2025-11-13T08:49:29-06:00 2024-12-31 346565596 ERNST & YOUNG US LLP 155 N WACKER DRIVE CHICAGO IL 60606 990 2024-01-01 453791176 SANFORD GROUP RETURN SANF 6053331000 PO BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 NICHOLAS OLSON EVP, CFO 6053331000 2025-11-13 1 0 JESS WAGENER P01622613 3128792000 2024 2025-03-06 01:10:19Z BILL GASSEN 2301 EAST 60TH ST SIOUX FALLS SD 57104 6128553345 1 1 5851 X WWW.SANFORDHEALTH.ORG X TO CARE, COMFORT AND CURE 12 8 3271 1302 129413179 8490549 100653729 106770013 5616529846 5979938305 19460626 21264847 2011713 2607388 5738655914 6110580553 46276954 47489473 0 0 3036308464 3288698827 0 0 0 2290939774 2492950369 5373525192 5829138669 365130722 281441884 3759919108 4274026030 1129335603 1142418868 2630583505 3131607162 X SANFORD HEALTH IS COMMITTED TO THE HEALTHCARE NEEDS OF COMMUNITIES THROUGHOUT THE UPPER MIDWEST. SANFORD HEALTH PROVIDES A FULL RANGE OF PRIMARY AND SPECIALTY HEALTHCARE SERVICES AND STRIVES TO BE THE PREMIER RURAL HEALTH SYSTEM IN THE UNITED STATES. 0 0 5293466097 47489473 5949015399 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 MANAGED 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. 51679766 0 6642227 SANFORD HEALTH 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 DIFFERENCES AND ADDRESSES THE NEED FOR SPECIALTY TRAINING. SANFORD HEALTH 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. 38934194 0 19511850 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. 5384080057 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 1 0 0 0 1 1 1 0 1 0 1 X 4348 0 1 3271 1 1 1 1 CH GH GM 0 0 0 0 0 0 0 1 0 0 0 X 12 8 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 BILL GASSEN TRUSTEE, PRESIDENT & CEO 23.70 36.30 X X 0 4414119 585241 ANDY NORTH TRUSTEE, SECRETARY, INDEP CONTRACTOR 1.91 2.99 X X 379383 0 0 LAURIS MOLBERT TRUSTEE, CHAIRPERSON 1.91 2.99 X X 107199 0 0 BRENT TEIKEN TRUSTEE 1.91 2.99 X 84246 0 0 JAMES CAIN TRUSTEE, TREASURER 1.91 2.99 X X 81651 0 0 MARNIE HERMANN TRUSTEE, VICE CHAIR 1.91 2.99 X X 80382 0 0 NEIL GULSVIG TRUSTEE, PAST CHAIR 1.91 2.99 X X 80055 0 0 MARK LUNDEEN MD TRUSTEE 1.91 2.99 X 80000 0 0 DAVID SHULKIN TRUSTEE (START 1/24) 1.91 2.99 X 79826 0 0 STEPHANIE HERSETH SANDLIN TRUSTEE (START 1/24) 1.91 2.99 X 78750 0 0 WESLEY ENGBRECHT TRUSTEE 1.91 2.99 X 77594 0 0 DANA DYKHOUSE TRUSTEE (START 1/24) 1.91 2.99 X 76727 0 0 SCOTT WOOTEN EVP, CFO (END 4/24) 23.70 36.30 X 0 2525208 51220 NICK OLSON EVP, CFO (BEG 4/24) 23.70 36.30 X 0 1047876 123386 BILL MARLETTE INTERIM, EVP, CFO (END 1/24) 23.70 36.30 X 0 894301 275 MATT HOCKS EVP, CHIEF OPERATING OFFICER 54.00 6.00 X 0 2798445 276533 JENNIFER GRENNAN EVP, CHIEF ADMIN OFFICER 51.00 9.00 X 0 1991610 207852 MICHAEL LEBEAU MD SVP, HEALTH SVC OPERATIONS 50.00 10.00 X 0 1824864 209688 PAUL HANSON PRESIDENT & CEO, SIOUX FALLS 60.00 0.00 X 0 1471880 172935 TIFFANY LAWRENCE PRESIDENT & CEO, FARGO 55.00 5.00 X 0 1426252 179445 TODD SCHAFFER PRESIDENT & CEO, BISMARCK 60.00 0.00 X 0 1224459 127517 KARLA EISCHENS PRESIDENT & CEO, BEMIDJI 60.00 0.00 X 0 729610 107668 WILLIAM BRUNNER MD PHYSICIAN 60.00 0.00 X 3286993 0 46564 ADAM STYS MD PHYSICIAN 60.00 0.00 X 3250190 0 53103 TOMASZ STYS MD PHYSICIAN 60.00 0.00 X 2911937 0 48065 ERIC BELANGER MD PHYSICIAN 60.00 0.00 X 2885080 0 41962 ALEXANDER DROFA MD PHYSICIAN 60.00 0.00 X 2835917 0 48215 DON JACOBS FORMER TRUSTEE 0.00 0.00 X 13502 0 0 MICHELLE BRUHN FORMER EVP, CFO & TREASURER 0.00 0.00 X 0 293725 0 SUSAN JARVIS FORMER PRESIDENT & CEO, BEMIDJI 60.00 0.00 X 0 920606 146335 BRYAN NERMOE FORMER PRESIDENT & CEO, FARGO 0.00 0.00 X 0 252724 0 16389432 21815679 2426004 2543 1 1 0 FOCUSONE SOLUTIONS LLC 1010 N 102ND ST STE 300 OMAHA NE 68114 STAFFING SERVICES 82249583 HENRY CARLSON CONSTRUCTION LLC 1205 RUSSELL ST SIOUX FALLS SD 57104 CONSTRUCTION SERVICES 48201317 SIRIUS COMPUTER SOLUTIONS LLC PO BOX 405547 ATLANTA GA 30384 SOFTWARE MAINTENANCE & SUPPORT 40889798 FIEGEN CONSTRUCTION COMPANY 3712 S WESTERN AVE SUITE 200 SIOUX FALLS SD 57105 CONSTRUCTION SERVICES 19562363 EPIC SYSTEMS GROUP 1979 MILKY WAY VERONA WI 53593 SOFTWARE MAINTENANCE & SUPPORT 14086173 409 72319564 31547938 2902511 495000 106770013 PATIENT SERVICES 621110 2606060516 2606060516 MEDICARE / MEDICAID 621400 2231956275 2231956275 PHARMACY REVENUE 456110 618161606 603322453 14839153 RETAIL SALES 446199 392976809 372171388 20805421 REFERENCE LAB 621500 20095023 49759 20045264 110688076 36652003 72992546 1043527 5979938305 14394451 14394451 24178 24178 4008915 1425705 2583210 2583210 2583210 23417483 432661 16114426 -432661 7303057 6870396 -4768829 730795 10908430 6110580553 5845443565 129413179 28953796 47295864 47295864 193609 193609 25637961 23526842 2111119 1626893 1626893 2661473477 2443811412 217662065 153437024 143520974 9916050 277328969 245679776 31649193 169194503 155782890 13411613 3503714 650966 2852748 1380826 103959 1276867 823506 823506 711706 711706 376585985 336255426 40330559 19644933 5997774 13647159 62842849 42907221 19935628 140847720 12101124 128746596 121162468 112360071 8802397 22214217 20079245 2134972 7049054 5524046 1525008 26244908 18345602 7899306 136664535 110002562 26661973 26097031 23280540 2816491 MEDICAL SUPPLIES 1540145054 1543546010 -3400956 BIOMEDICAL SERVICES 30272277 30272277 OTHER TAXES 20733970 20287513 446457 CERT/LICENSES/SUBSCRIPT 11538834 10410799 1128035 -55513218 32143555 -87656773 5829138669 5384080057 445058612 0 59316362 140911773 183735153 254828846 836469834 809694586 21449 17989 74098691 76107318 131499348 136859819 93247192 101889548 4192108718 2108709461 1864744233 2083399257 192795 210450 57598283 17127027 33679559 33758470 44839780 186355134 380476429 432865813 3759919108 4274026030 322769972 330107354 6139321 1597851 20072536 15468583 451201775 425371043 349593 425450 7847503 8970172 320954903 360478415 1129335603 1142418868 X 2630576405 3131607162 7100 0 2630583505 3131607162 3759919108 4274026030 X 281441884 -42153731 261735504 X 0 1 X 1 1 1 X 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) SANFORD HEALTH OF SOUTH DAKOTA 170(B)(1)(A)(III) SCHEDULE A, PART I PART I, LINE 12B - SANFORD HEALTH, SANFORD NORTH, AND SANFORD WEST ARE ALL TYPE II SUPPORTING ORGANIZATIONS. PART I, LINE 12F - TOTAL NUMBER OF SUPPORTED ORGANIZATIONS - 21 DETAIL FOR SCHEDULE A, PART I, LINE 12G LINE 12, COLUMN: (I) SANFORD MEDICAL CENTER; (II) 46-0227855; (III) 3; (IV) YES; (V) $47,862,238 LINE 12, COLUMN: (I) SANFORD CLINIC; (II) 46-0447693; (III) 10; (IV) YES; (V) $3,593,622 LINE 12, COLUMN: (I) SANFORD RESEARCH; (II) 46-0450378; (III) 4; (IV) YES; (V) $1,202,755 LINE 12, COLUMN: (I) SANFORD RESEARCH NORTH; (II) 45-0274828; (III) 4; (IV) YES; (V) $181,436 LINE 12, COLUMN: (I) SANFORD HOME HEALTH; (II) 46-0282134; (III) 10; (IV) YES; (V) $493,751 LINE 12, COLUMN: (I) SANFORD HEALTH NETWORK; (II) 46-0388596; (III) 3; (IV) YES; (V) $12,403,116 LINE 12, COLUMN: (I) SANFORD CLINIC NORTH; (II) 91-1770748; (III) 10; (IV) YES; (V) $1,936,538 LINE 12, COLUMN: (I) SANFORD HEALTH NETWORK NORTH; (II) 45-0409348; (III) 3; (IV) YES; (V) $4,745,936 LINE 12, COLUMN: (I) SANFORD MEDICAL CENTER FARGO; (II) 45-0226909; (III) 3; (IV) YES; (V) $60,510,131 LINE 12, COLUMN: (I) SANFORD WORLD CLINICS; (II) 26-2707628; (III) 10; (IV) YES; (V) $430,079 LINE 12, COLUMN: (I) SANFORD WORLD CLINICS-KLAMATH FALLS; (II) 92-0396212 (III) 10; (IV) YES; (V) $99,977 LINE 12, COLUMN: (I) SANFORD HEALTH OF NORTHERN MINNESOTA; (II) 41-1266009; (III) 3; (IV) YES; (V) $14,102,329 LINE 12, COLUMN: (I) BAKER PARK, INC.; (II) 41-1372480; (III) 10; (IV) YES; (V) $29,048 LINE 12, COLUMN: (I) SANFORD HEALTH FOUNDATION NORTH; (II) 45-0398104; (III) 7; (IV) YES; (V) $142,347 LINE 12, COLUMN: (I) SANFORD BISMARCK; (II) 45-0226700; (III) 3; (IV) YES; (V) $26,745,913 LINE 12, COLUMN: (I) SANFORD HEALTH FOUNDATION WEST; (II) 45-0397196; (III) 7; (IV) YES; (V) $47,721 LINE 12, COLUMN: (I) SANFORD VIRTUAL CARE; (II) 88-0976483; (III) 10; (IV) YES; (V) $25,016 LINE 12, COLUMN: (I) THE EVANGELICAL LUTHERAN GOOD SAMARITAN FOUNDATION; (II) 46-0422866; (III) 7; (IV) YES; (V) $29,454,572 LINE 12, COLUMN: (I) THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY; (II) 45-0228055; (III) 10; (IV) YES; (V) $403,745 LINE 12, COLUMN: (I) SANFORD HEALTH FOUNDATION OF NORTHERN MINNESOTA; (II) 41-1389317; (III) 7; (IV) YES; (V) $14,102,329 LINE 12, COLUMN: (I) SANFORD HEALTH OF SOUTH DAKOTA; (II) 33-1259188; (III) 3; (IV) YES; (V) $403,745 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) 9,415,179; (B) (3,426,082); (C) 3,504,069; (D) 2,528,926; (E) 3,897,496; (F) 15,919,589 LINE 2 - COLUMN: (A) 177,631,632; (B) 204,250,348; (C) 261,882,016; (D) 205,463,244; (E) 207,778,397; (F) 1,057,005,637 LINE 6 - COLUMN: (A) 187,046,811; (B) 200,824,266; (C) 265,386,085; (D) 246,599,928; (E) 211,675,894; (F) 1,111,532,984 LINE 7C - COLUMN: (A) 718,178; (B) 0; (C) 0; (D) 0; (E) 0; (F) 718,178 LINE 8 - COLUMN: (F) 1,110,814,806 LINE 9 - COLUMN: (A) 187,046,811; (B) 200,824,266; (C) 265,386,085; (D) 246,883,076; (E) 211,675,894; (F) 1,111,816,132 LINE 10A - COLUMN: (A) 1,544,624; (B) 1,377,220; (C) 1,495,086; (D) 163,641; (E) 335,549; (F) 4,916,120 LINE 10C - COLUMN: (A) 1,544,624; (B) 1,377,220; (C) 1,495,086; (D) 163,641; (E) 335,549; (F) 4,916,120 LINE 11 - COLUMN: (A) 673,203; (B) 151,437; (C) 789,277; (D) 508,990; (E) 67,393; (F) 2,122,907 LINE 13 - COLUMN: (A) 189,264,638; (B) 202,352,923; (C) 267,670,448; (D) 247,555,707; (E) 212,011,443; (F) 1,118,855,159 LINE 15: 99.28% LINE 16: 99.05% LINE 17: 0.44% LINE 18: 0.56% 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 WEST 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 WEST AS WELL AS ALL OF THE NAMED TAX-EXEMPT SUBSIDIARY ORGANIZATIONS. THUS, SANFORD HEALTH, SANFORD NORTH AND SANFORD WEST MEET THE RELATIONSHIP TEST AS A TYPE II ORGANIZATIONS BECAUSE THERE IS COMMON SUPERVISION AND CONTROL BETWEEN SANFORD HEALTH, SANFORD NORTH AND SANFORD WEST AND THEIR NAMED SUPPORTED ORGANIZATIONS. SANFORD HEALTH, SANFORD NORTH, AND SANFORD WEST 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 (1) SANFORD HEALTH OF SOUTH DAKOTA, 33-1259188; (II) THE ORGANIZATION WAS FORMED ON SEPTEMBER, 27TH, 2024 AND ADDED TO SANFORD GROUP RULING UPON ACQUISITION OF A HOSPITAL, URGENT CARE CENTER, AND SURGERY CENTER THAT OCCURED ON NOVEMBER 15TH, 2024. (III) THE SUPPORTED ORGANIZATION WAS PART OF A CLASS ALREADY DESIGNATED IN THE ORGANIZATION'S 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 1 582244 1 10000 1 231262 823506 0 PART II-B, LINE 1: THE FILING ORGANIZATION HAS MEMBERSHIPS IN THE FOLLOWING ORGANIZATIONS: 340B HEALTH, ABERDEEN AREA CHAMBER OF COMMERCE, AMERICAN ACADEMY OF PROFESSIONAL CODERS, AMERICAN ADVERTISING FEDERATION OF SD, AMERICAN COLLEGE OF HEALTHCARE EXECUTIVES, AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION, AMERICAN SOCIETY FOR GASTRO ENDOSCOPY, AMERICAN SOCIETY OF ECHOCARDIOGRAPHY, AMERICAN ACADEMY OF OPHTHALMOLOGY, AMERICAN ACADEMY OF SLEEP MEDICINE, AMERICAN HOSPITAL ASSOCIATION, AMERICAN MEDICAL ASSOCIATION, AMERICAN MEDICAL GROUP ASSOCIATION, AMERICAN OPTOMETRIC ASSOCIATION, AMERICAN SOCIETY OF REPRODUCTIVE MEDICINE, ASSOCIATION OF COMMUNITY CANCER CENTERS, ASSOCIATION OF CRITICAL CARE TRANSPORT, BISMARCK MANDAN CHAMBER EDC, CHAMBER OF COMMERCE GRAND FORKS & EAST GRAND FORKS, CHAMBER OF COMMERCE MINOT, GREATER SIOUX FALLS CHAMBER OF COMMERCE, IOWA HEALTH CARE ASSOCIATION, KLAMATH COUNTY CHAMBER OF COMMERCE, CARE PROVIDERS OF MN, MEDICAL GROUP MANAGEMENT ASSOCIATION, MN HOSPITAL ASSOCIATION, MN AMBULANCE ASSOCIATION, MN CHAMBER OF COMMERCE, NATIONAL ASSOCIATION FOR BIOMEDICAL RESEARCH, NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS, NATIONAL ASSOCIATION OF SOCIAL WORKERS, NATIONAL ASSOCIATION OF SPECIALTY PHARMACY, NATIONAL RURAL HEALTH ASSOCIATION, NATIONAL ATHLETIC TRAINERS ASSOCIATION, ND EMS ASSOCIATION, ND HOSPITAL ASSOCIATION, ND LONG TERM CARE ASSOCIATES, ND MOTOR CARRIERS ASSOCIATION, ND PETROLEUM COUNCIL, SD BIOTECH ASSOCIATION, SD CHAMBER OF COMMERCE & INDUSTRY, SD HEALTH CARE ASSOCIATION, SOCIETY FOR VASCULAR ULTRASOUND, SOCIETY OF DIAGNOSTIC MEDICAL SONOGRAPHY, SOUTH DAKOTA ASSOCIATION OF HEALTHCARE ORGANIZATION, SOUTH DAKOTA NETWORK AGAINST FAMILY, CHAMBER OF COMMERCE FARGO/MOORHEAD/WEST FARGO, TOBACCO FREE ND, & 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 98989485 2430924 34960 101455369 98286566 538214 164705 98989485 95588573 3117005 -419012 98286566 92002112 3277428 309033 95588573 89216166 3261419 99138 -574611 92002112 0.00000 1.00000 0.00000 0 1 1 134029091 134029091 1827505435 804122473 1023382962 88898764 62743144 26155620 2060579512 1201577491 859002021 81095916 40266353 40829563 2083399257 DEFERRED COMPENSATION ASSETS 230851445 RIGHT OF USE ASSET 96686738 NON-OPERATING PROPERTY 92351631 OTHER ASSETS 12975999 432865813 DEFERRED COMPENSATION LIABILITY 229551512 LONG TERM OPERATING LEASE PAYABLE 81163050 OTHER NON-CURRENT LIABILITIES 49763853 360478415 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, 2024; SOME RELATED ORGANIZATIONS HAVE ESTABLISHED RESERVES. 