2024-11-11T13:48:58+00:00 2023-12-31 990 2023-01-01 411456897 Healtheast St John's Hospital HEAL 6126724976 2450 Riverside Avenue Minneapolis MN 55454 James Hereford President/CEO 2024-11-11 true 2023 2024-10-15 13:58:12Z James Hereford 2450 Riverside Avenue Minneapolis MN 55454 444011316 false X www.fairview.org X 1983 MN HealthEast St. John's Hospital is an acute care hospital. 20 19 0 182 147226 0 3785610 97504 383045790 443489312 -349773 400350 0 386481627 443987166 0 0 222220865 238346956 0 0 192190099 205959686 414410964 444306642 -27929337 -319476 162700153 190600402 104721997 133487766 57978156 57112636 Fairview is driven to heal, discover, and educate for longer, healthier lives. false false 369226014 443489312 HealthEast St. John's Hospital opened in Maplewood in 1985. State-of-the-art care in a comforting environment. From the moment patients and visitors walk into HealthEast St. John's Hospital they experience our warm, inviting atmosphere and caring, personal staff. State-of-the-art technology, combined with the expertise of our specialists, nurses and staff, contribute to our innovative healing environment and personal, compassionate health care delivery. Our 184-bed facility offers a wide variety of diagnostic and therapeutic services. To meet the needs of our growing community, St. John's Hospital provides innovative technologies and services such as the intensivist program (on-site critical care physician specialists), 24-hour in-house obstetrics coverage and a neonatal intensive care unit (NICU). Truly a community hospital, St. John's is part of a 32-acre health care campus and offers a convenient, suburban location, easy access to major highways and free parking. We are proud to have served our community for 100 years. St. John's is part of Fairview Health Services. Fairview Health Services is an integrated academic health system located in Minneapolis, Minnesota, and, along with its affiliates and subsidiaries, is one of the leading health care providers in Minnesota with $7.3 billion in operating revenue for 2023. Fairview offers a broad continuum of health care services through its hospitals, clinics, and other health care related operations and is a Minnesota nonprofit corporation that is exempt from federal income taxation under Section 501(c)(3) of the Internal Revenue Code. The most recent community health needs assessment (CHNA) identified 3 key areas as the greatest needs in our community - navigating and accessing care and resources; healing, connectedness, and mental health; structural racism and barriers to equity. Fairview Health Services is meeting the needs of the community by focusing on racial and ethnic populations experiencing health disparities and people experiencing poverty through partnering with the community to build solutions, removing barriers to create and expand relevant programs and focused services. Please see Schedule H for a description of additional services, community benefit activities, and the full spectrum of charity care that Fairview Health Services provides to the community. Fairview serves the entire twelve-county Minneapolis/St. Paul Metro Area, as well as communities throughout greater Minnesota and portions of Northern Iowa and Western Wisconsin and is one of the most comprehensive and geographically accessible systems in Minnesota. The Fairview System consists of ten hospitals, including M Health Fairview University of Minnesota Medical Center and M Health Fairview Masonic Children's Hospital (collectively, "UMMC"), which is the adult and pediatric teaching hospital of the University of Minnesota. UMMC and seven of Fairview's other hospitals are in the Metro Area. Fairview's other two hospitals are located in northern Minnesota. Fairview operates over 80 primary and specialty care clinics, seven ambulatory care centers, 37 retail and specialty pharmacies, pharmacy benefit management services, rehabilitation centers, physician network, senior care housing and long- term care facilities and medical transportation. Fairview, through its integrated care model, aims to deliver the benefits of academic medicine to more patients and families by expanding care, research, and education by offering access to a greater pool of physicians and patients, while seeking to reduce the total cost of care for patients. Fairview, the University of Minnesota and the University of Minnesota Physicians approved an agreement which became effective in late 2018 (the "M Health Fairview Agreement"). While the parties maintain their separate governance, the M Health Fairview Agreement further integrated operations across the clinical delivery system and enhances research and education by creating a joint clinical enterprise among the parties. The M Health Fairview Agreement brings together UMMC and its related service lines, Fairview's community hospitals and primary care clinics, and other services. All are part of a shared care delivery system that is led by a single structure that includes academic physician leadership. The goal of the joint clinical enterprise is to create a nationally-renowned academic health system. This care system was united in 2020 under a single brand, M Health Fairview, which is inclusive of Fairview's ten hospitals and its clinics. Fairview owns and operates the following hospitals: UMMC, M Health Fairview Southdale Hospital, M Health Fairview Ridges Hospital, M Health Fairview Lakes Medical Center, M Health Fairview Northland Medical Center, Fairview University Medical Center - Mesabi ("Range"), Grand Itasca Clinic and Hospital, M Health Fairview St. John's Hospital, M Health Fairview Woodwinds Hospital and M Health Fairview Bethesda Long Term Acute Hospital. As of December 31, 2023, the Fairview System Hospitals had a total of 3,529 licensed beds and 1,824 staffed beds. Fairview operates their more than 80 primary and specialty care clinics throughout the Metro Area, greater Minnesota and western Wisconsin. These clinics offer services in over 70 medical specialties, including family medicine, pediatrics, obstetrics, gynecology, heart care, cancer care, otolaryngology, transplant care, and orthopedics. As of December 31, 2023, Fairview owned all or a portion of six ambulatory surgery centers located in the Metro Area. Fairview and Fairview Pharmacy Services own and operate pharmacies at 37 locations, including a network of retail pharmacies, oncology pharmacies, two home infusion pharmacies (Minneapolis and Duluth, Minnesota), and a specialty pharmacy. M Health Fairview Rehabilitation Services ("MHFRS") provides a full continuum of inpatient and outpatient rehabilitation services for pediatric and adult patients as well as an inpatient rehabilitation facility, a hospital based skilled nursing facility and an adult day program. In addition to providing inpatient services in nine hospitals, MHFRS has 58 outpatient hospital based and free-standing clinics that serve pediatric and adult patients. Specialty services include rehabilitation in the following areas: Cardiac and Pulmonary rehabilitation, Audiology, Orthopedic, Sports related injuries, Neurological, Vestibular, and Cancer Rehab. Hand therapy services are also provided in seven locations. MHFRS serves about 750,000 patient visits/year. M Health Fairview Emergency Medical Services offers emergency medical services and scheduled transportation across the Metro Area and supports the community by responding to more than 60,000 calls annually. Ebenezer, a non-profit subsidiary of Fairview, provides long-term senior care facilities, senior housing, adult care services. Ebenezer's goal is to provide a supportive environment where older adults can pursue longer, healthier, and more meaningful lives. COMMUNITY COMMITMENT Fairview, an anchor institution rooted in our communities, continues to invest heavily in the health and wellness of its communities in which it operates. This commitment includes education, training, community programs and research, as well as significant investments in care delivery. The COVID pandemic exposed persistent health inequities for communities of color and has exacerbated racial disparities. Communities of color experienced statistically higher rates of COVID, including higher rates of hospitalization and death. To reduce the impact on Black, Indigenous, or people of color ("BIPOC"), vaccinations must be accessible, free and provided within a trusted space with appropriate language and cultural considerations. Fairview has led a multi-cultural mobile vaccination program for the past 17 years, which excels at reaching BIPOC communities facing barriers to immunization. Further, Fairview's longstanding relationship with local public health agencies and community partners has allowed Fairview to provide staffing, coordination, and outreach for mobile vaccination clinics at schools, public high rises, community centers, churches, and other locations, increasing vaccine access to those in the area. From January 2021 (when Fairview initiated its free community COVID vaccination clinics) through December 31, 2023, Fairview has worked with over 150 partners to provide 1,424 vaccination clinics in community settings, administering 62,416 free COVID-19 vaccine doses and 21,004 free flu shots. 369226014 true true false true false false false false false true false true true true true false true false false false false false false false false true true false false true false false false false false false false false false false false false true true false false false true X 0 0 0 true true false false false false false false false false false false false X 20 19 false false false false true true true true true false false true true true true true true true true false MN X Dawn Ksepka 6126724986 1700 University Avenue W St Paul MN 55104 Jakub Tolar MD Vice Chair 0.0 2.0 X X 0 0 0 James Hereford President & CEO 2.0 40.0 X X 0 5208444 38307 Karen Grabow Vice Chair 0.0 2.0 X X 0 25000 0 RIch Ostlund Chair 0.0 2.0 X X 0 35000 0 Timothy Marx Secretary 0.0 2.0 X X 0 25000 0 Ann Lowry MD Director 0.0 2.0 X 0 25000 0 Ann Williamson Director 0.0 2.0 X 0 20000 0 Barclay Berdan Director 0.0 4.0 X 0 20000 0 Brad Wallin Director 0.0 4.0 X 0 20000 0 David Levy Director 0.0 2.0 X 0 20000 0 Jodi RIchard Director 0.0 4.0 X 0 25000 0 John Heinmiller Director 0.0 2.0 X 0 25000 0 Julie Causey Director 0.0 4.0 X 0 25000 0 Kenneth Roering Director 0.0 2.0 X 0 20000 0 Melissa Geller MD Director 0.0 2.0 X 0 0 0 Michael Connly Director 0.0 4.0 X 0 25000 0 Myron Frans Director 0.0 4.0 X 0 0 0 PJ Hill Director 0.0 2.0 X 0 20000 0 Shawntera Hardy Director 0.0 2.0 X 0 20000 0 Stephen Swensen MD Director 0.0 2.0 X 0 20000 0 Andrea Mokros Chf Public Affairs Officer 2.0 40.0 X 0 749408 97934 Euthemy Lebrew EVP & Chf Transformation Officer 2.0 40.0 X 0 813268 116219 Jeoff Will EVP, COO 2.0 40.0 X 0 1082554 170630 Joseph Gaylord CFO 2.0 40.0 X 0 1643003 200937 Laura Reed COO 2.0 40.0 X 0 1929528 103835 Mark Welton CMO 2.0 40.0 X 0 1577623 103992 Mary Nease Chf People Officer 2.0 40.0 X 0 969761 65596 Robert Beacher EVP & Chf Shared Clinical Svcs 2.0 40.0 X 0 1304189 206096 Sameer Badlani Chf Digital Officer 2.0 40.0 X 0 1183898 187871 Trudi Trysla Chf Legal Counsel 2.0 40.0 X 0 1133415 276107 Alexander Ivaskovic MD Physician 40.0 0.0 X 0 530686 37123 Avraham Sofer MD Physician 40.0 0.0 X 0 528932 38061 Liu-Ying Luo MD Physician 40.0 0.0 X 0 611415 17215 Nadiya Beliveau MD Physician 40.0 0.0 X 0 502755 25121 Rahul Chauhan MD Physician 40.0 0.0 X 0 596210 37509 Roma Teekamdas MD Physician 40.0 0.0 X 0 0 0 Diane Ogren MD Physician 0.0 40.0 X 0 580626 38897 Elizabeth Bennett MD Physician 0.0 40.0 X 0 1437846 18217 James McGreevy MD Physician 0.0 40.0 X 0 738539 38835 Jeffrey Borut MD Physician 0.0 40.0 X 0 716176 38897 Kyle Wahlstrom MD Physician 0.0 40.0 X 0 703107 38897 Puneet Cheema MD Physician 0.0 40.0 X 0 718992 41095 Xin Wang MD Physician 0.0 40.0 X 0 798501 38897 0 26428876 1976288 0 true true false 0 60769 36735 97504 Patient Revenue 621110 441117055 441117055 Cafeteria Revenue 722514 1151347 1151347 JV Income-MSC 621400 1073684 1073684 Lab Services 621500 147226 147226 0 0 0 0 443489312 93515 93515 0 0 330985 24150 0 306835 306835 306835 0 0 0 0 0 443987166 443342086 147226 400350 192278535 183806941 8471594 11584850 11379016 205834 22255526 22040176 215350 12228045 11602180 625865 63068008 1509378 61558630 12998 12998 19033 19033 18172896 16155198 2017698 0 20000 20000 7450374 6347238 1103136 7089899 6942628 147271 157828 111039 46789 290597 163570 127027 3993475 3993475 8060402 7884581 175821 1095221 1095221 Medical Supplies 84976962 84779164 197798 Medical Tazes 6934677 6934677 Other Supplies 2205628 2147317 58311 Utilities Repair & Maintenance 2082765 2030994 51771 328923 270223 58700 0 444306642 369226014 75080628 0 450 0 47171637 52514182 0 0 0 0 7086912 10946423 414693 0 139950596 37390949 84996164 102559647 0 14797986 14782846 8232311 9797304 162700153 190600402 21360072 21047446 0 0 83361925 112440320 104721997 133487766 57978156 57112636 57978156 57112636 162700153 190600402 X -319476 -546044 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 19033 19033 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY The organization pays annual membership dues to the American Hospital Association and the Minnesota Hospital Association. A portion of these annual dues are determined to be used for lobbying purposes. 