2024-11-13T07:03:56-06:00 2023-12-31 346565596 ERNST & YOUNG US LLP 155 N WACKER DRIVE CHICAGO IL 60606 990 2023-01-01 453791176 SANFORD GROUP RETURN SANF 6053331000 PO BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 NICHOLAS OLSON EVP, CFO 6053331000 2024-11-13 1 0 JESS WAGENER P01622613 3128792000 2023 2024-10-15 13:58:12Z BILL GASSEN 2301 EAST 60TH ST SIOUX FALLS SD 57104 5750109099 1 1 5851 X WWW.SANFORDHEALTH.ORG X "DEDICATED TO SHARING GOD'S LOVE THROUGH THE WORK OF HEALTH, HEALING AND COMFORT." 10 5 3175 1247 105652845 10639282 100939514 100653729 5209223752 5616529846 9136742 19460626 2637006 2011713 5321937014 5738655914 44519605 46276954 0 0 2907712001 3036308464 0 0 0 2208856104 2290939774 5161087710 5373525192 160849304 365130722 3588870437 3759919108 1069980166 1129335603 2518890271 2630583505 X PART OF THE SANFORD HEALTH SYSTEM, SANFORD IS COMMITTED TO THE HEALTHCARE NEEDS OF COMMUNITIES THROUGHOUT SOUTH DAKOTA, NORTH DAKOTA, MINNESOTA AND IOWA. SANFORD PROVIDES A FULL RANGE OF PRIMARY AND SPECIALTY HEALTH CARE SERVICES. 0 0 5035649680 45746954 5492573325 SANFORD HEALTH, THE LARGEST RURAL HEALTH SYSTEM IN THE UNITED STATES, IS DEDICATED TO TRANSFORMING THE HEALTH CARE EXPERIENCE AND PROVIDING ACCESS TO WORLD-CLASS HEALTH CARE IN AMERICA'S HEARTLAND.SANFORD PROVIDES MEDICAL SERVICES AT EVERY LEVEL FROM CRITICAL ACCESS HOSPITALS TO TERTIARY AND QUATERNARY CARE. THE SANFORD FOOTPRINT OF OWNED, LEASED AND MANGED SITES INCLUDES OVER 250,000 SQUARE MILES WITH A NINE-STATE SERVICE AREA INCLUDING A NETWORK OF CHILDREN'S PRIMARY CARE CLINIC LOCATIONS ACROSS THE COUNTRY AND THE WORLD. SANFORD OPERATES FULL-TIME EMERGENCY CENTERS AND PROVIDES EMERGENCY CARE TO EVERYONE REGARDLESS OF THEIR ABILITY TO PAY. SANFORD FACILITIES AND CLINICS PROVIDE SERVICES TO REMOTE AND MEDICALLY UNDERSERVED AREAS THAT WOULD OTHERWISE NOT HAVE ACCESS TO EVEN PRIMARY CARE SERVICES. 44721169 0 6312341 SANFORD PROVIDES HIGH QUALITY MEDICAL EDUCATIONAL AND PROFESSIONAL DEVELOPMENT THAT IS EVIDENCE AND RESEARCH BASED; ACCREDITED FOR PHYSICIANS, NURSES, PHARMACISTS, AND ALLIED HEALTH PROFESSIONALS AND SCIENTISTS; INCLUSIVE OF CULTURAL DIVERSITY AND ADDRESSES THE NEED FOR SPECIALTY TRAINING. SANFORD IS DEDICATED TO PREPARING HEALTH CARE PROFESSIONALS FOR THE FUTURE. THE SANFORD PROMISE PROGRAM CONNECTS STUDENTS, EDUCATORS AND COMMUNITIES WITH SCIENCE AND RESEARCH IN HEALTH CARE AT A SECONDARY EDUCATION AGE. SANFORD WORKS IN PARTNERSHIP WITH UNIVERSITIES TO PROVIDE ROTATIONS FOR MEDICAL STUDENTS, RESIDENCIES AND FELLOWSHIPS. SANFORD WORKS IN PARTNERSHIP WITH AN EXTENSIVE GROUP OF HIGHER LEARNING ORGANIZATIONS TO PROVIDE STUDENT TRAINING AND LEARNING OPPORTUNITIES IN MANY VENUES ACROSS OUR REGION. 37890173 530000 8445896 RESEARCH ENDEAVORS SPAN CHILDREN'S HEALTH, FOCUSED ON PEDIATRIC RARE DISEASES AND CANCER; THE SANFORD PROJECT, SEEKING TO REDUCE THE BURDEN OF TYPE 1 DIABETES THROUGH DISCOVERY AND CLINICAL APPLICATION; GENOMIC AND MOLECULAR MEDICINE INCLUDING GENOMICS, BIOBANKING AND IMMUNOTHERAPY; EDITH SANFORD BREAST CANCER FOR ADVANCED MOLECULAR RESEARCH AND PERSONALIZED TREATMENT; NEUROBEHAVIORAL SCIENCES, STUDYING EATING DISORDERS, OBESITY AND BARIATRIC SURGERY OUTCOMES AS WELL AS PHYSIOLOGICAL ASPECTS OF EATING AND ADDICTION AND CLINICAL RESEARCH HOSTING DRUG AND DEVICE STUDIES, THE NCI COMMUNITY ONCOLOGY RESEARCH PROGRAM AND THE NEONATAL RESEARCH NETWORK. RESEARCH ALSO LEADS EDUCATIONAL PROGRAMS SUPPORTING SCIENCE IN LOCAL K-12 SCHOOL DISTRICTS, UNDERGRADUATE, GRADUATE AND POST-DOCTORAL PROGRAMS. 5118261022 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 1 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 1 0 0 1 0 0 0 0 0 1 1 1 0 1 0 1 X 4269 0 1 3175 1 1 1 1 CH GH GM 0 0 0 0 0 0 0 0 0 0 X 10 5 1 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 MN OR CA X NICHOLAS OLSON EVP CFO 6053331000 2301 EAST 60TH STREET SIOUX FALLS SD 57104 X MICHELLE BRUHN EVP, CFO & TREASURER (END 6/23) 49.64 10.36 X 0 3526262 105043 WILLIAM BRUNNER MD PHYSICIAN 60.00 0.00 X 3475847 0 44583 BILL GASSEN TRUSTEE, PRESIDENT & CEO 49.64 10.36 X X 0 2821352 439680 TOMASZ STYS MD PHYSICIAN 60.00 0.00 X 2948374 0 46256 ERIC BELANGER MD PHYSICIAN 60.00 0.00 X 2920835 0 40768 THOMAS MATZKE MD PHYSICIAN 60.00 0.00 X 2847035 0 50140 ADAM STYS MD PHYSICIAN 60.00 0.00 X 2803290 0 50828 MATT HOCKS EVP, CHIEF OPERATING OFFICER 53.85 6.15 X 0 2082393 267738 JENNIFER GRENNAN EVP, CHIEF ADMIN OFFICER 55.00 5.00 X 0 1455716 191157 MICHAEL LEBEAU MD SVP, HEALTH SVC OPERATIONS 60.00 0.00 X 0 1346734 201675 PAUL HANSON PRESIDENT & CEO, SIOUX FALLS 60.00 0.00 X 0 1151807 168193 BILL MARLETTE INTERIM, EVP, CFO (BEG 6/23) 49.64 10.36 X 0 1306330 378 TIFFANY LAWRENCE PRESIDENT & CEO, FARGO 55.00 5.00 X 0 1071549 174779 TODD SCHAFFER PRESIDENT & CEO, BISMARCK 60.00 0.00 X 0 991741 122409 SUSAN JARVIS FORMER PRESIDENT & CEO, BEMIDJI 60.00 0.00 X 0 872006 141301 KIM PATRICK FORMER CLO 0.00 0.00 X 0 998482 0 MARK LUNDEEN MD TRUSTEE, PHYSICIAN 57.99 2.01 X 591873 0 16560 KARLA EISCHENS PRESIDENT & CEO, BEMIDJI 60.00 0.00 X 0 509847 95832 MICAH ABERSON FORMER EVP, CIO 0.00 0.00 X 0 453110 0 ANDY NORTH TRUSTEE, SECRETARY, INDEP CONTRACTOR 9.10 2.01 X X 324345 0 0 RANDY BURY FORMER CAO 0.00 0.00 X 0 283920 0 NEIL GULSVIG TRUSTEE, CHAIRPERSON 5.10 2.01 X X 66718 0 0 BRENT TEIKEN TRUSTEE, PAST CHAIR 5.10 2.01 X X 38404 0 0 DON JACOBS TRUSTEE (END 12/23) 5.10 2.01 X 37332 0 0 LAURIS MOLBERT TRUSTEE, VICE CHAIR 5.10 2.01 X X 37099 0 0 JAMES CAIN TRUSTEE 5.10 2.01 X 35599 0 0 WESLEY ENGBRECHT TRUSTEE 5.10 2.01 X 34599 0 0 MARNIE HERMANN TRUSTEE, TREASURER (BEG 4/23) 5.10 2.01 X X 32099 0 0 ROBIN SMITH TRUSTEE, TREASURER (END 4/23) 5.10 2.01 X X 11000 0 0 16204449 18871249 2157320 2442 1 1 0 FOCUSONE SOLUTIONS LLC 1010 N 102ND ST STE 300 OMAHA NE 68114 STAFFING SERVICES 116434096 HENRY CARLSON CONSTRUCTION LLC 1205 RUSSELL ST SIOUX FALLS SD 57104 CONSTRUCTION SERVICES 55913294 LOCUMTENENSCOM LLC PO BOX 405547 ATLANTA GA 30384 STAFFING SERVICES 6479253 MCGOUGH CONSTRUCTION CO LLC 2737 FAIRVIEW AVE N ST PAUL MN 55113 CONSTRUCTION SERVICES 4554839 PAUL WEISS RIFKIND WHARTON & GARRISON LL 1285 AVENUE OF THE AMERICAS NEW YORK NY 10019 CONSULTING SERVICES 4466457 155 58794765 33041666 8817298 100653729 PATIENT SERVICES 621110 2438530005 2438530005 MEDICARE/MEDICAID 621400 2151419659 2151419659 PHARMACY 456110 645121940 635716866 9405074 RETAIL SALES 456199 263038271 241439261 21599010 REFERENCE LAB REVENUE 621500 27470001 1985584 25484417 90949970 38240187 49164344 3545439 5616529846 11185868 11185868 213 213 4498232 2486732 2011500 2011500 2011500 1633450 15607761 1659529 7306924 -26079 8300837 8274758 8274758 5738655914 5507331562 105652845 25017778 46155099 46155099 121855 121855 19256244 17816411 1439833 2748819 2748819 2444250049 2264031202 180218847 112587756 104843169 7744587 297946700 268042660 29904040 159518896 146788816 12730080 5676111 272365 5403746 1391836 76369 1315467 592687 592687 581547 581547 377508328 344848425 32659903 20529796 3617273 16912523 60466688 39813739 20652949 132506215 43223216 89282999 117760302 108852648 8907654 20128285 18525942 1602343 5736218 4566611 1169607 23752794 23672174 80620 134906349 116234236 18672113 27426303 27198915 227388 MEDICAL SUPPLIES 1365168572 1359827167 5341405 BIOMEDICAL SERVICES 29692369 29692369 EMPLOYEE RECRUITMENT 16600718 11988875 4611843 OTHER TAXES 14562766 14303299 259467 -64048110 123166640 -187214750 5373525192 5118261022 255264170 0 6676428 59316362 230746569 183735153 220673 0 747344512 836469834 21449 69083286 74098691 124928258 131499348 78225069 93247192 3930448275 2065704042 1790130185 1864744233 433579 192795 33508819 57598283 33414398 33679559 47957708 44839780 426200953 380476429 3588870437 3759919108 321874655 322769972 5118766 6139321 4018002 20072536 479072573 451201775 174332 349593 11901748 7847503 247820090 320954903 1069980166 1129335603 X 2518883171 2630576405 7100 7100 2518890271 2630583505 3588870437 3759919108 X 365130722 90395 -253527883 X 0 1 X 1 1 1 X 20 20 LIST OF ORGANIZATIONS AND PUBLIC CHARITY STATUS: SANFORD HEALTH 509(A)(3) SANFORD MEDICAL CENTER 170(B)(1)(A)(III) SANFORD CLINIC 509(A)(2) SANFORD RESEARCH 170(B)(1)(A)(III) SANFORD RESEARCH NORTH 170(B)(1)(A)(III) SANFORD HOME HEALTH 509(A)(2) SANFORD HEALTH NETWORK 170(B)(1)(A)(III) SANFORD WORLD CLINICS 509(A)(2) SANFORD NORTH 509(A)(3) SANFORD MEDICAL CENTER FARGO 170(B)(1)(A)(III) SANFORD CLINIC NORTH 509(A)(2) SANFORD HEALTH NETWORK NORTH 170(B)(1)(A)(III) SANFORD HEALTH OF NORTHERN MINNESOTA 170(B)(1)(A)(III) BAKER PARK, INC. 509(A)(2) SANFORD WEST 509(A)(3) SANFORD BISMARCK 170(B)(1)(A)(III) SANFORD WORLD CLINICS-KLAMATH FALLS 509(A)(2) SANFORD VIRTUAL CARE 509(A)(2) SCHEDULE A, PART I PART I, LINE 12B - SANFORD HEALTH, SANFORD NORTH, AND SANFORD WEST ARE ALL TYPE II SUPPORTING ORGANIZATIONS. DETAIL FOR SCHEDULE A, PART I, LINE 12G LINE 12, COLUMN: (I) SANFORD MEDICAL CENTER; (II) 46-0227855; (III) 3; (IV) YES; (V) $23,246,952 LINE 12, COLUMN: (I) SANFORD CLINIC; (II) 46-0447693; (III) 10; (IV) YES; (V) $1,228,104 LINE 12, COLUMN: (I) SANFORD RESEARCH; (II) 46-0450378; (III) 4; (IV) YES; (V) $464,594 LINE 12, COLUMN: (I) SANFORD RESEARCH NORTH; (II) 45-0274828; (III) 4; (IV) YES; (V) $104,230 LINE 12, COLUMN: (I) SANFORD HOME HEALTH; (II) 46-0282134; (III) 10; (IV) YES; (V) $220,204 LINE 12, COLUMN: (I) SANFORD HEALTH NETWORK; (II) 46-0388596; (III) 3; (IV) YES; (V) $7,672,967 LINE 12, COLUMN: (I) SANFORD CLINIC NORTH; (II) 91-1770748; (III) 10; (IV) YES; (V) $303,931 LINE 12, COLUMN: (I) SANFORD HEALTH NETWORK NORTH; (II) 45-0409348; (III) 3; (IV) YES; (V) $54,775 LINE 12, COLUMN: (I) SANFORD MEDICAL CENTER FARGO; (II) 45-0226909; (III) 3; (IV) YES; (V) $25,082,891 LINE 12, COLUMN: (I) SANFORD WORLD CLINICS; (II) 26-2707628; (III) 10; (IV) YES; (V) $143,557 LINE 12, COLUMN: (I) SANFORD WORLD CLINICS-KLAMATH FALLS; (II) 92-0396212 (III) 10; (IV) YES; (V) $76,906 LINE 12, COLUMN: (I) SANFORD HEALTH OF NORTHERN MINNESOTA; (II) 41-1266009; (III) 3; (IV) YES; (V) $8,562,799 LINE 12, COLUMN: (I) BAKER PARK, INC.; (II) 41-1372480; (III) 10; (IV) YES; (V) $15,330 LINE 12, COLUMN: (I) SANFORD HEALTH FOUNDATION NORTH; (II) 45-0398104; (III) 7; (IV) YES; (V) $179,377 LINE 12, COLUMN: (I) SANFORD BISMARCK; (II) 45-0226700; (III) 3; (IV) YES; (V) $18,374,349 LINE 12, COLUMN: (I) SANFORD HEALTH FOUNDATION WEST; (II) 45-0397196; (III) 7; (IV) YES; (V) $27,337 LINE 12, COLUMN: (I) SANFORD VIRTUAL CARE; (II) 88-0976483; (III) 10; (IV) YES; (V) $0 LINE 12, COLUMN: (I) THE EVANGELICAL LUTHERAN GOOD SAMARITAN FOUNDATION; (II) 46-0422866; (III) 7; (IV) YES; (V) $122,067 LINE 12, COLUMN: (I) THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY; (II) 45-0228055; (III) 10; (IV) YES; (V) $19,310,679 LINE 12, COLUMN: (I) SANFORD HEALTH FOUNDATION OF NORTHERN MINNESOTA; (II) 41-1389317; (III) 7; (IV) YES; (V) $ 24,091 SCHEDULE A, PART I, LINE 12G, COLUMN (IV) WE HAVE ANSWERED YES THAT THE ORGANIZATIONS ARE LISTED IN OUR GOVERNING DOCUMENTS BECAUSE THE ARTICLES DESCRIBE THE SPECIFIED SUPPORTED ORGANIZATIONS AND THE OTHER SUPPORTED ORGANIZATIONS BY CLASS (AFFILIATED WITH THE SPECIFIED SUPPORTED ORGANIZATIONS). SCHEDULE A, PART III LINE 1 - COLUMN: (A) 429,804; (B) 9,415,179; (C) (3,426,082); (D) 3,504,069; (E) 2,528,926; (F) 12,451,896 LINE 2 - COLUMN: (A) 172,939,530; (B) 177,631,632; (C) 204,250,348; (D) 261,882,016; (E) 205,463,244; (F) 1,022,166,769 LINE 6 - COLUMN: (A) 173,369,334; (B) 187,046,811; (C) 200,824,266; (D) 265,386,085; (E) 207,992,170; (F) 1,034,618,665 LINE 7C - COLUMN: (A) 0; (B) 718,178; (C) 0; (D) 0; (E) 0; (F) 718,178 LINE 8 - COLUMN: (F) 1,033,900,487 LINE 9 - COLUMN: (A) 173,369,334; (B) 187,046,811; (C) 200,824,266; (D) 265,386,085; (E) 207,992,170; (F) 1,034,618,665 LINE 10A - COLUMN: (A) 1,216,540; (B) 1,544,624; (C) 1,377,220; (D) 1,495,086; (E) 163,641; (F) 5,797,111 LINE 10C - COLUMN: (A) 1,216,540; (B) 1,544,624; (C) 1,377,220; (D) 1,495,086; (E) 163,641; (F) 5,797,111 LINE 11 - COLUMN: (A) 1,230,289; (B) 673,203; (C) 151,437; (D) 789,277; (E) 508,990; (F) 3,353,196 LINE 13 - COLUMN: (A) 175,816,163; (B) 189,264,638; (C) 202,352,923; (D) 267,670,448; (E) 208,664,801; (F) 1,043,768,972 LINE 15: 99.05% LINE 16: 98.88% LINE 17: 0.56% LINE 18: 0.73% LINE 19A: X LINE 19B: X PART IV, SECTION A LINE 1: NO LINE 2: NO LINE 3A: NO LINE 4A: NO LINE 5A: YES LINE 5B: YES LINE 5C: NO LINE 6: YES LINE 7: NO LINE 8: NO LINE 9A: NO LINE 9B: NO LINE 9C: NO LINE 10A: NO LINE 11A: NO LINE 11B: NO LINE 11C: NO SCHEDULE A, PART IV, SECTION A, LINE 1 THE ARTICLES OF INCORPORATION OF SANFORD HEALTH, SANFORD NORTH AND SANFORD BISMARCK PROVIDE THAT THEY SHALL PROVIDE OVERSIGHT, OPERATE FOR THE BENEFIT OF, TO SUPPORT THE FUNCTIONS OF, AND TO CARRY OUT SOME OR ALL OF THE CHARITABLE PURPOSES OF THE NAMED SUBSIDIARY ORGANIZATIONS WHICH ARE EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ALL OTHER 501(C)(3) ORGANIZATIONS OPERATED, SUPERVISED OR CONTROLLED BY OR SUPERVISED OR CONTROLLED IN CONNECTION WITH, SUCH ORGANIZATIONS. FURTHER, PURSUANT TO THEIR BY-LAWS, THE GOVERNING BODY OF SANFORD (PARENT), SERVES AS THE GOVERNING BODY OF SANFORD HEALTH, SANFORD NORTH AND SANFORD BISMARCK AS WELL AS ALL OF THE NAMED TAX-EXEMPT SUBSIDIARY ORGANIZATIONS. THUS, SANFORD HEALTH, SANFORD NORTH AND SANFORD BISMARCK MEET THE RELATIONSHIP TEST AS A TYPE II ORGANIZATIONS BECAUSE THERE IS COMMON SUPERVISION AND CONTROL BETWEEN SANFORD HEALTH, SANFORD NORTH AND SANFORD BISMARCK AND THEIR NAMED SUPPORTED ORGANIZATIONS. SANFORD HEALTH, SANFORD NORTH, AND SANFORD BISMARCK ALSO SUPPORT ORGANIZATIONS WHICH ARE 501(C)(3) ORGANIZATIONS AFFILIATED WITH THE SUPPORTED ORGANIZATIONS OR ARE 501(C)(3) PUBLIC CHARITIES AFFILIATED WITH THESE AFFILIATED ENTITIES. THEY ARE DESCRIBED BY CLASS. IN ADDITION, THE ARTICLES PROVIDE THAT IN FURTHERANCE OF THEIR PURPOSES, THESE CORPORATIONS MAY ENGAGE IN, ADVANCE, PROMOTE, SUPPORT, AND ADMINISTER CHARITABLE, SCIENTIFIC, AND EDUCATIONAL ACTIVITIES AND PROJECTS OF EVERY KIND AND NATURE WHATSOEVER IN ITS OWN BEHALF OR AS THE AGENT, TRUSTEE, OR REPRESENTATIVE OF OTHERS. THIS INCLUDES TO AID OR ASSIST OTHER ORGANIZATIONS WHOSE ACTIVITIES ARE SUCH AS TO FURTHER, ACCOMPLISH, FOSTER, OR ATTAIN ANY SUCH PURPOSES. ALL POWERS OF THESE CORPORATIONS SHALL BE EXERCISED ONLY SO THAT THESE CORPORATIONS' OPERATIONS SHALL BE EXCLUSIVELY WITHIN THE CONTEMPLATION OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. TO QUALIFY AS A SECTION 509(A)(3) SUPPORTING ORGANIZATION, AN ORGANIZATION MUST SUPPORT ONE OR MORE SPECIFIED ORGANIZATIONS. FOR TYPE II SUPPORTING ORGANIZATION'S ARTICLES OF INCORPORATION, THE ARTICLES MUST DESIGNATE THE SUPPORTING ORGANIZATION(S) BY CLASS OR PURPOSE, AND WHICH INCLUDE PUBLICLY SUPPORTED ORGANIZATIONS WHICH ARE CLOSELY RELATED IN PURPOSE OR FUNCTION TO THE PUBLICLY SUPPORTED ORGANIZATION SPECIFIED IN THE ARTICLES. THEREFORE, THE LACK OF INCLUDING THE NAME OF THE AFFILIATED ORGANIZATIONS THAT SANFORD HEALTH, SANFORD NORTH, AND SANFORD WEST WILL SUPPORT IN THEIR ARTICLES OF INCORPORATION DOES NOT OTHERWISE DEFEAT THE ORGANIZATIONS STATUSES AS TYPE II SUPPORTING ORGANIZATIONS, BECAUSE THEIR ARTICLES DESCRIBE THESE SUPPORTED ORGANIZATIONS BY CLASS (AFFILIATED WITH THE SPECIFIED SUPPORTED ORGANIZATION) AND REQUIRE THAT THEY BE EXEMPT FROM TAX UNDER IRC SECTION 501(C)(3). SCHEDULE A, PART IV, SECTION A, LINE 5A (I) SANFORD HEALTH NETWORK NORTH, 45-0409348; (II) THE ORGANIZATION WAS ADDED BECAUSE IT NO LONGER IS A SUPPORTING ORGANIZATION, IT IS SUPPORTED BY THE SUPPORTING ORGANIZATIONS; (III) THE SUPPORTED ORGANIZATION WAS PART OF A CLASS ALREADY DESIGNATED IN THE ORGANIZATIONS ORGANIZING DOCUMENTS; (IV) NO ACTION NEEDED TO ACCOMPLISH SCHEDULE A, PART IV, SECTION A, LINE 6 THE ORGANIZATIONS GIVE GRANTS AND PROVIDE SUPPORT TO QUALIFIED 501(C)(3) PUBLIC CHARITIES, GOVERNMENTAL ENTITIES AND VARIOUS LOCAL NONPROFIT ORGANIZATIONS THAT SUPPORT THE MISSIONS OF SANFORD HEALTH, SANFORD NORTH, AND SANFORD WEST AND THE ORGANIZATIONS THAT THEY SUPPORT. SCHEDULE A, PART IV, SECTION C, LINE 1 LINE 1: YES RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 0 1 411862 0 1 180825 592687 0 PART II-B, LINE 1: THE FILING ORGANIZATION HAS MEMBERSHIPS IN THE FOLLOWING ORGANIZATIONS: 340B HEALTH, AMERICAN ACADEMY OF HOSPICE AND PALLIATIVE MEDICINE, ABERDEEN AREA CHAMBER OF COMMERCE, AMERICAN COLLEGE HEALTHCARE EXECUTIVES, AMERICAN SOCIETY FOR GASTRO ENDOSCOPY, AMERICAN SOCIETY OF ECHOCARDIOGRAPHY, AMERICAN ACADEMY OF OPTHALMOLOGY, AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS, AMERICAN ACADEMY OF SLEEP MEDICINE, AMERICAN AMBULANCE ASSOCIATION, AMERICAN ASSOCIATION OF HEALTHCARE ADMINISTRATIVE MANAGEMENT, AMERICAN COLLEGE OF OSTEOPATHIC SURGEONS, AMERICAN COLLEGE OF SURGEONS PROFESSIONAL ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION, AMERICAN MEDICAL ASSOCIATION, AMERICAN MEDICAL GROUP ASSOCIATION, AMERICAN OPTOMETRIC ASSOCIATION, AMERICAN OSTEOPATHIC ASSOCIATION, ASSOCIATION HEALTHCARE PHILANTHROPY, ASSOCIATION OF COMMUNITY CANCER CENTERS, ASSOCIATION OF CRITICAL CARE TRANSPORT, CARE PROVIDERS OF MN, CHAMBER FARGO MOORHEAD, CHAMBER OF COMMERCE GRAND FORKS, CHILDREN'S ADVOCACY CENTERS OF SOUTH DAKOTA, CHILDREN'S HOSPITAL ASSOCIATION, COALITION TO STRENGTHEN AMERICA'S HEALTHCARE, ELEVATE RAPID CITY, GREATER FARGO MOORHEAD EDC, GREATER NORTH DAKOTA CHAMBER, GREATER SIOUX FALLS CHAMBER OF COMMERCE, IOWA HEALTH CARE ASSOCIATION, IOWA HOSPITAL ASSOCIATION, KLAMATH CITY CHAMBER OF COMMERCE, MEDICAL GROUP MANAGEMENT ASSOCIATION, MIDWEST ASSOCIATION FOR MEDICAL EQUIPMENT & SUPPLIES, MINNESOTA HOSPITAL ASSOCIATION, MINNESOTA AMBULANCE ASSOCIATION, MINNESOTA CHAMBER OF COMMERCE, NATIONAL ASSOCIATION FOR BIOMEDICAL RESEARCH, NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS, NATIONAL ASSOCIATION OF EPILEPSY CENTERS, NATIONAL ASSOCIATION OF SPECIALTY PHARMACY, NATIONAL HOME INFUSION ASSOCIATION, NATIONAL RURAL HEALTH ASSOCIATION, NORTH DAKOTA EMS ASSOCIATION, NORTH DAKOTA HOSPITAL ASSOCIATION, NORTH DAKOTA LONG TERM CARE ASSOCIATION, PERSONALIZED MEDICINE COALITION, SOUTH DAKOTA ASSOCIATION OF HEALTHCARE ORGANIZATION, SOUTH DAKOTA BIOTECH ASSOCIATION, SOUTH DAKOTA CHAMBER OF COMMERCE & INDUSTRY, SOUTH DAKOTA HEALTH CARE ASSOCIATION, SOUTH DAKOTA NETWORK AGAINST FAMILY, SOUTH DAKOTA STATE MEDICAL ASSOCIATION, SIOUXLAND CHAMBER OF COMMERCE, SOCIETY FOR VASCULAR ULTRASOUND, SOCIETY OF DIAGNOSTIC MEDICAL SONOGRAPHY, STRATEGIC HEALTH CARE, TOBACCO FREE NORTH DAKOTA, AND TRAUMA CENTER ASSOCIATION OF AMERICA. A PERCENTAGE OF MEMBERSHIP DUES PAID TO THESE ORGANIZATIONS RELATE TO LOBBYING EXPENSES. IN ADDITION, THE ORGANIZATION EMPLOYS CERTAIN INDIVIDUALS, AND CONTRACTS WITH VARIOUS LOBBYISTS, TO MONITOR LEGISLATIVE ACTS IMPORTANT TO ALL SANFORD ENTITIES ON BOTH STATE AND NATIONAL LEVELS. OCCASIONALLY, SANFORD EMPLOYEES SEND MAILINGS TO LEGISLATORS ON ISSUES THAT MAY AFFECT HEALTHCARE. 0 1 X 98286566 538214 164705 98989485 95588573 3117005 -419012 98286566 92002112 3277428 309033 95588573 89216166 3261419 99138 -574611 92002112 84843272 4005822 367072 89216166 0.00000 1.00000 0.00000 0 1 1 129551293 129551293 1672895525 776506681 896388844 99236802 62610829 36625973 1950066914 1189420155 760646759 78697741 37166377 41531364 1864744233 DEFERRED COMPENSATION ASSETS 198050108 RIGHT OF USE ASSET 87661345 NON-OPERATING PROPERTY 86931691 OTHER ASSETS 7833285 380476429 DEFERRED COMPENSATION LIABILITY 197637485 LONG TERM OPERATING LEASE PAYABLE 72771572 OTHER NON-CURRENT LIABILITIES 50545846 320954903 X PART IV, LINE 2B: LONG TERM CARE FACILITIES HOLD SECURITY DEPOSITS FOR TENANTS. PART V, LINE 4: SANFORD HEALTH FOUNDATION, SANFORD HEALTH FOUNDATION NORTH, SANFORD HEALTH FOUNDATION OF NORTHERN MINNESOTA AND SANFORD HEALTH FOUNDATION WEST HOLD ENDOWMENT FUNDS ON BEHALF OF THE FILING ORGANIZATION TO BE USED FOR ASSISTANCE IN ITS ACTIVITIES AND FOR PROVIDING HEALTH CARE, MEDICAL, OR EDUCATIONAL SERVICES. PART X, LINE 2: CERTAIN CONTROLLED ORGANIZATIONS ARE SUBJECT TO INCOME TAXES. DEFERRED INCOME TAX ASSETS AND LIABILITIES ARE RECOGNIZED FOR THE DIFFERENCES BETWEEN THE FINANCIAL AND INCOME TAX REPORTING BASIS OF ASSETS AND LIABILITIES BASED ON ENACTED TAX RATES AND LAWS. A TAX BENEFIT FROM AN UNCERTAIN TAX POSITION MAY BE RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION. THE DEFERRED INCOME TAX PROVISION OR BENEFIT GENERALLY REFLECTS THE NET CHANGE IN DEFERRED INCOME TAX ASSETS AND LIABILITIES DURING THE YEAR. THE CURRENT INCOME TAX PROVISION REFLECTS THE TAX CONSEQUENCES OF REVENUES AND EXPENSES CURRENTLY TAXABLE OR DEDUCTIBLE ON VARIOUS INCOME TAX RETURNS FOR THE YEAR REPORTED. SANFORD GROUP DID NOT HAVE A MATERIAL INCOME TAX LIABILITY AT DECEMBER 31, 2023; SOME RELATED ORGANIZATIONS HAVE ESTABLISHED RESERVES. 1 EAST ASIA AND THE PACIFIC 0 0 INVESTMENTS 410000 EAST ASIA AND THE PACIFIC 0 0 PROGRAM SERVICES MSA 113000 SUB-SAHARAN AFRICA 0 0 PROGRAM SERVICES OPERATING EXPENSES FOR CLINIC 2126000 EUROPE (INCLUDING ICELAND & GREENLAND) 0 0 INVESTMENTS 10972000 SUB-SAHARAN AFRICA 0 0 INVESTMENTS 2285000 CENTRAL AMERICA AND THE CARIBBEAN 0 0 PROGRAM SERVICES MSA AND EMR WORK 1910000 MIDDLE EAST AND NORTH AFRICA 0 0 INVESTMENTS 1300000 EAST ASIA AND THE PACIFIC 0 0 INVESTMENTS 1600000 CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENT 8000000 EUROPE (INCLUDING ICELAND & GREENLAND) 0 0 60000 0 0 0 0 0 0 20716000 8060000 28776000 0 0 1 0 1 0 0 0 PART I, LINE 2: PRIOR TO DISBURSEMENT ALL GRANT FUND REQUESTS ARE REVIEWED TO ENSURE THE RECEIVING ORGANIZATION AND PROPOSED USE OF FUNDS ALIGN WITH SANFORD'S MISSION. GRANTS ARE DISBURSED BY THE ORGANIZATION ONLY AFTER THE EXPENDITURE HAS BEEN MADE AND PROPERLY AUTHORIZED BY THE ORGANIZATION ALONG WITH RELATED DOCUMENTATION TO ENSURE THE FUNDS ARE NOT DIVERTED FOR NON-CHARITABLE USE. PART I, LINE 3: EXPENDITURES ARE ACCOUNTED FOR ON THE ACCRUAL BASIS OF ACCOUNTING. PART II, LINE 1 ACCOUNTING METHOD: GRANTS AND OTHER ASSISTANCE TO ORGANIZATIONS OR ENTITIES OUTSIDE THE UNITED STATES ARE ACCOUNTED FOR ON THE ACCRUAL BASIS OF ACCOUNTING. 1 1 X 1 X 225.000000000000 1 X 375.000000000000 1 1 0 1 1 81559572 0 81559572 0.01520 659248860 513730327 145518533 0.02710 0 0 740808432 513730327 227078105 0.04230 58560290 588793 57971497 0.01080 44721169 6312341 38408828 0.00710 2159171751 1908097884 251073867 0.04670 36274121 17302886 18971235 0.00350 18372472 0 18372472 0.00340 2317099803 1932301904 384797899 0.07150 3057908235 2446032231 611876004 0.11380 1870014 1870014 0.00030 11373692 11373692 0.00210 2685655 2685655 0.00050 22422 22422 0.00000 528645 528645 0.00010 9735186 9735186 0.00180 115668 115668 0.00000 26331282 26331282 0.00480 1 79010205 0 264239278 273505582 -9266304 X 1 1 25 1 SANFORD MEDICAL CENTER 1305 W 18TH STREET SIOUX FALLS SD 57117 WWW.SANFORDHEALTH.ORG SD 10564 SANFORD MEDICAL CENTER 460227855 X X X X X A 2 SANFORD MEDICAL CENTER FARGO 5225 23RD AVENUE S FARGO ND 58104 WWW.SANFORDHEALTH.ORG ND 5070 SANFORD MEDICAL CENTER FARGO 450226909 X X X X X A 3 SANFORD BROADWAY MEDICAL CENTER FARGO 801 BROADWAY NORTH FARGO ND 58122 WWW.SANFORDHEALTH.ORG ND 5018A SANFORD MEDICAL CENTER FARGO 450226909 X X X X X A 4 SANFORD MEDICAL CENTER SOUTH UNIVERSITY 1720 SOUTH UNIVERSITY FARGO ND 58103 WWW.SANFORDHEALTH.ORG ND 5068A SANFORD MEDICAL CENTER FARGO 450226909 X X X A 5 SANFORD BISMARCK MEDICAL CENTER 300 N 7TH STREET BISMARCK ND 58501 WWW.SANFORDHEALTH.ORG ND 5003A SANFORD BISMARCK 450226700 X X X X A 6 SANFORD BEMIDJI MEDICAL CENTER 1300 ANNE STREET NW BEMIDJI MN 56601 WWW.SANFORDHEALTH.ORG MN 371073 SANFORD HEALTH OF NORTHERN MINNESOTA 411266009 X X X A 7 SANFORD MEDICAL CENTER THIEF RIVER FALLS 3001 SANFORD PARKWAY THIEF RIVER FALLS MN 56701 WWW.SANFORDHEALTH.ORG MN 371500 SANFORD HEALTH NETWORK NORTH 450409348 X X X X INPATIENT MENTAL HEALTH A 8 SANFORD ABERDEEN MEDICAL CENTER 2905 3RD AVENUE SE ABERDEEN SD 57401 WWW.SANFORDHEALTH.ORG SD 65089 SANFORD HEALTH NETWORK 460388596 X X X A 9 SANFORD WORTHINGTON MEDICAL CENTER 1018 6TH AVENUE WORTHINGTON MN 56187 WWW.SANFORDHEALTH.ORG MN 371449 SANFORD HEALTH NETWORK 460388596 X X X A 10 SANFORD SHELDON MEDICAL CENTER 118 N 7TH AVENUE SHELDON IA 51201 WWW.SANFORDHEALTH.ORG IA 161381 SANFORD HEALTH NETWORK 460388596 X X X X NURSING FACILITY A 11 SANFORD VERMILLION MEDICAL CENTER 20 S PLUM STREET VERMILLION SD 57069 WWW.SANFORDHEALTH.ORG SD 53082 SANFORD HEALTH NETWORK 460388596 X X X X NURSING FACILITY A 12 SANFORD CHAMBERLAIN MEDICAL CENTER 300 S BYRON BLVD CHAMBERLAIN SD 57325 WWW.SANFORDHEALTH.ORG SD 50302 SANFORD HEALTH NETWORK 460388596 X X X X NURSING FACILITY A 13 SANFORD LUVERNE MEDICAL CENTER 1600 N KNISS AVENUE LUVERNE MN 56156 WWW.SANFORDHEALTH.ORG MN 371352 SANFORD HEALTH NETWORK 460388596 X X X X A 14 SANFORD CANBY MEDICAL CENTER 112 ST OLAF AVENUE S CANBY MN 56220 WWW.SANFORDHEALTH.ORG MN 371019 SANFORD HEALTH NETWORK 460388596 X X X X NURSING FACILITY A 15 SANFORD JACKSON MEDICAL CENTER 1430 N HIGHWAY JACKSON MN 56143 WWW.SANFORDHEALTH.ORG MN 371002 SANFORD HEALTH NETWORK 460388596 X X X X A 16 SANFORD TRACY MEDICAL CENTER 251 5TH STREET E TRACY MN 56175 WWW.SANFORDHEALTH.ORG MN 371440 SANFORD HEALTH NETWORK 460388596 X X X X A 17 SANFORD HILLSBORO MEDICAL CENTER 12 3RD STREET SE HILLSBORO ND 58045 WWW.SANFORDHEALTH.ORG ND 5026A SANFORD HEALTH NETWORK NORTH 450409348 X X X X A 18 SANFORD MEDICAL CENTER MAYVILLE 42 6TH AVENUE SE MAYVILLE ND 58257 WWW.SANFORDHEALTH.ORG ND 5034A SANFORD HEALTH NETWORK NORTH 450409348 X X X X A 19 SANFORD WEBSTER MEDICAL CENTER 1401 W 1ST STREET WEBSTER SD 57274 WWW.SANFORDHEALTH.ORG SD 10573 SANFORD HEALTH NETWORK 460388596 X X X X A 20 SANFORD MEDICAL CENTER WHEATON 401 12TH STREET N WHEATON MN 56296 WWW.SANFORDHEALTH.ORG MN 371390 SANFORD HEALTH NETWORK NORTH 450409348 X X X X A 21 SANFORD BAGLEY MEDICAL CENTER 203 4TH STREET NW BAGLEY MN 56621 WWW.SANFORDHEALTH.ORG MN 371484 SANFORD HEALTH OF NORTHERN MINNESOTA 411266009 X X X X A 22 SANFORD CANTON-INWOOD MEDICAL CENTER 440 N HIAWATHA DRIVE CANTON SD 57013 WWW.SANFORDHEALTH.ORG SD 51569 SANFORD HEALTH NETWORK 460388596 X X X X A 23 SANFORD CLEAR LAKE MEDICAL CENTER 701 3RD AVENUE S CLEAR LAKE SD 57226 WWW.SANFORDHEALTH.ORG SD 10533 SANFORD HEALTH NETWORK 460388596 X X X X A 24 SANFORD WESTBROOK MEDICAL CENTER 920 BELL AVENUE WESTBROOK MN 56183 WWW.SANFORDHEALTH.ORG MN 371439 SANFORD HEALTH NETWORK 460388596 X X X X A 25 SANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTER 120 LA BREE AVENUE S THIEF RIVER FALLS MN 56701 WWW.SANFORDHEALTH.ORG MN 410505 SANFORD HEALTH NETWORK NORTH 450409348 X BEHAVIORAL HEALTH CENTER-INPATIENT MENTAL HEALTH A FACILITY REPORTING GROUP - A 0 0 1 X X X X X X X X X 21 1 1 0 1 X WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT X X 1 21 1 WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT 0 1 X 225.000000000000 375.000000000000 X X X X X X 1 1 X X X X 1 X SEE NARRATIVE FOR FULL URL X SEE NARRATIVE FOR FULL URL X SEE NARRATIVE FOR FULL URL X X X X X X X 1 X 0 X X X X 1 X 0 0 PART V, SECTION B FACILITY REPORTING GROUP A FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: SANFORD MEDICAL CENTER, - FACILITY 3: SANFORD BROADWAY MEDICAL CENTER FARGO, - FACILITY 4: SANFORD MEDICAL CENTER SOUTH UNIVERSITY, - FACILITY 5: SANFORD BISMARCK MEDICAL CENTER, - FACILITY 6: SANFORD BEMIDJI MEDICAL CENTER, - FACILITY 7: SANFORD MEDICAL CENTER THIEF RIVER FALLS, - FACILITY 8: SANFORD ABERDEEN MEDICAL CENTER, - FACILITY 9: SANFORD WORTHINGTON MEDICAL CENTER, - FACILITY 10: SANFORD SHELDON MEDICAL CENTER, - FACILITY 11: SANFORD VERMILLION MEDICAL CENTER, - FACILITY 12: SANFORD CHAMBERLAIN MEDICAL CENTER, - FACILITY 13: SANFORD LUVERNE MEDICAL CENTER, - FACILITY 14: SANFORD CANBY MEDICAL CENTER, - FACILITY 15: SANFORD JACKSON MEDICAL CENTER, - FACILITY 16: SANFORD TRACY MEDICAL CENTER, - FACILITY 17: SANFORD HILLSBORO MEDICAL CENTER, - FACILITY 18: SANFORD MEDICAL CENTER MAYVILLE, - FACILITY 19: SANFORD WEBSTER MEDICAL CENTER, - FACILITY 20: SANFORD MEDICAL CENTER WHEATON, - FACILITY 21: SANFORD BAGLEY MEDICAL CENTER, - FACILITY 22: SANFORD CANTON-INWOOD MEDICAL CENTER, - FACILITY 23: SANFORD CLEAR LAKE MEDICAL CENTER, - FACILITY 24: SANFORD WESTBROOK MEDICAL CENTER, - FACILITY 2: SANFORD MEDICAL CENTER FARGO, - FACILITY 25: SANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH C GROUP A-FACILITY 1 -- SANFORD MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 1 -- SANFORD MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 1 -- SANFORD MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 1 -- SANFORD MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO CAREACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET. SANFORD HAS MADE ACCESS TO CARE A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO INCREASE ACCESS TO AND AWARENESS OF AFFORDABLE CARE OPTIONS AND TO IMPROVE ACCESS THROUGH VIRTUAL CARE OPTIONS. IT IS SANFORD'S GOAL TO IMPROVE COMMUNITY ACCESS SO CARE IS AVAILABLE AND AFFORDABLE FOR ALL. PRIORITY 2: CHRONIC DISEASE PREVENTIONSANFORD MEDICAL CENTER TAKES AN INTEGRATED APPROACH TO DISEASE PREVENTION. PROMOTING THE IMPORTANCE OF HAVING A PRIMARY CARE PROVIDER AND OFFERS SCREENING OPPORTUNITIES FOR EARLY DETECTION AND INTERVENTION OF CHRONIC DISEASE.CHRONIC DISEASE PREVENTION IS A SIGNIFICANT PRIORITY AND DEVELOPED STRATEGIES TO BROADEN COMMUNITY AWARENESS OF THE IMPORTANCE OF PRIMARY AND PREVENTIVE CARE AND IMPROVE CARE FOR CHILDREN AT RISK FOR OBESITY. OUR GOAL IS TO IMPROVE CHRONIC DISEASE MANAGEMENT AND REDUCE OBESITY.PRIORITY 3: MENTAL HEALTH AND ADDICTIONMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE.SANFORD MADE MENTAL HEALTH AND ADDICTION SIGNIFICANT PRIORITIES AND DEVELOPED STRATEGIES TO EXPAND ACCESS TO TIMELY BEHAVIORAL HEALTH CARE AND REDUCE THE NEGATIVE IMPACT OF ADDICTION AND SUBSTANCE ABUSE ON THE COMMUNITY. IT IS SANFORD'S GOAL TO IMPROVE CARE MANAGEMENT FOR RESIDENTS SUFFERING FROM SUBSTANCE ABUSE AND MENTAL HEALTH ISSUES.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEAR:ACCESS TO CARESANFORD HEALTH WAS A MEMBER OF THE BROAD COALITION OF ADVOCATES TO PASS MEDICAID EXPANSION IN 2022, EXPANDING ELIGIBILITY TO 40,000 PEOPLE IN SD. WE CONTINUE TO WORK WITH PATIENTS ELIGIBLE FOR COVERAGE TO ENSURE THEY HAVE APPROPRIATE RESOURCES AND SUPPORT. HEALTH LITERACY AND FINANCIAL ADVOCACY ARE ONGOING EFFORTS. WE COLLABORATE WITH SANFORD HEALTH PLAN TO HELP PATIENTS FIND AFFORDABLE COVERAGE. ON-SITE FINANCIAL ADVOCATES SPECIALIZE IN COVERAGE ENROLLMENT AND HELP PATIENTS NAVIGATE SANFORD'S FINANCIAL ASSISTANCE PROGRAM IF ELIGIBLE. WE CONTINUE TO INVEST IN LANGUAGE SERVICES TO ENSURE PATIENTS NEEDING FINANCIAL SUPPORT DO NOT FACE LANGUAGE BARRIERS. SANFORD HEALTH LAUNCHED A VIRTUAL CARE INITIATIVE AS PART OF OUR COMMITMENT TO TRANSFORM HEALTH CARE FOR PATIENTS LIVING IN RURAL AND UNDERSERVED AREAS. IN 2023, VIRTUAL CARE, WORKING WITH 33 REGIONAL NETWORK FACILITIES, UP FROM 26 THE YEAR PRIOR, PROVIDED ACCESS TO VIRTUAL EMERGENCY SERVICES, TELE STROKE, AND TELE BURN. 5 PEDIATRIC VIRTUAL OPTIONS WERE ADDED IN 2023. CARESIGNAL HOME MONITORING EXPANDED WITH 1507 PATIENTS ENROLLED IN 2023 (71 IN 2022). THE SANFORD HEALTH SIOUX FALLS REGION CONDUCTED OVER 45,000 VIDEO VISITS AND 26,000 E-VISITS THE LAST 2 YEARS.THE CLINICAL CALL CENTER ANSWERS AFTER-HOURS CALLS FOR ALL THE CLINIC LOCATIONS AND MY SANFORD NURSE CALLS. THE CENTER FIELDED 550,633 CALLS IN 2023. IN 2022, MY SANFORD NURSE HAD 47,743 CALLS AND THERE WERE 233,045 ONE CALL SYSTEM CALLS.CHRONIC DISEASE PREVENTIONIN 2022, WE JOINED A NEW COLLABORATIVE INITIATED BY THE CITY OF SIOUX FALLS PUBLIC HEALTH DEPT. THIS COMMUNITY HEALTH IMPROVEMENT PLAN IS A COMPLEMENT TO THE CHNA BUT WITH A TARGETED FOCUS ON THE SIOUX FALLS METRO. COMMUNITY PARTNERS DEVELOPED STRATEGIES TO ADDRESS GAPS IN PREVENTIVE CARE IN RESPONSE TO ASSESSMENT DATA.SANFORD PROVIDES COMPREHENSIVE CARE AND COMMUNITY SERVICES TO SUPPORT PATIENTS AT HIGH RISK OF READMISSION AND WITH COMPLEX MEDICAL AND SOCIAL SITUATIONS IMPACTING HEALTH OUTCOMES. THE TEAM IS COMPRISED OF NURSE PRACTITIONERS, NURSE CASE MANAGERS, AND SOCIAL WORKERS WHO MEET THE PATIENT IN THEIR LIVING SITUATION TO RESOLVE BARRIERS FOR PATIENTS TO HELP ENSURE PATIENTS REMAIN OUT OF THE HOSPITAL, RECEIVE PREVENTATIVE CARE, AND IMPROVE OUTCOMES. THE TEAM SERVES THOSE IN SIOUX FALLS AND A 30-MILE RADIUS AND HAVE A CASE LOAD OF APPROX. 60 PATIENTS.OUR COMMUNITY HEALTH WORKER (CHW) PROGRAM LAUNCHED IN 2022 AT PRIMARY CARE CLINICS. CHWS WORK WITH AT-RISK POPULATIONS TO ENSURE THEY RECEIVE APPROPRIATE CARE AND CONNECT THEM TO COMMUNITY RESOURCES AND SUPPORT SERVICES. 2023 WAS OUR FIRST FULL YEAR OF ALL FOUR SIOUX FALLS CHWS ROUTINELY SEEING PATIENTS. CHWS HAD 1,416 FACE-TO-FACE ENCOUNTERS WITH 745 PATIENTS IN 2023. OUR MOBILE HEART SCREENING TRUCK WAS OUT IN THE COMMUNITY FOR A TOTAL OF 48 DAYS THE LAST TWO YEARS. IN CLINIC & MOBILE SCREENINGS WERE 20,693 IN 2022 AND 2023 (HEART: 11,228 WITH 3,265 POSITIVE SCREENS, VASCULAR: 9,465 WITH 190 POSITIVE). THE YOY INCREASE WAS 503 OVER THE 2022 TOTAL NUMBER OF SCREENS. WE PROMOTED COLORECTAL CANCER MONTH AND HEALTHY LIFESTYLE HABITS TO DECREASE RISK. EDUCATIONAL INFORMATION WAS SHARED, AND PRIMARY CARE STAFF ADVISED PATIENTS AS APPROPRIATE WHEN DUE FOR A SCREENING. THE 68.2% COLORECTAL CANCER SCREENING RATE IN 2023 IS ON PAR WITH 2022. AN ENTERPRISE-WIDE PROJECT TO IMPROVE COLORECTAL CANCER SCREENING IS CURRENTLY UNDERWAY. SMC ATTAINED A CERVICAL CANCER SCREENING RATE OF 74.4% IN 2023, EXCEEDING THE 68.9% GOAL. MAMMOGRAMS ARE ENCOURAGED FOR PATIENTS AS APPROPRIATE WITH A 2023 SCREENING RATE OF 73.5% (GOAL IS 84.6%). SCHOOLS HAVE ACCESS TO SANFORD FIT TO ENGAGE CHILDREN AND FAMILIES TO MAKE HEALTHY LIFESTYLE CHOICES. OUR REGION HAD 2,811 FIT WEBSITE USERS IN 2023 AND A TWO-YEAR TOTAL OF 54,939 PAGE VIEWS. THE FIT TEAM CONDUCTED 76 EVENTS IN SIOUX FALLS FOR 8,154 CHILDREN THE PAST TWO YEARS.MENTAL HEALTH AND ADDICTIONSMC OFFERS MENTAL HEALTH SERVICES FOR ANY ADMITTED PATIENT AND THOSE THAT PRESENT TO THE ED IN A MENTAL HEALTH CRISIS. MENTAL HEALTH STAFF ALSO SEE THOSE WITH A NEW MEDICAL DIAGNOSIS SUCH AS CANCER, PULMONARY ISSUES, AND POSTPARTUM DEPRESSION. SMC'S MENTAL HEALTH TEAM CONSISTS OF 15 MASTER'S LEVEL COUNSELORS AND CLINICAL SOCIAL WORKERS TO ENSURE ANY MENTAL HEALTH NEEDS ARE TAKEN CARE OF WHILE A PATIENT IS HOSPITALIZED. SMC OFFERS TWO IHTS THAT SEE PATIENTS IN OUR SPECIALTY CLINICS, ALSO AVAILABLE FOR CRISIS COUNSELING AND FOLLOW UP VISITS AS NEEDED, THAT ARE ON THE MAIN CAMPUS.IHTS WITHIN PRIMARY CARE CLINICS ENSURE BROADER ACCESS FOR PATIENTS SEEKING OUTPATIENT CARE ENSURING REGULAR, CONSISTENT SCREENING AND FOLLOW-UP. SANFORD PSYCHIATRY AND PSYCHOLOGY CLINIC CURRENTLY HAS 31 PROVIDERS.IN 2023, THE CLINIC HAD 37,226 TOTAL APPOINTMENTS (36,505 IN 2022) INCLUDING OVER 4,849 NEW REFERRALS (5,000 IN 2022). IN-PERSON AND VIRTUAL APPOINTMENTS ARE AVAILABLE TO MEET THE NEEDS OF THOSE COMING FROM A DISTANCE AND/OR FOR THEIR CONVENIENCE. OF THE 36,000+ VISITS IN 2022, 2,827 WERE MYCHART TELEMED HOME VISITS, 2,621 WERE TELEMED HOME VISITS. TWO PSYCHIATRISTS AND ONE BEHAVIORAL HEALTH THERAPIST WILL JOIN THE CLINIC BY LATE 2024. WE CONTINUE TO ADD TO OUR MENTAL HEALTH TEAM IN PRIMARY CARE SETTINGS.SMC STAFF AND PROVIDERS FOLLOW BEST PRACTICES REGARDING OPIOID PRESCRIBING/TREATMENT. THE EMR PROMPTS PROVIDERS TO CHECK PRESCRIPTION DRUG MONITORING PROGRAM BEFORE PRESCRIBING OPIOIDS, PERFORM ROUTINE YEARLY URINE DRUG SCREEN TESTS, PROVIDE EDUCATIONAL RESOURCES IN DEALING WITH PRESCRIBING OPIOIDS, AND GIVE CONTROLLED SUBSTANCE AGREEMENTS FOR PATIENTS USING OPIOIDS CHRONICALLY. THE ONECHART SYSTEM HAS AN OPIOID MANAGEMENT DASHBOARD WHERE PAIN AGREEMENTS, DRUG TESTS, AND NALOXONE COMPLIANCE ARE MONITORED. THERE IS ALSO A CHRONIC OPIOID USE REGISTRY TO SEE WHO HAS AN UPDATED OPIOID RISK TOOL ASSESSING RISK OF OPIOID ABUSE AND PAIN SCREENING TOOL.THE LINK, WHICH IS A COMMUNITY TRIAGE CENTER FORMED BY CHNA PARTNERS TO PROVIDE A SAFE PLACE FOR PEOPLE EXPERIENCING NON-VIOLENT BEHAVIORAL HEALTH CRISIS OR CARE FOR SUDS TO ACCESS TREATMENT AND REFERRALS TO SUPPORT SERVICES. WE PARTICIPATE IN VARIOUS PLANNING AND OPERATIONAL COMMITTEES AND OUR PRESIDENT AND CEO IS ON THE BOARD OF DIRECTORS.