADDED DEPRESSION SCREENING TO SEVERAL SPECIALTY DEPARTMENTS AND THE WALK-IN CLINIC. THE RESULTS WERE EXCELLENT. IN A 1-MONTH PERIOD, FALL 2022, THE WALK-IN CLINIC ALONE SCREENED OVER 1,000 PATIENTS THAT LIKELY WOULD HAVE BEEN MISSED. AT YEAR END, THE PRIMARY CARE CLINICS SCREENED 65.7% OF ELIGIBLE PATIENTS, AN IMPROVEMENT FROM 48.3% IN 2021. THIS RATE PLACES OUR PRIMARY CARE IN THE TOP 30% OF ALL CLINICIANS NATIONWIDE. ADDING THE SPECIALTY AND WALK-IN CLINICS IMPROVED THE REGIONAL SCREENING FROM 42.9% TO 49.3% OF ELIGIBLE PATIENTS AND RANKS BETTER THAN 50% NATIONWIDE. DEPRESSION REMISSION RATES ALSO IMPROVED IN PRIMARY CARE AND THE REGION. PRIMARY CARE IMPROVED FROM 14% TO 16%, AND ALTHOUGH THESE NUMBERS SEEM LOW, THEY ARE ALSO IN THE TOP 30% NATIONWIDE. THE REGION IS IN TOP HALF.THE PRIMARY CARE GOAL OF REDUCING UNCONTROLLED DIABETES TO BETTER THAN 23.5% WAS REALIZED, MOVING FROM 24.6% OF PATIENTS UNCONTROLLED TO 22.1% (TOP 20% NATIONWIDE). REFERRALS TO SELF-CARE IMPROVED FROM 0-2 PER MONTH IN AUGUST 2021 TO 15 PATIENTS/MONTH BY AUGUST 2022 THROUGH PROMOTION EFFORTS. PATIENTS WHO ATTEND THE BETTER CHOICES/BETTER HEALTH CLASS HAVE A 12% IMPROVEMENT IN MEDICATION COMPLIANCE.THE PEDIATRIC CLINIC IMPLEMENTED THE FOOD PANTRY IN JUNE 2022. DUE TO STAFFING CONSTRAINTS THE CLINIC WAS UNABLE TO SCREEN EACH FAMILY AS ORIGINALLY PLANNED. STAFFING CONSTRAINTS ARE DECREASING, THE PANTRY HAD A RESET JAN. 2023. IN THE MONTH OF JANUARY IT WAS ESTIMATED THAT APPROXIMATELY 350-400 LBS OF FOOD WAS GIVEN OUT. THIS IMPACTED 6 FAMILIES, INCLUDING A FAMILY OF 12. THE GOAL MOVING FORWARD IS TO SCREEN EACH FAMILY AT WELL-CHILD CHECKS. STAFF WILL MONITOR THE NUMBER OF PATIENTS SCREENED COMPARED TO THE NUMBER OF WELL-CHILD CHECKS. OVER TIME WE WILL LOOK TO EXPAND THIS TO OTHER VISIT TYPES. SANFORD STAFF ATTEND QUARTERLY ACTION PARK RAPIDS NON-PROFIT AGENCY NETWORKING MEETINGS TO LISTEN TO THE NEEDS/CONCERNS OF THE NON-PROFIT COMMUNITY INCLUDING SOCIAL ISSUES, EDUCATION AND EXPANDED BEHAVIORAL HEALTH NEEDS. COLLABORATION WITH UNITED WAY TO FIND INITIATIVE IN HUBBARD COUNTY.SANFORD PARTICIPATED IN THE CHI ST. JOSEPH HEALTH CARE/HUBBARD CHNA SURVEY AND STAKEHOLDERS MEETING.WE SURVEYED OUR STAFF WHO HAVE DEPENDENTS ON THEIR CHILDCARE NEEDS. QUESTIONS INCLUDED THE TIMES THEY NEEDED CARE, AS WELL AS NUMBER OF KIDS AND NUMBER OF HOURS PER WEEK. THE RESPONSE RATE WAS APPROXIMATELY 40%. THE HIGHEST NEEDS OF OUR STAFF INCLUDE DROP IN AND BACKUP CHILD CARE (FOR THE TIMES THEIR REGULAR DAYCARE BECOMES SICK OR TAKES VACATION), AND INFANT SPOTS. CONVERSATIONS CONTINUE WITH COMMUNITY PARTNERS ON HOW ADDITIONAL CHILDCARE IN OUR COMMUNITY CAN BE SUPPORTED.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:EMPLOYMENT AND INCOMEACCESS TO AFFORDABLE HEALTH CAREAFFORDABLE HOUSINGPUBLIC TRANSPORTATIONCHILD CARE QUALITYCOMMUNITY SAFETYSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 6 -- SANFORD BEMIDJI MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 6 -- SANFORD BEMIDJI MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 7 -- SANFORD MEDICAL CENTER THIEF RIVER FALLS PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 7 -- SANFORD MEDICAL CENTER THIEF RIVER FALLS PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 7 -- SANFORD MEDICAL CENTER THIEF RIVER FALLS PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 7 -- SANFORD MEDICAL CENTER THIEF RIVER FALLS PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: MENTAL HEALTHMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES FOR MENTAL HEALTH PROMOTION, SUICIDE PREVENTION AND EDUCATION FOR PARENTING RELATED SKILLS. IT IS SANFORD'S GOAL TO INCREASE ACCESS TO MENTAL/BEHAVIORAL HEALTH AND SUBSTANCE ABUSE SERVICES, IN PARTICULAR FOR AT RISK YOUTH AND TO DECREASE THE NUMBER OF SUICIDES.PRIORITY 2: ACCESS TO HEALTHCARE PROVIDERSACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE HEALTH CARE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET. SANFORD HAS MADE ACCESS TO HEALTHCARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO DEVELOP A FULLTIME DERMATOLOGY CLINIC AND TO EXPAND ACCESS TO TELEHEALTH TECHNOLOGIES IN BEHAVIORAL HEALTH. IT IS SANFORD'S GOAL TO INCREASE THE NUMBER OF LOCAL PROVIDERS SERVICING THIEF RIVER FALLS THROUGH LOCALLY BASED PROVIDERS, OUTREACH FROM OTHER SANFORD FACILITIES, OR TELEHEALTH/VIRTUAL CARE PLATFORMS. INCREASED PROVIDERS WILL EXPAND THE NUMBER OF AVAILABLE SERVICES AND APPOINTMENTS AVAILABLE TO THE LOCAL COMMUNITY.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARMENTAL HEALTH SANFORD THIEF RIVER FALLS AND SANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTER ESTABLISHED TWO GOALS WITHIN THE MENTAL HEALTH PRIORITY. THE FIRST IS TO DEVELOP AND IMPLEMENT COMMUNITY STRATEGY FOR MENTAL HEALTH PROMOTION AND SUICIDE PREVENTION. THE SECOND GOAL IS TO DEVELOP AND IMPLEMENT COMMUNITY EDUCATION FOR PARENTING RELATED SKILLS.IN LATE 2021, AS PART OF THE GOAL TO DEVELOP AND IMPLEMENT COMMUNITY STRATEGY FOR MENTAL HEALTH PROMOTION AND SUICIDE PREVENTION, SANFORD BEHAVIORAL HEALTH IDENTIFIED A CORE TEAM OF STAFF AND DEVELOPED A STRATEGY TO GROW A COMMUNITY COALITION FOR MENTAL HEALTH PROMOTION AND SUICIDE PREVENTION IN OUR COMMUNITY. IN JANUARY OF 2022, SANFORD BEHAVIORAL HEALTH BEGAN MEETING MONTHLY WITH COMMUNITY PARTNERS FROM TEN PUBLIC AND PRIVATE ENTITIES INCLUDING PUBLIC HEALTH, LAW ENFORCEMENT, FAITH COMMUNITY, EDUCATION, EMPLOYERS, HEALTH CARE, AND YOUTH ACTIVITIES. OVER THE PAST YEAR, SIX ADDITIONAL PARTNERS WERE ADDED, INCLUDING SCHOOL COUNSELORS, VIP, ADDITIONAL SCHOOL DISTRICT, MENTAL HEALTH PROVIDER, HIGH SCHOOL STUDENT, AND A SUICIDE LOSS SURVIVOR. THROUGHOUT THE YEAR, THIS GROUP BECAME KNOWN AS "COMMUNITY STRONG," DEFINED OUR COMMUNITY AS PENNINGTON COUNTY, AND IDENTIFIED OUR FOCUS ON YOUTH AND FAMILY EDUCATION. COMMUNITY STRONG ESTABLISHED A VISION STATEMENT TO BE "A COMMUNITY THAT STRIVES, PROMOTES AND SEEKS OUT MENTAL AND EMOTIONAL WELLBEING AND A MISSION STATEMENT "TO EMPOWER A HEALTHY COMMUNITY IN PENNINGTON COUNTY THROUGH EDUCATION, OUTREACH AND SUPPORT THAT RESHAPES THINKING AND AWARENESS AROUND MENTAL WELL-BEING AND SUICIDE PREVENTION." IN 2022, IN PARTNERSHIP WITH COMMUNITY STRONG, SANFORD BEHAVIORAL HEALTH PROVIDED FOUR EDUCATIONAL EVENTS IN PENNINGTON COUNTY, WITH ADDITIONAL OUTREACH EVENTS.IN EARLY 2022, SANFORD BEHAVIORAL HEALTH IDENTIFIED KEY PERSONNEL TO DEVELOP A STRATEGY FOR IMPLEMENTING PARENTING RELATED SKILLS IN THE COMMUNITY AS PART OF THE GOAL TO DEVELOP AND IMPLEMENT COMMUNITY EDUCATION FOR PARENTING RELATED SKILLS. IN MAY OF 2022, SANFORD BEHAVIORAL HEALTH USED ESTABLISHED RELATIONSHIPS THROUGH THE JUVENILE DIVERSION PROGRAM TO IDENTIFY PARTNERS WHO COULD JOIN IN THE EFFORT TO IMPLEMENT AND PROMOTE THIS TYPE OF EDUCATIONAL GROUP FOR PARENTS. THROUGH WORK WITH THE TRF POLICE DEPARTMENT, PENNINGTON COUNTY SOCIAL SERVICES, PENNINGTON COUNTY COURT AND COUNTY ATTORNEY, AND TRF SCHOOL DISTRICT, IT WAS IDENTIFIED THAT THE INITIAL TARGETED POPULATION OF THIS PARENTING SKILLS EDUCATION WOULD BE PARENTS OF CHILDREN IN THE JUVENILE DIVERSION PROGRAM, OR THOSE THAT THE AGENCIES INVOLVED ARE IDENTIFYING AS ESCALATING IN CRIMINAL JUSTICE SYSTEM AND AT AN INCREASED NEED FOR SERVICES. IN LATE MAY, THE CURRICULUM TO BE USED WAS IDENTIFIED AS THE INCREDIBLE YEARS AND LOVE & LOGIC CURRICULUM. FACILITATORS WERE ALSO IDENTIFIED FROM SANFORD BEHAVIORAL HEALTH AND PENNINGTON COUNTY SOCIAL SERVICES. THE FIRST SIX-WEEK SESSION OF THE PARENTING SKILLS GROUP BEGAN IN OCTOBER OF 2022 WITH SIX FAMILIES COMPLETING THE TRAINING.ACCESS TO HEALTHCARE PROVIDERSTWO GOALS WERE ESTABLISHED TO SUPPORT THE PRIORITY, INCLUDING THE DEVELOPMENT OF A FULLTIME DERMATOLOGY CLINIC IN THIEF RIVER FALLS, AND EXPANDING THE PLATFORM AND ACCESS TO TELEHEALTH TECHNOLOGIES IN BEHAVIORAL HEALTH.TO SUPPORT THE GOAL OF DEVELOPING A FULL-TIME DERMATOLOGY CLINIC IN THIEF RIVER FALLS, SANFORD HEALTH TRF HIRED A FULL-TIME DERMATOLOGY NURSE PRACTITIONER IN APRIL OF 2021. THE DERMATOLOGIST STARTED IN THIEF RIVER FALLS AFTER SIX MONTHS OF TRAINING WITH A DERMATOLOGIST IN GRAND FORKS, SO THE COMMUNITY NOW HAS A FULL-TIME DERMATOLOGY SERVICE. CY2022 FOCUSED ON BUILDING THE PRACTICE TO INCLUDE RESOURCES NEEDED FOR SKIN TESTING, SKIN CHECKS, BIOPSIES, AND PROCEDURES ALONG WITH STAFFING AND SCHEDULING RESOURCES TO BEST ACCOMMODATE PATIENT NEEDS. AVAILABLE LOCAL DERMATOLOGY APPOINTMENTS WENT FROM MONTHLY OUTREACH, ROUGHLY 40 APPOINTMENTS, TO FULL-TIME COMMUNITY CLINIC, ROUGHLY 140 APPOINTMENTS PER MONTH. PATIENT UTILIZATION OF DERMATOLOGY SERVICES WAS BUILT AND SUSTAINED EARLY IN 2022. HELPING WITH THE PRACTICE AWARENESS AND PATIENT EDUCATION INCLUDED MARKETING THE NEW NURSE PRACTITIONER TO THE PUBLIC VIA TRADITIONAL AND SOCIAL MEDIA SOURCES, HOSTING FREE PUBLIC SKIN CHECK EVENTS, COMMUNITY OUTREACH WITH EMPLOYERS AND THE SCHOOL DISTRICT, AND PRODUCING AND DISTRIBUTING SKIN PREVENTION EDUCATIONAL MATERIALS. THIEF RIVER FALLS DERMATOLOGY IS OFFERING ROBUST GEOGRAPHICAL OFFERINGS IN OUR PRIMARY SERVICE AREA BY SPENDING TWO DAYS OF OUTREACH DERMATOLOGY TIME IN COMMUNITIES HALLOCK AND CROOKSTON, GIVING THEM 16 PATIENT APPOINTMENTS OF DERMATOLOGY ACCESS NOT PREVIOUSLY HAD. IN CY2023, THE FOCUS WILL BE ON GROWING AVAILABLE ACCESS BY INCREASING APPOINTMENTS EACH CLINIC DAY.AS PART OF THE EXPANDED PLATFORM AND ACCESS TO TELEHEALTH TECHNOLOGIES IN BEHAVIORAL HEALTH GOAL, SANFORD BEHAVIORAL HEALTH PROVIDES PATIENTS THE FLEXIBILITY OF SCHEDULING THEIR APPOINTMENT IN THE MANNER THAT BEST SUITS THEIR NEEDS, PROVIDED THAT WE ARE ABLE TO MEET REGULATORY REQUIREMENTS AND IT IS IN THE PATIENT'S BEST INTEREST CLINICALLY. AS A RESULT, MORE THAN 40% OF APPOINTMENTS ARE CURRENTLY SCHEDULED AS TELEHEALTH APPOINTMENTS. THIS DATA DOES NOT REFLECT ANY NEW PATIENT ASSESSMENTS WHO MAY BE SEEN VIA TELEHEALTH DUE TO THE INABILITY TO CAPTURE THE DATA WITHOUT A MANUAL PROCESS.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO QUALITY HEALTHCAREAFFORDABLE HOUSINGLONG-TERM CAREPUBLIC TRANSPORTATIONSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 7 -- SANFORD MEDICAL CENTER THIEF RIVER FALLS PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 7 -- SANFORD MEDICAL CENTER THIEF RIVER FALLS PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 8 -- SANFORD ABERDEEN MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 8 -- SANFORD ABERDEEN MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 8 -- SANFORD ABERDEEN MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 8 -- SANFORD ABERDEEN MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: PHYSICAL ACTIVITY AND NUTRITIONTHE ENVIRONMENTS WHERE PEOPLE LIVE, LEARN, WORK, AND PLAY AFFECT ACCESS TO HEALTHY FOOD AND OPPORTUNITIES FOR PHYSICAL ACTIVITY WHICH, ALONG WITH GENETIC FACTORS AND PERSONAL CHOICES, SHAPE HEALTH AND THE RISK OF BEING OVERWEIGHT AND OBESE. SANFORD HAS MADE PHYSICAL ACTIVITY AND NUTRITION A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO PROMOTE AND IMPROVE CARE OF PATIENTS WITH OBESITY DIAGNOSIS AND TO PROVIDE EDUCATION TO SCHOOLS REGARDING PHYSICAL ACTIVITY AND NUTRITION. IT IS SANFORD'S GOAL TO IMPROVE PHYSICAL ACTIVITY AND NUTRITION FOR THE COMMUNITY. PRIORITY 2: ACCESS TO HEALTH CARE PROVIDERSACCORDING TO THE COUNTY HEALTH RANKINGS FOR CLINICAL CARE, ACCESS TO HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE HEALTH CARE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET.SANFORD HAS MADE HEALTHCARE ACCESS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO PROMOTE AND IMPROVE ACCESS TO SERVICES AND EDUCATION. IT IS SANFORD'S GOAL THAT ALL PATIENTS REQUIRING ACCESS TO HEALTHCARE ARE SUCCESSFUL IN SECURING TIMELY APPOINTMENTS AND IMPROVING MENTAL HEALTH SERVICES IN THE COMMUNITY. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARPHYSICAL ACTIVITY AND NUTRITIONSANFORD ABERDEEN SUPPORTED THE PRIORITY THROUGH A COMBINATION OF VOLUNTEER SUPPORT AND OUTREACH BY ITS REGISTERED DIETICIAN. THE NEED FOR CONTINUED FOCUS ON THE GOAL IS VISIBLE WITHIN THE RESULTS OF THE FINDHELP SEARCH TOOL NOTED WITHIN THE SYSTEM SUMMARY IN THE PREVIOUS SECTION. RESIDENTS OF THE CHNA-DEFINED SANFORD ABERDEEN MEDICAL CENTER COMMUNITY CONDUCTED 783 SEARCHES IN 2022 ACROSS THE PLATFORM, 25% OF THE SEARCHES WERE RELATED TO FOOD ISSUES, SUCH AS PANTRIES, PAYING FOR FOOD, AND MEALS. COMMUNITY RESIDENTS ENGAGED WITH FOOD RESOURCES ON THE SANFORD FINDHELP TOOL 14 TIMES IN 2022. BY ONE MEASURE, BROWN COUNTY OBESITY RATES ARE 35.5% FOR FEMALES AND 35.1% FOR MALES PER DATA FROM THE INSTITUTE FOR HEALTH METRICS AND EVALUATION.VOLUNTEER EFFORTS FOCUSED ON GETTING HEALTHY FOOD IN THE HANDS OF THOSE THAT NEED IT. TO THAT END SANFORD VOLUNTEERED TEN HOURS TO MEALS ON WHEELS IN 2022, EXTENDING CARE BEYOND THE HOSPITAL WALLS TO PARTNER WITH A LOCAL COMMUNITY PARTNER TO DELIVER FOOD TO LOCAL SENIORS. SANFORD ABERDEEN PARTNERED WITH ANOTHER COMMUNITY PARTNER, THE SALVATION ARMY, TO DONATE ITEMS TO HOST A HEALTH FOOD DRIVE FOR YOUTH. IN TOTAL, 800 POUNDS OF FOOD AND $700 IN MONETARY DONATIONS WERE COLLECTED THROUGH THE EFFORT.SANFORD ABERDEEN EMPLOYS A REGISTERED DIETICIAN. IN ADDITION TO THEIR WORK WITHIN THE HEALTH SYSTEM, THE REGISTERED DIETICIAN COMPLETED A HEALTHY COOKING CLASS FOR AGING ADULTS AT THE ABERDEEN SENIOR CENTER. THE DIETITIAN ALSO ANALYZED LOCAL RESTAURANT MENUS TO PROVIDE INFORMATION TO CONSUMERS ON HEALTH OPTIONS AS PART OF PARTICIPATION IN HUB CITY HEALTHY EATS. ACCESS TO HEALTH CARE PROVIDERSSANFORD ABERDEEN IS SUPPORTING THE PRIORITY BY AUGMENTING LOCAL RESOURCES VIA TELEMEDICINE OUTREACH TO THE COMMUNITY FROM RESOURCES AVAILABLE THROUGH SANFORD HEALTH IN SIOUX FALLS, THROUGH INTEGRATED HEALTH THERAPISTS INTEGRATED INTO PRIMARY CARE SETTINGS, AND STANDARDIZING WORKFLOW TO ALL HEALTH COACHES AND PANEL SPECIALISTS WITHIN THE HOSPITAL AND CLINIC THROUGH EDUCATIONAL EFFORTS. SANFORD ABERDEEN HAD 180 REFERRALS FOR INTEGRATED HEALTH THERAPISTS (IHT) FROM VARIOUS SERVICE LINES, INCLUDING 139 FROM FAMILY PRACTICE, 11 FROM ORTHOPEDICS, 3 FROM ONCOLOGY, 9 FROM OBGYN, 7 FROM ENT, 3 FROM CHILDREN'S, AND 7 FROM CARDIOLOGY. IHT VISITS TOTALED 393 IN 2022 AND TOTAL 92 THROUGH THE FIRST TWO MONTHS OF 2023. REFERRALS TO BEHAVIORAL HEALTH/PSYCHOLOGY WERE 130 IN 2022 INCLUDING 123 FROM FAMILY PRACTICE, 3 FROM OBGYN, AND 4 FROM CHILDREN'S. BEHAVIORAL HEALTH THERAPISTS (BHT) BEGAN SEEING PATIENTS IN OCTOBER 2022 AND HAD 79 VISITS THROUGH THE END OF THE YEAR. BHT VISITS TOTALED 135 THROUGH THE FIRST TWO MONTHS OF 2023. COMMUNITY HEALTH WORKERS HAD 56 VISITS DURING THE PAST YEAR.SANFORD ABERDEEN COMPLETED WORKFLOW EDUCATION TO ALL PROVIDERS AND NURSING STAFF FOR REFERRALS. SANFORD ABERDEEN HAS HIRED A PMHNP, CNP WHO WILL BE ABLE TO COMPLETE LOCAL PSYCH REFERRALS AND MEDICATION MANAGEMENT.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO AFFORDABLE HEALTH CAREPUBLIC TRANSPORTATIONAFFORDABLE HOUSINGSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 8 -- SANFORD ABERDEEN MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 8 -- SANFORD ABERDEEN MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 9 -- SANFORD WORTHINGTON MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 9 -- SANFORD WORTHINGTON MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTER GROUP A-FACILITY 9 -- SANFORD WORTHINGTON MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 9 -- SANFORD WORTHINGTON MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO PROVIDERS (BILINGUAL MENTAL HEALTH AND PEDIATRIC DENTAL CARE)ACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE HELPS INDIVIDUALS AND FAMILIES ACCESS NEEDED PRIMARY CARE, SPECIALISTS, AND EMERGENCY CARE, BUT DOES NOT ENSURE ACCESS ON ITS OWNIT IS ALSO NECESSARY FOR PROVIDERS TO OFFER AFFORDABLE CARE, BE AVAILABLE TO TREAT PATIENTS, AND BE IN RELATIVELY CLOSE PROXIMITY TO PATIENTS.SANFORD HAS MADE ACCESS TO HEALTH CARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO INCREASE SCREENING OF MENTAL HEALTH AND REFERRAL SOURCES FOR MENTAL HEALTH SUPPORT AND TO INCREASE ACCESS TO PEDIATRIC DENTAL CARE FOR AT-RISK PATIENTS. IT IS SANFORD'S GOAL THAT MORE AREA RESIDENTS WILL HAVE ACCESS TO PROVIDERS OF BILINGUAL MENTAL HEALTH AND PEDIATRIC DENTAL CARE.PRIORITY 2: TEEN PREGNANCYTEEN PREGNANCY RESULTS IN SUBSTANTIAL SOCIAL, ECONOMIC, AND HEALTH COSTS THROUGH IMMEDIATE AND LONG-TERM IMPACTS ON TEEN PARENTS AND THEIR CHILDREN. STUDIES SHOW THAT THE CHILDREN OF TEENAGE MOTHERS ARE MORE LIKELY TO HAVE LOWER SCHOOL ACHIEVEMENT AND TO DROP OUT OF HIGH SCHOOL, HAVE MORE HEALTH PROBLEMS, BE INCARCERATED AT SOME TIME DURING ADOLESCENCE, AND FACE UNEMPLOYMENT AS A YOUNG ADULT, THAN CHILDREN BORN TO OLDER MOTHERS.SANFORD HAS MADE TEEN PREGNANCY A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO INCREASE LINKAGES BETWEEN TEEN PREGNANCY PREVENTION PROGRAMS AND COMMUNITY-BASED CLINICAL SERVICES. IT IS SANFORD'S GOAL THAT THE COMMUNITY WILL BENEFIT FROM STRONG LOCAL PARTNERSHIPS THROUGH SANFORD'S FOCUS ON THIS ISSUE. FAMILY PRACTICE AND PEDIATRIC PROVIDERS WILL PROVIDE PATIENT EDUCATION, RECOMMEND, AND SUPPORT SPECIALTY REFERRALS. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARACCESS TO PROVIDERS (BILINGUAL MENTAL HEALTH AND PEDIATRIC DENTAL CARE)SANFORD WORTHINGTON ESTABLISHED TWO GOALS FOR THE PRIORITY, INCLUDING INCREASING ACCESS TO PEDIATRIC DENTAL CARE FOR AT-RISK PATIENTS, IN ADDITION TO INCREASED SCREENING OF MENTAL HEALTH AND REFERRAL SOURCES FOR MENTAL HEALTH SUPPORT. DENTAL CARE WAS THE EIGHTH MOST SEARCHED TERM ON THE FINDHELP PLATFORM. IN TOTAL COMMUNITY MEMBERS CONDUCTED 434 SEARCHES IN 2022 WITH 28% BEING HEALTH-RELATED TOPICS.THE ORGANIZATION COMPLETED A PROFORMA FOR A DENTAL THERAPIST IN THE CLINIC SETTING. THE PROFORMA INDICATED THAT IT WAS NOT A FEASIBLE OPPORTUNITY. HOWEVER, SANFORD WORTHINGTON EDUCATED CLINICAL STAFF ON LOCAL DENTAL DISPARITIES AND IS SHARING LOCAL DATA. DATA IS SHARED BI-ANNUALLY WITH STAFF. STAFF ALSO EXPLORED THE OPPORTUNITY FOR PARTNERSHIP WITH HIGHER EDUCATION AND DENTAL PROGRAMS TO COMPLETE A ROTATION OF DENTAL SERVICE PRACTICE IN AMBULATORY SETTING. THIS WAS ALSO DETERMINED TO NOT BE FEASIBLE.THE ORGANIZATION IS COLLABORATING TO DETERMINE A LOCAL STRATEGY TO ASSIST PATIENTS IN GREATEST NEED. LAST YEAR, SANFORD SHARED OPPORTUNITIES FOR LOCAL PROJECTS AND SERVICES IN THE COMMUNITY SETTING FOR REFERRAL OF AT-RISK PATIENTS AND CONTINUES TO STRENGTHEN RELATIONSHIPS WITH LOCAL DENTAL PROVIDERS, PUBLIC HEALTH, AND OTHER COMMUNITY STAKEHOLDERS TO ENSURE THOSE IN GREATEST NEED GET CONNECTED TO THE RESOURCES NEEDED TO TREAT AND PREVENT PEDIATRIC DENTAL ISSUES.FOR MENTAL HEALTH, THE ORGANIZATION WAS ABLE TO SUCCESSFULLY RECRUIT AN INTEGRATED HEALTH THERAPIST (IHT) AFTER THE POSITION WAS POSTED FOR MORE THAN 600 DAYS. THE IHT JOINED THE ORGANIZATION IN OCTOBER 2022. TWO BILINGUAL SPANISH COMMUNITY HEALTH WORKERS (CHWS) COMPLETED APPROXIMATELY 50 SOCIAL DETERMINANTS OF HEALTH ASSESSMENTS (SDOH) ON TARGETED PATIENTS REFERRED TO CHWS AFTER THE SDOH ASSESSMENT WAS INTRODUCED AND IMPLEMENTED INTO CHW WORKFLOW IN JUNE OF 2022. THE SDOH SCREENING CONTAINS QUESTIONS REGARDING MENTAL HEALTH AND STRESS. IF PATIENTS RESPOND TO THOSE QUESTIONS WITH A CONCERN, THE CHWS FURTHER ASSESS AND REFER TO INTERNAL AND/OR EXTERNAL COMMUNITY MENTAL HEALTH RESOURCES AS NEEDED. IN NOVEMBER, A SHORTENED VERSION OF THE SDOH ASSESSMENT WAS DEPLOYED TO ALL PATIENTS CHECKING IN FOR THEIR APPOINTMENT AT REGISTRATION WHICH INCREASES LIKELIHOOD OF IDENTIFYING MENTAL HEALTH CONCERNS TO BE ADDRESSED WITH THE PROVIDER AND OPPORTUNITY FOR APPROPRIATE REFERRAL AND FOLLOW UP.SANFORD WORTHINGTON IS WORKING TO IMPROVE PATIENT COMPLETION RATE OF APPROPRIATE MENTAL HEALTH SCREENING IN AMBULATORY SETTINGS THROUGH STAFF WORKFLOW IMPROVEMENTS. THE CMS QUALITY GOAL FOR DEPRESSION SCREENING IS 95% AND WORTHINGTON WAS AT 26% IN JANUARY 2021. HOWEVER, THIS HAS IMPROVED TO 67.7% AS OF THE END OF 2022. THE SIGNIFICANT IMPROVEMENT WAS THE RESULT OF FOCUSED WORK BY STAFF. THE PANEL ASSISTANT RAN A REGISTRY OF PATIENTS THAT WERE MISSING THE DEPRESSION SCREEN OR HAD AN OUTDATED SCREENING TO COMPLETE. SOME OF THOSE WITH A MISSING SCREED WERE UPDATED VIA TELEPHONE OUTREACH WHILE OTHERS WERE FLAGGED AND COMPLETED DURING A SCHEDULED APPOINTMENT. WORTHINGTON WAS ABLE TO INCREASE ACCESS TO MENTAL HEALTH TELEMEDICINE SERVICES WITH THE ADDITION OF A CREDENTIALED LICENSED MENTAL HEALTH SERVICE PROVIDER TO COVER WORTHINGTON CLINIC PATIENTS IN MARCH 2022.TEEN PREGNANCYSANFORD WORTHINGTON WORKED TOGETHER WITH NOBLES COUNTY PUBLIC HEALTH AND SMOC FAMILY PLANNING TO ORGANIZE A BRAINSTORMING MEETING WITH COMMUNITY STAKEHOLDERS REGARDING TEEN PREGNANCY. SMOC FAMILY PLANNING IS THE LEAD FOR THIS PROJECT. ORGANIZATIONS AND COMMUNITY MEMBERS REPRESENTED AT THE INITIAL BRAINSTORM MEETING ON MARCH 22, 2022, INCLUDED LOCAL PUBLIC HEALTH, SMOC FAMILY PLANNING, SANFORD WORTHINGTON, WELLSHARE INTERNATIONAL, SMOC HEAD START, AND COMMUNITY HEALTH WORKERS. THE MEETING WAS HELD AT THE SANFORD WORTHINGTON HOSPITAL WITH DISCUSSION THAT COVERED CURRENT STATISTICS FOR NOBLES COUNTY, AN INFORMAL ASSESSMENT OF SERVICES OFFERED, A GAP ANALYSIS, AND A LIST OF COMMUNITY REPRESENTATIVES THAT SHOULD BE AT THE TABLE FOR AN OFFICIAL WORK GROUP. A SECOND BRAINSTORM MEETING WAS HELD ON APRIL 27TH WITH A FEW ADDITIONAL STAKEHOLDERS THAT WERE UNABLE TO ATTEND THE FIRST BRAINSTORM SESSION. NEW ATTENDEES INCLUDED COMMUNITY ADVOCATE/JBS, SOUTHWEST CRISIS CENTER, COUNSELOR, WORTHINGTON HIGH SCHOOL, AND CHILD PROTECTION NOBLES COUNTY COMMUNITY SERVICES. WITH THE ADDITIONAL FEEDBACK AND INPUT, IT WAS DECIDED TO OFFICIALLY EXTEND AN INVITE TO THOSE THE GROUP LISTED AND KICK OFF A TEEN PREGNANCY WORK GROUP WITH THE EXPANDED GROUP.IN MAY, SMOC FAMILY PLANNING PRESENTED TO THE SANFORD PATIENT AND FAMILY ADVISORY COUNCIL REGARDING THE NEW WORKGROUP AND PLANS TO MOVE FORWARD WITH REGULAR MEETINGS.OTHER FAMILY PLANNING PRIORITIES TOOK PRECEDENCE FOR THE REMAINDER OF 2022. THE WORKGROUP WILL RECONVENE IN 2023 TO DETERMINE THE NEXT STEPS FOR ADDRESSING TEEN PREGNANCY IN NOBLES COUNTY. SANFORD WORTHINGTON IS A WILLING AND ENGAGED PARTNER TO CONTINUE THIS IMPORTANT WORK. THERE IS MUCH ENTHUSIASM AMONG OTHER COMMUNITY PARTNERS TO CONTINUE MOMENTUM WITH TEEN PREGNANCY PREVENTION EFFORTS.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:INCOME AND POVERTYPUBLIC TRANSPORTATIONAFFORDABLE HOUSINGACCESS TO AFFORDABLE HEALTH CAREPHYSICAL ACTIVITY AND NUTRITIONCHILDCARE QUALITYLONG-TERM CARESANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 9 -- SANFORD WORTHINGTON MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 9 -- SANFORD WORTHINGTON MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 10 -- SANFORD SHELDON MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 10 -- SANFORD SHELDON MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 10 -- SANFORD SHELDON MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 10 -- SANFORD SHELDON MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO AFFORDABLE HEALTH CARE ACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE HEALTH CARE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET. SANFORD HAS MADE ACCESS TO AFFORDABLE HEALTH CARE A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO EDUCATE THE COMMUNITY ON THE FULL SCOPE OF LOCALLY AVAILABLE SERVICES AND OFFER COMMUNITY EDUCATIONAL AND SCREENING EVENTS TO ENHANCE PREVENTATIVE CARE AND REDUCE OUT-OF-POCKET COSTS. IT IS SANFORD'S GOAL TO INCREASE THE PUBLIC EDUCATION ON THE PROMOTION OF SERVICES AVAILABLE IN SHELDON, REDUCING OUT-OF-POCKET COSTS DUE TO TRAVEL TIME AND TIME AWAY FROM THEIR EMPLOYMENT.PRIORITY 2: ACCESS TO HEALTH CARE PROVIDERSACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE HELPS INDIVIDUALS AND FAMILIES ACCESS NEEDED PRIMARY CARE, SPECIALISTS, AND EMERGENCY CARE, BUT DOES NOT ENSURE ACCESS ON ITS OWNIT IS ALSO NECESSARY FOR PROVIDERS TO OFFER AFFORDABLE CARE, BE AVAILABLE TO TREAT PATIENTS, AND BE IN RELATIVELY CLOSE PROXIMITY TO PATIENTS.SANFORD HAS MADE ACCESS TO HEALTH CARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO ENHANCE MARKETING AND PROMOTIONAL ACTIVITIES TO IMPROVE ACCESS AND TO PROMOTE VIRTUAL CARE TO AUGMENT ACCESS TO MENTAL AND BEHAVIORAL HEALTH CARE. IT IS SANFORD'S GOAL TO ENHANCE ACCESS TO CARE FOR RESIDENTS OF SHELDON AND THE SURROUNDING AREA.