11880000 11880000 72855574 17817396 55038178 173841 167541 6300 32425210 18180681 14244529 22615971 1225331 21390640 102559647 Invesment in Joint Venture 14782846 14782846 Other Assets Goodwill 165750 Operating Leases 9631554 9797304 Lease Liabilities 10068987 Intercompany Payable 101487689 Post Retirement Benefits - MNA 831019 Deferred Revenue 52625 112440320 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote HealthEast St. John's Hospital is part of Fairview Health Services. Fairview recognizes all tax positions, including those positions in a previously filed tax return or a position expected to be taken in a future tax filing that is reflected in measuring current or deferred income tax assets and liabilities, when it is more likely than not (likelihood of greater than 50%) that, based on technical merits, the position will be sustained upon examination. There are $6,800,000 and $8,400,000 uncertain tax positions recorded on the consolidated balance sheets as of December 31, 2023 and 2022, respectively. Fairview has made reasonable estimates of the provision for income taxes and on existing deferred tax balances based on accounting guidance included in ASC 740, Income Taxes. Fairview does not expect that there will be a significant change in the total amount of unrecognized tax benefits within the next 12 months. true true X true X true X true true true false true true 5118552 162100 4956452 0.0112 77388037 55643167 21744870 0.0489 0 0.0 0 0 82506589 55805267 26701322 0.0601 226883 226883 0.0005 8632575 1895278 6737297 0.0152 17052388 15847177 1205211 0.0027 511 511 0 0.0 72375 72375 0.0002 0 0 25984732 17742966 8241766 0.0185 0 0 108491321 73548233 34943088 0.0786 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 true 7134307 142686 185001358 232871582 -47870224 X true true HealthEast Surgery Center-Maplewood LLC Surgery Center 0.5239 0.0837 Maplewood Imaging LLC Radiology Imaging Center 0.5 0.0 1 1 HealthEast St John's Hospital https://mhealthfairview.org/locations/m-health-fairview-st-johns-hospital 406183 X X X HealthEast St John's Hospital 1 false false true X X X X X X X X X X 21 true false false true X https://www.fairview.org/our-community-commitment/local-health-needs X X true 22 true https://www.fairview.org/our-community-commitment/local-health-needs false true X 200.0 400.0 X X X X X X true true X X X X true X mhealthfairview.org/resources/policies-and-documentation/Financial-Assistance-Policy X https://www.fvfiles.com/2266.pdf X mhealthfairview.org/resources/policies-and-documentation/Financial-Assistance-Plain-Language-Summary X X X X X X X true X false X X X true X false false Schedule H, Part V, Section B, Line 3E Fairview is committed to transparency and accountability in all we do, including our efforts to assess - and respond to - our community's most pressing health needs. The community benefit work that we do across Fairview must reflect our community's actual needs, not our assumptions about what those needs might or should be. Because we understand that change cannot happen when we work in silos, and it cannot happen in a single year, we grounded our 2021 CHNA process in alignment with our 2018 CHNA needs, existing data, and the voices of community members and community partners. Once we had collected, analyzed, and synthesized the information we received from both primary and secondary data sources, we established a prioritization process through which we could identify the community health needs that, if effectively addressed, would have the greatest positive impact on our communities and particularly on our priority populations. Having a consistent, defined process helps reduce the skewing effect of conscious and unconscious biases and enables us to define priority need areas that reflect our community's top health needs rather than our perception of those needs. We evaluated areas of need based on four broad criteria: -Has this need been voiced by the community? Has this need been vetted by the community? -Does this need align with Fairview's strategies and priorities? -Does this need align with existing public health strategies and community health assessments? -Does this need build upon Fairview's 2018 CHNA priority needs? Our process resulted in the identification of three priority need areas. They are: -Navigating and accessing care and resources -Healing, connectedness, and mental health -Addressing structural racism and barriers to achieving health equity. Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - HealthEast St. John's Hospital. The assessment process and data collection methods we used during this CHNA cycle were different than ever before due to the COVID-19 pandemic. COVID- 19 caused delays in data collection among local, state, and national organizations. As a result of these delays, the U.S. Census Bureau had not yet released finalized data from the 2020 U.S. Census by the time we began the CHNA process. As a result, we used 2015-2019 American Community Survey data. Local public health agencies also were not able to provide updated data as they have in the past. We acknowledge that, due to these setbacks, the data we used is less recent than desired. Additionally, COVID-19 required us to add new safety precautions to our method of gathering community voice data. For example, all conversations and interviews, which had previously been in-person meetings, took place in a virtual format instead. We collected additional community voice data by convening a broad array of stakeholders, with special focus on the priority populations. The process included discussions with community benefit and assessment committees, our community advisory council, the HOPE Commission listening and learning sessions, and key stakeholder interviews. Throughout this process, community members, local business leaders, government representatives, nonprofit and community organizations, and content experts shared their voices and perspectives about their community's health needs. Each hospital within Fairview has a community benefit and assessment committee that is involved in the CHNA process throughout the three-year cycle. Each committee is comprised of local community and organizational leaders and staffed by the Fairview Community Advancement department. The community benefit and assessment committees met four times between April and October in 2021, three of which were individual committee meetings and one of which was a system-wide Community Impact Summit that brought all the committees together. Each committee meeting consisted of facilitated discussions through which our team gathered input about top community needs. The Fairview Community Advisory Council, composed of key community leaders and staffed by Community Advancement, reviews the CHNA report and written implementation strategy and recommends it to the Patient Care and Experience Committee of the Fairview Board of Directors for review and adoption. Each member represents the member's respective community, and members represent a broad range of sectors, among them community organizations serving cultural communities, higher education organizations, banks, and a nonprofit electric company. The Community Advisory Council met from May through November 2021 to participate in the CHNA process, give feedback, and ultimately recommend the CHNA and implementation strategy for adoption. The HOPE Commission is a multi-year transformational change effort of M Health Fairview to drive more equitable outcomes and inclusive environments and experiences for our patients, employees, and communities. The Commission conducted a series of listening and learning sessions in 2020 and 2021. The objective was to hold a mirror to Fairview to assess where we are now and how we can make lasting change. Part of being an anti-racist health system is developing a candid understanding of our shortcomings. We particularly sought to hear perspectives and ideas from the most impacted populations: BIPOC employees and patients, front-line workers who care for underserved and marginalized patients, and those patients themselves. A survey was also made available each year to gather insights and suggestions from employees and patients who could not directly participate in a listening and learning session. In 2020, the commission convened 32 virtual listening and learning sessions and two town halls involving more than 1,500 participants across Fairview sites. The sessions focused on employees but included patients and community members as well. In September 2021, the HOPE Commission continued the listening and learning sessions following the same model. In this iteration, however, the focus was primarily on gathering input from patients (and employees as patients). In both 2020 and 2021's listening and learning sessions, the facilitators and note takers reflected the community represented by the session's group to the greatest degree possible. In August and September 2021, Fairview's Community Advancement team conducted a series of interviews with staff members who work with communities. Each conversation followed a consistent interview protocol developed for this purpose, and each interview was captured by means of detailed notes. The goal of these interviews was to draw on staff expertise to gain a deeper understanding of our priority needs and to determine whether there are any emerging needs that we should be considering. Between Aug. 31 and Sept.17, 2021, we conducted 17 interviews. In August 2021, we held two focus groups in partnership with other organizations. We convened the first focus group in partnership with HealthPartners and Allina Health, and the participants were faith community nurses. We convened the second focus group in partnership with the organizations that are a part of the East Side Health and Well-being Collaborative. This meeting's focus was on accessing care and resources for different cultural communities. Fairview also participated in two large surveys. KRC Research conducted a survey around health and health care needs in St. Paul between June 8 and July 7, 2021, and administered it to community members, Fairview employees, patients, and community partners. Responses were received from 294 residents, more than 1,000 employees, 221 patients, and 20 partners. The survey was offered online and by phone and in five languages: English, Spanish, Hmong, Somali, and Karen. Fairview also supported and was a partner organization in Bridge to Health, a survey that assesses the health needs of northern Minnesota residents. The Bridge to Health survey was administered between Aug. 28 and Oct. 23, 2020. The geographic areas that were sampled included Aitkin, Carlton, Cook, Itasca, Koochiching, Lake, St. Louis, and Pine counties in Minnesota, as well as Douglas County in Wisconsin. As a foundational part of program planning and evaluation, Community Advancement staff are continuously soliciting feedback from community partners and program participants. We capture this information on an ongoing basis and use it to provide valuable context and drive insights into the needs of the communities we serve. Fairview staff developed standardized tools, processes, instructions, and facilitator, interviewer, and note-taker protocols and training. All primary data was compiled, cleaned, and analyzed. Community conversations lasted various lengths from 30-120 minutes. All community input was captured by a note-taker. The Fairview team contracted with the following groups to support our assessment process: -Loren Blinde, PhD of Writing Power, a copywriter and content strategist, on the writing of the report. -Kristi Fordyce, an independent contractor, for analysis support. -Weber Shandwick, for data collection and analysis of focus groups and stakeholder interviews focused on St. Paul. -KRC Research for the administration and analysis of the St. Paul Community Survey Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - HealthEast St. John's Hospital. Review of the 2021 Community Health Needs Assessment. Our triennial community health needs assessment (CHNA) process provides an important opportunity to engage with and understand our community, analyze what has changed since the last assessment, and prioritize together with the community the issues we must urgently address to improve wellbeing and resilience. As part of the 2021 CHNA process, we reexamined and built upon the extensive community insights shared during our 2018 CHNA, while also surveying the community for current and emerging needs. Our 2021 CHNA used social determinants of health as a lens through which we frame our understanding of our community's most significant health needs. A social determinants of health lens enables us to identify inequitable distribution of resources and access that negatively impacts health. Through this lens we looked at both qualitative and quantitative data. Quantitative data included data points related to demographics, physical environment, socioeconomic factors, health care and health outcomes. We collected additional community voice data by convening a broad array of stakeholders, with special focus on the priority populations - racial or ethnic populations experiencing health disparities and persons experiencing poverty. St. John's Hospital has a community advisory committee (CAC) that is involved in the CHNA process. The committee is comprised of local community and organizational leaders, such as local public health, social services organizations, higher education institutions, school districts, and local businesses. The assessment process also included discussions with our community advisory council, listening and learning sessions, and key stakeholder interviews. Throughout this process, community members, local business leaders, government representatives, nonprofit and community organizations, and content experts shared their voices and perspectives about their community's health needs. Bringing together both the qualitative and quantitative data we established a prioritization process through which we could identify the community health needs that, if effectively addressed, would have the greatest positive impact on our communities and particularly on our priority populations. We prioritized areas of need based on four broad criteria: 1) Has this need been voiced by the community? Has this need been vetted by the community? 