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE: LONG-TERM CAREPUBLIC TRANSPORTATIONAFFORDABLE HOUSINGSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 1 -- SANFORD MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 1 -- SANFORD MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 3 -- SANFORD BROADWAY MEDICAL CENTER FARGO PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 3 -- SANFORD BROADWAY MEDICAL CENTER FARGO PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 3 -- SANFORD BROADWAY MEDICAL CENTER FARGO PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 3 -- SANFORD BROADWAY MEDICAL CENTER FARGO PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO AFFORDABLE HEALTH CAREACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE HEALTH CARE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET. NDSU REPORTED HEALTH CARE ACCESSIBILITY AND COST AS TWO SEPARATE HEALTH NEEDS. THE CASS-CLAY WORKING GROUP DETERMINED THAT THE TWO TOPICS ARE MOST APPROPRIATELY ADDRESSED AS A COMBINED TOPIC FOR PURPOSES OF THE LOCAL CHNA PROCESS.SANFORD HAS MADE HEALTHCARE ACCESS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO EXPAND HEALTHCARE ACCESS AND ACCESS TO PRIMARY CARE SERVICES. IT IS SANFORD'S GOAL THAT THE COMMUNITY WOULD SEE THAT PATIENTS WILL HAVE GREATER EASE TO ACCESS PRIMARY CARE PROVIDERS FOR VIRTUAL OR IN-PERSON VISITS, HOME VISITS AND INCREASED EXPANDED HOURS. PATIENTS MAY EXPERIENCE LESS FREQUENT UTILIZATION OF EMERGENCY CARE, WHICH IS OFTEN MORE EXPENSIVE THAN PREVENTATIVE AND SCREENING SERVICES.PRIORITY 2: MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSEMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSE SIGNIFICANT PRIORITIES AND HAS DEVELOPED STRATEGIES TO RECRUIT PROVIDERS, INCREASE ACCESS TO CARE AND MENTAL HEALTH PROMOTION. IT IS SANFORD'S GOAL TO HAVE BETTER ACCESS TO AND UTILIZATION OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES DUE TO SERVICES BEING PROVIDED AT THE RIGHT TIME AND RIGHT PLACE. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEAR: ACCESS TO AFFORDABLE HEALTH CARESANFORD FARGO ESTABLISHED TWO GOALS IN SUPPORT OF THE PRIORITY, ACCESS TO AFFORDABLE HEALTH CARE. THE FIRST IS TO EXPAND HEALTHCARE ACCESS AND SUPPORT RESOURCES FOR VULNERABLE AND UNDERSERVED POPULATIONS. THE SECOND IS TO EXPAND PLATFORM AND ACCESS TO PRIMARY CARE SERVICES.TO INCREASE ACCESS TO PRIMARY CARE AVAILABILITY, SANFORD FARGO INCREASED HOME BASED PRIMARY CARE ACCESS. SANFORD FARGO/MOORHEAD METRO AREA INTERNAL MED AND FAMILY MEDICINE PROVIDERS CONDUCTED ABOUT 500 HOME VISITS IN 2023. THE FAMILY MEDICINE RESIDENCY PROGRAM IS OUTREACHING TO MULTIPLE LOCATIONS IN OUR COMMUNITY TO PROVIDE MEDICAL CARE TO UNDERSERVED POPULATIONS. THE FAMILY MEDICINE RESIDENCY PROGRAM PROVIDED MEDICAL CARE THIS PAST YEAR AT THE YWCA, NEW LIFE CENTER, YOUTHWORKS, AND JEFFERSON SCHOOL. IN 2023, 170 PATIENTS WERE SERVED IN THESE LOCATIONS. YOUTHWORKS IS A "501C3 NON-PROFIT DEDICATED TO PROVIDING YOUTH AND FAMILY SERVICES THROUGHOUT NORTH DAKOTA. THEIR FOCUS AND EXPERTISE IS IN WORKING WITH TEENS, PARENTS AND YOUNG ADULTS UNDER 22 YEARS OF AGE. OUR SERVICES INCLUDE PROGRAMS FOR RUNAWAY, HOMELESS AND STREET YOUTH; JUVENILE OFFENDERS; YOUTH FAILING IN SCHOOL; YOUTH SUSPENDED OR EXPELLED FROM SCHOOL; YOUNG PARENTS AND PREGNANT MOMS (UNDER 22); YOUTH ARRESTED AND UNABLE TO IMMEDIATELY RETURN HOME; YOUTH NEEDING EMERGENCY CARE; YOUTH NEEDING PEER SUPPORT OR CROSS-AGE MENTORING; AND YOUTH WITH ANGER ISSUES." THIS STRATEGY WILL HELP IMPROVE ACCESS FOR VULNERABLE AND UNDERSERVED RESIDENTS OF THE FARGO/MOORHEAD METRO AREA.SANFORD FARGO OPENED THE HORACE CLINIC ON NOVEMBER 8, 2023. ONE PHYSICIAN AND THREE ADVANCED PRACTICE PROVIDERS BEGAN PROVIDING CARE IN HORACE, WITH THE ABILITY TO EXPAND TO SEVEN CLINICIANS IN THE FUTURE. FROM OPENING DATE THROUGH THE END OF 2023, CLINICIANS CONDUCTED 615 VISITS. WITH HORACE RAPIDLY GROWING, THIS CLINIC WILL ALLOW SANFORD FARGO TO CONTINUE TO KEEP PATIENTS IN THE SOUTH END OF THE METRO AREA AND BEYOND CONNECTED TO CARE. ALL SANFORD FARGO PRIMARY CARE PROVIDERS ARE NOW ABLE TO PROVIDE VIRTUAL VISITS TO PATIENTS WHICH WILL HELP SERVE PATIENTS WHO MAY BE EXPERIENCING BARRIERS TO CARE SUCH AS LIMITED ACCESS TO TRANSPORTATION. SANFORD FARGO/MOORHEAD METRO AREA PROVIDERS CONDUCTED 1,015 VIDEO VISITS IN PRIMARY CARE FOR 2023. SANFORD FARGO ADDED SIX PRIMARY CARE PROVIDERS TO CLINICS IN THE FARGO/MOORHEAD METRO AREA IN 2023 AND THREE THAT STARTED IN Q4 2022. THESE ADDITIONS ARE CONTINUING TO HELP MAKE PRIMARY CARE READILY AVAILABLE FOR PATIENTS WE SERVE. ONE STRATEGY IDENTIFIED WITHIN THE COMMUNITY HEALTH NEEDS ASSESSMENT PROGRAM IS TO MAKE VIRTUAL VISITS AVAILABLE FOR ALL PRIMARY CARE PROVIDERS. AS OF THE END OF 2022, ACCESS TO TELEHEALTH IS AVAILABLE FOR ALL FAMILY MEDICINE PROVIDERS, WHICH ALLOWS PATIENTS TO RECEIVE CARE WITHIN THEIR HOMES IF THEY DO NOT HAVE ACCESS TO RELIABLE TRANSPORTATION OR CANNOT TRAVEL FOR APPOINTMENTS.MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSE THREE GOALS SUPPORT THE MENTAL HEALTH AND SUBSTANCE ABUSE GOAL. THE FIRST IS RECRUITING PROVIDERS AND INCREASING ACCESS TO CARE. THE SECOND IS TO DEVELOP A COMMUNITY STRATEGY FOR MENTAL HEALTH PROMOTION. THE THIRD IS TO DECREASE SUBSTANCE ABUSE.TO INCREASE ACCESS TO MENTAL HEALTH CARE, SANFORD FARGO EXPANDED ITS PARTNERSHIP WITH REGIONAL SCHOOLS TO PROVIDE STUDENT PLACEMENT FOR MASTER'S LEVEL THERAPISTS INTO THE INTERNAL MEDICINE DEPARTMENT. COORDINATION OF CARE WITH PRIMARY CARE, EMERGENCY DEPARTMENT, AND HOSPITAL CARE COORDINATION HAS RESULTED IN THE WAIT LIST FOR BEHAVIORAL HEALTH AND PSYCHIATRY APPOINTMENTS TO DECREASE (FROM 2,000 PATIENTS TO 180 PATIENTS WAITING TO BE SCHEDULED IN 2022 ALONE). FURTHERMORE, ACCESS TO SUPPORTIVE BEHAVIORAL HEALTH SERVICES AND RESOURCES HAVE IMPROVED IN THE HOSPITAL WITH THE CREATION OF A DEDICATED UNIT AT THE SANFORD MEDICAL CENTER FARGO FOR PATIENTS ADMITTED FOR MEDICAL CARE WHO REQUIRE ADDITIONAL BEHAVIORAL HEALTH SUPPORT. ACCESS TO ADULT PSYCHIATRY SERVICES AT SANFORD FARGO CONTINUES TO UNDERGO IMPROVEMENT. WAIT TIMES TO BE SEEN FOR AN ADULT PSYCHIATRY APPOINTMENT IMPROVED FROM ROUGHLY SIX MONTHS AT END OF 2022 TO ABOUT 10-12 WEEKS BY THE END OF 2023. SANFORD IS CONTINUING ITS EFFORTS TO MONITOR AND WORK TO IMPROVE ACCESS FOR BEHAVIORAL HEALTH SERVICES IN OUR REGION. THE STUDENT LED CLINIC PROVIDED CLINICAL INTERNSHIPS FOR 14 STUDENTS COMPLETING THEIR MASTER'S LEVEL THERAPIST PROGRAMS IN SOCIAL WORK OR COUNSELING. OF THESE, NINE WERE HIRED AS MASTER'S LEVEL THERAPISTS FOLLOWING COMPLETION OF THE PROGRAM. SANFORD FARGO/MOORHEAD METRO AREA PROVIDERS COMPLETED 7,927 BEHAVIORAL HEALTH VIDEO VISITS IN 2023. 92,865 PATIENTS SEEN IN THE FARGO REGION WITHOUT A DIAGNOSIS OF DEPRESSION OR BIPOLAR DISORDER WERE SCREENED FOR DEPRESSION WITH DOCUMENTED FOLLOW UP WHEN APPROPRIATE THOUGH SANFORD HEALTH SITES IN 2023. OF 6,593 ELIGIBLE PATIENTS WHO MET THE CRITERIA FOR DEPRESSION REMISSION TRACKING, 528 REACHED REMISSION. SINCE 2022, SANFORD AMBULANCE REPORTED 2,790 PATIENTS RECEIVING CARE FOR A PRIMARY IMPRESSION RELATED TO ALCOHOL USE, WITHDRAWAL, OR ALCOHOL OVERDOSE FOR THE FARGO/MOORHEAD AREA, ALONG WITH ABOUT 3,836 PATIENTS WITH A PRIMARY IMPRESSION RELATED TO BEHAVIORAL HEALTH/PSYCHIATRIC EPISODE, ANXIETY, MENTAL DISORDER, SUICIDAL IDEATION, OR SUICIDE ATTEMPT. SANFORD FARGO IS CONTINUING A PARTNERSHIP WITH CLAY COUNTY DETOX TO ENSURE COORDINATED UTILIZATION OF MEDICAL AND LAW ENFORCEMENT SUPPORT FOR INDIVIDUALS ACTIVELY IN DETOX. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:PHYSICAL ACTIVITY AND NUTRITIONSENIOR HOUSING AND LONG-TERM CAREPUBLIC TRANSPORTATIONAFFORDABLE HOUSING, EMPLOYMENT, ECONOMIC DEVELOPMENTDIVERSITY, INCLUSION, HEALTH EQUITYCHILDCAREHEALTH LITERACY AND NAVIGATIONSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 3 -- SANFORD BROADWAY MEDICAL CENTER FARGO PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 3 -- SANFORD BROADWAY MEDICAL CENTER FARGO PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 4 -- SANFORD MEDICAL CENTER SOUTH UNIVERSITY PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 4 -- SANFORD MEDICAL CENTER SOUTH UNIVERSITY PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 4 -- SANFORD MEDICAL CENTER SOUTH UNIVERSITY PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 4 -- SANFORD MEDICAL CENTER SOUTH UNIVERSITY PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO AFFORDABLE HEALTH CARE ACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE HEALTH CARE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET. NDSU REPORTED HEALTH CARE ACCESSIBILITY AND COST AS TWO SEPARATE HEALTH NEEDS. THE CASS-CLAY WORKING GROUP DETERMINED THAT THE TWO TOPICS ARE MOST APPROPRIATELY ADDRESSED AS A COMBINED TOPIC FOR PURPOSES OF THE LOCAL CHNA PROCESS.SANFORD HAS MADE HEALTHCARE ACCESS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO EXPAND HEALTHCARE ACCESS AND ACCESS TO PRIMARY CARE SERVICES. IT IS SANFORD'S GOAL THAT THE COMMUNITY WOULD SEE THAT PATIENTS WILL HAVE GREATER EASE TO ACCESS PRIMARY CARE PROVIDERS FOR VIRTUAL OR IN-PERSON VISITS, HOME VISITS AND INCREASED EXPANDED HOURS. PATIENTS MAY EXPERIENCE LESS FREQUENT UTILIZATION OF EMERGENCY CARE, WHICH IS OFTEN MORE EXPENSIVE THAN PREVENTATIVE AND SCREENING SERVICES.PRIORITY 2: MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSEMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSE SIGNIFICANT PRIORITIES AND HAS DEVELOPED STRATEGIES TO RECRUIT PROVIDERS, INCREASE ACCESS TO CARE AND MENTAL HEALTH PROMOTION. IT IS SANFORD'S GOAL TO HAVE BETTER ACCESS TO AND UTILIZATION OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES DUE TO SERVICES BEING PROVIDED AT THE RIGHT TIME AND RIGHT PLACE. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEAR: ACCESS TO AFFORDABLE HEALTH CARESANFORD FARGO ESTABLISHED TWO GOALS IN SUPPORT OF THE PRIORITY, ACCESS TO AFFORDABLE HEALTH CARE. THE FIRST IS TO EXPAND HEALTHCARE ACCESS AND SUPPORT RESOURCES FOR VULNERABLE AND UNDERSERVED POPULATIONS. THE SECOND IS TO EXPAND PLATFORM AND ACCESS TO PRIMARY CARE SERVICES.TO INCREASE ACCESS TO PRIMARY CARE AVAILABILITY, SANFORD FARGO INCREASED HOME BASED PRIMARY CARE ACCESS. SANFORD FARGO/MOORHEAD METRO AREA INTERNAL MED AND FAMILY MEDICINE PROVIDERS CONDUCTED ABOUT 500 HOME VISITS IN 2023. THE FAMILY MEDICINE RESIDENCY PROGRAM IS OUTREACHING TO MULTIPLE LOCATIONS IN OUR COMMUNITY TO PROVIDE MEDICAL CARE TO UNDERSERVED POPULATIONS. THE FAMILY MEDICINE RESIDENCY PROGRAM PROVIDED MEDICAL CARE THIS PAST YEAR AT THE YWCA, NEW LIFE CENTER, YOUTHWORKS, AND JEFFERSON SCHOOL. IN 2023, 170 PATIENTS WERE SERVED IN THESE LOCATIONS. YOUTHWORKS IS A "501C3 NON-PROFIT DEDICATED TO PROVIDING YOUTH AND FAMILY SERVICES THROUGHOUT NORTH DAKOTA. THEIR FOCUS AND EXPERTISE IS IN WORKING WITH TEENS, PARENTS AND YOUNG ADULTS UNDER 22 YEARS OF AGE. OUR SERVICES INCLUDE PROGRAMS FOR RUNAWAY, HOMELESS AND STREET YOUTH; JUVENILE OFFENDERS; YOUTH FAILING IN SCHOOL; YOUTH SUSPENDED OR EXPELLED FROM SCHOOL; YOUNG PARENTS AND PREGNANT MOMS (UNDER 22); YOUTH ARRESTED AND UNABLE TO IMMEDIATELY RETURN HOME; YOUTH NEEDING EMERGENCY CARE; YOUTH NEEDING PEER SUPPORT OR CROSS-AGE MENTORING; AND YOUTH WITH ANGER ISSUES." THIS STRATEGY WILL HELP IMPROVE ACCESS FOR VULNERABLE AND UNDERSERVED RESIDENTS OF THE FARGO/MOORHEAD METRO AREA.SANFORD FARGO OPENED THE HORACE CLINIC ON NOVEMBER 8, 2023. ONE PHYSICIAN AND THREE ADVANCED PRACTICE PROVIDERS BEGAN PROVIDING CARE IN HORACE, WITH THE ABILITY TO EXPAND TO SEVEN CLINICIANS IN THE FUTURE. FROM OPENING DATE THROUGH THE END OF 2023, CLINICIANS CONDUCTED 615 VISITS. WITH HORACE RAPIDLY GROWING, THIS CLINIC WILL ALLOW SANFORD FARGO TO CONTINUE TO KEEP PATIENTS IN THE SOUTH END OF THE METRO AREA AND BEYOND CONNECTED TO CARE. ALL SANFORD FARGO PRIMARY CARE PROVIDERS ARE NOW ABLE TO PROVIDE VIRTUAL VISITS TO PATIENTS WHICH WILL HELP SERVE PATIENTS WHO MAY BE EXPERIENCING BARRIERS TO CARE SUCH AS LIMITED ACCESS TO TRANSPORTATION. SANFORD FARGO/MOORHEAD METRO AREA PROVIDERS CONDUCTED 1,015 VIDEO VISITS IN PRIMARY CARE FOR 2023. SANFORD FARGO ADDED SIX PRIMARY CARE PROVIDERS TO CLINICS IN THE FARGO/MOORHEAD METRO AREA IN 2023 AND THREE THAT STARTED IN Q4 2022. THESE ADDITIONS ARE CONTINUING TO HELP MAKE PRIMARY CARE READILY AVAILABLE FOR PATIENTS WE SERVE. ONE STRATEGY IDENTIFIED WITHIN THE COMMUNITY HEALTH NEEDS ASSESSMENT PROGRAM IS TO MAKE VIRTUAL VISITS AVAILABLE FOR ALL PRIMARY CARE PROVIDERS. AS OF THE END OF 2022, ACCESS TO TELEHEALTH IS AVAILABLE FOR ALL FAMILY MEDICINE PROVIDERS, WHICH ALLOWS PATIENTS TO RECEIVE CARE WITHIN THEIR HOMES IF THEY DO NOT HAVE ACCESS TO RELIABLE TRANSPORTATION OR CANNOT TRAVEL FOR APPOINTMENTS.MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSETHREE GOALS SUPPORT THE MENTAL HEALTH AND SUBSTANCE ABUSE GOAL. THE FIRST IS RECRUITING PROVIDERS AND INCREASING ACCESS TO CARE. THE SECOND IS TO DEVELOP A COMMUNITY STRATEGY FOR MENTAL HEALTH PROMOTION. THE THIRD IS TO DECREASE SUBSTANCE ABUSE.TO INCREASE ACCESS TO MENTAL HEALTH CARE, SANFORD FARGO EXPANDED ITS PARTNERSHIP WITH REGIONAL SCHOOLS TO PROVIDE STUDENT PLACEMENT FOR MASTER'S LEVEL THERAPISTS INTO THE INTERNAL MEDICINE DEPARTMENT. COORDINATION OF CARE WITH PRIMARY CARE, EMERGENCY DEPARTMENT, AND HOSPITAL CARE COORDINATION HAS RESULTED IN THE WAIT LIST FOR BEHAVIORAL HEALTH AND PSYCHIATRY APPOINTMENTS TO DECREASE (FROM 2,000 PATIENTS TO 180 PATIENTS WAITING TO BE SCHEDULED IN 2022 ALONE). FURTHERMORE, ACCESS TO SUPPORTIVE BEHAVIORAL HEALTH SERVICES AND RESOURCES HAVE IMPROVED IN THE HOSPITAL WITH THE CREATION OF A DEDICATED UNIT AT THE SANFORD MEDICAL CENTER FARGO FOR PATIENTS ADMITTED FOR MEDICAL CARE WHO REQUIRE ADDITIONAL BEHAVIORAL HEALTH SUPPORT. ACCESS TO ADULT PSYCHIATRY SERVICES AT SANFORD FARGO CONTINUES TO UNDERGO IMPROVEMENT. WAIT TIMES TO BE SEEN FOR AN ADULT PSYCHIATRY APPOINTMENT IMPROVED FROM ROUGHLY SIX MONTHS AT END OF 2022 TO ABOUT 10-12 WEEKS BY THE END OF 2023. SANFORD IS CONTINUING ITS EFFORTS TO MONITOR AND WORK TO IMPROVE ACCESS FOR BEHAVIORAL HEALTH SERVICES IN OUR REGION. THE STUDENT LED CLINIC PROVIDED CLINICAL INTERNSHIPS FOR 14 STUDENTS COMPLETING THEIR MASTER'S LEVEL THERAPIST PROGRAMS IN SOCIAL WORK OR COUNSELING. OF THESE, NINE WERE HIRED AS MASTER'S LEVEL THERAPISTS FOLLOWING COMPLETION OF THE PROGRAM. SANFORD FARGO/MOORHEAD METRO AREA PROVIDERS COMPLETED 7,927 BEHAVIORAL HEALTH VIDEO VISITS IN 2023. 92,865 PATIENTS SEEN IN THE FARGO REGION WITHOUT A DIAGNOSIS OF DEPRESSION OR BIPOLAR DISORDER WERE SCREENED FOR DEPRESSION WITH DOCUMENTED FOLLOW UP WHEN APPROPRIATE THOUGH SANFORD HEALTH SITES IN 2023. OF 6,593 ELIGIBLE PATIENTS WHO MET THE CRITERIA FOR DEPRESSION REMISSION TRACKING, 528 REACHED REMISSION. SINCE 2022, SANFORD AMBULANCE REPORTED 2,790 PATIENTS RECEIVING CARE FOR A PRIMARY IMPRESSION RELATED TO ALCOHOL USE, WITHDRAWAL, OR ALCOHOL OVERDOSE FOR THE FARGO/MOORHEAD AREA, ALONG WITH ABOUT 3,836 PATIENTS WITH A PRIMARY IMPRESSION RELATED TO BEHAVIORAL HEALTH/PSYCHIATRIC EPISODE, ANXIETY, MENTAL DISORDER, SUICIDAL IDEATION, OR SUICIDE ATTEMPT. SANFORD FARGO IS CONTINUING A PARTNERSHIP WITH CLAY COUNTY DETOX TO ENSURE COORDINATED UTILIZATION OF MEDICAL AND LAW ENFORCEMENT SUPPORT FOR INDIVIDUALS ACTIVELY IN DETOX. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:PHYSICAL ACTIVITY AND NUTRITIONSENIOR HOUSING AND LONG-TERM CAREPUBLIC TRANSPORTATIONAFFORDABLE HOUSING, EMPLOYMENT, ECONOMIC DEVELOPMENTDIVERSITY, INCLUSION, HEALTH EQUITYCHILDCAREHEALTH LITERACY AND NAVIGATIONSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 4 -- SANFORD MEDICAL CENTER SOUTH UNIVERSITY PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 4 -- SANFORD MEDICAL CENTER SOUTH UNIVERSITY PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 5 -- SANFORD BISMARCK MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 5 -- SANFORD BISMARCK MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 5 -- SANFORD BISMARCK MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 5 -- SANFORD BISMARCK MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: IMPROVE ACCESS TO BEHAVIORAL HEALTH SERVICESMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE ACCESS TO BEHAVIORAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE AN IMPROVED CONTINUUM OF CARE APPROACH TO ADDRESSING MENTAL AND BEHAVIORAL HEALTH NEEDS AND SUBSTANCE USE DISORDERS. PRIORITY 2: IMPROVE ACCESS TO AFFORDABLE CAREACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE HEALTH CARE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET. SANFORD HAS MADE HEALTHCARE ACCESS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO PROMOTE AND IMPROVE ACCESS TO SERVICES. IMPROVING ACCESS TO HEALTHCARE SERVICES HAS BOTH FINANCIAL AND QUALITY OF LIFE IMPLICATIONS ON THE COMMUNITY. BY HELPING COMMUNITY MEMBERS ACCESS THE RIGHT CARE AT THE RIGHT TIME IN THE RIGHT PLACE, THEY ARE BETTER ABLE TO PREVENT AND MANAGE CHRONIC DISEASE AND ENJOY A BETTER QUALITY OF LIFE. FROM A FINANCIAL PERSPECTIVE, BETTER ACCESS TO CARE CAN BE MEASURED IN REDUCED UNNECESSARY EMERGENCY VISITS AND HOSPITALIZATIONS. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEAR IMPROVE ACCESS TO BEHAVIORAL HEALTH SERVICESTWO GOALS WERE IDENTIFIED THROUGH THE CHNA PROCESS TO IMPROVE ACCESS TO BEHAVIORAL HEALTH SERVICES, A VITAL NEED FOR THE COMMUNITIES. GOAL ONE ADVANCES SCHOOL-BASED SERVICES FOR PEDIATRIC PATIENTS WHILE GOAL TWO EXPANDS BEHAVIORAL HEALTH SERVICES AVAILABLE THROUGH THE EMERGENCY DEPARTMENT.SANFORD HEALTH HAS PARTNERED WITH NUMEROUS SCHOOLS IN THE BISMARCK PUBLIC SCHOOLS DISTRICT TO PROVIDE ONSITE BEHAVIORAL HEALTH SERVICES AS PART OF A COMPREHENSIVE TIERED-SYSTEM APPROACH TO PROVIDING RESILIENCY TRAINING AND INTERVENTIONS TO HELP STUDENTS BE SUCCESSFUL. FOR THOSE STUDENTS WHO MAY BENEFIT FROM SERVICES PROVIDED BY A LICENSED BEHAVIORAL HEALTH PROVIDER, SANFORD HEALTH'S ROLE IN THIS PARTNERSHIP IS TO PROVIDE ONSITE CARE. SANFORD'S THERAPIST MEETS WEEKLY WITH THE SCHOOLS' LEADERSHIP TEAMS TO BETTER COORDINATE SUPPORT SERVICES FOR HIGH-RISK STUDENTS. TO ENSURE ACCESS, SANFORD PROVIDED TELEHEALTH VISIT OPTIONS AND CONTINUED CARING FOR THE STUDENTS DURING THE SUMMER BREAK.THIS PROJECT BEGAN AS A PILOT PROGRAM WITH SIMLE MIDDLE SCHOOL. IN 2022, WE PROVIDED 341 VISITS WITH SIMLE STUDENTS AND THEIR FAMILIES AND EXTENDED THE SERVICE EIGHT ADDITIONAL SCHOOLS, PROVIDING A TOTAL OF 989 VISITS IN 2022.BETWEEN JANUARY 1, 2023 - AUGUST 31, 2023, SANFORD BISMARCK CONDUCTED 680 BEHAVIORAL HEALTH VISITS WITHIN AREA PUBLIC SCHOOLS. IN ADDITION TO MEASURING THE PROGRAM'S SUCCESS BASED UPON THE NUMBER OF VISITS CONDUCTED, IT IS ADVISABLE TO CONSIDER THE NUMBER OF AREA SCHOOLS AT WHICH SANFORD IS PROVIDING THESE SERVICES. CURRENTLY, SANFORD IS PRESENT AT EIGHT BISMARCK SCHOOLS, INCLUDING: LEGACY AND CENTURY HIGH SCHOOLS; HORIZON AND SIMLE MIDDLE SCHOOL; AND LIBERTY, CENTENNIAL, SOLHEIM AND MURPHY ELEMENTARY SCHOOLS ALONG WITH WILTON PUBLIC SCHOOL. THESE SCHOOLS COLLECTIVELY SERVE THOUSANDS OF STUDENTS CREATING AN IMPACTFUL OPPORTUNITY FOR SANFORD BISMARCK TO IMPROVE ACCESS TO BEHAVIORAL HEALTH SERVICES FOR YOUNG PEOPLE IN THE AREA.SANFORD BISMARCK ADDED THE AMWELL AFTER-HOURS PSYCHIATRY SERVICE THAT PROVIDES TELEHEALTH ASSESSMENTS TO BEHAVIORAL HEALTH (BH) PATIENTS THAT PRESENT TO THE EMERGENCY DEPARTMENT (ED) FROM 7:00 PM 7:00 AM EACH DAY. THE ASSESSMENTS ARE SUPPORTED BY A BH RN THAT GOES TO THE ED AND SETS UP THE IPAD TELE VISIT AND REMAINS IN THE ROOM WITH THE PATIENT THROUGHOUT, WHICH ENSURES 24/7 COVERAGE FOR EMERGENT MENTAL AND BH NEEDS. SANFORD PARTNERS WITH HEARTVIEW FOUNDATION, A SUBSTANCE USE DISORDER TREATMENT CENTER, TO CO-LOCATE THE COUNSELOR IN SANFORD'S EMERGENCY ROOM. THE COUNSELOR MET WITH 159 PATIENTS, 93 OF WHOM WERE REFERRED TO TREATMENT AT HEARTVIEW OR ELSEWHERE IN 2022 ALONE. HEARTVIEW OFFERS A 16-BED RESIDENTIAL FACILITY IN BISMARCK AMONG OTHER SERVICES AND RESIDENTIAL FACILITIES IN CANDO, ND AND DICKINSON, ND.SANFORD EXPANDED ITS PARTNERSHIP BY COLLABORATING WITH HEARTVIEW AND THE BISMARCK POLICE DEPARTMENT ON A GRANT APPLICATION TO PROVIDE TREATMENT FOR PATIENTS WITH CHRONIC SUD AND/OR OPIOID OVERDOSE. THE GRANT WAS APPROVED JANUARY 2022, AND THE PROGRAM BEGAN AUGUST 2022. AS OF 2022, SANFORD HAS REFERRED 13 PATIENTS TO HEARTVIEW FOR SUD MEDICATION-ASSISTED TREATMENT OPPORTUNITIES. AS PART OF THE PROGRAM TO HELP PATIENTS WHO EXPERIENCE AN OVERDOSE BE SUCCESSFUL IN SEEKING TREATMENT, SANFORD PHYSICIANS PRESCRIBE BUPRENORPHINE TO HELP PATIENTS SAFELY TRANSITION TO A MEDICATION-ASSISTED THERAPY PROGRAM.IMPROVE ACCESS TO AFFORDABLE CARESANFORD BISMARCK IS ADDRESSING THE PRIORITY THROUGH TWO GOALS: REDUCING HEALTHCARE COSTS BY REDUCING AVOIDABLE VISITS AND INCREASING HEALTHCARE COVERAGE IN THE COMMUNITY. RESIDENTS OF THE CHNA AREA CONDUCTED 6,472 SEARCHES ON THE FINDHELP PLATFORM SINCE 2022, A QUARTER (27%) BEING HEALTH RELATED.COMMUNITY HEALTH WORKERS (CHWS) ARE ONE OF THE STRATEGIES DEPLOYED BY THE REGION TO REDUCE AVOIDABLE VISITS. CHWS ARE TRAINED PUBLIC HEALTH WORKERS WHO SERVE AS A BRIDGE BETWEEN THE COMMUNITY AND THE HEALTHCARE SYSTEM BY HELPING PATIENTS ADDRESS THEIR SOCIAL DETERMINANTS OF HEALTH OUTSIDE OF THE CLINIC SETTING. WE ADDED A CHW IN 2022 TO ADDRESS PATIENT NEEDS OUTSIDE OF A CLINIC OR HOSPITAL. THE CHW WORKS WITH PATIENTS TO IMPROVE HEALTH OUTCOMES BY HELPING THOSE WHO MIGHT OTHERWISE HAVE TROUBLE ACCESSING THE HEALTH SYSTEM AND CONNECTING PATIENTS TO COMMUNITY SERVICES. THE CHW PLAYS AN IMPORTANT ROLE WITH HEALTH CARE TEAMS AND HAVING THE KNOWLEDGE OF BARRIERS TO ACCESS AND HOW TO OVERCOME THEM. CARE MANAGEMENT IS A DYNAMIC PROCESS TO IMPROVE COMMUNICATION AND FACILITATE CARE FOR PATIENTS ALONG A CONTINUUM THROUGH EFFECTIVE RESOURCE COORDINATION, ONGOING COMMUNICATION, AND REFERRALS FOR NECESSARY SOCIAL SUPPORTS. STAFF IN BOTH CLINICAL AND NON-CLINICAL ROLES, SUCH AS CHWS, HAVE BEEN INSTRUMENTAL IN ENSURING ALL PATIENTS HAVE ACCESS TO CARE.IN 2022, SANFORD BISMARCK'S CHW HELPED 164 PATIENTS. BY HELPING PATIENTS CONNECT TO NEEDED COMMUNITY SERVICES AND OTHER HEALTH-RELATED LIVING FACTORS, THE CHW HELPED REDUCE AVOIDABLE ER VISITS AND AVOIDABLE HOSPITALIZATIONS FOR THESE PATIENTS BY 56% AND 68%. BOTH THE HEALTH IMPROVEMENT AND COST SAVINGS FOR BOTH THE PATIENT AND THE HEALTHCARE SYSTEM ARE TREMENDOUS. IN 2023, OVER 1,800 PATIENTS WERE SERVED BY BISMARCK CARE MANAGEMENT TEAMS INCLUDING: AMBULATORY RN CARE MANAGER, SOCIAL WORKERS, TRANSITIONAL CARE RN, HEALTH GUIDES AND COMMUNITY PARAMEDICS. COLLECTIVELY FROM JANUARY-OCTOBER OF 2023 THIS TEAM DECREASED ED VISITS BY 70% AND INPATIENT ENCOUNTERS BY 76%. TO INCREASE HEALTHCARE COVERAGE IN THE COMMUNITY, SANFORD HEALTH HAS INTEGRATED FULLTIME, ONSITE FINANCIAL ADVOCATES WHO SPECIALIZE IN HEALTHCARE COVERAGE ENROLLMENT TO HELP COMMUNITY MEMBERS WHO ARE UNINSURED AND UNDERINSURED SECURE ACCESS TO HEALTHCARE SERVICES. THEY HELP SANFORD PATIENTS AS WELL AS COMMUNITY REFERRALS. ACCORDING TO ELEVATE PATIENT FINANCIAL SOLUTIONS, WE ASSISTED MORE THAN 3,000 PATIENTS EACH YEAR SINCE 2021: 2021-3,464, 2022-3,363, AND 2023-3,635. EACH PATIENT REPRESENTS AN UNINSURED AND UNDERINSURED PERSON AND THEIR FAMILIES THAT SECURED HEALTH CARE COVERAGE, HELPING PATIENTS PAY FOR MUCH-NEEDED HEALTHCARE SERVICES AND ONGOING CARE.THE SANFORD HEALTH FOUNDATION ALSO SUPPORTS PATIENTS THAT MAY BE TEMPORARILY UNABLE TO AFFORD THE MEDICATIONS THEY NEED DUE TO EXTENUATING CIRCUMSTANCES BY ESTABLISHING A FUND TO HELP COMMUNITY MEMBERS. ESTABLISHED INTERNAL WORKFLOW PROCESSES TO HELP INDIVIDUALS UNABLE TO AFFORD PRESCRIPTIONS RECEIVE THE MEDICATION FREE OF CHARGE.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:HEALTHY LIVING ACCESS TO HEALTH CARE PROVIDERSLONG-TERM CARE PUBLIC TRANSPORTATIONAFFORDABLE HOUSINGSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 5 -- SANFORD BISMARCK MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 5 -- SANFORD BISMARCK MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 6 -- SANFORD BEMIDJI MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 6 -- SANFORD BEMIDJI MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 6 -- SANFORD BEMIDJI MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 6 -- SANFORD BEMIDJI MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO HEALTH CARE: MENTAL HEALTHMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO ADD ADDITIONAL BEHAVIORAL HEALTH PROVIDERS, PROGRAMS, IMPROVED ACCESS, AND ALTERNATE WAYS TO ENGAGE WITH BEHAVIORAL HEALTH PROVIDERS. IT IS SANFORD'S GOAL TO PROVIDE ACCESS TO QUALITY AND TIMELY HEALTH CARE RELATED TO MENTAL HEALTH AND SUBSTANCE ABUSE. PRIORITY 2: HEALTHY LIVINGIN THE UNITED STATES, MANY OF THE LEADING CAUSES OF DEATH AND DISEASE ARE ATTRIBUTED TO UNHEALTHY BEHAVIORS. FOR EXAMPLE, POOR NUTRITION AND LOW LEVELS OF PHYSICAL ACTIVITY ARE ASSOCIATED WITH HIGHER RISK OF CARDIOVASCULAR DISEASE, TYPE 2 DIABETES, AND OBESITY. TOBACCO USE IS ASSOCIATED WITH HEART DISEASE, CANCER, AND POOR PREGNANCY OUTCOMES IF THE MOTHER SMOKES DURING PREGNANCY. EXCESSIVE ALCOHOL USE IS ASSOCIATED WITH INJURIES, CERTAIN TYPES OF CANCERS, AND CIRRHOSIS. SANFORD HAS MADE HEALTHY LIVING A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE AN INCREASE IN OPTIONS AND ASSISTANCE FOR HEALTHY LIVING. IT IS SANFORD'S GOAL TO FOCUS ON HEALTHY LIVING TO INCLUDE ASSESSMENT AND TREATMENT OF CHRONIC HEALTH ISSUES, LEVELS OF PHYSICAL ACTIVITY AND FOOD INSECURITY.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARACCESS TO HEALTH CARE: MENTAL HEALTHIN 2023, SANFORD BEMIDJI BEHAVIORAL HEALTH (SBBH) BECAME A CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINIC. WE EXPANDED CHILDREN AND ADULT BEHAVIORAL HEALTH SERVICES IN SEVERAL LOCAL COMMUNITIES INCLUDING PARK RAPIDS AND WALKER. BASED ON CURRENT EXPANSION IN PARK RAPIDS ALONE, WE INCREASED SERVICES BY 20% FOR THE COMMUNITY. SBBH IS ACTIVELY EXPLORING SERVICE EXPANSION INTO MULTIPLE COMMUNITIES.SBBH ENDED 2023 WITH 15 INTERNS DURING THE YEAR, SIX OF THEM AT THE PROVIDER LEVEL. 2023 HAD A 73.3% RETENTION RATE FOR THE BH INTERNS. WE CREATED A PIPELINE GRANT TO ENCOURAGE STAFF TO RETURN TO SCHOOL AND OBTAIN THEIR LICENSED ALCOHOL & DRUG COUNSELOR LICENSE STARTING IN Q1 2024. CURRENTLY, WE HAVE 18 STAFF UNDER CLINICAL SUPERVISION TO OBTAIN THEIR INDEPENDENT LICENSES TO BECOME MENTAL HEALTH PROFESSIONALS. IN 2023, WE SIGNED TWO PSYCHIATRISTS AND TWO APPS TO INCREASE ACCESS TO BEHAVIORAL AND MENTAL HEALTH CARE. TWO PSYCHIATRISTS AND THREE APPS SIGNED IN 2022.HEARTLAND LAKES DEVELOPMENT CORPORATION IS FINISHING CONSTRUCTION OF THEIR FIRST HOUSING PROJECT IN Q2 2024. IN 2023, WE CONTRIBUTED FINANCIALLY TO HLDC TOWARDS THEIR WORK AROUND DIFFERENT HOUSING IN HUBBARD COUNTY (INCLUDING ADDING SUPPORTIVE HOUSING). THE PENDING DEVELOPMENT OF THE PROJECT WAS NOTED IN THE PREVIOUS YEAR'S REPORT. THE SBBH EMPATH UNIT OPENED IN Q1 2023. MARCH 2023-FEBRUARY 2024 HAD 674 APPOINTMENTS WITH PATIENTS AGED SIX TO 74 YEARS OLD. IN 2024, THE EMPATH TEAM STARTED CALLING ALL PATIENTS ON THE THERAPY WAITLIST TO IDENTIFY IF THEY CAN BRIDGE GAPS THAT MAY EXIST IN SERVICE. ACCESS TO MOBILE CRISIS SERVICES EXPANDED BY INCREASING FULL-TIME FTES.TO INCREASE ACCESS TO CULTURALLY SENSITIVE SUBSTANCE ABUSE PREVENTION AND TREATMENT, BEHAVIORAL HEALTH'S SUD PROGRAM BECAME A WELLBRIETY CERTIFIED TREATMENT CENTER IN 2022, CURRENTLY HAVING THREE STAFF MEMBERS TRAINED IN WELLBRIETY TREATMENT. THE CRITERIA ENSURES ALL COUNSELORS ARE TRAINED IN AND INCORPORATE CULTURALLY BASED CURRICULUM, PROVIDED ACCESS TO A NATIVE AMERICAN ELDER WHO CONDUCTS CEREMONIES AND PROVIDES TEACHINGS, AND INCORPORATES HEALING PRACTICES INTO THE PROGRAM. IN 2023, OFFERINGS EXPANDED TO INCLUDE MONTHLY COMMUNITY SWEAT LODGES. OUR TEAM RECENTLY RECEIVED RECOGNITION FROM WHITE BISON FOR PROVIDING CULTURALLY ALIGNED SERVICES FOR INDIGENOUS PEOPLE SEEKING LONG-TERM RECOVERY. THE MEDICATION ASSISTANCE TREATMENT PROGRAM MOVED TO THE 1705 CLINIC AND TREATED 365 UNDUPLICATED PATIENTS IN 2023. DUE TO LIMITED RESOURCES INCLUDING WORKFORCE AND FINANCIAL RESOURCES, SBBH WILL NOT MOVE FORWARD WITH OPENING A DETOX UNIT IN THE NEAR FUTURE.SBBH HIRED ADDITIONAL FTES TO CHILDREN'S THERAPEUTIC SERVICES & SUPPORTS AND INCREASED THE NUMBER OF CHILDREN AND FAMILIES SERVED BY THE PROGRAM. BEMIDJI AREA SCHOOL DISTRICT CONTRACTS OUT THEIR IN-SCHOOL BEHAVIORAL HEALTH TO COMMUNITY AGENCIES INCLUDING SBBH. THE SCHOOL LINKED MENTAL HEALTH GRANT REQUEST WAS INCREASED BY $300,000, TO SUPPORT AN INCREASE OF FIVE FTES TO SERVE ADDITIONAL SCHOOLS. WE WILL BE OFFERING CTSS TO ALL BEMIDJI SCHOOLS.IN ADDITION TO THE NEEDS WITHIN THE CHNA COMMUNITY, SANFORD IS EXPLORING THE EXPANSION OF BEHAVIORAL HEALTH SERVICES INTO MULTIPLE COMMUNITIES ADJACENT TO THE CURRENT SERVICE FOOTPRINT. BEHAVIORAL HEALTH SERVICES EXPANDED INTO PARK RAPIDS THROUGH THE ACQUISITION OF A BETTER CONNECTION IN 2021. THE ADDITION TO THE SANFORD ORGANIZATION INCREASED SERVICES BY 20% WITH A 1.0 CARE COORDINATOR, AND 1.0 BHC.HEALTHY LIVINGWE STARTED 2022 COMMITTED TO IMPROVING DEPRESSION SCREENING IN PRIMARY CARE. DURING THE YEAR, WE ADDED DEPRESSION SCREENING TO SEVERAL SPECIALTY DEPARTMENTS AND THE WALK-IN CLINIC. IN 2023, PRIMARY CARE CLINICS SCREENED 76.4% OF ELIGIBLE PATIENTS, A NEARLY 30% IMPROVEMENT FROM AN INITIAL SCREENING RATE OF 48.3% IN 2021. IN 2022, WE ADOPTED AN IMPROVEMENT STRATEGY FOCUSED ON 'NO MISSED OPPORTUNITIES' FOR SCREENING WHICH ADDED DEPRESSION SCREENING TO SEVERAL SPECIALTY DEPARTMENTS AS A STANDARD OF CARE. THE COMPREHENSIVE APPROACH LED TO OUR HIGHEST RATE OF DEPRESSION SCREENING TO DATE: 54.5% (FROM 31.4% IN 2021) WHICH IS ROUGHLY 8,000 ADDITIONAL PATIENTS SCREENED ANNUALLY. THE PRIMARY CARE GOAL TO REDUCE UNCONTROLLED DIABETES TO 23.5% WAS REALIZED, IMPROVING FROM 36% UNCONTROLLED A1C TO 19.7%. WE ARE PROGRESSING TOWARD THE 2024 GOAL OF <14.5%. REFERRALS TO SELF-CARE ALSO IMPROVED FROM TWO PER MONTH IN AUGUST 2021, 15 PPM BY AUGUST 2022, AND OVER 53 PPM BY DECEMBER 2023 THROUGH PROMOTION EFFORTS. PATIENTS ATTENDING BETTER CHOICES/BETTER HEALTH CLASSES HAD UP TO A 12% IMPROVEMENT IN MEDICATION COMPLIANCE. IN 2023, OUR POWER PROGRAM EXPANDED TO PROVIDE INDIVIDUAL TEAM TRAINING TO FOUR DIFFERENT TYPES OF YOUTH SPORTS. OUR TEAM ALSO STARTED TO PROVIDE ADULT TRAINING THROUGH SMALL GROUP FITNESS AND PERSONAL TRAINING. SCHOLARSHIPS ARE AVAILABLE SO NO STUDENT ATHLETE IS TURNED AWAY DUE TO THEIR ABILITY TO PAY. COMMUNITY CONVERSATIONS CONTINUE ON A COMMUNITY WELLNESS CENTER AND COMMUNITY NEEDS. A DECISION WAS MADE TO MOVE FORWARD WITH A PARTNERSHIP FOR A YMCA PROJECT. IN 2024, SANFORD HEALTH INTENDS TO SIGN AN LOI FOR THE LEAD GIFT. THE PEDIATRIC CLINIC STARTED THE FOOD PANTRY IN JUNE 2022. IN 2023, 21,040 POUNDS OF FOOD WERE DISTRIBUTED TO 196 FAMILIES, INCLUDING 484 CHILDREN, 318 ADULTS, AND 48 SENIORS. THE CHNA AREA HAS PERFORMED 3,756 SEARCHES ON FINDHELP SINCE JANUARY 2022. OVER 24% OF SEARCHES ARE RELATED TO FOOD RESOURCES. WE CONTINUED TO FUND THE BEMIDJI SCHOOL DISTRICT ANGEL FUND TO PROVIDE HOT BREAKFAST AND LUNCH TO ALL CHILDREN WHO DO NOT HAVE MONEY IN THEIR FOOD ACCOUNT. MINNESOTA ALLOCATED FUNDS TO PROVIDE FREE HOT BREAKFAST AND LUNCH TO ALL STUDENTS. DUE TO THIS, THE PARTNERSHIP WAS PUT ON PAUSE IN THE FALL OF 2023 AND IN 2024.IN 2022, SANFORD HEALTH DONATED TO THE BEMIDJI COMMUNITY FOOD SHELF SO THEY COULD PURCHASE A VAN TO PROVIDE MONTHLY MOBILE FOOD DROPS IN BLACKDUCK AND KELLIHER. THIS SERVICE IS STILL AVAILABLE IN 2023. SANFORD HEALTH IS EXPLORING THE OPTION OF OPENING A FOOD PANTRY IN OUR BLACKDUCK CLINIC. THE UNITED WAY BACKPACK BUDDIES PROGRAM HAS EXPANDED PROGRAMMING TO BAGLEY, BLACKDUCK, KELLIHER, CLEARBROOK, GONVICK AND RED LAKE SCHOOLS, MADE POSSIBLE BY FUNDING FROM SANFORD HEALTH.WE CONTINUE TO MEET WITH COMMUNITY LEADERS IN PARK RAPIDS AND HUBBARD COUNTY AS WE EXPLORE OPPORTUNITIES TO SUPPORT THESE COMMUNITIES. SANFORD SUPPORTS OTHER HEALTH SYSTEMS, PARTICIPATING IN THE CHI ST. JOSEPH HEALTH CARE/HUBBARD COUNTY CHNA SURVEY AND STAKEHOLDERS MEETING IN 2022.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:EMPLOYMENT AND INCOMEACCESS TO AFFORDABLE HEALTH CAREAFFORDABLE HOUSINGPUBLIC TRANSPORTATIONCHILD CARE QUALITYCOMMUNITY SAFETYSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 6 -- SANFORD BEMIDJI MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 6 -- SANFORD BEMIDJI MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 7 -- SANFORD MEDICAL CENTER THIEF RIVER FALLS PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 7 -- SANFORD MEDICAL CENTER THIEF RIVER FALLS PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 7 -- SANFORD MEDICAL CENTER THIEF RIVER FALLS PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 7 -- SANFORD MEDICAL CENTER THIEF RIVER FALLS PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: MENTAL HEALTHMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES FOR MENTAL HEALTH PROMOTION, SUICIDE PREVENTION AND EDUCATION FOR PARENTING RELATED SKILLS. IT IS SANFORD'S GOAL TO INCREASE ACCESS TO MENTAL/BEHAVIORAL HEALTH AND SUBSTANCE ABUSE SERVICES, IN PARTICULAR FOR AT RISK YOUTH AND TO DECREASE THE NUMBER OF SUICIDES.PRIORITY 2: ACCESS TO HEALTHCARE PROVIDERSACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE HEALTH CARE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET. SANFORD HAS MADE ACCESS TO HEALTHCARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO DEVELOP A FULLTIME DERMATOLOGY CLINIC AND TO EXPAND ACCESS TO TELEHEALTH TECHNOLOGIES IN BEHAVIORAL HEALTH. IT IS SANFORD'S GOAL TO INCREASE THE NUMBER OF LOCAL PROVIDERS SERVICING THIEF RIVER FALLS THROUGH LOCALLY BASED PROVIDERS, OUTREACH FROM OTHER SANFORD FACILITIES, OR TELEHEALTH/VIRTUAL CARE PLATFORMS. INCREASED PROVIDERS WILL EXPAND THE NUMBER OF AVAILABLE SERVICES AND APPOINTMENTS AVAILABLE TO THE LOCAL COMMUNITY.