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARACCESS TO AFFORDABLE HEALTH CARESANFORD SET TWO GOALS IN AN EFFORT TO INCREASE ACCESS TO AFFORDABLE HEALTH CARE. THE FIRST IS TO EDUCATE THE COMMUNITY ON THE FULL SCOPE OF SERVICES AVAILABLE LOCALLY. THE SECOND GOAL IS TO OFFER COMMUNITY EDUCATIONAL AND SCREENING EVENTS TO ENHANCE PREVENTATIVE CARE AND REDUCE OUT-OF-POCKET COSTS.SANFORD HEALTH LAUNCHED TWO CAMPAIGNS FOCUSING ON PRIMARY CARE IN THE CALENDAR YEAR 2022. "CARE CLOSE TO HOME" ADVERTISEMENTS WERE CREATED FOR ALL SANFORD CLINIC LOCATIONS AND UTILIZED WITHIN THE SHELDON MARKET. THE BOYDEN, SHELDON, SANBORN, HARTLEY, AND LAKE PARK CLINICS LISTED THEIR SPECIFIC HOURS AND AVAILABLE PROVIDERS WITHIN THE CAMPAIGN. "HERE FOR ALL. HERE FOR GOOD" WAS THE SECOND CAMPAIGN THAT WAS DIGITALLY LAUNCHED WITHIN THE SHELDON MARKET. DUE TO COVID POSITIVITY RATES SANFORD SHELDON DID NOT HOLD ANY IN HOUSE COMMUNITY EDUCATION EVENTS IN 2022. THE ORGANIZATION CONTINUED TO ASSIST O'BRIEN COUNTY PUBLIC HEALTH WITH VACCINE ASSISTANCE. IN CALENDAR YEAR 2022 APPROXIMATELY 130 INDIVIDUALS RECEIVED A VACCINE AT EVENTS. ADDITIONALLY, SANFORD SHELDON STAFF TRAVELED TO SIOUX CITY IA TO ASSIST WITH NATIONAL GUARD COVID TESTING FOR APPROXIMATELY 110 TROOPS THAT WERE BEING DEPLOYED.SANFORD SHELDON DID HOST HEART AND VASCULAR SCREENS WHICH CORRELATED WITH HEART MONTH IN FEBRUARY 2022 AT REDUCED COSTS FOR THE PATIENT.ACCESS TO HEALTH CARE PROVIDERSSANFORD SHELDON EXPANDED MENTAL HEALTH SERVICES IN JULY 2022 WITH THE ADDITION OF CYNTHIA KANTOS, INTEGRATED HEALTH THERAPIST. KANTOS BRINGS THE TOTAL NUMBER OF MENTAL HEALTH PROVIDERS AVAILABLE AT SANFORD SHELDON TO FIVE. CYNTHIA KANTOS JOINS JASON CHESTER, LISW AND STACEY JUMBECK PMHNP, APRN, CNP AS IN HOUSE PROVIDERS. MATTHEW EGGERS, DO AND MARK DANIELS, PHD PROVIDE MENTAL HEALTH SERVICES VIA TELEMED.IN ORDER TO PROVIDE ADDITIONAL CLINIC SERVICES TO PATIENTS IN NORTHWEST IOWA, SANFORD SHELDON BEGAN A CLINIC EXPANSION PROJECT WHICH WILL INCLUDE EIGHT ADDITIONAL EXAM ROOMS PLUS FOUR PROCEDURE ROOMS. ESTIMATED COMPLETION DATE IS JULY 2023.AS NOTED IN THE PREVIOUS GOAL, SANFORD HEALTH LAUNCHED TWO CAMPAIGNS FOCUSING ON PRIMARY CARE IN THE CALENDAR YEAR 2022. "CARE CLOSE TO HOME" ADVERTISEMENTS WERE CREATED FOR ALL SANFORD CLINIC LOCATIONS AND UTILIZED WITHIN THE SHELDON MARKET. THE BOYDEN, SHELDON, SANBORN, HARTLEY, AND LAKE PARK CLINICS LISTED THEIR SPECIFIC HOURS AND AVAILABLE PROVIDERS WITHIN THE CAMPAIGN. "HERE FOR ALL. HERE FOR GOOD" WAS THE SECOND CAMPAIGN THAT WAS DIGITALLY LAUNCHED WITHIN THE SHELDON MARKET. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:PHYSICAL ACTIVITY AND NUTRITIONAFFORDABLE HOUSINGPUBLIC TRANSPORTATIONLONG-TERM CAREENVIRONMENTAL HEALTHSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 10 -- SANFORD SHELDON MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 10 -- SANFORD SHELDON MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 11 -- SANFORD VERMILLION MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 11 -- SANFORD VERMILLION MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 11 -- SANFORD VERMILLION MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 11 -- SANFORD VERMILLION MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO AFFORDABLE HEALTH CAREACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE HEALTH CARE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET.SANFORD VERMILLION HAS MADE ACCESS TO AFFORDABLE HEALTH CARE A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO ENSURE PATIENTS AND COMMUNITY PARTNERS ARE AWARE OF ITS FINANCIAL ASSISTANCE PROGRAM AND OTHER PROGRAMS AVAILABLE TO ELIGIBLE PATIENTS TO ASSIST WITH MEDICATIONS AND PREVENTATIVE CARE. IT IS SANFORD'S GOAL TO SEE LESS ACCOUNTS GOING TO COLLECTIONS OR WRITTEN OFF TO BAD DEBT AND A GREATER SHARE WRITTEN OFF TO OUR FINANCIAL ASSISTANCE PROGRAM. THERE ARE OTHER ASSISTANCE PROGRAMS FOR MEDICATIONS AND WOMEN'S PREVENTATIVE CARE THAT WE CAN HELP PATIENTS GET SIGNED UP FOR AS WELL.PRIORITY 2: HEALTH CARE ACCESS: MENTAL HEALTH/BEHAVIORAL HEALTHACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE HELPS INDIVIDUALS AND FAMILIES ACCESS NEEDED PRIMARY CARE, SPECIALISTS, AND EMERGENCY CARE, BUT DOES NOT ENSURE ACCESS ON ITS OWNIT IS ALSO NECESSARY FOR PROVIDERS TO OFFER AFFORDABLE CARE, BE AVAILABLE TO TREAT PATIENTS, AND BE IN RELATIVELY CLOSE PROXIMITY TO PATIENTS.SANFORD HAS MADE HEALTH CARE ACCESS: MENTAL HEALTH/BEHAVIORAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO PROMOTE ALTERNATIVE VISIT TYPES AND TO ALLOW OPEN SCHEDULING AND EXPANSION OF WEEKEND HOURS. IT IS SANFORD'S GOAL TO OFFER THE ALTERNATIVE VISITS, ADDING OPEN SCHEDULING AND EXPANSION OF OUR WEEKEND HOURS, THUS ALLOWING GREATER ACCESS TO OUR PROVIDERS FOR THE COMMUNITY AND WILL ADVERTISE THESE SO THE COMMUNITY IS AWARE.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARACCESS TO AFFORDABLE HEALTH CARESANFORD VERMILLION ESTABLISHED TWO GOALS TO SUPPORT IMPROVED ACCESS TO AFFORDABLE HEALTH CARE. THE FIRST GOAL CENTERED ON BUILDING UPON CURRENT EFFORTS TO PROMOTE THE ORGANIZATION'S FINANCIAL ASSISTANCE PROGRAM TO REDUCE BAD DEBT AND INCREASE UTILIZATION BY POPULATIONS THAT WOULD BENEFIT. THE SECOND GOAL IS TO PROMOTE AWARENESS OF OTHER ASSISTANCE PROGRAMS FOR MEDICATIONS AND PREVENTATIVE CARE. ONE ILLUSTRATION OF THE NEED IS THROUGH THE 436 SEARCHES CONDUCTED WITHIN THE COMMUNITY ON THE FINDHELP PLATFORM IN 2022. OVER A QUARTER OF SEARCHES (28%) WERE FOR HEALTH-RELATED TOPICS WITH SEVERAL RELATED TO COST APPEARING ON THE MOST-SEARCHED LIST, INCLUDING "DISCOUNTED HEALTHCARE," "HELP PAY FOR HEALTHCARE, AND "MEDICAL BILLS."THE HOSPITAL PROVIDED A FINANCIAL ASSISTANCE PROGRAM PATIENT BROCHURE TO ALL ADMITTED PATIENTS IN 2022. THE PLAN IS TO DISPLAY THIS BROCHURE AT THE CENTRAL REGISTRATION AREA, CLINIC AND OUTPATIENT WAITING ROOMS. THE CLINIC PROVIDED THE BILLING OFFICE'S BUSINESS CARDS WITH THEIR PHONE NUMBER TO PATIENTS WHO WISHED TO CALL ABOUT THE FINANCIAL ASSISTANCE PROGRAM OR HAD OTHER BILLING INQUIRIES. FINANCIAL ASSISTANCE PACKETS WERE ALSO PROVIDED TO PATIENTS AS REQUESTED AT THE CLINIC. THE CLINIC ALSO HAS THE MEDDATA PATIENT BROCHURE IN THEIR LOBBY FOR PATIENTS TO ACCESS ON THEIR PROGRAM TO ASSIST WITH MEDICAL BILLS FOR UNINSURED AND/OR GAPS IN COVERAGE.THE CLINIC DIRECTOR ENSURED EDUCATION WAS PROVIDED AT ORIENTATION FOR STAFF AND PROVIDERS ON PATIENT ASSISTANCE PROGRAMS FOR MEDICATIONS AND PREVENTATIVE CARE SUCH AS NEEDYMEDS.COM AND ALL WOMEN COUNT. THE CLINIC HEALTH COACH AND NEW COMMUNITY HEALTH CARE WORKER (OCTOBER 2022) ASSISTED PATIENTS WITH ACCESSING THESE RESOURCES FOR THOSE APPLICABLE. THE FINANCIAL ASSISTANCE PROGRAM APPLICATION FORM IS AVAILABLE AT THE CLINIC OR HOSPITAL AND ON THE SANFORD WEBSITE FOR PATIENTS TO ACCESS. THE OTHER ASSISTANCE PROGRAMS ARE ALSO ON THE WEBSITE AND BROCHURES FOR EACH ARE IN THE CLINIC LOBBY AND ARE PROVIDED TO APPLICABLE PATIENTS. THE HOSPITAL HAS A LIST OF RESOURCES CREATED BY THE SOCIAL WORKER THAT IS REVIEWED WITH AND GIVEN TO APPLICABLE PATIENTS AT DISCHARGE. THE WRITE OFFS FOR BAD DEBT (ACCOUNTS SENT TO COLLECTIONS) IN 2022 DECREASED FROM 2021 BY OVER $389,000 WHICH WAS ONE OF THE GOALS. TOTAL WRITTEN OFF TO THE FINANCIAL ASSISTANCE PROGRAM IN 2022 WAS DOWN APPROXIMATELY $15,000 FROM 2021.CLINIC STAFF AND PROVIDERS HAVE ALSO PROMOTED DIRECT ACCESS LABS TO PATIENTS WHO MAY BENEFIT FROM THEM, SUCH AS THOSE WITH HIGH DEDUCTIBLES. FOR THESE LABS, PATIENTS CAN COME IN AND GET LAB SERVICES WITHOUT SEEING A PROVIDER AND PAY A REDUCED COST AT TIME OF SERVICE; NO INSURANCE IS BILLED. SANFORD VERMILLION IS ALSO LISTED AS A SITE ON SANFORD HEALTH'S WEBSITE THAT OFFERS DIRECT ACCESS LABS. IN 2021 VERMILLION CONDUCTED 77 DIRECT ACCESS LABS AND IN 2022 IT INCREASED TO 219.HEALTH CARE ACCESS: MENTAL HEALTH/BEHAVIORAL HEALTH TWO GOALS WERE ESTABLISHED VIA THE CHNA TO INCREASE ACCESS TO MENTAL AND BEHAVIORAL HEALTH; PROMOTE ALTERNATIVE VISIT TYPES TO INCREASE ACCESS-VERBAL, VIDEO, TELEHEALTH, AND DIRECT ACCESS LABORATORY VISITS AND ALLOW OPEN SCHEDULING AND EXPANSION OF WEEKEND HOURS.ALL BEHAVIORAL HEALTH VISITS WERE OPENED UP TO VIRTUAL VISITS AT THE END OF 2022. THE INTEGRATED HEALTH THERAPIST (IHT) OFFERS ALL VISIT TYPES INCLUDING IN-PERSON, VIDEO, TELEHEALTH, AND PHONE VISITS. THE OUTREACH PSYCHOLOGY PROVIDER WHO COMES TO VERMILLION OFFERS TELEHEALTH WHEN THERE'S INCLEMENT WEATHER AND THE OTHER MENTAL HEALTH COUNSELOR ONLY OFFERS IN-PERSON VISITS. THE NUMBER OF BEHAVIORAL/MENTAL HEALTH VISITS INCREASED AT THE CLINIC FROM 2,149 TO 2,412 IN 2022 COMPARED TO 2021. HOWEVER, THE NUMBER AND % OF CANCELED VISITS AND NO-SHOW APPOINTMENTS DID NOT DECREASE BUT REMAINED ABOUT 5%, IN LINE WITH THE INDUSTRY AVERAGE.BEHAVIORAL/MENTAL HEALTH PROVIDERS EACH HAVE A PAGE DESCRIPTION ON THE SANFORD CLINIC VERMILLION WEBSITE FOR PATIENTS TO ACCESS INFORMATION ABOUT THEM. THEY WERE ALSO FEATURED AND PROMOTED AT THE 4/12/22 DHF EVENING FOR WOMEN, "MENTAL HEALTH AND EMOTIONAL RESILIENCY." THE ALTERNATE VISIT TYPES ARE PROMOTED BY CLINIC STAFF AND PROVIDERS, THROUGH THE SANFORD WEBSITE, WITH OUR OUTREACH PROVIDER ADS AND WITH OUR MYCHART APP WHERE THEY CAN SELF-SCHEDULE APPOINTMENTS. THE ACCESSIBILITY FOR PATIENTS TO COME IN AND GET LABS ON THEIR OWN WITHOUT SEEING A DOCTOR THROUGH THE DIRECT ACCESS LABS WAS UTILIZED BY MORE PATIENTS IN 2022 WITH 219 LABS COMPLETED COMPARED TO 77 IN 2021.OPEN SCHEDULING OF APPOINTMENTS WAS AVAILABLE TO PATIENTS IN 2022 VIA THE MYCHART APP. FOR 2022, 6% OF OUR CLINIC APPOINTMENTS WERE SCHEDULED ONLINE BY SANFORD VERMILLION PATIENTS. UNFORTUNATELY, WEEKEND BEHAVIORAL HEALTH APPOINTMENTS WERE UNABLE TO BE OFFERED IN 2022.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:AFFORDABLE HOUSINGPUBLIC TRANSPORTATIONSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 11 -- SANFORD VERMILLION MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 11 -- SANFORD VERMILLION MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 12 -- SANFORD CHAMBERLAIN MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 12 -- SANFORD CHAMBERLAIN MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 12 -- SANFORD CHAMBERLAIN MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 12 -- SANFORD CHAMBERLAIN MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: MENTAL HEALTH AND SUBSTANCE ABUSEMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO ADD ADDITIONAL MENTAL HEALTH RESOURCES IN THE COMMUNITY AND TO INCREASE ACCESSIBILITY TO MENTAL HEALTH CARE FOR YOUTH. IT IS SANFORD'S GOAL TO INCREASE MENTAL HEALTH COUNSELING AND SUBSTANCE ABUSE COUNSELING OPTIONS IN THE COMMUNITY. PRIORITY 2: ACCESS TO HEALTH CARE PROVIDERS SPECIALTY CAREACCESS TO CARE REQUIRES NOT ONLY FINANCIAL COVERAGE, BUT ALSO ACCESS TO PROVIDERS. WHILE HIGH RATES OF SPECIALIST PHYSICIANS HAVE BEEN SHOWN TO BE ASSOCIATED WITH HIGHER (AND PERHAPS UNNECESSARY) UTILIZATION, SUFFICIENT AVAILABILITY OF PRIMARY CARE PHYSICIANS IS ESSENTIAL FOR PREVENTIVE AND PRIMARY CARE, AND, WHEN NEEDED, REFERRALS TO APPROPRIATE SPECIALTY CARE.SANFORD HAS MADE ACCESS TO SPECIALTY HEALTH CARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO PROMOTE NEW SPECIALTY CARE SERVICES INCLUDING OPHTHALMOLOGY AND ORTHOPEDICS AND CREATE AWARENESS OF VIRTUAL CARE OPTIONS FOR SPECIALTY SERVICES. IT IS SANFORD'S GOAL TO PROVIDE ENHANCED ACCESS TO A VARIETY OF SPECIALTY CARE SERVICES IN THE COMMUNITY.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARMENTAL HEALTH AND SUBSTANCE ABUSETHE SANFORD CHAMBERLAIN MEDICAL CENTER IS SUPPORTING THE PRIORITY THROUGH ITS GOAL OF ADDING ADDITIONAL MENTAL HEALTH RESOURCES TO THE COMMUNITY AND INCREASING ACCESSIBILITY FOR MENTAL HEALTH CARE FOR YOUTH, SPECIFICALLY, THROUGH ITS PARTNERSHIP WITH THE CHAMBERLAIN SCHOOL DISTRICT. THE SANFORD CHAMBERLAIN MEDICAL CENTER PROVIDES MENTAL HEALTH SERVICES AND SUBSTANCE ABUSE PREVENTION EDUCATION TO STUDENTS IN THE CHAMBERLAIN SCHOOL DISTRICT. MENTAL HEALTH SERVICES INCLUDE AN EMBEDDED LICENSED MENTAL HEALTH COUNSELOR WITHIN THE MIDDLE SCHOOL AND HIGH SCHOOL. THE COUNSELOR ALSO PROVIDES SERVICES TO THE ELEMENTARY SCHOOL. THE COUNSELOR IS IN THE ELEMENTARY SCHOOL ONE HALF DAY PER WEEK AND THE MIDDLE SCHOOL/HIGH SCHOOL ONE HALF DAY PER WEEK.SANFORD CHAMBERLAIN MADE PLANS TO PROVIDE YOUTH MENTAL HEALTH FIRST AID TRAINING TO THE CHAMBERLAIN COMMUNITY FOR THE FIRST TIME. THIS PROGRAM IS SCHEDULED TO TAKE PLACE IN FEBRUARY 2023. PLANS WERE DEVELOPED IN 2022 FOR ADDITIONAL SERVICES, INCLUDING LIFE AFTER LOSS, A WHOLE FAMILY GRIEF COUNSELING PROGRAM, WERE ALSO DEVELOPED AND ARE SCHEDULED TO START AS AN ONGOING PROGRAM BEGINNING IN JANUARY 2023.ACCESS TO HEALTH CARE PROVIDERS SPECIALTY CARESANFORD CHAMBERLAIN PRIORITIZED OPHTHALMOLOGY AND ORTHOPEDICS AS TWO SPECIALTIES FOR ADDITIONAL PROMOTION LOCALLY AS PART OF THE PRIORITY IN ADDITION TO INCREASED PROMOTION OF VIRTUAL CARE OPTIONS FOR THOSE THAT QUALITY BASED UPON THEIR NEEDED TYPE OF CARE. RESIDENTS OF THE THREE COUNTIES INCLUDED IN THE CHNA-DEFINED COMMUNITY CONDUCTED 326 SEARCHES ON THE FINDHELP PLATFORM IN 2022, WITH 19% FOR HEALTH-RELATED TOPICS.UNFORTUNATELY, SANFORD HAD TO CANCEL OPHTHALMOLOGY OUTREACH TO CHAMBERLAIN DUE TO PROVIDER AVAILABILITY. THE LOCAL MEDICAL CENTER IS EXPLORING OPTIONS FOR THE SERVICE DUE TO THE IDENTIFIED NEED FOR LOCAL CATARACTS SURGERY SERVICES. ORTHOPEDIC PROCEDURES WERE RE-ESTABLISHED LOCALLY IN NOVEMBER 2022 WITH CLINT BENGE, MD PROVIDING OUTREACH SERVICES. DR. BENGE IS AN ORTHOPEDIC SURGEON BASED IN SIOUX FALLS, SD AND OFFERS ACL RECONSTRUCTION, CARTILAGE RESTORATION, HIP ARTHROSCOPY, KNEE ARTHROSCOPY, MENISCAL REPAIR AND TRANSPLANTATION, AND SHOULDER ARTHROSCOPY AND ARTHROPLASTY.SANFORD CHAMBERLAIN, AND THE SYSTEM GENERALLY, UTILIZES TELE/VIRTUAL HEALTH AS AN OPTION TO AUGMENT SOME SERVICES THAT ARE PROVIDED IN THE LOCAL COMMUNITY. SANFORD CHAMBERLAIN SET A GOAL OF INCREASING THE PROMOTION OF TELE/VIRTUAL HEALTH TO INCREASE AWARENESS OF THE OPTION WITHIN THE COMMUNITY. THE FIRST INSTALLMENT OF TELEHEALTH EDUCATION WAS PRESENTED TO THE LOCAL ADVISORY BOARD IN OCTOBER 2022.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO AFFORDABLE HEALTH CAREPHYSICAL ACTIVITY AND NUTRITIONSEXUAL ACTIVITYCOMMUNITY SAFETYCHILDCARE QUALITYAFFORDABLE HOUSINGPUBLIC TRANSPORTATION AND THE INTERNETSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD SHARED THE FINDINGS OF THE CHNA RESEARCH AND THESE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 12 -- SANFORD CHAMBERLAIN MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 12 -- SANFORD CHAMBERLAIN MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 13 -- SANFORD LUVERNE MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 13 -- SANFORD LUVERNE MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 13 -- SANFORD LUVERNE MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 13 -- SANFORD LUVERNE MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: MENTAL HEALTHMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO EXPAND MENTAL HEALTH OPPORTUNITIES AND DECREASE SUBSTANCE ABUSE IN THE COMMUNITY. IT IS SANFORD'S GOAL THAT THE COMMUNITY WOULD SEE EXPANDED ACCESS TO MENTAL HEALTH SERVICES WITHIN THE COMMUNITY.PRIORITY 2: ACCESS TO HEALTH CARE PROVIDERSACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE HELPS INDIVIDUALS AND FAMILIES ACCESS NEEDED PRIMARY CARE, SPECIALISTS, AND EMERGENCY CARE, BUT DOES NOT ENSURE ACCESS ON ITS OWNIT IS ALSO NECESSARY FOR PROVIDERS TO OFFER AFFORDABLE CARE, BE AVAILABLE TO TREAT PATIENTS, AND BE IN RELATIVELY CLOSE PROXIMITY TO PATIENTS.SANFORD HAS MADE ACCESS TO HEALTH CARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO INCREASE ACCESS TO PRIMARY CARE AND EXPAND TELEHEALTH AND DENTAL ACCESS. IT IS SANFORD'S GOAL TO PROVIDE GREATER ACCESS TO CARE USING THE VISIT STYLE PREFERRED BY THE PATIENT. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARMENTAL HEALTHSANFORD LUVERNE IS ADDRESSING THE PRIORITY WITH THE GOALS OF EXPANDING MENTAL HEALTH OPPORTUNITIES AND DECREASING SUBSTANCE ABUSE IN THE COMMUNITY. MENTAL HEALTH IS TOP OF MIND FOR AREA RESIDENTS AS COMMUNITY RESIDENTS CONDUCTED 289 SEARCHES ON THE FINDHELP PLATFORM IN 2022, WITH 19% ON HEALTH-RELATED TOPICS. "PSYCHIATRIC EMERGENCY SERVICES" APPEARED IN THE TOP FIVE MOST SEARCHED LIST.ROCK COUNTY VOTED AT END OF 2022 TO NOT RENEW THE CONTRACT WITH SW MENTAL HEALTH, THUS CREATING A NEED FOR MORE MENTAL HEALTH SERVICES IN ROCK COUNTY. THE LOCAL SANFORD TEAM MET WITH COUNTY LEADERSHIP TO DISCUSS TRANSITION AND SUBSEQUENTLY RECEIVED APPROVAL TO POST FOR A FULL TIME LICSW BEHAVIORAL HEALTH THERAPIST AND ARE CURRENTLY WAITING FOR APPLICATIONS.SANFORD'S CURRENT INTEGRATED HEALTH THERAPIST (IHT) HAS BEEN ACTIVELY ENGAGED WITHIN THE COMMUNITY THIS PAST YEAR. MENTAL HEALTH PROVIDERS ENGAGE THE 6TH GRADE CLASS OF 80-90 STUDENTS ON ISSUES SURROUNDING MENTAL HEALTH, INCLUDING MINDFULNESS, HEALTHY RELATIONSHIPS, SUBSTANCE USE, TAKING CARE OF YOUR BRAIN, BRAIN HEALTH BASICS, AND BULLYING. SANFORD'S IHT COORDINATES AND IS A PRESENTER. ALL LOCAL MENTAL HEALTH PROVIDERS MEET ONCE PER MONTH IN BRAIN HEALTH GROUP MEETINGS TO EXPLORE GAPS IN CARE, COMMUNITY ENGAGEMENT, AND AVAILABILITY. SANFORD'S IHT LEADS THESE MEETINGS OF APPROXIMATELY 20 INDIVIDUALS. THIS GROUP ORGANIZED AMERICAN FOUNDATION FOR SUICIDE PREVENTION CLASSES AND HAD APPROXIMATELY 20 PEOPLE BETWEEN THE TWO CLASSES.ORGANIZED BY SANFORD'S IHT, THE OUT OF THE DARKNESS SUICIDE PREVENTION WALK TOOK PLACE SEPT 2022 AND DREW 200-300 WALKERS.GOAL: SUBSTANCE ABUSESANFORD HEALTH HAS BEEN ACTIVELY INVOLVED IN THE COMMUNITY'S OPIOID GRANT WORK AS WELL AS WITH COMMUNITY EDUCATION. THROUGH THE OPIOID GRANT WORK, THERE HAVE BEEN TWO BILLBOARDS PUT UP WITHIN THE COMMUNITY FOR AWARENESS. IN ADDITION, ANGELA KENNECKE PRESENTED EMILY'S HOPE IN FEBRUARY 2022 AND THE 3RD GRADE HAD EMILY'S HOPE CURRICULUM PRESENTED. LOCAL SUBSTANCE USE COUNSELORS HAVE BEEN ACTIVELY INVOLVED WITH COMMUNITY EDUCATION EVENTS FOCUSING AROUND NARCAN TRAINING THROUGH THE STEVE RUMMLER HOPE FOUNDATION.ADDITIONAL EVENTS INCLUDE A JANUARY 6TH GRADE BRAIN HEALTH PRESENTATION ON SUBSTANCE USE AND ABUSE WITH 80 KIDS, A FEBRUARY OPIOID PANEL WITH 150 PEOPLE AT LUVERNE HIGH SCHOOL, SUBSTANCE USE AND ABUSE EDUCATION WITH 80 KIDS WITHIN LUVERNE HIGH SCHOOL HEALTH CLASSES, AN APRIL EDUCATION SESSION TO SANFORD LUVERNE LAB STAFF ON ADDICTION AND STIGMA WITH SEVEN PEOPLE, AND A WOMEN'S ECUMENICAL BRUNCH IN MAY WITH 100 PEOPLE COVERING EDUCATION, ADDICTION, AND FAITH.IN THE FALL, 100 PEOPLE ATTENDED AN OCTOBER PRESENTATION ON ADDICTION AND FAITH, 10 PEOPLE ATTENDED A SANFORD LUVERNE LUNCH AND LEARN ON ADDICTION AND STIGMA IN NOVEMBER, 15 LADIES ATTENDED ANOTHER NOVEMBER EVENT ON THE TOPIC WITH PINK LADIES SANFORD LUVERNE, AND 45 PEOPLE ATTENDED A COMMUNITY NALOXONE TRAINING IN DECEMBER.ACCESS TO HEALTH CARE PROVIDERSACCESS TO HEALTH CARE PROVIDERS IS ADDRESSED THROUGH INCREASING ACCESS TO FAMILY MEDICINE AND EXPANDING TELEHEALTH AND DENTAL ACCESS. DR. KAT DAHL JOINED THE LUVERNE FAMILY MEDICINE TEAM IN FEBRUARY 2022 TO EXPAND ACCESS AND HAS BUILT A FULL CASELOAD. IN THE FALL OF 2022, LUVERNE HAD A TRANSITION FROM ONE NURSE PRACTITIONER TO ANOTHER NURSE PRACTITIONER WHO ADDED AN ADDITIONAL DAY EVERY TWO WEEKS, PROVIDING GREATER ACCESS. ENCOUNTER NUMBERS CONTINUE TO INCREASE WITH THE EXPANDED ACCESS.AFTER HOURS CARE IS AVAILABLE THROUGH A VIRTUAL VISIT WITHIN THE MYCHART APP. AFTER HOURS ACUTE CARE IS NOT AVAILABLE AT LUVERNE, BUT PATIENTS CAN BE DIRECTED TO WORTHINGTON, ROCK RAPIDS, OR SIOUX FALLS. TELEHEALTH EXPANSION HAS BEEN MINIMAL THIS YEAR DUE TO LIMITED OFFERINGS. TELEPSYCH IS FREQUENTLY USED AND PRESENTLY HAS WAIT TIMES OF SEVERAL WEEKS. THIS AREA CONTINUES TO BE A FOCUS OF THE SYSTEM AND WILL EXPAND AS THE VIRTUAL HEALTH INITIATIVE GROWS.CLINIC PROVIDERS CONTINUE TO PARTNER WITH THE MOBILE DENTAL UNIT THAT COMES TO LUVERNE. THE MOBILE DENTAL UNIT COMES 1-2 DAYS PER MONTH. THE ORGANIZATION HAS ALSO PARTNERED WITH CARING HANDS CLINIC IN PIPESTONE FOR MEDICAID PATIENTS. HOWEVER, CARING HANDS NOW HAS A SEVERAL WEEK WAIT TIME.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO AFFORDABLE HEALTH CAREPHYSICAL ACTIVITY AND NUTRITIONAFFORDABLE HOUSINGCHILDCARE/DAYCARE SERVICESSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 13 -- SANFORD LUVERNE MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 13 -- SANFORD LUVERNE MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 14 -- SANFORD CANBY MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 14 -- SANFORD CANBY MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 14 -- SANFORD CANBY MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 14 -- SANFORD CANBY MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: MENTAL HEALTH MENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO FOCUS ON TWO PRIMARY GOALS: EXPANDING AWARENESS OF THE SANFORD CANBY AMBULATORY CARE MANAGER'S ROLE IN MENTAL HEALTH AND PROVIDING AND/OR SUPPORTING MENTAL HEALTH RESOURCES TO AREA YOUTH. IT IS SANFORD'S GOAL TO MAKE THE COMMUNITY MORE AWARE OF MENTAL HEALTH RESOURCES THAT ARE AVAILABLE IN THEIR LOCAL COMMUNITY.PRIORITY 2: ACCESS TO HEALTH CARE PROVIDERS ACCESS TO CARE REQUIRES NOT ONLY FINANCIAL COVERAGE, BUT ALSO ACCESS TO PROVIDERS. WHILE HIGH RATES OF SPECIALIST PHYSICIANS HAVE BEEN SHOWN TO BE ASSOCIATED WITH HIGHER (AND PERHAPS UNNECESSARY) UTILIZATION, SUFFICIENT AVAILABILITY OF PRIMARY CARE PHYSICIANS IS ESSENTIAL FOR PREVENTIVE AND PRIMARY CARE, AND, WHEN NEEDED, REFERRALS TO APPROPRIATE SPECIALTY CARE.SANFORD HAS MADE ACCESS TO HEALTH CARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO IMPROVE ACCESS TO PROVIDERS, SPECIFICALLY TO INCREASE ACCESS TO PRIMARY CARE PROVIDERS AND IMPROVE MARKETING AROUND SPECIALTY OUTREACH SERVICES. IT IS SANFORD'S GOAL THAT THE COMMUNITY WOULD FEEL EMPOWERED TO TAKE OWNERSHIP OF PREVENTATIVE HEALTH MAINTENANCE AND SEE PROGRESS TOWARDS AN OVERALL HEALTHIER POPULATION. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARMENTAL HEALTHSANFORD CANBY SUPPORTS THIS PRIORITY THROUGH A DUAL FOCUS ON EXPANDING AWARENESS OF AMBULATORY CARE MANAGER'S ROLE IN MENTAL HEALTH WITHIN THE COMMUNITY AND PROVIDING MENTAL HEALTH RESOURCES TO AREA YOUTH. A TOTAL OF 91 MENTAL HEALTH APPOINTMENTS TOOK PLACE FOR THE 2022 YEAR.ONE OF THE TACTICS IDENTIFIED BY THE HOSPITAL ROLE TO INCREASE COMMUNITY AWARENESS LEVELS WAS TO PRESENT FOUR EDUCATION SESSIONS ANNUALLY ON THE ROLE OF THE AMBULATOR CARE MANAGER. THE AMBULATORY CARE MANAGER PRESENTED TO SEVERAL STAKEHOLDER GROUPS IN 2022 IN ORDER TO EXPAND AWARENESS OF HER ROLE IN MENTAL HEALTH. THE CANBY ROTARY CLUB (OCTOBER 13) DISCUSSED WHAT MENTAL HEALTH CONDITIONS ARE AND HOW TO RECOGNIZE THEM, IN ADDITION TO COMMUNITY RESOURCES AND LOCAL SERVICES. SANFORD CANBY'S PATIENT ADVISORY AND PATIENT AND FAMILY ENGAGEMENT COUNCIL RECEIVED A SIMILAR PRESENTATION ON APRIL 27. MENTAL HEALTH AMONG THE ELDERLY, INCLUDING SIGNS AND SYMPTOMS, WAS THE TOPIC FOR NOVEMBER 11 AND DECEMBER 6 PRESENTATIONS TO THE SYLVAN PLACE RESIDENT COUNCIL AND SYLVAN COURT FAMILY COUNCIL, RESPECTIVELY. THE DISCUSSION INCLUDED INFORMATION ON THE AVAILABILITY OF LOCAL RESOURCES. THE SEVEN MEMBERS OF THE SYLVAN COURT FAMILY COUNCIL ALSO REVIEWED A VIDEO ON DEPRESSION ON MARCH 7.MENTAL HEALTH EDUCATION WAS PROVIDED BY THE AMBULATORY CARE MANAGER TO SANFORD CANBY STAFF VIA AN ARTICLE IN THE AUGUST 2022 SANFORD CANBY EMPLOYEE NEWSLETTER ON THE 988 SUICIDE & CRISIS LIFELINE. THE SAME INFORMATION WAS ALSO POSTED ON SANFORD CANBY WELLNESS CENTER'S FACEBOOK PAGE ON OCTOBER 17, 2022. IN THE COMING YEAR, INFORMATION ON DEPRESSION/MENTAL HEALTH EDUCATION AND AWARENESS WILL BE PRESENTED TO THE EMR CANBY HIGH SCHOOL STUDENTS ON MAY 8, 2023. STAFF ALSO SUPPORTED THE NATIONAL NIGHT OUT FOR AREA YOUTH ON JULY 26, 2022. REHAB, WELLNESS CENTER, AND AMBULANCE STAFF MEMBERS FROM SANFORD CANBY PARTICIPATED IN THE EVENT.ACCESS TO HEALTH CARE PROVIDERSTO SUPPORT THE PRIORITY, THE HOSPITAL IS WORKING TO INCREASE PREVENTATIVE HEALTH AND WELLNESS VISITS AND EXPAND KNOWLEDGE AND AWARENESS OF SANFORD-PROVIDED SPECIALTY OUTREACH SERVICES AVAILABLE LOCALLY. YELLOW MEDICINE COUNTY RESIDENTS AND STAFF ENGAGED THE FINDHELP PLATFORM IN 2022 WITH 114 SEARCHES, 24% OF WHICH WERE FOR HEALTH-RELATED TERMS. SANFORD CANBY HAD A TOTAL OF 969 PREVENTATIVE CARE PROVIDER ENCOUNTERS IN 2022.SANFORD PROVIDERS CONDUCTED A NUMBER OF PUBLIC ENGAGEMENTS TO INTERACT WITH THE PUBLIC IN SUPPORT OF INCREASED PREVENTATIVE CARE VISITS. DR. AYBAR AND DR. LOPEZ WERE THE GRAND MARSHALLS OF THE CANBY HAT DAZE PARADE ON JUNE 18TH. A COMMUNITY RETIREMENT PARTY WAS HELD FOR DR. AYBAR AND DR. LOPEZ WITH SANFORD'S PA-C KAHLEY MEYER IN ATTENDANCE. DR. FUHRMAN, DR. AYBAR, DR. HANSON, AND MICHELLE DANIELSON, CNP PARTICIPATED IN ADDITIONAL COMMUNITY EVENTS THROUGHOUT THE YEAR. DR. FUHRMAN AND HANSON PARTICIPATED IN THE CANBY TRUNK OR TREAT ON OCTOBER 31, 2022, WHILE DRS. FUHRMAN AND DANIELSON PARTICIPATED IN THE CANBY HOMETOWN HOLIDAY PARADE IN DECEMBER. AYBAR AND HANSON PRESENTED A MATURATION CLASS AT CANBY ELEMENTARY SCHOOL ON APRIL 27. AYBAR PROVIDED WEIGHT CERTIFICATIONS FOR MINNESOTA HIGH SCHOOL WRESTLERS IN DECEMBER 2022.SANFORD CANBY IS EXPANDING ITS MARKETING OF DIRECT ACCESS LABORATORY TESTING. DIRECT ACCESS LABORATORY TESTING BROCHURES HAVE BEEN DISPLAYED AT THE SANFORD CANBY CLINIC FRONT DESK SINCE JANUARY 2022 AND WAS EXTENDED TO THE ELECTRONIC DISPLAY TV IN THE SANFORD CANBY CLINIC WAITING AREA IN FEBRUARY 2023. DIRECT ACCESS LABS RECEIVED $7,150 IN TESTING REVENUE IN 2022.A CAMPAIGN TO EXPAND AWARENESS OF SANFORD-PROVIDED SPECIALTY AND OUTREACH SERVICES STARTED IN 2023. EFFORTS INCLUDE POSTING ONE OUTREACH PROVIDER'S INFORMATION ON THE SANFORD CANBY WELLNESS CENTER FACEBOOK PAGE EACH MONTH BEGINNING MARCH 2023 AND THE SAME INFORMATION WILL BE DISPLAYED ON THE ELECTRONIC DISPLAY TV IN THE SANFORD CANBY CLINIC WAITING AREA. 2022 VOLUMES FOR SPECIALTY AND OUTREACH SERVICES INCLUDE UROLOGY 91, CARDIOLOGY 466, NEPHROLOGY 145, GASTROENTEROLOGY 177, PODIATRY 221, AND VASCULAR 49. ADDITIONAL EDUCATION TO SANFORD CANBY EMPLOYEES WILL TAKE PLACE VIA THE EMPLOYEE NEWSLETTER EACH MONTH BEGINNING IN APRIL 2023. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:AFFORDABLE HOUSINGEMPLOYMENT AND ECONOMIC OPPORTUNITIESSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 14 -- SANFORD CANBY MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 14 -- SANFORD CANBY MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 15 -- SANFORD JACKSON MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 15 -- SANFORD JACKSON MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 15 -- SANFORD JACKSON MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 15 -- SANFORD JACKSON MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: MENTAL HEALTH MENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO ADVANCE INTEGRATED HEALTHCARE IN THE COMMUNITY AND TO INCREASE AWARENESS AND EDUCATION ON SUICIDE PREVENTION. IT IS SANFORD'S GOAL TO INCREASE THE NUMBER OF PATIENTS THAT SANFORD PROVIDES INTEGRATED HEALTH THERAPIST SERVICES TO IN THE JACKSON AREA. PRIORITY 2: ACCESS TO HEALTH CARE PROVIDERSACCESS TO CARE REQUIRES NOT ONLY FINANCIAL COVERAGE, BUT ALSO ACCESS TO PROVIDERS. WHILE HIGH RATES OF SPECIALIST PHYSICIANS HAVE BEEN SHOWN TO BE ASSOCIATED WITH HIGHER (AND PERHAPS UNNECESSARY) UTILIZATION, SUFFICIENT AVAILABILITY OF PRIMARY CARE PHYSICIANS IS ESSENTIAL FOR PREVENTIVE AND PRIMARY CARE, AND, WHEN NEEDED, REFERRALS TO APPROPRIATE SPECIALTY CARE.SANFORD HAS MADE ACCESS TO HEALTH CARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO INCREASE COMMUNITY AWARENESS OF LOCAL PROVIDERS AND INCREASE ACCESS TO SPECIALTY CARE AT SANFORD JACKSON MEDICAL CENTER. IT IS SANFORD'S GOAL TO INCREASE AWARENESS OF PRIMARY CARE PROVIDERS AND SPECIALTY CARE.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARMENTAL HEALTHSANFORD JACKSON IS WORKING ON THE GOALS OF ADVANCING INTEGRATED HEALTHCARE IN THE COMMUNITY AND INCREASING AWARENESS AND PROVIDING EDUCATION ON SUICIDE PREVENTION IN SUPPORT OF THE PRIORITY. SANFORD JACKSON MEDICAL CENTER'S INTEGRATED HEALTH THERAPIST (IHT) LEADS A COMMUNITY TASK FORCE COMPRISED OF REPRESENTATIVES FROM DES MOINES VALLEY HEALTH AND HUMAN SERVICES (PUBLIC HEALTH), LAW ENFORCEMENT OFFICIALS, EMS, INDUSTRY LEADERS, SOUTHWEST MENTAL HEALTH, AND FAMILY SERVICES NETWORK. THIS TASK FORCE MEETS MONTHLY TO DISCUSS BEHAVIORAL HEALTH ISSUES OF ALL AGES, AVAILABLE RESOURCES, AND THE IMPACT ON OUR COMMUNITY. THE IHT AND OTHER STAFF MEMBERS WERE ALSO INVOLVED IN A STRATEGIC PLANNING SUICIDE PREVENTION COHORT FACILITATED BY MINNESOTA DEPARTMENT OF PUBLIC HEALTH ALONGSIDE DES MOINES VALLEY HEALTH AND HUMAN SERVICES (PUBLIC HEALTH) AND VARIOUS OTHER LOCAL COMMUNITY STAKEHOLDERS. THIS SPECIFIC GROUP BEGAN MEETING MONTHLY IN SEPTEMBER 2021 AND CONTINUED TO DO SO THROUGH 2022 CALENDAR YEAR. THE GOAL OF THIS COHORT IS TO GAIN SKILLS TO DEVELOP A COMPREHENSIVE PLAN TO PRIORITIZE PREVENTION EFFORTS RELATED TO DEATH BY SUICIDE.IN MAY OF 2022 SANFORD JACKSON MEDICAL CENTER'S INTEGRATED HEALTH THERAPIST ALONG WITH A FAMILY NURSE PRACTITIONER COMPLETED A BEHAVIORAL HEALTH EDUCATION, AWARENESS AND RESPONSE DEVELOPMENT COURSE. THIS COURSE HELPS INCREASE KNOWLEDGE, SKILLS, AND CONFIDENCE TO SUPPORT PEOPLE WITH BEHAVIORAL HEALTH CONCERNS. ITS FOCUS IS TO ASSIST ATTENDEES TO SUPPORT PATIENTS STRUGGLING WITH A WIDE RANGE OF BEHAVIORAL HEALTH CONCERNS. IN 2022 SANFORD JACKSON MEDICAL CENTER SOUGHT TO MAINTAIN AND FILL OPEN INTEGRATED HEALTH THERAPIST POSITIONS. STAFF MEMBERS WORKED TIRELESSLY WITH SANFORD TALENT ADVISORS AND OTHER INTERNAL CONTACTS TO ATTRACT CANDIDATES AND MAINTAIN RELATIONSHIPS.SANFORD JACKSON MEDICAL CENTER STAFF IS A STRONG PRESENCE IN THE LOCAL POSITIVE COMMUNITY NORMS PROGRAM PATH, (POSITIVE ACTIONS TOWARDS HEALTH) BY ATTENDING MONTHLY AND OCCASIONAL BIMONTHLY MEETINGS. THE OVERALL GOAL IS TO CULTIVATE LASTING CULTURAL TRANSFORMATION BY INVOLVING THE STUDENTS, PARENTS, TEACHERS, AND THE ENTIRE COMMUNITY IN UNDERSTANDING NOT JUST WHAT IS CONCERNING, BUT ALSO WHAT IS HELPFUL. THEY ENCOURAGED ATTENDANCE TO MOTIVATIONAL SPEAKER, CORY GREENWOOD IN A FEBRUARY 18, 2022, PRESENTATION. THIS SPEAKER WAS BROUGHT TO OUR COMMUNITY AND SCHOOL SYSTEMS BY FUNDING PROVIDED BY PATH. ON DECEMBER 2, 2022, THE SANFORD JACKSON MEDICAL CENTER ADMINISTRATOR SIGNED THE STIGMA FREE RESOLUTION TO RECOGNIZE THE COMMUNITY NEEDS AND AGREE TO JOIN THE COLLABORATE CAMPAIGN AGAINST THE STIGMA OF MENTAL ILLNESS. SANFORD JACKSON MEDICAL CENTER WAS ESTABLISHED AS A STIGMA-FREE ZONE AND WILL CONTINUE TO HELP RAISE AWARENESS OF RESOURCES AND ENCOURAGE PATIENTS, RESIDENTS, AND FELLOW STAFF MEMBERS TO ENGAGE IN CARE AS SOON AS THE NEED IS IDENTIFIED SO RECOVERY CAN BEGIN.ACCESS TO HEALTH CARE PROVIDERSTO INCREASE ACCESS TO HEALTH CARE PROVIDERS, THE MEDICAL CENTER IS WORKING TO CREATE COMMUNITY AWARENESS OF PROVIDER OFFERING LOCAL CARE AND WORKING TO INCREASE SPECIALTY CARE ACCESS AT THE SANFORD JACKSON MEDICAL CENTER.TO INCREASE AWARENESS, SANFORD JACKSON MEDICAL CENTER PROVIDED BIOMETRIC SCREENINGS TO SIX AREA EMPLOYERS AND SCREENED 188 PEOPLE. THE RESULTS WERE GIVEN TO PATIENTS WITH INSTRUCTIONS TO FOLLOW UP WITH THEIR PRIMARY CARE PROVIDER (PCP) OR SEEK MEDICAL CARE IF ANY OF THE MEASURES FELL OUTSIDE OF THE NORMAL RANGE. ADDITIONALLY IN MARCH 2022 SANFORD JACKSON MEDICAL CENTER PARTICIPATED IN THE MARTIN COUNTY STAR HEALTH AND WELLNESS EDITION. THE MEDICAL CENTER PROVIDED A "HERE FOR YOUR HEALTH IN JACKSON" AD AND ARTICLE "WHEN SHOULD I FIND A PRIMARY CARE PROVIDER?" TO HELP GENERATE AWARENESS ABOUT THE IMPORTANCE OF HAVING A PCP. SANFORD JACKSON MEDICAL CENTER ALSO CONTINUED TO RECEIVE FEEDBACK AND COMMUNITY INPUT FROM BOTH OUR ADVISORY BOARD AND PATIENT ADVISORY BOARD. IN 2022 SANFORD JACKSON MEDICAL CENTER DESIGNED AND STARTED CONSTRUCTION ON A NEW STATE OF THE ART TELEHEALTH SUITE FOR AN IMPROVED TELEHEALTH EXPERIENCE. THE NEW TELEHEALTH SUITE IS EQUIPPED WITH A LARGE SCREEN TELEVISION, MICROPHONE, AND SPEAKERS TO ENHANCE OUR PATIENT'S TELEMEDICINE EXPERIENCE AT THE MEDICAL CENTER. THE ADDITION OF THE TELEHEALTH SUITE HAS IMPROVED THE QUALITY OF CARE FOR CURRENT TELEMEDICINE PATIENTS THAT WAS ALREADY TAKING PLACE WITH DR. EGGERS, A PEDIATRIC PSYCHIATRIST. IT ALSO PAVED THE WAY FOR EXPLORATION OF OTHER OPPORTUNITIES FOR TELEHEALTH PROVIDERS AND SPECIALTY SERVICES THAT ARE SCHEDULED TO BEGIN IN EARLY 2023. THOSE SERVICES CURRENTLY SCHEDULED TO BEGIN ARE VASCULAR HEALTH (MARCH) AND NEPHROLOGY (APRIL). IN 2022 WE ALSO SAW THE ADDITION OF AN UPGRADED ULTRASOUND MACHINE THAT IMPROVED THE ULTRASOUND OB/GYN CAPABILITIES LOCALLY, SO PATIENTS DID NOT HAVE TO TRAVEL TO RECEIVE THESE SCANS.SANFORD JACKSON MEDICAL CENTER WAS FORTUNATE TO ADD TWO TALENTED PROFESSIONALS TO ITS STAFF IN 2022. IN JANUARY OF 2022, KAITLIN JOHNSON ACCEPTED THE ROLE AS THE NEW SUPERVISOR OVER THERAPY AND REHABILITATION. KAITLIN BRINGS WITH HER A BACKGROUND THAT SPECIALIZES IN WOMEN'S HEALTH, PARKINSON'S, PEDIATRICS, GERIATRICS, CONTINENCE, POST-SURGERY, AS WELL AS SPORTS, AND ORTHOPEDIC INJURIES. SHE ALSO BRINGS WITH HER NEW THERAPIES THAT ARE NOW AVAILABLE LOCALLY SUCH AS DRY NEEDLING, CUPPING, TAPING, BALANCE THERAPY, MANUAL/HANDS ON THERAPY AND THE GRASTON TECHNIQUE. IN NOVEMBER OF 2022 SANFORD JACKSON MEDICAL CENTER INCREASED THEIR SURGICAL STAFF AND AVAILABLE SURGICAL SERVICES WITH THE ADDITION OF DR. RODNEY DYNES, MD. HE IS CURRENTLY PERFORMING COLONOSCOPIES, ENDOSCOPIES, VASECTOMIES, HEMORRHOIDECTOMY, AND LIPOMA REMOVALS, WITH PLANS TO EXPAND SERVICES IN 2023. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:PHYSICAL ACTIVITY AND NUTRITIONHUMAN IMMUNODEFICIENCY VIRUS (HIV)ALCOHOL-RELATED DRIVING DEATHSAFFORDABLE HOUSINGSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 15 -- SANFORD JACKSON MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 15 -- SANFORD JACKSON MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 16 -- SANFORD TRACY MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 16 -- SANFORD TRACY MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 16 -- SANFORD TRACY MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 16 -- SANFORD TRACY MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: PHYSICAL ACTIVITY AND NUTRITIONTHE ENVIRONMENTS WHERE PEOPLE LIVE, LEARN, WORK, AND PLAY AFFECT ACCESS TO HEALTHY FOOD AND OPPORTUNITIES FOR PHYSICAL ACTIVITY WHICH, ALONG WITH GENETIC FACTORS AND PERSONAL CHOICES, SHAPE THE HEALTH AND THE RISK OF BEING OVERWEIGHT AND OBESE.SANFORD HEALTH TRACY HAS MADE PHYSICAL ACTIVITY AND NUTRITION SIGNIFICANT PRIORITIES AND HAS DEVELOPED STRATEGIES TO CONTINUE THE RN HEALTH COACH PROGRAM AND TO BEGIN A DIABETIC EDUCATION PROGRAM. IN ADDITION, SANFORD HAS DEVELOPED A STRATEGY TO PROVIDE AN ALTERNATIVE OPTION FOR THOSE COMMUNITY MEMBERS WHO ARE HUNGRY AND/OR LACKING FOOD OPTIONS. IT IS SANFORD'S GOAL TO PROVIDE A POSITIVE IMPACT ON PHYSICAL WELLBEING SPECIFICALLY RELATED TO OBESITY AND CHRONIC ILLNESS LIKE HIGH BLOOD PRESSURE AND DIABETES, AS WELL AS A POSITIVE IMPACT ON THE LACK OF NUTRITIONAL FOOD ACCESS.PRIORITY 2: MENTAL HEALTHMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO INCREASE SCREENING FOR DEPRESSION AND TO PROMOTE AND IMPROVE ACCESS TO SERVICES. IT IS SANFORD'S GOAL THAT THE COMMUNITY WOULD SEE A LOWERED NUMBER OF MENTAL HEALTH DAYS FROM COMMUNITY MEMBERS AND A POSITIVE INCREASE IN AWARENESS OF MENTAL HEALTH SERVICES IN THE COMMUNITY.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARPHYSICAL ACTIVITY AND NUTRITIONSANFORD TRACY HAS THE GOAL OF USING THE RN HEALTH COACH AND DIABETIC EDUCATION PROGRAMS TO INCREASE AWARENESS OF DIABETES AND IMPROVE KEY MEASURES, SUCH AS A1C IN DIABETICS. SANFORD TRACY ALSO SEEKS TO SUPPORT COMMUNITY MEMBERS WHO ARE HUNGRY AND/OR LACK FOOD OPTIONS THROUGH A PANTRY LOCATION IN THE CLINIC.THE FOOD PANTRY PROGRAM BEGAN IN 2022 WITH SIX INDIVIDUALS/FAMILIES RECEIVING BOXES. DUE TO THE RESIGNATION OF BEHAVIORAL HEALTH ON-SITE STAFF IN 2022, THE PROGRAM SLOWED. IT IS MORE DIFFICULT FOR PCPS AND NURSES TO IDENTIFY THESE INDIVIDUALS AND FAMILIES IN NEED AT TIMES. THE ORGANIZATION IS EXPLORING OPTIONS TO RENEW THE PROGRAM IN 2023.REGARDING SANFORD'S RN HEALTH COACH, A1C IMPROVED QUARTERLY RATES FROM 16.6% IN Q1 2022 TO 14.4% IN Q4 OF 2022. HYPERTENSION CONTROL INCREASED FROM 84.3% IN Q1 2022 TO 87.5% IN Q4 2022. BMI DATA UNAVAILABLE DUE TO INACCURACIES IN DATA. PROVIDERS CONTINUE TO REVIEW BMI WITH PATIENTS, BUT DATA IS NO LONGER MONITORED OR MEASURED FOR QUALITY PURPOSES. THE DIABETIC EDUCATION PROGRAM STARTED 2022 SLOW DUE TO A MATERNITY LEAVE WITH STAFF. UPON RETURN IN APRIL, THE PROGRAM SAW 11 PATIENTS. COMMUNITY EDUCATION EVENTS WERE POSTPONED IN 2022 DUE TO THE MATERNITY LEAVE AND LIMITED AVAILABILITY OF STAFF. EDUCATION PROGRAMS ARE BEING CONSIDERED FOR 2023 BASED UPON STAFF AVAILABILITY.MENTAL HEALTHTHE PRIORITY WILL BE ADDRESSED BY SANFORD TRACY THROUGH TWO GOALS. THE FIRST GOAL IS TO INCREASE SCREENING FOR DEPRESSION AND REFERRALS TO BEHAVIORAL HEALTH SPECIALISTS. THE SECOND GOAL IS TO RAISE AWARENESS OF MENTAL HEALTH AND BEHAVIORAL HEALTH PROVIDERS AND SERVICES AT SANFORD TRACY.BEHAVIORAL HEALTH SCREENINGS AVERAGED APPROXIMATELY 68% FOR 2022. THE STRETCH GOAL IS TO ACHIEVE 100% SCREENING OF ALL PATIENTS TWELVE YEARS AND OLDER WITH A PRIOR HISTORY OF DEPRESSION OR ANXIETY. STAFF EDUCATION WILL CONTINUE TO HELP INCREASE THIS SCREENING NUMBER IN 2023. MENTAL HEALTH REFERRAL EFFORTS TO OUTSIDE PROVIDERS AND FACILITIES WERE PUT ON HOLD IN 2022 DUE TO THE RESIGNATION OF IN-HOUSE BEHAVIORAL HEALTH PROVIDERS AT SANFORD TRACY. THE STAFFING UPDATE ALSO PAUSED THE PROMOTION OF IN-HOUSE BEHAVIORAL HEALTH SERVICES FOR 2022. CURRENT UTILIZATION REMAINS LIMITED DUE TO AVAILABILITY CONSTRAINTS FROM HAVING ONE OUTREACH TELEMEDICINE PSYCHIATRIST. HOWEVER, THE PSYCHIATRIST SAW 197 PATIENTS VIA TELEMEDICINE VISITS IN 2022, AN INCREASE FROM 99 IN 2021.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO HEALTH CARE PROVIDERSACCESS TO AFFORDABLE HEALTH CAREEMPLOYMENT AND ECONOMIC OPPORTUNITIESPUBLIC TRANSPORTATIONAFFORDABLE HOUSINGSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 16 -- SANFORD TRACY MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 16 -- SANFORD TRACY MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 17 -- SANFORD HILLSBORO MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 17 -- SANFORD HILLSBORO MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 17 -- SANFORD HILLSBORO MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 17 -- SANFORD HILLSBORO MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: MENTAL HEALTH SERVICESMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH SERVICES A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO IMPROVE ACCESS, USE OF INTEGRATED HEALTH THERAPISTS AND IMPROVE SCREENING PROCEDURES. IT IS SANFORD'S GOAL TO REDUCE THE SEVERITY OF DEPRESSION THROUGH SCREENING AND CARE DELIVERY EFFORTS. PRIORITY 2: TRANSPORTATIONTRANSPORTATION SYSTEMS HELP ENSURE THAT PEOPLE CAN REACH EVERYDAY DESTINATIONS, SUCH AS JOBS, SCHOOLS, HEALTHY FOOD OUTLETS, AND HEALTH CARE FACILITIES, SAFELY AND RELIABLY. PUBLIC TRANSPORTATION SERVICES PLAY AN IMPORTANT ROLE FOR PEOPLE WHO ARE UNABLE TO DRIVE, PEOPLE WITHOUT ACCESS TO PERSONAL VEHICLES, CHILDREN, INDIVIDUALS WITH DISABILITIES, AND OLDER ADULTS.SANFORD HEALTH HILLSBORO HAS MADE TRANSPORTATION A SIGNIFICANT PRIORITY AND HAS DEVELOPED A STRATEGY TO WORK IN COLLABORATION WITH CITY AND COUNTY LEADERSHIP TO EXPLORE OPTIONS FOR THE LOCAL COMMUNITY AND COUNTY MEMBERS. IT IS SANFORD'S GOAL TO IMPROVE THE AVAILABILITY OF PUBLIC TRANSPORTATION THROUGH BOTH THE PROMOTION OF CURRENT RESOURCES WITHIN THE HOSPITAL AND CLINIC SETTINGS, BUT ALSO IN WORKING TO ESTABLISH NEW RESOURCES THAT EXPAND OPPORTUNITIES.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARMENTAL HEALTH SERVICES SANFORD HILLSBORO HAS ESTABLISHED TWO GOALS FOR THE MENTAL HEALTH SERVICES PRIORITY. THE FIRST IS IMPROVING PHQ-9 SCORES FOR PATIENTS WITH DEPRESSION. THE SECOND IS TO PROVIDE FOR IMPROVED ACCESS TO MENTAL HEALTH/BEHAVIORAL HEALTH SERVICES. ALTHOUGH THE FINDHELP TOOL IS NOT SPECIFIC TO MENTAL HEALTH, RESIDENTS OF THE CHNA COMMUNITY CONDUCTED 298 SEARCHES ON THE FINDHELP PLATFORM IN 2022, WITH 29% ON HEALTH-RELATED TOPICS.SANFORD HILLSBORO HAD IMPLEMENTED INTEGRATED HEALTH THERAPISTS (IHTS) INTO THE CLINICS, PRIMARILY VIA TELEHEALTH, BUT THE IHT RESIGNED, AND THE ORGANIZATION IS IN THE PROCESS OF RECRUITING A REPLACEMENT. PATIENTS AND PROVIDERS FELT THAT THE PROGRAM WAS GOING WELL, AND IT IS USED QUITE FREQUENTLY.HILLSBORO'S GO LIVE FOR SENIOR LIFE SOLUTIONS OUTPATIENT GROUP THERAPY PROGRAM RESTARTED EARLY 2023 AND WE HAVE 4-10 PATIENTS PER DAY PARTICIPATING IN THE PROGRAM. THE SERVICE PREVIOUSLY OPERATED VIRTUALLY BEGINNING IN JANUARY 2021.TRANSPORTATIONSANFORD SEEKS TO ADDRESS TRANSPORTATION PRIORITIES BY PROVIDING A COMPREHENSIVE DIRECTION OF OPTIONS AVAILABLE WITHIN THE COUNTY. COMMUNITY RESIDENTS CONDUCTED 298 SEARCHES ON THE FINDHELP PLATFORM IN 2022, WITH 11% ON TRANSIT-RELATED TOPICS. SEARCH TERMS INCLUDE "HELP PAY FOR TRANSIT," "TRANSPORTATION, AND "HELP PAY FOR GAS."A LIST OF TRANSPORTATION OPTIONS IS AVAILABLE ACROSS THE COUNTY BY SANFORD HILLSBORO IN COORDINATION WITH TRAILL COUNTY. THE COMMUNITY HAS A BUS/VAN AVAILABLE FOR USE AND INDICATIONS ARE IT IS WELL-RECEIVED IN THE COMMUNITY. A LIMITATION TO THE PROGRAM IS DRIVER AVAILABILITY.SANFORD SUPPORTS THE USE OF VIRTUAL CARE AS AN ALTERNATIVE TO IN PERSON VISITS FOR SEVERAL TYPES OF CARE. AS SUCH, SANFORD HILLSBORO PROMOTES VIRTUAL CARE INCLUDING VIDEO VISITS, TELEHEALTH, AND E-VISITS TO PATIENTS AS APPROPRIATE.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO HEALTH CAREPHYSICAL ACTIVITY AND NUTRITIONACCESS TO QUALITY CHILDCARE AND AFFORDABLE HOUSINGSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 17 -- SANFORD HILLSBORO MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 17 -- SANFORD HILLSBORO MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 18 -- SANFORD MEDICAL CENTER MAYVILLE PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 18 -- SANFORD MEDICAL CENTER MAYVILLE PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 18 -- SANFORD MEDICAL CENTER MAYVILLE PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 18 -- SANFORD MEDICAL CENTER MAYVILLE PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: MENTAL HEALTH SERVICESMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO IMPROVE ACCESS TO MENTAL HEALTH SERVICES AND REDUCE THE SEVERITY OF DEPRESSION THROUGH USE OF INTEGRATED HEALTH THERAPISTS AND IMPROVE SCREENING PROCEDURES REDUCE MORTALITY AND MORBIDITY FROM MENTAL HEALTH AND BEHAVIORAL HEALTH AND SUBSTANCE ABUSE. IT IS SANFORD'S GOAL TO REDUCE THE SEVERITY OF DEPRESSION THROUGH SCREENING AND CARE DELIVERY EFFORTS.PRIORITY 2: TRANSPORTATIONTRANSPORTATION SYSTEMS HELP ENSURE THAT PEOPLE CAN REACH EVERYDAY DESTINATIONS, SUCH AS JOBS, SCHOOLS, HEALTHY FOOD OUTLETS, AND HEALTH CARE FACILITIES, SAFELY AND RELIABLY. PUBLIC TRANSPORTATION SERVICES PLAY AN IMPORTANT ROLE FOR PEOPLE WHO ARE UNABLE TO DRIVE, PEOPLE WITHOUT ACCESS TO PERSONAL VEHICLES, CHILDREN, INDIVIDUALS WITH DISABILITIES, AND OLDER ADULTS.SANFORD HEALTH MAYVILLE HAS MADE TRANSPORTATION A SIGNIFICANT PRIORITY AND HAS DEVELOPED A STRATEGY TO WORK IN COLLABORATION WITH CITY AND COUNTY LEADERSHIP TO EXPLORE OPTIONS FOR THE LOCAL COMMUNITY AND COUNTY MEMBERS. IT IS SANFORD'S GOAL TO IMPROVE AVAILABILITY OF PUBLIC TRANSPORTATION THROUGH BOTH THE PROMOTION OF CURRENT RESOURCES WITHIN THE HOSPITAL AND CLINIC SETTINGS, BUT ALSO IN WORKING TO ESTABLISH NEW RESOURCES THAT EXPAND OPPORTUNITIES.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARMENTAL HEALTH SERVICESSANFORD MAYVILLE CHANGED TO USING THE PHQ2 FOR ALL PATIENT HEALTH QUESTIONNAIRE ON INITIAL APPOINTMENTS TO ENSURE THOSE IN NEED OF MENTAL HEALTH SERVICES ARE IDENTIFIED AND OFFERED TREATMENT. THE PANEL MANAGEMENT TEAM IS COMPLETING FOLLOW-UP FOR NEW DEPRESSION DIAGNOSIS. SANFORD HILLSBORO WILL START THE SAME PROCESS IN QUARTER TWO OF 2023.SANFORD MAYVILLE HAD IMPLEMENTED INTEGRATED HEALTH THERAPISTS (IHTS) INTO THE CLINICS, PRIMARILY VIA TELEHEALTH, BUT THE IHT RESIGNED, AND THE ORGANIZATION IS IN THE PROCESS OF RECRUITING A REPLACEMENT. PATIENTS AND PROVIDERS FELT THAT THE PROGRAM WAS GOING WELL, AND IT IS USED QUITE FREQUENTLY.TRANSPORTATIONSANFORD SEEKS TO ADDRESS TRANSPORTATION PRIORITIES BY PROVIDING A COMPREHENSIVE DIRECTION OF OPTIONS AVAILABLE WITHIN THE COUNTY. COMMUNITY RESIDENTS CONDUCTED 298 SEARCHES ON THE FINDHELP PLATFORM IN 2022, WITH 11% ON TRANSIT-RELATED TOPICS. SEARCH TERMS INCLUDE "HELP PAY FOR TRANSIT," "TRANSPORTATION, AND "HELP PAY FOR GAS."A LIST OF TRANSPORTATION OPTIONS IS AVAILABLE ACROSS THE COUNTY BY SANFORD MAYVILLE IN COORDINATION WITH TRAILL COUNTY. THE COMMUNITY HAS A BUS/VAN AVAILABLE FOR USE AND INDICATIONS ARE IT IS WELL-RECEIVED IN THE COMMUNITY. A LIMITATION TO THE PROGRAM IS DRIVER AVAILABILITY.SANFORD SUPPORTS THE USE OF VIRTUAL CARE AS AN ALTERNATIVE TO IN PERSON VISITS FOR SEVERAL TYPES OF CARE. AS SUCH, SANFORD HILLSBORO PROMOTES VIRTUAL CARE INCLUDING VIDEO VISITS, TELEHEALTH, AND E-VISITS TO PATIENTS AS APPROPRIATE.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO HEALTH CAREPHYSICAL ACTIVITY AND NUTRITIONACCESS TO QUALITY CHILDCARE AND AFFORDABLE HOUSINGSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 18 -- SANFORD MEDICAL CENTER MAYVILLE PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 18 -- SANFORD MEDICAL CENTER MAYVILLE PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 19 -- SANFORD WEBSTER MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 19 -- SANFORD WEBSTER MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 19 -- SANFORD WEBSTER MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 19 -- SANFORD WEBSTER MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: PHYSICAL ACTIVITY AND NUTRITIONTHE ENVIRONMENTS WHERE PEOPLE LIVE, LEARN, WORK, AND PLAY AFFECT ACCESS TO HEALTHY FOOD AND OPPORTUNITIES FOR PHYSICAL ACTIVITY WHICH, ALONG WITH GENETIC FACTORS AND PERSONAL CHOICES, SHAPE THE HEALTH AND THE RISK OF BEING OVERWEIGHT AND OBESE.SANFORD HAS MADE PHYSICAL ACTIVITY AND NUTRITION A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO INCREASE THE NUMBER OF PATIENTS ENGAGING WITH DIETICIANS TO IMPROVE NUTRITION AND TO CREATE A COMPREHENSIVE APPROACH TO CARE MANAGEMENT. IT IS SANFORD'S GOAL TO SEE IMPROVED HEALTH AND WELLNESS AND BETTER OVERALL MANAGEMENT OF CHRONIC DISEASES.PRIORITY 2: COMMUNITY SAFETYACCIDENTS AND VIOLENCE AFFECT HEALTH AND QUALITY OF LIFE IN THE SHORT- AND LONG-TERM, FOR THOSE BOTH DIRECTLY AND INDIRECTLY AFFECTED, AND LIVING IN UNSAFE NEIGHBORHOODS CAN IMPACT HEALTH IN A MULTITUDE OF WAYS. SANFORD HAS MADE COMMUNITY SAFETY A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO PROMOTE AND LEVERAGE RESOURCES TO ADDRESS SUBSTANCE ABUSE ISSUES AND EXPAND ACCESS TO MENTAL HEALTH AND BEHAVIORAL HEALTH CARE. IT IS SANFORD'S GOAL TO INCREASE GREATER AWARENESS OF RESOURCES AVAILABLE TO MITIGATE COMMUNITY SAFETY ISSUES. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARPHYSICAL ACTIVITY AND NUTRITIONSANFORD WEBSTER IS ADDRESSING THE PRIORITY THROUGH THE GOALS OF CREATING A COMPREHENSIVE APPROACH TO CARE MANAGEMENT AND INCREASING THE NUMBER OF PATIENTS ENGAGING WITH DIETICIANS TO IMPROVE NUTRITION. THE NEED FOR PHYSICAL ACTIVITY AND NUTRITION GOAL IS SHOWN THROUGH THE FINDHELP TOOL. IN 2022, 37% OF THE LOCAL SEARCHES ON FINDHELP WERE FOR FOOD-RELATED TOPICS.THE SANFORD WEBSTER MEDICAL CENTER HAD 173 DIETICIAN REFERRALS IN 2022. SANFORD STAFF PROMOTED DISEASE MANAGEMENT AND NUTRITION PROGRAMS WITHIN THE COMMUNITY THROUGHOUT THE YEAR TO GENERATE THE REFERRALS. MEDICAL STAFF WERE INVOLVED IN THE REFERRALS OF THESE PATIENTS TO MAKE SURE ACCESS TO NUTRITION AND PATIENT/COMMUNITY ENGAGEMENT WERE A TOP PRIORITY. THE SANFORD WEBSTER MEDICAL CENTER ENGAGED WITH 18-28 PATIENTS A MONTH WITH THE ORGANIZATION'S CHRONIC CARE MANAGEMENT PROGRAM. PROVIDERS REVIEW THE PLAN OF CARE AND THE NURSES LEADING THE PROGRAMS CONNECT WITH THE PATIENTS TO HELP IMPROVE OVERALL HEALTHCARE. THE COLLABORATION BETWEEN THE PATIENT, MEDICAL STAFF, AND NURSES INCREASED THE OVERALL PARTICIPATION IN THE PROGRAM. STAFF WERE ALSO ABLE TO REFER TO THE DIETICIAN AND CARE TEAM, CREATING GREATER OVERALL COMMUNITY ENGAGEMENT AND BETTER HEALTH WITHIN THE COMMUNITY.COMMUNITY SAFETYSANFORD WEBSTER SET TWO GOALS TO PROMOTE AND LEVERAGE RESOURCES TO ADDRESS SUBSTANCE ABUSE ISSUES AND EXPANDED ACCESS TO MENTAL HEALTH AND BEHAVIORAL HEALTH CARE TO IMPROVE COMMUNITY SAFETY.THE SANFORD WEBSTER MEDICAL CENTER PROVIDES ACCESS TO PSYCHIATRY SERVICES THROUGH TELEMEDICINE. THE WEBSTER MEDICAL STAFF WORK CLOSELY WITH DR. NUSS AND DR. EGGERS ON A FULL RANGE OF SERVICES INCLUDING SUBSTANCE ABUSE. THE WEBSTER CLINIC ASSISTED WITH 183 VISITS IN 2022 TO HELP ADDRESS SUBSTANCE ABUSE ISSUES WITHIN THE COMMUNITY. THE SANFORD WEBSTER MEDICAL CENTER PROVIDES ACCESS TO AN INTEGRATED HEALTH THERAPIST. THE ENGAGEMENT AND ACCESS ARE DRIVEN BY THE MEDICAL STAFF TO PROVIDE REFERRALS AND ACCESS INTO THIS SERVICE LINE. INTEGRATED HEALTH PROVIDERS HAD 222 IHT APPOINTMENTS IN 2022. INTEGRATED HEALTH THERAPISTS ARE AVAILABLE DURING CLINIC HOURS FOR AVAILABLE APPOINTMENT WITH DR. DANIELS. THE UTILIZATION AND ACCESS WERE IDENTIFIED AND HAS BEEN UTILIZED BY THE COMMUNITY AND MEDICAL STAFF.