2) Does this need align with Fairview's strategies and priorities? 3) Does this need align with existing public health strategies and community health assessments? 4) Does this need build upon Fairview's 2018 CHNA priority needs? The St. John's Hospital identified three system-wide priority need areas, and will collaborate with other Fairview hospitals, medical centers, and shared business and clinical services to address these priorities. Our specific response varies by hospital based on the ways in which the priority needs manifest across a given community as well as the partnerships, both ongoing and new, that we have developed to address those needs. The three identified needs are: 1) Navigating and accessing care and resources, 2) Healing, connectedness, and mental health, 3) Addressing structural racism and barriers to equity. Each priority has a set of anticipated impacts, described in more detail below, and can be found in the St. John's Hospital CHNA Implementation Strategy Report (2022-2024). We also identified two priority populations that reach across the lifespan and impact from rural to urban. They are racial or ethnic populations experiencing health disparities and people experiencing poverty. For more details about our priority needs and the priority populations as they relate to the St. John's Hospital, please see the St. John's Hospital 2021 Community Health Needs Assessment. https://www.fairview.org/about/Our-Community-Commitment/Local-Health-Needs Development of 2022-2024 CHNA Implementation Strategies As a learning organization that works closely with our community advisory committees and community partners, over the past decades we have gleaned important lessons which have guided us in the development of our Fairview Health Services 2022-2024 implementation strategies. 1. Despite best efforts, health needs and health inequities continue to grow and deepen. 2. Collective action is critical. 3. Transformational change requires sustained and focused commitment. In response to our 2021 community health needs assessment and our lessons learned, all Fairview hospitals and medical centers worked collaboratively amongst each other, as well as in partnership with local and statewide organizations to address communities' most pressing needs. To rise to the challenge, we put forth a 2032 vision of increased community health equity supported by three strategies to address the priority need areas in distinct ways while collectively moving us closer to our vision of increased community health equity. The three strategies are: Strategy 1: Addressing SDOH - Addressing the social determinants of health (SDOH) as well as individual social risks and social needs through the creation and expansion of programs; initiatives; collaborations; research; and policy, system, and environmental work. Strategy 2: Community engagement infrastructure - Creating community engagement infrastructure that builds trusting partnerships and enables community voice to inform and influence the institution. Strategy 3: Inclusive institution - Transforming internal structures to create an antiracist and inclusive environment and to build community health by building wealth. For this three-year cycle, we are implementing our strategies to work toward distinct anticipated impacts for each priority need and ultimately our 10-year vision of increased community health equity. For more information, the St. John's Hospital CHNA Implementation Strategy Report outlines the major strategies and actions we will deploy throughout the 2022-2024 assessment cycle as well as the ties between the St. John's Hospital CHNA implementation strategies, anticipated impacts, and key responses. St. John's Hospital Community Health Needs Assessments Implementation Strategy Reports (2022-2024): https://www.fairview.org/about/Our-Community-Commitment/Local-Health-Needs Fairview's mission and vision extend beyond traditional healthcare settings, driving a healthier future for the communities we serve. Significant efforts towards Strategy 1 occurred over the first three years of our ten-year vision, demonstrated through standing up three Social Determinants of Health Initiatives. 1) "Food is Medicine" Using the healing power of food to nourish our patients, enrich our communities, and transform our systems. 2) "Housing is Health" Using the protective power of housing to support patient health and build thriving communities. 3) "Connection is Cure" aims to address social isolation and improve community mental health and well-being by strengthening the connection between patients and the healthcare system. These initiatives are key responses that intersect all three priority needs and are also synergistic among themselves. Relationship with our partners. Fairview has a long partnership with the University of Minnesota and University of Minnesota Physicians, now represented in the M Health Fairview brand. Together, we offer access to breakthrough medical research and specialty expertise as part of a continuum of care that reaches all ages and health needs. Policy, systems, and environmental change initiatives are implemented across the system (hospitals, clinics, etc.) and in some instances across the M Health Fairview partners to create sustainable and lasting change to advance health equity and community wellbeing. Where indicated, community responses as a part of strategy 2 (Community engagement infrastructure) and strategy 3 (Inclusive institution) represent the work of Fairview in collaboration with the other M Health Fairview partners. Schedule H, Part V, Section B, Line 11 Facility , 2 Facility , 2 - HealthEast St. John's Hospital - Continued. Community action plan. The St. John's Hospital has an annual CHNA action plan that supports our vision of increased community health equity, rolls up to our system CHNA implementation strategies, and addresses priority needs. The Fairview Health Services Community Action Plan details the specific and measurable steps we will take during the year to drive change. Program lists by hospital can be found in the appendix. The System Community Action Plan is updated annually and includes impacts from the prior years. This report is shared with the St. John's Hospital Community Advisory Committee, the Fairview Health Services Board of Directors, and is publicly available on the website: https://www.fairview.org/about/Our-Community-Commitment/Local-Health-Needs Evaluation of Impact. To best evaluate our impact and track progress towards our anticipated impacts, we used a multi-tiered and tailored evaluation approach. We ground our work in understanding core information about our communities. This includes identifying and understanding the community need being addressed, the population or community being impacted, and current and/or potential partners to work with to address the need, and the impacts we anticipate. Community needs are determined in several ways. In addition to being determined through our formal CHNA process, we also respond to emerging needs brought to us by a community partner, public health, or through patient or community data showing significant health disparities. We have standardized several key measures to assess that we are meeting the needs of the CHNA priority populations, focusing our efforts on equity, and participant satisfaction. A subset of established programs and initiatives are set up and supported for deeper evaluation. We have found with the populations we serve; one-size fits all evidence-based approaches are not a good fit for our diverse communities. In response to the unique and differing needs of our community members, our programs have been co-developed in partnership with community, centering the needs of specific populations, and often have unique local tactics. We approach evaluation from a similar perspective by building evaluation approaches informed by our partners, and considering strategies that are culturally and linguistically appropriate and to determine if the programs reflect the values we set out to embody. We are guided by the Centers for Disease Control and Prevention (CDC) model for program evaluation to establish primary outcomes, process measures, and demographics. We evaluate program impact and success from a variety of approaches using both qualitative and quantitative data. For many of the programs described here we are reporting out our reach or outputs through counts on a variety of levels including meeting the rigor required for reporting on grants and contracts. We offer a diverse set of programs that vary the spectrum of low touch and high count or high touch and lower count, or more generally put, the effort and impacts of the programs are not the same. This is a purposeful approach as we want a variety of programs and to "right-size" programs to address the community and population specific needs. We provide outcomes for programs here when we are able, acknowledging not all programs run on a calendar year and analysis may not be complete for some of the programs we do deeper evaluation on. We are currently in the process of building an evaluative approach and capacity for our ten-year vision, increased community health equity, and three social determinants of health initiatives: Housing is Health, Food is Medicine, and Connection is Cure. Part of this evaluative approach is a monthly Social Determinants of Health dashboard. St. John's Hospital 2023 Implementation Strategy Progress Highlights. The following highlights our implementation strategy work for each of our three priority needs. For a more comprehensive view of what we are doing to impact community needs please see our Fairview Health Services Community Action Plan and for a view of the St. John's Hospital's list of programs see the appendices. Fairview Health Services Community Action Plan: https://www.fairview.org/about/Our-Community-Commitment/Local-Health-Needs In this first three-year CHNA cycle working towards our 2032 vision of increased community health equity the primary way we are directly addressing the three priority needs is through strategy 1 (Addressing SDOH). Through this strategy we create programs and partner with community organizations to address social risk factors, social needs and social determinants of health. Strategy 2 (Engagement infrastructure) and strategy 3 (Inclusive institution) focus on building infrastructure and creating system changes so that we can more effectively respond to these priority needs in the future, as well as any emerging needs. Strategy 1 Priority Need: Navigating and accessing care and resources. St. John's Hospital has a variety of programs that work as a part of strategy 1 (Addressing SDOH) to address barriers related to navigating and accessing care and resources. Through this strategy, the St. John's Hospital Action Plan programs work towards two anticipated impacts to address this priority need 1) Remove barriers to care by providing community-placed care, co-located services, and navigation supports that address cultural and language barriers. 