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARMENTAL HEALTH IN 2023, SANFORD BEHAVIORAL HEALTH CENTER (SBHC) PROVIDED 131 EDUCATIONAL AND OUTREACH EVENTS. THIS INCLUDED WORKING WITH NORTHLAND COMMUNITY AND TECHNICAL COLLEGE TO PROVIDE DE-ESCALATION CLASSES AND PROVIDING MENTAL HEALTH EDUCATION AND SIMULATION LABS TO THE CRIMINAL JUSTICE PROGRAM. IN 2021, AS PART OF THE GOAL TO DEVELOP AND IMPLEMENT COMMUNITY STRATEGY FOR MENTAL HEALTH PROMOTION AND SUICIDE PREVENTION, SANFORD BEHAVIORAL HEALTH IDENTIFIED A CORE TEAM OF STAFF AND DEVELOPED A STRATEGY TO GROW A COMMUNITY COALITION FOR MENTAL HEALTH PROMOTION AND SUICIDE PREVENTION IN OUR COMMUNITY.IN JANUARY 2022, SANFORD BEHAVIORAL HEALTH BEGAN MEETING MONTHLY WITH COMMUNITY PARTNERS FROM TEN PUBLIC AND PRIVATE ENTITIES AROUND PENNINGTON COUNTY INCLUDING PUBLIC HEALTH, LAW ENFORCEMENT, FAITH COMMUNITY, EDUCATION, EMPLOYERS, HEALTH CARE, AND YOUTH ACTIVITIES. OVER THE PAST YEAR, SIX ADDITIONAL PARTNERS WERE ADDED, INCLUDING SCHOOL COUNSELORS, VIP, ADDITIONAL SCHOOL DISTRICT, MENTAL HEALTH PROVIDER, HIGH SCHOOL STUDENT, AND A SUICIDE LOSS SURVIVOR. THIS GROUP BECAME KNOWN AS "COMMUNITY STRONG AND IDENTIFIED OUR FOCUS ON YOUTH AND FAMILY EDUCATION. COMMUNITY STRONG ESTABLISHED BOTH A VISION AND MISSION STATEMENT TO ESTABLISH THE GROUPS GOALS OF SUPPORTING MENTAL WELL-BEING AND SUICIDE PREVENTION. IN 2022, IN PARTNERSHIP WITH COMMUNITY STRONG, SANFORD BEHAVIORAL HEALTH PROVIDED FOUR EDUCATIONAL EVENTS IN PENNINGTON COUNTY, WITH ADDITIONAL OUTREACH EVENTS.SBHC STAFF PROVIDED 8 SAFETALK TRAININGS THROUGHOUT THE REGION, WHICH IS A 4-HOUR TRAINING THAT EQUIPS PEOPLE TO BE MORE ALERT TO SOMEONE THINKING OF SUICIDE AND BETTER ABLE TO CONNECT THEM WITH FURTHER HELP. SBHC AND SANFORD HEALTH MEDICAL CENTER STAFF PARTNERED ALSO WITH COMMUNITY STRONG TO PROVIDE EDUCATION AND OUTREACH EVENTS AT SPORTS GAMES, TEENS TOWARD ZERO DEATHS, AS WELL AS HOSTING/SPONSORING THE ANNUAL BE THE VOICE EVENT IN THIEF RIVER FALLS. IN ADDITION, SBHC CONNECTED WITH VARIOUS OTHER AGENCIES, GROUPS, AND COMMUNITIES. SANFORD HEALTH MEDICAL CENTER IN PARTNERSHIP WITH SANFORD BEHAVIORAL HEALTH CENTER, WAS ABLE TO ENGAGE IN PATIENT REGISTRATION TECHNOLOGY THAT ALLOWS THE DEPLOYMENT OF DEPRESSION AND ANXIETY SCREENS AT APPOINTMENTS. THIS WENT LIVE IN LATE 2023 AND HAS ALREADY BEEN UTILIZED BY THOUSANDS OF PATIENTS. WE HAVE ALSO INCREASED ACCESS TO SUICIDE PREVENTION RESOURCES IN THE MEDICAL CLINIC BY TRAINING AND STAFFING A FULL-TIME INTEGRATIVE HEALTH THERAPIST (IHT) AT THE MEDICAL CLINIC. THIS POSITION SEES 6+ PATIENTS PER DAY AND HAS BEEN UTILIZED, AT LEAST MONTHLY, FOR PATIENTS WHO ARE IN SEVERE MENTAL HEALTH DISTRESS IN REAL-TIME. IN EARLY 2022, SANFORD BEHAVIORAL HEALTH IDENTIFIED KEY PERSONNEL TO DEVELOP A STRATEGY FOR IMPLEMENTING PARENTING RELATED SKILLS AS PART OF THE GOAL TO DEVELOP AND IMPLEMENT COMMUNITY EDUCATION FOR PARENTING RELATED SKILLS. IN MAY 2022, SANFORD BEHAVIORAL HEALTH USED ESTABLISHED RELATIONSHIPS THROUGH THE JUVENILE DIVERSION PROGRAM TO IDENTIFY PARTNERS TO JOIN THE EFFORT TO IMPLEMENT AND PROMOTE THIS EDUCATIONAL GROUP FOR PARENTS. THROUGH WORK WITH THE TRF POLICE DEPARTMENT, PENNINGTON COUNTY SOCIAL SERVICES, PENNINGTON COUNTY COURT AND COUNTY ATTORNEY, AND TRF SCHOOL DISTRICT, IT WAS IDENTIFIED THAT THE INITIAL TARGETED POPULATION OF THIS PARENTING SKILLS EDUCATION WOULD BE PARENTS OF CHILDREN IN THE JUVENILE DIVERSION PROGRAM, OR THE AGENCIES INVOLVED ARE IDENTIFIED AS ESCALATING IN CRIMINAL JUSTICE SYSTEM AND AT AN INCREASED NEED FOR SERVICES. IN LATE MAY, THE CURRICULUM USED WAS THE INCREDIBLE YEARS AND LOVE & LOGIC CURRICULUM. FACILITATORS WERE IDENTIFIED FROM SANFORD BEHAVIORAL HEALTH AND PENNINGTON COUNTY SOCIAL SERVICES. THE FIRST SIX-WEEK SESSION OF THE PARENTING SKILLS GROUP BEGAN IN OCTOBER OF 2022 WITH SIX FAMILIES COMPLETING THE TRAINING. IN 2023, THERE WERE FOUR SESSIONS CONDUCTED, THREE WERE SIX-WEEK SESSIONS AND ONE ALL DAY SATURDAY CLASS. THERE WERE 42 TOTAL REGISTRANTS AND 36 COMPLETED THE CLASS FOR AN 86% COMPLETION RATE. CLASSES HAVE RECEIVED POSITIVE FEEDBACK AND WILL CONTINUE TO BE PROVIDED.ACCESS TO HEALTHCARE PROVIDERSSANFORD BEHAVIORAL HEALTH HAS CONTINUED TO PROVIDE PATIENTS WITH FLEXIBILITY IN SCHEDULING APPOINTMENTS IN THE MANNER THAT BEST SUITS SCHEDULING AND CLINICAL NEEDS. THIS HAS ALSO ADDED FLEXIBILITY FOR PATIENTS WHO ARE HAVING TROUBLE ATTENDING THEIR APPOINTMENTS RELATED TO WEATHER, TRANSPORTATION, AND ILLNESS CONCERNS.AS PART OF THE EXPANDED PLATFORM AND ACCESS TO TELEHEALTH TECHNOLOGIES, SANFORD BEHAVIORAL HEALTH PROVIDES PATIENTS THE FLEXIBILITY OF SCHEDULING THEIR APPOINTMENT IN THE MANNER THAT BEST SUITS THEIR NEEDS, ACCORDING TO REGULATORY REQUIREMENTS AND WHAT IS IN THE PATIENT'S BEST INTEREST CLINICALLY. AS A RESULT, MORE THAN 40% OF APPOINTMENTS WERE TELEHEALTH VISITS IN 2022 AND 35% IN 2023. FOR PATIENTS WHO HAVE DIFFICULTY WITH TECHNOLOGY, SANFORD BEHAVIORAL HEALTH CENTER STAFF WILL PROVIDE EDUCATION ON HOW TO USE THE VIRTUAL PLATFORM FOR PATIENTS PREFERRING TELEHEALTH VISITS. THE GOAL OF A FULL-TIME DERMATOLOGY CLINIC FOR SANFORD HEALTH TRF STARTED BY HIRING A DERMATOLOGY NURSE PRACTITIONER IN APRIL 2021. THEY STARTED AFTER SIX MONTHS OF TRAINING WITH A DERMATOLOGIST IN GRAND FORKS. CY2022 FOCUSED ON BUILDING THE PRACTICE TO INCLUDE RESOURCES FOR SKIN TESTING, SKIN CHECKS, BIOPSIES, AND PROCEDURES ALONG WITH STAFFING AND SCHEDULING RESOURCES TO ACCOMMODATE PATIENT NEEDS. LOCAL DERMATOLOGY APPOINTMENTS WENT FROM MONTHLY OUTREACH, AROUND 40 APPOINTMENTS, TO FULLTIME COMMUNITY CLINIC, AROUND 140 APPOINTMENTS. PATIENT UTILIZATION FOR DERMATOLOGY SERVICES WAS SUSTAINED IN EARLY 2022, WHICH ALLOWED FOR SANFORD HEALTH MEDICAL CENTER AND CLINIC TO MAINTAIN DERMATOLOGY ACCESS. THE DERMATOLOGY NURSE PRACTITIONER INCREASED HER DAILY CAPACITY BY 14% IN 2023, AROUND 160 PATIENTS A MONTH. OUTREACH CONTINUES IN TWO ADDITIONAL COMMUNITIES, HALLOCK AND CROOKSTON, FOR FOUR FULL DAYS. WE HELD OUR ANNUAL FREE SKIN CHECKING EVENT SEEING OVER 100 PATIENTS IN APRIL 2023. WE ARE CONTINUING IN SCHOOL AGED SKIN HEALTH EDUCATION AND PROVIDE EDUCATION MATERIALS AT APPOINTMENTS. HELPING WITH THE PRACTICE AWARENESS AND PATIENT EDUCATION INCLUDED MARKETING THE NEW NURSE PRACTITIONER TO THE PUBLIC VIA TRADITIONAL AND SOCIAL MEDIA SOURCES, HOSTING FREE PUBLIC SKIN CHECK EVENTS, COMMUNITY OUTREACH WITH EMPLOYERS AND THE SCHOOL DISTRICT, AND PRODUCING AND DISTRIBUTING SKIN PREVENTION EDUCATIONAL MATERIALS.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO QUALITY HEALTHCAREAFFORDABLE HOUSINGLONG-TERM CAREPUBLIC TRANSPORTATIONSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 7 -- SANFORD MEDICAL CENTER THIEF RIVER FALLS PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 7 -- SANFORD MEDICAL CENTER THIEF RIVER FALLS PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 8 -- SANFORD ABERDEEN MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 8 -- SANFORD ABERDEEN MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 8 -- SANFORD ABERDEEN MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 8 -- SANFORD ABERDEEN MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: PHYSICAL ACTIVITY AND NUTRITIONTHE ENVIRONMENTS WHERE PEOPLE LIVE, LEARN, WORK, AND PLAY AFFECT ACCESS TO HEALTHY FOOD AND OPPORTUNITIES FOR PHYSICAL ACTIVITY WHICH, ALONG WITH GENETIC FACTORS AND PERSONAL CHOICES, SHAPE HEALTH AND THE RISK OF BEING OVERWEIGHT AND OBESE. SANFORD HAS MADE PHYSICAL ACTIVITY AND NUTRITION A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO PROMOTE AND IMPROVE CARE OF PATIENTS WITH OBESITY DIAGNOSIS AND TO PROVIDE EDUCATION TO SCHOOLS REGARDING PHYSICAL ACTIVITY AND NUTRITION. IT IS SANFORD'S GOAL TO IMPROVE PHYSICAL ACTIVITY AND NUTRITION FOR THE COMMUNITY. PRIORITY 2: ACCESS TO HEALTH CARE PROVIDERSACCORDING TO THE COUNTY HEALTH RANKINGS FOR CLINICAL CARE, ACCESS TO HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE HEALTH CARE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET.SANFORD HAS MADE HEALTHCARE ACCESS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO PROMOTE AND IMPROVE ACCESS TO SERVICES AND EDUCATION. IT IS SANFORD'S GOAL THAT ALL PATIENTS REQUIRING ACCESS TO HEALTHCARE ARE SUCCESSFUL IN SECURING TIMELY APPOINTMENTS AND IMPROVING MENTAL HEALTH SERVICES IN THE COMMUNITY. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARPHYSICAL ACTIVITY AND NUTRITIONTHE NEED FOR CONTINUED FOCUS ON THE GOAL IS VISIBLE WITHIN THE RESULTS OF THE FINDHELP SEARCH TOOL. RESIDENTS OF THE CHNA-DEFINED SANFORD ABERDEEN MEDICAL CENTER COMMUNITY CONDUCTED 1,375 SEARCHES SINCE 2022 ACROSS THE PLATFORM, 26% OF THE SEARCHES WERE FOOD RELATED ISSUES SUCH AS PANTRIES, PAYING FOR FOOD, AND MEALS. THE ABERDEEN CHNA AREA HAS OVER 26 FOOD-RELATED PROGRAMS AND ORGANIZATIONS AVAILABLE TO LOCAL RESIDENTS THROUGH THE FINDHELP TOOL. VOLUNTEER EFFORTS FOCUSED ON GETTING HEALTHY FOOD IN THE HANDS OF THOSE THAT NEED IT. TO THAT END SANFORD VOLUNTEERED TEN HOURS TO MEALS ON WHEELS IN 2022, EXTENDING CARE BEYOND THE HOSPITAL WALLS TO PARTNER WITH A COMMUNITY PARTNER TO DELIVER FOOD TO LOCAL SENIORS. THE MEALS ON WHEELS PROGRAM PROVIDES HOME-DELIVERED MEALS TO THOSE IN NEED OF A SPECIAL DIET SUCH AS IF THEY ARE CONVALESCING FROM AN ILLNESS OR ACCIDENT; ARE PHYSICALLY HANDICAPPED, DISABLED OR ELDERLY; OR ARE UNABLE TO PREPARE MEALS FOR THEMSELVES OR CONFINED TO THEIR HOME. OUR STAFF PROVIDED 36 TOTAL VOLUNTEER HOURS PLANNING AND DELIVERING MEALS DIRECTLY TO RECIPIENTS' HOMES IN 2023. SANFORD ABERDEEN ALSO PARTNERED WITH ANOTHER COMMUNITY PARTNER, THE SALVATION ARMY, TO DONATE ITEMS TO HOST A HEALTH FOOD DRIVE FOR YOUTH IN 2022. IN TOTAL, 800 POUNDS OF FOOD AND $700 IN MONETARY DONATIONS WERE COLLECTED THROUGH THE EFFORT.SANFORD ABERDEEN ALSO SUPPORTS TABLE OF PLENTY ANNUALLY. TABLE OF PLENTY IS A FREE COMMUNITY MEAL SERVED ON THE FOURTH MONDAY OF THE MONTH AT ZION LUTHERAN CHURCH, AND ALL ARE WELCOME. OUR STAFF PROVIDED 56 TOTAL VOLUNTEER HOURS PLANNING, PREPARING FOOD, AND SERVING FOOD IN A WELCOMING ATMOSPHERE WHERE ALL WHO ARE HUNGRY FOR FOOD AND FELLOWSHIP CAN GATHER. SANFORD ABERDEEN EMPLOYS A REGISTERED DIETICIAN (RD) WHO IN ADDITION TO THEIR WORK WITHIN THE HEALTH SYSTEM PROVIDED VALUABLE INFORMATION TO THE ABERDEEN COMMUNITY ON A VARIETY OF TOPICS. IN THE PAST YEAR, THE RD COMPLETED A HEALTHY COOKING CLASS FOR AGING ADULTS AT THE ABERDEEN SENIOR CENTER. THEY ALSO PRESENTED TO THE CENTRAL HIGH SCHOOL CROSS COUNTRY CAMP WHERE 100 7TH TO 12TH GRADE STUDENTS WERE IN ATTENDANCE, ALONG WITH A PHYSICAL THERAPIST (PT) WHO PROVIDED EDUCATION ON INJURY PREVENTION. OUR RD ALSO PRESENTED TO NSU WRESTLING TEAM AND PROVIDED APPROXIMATELY 30 COLLEGIATE WRESTLERS AND COACHING STAFF WITH EDUCATION ON NUTRITION FOR PERFORMANCE AND INJURY PREVENTION. THEY ALSO PRESENTED TWO DIFFERENT CLASSES ON NUTRITION FOR PERFORMANCE AND INJURY PREVENTION FOR CENTRAL HIGH SCHOOL'S STRENGTH AND CONDITIONING CLASSES. THE RD SPENT APPROXIMATELY 16 HOURS FOR PREPARATION AND PRESENTATION FOR THESE CLASSES IN THE PAST YEAR. OUR PEDIATRIC PROVIDERS ATTENDED THE NATIONAL NIGHT OUT EVENT IN ABERDEEN. THIS EVENT IS AN ANNUAL COMMUNITY-BUILDING CAMPAIGN THAT PROMOTES POLICE-COMMUNITY PARTNERSHIPS AND NEIGHBORHOOD CAMARADERIE. OUR PROVIDERS STAFFED A BOOTH WHICH PROMOTED PHYSICAL FITNESS AND WELL-BEING. THE PREPARATION AND PRESENTATION FOR THIS EVENT TOOK AN ESTIMATED 10 HOURS. OUR TEAM ALSO PARTNERED WITH SANFORD FIT PROGRAMMING TO PURCHASE A TV WHICH CAN RUN SANFORD FIT EDUCATION INFORMATION. CLINICIANS ALSO HAVE FIT MATERIALS TO SEND HOME WITH FAMILIES TO PROMOTE HEALTHY EATING, PHYSICAL FITNESS, AND WELL-BEING. A REGISTERED DIETICIAN ALSO REVIEWS BLOG POSTS FOR SANFORD FIT AND PROVIDES CONTENT INFORMATION. THE ESTIMATED HOURS FOR SANFORD FIT PROGRAMMING TOTALED 20 HOURS. IN SUMMARY, 98 TOTAL VOLUNTEER HOURS TOWARD COMMUNITY FOOD ORGANIZATIONS, AND FIVE COMMUNITY GROUP EDUCATION SESSIONS (560 INDIVIDUALS IMPACTED) WERE PROVIDED TO THE COMMUNITY IN 2023.ACCESS TO HEALTH CARE PROVIDERSSANFORD ABERDEEN IS SUPPORTING THE PRIORITY BY AUGMENTING LOCAL RESOURCES VIA TELEMEDICINE OUTREACH TO THE COMMUNITY FROM RESOURCES AVAILABLE THROUGH SANFORD HEALTH IN SIOUX FALLS, THROUGH INTEGRATED HEALTH THERAPISTS INTEGRATED INTO PRIMARY CARE SETTINGS, AND STANDARDIZING WORKFLOW TO ALL HEALTH COACHES AND PANEL SPECIALISTS WITHIN THE HOSPITAL AND CLINIC THROUGH EDUCATIONAL EFFORTS. DR. SANDRA PEYNADO COMPLETES PSYCHIATRY TELEMEDICINE VISITS FOR SANFORD ABERDEEN PATIENTS. IN 2023, 105 PATIENTS RECEIVED SERVICES FROM DR. PEYNADO, WHO PRIMARILY TREATS PEDIATRIC PATIENTS, IN THE ABERDEEN AREA. THE AGE BREAKDOWN FOR THE PATIENTS SERVED WAS: 5 PATIENTS AGES 0-9; 96 PATIENTS AGES 10-19; 3 PATIENTS AGES 20-29; AND 4 PATIENTS AGES 40-49. BEHAVIORAL HEALTH REFERRALS FROM SANFORD ABERDEEN CLINIC PROVIDERS IN 2023 TOTALED 361, COMPRISED OF 188 EXTERNAL REFERRALS AND 173 INTERNAL REFERRALS. THE LARGEST REFERRAL DEPARTMENTS BEING FAMILY PRACTICE, OBGYN, AND PEDIATRICS. BEHAVIORAL HEALTH THERAPISTS (BHT) BEGAN SEEING PATIENTS IN OCTOBER 2022 AND HAD 79 VISITS BY THE END OF THE YEAR. KRISTI SPITZER, LPC-MH, COMPLETES BEHAVIORAL HEALTH VISITS AND TRIAGE VISITS AT SANFORD ABERDEEN CLINIC. IN 2023 SHE COMPLETED 429 INDIVIDUAL VISITS. IN 2022 SANFORD ABERDEEN HAD 180 REFERRALS FOR IHT FROM VARIOUS SERVICE LINES, INCLUDING 139 FAMILY PRACTICE, 11 ORTHOPEDICS, 3 ONCOLOGY, 9 OBGYN, 7 ENT, 3 CHILDREN'S, AND 7 CARDIOLOGY. IHT VISITS TOTALED 393 IN 2022 AND TOTALED 92 THROUGH THE FIRST TWO MONTHS OF 2023. REFERRALS TO BEHAVIORAL HEALTH/PSYCHOLOGY WERE 130 IN 2022 INCLUDING 123 FAMILY PRACTICE, 3 OBGYN, AND 4 CHILDREN'S. COMMUNITY HEALTH WORKERS HAD 56 VISITS DURING THE PAST YEAR. PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER VISITS FOR 2023 WERE 1,238 TOTAL VISITS PRIOR TO PROVIDER LEAVING CLINIC. SANFORD ABERDEEN HAS AN RN CARE MANAGER AND COMMUNITY HEALTH WORKER THAT WORKS IN CONJUNCTION WITH OUR BEHAVIORAL CARE COUNSELOR, PROVIDERS IN FAMILY MEDICINE, AND SPECIALTY TO FIND RESOURCES FOR INDIVIDUALS WITH MENTAL HEALTH DISPARITIES. SANFORD ABERDEEN IN 2024 WILL BE STARTING A PREGNANCY HEALTH HOME PROGRAM, MODELED AFTER THE PRIMARY CARE MEDICAID HEALTH HOME PROGRAM. THIS PROGRAM WILL ROLL OUT IN MAY 2024. ALL STAFF IN SANFORD ABERDEEN ARE AWARE OF THE WORKFLOW OF REFERRALS AND TRIAGE FOR ANY MENTAL HEALTH CONCERNS WHICH ARISE IN THE CLINIC. THEY APPROPRIATELY USE LEADERSHIP RESOURCES IF THEY NEED ASSISTANCE WITH THE PROCESS. IF LPC-MH TRIAGE INDIVIDUAL IS NOT AVAILABLE ON SITE, UTILIZATION OF NORTHEASTERN MENTAL HEALTH CRISIS LINE IS THEN IMPLEMENTED. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO AFFORDABLE HEALTH CAREPUBLIC TRANSPORTATIONAFFORDABLE HOUSINGSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 8 -- SANFORD ABERDEEN MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 8 -- SANFORD ABERDEEN MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 9 -- SANFORD WORTHINGTON MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 9 -- SANFORD WORTHINGTON MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTER GROUP A-FACILITY 9 -- SANFORD WORTHINGTON MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 9 -- SANFORD WORTHINGTON MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO PROVIDERS (BILINGUAL MENTAL HEALTH AND PEDIATRIC DENTAL CARE)ACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE HELPS INDIVIDUALS AND FAMILIES ACCESS NEEDED PRIMARY CARE, SPECIALISTS, AND EMERGENCY CARE, BUT DOES NOT ENSURE ACCESS ON ITS OWNIT IS ALSO NECESSARY FOR PROVIDERS TO OFFER AFFORDABLE CARE, BE AVAILABLE TO TREAT PATIENTS, AND BE IN RELATIVELY CLOSE PROXIMITY TO PATIENTS.SANFORD HAS MADE ACCESS TO HEALTH CARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO INCREASE SCREENING OF MENTAL HEALTH AND REFERRAL SOURCES FOR MENTAL HEALTH SUPPORT AND TO INCREASE ACCESS TO PEDIATRIC DENTAL CARE FOR AT-RISK PATIENTS. IT IS SANFORD'S GOAL THAT MORE AREA RESIDENTS WILL HAVE ACCESS TO PROVIDERS OF BILINGUAL MENTAL HEALTH AND PEDIATRIC DENTAL CARE.PRIORITY 2: TEEN PREGNANCYTEEN PREGNANCY RESULTS IN SUBSTANTIAL SOCIAL, ECONOMIC, AND HEALTH COSTS THROUGH IMMEDIATE AND LONG-TERM IMPACTS ON TEEN PARENTS AND THEIR CHILDREN. STUDIES SHOW THAT THE CHILDREN OF TEENAGE MOTHERS ARE MORE LIKELY TO HAVE LOWER SCHOOL ACHIEVEMENT AND TO DROP OUT OF HIGH SCHOOL, HAVE MORE HEALTH PROBLEMS, BE INCARCERATED AT SOME TIME DURING ADOLESCENCE, AND FACE UNEMPLOYMENT AS A YOUNG ADULT, THAN CHILDREN BORN TO OLDER MOTHERS.SANFORD HAS MADE TEEN PREGNANCY A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO INCREASE LINKAGES BETWEEN TEEN PREGNANCY PREVENTION PROGRAMS AND COMMUNITY-BASED CLINICAL SERVICES. IT IS SANFORD'S GOAL THAT THE COMMUNITY WILL BENEFIT FROM STRONG LOCAL PARTNERSHIPS THROUGH SANFORD'S FOCUS ON THIS ISSUE. FAMILY PRACTICE AND PEDIATRIC PROVIDERS WILL PROVIDE PATIENT EDUCATION, RECOMMEND, AND SUPPORT SPECIALTY REFERRALS. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARACCESS TO PROVIDERS (BILINGUAL MENTAL HEALTH AND PEDIATRIC DENTAL CARE)SANFORD WORTHINGTON ESTABLISHED TWO PRIORITY GOALS, INCLUDING INCREASING ACCESS TO PEDIATRIC DENTAL CARE FOR AT-RISK PATIENTS, IN ADDITION TO INCREASED SCREENING OF MENTAL HEALTH AND REFERRAL SOURCES FOR MENTAL HEALTH SUPPORT. IN TOTAL COMMUNITY MEMBERS CONDUCTED 688 FINDHELP SEARCHES IN 2022 AND 2023 WITH 36% BEING HEALTH-RELATED TOPICS, DENTAL CARE BEING THE EIGHTH MOST SEARCHED TERM.SANFORD WORTHINGTON IS A MEMBER OF THE SW MN REGIONAL ORAL HEALTH COALITION, WHICH STARTED IN NOBLES COUNTY AND HAS EXPANDED TO SURROUNDING COUNTIES, LED BY SOUTHWEST MINNESOTA DENTAL INNOVATIONS. THE COALITION'S GOAL IS TO COORDINATE, INNOVATE, PLAN AND MANAGE DENTAL OUTREACH SERVICES FOR UNDERSERVED POPULATIONS IN SW MN, ESPECIALLY FOR THOSE UTILIZING MHCP INSURANCES. THE GATHERINGS PROVIDE OPPORTUNITY FOR NETWORKING, RESOURCE/DATA SHARING AND PROBLEM SOLVING AS PEDIATRIC DENTAL CHALLENGES CONTINUE TO BURDEN OUR RURAL COMMUNITIES. RELEVANT INFORMATION AND RESOURCES ARE SHARED WITH SANFORD WORTHINGTON PROVIDERS AND SUPPORT STAFF TO GIVE AS A RESOURCE TO PATIENTS. OUR SANFORD WORTHINGTON PEDIATRICIANS OFFER FLUORIDE VARNISH TREATMENTS AS A STANDARD OF CARE AT THE RECOMMENDED INTERVALS DURING PEDIATRIC WELLNESS VISITS. PROVIDERS AND SUPPORT STAFF ALSO EDUCATE PARENTS ABOUT PROPER ORAL HEALTH AND HYGIENE AND OFFER RESOURCES AS NECESSARY ALONG WITH OFFERING TOOTHBRUSHES TO PEDIATRIC PATIENTS. THE ORGANIZATION COMPLETED A PROFORMA FOR A DENTAL THERAPIST IN THE CLINIC SETTING, WHICH INDICATED THAT IT WASN'T A FEASIBLE OPPORTUNITY. HOWEVER, SANFORD WORTHINGTON EDUCATED CLINICAL STAFF ON LOCAL DENTAL DISPARITIES AND IS SHARING LOCAL DATA, SHARED BI-ANNUALLY. STAFF ALSO EXPLORED THE OPPORTUNITY FOR PARTNERSHIP WITH HIGHER EDUCATION AND DENTAL PROGRAMS TO COMPLETE A ROTATION OF DENTAL SERVICE PRACTICE IN AMBULATORY SETTING, WHICH ALSO DETERMINED TO NOT BE FEASIBLE.FOR MENTAL HEALTH, THE ORGANIZATION WAS ABLE TO SUCCESSFULLY RECRUIT AN INTEGRATED HEALTH THERAPIST (IHT) WHO JOINED IN OCTOBER OF 2022, AFTER THE POSITION WAS POSTED FOR MORE THAN 600 DAYS. OUR IHT REMAINS AN INTEGRAL PART OF THE CLINICAL CARE TEAM AND IS HIGHLY ENGAGED WITH THE SANFORD WORTHINGTON TEAM. THE IHT HOLDS A BROAD SCOPE OF CREDENTIALED SKILLS AND REFERRAL TO HER SERVICES IS ESTABLISHED IN THE CLINIC AND HOSPITAL. THE ONSITE AVAILABILITY INCREASES ACCESS FOR PATIENTS WITH TIME-SENSITIVE MENTAL AND BEHAVIORAL HEALTH NEEDS. IN ADDITION TO THE INCREASED ACCESS TO MENTAL HEALTH SERVICES ONSITE, THE CONTINUATION OF THE REGISTRY WORK BY THE CARE COORDINATION ASSISTANT AND EMPHASIS ON SUPPORT STAFF COMPLETING THE DEPRESSION SCREENING WITH PATIENTS DURING THE ROOMING PROCESS HAS LED TO AN INCREASE IN THE CMS DEPRESSION SCREEN SCORE EACH YEAR AT SANFORD WORTHINGTON. THE SANFORD NETWORK DEPRESSION SCREEN SCORE GOAL IS 90.5% AND SANFORD WORTHINGTON SCORES ARE AS FOLLOWS: 2021: 26.0% 2022: 67.6% 2023: 76.0% IN 2023, SANFORD WORTHINGTON WAS ABLE TO INCREASE THE NUMBER OF CREDENTIALED MENTAL HEALTH SERVICE PROVIDERS TO SERVE PATIENTS FROM ONE TO TWO; WITH ONE PROVIDER TO WORK WITH ADULT PATIENTS AND ONE PROVIDER THAT CAN ASSIST YOUTH. COMMUNITY HEALTH WORKERS (CHWS) PLAY A CRITICAL ROLE IN ASSESSING MENTAL HEALTH NEEDS. THE CHWS ARE BILINGUAL ENGLISH/SPANISH AND CAN BRIDGE THE GAP BETWEEN CULTURAL BARRIERS AND COMMUNITY RESOURCE CONNECTION. TWO BILINGUAL SPANISH COMMUNITY HEALTH WORKERS (CHWS) COMPLETED APPROXIMATELY 50 SOCIAL DETERMINANTS OF HEALTH ASSESSMENTS (SDOH) ON PATIENTS AFTER THE SDOH ASSESSMENT WAS INTRODUCED AND IMPLEMENTED IN JUNE OF 2022. THE SDOH SCREENING CONTAINS QUESTIONS REGARDING MENTAL HEALTH AND STRESS. IF PATIENTS RESPOND WITH A CONCERN, CHWS FURTHER ASSESS AND REFER TO INTERNAL AND/OR EXTERNAL COMMUNITY MENTAL HEALTH RESOURCES. IN NOVEMBER, A SHORTENED VERSION OF THE SDOH ASSESSMENT WAS INTRODUCED FOR PATIENTS CHECKING IN FOR THEIR APPOINTMENT AT REGISTRATION INCREASING LIKELIHOOD OF IDENTIFYING MENTAL HEALTH CONCERNS TO BE ADDRESSED WITH THE PROVIDER AND OPPORTUNITY FOR REFERRAL AND FOLLOW UP.TEEN PREGNANCYSANFORD WORTHINGTON SUPPORTED SMOC FAMILY PLANNING IN WORTHINGTON ON THE DEVELOPMENT OF A 5-YEAR WORK PLAN FOR THE MINNESOTA DEPARTMENT OF HEALTH (MDH) SEXUAL AND REPRODUCTIVE HEALTH SERVICES (SRHS) GRANT PROJECT FOCUSED ON TEEN PREGNANCY PREVENTION INITIATIVES IN SW MN COUNTIES. SANFORD WORTHINGTON CONTINUES TO BE A COLLABORATIVE PARTNER WITH SMOC FAMILY PLANNING ON THE ISSUE OF TEEN PREGNANCY TO ADDRESS DISPARITIES THAT CHALLENGE TEEN PARENTS. THE GRANT MONEY WAS AWARDED IN LATE 2023. A SERIES OF FOCUS GROUPS AND STAKEHOLDER GROUP WORK WILL BEGIN IN LATE SPRING 2024 TO LEARN MORE DIRECTLY FROM THE COMMUNITY REGARDING THE NEED TO REDUCE THE TEEN PREGNANCY RATE. CURRENTLY, NOBLES COUNTY, MN TEEN PREGNANCY RATE IS 45/1,000 BIRTHS COMPARED TO THE STATE AVERAGE OF 12/1,000 BIRTHS BEING TO A TEEN MOTHER.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:INCOME AND POVERTYPUBLIC TRANSPORTATIONAFFORDABLE HOUSINGACCESS TO AFFORDABLE HEALTH CAREPHYSICAL ACTIVITY AND NUTRITIONCHILDCARE QUALITYLONG-TERM CARESANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 9 -- SANFORD WORTHINGTON MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 9 -- SANFORD WORTHINGTON MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 10 -- SANFORD SHELDON MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 10 -- SANFORD SHELDON MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 10 -- SANFORD SHELDON MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 10 -- SANFORD SHELDON MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO AFFORDABLE HEALTH CARE ACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE HEALTH CARE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET. SANFORD HAS MADE ACCESS TO AFFORDABLE HEALTH CARE A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO EDUCATE THE COMMUNITY ON THE FULL SCOPE OF LOCALLY AVAILABLE SERVICES AND OFFER COMMUNITY EDUCATIONAL AND SCREENING EVENTS TO ENHANCE PREVENTATIVE CARE AND REDUCE OUT-OF-POCKET COSTS. IT IS SANFORD'S GOAL TO INCREASE THE PUBLIC EDUCATION ON THE PROMOTION OF SERVICES AVAILABLE IN SHELDON, REDUCING OUT-OF-POCKET COSTS DUE TO TRAVEL TIME AND TIME AWAY FROM THEIR EMPLOYMENT.PRIORITY 2: ACCESS TO HEALTH CARE PROVIDERSACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE HELPS INDIVIDUALS AND FAMILIES ACCESS NEEDED PRIMARY CARE, SPECIALISTS, AND EMERGENCY CARE, BUT DOES NOT ENSURE ACCESS ON ITS OWNIT IS ALSO NECESSARY FOR PROVIDERS TO OFFER AFFORDABLE CARE, BE AVAILABLE TO TREAT PATIENTS, AND BE IN RELATIVELY CLOSE PROXIMITY TO PATIENTS.SANFORD HAS MADE ACCESS TO HEALTH CARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO ENHANCE MARKETING AND PROMOTIONAL ACTIVITIES TO IMPROVE ACCESS AND TO PROMOTE VIRTUAL CARE TO AUGMENT ACCESS TO MENTAL AND BEHAVIORAL HEALTH CARE. IT IS SANFORD'S GOAL TO ENHANCE ACCESS TO CARE FOR RESIDENTS OF SHELDON AND THE SURROUNDING AREA.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARACCESS TO AFFORDABLE HEALTH CARESANFORD SET TWO GOALS IN AN EFFORT TO INCREASE ACCESS TO AFFORDABLE HEALTH CARE. THE FIRST IS TO EDUCATE THE COMMUNITY ON THE FULL SCOPE OF SERVICES AVAILABLE LOCALLY. THE SECOND GOAL IS TO OFFER COMMUNITY EDUCATIONAL AND SCREENING EVENTS TO ENHANCE PREVENTATIVE CARE AND REDUCE OUT-OF-POCKET COSTS.COMMUNITY EDUCATION HAS IMPROVED VIA VARIOUS METHODS OF INCREASED COMMUNITY EXPOSURE. NEWS MEDIA INTERVIEWS AND EDUCATIONAL STORIES HAVE INCREASED. IN 2023 STORIES WERE COMPLETED ON EDUCATIONAL TOPICS SUCH AS COLON CANCER, STROKE CARE, HEART HEALTH, FARM SAFETY, AND HEAT SAFETY. PRESS RELEASES WERE ALSO DISTRIBUTED FOR EMPLOYEE AWARDS RECEIVED IN 2023. THE RECOGNITION HIGHLIGHTS MEDICAL SERVICES THAT ARE PROVIDED LOCALLY. SANFORD HEALTH LAUNCHED TWO CAMPAIGNS FOCUSING ON PRIMARY CARE IN CALENDAR YEAR 2022. "CARE CLOSE TO HOME" ADVERTISEMENTS WERE CREATED FOR ALL SANFORD CLINIC LOCATIONS AND UTILIZED WITHIN THE SHELDON MARKET. THE BOYDEN, SHELDON, SANBORN, HARTLEY AND LAKE PARK CLINICS LISTED THEIR SPECIFIC HOURS AND AVAILABLE PROVIDERS WITHIN THE CAMPAIGN. "HERE FOR ALL. HERE FOR GOOD" WAS THE SECOND CAMPAIGN THAT WAS DIGITALLY LAUNCHED WITHIN THE SHELDON MARKET. A LISTING OF SERVICES FLYER WAS CREATED LOCALLY AND DISTRIBUTED AT SPEAKER'S BUREAU EVENTS WHICH LISTS ALL SERVICES PROVIDED AT SANFORD SHELDON INCLUDING OUR OUTLYING MEDICAL CLINICS IN BOYDEN, HARTLEY, SANBORN AND LAKE PARK. THROUGHOUT THE YEAR LEADERS OF THE ORGANIZATION SPEAK AT DIFFERENT GROUPS SUCH AS SHELDON NOON KIWANIS AND PRAIRIE QUEEN KIWANIS. PROMOTION OF THE SANFORD SHELDON FACILITY AT COMMUNITY EVENTS WAS ALSO SUCCESSFUL IN 2023 INCLUDING LOCAL COMMUNITY EVENTS SUCH AS LADIES DAY OUT, LADIES SHOPPING NIGHT AT BOMGAARS, COMMUNITY PARADES, RISEFEST MUSIC FESTIVAL. THE STAFF ALSO PARTICIPATED IN HIGH SCHOOL CAREER TOURS WHICH CONSIST OF EDUCATING HIGH SCHOOL JUNIOR STUDENTS ON THE MANY DIFFERENT TYPES OF CAREERS WITHIN HEALTHCARE, WHICH INCREASES THE AWARENESS OF THE SERVICES WE OFFER. DUE TO COVID POSITIVITY RATES SANFORD SHELDON DID NOT HOLD ANY IN HOUSE COMMUNITY EDUCATION EVENTS IN 2022.THE ORGANIZATION ASSISTED O'BRIEN COUNTY PUBLIC HEALTH WITH VACCINE ASSISTANCE. IN CALENDAR YEAR 2022 APPROXIMATELY 130 INDIVIDUALS RECEIVED A VACCINE AT EVENTS. ADDITIONALLY, SANFORD SHELDON STAFF TRAVELED TO SIOUX CITY, IA TO ASSIST WITH NATIONAL GUARD COVID TESTING FOR APPROXIMATELY 110 TROOPS THAT WERE BEING DEPLOYED.HEART, VASCULAR SCREENINGS WERE HELD IN 2022 AND 2023 AS WELL AS FLU SHOT CLINICS PROMOTING IMPROVING HEALTH FOR THE COMMUNITIES WE SERVE. DIRECT ACCESS LABS WAS ALSO A NEW SERVICE THAT IS PROVIDED TO PATIENTS IN SHELDON. THE PATIENT CAN HAVE SPECIFIC LABS PERFORMED WITHOUT A SPECIFIC PHYSICIAN ORDER. ACCESS TO HEALTH CARE PROVIDERSADDITIONAL OUTREACH SERVICES BEGAN IN 2023 WITH DR. DAYAMA AND DR. ELSHAMI. WITH THE RETIREMENT OF CLINIC PROVIDERS IN OUR OUTLYING CLINICS WE WERE ABLE TO RECRUIT PROVIDERS FOR OUR HARTLEY AND LAKE PARK OUTREACH CLINICS TO CONTINUE TO PROVIDE CARE IN THOSE COMMUNITIES. IN JULY 2023 OUR CLINIC EXPANSION WAS COMPLETED. THIS PROVIDES SANFORD SHELDON CLINIC AN ADDITIONAL 4,000 SQUARE FEET OF SPACE FOR PROVIDERS TO SEE PATIENTS. THIS ALSO PROVIDES ONE CONVENIENT ENTRANCE FOR PATIENTS FOR CLINIC APPOINTMENTS AS WELL AS OUTPATIENT SERVICES. IN 2023, SANFORD SHELDON EXPANDED MENTAL HEALTH SERVICES WITH THE ADDITION OF DARIENNE DRIESEN, INTEGRATED HEALTH THERAPIST. DRIESEN BRINGS THE TOTAL NUMBER OF MENTAL HEALTH PROVIDERS AVAILABLE AT SANFORD SHELDON TO SIX. CYNTHIA KANTOS JOINS JASON CHESTER, LISW AND STACEY JUMBECK PMHNP, APRN, CNP AS IN HOUSE PROVIDERS. MATTHEW EGGERS, DO AND MARK DANIELS, PHD PROVIDE MENTAL HEALTH SERVICES VIA TELEMED. IN 2023 SANFORD SHELDON BEGAN PARTICIPATING IN AN O'BRIEN COUNTY MENTAL HEALTH GROUP MEETING WITH INDIVIDUALS FROM MERCYONE, ELDERBRIDGE, O'BRIEN COUNTY PUBLIC HEALTH, UPPER DES MOINES OPPORTUNITY, VETERANS AFFAIRS, SEASONS CENTER, CREATIVE LIVING, ROSECRANCE, CREATIVE LIVING AND PLAINS. THIS GROUP WORKS TOGETHER TO HELP TELL THE STORY OF THE IMPORTANCE OF MENTAL HEALTH RESOURCES AVAILABLE IN THE COUNTY PLUS THOSE THAT ARE NEEDED. AS NOTED IN THE PREVIOUS GOAL, SANFORD HEALTH LAUNCHED TWO CAMPAIGNS FOCUSING ON PRIMARY CARE IN THE CALENDAR YEAR 2022. "CARE CLOSE TO HOME" ADVERTISEMENTS WERE CREATED FOR ALL SANFORD CLINIC LOCATIONS AND UTILIZED WITHIN THE SHELDON MARKET. THE BOYDEN, SHELDON, SANBORN, HARTLEY AND LAKE PARK CLINICS LISTED THEIR SPECIFIC HOURS AND AVAILABLE PROVIDERS WITHIN THE CAMPAIGN. "HERE FOR ALL. HERE FOR GOOD" WAS THE SECOND CAMPAIGN THAT WAS DIGITALLY LAUNCHED WITHIN THE SHELDON MARKET. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:PHYSICAL ACTIVITY AND NUTRITIONAFFORDABLE HOUSINGPUBLIC TRANSPORTATIONLONG-TERM CAREENVIRONMENTAL HEALTHSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 10 -- SANFORD SHELDON MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 10 -- SANFORD SHELDON MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 11 -- SANFORD VERMILLION MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 11 -- SANFORD VERMILLION MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 11 -- SANFORD VERMILLION MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 11 -- SANFORD VERMILLION MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO AFFORDABLE HEALTH CAREACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE HEALTH CARE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET.SANFORD VERMILLION HAS MADE ACCESS TO AFFORDABLE HEALTH CARE A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO ENSURE PATIENTS AND COMMUNITY PARTNERS ARE AWARE OF ITS FINANCIAL ASSISTANCE PROGRAM AND OTHER PROGRAMS AVAILABLE TO ELIGIBLE PATIENTS TO ASSIST WITH MEDICATIONS AND PREVENTATIVE CARE. IT IS SANFORD'S GOAL TO SEE LESS ACCOUNTS GOING TO COLLECTIONS OR WRITTEN OFF TO BAD DEBT AND A GREATER SHARE WRITTEN OFF TO OUR FINANCIAL ASSISTANCE PROGRAM. THERE ARE OTHER ASSISTANCE PROGRAMS FOR MEDICATIONS AND WOMEN'S PREVENTATIVE CARE THAT WE CAN HELP PATIENTS GET SIGNED UP FOR AS WELL.PRIORITY 2: HEALTH CARE ACCESS: MENTAL HEALTH/BEHAVIORAL HEALTHACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE HELPS INDIVIDUALS AND FAMILIES ACCESS NEEDED PRIMARY CARE, SPECIALISTS, AND EMERGENCY CARE, BUT DOES NOT ENSURE ACCESS ON ITS OWNIT IS ALSO NECESSARY FOR PROVIDERS TO OFFER AFFORDABLE CARE, BE AVAILABLE TO TREAT PATIENTS, AND BE IN RELATIVELY CLOSE PROXIMITY TO PATIENTS.SANFORD HAS MADE HEALTH CARE ACCESS: MENTAL HEALTH/BEHAVIORAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO PROMOTE ALTERNATIVE VISIT TYPES AND TO ALLOW OPEN SCHEDULING AND EXPANSION OF WEEKEND HOURS. IT IS SANFORD'S GOAL TO OFFER THE ALTERNATIVE VISITS, ADDING OPEN SCHEDULING AND EXPANSION OF OUR WEEKEND HOURS, THUS ALLOWING GREATER ACCESS TO OUR PROVIDERS FOR THE COMMUNITY AND WILL ADVERTISE THESE SO THE COMMUNITY IS AWARE.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARACCESS TO AFFORDABLE HEALTH CARESANFORD VERMILLION CONTINUED TO WORK IN 2023 ON OUR TWO GOALS TO ENHANCE ACCESS TO AFFORDABLE HEALTH CARE FOR THE COMMUNITY. FOR THE FIRST GOAL, THE HOSPITAL AND CLINIC AGAIN PROMOTED THE ORGANIZATION'S FINANCIAL ASSISTANCE PROGRAM TO APPLICABLE PATIENTS. THIS HELPED TO REDUCE THE NUMBER OF UNPAID ACCOUNTS GOING TO BAD DEBT OR COLLECTIONS BY INCREASING THE UTILIZATION OF THE ASSISTANCE PROGRAM TO ASSIST PAYING FOR APPROVED PATIENTS' MEDICAL BILLS FOR UP TO 12 MONTHS. TO PROMOTE THE PROGRAM, THE HOSPITAL STAFF CONTINUED TO PROVIDE THE FINANCIAL ASSISTANCE PROGRAM PATIENT BROCHURE TO ALL ADMITTED PATIENTS IN 2023 AND THE EMERGENCY ROOM WAITING ROOM. THE CLINIC STAFF PROVIDED EDUCATION SESSIONS AT THE UNIVERSITY OF SOUTH DAKOTA (USD) ON OUR FINANCIAL ASSISTANCE PROGRAM SO THE STUDENT POPULATION WOULD BE AWARE OF THE PROGRAM SINCE WE HAVE THE CONTRACT TO PROVIDE USD STUDENT HEALTH SERVICES. THE CLINIC ALSO DISPLAYS THE BROCHURE IN THE CENTRAL REGISTRATION AREA WHERE MOST PATIENTS CHECK IN AS WELL AS THE OUTPATIENT WAITING ROOMS. THE CLINIC PROVIDES OUR BILLING OFFICE'S BUSINESS CARDS WITH THEIR PHONE NUMBER TO PATIENTS WHO WISH TO CALL ABOUT THE FINANCIAL ASSISTANCE PROGRAM, SETTING UP PAYMENT PLANS, OR HAVE OTHER BILLING INQUIRIES. FINANCIAL ASSISTANCE PACKETS ARE ALSO PROVIDED TO PATIENTS AS REQUESTED AT THE CLINIC AND THE FINANCIAL ASSISTANCE PROGRAM APPLICATION IS AVAILABLE AT THE CLINIC, HOSPITAL AND ON THE SANFORD WEBSITE FOR PATIENTS TO ACCESS. THE WRITE OFFS FOR PATIENT ACCOUNTS SENT TO BAD DEBT OR COLLECTIONS IN 2023 DECREASED FROM 2022 BY OVER $190,000 WHICH WAS ONE OF OUR GOALS. THE TOTAL AMOUNT OF ACCOUNTS WRITTEN OFF TO OUR FINANCIAL ASSISTANCE PROGRAM IN 2023 WAS UP FROM 2022 OVER $7,000 FOR A TOTAL OF $1,756,454. FOR THE SECOND GOAL TO PROMOTE COMMUNITY AWARENESS OF OTHER ASSISTANCE PROGRAMS FOR MEDICATIONS AND PREVENTATIVE CARE, THE CLINIC DIRECTOR CONTINUED TO PROVIDE EDUCATION AT ORIENTATION FOR ALL NEW STAFF AND PROVIDERS ON THE PATIENT ASSISTANCE PROGRAMS AVAILABLE FOR MEDICATIONS AND PREVENTATIVE CARE SUCH AS NEEDYMEDS.COM AND ALL WOMEN COUNT. THE CLINIC HEALTH COACH AND OUR COMMUNITY HEALTH CARE WORKER ASSISTED PATIENTS WITH ACCESSING THESE RESOURCES FOR THOSE APPLICABLE. THE COMMUNITY HEALTH CARE WORKER SAW 21 PATIENTS IN 2023 ASSISTING THEM WITH VARIOUS RESOURCES AND SERVICES DURING HOME VISITS. THE CLINIC ALSO PROVIDED THE MEDDATA PATIENT BROCHURE IN THE WAITING ROOM FOR PATIENTS TO ACCESS THEIR PROGRAM TO ASSIST WITH MEDICAL BILLS FOR UNINSURED AND/OR GAPS IN COVERAGE. THE OTHER PATIENT ASSISTANCE PROGRAMS ARE ALSO ON THE WEBSITE AND BROCHURES FOR EACH ARE IN THE CLINIC LOBBY AND ARE PROVIDED TO APPLICABLE PATIENTS. THE HOSPITAL HAS A LIST OF AVAILABLE COMMUNITY ASSISTANCE RESOURCES CREATED BY OUR SOCIAL WORKER THAT IS REVIEWED WITH AND GIVEN TO ALL APPLICABLE PATIENTS AT DISCHARGE. CLINIC STAFF AND PROVIDERS ALSO CONTINUE TO PROMOTE OUR DIRECT ACCESS LABS TO PATIENTS WITH HIGH DEDUCTIBLES OR NO INSURANCE TO GET LAB SERVICES AT REDUCED COSTS WITHOUT SEEING A PROVIDER IF PAID AT TIME OF SERVICE; NO INSURANCE IS BILLED. THIS SERVICE IS PROMOTED ON SANFORD HEALTH'S WEBSITE AS SANFORD VERMILLION BEING A PROVIDER OF IT; WE PROMOTE IT INTERNALLY AT OUR FACILITY ON ALL OUR TV MONITORS IN WAITING ROOMS AND EDUCATE ALL NEW PROVIDERS AT ORIENTATION ON THIS SERVICE. IN 2023 WE CONDUCTED 346 DIRECT ACCESS LABS WHICH IS AN INCREASE FROM 219 IN 2022. SINCE 2022, SANFORD VERMILLION HAS ALSO PROVIDED A FREE HEALTH CLINIC ONE EVENING PER MONTH FOR THOSE WHO ARE UNINSURED IN COLLABORATION WITH THE UNIVERSITY OF SOUTH DAKOTA. SERVICES INCLUDE TREATING ACUTE CARE ISSUES, CHRONIC HEALTH CARE CONDITIONS AND PREVENTATIVE MEDICINE. HEALTH CARE ACCESS: MENTAL HEALTH/BEHAVIORAL HEALTH IN 2023 SANFORD VERMILLION CONTINUED WORK TO IMPROVE ACCESS TO MENTAL AND BEHAVIORAL HEALTH SERVICES; PROMOTING ALTERNATIVE VISIT TYPES TO INCREASE THIS ACCESS VIA VERBAL, VIDEO, TELEHEALTH, AND DIRECT ACCESS LABORATORY VISITS AND ALLOWING OPEN SCHEDULING OF MENTAL AND BEHAVIORAL HEALTH SERVICES. WE WERE NOT ABLE TO EXPAND SERVICES INTO WEEKEND HOURS BUT CONTINUE TO MAINTAIN THAT AS A FUTURE GOAL. ALL BEHAVIORAL HEALTH VISITS WERE OPEN TO VIRTUAL VISITS IN 2023 AND SELF-SCHEDULING. THE INTEGRATED HEALTH THERAPIST (IHT) OFFERS ALL VISIT TYPES INCLUDING IN-PERSON, VIDEO, TELEHEALTH, AND PHONE VISITS. THE OUTREACH PSYCHOLOGY PROVIDER WHO COMES TO VERMILLION OFFERS TELEHEALTH WHEN THERE'S INCLEMENT WEATHER AND THE OTHER MENTAL HEALTH COUNSELOR OFFERS IN-PERSON VISITS. THE TOTAL NUMBER OF BEHAVIORAL/MENTAL HEALTH VISITS DID NOT INCREASE FROM 2022 TO 2023; WE HAD A TOTAL OF 1,942 MENTAL/BEHAVIORAL HEALTH VISITS FOR 2023, WHICH IS DOWN FROM 2,412 LAST YEAR. WE DID HAVE 241 VIRTUAL VISITS IN 2023 WHICH WAS AN INCREASE. THE NUMBER AND % OF CANCELED VISITS AND NO-SHOW APPOINTMENTS REMAINED ABOUT 5%, IN LINE WITH THE INDUSTRY AVERAGE. SANFORD VERMILLION'S BEHAVIORAL/MENTAL HEALTH PROVIDERS ARE PROMOTED ON OUR WEBSITE; EACH HAVE A PAGE DESCRIPTION FOR PATIENTS TO SEE AND ACCESS INFORMATION ABOUT THEM. THEY ARE ALSO FEATURED AND PROMOTED AT ALL OF OUR DAKOTA HOSPITAL FOUNDATION EVENTS THROUGHOUT THE YEAR. THE ALTERNATE VISIT TYPES ARE PROMOTED BY CLINIC STAFF AND PROVIDERS, THROUGH THE SANFORD WEBSITE, WITH OUR OUTREACH PROVIDER ADS AND WITH OUR MYCHART APP WHERE THEY CAN SELF-SCHEDULE APPOINTMENTS. THE ACCESSIBILITY FOR PATIENTS TO COME IN AND GET LABS ON THEIR OWN WITHOUT SEEING A DOCTOR THROUGH THE DIRECT ACCESS LABS WAS UTILIZED BY MORE PATIENTS IN 2023 WITH 346 LABS COMPLETED COMPARED TO 219 IN 2022. OPEN SCHEDULING OF APPOINTMENTS ALSO INCREASED IN 2023 VIA THE MYCHART APP. FOR 2023, 8% OF OUR CLINIC APPOINTMENTS WERE SCHEDULED ONLINE BY SANFORD VERMILLION PATIENTS. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:AFFORDABLE HOUSINGPUBLIC TRANSPORTATIONSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 11 -- SANFORD VERMILLION MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 11 -- SANFORD VERMILLION MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 12 -- SANFORD CHAMBERLAIN MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 12 -- SANFORD CHAMBERLAIN MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 12 -- SANFORD CHAMBERLAIN MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 12 -- SANFORD CHAMBERLAIN MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: MENTAL HEALTH AND SUBSTANCE ABUSEMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO ADD ADDITIONAL MENTAL HEALTH RESOURCES IN THE COMMUNITY AND TO INCREASE ACCESSIBILITY TO MENTAL HEALTH CARE FOR YOUTH. IT IS SANFORD'S GOAL TO INCREASE MENTAL HEALTH COUNSELING AND SUBSTANCE ABUSE COUNSELING OPTIONS IN THE COMMUNITY. PRIORITY 2: ACCESS TO HEALTH CARE PROVIDERS SPECIALTY CAREACCESS TO CARE REQUIRES NOT ONLY FINANCIAL COVERAGE, BUT ALSO ACCESS TO PROVIDERS. WHILE HIGH RATES OF SPECIALIST PHYSICIANS HAVE BEEN SHOWN TO BE ASSOCIATED WITH HIGHER (AND PERHAPS UNNECESSARY) UTILIZATION, SUFFICIENT AVAILABILITY OF PRIMARY CARE PHYSICIANS IS ESSENTIAL FOR PREVENTIVE AND PRIMARY CARE, AND, WHEN NEEDED, REFERRALS TO APPROPRIATE SPECIALTY CARE.SANFORD HAS MADE ACCESS TO SPECIALTY HEALTH CARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO PROMOTE NEW SPECIALTY CARE SERVICES INCLUDING OPHTHALMOLOGY AND ORTHOPEDICS AND CREATE AWARENESS OF VIRTUAL CARE OPTIONS FOR SPECIALTY SERVICES. IT IS SANFORD'S GOAL TO PROVIDE ENHANCED ACCESS TO A VARIETY OF SPECIALTY CARE SERVICES IN THE COMMUNITY.