1 CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, 0 0 INVESTMENTS 8000000 MIDDLE EAST AND NORTH AFRICA 0 0 INVESTMENTS 1300000 EAST ASIA AND THE PACIFIC 0 0 INVESTMENTS 1600000 EAST ASIA AND THE PACIFIC 0 0 PROGRAM SERVICES MSA 49000 SUB-SAHARAN AFRICA 0 0 PROGRAM SERVICES OPERATING EXPENSES FOR CLINIC 2215000 CENTRAL AMERICA AND THE CARIBBEAN 0 0 PROGRAM SERVICES MSA AND EMR WORK 1346000 0 0 0 0 0 0 14510000 0 14510000 0 0 1 0 1 0 0 0 PART I, LINE 3: EXPENDITURES 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 89067697 0 89067697 0.01530 724708418 543761018 180947400 0.03100 0 0 813776115 543761018 270015097 0.04630 69436840 1035701 68401139 0.01170 51679766 6642227 45037539 0.00770 2401616506 2129499728 272116778 0.04670 38934194 19511850 19422344 0.00330 28425818 0 28425818 0.00490 2590093124 2156689506 433403618 0.07430 3403869239 2700450524 703418715 0.12060 1671855 0 1671855 0.00030 17761370 0 17761370 0.00300 1084250 0 1084250 0.00020 0 0 35523 0 35523 0.00000 502894 0 502894 0.00010 0 0 6338895 0 6338895 0.00110 0 0 27394787 27394787 0.00470 1 218244951 0 451184733 436174426 15010307 X 1 1 26 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 26 BLACK HILLS SURGICAL HOSPITAL LLC 216 ANAMARIA DRIVE RAPID CITY SD 57701 WWW.BHSH.COM SD 10582 SANFORD HEALTH OF SOUTH DAKOTA 331259188 X X FACILITY REPORTING GROUP - A 0 0 1 X X X X X X X X X 24 1 1 0 1 X WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT X X 1 24 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 LINE 16J X SEE NARRATIVE FOR LINE 16J X SEE NARRATIVE FOR LINE 16J 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 2023 THROUGH DECEMBER 2024, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2025-2027. 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.CHI ST. ALEXIUS HEALTH AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTERESSENTIA HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH CLAY COUNTY PUBLIC HEALTHFARGO CASS PUBLIC HEALTHFAMILY HEALTHCARESIOUX FALLS DEPARTMENT OF HEALTHBISMARCK-BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION WESTERN PLAINS PUBLIC HEALTHLIMITATIONSTHE 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 RESPONDENTS 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 COMMUNITY RESIDENTS WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS, PARTICIPATING ORGANIZATIONS NOTED PREVIOUSLY, AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND HEALTH NEEDS. 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 FOR THEIR RANKING. 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.THE SURVEY WAS THE FIRST OF MULTIPLE EFFORTS TO ENGAGE COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE SENT THE SURVEY AND ASKED TO COMPLETE THE INSTRUMENT AND THEN FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT.SANFORD INVESTED IN A MULTIFACETED CAMPAIGN THAT INCLUDED AN EARNED MEDIA CAMPAIGN ON LOCAL MEDIA OUTLETS AND THE PUBLIC-FACING SANFORD HEALTH NEWS (HTTPS://NEWS.SANFORDHEALTH.ORG/). THE SYSTEM ALSO PROMOTED THE SURVEY INTERNALLY THROUGH THE ORGANIZATION'S INTRANET, ALL-STAFF EMAILS, AND NEWSLETTERS.INTERNAL EFFORTS WERE SUPPORTED WITH A ROBUST ADVERTISING CAMPAIGN THAT INCLUDED, AMONG OTHER EFFORTS, A DIGITAL MEDIA PROGRAM YIELDING 3.6 MILLION IMPRESSIONS AND A PRINT AD CAMPAIGN ENCOURAGING NATIVE AMERICAN COMMUNITIES TO PARTICIPATE THROUGH PLACEMENTS IN DEBAHJIMON MAGAZINE, ANISHINAABEG MAGAZINE AND MHA TIMES (MANDAN, HIDATSA, ARIKARA). FURTHER SUPPORT WAS GIVEN TO COLLECTING SURVEYS AT VARIOUS COMMUNITY EVENTS. THE GOAL OF THESE EFFORTS WAS TO INCREASE PARTICIPATION BY THOSE UNDERREPRESENTED THE PREVIOUS CYCLE, INCLUDING LOWER INCOME, MINORITY, AND MEDICALLY UNDERSERVED POPULATIONS.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. PROMOTION INVESTMENTS BY THE SYSTEM YIELDED A TOTAL OF 9,714 COMPLETED SURVEYS FROM ACROSS THE SANFORD FOOTPRINT, AN INCREASE FROM 6,748 THE PREVIOUS CYCLE. THE RESPONSES GENERATED 48,643 OPEN-ENDED RESPONSES AND 1.76 MILLION PIECES OF DATA.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, BUILDING 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. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS 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 WERE ALSO INCLUDED IN THE FINDINGS.THE CENTER FOR SOCIAL RESEARCH VALIDATES THE FINDINGS OF THE PRIMARY RESEARCH BY ENGAGING AT LEAST TWO INTERNAL REVIEWERS. EACH REVIEWER HAS THEIR OWN TECHNIQUE AND STRENGTHS TO REVIEW THE FINDINGS; HOWEVER, THEY CHECK FOR ACCURACY IN THE DATA BY REVIEWING THE CODE AND SYNTAX, THE OUTPUT, THE CORRECT REPRESENTATION OF THE DATA IN THE REPORT, VERBIAGE, CONSISTENCY, CONTEXT, AND OVERALL READABILITY. BOTH REVIEWERS ALSO SUPPORTED PREVIOUS CHNA REPORTS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO LOCATE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT LOCAL RESOURCES ARE AVAILABLE.COMMUNITY STAKEHOLDER MEETINGSNEEDS, AS IDENTIFIED BY NDSU CENTER FOR SOCIAL RESEARCH, WERE PRESENTED TO COMMUNITY STAKEHOLDERS. FACILITATED DISCUSSION COMMENCED AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS IDENTIFIED 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 AND PRIORITIZATION OF LOCAL NEEDS. PARTICIPANTS IN THE MEETINGS INCLUDED COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS.THE PARTICIPANTS PROVIDED INFORMATION TO ANSWER THE FOLLOWING TYPES OF QUESTIONS AS IT RELATES TO IDENTIFIED NEEDS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHAT OPPORTUNITIES EXIST, WHERE CAN WE HAVE THE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ALREADY WORK BEING DONE ON THESE NEEDS?WHAT ARE THE RESOURCES CURRENTLY NOT UTILIZED WITHIN THE COMMUNITY THAT COULD ADDRESS THIS TOPIC?WHICH NEEDS FALL WITHIN THE PURVIEW OF HEALTH CARE SYSTEM AND WHICH DO NOT? CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES OR ORGANIZATIONS?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2025-2027 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: HEALTHY LIVINGIN THE UNITED STATES, MANY 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 SIOUX FALLS USD MEDICAL CENTER (SUSDMC) HAS MADE HEALTHY LIVING A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE A DECREASE IN OLDER ADULT INJURY FALLS. IT IS SANFORD'S GOAL TO EXPAND ACCESS TO FALL PREVENTION EDUCATION AND TO INCREASE SANFORD HEALTH PROVIDER AWARENESS AND KNOWLEDGE OF THE IMPORTANCE OF FALL PREVENTION. PRIORITY 2: ADOLESCENT 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.SUSDMC HAS MADE ADOLESCENT MENTAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO PROVIDE YOUTH WITH MORE ACCESS TO MENTAL AND BEHAVIORAL HEALTH INFORMATION, EDUCATION AND SERVICES. IT IS SANFORD'S GOAL TO INCREASE DEPRESSION SCREENING WITH PATIENTS AGES 12-18 YEARS OLD AND TO ENHANCE OVERALL ACCESS TO BEHAVIORAL AND MENTAL HEALTH SERVICES FOR AREA YOUTH.PRIORITY 3: ACCESS TO CAREWHEN SURVEY RESPONDENTS WERE ASKED ABOUT THE MOST IMPORTANT HEALTH CARE ISSUES IMPACTING THEIR COMMUNITY, ACCESS TO HEALTH CARE SERVICES AND PROVIDERS WAS THE SECOND HIGHEST ISSUE. WHEN ASKED WHICH HEALTH CARE SERVICES THEY WOULD LIKE TO SEE OFFERED OR IMPROVED IN THEIR COMMUNITY, RESPONDENTS INDICATED WALK-IN/URGENT CARE, DENTAL CARE, AND FAMILY MEDICINE OR PRIMARY CARE.SUSDMC HAS MADE ACCESS TO CARE A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES FOR MORE AREA RESIDENTS TO RECEIVE APPROPRIATE, NEEDED CARE. IT IS SANFORD'S GOAL TO INCREASE RATES OF PREVENTIVE SCREENING FOR CANCER AND INCREASE ACCESS TO SENIOR CARE SERVICES.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEAR:HEALTHY LIVINGSUSDMC HAS OBTAINED ADMINISTRATION FOR COMMUNITY LIVING GRANT FUNDING TO PARTNER WITH LOCAL COMMUNITY AGENCIES TO PROVIDE FALL PREVENTION SCREENING AND EVIDENCE-BASED FALL PREVENTION PROGRAMS FOR OLDER ADULTS IN THE COMMUNITY.ADOLESCENT MENTAL HEALTH BEHAVIORAL HEALTH CARE ACCESS HAS BEEN ENHANCED WITH THE RECRUITMENT OF ADDITIONAL PROVIDERS AND PLACING BEHAVIORAL HEALTH TRIAGE THERAPISTS IN ALL PRIMARY CARE CLINICS. THE PHQ-2 ASSESSMENT IS GIVEN AT ALL PRIMARY CARE VISITS.WE CONTINUE TO EXPAND BEHAVIORAL HEALTH SERVICES COMMENSURATE TO INCREASING DEMAND. SUSDMC OFFERS MENTAL HEALTH SERVICES FOR ANY ADMITTED PATIENT AND THOSE THAT PRESENT TO THE EMERGENCY DEPARTMENT IN A MENTAL HEALTH CRISIS. PATIENTS ARE SEEN FOR SUICIDAL IDEATION, DEPRESSION, ANXIETY, PTSD, SUBSTANCE AND ADDICTION ISSUES. MENTAL HEALTH STAFF ALSO SEE THOSE WITH A NEW MEDICAL DIAGNOSIS SUCH AS CANCER, PULMONARY ISSUES AND POSTPARTUM DEPRESSION. SUSDMC'S MENTAL HEALTH TEAM CONSISTS OF 15 MASTERS LEVEL COUNSELORS AND CLINICAL SOCIAL WORKERS TO ENSURE ANY MENTAL HEALTH NEEDS ARE TAKEN CARE OF WHILE A PATIENT IS HOSPITALIZED. SUSDMC ALSO OFFERS TWO INTEGRATED HEALTH THERAPISTS THAT SEE PATIENTS IN OUR SPECIALTY CLINICS THAT ARE ON THE MAIN SUSDMC CAMPUS. THEY ARE AVAILABLE FOR CRISIS COUNSELING AND FOLLOW UP VISITS AS NEEDED AT THE SAME TIME AS THE PATIENT'S CLINIC VISIT. SUSDMC HAS SEVERAL STAFF THAT ARE PART OF THE PARTNERSHIP THAT SANFORD HEALTH AND AVERA HEALTH HAVE WITH THE CITY OF SIOUX FALLS TO FORM THE LINK. THE LINK IS A COMMUNITY TRIAGE CENTER PROVIDING A SAFE PLACE FOR PEOPLE EXPERIENCING A NON-VIOLENT BEHAVIORAL HEALTH CRISIS OR NEEDING CARE FOR SUBSTANCE ABUSE DISORDERS TO ACCESS IMMEDIATE TREATMENT AND REFERRAL TO SUPPORT SERVICES. IT OFFERS OUR COMMUNITY AN INNOVATIVE APPROACH TO ADDRESS GAPS IN CRITICAL SERVICES FOR PEOPLE LIVING WITH MENTAL HEALTH AND SUBSTANCE ABUSE CHALLENGES. WE PARTICIPATE IN VARIOUS PLANNING AND OPERATIONAL COMMITTEES AND OUR PRESIDENT AND CEO, PAUL HANSON, IS ON THE LINK BOARD OF DIRECTORS. ACCESS TO CAREWALK-INS, VIDEO VISITS, E-VISITS, ONLINE SCHEDULING, AND SAME-DAY ACCESS ARE AVAILABLE AT ALL PRIMARY CARE LOCATIONS. APPROPRIATE PREVENTIVE SCREENINGS ARE OFFERED ALONG WITH EDUCATIONAL INFORMATION ON WELLNESS AND DISEASE PREVENTION.HEALTH CARE LITERACY AND FINANCIAL ADVOCACY ARE ONGOING EFFORTS. WE COLLABORATE WITH SANFORD HEALTH PLAN TO HELP PATIENTS FIND AFFORDABLE COVERAGE. THE HOSPITAL ALSO HAS ONSITE FINANCIAL ADVOCATES WHO SPECIALIZE IN HEALTH CARE COVERAGE ENROLLMENT AND HELP PATIENTS NAVIGATE SANFORD'S FINANCIAL ASSISTANCE PROGRAM IF ELIGIBLE. WE CONTINUE TO INVEST IN LANGUAGE SERVICES TO ENSURE PATIENTS NEEDING FINANCIAL SUPPORT DO NOT FACE COMMUNICATION BARRIERS.OUR CALL CENTER, INCLUSIVE OF OUR ONE CALL SYSTEM, THE CLINICAL CALL CENTER, AND THE MY SANFORD NURSE LINE RESPONDS TO HUNDREDS OF THOUSANDS OF CALLS PER YEAR. THE CLINICAL CALL CENTER ANSWERS AFTER HOURS CALLS FOR ALL THE METRO/NETWORK CLINIC LOCATIONS, IN ADDITION TO MY SANFORD NURSE CALLS.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE: ACCESS TO AFFORDABLE HEALTH CAREQUALITY CHILD CARELONG-TERM SENIOR 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. SANFORD HEALTH FURTHER SUPPORTS THROUGH ITS FINDHELP RESOURCE, AN ONLINE TOOL TO INCORPORATE CONTACT AND REFERRAL INFORMATION TO CONNECT COMMUNITY-BASED ORGANIZATIONS WITH PATIENTS TO MEET THEIR HEALTH RELATED-SOCIAL CARE NEEDS. A LINK IS INCLUDED ON EVERY AFTER-VISIT SUMMARY PROVIDED TO PATIENTS AND IS AVAILABLE ON SANFORDHEALTH.ORG AND MYCHART. 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 2023 THROUGH DECEMBER 2024, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2025-2027. 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.CHI ST. ALEXIUS HEALTH AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTERESSENTIA HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH CLAY COUNTY PUBLIC HEALTHFARGO CASS PUBLIC HEALTHFAMILY HEALTHCARESIOUX FALLS DEPARTMENT OF HEALTHBISMARCK-BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION WESTERN PLAINS PUBLIC HEALTHLIMITATIONSTHE 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 RESPONDENTS 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 COMMUNITY RESIDENTS WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS, PARTICIPATING ORGANIZATIONS NOTED PREVIOUSLY, AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND HEALTH NEEDS. 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 FOR THEIR RANKING. 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.THE SURVEY WAS THE FIRST OF MULTIPLE EFFORTS TO ENGAGE COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE SENT THE SURVEY AND ASKED TO COMPLETE THE INSTRUMENT AND THEN FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT.SANFORD INVESTED IN A MULTIFACETED CAMPAIGN THAT INCLUDED AN EARNED MEDIA CAMPAIGN ON LOCAL MEDIA OUTLETS AND THE PUBLIC-FACING SANFORD HEALTH NEWS (HTTPS://NEWS.SANFORDHEALTH.ORG/). THE SYSTEM ALSO PROMOTED THE SURVEY INTERNALLY THROUGH THE ORGANIZATION'S INTRANET, ALL-STAFF EMAILS, AND NEWSLETTERS.INTERNAL EFFORTS WERE SUPPORTED WITH A ROBUST ADVERTISING CAMPAIGN THAT INCLUDED, AMONG OTHER EFFORTS, A DIGITAL MEDIA PROGRAM YIELDING 3.6 MILLION IMPRESSIONS AND A PRINT AD CAMPAIGN ENCOURAGING NATIVE AMERICAN COMMUNITIES TO PARTICIPATE THROUGH PLACEMENTS IN DEBAHJIMON MAGAZINE, ANISHINAABEG MAGAZINE AND MHA TIMES (MANDAN, HIDATSA, ARIKARA). FURTHER SUPPORT WAS GIVEN TO COLLECTING SURVEYS AT VARIOUS COMMUNITY EVENTS. THE GOAL OF THESE EFFORTS WAS TO INCREASE PARTICIPATION BY THOSE UNDERREPRESENTED THE PREVIOUS CYCLE, INCLUDING LOWER INCOME, MINORITY, AND MEDICALLY UNDERSERVED POPULATIONS.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. PROMOTION INVESTMENTS BY THE SYSTEM YIELDED A TOTAL OF 9,714 COMPLETED SURVEYS FROM ACROSS THE SANFORD FOOTPRINT, AN INCREASE FROM 6,748 THE PREVIOUS CYCLE. THE RESPONSES GENERATED 48,643 OPEN-ENDED RESPONSES AND 1.76 MILLION PIECES OF DATA.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, BUILDING 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. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS 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 WERE ALSO INCLUDED IN THE FINDINGS.THE CENTER FOR SOCIAL RESEARCH VALIDATES THE FINDINGS OF THE PRIMARY RESEARCH BY ENGAGING AT LEAST TWO INTERNAL REVIEWERS. EACH REVIEWER HAS THEIR OWN TECHNIQUE AND STRENGTHS TO REVIEW THE FINDINGS; HOWEVER, THEY CHECK FOR ACCURACY IN THE DATA BY REVIEWING THE CODE AND SYNTAX, THE OUTPUT, THE CORRECT REPRESENTATION OF THE DATA IN THE REPORT, VERBIAGE, CONSISTENCY, CONTEXT, AND OVERALL READABILITY. BOTH REVIEWERS ALSO SUPPORTED PREVIOUS CHNA REPORTS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO LOCATE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT LOCAL RESOURCES ARE AVAILABLE.COMMUNITY STAKEHOLDER MEETINGSNEEDS, AS IDENTIFIED BY NDSU CENTER FOR SOCIAL RESEARCH, WERE PRESENTED TO COMMUNITY STAKEHOLDERS. FACILITATED DISCUSSION COMMENCED AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS IDENTIFIED 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 AND PRIORITIZATION OF LOCAL NEEDS. PARTICIPANTS IN THE MEETINGS INCLUDED COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS.THE PARTICIPANTS PROVIDED INFORMATION TO ANSWER THE FOLLOWING TYPES OF QUESTIONS AS IT RELATES TO IDENTIFIED NEEDS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHAT OPPORTUNITIES EXIST, WHERE CAN WE HAVE THE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ALREADY WORK BEING DONE ON THESE NEEDS?WHAT ARE THE RESOURCES CURRENTLY NOT UTILIZED WITHIN THE COMMUNITY THAT COULD ADDRESS THIS TOPIC?WHICH NEEDS FALL WITHIN THE PURVIEW OF HEALTH CARE SYSTEM AND WHICH DO NOT? CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES OR ORGANIZATIONS?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2025-2027 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: 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 A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE INCREASED UTILIZATION OF BEHAVIORAL HEALTH AND SUBSTANCE ABUSE SERVICES FOR THOSE THAT NEED THEM IN THE COMMUNITY. IT IS SANFORD'S GOAL TO IMPROVE TIMELY ACCESS TO MENTAL/BEHAVIORAL HEALTH CARE SERVICES AND TO ENHANCE AND EXPAND SERVICES TO EFFECTIVELY SUPPORT AND TREAT PATIENTS WITH SUBSTANCE USE DISORDERS.PRIORITY 2: ACCESS TO HEALTH CARE PROVIDERS AND QUALITY CAREWHEN RESPONDENTS WERE ASKED ABOUT THE MOST IMPORTANT HEALTH CARE ISSUES IMPACTING THEIR COMMUNITY, HAVING ACCESS TO HEALTH CARE WAS ONE OF THE TOP ISSUES BEHIND COST. AND WHEN RESPONDENTS, WHO RATED THEIR OWN ABILITY TO ACCESS HEALTH CARE AS POOR OR FAIR, WERE ASKED WHY THEY RATED ACCESS AS THEY DID, ISSUES OF LIMITED HOURS, WAIT TIMES, LIMITED LOCATIONS, AND LACK OF PROVIDERS AND SPECIALTY CARE WERE AMONG THE TOP CONCERNS.SANFORD HAS MADE ACCESS TO HEALTH CARE PROVIDERS AND QUALITY CARE A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE INCREASED COLLABORATION WITH EXTERNAL PARTNERS AND IMPROVED ACCESS TO CARE. IT IS SANFORD'S GOAL TO IMPROVE ACCESS TO PRIMARY AND SPECIALTY CARE AND TO COLLABORATIVELY SHARE CHNA INFORMATION WITH PUBLIC AND PRIVATE PARTNERS. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEAR: MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSESANFORD FARGO IS CONTINUING ITS EFFORTS TO IMPROVE ACCESS TO MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSE SERVICES. UTILIZATION OF VIRTUAL VISITS FOR BEHAVIORAL HEALTH HAS CONTINUED TO GROW AND CONTRIBUTE TOWARD IMPROVED ACCESS. TIMELY ACCESS TO ADULT PSYCHIATRY CONTINUES TO BE AN AREA WE ARE WORKING TO IMPROVE AND MONITOR PROGRESS QUARTERLY. SANFORD CURRENTLY OFFERS MENTAL HEALTH AND SUBSTANCE ABUSE PROVIDERS IN THE COMMUNITY THROUGH VARIOUS DELIVERY OPPORTUNITIES. DEPRESSION SCREENING WILL BE UTILIZED IN THE ROOMING NAVIGATOR IN ALL CLINICS TO HELP IDENTIFY THOSE IN NEED OF CARE. OUR SUBOXONE CLINIC CONTINUES TO SERVE PATIENTS IN ADDICTION RECOVERY AND ENGAGES IN HOSPITAL PEER COACHING. 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.ACCESS TO HEALTH CARE PROVIDERS AND QUALITY CARE SANFORD FARGO INCREASED HOME-BASED PRIMARY CARE ACCESS AND CONTINUES TO UTILIZE THIS APPROACH TO IMPROVE ACCESS AS ALL PRIMARY CARE PROVIDERS NOW HAVE ACCESS TO THIS OPTION. PROVIDER RECRUITMENT PLAYS A MAJOR ROLE IN OUR ABILITY TO INCREASE OUR CAPACITY. INVESTING IN OUR EDUCATIONAL PROGRAMS TO SERVE AS A PIPELINE FOR PROVIDERS CONTINUES TO BE A PRIORITY. THE BROADWAY CAMPUS IS UNDERGOING EXTENSIVE REMODELING FOLLOWING THE OPENING OF SANFORD MEDICAL CENTER FARGO IN JULY 2017 AND THE RELOCATION OF MANY SERVICES TO THAT LOCATION. THE LONGER-TERM MISSION FOR THE BROADWAY FACILITY IS A GREATLY EXPANDED ROGER MARIS CANCER CENTER WHICH WILL ANCHOR THE BROADWAY CAMPUS AND PROVIDE MANY NEW SERVICES AND SPECIALTIES. IN ADDITION TO AN EXTENSIVE ARRAY OF CANCER SERVICES PROVIDED, INCLUDING A BONE MARROW TRANSPLANT PROGRAM, AND AN INPATIENT ONCOLOGY UNIT, SANFORD BROADWAY IS CURRENTLY HOME TO THE CARDIOVASCULAR CLINIC, CV DIAGNOSTIC SERVICES, INPATIENT HOSPICE UNIT, INPATIENT ICU, URGENT CARE, SAME DAY SURGERY, INPATIENT EATING DISORDER UNIT AND OTHERS. IT IS CONNECTED TO SANFORD BROADWAY CLINIC, WHICH IS THE REGION'S LARGEST MULTI-SPECIALTY CLINIC OFFERING OVER 50 MEDICAL SPECIALTIES INCLUDING NUMEROUS PEDIATRIC SUB-SPECIALTIES. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO AFFORDABLE HEALTH CAREHEALTHY LIVINGPUBLIC TRANSPORTATIONQUALITY CHILDCAREAFFORDABLE 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. SANFORD HEALTH FURTHER SUPPORTS THROUGH ITS FINDHELP RESOURCE, AN ONLINE TOOL TO INCORPORATE CONTACT AND REFERRAL INFORMATION TO CONNECT COMMUNITY-BASED ORGANIZATIONS WITH PATIENTS TO MEET THEIR HEALTH RELATED-SOCIAL CARE NEEDS. A LINK IS INCLUDED ON EVERY AFTER-VISIT SUMMARY PROVIDED TO PATIENTS AND IS AVAILABLE ON SANFORDHEALTH.ORG AND MYCHART. 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 2023 THROUGH DECEMBER 2024, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2025-2027. 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.CHI ST. ALEXIUS HEALTH AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTERESSENTIA HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH CLAY COUNTY PUBLIC HEALTHFARGO CASS PUBLIC HEALTHFAMILY HEALTHCARESIOUX FALLS DEPARTMENT OF HEALTHBISMARCK-BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION WESTERN PLAINS PUBLIC HEALTHLIMITATIONSTHE 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 RESPONDENTS 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 COMMUNITY RESIDENTS WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS, PARTICIPATING ORGANIZATIONS NOTED PREVIOUSLY, AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND HEALTH NEEDS. 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 FOR THEIR RANKING. 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.THE SURVEY WAS THE FIRST OF MULTIPLE EFFORTS TO ENGAGE COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE SENT THE SURVEY AND ASKED TO COMPLETE THE INSTRUMENT AND THEN FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT.SANFORD INVESTED IN A MULTIFACETED CAMPAIGN THAT INCLUDED AN EARNED MEDIA CAMPAIGN ON LOCAL MEDIA OUTLETS AND THE PUBLIC-FACING SANFORD HEALTH NEWS (HTTPS://NEWS.SANFORDHEALTH.ORG/). THE SYSTEM ALSO PROMOTED THE SURVEY INTERNALLY THROUGH THE ORGANIZATION'S INTRANET, ALL-STAFF EMAILS, AND NEWSLETTERS.INTERNAL EFFORTS WERE SUPPORTED WITH A ROBUST ADVERTISING CAMPAIGN THAT INCLUDED, AMONG OTHER EFFORTS, A DIGITAL MEDIA PROGRAM YIELDING 3.6 MILLION IMPRESSIONS AND A PRINT AD CAMPAIGN ENCOURAGING NATIVE AMERICAN COMMUNITIES TO PARTICIPATE THROUGH PLACEMENTS IN DEBAHJIMON MAGAZINE, ANISHINAABEG MAGAZINE AND MHA TIMES (MANDAN, HIDATSA, ARIKARA). FURTHER SUPPORT WAS GIVEN TO COLLECTING SURVEYS AT VARIOUS COMMUNITY EVENTS. THE GOAL OF THESE EFFORTS WAS TO INCREASE PARTICIPATION BY THOSE UNDERREPRESENTED THE PREVIOUS CYCLE, INCLUDING LOWER INCOME, MINORITY, AND MEDICALLY UNDERSERVED POPULATIONS.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. PROMOTION INVESTMENTS BY THE SYSTEM YIELDED A TOTAL OF 9,714 COMPLETED SURVEYS FROM ACROSS THE SANFORD FOOTPRINT, AN INCREASE FROM 6,748 THE PREVIOUS CYCLE. THE RESPONSES GENERATED 48,643 OPEN-ENDED RESPONSES AND 1.76 MILLION PIECES OF DATA.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, BUILDING 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. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS 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 WERE ALSO INCLUDED IN THE FINDINGS.THE CENTER FOR SOCIAL RESEARCH VALIDATES THE FINDINGS OF THE PRIMARY RESEARCH BY ENGAGING AT LEAST TWO INTERNAL REVIEWERS. EACH REVIEWER HAS THEIR OWN TECHNIQUE AND STRENGTHS TO REVIEW THE FINDINGS; HOWEVER, THEY CHECK FOR ACCURACY IN THE DATA BY REVIEWING THE CODE AND SYNTAX, THE OUTPUT, THE CORRECT REPRESENTATION OF THE DATA IN THE REPORT, VERBIAGE, CONSISTENCY, CONTEXT, AND OVERALL READABILITY. BOTH REVIEWERS ALSO SUPPORTED PREVIOUS CHNA REPORTS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO LOCATE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT LOCAL RESOURCES ARE AVAILABLE.COMMUNITY STAKEHOLDER MEETINGSNEEDS, AS IDENTIFIED BY NDSU CENTER FOR SOCIAL RESEARCH, WERE PRESENTED TO COMMUNITY STAKEHOLDERS. FACILITATED DISCUSSION COMMENCED AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS IDENTIFIED 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 AND PRIORITIZATION OF LOCAL NEEDS. PARTICIPANTS IN THE MEETINGS INCLUDED COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS.THE PARTICIPANTS PROVIDED INFORMATION TO ANSWER THE FOLLOWING TYPES OF QUESTIONS AS IT RELATES TO IDENTIFIED NEEDS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHAT OPPORTUNITIES EXIST, WHERE CAN WE HAVE THE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ALREADY WORK BEING DONE ON THESE NEEDS?WHAT ARE THE RESOURCES CURRENTLY NOT UTILIZED WITHIN THE COMMUNITY THAT COULD ADDRESS THIS TOPIC?WHICH NEEDS FALL WITHIN THE PURVIEW OF HEALTH CARE SYSTEM AND WHICH DO NOT? CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES OR ORGANIZATIONS?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2025-2027 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: 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 A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE INCREASED UTILIZATION OF BEHAVIORAL HEALTH AND SUBSTANCE ABUSE SERVICES FOR THOSE THAT NEED THEM IN THE COMMUNITY. IT IS SANFORD'S GOAL TO IMPROVE TIMELY ACCESS TO MENTAL/BEHAVIORAL HEALTH CARE SERVICES AND TO ENHANCE AND EXPAND SERVICES TO EFFECTIVELY SUPPORT AND TREAT PATIENTS WITH SUBSTANCE USE DISORDERS.PRIORITY 2: ACCESS TO HEALTH CARE PROVIDERS AND QUALITY CAREWHEN RESPONDENTS WERE ASKED ABOUT THE MOST IMPORTANT HEALTH CARE ISSUES IMPACTING THEIR COMMUNITY, HAVING ACCESS TO HEALTH CARE WAS ONE OF THE TOP ISSUES BEHIND COST. AND WHEN RESPONDENTS, WHO RATED THEIR OWN ABILITY TO ACCESS HEALTH CARE AS POOR OR FAIR, WERE ASKED WHY THEY RATED ACCESS AS THEY DID, ISSUES OF LIMITED HOURS, WAIT TIMES, LIMITED LOCATIONS, AND LACK OF PROVIDERS AND SPECIALTY CARE WERE AMONG THE TOP CONCERNS.SANFORD HAS MADE ACCESS TO HEALTH CARE PROVIDERS AND QUALITY CARE A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE INCREASED COLLABORATION WITH EXTERNAL PARTNERS AND IMPROVED ACCESS TO CARE. IT IS SANFORD'S GOAL TO IMPROVE ACCESS TO PRIMARY AND SPECIALTY CARE AND TO COLLABORATIVELY SHARE CHNA INFORMATION WITH PUBLIC AND PRIVATE PARTNERS. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEAR: MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSESANFORD FARGO IS CONTINUING ITS EFFORTS TO IMPROVE ACCESS TO MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSE SERVICES. UTILIZATION OF VIRTUAL VISITS FOR BEHAVIORAL HEALTH HAS CONTINUED TO GROW AND CONTRIBUTE TOWARD IMPROVED ACCESS. TIMELY ACCESS TO ADULT PSYCHIATRY CONTINUES TO BE AN AREA WE ARE WORKING TO IMPROVE AND MONITOR PROGRESS QUARTERLY. SANFORD CURRENTLY OFFERS MENTAL HEALTH AND SUBSTANCE ABUSE PROVIDERS IN THE COMMUNITY THROUGH VARIOUS DELIVERY OPPORTUNITIES. DEPRESSION SCREENING WILL BE UTILIZED IN THE ROOMING NAVIGATOR IN ALL CLINICS TO HELP IDENTIFY THOSE IN NEED OF CARE. OUR SUBOXONE CLINIC CONTINUES TO SERVE PATIENTS IN ADDICTION RECOVERY AND ENGAGES IN HOSPITAL PEER COACHING. 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.ACCESS TO HEALTH CARE PROVIDERS AND QUALITY CARE SANFORD FARGO INCREASED HOME-BASED PRIMARY CARE ACCESS AND CONTINUES TO UTILIZE THIS APPROACH TO IMPROVE ACCESS AS ALL PRIMARY CARE PROVIDERS NOW HAVE ACCESS TO THIS OPTION. PROVIDER RECRUITMENT PLAYS A MAJOR ROLE IN OUR ABILITY TO INCREASE OUR CAPACITY. INVESTING IN OUR EDUCATIONAL PROGRAMS TO SERVE AS A PIPELINE FOR PROVIDERS CONTINUES TO BE A PRIORITY. SANFORD SOUTH UNIVERSITY MEDICAL CENTER HAS 115 LICENSED BEDS AND SERVES AS A HUB FOR ORTHOPEDIC SURGERY AND REHABILITATION WITH INPATIENT UNITS FOR THESE SERVICES. SOUTH UNIVERSITY ALSO CURRENTLY HOUSES HIGHLY SPECIALIZED SERVICES, INCLUDING A BEHAVIORAL HEALTH INPATIENT AND PARTIAL HOSPITALIZATION UNIT, OPHTHALMOLOGY, A CENTER FOR CARDIAC AND VASCULAR SCREENING, AND A BIO-SKILLS AND CADAVER LAB FOR MEDICAL RESIDENTS. SANFORD HEALTH IS A MAJOR TEACHING HOSPITAL IN PARTNERSHIP WITH THE UNIVERSITY OF NORTH DAKOTA SCHOOL OF MEDICINE AND HEALTH SCIENCES. THEY HAVE COLLABORATED TO LAUNCH SEVERAL NEW RESIDENCY AND FELLOWSHIP PROGRAMS IN THE LAST FIVE YEARS, INCLUDING ORTHOPEDICS, NEUROLOGY, ONCOLOGY, AND FAMILY MEDICINE.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO AFFORDABLE HEALTH CAREHEALTHY LIVINGPUBLIC TRANSPORTATIONQUALITY CHILDCAREAFFORDABLE 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. SANFORD HEALTH FURTHER SUPPORTS THROUGH ITS FINDHELP RESOURCE, AN ONLINE TOOL TO INCORPORATE CONTACT AND REFERRAL INFORMATION TO CONNECT COMMUNITY-BASED ORGANIZATIONS WITH PATIENTS TO MEET THEIR HEALTH RELATED-SOCIAL CARE NEEDS. A LINK IS INCLUDED ON EVERY AFTER-VISIT SUMMARY PROVIDED TO PATIENTS AND IS AVAILABLE ON SANFORDHEALTH.ORG AND MYCHART. 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 2023 THROUGH DECEMBER 2024, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2025-2027. 