2) Increased awareness of, knowledge about, and access to healthcare and community-based resources that support opportunities for health and wellbeing. Following is more information on a selection of programs from the system community action plan that are working to meet the two anticipated impacts. Fairview System Key Initiative Highlight. The Community Clinical Care initiative involves multiple community-based clinical programs, including Fairview's Minnesota Immunization Networking Initiative, Blood Pressure and Oral Health Services. All services are multi-sector, community collaborations that provide care and education to the uninsured, under-served, and communities facing health disparities in the greater Twin Cities area. The Community Clinical Care team provides clinical care in trusted community settings at no cost and improves equitable access to vaccines and other services across various populations. The programs ensure a culturally and linguistically appropriate experience in a safe and trusted environment in partnership with over 125 faith-based and grassroots community partners, serving clients at local churches, mosques, temples, schools, community centers, food pantries, and homeless shelters. In 2023, across the system, the community clinical care team provided blood pressure, and oral health services at 180 events, including 74 events in the St. John's Hospital community, providing 98 blood pressure checks, and 446 dental fluoride applications. Fairview's Minnesota Immunization Networking Initiative (MINI), a multi-sector, community collaboration that initiated the Community Clinical Care approach provides free vaccinations, and education to the uninsured, under-served, and communities facing health disparities in the greater Twin Cities area. In 2023, across the system the team hosted 574 vaccination clinics. There were 7,037 free COVID-19 vaccine doses and 6,428 free flu shots administered. Of those participants who shared their identity, 81% of people who received a COVID-19 vaccine identified as a person of color and 38% indicated a language other than English as their preferred language. In 2023 the Minnesota Immunization Networking Initiative was invited to submit to the New England Journal of Medicine on their approach and successes, with a focus on partnerships with public health. This continues to build the evidence base for community placed and community centered approaches. In the St. John's Hospital community specifically, there were 200 MINI clinics at which 2,136 COVID-19 shots and 2,068 flu shots were administered. Schedule H, Part V, Section B, Line 11 Facility , 3 Facility , 3 - HealthEast St. John's Hospital - Continued. The Cultural Broker program was co-developed in 2016 in partnership with Fairview's East Side Health and Wellbeing Collaborative. Cultural Brokers help bridge cultural gaps by translating and supporting people as they navigate schools, healthcare, and other mainstream systems to ultimately build self-sufficiency. The Cultural Brokers belong to the communities they serve, so they can more easily build trust and can have a greater impact on the communities' health. The program comprises six Cultural Brokers, who are Fairview employees, located at five respective partner organizations representing distinct cultural communities: African American, American Indian, Hispanic/Latino, Hmong, and Karen. Based on a one-month follow-up feedback survey, 98% of the Cultural Broker clients say they strongly agree or agree that working with the cultural broker has decreased their stress, additionally there was an increase in those that reported feeling connected to others in the community and confidence in accessing services themselves. In 2023, there were 399 clients served across all the Cultural Brokers with 347 of those clients being specifically in the St. John's community. Health Commons is a drop-in health and wellness center that began in 2011 in Cedar Riverside, expanded to the Harrison neighborhood in 2014, and to the East Side of Saint Paul in 2023. Health Commons focuses on supporting the health of individuals and building community connections. It is supported by Fairview in collaboration with other organizations, and the services are free of charge and open to everyone. The mission of Health Commons is to provide services based on respect, relationship building, hospitality, and collaboration connecting health and hope for the community to live healthier lives. In 2023, there were 11,434 visits across all the Health Commons sites with 293 visits specifically at the Health Commons East location. The Fairview Community Health and Wellness Hub (The Hub) opened in 2022. The hub is a first-of-its-kind center that will address health disparities while providing a range of critical healthcare services and community resources alongside trusted local partners. The Hub provides a variety of services to the community - from primary care to mental healthcare to enrichment options for seniors, food access programs, and community gathering spaces. We bring our own services together with local organizations to make it easier for people to access what they need to thrive. In 2023 we celebrated the 1-year anniversary of the opening of the hub and the Center for Community Health Equity. Through the year, we provided free community gathering space to more than 50 partners and local groups at the Hub. More than 250 community members were reached through cultural healing and community wellness programming delivered in, or partnering with, the Health and Wellness Hub and Center for Community Health Equity. In 2023 we expanded our work relating to opioid overdose. In response to the increase in drug overdose rates nationally and locally, including those caused by opioids, the community clinical care team partnered with the Steve Rummler Hope Network. The team trained several staff members to become Naloxone educators and helped develop a Spanish and Somali language curriculum to address racial disparities in overdose mortality rates, which are worsening. The training covers how to recognize an opioid overdose; what Naloxone/Narcan is and how it works; how to administer Naloxone to someone experiencing an overdose; and information about Steve's Law/MN's Good Samaritan and Naloxone Law. In total, there were 19 Naloxone trainings where 360 individuals were trained in 2023. In addition, Fairview hosts three low-barrier Naloxone access points (NAPs) at locations across the system. For more information about these and other action plan programs that are addressing the priority need Navigating and Accessing Care and Resources, please see our Fairview Health Services Community Action Plan: https://www.fairview.org/about/Our-Community-Commitment/Local-Health-Needs Priority Need: Addressing Structural Racism and Barriers to Equity. St. John's Hospital as a part of strategy 1, (Addressing the SDoH), has a variety of programs, events, and community education as a part of the Community Action Plan that work toward the anticipated impact: Develop, grow, and sustain programs, educational offerings, partnerships, and initiatives, to address structural racism and barriers to equity. Fairview system highlights. One of the Fairview social determinants of health initiatives, Food is Medicine, utilizes the knowledge and resources of a large healthcare institution to work towards meeting the immediate needs of our patients, while also transforming the food system into something just, equitable, and sustainable. The initiative aims to 1) Nourish our patients: Advance food security to reduce health disparities and diet-related health conditions. 2) Enrich our communities: Cultivate trusting and engaged partnerships to build and share resources, assets, and capacity. 3) Transform our systems: Nurture just and equitable food systems to ensure health equity. These approaches are framed to increase health equity through focused efforts to serve patients who have been historically marginalized, by providing culturally appropriate food options, and reducing food insecurity in a manner that upholds dignity and empowers the local food system. Clinically, it enables providers to serve patients experiencing food insecurity through a menu of distinct programs comprising an innovative wrap-around approach. One, or more, of the Food is Medicine programs, a selection of which are described below, are available to patients in 43+ clinics and 5 acute sites across the health system. One of the Food is Medicine initiative programmatic responses is Veggie Rx, which distributes fresh, locally grown produce from four farm partners (Hmong American Farmers Association, Sin Fronteras, Naima's Farm and Women's Environmental Institute) via a Community Supported Agriculture (CSA) box. The program offers home delivery to address transportation barriers. In 2023, 20 clinics participated in Veggie Rx across Fairview hospital and medical center communities. In St. John's Hospital community there were four clinic sites that offered Veggie Rx serving 87 patients. Almost one third (29%) of all program participants identified as Asian, 20% as Black and 4% as Hispanic/Latino. While just three quarters speak English as a preferred language, 7% had a preferred language of Hmong, 13% Karen, and 2% Spanish. Most participants had public insurance (73%) or were uninsured (1%). Fairview's MarketRx program provides patients with $80 per month to purchase groceries at either the Twin Cities Mobile Market or Fare for All program. The program runs year-round and offers rolling enrollment. Through the year, 195 patients redeemed vouchers for groceries. In the St. John's Hospital community there were 91 participants enrolled in MarketRx. Additionally, we provided shelf stable immediate need food resource options. MATTERboxes were available in the St. John's Hospital community with each box containing enough food to feed a family of four for three days. In 2023 there were 1,900 MATTERboxes distributed at 26 sites across the system. There were also 240 food resource packets distributed that contained information about local food resources along with a grocery gift card to assist with immediate grocery needs. East Side Table Meal Box Program is a program co-designed by a diverse group of partner organizations from the East Side of Saint Paul. East Side Table aims to empower individuals to improve at-home cooking skills while being mindful of common barriers East Side community members face. Through the Meal Box program, community events, tastings, cooking demos, and a multi-language website with resources, East Side Table partner organizations hope to lower the barriers to eating healthier at home, time, motivation, and expense. In 2023, there were 194 participants enrolled in the meal box program with 91% reporting they would recommend the program to a friend or family member. Schedule H, Part V, Section B, Line 11 Facility , 4 Facility , 4 - HealthEast St. John's Hospital - Continued. In November of 2023, Fairview and local partners hosted the Harvest at the Hub at the Fairview Community Health and Wellness Hub. The event consisted of a food giveaway with turkeys, fresh produce, and other holiday staples, a community resource fair, a vaccine clinic, and other health and wellbeing services. We served a total of 421 unduplicated households (over twice that of 2022). Another of the Fairview social determinants of health initiatives, Housing is Health initiative is also in response to the priority need Structural Racism and Barriers to Equity. The Housing is Health initiative aims to use the protective power of housing to support patient health and build thriving communities. We approach this initiative with clinically connected programs, supporting community partnerships, contributing time and expertise to collaboratives, and work to impact policy. As an example, Fairview partners with Our Savior's Community Services to provide critical follow-up care and temporary housing for people who are unsheltered after a hospital stay. Patients are referred by staff at hospital or medical center and sheltered at Our Saviors. Additionally, a nurse provides care, and patients receive wrap-around services and social work support. In 2023, 76 patients were provided supports through this program. Also, as a part of Housing is Health, we are proud to have completed inaugural Housing and Health Equity Fellowship hosted by the Greater Minnesota Housing Fund, which aimed to expand community investment by health systems to address the housing crisis in Minnesota. In October 2023, teams from across the system participated in our annual Build Week with Twin Cities Habitat for Humanity, contributing 456 volunteer hours. For more information about the action plan programs that are addressing the priority need Structural Racism and Barriers to Equity please see our Fairview Health Services Community Action Plan. https://www.fairview.org/about/Our-Community-Commitment/Local-Health-Needs Priority Need: Healing, connectedness, and mental health. St. John's