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARMENTAL HEALTH AND SUBSTANCE ABUSESANFORD CHAMBERLAIN MEDICAL CENTER HAS SUCCESSFULLY RECRUITED A MENTAL HEALTH NURSE PRACTITIONER. THIS 1.0 FTE POSITION WILL BEGIN TO OFFER SERVICES IN LATE 2024 AND WILL EXPAND ACCESS TO MENTAL HEALTH CARE SIGNIFICANTLY FOR THE CHAMBERLAIN COMMUNITY AND BEYOND. THE SANFORD CHAMBERLAIN MEDICAL CENTER IS SUPPORTING THE PRIORITY THROUGH ITS GOAL OF ADDING ADDITIONAL MENTAL HEALTH RESOURCES TO INCREASE ACCESSIBILITY FOR MENTAL HEALTH CARE FOR YOUTH, SPECIFICALLY, THROUGH ITS PARTNERSHIP WITH THE CHAMBERLAIN SCHOOL DISTRICT. THE SANFORD CHAMBERLAIN MEDICAL CENTER PROVIDES MENTAL HEALTH SERVICES AND SUBSTANCE ABUSE PREVENTION EDUCATION TO STUDENTS IN THE CHAMBERLAIN SCHOOL DISTRICT. MENTAL HEALTH SERVICES INCLUDE AN EMBEDDED LICENSED MENTAL HEALTH COUNSELOR WITHIN THE MIDDLE SCHOOL AND HIGH SCHOOL. THE COUNSELOR ALSO PROVIDES SERVICES TO THE ELEMENTARY SCHOOL. THE COUNSELOR IS IN THE ELEMENTARY SCHOOL ONE HALF DAY PER WEEK AND THE MIDDLE SCHOOL/HIGH SCHOOL ONE HALF DAY PER WEEK.SANFORD CHAMBERLAIN PROVIDED YOUTH MENTAL HEALTH FIRST AID TRAINING TO THE CHAMBERLAIN COMMUNITY FOR THE FIRST TIME. THIS PROGRAM TOOK PLACE IN FEBRUARY 2023. PLANS WERE DEVELOPED IN 2022 FOR ADDITIONAL SERVICES, INCLUDING LIFE AFTER LOSS, A WHOLE FAMILY GRIEF COUNSELING PROGRAM, WE ALSO DEVELOPED AND STARTED ON AN ONGOING PROGRAM BEGINNING IN JANUARY 2023.ACCESS TO HEALTH CARE PROVIDERS SPECIALTY CARESANFORD CHAMBERLAIN PRIORITIZED OPHTHALMOLOGY AND ORTHOPEDICS AS TWO SPECIALTIES FOR ADDITIONAL PROMOTION LOCALLY AS PART OF THE PRIORITY IN ADDITION TO INCREASED PROMOTION OF VIRTUAL CARE OPTIONS FOR THOSE THAT QUALIFY BASED UPON THEIR NEEDED TYPE OF CARE. NEARLY 16% OF ALL FINDHELP SEARCHES FROM THE CHNA COMMUNITY WERE IN REGARD TO HEALTH-RELATED TOPICS.UNFORTUNATELY, SANFORD HAD TO CANCEL OPHTHALMOLOGY OUTREACH TO CHAMBERLAIN DUE TO PROVIDER AVAILABILITY. THE LOCAL MEDICAL CENTER IS EXPLORING OPTIONS FOR THE SERVICE DUE TO THE IDENTIFIED NEED FOR LOCAL CATARACTS SURGERY SERVICES. ORTHOPEDIC PROCEDURES WERE RE-ESTABLISHED LOCALLY IN NOVEMBER 2022 WITH CLINT BENGE, MD PROVIDING OUTREACH SERVICES. DR. BENGE IS AN ORTHOPEDIC SURGEON BASED IN SIOUX FALLS, SD AND OFFERS ACL RECONSTRUCTION, CARTILAGE RESTORATION, HIP ARTHROSCOPY, KNEE ARTHROSCOPY, MENISCAL REPAIR AND TRANSPLANTATION, AND SHOULDER ARTHROSCOPY AND ARTHROPLASTY.SANFORD CHAMBERLAIN, AND THE SYSTEM GENERALLY, UTILIZES TELE/VIRTUAL HEALTH AS AN OPTION TO AUGMENT SOME SERVICES THAT ARE PROVIDED IN THE LOCAL COMMUNITY. SANFORD CHAMBERLAIN SET A GOAL OF INCREASING THE PROMOTION OF TELE/VIRTUAL HEALTH TO INCREASE AWARENESS OF THE OPTION WITHIN THE COMMUNITY. THE FIRST INSTALLMENT OF TELEHEALTH EDUCATION WAS PRESENTED TO THE LOCAL ADVISORY BOARD IN OCTOBER 2022.THE HIRE OF THE 1.0 FTE MENTAL HEALTH NURSE PRACTITIONER ALSO SUPPORTS OUR PRIORITY TO INCREASE ACCESS TO SPECIALTY CARE IN THE COMMUNITY. WHILE WE'VE NOT BEEN ABLE TO ADD OPHTHALMOLOGY AND ORTHOPEDICS OUTREACH SERVICES, THE ADDITIONAL MENTAL HEALTH STAFF WILL ENSURE EXPANDED ACCESS TO CRITICAL MENTAL AND BEHAVIORAL HEALTH CARE SERVICES, MUCH NEEDED IN OUR COMMUNITY AT THIS TIME.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO AFFORDABLE HEALTH CAREPHYSICAL ACTIVITY AND NUTRITIONSEXUAL ACTIVITYCOMMUNITY SAFETYCHILDCARE QUALITYAFFORDABLE HOUSINGPUBLIC TRANSPORTATION AND THE INTERNETSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD SHARED THE FINDINGS OF THE CHNA RESEARCH AND THESE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 12 -- SANFORD CHAMBERLAIN MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 12 -- SANFORD CHAMBERLAIN MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 13 -- SANFORD LUVERNE MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 13 -- SANFORD LUVERNE MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 13 -- SANFORD LUVERNE MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 13 -- SANFORD LUVERNE MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: MENTAL HEALTHMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO EXPAND MENTAL HEALTH OPPORTUNITIES AND DECREASE SUBSTANCE ABUSE IN THE COMMUNITY. IT IS SANFORD'S GOAL THAT THE COMMUNITY WOULD SEE EXPANDED ACCESS TO MENTAL HEALTH SERVICES WITHIN THE COMMUNITY.PRIORITY 2: ACCESS TO HEALTH CARE PROVIDERSACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE HELPS INDIVIDUALS AND FAMILIES ACCESS NEEDED PRIMARY CARE, SPECIALISTS, AND EMERGENCY CARE, BUT DOES NOT ENSURE ACCESS ON ITS OWNIT IS ALSO NECESSARY FOR PROVIDERS TO OFFER AFFORDABLE CARE, BE AVAILABLE TO TREAT PATIENTS, AND BE IN RELATIVELY CLOSE PROXIMITY TO PATIENTS.SANFORD HAS MADE ACCESS TO HEALTH CARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO INCREASE ACCESS TO PRIMARY CARE AND EXPAND TELEHEALTH AND DENTAL ACCESS. IT IS SANFORD'S GOAL TO PROVIDE GREATER ACCESS TO CARE USING THE VISIT STYLE PREFERRED BY THE PATIENT. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARMENTAL HEALTHSANFORD LUVERNE IS ADDRESSING THE PRIORITY WITH THE GOALS OF EXPANDING MENTAL HEALTH OPPORTUNITIES AND DECREASING SUBSTANCE ABUSE IN THE COMMUNITY. MENTAL HEALTH IS TOP OF MIND FOR AREA RESIDENTS AS COMMUNITY RESIDENTS CONDUCTED 447 SEARCHES ON THE FINDHELP PLATFORM IN THE LAST TWO YEARS, WITH 23% ON HEALTH-RELATED TOPICS. "PSYCHIATRIC EMERGENCY SERVICES" APPEARED IN THE TOP TEN MOST SEARCHED LIST. ROCK COUNTY VOTED AT END OF 2022 TO NOT RENEW THE CONTRACT WITH SW MENTAL HEALTH, THUS CREATING A NEED FOR MORE MENTAL HEALTH SERVICES. THE LOCAL SANFORD TEAM MET WITH COUNTY LEADERSHIP TO DISCUSS TRANSITION AND SUBSEQUENTLY RECEIVED APPROVAL TO POST A FULL-TIME LICSW BEHAVIORAL HEALTH THERAPIST AND ARE CURRENTLY WAITING FOR APPLICATIONS. SANFORD'S CURRENT INTEGRATED HEALTH THERAPIST (IHT) HAS BEEN ACTIVELY ENGAGED WITHIN THE COMMUNITY. IN 2022, MENTAL HEALTH PROVIDERS ENGAGE THE 6TH GRADE CLASS OF 80-90 STUDENTS ON ISSUES SURROUNDING YOUTH MENTAL HEALTH, INCLUDING MINDFULNESS, HEALTHY RELATIONSHIPS, SUBSTANCE USE, TAKING CARE OF YOUR BRAIN, BRAIN HEALTH BASICS, AND BULLYING. ADDITIONALLY ORGANIZED BY SANFORD'S IHT, THE OUT OF THE DARKNESS SUICIDE PREVENTION WALK TOOK PLACE SEPT, 2022 AND DREW 200-300 WALKERS. THIS YEAR, THE OUTREACH CONTINUED WITH THE IHT WORKED WITH THE AMERICAN FOUNDATION FOR SUICIDE PREVENTION AND COORDINATED YEAR THREE OF THE OUT OF THE DARKNESS SUICIDE PREVENTION WALK. THE IHT ALSO PRESENTED MENTAL HEALTH INFORMATION AT NUMEROUS MEETINGS, INCLUDING ROTARY, ST. CATHERINE'S CHURCH (YOUTH FAITH FORMATION POST SUICIDE LOSS, ADULT BIBLE STUDY (DEC, 2023), COMMISSIONER MEETING (APRIL, 2024), SDSU CLASS (MARCH, 2024), AND TO LUVERNE HIGH SCHOOL STUDENTS INTERESTED IN SERVICE ACADEMY (SPRING AND FALL, 2023). ADDITIONALLY, OUR IHT ATTENDED CAPITOL HILL DAYS IN WASHINGTON DC ADVOCATING FOR FEDERAL BILLS THAT SUPPORT MENTAL HEALTH IN JUNE, 2023.THROUGH OUR PARTNERSHIP WITH THE MN DEPT OF HEALTH YOUTH SUICIDE PREVENTION GRANT, OUR IHT HELD 2 COMMUNITY CONVERSATIONS REGARDING COMMUNITY MENTAL HEALTH NEEDS, CONCERNS, AND OPPORTUNITIES FOR IMPROVEMENT (MAY & DEC, 2023) AND MET WITH EMS, VOLUNTEER FIRE, AND LAW ENFORCEMENT ABOUT THEIR NEEDS AND CONCERNS (SUMMER, 2023). ADDITIONAL PARTNERSHIP OCCURRED WHEN OUR IHT BEGAN TO COLLABORATE WITH SW SUICIDE PREVENTION COORDINATOR.ALL LOCAL MENTAL HEALTH PROVIDERS MEET ONCE PER MONTH IN BRAIN HEALTH GROUP MEETINGS TO EXPLORE GAPS IN CARE, COMMUNITY ENGAGEMENT, AND AVAILABILITY. SANFORD'S IHT LEADS THESE MEETINGS OF APPROXIMATELY 20 INDIVIDUALS. THIS GROUP ORGANIZED AMERICAN FOUNDATION FOR SUICIDE PREVENTION CLASSES AND HAD APPROXIMATELY 20 PEOPLE BETWEEN THE TWO CLASSES IN 2022. SUBSTANCE USE HAS BEEN ACTIVELY INVOLVED IN THE COMMUNITY'S OPIOID GRANT WORK AS WELL AS WITH COMMUNITY EDUCATION. THROUGH THE OPIOID GRANT WORK, THERE HAVE BEEN TWO BILLBOARDS PUT UP WITHIN THE COMMUNITY FOR AWARENESS. IN ADDITION, ANGELA KENNECKE FOUNDER OF EMILY'S HOPE PRESENTED IN FEBRUARY, 2022. SUBSTANCE USE COUNSELORS HAVE BEEN ACTIVELY INVOLVED WITH COMMUNITY EDUCATION EVENTS FOCUSING AROUND NARCAN TRAINING THROUGH THE STEVE RUMMLER HOPE FOUNDATION. IN 2023, SUBSTANCE USE COUNSELORS WORKED WITH THE HIGH SCHOOL HEALTH CLASSES FOR PRESENTATIONS ON SUBSTANCE USE/ABUSE, THEY ALSO CONTINUE TO BE INVOLVED IN THE LOCAL COUNTY DRUG COURTS. THEY CONTINUE TO WORK ON OPIOID RESPONSE AND NALOXONE TRAININGS FOR FAMILY SERVICES, COURTS, COMMUNITY ORGANIZATIONS, SCHOOLS (TEACHERS/STAFF AND STUDENTS). SUBSTANCE USE COUNSELORS OFFERED SUBSTANCE USE/ABUSE EDUCATION IN THE BRAIN HEALTH SERIES FOR 6TH GRADE AT THE LUVERNE SCHOOL. SUBSTANCE USE COUNSELORS AND INTEGRATED HEALTH THERAPIST SPOKE ON BRAIN HEALTH TO THE WOMEN'S GIVING CIRCLE GROUP IN LUVERNE.IN 2022, ADDITIONAL EVENTS INCLUDE A 6TH-GRADE BRAIN HEALTH PRESENTATION ON SUBSTANCE USE AND ABUSE WITH 80 KIDS IN JANUARY, AN OPIOID PANEL WITH 150 PEOPLE AT LUVERNE HIGH SCHOOL IN FEBRUARY, SUBSTANCE USE AND ABUSE EDUCATION WITH 80 KIDS WITHIN LUVERNE HIGH SCHOOL HEALTH CLASSES, AN APRIL EDUCATION SESSION TO SANFORD LUVERNE LAB STAFF ON ADDICTION AND STIGMA WITH SEVEN PEOPLE, AND A WOMEN'S ECUMENICAL BRUNCH IN MAY WITH 100 PEOPLE COVERING EDUCATION, ADDICTION, AND FAITH. IN THE FALL OF 2022, 100 PEOPLE ATTENDED AN OCTOBER PRESENTATION ON ADDICTION AND FAITH, 10 PEOPLE ATTENDED A SANFORD LUVERNE LUNCH AND LEARN ON ADDICTION AND STIGMA IN NOVEMBER, 15 LADIES ATTENDED ANOTHER NOVEMBER EVENT ON THE TOPIC WITH PINK LADIES SANFORD LUVERNE, AND 45 PEOPLE ATTENDED A COMMUNITY NALOXONE TRAINING IN DECEMBER.SANFORD LUVERNE WAS ABLE TO RECRUIT A MENTAL HEALTH COUNSELOR THIS PAST YEAR, HOWEVER SHE RESIGNED AT THE END OF 2023.BEGINNING JANUARY 1, 2024 OUR IHT, THAT IS AN LPCC, IS NOW ABLE TO BILL MEDICARE AND TREAT THOSE PATIENTS. IN ADDITION, OUR IHT IS ON A COMMUNITY WORK GROUP TO RESEARCH A GAP FUND WITHIN THE FOUNDATION TO SUPPORT MENTAL HEALTH SERVICES FOR THOSE WHO CANNOT AFFORD IT.BEHAVIORAL HEALTH ENCOUNTERS HAVE INCREASED FROM 2021 TO 2023 TO APPROXIMATELY 500 ENCOUNTERS IN 2023. SUBSTANCE USE ENCOUNTERS HAVE INCREASED FROM 2021 TO 2023 TO APPROXIMATELY 1500 ENCOUNTERS IN 2023.ACCESS TO HEALTH CARE PROVIDERSACCESS TO HEALTH CARE PROVIDERS IS BEING ENHANCED THROUGH INCREASING ACCESS TO FAMILY MEDICINE AND EXPANDING TELEHEALTH AND DENTAL ACCESS. IN THE FALL OF 2022, LUVERNE HAD A TRANSITION FROM ONE NURSE PRACTITIONER TO ANOTHER NURSE PRACTITIONER WHO ADDED AN ADDITIONAL DAY EVERY TWO WEEKS, PROVIDING GREATER ACCESS. ENCOUNTER NUMBERS CONTINUE TO INCREASE WITH THE EXPANDED ACCESS. IN 2023, DR KAT DAHL AND RACHELLE VANDEGRIEND HAVE CONTINUED TO GROW THEIR PRACTICE AND EXPAND ACCESS. FAMILY MEDICINE ENCOUNTERS IN LUVERNE HAVE INCREASED FROM 21,200 IN 2021 TO 22,100 IN 2023. IN ADDITION, THE EDGERTON CLINIC IS NOW OPEN ONE FULL DAY/WEEK AS OF JANUARY 1, 2024, TO IMPROVE LOCAL ACCESS TO PRIMARY CARE.TELEHEALTH EXPANSION HAS BEEN MINIMAL IN 2022 DUE TO LIMITED OFFERINGS BUT CONTINUED TO GROW OFFERINGS IN 2023 WITH PSYCHIATRY BEING THE MOST POPULAR WITH 246 OUTPATIENT ENCOUNTERS IN 2023. FAMILY MEDICINE TELEMEDICINE HAVE DECREASED OVER THIS PERIOD AS PATIENTS HAVE BECOME MORE COMFORTABLE WITH RETURNING TO THE CLINIC AFTER COVID. WITHIN THE HOSPITAL, TELEHEALTH IS UTILIZED PRIMARILY FOR INFECTIOUS DISEASE CONSULTATIONS OR IN THE ER WITH THE TEAM OF SPECIALISTS IN SIOUX FALLS.CLINIC PROVIDERS CONTINUE TO PARTNER WITH THE MOBILE DENTAL UNIT THAT COMES TO LUVERNE. THE MOBILE DENTAL UNIT COMES TO THE COMMUNITY ONE TO TWO DAYS PER MONTH. THE ORGANIZATION HAS ALSO PARTNERED WITH CARING HANDS CLINIC IN PIPESTONE FOR MEDICAID PATIENTS. HOWEVER, THEY HAVE A SEVERAL WEEKS' WAIT TIME FOR SERVICE.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO AFFORDABLE HEALTH CAREPHYSICAL ACTIVITY AND NUTRITIONAFFORDABLE HOUSINGCHILDCARE/DAYCARE SERVICESSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 13 -- SANFORD LUVERNE MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 13 -- SANFORD LUVERNE MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 14 -- SANFORD CANBY MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 14 -- SANFORD CANBY MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 14 -- SANFORD CANBY MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 14 -- SANFORD CANBY MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: MENTAL HEALTH MENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO FOCUS ON TWO PRIMARY GOALS: EXPANDING AWARENESS OF THE SANFORD CANBY AMBULATORY CARE MANAGER'S ROLE IN MENTAL HEALTH AND PROVIDING AND/OR SUPPORTING MENTAL HEALTH RESOURCES TO AREA YOUTH. IT IS SANFORD'S GOAL TO MAKE THE COMMUNITY MORE AWARE OF MENTAL HEALTH RESOURCES THAT ARE AVAILABLE IN THEIR LOCAL COMMUNITY.PRIORITY 2: ACCESS TO HEALTH CARE PROVIDERS ACCESS TO CARE REQUIRES NOT ONLY FINANCIAL COVERAGE, BUT ALSO ACCESS TO PROVIDERS. WHILE HIGH RATES OF SPECIALIST PHYSICIANS HAVE BEEN SHOWN TO BE ASSOCIATED WITH HIGHER (AND PERHAPS UNNECESSARY) UTILIZATION, SUFFICIENT AVAILABILITY OF PRIMARY CARE PHYSICIANS IS ESSENTIAL FOR PREVENTIVE AND PRIMARY CARE, AND, WHEN NEEDED, REFERRALS TO APPROPRIATE SPECIALTY CARE.SANFORD HAS MADE ACCESS TO HEALTH CARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO IMPROVE ACCESS TO PROVIDERS, SPECIFICALLY TO INCREASE ACCESS TO PRIMARY CARE PROVIDERS AND IMPROVE MARKETING AROUND SPECIALTY OUTREACH SERVICES. IT IS SANFORD'S GOAL THAT THE COMMUNITY WOULD FEEL EMPOWERED TO TAKE OWNERSHIP OF PREVENTATIVE HEALTH MAINTENANCE AND SEE PROGRESS TOWARDS AN OVERALL HEALTHIER POPULATION. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARMENTAL HEALTHSANFORD CANBY SUPPORTS THIS PRIORITY THROUGH A DUAL FOCUS ON EXPANDING AWARENESS OF AMBULATORY CARE MANAGER'S ROLE IN MENTAL HEALTH WITHIN THE COMMUNITY AND PROVIDING MENTAL HEALTH RESOURCES TO AREA YOUTH. A TOTAL OF 91 MENTAL HEALTH APPOINTMENTS TOOK PLACE FOR THE 2022 YEAR ALONE.ONE OF THE TACTICS IDENTIFIED BY THE HOSPITAL ROLE TO INCREASE COMMUNITY AWARENESS. SANFORD CAMBY OFFERED NUMEROUS COMMUNITY OPPORTUNITIES OVER THE LAST TWO YEARS IN SUPPORT OF THE GOAL. THE AMBULATORY CARE MANAGER PRESENTED TO SEVERAL STAKEHOLDER GROUPS IN 2022 IN ORDER TO EXPAND AWARENESS OF HER ROLE IN MENTAL HEALTH. THE CANBY ROTARY CLUB (OCTOBER 13) DISCUSSED WHAT MENTAL HEALTH CONDITIONS ARE AND HOW TO RECOGNIZE THEM, IN ADDITION TO COMMUNITY RESOURCES AND LOCAL SERVICES. SANFORD CANBY'S PATIENT ADVISORY AND PATIENT AND FAMILY ENGAGEMENT COUNCIL RECEIVED A SIMILAR PRESENTATION ON APRIL 27. MENTAL HEALTH AMONG THE ELDERLY, INCLUDING SIGNS AND SYMPTOMS, WAS THE TOPIC FOR NOVEMBER 11 AND DECEMBER 6 PRESENTATIONS TO THE SYLVAN PLACE RESIDENT COUNCIL AND SYLVAN COURT FAMILY COUNCIL, RESPECTIVELY. THE DISCUSSION INCLUDED INFORMATION ON THE AVAILABILITY OF LOCAL RESOURCES. THE SEVEN MEMBERS OF THE SYLVAN COURT FAMILY COUNCIL ALSO REVIEWED A VIDEO ON DEPRESSION ON MARCH 7, 2023, WHICH IS NOTED BELOW.THE WORK TO IMPROVE COMMUNITY HEALTH CONTINUES IN 2023. A VIDEO ON DEPRESSION WAS VIEWED DURING THE MARCH 7, 2023, SYLVAN COURT FAMILY COUNCIL MEETING. THERE WERE SEVEN PEOPLE IN ATTENDANCE. MENTAL HEALTH EDUCATION WAS PROVIDED BY THE AMBULATORY CARE MANAGER TO SANFORD CANBY STAFF VIA AN ARTICLE IN THE AUGUST 2022 AND 2023 SANFORD CANBY EMPLOYEE NEWSLETTER ON THE 988 SUICIDE & CRISIS LIFELINE. THE SAME INFORMATION, RESPECTIVE OF THE YEARS, WAS POSTED ON THE SANFORD CANBY WELLNESS CENTER'S FACEBOOK PAGE ON OCTOBER 2022 AND MAY 3, 2023. MENTAL HEALTH EDUCATION WAS PROVIDED BY THE AMBULATORY CARE MANAGER TO PATIENT ADVISORY AND PATIENT AND FAMILY ENGAGEMENT COUNCIL VIA HANDOUTS AND EDUCATION ON SUICIDE AWARENESS AND NATIONAL HOTLINE NUMBER ON MAY 3, 2023. ON NOVEMBER 16TH, THE AMBULATORY CARE MANAGER GAVE THE PATIENT ADVISORY COMMITTEE INFORMATION AND EDUCATION ON ALTERNATIVE SOURCES OF MENTAL HEALTH SERVICES. THE GROUP WAS ADVISED THAT DR. EGGERS WILL ONLY SEE PEDIATRIC PATIENTS. MENTAL HEALTH INFORMATION ON DEPRESSION/MENTAL HEALTH EDUCATION AND AWARENESS WAS PRESENTED TO THE EMR CANBY HIGH SCHOOL STUDENTS ON APRIL 27, 2023. THERE WERE 22 STUDENTS IN ATTENDANCE FOR THE PRESENTATION. STAFF ALSO SUPPORTED NATIONAL NIGHT OUT FOR AREA YOUTH ON JULY 2022. REHAB, WELLNESS CENTER, AND AMBULANCE STAFF MEMBERS FROM SANFORD CANBY PARTICIPATED IN THE EVENT.ACCESS TO HEALTH CARE PROVIDERSIN AN EFFORT TO INCREASE PREVENTIVE HEALTH AND WELLNESS VISITS AND EXPAND AWARENESS OF SANFORD-PROVIDED SPECIALTY/OUTREACH SERVICES, SANFORD CANBY MEDICAL CENTER IS PROMOTING THE AVAILABILITY OF OUR OUTREACH SPECIALISTS. YELLOW MEDICINE COUNTY RESIDENTS, THE CANBY CHNA COMMUNITY DEFINITION, SEARCHED THE FINDHELP PLATFORM 157 SINCE 2022, WITH HEALTH TOPICS BEING THE MOST FREQUENT AT 28%.SANFORD PROVIDERS CONDUCTED A NUMBER OF PUBLIC ENGAGEMENTS TO INTERACT WITH THE PUBLIC IN SUPPORT OF INCREASED PREVENTATIVE CARE VISITS. DR. AYBAR AND DR. LOPEZ WERE THE GRAND MARSHALLS OF THE CANBY HAT DAZE PARADE ON JUNE 18TH. A COMMUNITY RETIREMENT PARTY WAS HELD FOR DR. AYBAR AND DR. LOPEZ WITH SANFORD'S PA-C KAHLEY MEYER IN ATTENDANCE. DR. FUHRMAN, DR. AYBAR, DR. HANSON, AND MICHELLE DANIELSON, CNP PARTICIPATED IN ADDITIONAL COMMUNITY EVENTS THROUGHOUT THE YEAR. DR. FUHRMAN AND HANSON PARTICIPATED IN CANBY TRUNK OR TREAT ON OCTOBER 31, 2022 WHILE DRS. FUHRMAN AND DANIELSON PARTICIPATED IN THE CANBY HOMETOWN HOLIDAY PARADE IN DECEMBER. AYBAR AND HANSON PRESENTED A MATURATION CLASS AT CANBY ELEMENTARY SCHOOL ON APRIL 27. AYBAR PROVIDED WEIGHT CERTIFICATIONS FOR MINNESOTA HIGH SCHOOL WRESTLERS IN DECEMBER 2022.SANFORD CANBY IS EXPANDING ITS MARKETING OF DIRECT ACCESS LABORATORY TESTING. DIRECT ACCESS LABORATORY TESTING BROCHURES HAVE BEEN DISPLAYED AT THE SANFORD CANBY CLINIC FRONT DESK SINCE JANUARY 2022 AND WAS EXTENDED TO THE ELECTRONIC DISPLAY TV IN THE SANFORD CANBY CLINIC WAITING AREA IN FEBRUARY 2023. A CAMPAIGN TO EXPAND AWARENESS OF SANFORD-PROVIDED SPECIALTY AND OUTREACH SERVICES STARTED IN 2023. EFFORTS INCLUDE POSTING ONE OUTREACH PROVIDER'S INFORMATION ON THE SANFORD CANBY WELLNESS CENTER FACEBOOK PAGE EACH MONTH BEGINNING MARCH 2023 AND THE SAME INFORMATION IS DISPLAYED ON THE ELECTRONIC DISPLAY TV IN THE SANFORD CANBY CLINIC WAITING AREA. 2022 VOLUMES FOR SPECIALTY AND OUTREACH SERVICES INCLUDE UROLOGY 91, CARDIOLOGY 466, NEPHROLOGY 145, GASTROENTEROLOGY 177, PODIATRY 221, AND VASCULAR 49. IN 2023, WE DID SEVEN PUSHES WHEREBY WE PROMOTED OUR OUTREACH SPECIALISTS INCLUDING PROMOTION VIA OUR WELLNESS CENTER FACEBOOK PAGE AS WELL AS VIA THE DIGITAL DISPLAY IN THE CLINIC WAITING AREA. THESE EFFORTS ARE BUILDING COMMUNITY AWARENESS OF THE HIGH-QUALITY SPECIALTY CARE SERVICES AVAILABLE TO AREA RESIDENTS. ADDITIONALLY, THE OUTREACH SPECIALISTS WERE FEATURED IN OUR MONTHLY EMPLOYEE NEWSLETTER TO INCREASE AWARENESS OF SPECIALTY SERVICES OFFERED AMONGST OUR OWN STAFF AND THEIR FAMILY AND FRIENDS. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:AFFORDABLE HOUSINGEMPLOYMENT AND ECONOMIC OPPORTUNITIESSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 14 -- SANFORD CANBY MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 14 -- SANFORD CANBY MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 15 -- SANFORD JACKSON MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 15 -- SANFORD JACKSON MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 15 -- SANFORD JACKSON MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 15 -- SANFORD JACKSON MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: MENTAL HEALTH MENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO ADVANCE INTEGRATED HEALTHCARE IN THE COMMUNITY AND TO INCREASE AWARENESS AND EDUCATION ON SUICIDE PREVENTION. IT IS SANFORD'S GOAL TO INCREASE THE NUMBER OF PATIENTS THAT SANFORD PROVIDES INTEGRATED HEALTH THERAPIST SERVICES TO IN THE JACKSON AREA. PRIORITY 2: ACCESS TO HEALTH CARE PROVIDERSACCESS TO CARE REQUIRES NOT ONLY FINANCIAL COVERAGE, BUT ALSO ACCESS TO PROVIDERS. WHILE HIGH RATES OF SPECIALIST PHYSICIANS HAVE BEEN SHOWN TO BE ASSOCIATED WITH HIGHER (AND PERHAPS UNNECESSARY) UTILIZATION, SUFFICIENT AVAILABILITY OF PRIMARY CARE PHYSICIANS IS ESSENTIAL FOR PREVENTIVE AND PRIMARY CARE, AND, WHEN NEEDED, REFERRALS TO APPROPRIATE SPECIALTY CARE.SANFORD HAS MADE ACCESS TO HEALTH CARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO INCREASE COMMUNITY AWARENESS OF LOCAL PROVIDERS AND INCREASE ACCESS TO SPECIALTY CARE AT SANFORD JACKSON MEDICAL CENTER. IT IS SANFORD'S GOAL TO INCREASE AWARENESS OF PRIMARY CARE PROVIDERS AND SPECIALTY CARE.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARMENTAL HEALTHSANFORD JACKSON IS WORKING ON THE GOALS OF ADVANCING INTEGRATED HEALTHCARE IN THE COMMUNITY AND INCREASING AWARENESS AND PROVIDING EDUCATION ON SUICIDE PREVENTION IN SUPPORT OF THE PRIORITY.AFTER JOINING THE STIGMA FREE CAMPAIGN AT THE END OF 2022, THE SANFORD JACKSON MEDICAL CENTER (SJMC) LEADERSHIP BEGAN TO ENGAGE ITS EMPLOYEES IN THE CAMPAIGN TO UNDERSCORE THE IMPORTANCE OF THE CAMPAIGN. THE MESSAGE IS TO BREAK DOWN BARRIERS AND ENCOURAGE RESIDENTS OF ALL AGES TO BE MINDFUL OF MENTAL HEALTH AND ASK FOR HELP WHEN NEEDED WITHOUT FEAR OF STIGMA. IN MAY, MENTAL HEALTH WAS THE THEME OF THE SJMC'S HOSPITAL WEEK CELEBRATION AND THE KICKOFF TO MENTAL HEALTH MONTH. EMPLOYEES ATTENDED EDUCATIONAL VISITS WITH JANETTE SIMON, THE COMMUNITY HEALTH PLANNER FROM DES MOINES VALLEY HEALTH AND HUMAN SERVICES AND HEAD OF THE STIGMA FREE CAMPAIGN. THE TEAM ALSO SIGNED THE COMMITMENT POSTER TO HANG IN THE WAITING AREA TO SHOW SUPPORT AND ENGAGEMENT OF THE CAMPAIGN TO THE PUBLIC. MRS. SIMON ALSO VISITED OUR ADVISORY BOARD AND PATIENT ADVISORY BOARD TO HELP EDUCATE INDIVIDUALS ON THE CAMPAIGN AND ITS IMPORTANT MESSAGE. A STIGMA FREE CHAMPION WAS SELECTED FROM THE SJMC STAFF, AND THEY ATTEND QUARTERLY STIGMA FREE CHAMPION MEETINGS AND ENGAGE THE COMMUNITY DURING EVENTS SUCH AS THE ANNUAL SANFORD TRI 4 HEALTH AND THE ANNUAL TRI 4 HEALTH OBSTACLE COURSE. IN MAY OF 2022, SJMC'S INTEGRATED HEALTH THERAPIST (IHT) ALONG WITH A FAMILY NURSE PRACTITIONER COMPLETED A BEHAVIORAL HEALTH EDUCATION, AWARENESS AND RESPONSE DEVELOPMENT COURSE. THIS COURSE HELPS INCREASE KNOWLEDGE, SKILLS, AND CONFIDENCE TO SUPPORT PEOPLE WITH BEHAVIORAL HEALTH CONCERNS. ITS FOCUS IS TO ASSIST ATTENDEES TO SUPPORT PATIENTS STRUGGLING WITH A WIDE RANGE OF BEHAVIORAL HEALTH CONCERNS. IN 2022 SJMC SOUGHT TO MAINTAIN AND FILL OPEN IHT POSITIONS, WHICH ENDED UP NOT FILLED. AFTER OPENING THE IHT SEARCH AGAIN, SJMC HAS ENGAGED SANFORD WORTHINGTON IN A PARTNERSHIP THAT WILL PROVIDE TELEHEALTH SERVICES WITH JESSICA GRANT, MSW, LICSW, BEGINNING IN EARLY 2024. THE SEARCH FOR A SECOND IHT TO FILL THE AREA'S PATIENT LOAD CONTINUES, WITH NEW INTEREST FROM APPLICANTS. WE ANTICIPATE HAVING A SECOND IHT ON STAFF BY MID-2024. THE IHT AND OTHER STAFF MEMBERS WERE INVOLVED IN A STRATEGIC PLANNING SUICIDE PREVENTION COHORT FACILITATED BY MN DEPARTMENT OF PUBLIC HEALTH ALONGSIDE DES MOINES VALLEY HEALTH AND HUMAN SERVICES (PUBLIC HEALTH) AND VARIOUS OTHER LOCAL COMMUNITY STAKEHOLDERS, WITH MONTHLY MEETINGS STARTING IN SEPTEMBER 2021. 2022 SAW AN INCREASE IN PATIENTS FOR PSYCHIATRY SERVICES. DR. MOELLER, THE CONTRACTED PSYCHIATRIST, WAS ABLE TO INCREASE NUMBER OF DAYS TREATING PATIENTS ONSITE AND OFFSITE AT THE NURSING HOME IN JACKSON DURING 2023. SJMC COMPLETED THE CONSTRUCTION OF A DEDICATED TELEMEDICINE SUITE IN 2023. THE SUITE FEATURES A LARGE SCREEN, CAMERA, AND MICROPHONES TO VISIT WITH OFF-SITE PROVIDERS WITH THE INTENTION OF PROVIDING A MORE PERSONAL EXPERIENCE. WITH THE ADDITION OF THE SELF-SCHEDULED MYCHART VIRTUAL VISITS AS WELL AS THE SUCCESS AND POSITIVE PATIENT FEEDBACK, THE SJMC LEADERSHIP DETERMINED THEY NEEDED TO CONTINUE IMPROVING ACCESS TO TELEMEDICINE PROVIDERS. THEY DECIDED AT THE END OF 2023 TO ADD ANOTHER DEDICATED TELEMEDICINE SUITE, SCHEDULED TO BE COMPLETED MID-2024. THE NUMBER OF TELEMEDICINE VISITS HAS INCREASED FROM 42 IN 2021 TO 187 IN 2023. STAFF MEMBERS HAVE CONTINUED TO ATTEND MONTHLY MEETINGS AND ACTIVELY PARTICIPATE IN COMMUNITY GROUPS GEARED TOWARDS IMPROVING MENTAL HEALTH LIKE THE BEHAVIORAL HEALTH COMMUNITY TASK FORCE AND THE JACKSON COUNTY CENTRAL SCHOOL DISTRICT'S POSITIVE ACTIONS TOWARD HEALTH (PATH) PROGRAM. ON DECEMBER 2, 2022, THE SJMC ADMINISTRATOR SIGNED THE STIGMA FREE RESOLUTION TO RECOGNIZE COMMUNITY NEEDS AND JOIN THE COLLABORATE CAMPAIGN AGAINST THE STIGMA OF MENTAL ILLNESS. SJMC WAS ESTABLISHED AS A STIGMA-FREE ZONE AND WILL CONTINUE TO HELP RAISE AWARENESS OF RESOURCES AND ENCOURAGE PATIENTS, RESIDENTS, AND FELLOW STAFF MEMBERS TO ENGAGE IN CARE AS SOON AS THE NEED IS IDENTIFIED SO RECOVERY CAN BEGIN.ACCESS TO HEALTH CARE PROVIDERSTO INCREASE ACCESS TO HEALTH CARE PROVIDERS, THE MEDICAL CENTER IS WORKING TO CREATE COMMUNITY AWARENESS OF PROVIDERS OFFERING LOCAL CARE AND WORKING TO INCREASE SPECIALTY CARE ACCESS AT THE SJMC.SJMC PROVIDED BIOMETRIC SCREENINGS TO SIX AREA EMPLOYERS AND SCREENED 188 PEOPLE IN 2022. THE RESULTS WERE GIVEN TO PATIENTS WITH INSTRUCTIONS TO FOLLOW UP WITH THEIR PRIMARY CARE PROVIDER (PCP) OR SEEK MEDICAL CARE IF ANY OF THE MEASURES FELL OUTSIDE OF THE NORMAL RANGE. IN MARCH 2022 SJMC PARTICIPATED IN THE MARTIN COUNTY STAR HEALTH AND WELLNESS EDITION. THE MEDICAL CENTER PROVIDED A "HERE FOR YOUR HEALTH IN JACKSON" AD AND ARTICLE "WHEN SHOULD I FIND A PRIMARY CARE PROVIDER?" TO HELP GENERATE AWARENESS ABOUT THE IMPORTANCE OF HAVING A PCP. SJMC CONTINUED TO RECEIVE FEEDBACK AND COMMUNITY INPUT FROM OUR ADVISORY BOARD AND PATIENT ADVISORY BOARD.SJMC ADDED FOUR PROFESSIONALS TO THE STAFF IN 2022 AND 2023. IN 2022 THEY ADDED A SUPERVISOR OVER THERAPY AND REHABILITATION AND A PHYSICIAN. BOTH ADDITIONS HAVE BROUGHT DIFFERENT TECHNIQUES AND AN INCREASE IN PROCEDURES PERFORMED, WITH 128 PROCEDURES BEING PERFORMED IN 2022 AND 223 IN 2023. IN 2023 SJMC ADDED A CNP AND A DO TO THE STAFF. THE HIRING OF THESE NEW STAFF MEMBERS HAS BROUGHT AN INCREASE IN PATIENT SATISFACTION. DUE TO CHANGES IN HEALTH INSURANCE, SOME PLANS REQUIRE A HOME SLEEP STUDY RATHER THAN THE PREVIOUS INPATIENT TRADITIONAL SLEEP STUDY. AFTER TRAINING WAS COMPLETED, SJMC BECAME LICENSED TO PROVIDE BOTH STUDY TYPES. BIOMETRIC SCREENINGS OFFERED TO LOCAL BUSINESSES ALSO SAW IMPROVEMENT IN 2023. FIVE ORGANIZATIONS WITH A TOTAL OF 160 STAFF WERE SCREENED AND GIVEN A MORE COMPREHENSIVE EXPLANATION OF THEIR RESULTS WITH DETAILS ON THE IMPORTANCE OF FOLLOWING UP WITH A PCP AND AN INVITATION TO ASSIST IN HELPING THEM FIND THE RIGHT PROVIDER IN OUR FACILITY. DUE TO MARKETING BUDGET CUTS, SJMC WAS UNABLE TO COMPLETE WIDESPREAD MARKETING AS PLANNED, BUT STILL ENGAGED IN LOCAL MARKETING INCLUDING ADVERTISING IN THE LOCAL NEWSPAPER, THE JACKSON COUNTY PILOT. SJMC HAD NOTICEABLE ADVERTISING SPACE IN THE SPRING "LIVING WELL" SPECIAL EDITION ON THE IMPORTANCE OF A PCP AND AGAIN IN THE SUMMER "PROGRESS" SPECIAL EDITION. THE LOCAL PAPER ALSO FEATURED SJMC'S NEWEST PROVIDERS IN A NEWS ARTICLE AND FOCUSED ATTENTION TO FLU SHOT AVAILABILITY AND VARIOUS DRIVE-UP FLU SHOT CLINICS IN THE FALL OF 2023. SJMC CONTINUED TO RECEIVE FEEDBACK AND COMMUNITY INPUT FROM BOTH OUR ADVISORY BOARD AND PATIENT ADVISORY BOARD WITH QUARTERLY MEETINGS HELD THROUGHOUT THE YEAR. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:PHYSICAL ACTIVITY AND NUTRITIONHUMAN IMMUNODEFICIENCY VIRUS (HIV)ALCOHOL-RELATED DRIVING DEATHSAFFORDABLE HOUSINGSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 15 -- SANFORD JACKSON MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 15 -- SANFORD JACKSON MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 16 -- SANFORD TRACY MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 16 -- SANFORD TRACY MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 16 -- SANFORD TRACY MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 16 -- SANFORD TRACY MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: PHYSICAL ACTIVITY AND NUTRITIONTHE ENVIRONMENTS WHERE PEOPLE LIVE, LEARN, WORK, AND PLAY AFFECT ACCESS TO HEALTHY FOOD AND OPPORTUNITIES FOR PHYSICAL ACTIVITY WHICH, ALONG WITH GENETIC FACTORS AND PERSONAL CHOICES, SHAPE THE HEALTH AND THE RISK OF BEING OVERWEIGHT AND OBESE.SANFORD HEALTH TRACY HAS MADE PHYSICAL ACTIVITY AND NUTRITION SIGNIFICANT PRIORITIES AND HAS DEVELOPED STRATEGIES TO CONTINUE THE RN HEALTH COACH PROGRAM AND TO BEGIN A DIABETIC EDUCATION PROGRAM. IN ADDITION, SANFORD HAS DEVELOPED A STRATEGY TO PROVIDE AN ALTERNATIVE OPTION FOR THOSE COMMUNITY MEMBERS WHO ARE HUNGRY AND/OR LACKING FOOD OPTIONS. IT IS SANFORD'S GOAL TO PROVIDE A POSITIVE IMPACT ON PHYSICAL WELLBEING SPECIFICALLY RELATED TO OBESITY AND CHRONIC ILLNESS LIKE HIGH BLOOD PRESSURE AND DIABETES, AS WELL AS A POSITIVE IMPACT ON THE LACK OF NUTRITIONAL FOOD ACCESS.PRIORITY 2: MENTAL HEALTHMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO INCREASE SCREENING FOR DEPRESSION AND TO PROMOTE AND IMPROVE ACCESS TO SERVICES. IT IS SANFORD'S GOAL THAT THE COMMUNITY WOULD SEE A LOWERED NUMBER OF MENTAL HEALTH DAYS FROM COMMUNITY MEMBERS AND A POSITIVE INCREASE IN AWARENESS OF MENTAL HEALTH SERVICES IN THE COMMUNITY.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARPHYSICAL ACTIVITY AND NUTRITIONSANFORD TRACY HAS THE GOAL OF USING THE RN HEALTH COACH AND DIABETIC EDUCATION PROGRAMS TO INCREASE AWARENESS OF DIABETES AND IMPROVE KEY MEASURES, SUCH AS A1C IN DIABETICS. SANFORD TRACY ALSO SEEKS TO SUPPORT COMMUNITY MEMBERS WHO ARE HUNGRY AND/OR LACK FOOD OPTIONS THROUGH A PANTRY LOCATION IN THE CLINIC. AS NOTED ABOVE, THE TOTAL FINDHELP SEARCHES WERE 725 FROM THE COMMUNITY. OF THOSE, NEARLY 23% WERE RELATED TO FOOD NEEDS. THE TRACY CHNA AREA HAS OVER 107 FOOD-RELATED PROGRAMS AND ORGANIZATIONS AVAILABLE TO LOCAL RESIDENTS THROUGH THE FINDHELP TOOL, INCLUDING 30 LOCAL OPPORTUNITIES. THESE PROGRAMS AND ORGANIZATIONS CAN MAINTAIN THEIR CONTACT INFORMATION AND RESOURCES AND CAN RECEIVE REFERRALS THROUGH THE SYSTEM, IF DESIRED.A NEW INTEGRATED HEALTH THERAPIST (IHT) WAS HIRED IN JULY OF 2023. THE FOOD PANTRY PROGRAM WAS CONTINUED AND PROVIDED ONE FAMILY WITH FOOD BOXES IN 2023 WITH REFERRALS TO THE LOCAL FOOD PANTRY AS WELL. THE PROGRAM WILL BE CONTINUED INTO 2024 WITH THE HOPE FOR MORE REFERRALS FROM NEW IHT. IN 2023, 308 OF 365 ELIGIBLE PATIENTS MET THE GOAL OF A1C RESULTS LESS THAN 9%. 83.3% OF PATIENTS' BLOOD PRESSURE READINGS WERE CONTROLLED UTILIZING OUR HYPERTENSION MEASURE AND MONITOR QUALITY GUIDELINES. BMI IS NO LONGER TRACKED AS A QUALITY MEASURE, DUE TO INACCURACIES IN DATA. PROVIDERS CONTINUE TO REVIEW BMI WITH PATIENTS, AND BEST PRACTICE ADVISORIES TRIGGER IN THE ELECTRONIC MEDICAL RECORD IF A PATIENT'S WEIGHT MEETS OVERWEIGHT OR OBESE CRITERIA. THE DIABETIC EDUCATION PROGRAM SAW 11 PATIENTS IN 2023. EDUCATION AND INFORMATIONAL MATERIALS REGARDING DIABETIC EDUCATION AND DIABETES WERE AVAILABLE FOR PATIENTS AT MANY COMMUNITY EVENTS, INCLUDING THE PRAIRIE WOMEN'S EXPO IN APRIL AND THE SANFORD TRACY COMMUNITY PICNIC IN MAY. THE FOOD PANTRY PROGRAM BEGAN IN 2022 WITH SIX INDIVIDUALS/FAMILIES RECEIVING BOXES. DUE TO THE RESIGNATION OF BEHAVIORAL HEALTH ON-SITE STAFF IN 2022, THE PROGRAM SLOWED. IT IS MORE DIFFICULT FOR PCPS AND NURSES TO IDENTIFY THESE INDIVIDUALS AND FAMILIES IN NEED AT TIMES.MENTAL HEALTHTHE PRIORITY WILL BE ADDRESSED BY SANFORD TRACY THROUGH TWO GOALS. THE FIRST GOAL IS TO INCREASE SCREENING FOR DEPRESSION AND REFERRALS TO BEHAVIORAL HEALTH SPECIALISTS. THE SECOND GOAL IS TO RAISE AWARENESS OF MENTAL HEALTH AND BEHAVIORAL HEALTH PROVIDERS AND SERVICES AT SANFORD TRACY. BEHAVIORAL HEALTH SCREENINGS AVERAGED APPROXIMATELY 73.1% FOR 2023, UP FROM 68% IN 2022. THE STRETCH GOAL IS TO ACHIEVE 100% SCREENING OF ALL PATIENTS TWELVE YEARS AND OLDER WITH A PRIOR HISTORY OF DEPRESSION OR ANXIETY. A NEW INTEGRATED HEALTH THERAPIST WAS HIRED IN JULY OF 2023. THE IHT SAW 51 PATIENTS IN THAT TIME FRAME (JULY 24 TO DECEMBER 31, 2023). THE ONE OUTREACH TELEMEDICINE PSYCHIATRIST CONTINUES TO SEE PATIENTS AS NEEDED. PROMOTION FOR THE NEW IHT WAS LIMITED TO BUDGET CONSTRAINTS ON MARKETING. HOWEVER, REFERRALS TO THE NEW IHT FROM PRIMARY CARE PROVIDERS INCREASED AFTER HER HIRE. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO HEALTH CARE PROVIDERSACCESS TO AFFORDABLE HEALTH CAREEMPLOYMENT AND ECONOMIC OPPORTUNITIESPUBLIC TRANSPORTATIONAFFORDABLE HOUSINGSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 16 -- SANFORD TRACY MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 16 -- SANFORD TRACY MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 17 -- SANFORD HILLSBORO MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 17 -- SANFORD HILLSBORO MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 17 -- SANFORD HILLSBORO MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 17 -- SANFORD HILLSBORO MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: MENTAL HEALTH SERVICESMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH SERVICES A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO IMPROVE ACCESS, USE OF INTEGRATED HEALTH THERAPISTS AND IMPROVE SCREENING PROCEDURES. IT IS SANFORD'S GOAL TO REDUCE THE SEVERITY OF DEPRESSION THROUGH SCREENING AND CARE DELIVERY EFFORTS. PRIORITY 2: TRANSPORTATIONTRANSPORTATION SYSTEMS HELP ENSURE THAT PEOPLE CAN REACH EVERYDAY DESTINATIONS, SUCH AS JOBS, SCHOOLS, HEALTHY FOOD OUTLETS, AND HEALTH CARE FACILITIES, SAFELY AND RELIABLY. PUBLIC TRANSPORTATION SERVICES PLAY AN IMPORTANT ROLE FOR PEOPLE WHO ARE UNABLE TO DRIVE, PEOPLE WITHOUT ACCESS TO PERSONAL VEHICLES, CHILDREN, INDIVIDUALS WITH DISABILITIES, AND OLDER ADULTS.SANFORD HEALTH HILLSBORO HAS MADE TRANSPORTATION A SIGNIFICANT PRIORITY AND HAS DEVELOPED A STRATEGY TO WORK IN COLLABORATION WITH CITY AND COUNTY LEADERSHIP TO EXPLORE OPTIONS FOR THE LOCAL COMMUNITY AND COUNTY MEMBERS. IT IS SANFORD'S GOAL TO IMPROVE THE AVAILABILITY OF PUBLIC TRANSPORTATION THROUGH BOTH THE PROMOTION OF CURRENT RESOURCES WITHIN THE HOSPITAL AND CLINIC SETTINGS, BUT ALSO IN WORKING TO ESTABLISH NEW RESOURCES THAT EXPAND OPPORTUNITIES.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARMENTAL HEALTH SERVICES SANFORD HILLSBORO HAS ESTABLISHED TWO GOALS FOR THE MENTAL HEALTH SERVICES PRIORITY. THE FIRST IS IMPROVING PHQ-9 SCORES FOR PATIENTS WITH DEPRESSION. THE SECOND IS TO PROVIDE FOR IMPROVED ACCESS TO MENTAL HEALTH/BEHAVIORAL HEALTH SERVICES. ALTHOUGH THE FINDHELP TOOL IS NOT SPECIFIC TO MENTAL HEALTH, RESIDENTS OF THE CHNA COMMUNITY CONDUCTED 436 SEARCHES ON THE FINDHELP PLATFORM IN 2022 AND 2023, WITH 35% ON HEALTH-RELATED TOPICS.SANFORD MAYVILLE CONTINUES TO USE THE PHQ2 FOR ALL PATIENT HEALTH QUESTIONNAIRES ON INITIAL APPOINTMENTS TO ENSURE THOSE IN NEED OF MENTAL HEALTH SERVICES ARE IDENTIFIED AND OFFERED TREATMENT. THE PANEL MANAGEMENT TEAM IS COMPLETING FOLLOW-UP FOR NEW DEPRESSION DIAGNOSIS. SANFORD HILLSBORO STARTED THE SAME PROCESS IN QUARTER TWO OF 2023 WITH GREAT COMPLIANCE BY THE STAFF. WE HAVE SHOWN SUCCESS IN SCREENING OUR PATIENTS IN BOTH FACILITIES. BOTH SANFORD MAYVILLE AND SANFORD HILLSBORO HAD IMPLEMENTED INTEGRATED HEALTH THERAPISTS (IHTS) INTO THE CLINICS, PRIMARILY VIA TELEHEALTH, BUT THE IHT RESIGNED. HILLSBORO CONTINUED TO OFFER THE SENIOR LIFE SOLUTIONS OUTPATIENT GROUP THERAPY PROGRAM RESTARTED EARLY 2023 AND WE HAD 5 TO 7 PATIENTS PER DAY PARTICIPATING IN THE PROGRAM THROUGHOUT 2023. TRANSPORTATIONSANFORD SEEKS TO ADDRESS TRANSPORTATION PRIORITIES BY PROVIDING A COMPREHENSIVE DIRECTION OF OPTIONS AVAILABLE WITHIN THE COUNTY. COMMUNITY RESIDENTS CONDUCTED 436 SEARCHES ON THE FINDHELP PLATFORM IN 2022 AND 2023, WITH 11% ON TRANSIT-RELATED TOPICS. SEARCH TERMS INCLUDE "HELP PAY FOR TRANSIT," "TRANSPORTATION, AND "HELP PAY FOR GAS." THESE PROGRAMS AND ORGANIZATIONS CAN MAINTAIN THEIR CONTACT INFORMATION AND RESOURCES AND CAN RECEIVE REFERRALS THROUGH THE SYSTEM, IF DESIRED. OF THE 79 ORGANIZATIONS, 51 ARE STATE-BASED AND 2 ARE LOCAL.A LIST OF TRANSPORTATION OPTIONS CONTINUES TO BE AVAILABLE ACROSS THE COUNTY BY SANFORD HILLSBORO AND SANFORD MAYVILLE IN COORDINATION WITH TRAILL COUNTY. THE COMMUNITY HAS A BUS/VAN AVAILABLE FOR USE AND INDICATIONS ARE IT IS WELL-RECEIVED IN THE COMMUNITY. A LIMITATION TO THE PROGRAM IS DRIVER AVAILABILITY. SANFORD SUPPORTS THE USE OF VIRTUAL CARE AS AN ALTERNATIVE TO IN PERSON VISITS FOR SEVERAL TYPES OF CARE. AS SUCH, SANFORD HILLSBORO AND SANFORD MAYVILLE PROMOTES VIRTUAL CARE, INCLUDING VIDEO VISITS, TELEHEALTH, AND E-VISITS, TO PATIENTS AS APPROPRIATE.