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO AFFORDABLE HEALTH CAREEMPLOYMENT AND ECONOMIC OPPORTUNITIESSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 19 -- SANFORD WEBSTER MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 19 -- SANFORD WEBSTER MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 20 -- SANFORD MEDICAL CENTER WHEATON PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 20 -- SANFORD MEDICAL CENTER WHEATON PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 20 -- SANFORD MEDICAL CENTER WHEATON PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 20 -- SANFORD MEDICAL CENTER WHEATON PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: MENTAL HEALTH AND SUBSTANCE ABUSE MENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH AND SUBSTANCE ABUSE SIGNIFICANT PRIORITIES AND HAS DEVELOPED STRATEGIES TO IMPROVE ACCESS TO SERVICES. IT IS SANFORD'S GOAL TO INCREASE ACCESS TO PSYCHOLOGY AND PSYCHIATRY AND TO EXPAND TELEHEALTH SERVICES. PRIORITY 2: PHYSICAL ACTIVITY AND NUTRITIONTHE ENVIRONMENTS WHERE PEOPLE LIVE, LEARN, WORK, AND PLAY AFFECT ACCESS TO HEALTHY FOOD AND OPPORTUNITIES FOR PHYSICAL ACTIVITY WHICH, ALONG WITH GENETIC FACTORS AND PERSONAL CHOICES, SHAPE THE HEALTH AND THE RISK OF BEING OVERWEIGHT AND OBESE.SANFORD HAS MADE PHYSICAL ACTIVITY AND NUTRITION SIGNIFICANT PRIORITIES HAS DEVELOPED STRATEGIES IMPROVE ACCESS TO NUTRITION AND TO PROMOTE AND SUPPORT OPPORTUNITIES FOR PHYSICAL ACTIVITY. IT IS SANFORD'S GOAL TO HAVE ADDITIONAL FOOD SOURCES AND AVAILABILITY FOR FOOD OPTIONS AND TO IMPROVE AND EXPAND COMMUNITY AREAS FOR PHYSICAL ACTIVITY.ADDRESSING OF SIGNIFICANT NEEDS DURING THE CURRENT YEARMENTAL HEALTH AND SUBSTANCE ABUSESANFORD MEDICAL CENTER WHEATON IS WORKING TO IMPROVE ACCESS TO SERVICES BY ADVANCING TELEHEALTH SERVICES, EXPANDING PSYCHOLOGY SERVICES, AND COORDINATING WITH GOVERNMENTAL ENTITIES TO EXPAND ACCESS WITHIN THEIR PROGRAMS AND FACILITIES. IN 2022, SANFORD WHEATON HAD 28 ADULT AND ONE PEDIATRIC BEHAVIORAL HEALTH REFERRALS FROM A PATIENT BASE OF 3,447. THE REFERRALS ALL OCCURRED VIA THE TELEHEALTH SERVICE. SANFORD WHEATON IS WORKING WORTH SANFORD HEALTH LEADERSHIP TO EXPLORE OPTIONS WITHIN THE ORGANIZATION FOR EXPANDED TELEHEALTH SERVICES WITH THIEF RIVER FALLS-BASED PROVIDERS AS PSYCHOLOGY CONTINUES TO BE A SERVICE WITH LIMITED LOCAL CAPACITY. SANFORD WHEATON CONTINUES TO WORK ON DEVELOPING PARTNERSHIP AND PLANNING WITH CURRENT PARTNERS TO FILL THE NEED WITHIN THE REGION AND COMMUNITY. FOR EXAMPLE, HORIZON PUBLIC HEALTH ALSO RECOGNIZES THE PRIORITY OF MENTAL CARE AND MENTAL ILLNESS AS A TOP PRIORITY IN THEIR COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP).PHYSICAL ACTIVITY AND NUTRITIONSANFORD MEDICAL CENTER WHEATON SET TWO GOALS FOR THE PHYSICAL ACTIVITY AND NUTRITION PRIORITY. THE FIRST GOAL IS TO IMPROVE ACCESS TO NUTRITION THROUGH SUPPORT OF THE COMMUNITY BACKPACK PROGRAM. THE TOP FOUR SEARCHES FROM THE COMMUNITY ON FINDHELP WERE BASED UPON FOOD INSECURITY, INCLUDING "HELP PAY FOR FOOD," "FOOD DELIVERY," "FOOD PANTRY, AND "EMERGENCY FOOD." THE SECOND GOAL IS PROMOTING AND SUPPORTING OPPORTUNITIES FOR PHYSICAL ACTIVITY.SANFORD WHEATON PARTICIPATES IN THE LOCAL BACKPACK PROGRAM PROVIDING FOOD TO CHILDREN IN THE LOCAL SCHOOLS. THE PROGRAM PROVIDES FOOD FOR CHILDREN EVERY OTHER WEEKEND BY PLACING ENTREES, CEREAL, AND SNACKS IN THEIR LOCKER. THERE ARE 51 STUDENTS THAT PARTICIPATE IN GRADES K-12 OUT OF A TOTAL STUDENT BASE OF 359. SANFORD STAFF PACK AND DELIVER THE BAGS TO A VOLUNTEER AT THE SCHOOL.SANFORD WHEATON ALSO SUPPORTS DEVELOPMENT OF BALL PARKS IN THE COMMUNITY TO PROMOTE PHYSICAL ACTIVITY. IN SUPPORT, SANFORD HAS OFFERED $10,000 OVER THE NEXT 3 YEARS FOR THE BALLPARK IMPROVEMENT PROGRAM. THE HOSPITAL IS ALSO ACTIVELY PARTICIPATING IN AN ACTIVE TRANSPORTATION GRANT WITH THE MINNESOTA DEPARTMENT OF TRANSPORTATION, COLLABORATING WITH THE LOCAL CITY AND PARK BOARD. WE ARE ALSO EXPLORING HAVING AN OPEN TIME FOR THE HOSPITAL CARDIAC REHAB SPACE AND WORKING TOWARDS A HEALTHIER COMMUNITY.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN:ACCESS TO HEALTH CARE PROVIDERSEMPLOYMENT AND ECONOMIC OPPORTUNITIESSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 20 -- SANFORD MEDICAL CENTER WHEATON PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 20 -- SANFORD MEDICAL CENTER WHEATON PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 21 -- SANFORD BAGLEY MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 21 -- SANFORD BAGLEY MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 21 -- SANFORD BAGLEY MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 21 -- SANFORD BAGLEY MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO HEALTH CARE PROVIDERSACCESS TO CARE REQUIRES NOT ONLY FINANCIAL COVERAGE, BUT ALSO ACCESS TO PROVIDERS. WHILE HIGH RATES OF SPECIALIST PHYSICIANS HAVE BEEN SHOWN TO BE ASSOCIATED WITH HIGHER (AND PERHAPS UNNECESSARY) UTILIZATION, SUFFICIENT AVAILABILITY OF PRIMARY CARE PHYSICIANS IS ESSENTIAL FOR PREVENTIVE AND PRIMARY CARE, AND, WHEN NEEDED, REFERRALS TO APPROPRIATE SPECIALTY CARE. SANFORD HEALTH IS POSITIONED LOCALLY TO HAVE A POSITIVE IMPACT ON ACCESS TO AFFORDABLE, QUALITY HEALTHCARE WITHIN THE COMMUNITY. THIS EFFORT WILL FOCUS ON TWO PRIMARY GOALS. THE FIRST GOAL IS TO HAVE INCREASED ACCESS TO PRIMARY AND SPECIALTY CARE AND THE SECOND GOAL IS TO HAVE INCREASED UTILIZATION OF TELEMEDICINE SERVICES.PRIORITY 2: MENTAL HEALTHMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HEALTH IS POSITIONED LOCALLY TO HAVE A POSITIVE IMPACT ON BEHAVIORAL HEALTH SERVICES WITHIN THE COMMUNITY. THIS EFFORT WILL FOCUS ON TWO PRIMARY GOALS. THE FIRST GOAL IS TO PROVIDE ADDITIONAL BEHAVIORAL HEALTH SERVICES WITHIN SANFORD BAGLEY. THE SECOND GOAL IS THE ASSESSMENT AND TREATMENT OF BEHAVIORAL HEALTH CONCERNS WITHIN PRIMARY CARE VISITS.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARACCESS TO HEALTH CARE PROVIDERSSANFORD BAGLEY HAS SET THE GOALS OF INCREASING ACCESS TO PRIMARY AND SPECIALTY CARE WITHIN THE COMMUNITY AND TO INCREASE UTILIZATION OF TELEMEDICINE SERVICES AS A CARE DELIVERY MECHANISM. RESIDENTS OF CLEARWATER COUNTY CONDUCTED 206 SEARCHES ON THE FINDHELP PLATFORM IN 2022. NEARLY 14% OF SEARCHES WERE FOR HEALTH-RELATED SUPPORT.EFFORTS PROGRESSED IN 2022 TO INCREASE PRIMARY AND SPECIALTY CARE WITHIN SANFORD BAGLEY CLINICS. DR. COLLEEN SWANK, MD BEGAN OFFERING PEDIATRIC CARE OUTREACH AT THE BAGLEY CLINIC ONE DAY A MONTH. DR. SWANK IS BASED IN BEMIDJI, MN. DR. SWANK HAD A TOTAL OF 18 PATIENTS SCHEDULED AND 13 VISITS COMPLETED. IN 2022, THE EPIC BUILD (PROGRAMMING NEEDED FOR SCHEDULING, DOCUMENTATION, AND BILLING) WAS COMPLETED FOR DERMATOLOGY SERVICES WITHIN THE BAGLEY CLINIC. IN DECEMBER 2022, DR. CHET MAINGI, EXPRESSED INTEREST IN PROVIDING OUTREACH DERMATOLOGY SERVICES AT THE BAGLEY CLINIC STARTING THE SPRING OF 2023. DR. MAINGI WILL BE AVAILABLE TO SEE PATIENTS APPROXIMATELY TWICE A MONTH.EFFORTS HAVE BEEN MADE TO PROMOTE UTILIZATION TELEHEALTH SERVICES FOR PRIMARY CARE APPOINTMENTS. SANFORD PROMOTED ON-DEMAND VISITS FOR PATIENTS IN 2022. THE SANFORD HEALTH PLAN PROMOTED ZERO DOLLAR ON-DEMAND URGENT CARE VIDEO VISITS 24 HOURS A DAY AND SEVEN DAYS A WEEK IN ADDITION PROMOTIONS CENTERED ON SCHEDULED VIRTUAL CARE APPOINTMENTS FOR PRIMARY CARE. THE PRIMARY CARE VIRTUAL VISITS ALLOWED EXISTING SANFORD PATIENTS TO VISIT WITH A PROVIDER IN THE PLACE OF A CLINIC VISIT. THIS OPTION WAS EXPANDED TO NOT ONLY SANFORD HEALTH PLAN PATIENTS, BUT TO ANYONE WHO WAS AN ESTABLISHED PATIENT. IN 2022, SANFORD BAGLEY CLINIC PROVIDERS HAVE BEEN TRAINED ON HOW TO CONDUCT TELEHEALTH VISITS AND EQUIPMENT WAS PROCURED (WEBCAMS-SPEAKERS). A TOTAL OF 212 TELEHEALTH VISITS WERE PERFORMED IN FAMILY MEDICINE, 17 TELEHEALTH VISITS FOR INTERNAL MEDICINE, AND 429 TELEHEALTH VISITS FOR BEHAVIORAL HEALTH.MENTAL HEALTHSIGNIFICANT WORK HAS BEEN PERFORMED IN 2022 TO INCREASE BEHAVIORAL HEALTH SERVICES AND SUPPORT IN THE SANFORD BAGLEY COMMUNITY. SANFORD CONTRACTED WITH A SENOR LIFE SOLUTIONS FOR BEHAVIORAL HEALTH SERVICES. SENIOR LIFE SOLUTIONS IS AN INTENSIVE OUTPATIENT GROUP THERAPY PROGRAM DESIGNED TO MEET THE NEEDS OF INDIVIDUALS TYPICALLY 65 AND OLDER, EXPERIENCING DEPRESSION OR ANXIETY RELATED TO LIFE CHANGES THAT ARE OFTEN ASSOCIATED WITH AGING. THE PARTICIPANTS MEET UP TO THREE TIMES PER WEEK IN A SUPPORTIVE, ENCOURAGING GROUP SETTING. THE SENIOR LIFE SOLUTION PROGRAM WAS ESTABLISHED IN 2022 AND BEGAN SEEING PATIENTS IN DECEMBER OF 2022. THE PROGRAM PERFORMED 27 THERAPY SESSIONS IN 2022.SANFORD BAGLEY CLINIC MADE DEPRESSION SCREENING AT ROUTINE PRIMARY CARE VISITS A FOCUS FOR 2022. DEPRESSION IS A SERIOUS MEDICAL ILLNESS ASSOCIATED WITH HIGHER RATES OF CHRONIC DISEASE, INCREASED HEALTH CARE UTILIZATION, AND IMPAIRED FUNCTIONING. SANFORD BAGLEY CLINIC DEPRESSION SCREENING RATE WAS AT 65.2% IN JANUARY 2022. A SCREENING RATE GOAL OF 87.4 % WAS ESTABLISHED AND STEADY PROGRESS WAS MADE THROUGHOUT THE YEAR TO MEET THIS TARGET. THE DEPARTMENT EXCEEDED THE GOAL IN NOVEMBER (87.7%) AND MET THE GOAL AGAIN IN DECEMBER (87.3%). THE DEPARTMENT WILL FOCUS ON MAINTAINING THIS AND THEIR STRETCH GOAL WILL CONTINUE TO BE 95%. DEPRESSION REMISSION AT 12 MONTHS WAS AT 17.56%. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:LONG-TERM CARE, NURSING HOMES, AND SENIOR HOUSINGAFFORDABLE HOUSINGCOMMUNITY SAFETY ACCESS TO AFFORDABLE HEALTH CAREPUBLIC TRANSPORTATIONACCESS TO QUALITY HEALTH CARESANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 21 -- SANFORD BAGLEY MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 21 -- SANFORD BAGLEY MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 22 -- SANFORD CANTON-INWOOD MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 22 -- SANFORD CANTON-INWOOD MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 22 -- SANFORD CANTON-INWOOD MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 22 -- SANFORD CANTON-INWOOD MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO AFFORDABLE HOUSINGTHERE IS A STRONG AND GROWING EVIDENCE BASE LINKING STABLE AND AFFORDABLE HOUSING TO HEALTH. AS HOUSING COSTS HAVE OUTPACED LOCAL INCOMES, HOUSEHOLDS NOT ONLY STRUGGLE TO ACQUIRE AND MAINTAIN ADEQUATE SHELTER, BUT ALSO FACE DIFFICULT TRADE-OFFS IN MEETING OTHER BASIC NEEDS. WHEN THE MAJORITY OF A PAYCHECK GOES TOWARD THE RENT OR MORTGAGE, IT CAN BE DIFFICULT TO AFFORD DOCTOR VISITS, HEALTHY FOODS, UTILITY BILLS, AND RELIABLE TRANSPORTATION TO WORK OR SCHOOL. THIS CAN, IN TURN, LEAD TO INCREASED STRESS LEVELS AND EMOTIONAL STRAIN. SANFORD HAS MADE ACCESS TO AFFORDABLE HOUSING A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO INCREASE HOUSING OPTIONS WHICH WOULD SEE AN INCREASE IN POPULATION AND ABILITY FOR CITIZENS TO AGE IN PLACE VERSUS MOVING OUT OF TOWN DUE TO NO OPTIONS. THIS WORK WILL PROVIDE A MUCH NEEDED ECONOMIC STIMULUS TO THE COMMUNITY, AS WELL AS INCREASED ACCESS TO AFFORDABLE HOUSING OPTIONS. IT IS SANFORD'S GOAL TO WORK WITH THE CANTON ECONOMIC DEVELOPMENT CORPORATION (CEDC) TO RECRUIT A DEVELOPER TO CANTON TO BUILD AFFORDABLE MULTI-FAMILY AND SINGLE-FAMILY HOMES.PRIORITY 2: ACCESS TO SENIOR LIVINGLONG-TERM CARE REFERS TO A BROAD RANGE OF SERVICES AND SUPPORTS TO MEET THE NEEDS OF FRAIL OLDER ADULTS AND OTHER PEOPLE WHO ARE LIMITED IN THEIR ABILITIES FOR SELF-CARE BECAUSE OF CHRONIC ILLNESS, DISABILITY, AGE, OR OTHER HEALTH-RELATED CONDITIONS. THESE SERVICES HELP PEOPLE LIVE AS INDEPENDENTLY AND SAFELY AS POSSIBLE WHEN THEY CAN NO LONGER PERFORM EVERYDAY ACTIVITIES ON THEIR OWN. CARE CAN BE PROVIDED IN THE HOME, A NURSING HOME, OR IN A VARIETY OF OTHER SETTINGS.SANFORD HAS MADE ACCESS TO SENIOR LIVING A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO EXPLORE ADDITIONAL OPTIONS FOR SENIOR CARE, INCLUDING HOME-BASED CARE AND HOUSING ALTERNATIVES. IT IS SANFORD'S GOAL TO DO A HOME HEALTH FEASIBILITY STUDY AND EXPAND SENIOR HOUSING OPTIONS IN THE COMMUNITY.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARACCESS TO AFFORDABLE HOUSINGSANFORD CANTON-INWOOD MEDICAL CENTER SEEKS TO INCREASE ACCESS TO AFFORDABLE HOUSING THROUGH ITS MEMBERSHIP IN AND SUPPORT OF THE CANTON ECONOMIC DEVELOPMENT CORPORATION (CEDC). THE CEDC IS WORKING TO INCREASE THE NUMBER OF AFFORDABLE HOUSING AND CUSTOM-BUILT HOMES AVAILABLE IN THE COMMUNITY. AN EXAMPLE OF THE NEED IS SHOWN THROUGH THE SANFORD FINDHELP TOOL. RESIDENTS OF THE CHNA AREA, EXCLUDING SIOUX FALLS, HARRISBURG, AND TEA CONDUCTED 326 SEARCHES IN 2022 WITH HALF ORIGINATING FROM THE CANTON, SD ZIP CODE. HOUSING-RELATED TERMS WERE ONE-FOURTH OF ALL SEARCHES, WITH TERMS SUCH AS "HELP PAY FOR HOUSING AND "HOUSING VOUCHERS" COMMONLY USED.THE CANTON ECONOMIC DEVELOPMENT CORPORATION (CEDC) PURCHASED THE 64.12-ACRE PARCEL FROM THE CANTON INWOOD AREA HEALTH FOUNDATION ON SEPTEMBER 1, 2022. AN AGREEMENT WAS LATER SIGNED WITH EXP GROUP TO CREATE A LIMITED LIABILITY COMPANY (LLC) CALLED MONARCH DEVELOPMENT PARTNERS ON OCTOBER 17, 2022. THIS AGREEMENT WILL BRING EXP GROUP AND CANTON ECONOMIC DEVELOPMENT CORPORATION TOGETHER TO DESIGN A LAYOUT OF THE HOUSING DEVELOPMENT TO COVER MULTI-FAMILY AND SINGLE-FAMILY HOUSING IN ADDITION TO GREEN SPACES AND A BIKE/WALKING TRAIL. ENGINEERS ARE CURRENTLY CONDUCTING THE NECESSARY SURVEYS SO THAT THE ARCHITECT AND DESIGNER CAN MAP THE DEVELOPMENT. ONCE MAPPED, THE PROJECT WILL SEEK APPROVAL FROM THE CITY OF CANTON.AN AREA OF INTEREST TO THE ORGANIZATION IS LEGISLATION RECENTLY PASSED BY THE SOUTH DAKOTA LEGISLATURE. SB41 WILL PROVIDE $200 MILLION DOLLARS TO INFRASTRUCTURE PROJECTS, LIKE THE ONE TAKING PLACE IN CANTON. THE BILL HAS THE POTENTIAL TO SPEED UP THE PROJECT, SHOULD IT BE SELECTED AS PART OF THE PROCESS. ACCESS TO SENIOR LIVING SANFORD IS WORKING TO EXPAND ACCESS TO SENIOR LIVING THROUGH A COMBINED EFFORT OF EXPANDED LOCAL SENIOR HOUSING OPTIONS AND VIA POTENTIAL DEVELOPMENT OF HOME HEALTH SERVICES IN THE COMMUNITY. SANFORD CANTON PROVIDES HOME HEALTH SERVICES TO THE COMMUNITY ON AN AS-NEEDED BASIS. ADDITIONALLY, SANFORD HOME HEALTH AND COMMUNITY SERVICES IN SIOUX FALLS SENDS SANFORD NURSES TO CANTON PATIENTS WHO QUALIFY FOR AND NEED HOME HEALTH SERVICES. SANFORD CANTON CLINIC STAFF AND PROVIDERS ARE AWARE THAT HOME HEALTH IS AN OPTION IN CANTON FOR THOSE THAT QUALIFY.THE LOCAL RN CARE MANAGER FOR THE CANTON AND BERESFORD CLINICS PROVIDES ASSISTANCE TO MANY OF OUR CHRONIC PATIENTS AND ELDERLY THAT LACK THE RESOURCES TO PROVIDE THE NECESSARY TREATMENTS ON THEIR OWN. THE CARE MANAGER HELPS THEM FIND HOUSING, FOOD, AND UTILITY ASSISTANCE. ADDITIONALLY, SHE WORKS WITH DRUG COMPANIES TO GET MEDICATION VOUCHERS FOR PATIENTS AND WILL HELP PATIENTS GET SET UP ON THEIR DIABETIC TREATMENTS. THE CARE MANAGER WILL HELP MONITOR DIABETIC PATIENTS AND WILL PROVIDE EDUCATION TO PATIENTS AS NEEDED. SHE HAS SUPPORTED PROVIDERS IN THE CLINIC BY TAKING PATIENTS THAT ARE NOT ALWAYS COMPLIANT AT HOME AND NEED ADDITIONAL HELP. SHE HELPS PROVIDE SUPPORT AND HELPS NURTURE THEM SO THAT THEY CAN, AT SOME POINT, SUPPORT THEMSELVES IN THEIR OWN HOME.SANFORD CANTON-INWOOD HAS WHAT SANFORD CALLS THE RURAL HEALTH COOP. THE RURAL HEALTH COOP COMES TO CANTON ON MONDAYS FROM 11-1 P.M. TO HELP THOSE 18 AND OVER WITH NO INSURANCE, MEDICAID, OR MEDICARE. THEY HAVE TWO RN'S AND A PHARMACIST THAT ASSIST WITH THESE PATIENTS. THEY ALSO HAVE ACCESS TO A NURSE PRACTITIONER AND A DIETICIAN.WE CONTINUE TO EVALUATE OPTIONS TO EXPAND SENIOR CARE SERVICES IN THE COMMUNITY AS RESOURCES ALLOW.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO AFFORDABLE HEALTH CAREMENTAL HEALTH AND SUBSTANCE ABUSEPUBLIC TRANSPORTATION SANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 22 -- SANFORD CANTON-INWOOD MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 22 -- SANFORD CANTON-INWOOD MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 23 -- SANFORD CLEAR LAKE MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 23 -- SANFORD CLEAR LAKE MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 23 -- SANFORD CLEAR LAKE MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 23 -- SANFORD CLEAR LAKE MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO HEALTH CARE PROVIDERS/AFFORDABLE HEALTH CAREACCESS TO CARE REQUIRES NOT ONLY FINANCIAL COVERAGE, BUT ALSO ACCESS TO PROVIDERS. WHILE HIGH RATES OF SPECIALIST PHYSICIANS HAVE BEEN SHOWN TO BE ASSOCIATED WITH HIGHER (AND PERHAPS UNNECESSARY) UTILIZATION, SUFFICIENT AVAILABILITY OF PRIMARY CARE PHYSICIANS IS ESSENTIAL FOR PREVENTIVE AND PRIMARY CARE, AND, WHEN NEEDED, REFERRALS TO APPROPRIATE SPECIALTY CARE.ACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE HEALTH CARE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET. SANFORD HEALTH CLEAR LAKE HAS MADE ACCESS TO HEALTH CARE PROVIDERS AND AFFORDABLE HEALTH CARE SIGNIFICANT PRIORITIES AND HAS DEVELOPED STRATEGIES TO RECRUIT AN ADDITIONAL PRIMARY CARE PROVIDER AND TO INCREASE ANNUAL WELLNESS VISITS. IT IS SANFORD'S GOAL TO INCREASE MEDICAL STAFF RESULTING IN INCREASED APPOINTMENT AVAILABILITY, AS WELL AS A GREATER PATIENT CHOICE IN PROVIDERS. PRIORITY 2: TRANSPORTATIONTRANSPORTATION SYSTEMS HELP ENSURE THAT PEOPLE CAN REACH EVERYDAY DESTINATIONS, SUCH AS JOBS, SCHOOLS, HEALTHY FOOD OUTLETS, AND HEALTHCARE FACILITIES, SAFELY AND RELIABLY. PUBLIC TRANSPORTATION SERVICES PLAY AN IMPORTANT ROLE FOR PEOPLE WHO ARE UNABLE TO DRIVE, PEOPLE WITHOUT ACCESS TO PERSONAL VEHICLES, CHILDREN, INDIVIDUALS WITH DISABILITIES, AND OLDER ADULTS.SANFORD HEALTH CLEAR LAKE HAS MADE TRANSPORTATION A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO DEVELOP A SUSTAINABLE PUBLIC TRANSPORTATION SERVICE IN THE CLEAR LAKE COMMUNITY AND TO ESTABLISH AN INFRASTRUCTURE IMPROVEMENT PLAN TO ALLOW FOR ENHANCED WALKABILITY IN THE CLEAR LAKE COMMUNITY. IT IS SANFORD'S GOAL TO IMPROVE THE AVAILABILITY OF TRANSPORTATION OPTIONS FOR COMMUNITY MEMBERS UNABLE TO KEEP APPOINTMENTS DUE TO LACK OF PERSONAL TRANSPORTATION OPTIONS. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARACCESS TO HEALTH CARE PROVIDERS/AFFORDABLE HEALTH CARESANFORD CLEAR LAKE MEDICAL CENTER IDENTIFIED A NEED FOR ADDITIONAL PRIMARY CARE AVAILABILITY AND INCREASED USE OF WELLNESS VISITS THROUGH ITS CHNA PROGRAM. TO ADDRESS THIS PRIORITY, SANFORD CLEAR LAKE SET THE GOALS OF RECRUITING TWO PRIMARY CARE PROVIDERS AND INCREASING WELLNESS VISITS BY 10% BY THE END OF 2024.SANFORD CLEAR LAKE WAS ABLE TO HIRE TWO NEW PRIMARY CARE ADVANCED PRACTICE PROVIDERS (APPS) IN THE LAST YEAR. AS A RESULT, THE CLINIC IS NOW STAFFED MONDAY THROUGH FRIDAY BY TWO PA-CS AND ONE CNP. ONE PROVIDER ALSO DOES OUTREACH SERVICES TO THE SANFORD CANBY CLINIC.TO INCREASE WELLNESS VISITS, SANFORD CLEAR LAKE IS WORKING INTERNALLY WITH THE ORGANIZATION'S MARKETING DEPARTMENT AND PHYSICIANS ON EXPANDED COMMUNITY CAMPAIGNS. DURING THE PAST YEAR, THE MARKETING DEPARTMENT COMPLETED VIDEOS ON ALL NEW PROVIDERS HIGHLIGHTING THEIR BIOGRAPHIES. THE VIDEOS ARE AVAILABLE ON SANFORDHEALTH.ORG. THE NEW PROVIDERS WERE INTRODUCED TO THE COMMUNITY THROUGH COORDINATED SOCIAL MEDIA AND NEWSPAPER CAMPAIGNS. THE NEW PROVIDER SOCIAL MEDIA POSTS SHOWED SIGNIFICANT ENGAGEMENT WITH OUR MARKET WITH HUNDREDS OF VIEWS AND SHARED VIDEOS. FOR REFERENCE, THE POPULATION OF DEUEL COUNTY, THE CHNA COMMUNITY, IS 1,220 AS PROVIDED IN THE CHNA REPORT. ADDITIONALLY, DEUEL COUNTY RESIDENTS CONDUCTED 67 SEARCHES ON THE FINDHELP PLATFORM IN 2022, WITH 13% FOR HEALTH-RELATED TOPICS.PROVIDER ENGAGEMENT WITH THE COMMUNITY INCLUDED OUTREACH TO THE CRYSTAL SPRINGS RODEO, THE ST PATRICK'S DAY PIE AUCTION, AND THE COMMUNITY'S THURSDAYS ON THIRD MUSIC NIGHT. TWO PROVIDERS ATTENDED THE DEUEL COUNTY COMMUNITY FOUNDATION'S TOUR OF TABLES IN OCTOBER 2022. ALL OF THESE ACTIVITIES PROMOTE PRIMARY CARE PROVIDERS ENGAGING WITH THE COMMUNITY.TRANSPORTATION SANFORD CLEAR LAKE ESTABLISHED TWO GOALS FOR THE PRIORITY, INCLUDING THE DEVELOPMENT OF A SUSTAINABLE PUBLIC TRANSPORTATION SERVICE FOR THE CLEAR LAKE COMMUNITY BY 2024 AND ESTABLISHING AN INFRASTRUCTURE IMPROVEMENT PLAN TO ALLOW FOR ENHANCED WALKABILITY IN THE CLEAR LAKE COMMUNITY. ONE IN TEN FINDHELP SEARCHES FROM THE COUNTY IN 2022 WERE TRANSIT-RELATED TOPICS. TRANSIT SEARCH TERMS INCLUDED "TRANSPORTATION FOR HEALTHCARE AND "HELP PAY FOR TRANSIT."UPON STUDY, THE DEUEL COUNTY COMMUNITY TRANSIT DETERMINED THAT RIDERSHIP WITHIN THE COMMUNITY OF CLEAR LAKE WAS LIMITED AND WOULD NOT SUPPORT A PUBLIC TRANSIT OPTION WITHIN THE CITY. AS SUCH, THE TRANSIT PROJECT WAS PUT ON HOLD AS NEXT STEPS ARE EVALUATED. SANFORD HEALTH DOES COORDINATE WITH A VOLUNTEER THAT CAN PROVIDE TRANSPORTATION TO COMMUNITY MEMBERS AND HOSPITALIZED PATIENTS BASED UPON THE VOLUNTEER'S SCHEDULE.THE MEDICAL CENTER PARTICIPATES IN THE HEALTHY HOMETOWN COMMITTEE. HEALTHY HOMETOWN IS A PROGRAM THAT ASSISTS COMMUNITIES IN IMPLEMENTING CHANGES THAT PROMOTE HEALTHY LIVING BY FOCUSING ON THREE AREAS; MOVE MORE, EAT WELL, AND FEEL BETTER. THE COMMITTEE IS WORKING WITH THE SOUTH DAKOTA DEPARTMENT OF TRANSPORTATION FOR A FLASHING CROSS WALK AND PAINTED BUMP OUTS AT HIGHWAY 15. THIS INTERSECTION IS A BUSY LOCATION WHERE MANY STUDENTS CROSS TO WALK TO AND FROM SCHOOL. INTERNALLY, SANFORD CLEAR LAKE HAD BUCKLED CONCRETE SIDEWALKS AROUND THE BUILDING THAT WERE REPAIRED IN THE SUMMER OF 2022 TO PROVIDE SAFER WALKING CONDITIONS FOR PATIENTS AND STAFF. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:MENTAL HEALTHAFFORDABLE HOUSING PHYSICAL ACTIVITY AND NUTRITIONSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 23 -- SANFORD CLEAR LAKE MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 23 -- SANFORD CLEAR LAKE MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 24 -- SANFORD WESTBROOK MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 24 -- SANFORD WESTBROOK MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 24 -- SANFORD WESTBROOK MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 24 -- SANFORD WESTBROOK MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: MENTAL HEALTHMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HEALTH WESTBROOK HAS MADE MENTAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO EXPAND THE USE OF TELEMEDICINE AND IN-HOUSE MENTAL HEALTH SERVICES AND INCREASE THE NUMBER OF SCREENINGS AND REFERRALS TO BEHAVIORAL HEALTH PROVIDERS. IT IS SANFORD'S GOAL TO SEE A LOWERED NUMBER OF MENTAL HEALTH DAYS FROM COMMUNITY MEMBERS AND A POSITIVE INCREASE IN AWARENESS OF MENTAL HEALTH SERVICES IN THE COMMUNITY.PRIORITY 2: ACCESS TO HEALTH CARE PROVIDERSACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE HELPS INDIVIDUALS AND FAMILIES ACCESS NEEDED PRIMARY CARE, SPECIALISTS, AND EMERGENCY CARE, BUT DOES NOT ENSURE ACCESS ON ITS OWNIT IS ALSO NECESSARY FOR PROVIDERS TO OFFER AFFORDABLE CARE, BE AVAILABLE TO TREAT PATIENTS, AND BE IN RELATIVELY CLOSE PROXIMITY TO PATIENTS.SANFORD HAS MADE ACCESS TO HEALTH CARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO EXPAND OUTREACH SERVICES AND TO ADDRESS THE NEED FOR LIMITED ACCESS TO DENTAL CARE. REDUCE MORTALITY AND MORBIDITY FROM MENTAL HEALTH AND BEHAVIORAL HEALTH AND SUBSTANCE ABUSE. IT IS SANFORD'S GOAL TO INCREASE THE AVAILABILITY OF SPECIALTY SERVICES LOCALLY THROUGH OUTREACH AND/OR TELEHEALTH.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARMENTAL HEALTHTHE MENTAL HEALTH PRIORITY IS BEING ADDRESSED THROUGH EXPANDED USE OF CURRENT TELEMEDICINE AND IN-HOUSE MENTAL HEALTH SERVICES AND THE ADDITIONAL GOAL OF INCREASING THE NUMBER OF SCREENINGS AND REFERRALS TO BEHAVIORAL HEALTH PROVIDERS. SANFORD WESTBROOK BEHAVIORAL HEALTH PROVIDERS RESIGNED IN 2022. AS SUCH, PROMOTION OF IN-HOUSE PROVIDERS WAS PLACED ON HOLD UNTIL A SOLUTION IS DEVELOPED TO ADDRESS THE CAPACITY NEED. UTILIZATION HAS BEEN LIMITED TO ACCESS TO ONE OUTREACH TELEMEDICINE PSYCHIATRIST. THIS PSYCHIATRIST SAW 158 PATIENTS VIA TELEMEDICINE VISITS IN 2022: UP FROM 134 IN 2021. SIMILARLY, REFERRAL EFFORTS TO OUTSIDE PROVIDERS AND FACILITIES HAVE BEEN PUT ON HOLD.BEHAVIORAL HEALTH SCREENINGS AVERAGED APPROXIMATELY 80.73% FOR 2022. THE STRETCH GOAL IS TO ACHIEVE 100% SCREENING OF ALL PATIENTS TWELVE YEARS AND OLDER WITH A PRIOR HISTORY OF DEPRESSION OR ANXIETY. STAFF EDUCATION WILL CONTINUE TO HELP INCREASE THIS SCREENING NUMBER IN 2023.ACCESS TO HEALTH CARE PROVIDERSSANFORD WESTBROOK SET A GOAL OF EXPANDED OUTREACH SERVICES TO ADDRESS THE ACCESS NEED. THE HOSPITAL CONTINUES TO RECRUIT AN ORTHOPEDIC OUTREACH SPECIALIST AND AN ADDITIONAL GENERAL SURGEON. SANFORD WORTHINGTON DOES HAVE A POSSIBLE ORTHOPEDIC AND GENERAL SURGEON THAT MAY BEGIN OUTREACH SERVICES AT SANFORD WESTBROOK IN 2023. OUTREACH TELEHEALTH APPOINTMENTS CONTINUE TO BE OFFERED WITH 2022 SEEING SEVEN ONCOLOGY TELEMED VISITS (UP FROM 0 IN 2021); 87 NEPHROLOGY TELEMED VISITS (UP FROM 79 IN 2021); FIVE INFECTIOUS DISEASE TELEMED VISITS (DOWN FROM 12 IN 2021) AND 158 PSYCH TELEMED VISITS (UP FROM 134 IN 2021). THE GOAL OF ADDRESSING THE NEED FOR LIMITED ACCESS TO DENTAL CARE, MEETINGS WITH SCHOOL PROGRAM DIRECTORS AND SCHOOL NURSE WAS COMPLETED IN 2022. THE APPLICATION AND A SUCCESSFUL RECEIPT OF A MDH COMMUNITY CLINIC GRANT TO FUND THE WESTBROOK WALNUT GROVE ELEMENTARY AND JUNIOR HIGH SCHOOLS DENTAL HEALTH PROGRAM WERE ALSO COMPLETED IN 2022. BY SEPTEMBER, THE SUPPLIES FOR THE PROGRAM WERE PURCHASED, WHICH INCLUDE TOOTHBRUSHES, TOOTHPASTE, FLOSSERS, AND FLUORIDE RINSES THAT STUDENTS RECEIVE EVERY MONTH. DENTAL EDUCATION INFORMATION FOR PROVIDERS WAS SHARED AT PROVIDER MEETINGS IN 2022. PROVIDERS AND CLINIC NURSES SHARE DENTAL INFORMATION WITH PARENTS AT ALL WELL CHILD VISITS, AS WELL AS OFFER FLUORIDE VARNISH IF APPROPRIATE AT WELL CHILD VISITS.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:COMMUNITY SAFETYENVIRONMENTAL HEALTHAFFORDABLE HOUSINGPUBLIC TRANSPORTATIONPHYSICAL ACTIVITY AND NUTRITIONEMPLOYMENT AND ECONOMIC OPPORTUNITIESSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 24 -- SANFORD WESTBROOK MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 24 -- SANFORD WESTBROOK MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 2 -- SANFORD MEDICAL CENTER FARGO PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 2 -- SANFORD MEDICAL CENTER FARGO PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 2 -- SANFORD MEDICAL CENTER FARGO PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCULDED. GROUP A-FACILITY 2 -- SANFORD MEDICAL CENTER FARGO PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO AFFORDABLE HEALTH CAREACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE HEALTH CARE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET. NDSU REPORTED HEALTH CARE ACCESSIBILITY AND COST AS TWO SEPARATE HEALTH NEEDS. THE CASS-CLAY WORKING GROUP DETERMINED THAT THE TWO TOPICS ARE MOST APPROPRIATELY ADDRESSED AS A COMBINED TOPIC FOR PURPOSES OF THE LOCAL CHNA PROCESS.SANFORD HAS MADE HEALTHCARE ACCESS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO EXPAND HEALTHCARE ACCESS AND ACCESS TO PRIMARY CARE SERVICES. IT IS SANFORD'S GOAL THAT THE COMMUNITY WOULD SEE THAT PATIENTS WILL HAVE GREATER EASE TO ACCESS PRIMARY CARE PROVIDERS FOR VIRTUAL OR IN-PERSON VISITS, HOME VISITS AND INCREASED EXPANDED HOURS. PATIENTS MAY EXPERIENCE LESS FREQUENT UTILIZATION OF EMERGENCY CARE, WHICH IS OFTEN MORE EXPENSIVE THAN PREVENTATIVE AND SCREENING SERVICES.PRIORITY 2: MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSEMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSE SIGNIFICANT PRIORITIES AND HAS DEVELOPED STRATEGIES TO RECRUIT PROVIDERS, INCREASE ACCESS TO CARE AND MENTAL HEALTH PROMOTION. IT IS SANFORD'S GOAL TO HAVE BETTER ACCESS TO AND UTILIZATION OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES DUE TO SERVICES BEING PROVIDED AT THE RIGHT TIME AND RIGHT PLACE. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEAR: ACCESS TO AFFORDABLE HEALTH CARESANFORD FARGO ESTABLISHED TWO GOALS IN SUPPORT OF THE PRIORITY, ACCESS TO AFFORDABLE HEALTH CARE. THE FIRST IS TO EXPAND HEALTHCARE ACCESS AND SUPPORT RESOURCES FOR VULNERABLE AND UNDERSERVED POPULATIONS. THE SECOND IS TO EXPAND PLATFORM AND ACCESS TO PRIMARY CARE SERVICES.ONE STRATEGY IDENTIFIED WITHIN THE COMMUNITY HEALTH NEEDS ASSESSMENT PROGRAM IS TO MAKE VIRTUAL VISITS AVAILABLE FOR ALL PRIMARY CARE PROVIDERS. AS OF THE END OF 2022, ACCESS TO TELEHEALTH IS AVAILABLE FOR ALL FAMILY MEDICINE PROVIDERS, WHICH ALLOWS PATIENTS TO RECEIVE CARE WITHIN THEIR HOMES IF THEY DO NOT HAVE ACCESS TO RELIABLE TRANSPORTATION OR CANNOT TRAVEL FOR APPOINTMENTS. TO INCREASE PRIMARY CARE AVAILABILITY, THE FAMILY MEDICINE RESIDENCY PROGRAM HAS BEGUN OUTREACH TO JEFFERSON ELEMENTARY (FARGO PUBLIC SCHOOLS) AND WILL BE EXPANDING TO YOUTHWORKS. JEFFERSON ELEMENTARY HAS APPROXIMATELY 288 STUDENTS, 231 OF WHICH ARE ELIGIBLE TO PARTICIPATE IN THE FREE LUNCH AND REDUCED-PRICE LUNCH PROGRAMS, ACCORDING TO THE NATIONAL CENTER FOR EDUCATION STATISTICS. YOUTHWORKS IS A "501C3 NON-PROFIT DEDICATED TO PROVIDING YOUTH AND FAMILY SERVICES THROUGHOUT NORTH DAKOTA. THEIR FOCUS AND EXPERTISE IS IN WORKING WITH TEENS, PARENTS, AND YOUNG ADULTS UNDER 22 YEARS OF AGE. OUR SERVICES INCLUDE PROGRAMS FOR RUNAWAY, HOMELESS AND STREET YOUTH; JUVENILE OFFENDERS; YOUTH FAILING IN SCHOOL; YOUTH SUSPENDED OR EXPELLED FROM SCHOOL; YOUNG PARENTS AND PREGNANT MOMS (UNDER 22); YOUTH ARRESTED AND UNABLE TO IMMEDIATELY RETURN HOME; YOUTH NEEDING EMERGENCY CARE; YOUTH NEEDING PEER SUPPORT OR CROSS-AGE MENTORING; AND YOUTH WITH ANGER ISSUES." THIS STRATEGY WILL HELP IMPROVE ACCESS FOR VULNERABLE AND UNDERSERVED RESIDENTS OF THE FARGO/MOORHEAD METRO AREA.A NEW PRIMARY CARE CLINIC IS UNDER CONSTRUCTION IN HORACE, ND AND IS SET TO OPEN IN 2023. THIS WILL SERVE THE NEEDS OF THE RAPIDLY GROWING TOWN OF HORACE AS WELL AS PORTIONS OF WEST FARGO TO ALLOW FOR INCREASED SPEED OF ACCESS TO INDIVIDUALS ACROSS ALL CLINICS. THREE NEW PROVIDERS WERE RECRUITED TO PRIMARY CARE. THE NEW PROVIDERS TOTALED 148 VISITS UPON STARTING IN THE FOURTH QUARTER OF 2022.MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSE THREE GOALS SUPPORT THE MENTAL HEALTH AND SUBSTANCE ABUSE GOAL. THE FIRST IS RECRUITING PROVIDERS AND INCREASING ACCESS TO CARE. THE SECOND IS TO DEVELOP A COMMUNITY STRATEGY FOR MENTAL HEALTH PROMOTION. THE THIRD IS TO DECREASE SUBSTANCE ABUSE.TO INCREASE ACCESS TO MENTAL HEALTH CARE, SANFORD FARGO EXPANDED ITS PARTNERSHIP WITH REGIONAL SCHOOLS TO PROVIDE STUDENT PLACEMENT FOR MASTER'S LEVEL THERAPISTS INTO THE INTERNAL MEDICINE DEPARTMENT. COORDINATION OF CARE WITH PRIMARY CARE, EMERGENCY DEPARTMENT, AND HOSPITAL CARE COORDINATION HAS RESULTED IN THE WAIT LIST FOR BEHAVIORAL HEALTH AND PSYCHIATRY APPOINTMENTS DECREASING FROM 2,000 PATIENTS TO 180 PATIENTS WAITING TO BE SCHEDULED. FURTHERMORE, ACCESS TO SUPPORTIVE BEHAVIORAL HEALTH SERVICES AND RESOURCES HAVE IMPROVED IN THE HOSPITAL WITH THE CREATION OF A DEDICATED UNIT AT THE SANFORD MEDICAL CENTER FARGO FOR PATIENTS ADMITTED FOR MEDICAL CARE WHO REQUIRE ADDITIONAL BEHAVIORAL HEALTH SUPPORT. IN 2022, SANFORD FARGO COMPLETED 10,083 COMPLETED VIDEO VISITS, 144 TRADITIONAL TELEMEDICINE AND 90 VERBAL VISITS.SANFORD FARGO CONDUCTED A DEPRESSION SCREENING INITIATIVE THROUGHOUT SANFORD-FARGO CLINICS TO SUPPORT COMMUNITY MENTAL HEALTH PROMOTION. THE PROMOTION RESULTED IN 40,000 DEPRESSION SCREENINGS COMPLETED BY INTERNAL MEDICINE, FAMILY MEDICINE, AND OB/GYN PROVIDERS AND RESIDENCY CLINICS. FOR ALL POSITIVE DEPRESSION SCREENINGS, THERE WAS A DOCUMENTED FOLLOW-UP PLAN WITHIN 14 DAYS OF THE SCREENING. SANFORD AMBULANCE REPORTED 1,200 PATIENTS RECEIVING CARE RELATED TO ALCOHOL USE, 1,350 RELATED TO BEHAVIORAL HEALTH/PSYCHIATRIC EPISODE. SANFORD FARGO IS ACTIVELY RECRUITING A NEW PROVIDER TO SUPPORT SUBOXONE CLINIC FOR PATIENTS WORKING ON ADDICTION AND RECOVERY TO DECREASE SUBSTANCE ABUSE. FURTHER SUPPORT IS PROVIDED THROUGH HOSPITAL PEER COACHING, WITH CONTINUED WORK WITH F5 AND THE LOTUS CENTER THROUGHOUT 2022 TO PROVIDE PEER COACHING IN THE HOSPITAL. SANFORD FARGO ALSO ENGAGES IN A PARTNERSHIP WITH CASS COUNTY'S WITHDRAWAL MANAGEMENT UNIT TO ENSURE COORDINATED UTILIZATION OF MEDICAL AND LAW ENFORCEMENT SUPPORT FOR INDIVIDUALS ACTIVELY IN DETOX.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:PHYSICAL ACTIVITY AND NUTRITIONSENIOR HOUSING AND LONG-TERM CAREPUBLIC TRANSPORTATIONAFFORDABLE HOUSING, EMPLOYMENT, ECONOMIC DEVELOPMENTDIVERSITY, INCLUSION, HEALTH EQUITYCHILDCAREHEALTH LITERACY AND NAVIGATIONSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 2 -- SANFORD MEDICAL CENTER FARGO PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 2 -- SANFORD MEDICAL CENTER FARGO PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 25 -- SANFORD THIEF RIVER FALLS BEHAVIORAL HEA PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 25 -- SANFORD THIEF RIVER FALLS BEHAVIORAL HEA PART V, SECTION B, LINE 6A: SANFORD USD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 25 -- SANFORD THIEF RIVER FALLS BEHAVIORAL HEA PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 25 -- SANFORD THIEF RIVER FALLS BEHAVIORAL HEA PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: MENTAL HEALTHMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES FOR MENTAL HEALTH PROMOTION, SUICIDE PREVENTION AND EDUCATION FOR PARENTING RELATED SKILLS. IT IS SANFORD'S GOAL TO INCREASE ACCESS TO MENTAL/BEHAVIORAL HEALTH AND SUBSTANCE ABUSE SERVICES, IN PARTICULAR FOR AT RISK YOUTH AND TO DECREASE THE NUMBER OF SUICIDES.PRIORITY 2: ACCESS TO HEALTHCARE PROVIDERSACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE HEALTH CARE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET. SANFORD HAS MADE ACCESS TO HEALTHCARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO DEVELOP A FULLTIME DERMATOLOGY CLINIC AND TO EXPAND ACCESS TO TELEHEALTH TECHNOLOGIES IN BEHAVIORAL HEALTH. IT IS SANFORD'S GOAL TO INCREASE THE NUMBER OF LOCAL PROVIDERS SERVICING THIEF RIVER FALLS THROUGH LOCALLY BASED PROVIDERS, OUTREACH FROM OTHER SANFORD FACILITIES, OR TELEHEALTH/VIRTUAL CARE PLATFORMS. INCREASED PROVIDERS WILL EXPAND THE NUMBER OF AVAILABLE SERVICES AND APPOINTMENTS AVAILABLE TO THE LOCAL COMMUNITY.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARMENTAL HEALTH SANFORD THIEF RIVER FALLS AND SANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTER ESTABLISHED TWO GOALS WITHIN THE MENTAL HEALTH PRIORITY. THE FIRST IS TO DEVELOP AND IMPLEMENT COMMUNITY STRATEGY FOR MENTAL HEALTH PROMOTION AND SUICIDE PREVENTION. THE SECOND GOAL IS TO DEVELOP AND IMPLEMENT COMMUNITY EDUCATION FOR PARENTING RELATED SKILLS.IN LATE 2021, AS PART OF THE GOAL TO DEVELOP AND IMPLEMENT COMMUNITY STRATEGY FOR MENTAL HEALTH PROMOTION AND SUICIDE PREVENTION, SANFORD BEHAVIORAL HEALTH IDENTIFIED A CORE TEAM OF STAFF AND DEVELOPED A STRATEGY TO GROW A COMMUNITY COALITION FOR MENTAL HEALTH PROMOTION AND SUICIDE PREVENTION IN OUR COMMUNITY. IN JANUARY OF 2022, SANFORD BEHAVIORAL HEALTH BEGAN MEETING MONTHLY WITH COMMUNITY PARTNERS FROM TEN PUBLIC AND PRIVATE ENTITIES INCLUDING PUBLIC HEALTH, LAW ENFORCEMENT, FAITH COMMUNITY, EDUCATION, EMPLOYERS, HEALTH CARE, AND YOUTH ACTIVITIES. OVER THE PAST YEAR, SIX ADDITIONAL PARTNERS WERE ADDED, INCLUDING SCHOOL COUNSELORS, VIP, ADDITIONAL SCHOOL DISTRICT, MENTAL HEALTH PROVIDER, HIGH SCHOOL STUDENT, AND A SUICIDE LOSS SURVIVOR. THROUGHOUT THE YEAR, THIS GROUP BECAME KNOWN AS "COMMUNITY STRONG," DEFINED OUR COMMUNITY AS PENNINGTON COUNTY, AND IDENTIFIED OUR FOCUS ON YOUTH AND FAMILY EDUCATION. COMMUNITY STRONG ESTABLISHED A VISION STATEMENT TO BE "A COMMUNITY THAT STRIVES, PROMOTES AND SEEKS OUT MENTAL AND EMOTIONAL WELLBEING AND A MISSION STATEMENT "TO EMPOWER A HEALTHY COMMUNITY IN PENNINGTON COUNTY THROUGH EDUCATION, OUTREACH AND SUPPORT THAT RESHAPES THINKING AND AWARENESS AROUND MENTAL WELL-BEING AND SUICIDE PREVENTION." IN 2022, IN PARTNERSHIP WITH COMMUNITY STRONG, SANFORD BEHAVIORAL HEALTH PROVIDED FOUR EDUCATIONAL EVENTS IN PENNINGTON COUNTY, WITH ADDITIONAL OUTREACH EVENTS.IN EARLY 2022, SANFORD BEHAVIORAL HEALTH IDENTIFIED KEY PERSONNEL TO DEVELOP A STRATEGY FOR IMPLEMENTING PARENTING RELATED SKILLS IN THE COMMUNITY AS PART OF THE GOAL TO DEVELOP AND IMPLEMENT COMMUNITY EDUCATION FOR PARENTING RELATED SKILLS. IN MAY OF 2022, SANFORD BEHAVIORAL HEALTH USED ESTABLISHED RELATIONSHIPS THROUGH THE JUVENILE DIVERSION PROGRAM TO IDENTIFY PARTNERS WHO COULD JOIN IN THE EFFORT TO IMPLEMENT AND PROMOTE THIS TYPE OF EDUCATIONAL GROUP FOR PARENTS. THROUGH WORK WITH THE TRF POLICE DEPARTMENT, PENNINGTON COUNTY SOCIAL SERVICES, PENNINGTON COUNTY COURT AND COUNTY ATTORNEY, AND TRF SCHOOL DISTRICT, IT WAS IDENTIFIED THAT THE INITIAL TARGETED POPULATION OF THIS PARENTING SKILLS EDUCATION WOULD BE PARENTS OF CHILDREN IN THE JUVENILE DIVERSION PROGRAM, OR THOSE THAT THE AGENCIES INVOLVED ARE IDENTIFYING AS ESCALATING IN CRIMINAL JUSTICE SYSTEM AND AT AN INCREASED NEED FOR SERVICES. IN LATE MAY, THE CURRICULUM TO BE USED WAS IDENTIFIED AS THE INCREDIBLE YEARS AND LOVE & LOGIC CURRICULUM. FACILITATORS WERE ALSO IDENTIFIED FROM SANFORD BEHAVIORAL HEALTH AND PENNINGTON COUNTY SOCIAL SERVICES. THE FIRST SIX-WEEK SESSION OF THE PARENTING SKILLS GROUP BEGAN IN OCTOBER OF 2022 WITH SIX FAMILIES COMPLETING THE TRAINING.ACCESS TO HEALTHCARE PROVIDERSTWO GOALS WERE ESTABLISHED TO SUPPORT THE PRIORITY, INCLUDING THE DEVELOPMENT OF A FULLTIME DERMATOLOGY CLINIC IN THIEF RIVER FALLS, AND EXPANDING THE PLATFORM AND ACCESS TO TELEHEALTH TECHNOLOGIES IN BEHAVIORAL HEALTH.TO SUPPORT THE GOAL OF DEVELOPING A FULL-TIME DERMATOLOGY CLINIC IN THIEF RIVER FALLS, SANFORD HEALTH TRF HIRED A FULL-TIME DERMATOLOGY NURSE PRACTITIONER IN APRIL OF 2021. THE DERMATOLOGIST STARTED IN THIEF RIVER FALLS AFTER SIX MONTHS OF TRAINING WITH A DERMATOLOGIST IN GRAND FORKS, SO THE COMMUNITY NOW HAS A FULL-TIME DERMATOLOGY SERVICE. CY2022 FOCUSED ON BUILDING THE PRACTICE TO INCLUDE RESOURCES NEEDED FOR SKIN TESTING, SKIN CHECKS, BIOPSIES, AND PROCEDURES ALONG WITH STAFFING AND SCHEDULING RESOURCES TO BEST ACCOMMODATE PATIENT NEEDS. AVAILABLE LOCAL DERMATOLOGY APPOINTMENTS WENT FROM MONTHLY OUTREACH, ROUGHLY 40 APPOINTMENTS, TO FULL-TIME COMMUNITY CLINIC, ROUGHLY 140 APPOINTMENTS PER MONTH. PATIENT UTILIZATION OF DERMATOLOGY SERVICES WAS BUILT AND SUSTAINED EARLY IN 2022. HELPING WITH THE PRACTICE AWARENESS AND PATIENT EDUCATION INCLUDED MARKETING THE NEW NURSE PRACTITIONER TO THE PUBLIC VIA TRADITIONAL AND SOCIAL MEDIA SOURCES, HOSTING FREE PUBLIC SKIN CHECK EVENTS, COMMUNITY OUTREACH WITH EMPLOYERS AND THE SCHOOL DISTRICT, AND PRODUCING AND DISTRIBUTING SKIN PREVENTION EDUCATIONAL MATERIALS. THIEF RIVER FALLS DERMATOLOGY IS OFFERING ROBUST GEOGRAPHICAL OFFERINGS IN OUR PRIMARY SERVICE AREA BY SPENDING TWO DAYS OF OUTREACH DERMATOLOGY TIME IN COMMUNITIES HALLOCK AND CROOKSTON, GIVING THEM 16 PATIENT APPOINTMENTS OF DERMATOLOGY ACCESS NOT PREVIOUSLY HAD. IN CY2023, THE FOCUS WILL BE ON GROWING AVAILABLE ACCESS BY INCREASING APPOINTMENTS EACH CLINIC DAY.AS PART OF THE EXPANDED PLATFORM AND ACCESS TO TELEHEALTH TECHNOLOGIES IN BEHAVIORAL HEALTH GOAL, SANFORD BEHAVIORAL HEALTH PROVIDES PATIENTS THE FLEXIBILITY OF SCHEDULING THEIR APPOINTMENT IN THE MANNER THAT BEST SUITS THEIR NEEDS, PROVIDED THAT WE ARE ABLE TO MEET REGULATORY REQUIREMENTS AND IT IS IN THE PATIENT'S BEST INTEREST CLINICALLY. AS A RESULT, MORE THAN 40% OF APPOINTMENTS ARE CURRENTLY SCHEDULED AS TELEHEALTH APPOINTMENTS. THIS DATA DOES NOT REFLECT ANY NEW PATIENT ASSESSMENTS WHO MAY BE SEEN VIA TELEHEALTH DUE TO THE INABILITY TO CAPTURE THE DATA WITHOUT A MANUAL PROCESS.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO QUALITY HEALTHCAREAFFORDABLE HOUSINGLONG-TERM CAREPUBLIC TRANSPORTATIONSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 25 -- SANFORD THIEF RIVER FALLS BEHAVIORAL HEA PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 25 -- SANFORD THIEF RIVER FALLS BEHAVIORAL HEA PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY 251 1 - SANFORD CLINIC ABERDEEN 3015 3RD AVENUE SE ABERDEEN SD 57401 MEDICAL CLINIC 2 - SANFORD CLINIC ABERDEEN SURGICAL CENTER 3015 3RD AVENUE SE ABERDEEN SD 57401 AMBULATORY SURGERY CENTER 3 - SANFORD HEALTH ADRIAN CLINIC 201 MAINE AVE ADRIAN SD 56110 RURAL HEALTH CLINIC 4 - SANFORD HEALTH BROADWAY CLINIC 1527 BROADWAY STREET ALEXANDRIA MN 56308 MEDICAL CLINIC 5 - SANFORD HEALTH EASTON PLACE CLINIC 510 - 22ND AVENUE E SUITE 602 ALEXANDRIA MN 56308 MEDICAL CLINIC 6 - SANFORD BAGLEY CLINIC 1656 CENTRAL ST W BAGLEY MN 56621 RURAL HEALTH CLINIC 7 - SANFORD BAGLEY EYE CENTER & OPTICAL 1656 CENTRAL ST W BAGLEY MN 56621 EYE CARE CENTER 8 - SANFORD TRACY BALATON CLINIC 551 HIGHWAY 14 E BALATON MN 56115 MEDICARE CERTIFIED RURAL HEALTH CLINIC 9 - SANFORD HEALTH BASSETT FAMILY CLINIC 103 CLARK ST BASSETT NE 68714 MEDICAL CLINIC 10 - SANFORD HEALTH BAUDETTE EYE CENTER 103 MAIN ST BAUDETTE MN 56623 EYE CARE CENTER 11 - BAKER PARK INC 803 DEWEY AVENUE BEMIDJI MN 56601 ASSISTED LIVING CENTER 12 - EDITH SANFORD BREAST CENTER BEMIDJI 1233 34TH ST NW BEMIDJI MN 56601 WOMEN'S HEALTH 13 - SANFORD BEMIDJI 1611 ANNE ST CLINIC 1611 ANNE ST NW BEMIDJI MN 56601 MEDICAL CLINIC 14 - SANFORD BEMIDJI 1705 ANN ST CLINIC 1705 ANNE ST NW BEMIDJI MN 56601 MEDICAL CLINIC 15 - SANFORD BEMIDJI EYE CENTER & OPTICAL 1611 ANNE ST NW BEMIDJI MN 56601 EYE CARE CENTER 16 - SANFORD BEMIDJI DOWNTOWN EYE CENTER & OP 506 BELTRAMI AVE NW BEMIDJI MN 56601 EYE CARE CENTER 17 - SANFORD BEMIDJI HOME CARE & HOSPICE 3201 PINE RIDGE AVE NW BEMIDJI MN 56601 HOME CARE AND HOSPICE 18 - SANFORD BEMIDJI MAIN CLINIC 1233 34TH ST NW BEMIDJI MN 56601 MEDICAL CLINIC 19 - SANFORD BEMIDJI OTHOPEDICS & SPORTS MEDI 1300 ANNE STREET NW BEMIDJI MN 56601 MEDICAL CLINIC 20 - SANFORD DIALYSIS BEMIDJI 1300 ANNE STREET NW BEMIDJI MN 56601 DIALYSIS 21 - SANFORD HEALTH NEILSON PLACE 1000 ANNE ST NW BEMIDJI MN 56601 SKILLED NURSING FACILITY 22 - SANFORD HEALTH TRILLIUM 930 ANNE STREET NW BEMIDJI MN 56601 ASSISTED LIVING CENTER 23 - SANFORD HEALTH WINDSONG 1000 ANNE ST NW BEMIDJI MN 56601 ASSISTED LIVING CENTER 24 - SANFORD JOE LUEKEN CANCER CENTER 1233 34TH ST NW BEMIDJI MN 56601 CANCER CENTER 25 - SANFORD BEHAVIORAL HEALTH HEADWATERS ACT 1705 ANNE ST NW BEMIDJI MN 56601 BEHAVIORAL HEALTH TREATMENT CENTER 26 - SANFORD HEALTH PRIMEWEST RESIDENTIAL 3124 HANNAH AVE NW BEMIDJI MN 56601 BEHAVIORAL HEALTH & ADDICTION CENTER 27 - SANFORD CLINIC BERESFORD 600 W CEDAR STREET BERESFORD SD 57004 RURAL HEALTH CLINIC 28 - BISMARCK CANCER CENTER 500 N 8TH STREET BISMARCK ND 58501 CANCER CENTER 29 - SANFORD BIRTH CENTER 300 N 7TH STREET BISMARCK ND 58501 BIRTH CENTER 30 - SANFORD CANCER CENTER BISMARCK 300 N 7TH STREET BISMARCK ND 58501 CANCER CENTER 31 - SANFORD CHILDREN'S NORTH CLINIC 765 W INTERSTATE AVE BISMARCK ND 58503 CHILDREN'S CLINIC 32 - SANFORD CLINIC 222 N 7TH STREET BISMARCK ND 58501 MEDICAL CLINIC 33 - SANFORD EAST INTERSTATE AVE CLINIC 1800 E INTERSTATE AVE BISMARCK ND 58503 MEDICAL CLINIC 34 - SANFORD FIFTH & BROADWAY CLINIC 515 E BROADWAY AVE BISMARCK ND 58501 MEDICAL CLINIC 35 - SANFORD HEALTH CHIROPRACTICOCC MED CLIN 2603 E BROADWAY AVE BISMARCK ND 58501 MEDICAL CLINIC 36 - SANFORD NORTH CLINIC 2830 N WASHINGTON STREET BISMARCK ND 58503 MEDICAL CLINIC 37 - SANFORD ORTHOPEDIC & SPORTS MEDICINE 225 N 7TH STREET BISMARCK ND 58501 MEDICAL CLINIC 38 - SANFORD SEVENTH & BROADWAY CLINIC 715 E BROADWAY AVE BISMARCK ND 58501 MEDICAL CLINIC 39 - SANFORD SEVENTH & ROSSER CLINIC 414 N 7TH STREET BISMARCK ND 58501 MEDICAL CLINIC 40 - SANFORD SEVENTH & THAYER CLINIC 209 N 7TH STREET BISMARCK ND 58501 MEDICAL CLINIC 41 - SANFORD SOUTH CLINIC 1040 TACOMA AVE BISMARCK ND 58504 MEDICAL CLINIC 42 - SANFORD STATE SREET CLINIC 3318 N 14TH STREET BISMARCK ND 58503 MEDICAL CLINIC 43 - SANFORD TOM & FRANCES LEACH BISMARCK DIA 209 N 7TH STREET BISMARCK ND 58501 DIALYSIS CENTER 44 - SANFORD BEMIDJI BLACKDUCK CLINIC 81 1ST ST NW BLACKDUCK MN 56630 MEDICAL CLINIC 45 - SANFORD BOYDEN CLINIC 3971 320TH ST BOYDEN IA 51234 MEDICAL CLINIC 46 - SANFORD BRANDON ACUTE CARE & ORTHO FAST 1105 E HOLLY BLVD BRANDON SD 57005 MEDICAL CLINIC 47 - SANFORD BRANDON FAMILY MEDICINE & CHILDR 1105 E HOLLY BLVD BRANDON SD 57005 MEDICAL CLINIC 48 - SANFORD HEALTH BROOKINGS CLINIC 922 - 22ND AVENUE S BROOKINGS SD 57006 MEDICAL CLINIC 49 - SANFORD CANBY CLINIC 112 ST OLAF AVENUE S CANBY MN 56220 MEDICARE CERTIFIED RURAL HEALTH CLINIC 50 - SANFORD CANBY DENTAL CLINIC 11 ST OLAF AVENUE S CANBY MN 56220 DENTAL CLINIC 51 - SANFORD CANBY DIALYSIS UNIT 112 ST OLAF AVENUE S CANBY MN 56220 MEDICARE CERTIFIED END STAGE RENAL DIALYSIS 52 - SANFORD CANBY HOME CARE 213 ST OLAF AVENUE N CANBY MN 56220 MEDICARE CERTIFIED HOME HEALTH AGENCY 53 - SANFORD CANBY MEDICAL CENTER 112 ST OLAF AVENUE S CANBY MN 56220 CLASS F HOME CARE PROVIDER 54 - SANFORD DIALYSIS CANBY 112 ST OLAF AVENUE S CANBY MN 56220 DIALYSIS 55 - SANFORD HEALTH CANBY SYLVAN PLACE 212 ST OLAF AVENUE S CANBY MN 56220 HOUSING WITH SERVICES 56 - SANFORD HEALTH CANISTOTAUSD CLINIC 320 W MAIN ST CANISTOTA SD 57012 RURAL HEALTH CLINIC 57 - SANFORD CANTON CLINIC 400 N HIAWATHA DRIVE CANTON SD 57013 RURAL HEALTH CLINIC 58 - SANFORD HEALTH CANTON HIAWATHA HEIGHTS 398 N HIAWATHA DRIVE CANTON SD 57013 ASSISTED LIVING CENTER 59 - SANFORD BEMIDJI CASS LAKE CLINIC 219 GRANT UTLEY AVE NW CASS LAKE MN 56633 MEDICAL CLINIC 60 - SANFORD CHAMBERLAIN CLINIC 300 S BYRON BLVD CHAMBERLAIN SD 57325 RURAL HEALTH CLINIC 61 - SANFORD DIALYSIS 300 S BYRON BLVD CHAMBERLAIN SD 57325 DIALYSIS 62 - SANFORD HEALTH CHAMBERLAIN CARE CENTER 300 S BYRON BLVD CHAMBERLAIN SD 57325 NURSING FACILITY 63 - SANFORD HOME HEALTH & HOSPICE CHAMBERLAI 110 W BEEBE AVE CHAMBERLAIN SD 57325 HOME HEALTH CARE & HOSPICE 64 - SANFORD HEALTH CLARK CLINIC 211 N COMMERCIAL STREET CLARK SD 57225 RURAL HEALTH CLINIC 65 - SANFORD CLEAR LAKE CLINIC 701 3RD AVENUE S CLEAR LAKE SD 57226 RURAL HEALTH CLINIC 66 - SANFORD CLEAR LAKE MEDICAL CENTER 701 3RD AVENUE S CLEAR LAKE SD 57226 HOME HEALTH CARE 67 - SANFORD BAGLEY CLEARBROOK CLINIC 22 ELM STREET CLEARBROOK MN 56634 RURAL HEALTH CLINIC 68 - SANFORD HEALTH DAKOTA DUNES CLINIC 350 OAK TREE LN DAKOTA DUNES SD 57049 MEDICAL CLINIC 69 - SANFORD HEALTH DELL RAPIDS ORCHARD HILLS 200 W 10TH STREET DELL RAPIDS SD 57022 ASSISTED LIVING CENTER 70 - SANFORD DIALYSIS 1234 WASHINGTON AVE SUITE B DETROIT LAKES MN 56501 DIALYSIS CENTER 71 - SANFORD HEALTH DETROIT LAKES CLINC & SAM 1245 WASHINGTON AVENUE DETROIT LAKES MN 56501 AMBULATORY SURGERY CENTER/CLINIC 72 - SANFORD HEALTH DETROIT LAKES EYE CENTER 1234 WASHINGTON AVE SUITE A DETROIT LAKES MN 56501 EYE CARE CENTER 73 - SANFORD HEALTH WEST DICKINSON CLINIC 2615 FAIRWAY STREET DICKINSON ND 58601 MEDICAL CLINIC 74 - SANFORD HEALTH EAST DICKINSON CLINIC 33 9TH ST W DICKINSON ND 58601 MEDICAL CLINIC 75 - SANFORD HEALTH HEARING CENTER DICKINSON 1531 W VILLARD ST DICKINSON ND 58601 HEARING CENTER 76 - SANFORD DERMATOLOGY CLINIC 625 DEMERS AVE NW EAST GRAND FORKS MN 56721 MEDICAL CLINIC 77 - SANFORD HEALTH 621 DEMERS AVE CLINIC 621 DEMERS AVE NW EAST GRAND FORKS MN 56721 MEDICAL CLINIC 78 - SANFORD HEALTH 929 CENTRAL AVE CLINIC 929 CENTRAL AVE EAST GRAND FORKS MN 56721 MEDICAL CLINIC 79 - SANFORD HEALTH 625 DEMERS AVE CLINIC 625 DEMERS AVE NW EAST GRAND FORKS MN 56721 MEDICAL CLINIC 80 - SANFORD HOME CARE EAST GRAND FORKS 404 DEMERS AVE EAST GRAND FORKS MN 56721 HOME HEALTH CARE 81 - SANFORD HEALTH EDGELEY CLINIC 506 2ND ST EDGELEY ND 58433 MEDICAL CLINIC 82 - SANFORD LUVERNE EDGERTON CLINIC 733 MAIN AVE EDGERTON MN 56128 RURAL HEALTH CLINIC 83 - SANFORD HEALTH ELLENDALE CLINIC 141 MAIN ST ELLENDALE ND 58436 RURAL HEALTH CLINIC 84 - SANFORD HEALTH ENDERLIN CLINIC 201 4TH AVENUE ENDERLIN ND 58027 RURAL HEALTH CLINIC 85 - SANFORD CLINIC ESTELLINE 305 HOSPITAL DRIVE ESTELLINE SD 57234 RURAL HEALTH CLINIC 86 - EDITH SANFORD BREAST CENTER FARGO 737 BROADWAY N FARGO ND 58102 WOMEN'S HEALTH 87 - SANFORD 1711 MEDICAL BUILDING 1711 UNIVERSITY DRIVE S FARGO ND 58103 MEDICAL CLINIC 88 - SANFORD 2801 MEDICAL BUILDING 2801 S UNIVERSITY DRIVE FARGO ND 58122 MEDICAL CLINIC 89 - SANFORD BRAIN & SPINE CENTER FARGO 2301 25TH ST S FARGO ND 58103 MEDICAL CLINIC 90 - SANFORD BROADWAY CLINIC 801 BROADWAY N FARGO ND 58102 MEDICAL CLINIC 91 - SANFORD BROADWAY MEDICAL BUILDING 736 BROADWAY N FARGO ND 58102 MEDICAL CLINIC 92 - SANFORD CHILDREN'S BROADWAY CLINIC 737 BROADWAY N FARGO ND 58102 CHILDREN'S CLINIC 93 - SANFORD CHILDREN'S CARE CLINIC 100 4TH STREET S FARGO ND 58103 CHILDREN'S CLINIC 94 - SANFORD CHILDREN'S SOUTHWEST CLINIC 2701 13TH AVE S FARGO ND 58103 CHILDREN'S CLINIC 95 - SANFORD DERMATOLOGY & LASER CLINIC 4656 40TH AVE S FARGO ND 58104 MEDICAL CLINIC 96 - SANFORD DIALYSIS FARGO 2801 S UNIVERSITY DRIVE FARGO ND 58122 DIALYSIS 97 - SANFORD FOOT AND ANKLE CLINIC 1720 S UNIVERSITY DR FARGO ND 58103 MEDICAL CLINIC 98 - SANFORD HOME CARE FARGO 100 4TH STREET S FARGO ND 58103 HOME HEALTH AGENCY 99 - SANFORD I-94 CLINIC 5225 23RD AVENUE SOUTH FARGO ND 58104 MEDICAL CLINIC 100 - SANFORD NEUROSCIENCE CLINIC 700 1ST AVE S FARGO ND 58103 MEDICAL CLINIC 101 - SANFORD NORTH FARGO CLINIC 2601 BROADWAY N FARGO ND 58102 MEDICAL CLINIC 102 - SANFORD ORTHOPEDIC WALK-IN CLINIC FARGO 1720 S UNIVERSITY DR FARGO ND 58103 MEDICAL CLINIC 103 - SANFORD PAIN CENTER FARGO 2301 25TH ST S FARGO ND 58103 MEDICAL CLINIC 104 - SANFORD REPRODUCTIVE MEDICINE CLINIC 1111 HARWOOD DRIVE S FARGO ND 58104 MEDICAL CLINIC 105 - SANFORD ROGER MARIS CANCER CENTER 820 4TH STREET N FARGO ND 58102 CANCER CENTER 106 - SANFORD SOUTH UNIVERSITY CLINIC 1717 S UNIVERSITY DR FARGO ND 58103 MEDICAL CLINIC 107 - SANFORD SOUTH UNIVERSITY EYE CENTER & OP 1717 S UNIVERSITY DR FARGO ND 58103 EYE CARE CENTER 108 - SANFORD SOUTHPOINTE CLINIC 2400 32ND AVE S FARGO ND 58103 MEDICAL CLINIC 109 - SANFORD SOUTHPOINTE EYE CENTER & OPTICAL 2400 32ND AVE S FARGO ND 58103 EYE CARE CENTER 110 - SANFORD VETERANS SQUARE CLINIC 3955 56TH ST S FARGO ND 58104 MEDICAL CLINIC 111 - SANFORD HEALTH FINLEY CLINIC 407 WASHINGTON AVE E FINLEY ND 58230 RURAL HEALTH CLINIC 112 - SANFORD HEALTH FORMAN CLINIC 336 MAIN ST FORMAN ND 58032 RURAL HEALTH CLINIC 113 - SANFORD DIALYSIS FORT YATES 10 N RIVER ROAD FORT YATES ND 58538 DIALYSIS CENTER 114 - SANFORD HEALTH FOSSTON EYE CENTER & OPTI 111 2ND ST NE FOSSTON MN 56542 EYE CARE CENTER 115 - SANFORD ROCK RAPIDS GEORGE CLINIC 101 N MAIN GEORGE IA 51237 RURAL HEALTH CLINIC 116 - SANFORD HEALTH GRAND FORKS CLINIC 1750 47TH AVE S GRAND FORKS ND 58201 MEDICAL CLINIC 117 - SANFORD HEALTH GWINNER CLINIC 69 HIGHWAY 13 W GWINNER ND 58040 MEDICAL CLINIC 118 - SANFORD HEALTH HALSTAD CLINIC 445 1ST STREET E HALSTAD MN 56548 RURAL HEALTH CLINIC 119 - SANFORD HEALTH HARTFORD CLINIC 905 N OAKS AVE HARTFORD SD 57033 MEDICAL CLINIC 120 - SANFORD SHELDON HARTLEY CLINIC 512 3RD ST NE HARTLEY IA 51346 MEDICAL CLINIC 121 - SANFORD HAWLEY CLINIC 1412 MAIN ST HAWLEY MN 56549 MEDICAL CLINIC 122 - SANFORD HEALTH COMSTOCK CORNER 12 3RD STREET SE HILLSBORO ND 58045 ASSISTED LIVING CENTER 123 - SANFORD HILLSBORO CARE CENTER 12 3RD STREET SE HILLSBORO ND 58045 HOSPITAL BASED-NURSING FACILITIES LTC 124 - SANFORD HEALTH HILLSBORO CLINIC 315 EAST CALEDONIA HILLSBORO ND 58045 RURAL HEALTH CLINIC 125 - SANFORD HEALTH DIALYSIS HOSPERS 112 SUNRISE DRIVE HOSPERS IA 51238 END STAGE RENAL DIALYSIS 126 - SANFORD HEALTH INTL FALLS EYE CENTER 1400 HIGHWAY 71 INTERNATIONAL FALLS MN 56649 EYE CARE CENTER 127 - SANFORD HEALTH INWOOD CLINIC 303 E JEFFERSON ST INWOOD IA 51240 MEDICAL CLINIC 128 - SANFORD CLINIC IPSWICH 110 5TH AVENUE IPSWICH SD 57451 RURAL HEALTH CLINIC 129 - SANFORD JACKSON CLINIC 1430 NORTH HIGHWAY JACKSON MN 56143 MEDICARE CERTIFIED RURAL HEALTH CLINIC 130 - SANFORD DIALYSIS JAMESTOWN 300 2ND AVENUE NE JAMESTOWN ND 58401 DIALYSIS CENTER 131 - SANFORD HEALTH HEARING CENTER JAMESTOWN 904 5TH AVE NE JAMESTOWN ND 58401 HEARING CENTER 132 - SANFORD HEALTH JAMESTOWN 2ND AVE CLINIC 300 2ND AVENUE NE JAMESTOWN ND 58401 MEDICAL CLINIC 133 - SANFORD DIALYSIS JAMESTOWN 300 2ND AVENUE NE JAMESTOWN ND 58401 DIALYSIS 134 - SANFORD HEALTH JAMESTOWN CLINIC 904 5TH AVE NE JAMESTOWN ND 58401 MEDICAL CLINIC 135 - SANFORD HEALTH KELLIHER CLINIC 243 CLARK AVE N KELLIHER MN 56650 MEDICAL CLINIC 136 - SANFORD HEALTH KIMBALL CLINIC 101 S MAIN ST KIMBALL SD 57355 RURAL HEALTH CLINIC 137 - SANFORD CHILDREN'S CLINIC 3001 DAGGETT ST KLAMATH FALLS OR 97601 MEDICAL CLINIC 138 - SANFORD HEALTH LAKE NORDEN CLINIC 512 MAIN AVE LAKE NORDEN SD 57248 RURAL HEALTH CLINIC 139 - SANFORD JACKSON LAKEFIELD CLINIC 209 MAIN STREET LAKEFIELD MN 56150 MEDICARE CERTIFIED RURAL HEALTH CLINIC 140 - SANFORD HEALTH LAKE PARK CLINIC 215 N MARKET ST LAKE PARK IA 51347 MEDICAL CLINIC 141 - SANFORD HEALTH LAMOURE CLINIC 100 1ST AVE SW LAMOURE ND 58458 RURAL HEALTH CLINIC 142 - SANFORD HEALTH LENNOX CLINIC 108 S MAIN