Hospital works toward the anticipated impact: develop, grow, and sustain programs, educational offerings, partnerships, and initiatives, address barriers to healing, connectedness and mental health through strategy 1 (Addressing the SDoH) and the Community Action Plan. In response to the priority need, healing, connectedness, and mental health, we have a body of work that makes up the Connection is Cure initiative. Connection is Cure aims to build trust through social connections, centering linguistic and cultural diversity, and bridging silos across our hospital system and communities to transform medical practice. As a part of Connection is Cure, we participated in the Institute for Healthcare improvement trust prototyping network. We were one of eight health care organizations nationwide that are part of a 10-month project to test approaches to improve trust in healthcare systems. Our organization is focusing on a project to identify and remove system level equity barriers for interpreters and patients with limited English proficiency aiming to improve patient outcomes, customer experience, and care team cohesion. Additionally, we are responding to the need healing, connectedness, and mental health with a variety of evidence-based programs, as well as trainings and education sessions. The East Side Health and Well-being Collaborative aims to achieve widespread and equitable wellbeing in the East Metro to lift Ramsey County higher in the ranks of vibrant and healthy places. A community that shares power and responsibility in sustainable work to improve health and wellbeing. The goal will be achieved through strategic alignment within the Collaborative whereby key strategies work together and focus on the whole community, not just those who walk through clinic and organization doors. By convening the community to identify and develop solutions to improve health together as a shared responsibility and opportunity, our health system can cocreate transformational change by focusing on upstream drivers of health and changing the way the community invests in and contributes to population health. In 2023 the collaborative hosted 3 meetings held by the respective workgroups (Policy Forum, East Side Table, and the Mental Health and Stress Resilience Partnership. The Collaborative also completed 2 volunteerism events with collaborative partners, both benefitting Dayton's Bluff Achievement Plus School East Side Table, in partnership with East Side Elders and NE Seniors for Better Living, is hosting bi-weekly "social hours" at Conway Rec Center in connection to their Walk with East programming, offering East Side of Saint Paul seniors/elders an opportunity for social connectedness and good food. East Side Table also supports monthly grocery delivery through East Side Elder's FETCH program and are hosting monthly community meals at Elder's Lodge in the Payne-Phalen neighborhood. In 2023 there were 8 months of community meals and 1440 grocery deliveries. Psychological First Aid (PFA) is an evidence-informed training for the broader community as well as professionals. Trainees learn how to support healthy recovery for individuals following a traumatic event, public health emergency, natural disaster, or personal crisis. The curriculum integrates public health, community health and individual psychology by drawing upon skills the trainees probably already have. PFA is a two-hour training. In 2023, in the St. John's Hospital community, there were two classes offered with 59 participants attending. For more information about the action plan programs that are addressing the priority need Structural Racism and Barriers to Equity please see our Fairview Health Services Community Action Plan: https://www.fairview.org/about/Our-Community-Commitment/Local-Health-Needs In addition to strategy 1 (Addressing SDOH) and the programmatic work included on our Action Plans, we are striving to reduce health disparities and increase community health equity through two additional system strategies. While strategy 1 (Addressing SDOH) allows us to directly respond to the three prioritized needs from our community health needs assessment, strategy 2 (Engagement Infrastructure) and strategy 3 (Inclusive institution) focus on building the structures and systems for us do the work more capably. Strategy 2 - Engagement Infrastructure Addressing our three priority needs while also responding to emerging needs requires an infrastructure that supports building and sustaining strong community partnerships and allows for ongoing, trusting exchanges between Fairview and community members. Strategy 2 (Engagement Infrastructure): Creating community engagement infrastructure that builds trusting partnerships and enables community voice to inform and influence the institution. The anticipated Impacts for this strategy are 1. Build and expand feedback systems for patients and community members; embed process improvement in the health system's response to community voice. 2. Create sustainable structures to convene and engage community voice around addressing social determinants of health. While Fairview boasts an extensive engagement infrastructure already, we continued to bolster and expand thew work we do to expand feedback systems and sustainable convening structures. The M Health Fairview Center for Community Health Equity (the center) was launched in August 2022. The center guides our philosophy around how we gather community voice and who we talk to as we learn how to tie the learnings back into the organization. The 1-year anniversary of the Center for Community Health Equity was celebrated through a 3-day event welcoming over 250 people, where we offered free vaccinations, blood pressure checks, the opportunity to connect and network, and learn more about the work of the center. Throughout the year, we hosted six Center Community Health Equity Work Group meetings to hold strategic discussions on issues of relevance to the center. The work group was comprised of representatives from across the M Health Fairview Joint Clinical Enterprise. We also moved forward the development of a Center for Community Health Equity Model of Community Engagement. The model shares our approach to community engagement, community voice, and community partnerships to advance community health equity. We will utilize this model in 2024 to help guide how we gather feedback and inform our community health needs assessment. Schedule H, Part V, Section B, Line 11 Facility , 5 Facility , 5 - HealthEast St. John's Hospital - Continued. Enabling community voice, particularly the voices of priority populations, to influence, and inform the health system, is integral to strategy 2 (Engagement infrastructure). In 2023 we expanded our patient Listening and Learning sessions to host a session for patients who use American Sign Language. Additionally, Fairview hosted 8 Food is Medicine community conversations where we heard from 74 partner organizations to help inform our Food is Medicine approach as well as to convene food partners to increase opportunities for mutual awareness and collaboration. At St. John's Hospital, we co-hosted the community conversation with Urban Roots, and a total of 9 organizations participated. Building our engagement infrastructure involves engaging broadly with community but also building our capacity to engage with complex and intersectional groups. We are building a set of population health equity initiatives, one of which is the Native Health Equity Initiative. As a part of this body of work in 2023, a cohort of employees from across our system began work to advance health equity efforts in partnership with Native Americans and Indigenous communities. We facilitated six sessions to help our employees learn about the historical and current challenges faced by Native communities, connecting with key Native leaders and organizations, and local priority issues including healthcare. The sessions also engaged employees in working to improve experiences and outcomes for our Native patients, employees, and communities. In summer 2023, we co-hosted a "Heal the Healers" Summit with Indigenous Roots Cultural Art Center. The two-day summit welcomed more than 200 attendees for group learning sessions, rituals, seminars, and individual sessions with healers and professionals skilled in traditional healing modalities. Hosted an American Indian and Indigenous focused recruitment event at the Community Health and Wellness Hub. Finally, core to this strategy is building and sustaining trusting partnerships. We continue to support and build on existing engagement infrastructure and support existing collaboratives. Our St. John's Hospital Community Advisory Committee met through the year to provide input as well as insight and local expertise. We conducted an inventory of the Community Advisory Committee member organizations focus and identified gap areas for expertise and aligned representation with CHNA priority populations. We continue to intentionally recruit participants to expand representation on the committees focusing on these gap areas. Committee members also participated, in addition to other community partners in our annual Community Impact Summit. In the St. John's Hospital community, we participate in and have leadership roles in collaboratives such as the Minnesota Food Justice Network, Interfaith Health Collaborative, East Metro Strong, and the Center for Community Health. These are spaces where we do ongoing listening and relationship building with community partners and community members. Strategy 3 - Inclusive Institution Strategy 3: Transforming internal structures to create an antiracist and inclusive environment and to build community health by building wealth. The anticipated impacts tied to strategy 3 (Inclusive Institution) are: 1) Build internal and external processes and structures to provide spaces that are safe and welcoming to all, responsive to community needs, and based on a culture of inclusion. 2) Using an antiracist approach, work to identify and eliminate racism by changing systems, organizational structures, policies, practices, and attitudes. 3) Leverage everyday business practices to build community wealth, promoting economic and racial equity and justice. This strategy has been partially operationalized through the HOPE Commission. The work of the HOPE Commission has been to identify foundational and transformational opportunities for our organizations to advance health equity (HE) and promote diversity, equity, and inclusion (DEI). To learn more about the goals, strategies and successes of the HOPE commission please see: The HOPE Commission website: https://mhealthfairview.org/About-Us/health-equity/hope-commission The 2023 HOPE Commission Report: https://www.mhealthfairview.org/-/media/Files/240033-2023-HOPE-Report-R5.pdf This work will continue to be operationalized through various departments across the organization as well as through the Center for Community Health Equity (CCHE). Key achievements in alignment with strategy 3 include the launch of standardized Social Determinants of Health patient screenings (i.e. food security, housing stability) at all ambulatory sites as well as implementation of targeted interventions to improve healthcare disparities which resulted in marked improvement in breast cancer and colon cancer screening rates. There was also improvement in breast cancer screening rates among Karen, Hmong and Somali patients with 6 mobile mammography events. Additionally, we are building capacity across the system to allow more individuals and teams to participate in the Intercultural Development Inventory (IDI). Operational improvements from the Office of Equity Strategy (OES) include dashboarding and reporting on metrics across the areas of health equity, healthcare equity, and diversity, equity, and inclusion, which will inform the creation of actions plans to reduce any disparities found and create line of sight for progress being made. Fairview is currently enhancing existing data collection and analytics across the institution to uncover and address health disparities. Fairview has successfully enhanced its analytics of Race, Ethnicity and Language (REaL) data across the institution, enabling us to uncover and address health disparities more effectively. With the improved analysis of REaL data, we are now setting Performance Dimension goals specifically aimed at closing these disparities. OES also supported strategic leadership within Human Resources and Customer Experience to incorporate Restorative Justice practices into their Just Culture and patient relations efforts. Additionally, in 2023, various units across the system operationalized systems to embed equity in project development and implementation across various parts of system decision-making. Our anchor strategy works to advance health equity by investing in the social and economic wellbeing of the communities we serve through our everyday business