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO HEALTH CAREPHYSICAL ACTIVITY AND NUTRITIONACCESS TO QUALITY CHILDCARE AND AFFORDABLE HOUSINGSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 17 -- SANFORD HILLSBORO MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 17 -- SANFORD HILLSBORO MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 18 -- SANFORD MEDICAL CENTER MAYVILLE PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 18 -- SANFORD MEDICAL CENTER MAYVILLE PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 18 -- SANFORD MEDICAL CENTER MAYVILLE PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 18 -- SANFORD MEDICAL CENTER MAYVILLE PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: MENTAL HEALTH SERVICESMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO IMPROVE ACCESS TO MENTAL HEALTH SERVICES AND REDUCE THE SEVERITY OF DEPRESSION THROUGH USE OF INTEGRATED HEALTH THERAPISTS AND IMPROVE SCREENING PROCEDURES REDUCE MORTALITY AND MORBIDITY FROM MENTAL HEALTH AND BEHAVIORAL HEALTH AND SUBSTANCE ABUSE. IT IS SANFORD'S GOAL TO REDUCE THE SEVERITY OF DEPRESSION THROUGH SCREENING AND CARE DELIVERY EFFORTS.PRIORITY 2: TRANSPORTATIONTRANSPORTATION SYSTEMS HELP ENSURE THAT PEOPLE CAN REACH EVERYDAY DESTINATIONS, SUCH AS JOBS, SCHOOLS, HEALTHY FOOD OUTLETS, AND HEALTH CARE FACILITIES, SAFELY AND RELIABLY. PUBLIC TRANSPORTATION SERVICES PLAY AN IMPORTANT ROLE FOR PEOPLE WHO ARE UNABLE TO DRIVE, PEOPLE WITHOUT ACCESS TO PERSONAL VEHICLES, CHILDREN, INDIVIDUALS WITH DISABILITIES, AND OLDER ADULTS.SANFORD HEALTH MAYVILLE HAS MADE TRANSPORTATION A SIGNIFICANT PRIORITY AND HAS DEVELOPED A STRATEGY TO WORK IN COLLABORATION WITH CITY AND COUNTY LEADERSHIP TO EXPLORE OPTIONS FOR THE LOCAL COMMUNITY AND COUNTY MEMBERS. IT IS SANFORD'S GOAL TO IMPROVE AVAILABILITY OF PUBLIC TRANSPORTATION THROUGH BOTH THE PROMOTION OF CURRENT RESOURCES WITHIN THE HOSPITAL AND CLINIC SETTINGS, BUT ALSO IN WORKING TO ESTABLISH NEW RESOURCES THAT EXPAND OPPORTUNITIES.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARMENTAL HEALTH SERVICESSANFORD HILLSBORO HAS ESTABLISHED TWO GOALS FOR THE MENTAL HEALTH SERVICES PRIORITY. THE FIRST IS IMPROVING PHQ-9 SCORES FOR PATIENTS WITH DEPRESSION. THE SECOND IS TO PROVIDE FOR IMPROVED ACCESS TO MENTAL HEALTH/BEHAVIORAL HEALTH SERVICES. ALTHOUGH THE FINDHELP TOOL IS NOT SPECIFIC TO MENTAL HEALTH, RESIDENTS OF THE CHNA COMMUNITY CONDUCTED 436 SEARCHES ON THE FINDHELP PLATFORM IN 2022 AND 2023, WITH 35% ON HEALTH-RELATED TOPICS.SANFORD MAYVILLE CONTINUES TO USE THE PHQ2 FOR ALL PATIENT HEALTH QUESTIONNAIRES ON INITIAL APPOINTMENTS TO ENSURE THOSE IN NEED OF MENTAL HEALTH SERVICES ARE IDENTIFIED AND OFFERED TREATMENT. THE PANEL MANAGEMENT TEAM IS COMPLETING FOLLOW-UP FOR NEW DEPRESSION DIAGNOSIS. SANFORD HILLSBORO STARTED THE SAME PROCESS IN QUARTER TWO OF 2023 WITH GREAT COMPLIANCE BY THE STAFF. WE HAVE SHOWN SUCCESS IN SCREENING OUR PATIENTS IN BOTH FACILITIES. BOTH SANFORD MAYVILLE AND SANFORD HILLSBORO HAD IMPLEMENTED INTEGRATED HEALTH THERAPISTS (IHTS) INTO THE CLINICS, PRIMARILY VIA TELEHEALTH, BUT THE IHT RESIGNED. HILLSBORO CONTINUED TO OFFER THE SENIOR LIFE SOLUTIONS OUTPATIENT GROUP THERAPY PROGRAM RESTARTED EARLY 2023 AND WE HAD 5-7 PATIENTS PER DAY PARTICIPATING IN THE PROGRAM THROUGHOUT 2023. TRANSPORTATIONSANFORD SEEKS TO ADDRESS TRANSPORTATION PRIORITIES BY PROVIDING A COMPREHENSIVE DIRECTION OF OPTIONS AVAILABLE WITHIN THE COUNTY. COMMUNITY RESIDENTS CONDUCTED 436 SEARCHES ON THE FINDHELP PLATFORM IN 2022 AND 2023, WITH 11% ON TRANSIT-RELATED TOPICS. SEARCH TERMS INCLUDE "HELP PAY FOR TRANSIT," "TRANSPORTATION, AND "HELP PAY FOR GAS." THESE PROGRAMS AND ORGANIZATIONS CAN MAINTAIN THEIR CONTACT INFORMATION AND RESOURCES AND CAN RECEIVE REFERRALS THROUGH THE SYSTEM, IF DESIRED. OF THE 79 ORGANIZATIONS, 51 ARE STATE-BASED AND 2 ARE LOCAL.A LIST OF TRANSPORTATION OPTIONS CONTINUES TO BE AVAILABLE ACROSS THE COUNTY BY SANFORD HILLSBORO AND SANFORD MAYVILLE IN COORDINATION WITH TRAILL COUNTY. THE COMMUNITY HAS A BUS/VAN AVAILABLE FOR USE AND INDICATIONS ARE IT IS WELL-RECEIVED IN THE COMMUNITY. A LIMITATION TO THE PROGRAM IS DRIVER AVAILABILITY. SANFORD SUPPORTS THE USE OF VIRTUAL CARE AS AN ALTERNATIVE TO IN PERSON VISITS FOR SEVERAL TYPES OF CARE. AS SUCH, SANFORD HILLSBORO AND SANFORD MAYVILLE PROMOTES VIRTUAL CARE, INCLUDING VIDEO VISITS, TELEHEALTH, AND E-VISITS, TO PATIENTS AS APPROPRIATE.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO HEALTH CAREPHYSICAL ACTIVITY AND NUTRITIONACCESS TO QUALITY CHILDCARE AND AFFORDABLE HOUSINGSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 18 -- SANFORD MEDICAL CENTER MAYVILLE PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 18 -- SANFORD MEDICAL CENTER MAYVILLE PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 19 -- SANFORD WEBSTER MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 19 -- SANFORD WEBSTER MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 19 -- SANFORD WEBSTER MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 19 -- SANFORD WEBSTER MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: PHYSICAL ACTIVITY AND NUTRITIONTHE ENVIRONMENTS WHERE PEOPLE LIVE, LEARN, WORK, AND PLAY AFFECT ACCESS TO HEALTHY FOOD AND OPPORTUNITIES FOR PHYSICAL ACTIVITY WHICH, ALONG WITH GENETIC FACTORS AND PERSONAL CHOICES, SHAPE THE HEALTH AND THE RISK OF BEING OVERWEIGHT AND OBESE.SANFORD HAS MADE PHYSICAL ACTIVITY AND NUTRITION A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO INCREASE THE NUMBER OF PATIENTS ENGAGING WITH DIETICIANS TO IMPROVE NUTRITION AND TO CREATE A COMPREHENSIVE APPROACH TO CARE MANAGEMENT. IT IS SANFORD'S GOAL TO SEE IMPROVED HEALTH AND WELLNESS AND BETTER OVERALL MANAGEMENT OF CHRONIC DISEASES.PRIORITY 2: COMMUNITY SAFETYACCIDENTS AND VIOLENCE AFFECT HEALTH AND QUALITY OF LIFE IN THE SHORT- AND LONG-TERM, FOR THOSE BOTH DIRECTLY AND INDIRECTLY AFFECTED, AND LIVING IN UNSAFE NEIGHBORHOODS CAN IMPACT HEALTH IN A MULTITUDE OF WAYS. SANFORD HAS MADE COMMUNITY SAFETY A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO PROMOTE AND LEVERAGE RESOURCES TO ADDRESS SUBSTANCE ABUSE ISSUES AND EXPAND ACCESS TO MENTAL HEALTH AND BEHAVIORAL HEALTH CARE. IT IS SANFORD'S GOAL TO INCREASE GREATER AWARENESS OF RESOURCES AVAILABLE TO MITIGATE COMMUNITY SAFETY ISSUES. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARPHYSICAL ACTIVITY AND NUTRITIONSANFORD WEBSTER IS ADDRESSING THE PRIORITY THROUGH THE GOALS OF CREATING A COMPREHENSIVE APPROACH TO CARE MANAGEMENT AND INCREASING THE NUMBER OF PATIENTS ENGAGING WITH DIETICIANS TO IMPROVE NUTRITION. THE NEED FOR A PHYSICAL ACTIVITY AND NUTRITION GOAL IS EVIDENCED THROUGH THE FINDHELP TOOL. IN THE LAST TWO YEARS, 15% OF THE LOCAL SEARCHES ON FINDHELP WERE FOR FOOD-RELATED TOPICS. THE SANFORD WEBSTER MEDICAL CENTER HAD 352 DIETICIAN REFERRALS IN THE CHNA CYCLE. SANFORD STAFF PROMOTED DISEASE MANAGEMENT AND NUTRITION PROGRAMS WITHIN THE COMMUNITY THROUGHOUT THE YEAR TO GENERATE THE REFERRALS. MEDICAL STAFF WERE INVOLVED IN THE REFERRALS OF THESE PATIENTS TO MAKE SURE ACCESS TO NUTRITION AND PATIENT/COMMUNITY ENGAGEMENT WERE A TOP PRIORITY. THE SANFORD WEBSTER MEDICAL CENTER ENGAGED WITH 18-28 PATIENTS A MONTH WITH THE ORGANIZATION'S CHRONIC CARE MANAGEMENT PROGRAM. PROVIDERS REVIEW THE PLAN OF CARE AND THE NURSES LEADING THE PROGRAMS CONNECT WITH THE PATIENTS TO HELP IMPROVE CARE AND OUTCOMES. THE COLLABORATION BETWEEN THE PATIENT, MEDICAL STAFF, AND NURSES INCREASED PARTICIPATION IN THE PROGRAM. STAFF WERE ALSO ABLE TO REFER TO THE DIETICIAN AND CARE TEAM, CREATING GREATER OVERALL COMMUNITY ENGAGEMENT AND BETTER HEALTH WITHIN THE COMMUNITY.COMMUNITY SAFETYSANFORD WEBSTER SET TWO GOALS; TO PROMOTE AND LEVERAGE RESOURCES TO ADDRESS SUBSTANCE ABUSE ISSUES, AND EXPAND ACCESS TO MENTAL HEALTH AND BEHAVIORAL HEALTH CARE TO IMPROVE COMMUNITY SAFETY. THE SANFORD WEBSTER MEDICAL CENTER PROVIDES ACCESS TO PSYCHIATRY SERVICES THROUGH TELEMEDICINE. THE WEBSTER MEDICAL STAFF WORK CLOSELY WITH DR. NUSS AND DR. EGGERS ON A FULL RANGE OF SERVICES INCLUDING SUBSTANCE ABUSE. THE WEBSTER CLINIC ASSISTED WITH 353 VISITS IN 2002 AND 2023 TO HELP ADDRESS SUBSTANCE ABUSE ISSUES WITHIN THE COMMUNITY. THE SANFORD WEBSTER MEDICAL CENTER PROVIDES ACCESS TO AN INTEGRATED HEALTH THERAPIST. THE ENGAGEMENT AND ACCESS ARE DRIVEN BY THE MEDICAL STAFF TO PROVIDE REFERRALS AND ACCESS INTO THIS SERVICE. INTEGRATED HEALTH PROVIDERS HAD 403 IHT APPOINTMENTS IN THE LAST TWO YEARS. INTEGRATED HEALTH THERAPISTS ARE AVAILABLE DURING CLINIC HOURS FOR AVAILABLE APPOINTMENTS WITH DR. DANIELS. THE UTILIZATION AND ACCESS WERE IDENTIFIED AND HAS BEEN UTILIZED BY THE COMMUNITY AND MEDICAL STAFF. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO AFFORDABLE HEALTH CAREEMPLOYMENT AND ECONOMIC OPPORTUNITIESSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 19 -- SANFORD WEBSTER MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 19 -- SANFORD WEBSTER MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 20 -- SANFORD MEDICAL CENTER WHEATON PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 20 -- SANFORD MEDICAL CENTER WHEATON PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 20 -- SANFORD MEDICAL CENTER WHEATON PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 20 -- SANFORD MEDICAL CENTER WHEATON PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: MENTAL HEALTH AND SUBSTANCE ABUSE MENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH AND SUBSTANCE ABUSE SIGNIFICANT PRIORITIES AND HAS DEVELOPED STRATEGIES TO IMPROVE ACCESS TO SERVICES. IT IS SANFORD'S GOAL TO INCREASE ACCESS TO PSYCHOLOGY AND PSYCHIATRY AND TO EXPAND TELEHEALTH SERVICES. PRIORITY 2: PHYSICAL ACTIVITY AND NUTRITIONTHE ENVIRONMENTS WHERE PEOPLE LIVE, LEARN, WORK, AND PLAY AFFECT ACCESS TO HEALTHY FOOD AND OPPORTUNITIES FOR PHYSICAL ACTIVITY WHICH, ALONG WITH GENETIC FACTORS AND PERSONAL CHOICES, SHAPE THE HEALTH AND THE RISK OF BEING OVERWEIGHT AND OBESE.SANFORD HAS MADE PHYSICAL ACTIVITY AND NUTRITION SIGNIFICANT PRIORITIES HAS DEVELOPED STRATEGIES IMPROVE ACCESS TO NUTRITION AND TO PROMOTE AND SUPPORT OPPORTUNITIES FOR PHYSICAL ACTIVITY. IT IS SANFORD'S GOAL TO HAVE ADDITIONAL FOOD SOURCES AND AVAILABILITY FOR FOOD OPTIONS AND TO IMPROVE AND EXPAND COMMUNITY AREAS FOR PHYSICAL ACTIVITY.ADDRESSING OF SIGNIFICANT NEEDS DURING THE CURRENT YEARMENTAL HEALTH AND SUBSTANCE ABUSESANFORD MEDICAL CENTER WHEATON IS WORKING TO IMPROVE ACCESS TO SERVICES BY ADVANCING TELEHEALTH SERVICES, EXPANDING PSYCHOLOGY SERVICES, AND COORDINATING WITH GOVERNMENTAL ENTITIES TO EXPAND ACCESS WITHIN THEIR PROGRAMS AND FACILITIES. IN 2023, SANFORD WHEATON HAD 36 ADULT AND 2 PEDIATRIC BEHAVIORAL HEALTH REFERRALS FROM A PATIENT BASE OF 7,587 ENCOUNTERS. THE 2023 NUMBERS WERE AN INCREASE FROM 2022, WHICH TOTALED 28 ADULTS AND ONE PEDIATRIC. THE REFERRALS ALL OCCURRED VIA THE TELEHEALTH SERVICE. SANFORD WHEATON IS WORKING COLLABORATIVELY WITH SANFORD HEALTH LEADERSHIP TO EXPLORE OPTIONS WITHIN THE ORGANIZATION. IN JAN 2024, WE ADDED A PSYCHIATRIC NP THAT COMES TO OUR CLINIC LOCALLY. THE TEAM IS ALSO ADDING A LICENSED DRUG AND ALCOHOL COUNSELOR. PSYCHOLOGY CONTINUES TO BE AN ONGOING ISSUE IN TERMS OF PROVIDER RECRUITMENT. SANFORD WHEATON CONTINUES TO WORK ON DEVELOPING PARTNERSHIP AND PLANNING WITH CURRENT PARTNERS TO FILL THE NEED WITHIN THE REGION AND COMMUNITY. FOR EXAMPLE, HORIZON PUBLIC HEALTH ALSO RECOGNIZES ISSUES OF MENTAL HEALTH CARE AND MENTAL ILLNESS AS A TOP PRIORITY IN THEIR COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP).PHYSICAL ACTIVITY AND NUTRITIONSANFORD MEDICAL CENTER WHEATON SET TWO GOALS FOR PHYSICAL ACTIVITY AND NUTRITION PRIORITY. THE FIRST GOAL IS TO IMPROVE ACCESS TO NUTRITION THROUGH SUPPORT OF THE COMMUNITY BACKPACK PROGRAM. FOOD REPRESENTS THE GREATEST SHARE OF FINDHELP SEARCHES FROM THE LOCAL COMMUNITY, ENCOMPASSING 41% OF THE SEARCHES. THE TOP TWO SEARCHES FROM THE COMMUNITY ON FINDHELP WERE BASED UPON FOOD INSECURITY, INCLUDING "FOOD DELIVERY AND "HELP PAY FOR FOOD" THE SECOND GOAL IS PROMOTING AND SUPPORTING OPPORTUNITIES FOR PHYSICAL ACTIVITY. IN 2024 SANFORD WHEATON PARTNERED WITH PRIMEWEST FOR THE FOOD RX PROGRAM AND FOOD BOXES TO GIVE PATIENTS THAT SCREEN AS A NEED. SANFORD WHEATON ALSO PARTICIPATES IN THE LOCAL BACKPACK PROGRAM PROVIDING FOOD TO CHILDREN IN THE LOCAL SCHOOLS. THE PROGRAM PROVIDES FOOD FOR CHILDREN EVERY OTHER WEEKEND BY PLACING ENTREES, CEREAL AND SNACKS IN THEIR LOCKER. THERE ARE 57 STUDENTS THAT PARTICIPATE IN GRADES K-12 OUT OF A TOTAL STUDENT BASE OF 357. THIS IS AN INCREASE FROM LAST YEAR IN WHICH 51 STUDENTS PARTICIPATED. SANFORD STAFF PACK AND DELIVER THE BAGS TO A VOLUNTEER AT THE SCHOOL. SANFORD WHEATON ALSO SUPPORTS DEVELOPMENT OF BALL PARKS IN THE COMMUNITY TO PROMOTE PHYSICAL ACTIVITY. IN SUPPORT, SANFORD RECEIVED $10,000 FOR THE BALLPARK IMPROVEMENT PROGRAM. SANFORD IS PARTNERING WITH THE MN DOT, CITY OF WHEATON AND COUNTY OF TRAVERSE TO WORK ON SAFE ROUTES TO SCHOOL AS WELL AS A DEMONSTRATION PROJECT TO MAKE A SEAMLESS SAFE ROUTE FROM THE HIGH SCHOOL, PAST THE SWIMMING POOL AND TO THE BALLFIELD. THIS WORK WILL BEGIN TO TAKE SHAPE IN MAY OF 2024. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN:ACCESS TO HEALTH CARE PROVIDERSEMPLOYMENT AND ECONOMIC OPPORTUNITIESSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 20 -- SANFORD MEDICAL CENTER WHEATON PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 20 -- SANFORD MEDICAL CENTER WHEATON PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 21 -- SANFORD BAGLEY MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 21 -- SANFORD BAGLEY MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 21 -- SANFORD BAGLEY MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 21 -- SANFORD BAGLEY MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO HEALTH CARE PROVIDERSACCESS TO CARE REQUIRES NOT ONLY FINANCIAL COVERAGE, BUT ALSO ACCESS TO PROVIDERS. WHILE HIGH RATES OF SPECIALIST PHYSICIANS HAVE BEEN SHOWN TO BE ASSOCIATED WITH HIGHER (AND PERHAPS UNNECESSARY) UTILIZATION, SUFFICIENT AVAILABILITY OF PRIMARY CARE PHYSICIANS IS ESSENTIAL FOR PREVENTIVE AND PRIMARY CARE, AND, WHEN NEEDED, REFERRALS TO APPROPRIATE SPECIALTY CARE. SANFORD HEALTH IS POSITIONED LOCALLY TO HAVE A POSITIVE IMPACT ON ACCESS TO AFFORDABLE, QUALITY HEALTHCARE WITHIN THE COMMUNITY. THIS EFFORT WILL FOCUS ON TWO PRIMARY GOALS. THE FIRST GOAL IS TO HAVE INCREASED ACCESS TO PRIMARY AND SPECIALTY CARE AND THE SECOND GOAL IS TO HAVE INCREASED UTILIZATION OF TELEMEDICINE SERVICES.PRIORITY 2: MENTAL HEALTHMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HEALTH IS POSITIONED LOCALLY TO HAVE A POSITIVE IMPACT ON BEHAVIORAL HEALTH SERVICES WITHIN THE COMMUNITY. THIS EFFORT WILL FOCUS ON TWO PRIMARY GOALS. THE FIRST GOAL IS TO PROVIDE ADDITIONAL BEHAVIORAL HEALTH SERVICES WITHIN SANFORD BAGLEY. THE SECOND GOAL IS THE ASSESSMENT AND TREATMENT OF BEHAVIORAL HEALTH CONCERNS WITHIN PRIMARY CARE VISITS.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARACCESS TO HEALTH CARE PROVIDERSMANY SLEEP DISORDERS GO UNDIAGNOSED BECAUSE THEIR SYMPTOMS SEEM HARMLESS. HOWEVER, CHRONIC SLEEP ISSUES CAN LEAD TO OBESITY, HEART PROBLEMS, DIABETES, DEPRESSION AND MORE. LAURIE STRAW, APRN, CNP SPECIALIZES IN TREATING CONDITIONS, INCLUDING SLEEP MEDICINE, SLEEP APNEA, NARCOLEPSY, RESTLESS LEG SYNDROME AND INSOMNIA IN ADULT PATIENTS. LAURIE PROVIDED OUTREACH SERVICES TO THE BAGLEY CLINIC IN 2023 AND SAW A TOTAL OF 28 NEW REFERRAL PATIENTS. MS. STRAW SEES PATIENTS IN PERSON ONE TIME A MONTH AND TELEHEALTH VISITS ONE TIME A MONTH.EFFORTS HAVE BEEN MADE TO PROMOTE UTILIZATION TELEHEALTH SERVICES FOR PRIMARY CARE APPOINTMENTS. SANFORD PROMOTED ON-DEMAND VISITS FOR PATIENTS IN 2022. THE SANFORD HEALTH PLAN PROMOTED ZERO DOLLAR ON-DEMAND URGENT CARE VIDEO VISITS 24 HOURS A DAY AND SEVEN DAYS A WEEK IN ADDITION PROMOTIONS CENTERED ON SCHEDULED VIRTUAL CARE APPOINTMENTS FOR PRIMARY CARE. THE PRIMARY CARE VIRTUAL VISITS ALLOWED EXISTING SANFORD PATIENTS TO VISIT WITH A PROVIDER IN THE PLACE OF A CLINIC VISIT. THIS OPTION WAS EXPANDED TO NOT ONLY SANFORD HEALTH PLAN PATIENTS, BUT TO ANYONE WHO WAS AN ESTABLISHED PATIENT. IN 2022, SANFORD BAGLEY CLINIC PROVIDERS HAVE BEEN TRAINED ON HOW TO CONDUCT TELEHEALTH VISITS AND EQUIPMENT WAS PROCURED (WEBCAMS-SPEAKERS). A TOTAL OF 212 TELEHEALTH VISITS WERE PERFORMED IN FAMILY MEDICINE, 17 TELEHEALTH VISITS FOR INTERNAL MEDICINE, AND 429 TELEHEALTH VISITS FOR BEHAVIORAL HEALTH DURING THAT YEAR. PROGRESS WAS MADE IN 2022 TO INCREASE PRIMARY AND SPECIALTY CARE WITHIN SANFORD BAGLEY CLINICS. DR. COLLEEN SWANK, MD BEGAN OFFERING PEDIATRIC CARE OUTREACH AT THE BAGLEY CLINIC ONE DAY A MONTH. DR. SWANK IS BASED IN BEMIDJI, MN. DR. SWANK HAD A TOTAL OF 18 PATIENTS SCHEDULED AND 13 VISITS COMPLETED. IN 2022, THE EPIC BUILD (PROGRAMMING NEEDED FOR SCHEDULING, DOCUMENTATION, AND BILLING) WAS COMPLETED FOR DERMATOLOGY SERVICES WITHIN THE BAGLEY CLINIC. IN DECEMBER 2022, DR. CHET MAINGI, EXPRESSED INTEREST IN PROVIDING OUTREACH DERMATOLOGY SERVICES AT THE BAGLEY CLINIC STARTING THE SPRING OF 2023. DR. CHET MAINGI, DERMATOLOGIST, BEGAN SEEING PATIENTS AT THE BAGLEY CLINIC IN JUNE OF 2023. 91 VISITS WERE BOOKED AND 85 VISITS WERE COMPLETED. DR. MAINGI WILL CONTINUE TO PROVIDE OUTREACH SERVICES TO THE BAGLEY CLINIC ONE TO TWO TIMES A MONTH. HAVING THESE SERVICES AVAILABLE AT THE RURAL CLINIC HELPS FOR EARLY DETECTION FOR CARCINOMAS, MELANOMAS, PROVIDES FOR SKIN HEALTHCARE NEEDS, AND MINOR SURGICAL PROCEDURES SUCH AS MOLE REMOVAL OR BIOPSIES. THIS SPECIALTY SERVICE HELPS TO FREE UP THE PRIMARY CARE PHYSICIANS TIME, IN TURN INCREASES ACCESS FOR CARE. APRIL OF 2023, DR. JOLYN SEITZ, MD BEGAN PROVIDING MUCH NEEDED OBSTETRICAL AND GYNECOLOGIST OUTREACH SERVICES AT THE BAGLEY CLINIC. IN 2023, SHE HAD 40 VISITS BOOKED AND 32 VISITS COMPLETED. MENTAL HEALTHINCREASE BEHAVIORAL HEALTH SERVICES AND SUPPORT IN THE SANFORD BAGLEY COMMUNITY. SIGNIFICANT WORK WAS COMPLETED IN 2022 TO INCREASE BEHAVIORAL HEALTH SERVICES AND SUPPORT IN THE SANFORD BAGLEY COMMUNITY. SANFORD CONTRACTED WITH A SENOR LIFE SOLUTIONS FOR BEHAVIORAL HEALTH SERVICES. SENIOR LIFE SOLUTIONS IS AN INTENSIVE OUTPATIENT GROUP THERAPY PROGRAM DESIGNED TO MEET THE NEEDS OF INDIVIDUALS TYPICALLY 65 AND OLDER, EXPERIENCING DEPRESSION OR ANXIETY RELATED TO LIFE CHANGES THAT ARE OFTEN ASSOCIATED WITH AGING. THE SENIOR LIFE SOLUTION PROGRAM PERFORMED 27 THERAPY SESSIONS IN 2022 AND ADMITTED 11 PATIENTS IN 2023. THE PARTICIPANTS MEET UP TO THREE TIMES PER WEEK IN A SUPPORTIVE, ENCOURAGING GROUP SETTING. PSYCHIATRY SERVICES RESUMED JULY 2023 AT THE BAGLEY CLINIC. DR. HILL, PSYCHIATRIST, COMPLETED AT TOTAL OF 352 VISITS. THE VISITS WERE A COMBINATION OF IN PERSON AND TELEPHONE VISITS. IN ADDITION, DR. TSIBULSKY, REMOTE PSYCHIATRIST, HAS PROVIDED 33 BEHAVIORAL HEALTH TELEHEALTH VISITS IN 2023. IN ADDITION, BAGLEY CLINIC POSTED AN INTEGRATED BEHAVIORAL HEALTH COUNCILOR POSITION TO HELP COMMUNITY NEEDS. DEPRESSION SCREENING AT ROUTINE PRIMARY CARE VISITS WAS THE FOCUS FOR 2022 IN THE SANFORD BAGLEY CLINIC. SANFORD BAGLEY CLINIC MADE DEPRESSION SCREENING AT ROUTINE PRIMARY CARE VISITS A FOCUS FOR 2022. DEPRESSION IS A SERIOUS MEDICAL ILLNESS ASSOCIATED WITH HIGHER RATES OF CHRONIC DISEASE, INCREASED HEALTH CARE UTILIZATION, AND IMPAIRED FUNCTIONING. SANFORD BAGLEY CLINIC DEPRESSION SCREENING RATE WAS AT 65.2% IN JANUARY 2022. A SCREENING RATE GOAL OF 87.4 % WAS ESTABLISHED AND STEADY PROGRESS WAS MADE THROUGHOUT THE YEAR TO MEET THIS TARGET. THE DEPARTMENT EXCEEDED THE GOAL IN NOVEMBER 2022 (87.7%) AND MET THE GOAL AGAIN IN DECEMBER (87.3%). THE BAGLEY CLINIC'S GOAL FOR 2023 WAS TO SCREEN 90.5% OF THE PATIENTS SEEN FOR DEPRESSION. THE CLINIC ENDED THE YEAR WITH 87.8% SCREENINGS COMPLETED, NEARLY REACHING THEIR LOFTY GOAL AND SURPASSING THE 2022 RATE.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:LONG-TERM CARE, NURSING HOMES, AND SENIOR HOUSINGAFFORDABLE HOUSINGCOMMUNITY SAFETY ACCESS TO AFFORDABLE HEALTH CAREPUBLIC TRANSPORTATIONACCESS TO QUALITY HEALTH CARESANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 21 -- SANFORD BAGLEY MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 21 -- SANFORD BAGLEY MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 22 -- SANFORD CANTON-INWOOD MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 22 -- SANFORD CANTON-INWOOD MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 22 -- SANFORD CANTON-INWOOD MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 22 -- SANFORD CANTON-INWOOD MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO AFFORDABLE HOUSINGTHERE IS A STRONG AND GROWING EVIDENCE BASE LINKING STABLE AND AFFORDABLE HOUSING TO HEALTH. AS HOUSING COSTS HAVE OUTPACED LOCAL INCOMES, HOUSEHOLDS NOT ONLY STRUGGLE TO ACQUIRE AND MAINTAIN ADEQUATE SHELTER, BUT ALSO FACE DIFFICULT TRADE-OFFS IN MEETING OTHER BASIC NEEDS. WHEN THE MAJORITY OF A PAYCHECK GOES TOWARD THE RENT OR MORTGAGE, IT CAN BE DIFFICULT TO AFFORD DOCTOR VISITS, HEALTHY FOODS, UTILITY BILLS, AND RELIABLE TRANSPORTATION TO WORK OR SCHOOL. THIS CAN, IN TURN, LEAD TO INCREASED STRESS LEVELS AND EMOTIONAL STRAIN. SANFORD HAS MADE ACCESS TO AFFORDABLE HOUSING A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO INCREASE HOUSING OPTIONS WHICH WOULD SEE AN INCREASE IN POPULATION AND ABILITY FOR CITIZENS TO AGE IN PLACE VERSUS MOVING OUT OF TOWN DUE TO NO OPTIONS. THIS WORK WILL PROVIDE A MUCH NEEDED ECONOMIC STIMULUS TO THE COMMUNITY, AS WELL AS INCREASED ACCESS TO AFFORDABLE HOUSING OPTIONS. IT IS SANFORD'S GOAL TO WORK WITH THE CANTON ECONOMIC DEVELOPMENT CORPORATION (CEDC) TO RECRUIT A DEVELOPER TO CANTON TO BUILD AFFORDABLE MULTI-FAMILY AND SINGLE-FAMILY HOMES.PRIORITY 2: ACCESS TO SENIOR LIVINGLONG-TERM CARE REFERS TO A BROAD RANGE OF SERVICES AND SUPPORTS TO MEET THE NEEDS OF FRAIL OLDER ADULTS AND OTHER PEOPLE WHO ARE LIMITED IN THEIR ABILITIES FOR SELF-CARE BECAUSE OF CHRONIC ILLNESS, DISABILITY, AGE, OR OTHER HEALTH-RELATED CONDITIONS. THESE SERVICES HELP PEOPLE LIVE AS INDEPENDENTLY AND SAFELY AS POSSIBLE WHEN THEY CAN NO LONGER PERFORM EVERYDAY ACTIVITIES ON THEIR OWN. CARE CAN BE PROVIDED IN THE HOME, A NURSING HOME, OR IN A VARIETY OF OTHER SETTINGS.SANFORD HAS MADE ACCESS TO SENIOR LIVING A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO EXPLORE ADDITIONAL OPTIONS FOR SENIOR CARE, INCLUDING HOME-BASED CARE AND HOUSING ALTERNATIVES. IT IS SANFORD'S GOAL TO DO A HOME HEALTH FEASIBILITY STUDY AND EXPAND SENIOR HOUSING OPTIONS IN THE COMMUNITY.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARACCESS TO AFFORDABLE HOUSINGTHE CANTON ECONOMIC DEVELOPMENT CORPORATION (CEDC) HAS CONTINUED WORK ON THE HOUSING PROJECT IN 2023. OUR COMMITTEE MEETS THE FIRST WEDNESDAY OF EVERY MONTH AND THE MAIN TOPIC HAS BEEN HOUSING. THE CEDC IS WORKING TO INCREASE THE NUMBER OF AFFORDABLE HOUSING AND CUSTOM-BUILT HOMES AVAILABLE IN THE COMMUNITY. WE CONTINUED TO HAVE ROUTINE MEETINGS, AT LEAST MONTHLY, WITH EXP DEVELOPMENT OUT OF CALIFORNIA. THE CEDC PURCHASED A 64.12-ACRE PARCEL FROM THE CANTON-INWOOD AREA HEALTH FOUNDATION ON SEPTEMBER 1, 2022. AN AGREEMENT WAS LATER SIGNED WITH EXP GROUP TO CREATE A LIMITED LIABILITY COMPANY (LLC) CALLED MONARCH DEVELOPMENT PARTNERS ON OCTOBER 17, 2022. THIS AGREEMENT BRINGS EXP GROUP AND CANTON ECONOMIC DEVELOPMENT CORPORATION TOGETHER TO DESIGN A LAYOUT OF THE HOUSING DEVELOPMENT TO COVER MULTI-FAMILY AND SINGLE-FAMILY HOUSING IN ADDITION TO GREEN SPACES AND A BIKE/WALKING TRAIL. DUE TO INTEREST RATES AND INFLATION, AN INFLUX OF MONEY WAS NEEDED IN ORDER TO CONTINUE THE PROJECT WITHOUT A TIF DISTRICT. IN THE MONTHS OF APRIL-JUNE THE HOUSING COMMITTEE, ALONG WITH THE CEDC DIRECTOR, MET TO PUT TOGETHER AN APPLICATION ON CEDC BEHALF TO THE STATE OF SOUTH DAKOTA THROUGH THE ARPA FUNDS FROM THE FEDERAL GOVERNMENT. AFTER SUBMISSION OF THE APPLICATION, CEDC AND EXP CONTINUED TO HAVE MONTHLY, OR BI-MONTHLY, CONFERENCE CALLS TO CONTINUE TO STRATEGIZE HOW AND WHEN WE CAN COMMENCE THE PROJECT, WITH OR WITHOUT THE GRANT DOLLARS. IN NOVEMBER OF 2023, CEDC RECEIVED $3.75 MILLION DOLLARS OF THE ARPA MONEY THE STATE HAD ALLOCATED FOR HOUSING INFRASTRUCTURE PROJECTS. SINCE THE AWARD CEDC CONTINUES TO WORK WITH EXP DEVELOPMENT AND ISG ENGINEERING (ENGINEER FROM SIOUX FALLS) ON DEVELOPING AND FINALIZING PLANS FOR OUR HOUSING DEVELOPMENT. THE ENGINEER, IN COORDINATION WITH EXP DEVELOPMENT, HAS FINE-TUNED DRAWINGS AND HAS HELD SEVERAL MEETINGS WITH THE CITY OF CANTON TO ENSURE SPECIFICATIONS AND CITY CODES ARE IN COMPLIANCE. AS OF MARCH 2024, PLANS HAVE BEEN DEVELOPED TO INCLUDE AT LEAST 84 SINGLE FAMILY LOTS, AT LEAST TWO MULTI-FAMILY UNITS, ALONG WITH COMMERCIAL AND SLAB ON GRADE UNITS. THESE PLANS HAVE BEEN APPROVED BY THE CITY'S PLANNING AND ZONING COMMITTEE AND WILL GO TO THE CITY COMMISSIONERS FOR APPROVAL IN APRIL 2024. ONCE THAT IS COMPLETE THE WORK WILL CONTINUE SO THAT WE CAN PUT BIDS OUT FOR THE INFRASTRUCTURE ON THE PROJECT (I.E. WATER, SEWER, GRADING, ELECTRICAL). STATE REQUIREMENTS INDICATE THAT DIRT START MOVING BY JUNE 1, 2024, BUT THAT MAY BE DELAYED UNTIL BIDS ARE BACK AND CONTRACTORS ARE ABLE TO MOBILIZE EQUIPMENT SO WE HAVE REQUESTED A 3-MONTH EXTENSION ON THE MOVING OF DIRT REQUIREMENT. THE PROJECT NEEDS TO BE COMPLETED NO LATER THAN DECEMBER 31, 2025 AS THAT IS THE DATE ALL THE AWARDED FUNDS NEED TO BE SPENT.ACCESS TO SENIOR LIVING THE SENIOR DIRECTOR AT THE SANFORD CANTON-INWOOD MEDICAL CENTER (SCIMC) ALSO SHARES RESPONSIBILITY AS THE ADMINISTRATOR OF THE CANTON GOOD SAMARITAN NURSING HOME. THIS HAS PROVIDED AN OPPORTUNITY TO RETHINK THE CONTINUITY OF CARE FOR OUR COMMUNITY. SCOTT LARSON, SENIOR DIRECTOR SCIMC, MET WITH PROVIDERS AND CLINIC NURSING STAFF IN FEBRUARY 2023. THE TEAM IDENTIFIED THAT HOME HEALTH ALREADY COMES TO CANTON ON A REGULAR BASIS, BUT THE BIGGEST AREA THAT IS LACKING IS HOUSING FOR OUR ELDERLY, AS MOST DESIRE TO AGE IN PLACE UNTIL THEY NEED FURTHER SERVICES. ANOTHER MEETING OF ALL SCIMC MANAGERS WAS HELD MAY 15, 2023. THIS INCLUDED THE DON, MAINTENANCE, ANCILLARY DEPARTMENTS, CLINIC STAFF, AND THERAPY, ALONG WITH A FEW NON-ANCILLARY STAFF. THE GROUP DISCUSSED FORMULATING A STRATEGIC PLAN THAT WOULD ENTAIL PLANS OF INDEPENDENT LIVING, ASSISTED LIVING, AND SKILLED NURSING ATTACHED TO OUR LOCAL HOSPITAL SO THAT WE COULD PROVIDE THE ENTIRE CONTINUUM OF CARE.AS PART OF OUR DUE DILIGENCE WE ALSO CONDUCT AN ANNUAL REVIEW OF OUR HOSPITAL AND CLINIC TO DETERMINE IF WE ARE PROVIDING THE SERVICES THE COMMUNITY NEEDS AND WANTS. THROUGH THIS EVALUATION OUR MEDICAL STAFF, MANAGERS, AND BOARD OF DIRECTORS DETERMINED WE CURRENTLY HAVE A LOT OF SERVICES THAT PATIENTS CAN TAKE ADVANTAGE OF, FROM AN RN CARE MANAGER, THE CANTON CO-OP, CLINIC, HOSPITAL, HOME HEALTH, HOSPICE, ASSISTED LIVING, AND SKILLED NURSING CARE. THE ANNUAL REVIEW WAS APPROVED BY OUR ADVISORY BOARD AND OUR MEDICAL STAFF IN FEBRUARY OF 2024. WE WILL CONTINUE TO MONITOR AND EVALUATE OUR SERVICES TO ENSURE WE ARE DELIVERING WHAT THE COMMUNITY NEEDS AND WANTS.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO AFFORDABLE HEALTH CAREMENTAL HEALTH AND SUBSTANCE ABUSEPUBLIC TRANSPORTATION SANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 22 -- SANFORD CANTON-INWOOD MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 22 -- SANFORD CANTON-INWOOD MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 23 -- SANFORD CLEAR LAKE MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 23 -- SANFORD CLEAR LAKE MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 23 -- SANFORD CLEAR LAKE MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 23 -- SANFORD CLEAR LAKE MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO HEALTH CARE PROVIDERS/AFFORDABLE HEALTH CAREACCESS TO CARE REQUIRES NOT ONLY FINANCIAL COVERAGE, BUT ALSO ACCESS TO PROVIDERS. WHILE HIGH RATES OF SPECIALIST PHYSICIANS HAVE BEEN SHOWN TO BE ASSOCIATED WITH HIGHER (AND PERHAPS UNNECESSARY) UTILIZATION, SUFFICIENT AVAILABILITY OF PRIMARY CARE PHYSICIANS IS ESSENTIAL FOR PREVENTIVE AND PRIMARY CARE, AND, WHEN NEEDED, REFERRALS TO APPROPRIATE SPECIALTY CARE.ACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE HEALTH CARE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET. SANFORD HEALTH CLEAR LAKE HAS MADE ACCESS TO HEALTH CARE PROVIDERS AND AFFORDABLE HEALTH CARE SIGNIFICANT PRIORITIES AND HAS DEVELOPED STRATEGIES TO RECRUIT AN ADDITIONAL PRIMARY CARE PROVIDER AND TO INCREASE ANNUAL WELLNESS VISITS. IT IS SANFORD'S GOAL TO INCREASE MEDICAL STAFF RESULTING IN INCREASED APPOINTMENT AVAILABILITY, AS WELL AS A GREATER PATIENT CHOICE IN PROVIDERS. PRIORITY 2: TRANSPORTATIONTRANSPORTATION SYSTEMS HELP ENSURE THAT PEOPLE CAN REACH EVERYDAY DESTINATIONS, SUCH AS JOBS, SCHOOLS, HEALTHY FOOD OUTLETS, AND HEALTHCARE FACILITIES, SAFELY AND RELIABLY. PUBLIC TRANSPORTATION SERVICES PLAY AN IMPORTANT ROLE FOR PEOPLE WHO ARE UNABLE TO DRIVE, PEOPLE WITHOUT ACCESS TO PERSONAL VEHICLES, CHILDREN, INDIVIDUALS WITH DISABILITIES, AND OLDER ADULTS.SANFORD HEALTH CLEAR LAKE HAS MADE TRANSPORTATION A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO DEVELOP A SUSTAINABLE PUBLIC TRANSPORTATION SERVICE IN THE CLEAR LAKE COMMUNITY AND TO ESTABLISH AN INFRASTRUCTURE IMPROVEMENT PLAN TO ALLOW FOR ENHANCED WALKABILITY IN THE CLEAR LAKE COMMUNITY. IT IS SANFORD'S GOAL TO IMPROVE THE AVAILABILITY OF TRANSPORTATION OPTIONS FOR COMMUNITY MEMBERS UNABLE TO KEEP APPOINTMENTS DUE TO LACK OF PERSONAL TRANSPORTATION OPTIONS. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARACCESS TO HEALTH CARE PROVIDERS/AFFORDABLE HEALTH CARESANFORD CLEAR LAKE MEDICAL CENTER IDENTIFIED A NEED FOR ADDITIONAL PRIMARY CARE AVAILABILITY AND INCREASED USE OF WELLNESS VISITS THROUGH ITS CHNA PROGRAM. TO ADDRESS THIS PRIORITY, SANFORD CLEAR LAKE SET GOALS TO RECRUIT TWO PRIMARY CARE PROVIDERS AND INCREASE WELLNESS VISITS BY 10% BY THE END OF 2024. SANFORD CLEAR LAKE WAS STAFFED WITH TWO PROVIDERS MONDAY-FRIDAY IN 2023 BUT WAS CHALLENGED WITH PROVIDER TURNOVER AND A PROVIDER 12-WEEK LOA. SOME OF THE COVERAGE WAS PROVIDED BY OUTSIDE LOCUM SERVICES. INTERVIEWS ARE UNDERWAY FOR HIRING A 3RD PROVIDER SINCE WE HAD TWO APP RESIGNATIONS IN 2023. ONE PROVIDER HIRED IN AUGUST OF 2023 DID ENROLL IN THE SD RURAL LOAN FORGIVENESS PROGRAM SO THE GOAL TO LEARN MORE ABOUT THESE PROGRAMS WAS MET. ADDITIONALLY, ONE MD OFFER WAS MADE IN 2023 WITH PART OF THE PACKAGE BEING SD RURAL LOAN FORGIVENESS. ALTHOUGH THE CANDIDATE DID NOT ACCEPT OUR OFFER, THE GOAL OF USING THIS PROGRAM WAS MET. TOWARD THE GOAL TO INCREASE ANNUAL WELLNESS VISITS BY 10% BY END OF 2024, THUS FAR OUR TEAM HAS AUGMENTED MARKETING AROUND THE PRIMARY CARE SERVICES AVAILABLE IN CLEAR LAKE. OUR STAFF ENSURES THAT PROVIDER BIO CARDS ARE AVAILABLE IN THE REGISTRATION AREA OF THE CLINIC, SO PATIENTS HAVE EASY ACCESS TO INFORMATION ABOUT OUR LOCAL PROVIDERS. TO INCREASE WELLNESS VISITS, SANFORD CLEAR LAKE WORKS INTERNALLY WITH THE ORGANIZATION'S MARKETING DEPARTMENT AND PHYSICIANS ON EXPANDED COMMUNITY CAMPAIGNS, INCLUDING VIDEOS ON ALL NEW PROVIDERS HIGHLIGHTING THEIR BIOGRAPHIES. THE VIDEOS ARE AVAILABLE ON SANFORDHEALTH.ORG. THE NEW PROVIDERS ARE INTRODUCED TO THE COMMUNITY THROUGH COORDINATED SOCIAL MEDIA AND NEWSPAPER CAMPAIGNS.THE TEAM ALSO INSTALLED A DIGITAL SIGN IN OCTOBER OF 2023. PROVIDERS ARE FEATURED ON THE SIGN ALONG WITH CLINIC INFORMATION AND GENERAL WELLNESS EDUCATION. PROVIDERS ENGAGED IN THE COMMUNITY VIA MULTIPLE EVENTS IN 2023. THESE INCLUDE THE 2022 AND 2023 ST PATRICK'S DAY PIE AUCTION (ALL THREE APPS WERE PRESENT IN 2023); THE CRYSTAL SPRINGS RODEO WHICH THE APPS ATTENDED; AND PROVIDER PRESENCE AT THE COMMUNITY FOUNDATION AUCTION IN OCTOBER. TWO PROVIDERS ATTENDED THE DEUEL COUNTY COMMUNITY FOUNDATION'S TOUR OF TABLES IN OCTOBER 2022. ADDITIONALLY, ALL THREE APPS STAFF ATTENDED ONE OF THE APRIL 2023 AND DECEMBER 2023 PATIENT AND FAMILY ADVISORY COUNCIL MEETINGS TO HEAR DIRECTLY FROM OUR PATIENTS AND THEIR FAMILIES. ALL OF THESE ACTIVITIES PROMOTE PRIMARY CARE PROVIDERS TO ENGAGE WITH THE COMMUNITY.TRANSPORTATION SANFORD CLEAR LAKE ESTABLISHED TWO GOALS AROUND IMPROVING TRANSPORTATION ACCESS. THE FIRST BEING TO DEVELOP A SUSTAINABLE PUBLIC TRANSPORTATION SERVICE FOR THE CLEAR LAKE COMMUNITY BY 2024. THE SECOND GOAL WAS TO ESTABLISH AN INFRASTRUCTURE IMPROVEMENT PLAN TO ALLOW FOR ENHANCED WALKABILITY IN THE CLEAR LAKE COMMUNITY. ONE IN TEN FINDHELP SEARCHES FROM THE COUNTY IN 2022 WERE TRANSIT-RELATED TOPICS. TRANSIT SEARCH TERMS INCLUDED "TRANSPORTATION FOR HEALTHCARE AND "HELP PAY FOR TRANSIT." UPON STUDY, THE DEUEL COUNTY COMMUNITY TRANSIT BOARD DETERMINED THAT RIDERSHIP WITHIN THE COMMUNITY OF CLEAR LAKE WAS LIMITED AND WOULD NOT SUPPORT A PUBLIC TRANSIT OPTION WITHIN THE CITY. AS SUCH, THE TRANSIT PROJECT WAS PUT ON HOLD AS NEXT STEPS ARE EVALUATED. SANFORD HEALTH DOES COORDINATE WITH A VOLUNTEER THAT CAN PROVIDE TRANSPORTATION TO COMMUNITY MEMBERS AND HOSPITALIZED PATIENTS BASED UPON THE VOLUNTEER'S SCHEDULE. SANFORD CLEAR LAKE PARTICIPATES IN THE HEALTHY HOMETOWN COMMITTEE. HEALTHY HOMETOWN IS A PROGRAM THAT ASSISTS COMMUNITIES IN IMPLEMENTING CHANGES THAT PROMOTE HEALTHY LIVING BY FOCUSING ON THREE AREAS; MOVE MORE, EAT WELL, AND FEEL BETTER. THE COMMITTEE IS WORKING WITH THE SOUTH DAKOTA DEPARTMENT OF TRANSPORTATION FOR A FLASHING CROSS WALK AND PAINTED BUMP OUTS AT HIGHWAY 15. THIS INTERSECTION IS A BUSY LOCATION WHERE MANY STUDENTS CROSS TO WALK TO AND FROM SCHOOL. INTERNALLY, SANFORD CLEAR LAKE HAD BUCKLED CONCRETE SIDEWALKS AROUND THE BUILDING THAT WERE REPAIRED IN THE SUMMER OF 2022 TO PROVIDE SAFER WALKING CONDITIONS FOR PATIENTS AND STAFF. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:MENTAL HEALTHAFFORDABLE HOUSING PHYSICAL ACTIVITY AND NUTRITIONSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 23 -- SANFORD CLEAR LAKE MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 23 -- SANFORD CLEAR LAKE MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 24 -- SANFORD WESTBROOK MEDICAL CENTER PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 24 -- SANFORD WESTBROOK MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 24 -- SANFORD WESTBROOK MEDICAL CENTER PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 24 -- SANFORD WESTBROOK MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: MENTAL HEALTHMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HEALTH WESTBROOK HAS MADE MENTAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO EXPAND THE USE OF TELEMEDICINE AND IN-HOUSE MENTAL HEALTH SERVICES AND INCREASE THE NUMBER OF SCREENINGS AND REFERRALS TO BEHAVIORAL HEALTH PROVIDERS. IT IS SANFORD'S GOAL TO SEE A LOWERED NUMBER OF MENTAL HEALTH DAYS FROM COMMUNITY MEMBERS AND A POSITIVE INCREASE IN AWARENESS OF MENTAL HEALTH SERVICES IN THE COMMUNITY.PRIORITY 2: ACCESS TO HEALTH CARE PROVIDERSACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE HELPS INDIVIDUALS AND FAMILIES ACCESS NEEDED PRIMARY CARE, SPECIALISTS, AND EMERGENCY CARE, BUT DOES NOT ENSURE ACCESS ON ITS OWNIT IS ALSO NECESSARY FOR PROVIDERS TO OFFER AFFORDABLE CARE, BE AVAILABLE TO TREAT PATIENTS, AND BE IN RELATIVELY CLOSE PROXIMITY TO PATIENTS.SANFORD HAS MADE ACCESS TO HEALTH CARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO EXPAND OUTREACH SERVICES AND TO ADDRESS THE NEED FOR LIMITED ACCESS TO DENTAL CARE. REDUCE MORTALITY AND MORBIDITY FROM MENTAL HEALTH AND BEHAVIORAL HEALTH AND SUBSTANCE ABUSE. IT IS SANFORD'S GOAL TO INCREASE THE AVAILABILITY OF SPECIALTY SERVICES LOCALLY THROUGH OUTREACH AND/OR TELEHEALTH.