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.CHI ST. ALEXIUS HEALTH AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTERESSENTIA HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH CLAY COUNTY PUBLIC HEALTHFARGO CASS PUBLIC HEALTHFAMILY HEALTHCARESIOUX FALLS DEPARTMENT OF HEALTHBISMARCK-BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION WESTERN PLAINS PUBLIC HEALTHLIMITATIONSTHE 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 RESPONDENTS 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 COMMUNITY RESIDENTS WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS, PARTICIPATING ORGANIZATIONS NOTED PREVIOUSLY, AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND HEALTH NEEDS. 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 FOR THEIR RANKING. 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.THE SURVEY WAS THE FIRST OF MULTIPLE EFFORTS TO ENGAGE COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE SENT THE SURVEY AND ASKED TO COMPLETE THE INSTRUMENT AND THEN FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT.SANFORD INVESTED IN A MULTIFACETED CAMPAIGN THAT INCLUDED AN EARNED MEDIA CAMPAIGN ON LOCAL MEDIA OUTLETS AND THE PUBLIC-FACING SANFORD HEALTH NEWS (HTTPS://NEWS.SANFORDHEALTH.ORG/). THE SYSTEM ALSO PROMOTED THE SURVEY INTERNALLY THROUGH THE ORGANIZATION'S INTRANET, ALL-STAFF EMAILS, AND NEWSLETTERS.INTERNAL EFFORTS WERE SUPPORTED WITH A ROBUST ADVERTISING CAMPAIGN THAT INCLUDED, AMONG OTHER EFFORTS, A DIGITAL MEDIA PROGRAM YIELDING 3.6 MILLION IMPRESSIONS AND A PRINT AD CAMPAIGN ENCOURAGING NATIVE AMERICAN COMMUNITIES TO PARTICIPATE THROUGH PLACEMENTS IN DEBAHJIMON MAGAZINE, ANISHINAABEG MAGAZINE AND MHA TIMES (MANDAN, HIDATSA, ARIKARA). FURTHER SUPPORT WAS GIVEN TO COLLECTING SURVEYS AT VARIOUS COMMUNITY EVENTS. THE GOAL OF THESE EFFORTS WAS TO INCREASE PARTICIPATION BY THOSE UNDERREPRESENTED THE PREVIOUS CYCLE, INCLUDING LOWER INCOME, MINORITY, AND MEDICALLY UNDERSERVED POPULATIONS.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. PROMOTION INVESTMENTS BY THE SYSTEM YIELDED A TOTAL OF 9,714 COMPLETED SURVEYS FROM ACROSS THE SANFORD FOOTPRINT, AN INCREASE FROM 6,748 THE PREVIOUS CYCLE. THE RESPONSES GENERATED 48,643 OPEN-ENDED RESPONSES AND 1.76 MILLION PIECES OF DATA.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, BUILDING 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. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS 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 WERE ALSO INCLUDED IN THE FINDINGS.THE CENTER FOR SOCIAL RESEARCH VALIDATES THE FINDINGS OF THE PRIMARY RESEARCH BY ENGAGING AT LEAST TWO INTERNAL REVIEWERS. EACH REVIEWER HAS THEIR OWN TECHNIQUE AND STRENGTHS TO REVIEW THE FINDINGS; HOWEVER, THEY CHECK FOR ACCURACY IN THE DATA BY REVIEWING THE CODE AND SYNTAX, THE OUTPUT, THE CORRECT REPRESENTATION OF THE DATA IN THE REPORT, VERBIAGE, CONSISTENCY, CONTEXT, AND OVERALL READABILITY. BOTH REVIEWERS ALSO SUPPORTED PREVIOUS CHNA REPORTS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO LOCATE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT LOCAL RESOURCES ARE AVAILABLE.COMMUNITY STAKEHOLDER MEETINGSNEEDS, AS IDENTIFIED BY NDSU CENTER FOR SOCIAL RESEARCH, WERE PRESENTED TO COMMUNITY STAKEHOLDERS. FACILITATED DISCUSSION COMMENCED AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS IDENTIFIED 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 AND PRIORITIZATION OF LOCAL NEEDS. PARTICIPANTS IN THE MEETINGS INCLUDED COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS.THE PARTICIPANTS PROVIDED INFORMATION TO ANSWER THE FOLLOWING TYPES OF QUESTIONS AS IT RELATES TO IDENTIFIED NEEDS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHAT OPPORTUNITIES EXIST, WHERE CAN WE HAVE THE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ALREADY WORK BEING DONE ON THESE NEEDS?WHAT ARE THE RESOURCES CURRENTLY NOT UTILIZED WITHIN THE COMMUNITY THAT COULD ADDRESS THIS TOPIC?WHICH NEEDS FALL WITHIN THE PURVIEW OF HEALTH CARE SYSTEM AND WHICH DO NOT? CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES OR ORGANIZATIONS?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2025-2027 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: ADDRESS THE MENTAL HEALTH OF THE COMMUNITY THROUGH NEAR-TERM ACCESS IMPROVEMENT AND EARLY INTERVENTION IN COMMUNITY SCHOOLSMENTAL 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.ACCORDING TO CHR, ADULTS IN THE BISMARCK AREA AVERAGE 3.7 MENTALLY UNHEALTHY DAYS EACH MONTH AND 12 PERCENT OF ADULTS AVERAGE AT LEAST 14 DAYS OF MENTAL DISTRESS PER MONTH. ONE OF THE MOST IMPORTANT MEASURES OF MENTAL HEALTH WITHIN A COMMUNITY IS SUICIDE. CHR DATA INDICATE THAT THERE ARE 17 SUICIDES FOR EVERY 100,000 PEOPLE IN THE BISMARCK AREA. IN ADDITION, THERE ARE 9 DRUG OVERDOSE DEATHS FOR EVERY 100,000 PEOPLE IN THE BISMARCK AREA. ACCORDING TO CHR, THE BISMARCK AREA HAS ONE MENTAL HEALTH PROVIDER FOR EVERY 437 PEOPLE, WHICH IS SLIGHTLY WORSE THAN THE COMPARISON GROUP AVERAGE. SANFORD HAS MADE THE MENTAL HEALTH OF THE COMMUNITY A PRIORITY AND HAS DEVELOPED STRATEGIES TO EXPAND BEHAVIORAL HEALTH SERVICES OFFERED IN THE PRIMARY CARE SETTING AND IMPROVE MENTAL HEALTH RESOURCES FOR AREA STUDENTS.PRIORITY 2: IMPROVE ACCESS THROUGH INCREASED AVAILABILITY OF PROVIDERS, ADDITIONAL ACCESS POINTS, AND INTERVENTIONS TO DECREASE SUBSTANCE ABUSEMULTIPLE STAKEHOLDER GROUPS HIGHLIGHTED THE WAIT TIMES AT LOCAL EMERGENCY ROOMS AS AN ACCESS ISSUE. ONE AREA OF DISCUSSION IS HOW THE LACK OF A LOCAL DETOX FACILITY RESULTS IN MORE ER UTILIZATION BY THOSE THAT COULD OTHERWISE BE AT SUCH A FACILITY. ADDITIONAL DISCUSSIONS CENTERED ON THE IMPACT OF COST, TRANSPORTATION, NEED FOR ADDITIONAL CASE MANAGERS, AND OTHER SERVICES THAT COULD BE OFFERED OR IMPROVED. SANFORD HAS MADE A DECREASE IN SUBSTANCE ABUSE A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO EXPLORE AND ENHANCE RELATIONSHIPS WITH ADDICTION SERVICE PROVIDERS AND TO EXPLORE FEASIBILITY OF JOINT DETOX FACILITIES AND FIRST RESPONDER RESOURCES. THIS WILL HAVE THE IMPACT OF INCREASING EMERGENCY ROOM ACCESS DUE TO FEWER INDIVIDUALS PRESENTING IN THE EMERGENCY ROOM WITH SUBSTANCE ABUSE RELATED ISSUES.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEAR ADDRESS THE MENTAL HEALTH OF THE COMMUNITY THROUGH NEAR-TERM ACCESS IMPROVEMENT AND EARLY INTERVENTION IN COMMUNITY SCHOOLS AT LEAST ONE SANFORD BEHAVIORAL HEALTH PROVIDER CURRENTLY PROVIDES SERVICES ON CAMPUS TO SIMLE MIDDLE SCHOOL. IN ADDITION, SANFORD'S BEHEARD PROGRAM IS BEING ROLLED OUT TO OTHER SCHOOLS ACROSS THE REGION AND OTHER STAFF, SUCH AS COACHES, AT SANFORD SPORTS HAVE BEEN TRAINED TO IDENTIFY AND ADDRESS SIGNS OF BEHAVIORAL HEALTH CRISIS. FURTHER SUPPORT IS PROVIDED THROUGH WEEKLY MEETINGS BETWEEN THERAPISTS AND THE SCHOOLS' LEADERSHIP TEAMS TO COORDINATE SUPPORT SERVICES FOR HIGH-RISK STUDENTS. TELEHEALTH SERVICES ARE PROVIDED DURING THE SUMMER TO CONTINUE CARE DELIVERY OPTIONS WHILE SCHOOL IS NOT IN SESSION. THE SUPPORT PROVIDED TO THE LOCAL SCHOOL DISTRICTS BUILDS UPON THE EFFORTS TO ENHANCE ACCESS THROUGH THE CLINIC AND HOSPITAL SYSTEM. SANFORD IS WORKING TO EXPAND ACCESS BEYOND STANDARD CLINIC HOURS. ONE EXAMPLE IS THE ADDITION OF AFTER-HOURS PSYCHIATRY SERVICES PROVIDED VIA TELEHEALTH ASSESSMENTS FOR PATIENTS THAT PRESENT IN THE EMERGENCY ROOM OVERNIGHT. FURTHERMORE, SANFORD PARTNERS WITH A LOCAL SUBSTANCE ABUSE TREATMENT CENTER TO CO-LOCATE A COUNSELOR IN THE EMERGENCY ROOM FOR THOSE THAT NEED IT. SANFORD ALSO OFFERS BEHAVIORAL AND SUBSTANCE ABUSE SERVICES THROUGHOUT THEIR CARE DELIVERY FOOTPRINT AND CONTINUES TO EXPAND THE INTEGRATION OF THESE SERVICES INTO VARIOUS CARE SETTINGS, INCLUDING INTEGRATED HEALTH THERAPISTS WITHIN PRIMARY CARE CLINICS.IMPROVE ACCESS THROUGH INCREASED AVAILABILITY OF PROVIDERS, ADDITIONAL ACCESS POINTS, AND INTERVENTIONS TO DECREASE SUBSTANCE ABUSESANFORD LEADERS HAVE ENGAGED BOTH LOCAL AND STATE LEADERS IN AN EFFORT TO EXPAND BOTH BEHAVIORAL HEALTH AND ADDICTION COUNSELING SERVICES. IN ADDITION, SANFORD HAS HIRED ADDITIONAL BEHAVIORAL HEALTH PROVIDERS IN BISMARCK-MANDAN AND ELSEWHERE IN THE REGION TO ACCOMMODATE INCREASING DEMAND. SANFORD ALSO MEETS ON A QUARTERLY BASIS WITH LOCAL LAW ENFORCEMENT, EMERGENCY DEPARTMENT PROVIDERS AND OTHER PARTNERS TO DISCUSS TRENDS, NEW DEVELOPMENTS, INCLUDING SUBSTANCE ABUSE.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO AFFORDABLE HEALTH CAREHEALTHY LIVING LONG-TERM SENIOR CARE QUALITY CHILD 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. SANFORD HEALTH FURTHER SUPPORTS THROUGH ITS FINDHELP RESOURCE, AN ONLINE TOOL TO INCORPORATE CONTACT AND REFERRAL INFORMATION TO CONNECT COMMUNITY-BASED ORGANIZATIONS WITH PATIENTS TO MEET THEIR HEALTH RELATED-SOCIAL CARE NEEDS. A LINK IS INCLUDED ON EVERY AFTER-VISIT SUMMARY PROVIDED TO PATIENTS AND IS AVAILABLE ON SANFORDHEALTH.ORG AND MYCHART. 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 2023 THROUGH DECEMBER 2024, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2025-2027. 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.CHI ST. ALEXIUS HEALTH AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTERESSENTIA HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH CLAY COUNTY PUBLIC HEALTHFARGO CASS PUBLIC HEALTHFAMILY HEALTHCARESIOUX FALLS DEPARTMENT OF HEALTHBISMARCK-BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION WESTERN PLAINS PUBLIC HEALTHLIMITATIONSTHE 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 RESPONDENTS 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 COMMUNITY RESIDENTS WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS, PARTICIPATING ORGANIZATIONS NOTED PREVIOUSLY, AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND HEALTH NEEDS. 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 FOR THEIR RANKING. 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.THE SURVEY WAS THE FIRST OF MULTIPLE EFFORTS TO ENGAGE COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE SENT THE SURVEY AND ASKED TO COMPLETE THE INSTRUMENT AND THEN FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT.SANFORD INVESTED IN A MULTIFACETED CAMPAIGN THAT INCLUDED AN EARNED MEDIA CAMPAIGN ON LOCAL MEDIA OUTLETS AND THE PUBLIC-FACING SANFORD HEALTH NEWS (HTTPS://NEWS.SANFORDHEALTH.ORG/). THE SYSTEM ALSO PROMOTED THE SURVEY INTERNALLY THROUGH THE ORGANIZATION'S INTRANET, ALL-STAFF EMAILS, AND NEWSLETTERS.INTERNAL EFFORTS WERE SUPPORTED WITH A ROBUST ADVERTISING CAMPAIGN THAT INCLUDED, AMONG OTHER EFFORTS, A DIGITAL MEDIA PROGRAM YIELDING 3.6 MILLION IMPRESSIONS AND A PRINT AD CAMPAIGN ENCOURAGING NATIVE AMERICAN COMMUNITIES TO PARTICIPATE THROUGH PLACEMENTS IN DEBAHJIMON MAGAZINE, ANISHINAABEG MAGAZINE AND MHA TIMES (MANDAN, HIDATSA, ARIKARA). FURTHER SUPPORT WAS GIVEN TO COLLECTING SURVEYS AT VARIOUS COMMUNITY EVENTS. THE GOAL OF THESE EFFORTS WAS TO INCREASE PARTICIPATION BY THOSE UNDERREPRESENTED THE PREVIOUS CYCLE, INCLUDING LOWER INCOME, MINORITY, AND MEDICALLY UNDERSERVED POPULATIONS.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. PROMOTION INVESTMENTS BY THE SYSTEM YIELDED A TOTAL OF 9,714 COMPLETED SURVEYS FROM ACROSS THE SANFORD FOOTPRINT, AN INCREASE FROM 6,748 THE PREVIOUS CYCLE. THE RESPONSES GENERATED 48,643 OPEN-ENDED RESPONSES AND 1.76 MILLION PIECES OF DATA.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, BUILDING 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. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS 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 WERE ALSO INCLUDED IN THE FINDINGS.THE CENTER FOR SOCIAL RESEARCH VALIDATES THE FINDINGS OF THE PRIMARY RESEARCH BY ENGAGING AT LEAST TWO INTERNAL REVIEWERS. EACH REVIEWER HAS THEIR OWN TECHNIQUE AND STRENGTHS TO REVIEW THE FINDINGS; HOWEVER, THEY CHECK FOR ACCURACY IN THE DATA BY REVIEWING THE CODE AND SYNTAX, THE OUTPUT, THE CORRECT REPRESENTATION OF THE DATA IN THE REPORT, VERBIAGE, CONSISTENCY, CONTEXT, AND OVERALL READABILITY. BOTH REVIEWERS ALSO SUPPORTED PREVIOUS CHNA REPORTS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO LOCATE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT LOCAL RESOURCES ARE AVAILABLE.COMMUNITY STAKEHOLDER MEETINGSNEEDS, AS IDENTIFIED BY NDSU CENTER FOR SOCIAL RESEARCH, WERE PRESENTED TO COMMUNITY STAKEHOLDERS. FACILITATED DISCUSSION COMMENCED AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS IDENTIFIED 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 AND PRIORITIZATION OF LOCAL NEEDS. PARTICIPANTS IN THE MEETINGS INCLUDED COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS.THE PARTICIPANTS PROVIDED INFORMATION TO ANSWER THE FOLLOWING TYPES OF QUESTIONS AS IT RELATES TO IDENTIFIED NEEDS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHAT OPPORTUNITIES EXIST, WHERE CAN WE HAVE THE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ALREADY WORK BEING DONE ON THESE NEEDS?WHAT ARE THE RESOURCES CURRENTLY NOT UTILIZED WITHIN THE COMMUNITY THAT COULD ADDRESS THIS TOPIC?WHICH NEEDS FALL WITHIN THE PURVIEW OF HEALTH CARE SYSTEM AND WHICH DO NOT? CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES OR ORGANIZATIONS?