practices. The strategy focuses on local and diverse hiring, purchasing and investing, and serving and leading with trusted community partners. Fairview's Workforce Partnerships team is addressing the social determinants of health by helping people secure employment with family sustaining wages and benefits, become successful in their job, and learn new skills. The team is also focused on inclusive, local hiring, resulting in a healthcare team that represents the communities we serve. Supply Chain leaders launched a Supplier Diversity program, including updated request for proposal language, creating a new webpage, and identifying potential diverse vendors. Fairview also has a robust social corporate responsibility program including employee volunteerism, memberships and affiliations and sponsorships. In 2023 there were five systemwide employee volunteerism events hosted, including Twin Cities Pride. Additionally, Fairview staff sit on boards and/or are members of a diverse set of community organizations. Fairview's sponsorship program is aligned with Fairview's commitment to advancing equity and Fairview's focus on diversity, equity, and inclusion. Within this focus, Fairview awards sponsorships to support local community organizations in the needs and opportunities they have identified. Schedule H, Part V, Section B, Line 11 Facility , 6 Facility , 6 - HealthEast St. John's Hospital - Continued. In efforts to increase diversity and trust in clinical trials, the CCHE partnered with Fairview Frontiers to improve representation in a set of clinical trials and hosted a Research Participant Appreciation event that was attended by over 70 research participants. The partnership between Center for Community Health Equity and Fairview Frontiers increased participant representation in a set of clinical trials of those that identified as a race or ethnicity other than white from 15.5% to 33.8%. A paper was published on the partnership and methods used that led to these successes. Significant needs not addressed. Prioritizing needs that are the root causes of almost all health disparities allows us to develop upstream strategies that will have a large and lasting impact in our communities. The significant needs we have identified will ultimately be positively impacted by addressing the root causes we have identified as our priority needs. The following needs were not directly addressed because this issue is beyond what the St. John's Hospital resources can support at this time: Cost of care, insurance and medications, childcare and employment benefits. The following needs were directly not addressed because this issue will be addressed as part of patient care but falls outside of the scope of the CHNA Implementation Strategy: Clinic/hospital hours, limited time spent with provider, limited specialty care. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - HealthEast St. John's Hospital. The Minnesota Attorney General agreement was used in the determination of the eligibility for financial assistance. Schedule H, Part V, Section B, Line 16 Facility , 1 Facility , 1 - HealthEast St. John's Hospital. The organization attaches a summary of the policy to billing invoices and also communicates to patients during admission, financial counseling and collection calls that there is a financial assistance program and that an application can be provided to them. A summary of the Financial Assistance Policy is posted in various locations in the hospital. Schedule H, Part V, Section B, Line 20 Facility , 1 Facility , 1 - HealthEast St. John's Hospital. Pursuant to Treas. Reg. Section 1.501(r)-6(c), HealthEast St. John's Hospital made reasonable efforts to determine whether an individual was FAP-eligible for care by satisfying the requirements of Section 1.501(r)-6(c)(3). 10 HealthEast Surgery Center-Maplewood 2945 Hazelwood Street Maplewood MN 55109 Outpatient Surgery Center HealthEast Medical Imaging LLC 2945 Hazelwood Street Suite 100 Maplewood MN 551091126 Outpatient Imaging Center HealthEast Optimum Rehabilitation-M 1570 Beam Avenue Suite 200 Maplewood MN 55109 Outpatient Rehabilitation Clinic HealthEast Optimum Rehabilitation-M 1390 University Avenue West St Paul MN 55104 Outpatient Rehabilitation Clinic HealthEast Optimum Rehabilitation-W 1825 Woodwinds Drive Woodbury MN 55125 Outpatient Rehabilitation Clinic HealthEast Optimum Rehabilitation-S 2900 Curve Crest Boulevard Stillwater MN 55082 Outpatient Rehabilitation Clinic HealthEast Spine Center 1747 Beam Avenue Maplewood MN 55109 Outpatient Spine Rehabilitation Clinic HealthEast Pain Care 1600 St Johns Blvd Suite 101 Maplewood MN 55109 Outpatient Pain Care Clinic Mental Health & Addiction Care-John 1675 Beam Avenue Suite 101A Maplewood MN 55109 Outpatient Mental Health Care HealthEast Sleep Center - Maplewood 3100 Kennard Street Suite 200 Maplewood MN 55109 Outpatient Sleep Center Schedule H, Part I, Line 7f Exclusions from Percent of Total Expense The provision for bad debts is based upon management's assessment of historical and expected net collections considering historical business and economic conditions, trends in healthcare coverage, and other collection indicators. There is no bad debt expense included in Form 990 Part IX as an expense. Due to the adoption of new GAAP reporting, the bad debt expense has been included with "discounts" netted against patient service revenue on Part VIII of Form 990. Schedule H, Part I, Line 3c If a household has assets totaling more than $100,000, they are not eligible for Financial Assistance. Exceptions may be made for catastrophic situations, where the outstanding balances exceed the patient's household asset totals. These will be reviewed on a case-by-case basis. UNINSURED PATIENTS WHO ARE RESIDENTS OF MINNESOTA OR WISCONSIN AND WITH A HOUSEHOLD INCOME GREATER THAN 400% OF THE FEDERAL POVERTY LEVEL AND RECEIVE MEDICALLY NECESSARY HOSPITAL OR HOSPITAL BASED SERVICES ARE CHARGED A DISCOUNT RATE EQUAL TO THE RATE FROM FAIRVIEW'S HIGHEST VOLUME PRIVATE PAYOR CONTRACT. As of November 1, 2023, this policy applied to all United States residents. Schedule H, Part I, Line 7g Subsidized Health Services THERE ARE NO COSTS ASSOCIATED WITH PHYSICIAN CLINICS INCLUDED IN LINE 7G. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance THE AMOUNTS REPORTED ON FORM 990, SCHEDULE H, PART I, LINE 7A THROUGH 7C WERE DETERMINED USING THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 IN THE SCHEDULE H, FORM 990 INSTRUCTIONS. FORM 990, SCHEDULE H, PART I, LINES 7E THROUGH 7J ARE REPORTED AT CHARGES AS RECORDED BY THE ORGANIZATION. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount The bad debt expense reported on Part III, Line 2 is reported at charges as recorded by the organization. The following describes the costing methodology used in determining bad debt and the rationale for including a portion of bad debt as community benefit: The bad debt allowance is calculated as a percentage of patient receivables after deductions for estimated provisions for contractual adjustments (discounts) on services provided to enrollees of Medicare, Medicaid, third-party payor programs, charity care, uninsured discounts, and other administrative adjustments. Certain patient accounts are written off to bad debt because the organization does not have sufficient information to determine if the patient would qualify for free care or financial aid. Therefore, it is possible that some bad debt is actually charity care. However, if a patient account is written off to bad debt and the collection agency later determines that the patient would have qualified for free care or financial aid, then the bad debt expense is reclassified to charity care. Schedule H, Part III, Line 3 Bad Debt Expense Methodology Bad Debt Expense, Patients Eligible for Assistance The bad debt expense attributable to patients that may be eligible for financial assistance is based upon management's assessment of historical and expected net collections considering historical business and economic conditions, trends in healthcare coverage, and other collection indicators. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote Subsequent changes that are determined to be the result of an adverse change in the patient's ability to pay (determined on a portfolio basis when applicable) are recorded as bad debt expense. Bad debt expense for the years ended December 31, 2023 and 2022, was not significant. See page 23 of the audited financial statements for additional information. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs IT IS PART OF the organization's MISSION THAT COMMUNITY BENEFIT ACTIVITY IS CARRIED OUT BY STAFF/LEADERSHIP AT EACH FACILITY BASED ON THE HEALTH CARE NEEDS IN THAT SERVICE AREA. THE MEDICARE COST TO CHARGE RATIO REPORTING IS CALCULATED SERVICE LINE BY SERVICE LINE. OTHER EXPENSES ARE CALCULATED USING THE OVERALL COST TO CHARGE RATIO. UNCOMPENSATED COSTS RESULTING FROM MEDICARE, MEDICAID AND STATE AND LOCAL INDIGENT CARE PROGRAMS ARE CONSIDERED A COMMUNITY BENEFIT BECAUSE OF THE SIGNIFICANT DIFFERENCES BETWEEN ACTUAL COSTS AND REIMBURSEMENT. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance After our patients have received services, it is the policy of Fairview Health Services to bill patients and their applicable payors on a timely and accurate basis. During this billing and collection process, Fairview staff is committed to providing quality customer service and timely follow up on all outstanding accounts. Billing: It is the goal of Fairview to bill all claims accurately and on a timely basis. Although dependent on information and communications from patients and payors, Fairview will provide sufficient follow up service to ensure that patients receive accurate account and billing information and have the opportunity to make payment and/or apply for community care. Fairview has agreed to certain billing and collection practices by an agreement with the Minnesota Attorney General's office. There are financial counselors at every entity Monday through Friday who interact with the patients in person and over the phone to inform of programs available to them as well as assist them in applying for the programs. The information about needing assistance with paying the bill is posted on signs in the hospitals and materials are distributed to self-pay patients by registration staff. The statements sent out after the visit provide this information as well. If a patient/family member calls the Central Business Office customer service staff to ask for assistance with paying their bill, they are informed about options at that time. Fairview provides an interpreter service that interprets conversations over the phone. This service can be used either as a three way phone call or the Financial Counselor, in a room with the patient or family can place the call together to the interpreter phone service. The interpreter services line accommodates close to 200 languages. The billing process will be assisted by the following guidelines: 1) For all insured patients, Fairview will assist in processing insurance for all in-network and out-of-network payers when possible (as provided by or verified by the patient) on a timely and accurate basis. 2) For all uninsured patients with Minnesota or Wisconsin residency receiving hospital based services deemed medically necessary, Fairview will apply an uninsured discount equal to the discount provider to our largest contracted non-government payor, any remaining balance will be billed to the patient in a timely and manner. As of November 1, 2023, this policy applied to all United States residents. 3) All billed patients have the opportunity to contact Fairview regarding financial assistance for their accounts. Financial assistance may include Community Care, payment arrangements, medical assistance or other applicable programs. 4) If a patient contacts Fairview regarding Community Care before the account is referred to a collection agency or attorney, an application and required documentation is requested (income verification etc.), the account will then be processed based on the outcome of the Community Care determination. 