LENNOX SD 57039 RURAL HEALTH CLINIC 143 - SANFORD HEALTH LIDGERWOOD CLINIC 21 WILEY AVE S LIDGERWOOD ND 58053 MEDICAL CLINIC 144 - SANFORD HEALTH LISBON CLINIC 102 10TH AVE W LISBON ND 58054 MEDICAL CLINIC 145 - SANFORD HOME CARE LISBON 404 FOREST ST LISBON ND 58054 HOME HEALTH CARE 146 - SANFORD HOME HEALTH LUVERNE 304 N MCKENZIE ST LUVERNE MN 56156 HOME HEALTH CARE 147 - SANFORD LUVERNE CLINIC 1601 SIOUX VALLEY DR LUVERNE MN 56156 MEDICAL CLINIC 148 - SANFORD LUVERNE HOSPICE 217 N OAKLEY ST LUVERNE MN 56156 MEDICARE CERTIFIED HOSPICE 149 - SANFORD DIALYSIS 323 SW 10TH STREET MADISON SD 57042 END STAGE RENAL DIALYSIS 150 - SANFORD HOSPICE MADISON 900 2ND AVENUE MADISON MN 56256 HOSPICE (LICENSED IN SD) 151 - SANFORD HEALTH MAHNOMEN CLINIC 410 W 4TH ST MAHNOMEN MN 56557 RURAL HEALTH CLINIC 152 - SANFORD HOME CARE MAHNOMEN 414 W JEFFERSON AVE MAHNOMEN MN 56557 HOME HEALTH CARE 153 - SANFORD HOME CARE BISMARCK 910 18TH STREET NW MANDAN ND 58554 HOME HEALTH AGENCY 154 - SANFORD EAST MANDAN CLINIC 102 MANDAN AVE MANDAN ND 58554 MEDICAL CLINIC 155 - SANFORD NORTH MANDAN CLINIC 910 18TH STREET NW MANDAN ND 58554 MEDICAL CLINIC 156 - SANFORD HOME CARE MAYVILLE 49 7TH AVE SE MAYVILLE ND 58257 HOME HEALTH CARE 157 - SANFORD MAYVILLE CLINIC 600 1ST ST SE MAYVILLE ND 58257 MEDICAL CLINIC 158 - SANFORD HEALTH HIGHWAY 2 CLINIC 801 21ST AVE SE MINOT ND 58701 MEDICAL CLINIC 159 - SANFORD HEALTH NORTHWEST CLINIC 1500 21ST AVE NW MINOT ND 58701 MEDICA 160 - SANFORD HEALTH MINNEOTA CLINIC 700 N MONROE ST MINNEOTA MN 56264 RURAL HEALTH CLINIC 161 - SANFORD HEALTH MITCHELL CLINIC 2100 HIGHLAND WAY MITCHELL SD 57301 MEDICAL CLINIC 162 - SANFORD MOORHEAD CAMPUS 4000 28TH AVE S MOORHEAD MN 56560 MEDICAL CLINIC 163 - SANFORD DIALYSIS MORRIS 400 1ST STREET EAST MORRIS MN 56267 DIALYSIS 164 - SANFORD HEALTH MOUNTAIN LAKE CLINIC 308 N 8TH STREET MOUNTAIN LAKE MN 56159 MEDICARE CERTIFIED RURAL HEALTH CLINIC 165 - SANFORD HEALTH OAKES CLINIC 420 7TH ST S OAKES ND 58474 MEDICAL CLINIC 166 - SANFORD CHILDREN'S CLINIC 3605 VISTA WAY OCEANSIDE CA 92056 CHILDREN'S CLINIC 167 - SANFORD HEALTH PARK RAPIDS CLINIC 110 7TH ST W PARK RAPIDS MN 56470 MEDICAL CLINIC 168 - SANFORD HEALTH PARKERS PRAIRIE CLINIC 115 E SOO STREET PARKERS PRAIRIE MN 56361 MEDICAL CLINIC 169 - SANFORD HEALTH PELICAN RAPIDS CLINIC 211 EAST MILL STREET PELICAN RAPIDS MN 56572 RURAL HEALTH CLINIC 170 - SANFORD HOME CARE PELICAN RAPIDS 211 EAST MILL STREET PELICAN RAPIDS MN 56572 HOME HEALTH CARE 171 - SANFORD HEALTH PIERRE CLINIC 521 E SIOUX AVE PIERRE SD 57501 MEDICAL CLINIC 172 - SANFORD VERMILLION PONCA CLINIC 111 E 2ND STREET PONCA NE 68770 MEDICAL CLINIC 173 - SANFORD DIALYSIS RED LAKE 24760 HOSPITAL DRIVE RED LAKE MN 56671 DIALYSIS 174 - SANFORD ROCK RAPIDS CLINIC 104 BUNCOMBE DRIVE ROCK RAPIDS IA 51246 RURAL HEALTH CLINIC 175 - SANFORD SHELDON SANBORN CLINIC 321 MAIN STREET SANBORN IA 51248 MEDICAL CLINIC 176 - SANFORD HEALTH SHELDON CARE CENTER 118 NORTH SEVENTH AVENUE PO BOX 250 SHELDON IA 51201 HOSPITAL BASED-NURSING FACILITIES 177 - SANFORD SHELDON CLINIC 800 OAK STREET SHELDON IA 51201 RURAL HEALTH CLINIC 178 - SANFORD SHELDON HOME HEALTH & HOSPICE 118 NORTH SEVENTH AVENUE PO BOX 250 SHELDON IA 51201 HOME HEALTH AGENCY AND HOSPICE 179 - AVA'S HOUSE 1320 W 17TH STREET SIOUX FALLS SD 57104 HOSPICE 180 - SANFORD 10TH & PHILLIPS ACUTE CARE & ORT 136 S PHILLIPS AVE SIOUX FALLS SD 57104 MEDICAL CLINIC 181 - SANFORD 26TH & SYCAMORE FAMILY MEDICINE 4405 E 26TH ST SIOUX FALLS SD 57103 MEDICAL CLINIC 182 - SANFORD 32ND & ELLIS CLINIC 2601 S ELLIS ROAD SIOUX FALLS SD 57106 MEDICAL CLINIC 183 - SANFORD 49TH & OXBOW FAMILY MEDICINE 3401 W 49TH STREET SIOUX FALLS SD 57106 MEDICAL CLINIC 184 - SANFORD 4TH & SYCAMORE FAMILY MEDICINE 600 N SYCAMORE AVE SIOUX FALLS SD 57110 MEDICAL CLINIC 185 - SANFORD 69TH & LOUISE FAMILY MEDICINE 6101 S LOUISE AVE SIOUX FALLS SD 57108 MEDICAL CLINIC 186 - SANFORD 69TH & MINNESOTA FAMILY MEDICINE 6110 S MINNESOTA AVE SIOUX FALLS SD 57108 MEDICAL CLINIC 187 - SANFORD CANCER CENTER 1309 W 17TH ST SIOUX FALLS SD 57104 CANCER CENTER 188 - SANFORD CARDIOVASCULAR INSTITUTE 1301 W 18TH STREET SIOUX FALLS SD 57105 MEDICAL CLINIC 189 - SANFORD CHILDREN'S MB2 CLINIC 1205 S GRANGE AVE SIOUX FALLS SD 57105 CHILDREN'S CLINIC 190 - SANFORD CHILDREN'S RESIDENCY CLINIC 6101 S LOUISE AVE SIOUX FALLS SD 57108 CHILDREN'S CLINIC 191 - SANFORD CHILDREN'S SPECIALTY CLINIC 1600 W 22ND STREET SIOUX FALLS SD 57117 CHILDREN'S CLINIC 192 - SANFORD DERMATOLOGY CLINIC 1310 W 22ND STREET SIOUX FALLS SD 57105 MEDICAL CLINIC 193 - SANFORD DIABETES & THYROID CLINIC 1305 W 18TH STREET SIOUX FALLS SD 57105 MEDICAL CLINIC 194 - SANFORD DIALYSIS SIOUX FALLS 1321 W 22ND STREET SIOUX FALLS SD 57117 DIALYSIS CENTER 195 - SANFORD EAR NOSE AND THROAT CLINIC 1310 W 22ND STREET SIOUX FALLS SD 57105 MEDICAL CLINIC 196 - SANFORD EYE CENTER & OPTICAL 1621 S MINNESOTA AVE SIOUX FALLS SD 57105 EYE CARE CENTER 197 - SANFORD HEALTH EYE CLINIC 2310 S MARION RD 140 SIOUX FALLS SD 57106 EYE CARE CENTER 198 - SANFORD HEALTH MB2 CLINIC 1205 S GRANGE AVE SIOUX FALLS SD 57105 MEDICAL CLINIC 199 - SANFORD HOME HEALTH SIOUX FALLS 2710 WEST 12TH STREET SIOUX FALLS SD 57104 HOME HEALTH CARE 200 - SANFORD HOSPICE SIOUX FALLS 2710 WEST 12TH STREET SIOUX FALLS SD 57104 HOSPICE (LICENSED IN MN AND SD) 201 - SANFORD IMAGENETICS 1321 W 22ND STREET SIOUX FALLS SD 57117 GENETICS 202 - SANFORD INTERNAL MEDICINE CLINIC 1321 W 22ND STREET SIOUX FALLS SD 57117 MEDICAL CLINIC 203 - SANFORD MATERNAL-FETAL MEDICINE 1500 W 22ND STREET SIOUX FALLS SD 57105 MEDICAL CLINIC 204 - SANFORD OBSTETRICS & GYNECOLOGY CLINIC 1500 W 22ND STREET SIOUX FALLS SD 57105 MEDICAL CLINIC 205 - SANFORD PSYCHIATRY & PSYCHOLOGY CLINIC 2400 W 49TH STREET SIOUX FALLS SD 57105 MEDICAL CLINIC 206 - SANFORD SURGICAL ASSOCIATES 1508 W 22ND STREET SIOUX FALLS SD 57105 AMBULATORY SURGERY CENTER/CLINIC 207 - SANFORD USD 34TH & KIWANIS FAMILY MEDICI 2701 S KIWANIS AVE SIOUX FALLS SD 57105 MEDICAL CLINIC 208 - SANFORD VAN DEMARK CLINIC 1210 W 18TH STREET SIOUX FALLS SD 57104 MEDICAL CLINIC 209 - SANFORD VASCULAR ASSOCIATES 1305 W 18TH STREET SIOUX FALLS SD 57105 MEDICAL CLINIC 210 - SANFORD WOMEN'S PRIMARY CARE CLINIC 5019 S WESTERN AVE SIOUX FALLS SD 57108 MEDICAL CLINIC 211 - THE BIRTH PLACE 1500 W 22ND STREET SIOUX FALLS SD 57105 BIRTH CENTER 212 - NORTHERN LIGHTS COMMUNITY RESIDENCE 921 ATLANTIC AVE N THIEF RIVER FALLS MN 56701 RESIDENTIAL BEHAVIORAL HEALTH 213 - SANFORD BEHAVIORAL HEALTH OUTPATIENT CLI 120 LABREE AVENUE S THIEF RIVER FALLS MN 56701 BEHAVIORAL HEALTH TREATMENT CENTER 214 - SANFORD DIALYSIS THIEF RIVER FALLS 120 LABREE AVENUE S THIEF RIVER FALLS MN 56701 DIALYSIS 215 - SANFORD HEALTH THIEF RIVER FALLS EYE CEN 1720 HIGHWAY 59 S THIEF RIVER FALLS MN 56701 EYE CARE CENTER 216 - SANFORD HEALTH THIEF RIVER FALLS SOUTHEA 1720 HIGHWAY 59 S THIEF RIVER FALLS MN 56701 MEDICAL CLINIC 217 - SANFORD THIEF RIVER FALLS CLINIC 3001 SANFORD PKWY THIEF RIVER FALLS MN 56701 MEDICAL CLINIC 218 - SANFORD HEALTH TRACY O'BRIEN COURT 410 STATE STREET TRACY MN 56175 HOUSING WITH SERVICES 219 - SANFORD TRACY CLINIC 249 FIFTH STREET E TRACY MN 56175 MEDICARE CERTIFIED RURAL HEALTH CLINIC 220 - SHETEK HOME CARE SERVICES 251 5TH ST E TRACY MN 56175 HOME HEALTH CARE 221 - SANFORD HEALTH TWIN VALLEY CLINIC 501 2ND ST NW TWIN VALLEY MN 56584 RURAL HEALTH CLINIC 222 - SANFORD HEALTH ULEN CLINIC 108 VIKING AVENUE W ULEN MN 56585 RURAL HEALTH CLINIC 223 - SANFORD HEALTH VALLEY CITY CLINIC 520 CHAUTAUQUA BLVD VALLEY CITY ND 58072 MEDICAL CLINIC 224 - SANFORD HEALTH VERMILLION CARE CENTER 125 WALKER STREET VERMILLION SD 57069 NURSING FACILITY 225 - SANFORD HEALTH VERMILLION DAKOTA GERDENS 126 S PLUM STREET VERMILLION SD 57069 RESIDENTIAL LIVING CENTER 226 - SANFORD HOSPICE VERMILLION 848 EAST CHERRY STREET VERMILLION SD 57069 HOSPICE 227 - SANFORD VERMILLION CLINIC 20 S PLUM STREET VERMILLION SD 56069 MEDICAL CLINIC 228 - SANFORD DIALYSIS 111 WASHINGTON AVE NW WAGNER SD 57380 DIALYSIS CENTER 229 - SANFORD HEALTH WAHPETON CLINIC 332 2ND AVE N WAHPETON ND 58075 MEDICAL CLINIC 230 - SANFORD HEALTH WAHPETON EYE CENTER & OPT 332 2ND AVE N WAHPETON ND 58075 EYE CARE CENTER 231 - SANFORD HEALTH WAHPETON PT & PSYCHOLOGY 123 2ND AVE N WAHPETON ND 58075 MEDICAL CLINIC 232 - SANFORD HEALTH WALKER CLINIC 614 MICHIGAN AVENUE WALKER MN 56484 RURAL HEALTH CLINIC 233 - SANFORD HEALTH WALKER REHAB 106 5TH ST S WALKER MN 56484 REHABILITATIVE SERVICES 234 - SANFORD TRACY WALNUT GROVE CLINIC 810 8TH ST WALNUT GROVE MN 56180 MEDICARE CERTIFIED RURAL HEALTH CLINIC 235 - SANFORD HEALTH WATERTOWN CLINIC 901 4TH STREET NW WATERTOWN SD 57201 MEDICAL CLINIC 236 - SANFORD HEALTH HEARING CENTER 116 8TH STREET NE WATFORD CITY ND 58854 HEARING CENTER 237 - SANFORD HEALTH WATFORD CITY CLINIC 709 4TH AVE NE WATFORD CITY ND 58854 MEDICAL CLINIC 238 - SANFORD WEBSTER CLINIC 101 PEABODY DRIVE WEBSTER SD 57274 RURAL HEALTH CLINIC 239 - SANFORD HEALTH WESTROOK PETERSON ESTATES 1012 9TH STREET WESTBROOK MN 56183 HOUSING WITH SERVICES 240 - SANFORD WESTBROOK CLINIC 920 BELL AVENUE WESTBROOK MN 56183 MEDICARE CERTIFIED RURAL HEALTH CLINIC 241 - SANFORD WEST FARGO CLINIC 1220 SHEYENNE STREET WEST FARGO ND 58078 MEDICAL CLINIC 242 - SANFORD HOME CARE WHEATON 405 12TH ST N WHEATON MN 56926 HOME HEALTH CARE 243 - SANFORD WHEATON CLINIC 401 12TH ST N WHEATON MN 56926 RURAL HEALTH CLINIC 244 - SANFORD CLINIC WINDOM 591 2ND AVENUE N WINDOM MN 56101 MEDICARE CERTIFIED RURAL HEALTH CLINIC 245 - SANFORD HOSPICE WINNER 745 E 8TH STREET WINNER SD 57580 HOSPICE 246 - SANFORD DIALYSIS 1018 SIXTH AVENUE WORTHINGTON MN 56187 DIALYSIS CENTER 247 - SANFORD HEALTH CANCER CENTER 1018 SIXTH AVENUE WORTHINGTON MN 56187 CANCER CENTER 248 - SANFORD HOSPICE WORTHINGTON 1935 WOODLAND CT WORTHINGTON MN 56187 HOSPICE (LICENSED IN SD) 249 - SANFORD WORTHINGTON CLINIC 1680 DIAGONAL ROAD WORTHINGTON MN 56187 MEDICAL CLINIC 250 - SANFORD WORTHINGTON MEDICAL CENTER 1018 SIXTH AVENUE WORTHINGTON MN 56187 MEDICARE CERTIFIED END STAGE RENAL DIALYSIS 251 - SANFORD WORTHINGTON OBGYN CLINIC 1018 SIXTH AVENUE WORTHINGTON MN 56187 MEDICAL CLINIC PART I, LINE 3C: SANFORD HEALTH DOES NOT DENY CARE TO ANYONE BASED ON THE ABILITY TO PAY. SANFORD'S FINANCIAL ASSISTANCE (CHARITY CARE) POLICY PROVIDES DISCOUNTED AND FREE SERVICES TO PATIENTS WHO LACK THE RESOURCES TO BE FULLY RESPONSIBLE FOR THE HEALTHCARE THEY RECEIVE. THE FINANCIAL ASSISTANCE POLICY IS DESIGNED TO ENSURE THE ENTIRE COMMUNITY SERVED BY SANFORD HAS ACCESS TO NEEDED HEALTHCARE SERVICES. ELIGIBILITY FOR DISCOUNTED OR FREE SERVICES UNDER THE FINANCIAL ASSISTANCE POLICY IS BASED ON INCOME LEVELS AND FAMILY SIZE. GENERALLY, INDIVIDUALS EARNING INCOME OF UP TO 375% OF THE FEDERAL POVERTY INCOME GUIDELINES ARE ELIGIBLE FOR VARYING LEVELS OF DISCOUNTS, INCLUDING FULL DISCOUNTS FOR CERTAIN INCOME LEVELS. APPLICATIONS FOR COVERAGE UNDER THE PROGRAM MAY BE OBTAINED AT ANY SANFORD PATIENT REGISTRATION AREA.THE PRIMARY SCOPE OF SANFORD'S FINANCIAL ASSISTANCE MATRIX CONSIDERS FAMILY INCOME AND FAMILY SIZE TO OBJECTIVELY DETERMINE FINANCIAL NEED. THE FAMILY INCOME RANGE VARIES FROM 0-225% UP TO 375% OF THE FEDERAL POVERTY LEVEL (FPL). AN APPLICANT OVER 375% MAY BE ELIGIBLE FOR SOME LEVEL OF FINANCIAL ASSISTANCE BASED ON A REVIEW OF ADDITIONAL FACTORS SUCH AS: THE SIZE OF THE ACCOUNT BALANCE, DEBT-TO-INCOME RATIO, CURRENT ASSETS, CURRENT LIABILITIES, IRS FOOD EXPENSE ALLOWANCES, MONTHLY CASH FLOW, ETC.ADDITIONALLY, IT IS POSSIBLE FOR A FAMILY TO QUALIFY IN ONE SEGMENT (BASED ON INCOME AND FAMILY SIZE ALONE) BUT BE MOVED TO A MORE GENEROUS (FOR THE PATIENT) SEGMENT BASED ON THE OTHER FINANCIAL VARIABLES MENTIONED ABOVE. AN APPLICANT MAY BE DENIED IF THEY HAVE SUBSTANTIAL ASSETS AND APPLICANTS ARE CONSIDERED ON A CASE BY CASE BASIS.THE AMOUNT GENERALLY BILLED (AGB) DISCOUNT PERCENTAGE IS THE LEAST AMOUNT SANFORD CAN DISCOUNT FOR ANY PATIENT QUALIFYING UNDER THE SANFORD FINANCIAL ASSISTANCE POLICY. IT IS THE PERCENTAGE USED FOR THE LOWEST LEVEL OF ASSISTANCE GRANTED FOR THOSE QUALIFYING UNDER THE SANFORD FINANCIAL ASSISTANCE POLICY AS LISTED ON APPENDIX 1 - SLIDING DISCOUNT SCHEDULE FOR ASSISTANCE. ANYONE ELSE QUALIFYING FOR ASSISTANCE AT GREATER LEVELS WILL RECEIVE DISCOUNT AMOUNTS GREATER THAN THE SANFORD AGB DISCOUNT AMOUNT. PART I, LINE 5B: SANFORD AS A WHOLE DID NOT EXCEED ITS FINANCIAL ASSISTANCE BUDGET FOR CY 2022, HOWEVER, IF THEY WOULD HAVE EXCEEDED THEIR BUDGET IT WOULD NOT IMPACT THEIR ABILITY TO SERVE ANY PATIENTS AND NO PATIENTS WOULD BE DISALLOWED SERVICES. THE ORGANIZATION PROVIDED FREE OR DISCOUNTED SERVICES TO PATIENTS WHO WERE ELIGIBLE FOR FREE OR DISCOUNTED CARE.PART I, LINE 6: SANFORD HEALTH'S COMMUNITY BENEFIT ANNUAL REPORT IS POSTED ANNUALLY ON THE SANFORD WEBSITE AT:HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT PART I, LINE 7: COST TO CHARGE RATIOS ARE USED TO CALCULATE THE AMOUNTS ON LINE 7A - 7C (FINANCIAL ASSISTANCE, MEDICAID SHORTFALL, AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS) AND ALSO LINE 7G (SUBSIDIZED HEALTH SERVICES) FOR EACH OF THE SUBSIDIARIES INCLUDED IN THE RETURN. ALL OTHER AMOUNTS FOR LINES 7E, 7F, 7H AND 7I WOULD COME FROM THE BOOKS AND RECORDS OF SPECIFIC SEGMENTS OF THE ORGANIZATION AND WOULD NOT BE BASED ON A COST TO CHARGE RATIO, OR SIMILAR COST ACCOUNTING METHODOLOGY. THESE COSTS STILL REPRESENT THE COSTS TO PROVIDE BENEFITS. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES ARE CLINICAL SERVICES PROVIDED TO BOTH INPATIENTS AND OUTPATIENTS DESPITE A FINANCIAL LOSS TO SANFORD. EACH LOSS HAS BEEN CALCULATED AFTER REMOVING LOSSES ASSOCIATED WITH BAD DEBTS, FINANCIAL ASSISTANCE AND MEDICAID. ALTHOUGH THESE SERVICES GENERATE OVERALL LOSSES TO SANFORD, THEY CONTINUE TO MEET THE NEEDS OF THE COMMUNITIES SERVED. VARIOUS SERVICES THAT GENERATE LOSSES ARE PROVIDED BY SANFORD THROUGH PHYSICIAN PRACTICES. FOR CY 2022, SUBSIDIZED HEALTH SERVICES PROVIDED THROUGH CLINIC PHYSICIAN PRACTICES GENERATED LOSSES OF $232,997,424.11. PART II, COMMUNITY BUILDING ACTIVITIES: SANFORD HEALTH IS A NOT-FOR-PROFIT ORGANIZATION DEDICATED TO THE WORK OF HEALTH AND HEALING FOR THE PUBLIC GOOD. SANFORD IS COMMITTED TO GIVING BACK TO THE COMMUNITIES IN WHICH ITS EMPLOYEES AND PATIENTS LIVE AND WORK. SANFORD INVESTS RESOURCES IN ORDER TO PRODUCE THE BEST OUTCOMES FOR PATIENT CARE, EDUCATION, RESEARCH, AND COMMUNITY ENRICHMENT, AND PARTNERS WITH OTHERS TO ENSURE THAT THE COMMUNITY IS A WELCOMING, HEALTHY ENVIRONMENT AND ONE THAT ATTRACTS AND SUSTAINS A DIVERSE SANFORD WORKFORCE TO DELIVER THE BEST PATIENT CARE AND MUCH NEEDED MEDICAL RESEARCH. SANFORD CONSIDERS REQUESTS FOR FUNDING AND IN KIND SUPPORT FOR NEW AND ONGOING PROGRAMS WITH ALL AREAS SUPPORTING THE ABOVE GOALS, SUCH AS BASIC HUMAN SERVICES, EDUCATION AND WORKFORCE DEVELOPMENT BY RECRUITING PHYSICIANS AND OTHER HEALTH PROFESSIONALS TO MEDICAL SHORTAGE OR UNDERSERVED AREAS AND COLLABORATING WITH EDUCATIONAL INSTITUTIONS TO TRAIN AND RECRUIT HEALTH PROFESSIONALS, ADVOCATING COMMUNITY HEALTH IMPROVEMENT THROUGH EFFORTS TO SUPPORT POLICIES AND PROGRAMS THAT SAFEGUARD OR IMPROVE PUBLIC HEALTH AND HELP TO ENSURE ACCESS TO HEALTH CARE SERVICES. PART III, LINE 2: BAD DEBT EXPENSE AT COST IS DETERMINED USING THE SAME COST TO CHARGE RATIOS THAT ARE USED TO CALCULATE FINANCIAL ASSISTANCE AND MEDICAID SHORTFALL. DISCOUNTS AND ALLOWANCES ARE ACCOUNTED FOR SEPARATELY FROM BAD DEBT EXPENSE. PART III, LINE 3: IT IS SANFORD'S POLICY TO MAKE FINANCIAL ASSISTANCE AVAILABLE TO PATIENTS WHO FIT THE FINANCIAL ASSISTANCE CRITERIA. IT IS THE ORGANIZATION'S GOAL TO MAKE CERTAIN THAT SANFORD IS PROACTIVE IN IDENTIFICATION OF THE PATIENTS WHO NEED HELP WITH FINANCIAL CONCERNS. FINANCIAL COUNSELORS MAKE EVERY EFFORT TO ENSURE THAT FINANCIAL ASSISTANCE ELIGIBLE PATIENTS DO NOT PROGRESS TO BAD DEBT. FOR THIS REASON, A DOLLAR AMOUNT FOR BAD DEBT IS NOT INCLUDED. PART III, LINE 4: THE AUDITED FINANCIAL STATEMENTS (AFS) OF SANFORD INCLUDE A BAD DEBT FOOTNOTE. SEE FOOTNOTE 3 ON PAGES 17 - 19 OF THE AFS. SANFORD REPORTS BAD DEBT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). PART III, LINE 8: PER IRS INSTRUCTIONS, SANFORD HAS IDENTIFIED THE COST ASSOCIATED WITH PROVIDING MEDICARE SERVICES FROM THE MEDICARE COST REPORT. THE MEDICARE COST REPORT CALCULATIONS ARE TOTAL EXPENSE LESS EXPENSES DEEMED "UNALLOWABLE" PER MEDICARE REGULATIONS. THE NET EXPENSE IS THEN USED TO CALCULATE THE COST PER DAY AND COST TO CHARGE RATIOS WHICH ARE MULTIPLIED BY THE MEDICARE DAYS AND ANCILLARY CHARGES TO DETERMINE THE COST OF PROVIDING MEDICARE SERVICES. IF ALL EXPENSES THAT SANFORD INCURRED WERE INCLUDED ON THE MEDICARE COST REPORT; THIS WOULD SHOW A SHORTFALL OF APPROXIMATELY $585,268,604. SANFORD BELIEVES THIS SHORTFALL SHOULD BE CONSIDERED COMMUNITY BENEFIT BECAUSE THESE SERVICES WOULD NEED TO BE PROVIDED BY EITHER ANOTHER CHARITABLE ORGANIZATION OR THE GOVERNMENT IF IT WAS NOT PROVIDED BY SANFORD. PART III, LINE 9B: SANFORD WILL PROVIDE SERVICES AT NO COST OR REDUCED COST TO PATIENTS WHO QUALIFY FOR THE PROGRAM. PATIENTS WITH INCOMES AT OR BELOW 225% OF THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES POVERTY GUIDELINE WILL RECEIVE A 100% REDUCTION OF THEIR PAYMENT RESPONSIBILITY. PATIENTS WITH INCOME BETWEEN 225% - 375% OF THE POVERTY GUIDELINE WILL BE GIVEN A DISCOUNT BASED ON A SLIDING SCALE AND ASSETS ARE CONSIDERED IN THE CALCULATION OF THE INCOME OF THE PATIENT, WITH THE EXCEPTION OF THE PATIENT'S PRINCIPAL RESIDENCE. PATIENTS ABOVE 375% OF THE FPG WILL BE REVIEWED FOR ADDITIONAL FACTORS SUCH AS SIZE OF MEDICAL DEBT BEFORE A FINAL DETERMINATION. PATIENTS MUST MAKE THEIR FINANCIAL NEED KNOWN TO APPROPRIATE PERSONNEL AND BE ENGAGED IN FILING APPROPRIATE AND COMPLETE APPLICATIONS. THE PROGRAM IS AVAILABLE TO THOSE PATIENTS WITHOUT HEALTH CARE BENEFITS FROM ANY SOURCE AS WELL AS TO THOSE WHO HAVE COVERAGE FOR HEALTH CARE COSTS THROUGH A GOVERNMENT PROGRAM, COMMERCIAL INSURANCE, OR OTHER HEALTH BENEFIT PLAN BUT CONTINUE TO HAVE A REMAINING BALANCE AFTER BENEFITS HAVE BEEN APPLIED TO THE CHARGES. SANFORD WILL NOT DENY FINANCIAL ASSISTANCE BASED ON RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP OR AGE.EVERY EFFORT IS MADE TO IDENTIFY PATIENTS WITH FINANCIAL NEED AS EARLY AS POSSIBLE IN THE REVENUE CYCLE.SANFORD HAS ZERO TOLERANCE FOR ABUSIVE, HARASSING, OPPRESSIVE, FALSE, DECEPTIVE, OR MISLEADING LANGUAGE OF COLLECTIONS CONDUCT. THIS ZERO TOLERANCE APPLIES TO INTERNAL SANFORD STAFF AND THIRD PARTY COLLECTION VENDORS AND ATTORNEYS.NEITHER SANFORD NOR ANY OF ITS THIRD PARTY COLLECTION VENDORS WILL TAKE ANY EXTRAORDINARY COLLECTION EFFORTS UNTIL SANFORD AND THE THIRD PARTY COLLECTION VENDOR HAVE MADE REASONABLE EFFORTS TO DETERMINE IF A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY. PART VI, LINE 2: SANFORD HEALTH REGULARLY UTILIZES A BROAD ARRAY OF RESOURCES AND PARTNERS TO ASSESS AND DELIVER CARE TO THE COMMUNITIES SERVED BY THE SYSTEM. ASSESSMENT AND, BY EXTENSION, COMMUNITY ENGAGEMENT, IS A COMPOSITE, PARTNER-DRIVEN APPROACH.WITHIN THE CONTEXT OF THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS, THE SYSTEM RELIES UPON A MULTI-STEP, MULTI-MODAL APPROACH THAT MINIMIZES THE INHERENT LIMITATIONS OF ANY GIVEN ASSESSMENT TOOL AND INCREASES THE POINTS OF CONTACT FOR COMMUNITY MEMBERS TO SHARE DIRECT INSIGHTS INTO THE PROCESS. STEP ONE OF THE CHNA IS ENGAGEMENT WITH OTHER HEALTH SYSTEMS IN THE COMMUNITIES IN WHICH SANFORD AND ANOTHER HEALTH SYSTEM BOTH OPERATE. ADDITIONALLY, SANFORD ENGAGES PUBLIC HEALTH ORGANIZATIONS AND OTHER CARE PROVIDERS IN THE DEVELOPMENT OF ASSESSMENT STRATEGIES AND TOOLS. THE COOPERATION BETWEEN THE ORGANIZATIONS ENSURES INFORMATION IS COLLECTED THAT WILL BENEFIT NOT ONLY THE CHNA PROGRAM, BUT ALSO THE STRATEGIES AND OPERATIONS OF THE RESPECTIVE ORGANIZATIONS. THE SYSTEMS ALSO COLLABORATE IN THE DEVELOPMENT OF THEIR RESPECTIVE IMPLEMENTATION PLANS TO FURTHER THE POSITIVE IMPACT TO THE COMMUNITY. AS NOTED ABOVE, THE CHNA ASSESSMENT INCLUDES A MULTI-MODAL PROCESS, WHICH BEGINS WITH A SURVEY TO COMMUNITY MEMBERS SENT VIA MULTIPLE PATHWAYS, WHICH INCLUDE THE PURCHASE OF A LOCAL SURVEY PANEL AND THE DEVELOPMENT OF A COMMUNITY STAKEHOLDER LIST. STAKEHOLDERS ARE ASKED TO COMPLETE THE SURVEY AND THEN FORWARD THE TOOL TO THEIR CONTACTS TO AMPLIFY THE COLLECTION OPPORTUNITIES. AN INDEPENDENT THIRD PARTY WITH SURVEY ANALYSIS EXPERTISE IS RETAINED TO EVALUATE THE RESULTS AND DEVELOP AN INITIAL LIST OF NEEDS WITH ADDITIONAL AUGMENTATION FROM COUNTYHEALTHRANKINGS.COM, CENSUS DATA, AND OTHER SECONDARY DATA SOURCES. LOCAL STAKEHOLDER MEETINGS THAT INCLUDE HEALTH CARE LEADERS, ELECTED OFFICIALS, REPRESENTATIVES OF UNDERSERVED COMMUNITIES, NONPROFIT LEADERS, AND OTHER COMMUNITY PARTNERS THEN REVIEW THE FINDINGS, PROVIDE INPUT, AND DEVELOP THE FINAL PRIORITIES FOR INCLUSION IN THE IMPLEMENTATION PLAN.DATA GATHERED FROM THE CHNA PROGRAM, PARTICULARLY SURVEY RESPONSES, IS MADE AVAILABLE TO LOCAL COMMUNITY ORGANIZATIONS THAT REQUEST THE INFORMATION. SANFORD VIEWS THE FINDINGS AS A COMMUNITY ASSET THAT CAN FURTHER THE POSITIVE IMPACT ON COMMUNITY HEALTH OUTSIDE THE WALLS OF THE SYSTEM.RECENTLY, SANFORD HAS ADDED MORE RESOURCES TO ADVANCE COMMUNITY HEALTH. FINDHELP IS AN ONLINE PLATFORM THAT CONNECTS LOCAL ORGANIZATIONS, FUNDING OPPORTUNITIES, AND OTHER RESOURCES CONNECTED TO SOCIAL DETERMINANTS OF HEALTH WITH INDIVIDUALS IN NEED. SANFORD INTEGRATED THE FINDHELP PLATFORM INTO THE ORGANIZATION'S WEBSITE, ELECTRONIC MEDICAL RECORD, AND POST-VISIT PAPERS. THE INTEGRATION NOT ONLY ALLOWS USERS TO SELF-SEARCH FOR LOCAL RESOURCES BASED UPON THEIR NEED, BUT ALSO ALLOWS SANFORD'S CARE MANAGEMENT TEAM TO DIRECTLY REFER PATIENTS TO LOCAL ORGANIZATIONS AND MONITOR ENGAGEMENT. FINDHELP IS PUBLIC TO ANY RESIDENT AND IS NOT RESERVED SPECIFICALLY FOR PATIENTS OF THE SYSTEM. THE SERVICES OFFERED ON THE NEW WEBSITE ARE EITHER FREE OR REDUCED COST AND COVER OPTIONS THAT MIGHT NOT BE INCLUDED WITH MEDICARE OR MEDICAID. THIS PARTNERSHIP ALLOWS SANFORD TO ADDRESS INEQUITY IN THE COMMUNITIES WE SERVE WITH EXISTING SERVICES THAT MEET THE NEEDS OF PATIENTS.ADDITIONAL EXTERNAL SOURCES ARE REGULARLY ENGAGED WITHIN THE STRATEGIC PLANNING, OPERATIONAL, AND CHNA PROCESS. THE ADVISORY BOARD IS REPRESENTATIVE OF THESE ASSESSMENT CAPABILITIES. THE ADVISORY BOARD (AB) OFFERS A WEALTH OF SECONDARY INFORMATION, SUCH AS INDUSTRY TRENDS, CONSUMER ASSESSMENTS, AND OTHER INFORMATION. AB ALSO INCLUDES DATA TOOLS, INCLUDING THE MARKET INNOVATION CENTER AND THE POST-ACUTE PATHWAYS EXPLORER THAT PROVIDES LINE OF SIGHT INTO DEMOGRAPHIC DATA, VOLUME PROJECTIONS, CARE COORDINATION PATTERNS, AND CARE DRIVERS BEYOND THE INTERNAL DATA SOURCES WITHIN SANFORD. OTHER ENGAGEMENTS AND ASSESSMENTS INCLUDE LEADERSHIP AND MEMBERSHIP IN STATE HEALTHCARE ASSOCIATIONS AND VIZIENT. THE DEVELOPMENT OF PATIENT FAMILY ADVISORY AND DIVERSITY, EQUITY AND INCLUSION COUNCILS WITHIN SYSTEM FACILITIES PROMOTES TWO-WAY COMMUNICATION WITH THE COMMUNITIES SERVED. THESE TOOLS ARE INCORPORATED THROUGHOUT THE PLANNING PROCESS AND ARE EMBEDDED WITHIN OPERATIONS. TO ENSURE CARE PROVIDED ENCOMPASSES THE WHOLE PERSON, SANFORD HEALTH EMPLOYS COMMUNITY HEALTH WORKERS (CHWS), FIRST ESTABLISHING THE ROLE IN 2014. THESE NON-CLINICAL STAFF PROVIDE FRONTLINE PUBLIC HEALTH SERVICES AND SERVE AS A LIAISON BETWEEN HEALTH CARE AND THE COMMUNITY TO FACILITATE ACCESS TO RESOURCES. THESE CARE TEAM MEMBERS PROVIDE A RANGE OF SERVICES AND ACTIVITIES FOR AT-RISK POPULATIONS INCLUDING OUTREACH, COMMUNITY EDUCATION, INFORMAL COUNSELING, SOCIAL SUPPORT, AND ADVOCACY.ANOTHER IMPORTANT SUPPORT/LIAISON ROLE IS THAT OF HEALTH GUIDES. THESE INDIVIDUALS IDENTIFY GAPS IN CARE PREVENTING RISING-RISK PATIENTS FROM ACHIEVING THEIR HEALTH GOALS. GUIDES ADDRESS BARRIERS PATIENTS ARE FACING IN ACCESSING THE RESOURCES THEY NEED TO BE SUCCESSFUL. HEALTH GUIDES HELP PATIENTS NAVIGATE THE HEALTH SYSTEM AND VARIOUS COMMUNITY RESOURCES, EMPOWERING PATIENTS TO TAKE MORE OWNERSHIP OF THEIR HEALTH AND BE AN ACTIVE PARTICIPANT IN THEIR CARE.MANY SANFORD HEALTH CLINIC FACILITIES OFFER A BROAD RANGE OF ROBUST, INTEGRATED CARE OPTIONS. FROM DIETICIANS TO PHARMACISTS TO SOCIAL WORKERS, AMBULATORY RN CARE MANAGERS AND INTEGRATED HEALTH THERAPISTS (IHTS), PATIENTS SEEN FOR PRIMARY CARE HAVE CLOSE PROXIMITY TO OTHER ANCILLARY SUPPORT SERVICES AND CARE OPTIONS. PATIENTS STRUGGLING WITH MENTAL HEALTH OR SUBSTANCE DEPENDENCY ISSUES, FOR EXAMPLE, CAN OFTEN IMMEDIATELY SEE A SUPPORT PROFESSIONAL ON-SITE VERSUS HAVING TO WAIT TO SEE A SPECIALIST VIA A REFERRAL FROM THEIR PRIMARY CARE PROVIDER. SANFORD ALSO SCREENS FOR SOCIAL DETERMINANTS OF HEALTH AND HAVE "WELLNESS PANTRIES" EMBEDDED IN OUR PEDIATRIC CLINICS ACROSS MINNESOTA, NORTH DAKOTA AND SOUTH DAKOTA. WE ARE CURRENTLY COLLECTING DATA TO BETTER UNDERSTAND HOW ADDRESSING FOOD INSECURITY HELPS REDUCE ANXIETY AND DEPRESSION IN CHILDREN. THE TIMELINESS OF THESE KEY SERVICES HELPS TO ENSURE THAT PATIENT NEEDS ARE NOT FALLING THROUGH THE CRACKS OR THAT CARE IS DELAYED. PART VI, LINE 3: SANFORD EMPLOYS A VARIETY OF STRATEGIES TO MAKE CERTAIN THAT THE ORGANIZATION IS TRANSPARENT IN THE COMMUNICATION OF FINANCIAL ASSISTANCE GUIDELINES. THE STAFF AT SANFORD MAKES EVERY EFFORT TO IDENTIFY PATIENTS NEEDING FINANCIAL ASSISTANCE AS EARLY IN THE REVENUE CYCLE AS POSSIBLE. ALL SANFORD ENTITIES DISPLAY SIGNAGE IN REGISTRATION AREAS ADVISING PATIENTS OF THEIR ABILITY TO REQUEST FINANCIAL ASSISTANCE. THE SIGNAGE WAS MADE AVAILABLE IN ENGLISH AND SPANISH. ALTERNATE LANGUAGES WERE INCLUDED ON THE SIGNAGE THAT BASICALLY STATED, IF YOU NEED INTERPRETER SERVICES, PLEASE INQUIRE AT THE REGISTRATION DESK. FINANCIAL ASSISTANCE APPLICATIONS WERE AVAILABLE IN ENGLISH, SPANISH, CHINESE, GERMAN, HINDI, KOREAN, LAOTIAN AND VIETNAMESE UPON REQUEST OR ON THE SANFORD WEBSITE. ALL HEALTHCARE WORKERS WHO IDENTIFY PATIENTS WITH FINANCIAL NEED ARE ENCOURAGED TO PROVIDE PATIENTS OR THEIR DESIGNEES A FINANCIAL APPLICATION. THIS MAY INCLUDE, BUT NOT BE LIMITED TO THE FOLLOWING AREAS: ADMINISTRATION, ADMISSIONS, PATIENT FINANCIAL SERVICES, FINANCIAL COUNSELORS, SOCIAL SERVICES, PHYSICIANS, NURSING, CLINIC DIRECTOR, RECEPTION STAFF AND HUMAN RESOURCES.FINANCIAL COUNSELORS ARE TRAINED TO WORK INDIVIDUALLY WITH PATIENTS TO DETERMINE THE FINANCIAL NEED AND RECOMMEND APPROPRIATE ASSISTANCE IN APPLICATION FOR CHARITY CARE, GOVERNMENT PROGRAMS OR DISCOUNTED SERVICES.SANFORD'S FINANCIAL ASSISTANCE PROGRAM IS AVAILABLE TO ANYONE WHO QUALIFIES FOR ASSISTANCE. THIS PROGRAM ENSURES THAT ALL PEOPLE RECEIVE THE CARE THEY NEED, REGARDLESS OF THEIR FINANCIAL SITUATION. SANFORD MAKES FINANCIAL ASSISTANCE INFORMATION AVAILABLE TO COMMUNITY AGENCIES AND REFERRAL ORGANIZATIONS. FINANCIAL ASSISTANCE INFORMATION IS ALSO AVAILABLE ON THE SANFORD WEBSITE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY PART VI, LINE 4: SANFORD HEALTH IS AN INTEGRATED HEALTH SYSTEM HEADQUARTERED IN THE DAKOTAS. IT IS ONE OF THE LARGEST RURAL HEALTH SYSTEMS IN THE NATION WITH 46 MEDICAL CENTERS AND 222 CLINIC LOCATIONS IN NINE STATES AND THREE COUNTRIES. SANFORD HEALTH'S APPROXIMATELY 44,000 EMPLOYEES, INCLUDING 2,827 PHYSICIANS AND 7,944 REGISTERED NURSES DELIVERING CARE IN MORE THAN 80 SPECIALTY AREAS, MAKE IT THE LARGEST EMPLOYER IN THE DAKOTAS. SANFORD USD MEDICAL CENTER - SIOUX FALLS, SOUTH DAKOTASIOUX FALLS IS THE LARGEST CITY IN THE STATE OF SOUTH DAKOTA AND IS THE COUNTY SEAT OF MINNEHAHA COUNTY. SIOUX FALLS ALSO EXTENDS INTO LINCOLN COUNTY. THE 2022 U.S. CENSUS BUREAU ESTIMATES A TOTAL POPULATION OF 203,971 FOR SIOUX FALLS. ACCORDING TO THE 2022 COUNTY HEALTH RANKINGS, THE POPULATION OF MINNEHAHA COUNTY IS 81.1% WHITE, 6.4% AFRICAN AMERICAN, 2.9% AMERICAN INDIAN, 2.2% ASIAN AND 5.4% HISPANIC. SIOUX FALLS IS A SIGNIFICANT REGIONAL HEALTH CARE CENTER. ONLY 2% OF THE POPULATION IS REPORTED TO BE NOT PROFICIENT IN ENGLISH. THE MEDIAN HOUSEHOLD INCOME IN SIOUX FALLS IS $66,502.SANFORD MEDICAL CENTER FARGO - FARGO, NORTH DAKOTAFARGO IS THE LARGEST CITY IN NORTH DAKOTA, ACCOUNTING FOR 17% OF THE STATE'S POPULATION. FARGO IS ALSO THE COUNTY SEAT OF CASS COUNTY. THE 2022 UNITED STATES CENSUS ESTIMATES THE POPULATION OF FARGO WAS 131,444. ACCORDING TO THE 2022 COUNTY HEALTH RANKINGS, THE POPULATION OF CASS COUNTY IS 84.1% WHITE, 6.3% AFRICAN AMERICAN, 1.5% AMERICAN INDIAN, 3.3% ASIAN AND 2.9% HISPANIC. ONLY 1% OF THE POPULATION IS REPORTED TO BE NOT PROFICIENT IN ENGLISH. THE MEDIAN HOUSEHOLD INCOME IS $68,718. SANFORD BEMIDJI MEDICAL CENTER - BEMIDJI, MINNESOTABEMIDJI IS LOCATED IN BELTRAMI COUNTY, MINNESOTA. BEMIDJI HOUSES MANY NATIVE AMERICAN SERVICES, INCLUDING THE INDIAN HEALTH SERVICE. THE CITY IS THE CENTRAL HUB OF THE RED LAKE INDIAN RESERVATION, WHITE EARTH INDIAN RESERVATION, AND THE LEECH LAKE INDIAN RESERVATION. ACCORDING TO THE 2022 UNITED STATES CENSUS ESTIMATES, THE POPULATION OF BEMIDJI IS 15,424. ACCORDING TO THE 2022 COUNTY HEALTH RANKINGS, THE POPULATION OF BELTRAMI COUNTY IS 71.9% WHITE, 0.7% AFRICAN AMERICAN, 22% AMERICAN INDIAN, 0.8% ASIAN AND 2.5% HISPANIC. 