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2025-2027 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: INCREASE ACCESS TO HEALTHCARE PROVIDERSSANFORD BEMIDJI (SB) PLAYS A VITAL ROLE IN ENSURING THAT PATIENTS IN RURAL MN HAVE ACCESS TO HEALTH CARE SERVICES. AS THE COMMUNITY AGES AND AS CHALLENGES WITH CLINICIAN RECRUITMENT AND HEALTH CARE INFRASTRUCTURE CHANGES ARISE, MAINTAINING ROBUST AND SUSTAINABLE HEALTH CARE ACCESS BECOMES INCREASINGLY CRITICAL. SANFORD HEALTH IS COMMITTED TO ENSURING THAT THE QUALITY OF CARE IS NOT INFLUENCED BY A PATIENT'S LOCATION.SB HAS MADE ACCESS TO HEALTH CARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO INCREASE ACCESS TO HEALTHCARE PROVIDERS WITHIN THE COMMUNITY. THIS EFFORT WILL FOCUS ON THREE PRIMARY GOALS: TO IMPROVE OPPORTUNITIES FOR TRANSPORTATION FOR PATIENTS TO HEALTH-RELATED APPOINTMENTS, TO PROVIDE INCREASED OPPORTUNITIES FOR PATIENTS TO RECEIVE EARLY SCREENING AND VACCINATIONS, AND TO EXPAND VIRTUAL HEALTH CARE OPTIONS FOR PATIENTS.PRIORITY 2: INCREASE ACCESS TO BEHAVIORAL HEALTH SERVICES AND SUBSTANCE ABUSE TREATMENTINCREASING BEHAVIORAL HEALTH SERVICES AND EXPANDING ACCESS TO SUBSTANCE ABUSE TREATMENT ARE CRITICAL FOR ADDRESSING THE GROWING MENTAL HEALTH AND ADDICTION CRISES. BY PROVIDING COMPREHENSIVE SUPPORT AND ACCESSIBLE CARE, SB CAN HELP INDIVIDUALS MANAGE THEIR CONDITIONS, REDUCE STIGMA, AND PROMOTE RECOVERY. STRENGTHENING THESE SERVICES IS ESSENTIAL FOR IMPROVING OVERALL PUBLIC HEALTH, ENHANCING QUALITY OF LIFE, AND BUILDING HEALTHIER COMMUNITIES.SANFORD HAS MADE BEHAVIORAL HEALTH AND SUBSTANCE ABUSE A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE AN INCREASE IN THESE SERVICES. IT IS SANFORD'S GOALS TO FOCUS ON INCREASING ACCESS TO VIRTUAL VISITS FOR BEHAVIORAL HEALTH CARE, TO INCREASE ACCESS TO SUBSTANCE USE SERVICES AND TO PROVIDE SUBSTANCE USE AND MENTAL HEALTH SERVICES TO THE INCARCERATED IN BELTRAMI COUNTY.PRIORITY 3: INCREASE ACCESS TO AFFORDABLE HEALTHCAREINCREASING ACCESS TO AFFORDABLE HEALTHCARE HELPS REDUCE HEALTH DISPARITIES BY PROVIDING EQUAL ACCESS TO PREVENTIVE SERVICES, TREATMENTS, AND ONGOING CARE, WHICH CONTRIBUTES TO OVERALL BETTER HEALTH OUTCOMES AND A HIGHER QUALITY OF LIFE. ACCESSIBLE, AFFORDABLE HEALTHCARE ALSO SUPPORTS EARLY INTERVENTION, REDUCING THE NEED FOR EMERGENCY CARE AND MITIGATING THE LONG-TERM ECONOMIC AND HEALTH IMPACTS ON THE COMMUNITY.SANFORD HAS MADE AFFORDABLE CARE A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE AN INCREASE IN OPTIONS FOR ACCESS TO AFFORDABLE CARE. IT IS SANFORD'S GOAL TO LAUNCH A "MAKING CARE PRIMARY" INITIATIVE TO IMPROVE PATIENTS CARE EXPERIENCE WHILE IMPROVING HEALTHCARE OUTCOMES AND LOWER THE OVERALL COST OF CARE.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARINCREASE ACCESS TO HEALTH CARE PROVIDERSSANFORD HEALTH CURRENTLY OPERATES A CRITICAL ACCESS HOSPITAL WITH REHAB AND AMBULANCE SERVICES IN BAGLEY AS WELL AS 11 NETWORK LOCATIONS, PROVIDING PRIMARY CARE, EYE CARE AND OPTICAL SERVICES, KIDNEY DIALYSIS, PHARMACY SERVICES, OUTPATIENT REHAB AND BEHAVIORAL HEALTH CARE. OUTREACH SERVICES AND SPECIALTIES INCLUDE ORTHOPEDICS, SLEEP MEDICINE, NEPHROLOGY, OBSTETRICS AND GYNECOLOGY, GENERAL SURGERY, CARDIOLOGY, PODIATRY, BARIATRICS, ONCOLOGY, OPHTHALMOLOGY, INTERVENTIONAL PAIN MANAGEMENT, DERMATOLOGY, OPTOMETRY, BEHAVIORAL HEALTH AND INTERNAL MEDICINE.IN AN EFFORT TO ATTRACT CLINICIANS, SB PARTNERS WITH REGIONAL MEDICAL SCHOOLS TO PREPARE STUDENTS FOR PRACTICING IN RURAL COMMUNITIES. THROUGH THESE PARTNERSHIPS, STUDENTS ENGAGE IN A YEAR-LONG EXPERIENCE LIVING IN BEMIDJI WHILE LEARNING FROM LOCAL CLINICIANS IN FAMILY MEDICINE, PEDIATRICS, INTERNAL MEDICINE, OB/GYN, SURGERY, PSYCHIATRY AND EMERGENCY MEDICINE. ADDITIONALLY, WE HAVE A ROBUST THREE-YEAR RECRUITMENT PLAN.THE "FAMILIES FIRST" PROGRAM EXPANDS AND ENHANCES SERVICES, DECREASING ADVERSE PATIENT OUTCOMES, REDUCING COSTS AND SUPPORTING PATIENTS SO MOTHERS, BABIES AND FAMILIES THRIVE FOR GENERATIONS TO COME. A CRITICAL PART OF THIS PROGRAM INCLUDES TRANSPORTATION FOR PRE-NATAL APPOINTMENTS. WE OFFER SEVERAL OPPORTUNITIES THROUGHOUT THE YEAR FOR COMMUNITY MEMBERS TO GET SCREENINGS, REGARDLESS IF THEY HAVE A PRIMARY CARE PROVIDER OR HEALTH INSURANCE.SANFORD HEALTH LAUNCHED A VIRTUAL CARE INITIATIVE TO TRANSFORM DELIVERING CARE BY EXPANDING ACCESS, IMPROVING PATIENT EXPERIENCES, ADVANCING INNOVATION THROUGH NEW RESEARCH, AND ATTRACTING AND TRAINING A NEW GENERATION OF CLINICIANS. INCREASE ACCESS TO BEHAVIORAL HEALTH SERVICES & SUBSTANCE ABUSE TREATMENTSANFORD BEHAVIORAL HEALTH OF NORTHERN MINNESOTA IS A CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINIC, ADOPTING A MODEL TO INTEGRATE BEHAVIORAL AND PHYSICAL HEALTH CARE, EXPAND ACCESS TO MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES, AND ENSURE CONSISTENT USE OF EVIDENCE-BASED PRACTICES. THIS EMPHASIZES COMMUNITY OUTREACH, OFFERING SERVICES IN PATIENTS' HOMES AND VIA TELEHEALTH.PATIENTS AGED 10 AND OLDER ARE ABLE TO SELF-SCHEDULE VIRTUAL BEHAVIORAL HEALTH APPOINTMENTS WITHOUT A REFERRAL. ADDITIONALLY, EMERGENCY DEPARTMENTS ARE CONNECTED TO PSYCHIATRISTS WHO ASSESS AND MANAGE EMERGENT BEHAVIORAL HEALTH CRISES VIRTUALLY.THE SANFORD BEMIDJI CRISIS CENTER FEATURES AN INNOVATIVE EMPATH UNIT (EMERGENCY PSYCHIATRIC ASSESSMENT, TREATMENT, AND HEALING), OFFERING URGENT CARE IN A CALMING ENVIRONMENT FOR UP TO 23 HOURS. IT INCLUDES SEPARATE AREAS FOR CHILDREN AND ADULTS, WITH SPACES DESIGNED FOR CULTURAL AND SPIRITUAL HEALING, PARTICULARLY FOR INDIGENOUS PATIENTS. THE CENTER INCLUDES THE REGION'S ONLY INPATIENT PSYCHIATRIC UNIT WITHIN A 90-MILE RADIUS.SANFORD HEALTH INTEGRATES BEHAVIORAL HEALTH SERVICES IN PRIMARY CARE CLINICS AND ONCOLOGY DEPARTMENTS THROUGH ON-SITE INTEGRATED HEALTH THERAPISTS, ENSURING THAT PATIENTS NEEDING FURTHER ASSESSMENT CAN RECEIVE IMMEDIATE SUPPORT. MOBILE CRISIS RESPONSE SERVICES PROVIDE 24/7 CRISIS INTERVENTION FOR ALL AGES.SANFORD'S SCHOOL-BASED PROGRAMS OFFER MENTAL HEALTH SUPPORT IN LOCAL ELEMENTARY SCHOOLS, WHILE THE YOUTH ASSERTIVE COMMUNITY TREATMENT PROGRAM PROVIDES INTENSIVE, MULTIDISCIPLINARY CARE FOR YOUTH WITH SEVERE MENTAL HEALTH NEEDS. THE SUBSTANCE USE DISORDER PROGRAM OFFERS PERSONALIZED TREATMENT PLANS, INCLUDING ABSTINENCE-BASED AND HARM-REDUCTION APPROACHES, WITH SPECIALIZED GROUPS FOR VARIOUS POPULATIONS. SANFORD HEALTH WAS THE FIRST NON-NATIVE ORGANIZATION TO EARN WELLBRIETY CERTIFICATION, INTEGRATING CULTURAL HEALING PRACTICES FOR NATIVE AMERICAN PATIENTS.THE PRIMEWEST RESIDENTIAL SUPPORT CENTER OFFERS SHORT-TERM RESIDENTIAL CARE FOR ADULTS IN MENTAL HEALTH CRISES. THE NEW BEGINNINGS RE-ENTRY PROJECT ASSISTS FORMERLY INCARCERATED INDIVIDUALS IN TRANSITIONING BACK TO SOCIETY.INCREASE ACCESS TO AFFORDABLE HEALTH CARESANFORD HEALTH CURRENTLY OFFERS FINANCIAL ASSISTANCE FOR PATIENTS WHO NEED MEDICALLY NECESSARY SERVICES OR EMERGENCY CARE. WE HAVE ALSO IMPLEMENTED A PRESUMPTIVE COMMUNITY CARE POLICY. INSTEAD OF WAITING FOR A PATIENT TO CONTACT US AFTER A BILL HAS BEEN SENT TO COLLECTIONS, WE PROACTIVELY EVALUATE SOME OF THE PATIENT'S DEMOGRAPHIC INFO AND OTHER FACTORS TO DETERMINE NEED OF FINANCIAL ASSISTANCE.SANFORD HEALTH HELPS PATIENTS IN NEED THROUGH THE PROVIDING NEEDED AID TO PATIENTS LOCALLY FOUNDATION FUND. FUNDS ARE USED TO HELP ESTABLISH PATIENT SELF-MANAGEMENT AND TO GET ITEMS THAT WILL STREAMLINE CARE LIKE BLOOD PRESSURE CUFFS, SCALES, PULSE OXIMETERS, PILL BOXES, WHEELCHAIRS, SHOWER CHAIRS AND DRESSING SUPPLIES. FUNDS CAN ALSO BE USED FOR COPAYS AND TRANSPORTATION.SANFORD HEALTH'S PRESCRIPTION ASSISTANCE PROGRAM OFFERS TIERED ASSISTANCE BASED ON INCOME LEVEL TO HELP PATIENTS AFFORD MEDICATION. IF A PATIENT INDICATES THEY CANNOT AFFORD THEIR MEDICATION, CLINICIANS CAN PRESUMPTIVELY QUALIFY THEM. PATIENTS WHO MEET PROGRAM GUIDELINES ARE ELIGIBLE FOR SIX MONTHS OF PRESCRIPTION ASSISTANCE. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:HEALTHY LIVINGEMPLOYMENT & ECONOMIC OPPORTUNITYLONG-TERM SENIOR CARECHILD CARE QUALITYCOMMUNITY SAFETYAFFORDABLE 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. SANFORD HEALTH FURTHER SUPPORTS THROUGH ITS FINDHELP RESOURCE, AN ONLINE TOOL TO INCORPORATE CONTACT AND REFERRAL INFORMATION TO CONNECT COMMUNITY-BASED ORGANIZATIONS WITH PATIENTS TO MEET THEIR HEALTH RELATED-SOCIAL CARE NEEDS. A LINK IS INCLUDED ON EVERY AFTER-VISIT SUMMARY PROVIDED TO PATIENTS AND IS AVAILABLE ON SANFORDHEALTH.ORG AND MYCHART. 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 2023 THROUGH DECEMBER 2024, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2025-2027. 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.CHI ST. ALEXIUS HEALTH AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTERESSENTIA HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH CLAY COUNTY PUBLIC HEALTHFARGO CASS PUBLIC HEALTHFAMILY HEALTHCARESIOUX FALLS DEPARTMENT OF HEALTHBISMARCK-BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION WESTERN PLAINS PUBLIC HEALTHLIMITATIONSTHE 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 RESPONDENTS 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 COMMUNITY RESIDENTS WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS, PARTICIPATING ORGANIZATIONS NOTED PREVIOUSLY, AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND HEALTH NEEDS. 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 FOR THEIR RANKING. 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.THE SURVEY WAS THE FIRST OF MULTIPLE EFFORTS TO ENGAGE COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE SENT THE SURVEY AND ASKED TO COMPLETE THE INSTRUMENT AND THEN FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT.SANFORD INVESTED IN A MULTIFACETED CAMPAIGN THAT INCLUDED AN EARNED MEDIA CAMPAIGN ON LOCAL MEDIA OUTLETS AND THE PUBLIC-FACING SANFORD HEALTH NEWS (HTTPS://NEWS.SANFORDHEALTH.ORG/). THE SYSTEM ALSO PROMOTED THE SURVEY INTERNALLY THROUGH THE ORGANIZATION'S INTRANET, ALL-STAFF EMAILS, AND NEWSLETTERS.INTERNAL EFFORTS WERE SUPPORTED WITH A ROBUST ADVERTISING CAMPAIGN THAT INCLUDED, AMONG OTHER EFFORTS, A DIGITAL MEDIA PROGRAM YIELDING 3.6 MILLION IMPRESSIONS AND A PRINT AD CAMPAIGN ENCOURAGING NATIVE AMERICAN COMMUNITIES TO PARTICIPATE THROUGH PLACEMENTS IN DEBAHJIMON MAGAZINE, ANISHINAABEG MAGAZINE AND MHA TIMES (MANDAN, HIDATSA, ARIKARA). FURTHER SUPPORT WAS GIVEN TO COLLECTING SURVEYS AT VARIOUS COMMUNITY EVENTS. THE GOAL OF THESE EFFORTS WAS TO INCREASE PARTICIPATION BY THOSE UNDERREPRESENTED THE PREVIOUS CYCLE, INCLUDING LOWER INCOME, MINORITY, AND MEDICALLY UNDERSERVED POPULATIONS.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. PROMOTION INVESTMENTS BY THE SYSTEM YIELDED A TOTAL OF 9,714 COMPLETED SURVEYS FROM ACROSS THE SANFORD FOOTPRINT, AN INCREASE FROM 6,748 THE PREVIOUS CYCLE. THE RESPONSES GENERATED 48,643 OPEN-ENDED RESPONSES AND 1.76 MILLION PIECES OF DATA.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, BUILDING 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. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS 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 WERE ALSO INCLUDED IN THE FINDINGS.THE CENTER FOR SOCIAL RESEARCH VALIDATES THE FINDINGS OF THE PRIMARY RESEARCH BY ENGAGING AT LEAST TWO INTERNAL REVIEWERS. EACH REVIEWER HAS THEIR OWN TECHNIQUE AND STRENGTHS TO REVIEW THE FINDINGS; HOWEVER, THEY CHECK FOR ACCURACY IN THE DATA BY REVIEWING THE CODE AND SYNTAX, THE OUTPUT, THE CORRECT REPRESENTATION OF THE DATA IN THE REPORT, VERBIAGE, CONSISTENCY, CONTEXT, AND OVERALL READABILITY. BOTH REVIEWERS ALSO SUPPORTED PREVIOUS CHNA REPORTS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO LOCATE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT LOCAL RESOURCES ARE AVAILABLE.COMMUNITY STAKEHOLDER MEETINGSNEEDS, AS IDENTIFIED BY NDSU CENTER FOR SOCIAL RESEARCH, WERE PRESENTED TO COMMUNITY STAKEHOLDERS. FACILITATED DISCUSSION COMMENCED AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS IDENTIFIED 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 AND PRIORITIZATION OF LOCAL NEEDS. PARTICIPANTS IN THE MEETINGS INCLUDED COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS.THE PARTICIPANTS PROVIDED INFORMATION TO ANSWER THE FOLLOWING TYPES OF QUESTIONS AS IT RELATES TO IDENTIFIED NEEDS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHAT OPPORTUNITIES EXIST, WHERE CAN WE HAVE THE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ALREADY WORK BEING DONE ON THESE NEEDS?WHAT ARE THE RESOURCES CURRENTLY NOT UTILIZED WITHIN THE COMMUNITY THAT COULD ADDRESS THIS TOPIC?WHICH NEEDS FALL WITHIN THE PURVIEW OF HEALTH CARE SYSTEM AND WHICH DO NOT? CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES OR ORGANIZATIONS?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2025-2027 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: INCREASE ACCESS TO SPECIALTY CARE SERVICES AND SAME-DAY APPOINTMENTSWHEN SURVEY RESPONDENTS IN THE THIEF RIVER FALLS (TRF) MARKET AREA WERE ASKED ABOUT THE MOST IMPORTANT HEALTH CARE ISSUES IMPACTING THEIR COMMUNITY, THREE-FOURTHS OF SURVEY RESPONDENTS INDICATED THAT THERE ARE HEALTH CARE SERVICES THEY WOULD LIKE TO SEE OFFERED OR IMPROVED IN THEIR COMMUNITY. WHEN THESE RESPONDENTS WERE ASKED WHICH HEALTH CARE SERVICES THEY WOULD LIKE TO SEE OFFERED OR IMPROVED, MOST SAID BEHAVIORAL AND MENTAL HEALTH SERVICES, FOLLOWED BY CANCER CARE, ADDICTION TREATMENT, DENTAL CARE, WALK-IN/URGENT CARE, LONG-TERM CARE AND NURSING HOMES, OBGYN/WOMEN'S CARE, FAMILY MEDICINE OR PRIMARY CARE, AND HEART CARE.SANFORD HAS MADE ACCESS TO SPECIALTY CARE SERVICES AND SAME-DAY APPOINTMENTS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE AN INCREASE IN SAME-DAY APPOINTMENT AVAILABILITY. IT IS SANFORD'S GOAL TO EXPAND SAME-DAY APPOINTMENTS WITHIN PRIMARY CARE AND TO ENHANCE ACCESS TO THE TOP THREE SERVICES IDENTIFIED IN THE COMMUNITY SURVEY (MENTAL HEALTH, CANCER CARE AND SUBSTANCE ABUSE).PRIORITY 2: PROMOTE COMMUNITY SERVICES WITH COMMUNITY PARTNERSBY PARTNERING WITH LOCAL ENTITIES, SANFORD MEDICAL CENTER TRF AIMS TO ADDRESS THE INTERCONNECTED ECONOMIC, SOCIAL, AND HEALTH NEEDS OF OUR COMMUNITY. THIS COLLABORATIVE APPROACH NOT ONLY ENHANCES ACCESS TO ESSENTIAL RESOURCES BUT ALSO FOSTERS A HEALTHIER, MORE RESILIENT POPULATION.SANFORD HAS MADE PROMOTING COMMUNITY SERVICES WITH COMMUNITY PARTNERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO CREATE A LASTING POSITIVE IMPACT ON THE OVERALL WELLBEING OF THE COMMUNITY WE SERVE. IT IS SANFORD'S GOAL TO PARTNER WITH COUNTY HEALTH FOR EDUCATIONAL RESOURCES AND TO PROMOTE SANFORD.FINDHELP.COMPRIORITY 3: INCREASE ACCESS TO 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 INCREASING ACCESS TO MENTAL HEALTH SERVICES A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES FOR THE COMMUNITY TO SEE EXPANDED ACCESS TO GROUP THERAPY SESSIONS AND AN EXPANDED CLINICAL TRAINING PROGRAM TO INCREASE ACCESS. IT IS SANFORD'S GOAL TO REDUCE WAIT TIME FOR MENTAL HEALTH SERVICES BY OFFERING GROUP THERAPY AND TO EXPAND THE CLINICAL TRAINING PROGRAM.