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARMENTAL HEALTHTHE MENTAL HEALTH PRIORITY IS BEING ADDRESSED THROUGH EXPANDED USE OF CURRENT TELEMEDICINE AND IN-HOUSE MENTAL HEALTH SERVICES AND THE ADDITIONAL GOAL OF INCREASING THE NUMBER OF SCREENINGS AND REFERRALS TO BEHAVIORAL HEALTH PROVIDERS. SANFORD WESTBROOK HIRED A NEW INTEGRATED HEALTH THERAPIST IN JULY OF 2023. THIS PROVIDER SAW 29 PATIENTS FROM JULY-DECEMBER OF 2023. WE CONTINUE TO UTILIZE THE OUTREACH TELEMEDICINE PSYCHIATRIST WHO SEES PATIENTS FOR TELEMED VISITS AS NEEDED. UNFORTUNATELY, BUDGET RESTRAINTS DID NOT ALLOW FOR EXTERNAL PROMOTION OF SERVICES IN 2023. REFERRALS WERE PRIMARILY BY WORD OF MOUTH AND FROM PRIMARY CARE PROVIDERS. ACCESS TO HEALTH CARE PROVIDERSSANFORD WESTBROOK HAS CONTINUED TO RECRUIT FOR AN ORTHOPEDIC SPECIALIST, WITH LITTLE TO NO MOVEMENT. THERE ARE VERY FEW PROVIDERS AVAILABLE FOR OUTREACH SERVICES CURRENTLY. CONTINUED EFFORTS TO RECRUIT ANOTHER OUTREACH SURGEON ALSO TOOK PLACE IN 2023. UNFORTUNATELY, THE CURRENT SURGEON HAS ANNOUNCED RETIREMENT IN 2024, SO EFFORTS WILL RAMP UP AT THAT TIME TO RECRUIT A NEW SURGEON. IN 2023, THE SURGEON SAW 46 PATIENTS AND COMPLETED 81 PROCEDURES. TELEHEALTH OUTREACH SERVICES CONTINUED IN 2023. ONCOLOGY TELEMED VISITS WERE AT FIVE IN 2023, DOWN FROM SEVEN IN 2022; NEPHROLOGY VISITS WERE 78 IN 2023, DOWN FROM 87 IN 2022; 11 INFECTIOUS DISEASE TELEMED VISITS IN 2023, UP FROM FIVE IN 2022. DENTAL CARE ACCESS: IN SUMMER 2023, THE SUPPLIES FOR STUDENTS K-6 AND 7&8 WERE PURCHASED FOR THE 2023-2024 SCHOOL YEAR AND DISTRIBUTED TO THE SCHOOLS. STUDENTS RECEIVE NEW TOOTHBRUSHES, TOOTHPASTE, FLOSSERS, AND FLUORIDE RINSES EVERY MONTH. PROVIDERS AND CLINIC NURSES HAVE CONTINUED TO PROVIDE DENTAL HEALTH INFORMATION WITH PARENTS AT WELL CHILD VISITS AND OFFER FLUORIDE VARNISH IF APPROPRIATE AT WELL CHILD VISITS. WORKING WITH PUBLIC HEALTH NURSES FROM DES MOINES VALLEY HEALTH AND HUMAN SERVICES OFFICE, WE CONTINUE TO SHARE INFORMATION FOR THEIR CHILDREN'S DENTAL SERVICES CLINICS (FREE) WITH PARENTS THROUGH THE SCHOOL AND CLINIC. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:COMMUNITY SAFETYENVIRONMENTAL HEALTHAFFORDABLE HOUSINGPUBLIC TRANSPORTATIONPHYSICAL ACTIVITY AND NUTRITIONEMPLOYMENT AND ECONOMIC OPPORTUNITIESSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 24 -- SANFORD WESTBROOK MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 24 -- SANFORD WESTBROOK MEDICAL CENTER PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 2 -- SANFORD MEDICAL CENTER FARGO PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 2 -- SANFORD MEDICAL CENTER FARGO PART V, SECTION B, LINE 6A: SANFORD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS BEHAVIORAL HEALTH CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 2 -- SANFORD MEDICAL CENTER FARGO PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCULDED. GROUP A-FACILITY 2 -- SANFORD MEDICAL CENTER FARGO PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO AFFORDABLE HEALTH CAREACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE HEALTH CARE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET. NDSU REPORTED HEALTH CARE ACCESSIBILITY AND COST AS TWO SEPARATE HEALTH NEEDS. THE CASS-CLAY WORKING GROUP DETERMINED THAT THE TWO TOPICS ARE MOST APPROPRIATELY ADDRESSED AS A COMBINED TOPIC FOR PURPOSES OF THE LOCAL CHNA PROCESS.SANFORD HAS MADE HEALTHCARE ACCESS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO EXPAND HEALTHCARE ACCESS AND ACCESS TO PRIMARY CARE SERVICES. IT IS SANFORD'S GOAL THAT THE COMMUNITY WOULD SEE THAT PATIENTS WILL HAVE GREATER EASE TO ACCESS PRIMARY CARE PROVIDERS FOR VIRTUAL OR IN-PERSON VISITS, HOME VISITS AND INCREASED EXPANDED HOURS. PATIENTS MAY EXPERIENCE LESS FREQUENT UTILIZATION OF EMERGENCY CARE, WHICH IS OFTEN MORE EXPENSIVE THAN PREVENTATIVE AND SCREENING SERVICES.PRIORITY 2: MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSEMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSE SIGNIFICANT PRIORITIES AND HAS DEVELOPED STRATEGIES TO RECRUIT PROVIDERS, INCREASE ACCESS TO CARE AND MENTAL HEALTH PROMOTION. IT IS SANFORD'S GOAL TO HAVE BETTER ACCESS TO AND UTILIZATION OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES DUE TO SERVICES BEING PROVIDED AT THE RIGHT TIME AND RIGHT PLACE. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEAR: ACCESS TO AFFORDABLE HEALTH CARESANFORD FARGO ESTABLISHED TWO GOALS IN SUPPORT OF THE PRIORITY, ACCESS TO AFFORDABLE HEALTH CARE. THE FIRST IS TO EXPAND HEALTHCARE ACCESS AND SUPPORT RESOURCES FOR VULNERABLE AND UNDERSERVED POPULATIONS. THE SECOND IS TO EXPAND PLATFORM AND ACCESS TO PRIMARY CARE SERVICES.TO INCREASE ACCESS TO PRIMARY CARE AVAILABILITY, SANFORD FARGO INCREASED HOME BASED PRIMARY CARE ACCESS. SANFORD FARGO/MOORHEAD METRO AREA INTERNAL MED AND FAMILY MEDICINE PROVIDERS CONDUCTED ABOUT 500 HOME VISITS IN 2023. THE FAMILY MEDICINE RESIDENCY PROGRAM IS OUTREACHING TO MULTIPLE LOCATIONS IN OUR COMMUNITY TO PROVIDE MEDICAL CARE TO UNDERSERVED POPULATIONS. THE FAMILY MEDICINE RESIDENCY PROGRAM PROVIDED MEDICAL CARE THIS PAST YEAR AT THE YWCA, NEW LIFE CENTER, YOUTHWORKS, AND JEFFERSON SCHOOL. IN 2023, 170 PATIENTS WERE SERVED IN THESE LOCATIONS. YOUTHWORKS IS A "501C3 NON-PROFIT DEDICATED TO PROVIDING YOUTH AND FAMILY SERVICES THROUGHOUT NORTH DAKOTA. THEIR FOCUS AND EXPERTISE IS IN WORKING WITH TEENS, PARENTS AND YOUNG ADULTS UNDER 22 YEARS OF AGE. OUR SERVICES INCLUDE PROGRAMS FOR RUNAWAY, HOMELESS AND STREET YOUTH; JUVENILE OFFENDERS; YOUTH FAILING IN SCHOOL; YOUTH SUSPENDED OR EXPELLED FROM SCHOOL; YOUNG PARENTS AND PREGNANT MOMS (UNDER 22); YOUTH ARRESTED AND UNABLE TO IMMEDIATELY RETURN HOME; YOUTH NEEDING EMERGENCY CARE; YOUTH NEEDING PEER SUPPORT OR CROSS-AGE MENTORING; AND YOUTH WITH ANGER ISSUES." THIS STRATEGY WILL HELP IMPROVE ACCESS FOR VULNERABLE AND UNDERSERVED RESIDENTS OF THE FARGO/MOORHEAD METRO AREA.SANFORD FARGO OPENED THE HORACE CLINIC ON NOVEMBER 8, 2023. ONE PHYSICIAN AND THREE ADVANCED PRACTICE PROVIDERS BEGAN PROVIDING CARE IN HORACE, WITH THE ABILITY TO EXPAND TO SEVEN CLINICIANS IN THE FUTURE. FROM OPENING DATE THROUGH THE END OF 2023, CLINICIANS CONDUCTED 615 VISITS. WITH HORACE RAPIDLY GROWING, THIS CLINIC WILL ALLOW SANFORD FARGO TO CONTINUE TO KEEP PATIENTS IN THE SOUTH END OF THE METRO AREA AND BEYOND CONNECTED TO CARE. ALL SANFORD FARGO PRIMARY CARE PROVIDERS ARE NOW ABLE TO PROVIDE VIRTUAL VISITS TO PATIENTS WHICH WILL HELP SERVE PATIENTS WHO MAY BE EXPERIENCING BARRIERS TO CARE SUCH AS LIMITED ACCESS TO TRANSPORTATION. SANFORD FARGO/MOORHEAD METRO AREA PROVIDERS CONDUCTED 1,015 VIDEO VISITS IN PRIMARY CARE FOR 2023. SANFORD FARGO ADDED SIX PRIMARY CARE PROVIDERS TO CLINICS IN THE FARGO/MOORHEAD METRO AREA IN 2023 AND THREE THAT STARTED IN Q4 2022. THESE ADDITIONS ARE CONTINUING TO HELP MAKE PRIMARY CARE READILY AVAILABLE FOR PATIENTS WE SERVE. ONE STRATEGY IDENTIFIED WITHIN THE COMMUNITY HEALTH NEEDS ASSESSMENT PROGRAM IS TO MAKE VIRTUAL VISITS AVAILABLE FOR ALL PRIMARY CARE PROVIDERS. AS OF THE END OF 2022, ACCESS TO TELEHEALTH IS AVAILABLE FOR ALL FAMILY MEDICINE PROVIDERS, WHICH ALLOWS PATIENTS TO RECEIVE CARE WITHIN THEIR HOMES IF THEY DO NOT HAVE ACCESS TO RELIABLE TRANSPORTATION OR CANNOT TRAVEL FOR APPOINTMENTS.MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSE THREE GOALS SUPPORT THE MENTAL HEALTH AND SUBSTANCE ABUSE GOAL. THE FIRST IS RECRUITING PROVIDERS AND INCREASING ACCESS TO CARE. THE SECOND IS TO DEVELOP A COMMUNITY STRATEGY FOR MENTAL HEALTH PROMOTION. THE THIRD IS TO DECREASE SUBSTANCE ABUSE.TO INCREASE ACCESS TO MENTAL HEALTH CARE, SANFORD FARGO EXPANDED ITS PARTNERSHIP WITH REGIONAL SCHOOLS TO PROVIDE STUDENT PLACEMENT FOR MASTER'S LEVEL THERAPISTS INTO THE INTERNAL MEDICINE DEPARTMENT. COORDINATION OF CARE WITH PRIMARY CARE, EMERGENCY DEPARTMENT, AND HOSPITAL CARE COORDINATION HAS RESULTED IN THE WAIT LIST FOR BEHAVIORAL HEALTH AND PSYCHIATRY APPOINTMENTS TO DECREASE (FROM 2,000 PATIENTS TO 180 PATIENTS WAITING TO BE SCHEDULED IN 2022 ALONE). FURTHERMORE, ACCESS TO SUPPORTIVE BEHAVIORAL HEALTH SERVICES AND RESOURCES HAVE IMPROVED IN THE HOSPITAL WITH THE CREATION OF A DEDICATED UNIT AT THE SANFORD MEDICAL CENTER FARGO FOR PATIENTS ADMITTED FOR MEDICAL CARE WHO REQUIRE ADDITIONAL BEHAVIORAL HEALTH SUPPORT. ACCESS TO ADULT PSYCHIATRY SERVICES AT SANFORD FARGO CONTINUES TO UNDERGO IMPROVEMENT. WAIT TIMES TO BE SEEN FOR AN ADULT PSYCHIATRY APPOINTMENT IMPROVED FROM ROUGHLY SIX MONTHS AT END OF 2022 TO ABOUT 10-12 WEEKS BY THE END OF 2023. SANFORD IS CONTINUING ITS EFFORTS TO MONITOR AND WORK TO IMPROVE ACCESS FOR BEHAVIORAL HEALTH SERVICES IN OUR REGION. THE STUDENT LED CLINIC PROVIDED CLINICAL INTERNSHIPS FOR 14 STUDENTS COMPLETING THEIR MASTER'S LEVEL THERAPIST PROGRAMS IN SOCIAL WORK OR COUNSELING. OF THESE, NINE WERE HIRED AS MASTER'S LEVEL THERAPISTS FOLLOWING COMPLETION OF THE PROGRAM. SANFORD FARGO/MOORHEAD METRO AREA PROVIDERS COMPLETED 7,927 BEHAVIORAL HEALTH VIDEO VISITS IN 2023. 92,865 PATIENTS SEEN IN THE FARGO REGION WITHOUT A DIAGNOSIS OF DEPRESSION OR BIPOLAR DISORDER WERE SCREENED FOR DEPRESSION WITH DOCUMENTED FOLLOW UP WHEN APPROPRIATE THOUGH SANFORD HEALTH SITES IN 2023. OF 6,593 ELIGIBLE PATIENTS WHO MET THE CRITERIA FOR DEPRESSION REMISSION TRACKING, 528 REACHED REMISSION. SINCE 2022, SANFORD AMBULANCE REPORTED 2,790 PATIENTS RECEIVING CARE FOR A PRIMARY IMPRESSION RELATED TO ALCOHOL USE, WITHDRAWAL, OR ALCOHOL OVERDOSE FOR THE FARGO/MOORHEAD AREA, ALONG WITH ABOUT 3,836 PATIENTS WITH A PRIMARY IMPRESSION RELATED TO BEHAVIORAL HEALTH/PSYCHIATRIC EPISODE, ANXIETY, MENTAL DISORDER, SUICIDAL IDEATION, OR SUICIDE ATTEMPT. SANFORD FARGO IS CONTINUING A PARTNERSHIP WITH CLAY COUNTY DETOX TO ENSURE COORDINATED UTILIZATION OF MEDICAL AND LAW ENFORCEMENT SUPPORT FOR INDIVIDUALS ACTIVELY IN DETOX. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:PHYSICAL ACTIVITY AND NUTRITIONSENIOR HOUSING AND LONG-TERM CAREPUBLIC TRANSPORTATIONAFFORDABLE HOUSING, EMPLOYMENT, ECONOMIC DEVELOPMENTDIVERSITY, INCLUSION, HEALTH EQUITYCHILDCAREHEALTH LITERACY AND NAVIGATIONSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 2 -- SANFORD MEDICAL CENTER FARGO PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 2 -- SANFORD MEDICAL CENTER FARGO PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY GROUP A-FACILITY 25 -- SANFORD THIEF RIVER FALLS BEHAVIORAL HEA PART V, SECTION B, LINE 5: SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/SANFORD-HEALTH-ADDRESSES-TOP-COMMUNITY-HEALTH-NEEDS/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE. GROUP A-FACILITY 25 -- SANFORD THIEF RIVER FALLS BEHAVIORAL HEA PART V, SECTION B, LINE 6A: SANFORD USD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER GROUP A-FACILITY 25 -- SANFORD THIEF RIVER FALLS BEHAVIORAL HEA PART V, SECTION B, LINE 7D: SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED. GROUP A-FACILITY 25 -- SANFORD THIEF RIVER FALLS BEHAVIORAL HEA PART V, SECTION B, LINE 11: THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: MENTAL HEALTHMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES FOR MENTAL HEALTH PROMOTION, SUICIDE PREVENTION AND EDUCATION FOR PARENTING RELATED SKILLS. IT IS SANFORD'S GOAL TO INCREASE ACCESS TO MENTAL/BEHAVIORAL HEALTH AND SUBSTANCE ABUSE SERVICES, IN PARTICULAR FOR AT RISK YOUTH AND TO DECREASE THE NUMBER OF SUICIDES.PRIORITY 2: ACCESS TO HEALTHCARE PROVIDERSACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE HEALTH CARE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET. SANFORD HAS MADE ACCESS TO HEALTHCARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO DEVELOP A FULLTIME DERMATOLOGY CLINIC AND TO EXPAND ACCESS TO TELEHEALTH TECHNOLOGIES IN BEHAVIORAL HEALTH. IT IS SANFORD'S GOAL TO INCREASE THE NUMBER OF LOCAL PROVIDERS SERVICING THIEF RIVER FALLS THROUGH LOCALLY BASED PROVIDERS, OUTREACH FROM OTHER SANFORD FACILITIES, OR TELEHEALTH/VIRTUAL CARE PLATFORMS. INCREASED PROVIDERS WILL EXPAND THE NUMBER OF AVAILABLE SERVICES AND APPOINTMENTS AVAILABLE TO THE LOCAL COMMUNITY.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARMENTAL HEALTH IN 2023, SANFORD BEHAVIORAL HEALTH CENTER (SBHC) PROVIDED 131 EDUCATIONAL AND OUTREACH EVENTS. THIS INCLUDED WORKING WITH NORTHLAND COMMUNITY AND TECHNICAL COLLEGE TO PROVIDE DE-ESCALATION CLASSES AND PROVIDING MENTAL HEALTH EDUCATION AND SIMULATION LABS TO THE CRIMINAL JUSTICE PROGRAM. IN 2021, AS PART OF THE GOAL TO DEVELOP AND IMPLEMENT COMMUNITY STRATEGY FOR MENTAL HEALTH PROMOTION AND SUICIDE PREVENTION, SANFORD BEHAVIORAL HEALTH IDENTIFIED A CORE TEAM OF STAFF AND DEVELOPED A STRATEGY TO GROW A COMMUNITY COALITION FOR MENTAL HEALTH PROMOTION AND SUICIDE PREVENTION IN OUR COMMUNITY.IN JANUARY 2022, SANFORD BEHAVIORAL HEALTH BEGAN MEETING MONTHLY WITH COMMUNITY PARTNERS FROM TEN PUBLIC AND PRIVATE ENTITIES AROUND PENNINGTON COUNTY INCLUDING PUBLIC HEALTH, LAW ENFORCEMENT, FAITH COMMUNITY, EDUCATION, EMPLOYERS, HEALTH CARE, AND YOUTH ACTIVITIES. OVER THE PAST YEAR, SIX ADDITIONAL PARTNERS WERE ADDED, INCLUDING SCHOOL COUNSELORS, VIP, ADDITIONAL SCHOOL DISTRICT, MENTAL HEALTH PROVIDER, HIGH SCHOOL STUDENT, AND A SUICIDE LOSS SURVIVOR. THIS GROUP BECAME KNOWN AS "COMMUNITY STRONG AND IDENTIFIED OUR FOCUS ON YOUTH AND FAMILY EDUCATION. COMMUNITY STRONG ESTABLISHED BOTH A VISION AND MISSION STATEMENT TO ESTABLISH THE GROUPS GOALS OF SUPPORTING MENTAL WELL-BEING AND SUICIDE PREVENTION. IN 2022, IN PARTNERSHIP WITH COMMUNITY STRONG, SANFORD BEHAVIORAL HEALTH PROVIDED FOUR EDUCATIONAL EVENTS IN PENNINGTON COUNTY, WITH ADDITIONAL OUTREACH EVENTS.SBHC STAFF PROVIDED 8 SAFETALK TRAININGS THROUGHOUT THE REGION, WHICH IS A 4-HOUR TRAINING THAT EQUIPS PEOPLE TO BE MORE ALERT TO SOMEONE THINKING OF SUICIDE AND BETTER ABLE TO CONNECT THEM WITH FURTHER HELP. SBHC AND SANFORD HEALTH MEDICAL CENTER STAFF PARTNERED ALSO WITH COMMUNITY STRONG TO PROVIDE EDUCATION AND OUTREACH EVENTS AT SPORTS GAMES, TEENS TOWARD ZERO DEATHS, AS WELL AS HOSTING/SPONSORING THE ANNUAL BE THE VOICE EVENT IN THIEF RIVER FALLS. IN ADDITION, SBHC CONNECTED WITH VARIOUS OTHER AGENCIES, GROUPS, AND COMMUNITIES. SANFORD HEALTH MEDICAL CENTER IN PARTNERSHIP WITH SANFORD BEHAVIORAL HEALTH CENTER, WAS ABLE TO ENGAGE IN PATIENT REGISTRATION TECHNOLOGY THAT ALLOWS THE DEPLOYMENT OF DEPRESSION AND ANXIETY SCREENS AT APPOINTMENTS. THIS WENT LIVE IN LATE 2023 AND HAS ALREADY BEEN UTILIZED BY THOUSANDS OF PATIENTS. WE HAVE ALSO INCREASED ACCESS TO SUICIDE PREVENTION RESOURCES IN THE MEDICAL CLINIC BY TRAINING AND STAFFING A FULL-TIME INTEGRATIVE HEALTH THERAPIST (IHT) AT THE MEDICAL CLINIC. THIS POSITION SEES 6+ PATIENTS PER DAY AND HAS BEEN UTILIZED, AT LEAST MONTHLY, FOR PATIENTS WHO ARE IN SEVERE MENTAL HEALTH DISTRESS IN REAL-TIME. IN EARLY 2022, SANFORD BEHAVIORAL HEALTH IDENTIFIED KEY PERSONNEL TO DEVELOP A STRATEGY FOR IMPLEMENTING PARENTING RELATED SKILLS AS PART OF THE GOAL TO DEVELOP AND IMPLEMENT COMMUNITY EDUCATION FOR PARENTING RELATED SKILLS. IN MAY 2022, SANFORD BEHAVIORAL HEALTH USED ESTABLISHED RELATIONSHIPS THROUGH THE JUVENILE DIVERSION PROGRAM TO IDENTIFY PARTNERS TO JOIN THE EFFORT TO IMPLEMENT AND PROMOTE THIS EDUCATIONAL GROUP FOR PARENTS. THROUGH WORK WITH THE TRF POLICE DEPARTMENT, PENNINGTON COUNTY SOCIAL SERVICES, PENNINGTON COUNTY COURT AND COUNTY ATTORNEY, AND TRF SCHOOL DISTRICT, IT WAS IDENTIFIED THAT THE INITIAL TARGETED POPULATION OF THIS PARENTING SKILLS EDUCATION WOULD BE PARENTS OF CHILDREN IN THE JUVENILE DIVERSION PROGRAM, OR THE AGENCIES INVOLVED ARE IDENTIFIED AS ESCALATING IN CRIMINAL JUSTICE SYSTEM AND AT AN INCREASED NEED FOR SERVICES. IN LATE MAY, THE CURRICULUM USED WAS THE INCREDIBLE YEARS AND LOVE & LOGIC CURRICULUM. FACILITATORS WERE IDENTIFIED FROM SANFORD BEHAVIORAL HEALTH AND PENNINGTON COUNTY SOCIAL SERVICES. THE FIRST SIX-WEEK SESSION OF THE PARENTING SKILLS GROUP BEGAN IN OCTOBER OF 2022 WITH SIX FAMILIES COMPLETING THE TRAINING. IN 2023, THERE WERE FOUR SESSIONS CONDUCTED, THREE WERE SIX-WEEK SESSIONS AND ONE ALL DAY SATURDAY CLASS. THERE WERE 42 TOTAL REGISTRANTS AND 36 COMPLETED THE CLASS FOR AN 86% COMPLETION RATE. CLASSES HAVE RECEIVED POSITIVE FEEDBACK AND WILL CONTINUE TO BE PROVIDED.ACCESS TO HEALTHCARE PROVIDERSSANFORD BEHAVIORAL HEALTH HAS CONTINUED TO PROVIDE PATIENTS WITH FLEXIBILITY IN SCHEDULING APPOINTMENTS IN THE MANNER THAT BEST SUITS SCHEDULING AND CLINICAL NEEDS. THIS HAS ALSO ADDED FLEXIBILITY FOR PATIENTS WHO ARE HAVING TROUBLE ATTENDING THEIR APPOINTMENTS RELATED TO WEATHER, TRANSPORTATION, AND ILLNESS CONCERNS.AS PART OF THE EXPANDED PLATFORM AND ACCESS TO TELEHEALTH TECHNOLOGIES, SANFORD BEHAVIORAL HEALTH PROVIDES PATIENTS THE FLEXIBILITY OF SCHEDULING THEIR APPOINTMENT IN THE MANNER THAT BEST SUITS THEIR NEEDS, ACCORDING TO REGULATORY REQUIREMENTS AND WHAT IS IN THE PATIENT'S BEST INTEREST CLINICALLY. AS A RESULT, MORE THAN 40% OF APPOINTMENTS WERE TELEHEALTH VISITS IN 2022 AND 35% IN 2023. FOR PATIENTS WHO HAVE DIFFICULTY WITH TECHNOLOGY, SANFORD BEHAVIORAL HEALTH CENTER STAFF WILL PROVIDE EDUCATION ON HOW TO USE THE VIRTUAL PLATFORM FOR PATIENTS PREFERRING TELEHEALTH VISITS. THE GOAL OF A FULL-TIME DERMATOLOGY CLINIC FOR SANFORD HEALTH TRF STARTED BY HIRING A DERMATOLOGY NURSE PRACTITIONER IN APRIL 2021. THEY STARTED AFTER SIX MONTHS OF TRAINING WITH A DERMATOLOGIST IN GRAND FORDS. CY2022 FOCUSED ON BUILDING THE PRACTICE TO INCLUDE RESOURCES FOR SKIN TESTING, SKIN CHECKS, BIOPSIES, AND PROCEDURES ALONG WITH STAFFING AND SCHEDULING RESOURCES TO ACCOMMODATE PATIENT NEEDS. LOCAL DERMATOLOGY APPOINTMENTS WENT FROM MONTHLY OUTREACH, AROUND 40 APPOINTMENTS, TO FULLTIME COMMUNITY CLINIC, AROUND 140 APPOINTMENTS. PATIENT UTILIZATION FOR DERMATOLOGY SERVICES WAS SUSTAINED IN EARLY 2022, WHICH ALLOWED FOR SANFORD HEALTH MEDICAL CENTER AND CLINIC TO MAINTAIN DERMATOLOGY ACCESS. THE DERMATOLOGY NURSE PRACTITIONER INCREASED HER DAILY CAPACITY BY 14% IN 2023, AROUND 160 PATIENTS A MONTH. OUTREACH CONTINUES IN TWO ADDITIONAL COMMUNITIES, HALLOCK AND CROOKSTON, FOR FOUR FULL DAYS. WE HELD OUR ANNUAL FREE SKIN CHECKING EVENT SEEING OVER 100 PATIENTS IN APRIL 2023. WE ARE CONTINUING IN SCHOOL AGED SKIN HEALTH EDUCATION AND PROVIDE EDUCATION MATERIALS AT APPOINTMENTS. HELPING WITH THE PRACTICE AWARENESS AND PATIENT EDUCATION INCLUDED MARKETING THE NEW NURSE PRACTITIONER TO THE PUBLIC VIA TRADITIONAL AND SOCIAL MEDIA SOURCES, HOSTING FREE PUBLIC SKIN CHECK EVENTS, COMMUNITY OUTREACH WITH EMPLOYERS AND THE SCHOOL DISTRICT, AND PRODUCING AND DISTRIBUTING SKIN PREVENTION EDUCATIONAL MATERIALS.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO QUALITY HEALTHCAREAFFORDABLE HOUSINGLONG-TERM CAREPUBLIC TRANSPORTATIONSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS. GROUP A-FACILITY 25 -- SANFORD THIEF RIVER FALLS BEHAVIORAL HEA PART V, SECTION B, LINE 13H: OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE. GROUP A-FACILITY 25 -- SANFORD THIEF RIVER FALLS BEHAVIORAL HEA PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY 250 1 - SANFORD CLINIC ABERDEEN 3015 3RD AVENUE SE ABERDEEN SD 57401 MEDICAL CLINIC 2 - SANFORD CLINIC ABERDEEN SURGICAL CENTER 3015 3RD AVENUE SE ABERDEEN SD 57401 AMBULATORY SURGERY CENTER 3 - SANFORD HEALTH ADRIAN CLINIC 201 MAINE AVE ADRIAN SD 56110 RURAL HEALTH CLINIC 4 - SANFORD HEALTH BROADWAY CLINIC 1527 BROADWAY STREET ALEXANDRIA MN 56308 MEDICAL CLINIC 5 - SANFORD HEALTH EASTON PLACE CLINIC 510 - 22ND AVENUE E SUITE 602 ALEXANDRIA MN 56308 MEDICAL CLINIC 6 - SANFORD BAGLEY CLINIC 1656 CENTRAL ST W BAGLEY MN 56621 RURAL HEALTH CLINIC 7 - SANFORD BAGLEY EYE CENTER & OPTICAL 1656 CENTRAL ST W BAGLEY MN 56621 EYE CARE CENTER 8 - SANFORD TRACY BALATON CLINIC 551 HIGHWAY 14 E BALATON MN 56115 MEDICARE CERTIFIED RURAL HEALTH CLINIC 9 - SANFORD HEALTH BAUDETTE EYE CENTER 103 MAIN ST BAUDETTE MN 56623 EYE CARE CENTER 10 - SANFORD HEALTH NEILSON PLACE 1000 ANNE ST NW BEMIDJI MN 56601 SKILLED NURSING FACILITY 11 - SANFORD HEALTH WINDSONG 1000 ANNE ST NW BEMIDJI MN 56601 ASSISTED LIVING CENTER 12 - EDITH SANFORD BREAST CENTER BEMIDJI 1233 34TH ST NW BEMIDJI MN 56601 WOMEN'S HEALTH 13 - SANFORD BEMIDJI MAIN CLINIC 1233 34TH ST NW BEMIDJI MN 56601 MEDICAL CLINIC 14 - SANFORD JOE LUEKEN CANCER CENTER 1233 34TH ST NW BEMIDJI MN 56601 CANCER CENTER 15 - SANFORD BEMIDJI OTHOPEDICS & SPORTS MEDI 1300 ANNE STREET NW BEMIDJI MN 56601 MEDICAL CLINIC 16 - SANFORD DIALYSIS BEMIDJI 1300 ANNE STREET NW BEMIDJI MN 56601 DIALYSIS 17 - SANFORD BEMIDJI 1611 ANNE ST CLINIC 1611 ANNE ST NW BEMIDJI MN 56601 MEDICAL CLINIC 18 - SANFORD BEMIDJI EYE CENTER & OPTICAL 1611 ANNE ST NW BEMIDJI MN 56601 EYE CARE CENTER 19 - SANFORD BEMIDJI 1705 ANN ST CLINIC 1705 ANNE ST NW BEMIDJI MN 56601 MEDICAL CLINIC 20 - SANFORD BEHAVIORAL HEALTH HEADWATERS ACT 1705 ANNE ST NW BEMIDJI MN 56601 BEHAVIORAL HEALTH TREATMENT CENTER 21 - SANFORD HEALTH PRIMEWEST RESIDENTIAL 3124 HANNAH AVE NW BEMIDJI MN 56601 BEHAVIORAL HEALTH & ADDICTION CENTER 22 - SANFORD BEMIDJI HOME CARE & HOSPICE 3201 PINE RIDGE AVE NW BEMIDJI MN 56601 HOME CARE AND HOSPICE 23 - SANFORD BEMIDJI DOWNTOWN EYE CENTER & OP 506 BELTRAMI AVE NW BEMIDJI MN 56601 EYE CARE CENTER 24 - BAKER PARK INC 803 DEWEY AVENUE BEMIDJI MN 56601 ASSISTED LIVING CENTER 25 - SANFORD HEALTH TRILLIUM 930 ANNE STREET NW BEMIDJI MN 56601 ASSISTED LIVING CENTER 26 - SANFORD CLINIC BERESFORD 600 W CEDAR STREET BERESFORD SD 57004 RURAL HEALTH CLINIC 27 - SANFORD SOUTH CLINIC 1040 TACOMA AVE BISMARCK ND 58504 MEDICAL CLINIC 28 - SANFORD EAST INTERSTATE AVE CLINIC 1800 E INTERSTATE AVE BISMARCK ND 58503 MEDICAL CLINIC 29 - SANFORD SEVENTH & THAYER CLINIC 209 N 7TH STREET BISMARCK ND 58501 MEDICAL CLINIC 30 - SANFORD TOM & FRANCES LEACH BISMARCK DIA 209 N 7TH STREET BISMARCK ND 58501 DIALYSIS CENTER 31 - SANFORD CLINIC 222 N 7TH STREET BISMARCK ND 58501 MEDICAL CLINIC 32 - SANFORD ORTHOPEDIC & SPORTS MEDICINE 225 N 7TH STREET BISMARCK ND 58501 MEDICAL CLINIC 33 - SANFORD HEALTH CHIROPRACTICOCC MED CLIN 2603 E BROADWAY AVE BISMARCK ND 58501 MEDICAL CLINIC 34 - SANFORD NORTH CLINIC 2830 N WASHINGTON STREET BISMARCK ND 58503 MEDICAL CLINIC 35 - SANFORD BIRTH CENTER 300 N 7TH STREET BISMARCK ND 58501 BIRTH CENTER 36 - SANFORD CANCER CENTER BISMARCK 300 N 7TH STREET BISMARCK ND 58501 CANCER CENTER 37 - SANFORD STATE SREET CLINIC 3318 N 14TH STREET BISMARCK ND 58503 MEDICAL CLINIC 38 - SANFORD SEVENTH & ROSSER CLINIC 414 N 7TH STREET BISMARCK ND 58501 MEDICAL CLINIC 39 - BISMARCK CANCER CENTER 500 N 8TH STREET BISMARCK ND 58501 CANCER CENTER 40 - SANFORD FIFTH & BROADWAY CLINIC 515 E BROADWAY AVE BISMARCK ND 58501 MEDICAL CLINIC 41 - SANFORD SEVENTH & BROADWAY CLINIC 715 E BROADWAY AVE BISMARCK ND 58501 MEDICAL CLINIC 42 - SANFORD CHILDREN'S NORTH CLINIC 765 W INTERSTATE AVE BISMARCK ND 58503 CHILDREN'S CLINIC 43 - SANFORD BEMIDJI BLACKDUCK CLINIC 81 1ST ST NW BLACKDUCK MN 56630 MEDICAL CLINIC 44 - SANFORD BOYDEN CLINIC 3971 320TH ST BOYDEN IA 51234 MEDICAL CLINIC 45 - SANFORD BRANDON ACUTE CARE & ORTHO FAST 1105 E HOLLY BLVD BRANDON SD 57005 MEDICAL CLINIC 46 - SANFORD BRANDON FAMILY MEDICINE & CHILDR 1105 E HOLLY BLVD BRANDON SD 57005 MEDICAL CLINIC 47 - SANFORD HEALTH BROOKINGS CLINIC 922 - 22ND AVENUE S BROOKINGS SD 57006 MEDICAL CLINIC 48 - SANFORD CANBY DENTAL CLINIC 11 ST OLAF AVENUE S CANBY MN 56220 DENTAL CLINIC 49 - SANFORD CANBY CLINIC 112 ST OLAF AVENUE S CANBY MN 56220 MEDICARE CERTIFIED RURAL HEALTH CLINIC 50 - SANFORD CANBY DIALYSIS UNIT 112 ST OLAF AVENUE S CANBY MN 56220 MEDICARE CERTIFIED END STAGE RENAL DIALYSIS 51 - SANFORD CANBY MEDICAL CENTER 112 ST OLAF AVENUE S CANBY MN 56220 CLASS F HOME CARE PROVIDER 52 - SANFORD DIALYSIS CANBY 112 ST OLAF AVENUE S CANBY MN 56220 DIALYSIS 53 - SANFORD HEALTH CANBY SYLVAN PLACE 212 ST OLAF AVENUE S CANBY MN 56220 HOUSING WITH SERVICES 54 - SANFORD CANBY HOME CARE 213 ST OLAF AVENUE N CANBY MN 56220 MEDICARE CERTIFIED HOME HEALTH AGENCY 55 - SANFORD HEALTH CANISTOTAUSD CLINIC 320 W MAIN ST CANISTOTA SD 57012 RURAL HEALTH CLINIC 56 - SANFORD HEALTH CANTON HIAWATHA HEIGHTS 398 N HIAWATHA DRIVE CANTON SD 57013 ASSISTED LIVING CENTER 57 - SANFORD CANTON CLINIC 400 N HIAWATHA DRIVE CANTON SD 57013 RURAL HEALTH CLINIC 58 - SANFORD BEMIDJI CASS LAKE CLINIC 219 GRANT UTLEY AVE NW CASS LAKE MN 56633 MEDICAL CLINIC 59 - SANFORD HOME HEALTH & HOSPICE CHAMBERLAI 110 W BEEBE AVE CHAMBERLAIN SD 57325 HOME HEALTH CARE & HOSPICE 60 - SANFORD CHAMBERLAIN CLINIC 300 S BYRON BLVD CHAMBERLAIN SD 57325 RURAL HEALTH CLINIC 61 - SANFORD DIALYSIS 300 S BYRON BLVD CHAMBERLAIN SD 57325 DIALYSIS 62 - SANFORD HEALTH CHAMBERLAIN CARE CENTER 300 S BYRON BLVD CHAMBERLAIN SD 57325 NURSING FACILITY 63 - SANFORD HEALTH CLARK CLINIC 211 N COMMERCIAL STREET CLARK SD 57225 RURAL HEALTH CLINIC 64 - SANFORD CLEAR LAKE CLINIC 701 3RD AVENUE S CLEAR LAKE SD 57226 RURAL HEALTH CLINIC 65 - SANFORD CLEAR LAKE MEDICAL CENTER 701 3RD AVENUE S CLEAR LAKE SD 57226 HOME HEALTH CARE 66 - SANFORD BAGLEY CLEARBROOK CLINIC 22 ELM STREET CLEARBROOK MN 56634 RURAL HEALTH CLINIC 67 - SANFORD HEALTH DAKOTA DUNES CLINIC 350 OAK TREE LN DAKOTA DUNES SD 57049 MEDICAL CLINIC 68 - SANFORD HEALTH DELL RAPIDS ORCHARD HILLS 200 W 10TH STREET DELL RAPIDS SD 57022 ASSISTED LIVING CENTER 69 - SANFORD HEALTH DETROIT LAKES EYE CENTER 1234 WASHINGTON AVE SUITE A DETROIT LAKES MN 56501 EYE CARE CENTER 70 - SANFORD DIALYSIS 1234 WASHINGTON AVE SUITE B DETROIT LAKES MN 56501 DIALYSIS CENTER 71 - SANFORD HEALTH DETROIT LAKES CLINC & SAM 1245 WASHINGTON AVENUE DETROIT LAKES MN 56501 AMBULATORY SURGERY CENTER/CLINIC 72 - SANFORD HEALTH HEARING CENTER DICKINSON 1531 W VILLARD ST DICKINSON ND 58601 HEARING CENTER 73 - SANFORD HEALTH WEST DICKINSON CLINIC 2615 FAIRWAY STREET DICKINSON ND 58601 MEDICAL CLINIC 74 - SANFORD HEALTH EAST DICKINSON CLINIC 33 9TH ST W DICKINSON ND 58601 MEDICAL CLINIC 75 - SANFORD HOME CARE EAST GRAND FORKS 404 DEMERS AVE EAST GRAND FORKS MN 56721 HOME HEALTH CARE 76 - SANFORD HEALTH 621 DEMERS AVE CLINIC 621 DEMERS AVE NW EAST GRAND FORKS MN 56721 MEDICAL CLINIC 77 - SANFORD DERMATOLOGY CLINIC 625 DEMERS AVE NW EAST GRAND FORKS MN 56721 MEDICAL CLINIC 78 - SANFORD HEALTH 625 DEMERS AVE CLINIC 625 DEMERS AVE NW EAST GRAND FORKS MN 56721 MEDICAL CLINIC 79 - SANFORD HEALTH 929 CENTRAL AVE CLINIC 929 CENTRAL AVE EAST GRAND FORKS MN 56721 MEDICAL CLINIC 80 - SANFORD HEALTH EDGELEY CLINIC 506 2ND ST EDGELEY ND 58433 MEDICAL CLINIC 81 - SANFORD LUVERNE EDGERTON CLINIC 733 MAIN AVE EDGERTON MN 56128 RURAL HEALTH CLINIC 82 - SANFORD HEALTH ELLENDALE CLINIC 141 MAIN ST ELLENDALE ND 58436 RURAL HEALTH CLINIC 83 - SANFORD HEALTH ENDERLIN CLINIC 201 4TH AVENUE ENDERLIN ND 58027 RURAL HEALTH CLINIC 84 - SANFORD CLINIC ESTELLINE 305 HOSPITAL DRIVE ESTELLINE SD 57234 RURAL HEALTH CLINIC 85 - SANFORD CHILDREN'S CARE CLINIC 100 4TH STREET S FARGO ND 58103 CHILDREN'S CLINIC 86 - SANFORD HOME CARE FARGO 100 4TH STREET S FARGO ND 58103 HOME HEALTH AGENCY 87 - SANFORD REPRODUCTIVE MEDICINE CLINIC 1111 HARWOOD DRIVE S FARGO ND 58104 MEDICAL CLINIC 88 - SANFORD 1711 MEDICAL BUILDING 1711 UNIVERSITY DRIVE S FARGO ND 58103 MEDICAL CLINIC 89 - SANFORD SOUTH UNIVERSITY CLINIC 1717 S UNIVERSITY DR FARGO ND 58103 MEDICAL CLINIC 90 - SANFORD SOUTH UNIVERSITY EYE CENTER & OP 1717 S UNIVERSITY DR FARGO ND 58103 EYE CARE CENTER 91 - SANFORD FOOT AND ANKLE CLINIC 1720 S UNIVERSITY DR FARGO ND 58103 MEDICAL CLINIC 92 - SANFORD ORTHOPEDIC WALK-IN CLINIC FARGO 1720 S UNIVERSITY DR FARGO ND 58103 MEDICAL CLINIC 93 - SANFORD BRAIN & SPINE CENTER FARGO 2301 25TH ST S FARGO ND 58103 MEDICAL CLINIC 94 - SANFORD PAIN CENTER FARGO 2301 25TH ST S FARGO ND 58103 MEDICAL CLINIC 95 - SANFORD SOUTHPOINTE CLINIC 2400 32ND AVE S FARGO ND 58103 MEDICAL CLINIC 96 - SANFORD SOUTHPOINTE EYE CENTER & OPTICAL 2400 32ND AVE S FARGO ND 58103 EYE CARE CENTER 97 - SANFORD NORTH FARGO CLINIC 2601 BROADWAY N FARGO ND 58102 MEDICAL CLINIC 98 - SANFORD CHILDREN'S SOUTHWEST CLINIC 2701 13TH AVE S FARGO ND 58103 CHILDREN'S CLINIC 99 - SANFORD 2801 MEDICAL BUILDING 2801 S UNIVERSITY DRIVE FARGO ND 58122 MEDICAL CLINIC 100 - SANFORD DIALYSIS FARGO 2801 S UNIVERSITY DRIVE FARGO ND 58122 DIALYSIS 101 - SANFORD VETERANS SQUARE CLINIC 3955 56TH ST S FARGO ND 58104 MEDICAL CLINIC 102 - SANFORD DERMATOLOGY & LASER CLINIC 4656 40TH AVE S FARGO ND 58104 MEDICAL CLINIC 103 - SANFORD I-94 CLINIC 5225 23RD AVENUE SOUTH FARGO ND 58104 MEDICAL CLINIC 104 - SANFORD NEUROSCIENCE CLINIC 700 1ST AVE S FARGO ND 58103 MEDICAL CLINIC 105 - SANFORD BROADWAY MEDICAL BUILDING 736 BROADWAY N FARGO ND 58102 MEDICAL CLINIC 106 - EDITH SANFORD BREAST CENTER FARGO 737 BROADWAY N FARGO ND 58102 WOMEN'S HEALTH 107 - SANFORD CHILDREN'S BROADWAY CLINIC 737 BROADWAY N FARGO ND 58102 CHILDREN'S CLINIC 108 - SANFORD BROADWAY CLINIC 801 BROADWAY N FARGO ND 58102 MEDICAL CLINIC 109 - SANFORD ROGER MARIS CANCER CENTER 820 4TH STREET N FARGO ND 58102 CANCER CENTER 110 - SANFORD HEALTH FINLEY CLINIC 407 WASHINGTON AVE E FINLEY ND 58230 RURAL HEALTH CLINIC 111 - SANFORD HEALTH FORMAN CLINIC 336 MAIN ST FORMAN ND 58032 RURAL HEALTH CLINIC 112 - SANFORD DIALYSIS FORT YATES 10 N RIVER ROAD FORT YATES ND 58538 DIALYSIS CENTER 113 - SANFORD HEALTH FOSSTON EYE CENTER & OPTI 111 2ND ST NE FOSSTON MN 56542 EYE CARE CENTER 114 - SANFORD HEALTH GRAND FORKS CLINIC 1750 47TH AVE S GRAND FORKS ND 58201 MEDICAL CLINIC 115 - SANFORD HEALTH GWINNER CLINIC 69 HIGHWAY 13 W GWINNER ND 58040 MEDICAL CLINIC 116 - SANFORD HEALTH HALSTAD CLINIC 445 1ST STREET E HALSTAD MN 56548 RURAL HEALTH CLINIC 117 - SANFORD HEALTH HARTFORD CLINIC 905 N OAKS AVE HARTFORD SD 57033 MEDICAL CLINIC 118 - SANFORD SHELDON HARTLEY CLINIC 512 3RD ST NE HARTLEY IA 51346 MEDICAL CLINIC 119 - SANFORD HAWLEY CLINIC 1412 MAIN ST HAWLEY MN 56549 MEDICAL CLINIC 120 - SANFORD HEALTH COMSTOCK CORNER 12 3RD STREET SE HILLSBORO ND 58045 ASSISTED LIVING CENTER 121 - SANFORD HILLSBORO CARE CENTER 12 3RD STREET SE HILLSBORO ND 58045 HOSPITAL BASED-NURSING FACILITIES LTC 122 - SANFORD HEALTH HILLSBORO CLINIC 315 EAST CALEDONIA HILLSBORO ND 58045 RURAL HEALTH CLINIC 123 - SANFORD HEALTH DIALYSIS HOSPERS 112 SUNRISE DRIVE HOSPERS IA 51238 END STAGE RENAL DIALYSIS 124 - SANFORD HEALTH INTL FALLS EYE CENTER 1400 HIGHWAY 71 INTERNATIONAL FALLS MN 56649 EYE CARE CENTER 125 - SANFORD HEALTH INWOOD CLINIC 303 E JEFFERSON ST INWOOD IA 51240 MEDICAL CLINIC 126 - SANFORD CLINIC IPSWICH 110 5TH AVENUE IPSWICH SD 57451 RURAL HEALTH CLINIC 127 - SANFORD JACKSON CLINIC 1430 NORTH HIGHWAY JACKSON MN 56143 MEDICARE CERTIFIED RURAL HEALTH CLINIC 128 - SANFORD DIALYSIS JAMESTOWN 300 2ND AVENUE NE JAMESTOWN ND 58401 DIALYSIS CENTER 129 - SANFORD HEALTH JAMESTOWN 2ND AVE CLINIC 300 2ND AVENUE NE JAMESTOWN ND 58401 MEDICAL CLINIC 130 - SANFORD DIALYSIS JAMESTOWN 300 2ND AVENUE NE JAMESTOWN ND 58401 DIALYSIS 131 - SANFORD HEALTH HEARING CENTER JAMESTOWN 904 5TH AVE NE JAMESTOWN ND 58401 HEARING CENTER 132 - SANFORD HEALTH JAMESTOWN CLINIC 904 5TH AVE NE JAMESTOWN ND 58401 MEDICAL CLINIC 133 - SANFORD HEALTH KELLIHER CLINIC 243 CLARK AVE N KELLIHER MN 56650 MEDICAL CLINIC 134 - SANFORD HEALTH KIMBALL CLINIC 101 S MAIN ST KIMBALL SD 57355 RURAL HEALTH CLINIC 135 - SANFORD CHILDREN'S CLINIC 3001 DAGGETT ST KLAMATH FALLS OR 97601 MEDICAL CLINIC 136 - SANFORD HEALTH LAKE NORDEN CLINIC 512 MAIN AVE LAKE NORDEN SD 57248 RURAL HEALTH CLINIC 137 - SANFORD HEALTH LAKE PARK CLINIC 215 N MARKET ST LAKE PARK IA 51347 MEDICAL CLINIC 138 - SANFORD JACKSON LAKEFIELD CLINIC 209 MAIN STREET LAKEFIELD MN 56150 MEDICARE CERTIFIED RURAL HEALTH CLINIC 139 - SANFORD HEALTH LAMOURE CLINIC 100 1ST AVE SW LAMOURE ND 58458 RURAL HEALTH CLINIC 140 - SANFORD HEALTH LENNOX CLINIC 108 S MAIN LENNOX SD 57039 RURAL HEALTH CLINIC 141 - SANFORD HEALTH LIDGERWOOD CLINIC 21 WILEY AVE S LIDGERWOOD ND 58053 MEDICAL CLINIC 142 - SANFORD HEALTH LISBON CLINIC 102 10TH AVE W LISBON ND 58054 MEDICAL CLINIC 143 - SANFORD HOME CARE LISBON 404 FOREST ST LISBON ND 58054 HOME HEALTH CARE 144 - SANFORD LUVERNE CLINIC 1601 SIOUX VALLEY DR LUVERNE MN 56156 MEDICAL CLINIC 145 - SANFORD LUVERNE HOSPICE 217 N OAKLEY ST LUVERNE MN 56156 MEDICARE CERTIFIED HOSPICE 146 - SANFORD HOME HEALTH LUVERNE 304 N MCKENZIE ST LUVERNE MN 56156 HOME HEALTH CARE 147 - SANFORD DIALYSIS 323 SW 10TH STREET MADISON SD 57042 END STAGE RENAL DIALYSIS 148 - SANFORD HOSPICE MADISON 900 2ND AVENUE MADISON MN 56256 HOSPICE (LICENSED IN SD) 149 - SANFORD HEALTH MAHNOMEN CLINIC 410 W 4TH ST MAHNOMEN MN 56557 RURAL HEALTH CLINIC 150 - SANFORD HOME CARE MAHNOMEN 414 W JEFFERSON AVE MAHNOMEN MN 56557 HOME HEALTH CARE 151 - SANFORD EAST MANDAN CLINIC 102 MANDAN AVE MANDAN ND 58554 MEDICAL CLINIC 152 - SANFORD HOME CARE BISMARCK 910 18TH STREET NW MANDAN ND 58554 HOME HEALTH AGENCY 153 - SANFORD NORTH MANDAN CLINIC 910 18TH STREET NW MANDAN ND 58554 MEDICAL CLINIC 154 - SANFORD HOME CARE MAYVILLE 49 7TH AVE SE MAYVILLE ND 58257 HOME HEALTH CARE 155 - SANFORD MAYVILLE CLINIC 600 1ST ST SE MAYVILLE ND 58257 MEDICAL CLINIC 156 - SANFORD HEALTH NORTHWEST CLINIC 1500 21ST AVE NW MINOT ND 58701 MEDICA 157 - SANFORD HEALTH HIGHWAY 2 CLINIC 801 21ST AVE SE MINOT ND 58701 MEDICAL CLINIC 158 - SANFORD HEALTH MITCHELL CLINIC 2100 HIGHLAND WAY MITCHELL SD 57301 MEDICAL CLINIC 159 - SANFORD MOORHEAD CAMPUS 4000 28TH AVE S MOORHEAD MN 56560 MEDICAL CLINIC 160 - SANFORD DIALYSIS MORRIS 400 1ST STREET EAST MORRIS MN 56267 DIALYSIS 161 - SANFORD HEALTH MOUNTAIN LAKE CLINIC 308 N 8TH STREET MOUNTAIN LAKE MN 56159 MEDICARE CERTIFIED RURAL HEALTH CLINIC 162 - SANFORD HEALTH OAKES CLINIC 420 7TH ST S OAKES ND 58474 MEDICAL CLINIC 163 - SANFORD CHILDREN'S CLINIC 3605 VISTA WAY OCEANSIDE CA 92056 CHILDREN'S CLINIC 164 - SANFORD HEALTH PARK RAPIDS CLINIC 110 7TH ST W PARK RAPIDS MN 56470 MEDICAL CLINIC 165 - SANFORD HEALTH PARKERS PRAIRIE CLINIC 115 E SOO STREET PARKERS PRAIRIE MN 56361 MEDICAL CLINIC 166 - SANFORD HEALTH PELICAN RAPIDS CLINIC 211 EAST MILL STREET PELICAN RAPIDS MN 56572 RURAL HEALTH CLINIC 167 - SANFORD HOME CARE PELICAN RAPIDS 211 EAST MILL STREET PELICAN RAPIDS MN 56572 HOME HEALTH CARE 168 - SANFORD HEALTH PIERRE CLINIC 521 E SIOUX AVE PIERRE SD 57501 MEDICAL CLINIC 169 - SANFORD VERMILLION PONCA CLINIC 111 E 2ND STREET PONCA NE 68770 MEDICAL CLINIC 170 - SANFORD DIALYSIS RED LAKE 24760 HOSPITAL DRIVE RED LAKE MN 56671 DIALYSIS 171 - SANFORD ROCK RAPIDS CLINIC 104 BUNCOMBE DRIVE ROCK RAPIDS IA 51246 RURAL HEALTH CLINIC 172 - SANFORD SHELDON SANBORN CLINIC 321 MAIN STREET SANBORN IA 51248 MEDICAL CLINIC 173 - SANFORD HEALTH SHELDON CARE CENTER 118 NORTH SEVENTH AVENUE PO BOX 250 SHELDON IA 51201 HOSPITAL BASED-NURSING FACILITIES 174 - SANFORD SHELDON HOME HEALTH & HOSPICE 118 NORTH SEVENTH AVENUE PO BOX 250 SHELDON IA 51201 HOME HEALTH AGENCY AND HOSPICE 175 - SANFORD SHELDON CLINIC 800 OAK STREET SHELDON IA 51201 RURAL HEALTH CLINIC 176 - SANFORD CHILDREN'S MB2 CLINIC 1205 S GRANGE AVE SIOUX FALLS SD 57105 CHILDREN'S CLINIC 177 - SANFORD HEALTH MB2 CLINIC 1205 S GRANGE AVE SIOUX FALLS SD 57105 MEDICAL CLINIC 178 - SANFORD VAN DEMARK CLINIC 1210 W 18TH STREET SIOUX FALLS SD 57104 MEDICAL CLINIC 179 - SANFORD CARDIOVASCULAR INSTITUTE 1301 W 18TH STREET SIOUX FALLS SD 57105 MEDICAL CLINIC 180 - SANFORD DIABETES & THYROID CLINIC 1305 W 18TH STREET SIOUX FALLS SD 57105 MEDICAL CLINIC 181 - SANFORD VASCULAR ASSOCIATES 1305 W 18TH STREET SIOUX FALLS SD 57105 MEDICAL CLINIC 182 - SANFORD CANCER CENTER 1309 W 17TH ST SIOUX FALLS SD 57104 CANCER CENTER 183 - SANFORD DERMATOLOGY CLINIC 1310 W 22ND STREET SIOUX FALLS SD 57105 MEDICAL CLINIC 184 - SANFORD EAR NOSE AND THROAT CLINIC 1310 W 22ND STREET SIOUX FALLS SD 57105 MEDICAL CLINIC 185 - AVA'S HOUSE 1320 W 17TH STREET SIOUX FALLS SD 57104 HOSPICE 186 - SANFORD DIALYSIS SIOUX FALLS 1321 W 22ND STREET SIOUX FALLS SD 57117 DIALYSIS CENTER 187 - SANFORD IMAGENETICS 1321 W 22ND STREET SIOUX FALLS SD 57117 GENETICS 188 - SANFORD INTERNAL MEDICINE CLINIC 1321 W 22ND STREET SIOUX FALLS SD 57117 MEDICAL CLINIC 189 - SANFORD 10TH & PHILLIPS ACUTE CARE & ORT 136 S PHILLIPS AVE SIOUX FALLS SD 57104 MEDICAL CLINIC 190 - SANFORD MATERNAL-FETAL MEDICINE 1500 W 22ND STREET SIOUX FALLS SD 57105 MEDICAL CLINIC 191 - SANFORD OBSTETRICS & GYNECOLOGY CLINIC 1500 W 22ND STREET SIOUX FALLS SD 57105 MEDICAL CLINIC 192 - THE BIRTH PLACE 1500 W 22ND STREET SIOUX FALLS SD 57105 BIRTH CENTER 193 - SANFORD SURGICAL ASSOCIATES 1508 W 22ND STREET SIOUX FALLS SD 57105 AMBULATORY SURGERY CENTER/CLINIC 194 - SANFORD CHILDREN'S SPECIALTY CLINIC 1600 W 22ND STREET SIOUX FALLS SD 57117 CHILDREN'S CLINIC 195 - SANFORD EYE CENTER & OPTICAL 1621 S MINNESOTA AVE SIOUX FALLS SD 57105 EYE CARE CENTER 196 - SANFORD HEALTH EYE CLINIC 2310 S