5) Fairview takes reasonable measures to avoid referring an account to collection unless there are no responses from the patient. If a patient contacts Fairview regarding Community Care after their account has been referred to a collection agency or attorney, Fairview will send an application to the patient. If the completed application along with required documentation (income verification, etc.) is submitted, all collection action will be suspended until the patient is notified of Fairview's determination. Schedule H, Part V, Section B, Line 16a FAP website - HealthEast St. John's Hospital: Line 16a URL: mhealthfairview.org/resources/policies-and-documentation/Financial-Assistance-Policy; Schedule H, Part V, Section B, Line 16b FAP Application website - HealthEast St. John's Hospital: Line 16b URL: https://www.fvfiles.com/2266.pdf; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - HealthEast St. John's Hospital: Line 16c URL: mhealthfairview.org/resources/policies-and-documentation/Financial-Assistance-Plain-Language-Summary; Schedule H, Part VI, Line 2 Needs assessment Our triennial community health needs assessment process provides an important opportunity to engage with and understand our community, analyze what has changed-for better or worse-since the last assessment, and prioritize together with the community the issues we must urgently address in order to improve wellbeing and resilience. Fairview's 2021 Community Health Needs Assessment (CHNA) builds upon previous assessments and was developed in partnership with community members and organizations, local public health agencies, and other hospitals and health systems. It serves as a tool for guiding policy, advocacy, and program planning. It also fulfills Internal Revenue Service (IRS) requirements for CHNA pursuant to the Affordable Care Act of 2010, which requires 501(c)(3) nonprofit hospitals to conduct an assessment at least every three years and provide an annual evaluation of the previous implementation strategy's impact. Through this process, we aim to: -Intentionally engage with community members and organizations, public health agencies, and other hospitals and health systems to identify and understand significant health needs in the community. -Understand the needs of the community it serves by analyzing current demographics and social determinants of health indicators, as well as by collecting direct input from community members and organizations. -Inform the CHNA implementation strategy and action plan development. As part of the 2021 CHNA process, we reexamined and built upon the extensive community insights shared during our 2018 CHNA, while also surveying the community for current and emerging needs. We have identified three system-wide priority need areas, and we will collaborate with our hospitals and shared services to address these priorities. Our specific response will vary by hospital based on the ways in which the priority needs manifest across a given community as well as the partnerships, both ongoing and new, that we have developed to address those needs. Our community commitment - creating a healthier future and Improving the health and wellbeing of our communities. The healthcare people receive in a hospital or clinic is only a small part of a person's overall health. That's why our commitment to advancing health equity goes beyond the walls of our facilities and reaches out into the community. We collaborate with community partners to improve health and wellbeing and advance health equity. Our priorities include: * Bringing clinical services into neighborhoods to expand access * Advancing our anchor mission initiatives - local hiring, local purchasing, local investing, and leading and serving locally * Addressing social risk factors through food access and housing programs and community education and outreach. Why is this a priority for our healthcare system? Nearly 80 percent of health is influenced by factors outside of clinical care. These factors, called the social determinants of health, are our health behaviors and the economic and social conditions in which we live. To help address the social determinants of health, we are creating a health and wellness hub in downtown St. Paul that will focus on health, housing, and supportive services for the community. All this work is closely tied to our HOPE Commission's health equity and anti-racism efforts. It's designed to be culturally appropriate and to meet the specific needs of the community. We seek to do "with not "to" the communities we belong to and are proud to contribute to our community in so many ways. Fairview Health Services is committed to the health and wellbeing of our communities. For generations we have served the people of Minnesota, cared for our patients, and invested in the people and partnerships that make us stronger, together. As a nonprofit health system and an anchor institution-an organization rooted in our communities-we have a commitment to intentionally apply our long-term, place-based economic power and human capital in partnership with community to mutually benefit the long-term wellbeing of both. We recognize that this commitment begins in and with our communities. This work cannot be done alone, we must collaborate with community-based organizations, local public health departments, and other health systems. Our efforts, resources, and commitments are investments in the health and wellbeing of our communities where we live, work, learn, play, and worship. Our community benefit programs and activities focus on our mission to heal, discover, and educate for longer, healthier lives and must meet at least one of these objectives: * Improve access to health care services. * Enhance the health of the community. * Advance medical or health care knowledge. * Relieve the burden of government to improve health. Fairview Health Services, is committed to providing exceptional care, delivering breakthrough research and innovation to healthcare, improving health and wellbeing, and promoting health equity. As anchor institutions rooted in the hearts of the communities we serve, this commitment goes beyond our walls and into the community. THERE ARE DIFFERENT WAYS OUR HEALTH SYSTEM FULFILLS THIS PROMISE INCLUDING: * Allocating resources to benefit the community. The process is guided by our community health needs assessments, developed collaboratively with the communities we serve, and implemented in partnership with local organizations and leaders. - The priority needs identified in our 2021 assessment are: healing, connectedness, and mental health; addressing structural racism and barriers to achieving health equity; and navigating and accessing care and resources. Our efforts will center on people experiencing poverty as well as racial or ethnic populations experiencing health disparities. * Bringing clinical services into neighborhoods to expand access. These free healthcare services are offered in diverse and/or under-resourced neighborhoods. * Addressing social risk factors, known as the social determinants of health, through food access and housing programs, and community education and outreach. The goal is to improve community health and wellbeing. * Advancing our HOPE (Healing, Opportunity, People, and Equity) Commission's - health equity and anti-racism efforts to drive more equitable outcomes and inclusive environments and experiences for our patients, employees, and communities. Success stories include: improving patient sociodemographic data to better understand the populations we serve and more accurately assess for disparities, and increasing the representation of diverse populations in clinical trials. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance The organization MAKES INFORMATION ABOUT ITS CHARITY CARE PROGRAMS AVAILABLE ON ITS WEBSITE (WWW.FAIRVIEW.ORG). AT THE TIME OF REGISTRATION FOR SERVICES AND THROUGH WRITTEN MATERIALS IN LOBBIES AND WAITING ROOMS. FOR PATIENTS IDENTIFIED AS SELF-PAY (WHETHER THAT OCCURS BEFORE SERVICES ARE DELIVERED OR DURING THE BILLING CYCLE), FAIRVIEW UTILIZES A STANDARD PROCESS TO ASSIST PATIENTS LEARN ABOUT AND ACCESS ASSISTANCE FROM GOVERNMENT PROGRAMS OR FAIRVIEW'S CHARITY CARE PROGRAM. FOR UNINSURED PATIENTS SEEN IN A FAIRVIEW HOSPITAL, FAIRVIEW PARTNERS WITH AN EXTERNAL VENDOR WHO MEETS WITH SELF-PAY PATIENTS TO ASSIST THEM DETERMINE ELIGIBILITY FOR GOVERNMENT PROGRAMS OF FAIRVIEW'S CHARITY CARE PROGRAM. THE VENDOR WILL ALSO ASSIST PATIENTS WITH COMPLETING THE NECESSARY PAPERWORK TO ACCESS THESE RESOURCES. STAFF IN FAIRVIEW'S CENTRAL BUSINESS OFFICE HAVE A SELF-PAY TEAM, WHICH DIRECTS PATIENTS TO THE APPROPRIATE RESOURCES. THERE IS ALSO A COMMUNITY CARE COORDINATOR WHO ASSISTS IN GETTING PATIENTS CONNECTED TO ADDITIONAL RESOURCES FOR WHICH THEY MAY QUALIFY. Schedule H, Part VI, Line 4 Community information The CHNA community of each hospital and medical center is defined as a subset of zip codes within the Fairview service area, where 90 percent of its patients live. Each of the hospitals and medical centers were attributed unique zip codes and geographies. The St. John's Hospital community is comprised of 13 zip codes. Our definition of communities includes all community members, including those who are patients and employees who live, work, and play in our Schedule H, Part VI, Line 5 Promotion of community health AS A NONPROFIT HEALTH SYSTEM, the organization REINVESTS ANY EXCESS REVENUES INTO THE CORE OPERATIONS OF THE ORGANIZATION. RESEARCH AND EDUCATION ARE AT THE VERY HEART OF THE MISSION. IN PARTNERSHIP WITH THE UNIVERSITY OF MINNESOTA, FAIRVIEW INVESTS MILLIONS OF DOLLARS EACH YEAR INTO GROUND-BREAKING RESEARCH AND EDUCATION OF OUR NEXT GENERATION OF HEALTHCARE WORKFORCE. FAIRVIEW ALSO PARTNERS WITH A MYRIAD OF HIGHER EDUCATIONAL INSTITUTIONS TO PROVIDE CLINICAL HANDS-ON TRAINING FOR FUTURE NURSES, PHARMACISTS, LABORATORY PROFESSIONALS AND MORE. FAIRVIEW SERVES AS A TRAINING SITE FOR RESIDENTS IN VARIOUS SPECIALTIES AND IS THE CORE TEACHING SITE FOR THE UNIVERSITY OF MINNESOTA RESIDENTS. SENIOR RESIDENTS AND FELLOWS PROVIDE FAIRVIEW SOME DEGREE OF CLINICAL SERVICE THAT WE WOULD OTHERWISE NOT RECEIVE. Schedule H, Part VI, Line 6 Affiliated health care system ST. JOHN'S HOSPITAL IS A COMMUNITY-FOCUSED, NON-PROFIT HOSPITAL THAT IS PART OF FAIRVIEW HEALTH SERVICES. WOODWINDS HEALTH CAMPUS PROVIDES INNOVATIVE TECHNOLOGY, COMPASSIONATE CARE, AND A FULL SPECTRUM OF FAMILY HEALTH SERVICES. FAIRVIEW HEALTH SERVICES IS A MINNEAPOLIS-BASED NONPROFIT HEALTH SYSTEM DRIVEN TO HEAL, DISCOVER, AND EDUCATE FOR LONGER, HEALTHIER LIVES. FOUNDED IN 1906, FAIRVIEW PROVIDES EXCEPTIONAL CARE TO PATIENTS AND COMMUNITIES AS ONE OF THE MOST COMPREHENSIVE AND GEOGRAPHICALLY ACCESSIBLE SYSTEMS IN MINNESOTA, SERVING THE GREATER TWIN CITIES METRO AREA AND NORTH-CENTRAL MINNESOTA. THROUGH A CLOSE RELATIONSHIP WITH THE UNIVERSITY OF MINNESOTA, FAIRVIEW OFFERS ACCESS TO BREAKTHROUGH MEDICAL RESEARCH AND SPECIALTY EXPERTISE AS PART OF A CONTINUUM OF CARE THAT REACHES ALL AGES AND HEALTH NEEDS. OUR MISSION: FAIRVIEW IS DRIVEN TO HEAL, DISCOVER, AND EDUCATE FOR LONGER, HEALTHIER LIVES. THE FAIRVIEW SYSTEM CONSISTS OF 11 HOSPITALS, IT CONTROLS AND OPERATES UNIVERSITY OF MINNESOTA MEDICAL CENTER, THE ADULT AND PEDIATRIC TEACHING HOSPITAL OF THE UNIVERSITY OF MINNESOTA MEDICAL SCHOOL, HAS 10 COMMUNITY BASED GENERAL ACUTE CARE HOSPITALS AND 1 LONG-TERM ACUTE CARE HOSPITAL; OVER 80 PRIMARY AND SPECIALTY CARE CLINICS; OFFERS OVER 100 SPECIALTY CARE SERVICES; URGENT CARE CLINICS; OCCUPATIONAL HEALTH CLINICS; 36 RETAIL AND SPECIALTY PHARMACIES; PHARMACY BENEFIT MANAGEMENT SERVICES; REHABILITATION CENTERS; COUNSELING; HOSPICE SERVICES; 90+ OWNED AND MANAGED SENIOR CARE FACILITIES AND LONG-TERM CARE HOUSING FACILITIES (THROUGH EBENEZER SOCIETY, A FAIRVIEW SUBSIDIARY); AND EMERGENCY MEDICAL TRANSPORTATION. FAIRVIEW'S 34,000+ EMPLOYEES AND NETWORK OF 5,000+ SYSTEM PROVIDERS EMBRACE INNOVATION AND NEW THINKING TO DRIVE A HEALTHIER FUTURE THROUGH HEALING, DISCOVERY AND EDUCATION. FAIRVIEW HOSPITALS AND MEDICAL CENTERS INCLUDED: BETHESDA HOSPITAL (ST. PAUL) FAIRVIEW LAKES MEDICAL CENTER (WYOMING) FAIRVIEW NORTHLAND MEDICAL CENTER (PRINCETON) FAIRVIEW RANGE MEDICAL CENTER (HIBBING) FAIRVIEW RIDGES HOSPITAL (BURNSVILLE) FAIRVIEW SOUTHDALE HOSPITAL (EDINA) GRAND ITASCA CLINIC & HOSPITAL (GRAND RAPIDS) ST. JOHN'S HOSPITAL (MAPLEWOOD) ST. JOSEPH'S HOSPITAL (ST. PAUL) UNIVERSITY OF MINNESOTA MEDICAL CENTER AND UNIVERSITY OF MINNESOTA MASONIC CHILDREN'S HOSPITAL (MINNEAPOLIS) WOODWINDS HEALTH CAMPUS (WOODBURY) Schedule H, Part VI, Line 7 State filing of community benefit report MN false true false false false false false true false James Hereford President & CEO 0 1888932 0 1260653 0 2058859 0 21097 0 17210 0 5246751 0 2049355 Trudi Trysla Chf Legal Counsel 0 684965 0 351134 0 97316 0 260378 0 15729 0 1409522 0 93957 Robert Beacher EVP & Chf Shared Clinical Svcs 0 784252 0 411436 0 108501 0 183623 0 22473 0 1510285 0 97040 Laura Reed COO 0 1136201 0 658230 0 135097 0 86725 0 17110 0 2033363 0 126353 Mark Welton CMO 0 777411 0 499863 0 300349 0 86958 0 17034 0 1681615 0 286840 Sameer Badlani Chf Digital Officer 0 724541 0 407178 0 52179 0 165645 0 22226 0 1371769 0 50935 Mary Nease Chf People Officer 0 617160 0 349603 0 2998 0 43474 0 22122 0 1035357 0 0 Andrea Mokros Chf Public Affairs Officer 0 506680 0 241891 0 837 0 88477 0 9457 0 847342 0 0 Joseph Gaylord CFO 0 997400 0 640623 0 4980 0 178444 0 22493 0 1843940 0 0 Euthemy Lebrew EVP & Chf Transformation Officer 0 543788 0 265338 0 4142 0 94841 0 21378 0 929487 0 0 Jeoff Will EVP, COO 0 709455 0 322267 0 50832 0 148183 0 22447 0 1253184 0 49594 Kyle Wahlstrom MD Physician 0 692180 0 3563 0 7364 0 13200 0 25697 0 742004 0 0 James McGreevy MD Physician 0 723245 0 7125 0 8169 0 13200 0 