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARINCREASE ACCESS TO SPECIALTY CARE SERVICES AND SAME-DAY APPOINTMENTSACCESS TO HEALTHCARE PROVIDERS REMAINS A TOP PRIORITY IN TRF. WE HAVE SUCCESSFULLY LEVERAGED TELEHEALTH TECHNOLOGIES TO EXPAND ACCESS BEYOND TRADITIONAL IN-PERSON CONSULTATIONS. WHILE THE POTENTIAL FOR TELEHEALTH IS SIGNIFICANT, ITS ADOPTION IS SOMEWHAT CONSTRAINED BY EXISTING PAYMENT MODELS AND THE WILLINGNESS OF INSURANCE PAYERS TO RECOGNIZE TELEHEALTH AS A COVERED SERVICE AND THE PERCEPTION OF THIS SERVICE FROM PROVIDERS AND OLDER PATIENTS NOT FEELING THE SAME PROVIDER-PATIENT RELATIONSHIP.PROMOTE COMMUNITY SERVICES WITH COMMUNITY PARTNERSSANFORD TRF IS COMMITTED TO BEING AN ENGAGED COMMUNITY PARTNER ACROSS VARIOUS LEVELS AND ORGANIZATIONS. WE ACTIVELY SUPPORT ECONOMIC DEVELOPMENT INITIATIVES, COLLABORATE WITH THE CHAMBER OF COMMERCE, AND ENGAGE WITH THE LOCAL SCHOOL SYSTEM. OUR INVOLVEMENT EXTENDS TO COMMUNITY HEALTH AND FITNESS PROGRAMS, EVENTS, AND A LOCAL YOUNG PROFESSIONALS' NETWORK, CONTRIBUTING TO A VIBRANT AND HEALTHY COMMUNITY.WE ARE ALSO DEDICATED TO INVESTING IN EDUCATIONAL PROGRAMS TAILORED TO ADDRESS CRITICAL HEALTH TOPICS, INCLUDING COURSES FOCUSED ON CARDIAC HEALTH, PREGNANCY, DIABETES, AND MORE. ADDITIONALLY, WE ADVOCATE FOR POLICY CHANGES AT THE LOCAL, STATE, AND FEDERAL LEVELS, WORKING ALONGSIDE ADVOCACY GROUPS TO PROMOTE HEALTH EQUITY AND IMPROVED HEALTH OUTCOMES.INCREASE ACCESS TO MENTAL HEALTH SERVICESSANFORD TRF BEHAVIORAL HEALTH CENTER (SBHC) SERVES AS THE ONLY FREESTANDING BEHAVIORAL HEALTH HOSPITAL AND PRIMARY PROVIDER OF INPATIENT PSYCHIATRIC SERVICES FOR NORTHWEST MINNESOTA, WITH 16 INPATIENT PSYCHIATRIC BEDS. THE HOSPITAL OFFERS OUTPATIENT MENTAL HEALTH SERVICES, CHILDREN'S THERAPEUTIC SERVICES AND SUPPORT, AND OUTPATIENT SUBSTANCE USE TREATMENT. THE HOSPITAL IS ACTIVELY RECRUITING BOTH MASTER'S AND DOCTORAL-LEVEL PROFESSIONALS. TELEHEALTH HAS BEEN INSTRUMENTAL IN RETAINING CLINICIANS WHO MIGHT HAVE RELOCATED, ALLOWING US TO MAINTAIN SERVICE CONTINUITY. EIGHT OF OUR CLINICIANS NOW EXCLUSIVELY PROVIDE TELEHEALTH SERVICES, WHILE MANY OTHERS INTEGRATE IT INTO THEIR PRACTICE. THIS EXPANSION OF TELEHEALTH HAS SIGNIFICANTLY IMPROVED ACCESS TO MENTAL HEALTH CARE.WE HAVE INVESTED SIGNIFICANT EFFORT TO IMPROVE OUR INTAKE PROCESS FOR THERAPY SERVICES INCLUDING COMPLETING AN INTAKE SCREENING AND UPDATING OUR WAITLIST TO AID IN BEST ALIGNING CLINICIAN EXPERTISE AND AVAILABILITY WITH PATIENT NEEDS.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 ALSO PARTNERED 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.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO QUALITY HEALTHCAREPUBLIC TRANSPORTATIONLONG-TERM SENIOR CAREQUALITY CHILD CAREAFFORDABLE 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. SANFORD HEALTH FURTHER SUPPORTS THROUGH ITS FINDHELP RESOURCE, AN ONLINE TOOL TO INCORPORATE CONTACT AND REFERRAL INFORMATION TO CONNECT COMMUNITY-BASED ORGANIZATIONS WITH PATIENTS TO MEET THEIR HEALTH RELATED-SOCIAL CARE NEEDS. A LINK IS INCLUDED ON EVERY AFTER-VISIT SUMMARY PROVIDED TO PATIENTS AND IS AVAILABLE ON SANFORDHEALTH.ORG AND MYCHART. 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 2023 THROUGH DECEMBER 2024, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2025-2027. 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.CHI ST. ALEXIUS HEALTH AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTERESSENTIA HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH CLAY COUNTY PUBLIC HEALTHFARGO CASS PUBLIC HEALTHFAMILY HEALTHCARESIOUX FALLS DEPARTMENT OF HEALTHBISMARCK-BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION WESTERN PLAINS PUBLIC HEALTHLIMITATIONSTHE 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 RESPONDENTS 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 COMMUNITY RESIDENTS WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS, PARTICIPATING ORGANIZATIONS NOTED PREVIOUSLY, AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND HEALTH NEEDS. 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 FOR THEIR RANKING. 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.THE SURVEY WAS THE FIRST OF MULTIPLE EFFORTS TO ENGAGE COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE SENT THE SURVEY AND ASKED TO COMPLETE THE INSTRUMENT AND THEN FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT.SANFORD INVESTED IN A MULTIFACETED CAMPAIGN THAT INCLUDED AN EARNED MEDIA CAMPAIGN ON LOCAL MEDIA OUTLETS AND THE PUBLIC-FACING SANFORD HEALTH NEWS (HTTPS://NEWS.SANFORDHEALTH.ORG/). THE SYSTEM ALSO PROMOTED THE SURVEY INTERNALLY THROUGH THE ORGANIZATION'S INTRANET, ALL-STAFF EMAILS, AND NEWSLETTERS.INTERNAL EFFORTS WERE SUPPORTED WITH A ROBUST ADVERTISING CAMPAIGN THAT INCLUDED, AMONG OTHER EFFORTS, A DIGITAL MEDIA PROGRAM YIELDING 3.6 MILLION IMPRESSIONS AND A PRINT AD CAMPAIGN ENCOURAGING NATIVE AMERICAN COMMUNITIES TO PARTICIPATE THROUGH PLACEMENTS IN DEBAHJIMON MAGAZINE, ANISHINAABEG MAGAZINE AND MHA TIMES (MANDAN, HIDATSA, ARIKARA). FURTHER SUPPORT WAS GIVEN TO COLLECTING SURVEYS AT VARIOUS COMMUNITY EVENTS. THE GOAL OF THESE EFFORTS WAS TO INCREASE PARTICIPATION BY THOSE UNDERREPRESENTED THE PREVIOUS CYCLE, INCLUDING LOWER INCOME, MINORITY, AND MEDICALLY UNDERSERVED POPULATIONS.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. PROMOTION INVESTMENTS BY THE SYSTEM YIELDED A TOTAL OF 9,714 COMPLETED SURVEYS FROM ACROSS THE SANFORD FOOTPRINT, AN INCREASE FROM 6,748 THE PREVIOUS CYCLE. THE RESPONSES GENERATED 48,643 OPEN-ENDED RESPONSES AND 1.76 MILLION PIECES OF DATA.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, BUILDING 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. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS 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 WERE ALSO INCLUDED IN THE FINDINGS.THE CENTER FOR SOCIAL RESEARCH VALIDATES THE FINDINGS OF THE PRIMARY RESEARCH BY ENGAGING AT LEAST TWO INTERNAL REVIEWERS. EACH REVIEWER HAS THEIR OWN TECHNIQUE AND STRENGTHS TO REVIEW THE FINDINGS; HOWEVER, THEY CHECK FOR ACCURACY IN THE DATA BY REVIEWING THE CODE AND SYNTAX, THE OUTPUT, THE CORRECT REPRESENTATION OF THE DATA IN THE REPORT, VERBIAGE, CONSISTENCY, CONTEXT, AND OVERALL READABILITY. BOTH REVIEWERS ALSO SUPPORTED PREVIOUS CHNA REPORTS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO LOCATE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT LOCAL RESOURCES ARE AVAILABLE.COMMUNITY STAKEHOLDER MEETINGSNEEDS, AS IDENTIFIED BY NDSU CENTER FOR SOCIAL RESEARCH, WERE PRESENTED TO COMMUNITY STAKEHOLDERS. FACILITATED DISCUSSION COMMENCED AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS IDENTIFIED 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 AND PRIORITIZATION OF LOCAL NEEDS. PARTICIPANTS IN THE MEETINGS INCLUDED COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS.THE PARTICIPANTS PROVIDED INFORMATION TO ANSWER THE FOLLOWING TYPES OF QUESTIONS AS IT RELATES TO IDENTIFIED NEEDS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHAT OPPORTUNITIES EXIST, WHERE CAN WE HAVE THE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ALREADY WORK BEING DONE ON THESE NEEDS?WHAT ARE THE RESOURCES CURRENTLY NOT UTILIZED WITHIN THE COMMUNITY THAT COULD ADDRESS THIS TOPIC?WHICH NEEDS FALL WITHIN THE PURVIEW OF HEALTH CARE SYSTEM AND WHICH DO NOT? CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES OR ORGANIZATIONS?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2025-2027 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: ACCESS TO HEALTH CARE PROVIDERS DUE TO LACK OF TRANSPORTATION OR COSTCOST AND THE ABILITY TO AFFORD NEEDED HEALTH CARE WAS IDENTIFIED AS THE TOP HEALTH CARE CONCERN THAT SURVEY RESPONDENTS AND THEIR FAMILIES IN THE AREA FACE ON A REGULAR BASIS. IN ADDITION, RESPONDENTS IN THE AREA INDICATED THAT THEY OR A FAMILY MEMBER NEEDED MEDICAL CARE IN THE PAST YEAR BUT DID NOT RECEIVE IT. ADDING TO THE CHALLENGES IN ACCESSING AFFORDABLE HEALTH CARE IS THE NUMBER IN THE AREA THAT ARE UNINSURED.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 TO IMPROVE SCREENING FOR SOCIAL DETERMINANTS OF HEALTH AND TO ADDRESS TRANSPORTATION BARRIERS FOR PATIENTS.PRIORITY 2: ACCESS TO HEALTH CARE PROVIDERSGENERAL ACCESS TO HEALTH CARE AND A SHORTAGE OF HEALTH CARE PROVIDERS WAS ONE OF THE TOP ISSUES, WHEN RESPONDENTS WERE ASKED ABOUT THE MOST IMPORTANT HEALTH CARE ISSUES IMPACTING THEIR COMMUNITY. NEARLY TWO-THIRDS OF RESPONDENTS HAD TRAVELED TO RECEIVE HEALTH CARE SERVICES OUTSIDE THEIR COMMUNITY AND THE SPECIALTY CARE, OR THE NEEDED SERVICES WERE NOT AVAILABLE LOCALLY. IN ADDITION, THERE ARE HEALTH CARE SERVICES THEY WOULD LIKE TO SEE OFFERED OR IMPROVED IN THE COMMUNITY. SANFORD HAS MADE ACCESS TO HEALTH CARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO PROMOTE AND IMPROVE ACCESS TO A COMPREHENSIVE PANEL OF PRIMARY CARE AND SPECIALTY PROVIDERS. IT IS SANFORD'S GOAL TO IMPROVE WEIGHT MANAGEMENT SERVICES TO MITIGATE CHRONIC DISEASE IMPACT AND ENHANCE OVERALL ACCESS TO PRIMARY CARE IN THE COMMUNITY. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARACCESS TO HEALTH CARE PROVIDERS DUE TO LACK OF TRANSPORTATION OR COSTSANFORD ABERDEEN MEDICAL CENTER (SAMC) IS COMMITTED TO IMPROVING ACCESS TO HEALTHCARE PROVIDERS. SAMC PROVIDES PATIENTS WITH TAXI VOUCHERS IF NECESSARY TO GET THEM A RIDE FROM SAMC'S FACILITY (ABERDEEN SHUTTLE AND TAXI SERVICE). SANFORD HEALTH FOUNDATION FUNDS ARE AVAILABLE TO ASSIST PATIENTS THAT HAVE A NEED TO TRAVEL FOR ONCOLOGY/CANCER CARE. SAMC DIRECTS PATIENTS TO LOCAL VETERAN ORGANIZATIONS WHICH HAVE SERVICES TO TRANSPORT VETERANS TO APPOINTMENTS AND TO PNAPLE (PROVIDING NEEDED AID TO PATIENTS LOCALLY) FUNDS WHICH ARE AVAILABLE TO ASSIST PATIENTS WITH NEEDS INCLUDING TRANSPORTATION. SAMC WILL CONTINUE TO PROVIDE OUTREACH AND TELEMEDICINE SERVICES WHERE ABLE.ACCESS TO HEALTH CARE PROVIDERSSAMC SEEKS TO ENSURE THAT PATIENTS HAVE ACCESS TO HEALTHCARE PROVIDERS IN ABERDEEN AND THE SURROUNDING AREA. CURRENT SERVICES PROVIDED ONSITE INCLUDE: PRIMARY CARE, CARDIOLOGY, HEART AND VASCULAR SCREENING, BEHAVIORAL HEALTH THERAPIST, GENERAL SURGERY, COLORECTAL SCREENING, UROLOGY, ONCOLOGY/CANCER CARE, EAR NOSE AND THROAT, ORTHOPEDICS AND PODIATRY, WOUND CARE, OB/GYN (INCLUDING THE DELIVERY OF BABIES), RADIOLOGY, RESPIRATORY THERAPY, OUTPATIENT THERAPY AND REHABILITATION, 24/7 ANESTHESIA AND 24/7 EMERGENCY DEPARTMENT. CURRENT SERVICES PROVIDED VIA OUTREACH CONSIST OF: NEUROSURGERY, VASCULAR, NEPHROLOGY, PULMONOLOGY, NEUROLOGY, RHEUMATOLOGY, MATERNAL FETAL MEDICINE, DERMATOLOGY, PEDIATRIC, HEMATOLOGY/ONCOLOGY, PEDIATRIC GASTROENTEROLOGY, PEDIATRIC ENDOCRINOLOGY, PEDIATRIC PULMONOLOGY (TELEMEDICINE), PEDIATRIC REHABILITATION, PEDIATRIC CARDIOLOGY, PEDIATRIC NEUROLOGY AND PEDIATRIC SURGERY.SANFORD ABERDEEN HAS AN RN CARE MANAGER AND A COMMUNITY HEALTH WORKER THAT WORKS IN CONJUNCTION WITH OUR BEHAVIORAL CARE COUNSELOR, PROVIDERS IN FAMILY MEDICINE, AND SPECIALTY PROVIDERS TO FIND RESOURCES FOR INDIVIDUALS WITH MENTAL HEALTH DISPARITIES.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:LONG-TERM SENIOR 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. SANFORD HEALTH FURTHER SUPPORTS THROUGH ITS FINDHELP RESOURCE, AN ONLINE TOOL TO INCORPORATE CONTACT AND REFERRAL INFORMATION TO CONNECT COMMUNITY-BASED ORGANIZATIONS WITH PATIENTS TO MEET THEIR HEALTH RELATED-SOCIAL CARE NEEDS. A LINK IS INCLUDED ON EVERY AFTER-VISIT SUMMARY PROVIDED TO PATIENTS AND IS AVAILABLE ON SANFORDHEALTH.ORG AND MYCHART. 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 2023 THROUGH DECEMBER 2024, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2025-2027. 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.CHI ST. ALEXIUS HEALTH AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTERESSENTIA HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH CLAY COUNTY PUBLIC HEALTHFARGO CASS PUBLIC HEALTHFAMILY HEALTHCARESIOUX FALLS DEPARTMENT OF HEALTHBISMARCK-BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION WESTERN PLAINS PUBLIC HEALTHLIMITATIONSTHE 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 RESPONDENTS 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 COMMUNITY RESIDENTS WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS, PARTICIPATING ORGANIZATIONS NOTED PREVIOUSLY, AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND HEALTH NEEDS. 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 FOR THEIR RANKING. 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.THE SURVEY WAS THE FIRST OF MULTIPLE EFFORTS TO ENGAGE COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE SENT THE SURVEY AND ASKED TO COMPLETE THE INSTRUMENT AND THEN FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT.SANFORD INVESTED IN A MULTIFACETED CAMPAIGN THAT INCLUDED AN EARNED MEDIA CAMPAIGN ON LOCAL MEDIA OUTLETS AND THE PUBLIC-FACING SANFORD HEALTH NEWS (HTTPS://NEWS.SANFORDHEALTH.ORG/). THE SYSTEM ALSO PROMOTED THE SURVEY INTERNALLY THROUGH THE ORGANIZATION'S INTRANET, ALL-STAFF EMAILS, AND NEWSLETTERS.INTERNAL EFFORTS WERE SUPPORTED WITH A ROBUST ADVERTISING CAMPAIGN THAT INCLUDED, AMONG OTHER EFFORTS, A DIGITAL MEDIA PROGRAM YIELDING 3.6 MILLION IMPRESSIONS AND A PRINT AD CAMPAIGN ENCOURAGING NATIVE AMERICAN COMMUNITIES TO PARTICIPATE THROUGH PLACEMENTS IN DEBAHJIMON MAGAZINE, ANISHINAABEG MAGAZINE AND MHA TIMES (MANDAN, HIDATSA, ARIKARA). FURTHER SUPPORT WAS GIVEN TO COLLECTING SURVEYS AT VARIOUS COMMUNITY EVENTS. THE GOAL OF THESE EFFORTS WAS TO INCREASE PARTICIPATION BY THOSE UNDERREPRESENTED THE PREVIOUS CYCLE, INCLUDING LOWER INCOME, MINORITY, AND MEDICALLY UNDERSERVED POPULATIONS.