MARION RD 140 SIOUX FALLS SD 57106 EYE CARE CENTER 197 - SANFORD PSYCHIATRY & PSYCHOLOGY CLINIC 2400 W 49TH STREET SIOUX FALLS SD 57105 MEDICAL CLINIC 198 - SANFORD 32ND & ELLIS CLINIC 2601 S ELLIS ROAD SIOUX FALLS SD 57106 MEDICAL CLINIC 199 - SANFORD USD 34TH & KIWANIS FAMILY MEDICI 2701 S KIWANIS AVE SIOUX FALLS SD 57105 MEDICAL CLINIC 200 - SANFORD HOME HEALTH SIOUX FALLS 2710 WEST 12TH STREET SIOUX FALLS SD 57104 HOME HEALTH CARE 201 - SANFORD HOSPICE SIOUX FALLS 2710 WEST 12TH STREET SIOUX FALLS SD 57104 HOSPICE (LICENSED IN MN AND SD) 202 - SANFORD 49TH & OXBOW FAMILY MEDICINE 3401 W 49TH STREET SIOUX FALLS SD 57106 MEDICAL CLINIC 203 - SANFORD ACUTE CARE AND ORTHOPEDIC FAST TRA 4000 N HERCULES AVE SIOUX FALLS SD 57110 MEDICAL CLINIC 204 - SANFORD 26TH & SYCAMORE FAMILY MEDICINE 4405 E 26TH ST SIOUX FALLS SD 57103 MEDICAL CLINIC 205 - SANFORD WOMEN'S PRIMARY CARE CLINIC 5019 S WESTERN AVE SIOUX FALLS SD 57108 MEDICAL CLINIC 206 - SANFORD MADISON AND VETERANS PARKWAY 5920 E MADISON ST SIOUX FALLS SD 57110 MEDICAL CLINIC 207 - SANFORD 4TH & SYCAMORE FAMILY MEDICINE 600 N SYCAMORE AVE SIOUX FALLS SD 57110 MEDICAL CLINIC 208 - SANFORD 69TH & LOUISE FAMILY MEDICINE 6101 S LOUISE AVE SIOUX FALLS SD 57108 MEDICAL CLINIC 209 - SANFORD CHILDREN'S RESIDENCY CLINIC 6101 S LOUISE AVE SIOUX FALLS SD 57108 CHILDREN'S CLINIC 210 - SANFORD 69TH & MINNESOTA FAMILY MEDICINE 6110 S MINNESOTA AVE SIOUX FALLS SD 57108 MEDICAL CLINIC 211 - SANFORD BEHAVIORAL HEALTH OUTPATIENT CLI 120 LABREE AVENUE S THIEF RIVER FALLS MN 56701 BEHAVIORAL HEALTH TREATMENT CENTER 212 - SANFORD DIALYSIS THIEF RIVER FALLS 120 LABREE AVENUE S THIEF RIVER FALLS MN 56701 DIALYSIS 213 - SANFORD HEALTH THIEF RIVER FALLS EYE CEN 1720 HIGHWAY 59 S THIEF RIVER FALLS MN 56701 EYE CARE CENTER 214 - SANFORD HEALTH THIEF RIVER FALLS SOUTHEA 1720 HIGHWAY 59 S THIEF RIVER FALLS MN 56701 MEDICAL CLINIC 215 - SANFORD THIEF RIVER FALLS CLINIC 3001 SANFORD PKWY THIEF RIVER FALLS MN 56701 MEDICAL CLINIC 216 - NORTHERN LIGHTS COMMUNITY RESIDENCE 921 ATLANTIC AVE N THIEF RIVER FALLS MN 56701 RESIDENTIAL BEHAVIORAL HEALTH 217 - SANFORD TRACY CLINIC 249 FIFTH STREET E TRACY MN 56175 MEDICARE CERTIFIED RURAL HEALTH CLINIC 218 - SHETEK HOME CARE SERVICES 251 5TH ST E TRACY MN 56175 HOME HEALTH CARE 219 - SANFORD HEALTH TRACY O'BRIEN COURT 410 STATE STREET TRACY MN 56175 HOUSING WITH SERVICES 220 - SANFORD HEALTH TWIN VALLEY CLINIC 501 2ND ST NW TWIN VALLEY MN 56584 RURAL HEALTH CLINIC 221 - SANFORD HEALTH ULEN CLINIC 108 VIKING AVENUE W ULEN MN 56585 RURAL HEALTH CLINIC 222 - SANFORD HEALTH VALLEY CITY CLINIC 520 CHAUTAUQUA BLVD VALLEY CITY ND 58072 MEDICAL CLINIC 223 - SANFORD HEALTH VERMILLION CARE CENTER 125 WALKER STREET VERMILLION SD 57069 NURSING FACILITY 224 - SANFORD HEALTH VERMILLION DAKOTA GERDENS 126 S PLUM STREET VERMILLION SD 57069 RESIDENTIAL LIVING CENTER 225 - SANFORD VERMILLION CLINIC 20 S PLUM STREET VERMILLION SD 56069 MEDICAL CLINIC 226 - SANFORD HOSPICE VERMILLION 848 EAST CHERRY STREET VERMILLION SD 57069 HOSPICE 227 - SANFORD DIALYSIS 111 WASHINGTON AVE NW WAGNER SD 57380 DIALYSIS CENTER 228 - SANFORD HEALTH WAHPETON PT & PSYCHOLOGY 123 2ND AVE N WAHPETON ND 58075 MEDICAL CLINIC 229 - SANFORD HEALTH WAHPETON CLINIC 332 2ND AVE N WAHPETON ND 58075 MEDICAL CLINIC 230 - SANFORD HEALTH WAHPETON EYE CENTER & OPT 332 2ND AVE N WAHPETON ND 58075 EYE CARE CENTER 231 - SANFORD HEALTH WALKER REHAB 106 5TH ST S WALKER MN 56484 REHABILITATIVE SERVICES 232 - SANFORD HEALTH WALKER CLINIC 614 MICHIGAN AVENUE WALKER MN 56484 RURAL HEALTH CLINIC 233 - SANFORD TRACY WALNUT GROVE CLINIC 810 8TH ST WALNUT GROVE MN 56180 MEDICARE CERTIFIED RURAL HEALTH CLINIC 234 - SANFORD HEALTH WATERTOWN CLINIC 901 4TH STREET NW WATERTOWN SD 57201 MEDICAL CLINIC 235 - SANFORD HEALTH HEARING CENTER 116 8TH STREET NE WATFORD CITY ND 58854 HEARING CENTER 236 - SANFORD HEALTH WATFORD CITY CLINIC 709 4TH AVE NE WATFORD CITY ND 58854 MEDICAL CLINIC 237 - SANFORD WEBSTER CLINIC 101 PEABODY DRIVE WEBSTER SD 57274 RURAL HEALTH CLINIC 238 - SANFORD WEST FARGO CLINIC 1220 SHEYENNE STREET WEST FARGO ND 58078 MEDICAL CLINIC 239 - SANFORD HEALTH WESTROOK PETERSON ESTATES 1012 9TH STREET WESTBROOK MN 56183 HOUSING WITH SERVICES 240 - SANFORD WESTBROOK CLINIC 920 BELL AVENUE WESTBROOK MN 56183 MEDICARE CERTIFIED RURAL HEALTH CLINIC 241 - SANFORD WHEATON CLINIC 401 12TH ST N WHEATON MN 56926 RURAL HEALTH CLINIC 242 - SANFORD HOME CARE WHEATON 405 12TH ST N WHEATON MN 56926 HOME HEALTH CARE 243 - SANFORD CLINIC WINDOM 591 2ND AVENUE N WINDOM MN 56101 MEDICARE CERTIFIED RURAL HEALTH CLINIC 244 - SANFORD HOSPICE WINNER 745 E 8TH STREET WINNER SD 57580 HOSPICE 245 - SANFORD DIALYSIS 1018 SIXTH AVENUE WORTHINGTON MN 56187 DIALYSIS CENTER 246 - SANFORD HEALTH CANCER CENTER 1018 SIXTH AVENUE WORTHINGTON MN 56187 CANCER CENTER 247 - SANFORD WORTHINGTON MEDICAL CENTER 1018 SIXTH AVENUE WORTHINGTON MN 56187 MEDICARE CERTIFIED END STAGE RENAL DIALYSIS 248 - SANFORD WORTHINGTON OBGYN CLINIC 1018 SIXTH AVENUE WORTHINGTON MN 56187 MEDICAL CLINIC 249 - SANFORD WORTHINGTON CLINIC 1680 DIAGONAL ROAD WORTHINGTON MN 56187 MEDICAL CLINIC 250 - SANFORD HOSPICE WORTHINGTON 1935 WOODLAND CT WORTHINGTON MN 56187 HOSPICE (LICENSED IN SD) PART I, LINE 3C: SANFORD HEALTH DOES NOT DENY CARE TO ANYONE BASED ON THE ABILITY TO PAY. SANFORD'S FINANCIAL ASSISTANCE (CHARITY CARE) POLICY PROVIDES DISCOUNTED AND FREE SERVICES TO PATIENTS WHO LACK THE RESOURCES TO BE FULLY RESPONSIBLE FOR THE HEALTHCARE THEY RECEIVE. THE FINANCIAL ASSISTANCE POLICY IS DESIGNED TO ENSURE THE ENTIRE COMMUNITY SERVED BY SANFORD HAS ACCESS TO NEEDED HEALTHCARE SERVICES. ELIGIBILITY FOR DISCOUNTED OR FREE SERVICES UNDER THE FINANCIAL ASSISTANCE POLICY IS BASED ON INCOME LEVELS AND FAMILY SIZE. GENERALLY, INDIVIDUALS EARNING INCOME OF UP TO 375% OF THE FEDERAL POVERTY INCOME GUIDELINES ARE ELIGIBLE FOR VARYING LEVELS OF DISCOUNTS, INCLUDING FULL DISCOUNTS FOR CERTAIN INCOME LEVELS. APPLICATIONS FOR COVERAGE UNDER THE PROGRAM MAY BE OBTAINED AT ANY SANFORD PATIENT REGISTRATION AREA.THE PRIMARY SCOPE OF SANFORD'S FINANCIAL ASSISTANCE MATRIX CONSIDERS FAMILY INCOME AND FAMILY SIZE TO OBJECTIVELY DETERMINE FINANCIAL NEED. THE FAMILY INCOME RANGE VARIES FROM 0-225% UP TO 375% OF THE FEDERAL POVERTY LEVEL (FPL). AN APPLICANT OVER 375% MAY BE ELIGIBLE FOR SOME LEVEL OF FINANCIAL ASSISTANCE BASED ON A REVIEW OF ADDITIONAL FACTORS SUCH AS: THE SIZE OF THE ACCOUNT BALANCE, DEBT-TO-INCOME RATIO, CURRENT ASSETS, CURRENT LIABILITIES, IRS FOOD EXPENSE ALLOWANCES, MONTHLY CASH FLOW, ETC.ADDITIONALLY, IT IS POSSIBLE FOR A FAMILY TO QUALIFY IN ONE SEGMENT (BASED ON INCOME AND FAMILY SIZE ALONE) BUT BE MOVED TO A MORE GENEROUS (FOR THE PATIENT) SEGMENT BASED ON THE OTHER FINANCIAL VARIABLES MENTIONED ABOVE. AN APPLICANT MAY BE DENIED IF THEY HAVE SUBSTANTIAL ASSETS AND APPLICANTS ARE CONSIDERED ON A CASE BY CASE BASIS.THE AMOUNT GENERALLY BILLED (AGB) DISCOUNT PERCENTAGE IS THE LEAST AMOUNT SANFORD CAN DISCOUNT FOR ANY PATIENT QUALIFYING UNDER THE SANFORD FINANCIAL ASSISTANCE POLICY. IT IS THE PERCENTAGE USED FOR THE LOWEST LEVEL OF ASSISTANCE GRANTED FOR THOSE QUALIFYING UNDER THE SANFORD FINANCIAL ASSISTANCE POLICY AS LISTED ON APPENDIX 1 - SLIDING DISCOUNT SCHEDULE FOR ASSISTANCE. ANYONE ELSE QUALIFYING FOR ASSISTANCE AT GREATER LEVELS WILL RECEIVE DISCOUNT AMOUNTS GREATER THAN THE SANFORD AGB DISCOUNT AMOUNT. PART I, LINE 5B: SANFORD AS A WHOLE DID NOT EXCEED ITS FINANCIAL ASSISTANCE BUDGET FOR CY 2023, HOWEVER, IF THEY WOULD HAVE EXCEEDED THEIR BUDGET IT WOULD NOT IMPACT THEIR ABILITY TO SERVE ANY PATIENTS AND NO PATIENTS WOULD BE DISALLOWED SERVICES. THE ORGANIZATION PROVIDED FREE OR DISCOUNTED SERVICES TO PATIENTS WHO WERE ELIGIBLE FOR FREE OR DISCOUNTED CARE.PART I, LINE 6: SANFORD HEALTH'S COMMUNITY BENEFIT ANNUAL REPORT IS POSTED ANNUALLY ON THE SANFORD WEBSITE AT:HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT PART I, LINE 7: COST TO CHARGE RATIOS ARE USED TO CALCULATE THE AMOUNTS ON LINE 7A - 7C (FINANCIAL ASSISTANCE, MEDICAID SHORTFALL, AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS) AND ALSO LINE 7G (SUBSIDIZED HEALTH SERVICES) FOR EACH OF THE SUBSIDIARIES INCLUDED IN THE RETURN. ALL OTHER AMOUNTS FOR LINES 7E, 7F, 7H AND 7I WOULD COME FROM THE BOOKS AND RECORDS OF SPECIFIC SEGMENTS OF THE ORGANIZATION AND WOULD NOT BE BASED ON A COST TO CHARGE RATIO, OR SIMILAR COST ACCOUNTING METHODOLOGY. THESE COSTS STILL REPRESENT THE COSTS TO PROVIDE BENEFITS. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES ARE CLINICAL SERVICES PROVIDED TO BOTH INPATIENTS AND OUTPATIENTS DESPITE A FINANCIAL LOSS TO SANFORD. EACH LOSS HAS BEEN CALCULATED AFTER REMOVING LOSSES ASSOCIATED WITH BAD DEBTS, FINANCIAL ASSISTANCE AND MEDICAID. ALTHOUGH THESE SERVICES GENERATE OVERALL LOSSES TO SANFORD, THEY CONTINUE TO MEET THE NEEDS OF THE COMMUNITIES SERVED. VARIOUS SERVICES THAT GENERATE LOSSES ARE PROVIDED BY SANFORD THROUGH PHYSICIAN PRACTICES. FOR CY 2023, SUBSIDIZED HEALTH SERVICES PROVIDED THROUGH CLINIC PHYSICIAN PRACTICES GENERATED LOSSES OF $245,298,414. PART II, COMMUNITY BUILDING ACTIVITIES: SANFORD HEALTH IS A NOT-FOR-PROFIT ORGANIZATION DEDICATED TO THE WORK OF HEALTH AND HEALING FOR THE PUBLIC GOOD. SANFORD IS COMMITTED TO GIVING BACK TO THE COMMUNITIES IN WHICH ITS EMPLOYEES AND PATIENTS LIVE AND WORK. SANFORD INVESTS RESOURCES IN ORDER TO PRODUCE THE BEST OUTCOMES FOR PATIENT CARE, EDUCATION, RESEARCH, AND COMMUNITY ENRICHMENT, AND PARTNERS WITH OTHERS TO ENSURE THAT THE COMMUNITY IS A WELCOMING, HEALTHY ENVIRONMENT AND ONE THAT ATTRACTS AND SUSTAINS A DIVERSE SANFORD WORKFORCE TO DELIVER THE BEST PATIENT CARE AND MUCH NEEDED MEDICAL RESEARCH. SANFORD CONSIDERS REQUESTS FOR FUNDING AND IN KIND SUPPORT FOR NEW AND ONGOING PROGRAMS WITH ALL AREAS SUPPORTING THE ABOVE GOALS, SUCH AS BASIC HUMAN SERVICES, EDUCATION AND WORKFORCE DEVELOPMENT BY RECRUITING PHYSICIANS AND OTHER HEALTH PROFESSIONALS TO MEDICAL SHORTAGE OR UNDERSERVED AREAS AND COLLABORATING WITH EDUCATIONAL INSTITUTIONS TO TRAIN AND RECRUIT HEALTH PROFESSIONALS, ADVOCATING COMMUNITY HEALTH IMPROVEMENT THROUGH EFFORTS TO SUPPORT POLICIES AND PROGRAMS THAT SAFEGUARD OR IMPROVE PUBLIC HEALTH AND HELP TO ENSURE ACCESS TO HEALTH CARE SERVICES. PART III, LINE 2: BAD DEBT EXPENSE AT COST IS DETERMINED USING THE SAME COST TO CHARGE RATIOS THAT ARE USED TO CALCULATE FINANCIAL ASSISTANCE AND MEDICAID SHORTFALL. DISCOUNTS AND ALLOWANCES ARE ACCOUNTED FOR SEPARATELY FROM BAD DEBT EXPENSE. PART III, LINE 3: IT IS SANFORD'S POLICY TO MAKE FINANCIAL ASSISTANCE AVAILABLE TO PATIENTS WHO FIT THE FINANCIAL ASSISTANCE CRITERIA. IT IS THE ORGANIZATION'S GOAL TO MAKE CERTAIN THAT SANFORD IS PROACTIVE IN IDENTIFICATION OF THE PATIENTS WHO NEED HELP WITH FINANCIAL CONCERNS. FINANCIAL COUNSELORS MAKE EVERY EFFORT TO ENSURE THAT FINANCIAL ASSISTANCE ELIGIBLE PATIENTS DO NOT PROGRESS TO BAD DEBT. FOR THIS REASON, A DOLLAR AMOUNT FOR BAD DEBT IS NOT INCLUDED. PART III, LINE 4: THE AUDITED FINANCIAL STATEMENTS (AFS) OF SANFORD INCLUDE A BAD DEBT FOOTNOTE. SEE FOOTNOTE 3 ON PAGES 17 - 19 OF THE AFS. SANFORD REPORTS BAD DEBT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). PART III, LINE 8: PER IRS INSTRUCTIONS, SANFORD HAS IDENTIFIED THE COST ASSOCIATED WITH PROVIDING MEDICARE SERVICES FROM THE MEDICARE COST REPORT. THE MEDICARE COST REPORT CALCULATIONS ARE TOTAL EXPENSE LESS EXPENSES DEEMED "UNALLOWABLE" PER MEDICARE REGULATIONS. THE NET EXPENSE IS THEN USED TO CALCULATE THE COST PER DAY AND COST TO CHARGE RATIOS WHICH ARE MULTIPLIED BY THE MEDICARE DAYS AND ANCILLARY CHARGES TO DETERMINE THE COST OF PROVIDING MEDICARE SERVICES. IF ALL EXPENSES THAT SANFORD INCURRED WERE INCLUDED ON THE MEDICARE COST REPORT; THIS WOULD SHOW A SHORTFALL OF APPROXIMATELY $657,786,189. SANFORD BELIEVES THIS SHORTFALL SHOULD BE CONSIDERED COMMUNITY BENEFIT BECAUSE THESE SERVICES WOULD NEED TO BE PROVIDED BY EITHER ANOTHER CHARITABLE ORGANIZATION OR THE GOVERNMENT IF IT WAS NOT PROVIDED BY SANFORD. PART III, LINE 9B: SANFORD WILL PROVIDE SERVICES AT NO COST OR REDUCED COST TO PATIENTS WHO QUALIFY FOR THE PROGRAM. PATIENTS WITH INCOMES AT OR BELOW 225% OF THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES POVERTY GUIDELINE WILL RECEIVE A 100% REDUCTION OF THEIR PAYMENT RESPONSIBILITY. PATIENTS WITH INCOME BETWEEN 225% - 375% OF THE POVERTY GUIDELINE WILL BE GIVEN A DISCOUNT BASED ON A SLIDING SCALE AND ASSETS ARE CONSIDERED IN THE CALCULATION OF THE INCOME OF THE PATIENT, WITH THE EXCEPTION OF THE PATIENT'S PRINCIPAL RESIDENCE. PATIENTS ABOVE 375% OF THE FPG WILL BE REVIEWED FOR ADDITIONAL FACTORS SUCH AS SIZE OF MEDICAL DEBT BEFORE A FINAL DETERMINATION. PATIENTS MUST MAKE THEIR FINANCIAL NEED KNOWN TO APPROPRIATE PERSONNEL AND BE ENGAGED IN FILING APPROPRIATE AND COMPLETE APPLICATIONS. THE PROGRAM IS AVAILABLE TO THOSE PATIENTS WITHOUT HEALTH CARE BENEFITS FROM ANY SOURCE AS WELL AS TO THOSE WHO HAVE COVERAGE FOR HEALTH CARE COSTS THROUGH A GOVERNMENT PROGRAM, COMMERCIAL INSURANCE, OR OTHER HEALTH BENEFIT PLAN BUT CONTINUE TO HAVE A REMAINING BALANCE AFTER BENEFITS HAVE BEEN APPLIED TO THE CHARGES. SANFORD WILL NOT DENY FINANCIAL ASSISTANCE BASED ON RACE, CREED, SEX, GENDER IDENTITY, NATIONAL ORIGIN, HANDICAP OR AGE.EVERY EFFORT IS MADE TO IDENTIFY PATIENTS WITH FINANCIAL NEED AS EARLY AS POSSIBLE IN THE REVENUE CYCLE.SANFORD HAS ZERO TOLERANCE FOR ABUSIVE, HARASSING, OPPRESSIVE, FALSE, DECEPTIVE, OR MISLEADING LANGUAGE OF COLLECTIONS CONDUCT. THIS ZERO TOLERANCE APPLIES TO INTERNAL SANFORD STAFF AND THIRD PARTY COLLECTION VENDORS AND ATTORNEYS.NEITHER SANFORD NOR ANY OF ITS THIRD PARTY COLLECTION VENDORS WILL TAKE ANY EXTRAORDINARY COLLECTION EFFORTS UNTIL SANFORD AND THE THIRD PARTY COLLECTION VENDOR HAVE MADE REASONABLE EFFORTS TO DETERMINE IF A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY. PART VI, LINE 2: SANFORD HEALTH REGULARLY UTILIZES A BROAD ARRAY OF RESOURCES AND PARTNERS TO ASSESS AND DELIVER CARE TO THE COMMUNITIES SERVED BY THE SYSTEM. ASSESSMENT AND, BY EXTENSION, COMMUNITY ENGAGEMENT, IS A COMPOSITE, PARTNER-DRIVEN APPROACH.WITHIN THE CONTEXT OF THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS, THE SYSTEM RELIES UPON A MULTI-STEP, MULTI-MODAL APPROACH THAT MINIMIZES THE INHERENT LIMITATIONS OF ANY GIVEN ASSESSMENT TOOL AND INCREASES THE POINTS OF CONTACT FOR COMMUNITY MEMBERS TO SHARE DIRECT INSIGHTS INTO THE PROCESS. STEP ONE OF THE CHNA IS ENGAGEMENT WITH OTHER HEALTH SYSTEMS IN THE COMMUNITIES IN WHICH SANFORD AND ANOTHER HEALTH SYSTEM BOTH OPERATE. ADDITIONALLY, SANFORD ENGAGES PUBLIC HEALTH ORGANIZATIONS AND OTHER CARE PROVIDERS IN THE DEVELOPMENT OF ASSESSMENT STRATEGIES AND TOOLS. THE COOPERATION BETWEEN THE ORGANIZATIONS ENSURES INFORMATION IS COLLECTED THAT WILL BENEFIT NOT ONLY THE CHNA PROGRAM, BUT ALSO THE STRATEGIES AND OPERATIONS OF THE RESPECTIVE ORGANIZATIONS. THE SYSTEMS ALSO COLLABORATE IN THE DEVELOPMENT OF THEIR RESPECTIVE IMPLEMENTATION PLANS TO FURTHER THE POSITIVE IMPACT TO THE COMMUNITY. AS NOTED ABOVE, THE CHNA ASSESSMENT INCLUDES A MULTI-MODAL PROCESS, WHICH BEGINS WITH A SURVEY TO COMMUNITY MEMBERS SENT VIA MULTIPLE PATHWAYS, WHICH INCLUDE THE PURCHASE OF A LOCAL SURVEY PANEL AND THE DEVELOPMENT OF A COMMUNITY STAKEHOLDER LIST. STAKEHOLDERS ARE ASKED TO COMPLETE THE SURVEY AND THEN FORWARD THE TOOL TO THEIR CONTACTS TO AMPLIFY THE COLLECTION OPPORTUNITIES. AN INDEPENDENT THIRD PARTY WITH SURVEY ANALYSIS EXPERTISE IS RETAINED TO EVALUATE THE RESULTS AND DEVELOP AN INITIAL LIST OF NEEDS WITH ADDITIONAL AUGMENTATION FROM COUNTYHEALTHRANKINGS.COM, CENSUS DATA, AND OTHER SECONDARY DATA SOURCES. LOCAL STAKEHOLDER MEETINGS THAT INCLUDE HEALTH CARE LEADERS, ELECTED OFFICIALS, REPRESENTATIVES OF UNDERSERVED COMMUNITIES, NONPROFIT LEADERS, AND OTHER COMMUNITY PARTNERS THEN REVIEW THE FINDINGS, PROVIDE INPUT, AND DEVELOP THE FINAL PRIORITIES FOR INCLUSION IN THE IMPLEMENTATION PLAN.DATA GATHERED FROM THE CHNA PROGRAM, PARTICULARLY SURVEY RESPONSES, IS MADE AVAILABLE TO LOCAL COMMUNITY ORGANIZATIONS THAT REQUEST THE INFORMATION. SANFORD VIEWS THE FINDINGS AS A COMMUNITY ASSET THAT CAN FURTHER THE POSITIVE IMPACT ON COMMUNITY HEALTH OUTSIDE THE WALLS OF THE SYSTEM.RECENTLY, SANFORD HAS ADDED MORE RESOURCES TO ADVANCE COMMUNITY HEALTH. FINDHELP IS AN ONLINE PLATFORM THAT CONNECTS LOCAL ORGANIZATIONS, FUNDING OPPORTUNITIES, AND OTHER RESOURCES CONNECTED TO SOCIAL DETERMINANTS OF HEALTH WITH INDIVIDUALS IN NEED. SANFORD INTEGRATED THE FINDHELP PLATFORM INTO THE ORGANIZATION'S WEBSITE, ELECTRONIC MEDICAL RECORD, AND POST-VISIT PAPERS. THE INTEGRATION NOT ONLY ALLOWS USERS TO SELF-SEARCH FOR LOCAL RESOURCES BASED UPON THEIR NEED, BUT ALSO ALLOWS SANFORD'S CARE MANAGEMENT TEAM TO DIRECTLY REFER PATIENTS TO LOCAL ORGANIZATIONS AND MONITOR ENGAGEMENT. FINDHELP IS PUBLIC TO ANY RESIDENT AND IS NOT RESERVED SPECIFICALLY FOR PATIENTS OF THE SYSTEM. THE SERVICES OFFERED ON THE NEW WEBSITE ARE EITHER FREE OR REDUCED COST AND COVER OPTIONS THAT MIGHT NOT BE INCLUDED WITH MEDICARE OR MEDICAID. THIS PARTNERSHIP ALLOWS SANFORD TO ADDRESS INEQUITY IN THE COMMUNITIES WE SERVE WITH EXISTING SERVICES THAT MEET THE NEEDS OF PATIENTS.ADDITIONAL EXTERNAL SOURCES ARE REGULARLY ENGAGED WITHIN THE STRATEGIC PLANNING, OPERATIONAL, AND CHNA PROCESS. THE ADVISORY BOARD IS REPRESENTATIVE OF THESE ASSESSMENT CAPABILITIES. THE ADVISORY BOARD (AB) OFFERS A WEALTH OF SECONDARY INFORMATION, SUCH AS INDUSTRY TRENDS, CONSUMER ASSESSMENTS, AND OTHER INFORMATION. AB ALSO INCLUDES DATA TOOLS, INCLUDING THE MARKET INNOVATION CENTER AND THE POST-ACUTE PATHWAYS EXPLORER THAT PROVIDES LINE OF SIGHT INTO DEMOGRAPHIC DATA, VOLUME PROJECTIONS, CARE COORDINATION PATTERNS, AND CARE DRIVERS BEYOND THE INTERNAL DATA SOURCES WITHIN SANFORD. OTHER ENGAGEMENTS AND ASSESSMENTS INCLUDE LEADERSHIP AND MEMBERSHIP IN STATE HEALTHCARE ASSOCIATIONS AND VIZIENT. THE DEVELOPMENT OF PATIENT FAMILY ADVISORY AND DIVERSITY, EQUITY AND INCLUSION COUNCILS WITHIN SYSTEM FACILITIES PROMOTES TWO-WAY COMMUNICATION WITH THE COMMUNITIES SERVED. THESE TOOLS ARE INCORPORATED THROUGHOUT THE PLANNING PROCESS AND ARE EMBEDDED WITHIN OPERATIONS. TO ENSURE CARE PROVIDED ENCOMPASSES THE WHOLE PERSON, SANFORD HEALTH EMPLOYS COMMUNITY HEALTH WORKERS (CHWS), FIRST ESTABLISHING THE ROLE IN 2014. THESE NON-CLINICAL STAFF PROVIDE FRONTLINE PUBLIC HEALTH SERVICES AND SERVE AS A LIAISON BETWEEN HEALTH CARE AND THE COMMUNITY TO FACILITATE ACCESS TO RESOURCES. THESE CARE TEAM MEMBERS PROVIDE A RANGE OF SERVICES AND ACTIVITIES FOR AT-RISK POPULATIONS INCLUDING OUTREACH, COMMUNITY EDUCATION, INFORMAL COUNSELING, SOCIAL SUPPORT, AND ADVOCACY.ANOTHER IMPORTANT SUPPORT/LIAISON ROLE IS THAT OF HEALTH GUIDES. THESE INDIVIDUALS IDENTIFY GAPS IN CARE PREVENTING RISING-RISK PATIENTS FROM ACHIEVING THEIR HEALTH GOALS. GUIDES ADDRESS BARRIERS PATIENTS ARE FACING IN ACCESSING THE RESOURCES THEY NEED TO BE SUCCESSFUL. HEALTH GUIDES HELP PATIENTS NAVIGATE THE HEALTH SYSTEM AND VARIOUS COMMUNITY RESOURCES, EMPOWERING PATIENTS TO TAKE MORE OWNERSHIP OF THEIR HEALTH AND BE AN ACTIVE PARTICIPANT IN THEIR CARE.MANY SANFORD HEALTH CLINIC FACILITIES OFFER A BROAD RANGE OF ROBUST, INTEGRATED CARE OPTIONS. FROM DIETICIANS TO PHARMACISTS TO SOCIAL WORKERS, AMBULATORY RN CARE MANAGERS AND INTEGRATED HEALTH THERAPISTS (IHTS), PATIENTS SEEN FOR PRIMARY CARE HAVE CLOSE PROXIMITY TO OTHER ANCILLARY SUPPORT SERVICES AND CARE OPTIONS. PATIENTS STRUGGLING WITH MENTAL HEALTH OR SUBSTANCE DEPENDENCY ISSUES, FOR EXAMPLE, CAN OFTEN IMMEDIATELY SEE A SUPPORT PROFESSIONAL ON-SITE VERSUS HAVING TO WAIT TO SEE A SPECIALIST VIA A REFERRAL FROM THEIR PRIMARY CARE PROVIDER. SANFORD ALSO SCREENS FOR SOCIAL DETERMINANTS OF HEALTH AND HAVE "WELLNESS PANTRIES" EMBEDDED IN OUR PEDIATRIC CLINICS ACROSS MINNESOTA, NORTH DAKOTA AND SOUTH DAKOTA. WE ARE CURRENTLY COLLECTING DATA TO BETTER UNDERSTAND HOW ADDRESSING FOOD INSECURITY HELPS REDUCE ANXIETY AND DEPRESSION IN CHILDREN. THE TIMELINESS OF THESE KEY SERVICES HELPS TO ENSURE THAT PATIENT NEEDS ARE NOT FALLING THROUGH THE CRACKS OR THAT CARE IS DELAYED. PART VI, LINE 3: SANFORD EMPLOYS A VARIETY OF STRATEGIES TO MAKE CERTAIN THAT THE ORGANIZATION IS TRANSPARENT IN THE COMMUNICATION OF FINANCIAL ASSISTANCE GUIDELINES. THE STAFF AT SANFORD MAKES EVERY EFFORT TO IDENTIFY PATIENTS NEEDING FINANCIAL ASSISTANCE AS EARLY IN THE REVENUE CYCLE AS POSSIBLE. ALL SANFORD ENTITIES DISPLAY SIGNAGE IN REGISTRATION AREAS ADVISING PATIENTS OF THEIR ABILITY TO REQUEST FINANCIAL ASSISTANCE. THE SIGNAGE WAS MADE AVAILABLE IN ENGLISH AND SPANISH. ALTERNATE LANGUAGES WERE INCLUDED ON THE SIGNAGE THAT BASICALLY STATED, IF YOU NEED INTERPRETER SERVICES, PLEASE INQUIRE AT THE REGISTRATION DESK. FINANCIAL ASSISTANCE APPLICATIONS WERE AVAILABLE IN ENGLISH, SPANISH, CHINESE, GERMAN, HINDI, KOREAN, LAOTIAN AND VIETNAMESE UPON REQUEST OR ON THE SANFORD WEBSITE. ALL HEALTHCARE WORKERS WHO IDENTIFY PATIENTS WITH FINANCIAL NEED ARE ENCOURAGED TO PROVIDE PATIENTS OR THEIR DESIGNEES A FINANCIAL APPLICATION. THIS MAY INCLUDE, BUT NOT BE LIMITED TO THE FOLLOWING AREAS: ADMINISTRATION, ADMISSIONS, PATIENT FINANCIAL SERVICES, FINANCIAL COUNSELORS, SOCIAL SERVICES, PHYSICIANS, NURSING, CLINIC DIRECTOR, RECEPTION STAFF AND HUMAN RESOURCES.FINANCIAL COUNSELORS ARE TRAINED TO WORK INDIVIDUALLY WITH PATIENTS TO DETERMINE THE FINANCIAL NEED AND RECOMMEND APPROPRIATE ASSISTANCE IN APPLICATION FOR CHARITY CARE, GOVERNMENT PROGRAMS OR DISCOUNTED SERVICES.SANFORD'S FINANCIAL ASSISTANCE PROGRAM IS AVAILABLE TO ANYONE WHO QUALIFIES FOR ASSISTANCE. THIS PROGRAM ENSURES THAT ALL PEOPLE RECEIVE THE CARE THEY NEED, REGARDLESS OF THEIR FINANCIAL SITUATION. SANFORD MAKES FINANCIAL ASSISTANCE INFORMATION AVAILABLE TO COMMUNITY AGENCIES AND REFERRAL ORGANIZATIONS. FINANCIAL ASSISTANCE INFORMATION IS ALSO AVAILABLE ON THE SANFORD WEBSITE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY PART VI, LINE 4: SANFORD HEALTH IS AN INTEGRATED HEALTH SYSTEM HEADQUARTERED IN THE DAKOTAS. IT IS ONE OF THE LARGEST RURAL HEALTH SYSTEMS IN THE NATION WITH 25 MEDICAL CENTERS AND 250 CLINICS. SANFORD HEALTH'S APPROXIMATE 43,000 EMPLOYEES, INCLUDING 2,900 PHYSICIANS/ADVANCED PRACTICE PROVIDERS AND 8,291 REGISTERED NURSES DELIVERING CARE IN MORE THAN 80 SPECIALTY AREAS, MAKE IT THE LARGEST EMPLOYER IN THE DAKOTAS. SANFORD USD MEDICAL CENTER - SIOUX FALLS, SOUTH DAKOTASIOUX FALLS IS THE LARGEST CITY IN THE STATE OF SOUTH DAKOTA AND IS THE COUNTY SEAT OF MINNEHAHA COUNTY. SIOUX FALLS ALSO EXTENDS INTO LINCOLN COUNTY. THE 2023 U.S. CENSUS BUREAU ESTIMATES A TOTAL POPULATION OF 206,410 FOR SIOUX FALLS. ACCORDING TO THE 2023 COUNTY HEALTH RANKINGS, THE POPULATION OF MINNEHAHA COUNTY IS 80.7% WHITE, 6.5% AFRICAN AMERICAN, 3.1% AMERICAN INDIAN, 2.2% ASIAN AND 5.6% HISPANIC. SIOUX FALLS IS A SIGNIFICANT REGIONAL HEALTH CARE CENTER. ONLY 1% OF THE POPULATION IS REPORTED TO BE NOT PROFICIENT IN ENGLISH. THE MEDIAN HOUSEHOLD INCOME IN MINNEHAHA COUNTY IS $73,000.SANFORD MEDICAL CENTER FARGO - FARGO, NORTH DAKOTAFARGO IS THE LARGEST CITY IN NORTH DAKOTA, ACCOUNTING FOR 17% OF THE STATE'S POPULATION. FARGO IS ALSO THE COUNTY SEAT OF CASS COUNTY. THE 2023 UNITED STATES CENSUS ESTIMATES THE POPULATION OF FARGO WAS 133,188. ACCORDING TO THE 2023 COUNTY HEALTH RANKINGS, THE POPULATION OF CASS COUNTY IS 83.7% WHITE, 6.5% AFRICAN AMERICAN, 1.7% AMERICAN INDIAN, 3.1% ASIAN AND 3.1% HISPANIC. ONLY 1% OF THE POPULATION IS REPORTED TO BE NOT PROFICIENT IN ENGLISH. THE MEDIAN HOUSEHOLD INCOME OF CASS COUNTY, ND IS $66,400. SANFORD BEMIDJI MEDICAL CENTER - BEMIDJI, MINNESOTABEMIDJI IS LOCATED IN BELTRAMI COUNTY, MINNESOTA. BEMIDJI HOUSES MANY NATIVE AMERICAN SERVICES, INCLUDING THE INDIAN HEALTH SERVICE. THE CITY IS THE CENTRAL HUB OF THE RED LAKE INDIAN RESERVATION, WHITE EARTH INDIAN RESERVATION, AND THE LEECH LAKE INDIAN RESERVATION. ACCORDING TO THE 2023 UNITED STATES CENSUS ESTIMATES, THE POPULATION OF BEMIDJI IS 15,743. ACCORDING TO THE 2023 COUNTY HEALTH RANKINGS, THE POPULATION OF BELTRAMI COUNTY IS 71.3% WHITE, 0.7% AFRICAN AMERICAN, 22.2% AMERICAN INDIAN, 0.8% ASIAN AND 2.6% HISPANIC. 0% OF THE POPULATION IS REPORTED TO BE NOT PROFICIENT IN ENGLISH. THE MEDIAN HOUSEHOLD INCOME IS $60,400.SANFORD BISMARCK MEDICAL CENTER - BISMARCK, NORTH DAKOTABISMARCK IS A CITY LOCATED IN BURLEIGH COUNTY IN CENTRAL NORTH DAKOTA. BISMARCK IS EXPERIENCING FAST-PACED GROWTH AS A DIRECT RESULT OF OIL DEVELOPMENT THROUGHOUT THE WESTERN PART OF THE STATE. BISMARCK IS THE STATE CAPITAL AND IS THE SECOND LARGEST CITY IN THE STATE OF NORTH DAKOTA WITH AN ESTIMATED POPULATION OF 75,092. ACCORDING TO THE 2023 COUNTY HEALTH RANKINGS, THE POPULATION OF BURLEIGH COUNTY IS 87.4% WHITE, 2.2% AFRICAN AMERICAN, 5.0% AMERICAN INDIAN, 0.9% ASIAN AND 2.9% HISPANIC. 0% OF THE POPULATION IS REPORTED TO BE NOT PROFICIENT IN ENGLISH. THE MEDIAN HOUSEHOLD INCOME IS $72,000.SANFORD NETWORK HOSPITALSSANFORD HEALTH NETWORK HOSPITALS IS A NETWORK OF RURAL HOSPITALS LOCATED THROUGHOUT SOUTH DAKOTA, NORTH DAKOTA, AND MINNESOTA.SANFORD CLINICSSANFORD CLINIC IS A MULTI-SPECIALTY CLINIC COMPRISED OF APPROXIMATELY 2,931 PHYSICIANS PROVIDING SERVICES IN THE US AS WELL AS INTERNATIONALLY. PART VI, LINE 5: SANFORD MAINTAINS AN OPEN MEDICAL STAFF. COMMUNITY BOARDS - THE SANFORD BOARD OF TRUSTEES WAS COMPRISED OF 10 MEMBERS AT THE END OF THE CALENDAR YEAR, INCLUDING 8 COMMUNITY MEMBERS, 1 PHYSICIAN AND THE CEO. SURPLUS FUNDS - SURPLUS FUNDS ARE INVESTED BACK INTO THE COMMUNITY, AS WELL AS TO RESOURCE DEVELOPMENT AND FACILITY DEVELOPMENT TO BETTER SERVE PATIENTS AND COMMUNITIES. PART VI, LINE 6: SANFORD HEALTH IS AN INTEGRATED HEALTH SYSTEM HEADQUARTERED IN THE DAKOTAS. IT IS ONE OF THE LARGEST RURAL HEALTH SYSTEMS IN THE NATION WITH 25 MEDICAL CENTERS AND 250 CLINIC LOCATIONS IN NINE STATES AND THREE COUNTRIES. SANFORD HEALTH'S APPROXIMATE 43,000 EMPLOYEES, INCLUDING 2,900 PHYSICIANS/ADVANCED PRACTICE PROVIDERS AND 8,291 REGISTERED NURSES DELIVERING CARE IN MORE THAN 80 SPECIALTY AREAS, MAKE IT THE LARGEST EMPLOYER IN THE DAKOTAS.SANFORD HEALTH PROVIDES SERVICES AT EVERY LEVEL FROM CRITICAL ACCESS HOSPITALS TO TERTIARY AND QUATERNARY CARE. THE SANFORD FOOTPRINT INCLUDES OVER 250,000 SQUARE MILES WITH A NINE STATE SERVICE AREA AND A NETWORK OF CHILDREN'S PRIMARY CARE CLINIC LOCATIONS ACROSS THE COUNTRY AND WORLD. SANFORD HEALTH OPERATES FULL-TIME EMERGENCY CENTERS AND PROVIDES EMERGENCY CARE TO EVERYONE REGARDLESS OF THEIR ABILITY TO PAY. SANFORD FACILITIES AND CLINICS PROVIDE SERVICES TO REMOTE AND MEDICALLY UNDERSERVED AREAS THAT WOULD OTHERWISE NOT HAVE ACCESS TO EVEN PRIMARY CARE SERVICES. SANFORD HEALTH FINANCIALLY SUPPORTS HEALTH AND WELLNESS, EDUCATION AND COMMUNITY DEVELOPMENT ACTIVITIES TO IMPROVE THE QUALITY OF LIFE AND STRENGHTEN COMMUNITIES THROUGHOUT THE REGION. EACH FACILITY PROMOTES HEALTH AND HEALING THAT RESPONDS TO THE UNIQUE NEEDS OF THE PATIENTS IN THE COMMUNITY, ENSURING ACCESS TO COMPREHENSIVE AND SPECIALIZED SERVICES. PART VI, LINE 7: COMMUNITY BENEFIT REPORTING IS NOT REQUIRED AND THEREFORE NOT FILED IN NORTH DAKOTA, SOUTH DAKOTA, OR NEBRASKA. FILING IN MINNESOTA IS VOLUNTARY. 1 218 SPORTS INC 102 FIRST ST W SUITE 1010 BEMIDJI MN 56601 863542403 501(C)(3) 20000 0 ECONOMIC DEVELOPMENT ABERDEEN DEVELOPMENT CORPORATION 416 PRODUCTION ST N ABERDEEN SD 57401 466011831 501(C)(6) 10000 0 ECONOMIC DEVELOPMENT ABERDEEN FAMILY YMCA 5 S STATE ST ABERDEEN SD 57401 460255779 501(C)(3) 15000 0 COMMUNITY SUPPORT ABERDEEN PUBLIC SCHOOLS FOUNDATION 1224 S 3RD ST ABERDEEN SD 57401 460423109 501(C)(3) 40000 0 WORKFORCE DEVELOPMENT ACTIVE GENERATIONS SIOUX FALLS 2300 W 46TH ST SIOUX FALLS SD 57105 460305500 501(C)(3) 30000 0 COMMUNITY SUPPORT ALZHEIMERS ASSOCIATION 225 N MICHIGAN AVE FLOOR 17 CHICAGO IL 60601 133039601 501(C)(3) 7000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES AMER FOUNDATON SUICIDE PREVENT 199 WATER ST FLOOR 11 NEW YORK NY 10038 133393329 501(C)(3) 6500 0 COMMUNITY HEALTH IMPROVEMENT SERVICES AMERICAN HEART ASSOCIATION PO BOX 5028 BOONE IA 50950 135613797 501(C)(3) 8000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES AMERICAN CANCER SOCIETY 250 WILLIAMS ST 4TH FL ATLANTA GA 30303 131788491 501(C)(3) 505000 0 RESEARCH AMERICAN HEART ASSOC MIDWEST 7272 GREENVILLE AVENUE DALLAS TX 75231 135613797 501(C)(3) 10000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES AMERICAN RED CROSS 2925 E 57TH ST SIOUX FALLS SD 57108 530196605 501(C)(3) 25000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES ANDRIA THEATRE 618 BROADWAY ST ALEXANDRIA MN 56308 510171992 501(C)(3) 6500 0 ECONOMIC DEVELOPMENT ARTHRITIS FOUNDATION PO BOX 932915 ATLANTA GA 31193 581341679 501(C)(3) 8500 0 COMMUNITY HEALTH IMPROVEMENT SERVICES AUGUSTANA UNIVERSITY 2001 S SUMMIT AVE SIOUX FALLS SD 57197 460224588 501(C)(3) 8347500 0 COALITION BUILDING, ECONOMIC DEVELOPMENT, HEALTH PROFESSIONS EDUCATION, WORKFORCE DEVELOPMEN BEEF LOGIC INC 316 S COTEAU AVE PIERRE SD 57501 872043795 501(C)(3) 20000 0 COMMUNITY SUPPORT BEMIDJI AREA SCHOOLS 502 MINNESOTA AVE BEMIDJI MN 56619 416000181 115 61500 0 COMMUNITY HEALTH IMPROVEMENT SERVICES BEMIDJI COMMUNITY ARENA CORP 3000 DIVISION ST BEMIDJI MN 56601 813622011 501(C)3 63600 0 ECONOMIC DEVELOPMENT BEMIDJI STATE UNIVERSITY 1500 BIRCHMONT DR NE BEMIDJI MN 56601 411687554 115 105400 0 ATHLETIC PROGRAM SUPPORT, COMMUNITY HEALTH IMPROVEMENT SERVICES, WORKFORCE DEVELOPMENT, BEMIDJI YOUTH BASEBALL INC PO BOX 1533 BEMIDJI MN 56619 411763981 501(C)(3) 7800 0 COMMUNITY HEALTH IMPROVEMENT SERVICES BEMIDJI YOUTH SOCCER PO BOX 265 BEMIDJI MN 56619 411870778 501(C)(3) 7300 0 COMMUNITY HEALTH IMPROVEMENT SERVICES BIG IDEA INC 506 S MAIN ST ABERDEEN SD 57401 921843670 501(C)(3) 7500 0 ECONOMIC DEVELOPMENT BIO GIRLS INC 4151 38TH ST STE A FARGO ND 58104 810792142 501(C)(3) 38500 0 COMMUNITY SUPPORT, ECONOMIC DEVELOPMENT, WORKFORCE DEVELOPMENT BISMARCK CANCER CENTER 500 N 8TH STREET BISMARCK ND 58501 450454363 501(C)(3) 11325 0 COMMUNITY SUPPORT, COMMUNITY HEALTH IMPROVEMENT SERVICES BISMARCK MANDAN CHAMBER EDC 1640 BURNT BOAT DR BISMARCK ND 58503 450116753 501(C)(6) 17950 0 ECONOMIC DEVELOPMENT, COMMUNITY HEALTH IMPROVEMENT SERVICES, WORKFORCE DEVELOPMENT BISMARCK MANDAN CHAMBER FDTN 1640 BURNT BOAT DR BISMARCK ND 58503 263807225 501(C)(3) 15000 0 ECONOMIC DEVELOPMENT BISMARCK PUBLIC SCHOOLS FDTN 806 N WASHINGTON ST BISMARCK ND 58501 450442960 501(C)(3) 135000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES, PHYSICAL IMPROVEMENT AND HOUSING, WORKFORCE DEVELOPMENT BISMARCK STATE COLLEGE FNDTN 806 N WASHINGTON ST BISMARCK ND 58501 450442960 501(C)(3) 110197 0 ATHLETIC PROGRAM SUPPORT, HEALTH PROFESSIONS EDUCATION BOARD OF EDUCATION OF THE CITY OF FARGO DBA FARGO PUBLIC SCHOOLS 700 7TH STREET SOUTH FARGO ND 58103 456000294 115 185550 0 COMMUNITY HEALTH IMPROVEMENT SERVICES, WORKFORCE DEVELOPMENT BOYS & GIRLS CLUB BEMIDJI AREA 1600 MINNESOTA AVE NW BEMIDJI MN 56601 810599601 501(C)(3) 13685 0 COMMUNITY SUPPORT BOYS & GIRLS CLUB SIOUX EMPIRE 100 S SPRING AVE SIOUX FALLS SD 57104 460399482 501(C)(3) 10000 0 COMMUNITY SUPPORT BRANDON VALLEY SCHOOL 300 S SPLITROCK BLVD BRANDON SD 57005 466002577 115 44800 0 COMMUNITY HEALTH IMPROVEMENT SERVICES BUTTERFLY HOUSE & AQUARIUM 4320 S OXBOW AVE SIOUX FALLS SD 57106 522370420 501(C)(3) 25000 0 ECONOMIC DEVELOPMENT CALL TO FREEDOM INC 1915 E 8TH ST STE 100 SIOUX FALLS SD 57103 475469817 501(C)(3) 20000 0 PHYSICAL IMPROVEMENT AND HOUSING CANTON SCHOOLS 800 N MAIN ST CANTON SD 57013 466002143 115 16444 0 WORKFORCE DEVELOPMENT CENTRAL CASS PUBLIC SCHOOLS 802 5TH ST N CASSELTON ND 58012 456000306 115 10000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES CHAMBER OF COMMERCE FMWF PO BOX 2443 FARGO ND 58108 450448041 501(C)(6) 54240 0 ECONOMIC DEVELOPMENT CHILDRENS HOME SOCIETY OF SD 801 N SYCAMORE SIOUX FALLS SD 57110 460224542 501(C)(3) 7500 0 COMMUNITY SUPPORT CITY OF BEMIDJI 317 4TH STREET NW BEMIDJI MN 56601 416004972 115 251500 0 ECONOMIC DEVELOPMENT, COMMUNITY HEALTH IMPROVEMENT SERVICES CITY OF MITCHELL DBA MITCHELL PARKS & RECREATION 612 NORTH MAIN STREET MITCHELL SD 57301 466000305 115 10000 0 COMMUNITY SUPPORT CITY OF TRACY 336 MORGAN ST TRACY MN 56175 416005581 115 10000 0 PHYSICAL IMPROVEMENT AND HOUSING CITY OF WEBSTER PO BOX 539 WEBSTER SD 57274 466000530 115 7143 0 PHYSICAL IMPROVEMENT AND HOUSING CITY OF YANKTON PO BOX 176 YANKTON SD 57078 466000567 115 10000 0 PHYSICAL IMPROVEMENT AND HOUSING COMMUNITY MEMORIAL HOSPITAL 814 JACKSON ST BURKE SD 57523 460219795 501(C)(3) 25000 0 PHYSICAL IMPROVEMENT AND HOUSING CONCORDIA COLLEGE 901 8TH STREET S MOORHEAD MN 56560 410693977 501(C)(3) 3301000 0 HEALTH PROFESSIONS EDUCATION, WORKFORCE DEVELOPMENT DAKOTA ALLIANCE SOCCER CLUB 401 W 39TH ST SIOUX FALLS SD 57105 460359817 501(C)(3) 60250 0 COMMUNITY HEALTH IMPROVEMENT SERVICES DAKOTA CHILDRENS ADVOCACY CTR 1800 E BROADWAY AVE BISMARCK ND 58501 814096679 501(C)(3) 10400 0 COMMUNITY HEALTH IMPROVEMENT SERVICES DAKOTA MEDICAL FOUNDATION 4141 28TH AVE SOUTH FARGO ND 58104 456012318 501(C)(3) 9500 0 COMMUNITY HEALTH IMPROVEMENT SERVICES DAKOTA STATE UNIVERSITY 820 N WASHINGTON AVE MADISON SD 57042 466000364 115 559816 2691934 FAIR MARKET VALUE LAND DONATION; PARCEL 53482 & 53484 COMMUNITY HEALTH IMPROVEMENT SERVICES, ECONOMIC DEVELOPMENT, WORKFORCE DEVELOPMENT DEPT OF VETERANS AFFAIRS 810 VERMONT AVE NW WASHINGTON DC 20420 540846950 115 5998054 0 COMMUNITY HEALTH IMPROVEMENT SERVICES DOWNTOWN COMMUNITY PARTNERSHIP 210 BROADWAY STE 202 FARGO ND 58102 464472309 501(C)(6) 5750 0 ECONOMIC DEVELOPMENT ELEVATE RAPID CITY 525 UNIVERSITY LOOP STE 102 RAPID CITY SD 57701 460118545 501(C)(6) 50000 0 ECONOMIC DEVELOPMENT EMBE 300 W 11TH ST SIOUX FALLS SD 57104 460234998 501(C)(3) 10000 0 COMMUNITY SUPPORT, COMMUNITY HEALTH IMPROVEMENT SERVICES EMERGING PRAIRIE 122 1/2 BROADWAY N FARGO ND 58102 810742137 501(C)(3) 5760 0 ECONOMIC DEVELOPMENT EMILYS HOPE INC 6225 S MINNESOTA AVE SIOUX FALLS SD 57108 833324332 501(C)(3) 6500 0 COMMUNITY SUPPORT ENDERLIN HISTORICAL SOCIETY 13207 55TH ST SE ENDERLIN ND 58027 450378134 501(C)(3) 10000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES FAMILY ADVOCACY CNTR OF NORTH 800 BEMIDJI AVE N STE 4 BEMIDJI MN 56601 202102302 501(C)(3) 71987 0 COMMUNITY HEALTH IMPROVEMENT SERVICES FAMILY WELLNESS 2960 SETER PARKWAY FARGO ND 58104 272862697 501(C)(3) 10000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES FARGO PARK DISTRICT 701 MAIN AVE FARGO ND 58103 456002070 501(C)(6) 1678464 0 COMMUNITY SUPPORT, PHYSICAL IMPROVEMENTS & HOUSING FIRST CITY OF LIGHTS FOUNDATIO PO BOX 1991 BEMIDJI MN 56619 854069354 501(C)(3) 6550 0 ECONOMIC DEVELOPMENT FITNESS ON MAIN 901 MAIN STREET BURKE SD 57523 264125455 501(C)(3) 10000 0 PHYSICAL IMPROVEMENT AND HOUSING FORWARD SIOUX FALLS PO BOX 907 SIOUX FALLS SD 57101 460396647 501(C)(6) 250000 0 ECONOMIC DEVELOPMENT FRESH START SURGICAL GIFTS 2011 PALOMAR AIRPORT RD STE 206 CARLSBAD CA 92011 330460177 501(C)(3) 80000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES, ECONOMIC DEVELOPMENT GATEWAY TO SCIENCE 1810 SCHAFER STREET STE 1 BISMARCK ND 58501 450443517 501(C)(3) 10000 0 ECONOMIC DEVELOPMENT GIRL SCOUTS DAKOTA HORIZONS 1101 S MARION ROAD SIOUX FALLS SD 57106 460250744 501(C)(3) 8500 0 COMMUNITY SUPPORT, ECONOMIC DEVELOPMENT GREAT NORTH POLE 675 13TH AVE E STE 101 WEST FARGO ND 58078 821969429 501(C)(3) 10000 0 COMMUNITY SUPPORT GREAT RIVER RESCUE 1612 CARR LAKE RD SE BEMIDJI MN 56601 411551248 501(C)(3) 6600 0 COMMUNITY HEALTH IMPROVEMENT SERVICES GREATER BEMIDJI 102 1ST ST WEST BEMIDJI MN 56601 363367707 501(C)(3) 60000 0 WORKFORCE DEVELOPMENT GREATER SF CHAMBER OF COMMERCE 200 N PHILLIPS AVE STE 200 SIOUX FALLS SD 57104 460189300 501(C)(6) 14200 0 ECONOMIC DEVELOPMENT GREATLIFE CARES FDN 3800 W 53RD ST SIOUX FALLS SD 57106 472447820 501(C)(3) 15000 0 COMMUNITY SUPPORT HARRISBURG SCHOOL DISTRICT 200 WILLOW ST HARRISBURG SD 57032 466002218 115 234800 0 COMMUNITY HEALTH IMPROVEMENT SERVICES, PHYSICAL IMPROVEMENT AND HOUSING HARTFORD AREA DEVELOPMENT FDTN 125 N MAIN AVE HARTFORD SD 57033 460354618 501(C)(3) 10000 0 ECONOMIC DEVELOPMENT HEARTVIEW FOUNDATION 101 E BROADWAY AVE BISMARCK ND 58501 450282159 501(C)(3) 10000 0 COMMUNITY SUPPORT HELPLINE