25635 0 777374 0 0 Jeffrey Borut MD Physician 0 708312 0 3563 0 4301 0 13200 0 25697 0 755073 0 0 Xin Wang MD Physician 0 506082 0 286355 0 6064 0 13200 0 25697 0 837398 0 0 Elizabeth Bennett MD Physician 0 1048618 0 388688 0 540 0 13200 0 5017 0 1456063 0 0 Puneet Cheema MD Physician 0 420554 0 296289 0 2149 0 8939 0 32156 0 760087 0 0 Diane Ogren MD Physician 0 566374 0 9500 0 4752 0 13200 0 25697 0 619523 0 0 Rahul Chauhan MD Physician 0 333687 0 34201 0 228322 0 13200 0 24309 0 633719 0 0 Liu-Ying Luo MD Physician 0 338291 0 40918 0 232206 0 13200 0 4015 0 628630 0 0 Avraham Sofer MD Physician 0 513749 0 12938 0 2245 0 13200 0 24861 0 566993 0 0 Alexander Ivaskovic MD Physician 0 514657 0 10050 0 5979 0 13200 0 23923 0 567809 0 0 Nadiya Beliveau MD Physician 0 344800 0 26638 0 131317 0 13200 0 11921 0 527876 0 0 Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan THE FOLLOWING INDIVIDUALS PARTICIPATED IN A NONQUALIFIED RETIREMENT PLAN: JAMES HEREFORD, SAMEER BADLANI, LAURA REED, MARK WELTON, ROBERT BEACHER, TRUDI TRYSLA, MARY NEASE, ANDREA MOKROS, Joseph Gaylord, Jeoff WIll, Eithemy Lebrew DUE TO A VESTING EVENT, THE FOLLOWING INDIVIDUALS HAD INCOME IN PART VII AND SCHEDULE J RELATED TO A NONQUALIFIED RETIREMENT PLAN: JAMES HEREFORD $2,049,355 LAURA REED $126,353 MARK WELTON $286,840 ROBERT BEACHER $97,040 TRUDI TRYSLA $93,957 Sameer Badlani $50,935 Jeoff WIll $49,594 Schedule J, Part I, Line 7 Non-fixed payments Fairview Health Services provides lump sum financial awards based on system-wide, business unit and/or departments financial and quality measures. Annual goals, specifically tied to productivity and quality indicators, are set for the year and an incentive paid out annually if key goals and measures are achieved. Schedule J, Part I, Line 3 Related Org to establish compensation THE ORGANIZATION IS PART OF THE FAIRVIEW HEALTH SERVICES SYSTEM AND FAIRVIEW HEALTH SERVICES HUMAN RESOURCES USES COMPARABLES TO ESTABLISH COMPENSATION FOR THE CEO/EXECUTIVE DIRECTOR ACCORDING TO MARKET STANDARDS. Schedule J, Part I, Line 4a Severance benefit payments will commence on the first regularly scheduled pay date that occurs at least five (5) days after the expiration of the rescission period. Payment of severance benefits is contingent upon (i) my having first signed and not rescinded my Service Agreement and Release Agreement and (ii) the return of Fairview's property. Schedule J, Part I, Line 4b Other Additional Information The nonqualified plan (the Plan) is only open to a select group of highly compensated employees. The plan contributes the difference of what 403(b) employer contributions were missed for participants who earn more than the IRS limit on eligible compensation for qualified retirement plans. Participants may not elect to defer compensation. Contributions will be made in the form of a credit to the participant's account. Within 60 days after a participant becomes vested in a contribution, the Plan shall pay to the participant an amount equal to the amount the Participant is required to pay Federal, state, local, and foreign income taxes and employment taxes due to the vesting. The remaining amount in the participant's account shall not be paid until the separation from service payment date. A participant's account shall be distributed in cash. The plan complies with section 457(f) of the Code. Form 990, Part III, Line 4a Continued In 2020, Fairview established the Healing, Opportunity, People, and Equity ("HOPE") Commission to help create a health system where all members of its community are treated with dignity and respect and all patients receive the highest levels and quality of care. To drive more equitable healthcare outcomes and inclusive environments, as part of its HOPE Commission work, Fairview implemented a multi-year journey to become an anti-racist organization. In addition, the Fairview Community Health and Wellness Hub ("Hub") opened in July 2022 and recently celebrated its one-year anniversary. The Hub represents Fairview's intentional, holistic approach to health and wellbeing and commitment to serving all in its communities, especially those who have been traditionally underserved. Services in the Hub include no- to low-cost primary care provided by Minnesota Community Care, a federally qualified health center, expanded outpatient mental health and addiction services, an enhanced adult day program operated by Ebenezer, a food distribution partnership with Second Harvest Heartland and The Sanneh Foundation, and long-term acute care services. The Hub also includes the M Health Fairview Center for Community Health Equity, which serves as an incubator for the next generation of community-based health and wellness programs focused on prevention and addressing the social determinants of health. Form 990, Part V, Line 1a All Form W-2's were filed by a related organization Fairview Health Services, a 501(c)(3) non-profit, tax-exempt organization. Form 990, Part V, Line 1a All cash disbursements are centralized through a related organization, Fairview Health Services a 501(c)3 non-profit tax-exempt organization. Therefore, the related organization, Fairview Health Services, makes the payment and files the related Form 1099's and Form 1096 instead of this organization. Form 990, Part V, Line 2a Additional Information HealthEast St. John's Hospital leases employees from a related organization, Fairview Health Services, a 501(c)(3) tax-exempt, non-profit organization. Therefore, Fairview Health Services files the appropriate W-3 and related W-2 tax forms for these individuals instead of HealthEast St. John's Hospital. The leased employee compensation on the HealthEast St. John's Hospital; Form 990 Part VII and Schedule J is reported as compensation paid by related organization, Fairview Health Services. Form 990, Part VI, Line 6 Classes of members or stockholders The members of the corporation are the individuals who constitute the Directors of this corporation. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body The Board has three categories of directors: 1) 3 ex officio who are Fairview's CEO and the University's Vice President of Medical School and a senior leader of the University Medical School or of the University appointed, from time to time, by the Vice President 2) 10 elected directors who are 1 director elected by the Regents of the University of Minnesota and 9 elected by the Board after nomination from certain components of the Fairview system; and 3) between 3 to 8 at-large directors elected by the Board. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders The Regents of the University of Minnesota have the right to approve proposed amendments to the Articles of Incorporation and Bylaws of the corporation if the amendment would adversely affect their rights and certain sales of substantially all of Fairview's assets. An association of approximately 70 Lutheran churches elects most of the Fairview Southdale Hospital, Fairview Ridges Hospital and part of the UMMC Boards of Trustees, as well as the FPA community directors and the Ebenezer Society Board of Directors and has the right to approve certain Fairview Bylaw amendments. Form 990, Part VI, Line 11b Review of form 990 by governing body The Tax Department conducts a detailed review of the completed return. The Form 990 is then presented to the Executive Committee of the Board for their review and approval on behalf of the Board of Directors. Upon approval from the Board of Directors, the Form 990 is filed. Form 990, Part VI, Line 12c Conflict of interest policy Managers, directors and senior management of Fairview are required to annually complete Fairview's Duty of Loyalty and Conflict of Interest Statement in compliance with Fairview's Conflict of Interest policy. Disclosures are reviewed by the compliance department. Conflicts of interests by Board members and senior management are brought to the Audit and Compliance Committee of the Board, along with additional detailed information, for review. In addition, the Compliance Officer compiles a schedule showing reported conflicts of interest by managers and key employees is also presented to the Conflict of Interest Review Committee for review and discussion. Any problematic issues arising from these disclosures are discussed and resolved by the committee. Board members and management employees are expected to update their conflicts, as necessary, during the year. Form 990, Part VI, Line 15a Process to establish compensation of top management official The determination of executive compensation of the organization is processed by the Human Resources Committee and includes a review of comparability data, review by independent experts and contemporaneous substantiation of the deliberation and decision process. This process is performed annually and was last completed in December 2023. Form 990, Part VI, Line 15b Process to establish compensation of other employees The determination of executive compensation of the organization is processed by the Human Resources Committee and includes a review of comparability data, review by independent experts and contemporaneous substantiation of the deliberation and decision process. This process is performed annually and was last completed in December 2023. Form 990, Part VI, Line 19 Required documents available to the public This organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Inspection of the documents is available at the corporate finance department. Form 990, Part VII, Section B, Line 1 Additional Information Form 1099's were filed by a related organization Fairview Health Services, a 501(c)(3) non-profit, tax-exempt organizations. Fairview Health Services reports the five highest compensated independent contractors for the system. Form 990, Part XI, Line 9 Other changes in net assets or fund balances Partnership Distribution - -478172; Defined Pension Plan Adjustment - -67872; HealthEast Outpatient Services LLC 1700 University Avenue W St Paul MN 55104 461336243 Outpatient MN 333344 450338 HealthEast St John's Hospital Ebenezer Society 7505 Metro Blvd Suite 100 Edina MN 55439 410706141 Nursing MN 501(c)(3) 10 Fairview Health Services false Fairview Foundation 2450 Riverside Avenue South Minneapolis MN 55454 411573810 Fundraising MN 501(c)(3) Type I Fairview Health Services false Fairview Health Services 2450 Riverside Avenue Minneapolis MN 55454 410991680 Hospital MN 501(c)(3) 3 NA false Fairview Home Care and Hospice 2450 26th Avenue South Minneapolis MN 55454 411434246 Home Health MN 501(c)(3) 10 Fairview Health Services false Fairview Physician Associates Netwo 3400 West 66th Street Minneapolis MN 55435 411753325 Clinical MN 501(c)(3) 10 Fairview Health Services false Grand Itasca Clinic and Hosptial 1601 Golf Course Road Grand Rapids MN 55744 411865874 Hospital MN 501(c)(3) 3 Fairview Health Services false Fairview Bethesda Hospital 2450 Riverside Avenue South Minneapolis MN 55454 363517697 Hospital MN 501(c)(3) 3 Fairview Health Services false HealthEast Medical Research Institute 2450 Riverside Avenue South Minneapolis MN 55454 411765832 Med Resear MN 501(c)(3) 4 Fairview Health Services false HealthEast Professional Services 2450 Riverside Avenue South Minneapolis MN 55454 261226617 Physician MN 501(c)(3) 11 Fairview Health Services false HealthEast Woodwinds Hospital 2450 Riverside Avenue South Minneapolis MN 55454 411592761 Hospital MN 501(c)(3) 3 Fairview Health Services false Range Regional Health Services 750 East 34th Street Hibbing MN 55746 411293970 Hospital MN 501(c)(3) 3 Fairview Health Services false Ridges Surgery Center LLC 14101 Fairview Drive Ste 400 Burnsville MN 55337 462441825 Surg Cntr MN Fairview Health Services N/A HealthEast Surgery Center-Maplewood 569 Brookwood Village Suite 901 Birmingham AL 35209 203349887 Surg Cntr AL HealthEast St John's Hospital Related 1073684 1404494 false true 0.52 SouthHealth ASC LLC 4200 Dahlberg Drive Suite 300 Golden Valley MN 55422 822364607 Surgery Center MN Fairview Health Services N/A Fairview Clinics 2450 Riverside Avenue South Minneapolis MN 55454 411761760 Physician MN Fairview Health Services C Corporation false Fairview Physician and Clinic Services 2450 Riverside Avenue South Minneapolis MN 55454 411544996 Physician MN Fairview Health Services C Corporation false Fairview Development Company 2450 Riverside Avenue South Minneapolis MN 55454 411568579 Leasehold MN Fairview Health Services C Corporation false Fairview Express Care 2450 Riverside Avenue South Minneapolis MN 55454 205996177 Physician MN Fairview Health Services C Corporation false FHS Assurance Limited 2450 Riverside Avenue South Minneapolis MN 55454 980417513 Self insur MN Fairview Health Services C Corporation false HealthEast Diversified Services Inc 2450 Riverside Avenue South Minneapolis MN 55454 411388583 Lab & Real MN Fairview Bethesda Hospital C Corporation false false false true false false false false false false false false true true true true true true true true