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. PROMOTION INVESTMENTS BY THE SYSTEM YIELDED A TOTAL OF 9,714 COMPLETED SURVEYS FROM ACROSS THE SANFORD FOOTPRINT, AN INCREASE FROM 6,748 THE PREVIOUS CYCLE. THE RESPONSES GENERATED 48,643 OPEN-ENDED RESPONSES AND 1.76 MILLION PIECES OF DATA.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, BUILDING 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. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS 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 WERE ALSO INCLUDED IN THE FINDINGS.THE CENTER FOR SOCIAL RESEARCH VALIDATES THE FINDINGS OF THE PRIMARY RESEARCH BY ENGAGING AT LEAST TWO INTERNAL REVIEWERS. EACH REVIEWER HAS THEIR OWN TECHNIQUE AND STRENGTHS TO REVIEW THE FINDINGS; HOWEVER, THEY CHECK FOR ACCURACY IN THE DATA BY REVIEWING THE CODE AND SYNTAX, THE OUTPUT, THE CORRECT REPRESENTATION OF THE DATA IN THE REPORT, VERBIAGE, CONSISTENCY, CONTEXT, AND OVERALL READABILITY. BOTH REVIEWERS ALSO SUPPORTED PREVIOUS CHNA REPORTS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO LOCATE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT LOCAL RESOURCES ARE AVAILABLE.COMMUNITY STAKEHOLDER MEETINGSNEEDS, AS IDENTIFIED BY NDSU CENTER FOR SOCIAL RESEARCH, WERE PRESENTED TO COMMUNITY STAKEHOLDERS. FACILITATED DISCUSSION COMMENCED AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS IDENTIFIED 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 AND PRIORITIZATION OF LOCAL NEEDS. PARTICIPANTS IN THE MEETINGS INCLUDED COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS.THE PARTICIPANTS PROVIDED INFORMATION TO ANSWER THE FOLLOWING TYPES OF QUESTIONS AS IT RELATES TO IDENTIFIED NEEDS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHAT OPPORTUNITIES EXIST, WHERE CAN WE HAVE THE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ALREADY WORK BEING DONE ON THESE NEEDS?WHAT ARE THE RESOURCES CURRENTLY NOT UTILIZED WITHIN THE COMMUNITY THAT COULD ADDRESS THIS TOPIC?WHICH NEEDS FALL WITHIN THE PURVIEW OF HEALTH CARE SYSTEM AND WHICH DO NOT? CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES OR ORGANIZATIONS?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2025-2027 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: INCREASE ACCESS TO PROVIDERS AND QUALITY OF CAREWHEN SURVEY RESPONDENTS IN THE WORTHINGTON AREA WERE ASKED ABOUT THE MOST IMPORTANT HEALTH CARE ISSUES IMPACTING THEIR COMMUNITY, ACCESS TO HEALTH CARE SERVICES AND PROVIDERS WAS THE TOP ISSUE. IN ADDITION, 76 PERCENT OF SURVEY RESPONDENTS IN THE WORTHINGTON AREA REPORTED TRAVELING OUTSIDE OF THEIR COMMUNITY TO RECEIVE HEALTH CARE SERVICES IN THE PAST THREE YEARS. REASONS GIVEN WERE THAT THEY NEEDED SPECIALTY CARE, OR THE NEEDED SERVICES WERE NOT AVAILABLE LOCALLY, THEY WERE REFERRED BY A PHYSICIAN OR THEY SOUGHT BETTER OR HIGHER QUALITY CARE ELSEWHERE. ADDING TO THE CHALLENGES OF RECEIVING QUALITY HEALTH CARE ARE POTENTIAL LANGUAGE BARRIERS. CHR DATA INDICATE THAT 11 PERCENT OF PEOPLE IN THE WORTHINGTON AREA DO NOT SPEAK ENGLISH WELL.SANFORD HAS MADE INCREASING ACCESS TO CARE AND QUALITY OF CARE A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO INCREASE ACCESS TO AND UTILIZATION OF LOCAL SERVICES. IT IS SANFORD'S GOAL TO FURTHER ASSESS STAFF PERCEPTIONS OF HEALTHCARE SERVICE GAPS AND UTILIZE INFORMATION LEARNED TO INFORM OPPORTUNITIES FOR ADDITIONAL SERVICES AND HIGH-QUALITY CARE, AND TO RECONVENE THE COMMUNITY HEALTH COALITION TO ADVANCE ACCESS IMPROVEMENT INITIATIVES.PRIORITY 2: EDUCATE COMMUNITY ON SERVICES AVAILABLE LOCALLYSANFORD HAS MADE IT A SIGNIFICANT PRIORITY TO EDUCATE THE COMMUNITY ON SERVICES AVAILABLE LOCALLY AND HAS DEVELOPED STRATEGIES TO INCREASE COMMUNICATION REGARDING HOSPITAL AND CLINIC SERVICE AND QUALITY EFFORTS. IT IS SANFORD'S GOAL TO DEVELOP COMMUNICATION AND MARKETING STRATEGIES THAT HAVE EXTENDED REACH INTO OUR SERVICE AREA.PRIORITY 3: HEALTHY LIVINGWHEN SURVEY RESPONDENTS IN THE WORTHINGTON AREA WERE ASKED ABOUT THE BIGGEST HEALTH CONCERNS FOR THEMSELVES AND THEIR FAMILY, CHRONIC HEALTH ISSUES WERE AMONG THE TOP CONCERNS. THE MOST FREQUENTLY CITED CHRONIC HEALTH CONCERNS INVOLVED WEIGHT, DIABETES, CANCER, AND HEART DISEASE. CHR DATA INDICATE THAT 11 PERCENT OF ADULTS IN THE WORTHINGTON AREA HAVE DIABETES AND 39 PERCENT OF ADULTS HAVE OBESITY.SANFORD HAS MADE HEALTHY LIVING A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES FOR THE COMMUNITY TO SEE SANFORD HEALTH PARTICIPATE IN HEALTH PROMOTION ACTIVITIES AND HAVE SANFORD STAFF SEE INCREASED OPPORTUNITIES FOR HEALTH AND WELLBEING. IT IS SANFORD'S GOAL TO COLLABORATE WITH COMMUNITY PARTNERS ON ACTIVITIES THAT PROMOTE HEALTH AND WELLBEING AND DELIVER HEALTH EDUCATION TO COMMUNITY GROUPS AND TO INCREASE OPPORTUNITIES THAT CONTRIBUTE TO SANFORD WORTHINGTON STAFF HEALTH AND WELLBEING.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARINCREASE ACCESS TO PROVIDERS AND QUALITY OF CARESANFORD WORTHINGTON PROVIDES MORE THAN 50 MEDICAL SERVICES TO THE LOCAL COMMUNITY, INCLUDING GENERAL AND SAME DAY SURGERY, A 27-BED MEDICAL/SURGICAL UNIT, INTENSIVE CARE, LAB AND MEDICAL IMAGING, WOMEN'S SERVICES INCLUDING DIGITAL MAMMOGRAPHY, OUTPATIENT DIALYSIS, INFUSION CENTER, ONCOLOGY SERVICES INCLUDING CHEMOTHERAPY AND RADIATION THERAPY, AND A 24/7 EMERGENCY DEPARTMENT WITH IN-HOUSE PHYSICIAN COVERAGE. AN ACUTE CARE CLINIC PROVIDES WALK-IN, AFTER-HOURS AND WEEKEND SERVICES. BILINGUAL SPANISH COMMUNITY HEALTH WORKERS (CHWS) ARE ALSO AVAILABLE TO COMPLETE SDOH ASSESSMENTS AND REFER PATIENTS TO NEEDED SERVICES. VIRTUAL CARE SERVICES ARE ALSO AVAILABLE THROUGH THE HEALTH SYSTEM. IN TOTAL, SANFORD WORTHINGTON EMPLOYS 25 MEDICAL STAFF. EDUCATE COMMUNITY ON SERVICES AVAILABLE LOCALLYSANFORD MARKETING ASSISTS WITH THE DEVELOPMENT OF MARKETING CAMPAIGNS FOR VARIOUS SERVICES, HEALTH SCREENINGS AND HEALTH TOPICS FOR THE SANFORD WORTHINGTON SERVICE AREA. DIGITAL SIGNAGE IS LOCATED AT THE SANFORD WORTHINGTON MEDICAL CENTER CAMPUS TO COMMUNICATE ABOUT IMPORTANT HEALTH REMINDERS AND EVENTS AS WELL AS LOCAL SERVICES. SANFORD WORTHINGTON ENGAGES THROUGH PARTICIPATION IN COMMUNITY EVENTS THAT PROMOTE SANFORD SERVICES, PROVIDERS AND EMPLOYMENT OPPORTUNITIES.HEALTHY LIVINGIN ADDITION TO THE SERVICES PROVIDED THROUGH THE CLINIC AND HOSPITAL, SANFORD WORTHINGTON MAINTAINS STRONG COMMUNITY PARTNERSHIPS THAT PROVIDE OPPORTUNITIES TO PROMOTE IMPORTANT HEALTH TOPICS. THE HOSPITAL INCLUDES AN ACTIVE INTERNAL EMPLOYEE HEALTH & WELLBEING COMMITTEE WITH REPRESENTATION OF ALL HOSPITAL AND CLINIC DEPARTMENTS THAT MEET MONTHLY TO CREATE VARIOUS HEALTH AND WELLNESS OPPORTUNITIES FOR STAFF TO ENGAGE IN.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO AFFORDABLE HEALTH CAREMENTAL HEALTHCHILD CARE QUALITYLONG-TERM SENIOR 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. SANFORD HEALTH FURTHER SUPPORTS THROUGH ITS FINDHELP RESOURCE, AN ONLINE TOOL TO INCORPORATE CONTACT AND REFERRAL INFORMATION TO CONNECT COMMUNITY-BASED ORGANIZATIONS WITH PATIENTS TO MEET THEIR HEALTH RELATED-SOCIAL CARE NEEDS. A LINK IS INCLUDED ON EVERY AFTER-VISIT SUMMARY PROVIDED TO PATIENTS AND IS AVAILABLE ON SANFORDHEALTH.ORG AND MYCHART. 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 2023 THROUGH DECEMBER 2024, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2025-2027. 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.CHI ST. ALEXIUS HEALTH AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTERESSENTIA HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH CLAY COUNTY PUBLIC HEALTHFARGO CASS PUBLIC HEALTHFAMILY HEALTHCARESIOUX FALLS DEPARTMENT OF HEALTHBISMARCK-BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION WESTERN PLAINS PUBLIC HEALTHLIMITATIONSTHE 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 RESPONDENTS 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 COMMUNITY RESIDENTS WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS, PARTICIPATING ORGANIZATIONS NOTED PREVIOUSLY, AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND HEALTH NEEDS. 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 FOR THEIR RANKING. 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.THE SURVEY WAS THE FIRST OF MULTIPLE EFFORTS TO ENGAGE COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE SENT THE SURVEY AND ASKED TO COMPLETE THE INSTRUMENT AND THEN FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT.SANFORD INVESTED IN A MULTIFACETED CAMPAIGN THAT INCLUDED AN EARNED MEDIA CAMPAIGN ON LOCAL MEDIA OUTLETS AND THE PUBLIC-FACING SANFORD HEALTH NEWS (HTTPS://NEWS.SANFORDHEALTH.ORG/). THE SYSTEM ALSO PROMOTED THE SURVEY INTERNALLY THROUGH THE ORGANIZATION'S INTRANET, ALL-STAFF EMAILS, AND NEWSLETTERS.INTERNAL EFFORTS WERE SUPPORTED WITH A ROBUST ADVERTISING CAMPAIGN THAT INCLUDED, AMONG OTHER EFFORTS, A DIGITAL MEDIA PROGRAM YIELDING 3.6 MILLION IMPRESSIONS AND A PRINT AD CAMPAIGN ENCOURAGING NATIVE AMERICAN COMMUNITIES TO PARTICIPATE THROUGH PLACEMENTS IN DEBAHJIMON MAGAZINE, ANISHINAABEG MAGAZINE AND MHA TIMES (MANDAN, HIDATSA, ARIKARA). FURTHER SUPPORT WAS GIVEN TO COLLECTING SURVEYS AT VARIOUS COMMUNITY EVENTS. THE GOAL OF THESE EFFORTS WAS TO INCREASE PARTICIPATION BY THOSE UNDERREPRESENTED THE PREVIOUS CYCLE, INCLUDING LOWER INCOME, MINORITY, AND MEDICALLY UNDERSERVED POPULATIONS.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. PROMOTION INVESTMENTS BY THE SYSTEM YIELDED A TOTAL OF 9,714 COMPLETED SURVEYS FROM ACROSS THE SANFORD FOOTPRINT, AN INCREASE FROM 6,748 THE PREVIOUS CYCLE. THE RESPONSES GENERATED 48,643 OPEN-ENDED RESPONSES AND 1.76 MILLION PIECES OF DATA.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, BUILDING 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. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS 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 WERE ALSO INCLUDED IN THE FINDINGS.THE CENTER FOR SOCIAL RESEARCH VALIDATES THE FINDINGS OF THE PRIMARY RESEARCH BY ENGAGING AT LEAST TWO INTERNAL REVIEWERS. EACH REVIEWER HAS THEIR OWN TECHNIQUE AND STRENGTHS TO REVIEW THE FINDINGS; HOWEVER, THEY CHECK FOR ACCURACY IN THE DATA BY REVIEWING THE CODE AND SYNTAX, THE OUTPUT, THE CORRECT REPRESENTATION OF THE DATA IN THE REPORT, VERBIAGE, CONSISTENCY, CONTEXT, AND OVERALL READABILITY. BOTH REVIEWERS ALSO SUPPORTED PREVIOUS CHNA REPORTS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO LOCATE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT LOCAL RESOURCES ARE AVAILABLE.COMMUNITY STAKEHOLDER MEETINGSNEEDS, AS IDENTIFIED BY NDSU CENTER FOR SOCIAL RESEARCH, WERE PRESENTED TO COMMUNITY STAKEHOLDERS. FACILITATED DISCUSSION COMMENCED AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS IDENTIFIED 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 AND PRIORITIZATION OF LOCAL NEEDS. PARTICIPANTS IN THE MEETINGS INCLUDED COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS.THE PARTICIPANTS PROVIDED INFORMATION TO ANSWER THE FOLLOWING TYPES OF QUESTIONS AS IT RELATES TO IDENTIFIED NEEDS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHAT OPPORTUNITIES EXIST, WHERE CAN WE HAVE THE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ALREADY WORK BEING DONE ON THESE NEEDS?WHAT ARE THE RESOURCES CURRENTLY NOT UTILIZED WITHIN THE COMMUNITY THAT COULD ADDRESS THIS TOPIC?WHICH NEEDS FALL WITHIN THE PURVIEW OF HEALTH CARE SYSTEM AND WHICH DO NOT? CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES OR ORGANIZATIONS?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2025-2027 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 CARECOST AND THE ABILITY TO AFFORD NEEDED HEALTH CARE WAS IDENTIFIED AS THE TOP HEALTH CARE CONCERN THAT SURVEY RESPONDENTS AND THEIR FAMILIES IN THE SHELDON AREA FACE ON A REGULAR BASIS. IT WAS ALSO THE SECOND LEADING COMMUNITY HEALTH CARE ISSUE, BEHIND GENERAL ACCESS ISSUES. CONCERNS AROUND THE COST OF HEALTH CARE EXIST DESPITE A POSITIVE PERCEPTION OF EMPLOYMENT AND ECONOMIC OPPORTUNITIES BY SURVEY RESPONDENTS IN THE SHELDON AREA. SANFORD HAS MADE ACCESS TO AFFORDABLE HEALTH CARE A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE INCREASED NUMBERS OF RESIDENTS RECEIVE RECOMMENDED PREVENTIVE SCREENINGS AND RECOMMENDED VACCINATIONS. IT IS SANFORD'S GOAL TO PROMOTE THE IMPORTANCE OF GETTING RECOMMENDED SCREENINGS AND VACCINATIONS AND KEEP MORE PATIENTS IN THE AREA VERSUS TRAVELING TO RECEIVE CARE.PRIORITY 2: ACCESS TO HEALTH CARE PROVIDERSWHEN SURVEY RESPONDENTS IN THE SHELDON MARKET AREA WERE ASKED ABOUT THE MOST IMPORTANT HEALTH CARE ISSUES IMPACTING THEIR COMMUNITY, HAVING ACCESS TO MEDICAL CARE AND HEALTH CARE PROVIDERS WAS THE LEADING ISSUE. FIFTY PERCENT OF SURVEY RESPONDENTS IN THE SHELDON AREA HAVE TRAVELED FOR CARE IN THE PAST THREE YEARS. FOR THOSE RESPONDENTS WHO HAVE TRAVELED FOR CARE, MOST RESPONDENTS INDICATED THE TRAVEL WAS DUE TO NEEDING SPECIALTY CARE THAT WAS NOT AVAILABLE LOCALLY, THEY WERE REFERRED BY A PHYSICIAN OR THEY TRAVELED FOR BETTER OR HIGHER QUALITY CARE. SANFORD HAS MADE ACCESS TO HEALTH CARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE INCREASED AWARENESS OF LOCALLY AVAILABLE SERVICES AND A REDUCTION IN PEOPLE TRAVELING FOR CARE. IT IS SANFORD'S GOAL TO MARKET AND PROMOTE ACTIVITIES TO INCREASE AWARENESS OF SANFORD SHELDON SERVICES AND TO ENSURE APPOINTMENT AVAILABILITY TO HEALTHCARE PROVIDERS.