0% OF THE POPULATION IS REPORTED TO BE NOT PROFICIENT IN ENGLISH. THE MEDIAN HOUSEHOLD INCOME IS $55,910.SANFORD BISMARCK MEDICAL CENTER - BISMARCK, NORTH DAKOTABISMARCK IS A CITY LOCATED IN BURLEIGH COUNTY IN CENTRAL NORTH DAKOTA. BISMARCK IS EXPERIENCING FAST-PACED GROWTH AS A DIRECT RESULT OF OIL DEVELOPMENT THROUGHOUT THE WESTERN PART OF THE STATE. BISMARCK IS THE STATE CAPITAL AND IS THE SECOND LARGEST CITY IN THE STATE OF NORTH DAKOTA WITH AN ESTIMATED POPULATION OF 74,445. ACCORDING TO THE 2022 COUNTY HEALTH RANKINGS, THE POPULATION OF BURLEIGH COUNTY IS 88.2% WHITE, 2.2 AFRICAN AMERICAN, 4.5% AMERICAN INDIAN, 0.9% ASIAN AND 2.7% HISPANIC. 0% OF THE POPULATION IS REPORTED TO BE NOT PROFICIENT IN ENGLISH. THE MEDIAN HOUSEHOLD INCOME IS $76,043.SANFORD NETWORK HOSPITALSSANFORD HEALTH NETWORK HOSPITALS IS A NETWORK OF RURAL HOSPITALS LOCATED THROUGHOUT SOUTH DAKOTA, NORTH DAKOTA, AND MINNESOTA.SANFORD CLINICSSANFORD CLINIC IS A MULTI-SPECIALTY CLINIC COMPRISED OF APPROXIMATELY 2,827 PHYSICIANS PROVIDING SERVICES IN THE US AS WELL AS INTERNATIONALLY. PART VI, LINE 5: SANFORD MAINTAINS AN OPEN MEDICAL STAFF. COMMUNITY BOARDS - THE SANFORD BOARD OF TRUSTEES WAS COMPRISED OF 13 MEMBERS AT THE END OF THE CALENDAR YEAR, INCLUDING 9 COMMUNITY MEMBERS, 3 PHYSICIANS AND THE CEO. SURPLUS FUNDS - SURPLUS FUNDS ARE INVESTED BACK INTO THE COMMUNITY, AS WELL AS TO RESOURCE DEVELOPMENT AND FACILITY DEVELOPMENT TO BETTER SERVE PATIENTS AND COMMUNITIES. PART VI, LINE 6: SANFORD HEALTH IS AN INTEGRATED HEALTH SYSTEM HEADQUARTERED IN THE DAKOTAS. IT IS ONE OF THE LARGEST RURAL HEALTH SYSTEMS IN THE NATION WITH 46 MEDICAL CENTERS AND 222 CLINIC LOCATIONS IN NINE STATES AND THREE COUNTRIES. SANFORD HEALTH'S APPROXIMATELY 44,000 EMPLOYEES, INCLUDING 2,827 PHYSICIANS AND 7,944 REGISTERED NURSES DELIVERING CARE IN MORE THAN 80 SPECIALTY AREAS, MAKE IT THE LARGEST EMPLOYER IN THE DAKOTAS.SANFORD HEALTH PROVIDES SERVICES AT EVERY LEVEL FROM CRITICAL ACCESS HOSPITALS TO TERTIARY AND QUATERNARY CARE. THE SANFORD FOOTPRINT INCLUDES OVER 220,000 SQUARE MILES WITH A NINE STATE SERVICE AREA AND A NETWORK OF CHILDREN'S PRIMARY CARE CLINIC LOCATIONS ACROSS THE COUNTRY AND WORLD. SANFORD HEALTH OPERATES FULL-TIME EMERGENCY CENTERS AND PROVIDES EMERGENCY CARE TO EVERYONE REGARDLESS OF THEIR ABILITY TO PAY. SANFORD FACILITIES AND CLINICS PROVIDE SERVICES TO REMOTE AND MEDICALLY UNDERSERVED AREAS THAT WOULD OTHERWISE NOT HAVE ACCESS TO EVEN PRIMARY CARE SERVICES. SANFORD HEALTH FINANCIALLY SUPPORTS HEALTH AND WELLNESS, EDUCATION AND COMMUNITY DEVELOPMENT ACTIVITIES TO IMPROVE THE QUALITY OF LIFE AND STRENGHTEN COMMUNITIES THROUGHOUT THE REGION. EACH FACILITY PROMOTES HEALTH AND HEALING THAT RESPONDS TO THE UNIQUE NEEDS OF THE PATIENTS IN THE COMMUNITY, ENSURING ACCESS TO COMPREHENSIVE AND SPECIALIZED SERVICES. PART VI, LINE 7: COMMUNITY BENEFIT REPORTING IS NOT REQUIRED AND THEREFORE NOT FILED IN NORTH DAKOTA, SOUTH DAKOTA, OR NEBRASKA. FILING IN MINNESOTA IS VOLUNTARY. 1 ABERDEEN AREA CHAMBER OF COMM PO BOX 1179 ABERDEEN SD 574021179 460103710 501(C)(6) 7750 0 ECONOMIC DEVELOPMENT ABERDEEN DEVELOPMENT CORP 416 PRODUCTION ST N ABERDEEN SD 57401 466011831 501(C)(6) 10000 0 ECONOMIC DEVELOPMENT,COMMUNITY HEALTH IMPROVEMENT ABERDEEN FAMILY YMCA 5 S STATE ST ABERDEEN SD 57401 460255779 501(C)(3) 25000 0 COMMUNITY HEALTH IMPROVEMENT ABERDEEN PUBLIC SCHOOLS FOUNDA 1224 S 3RD ST ABERDEEN SD 57401 460423109 501(C)(3) 40000 0 PROGRAM SUPPORT ALZHEIMERS ASSOC 225 N MICHIGAN AVE FLOOR 17 CHICAGO IL 60601 133039601 501(C)(3) 10000 0 COMMUNITY HEALTH IMPROVEMENT AMER CANCER ACTION SOC NETWORK 555 11TH ST NW WASHINGTON DC 20004 522340031 501(C)(4) 10000 0 COMMUNITY HEALTH IMPROVEMENT AMERICAN CANCER SOCIETY 250 WILLIAMS ST 4TH FL ATLANTA GA 30303 131788491 501(C)(3) 514000 0 RESEARCH AMERICAN GOLD GYMNASTICS INC 2001 17TH AVE S FARGO ND 58103 450333196 501(C)(3) 40000 0 PROGRAM SUPPORT AMERICAN HEART ASSOCIATION INC 7272 GREENVILLE AVENUE DALLAS TX 75231 135613797 501(C)(3) 34500 0 COMMUNITY HEALTH IMPROVEMENT ARTS PARTNERSHIP 1104 2ND AVE S STE 315 FARGO ND 58104 237108936 501(C)(3) 15000 0 PROGRAM SUPPORT AUGUSTANA UNIVERSITY 2001 S SUMMIT AVE SIOUX FALLS SD 57197 460224588 501(C)(3) 5058150 0 PROGRAM SUPPORT,EDUCATION/WORKFORCE DEVELOPMENT,SCHOLARSHIP ENDOWMENT BECKER COUNTY HISTORICAL SOC 714 SUMMIT AVE DETROIT LAKES MN 56501 410873609 501(C)(3) 6000 0 ECONOMIC DEVELOPMENT BEEF LOGIC INC 316 S COTEAU AVE PIERRE SD 57501 872043795 501(C)(3) 75000 0 ECONOMIC DEVELOPMENT BEMIDJI AREA SCHOOLS 502 MINNESOTA AVE BEMIDJI MN 56619 416000181 115 98000 0 EDUCATION/WORKFORCE DEVELOPMENT BEMIDJI BLUE OX MARATHON PO BOX 633 BEMIDJI MN 56619 461700357 501(C)(3) 15000 0 ECONOMIC DEVELOPMENT BEMIDJI COMMUNITY ARENA CORP PO BOX 1726 BEMIDJI MN 566191726 813622011 501(C)(3) 69060 0 ECONOMIC DEVELOPMENT BEMIDJI STATE UNIVERSITY 1500 BIRCHMONT DR NE BEMIDJI MN 56601 411687554 115 112200 0 PROGRAM SUPPORT,EDUCATION/WORKFORCE DEVELOPMENT,SCHOLARSHIP ENDOWMENT BEMIDJI SYMPHONY ORCHESTRA PO BOX 3136 BEMIDJI MN 56619 392017074 501(C)(3) 14500 0 PROGRAM SUPPORT BEMIDJI YOUTH SOCCER PO BOX 265 BEMIDJI MN 56619 411870778 501(C)(3) 6500 0 PROGRAM SUPPORT BIO GIRLS INC 4151 38TH ST STE A FARGO ND 58104 810792142 501(C)(3) 17000 0 COMMUNITY HEALTH IMPROVEMENT BISHOP DUDLEY HOSPITALITY HOUS 101 N INDIANA AVE SIOUX FALLS SD 57103 911836526 501(C)(3) 16000 0 COMMUNITY HEALTH IMPROVEMENT BISMARCK CANCER CENTER FDTN 500 N 8TH ST BISMARCK ND 58501 260466647 501(C)(3) 11464 0 COMMUNITY HEALTH IMPROVEMENT BISMARCK MANDAN CHAMBER EDC 1640 BURNT BOAT DR BISMARCK ND 58503 450116753 501(C)(6) 17725 0 ECONOMIC DEVELOPMENT BISMARCK MANDAN CHAMBER FOUNDATION 1640 BURNT BOAT DR BISMARCK ND 58503 263807225 501(C)(3) 25000 0 ECONOMIC DEVELOPMENT BISMARCK PUBLIC SCHOOL DISTRICT #1 806 N WASHINGTON ST BISMARCK ND 58501 456000242 115 67004 2747 FMV T-SHIRTS EDUCATION/WORKFORCE DEVELOPMENT,PROGRAM SUPPORT BISMARCK PUBLIC SCHOOLS FDTN 806 N WASHINGTON ST BISMARCK ND 58501 450442960 501(C)(3) 70000 0 EDUCATION/WORKFORCE DEVELOPMENT,PROGRAM SUPPORT BISMARCK STATE COLLEGE FOUND PO BOX 5587 BISMARCK ND 585065587 450358929 501(C)(3) 104842 0 EDUCATION/WORKFORCE DEVELOPMENT,SCHOLARSHIP ENDOWMENT BOY SCOUTS VOYAGEURS COUNCIL 3877 STEBNER ROAD HERMANTOWN MN 55811 410695583 501(C)(3) 10000 0 EDUCATION/WORKFORCE DEVELOPMENT BOYS & GIRLS CLUB ABERDEEN 1121 1ST AVE SE ABERDEEN SD 57401 237062273 501(C)(3) 6500 0 COMMUNITY HEALTH IMPROVEMENT BOYS & GIRLS CLUB BEMIDJI AREA 1600 MINNESOTA AVE NW BEMIDJI MN 56601 810599601 501(C)(3) 11540 0 COMMUNITY HEALTH IMPROVEMENT BOYS & GIRLS CLUBS OF THE RED RIVER VALLEY 2500 18TH ST S FARGO ND 58103 450316132 501(C)(3) 20000 0 COMMUNITY HEALTH IMPROVEMENT BRANDON VALLEY BOOSTER CLUB PO BOX 572 BRANDON SD 57005 460393971 501(C)(3) 95300 0 PROGRAM SUPPORT,EDUCATION/WORKFORCE DEVELOPMENT,SCHOLARSHIP ENDOWMENT BRANDON VALLEY SCHOOL DISTRICT 49-2 300 S SPLITROCK BLVD BRANDON SD 57005 466002577 115 10000 0 PROGRAM SUPPORT BUTTERFLY HOUSE & AQUARIUM 4320 S OXBOW AVE SIOUX FALLS SD 57106 522370420 501(C)(3) 16000 0 ECONOMIC DEVELOPMENT CALL TO FREEDOM INC 1915 E 8TH ST STE 100 SIOUX FALLS SD 57103 475469817 501(C)(3) 22500 0 COMMUNITY HEALTH IMPROVEMENT CANTON SCHOOLS 800 N MAIN ST CANTON SD 57013 466002143 115 18764 0 PROGRAM SUPPORT,EDUCATION/WORKFORCE DEVELOPMENT CHAD GREENWAYS LEAD WAY FDTN 59 CAVALIER BLVD STE 310 FLORENCE KY 41042 261782419 501(C)(3) 10000 0 COMMUNITY HEALTH IMPROVEMENT CHAMBER OF COMMERCE FMWF PO BOX 2443 FARGO ND 581082443 450448041 501(C)(6) 15920 0 ECONOMIC DEVELOPMENT CHARIS MINISTRY PARTNERS 1300 E 10TH ST SIOUX FALLS SD 57103 383775128 501(C)(3) 7000 0 COMMUNITY HEALTH IMPROVEMENT CHRISTIAN YOUTH ACTIVITY LEAGUE 47644 273RD ST HARRISBURG SD 57032 464964311 501(C)(3) 5427 0 PROGRAM SUPPORT CITY OF WEBSTER PO BOX 539 WEBSTER SD 57274 466000530 115 7143 0 COMMUNITY HEALTH IMPROVEMENT CITY OF YANKTON PO BOX 176 YANKTON SD 57078 466000567 115 10000 0 ECONOMIC DEVELOPMENT COMMUNITY MEMORIAL HOSPITAL 814 JACKSON ST BURKE SD 57523 460219795 501(C)(3) 25000 0 COMMUNITY HEALTH IMPROVEMENT CONCORDIA COLLEGE 901 8TH STREET S MOORHEAD MN 565609981 410693977 501(C)(3) 3306500 369883 APPRAISAL LAND EDUCATION/WORKFORCE DEVELOPMENT,SCHOLARSHIP ENDOWMENT CREIGHTON UNIVERSITY 2500 CALIFORNIA PLAZA OMAHA NE 68178 470376583 501(C)(3) 250000 0 SCHOLARSHIP ENDOWMENT CRIBS FOR KIDS INC 5450 SECOND AVE PITTSBURGH PA 15207 251442806 501(C)(3) 5036 0 PROGRAM SUPPORT DAKOTA ALLIANCE SOCCER CLUB 401 W 39TH ST SIOUX FALLS SD 57105 460359817 501(C)(3) 74250 0 PROGRAM SUPPORT DAKOTA MEDICAL FOUNDATION 4141 28TH AVE SOUTH FARGO ND 58104 456012318 501(C)(3) 12050 0 COMMUNITY HEALTH IMPROVEMENT DAKOTA STATE UNIVERSITY 820 N WASHINGTON AVE MADISON SD 57042 466000364 115 617500 0 EDUCATION/WORKFORCE DEVELOPMENT,PROGRAM SUPPORT DEADWOOD CHAMBER OF COMMERCE 501 MAIN ST DEADWOOD SD 57732 460118544 501(C)(6) 20000 0 ECONOMIC DEVELOPMENT DOWNTOWN COMMUNITY PARTNERSHIP 210 BROADWAY STE 202 FARGO ND 58102 464472309 501(C)(6) 5500 0 ECONOMIC DEVELOPMENT DOWNTOWN SIOUX FALLS INC 230 S PHILIPS AVE STE 306 SIOUX FALLS SD 57104 363627217 501(C)(4) 29104 0 ECONOMIC DEVELOPMENT DSU HERITAGE FDTN 230 8TH AVE W DICKINSON ND 58601 475378718 501(C)(3) 144000 0 EDUCATION/WORKFORCE DEVELOPMENT ELEVATE RAPID CITY 525 UNIVERSITY LOOP STE 102 RAPID CITY SD 57701 460118545 501(C)(6) 50000 0 ECONOMIC DEVELOPMENT FAMILY ADVOCACY CNTR OF NORTH 800 BEMIDJI AVE N STE 4 BEMIDJI MN 566013072 202102302 501(C)(3) 18000 0 COMMUNITY HEALTH IMPROVEMENT FAMILY FEST PO BOX 90646 SIOUX FALLS SD 57109 812254064 501(C)(3) 7500 0 COMMUNITY HEALTH IMPROVEMENT FARGO PARK DISTRICT 701 MAIN AVE FARGO ND 58103 456002070 501(C)(6) 3553103 0 COMMUNITY HEALTH IMPROVEMENT FARGO PUBLIC SCHOOLS 415 4TH ST N FARGO ND 57192 456012318 501(C)(3) 187500 0 PROGRAM SUPPORT FARGO YOUTH BASEBALL 1892 17TH AVE S FARGO ND 58103 450370089 501(C)(3) 17700 0 PROGRAM SUPPORT FARGO YOUTH HOCKEY ASSOC 831 17TH AVE N FARGO ND 58102 363548649 501(C)(3) 12000 0 PROGRAM SUPPORT FIRST CITY OF LIGHTS FOUNDATION PO BOX 1991 BEMIDJI MN 56619 854069354 501(C)(3) 6500 0 ECONOMIC DEVELOPMENT FIRST TEE OF SOUTH DAKOTA PO BOX 88938 SIOUX FALLS SD 57109 460449824 501(C)(3) 36000 0 PROGRAM SUPPORT FIRSTLINK 4357 13TH AVE S STE 107L FARGO ND 58103 450419491 501(C)(3) 25000 0 COMMUNITY HEALTH IMPROVEMENT FITNESS ON MAIN 901 MAIN STREET BURKE SD 57523 264125455 501(C)(3) 10000 0 COMMUNITY HEALTH IMPROVEMENT FOLDS OF HONOR SOUTH DAKOTA 5800 N PATRIOT DR OWASSO OK 74055 753240683 501(C)(3) 60800 0 PROGRAM SUPPORT FORWARD SIOUX FALLS PO BOX 907 SIOUX FALLS SD 57101 460396647 501(C)(6) 250000 0 ECONOMIC DEVELOPMENT FRESH START SURGICAL GIFTS 2011 PALOMAR AIRPORT RD STE 206 CARLSBAD CA 92011 330460177 501(C)(3) 75000 0 PROGRAM SUPPORT GATEWAY TO SCIENCE 1810 SCHAFER STREET STE 1 BISMARCK ND 58501 450443517 501(C)(3) 10000 0 EDUCATION/WORKFORCE DEVELOPMENT GLORY HOUSE OF SIOUX FALLS 4000 S WEST AVE SIOUX FALLS SD 57105 460308425 501(C)(3) 15000 0 COMMUNITY HEALTH IMPROVEMENT GREAT NORTH POLE 675 13TH AVE E STE 101 WEST FARGO ND 58078 821969429 501(C)(3) 20000 0 COMMUNITY HEALTH IMPROVEMENT GREATER SF CHAMBER OF COMMERCE 200 N PHILLIPS AVE STE 200 SIOUX FALLS SD 571046058 460189300 501(C)(6) 6200 0 ECONOMIC DEVELOPMENT GROUND WORKS 102 N KROHNS PL STE 116 SIOUX FALLS SD 57103 475498537 501(C)(3) 10000 0 ' COMMUNITY HEALTH IMPROVEMENT HARRISBURG HIGH SCHOOL 1300 E WILLOW ST HARRISBURG SD 57032 466002218 501(C)(3) 8050 0 PROGRAM SERVICES HARRISBURG SCHOOL DISTRICT 200 WILLOW ST HARRISBURG SD 57032 466002218 115 229800 0 PROGRAM SUPPORT,EDUCATION/WORKFORCE DEVELOPMENT HARTFORD AREA DEVELOPMENT FDTN 125 N MAIN AVE HARTFORD SD 57033 460354618 501(C)(3) 10000 0 ECONOMIC DEVELOPMENT HELPLINE CENTER INC 1000 N WEST AVE STE 310 SIOUX FALLS SD 571041314 237424387 501(C)(3) 10000 0 COMMUNITY HEALTH IMPROVEMENT HOPE HAVEN INC PO BOX 70 ROCK VALLEY IA 51247 420890017 501(C)(3) 10000 0 COMMUNITY HEALTH IMPROVEMENT HUETHER FAMILY MATCH POINTE 4210 N BOBHALLA DR SIOUX FALLS SD 57107 452784394 501(C)(3) 12000 0 PROGRAM SUPPORT INDEPENDENT SCHOOL DIST #2184 709 NORTH KNISS AVE LUVERNE MN 56156 411784004 115 10250 6147 EDUCATION/WORKFORCE DEVELOPMENT INDEPENDENT SCHOOL DISTRICT518 1117 MARINE AVE WORTHINGTON MN 561871610 416008522 115 112000 0 PROGRAM SUPPORT JUNIOR ACHIEVEMENT OF SD 300 S PHILLIPS AVE STE L102 SIOUX FALLS SD 57104 460306352 501(C)(3) 15200 0 EDUCATION/WORKFORCE DEVELOPMENT LAKOTA NATION INVITATIONAL PO BOX 3140 RAPID CITY SD 57709 461310975 501(C)(3) 7500 0 ECONOMIC DEVELOPMENT LEGENDS OF GOLD PO BOX 287 BERESFORD SD 57004 273794971 501(C)(3) 20000 0 PROGRAM SUPPORT LEVITT AT THE FALLS 524 N MAIN AVE 106 SIOUX FALLS SD 57104 611699910 501(C)(3) 75000 464 COST SIGNAGE ECONOMIC DEVELOPMENT LIFESCAPE 2501 WEST 26TH ST SIOUX FALLS SD 57105 460233030 501(C)(3) 41898 0 PROGRAM SUPPORT LINK 132 N DAKOTA AVE SIOUX FALLS SD 57104 844806781 501(C)(3) 400000 0 COMMUNITY HEALTH IMPROVEMENT LUVERNE AREA COMMUNITY FOUND 102 E MAIN ST LUVERNE MN 56156 411512905 501(C)(3) 6000 7 COST AED ACCESSORIES COMMUNITY HEALTH IMPROVEMENT MAKE A WISH FOUNDATION OF SOUTH DAKOTA & MONTANA 1400 W 17TH ST SIOUX FALLS SD 57104 460375953 501(C)(3) 12400 0 COMMUNITY HEALTH IMPROVEMENT MANDAN PUBLIC SCHOOL DISTRICT1 901 DIVISION ST NW MANDAN ND 58554 456001098 115 12500 0 PROGRAM SUPPORT MAYVILLE STATE UNIVERSITY 330 THIRD ST NE MAYVILLE ND 58257 456002485 501(C)(3) 30000 0 PROGRAM SUPPORT,SCHOLARSHIP ENDOWMENT MCCROSSAN BOYS RANCH 47135 260TH STREET SIOUX FALLS SD 57107 460311913 501(C)(3) 7500 0 PROGRAM SUPPORT MCKENZIE COUNTY HEALTHCARE SYS 709 4TH AVE NE WATFORD CITY ND 58854 770637498 501(C)(3) 100000 0 COMMUNITY HEALTH IMPROVEMENT METRO AREA TOURNAMENT COMM 415 NORTH 4TH ST FARGO ND 58102 450458883 501(C)(3) 20000 0 PROGRAM SUPPORT MINNESOTA STATE UNIVERSITY MOORHEAD 1104 7TH AVE SOUTH MOORHEAD MN 56563 411687554 115 102250 0 PROGRAM SUPPORT MINNETONKA TOUCHDOWN CLUB 18301 HWY 7 MINNETONKA MN 55435 460496128 501(C)(3) 10000 0 PROGRAM SUPPORT MITCHELL PARKS & RECREATION 612 NORTH MAIN STREET MITCHELL SD 57301 466000305 115 17000 0 COMMUNITY HEALTH IMPROVEMENT MN STATE UNIV MANKATO FDTN 236 WIGLEY ADMINISTRATION CTR MANKOTA MN 56001 416033423 501(C)(3) 200000 0 SCHOLARSHIP ENDOWMENT MN WEST FOUNDATION 1593 11TH AVENUE GRANITE FALLS MN 56241 363266500 501(C)(3) 10000 0 SCHOLARSHIP ENDOWMENT MO RIVER BASEBALL CLUB 540 CRESTLAND PLACE BISMARCK ND 58503 872686828 501(C)(3) 7500 0 PROGRAM SUPPORT MO SLOPE AREAWIDE UNITED WAY 515 N 4TH ST BISMARCK ND 58501 450387741 501(C)(3) 18500 0 COMMUNITY HEALTH IMPROVEMENT, ECONOMIC DEVELOPMENT MOORHEAD AREA PUBLIC SCHOOLS 2410 14TH ST S MOORHEAD MN 56560 812603701 115 140000 0 EDUCATION/WORKFORCE DEVELOPMENT MOORHEAD YOUTH HOCKEY ASSOC 707 SE MAIN AVE MOORHEAD MN 56560 237221429 501(C)(3) 50500 0 PROGRAM SUPPORT NAMELESS COALITION FOR THE HOMELESS PO BOX 353 BEMIDJI MN 566010353 472472053 501(C)(3) 10000 0 ECONOMIC SUPPORT NAMI SD PO BOX 89213 SIOUX FALLS SD 57109 363593641 501(C)(3) 6500 0 COMMUNITY HEALTH IMPROVEMENT NATIONAL KIDNEY FOUNDATION 30 EAST 33RD STREET NEW YORK NY 10016 131673104 501(C)(3) 27000 0 COMMUNITY HEALTH IMPROVEMENT NATL MULTIPLE SCLEROSIS SOC 733 THIRD AVENUE FLOOR 3 NEW YORK NY 10017 135661935 501(C)(3) 11500 0 COMMUNITY HEALTH IMPROVEMENT ND ASSISTIVE 3240 15TH ST S SUITE B FARGO ND 58104 270260522 501(C)(3) 10000 0 COMMUNITY HEALTH IMPROVEMENT ND SAFETY COUNCIL 1710 CANARY AVE SUITE A BISMARCK ND 58501 450353009 501(C)(3) 0 13000 COST WATER COMMUNITY HEALTH IMPROVEMENT ND STATE COLLEGE OF SCIENCE 800 N 6TH ST WAHPETON ND 580760002 450407617 501(C)(3) 7500 0 COMMUNITY HEALTH IMPROVEMENT NDSU PO BOX 6050 FARGO ND 581086050 456002439 501(C)(3) 668088 0 PROGRAM SUPPORT,EDUCATION/WORKFORCE DEVELOPMENT NDSU FOUNDATION & ALUMNI ASSOC 1241 UNIVERSITY DR N FARGO ND 58102 237120898 501(C)(3) 2430000 0 PROGRAM SUPPORT,EDUCATION/WORKFORCE DEVELOPMENT,SCHOLARSHIP ENDOWMENT NICKLAUS CHILDRENS HOSP FDTN 3100 SW 62ND AVE MIAMI FL 33155 461784918 501(C)(3) 3000000 0 COMMUNITY HEALTH IMPROVEMENT NORTHERN DENTAL ACCESS CENTER 1405 ANNE ST NW BEMIDJI MN 56601 841711812 501(C)(3) 20000 0 COMMUNITY HEALTH IMPROVEMENT NORTHERN LIGHTS COUNCIL 4200 19TH AVE S FARGO ND 581037207 450226415 501(C)(3) 7250 0 COMMUNITY HEALTH IMPROVEMENT NORTHERN STATE UNIVERSITY 1200 S JAY ST ABERDEEN SD 574017198 466000364 115 792000 0 PROGRAM SUPPORT,EDUCATION/WORKFORCE DEVELOPMENT NORTHERN SUN INTERCOLLEGIATE 2999 COUNTY RD 42 W BURNSVILLE MN 55306 411783486 501(C)(3) 100000 0 SCHOLARSHIP ENDOWMENT,PROGRAM SUPPORT NORTHWEST INDIAN CMTY DEV CTR 520 4TH ST NW BEMIDJI MN 56601 363505641 501(C)(3) 6000 0 COMMUNITY HEALTH IMPROVEMENT NORTHWEST MN FOUNDATION 201 3RD ST NW BEMIDJI MN 56601 411556013 501(C)(3) 28550 0 PROGRAM SUPPORT OAK GROVE LUTHERAN SCHOOL 124 N TERRACE FARGO ND 58102 450226473 501(C)(3) 24000 0 PROGRAM SUPPORT OUTDOOR ADVENTURE FOUNDATION 415 38TH ST S STE E FARGO ND 58103 270192316 501(C)(3) 7500 0 COMMUNITY HEALTH IMPROVEMENT PERHAM AREA COMMUNITY CENTER 620 3RD AVE SE PERHAM MN 56573 411565457 115 40500 0 COMMUNITY HEALTH IMPROVEMENT PREMIERE PLAYHOUSE 315 N PHILLIPS AVE SIOUX FALLS SD 57104 800074622 501(C)(3) 7500 0 EDUCATION/WORKFORCE DEVELOPMENT PROFESSIONAL PATIENT ADVOCATES IN LIFE SCIENCES 94 HILLANDALE RD DANBURY CT 06811 472878879 501(C)(3) 20000 0 COMMUNITY HEALTH IMPROVEMENT RAPID CITY CLUB FOR BOYS INC 320 N 4TH ST RAPID CITY SD 57701 460277778 501(C)(3) 10000 0 COMMUNITY HEALTH IMPROVEMENT REINBOWS INC OF WINDOM MN 43341 480TH AVE WINDOM MN 56101 208775427 501(C)(3) 7000 0 COMMUNITY HEALTH IMPROVEMENT RONALD MCDONALD HOUSE 4757 AGASSIZ XING S FARGO ND 58104 450365598 501(C)(3) 105000 0 COMMUNITY HEALTH IMPROVEMENT RONALD MCDONALD HOUSE CHARITY 825 S LAKE ROAD SIOUX FALLS SD 57104 460371152 501(C)(3) 25000 0 COMMUNITY HEALTH IMPROVEMENT SAMARITANS FEET PO BOX 78992 CHARLOTTE NC 282717045 141880905 501(C)(3) 2540000 0 COMMUNITY HEALTH IMPROVEMENT SD BASKETBALL COACHES ASSOCIATION 1404 YOSEMITE LANE BROOKINGS SD 57006 811379554 501(C)(3) 6232 0 PROGRAM SUPPORT SD COMMUNITY FOUNDATION 1714 N LINCOLN AVE PIERRE SD 57501 460398115 501(C)(3) 1266000 0 SCHOLARSHIP ENDOWMENT SD GOLF ASSOCIATION JUNIOR GOLF FOUNDATION PO BOX 88938 SIOUX FALLS SD 57109 460449824 501(C)(3) 25000 0 PROGRAM SUPPORT SD HALL OF FAME 1480 SOUTH MAIN CHAMBERLAIN SD 57325 460324210 501(C)(3) 50000 0 ECONOMIC DEVELOPMENT SD HIGH SCHOOL ACTIVITIES PO BOX 1217 PIERRE SD 575011217 460226882 501(C)(3) 125000 0 PROGRAM SUPPORT SD LAW ENFORCEMENT CHARITIES 101 SOUTH MAIN AVE STE 100 SIOUX FALLS SD 57104 460440378 501(C)(3) 10000 0 SCHOLARSHIP ENDOWMENT SD MILITARY HERITAGE ALLIANCE 1600 W RUSSELL ST SIOUX FALLS SD 57104 832381925 501(C)(3) 250000 0 MILITARY AND VETERANS SERVICES SD SCHOOL OF MINES AND TECHN 501 EAST ST JOSEPH STREET RAPID CITY SD 577013995 466000364 115 18000 0 PROGRAM SUPPORT SD STATE UNIV FOUNDATION 815 MEDARY AVE BROOKINGS SD 57007 460273801 501(C)(3) 1167000 0 PROGRAM SUPPORT,EDUCATION/WORKFORCE DEVELOPMENT,SCHOLARSHIP ENDOWMENT SD SYMPHONY ORCHESTRA 300 NORTH DAKOTA AVE STE 116 SIOUX FALLS SD 57104 466017026 501(C)(3) 43000 0 ECONOMIC DEVELOPMENT SD YOUTH SOCCER ASSOC 2127 S MINNESOTA AVE STE 201 SIOUX FALLS SD 57105 237183054 501(C)(3) 25000 0 PROGRAM SUPPORT SF AREA COMMUNITY FOUNDATION 200 N CHERAPA PL SIOUX FALLS SD 57103 311748533 501(C)(3) 50000 0 COMMUNITY HEALTH IMPROVEMENT,ECONOMIC DEVELOPMENT SF CHRISTIAN HIGH SCHOOL 6120 S CHARGER CIRCE SIOUX FALLS SD 57108 460340024 501(C)(3) 114460 0 SCHOLARSHIP ENDOWMENT,PROGRAM SUPPORT,EDUCATION/WORKFORCE DEVELOPMENT SF SWIM TEAM INC PO BOX 758 SIOUX FALLS SD 57101 460343732 501(C)(3) 25000 0 PROGRAM SUPPORT SF YOUTH HOCKEY ASSOC 5000 S MINNESOTA AVE SIOUX FALLS SD 57108 460427805 501(C)(3) 65000 0 PROGRAM SUPPORT SHELDON COMM SCHOOL DISTRICT 1700 E 4TH STREET SHELDON IA 51201 426038825 115 30000 0 PROGRAM SUPPORT SIGN FRACTURE CARE INTERNATIONAL 451 HILLS ST STE B RICHLAND WA 99354 911952283 501(C)(3) 250000 0 COMMUNITY HEALTH IMPROVEMENT SIOUX COUNCIL BOY SCOUTS 800 N WEST AVE SIOUX FALLS SD 57104 460224599 501(C)(3) 25000 0 EDUCATION/WORKFORCE DEVELOPMENT SIOUX EMPIRE UNITED WAY 1000 N W AVE 120 SIOUX FALLS SD 571041314 460233701 501(C)(3) 150000 0 COMMUNITY HEALTH IMPROVEMENT,ECONOMIC DEVELOPMENT SIOUX FALLS AREA CASA PROGRAM PO BOX 1901 SIOUX FALLS SD 57101 460430647 501(C)(3) 10000 0 COMMUNITY HEALTH IMPROVEMENT SIOUX FALLS LUTHERAN SCHOOL 308 W 37TH ST SIOUX FALLS SD 57105 460343381 501(C)(3) 1000000 0 EDUCATION/WORKFORCE DEVELOPMENT SIOUX FALLS POWER HOCKEY 5808 S PRAIRIE VIEW CT SIOUX FALLS SD 57108 471795011 501(C)(3) 40000 0 PROGRAM SUPPORT SIOUX FALLS SCHOOL DISTRICT 201 E 38TH ST SIOUX FALLS SD 57105 466002586 501(C)(3) 336852 0 PROGRAM SUPPORT, EDUCATION/WORKFORCE DEVELOPMENT SIOUX FALLS SPORTS AUTHORITY 200 N PHILLIPS AVE SUITE 304 SIOUX FALLS SD 57104 205850491 501(C)(3) 7500 0 ECONOMIC DEVELOPMENT SIOUX FALLS WOMEN RUN TRAINING 5235 S SWEETBRIAR CT SIOUX FALLS SD 57108 813518734 501(C)(6) 15000 0 COMMUNITY HEALTH IMPROVEMENT SIOUX FALLS YMCA 230 S MINNESOTA AVE SIOUX FALLS SD 57104 460225021 501(C)(3) 61090 0 COMMUNITY HEALTH IMPROVEMENT SMSU FOUNDATION 1501 STATE ST MARSHALL MN 56258 237108470 501(C)(3) 100000 0 PROGRAM SUPPORT SOUTH DAKOTA STATE UNIVERSITY 815 MEDARY AVE PO BOX 525 BROOKINGS SD 57007 460273801 115 1121500 0 PROGRAM SUPPORT SPECIAL OLYMPICS SOUTH DAKOTA 800 E I-90 LANE SIOUX FALLS SD 57104 460359776 501(C)(3) 10100 0 COMMUNITY HEALTH IMPROVEMENT ST JOHN PAUL II CATHOLIC SCHLS 5600 25TH ST S FARGO ND 581047123 450403317 501(C)(3) 20000 0 PROGRAM SUPPORT SUMMIT LEAGUE INC 4000 N HERCULES AVE STE 200 