CENTER INC 1000 N WEST AVE STE 310 SIOUX FALLS SD 57104 237424387 501(C)(3) 11000 0 COMMUNITY SUPPORT HUETHER FAMILY MATCH POINTE 4210 N BOBHALLA DR SIOUX FALLS SD 57107 452784394 501(C)(3) 25000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES INDEPENDENT SCHOOL DISTRICT #22 DBA DETROIT LAKES PUBLIC SCHOOLS 702 LAKE AVENUE DETROIT LAKES MN 56502 410971772 115 20000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES INDEPENDENT SCHOOL DISTRICT518 1117 MARINE AVE WORTHINGTON MN 56187 416008522 115 112000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES, PHYSICAL IMPROVEMENT AND HOUSING, PHYSICAL IMPROVEMENTS & HOUSING INTERNATIONAL ESPERANZA PROJECT 7700 WINDROSE AVE PLANO TX 75024 815106545 501(C)(3) 30551 0 COMMUNITY HEALTH IMPROVEMENT SERVICES JAMESTOWN PARKS & REC 1002 2ND AVE SE JAMESTOWN ND 58401 456002100 115 5920 0 COMMUNITY HEALTH IMPROVEMENT SERVICES JEREMIAH PROGRAM 3104 FIECHTNER DR S FARGO ND 58103 411801834 501(C)(3) 10000 0 COMMUNITY SUPPORT JOY RANCH OF SD 16633 449TH AVE FLORENCE SD 57235 871202375 501(C)(3) 25000 0 COMMUNITY SUPPORT JUNIOR ACHIEVEMENT OF SD 300 S PHILLIPS AVE STE L102 SIOUX FALLS SD 57104 460306352 501(C)(3) 15000 0 WORKFORCE DEVELOPMENT KNIGHTS OF COLUMBUS WALLEYE CL PO BOX 1788 BEMIDJI MN 56619 237543090 501(C)(8) 6900 0 ECONOMIC DEVELOPMENT LAKOTA NATION INVITATIONAL PO BOX 3140 RAPID CITY SD 57709 461310975 501(C)(3) 5500 0 WORKFORCE DEVELOPMENT LEADERSHIP SOUTH DAKOTA PO BOX 91533 SIOUX FALLS SD 57109 820880122 501(C)(3) 25000 0 WORKFORCE DEVELOPMENT LEGENDS OF GOLD PO BOX 287 BERESFORD SD 57004 273794971 501(C)(3) 20000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES LEVITT AT THE FALLS 524 N MAIN AVE 106 SIOUX FALLS SD 57104 611699910 501(C)3 75000 0 ECONOMIC DEVELOPMENT LIFESCAPE FOUNDATION 2501 W 26TH ST SIOUX FALLS SD 57105 460353254 501(C)(3) 15000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES LINCOLN HIGH SCHOOL 201 E 38TH ST SIOUX FALLS SD 57105 466002586 115 102500 0 COMMUNITY HEALTH IMPROVEMENT SERVICES LINK 132 N DAKOTA AVE SIOUX FALLS SD 57104 844806781 501(C)(3) 400000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES LOST&FOUND 319 N MAIN AVE SIOUX FALLS SD 57104 454306370 501(C)(3) 6000 0 COMMUNITY SUPPORT LUVERNE AREA COMMUNITY FOUND 102 E MAIN ST LUVERNE MN 56156 411512905 501(C)(3) 7623 0 ECONOMIC DEVELOPMENT MAKE A WISH 4143 26TH AVE S FARGO ND 58104 450393770 501(C)(3) 30000 0 COMMUNITY SUPPORT MAKE A WISH MINNESOTA 1919 UNIVERSITY AVE W ST PAUL MN 55104 411422893 501(C)(3) 7000 0 COMMUNITY SUPPORT MANDAN PARK DISTRICT 2600 46TH AVE SE MANDAN ND 58554 456002119 115 10000 0 PHYSICAL IMPROVEMENT AND HOUSING MANDAN PUBLIC SCHOOL DISTRICT 901 DIVISION ST NW MANDAN ND 58554 456001098 115 12500 0 COMMUNITY HEALTH IMPROVEMENT SERVICES MCCROSSAN BOYS RANCH 47135 260TH STREET SIOUX FALLS SD 57107 460311913 501(C)(3) 15000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY SUPPORT MCKENZIE COUNTY HEALTHCARE SYS 709 4TH AVE NE WATFORD CITY ND 58854 770637498 501(C)(3) 100000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES MN STATE UNIV MANKATO FDTN 236 WIGLEY ADMINISTRATION CTR MANKOTA MN 56001 416033423 501(C)(3) 200000 0 WORKFORCE DEVELOPMENT MN STATE UNIVERSITY MOORHEAD 1900 28TH AVE S MOORHEAD MN 56560 411687554 115 102000 0 ECONOMIC DEVELOPMENT, WORKFORCE DEVELOPMENT MO SLOPE AREAWIDE UNITED WAY 515 N 4TH ST BISMARCK ND 58501 450387741 501(C)(3) 9000 0 COALITION BUILDING, COMMUNITY HEALTH IMPROVEMENT SERVICES MOORHEAD AREA PUBLIC SCHOOLS 1520 MARKET ST ST LOUIS MO 63103 474153732 501(C)(3) 140500 0 COMMUNITY HEALTH IMPROVEMENT SERVICES MOORHEAD YOUTH HOCKEY ASSOC 707 SE MAIN AVE MOORHEAD MN 56560 237221429 501(C)(3) 50000 0 PHYSICAL IMPROVEMENT AND HOUSING MS RIVER CITIES INITIATIVE 1520 MARKET ST ST LOUIS MO 63103 474153732 501(C)(3) 7500 0 ECONOMIC DEVELOPMENT NATIONAL KIDNEY FOUNDATION 30 EAST 33RD STREET NEW YORK NY 10016 131673104 501(C)(3) 12500 0 COMMUNITY HEALTH IMPROVEMENT SERVICES ND HOSPITAL ASSOCIATION 1622 E INTERSTATE AVE BISMARCK ND 58503 450274165 501(C)(6) 11000 0 HEALTH PROFESSIONS EDUCATION ND STATE COLLEGE SCIENCE FOUNDATION 800 6TH ST N WAHPETON ND 58076 450407617 501(C)(3) 11269 0 ECONOMIC DEVELOPMENT NDSU FOUNDATION & ALUMNI ASSOC 1241 UNIVERSITY DR N FARGO ND 58102 237120898 501(C)(3) 2846667 0 ECONOMIC DEVELOPMENT, HEALTH PROFESSIONS EDUCATION, WORKFORCE DEVELOPMENT NORTH DAKOTA NURSES ASSOCIATION 1515 BURNT BOAT DR BISMARCK ND 58503 450173322 501(C)(6) 7250 0 WORKFORCE DEVELOPMENT NORTHERN DENTAL ACCESS CENTER 1405 ANNE ST NW BEMIDJI MN 56601 841711812 501(C)(3) 20000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES NORTHERN LIGHTS COUNCIL 4200 19TH AVE S FARGO ND 58103 450226415 501(C)(3) 7500 0 COMMUNITY SUPPORT NORTHERN STATE UNIVERSITY FOUNDATION 620 15TH AVE SE ABERDEEN SD 57401 237002314 501(C)3 687000 0 ATHLETIC PROGRAM SUPPORT, ECONOMIC DEVELOPMENT, WORKFORCE DEVELOPMENT NORTHERN SUN INTERCOLLEGIATE CONFERENCE 2999 COUNTY ROAD 42 WEST SUITE 136 BURNSVILLE MN 55306 411783486 501(C)3 45000 0 ECONOMIC DEVELOPMENT NORTHWEST MN FOUNDATION 201 3RD ST NW BEMIDJI MN 56601 411556013 501(C)(3) 28500 0 ATHLETIC PROGRAM SUPPORT, COMMUNITY HEALTH IMPROVEMENT SERVICES NORTHWOODS BATTERED WOMENS PO BOX 563 BEMIDJI MN 56619 411333404 501(C)(3) 22700 0 PHYSICAL IMPROVEMENT AND HOUSING OAHE FAMILY YMCA 900 E CHURCH ST PIERRE SD 57501 237169291 501(C)(3) 20000 0 COMMUNITY SUPPORT OAK GROVE LUTHERAN SCHOOL 124 N TERRACE FARGO ND 58102 450226473 501(C)(3) 21500 0 WORKFORCE DEVELOPMENT PERHAM AREA COMMUNITY CENTER 620 3RD AVE SE PERHAM MN 56573 411565457 115 40000 0 COMMUNITY SUPPORT PETIT KICKS SOCCER LLC DBA MAGIC SOCCER FC 8920 BRIARDALE DR BISMARCK ND 58504 473418017 10000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES PREMIERE PLAYHOUSE 315 N PHILLIPS AVE SIOUX FALLS SD 57104 800074622 501(C)(3) 7500 0 ECONOMIC DEVELOPMENT PROJECT CAR CALL A RIDE 2425 S WESTERN AVE SIOUX FALLS SD 57105 460358227 501(C)(3) 10000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES PROJECT PREP OLYMPIC DEVELOP PO BOX 385970 BLOOMINGTON MN 55438 043644163 501(C)(3) 8750 0 COMMUNITY HEALTH IMPROVEMENT SERVICES RAPE & ABUSE CRISIS CENTER FM 317 8TH ST N FARGO ND 58102 411310289 501(C)(3) 15000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES RAPID CITY CLUB FOR BOYS INC 320 N 4TH ST RAPID CITY SD 57701 460277778 501(C)(3) 10000 0 COMMUNITY SUPPORT REACH LITERACY 2102 W 41ST ST SIOUX FALLS SD 57105 460396579 501(C)(3) 5500 0 COMMUNITY SUPPORT RONALD MCDONALD HOUSE 4757 AGASSIZ XING S FARGO ND 58104 450365598 501(C)(3) 110000 0 COMMUNITY SUPPORT RONALD MCDONALD HOUSE CHARITY 825 S LAKE ROAD SIOUX FALLS SD 57104 460371152 501(C)(3) 35000 0 COMMUNITY SUPPORT ROOSEVELT HIGH SCHOOL 201 E 38TH ST SIOUX FALLS SD 57105 466002586 115 102500 0 COMMUNITY HEALTH IMPROVEMENT SERVICES ROTARY CLUB OF ALEXANDRIA PO BOX 1032 ALEXANDRIA MN 56308 416039175 501(C)(3) 6000 0 COMMUNITY SUPPORT SD COMMUNITY FOUNDATION 1714 N LINCOLN AVE PIERRE SD 57501 460398115 501(C)(3) 1250000 0 WORKFORCE DEVELOPMENT SD HALL OF FAME 1480 SOUTH MAIN CHAMBERLAIN SD 57325 460324210 501(C)(3) 50000 0 ECONOMIC DEVELOPMENT SD HOSA FUTURE HEALTH PROF 414 EAST CLARK ST VERMILLION SD 57069 466000364 115 30000 0 HEALTH PROFESSIONS EDUCATION SD LAW ENFORCEMENT CHARITIES 101 SOUTH MAIN AVE STE 100 SIOUX FALLS SD 57104 460440378 501(C)(3) 10000 0 COMMUNITY SUPPORT SD MILITARY HERITAGE ALLIANCE 1600 W RUSSELL ST SIOUX FALLS SD 57104 832381925 501(C)(3) 250000 0 PHYSICAL IMPROVEMENT AND HOUSING SD STATE UNIVERSITY 1015 CAMPANILE AVE BROOKINGS SD 57007 466000364 115 128000 0 HEALTH PROFESSIONS EDUCATION, PHYSICAL IMPROVEMENTS & EDUCATION SD STATE UNIVERSITY FOUNDATION 815 MEDARY AVE BROOKINGS SD 57006 460273801 501(C)(3) 2084000 0 ECONOMIC DEVELOPMENT, HEALTH PROFESSIONS EDUCATION, PHYSICAL IMPROVEMENT & HOUSING SD SYMPHONY ORCHESTRA 300 NORTH DAKOTA AVE STE 116 SIOUX FALLS SD 57104 466017026 501(C)(3) 20000 0 ECONOMIC DEVELOPMENT SD YOUTH SOCCER ASSOC 2127 S MINNESOTA AVE STE 201 SIOUX FALLS SD 57105 237183054 501(C)(3) 25000 0 COMMUNITY SUPPORT SF AREA COMMUNITY FOUNDATION 200 N CHERAPA PL SIOUX FALLS SD 57103 311748533 501(C)(3) 45000 0 ECONOMIC DEVELOPMENT, PHYSICAL IMPROVEMENT & HOUSING SF CHRISTIAN HIGH SCHOOL 6120 S CHARGER CIRCE SIOUX FALLS SD 57108 460340024 501(C)(3) 104800 0 COMMUNITY HEALTH IMPROVEMENT SERVICES SF SWIM TEAM INC PO BOX 758 SIOUX FALLS SD 57101 460343732 501(C)(3) 25000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES SF YOUTH HOCKEY ASSOC 5000 S MINNESOTA AVE SIOUX FALLS SD 57108 460427805 501(C)(3) 35750 0 COMMUNITY HEALTH IMPROVEMENT SERVICES SHELDON COMM SCHOOL DISTRICT 1700 E 4TH STREET SHELDON IA 51201 426038825 115 30000 0 PHYSICAL IMPROVEMENT AND HOUSING SHILOH CHRISTIAN SCHOOL 1915 SHILOH DR BISMARCK ND 58503 450348120 501(C)(3) 20000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES SIOUX EMPIRE UNITED WAY 1000 N W AVE 120 SIOUX FALLS SD 57104 460233701 501(C)(3) 155000 0 COALITION BUILDING SIOUX FALLS AREA CASA PROGRAM PO BOX 1901 SIOUX FALLS SD 57101 460430647 501(C)(3) 10000 0 COMMUNITY SUPPORT SIOUX FALLS HOPE COALITION 2601 S MINNESOTA AVE SIOUX FALLS SD 57105 822097994 501(C)(3) 7500 0 COALITION BUILDING SIOUX FALLS POWER HOCKEY 5808 S PRAIRIE VIEW CT SIOUX FALLS SD 57108 471795011 501(C)(3) 40000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES SIOUX FALLS SCHOOL DISTRICT 201 E 38TH ST SIOUX FALLS SD 57105 466002586 501(C)(3) 90000 0 PHYSICAL IMPROVEMENT AND HOUSING, WORKFORCE DEVELOPMENT SIOUX FALLS SPORTS AUTHORITY 200 N PHILLIPS AVE SUITE 304 SIOUX FALLS SD 57104 205850491 501(C)(3) 7500 0 COMMUNITY HEALTH IMPROVEMENT SERVICES SIOUX FALLS WOMEN RUN TRAINING 5235 S SWEETBRIAR CT SIOUX FALLS SD 57108 813518734 501(C)(6) 15000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES SIOUX FALLS YMCA 230 S MINNESOTA AVE SIOUX FALLS SD 57104 460225021 501(C)(3) 54500 0 COMMUNITY SUPPORT SLEEPY HOLLOW THEATRE & ARTS PO BOX 675 BISMARCK ND 58502 450424373 501(C)(3) 5500 0 COMMUNITY SUPPORT SMSU FDN 1501 STATE ST MARSHALL MN 56258 237108470 501(C)(3) 200000 0 WORKFORCE DEVELOPMENT SOUTH SUDANESE FOUNDATION 2037 67TH AVE S FARGO ND 58104 834476088 501(C)(3) 10000 0 ECONOMIC DEVELOPMENT SOUTHEAST TECHNICAL INSTITUTE 201 E 38TH ST SIOUX FALLS SD 57015 466002586 115 2012500 0 HEALTH PROFESSIONS EDUCATION SPECIAL OLYMPICS SOUTH DAKOTA 800 E I-90 LANE SIOUX FALLS SD 57104 460359776 501(C)(3) 10000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES ST PHILIPS BEMIDJI 702 BELTRAMI AVE NW BEMIDJI MN 56601 410701930 501(C)(3) 14000 0 COMMUNITY SUPPORT TEA AREA SCHOOL DISTRICT 41-5 131 N POPLAR AVE TEA SD 57064 743076050 115 40000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES TEAM FOUNDATION 105 PARK AVE NW BAGLEY MN 56621 061696861 501(C)(3) 6000 0 COMMUNITY SUPPORT TEAMMATES MENTORING OF SIOUX FALLS FOUNDATION 3800 W 53RD ST SIOUX FALLS SD 57106 874337113 501(C)(3) 25000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES TEDDY BEAR DEN 500 S MAIN AVENUE SIOUX FALLS SD 57104 311802800 501(C)(3) 20000 0 COMMUNITY SUPPORT THIEF RIVER FALLS PUBLIC SCHOOLS ISD 564 230 LABREE AVENUE SOUTH THIEF RIVER FALLS MN 56701 416003126 115 20500 0 COMMUNITY HEALTH IMPROVEMENT SERVICES TRI CITY UNITED SOCCER CLUB 2761 12TH AVE S FARGO ND 58103 363346894 501(C)(3) 35000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES UND ALUMNI ASSOC & FOUNDATION 3501 UNIVERSITY AVE STOP 8157 GRAND FORKS ND 58202 450348296 501(C)(3) 101350 0 HEALTH PROFESSIONS EDUCATION, WORKFORCE DEVELOPMENT UNITED WAY OF BEMIDJI AREA PO BOX 27 BEMIDJI MN 56619 411567744 501(C)(3) 78630 0 COALITION BUILDING UNITED WAY OF CASS-CLAY PO BOX 1609 FARGO ND 58107 410810008 501(C)(3) 156900 0 COALITION BUILDING UNITED WAY OF GF EGF & AREA 1013 N 5TH ST GRAND FORKS ND 58203 450255772 501(C)(3) 10000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES UNITED WAY OF NORTHEASTERN SD PO BOX 1065 ABERDEEN SD 57402 237086355 501(C)(3) 10000 0 COALITION BUILDING UNIV OF MARY 7500 UNIVERSITY DR BISMARCK ND 58504 450273403 501(C)(3) 268866 0 COMMUNITY HEALTH IMPROVEMENT SERVICES, HEALTH PROFESSIONS EDUCATION UNIV OF WI FOUNDATION 1848 UNIVERSITY AVE MADISON WI 53726 390743975 501(C)(3) 100000 0 RESEARCH UNIVERSITY OF JAMESTOWN 6085 COLLEGE LANE JAMESTOWN ND 58405 450231180 501(C)(3) 60700 0 ECONOMIC DEVELOPMENT UNIVERSITY OF SD FOUNDATION 1110 N DAKOTA ST VERMILLION SD 57069 466018891 501(C)(3) 3446227 0 ECONOMIC DEVELOPMENT, HEALTH PROFESSIONS EDUCATION, RESEARCH, WORKFORCE DEVELOPMENT UNIVERSITY OF SOUTH FLORIDA 4202 E FOWLER AVE TAMPA FL 33620 593102112 115 500000 0 RESEARCH VERMILLION CHAMBER OF COMMERCE 2 E MAIN ST STE 101 VERMILLION SD 57069 460284795 501(C)(3) 15000 0 ECONOMIC DEVELOPMENT VETERANS COMMUNITY PROJECT 88900 TROOST AVE KANSAS CITY MO 64131 474960735 501(C)(3) 16000 0 PHYSICAL IMPROVEMENT AND HOUSING VILLAGE FAMILY SERVICE CENTER 808 3RD AVE S STE 101 FARGO ND 58103 450226423 501(C)(3) 101700 0 COMMUNITY SUPPORT VILLAGE NORTHWEST UNLIMITED 330 VILLAGE CIRCLE SHELDON IA 51201 421044017 501(C)(3) 27500 0 COMMUNITY SUPPORT VOLUNTEERS OF AMERICA DAKOTAS PO BOX 89306 SIOUX FALLS SD 57109 237353508 501(C)(3) 10000 0 COMMUNITY SUPPORT WARNER SCHOOL DIST 6-5 FNDN PO BOX 20 WARNER SD 57479 204606639 501(C)(3) 10000 0 PHYSICAL IMPROVEMENT AND HOUSING WARROAD MEMORIAL ARENA ASSOCIATION DBA HDM 2024 707 ELK ST WARROAD MN 56763 363310495 C CORPORATION 20000 0 ECONOMIC DEVELOPMENT WASHINGTON PAVILION 301 S MAIN AVE SIOUX FALLS SD 57104 460435791 501(C)(3) 50000 0 ECONOMIC DEVELOPMENT WATERTOWN COMMUNITY FOUNDATION 211 E KEMP AVE WATERTOWN SD 57201 460350319 501(C)(3) 15000 0 ECONOMIC DEVELOPMENT WEST CENTRAL SCHOOL DISTRICT PO BOX 252 HARTFORD SD 57033 460284421 115 24800 0 COMMUNITY HEALTH IMPROVEMENT SERVICES WESTERN REGION ECONOMIC DEV PO BOX 1306 WILLISTON ND 58802 363803598 501(C)(6) 10000 0 ECONOMIC DEVELOPMENT WHEATON DUMONT AREA COMM FUND 1000 WESTERN AVE FERGUS FALLS MN 56538 363453471 501(C)(3) 9500 0 COMMUNITY HEALTH IMPROVEMENT SERVICES WINGS OF VALOR INC 45618 278TH ST PARKER SD 57053 843711088 501(C)(3) 50000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES WINNER REGIONAL FOUNDATION 745 E 8TH ST WINNER SD 57580 363739631 501(C)(3) 100000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES YELLOW JACKET FOUNDATION 1200 UNIVERSITY ST UNIT 9506 BELLE FOURCHE SD 57717 510151319 501(C)(3) 150000 0 ECONOMIC DEVELOPMENT YMCA OF CASS & CLAY COUNTIES 400 1ST AVE S FARGO ND 58104 450232096 501(C)(3) 36000 0 COMMUNITY SUPPORT YOUNG MENS CHRISTIAN ASSOC SF 606 E TAN TARA CIR SIOUX FALLS SD 57106 464887667 501(C)(3) 10000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES YWCA OF CASS CLAY 4650 38TH AVE S FARGO ND 58103 450226435 501(C)(3) 11500 0 COMMUNITY SUPPORT 179 14 GENERAL SUPPORT FOR COMMUNITY PROGRAMS 679 0 8355 COST SANFORD CARES CHRISTMAS PROGRAM; WHICH INCLUDES PHYSICAL ACTIVITES, BACKPACKS AND $25 GIFT CARDS. YOUTH SPORTS PROGRAM ASSISTANCE 172 17500 0 COST SCHOLARSHIPS, ASSISTANCE FOR UNIFORMS, WARMUPS, GYM RENTALS, AND TRAVEL EXPENSES. SANFORD HEALTH MILITARY AND VETERAN SCHOLARSHIPS 5 25000 COST SCHOLARSHIPS TO VETERANS WHO DEMONSTRATE LEADERSHIP AND COMMITMENT IN HIS/HER COMMUNITY. SANFORD HEALTH NETWORK SCHOLARSHIPS 23 46000 COST SCHOLARSHIPS TO STUDENTS PURSUING A POST-SECONDARY DEGREE IN A HEALTH CARE RELATED FIELD. SANFORD HEALTH EQUITY IN EDUCATION SCHOLARSHIP 5 25000 COST SCHOLARSHIPS TO UNDERREPRESENTED AND UNDERSERVED POPULATIONS SEEKING HIGHER EDUCATION. PART I, LINE 2: PRIOR TO DISBURSEMENT ALL GRANT FUND REQUESTS ARE REVIEWED TO ENSURE THE RECEIVING ORGANIZATION AND PROPOSED USE OF FUNDS ALIGN WITH SANFORD'S MISSION. X X X X 1 1 X X X X 1 1 0 0 0 1 1 1 0 MICHELLE BRUHN EVP, CFO & TREASURER (END 6/23) 0 517911 0 185400 0 2822951 0 88278 0 16765 0 3631305 0 430889 WILLIAM BRUNNER MD PHYSICIAN 3471007 0 643 0 4197 0 15669 0 28914 0 3520430 0 0 0 BILL GASSEN TRUSTEE, PRESIDENT & CEO 0 2105352 0 388071 0 327929 0 438925 0 755 0 3261032 0 0 TOMASZ STYS MD PHYSICIAN 2796443 0 0 0 151931 0 16500 0 29756 0 2994630 0 0 0 ERIC BELANGER MD PHYSICIAN 2918143 0 0 0 2692 0 16500 0 24268 0 2961603 0 0 0 THOMAS MATZKE MD PHYSICIAN 2846175 0 0 0 860 0 16500 0 33640 0 2897175 0 0 0 ADAM STYS MD PHYSICIAN 2541208 0 0 0 262082 0 16500 0 34328 0 2854118 0 0 0 MATT HOCKS EVP, CHIEF OPERATING OFFICER 0 1450706 0 363092 0 268595 0 232735 0 35003 0 2350131 0 0 JENNIFER GRENNAN EVP, CHIEF ADMIN OFFICER 0 992244 0 280000 0 183472 0 166500 0 24657 0 1646873 0 0 MICHAEL LEBEAU MD SVP, HEALTH SVC OPERATIONS 0 1001482 0 177840 0 167412 0 168035 0 33640 0 1548409 0 0 PAUL HANSON PRESIDENT & CEO, SIOUX FALLS 0 840724 0 151635 0 159448 0 142862 0 25331 0 1320000 0 0 BILL MARLETTE INTERIM, EVP, CFO (BEG 6/23) 0 856004 0 0 0 450326 0 0 0 378 0 1306708 0 0 TIFFANY LAWRENCE PRESIDENT & CEO, FARGO 0 806048 0 137733 0 127768 0 139200 0 35579 0 1246328 0 0 TODD SCHAFFER PRESIDENT & CEO, BISMARCK 0 687954 0 170510 0 133277 0 119938 0 2471 0 1114150 0 0 SUSAN JARVIS FORMER PRESIDENT & CEO, BEMIDJI 0 635599 0 98282 0 138125 0 114000 0 27301 0 1013307 0 0 KIM PATRICK FORMER CLO 0 0 0 0 0 998482 0 0 0 0 0 998482 0 0 MARK LUNDEEN MD TRUSTEE, PHYSICIAN 310852 0 0 0 281021 0 16500 0 60 0 608433 0 0 0 KARLA EISCHENS PRESIDENT & CEO, BEMIDJI 0 408795 0 26771 0 74281 0 79165 0 16667 0 605679 0 0 MICAH ABERSON FORMER EVP, CIO 0 0 0 0 0 453110 0 0 0 0 0 453110 0 0 ANDY NORTH TRUSTEE, SECRETARY, INDEP CONTRACTOR 324345 0 0 0 0 0 0 0 0 0 324345 0 0 0 RANDY BURY FORMER CAO 0 0 0 0 0 283920 0 0 0 0 0 283920 0 0 PART I, LINE 1A ON PART I, QUESTIONS REGARDING COMPENSATION, SANFORD CHECKED SEVERAL OF THE ITEMS AS PROVIDED TO LISTED PERSONS: FIRST CLASS OR CHARTER TRAVEL - CHARTER TRAVEL FOR BUSINESS PURPOSES IS PROVIDED FOR INDIVIDUALS AS NEEDED AND AS COST APPROPRIATE, IN ACCORDANCE WITH WRITTEN POLICIES. THESE COSTS ARE NOT INCLUDED IN THE W-2'S OF THE INDIVIDUALS AS THEY ARE INCURRED FOR BUSINESS PURPOSES OF SANFORD. TRAVEL FOR COMPANIONS - LIMITED TRAVEL FOR COMPANIONS IS OFFERED FOR CERTAIN MEETINGS AND EVENTS. THESE COSTS ARE INCLUDED IN THE 1099'S OF THE INDIVIDUALS. SANFORD USED THE SIFL (STANDARD INDUSTRY FARE LEVEL) RATE METHOD TO IMPUTE THE FRINGE BENEFIT TO THE LISTED PERSON. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS - CERTAIN COMPENSATION MAY BE GROSSED UP TO INCLUDE APPROPRIATE TAX AMOUNTS. HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES - ALL SANFORD EMPLOYEES ARE ELIGIBLE FOR DISCOUNTED WELLNESS MEMBERSHIPS, A PORTION OF THESE DISCOUNTS AND OTHER CLUB DUES ARE INCLUDED AS FRINGE BENEFITS AND TAXED AS SUCH. PART I, LINE 3: SANFORD ENGAGES A NATIONALLY RECOGNIZED INDEPENDENT COMPENSATION CONSULTING FIRM ANNUALLY TO REVIEW THE TOTAL COMPENSATION ARRANGEMENTS OF THE OFFICERS AND EXECUTIVES OF THE ORGANIZATION, INCLUDING THE CEO, AND TO REPORT THE FINDINGS TO THEM FOR DELIBERATION AND ACTION. THE DELIBERATIONS AND ACTIONS ARE RECORDED IN THE MINUTES OF THE SANFORD BOARD OF TRUSTEES. THE MOST RECENT STUDY WAS COMPLETED IN 2023. PART I, LINES 4A-B LINE 4A-SEVERANCE OR CHANGE OF CONTROL PAYMENT UPON HIRE OR PROMOTION, SELECT OFFICERS AND KEY EMPLOYEES SIGN AN EXECUTIVE SEVERANCE AGREEMENT (THE "AGREEMENT"). THE AGREEMENT PROVIDES THAT THE EXECUTIVE WILL RECEIVE A MULTIPLE OF HIS OR HER SALARY (BASED ON YEARS OF SERVICE OR POSITION) AS A PAYMENT IN THE EVENT OF A DEFINED SEPARATION EVENT, WHICH CAN INCLUDE AN INVOLUNTARY SEPARATION OR AN EMPLOYEE VOLUNTARILY LEAVING FOR A DEFINED CONTRACTUAL REASON. EXECUTIVES MAY ALSO QUALIFY FOR A PAYMENT FOR SATISFYING A NON-COMPETE. FINAL SEPARATION PAYMENTS MIGHT VARY FROM THE AMOUNT PROVIDED IN THE AGREEMENT AS A RESULT OF NEGOTIATIONS SURROUNDING POST-SEPARATION OBLIGATIONS AND INCENTIVES (THE "SEPARATION" PAYMENT). LINE 4B-SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS SANFORD SPONSORS NONQUALIFIED RETIREMENT PLANS FOR SELECT OFFICERS OR KEY EMPLOYEES. CERTAIN OF THE BELOW OFFICERS OR KEY EMPLOYEES WERE PAID AS A RESULT OF A VESTING EVENT. LINE 4A AND 4B-PAYMENTS THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE OR CHANGE OF CONTROL PAYMENTS AND/OR SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS: MICHELLE BRUHN: SEPARATION..................................$2,157,592 NONQUALIFIED RETIREMENT PLAN..................$576,899 TOTAL.......................................$2,734,491 BILL MARLETTE: NON-COMPETE PAYMENT...........................$436,802 KIM PATRICK: NONQUALIFIED RETIREMENT PLAN..................$998,482 MICAH ABERSON: NON-COMPETE PAYMENT...........................$453,110 RANDY BURY: NON-COMPETE PAYMENT...........................$283,920 PART I, LINE 6 SANFORD PHYSICIANS ARE COMPENSATED BASED ON THE PROFESSIONAL SERVICES THEY PERFORM WITHIN THE CLINIC IN WHICH THEY PROVIDE CARE. GENERALLY, THE MODEL IS BASED ON PRODUCTION. PART I, LINE 7 CERTAIN EMPLOYEES ARE ELIGIBLE FOR A DISCRETIONARY INCENTIVE BONUS. BONUSES ARE PAID BASED ON THE ACHIEVEMENT OF FINANCIAL AND OTHER GOALS. A SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 460315509 83755VHY3 2004-09-14 70073989 2004: NEW CONSTRUCTION OF HEALTHCARE FACILITIES 0 0 0 B CITY OF CHAMBERLAIN 460000094 000000000 2010-12-30 4000000 2010 CHAMB: NEW CONSTRUCTION OF LONG-TERM CARE FACILITIES 0 0 0 C SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 460315509 000000000 2012-03-29 66185000 2012AB: REFUNDING BONDS ISSUED 9/12/2001 AND 10/15/2002 0 0 0 D SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 460315509 000000000 2012-06-14 45000000 2012D:REFINANCE TAXABLE INDEBTEDNESS USED TO CONSTRUCT HEALTHCARE FACILITY 0 0 0 A 57925000 71581953 85352 764068 70817885 2006 0 0 1 1 B 3290094 4000000 4000000 2010 0 0 1 1 C 42025000 66185000 24356 66160644 2012 1 1 1 1 D 21480000 45000000 45000000 2012 0 0 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 D 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 1 0 0 0 0 B 0 0 1 0 1 0 0 0 0 C 0 0 0 1 1 0 0 0 0 D 0 0 1 0 1 0 0 0 0 A 0 B 0 C 0 D 0 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 09/14/2006 ISSUER NAME: SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 03/29/2013 ISSUER NAME: SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 10/30/2019 ISSUER NAME: SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 11/12/2020 SCHEDULE K, PART I, BOND ISSUES BONDS ISSUED 10/28/2014, COLUMN(C) CUSIP #: 83755VXF6 AND 83755VXE9 BONDS ISSUED 9/14/2004, COLUMN(C) CUSIP #: 83755VHY3 AND 83755VHZ0 PART I, COLUMN E AND PART II, LINE 3 DIFFERENCES BETWEEN THE ISSUE PRICE (PART I, COLUMN E) AND TOTAL PROCEEDS (PART II, LINE 3) ARE DUE TO INVESTMENT EARNINGS. PART II, LINE 4 THE AMOUNTS SHOWN HERE CONSIST OF DEBT SERVICE FUND DEPOSITS. PART III PART III HAS NOT BEEN COMPLETED FOR THE 3/29/2012 SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY BONDS. THESE BONDS REFUNDED PRE-2003 DEBT THAT DOES NOT HAVE TO BE REPORTED. PART IV, LINE 6 WITH RESPECT TO THE 3/29/2012 AND 10/21/2015 SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY BONDS, THIS QUESTION IS BEING ANSWERED WITHOUT REGARD TO A YIELD-RESTRICTED ADVANCE REFUNDING ESCROW FINANCED WITH PROCEEDS OF BONDS. A SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 460315509 83755VWA8 2014-08-05 52083720 2014A: CURRENT REFUND 2004A ISSUED 9/14/2004 0 0 0 B SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 460315509 83755VXE9 2014-10-28 207014209 2014B: NEW CONSTRUCTION AND REMODELING OF HEALTHCARE FACILITIES 0 0 0 C SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 460315509 83755VZW7 2015-10-21 192641206 2015:NEW CONSTRUCTION & ADVANCED REFUNDING OF BONDS ISSUED 4/19/07, 5/22/07 0 0 0 D SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 460315509 000000000 2016-10-28 50000000 2016: NEW CONSTRUCTION, EQUIPMENT AND IMPROVEMENTS 0 0 0 A 52083720 1009 52083720 2014 1 0 1 1 B 29085000 207081359 7733 31874 1906127 205143359 2017 0 0 1 1 C 29840000 192707024 7911 1431628 110529233 80746163 2017 0 1 1 1 D 35000000 50000000 150032 49849968 2017 0 0 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 C 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 D 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 0 0 0 0 0 0 B 0 0 0 1 0 0 0 0 0 C 0 0 0 1 0 0 0 0 0 D 0 0 1 0 1 0 0 0 0 A 0 B 0 C 0 D 0 PAIGE SCHAFFER FAMILY RELATIONSHIP - TODD SCHAFFER EDUCATION X 20000 21449 0 0 1 21449 KACEY DOYLE FAMILY RELATIONSHIP - MARNIE HERMANN 74583 EMPLOYMENT 0 KRISTI BENZ FAMILY RELATIONSHIP - LAURIS MOLBERT 59691 EMPLOYMENT 0 NICHOLE HESTER FAMILY RELATIONSHIP - ANDY NORTH 48869 INDEPENDENT CONTRACTOR ARRANGEMENT 0 JACOB PEARLSON FAMILY RELATIONSHIP - KARLA EISCHENS 94435 EMPLOYMENT 0 SCOTT ABERSON FAMILY RELATIONSHIP - MICAH ABERSON 689919 EMPLOYMENT 0 PART V, LINE 3A: SANFORD HEALTH, SANFORD MEDICAL CENTER, SANFORD NORTH, SANFORD MEDICAL CENTER FARGO, SANFORD CLINIC NORTH, SANFORD CLINIC, SANFORD BISMARCK, SANFORD HEALTH NETWORK NORTH, AND SANFORD WORLD CLINICS HAVE UNRELATED BUSINESS GROSS INCOME OVER $1,000. PART V, LINE 4A: SANFORD WORLD CLINICS HAS AN INTEREST IN FINANCIAL ACCOUNTS IN THE FOREIGN COUNTRIES OF GHANA, CHINA AND GERMANY. FORM 990, PART VI, SECTION A, LINE 2 THE FOLLOWING OFFICERS, BOARD MEMBERS, AND KEY EMPLOYEES ARE EMPLOYEES OF SANFORD OR ITS RELATED ORGANIZATIONS. MANY OF THESE EMPLOYEES ALSO SERVE ON OTHER RELATED SANFORD BOARDS, OR HAVE BUSINESS RELATIONSHIPS WITH EACH OTHER THAT SPAN THE ORGANIZATION AS A WHOLE: BILL GASSEN, JENNIFER GRENNAN, MARK LUNDEEN, MICHAEL LEBEAU, MICHELLE BRUHN, PAUL HANSON, MATT HOCKS, TODD SCHAFFER, BILL MARLETTE, KARLA EISCHENS & TIFFANY LAWRENCE. FORM 990, PART VI, SECTION A, LINE 6 SANFORD IS GOVERNED BY A BOARD OF TRUSTEES (BOT) THAT HAS ULTIMATE STRATEGIC AND DECISION MAKING AUTHORITY. THE BOT DELEGATES CERTAIN ACTIVITIES AND RESPONSIBILITIES TO BOARDS OF EACH OF SANFORD'S PRIMARY OPERATING SUBSIDIARIES. THE UNIQUE NATURE AND COMPLEXITY OF THE SUBSIDIARIES REQUIRES EACH TO HAVE A DELEGATED BOARD WITH A SINGULAR ENTITY FOCUS. SUCH BODIES, REFERRED TO AS BOARDS OF DIRECTORS AND BOARDS OF GOVERNORS, ADDRESS MATTERS SUCH AS CREDENTIALING, ACCREDITATION STANDARDS, DEVELOPING BUDGETS, PROGRAMS AND FACILITIES ON AN ENTITY-SPECIFIC BASIS, AND GENERALLY CONSIST OF INDIVIDUALS DISTINCT FROM THE BOT. THESE BOARDS FUNCTION MUCH LIKE COMMITTEES IN A TRADITIONAL CORPORATE STRUCTURE. THE BOT THEN ACTS AS A HOLDING COMPANY BOARD, SYNTHESIZING AND RECONCILING EACH ENTITY'S PROGRAMS AND BUDGETS INTO A SYSTEM-WIDE STRATEGIC PLAN. THIS STRUCTURE OF GOVERNANCE PRODUCES A SIGNIFICANT NUMBER OF TRUSTEES, GOVERNORS AND DIRECTORS. SUBSIDIARIES INCLUDED WITHIN THIS GROUP TAX RETURN CONSIST OF SANFORD HEALTH, SANFORD NORTH, SANFORD MEDICAL CENTER, SANFORD MEDICAL CENTER FARGO, SANFORD CLINIC, SANFORD CLINIC NORTH, SANFORD HEALTH NETWORK, SANFORD HEALTH NETWORK NORTH, SANFORD HOME HEALTH, SANFORD RESEARCH, SANFORD RESEARCH NORTH, SANFORD WORLD CLINICS, SANFORD HEALTH OF NORTHERN MINNESOTA, BAKER PARK, INC., SANFORD WEST, SANFORD BISMARCK, SANFORD VIRTUAL CARE, AND SANFORD WORLD CLINICS - KLAMATH FALLS. THE BOARD OF TRUSTEES OF SANFORD IS ALSO THE BOARD OF TRUSTEES FOR SANFORD HEALTH, SANFORD NORTH, AND SANFORD WEST, AND SANFORD IS THE SOLE CORPORATE MEMBER OF THESE ENTITIES. THESE ENTITIES, IN TURN, ARE THE SOLE CORPORATE MEMBERS OF THEIR SUBSIDIARIES. THE ACTIONS APPROVED BY A SUBSIDIARY'S BOARD OF DIRECTORS ARE THEN APPROVED BY THE SANFORD BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7A THE SANFORD BOARD OF TRUSTEES APPOINTS THE BOARD MEMBERS FOR THE BOARDS OF DIRECTORS AND BOARDS OF GOVERNORS OF THE SUBSIDIARY ENTITIES. FORM 990, PART VI, SECTION A, LINE 7B THE SANFORD BOARD OF TRUSTEES APPROVES THE ACTIONS APPROVED BY THE BOARDS OF DIRECTORS AND BOARDS OF GOVERNORS OF THE SUBSIDIARY ENTITIES. FORM 990, PART VI, SECTION B, LINE 10B: SANFORD NORTH, SANFORD CLINIC AND SANFORD HEALTH NETWORK HAVE LOCAL CHAPTERS, BRANCHES OR AFFILIATES OVER WHICH THE ORGANIZATION HAS THE LEGAL AUTHORITY TO EXERCISE DIRECT OR INDIRECT SUPERVISION AND CONTROL. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED INTERNALLY BY THE TAX DEPARTMENT AND REVIEWED BY EXECUTIVE MANAGEMENT. THE TAX DEPARTMENT PREPARES RETURN HIGHLIGHTS AND KEY DISCLOSURES FOR THE EXECUTIVE MANAGEMENT TEAM. AN EXTERNAL ACCOUNTING FIRM REVIEWS AND SIGNS THE RETURN. BEFORE THE RETURN IS FILED, A COMPLETE COPY IS PROVIDED TO THE CURRENT BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 12C THE ANNUAL CONFLICT OF INTEREST DISCLOSURE PROCESS IS MANAGED BY THE CHIEF COMPLIANCE OFFICER (CCO). THE CCO IS RESPONSIBLE FOR ASSURING THAT ALL COMPLETED FORMS ARE RETURNED IN A TIMELY AND COMPLETE MANNER. CONFLICT OF INTEREST QUESTIONNAIRES ARE SENT TO SYSTEM TRUSTEES, MEMBERS OF THE GOVERNING BOARDS OF SUBSIDIARY ENTITIES, OFFICERS, AND KEY EMPLOYEES FOR ALL ENTITIES SUBJECT TO THE IRS FORM 990 FILINGS. THE DISCLOSURES ARE SUMMARIZED FOR REVIEW BY THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES, PURSUANT TO POLICY. THIS REVIEW ALLOWS: 1) THE BOARD TO ACQUIRE AN AWARENESS OF FINANCIAL RELATIONSHIPS OF BOARD MEMBERS AND KEY MANAGEMENT EMPLOYEES AND CAN INVOKE THE RECUSAL PROCESS ON A CASE-BY-CASE BASIS IF POTENTIAL CONFLICTS ARE IMPLICATED IN BOARD DECISIONS AND DELIBERATIONS, AND, 2) GIVES THE BOARD THE OPPORTUNITY TO SEEK ADDITIONAL INFORMATION AND CLARIFICATION ABOUT DISCLOSURES TO DETERMINE POTENTIAL CONFLICTS OF INTEREST, AND HOW TO MANAGE THEM. FORM 990, PART VI, SECTION B, LINE 15 SANFORD HAS A PROCESS FOR DETERMINING COMPENSATION OF THE PERSONS LISTED ON PART VII, SECTION A. THIS INCLUDES A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, REVIEW OF COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION FOR SUCH COMPENSATION. SANFORD ENGAGES A NATIONALLY RECOGNIZED INDEPENDENT COMPENSATION CONSULTING FIRM ANNUALLY TO REVIEW THE TOTAL COMPENSATION ARRANGEMENTS OF THE OFFICERS AND EXECUTIVES OF THE ORGANIZATION, INCLUDING THE CEO, AND TO REPORT THE FINDINGS TO THEM FOR DELIBERATION AND ACTION. THE DELIBERATIONS AND ACTIONS ARE RECORDED IN THE MINUTES OF THE SANFORD BOARD OF TRUSTEES. THE MOST RECENT STUDY WAS COMPLETED IN 2023. PART VI, LINE 16A: SANFORD MEDICAL CENTER, SANFORD HEALTH, AND SANFORD CLINIC NORTH HAVE PARTICIPATED IN JOINT VENTURES WITH TAXABLE ENTITIES. FORM 990, PART VI, SECTION C, LINE 19 ALTHOUGH THE ORGANIZATION DOES NOT MAINTAIN A WEBSITE WHERE THE PUBLIC CAN ACCESS THESE DOCUMENTS, IT WOULD RESPOND INDIVIDUALLY TO ANY REQUESTS OR INQUIRIES FROM THE PUBLIC FOR THESE DOCUMENTS. FORM 990, PART VII, SECTION A THE TABLE REPORTS THE COMPENSATION OF THE SANFORD OFFICERS, DIRECTORS/TRUSTEES, SYSTEM KEY EMPLOYEES, AND FIVE HIGHEST COMPENSATED EMPLOYEES AND INDEPENDENT CONTRACTORS. THE SANFORD BOARD OF TRUSTEES HAS ULTIMATE GOVERNANCE RESPONSIBILITIES FOR EACH SUBORDINATE ORGANIZATION. FORM 990, PART VII, SECTION B WE ARE REPORTING ONE GROUP OF TOP FIVE EMPLOYEES AND INDEPENDENT CONTRACTORS FOR THE ENTIRE GROUP. AMOUNTS LISTED AS COMPENSATION FOR THE FIVE HIGHEST COMPENSATED INDEPENDENT CONTRACTORS INCLUDE PAYMENTS FOR BOTH MATERIALS AND SERVICES. FORM 990, PART XI, LINE 9: CASH SWEEP FOR POOLED INVESTMENTS -221,754,853. PENSION PLAN ACTURIAL GAIN/LOSS -10,318,072. CAPITAL CONTRIBUTIONS TO AFFILIATES -21,454,958. FORM 990 ELECTIONS FORM 990, PAGE 1, LINE H(A) - LISTING OF SUBORDINATE ORGANIZATIONS: NAMES, ADDRESSES, AND EINS SANFORD HEALTH 1305 W 18TH STREET, PO BOX 5039 SIOUX FALLS, SD 57117-5039 EIN: 31-1527032 SANFORD MEDICAL CENTER 1305 W 18TH STREET, PO BOX 5039 SIOUX FALLS, SD 57117-5039 EIN: 46-0227855 SANFORD HOME HEALTH 1305 W 18TH STREET, PO BOX 5039 SIOUX FALLS, SD 57117-5039 EIN: 46-0282134 SANFORD HEALTH NETWORK 1305 W 18TH STREET SIOUX FALLS, SD 57105 EIN: 46-0388596 SANFORD CLINIC 1305 W 18TH STREET, PO BOX 5039 SIOUX FALLS, SD 57117-5039 EIN: 46-0447693 SANFORD RESEARCH 2301 E 60TH STREET N SIOUX FALLS, SD 57104 EIN: 46-0450378 SANFORD RESEARCH NORTH 120 8TH STREET SOUTH FARGO, ND 58103 EIN: 45-0274828 SANFORD WORLD CLINICS 1305 W 18TH STREET SIOUX FALLS, SD 57105 EIN: 26-2707628 SANFORD WORLD CLINICS - KLAMATH FALLS 3001 DAGGETT AVE KLAMATH FALLS, OR 97601 92-0396212 SANFORD NORTH 801 BROADWAY DRIVE, PO BOX 2010 FARGO, ND 58122 EIN: 45-0385890 SANFORD CLINIC NORTH 801 BROADWAY DRIVE, PO BOX 2010 FARGO, ND 58122 EIN: 91-1770748 SANFORD MEDICAL CENTER FARGO 801 BROADWAY DRIVE, PO BOX 2010 FARGO, ND 58122 EIN: 45-0226909 SANFORD HEALTH NETWORK NORTH 801 BROADWAY DRIVE, PO BOX 2010 FARGO, ND 58122 EIN: 45-0409348 SANFORD HEALTH OF NORTHERN MINNESOTA 1300 ANNE STREET NW BEMIDJI, MN 56601 EIN: 41-1266009 BAKER PARK, INC. 803 DEWEY AVENUE NW BEMIDJI, MN 56601 EIN: 41-1372480 SANFORD WEST 300 N 7TH STREET BISMARCK, ND 58501 EIN: 45-0397195 SANFORD BISMARCK 300 N 7TH STREET BISMARCK, ND 58501 EIN: 45-0226700 SANFORD VIRTUAL CARE 1305 W 18TH STREET, PO BOX 5039 SIOUX FALLS, SD 57117-5039 EIN: 88-0976483 1527 BROADWAY LLC 1527 BROADWAY ALEXANDRIA MN 56308 411336392 RADIATION SERVICES MN 91852 0 SANFORD CLINIC NORTH DG DEVELOPMENTS 2 LLC 1300 W 57TH ST SUITE 100 SIOUX FALLS SD 57108 267317570 REAL ESTATE SD 0 3913231 SANFORD HEALTH HEALTHCARE ENVIRONMENTAL SERVICES LLC PO BOX 2010 FARGO ND 58122 205236701 RETAIL ENTERPRISES ND 1159963 3382508 SANFORD NORTH NATIONAL STUDENT HOUSING-SOUTH DAKOTA LLC 1305 W 18TH ST SIOUX FALLS SD 57105 202129839 REAL ESTATE SD 207842 2578690 SANFORD HEALTH NORTH COUNTRY SENIOR LIVING LLC 1000 ANNE ST NW BEMIDJI MN 56601 263862586 SENIOR HOUSING CO 3477489 4792463 SANFORD HEALTH OF NORTHERN MINNESOTA RAC RENTALS LLC 1305 W 18TH ST SIOUX FALLS SD 57105 261961077 REAL ESTATE SD 0 2950374 SANFORD HEALTH SANFORD HEALTHCARE ACCESSORIES LLC 3223 32ND AVE SW FARGO ND 58103 202404179 SALES OF DURABLE MEDICAL EQUIP ND 62003202 50721915 SANFORD HEALTH SOUTHWEST MINNESOTA RADIATION CENTER LLC 1018 6TH AVENUE WORTHINGTON MN 56187 460447693 RADIATION SERVICES MN 0 0 SANFORD HEALTH NETWORK ADAMS COUNTY GOOD SAMARITAN HOUSING GP INC P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 461495572 LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS AS GP SD 501(C)(3) 12-I THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY 1 ARLINGTON GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 371805492 PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS SD 501(C)(3) 10 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY 1 BOISE GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 363370371 PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS SD 501(C)(3) PF THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY 1 COLLISTER DRIVE HOUSING GP INC P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 300872973 LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS AS GP SD 501(C)(3) PF THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY 1 F-M AMBULANCE SERVICE INC P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 450344371 EMT ND 501(C)(4) SANFORD NORTH 1 GOOD SAMARITAN SOCIETY INC P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 460349951 PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS SD 501(C)(3) 12-I THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY 1 HASTINGS VILLAGE GARDENS GOOD SAMARITAN HOUSING GP INC P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 271212446 LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS AS GP SD 501(C)(3) 12-I THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY 1 LEA COUNTY GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 453946645 PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS SD 501(C)(3) 10 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY 1 LILAC WAY GOOD SAMARITAN HOUSING GP INC P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 465740381 LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS AS GP SD 501(C)(3) 12-I THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY 1 MILLARD GOOD SAMARITAN HOUSING GP INC P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 460396332 LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS AS GP SD 501(C)(3) 12-I THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY 1 OLATHE GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 460396398 LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS AS GP SD 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