SIOUX FALLS SD 571071401 391417116 501(C)(3) 1600000 0 PROGRAM SUPPORT TEAM FOUNDATION 105 PARK AVE NW BAGLEY MN 56621 061696861 501(C)(3) 7500 0 PROGRAM SUPPORT TEAM MAKERS CLUB INC 3309 FLECHTNER DR S STE G FARGO ND 58103 456014085 501(C)(3) 131000 0 PROGRAM SUPPORT THIEF RIVER FALLS SCHOOLS 230 LABREE AVENUE SOUTH THIEF RIVER FALLS MN 56701 416003126 115 21500 0 PROGRAM SUPPORT UND ALUMNI ASSOC & FOUNDATION 3501 UNIVERSITY AVE STOP 8157 GRAND FORKS ND 58202 450348296 501(C)(3) 112500 0 SCHOLARSHIP ENDOWMENT UNITED WAY OF BEMIDJI AREA PO BOX 27 BEMIDJI MN 56619 411567744 501(C)(3) 93760 0 ECONOMIC DEVELOPMENT UNITED WAY OF CASS-CLAY PO BOX 1609 FARGO ND 581071609 410810008 501(C)(3) 126900 0 COMMUNITY HEALTH IMPROVEMENT,ECONOMIC DEVELOPMENT UNITED WAY OF NORTHEASTERN SD PO BOX 1065 ABERDEEN SD 574021065 237086355 501(C)(3) 10450 0 COMMUNITY HEALTH IMPROVEMENT,ECONOMIC DEVELOPMENT UNIV OF MARY 7500 UNIVERSITY DR BISMARCK ND 58504 450273403 501(C)(3) 210000 0 EDUCATION/WORKFORCE DEVELOPMENT UNIV OF NE FOUNDATION 1010 LINCOLN MALL STE 300 LINCOLN NE 68508 470379839 501(C)(3) 250000 0 SCHOLARSHIP ENDOWMENT UNIV OF SD FOUNDATION 1110 N DAKOTA ST VERMILLION SD 57069 466018891 501(C)(3) 3143333 0 PROGRAM SUPPORT,EDUCATION/WORKFORCE DEVELOPMENT,SCHOLARSHIP ENDOWMENT UNIV OF WI FOUNDATION 1848 UNIVERSITY AVE MADISON WI 537264090 390743975 501(C)(3) 110000 0 PROGRAM SUPPORT UNIVERSITY OF COLORAD 13001 E 17TH PLACE AURORA CO 80045 846000555 115 250000 0 RESEARCH UNIVERSITY OF JAMESTOWN 6085 COLLEGE LANE JAMESTOWN ND 58405 450231180 501(C)(3) 70300 0 PROGRAM SUPPORT UPPER MIDWEST ELITE LEAGUE PO BOX 385970 BLOOMINGTON MN 55438 043644163 501(C)(3) 6250 0 PROGRAM SUPPORT USD SCHOOL OF MEDICINE 414 EAST CLARK ST VERMILLION SD 57069 466000364 115 52004 0 PROGRAM SUPPORT,EDUCATION/WORKFORCE DEVELOPMENT,SCHOLARSHIP ENDOWMENT VALLEY CITY STATE UNIVERSITY 101 COLLEGE ST SW VALLEY CITY ND 58072 456002482 115 5500 129 FMV BIKE DONATION FOR AUCTION EDUCATION/WORKFORCE DEVELOPMENT VERMILLION CHAMBER OF COMMERCE 2 E MAIN ST STE 101 VERMILLION SD 57069 460284795 501(C)(3) 22500 0 ECONOMIC DEVELOPMENT DEPARTMENT OF VETERAN AFFAIRS 2501 WEST 22ND ST SIOUX FALLS SD 57105 460227571 115 0 3051485 COST PGX TESTING COMMUNITY HEALTH IMPROVEMENT VETERANS COMMUNITY PROJECT 88900 TROOST AVE KANSAS CITY MO 64131 474960735 501(C)(3) 17000 0 MILITARY AND VETERANS SERVICES VILLAGE FAMILY SERVICE CENTER 808 3RD AVE S STE 101 FARGO ND 58103 450226423 501(C)(3) 102000 0 COMMUNITY HEALTH IMPROVEMENT VILLAGE NORTHWEST UNLIMITED 330 VILLAGE CIRCLE SHELDON IA 51201 421044017 501(C)(3) 27500 0 COMMUNITY HEALTH IMPROVEMENT VOLUNTEERS OF AMERICA DAKOTAS PO BOX 89306 SIOUX FALLS SD 57109 237353508 501(C)(3) 10000 0 COMMUNITY HEALTH IMPROVEMENT WARNER SCHOOL DIST 6-5 FNDN PO BOX 20 WARNER SD 57479 204606639 501(C)(3) 10000 0 ECONOMIC DEVELOPMENT WATERTOWN COMMUNITY FOUNDATION 211 E KEMP AVE WATERTOWN SD 57201 460350319 501(C)(3) 20000 0 ECONOMIC DEVELOPMENT WATERTOWN DEVELOPMENT COMPANY PO BOX 332 WATERTOWN SD 57201 470813269 501(C)(3) 15000 0 ECONOMIC DEVELOPMENT WEST CENTRAL SCHOOL DISTRICT PO BOX 252 HARTFORD SD 57033 460284421 115 25050 0 PROGRAM SUPPORT WESTERN REGION ECONOMIC DEV PO BOX 1306 WILLISTON ND 58802 363803598 501(C)(6) 10000 0 ECONOMIC DEVELOPMENT WINGS OF VALOR INC 45618 278TH ST PARKER SD 57053 843711088 501(C)(3) 51942 0 MILITARY AND VETERANS SERVICES WINNER REGIONAL HEALTHCARE CTR 745 E 8TH ST WINNER SD 57580 460274380 501(C)(3) 100000 0 COMMUNITY HEALTH IMPROVEMENT YELLOW JACKET FOUNDATION 1200 UNIVERSITY ST UNIT 9506 BELLE FOURCHE SD 57717 510151319 501(C)(3) 110000 0 PROGRAM SUPPORT YOUNG MENS CHRISTIAN ASSOC SF 606 E TAN TARA CIR SIOUX FALLS SD 57106 464887667 501(C)(3) 30000 0 PROGRAM SUPPORT 174 17 GENERAL SUPPORT FOR COMMUNITY PROGRAMS 25 30577 COST $25 GIFT CARDS SANFORD CARES CHRISTMAS PROGRAM; YOUTH SPORTS PROGRAM ASSISTANCE PART I, LINE 2: PRIOR TO DISBURSEMENT ALL GRANT FUND REQUESTS ARE REVIEWED TO ENSURE THE RECEIVING ORGANIZATION AND PROPOSED USE OF FUNDS ALIGN WITH SANFORD'S MISSION. X X X X 1 1 X X X X 1 1 0 0 0 1 0 1 0 WILLIAM BRUNNER MD PHYSICIAN 3264442 0 0 0 141633 0 15250 0 23892 0 3445217 0 0 0 BRYAN NERMOE PRESIDENT & CEO, FARGO-END 3/22 0 175719 0 252724 0 28831 0 30585 0 7367 0 495226 0 0 BRYAN NERMOE SEE SCH J, PART III, LINES 4A-4B 0 0 0 0 0 2719941 0 0 0 0 0 2719941 0 688398 BILL GASSEN III TRUSTEE, PRESIDENT & CEO 0 1818239 0 582757 0 282586 0 378828 0 755 0 3063165 0 0 TOMASZ STYS MD PHYSICIAN 2655388 0 0 0 151524 0 15250 0 24270 0 2846432 0 0 0 RANDY BURY FORMER CHIEF ADMIN OFFICER 0 36400 0 0 0 20288 0 0 0 0 0 56688 0 0 RANDY BURY SEE SCH J, PART III, LINES 4A-4B 0 0 0 0 0 2769572 0 0 0 0 0 2769572 0 0 ADAM STYS MD PHYSICIAN 2617365 0 0 0 133124 0 15250 0 27260 0 2792999 0 0 0 ERIC BELANGER MD PHYSICIAN 2543991 0 0 0 1242 0 15250 0 27676 0 2588159 0 0 0 MARIAN PETRASKO MD PHYSICIAN 2270184 0 0 0 156987 0 6240 0 28692 0 2462103 0 0 0 MATT HOCKS EVP, CHIEF OPERATING OFFICER 0 1448268 0 482335 0 233922 0 219455 0 28845 0 2412825 0 0 MICHELLE BRUHN EVP, CFO & TREASURER 0 1012253 0 350000 0 168285 0 160681 0 26317 0 1717536 0 0 JENNIFER GRENNAN EVP, CHIEF ADMIN OFFICER 0 989176 0 330001 0 156884 0 157092 0 26317 0 1659470 0 0 MICHAEL LEBEAU MD SVP, HEALTH SVC OPERATIONS 0 968405 0 285000 0 167120 0 154419 0 27692 0 1602636 0 0 PAUL HANSON PRESIDENT & CEO, SIOUX FALLS 0 835062 0 277997 0 141443 0 134455 0 20145 0 1409102 0 0 MARIA BELL MD TRUSTEE, PHYSICIAN 1020094 0 54000 0 69600 0 15250 0 28692 0 1187636 0 0 0 TODD SCHAFFER PRESIDENT & CEO, BISMARCK 0 664040 0 153130 0 131566 0 108543 0 2363 0 1059642 0 0 TIFFANY LAWRENCE PRESIDENT & CEO, FARGO-BEG 3/22 0 729385 0 68796 0 126586 0 105250 0 27517 0 1057534 0 0 SUSAN JARVIS PRESIDENT & CEO, BEMIDJI 0 531338 0 180184 0 93514 0 91858 0 30167 0 927061 0 0 MICHELLE MICKA SVP, FINANCE, HEALTH SERVICES 0 414734 0 146250 0 54832 0 61109 0 19598 0 696523 0 0 MARK LUNDEEN MD TRUSTEE, PHYSICIAN 332590 0 0 0 11324 0 11832 0 2130 0 357876 0 0 0 JOANN KUNKEL FORMER CFO-SCH J, PART III, LINES 4A 0 0 0 0 0 339000 0 0 0 0 0 339000 0 0 ANDY NORTH TRUSTEE, SECRETARY, INDEP CONTRACTOR 316771 0 0 0 0 0 0 0 0 0 316771 0 0 0 KIM PATRICK FORMER CLO-SCH J, PART III, LINES 4A 0 0 0 0 0 315000 0 0 0 0 0 315000 0 0 NATHAN WHITE FORMER COO-SCH J, PART III, LINES 4A 0 0 0 0 0 300000 0 0 0 0 0 300000 0 0 MARK PAULSON MD TRUSTEE, PHYSICIAN 221637 0 13500 0 4257 0 10612 0 28057 0 278063 0 0 0 ALLISON WIERDA-SUTTLE MD FORMER SVP, CMO-SCH J PT III, 4A-4B 0 0 0 0 0 264600 0 0 0 0 0 264600 0 0 PART I, LINE 1A ON PART I, QUESTIONS REGARDING COMPENSATION, SANFORD CHECKED SEVERAL OF THE ITEMS AS PROVIDED TO LISTED PERSONS: FIRST CLASS OR CHARTER TRAVEL - CHARTER TRAVEL FOR BUSINESS PURPOSES IS PROVIDED FOR INDIVIDUALS AS NEEDED AND AS COST APPROPRIATE, IN ACCORDANCE WITH WRITTEN POLICIES. THESE COSTS ARE NOT INCLUDED IN THE W-2'S OF THE INDIVIDUALS AS THEY ARE INCURRED FOR BUSINESS PURPOSES OF SANFORD. TRAVEL FOR COMPANIONS - LIMITED TRAVEL FOR COMPANIONS IS OFFERED FOR CERTAIN MEETINGS AND EVENTS. THESE COSTS ARE INCLUDED IN THE 1099'S OF THE INDIVIDUALS. SANFORD USED THE SIFL (STANDARD INDUSTRY FARE LEVEL) RATE METHOD TO IMPUTE THE FRINGE BENEFIT TO THE LISTED PERSON. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS - CERTAIN COMPENSATION MAY BE GROSSED UP TO INCLUDE APPROPRIATE TAX AMOUNTS. HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES - ALL SANFORD EMPLOYEES ARE ELIGIBLE FOR DISCOUNTED WELLNESS MEMBERSHIPS, A PORTION OF THESE DISCOUNTS AND OTHER CLUB DUES ARE INCLUDED AS FRINGE BENEFITS AND TAXED AS SUCH. PART I, LINE 3: THE EXECUTIVE COMPENSATION COMMITTEE OF THE SANFORD BOARD OF TRUSTEES DIRECTLY ENGAGES A NATIONALLY RECOGNIZED INDEPENDENT COMPENSATION CONSULTING FIRM ANNUALLY TO REVIEW THE TOTAL COMPENSATION ARRANGEMENTS OF THE OFFICERS AND EXECUTIVES OF THE ORGANIZATION, INCLUDING THE CEO, AND TO REPORT THE FINDINGS TO THEM FOR DELIBERATION AND ACTION. THE DELIBERATIONS AND ACTIONS ARE RECORDED IN THE MINUTES OF THE SANFORD BOARD OF TRUSTEES. THE MOST RECENT STUDY WAS COMPLETED IN 2022. PART I, LINES 4A-B LINE 4A-SEVERANCE OR CHANGE OF CONTROL PAYMENT UPON HIRE OR PROMOTION, SELECT OFFICERS AND KEY EMPLOYEES SIGN AN EXECUTIVE SEVERANCE AGREEMENT (THE "AGREEMENT"). THE AGREEMENT PROVIDES THAT THE EXECUTIVE WILL RECEIVE A MULTIPLE OF HIS OR HER SALARY (BASED ON YEARS OF SERVICE OR POSITION) AS A PAYMENT IN THE EVENT OF A DEFINED SEPARATION EVENT, WHICH CAN INCLUDE AN INVOLUNTARY SEPARATION OR AN EMPLOYEE VOLUNTARILY LEAVING FOR A DEFINED CONTRACTUAL REASON. EXECUTIVES MAY ALSO QUALIFY FOR A PAYMENT FOR SATISFYING A NON-COMPETE. FINAL SEPARATION PAYMENTS MIGHT VARY FROM THE AMOUNT PROVIDED IN THE AGREEMENT AS A RESULT OF NEGOTIATIONS SURROUNDING POST-SEPARATION OBLIGATIONS AND INCENTIVES (THE "SEPARATION" PAYMENT). LINE 4B-SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS SANFORD SPONSORS NONQUALIFIED RETIREMENT PLANS FOR SELECT OFFICERS OR KEY EMPLOYEES. CERTAIN OF THE BELOW OFFICERS OR KEY EMPLOYEES WERE PAID AS A RESULT OF A VESTING EVENT. LINE 4A AND 4B-PAYMENTS THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE OR CHANGE OF CONTROL PAYMENTS AND/OR SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS: BRYAN NERMOE: SEPARATION..................................$2,011,302 NONQUALIFIED RETIREMENT PLAN.................$708,639 TOTAL.......................................$2,719,941 RANDY BURY: SEPARATION..................................$2,769,572 JOANN KUNKEL: NON-COMPETE PAYMENT...........................$339,000 KIM PATRICK: NON-COMPETE PAYMENT...........................$315,000 NATHAN WHITE: NON-COMPETE PAYMENT...........................$300,000 ALLISON WIERDA-SUTTLE: NON-COMPETE PAYMENT...........................$264,600 PART I, LINE 6 SANFORD PHYSICIANS ARE COMPENSATED BASED ON THE PROFESSIONAL SERVICES THEY PERFORM WITHIN THE CLINIC IN WHICH THEY PROVIDE CARE. GENERALLY, THE MODEL IS BASED ON PRODUCTION. PART I, LINE 7 CERTAIN EMPLOYEES ARE ELIGIBLE FOR A DISCRETIONARY INCENTIVE BONUS. BONUSES ARE PAID BASED ON THE ACHIEVEMENT OF FINANCIAL AND OTHER GOALS. A SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 460315509 83755VHY3 2004-09-14 70073989 2004: NEW CONSTRUCTION OF HEALTHCARE FACILITIES 0 0 0 B CITY OF CHAMBERLAIN 460000094 000000000 2010-12-30 4000000 2010 CHAMB: NEW CONSTRUCTION OF LONG-TERM CARE FACILITIES 0 0 0 C SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 460315509 000000000 2012-03-29 66185000 2012AB: REFUNDING BONDS ISSUED 9/12/2001 AND 10/15/2002 0 0 0 D SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 460315509 000000000 2012-06-14 45000000 2012D:REFINANCE TAXABLE INDEBTEDNESS USED TO CONSTRUCT HEALTHCARE FACILITY 0 0 0 A 57490000 71581953 74550 764068 70817885 2006 0 0 1 1 B 2959679 4000000 4000000 2010 0 0 1 1 C 35040000 66185000 24356 66160644 2012 1 1 1 1 D 19220000 45000000 45000000 2012 0 0 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 D 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 1 0 0 0 0 B 0 0 1 0 1 0 0 0 0 C 0 0 0 1 1 0 0 0 0 D 0 0 1 0 1 0 0 0 0 A 0 B 0 C 0 D 0 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 09/14/2006 ISSUER NAME: SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 03/29/2013 ISSUER NAME: SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 10/30/2019 ISSUER NAME: SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 11/12/2020 SCHEDULE K, PART I, BOND ISSUES BONDS ISSUED 10/28/2014, COLUMN(C) CUSIP #: 83755VXF6 AND 83755VXE9 BONDS ISSUED 9/14/2004, COLUMN(C) CUSIP #: 83755VHY3 AND 83755VHZ0 PART I, COLUMN E AND PART II, LINE 3 DIFFERENCES BETWEEN THE ISSUE PRICE (PART I, COLUMN E) AND TOTAL PROCEEDS (PART II, LINE 3) ARE DUE TO INVESTMENT EARNINGS. PART II, LINE 4 THE AMOUNTS SHOWN HERE CONSIST OF DEBT SERVICE FUND DEPOSITS. PART III PART III HAS NOT BEEN COMPLETED FOR THE 3/29/2012 SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY BONDS. THESE BONDS REFUNDED PRE-2003 DEBT THAT DOES NOT HAVE TO BE REPORTED. PART IV, LINE 6 WITH RESPECT TO THE 3/29/2012 AND 10/21/2015 SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY BONDS, THIS QUESTION IS BEING ANSWERED WITHOUT REGARD TO A YIELD-RESTRICTED ADVANCE REFUNDING ESCROW FINANCED WITH PROCEEDS OF BONDS. A SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 460315509 83755VWA8 2014-08-05 52083720 2014A: CURRENT REFUND 2004A ISSUED 9/14/2004 0 0 0 B SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 460315509 83755VXE9 2014-10-28 207014209 2014B: NEW CONSTRUCTION AND REMODELING OF HEALTHCARE FACILITIES 0 0 0 C SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 460315509 83755VZW7 2015-10-21 192641206 2015:NEW CONSTRUCTION & ADVANCED REFUNDING OF BONDS ISSUED 4/19/07, 5/22/07 0 0 0 D SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 460315509 000000000 2016-10-28 50000000 2016: NEW CONSTRUCTION, EQUIPMENT AND IMPROVEMENTS 0 0 0 A 52083720 476 52083720 2014 1 0 1 1 B 24890000 207081359 3605 31874 1906127 205143359 2017 0 0 1 1 C 25260000 192707024 3685 1431628 110529233 80746163 2017 0 1 1 1 D 30000000 50000000 150032 49849968 2017 0 0 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 C 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 D 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 0 0 0 0 0 0 B 0 0 0 1 0 0 0 0 0 C 0 0 0 1 0 0 0 0 0 D 0 0 1 0 1 0 0 0 0 A 0 B 0 C 0 D 0 MELINDA ANDERSON FAMILY RELATIONSHIP - MARK PAULSON 169960 EMPLOYMENT 0 KATHRYN NERMOE FAMILY RELATIONSHIP - BRYAN NERMOE 150884 EMPLOYMENT 0 KACEY DOYLE FAMILY RELATIONSHIP - MARNIE HERMANN 65433 EMPLOYMENT 0 KRISTI BENZ FAMILY RELATIONSHIP - LAURIS MOLBERT 60298 EMPLOYMENT 0 NICHOLE HESTER FAMILY RELATIONSHIP - ANDY NORTH 58844 INDEPENDENT CONTRACTOR ARRANGEMENT 0 MALLORY NERMOE FAMILY RELATIONSHIP - BRYAN NERMOE 54485 EMPLOYMENT 0 MEGAN HEMMELGARN FAMILY RELATIONSHIP - MARK PAULSON 17259 EMPLOYMENT 0 PART V, LINE 3A: SANFORD HEALTH, SANFORD MEDICAL CENTER, SANFORD NORTH, SANFORD MEDICAL CENTER FARGO, SANFORD CLINIC NORTH, SANFORD CLINIC, SANFORD BISMARCK, SANFORD HEALTH NETWORK NORTH, AND SANFORD WORLD CLINICS HAVE UNRELATED BUSINESS GROSS INCOME OVER $1,000. PART V, LINE 4A: SANFORD WORLD CLINICS HAS AN INTEREST IN FINANCIAL ACCOUNTS IN THE FOREIGN COUNTRIES OF GHANA, CHINA AND GERMANY. FORM 990, PART VI, SECTION A, LINE 2 THE FOLLOWING OFFICERS, BOARD MEMBERS, AND KEY EMPLOYEES ARE EMPLOYEES OF SANFORD OR ITS RELATED ORGANIZATIONS. MANY OF THESE EMPLOYEES ALSO SERVE ON OTHER RELATED SANFORD BOARDS, OR HAVE BUSINESS RELATIONSHIPS WITH EACH OTHER THAT SPAN THE ORGANIZATION AS A WHOLE: BILL GASSEN, BRYAN NERMOE, JENNIFER GRENNAN, MARIA BELL, MARK LUNDEEN, MARK PAULSON, MICHAEL LEBEAU, MICHELLE BRUHN, MICHELLE MICKA, PAUL HANSON, MATT HOCKS, SUSAN JARVIS, TODD SCHAFFER, & TIFFANY LAWRENCE. FORM 990, PART VI, SECTION A, LINE 6 SANFORD IS GOVERNED BY A BOARD OF TRUSTEES (BOT) THAT HAS ULTIMATE STRATEGIC AND DECISION MAKING AUTHORITY. THE BOT DELEGATES CERTAIN ACTIVITIES AND RESPONSIBILITIES TO BOARDS OF EACH OF SANFORD'S PRIMARY OPERATING SUBSIDIARIES. THE UNIQUE NATURE AND COMPLEXITY OF THE SUBSIDIARIES REQUIRES EACH TO HAVE A DELEGATED BOARD WITH A SINGULAR ENTITY FOCUS. SUCH BODIES, REFERRED TO AS BOARDS OF DIRECTORS AND BOARDS OF GOVERNORS, ADDRESS MATTERS SUCH AS CREDENTIALING, ACCREDITATION STANDARDS, DEVELOPING BUDGETS, PROGRAMS AND FACILITIES ON AN ENTITY-SPECIFIC BASIS, AND GENERALLY CONSIST OF INDIVIDUALS DISTINCT FROM THE BOT. THESE BOARDS FUNCTION MUCH LIKE COMMITTEES IN A TRADITIONAL CORPORATE STRUCTURE. THE BOT THEN ACTS AS A HOLDING COMPANY BOARD, SYNTHESIZING AND RECONCILING EACH ENTITY'S PROGRAMS AND BUDGETS INTO A SYSTEM-WIDE STRATEGIC PLAN. THIS STRUCTURE OF GOVERNANCE PRODUCES A SIGNIFICANT NUMBER OF TRUSTEES, GOVERNORS AND DIRECTORS. SUBSIDIARIES INCLUDED WITHIN THIS GROUP TAX RETURN CONSIST OF SANFORD HEALTH, SANFORD NORTH, SANFORD MEDICAL CENTER, SANFORD MEDICAL CENTER FARGO, SANFORD CLINIC, SANFORD CLINIC NORTH, SANFORD HEALTH NETWORK, SANFORD HEALTH NETWORK NORTH, SANFORD HOME HEALTH, SANFORD RESEARCH, SANFORD RESEARCH NORTH, SANFORD WORLD CLINICS, SANFORD HEALTH OF NORTHERN MINNESOTA, BAKER PARK, INC., SANFORD WEST, SANFORD BISMARCK, SANFORD VIRTUAL CARE, AND SANFORD WORLD CLINICS - KLAMATH FALLLS. THE BOARD OF TRUSTEES OF SANFORD IS ALSO THE BOARD OF TRUSTEES FOR SANFORD HEALTH, SANFORD NORTH, AND SANFORD WEST, AND SANFORD IS THE SOLE CORPORATE MEMBER OF THESE ENTITIES. THESE ENTITIES, IN TURN, ARE THE SOLE CORPORATE MEMBERS OF THEIR SUBSIDIARIES. THE ACTIONS APPROVED BY A SUBSIDIARY'S BOARD OF DIRECTORS ARE THEN APPROVED BY THE SANFORD BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7A THE SANFORD BOARD OF TRUSTEES APPOINTS THE BOARD MEMBERS FOR THE BOARDS OF DIRECTORS AND BOARDS OF GOVERNORS OF THE SUBSIDIARY ENTITIES. FORM 990, PART VI, SECTION A, LINE 7B THE SANFORD BOARD OF TRUSTEES APPROVES THE ACTIONS APPROVED BY THE BOARDS OF DIRECTORS AND BOARDS OF GOVERNORS OF THE SUBSIDIARY ENTITIES. FORM 990, PART VI, SECTION B, LINE 10B: SANFORD NORTH, SANFORD CLINIC AND SANFORD HEALTH NETWORK HAVE LOCAL CHAPTERS, BRANCHES OR AFFILIATES OVER WHICH THE ORGANIZATION HAS THE LEGAL AUTHORITY TO EXERCISE DIRECT OR INDIRECT SUPERVISION AND CONTROL. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED INTERNALLY BY THE TAX DEPARTMENT AND REVIEWED BY EXECUTIVE MANAGEMENT. AN EXTERNAL ACCOUNTING FIRM REVIEWS THE RETURN. THE TAX DEPARTMENT PREPARES RETURN HIGHLIGHTS AND KEY DISCLOSURES FOR FINANCE SENIOR LEADERSHIP. BEFORE THE RETURN IS FILED, A COMPLETE COPY OF THE RETURN IS PROVIDED TO THE CURRENT BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 12C THE ANNUAL CONFLICT OF INTEREST DISCLOSURE PROCESS IS MANAGED BY THE CHIEF COMPLIANCE OFFICER (CCO). THE CCO IS RESPONSIBLE FOR ASSURING THAT ALL COMPLETED FORMS ARE RETURNED IN A TIMELY AND COMPLETE MANNER. CONFLICT OF INTEREST QUESTIONNAIRES ARE SENT TO SYSTEM TRUSTEES, MEMBERS OF THE GOVERNING BOARDS OF SUBSIDIARY ENTITIES, OFFICERS, AND KEY EMPLOYEES FOR ALL ENTITIES SUBJECT TO THE IRS FORM 990 FILINGS. THE DISCLOSURES ARE SUMMARIZED FOR REVIEW BY THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES, PURSUANT TO POLICY. THIS REVIEW ALLOWS: 1) THE BOARD TO ACQUIRE AN AWARENESS OF FINANCIAL RELATIONSHIPS OF BOARD MEMBERS AND KEY MANAGEMENT EMPLOYEES AND CAN INVOKE THE RECUSAL PROCESS ON A CASE-BY-CASE BASIS IF POTENTIAL CONFLICTS ARE IMPLICATED IN BOARD DECISIONS AND DELIBERATIONS, AND, 2) GIVES THE BOARD THE OPPORTUNITY TO SEEK ADDITIONAL INFORMATION AND CLARIFICATION ABOUT DISCLOSURES TO DETERMINE POTENTIAL CONFLICTS OF INTEREST, AND HOW TO MANAGE THEM. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMPENSATION COMMITTEE OF THE SANFORD BOARD OF TRUSTEES DIRECTLY ENGAGES A NATIONALLY RECOGNIZED INDEPENDENT COMPENSATION CONSULTING FIRM ANNUALLY TO REVIEW THE TOTAL COMPENSATION ARRANGEMENTS OF THE OFFICERS AND EXECUTIVES OF THE ORGANIZATION, INCLUDING THE CEO, AND TO REPORT THE FINDINGS TO THEM FOR DELIBERATION AND ACTION. THE DELIBERATIONS AND ACTIONS ARE RECORDED IN THE MINUTES OF THE SANFORD BOARD OF TRUSTEES. THE MOST RECENT STUDY WAS COMPLETED IN 2022. PART VI, LINE 16A: SANFORD MEDICAL CENTER, SANFORD CLINIC, SANFORD MEDICAL CENTER FARGO AND SANFORD CLINIC NORTH HAVE PARTICIPATED IN JOINT VENTURES WITH TAXABLE ENTITIES. FORM 990, PART VI, SECTION C, LINE 19 ALTHOUGH THE ORGANIZATION DOES NOT MAINTAIN A WEBSITE WHERE THE PUBLIC CAN ACCESS THESE DOCUMENTS, IT WOULD RESPOND INDIVIDUALLY TO ANY REQUESTS OR INQUIRIES FROM THE PUBLIC FOR THESE DOCUMENTS. FORM 990, PART VII, SECTION A THE TABLE REPORTS THE COMPENSATION OF THE SANFORD OFFICERS, DIRECTORS/TRUSTEES, SYSTEM KEY EMPLOYEES, AND FIVE HIGHEST COMPENSATED EMPLOYEES AND INDEPENDENT CONTRACTORS. THE SANFORD BOARD OF TRUSTEES HAS ULTIMATE GOVERNANCE RESPONSIBILITIES FOR EACH SUBORDINATE ORGANIZATION. FORM 990, PART VII, SECTION B WE ARE REPORTING ONE GROUP OF TOP FIVE EMPLOYEES AND INDEPENDENT CONTRACTORS FOR THE ENTIRE GROUP. AMOUNTS LISTED AS COMPENSATION FOR THE FIVE HIGHEST COMPENSATED INDEPENDENT CONTRACTORS INCLUDE PAYMENTS FOR BOTH MATERIALS AND SERVICES. FORM 990, PART XI, LINE 9: NET PAYROLL PAID BY PARENT NET OF OTHER EXPENSES PAID FOR AFFILIATES 62,167,718. PENSION PLAN ACTURIAL GAIN/LOSS 18,822,320. CAPITAL CONTRIBUTIONS TO SUBSIDIARIES -901,671. FORM 990 ELECTIONS FORM 990, PAGE 1, LINE H(A) - LISTING OF SUBORDINATE ORGANIZATIONS: NAMES, ADDRESSES, AND EINS SANFORD HEALTH 1305 W 18TH STREET, PO BOX 5039 SIOUX FALLS, SD 57117-5039 EIN: 31-1527032 SANFORD MEDICAL CENTER 1305 W 18TH STREET, PO BOX 5039 SIOUX FALLS, SD 57117-5039 EIN: 46-0227855 SANFORD HOME HEALTH 1305 W 18TH STREET, PO BOX 5039 SIOUX FALLS, SD 57117-5039 EIN: 46-0282134 SANFORD HEALTH NETWORK 1305 W 18TH STREET SIOUX FALLS, SD 57105 EIN: 46-0388596 SANFORD CLINIC 1305 W 18TH STREET, PO BOX 5039 SIOUX FALLS, SD 57117-5039 EIN: 46-0447693 SANFORD RESEARCH 2301 E 60TH STREET N SIOUX FALLS, SD 57104 EIN: 46-0450378 SANFORD RESEARCH NORTH 120 8TH STREET SOUTH FARGO, ND 58103 EIN: 45-0274828 SANFORD WORLD CLINICS 1305 W 18TH STREET SIOUX FALLS, SD 57105 EIN: 26-2707628 SANFORD WORLD CLINICS - KLAMATH FALLS 3001 DAGGETT AVE KLAMATH FALLS, OR 97601 92-0396212 SANFORD NORTH 801 BROADWAY DRIVE, PO BOX 2010 FARGO, ND 58122 EIN: 45-0385890 SANFORD CLINIC NORTH 801 BROADWAY DRIVE, PO BOX 2010 FARGO, ND 58122 EIN: 91-1770748 SANFORD MEDICAL CENTER FARGO 801 BROADWAY DRIVE, PO BOX 2010 FARGO, ND 58122 EIN: 45-0226909 SANFORD HEALTH NETWORK NORTH 801 BROADWAY DRIVE, PO BOX 2010 FARGO, ND 58122 EIN: 45-0409348 SANFORD HEALTH OF NORTHERN MINNESOTA 1300 ANNE STREET NW BEMIDJI, MN 56601 EIN: 41-1266009 BAKER PARK, INC. 803 DEWEY AVENUE NW BEMIDJI, MN 56601 EIN: 41-1372480 SANFORD WEST 300 N 7TH STREET BISMARCK, ND 58501 EIN: 45-0397195 SANFORD BISMARCK 300 N 7TH STREET BISMARCK, ND 58501 EIN: 45-0226700 SANFORD VIRTUAL CARE 1305 W 18TH STREET, PO BOX 5039 SIOUX FALLS, SD 57117-5039 EIN: 88-0976483 1527 BROADWAY LLC 1527 BROADWAY ALEXANDRIA MN 56308 411336392 REAL ESTATE MN 0 151829 SANFORD CLINIC NORTH B&K PROPERTIES LLC PO BOX 5039 RTE 5218 SIOUX FALLS SD 571175030 830614887 REAL ESTATE SD 0 0 SANFORD HEALTH HEALTHCARE ENVIRONMENTAL SERVICES LLC PO BOX 2010 FARGO ND 58122 205236701 RETAIL ENTERPRISES ND 1143510 3806618 SANFORD NORTH LINCOLN COUNTY REAL ESTATE TRUST 100 S PHILLIPS AVE SIOUX FALLS SD 57104 466126929 REAL ESTATE SD SANFORD HEALTH LYNX TRUST PO BOX 5186 SIOUX FALLS SD 57117 266167201 INVESTMENT SD SANFORD HEALTH NATIONAL STUDENT HOUSING TRUST-SD PO BOX 5186 SIOUX FALLS SD 57117 206831968 INVESTMENT SD 0 0 SANFORD HEALTH NORTH COUNTRY SENIOR LIVING LLC 1000 ANNE ST NW BEMIDJI MN 56601 263862586 SENIOR HOUSING CO 3839877 5143010 SANFORD HEALTH OF NORTHERN MINNESOTA PPK FAMILY TRUST 100 S PHILLIPS AVE SIOUX FALLS SD 57104 207317570 RENTAL REAL ESTATE SD 34580 2247575 SANFORD HEALTH SANFORD HEALTHCARE ACCESSORIES LLC 3223 32ND AVE SW FARGO ND 58103 202404179 SALES OF DURABLE MEDICAL EQUIP ND 0 0 SANFORD HEALTH SHETEK MEDICAL SERVICES LLC 251 5TH STREET E TRACY MN 56175 412004685 HOME HEALTH SERVICES MN 166282 246 SANFORD HEALTH NETWORK SOUTHWEST MN RADIATION CENTER LLC 1018 6TH AVENUE WORTHINGTON MN 56187 460447693 RADIATION SERVICES MN SANFORD HEALTH NETWORK ADAMS COUNTY GOOD SAMARITAN HOUSING GP INC P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 461495572 LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS AS GP SD 501(C)(3) 12-I THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY 1 ARLINGTON GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 371805492 PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS SD 501(C)(3) 10 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY 1 BOISE GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 363370371 PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS SD 501(C)(3) PF THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY 1 COLLISTER DRIVE HOUSING GP INC P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 300872973 LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS AS GP SD 501(C)(3) PF THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY 1 F-M AMBULANCE SERVICE INC P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 450344371 EMT ND 501(C)(4) SANFORD NORTH 1 GOOD SAMARITAN SOCIETY INC P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 460349951 PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS SD 501(C)(3) 12-I THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY 1 HASTINGS VILLAGE GARDENS GOOD SAMARITAN HOUSING GP INC P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 271212446 LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS AS GP SD 501(C)(3) 12-I THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY 1 HOWARD LAKE GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 364885253 PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS SD 501(C)(3) 10 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY 1 LEA COUNTY GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 453946645 PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS SD 501(C)(3) 10 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY 1 LILAC WAY GOOD SAMARITAN HOUSING GP INC P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 465740381 LOW INCOME HOUSING 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