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARACCESS TO AFFORDABLE HEALTH CARESANFORD SHELDON CONTINUES TO OFFER HEART AND VASCULAR SCREENINGS TO ENHANCE PREVENTATIVE CARE AND REDUCE OUT OF POCKET COSTS. IN ADDITION, DIRECT ACCESS LABORATORY SERVICES ARE AN OPTION FOR PATIENTS THAT HAVE A HIGH INSURANCE DEDUCTIBLE AND HAVE CONCERN WITH THE COSTS.ACCESS TO HEALTH CARE PROVIDERSSANFORD SHELDON CONTINUES TO WORK ON EDUCATING THE COMMUNITY ON OUR FULL SCOPE OF LOCALLY AVAILABLE SERVICES. RECRUITMENT OF OPEN HEALTH CARE PROVIDER POSITIONS IS AN ONGOING EFFORT.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:HEALTHY LIVINGPUBLIC 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. SANFORD HEALTH FURTHER SUPPORTS THROUGH ITS FINDHELP RESOURCE, AN ONLINE TOOL TO INCORPORATE CONTACT AND REFERRAL INFORMATION TO CONNECT COMMUNITY-BASED ORGANIZATIONS WITH PATIENTS TO MEET THEIR HEALTH RELATED-SOCIAL CARE NEEDS. A LINK IS INCLUDED ON EVERY AFTER-VISIT SUMMARY PROVIDED TO PATIENTS AND IS AVAILABLE ON SANFORDHEALTH.ORG AND MYCHART. 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 2023 THROUGH DECEMBER 2024, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2025-2027. 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.CHI ST. ALEXIUS HEALTH AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTERESSENTIA HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH CLAY COUNTY PUBLIC HEALTHFARGO CASS PUBLIC HEALTHFAMILY HEALTHCARESIOUX FALLS DEPARTMENT OF HEALTHBISMARCK-BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION WESTERN PLAINS PUBLIC HEALTHLIMITATIONSTHE 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 RESPONDENTS 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 COMMUNITY RESIDENTS WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS, PARTICIPATING ORGANIZATIONS NOTED PREVIOUSLY, AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND HEALTH NEEDS. 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 FOR THEIR RANKING. 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.THE SURVEY WAS THE FIRST OF MULTIPLE EFFORTS TO ENGAGE COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE SENT THE SURVEY AND ASKED TO COMPLETE THE INSTRUMENT AND THEN FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT.SANFORD INVESTED IN A MULTIFACETED CAMPAIGN THAT INCLUDED AN EARNED MEDIA CAMPAIGN ON LOCAL MEDIA OUTLETS AND THE PUBLIC-FACING SANFORD HEALTH NEWS (HTTPS://NEWS.SANFORDHEALTH.ORG/). THE SYSTEM ALSO PROMOTED THE SURVEY INTERNALLY THROUGH THE ORGANIZATION'S INTRANET, ALL-STAFF EMAILS, AND NEWSLETTERS.INTERNAL EFFORTS WERE SUPPORTED WITH A ROBUST ADVERTISING CAMPAIGN THAT INCLUDED, AMONG OTHER EFFORTS, A DIGITAL MEDIA PROGRAM YIELDING 3.6 MILLION IMPRESSIONS AND A PRINT AD CAMPAIGN ENCOURAGING NATIVE AMERICAN COMMUNITIES TO PARTICIPATE THROUGH PLACEMENTS IN DEBAHJIMON MAGAZINE, ANISHINAABEG MAGAZINE AND MHA TIMES (MANDAN, HIDATSA, ARIKARA). FURTHER SUPPORT WAS GIVEN TO COLLECTING SURVEYS AT VARIOUS COMMUNITY EVENTS. THE GOAL OF THESE EFFORTS WAS TO INCREASE PARTICIPATION BY THOSE UNDERREPRESENTED THE PREVIOUS CYCLE, INCLUDING LOWER INCOME, MINORITY, AND MEDICALLY UNDERSERVED POPULATIONS.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. PROMOTION INVESTMENTS BY THE SYSTEM YIELDED A TOTAL OF 9,714 COMPLETED SURVEYS FROM ACROSS THE SANFORD FOOTPRINT, AN INCREASE FROM 6,748 THE PREVIOUS CYCLE. THE RESPONSES GENERATED 48,643 OPEN-ENDED RESPONSES AND 1.76 MILLION PIECES OF DATA.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, BUILDING 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. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS 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 WERE ALSO INCLUDED IN THE FINDINGS.THE CENTER FOR SOCIAL RESEARCH VALIDATES THE FINDINGS OF THE PRIMARY RESEARCH BY ENGAGING AT LEAST TWO INTERNAL REVIEWERS. EACH REVIEWER HAS THEIR OWN TECHNIQUE AND STRENGTHS TO REVIEW THE FINDINGS; HOWEVER, THEY CHECK FOR ACCURACY IN THE DATA BY REVIEWING THE CODE AND SYNTAX, THE OUTPUT, THE CORRECT REPRESENTATION OF THE DATA IN THE REPORT, VERBIAGE, CONSISTENCY, CONTEXT, AND OVERALL READABILITY. BOTH REVIEWERS ALSO SUPPORTED PREVIOUS CHNA REPORTS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO LOCATE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT LOCAL RESOURCES ARE AVAILABLE.COMMUNITY STAKEHOLDER MEETINGSNEEDS, AS IDENTIFIED BY NDSU CENTER FOR SOCIAL RESEARCH, WERE PRESENTED TO COMMUNITY STAKEHOLDERS. FACILITATED DISCUSSION COMMENCED AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS IDENTIFIED 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 AND PRIORITIZATION OF LOCAL NEEDS. PARTICIPANTS IN THE MEETINGS INCLUDED COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS.THE PARTICIPANTS PROVIDED INFORMATION TO ANSWER THE FOLLOWING TYPES OF QUESTIONS AS IT RELATES TO IDENTIFIED NEEDS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHAT OPPORTUNITIES EXIST, WHERE CAN WE HAVE THE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ALREADY WORK BEING DONE ON THESE NEEDS?WHAT ARE THE RESOURCES CURRENTLY NOT UTILIZED WITHIN THE COMMUNITY THAT COULD ADDRESS THIS TOPIC?WHICH NEEDS FALL WITHIN THE PURVIEW OF HEALTH CARE SYSTEM AND WHICH DO NOT? CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES OR ORGANIZATIONS?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2025-2027 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: IMPROVING ACCESS TO MEDICAL CARE PROVIDERSSURVEY RESPONDENTS IN THE VERMILLION AREA RATED THEIR OWN ABILITY TO ACCESS HEALTH CARE AS GOOD. IN ADDITION, MOST RESPONDENTS HAVE A PRIMARY CARE PROVIDER AND HAVE BEEN IN FOR A ROUTINE CHECKUP OR SCREENING IN THE PAST YEAR. DESPITE THIS POSITIVE FEEDBACK, WHEN RESPONDENTS WERE ASKED ABOUT THE MOST IMPORTANT HEALTH CARE ISSUES IMPACTING THEIR COMMUNITY, GENERAL ACCESS TO HEALTH CARE AND A SHORTAGE OF HEALTH CARE PROVIDERS WAS THE TOP ISSUE, MORE SO THAN COST.SANFORD VERMILLION HAS MADE IMPROVING ACCESS TO MEDICAL CARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE AN INCREASE IN PRIMARY CARE VISITS AND PREVENTIVE CARE SERVICES. IT IS SANFORD'S GOAL TO OFFER ADDITIONAL TELEMEDICINE CARE SERVICES AND TO EXPAND OBSTETRICS SERVICES AT SANFORD VERMILLION.PRIORITY 2: IMPROVING HEALTHY LIVING IN THE COMMUNITYWHEN SURVEY RESPONDENTS IN THE VERMILLION AREA WERE ASKED ABOUT THEIR BIGGEST HEALTH CARE CONCERNS FOR THEMSELVES AND THEIR FAMILY, CHRONIC HEALTH ISSUES WERE AMONG TOP CONCERNS. THE MOST COMMONLY CITED CHRONIC HEALTH CONCERNS INVOLVED WEIGHT, DIABETES, AND THE HEART. IN ADDITION, DIABETES IS AN IMPORTANT MARKER FOR A RANGE OF HEALTH BEHAVIORS. CHR DATA INDICATE THAT NEARLY ONE IN TEN ADULTS IN THE VERMILLION AREA HAS DIABETES AND ONE IN THREE ADULTS HAS OBESITY.SANFORD HAS MADE IMPROVING HEALTHY LIVING FOR THE VERMILLION COMMUNITY A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO HELP THE COMMUNITY SEE LOWER INCIDENCE OF CHRONIC DISEASE RATES. IT IS SANFORD'S GOAL TO INCREASE SERVICES AT SANFORD VERMILLION FOR COLORECTAL SCREENINGS AND DIABETIC EDUCATION AND TO ESTABLISH DIABETIC EDUCATION SERVICES AT SANFORD VERMILLION MEDICAL CENTER IN PERSON AND/OR VIA TELEMEDICINE VISITS.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARIMPROVING ACCESS TO MEDICAL CARE PROVIDERSWE CURRENTLY HAVE ONE MENTAL HEALTH PROVIDER WHO OFFERS TELEMEDICINE VISIT TYPES AND NEEDED ONCOLOGY SPECIALTY OUTREACH, WHICH COULD BE DONE BY TELEMEDICINE. WE DO NOT CURRENTLY OFFER TELEMEDICINE FOR THE HOSPITALIST SERVICES AT THE HOSPITAL. WE ALSO HAVE TWO FAMILY MEDICINE PROVIDERS OFFERING OBSTETRIC SERVICES BUT WILL BE ADDING ONE MORE PROVIDER.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. IMPROVING HEALTHY LIVING IN THE COMMUNITYWE CURRENTLY DO MOST OF OUR COLORECTAL SCREENINGS BY COLONOSCOPY BUT ARE PARTICIPATING IN A SANFORD HEALTH INITIATIVE TO GET MORE PATIENTS SCREENED BY COLOGUARD. AT THIS TIME, WE DO NOT OFFER DIABETIC EDUCATION LOCALLY TO OUR DIABETIC PATIENTS. THEY MUST TRAVEL TO SIOUX FALLS FOR THIS SERVICE, OR TO OTHER COMMUNITIES.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO AFFORDABLE HEALTH CARELONG-TERM SENIOR 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. SANFORD HEALTH FURTHER SUPPORTS THROUGH ITS FINDHELP RESOURCE, AN ONLINE TOOL TO INCORPORATE CONTACT AND REFERRAL INFORMATION TO CONNECT COMMUNITY-BASED ORGANIZATIONS WITH PATIENTS TO MEET THEIR HEALTH RELATED-SOCIAL CARE NEEDS. A LINK IS INCLUDED ON EVERY AFTER-VISIT SUMMARY PROVIDED TO PATIENTS AND IS AVAILABLE ON SANFORDHEALTH.ORG AND MYCHART. 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 2023 THROUGH DECEMBER 2024, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2025-2027. 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.CHI ST. ALEXIUS HEALTH AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTERESSENTIA HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH CLAY COUNTY PUBLIC HEALTHFARGO CASS PUBLIC HEALTHFAMILY HEALTHCARESIOUX FALLS DEPARTMENT OF HEALTHBISMARCK-BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION WESTERN PLAINS PUBLIC HEALTHLIMITATIONSTHE 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 RESPONDENTS 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 COMMUNITY RESIDENTS WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS, PARTICIPATING ORGANIZATIONS NOTED PREVIOUSLY, AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND HEALTH NEEDS. 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 FOR THEIR RANKING. 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.THE SURVEY WAS THE FIRST OF MULTIPLE EFFORTS TO ENGAGE COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE SENT THE SURVEY AND ASKED TO COMPLETE THE INSTRUMENT AND THEN FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT.SANFORD INVESTED IN A MULTIFACETED CAMPAIGN THAT INCLUDED AN EARNED MEDIA CAMPAIGN ON LOCAL MEDIA OUTLETS AND THE PUBLIC-FACING SANFORD HEALTH NEWS (HTTPS://NEWS.SANFORDHEALTH.ORG/). THE SYSTEM ALSO PROMOTED THE SURVEY INTERNALLY THROUGH THE ORGANIZATION'S INTRANET, ALL-STAFF EMAILS, AND NEWSLETTERS.INTERNAL EFFORTS WERE SUPPORTED WITH A ROBUST ADVERTISING CAMPAIGN THAT INCLUDED, AMONG OTHER EFFORTS, A DIGITAL MEDIA PROGRAM YIELDING 3.6 MILLION IMPRESSIONS AND A PRINT AD CAMPAIGN ENCOURAGING NATIVE AMERICAN COMMUNITIES TO PARTICIPATE THROUGH PLACEMENTS IN DEBAHJIMON MAGAZINE, ANISHINAABEG MAGAZINE AND MHA TIMES (MANDAN, HIDATSA, ARIKARA). FURTHER SUPPORT WAS GIVEN TO COLLECTING SURVEYS AT VARIOUS COMMUNITY EVENTS. THE GOAL OF THESE EFFORTS WAS TO INCREASE PARTICIPATION BY THOSE UNDERREPRESENTED THE PREVIOUS CYCLE, INCLUDING LOWER INCOME, MINORITY, AND MEDICALLY UNDERSERVED POPULATIONS.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. PROMOTION INVESTMENTS BY THE SYSTEM YIELDED A TOTAL OF 9,714 COMPLETED SURVEYS FROM ACROSS THE SANFORD FOOTPRINT, AN INCREASE FROM 6,748 THE PREVIOUS CYCLE. THE RESPONSES GENERATED 48,643 OPEN-ENDED RESPONSES AND 1.76 MILLION PIECES OF DATA.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, BUILDING 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. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS 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 WERE ALSO INCLUDED IN THE FINDINGS.THE CENTER FOR SOCIAL RESEARCH VALIDATES THE FINDINGS OF THE PRIMARY RESEARCH BY ENGAGING AT LEAST TWO INTERNAL REVIEWERS. EACH REVIEWER HAS THEIR OWN TECHNIQUE AND STRENGTHS TO REVIEW THE FINDINGS; HOWEVER, THEY CHECK FOR ACCURACY IN THE DATA BY REVIEWING THE CODE AND SYNTAX, THE OUTPUT, THE CORRECT REPRESENTATION OF THE DATA IN THE REPORT, VERBIAGE, CONSISTENCY, CONTEXT, AND OVERALL READABILITY. BOTH REVIEWERS ALSO SUPPORTED PREVIOUS CHNA REPORTS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO LOCATE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT LOCAL RESOURCES ARE AVAILABLE.COMMUNITY STAKEHOLDER MEETINGSNEEDS, AS IDENTIFIED BY NDSU CENTER FOR SOCIAL RESEARCH, WERE PRESENTED TO COMMUNITY STAKEHOLDERS. FACILITATED DISCUSSION COMMENCED AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS IDENTIFIED 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 AND PRIORITIZATION OF LOCAL NEEDS. PARTICIPANTS IN THE MEETINGS INCLUDED COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS.THE PARTICIPANTS PROVIDED INFORMATION TO ANSWER THE FOLLOWING TYPES OF QUESTIONS AS IT RELATES TO IDENTIFIED NEEDS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHAT OPPORTUNITIES EXIST, WHERE CAN WE HAVE THE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ALREADY WORK BEING DONE ON THESE NEEDS?WHAT ARE THE RESOURCES CURRENTLY NOT UTILIZED WITHIN THE COMMUNITY THAT COULD ADDRESS THIS TOPIC?WHICH NEEDS FALL WITHIN THE PURVIEW OF HEALTH CARE SYSTEM AND WHICH DO NOT? CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES OR ORGANIZATIONS?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2025-2027 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: REDUCE PHYSICAL AND PERCEPTUAL BARRIERS TO SEEKING MENTAL HEALTH CAREMENTAL 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 REDUCING PHYSICAL AND PERCEPTUAL BARRIERS TO SEEKING MENTAL HEALTH CARE A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO INCREASE KNOWLEDGE OF BEST PRACTICES TO SUPPORT YOUTH WITH MENTAL HEALTH CONCERNS AND TO INCREASE MENTAL HEALTH APPOINTMENT AVAILABILITY. PRIORITY 2: REDUCE THE INCREASING TREND OF SEXUALLY TRANSMITTED DISEASES IN THE COMMUNITYCERTAIN AREAS OF THE COUNTRY, PARTICULARLY TRIBAL LANDS AND SURROUNDING COMMUNITIES SUCH AS THE CHAMBERLAIN AREA, HAVE LONG EXPERIENCED LOWER HEALTH STATUS WHEN COMPARED WITH OTHER PARTS OF THE COUNTRY. DISPARITIES IN HEALTH OUTCOMES, AS A RESULT OF SYSTEMS, POLICIES, AND SOCIAL AND PERSONAL FACTORS ARE PREVALENT.COMPARED TO SIMILAR-SIZED COMMUNITIES, THE CHAMBERLAIN MARKET AREA HAS THE HIGHEST RATE OF SEXUALLY TRANSMITTED INFECTIONS. SANFORD HAS MADE REDUCING THE INCREASING TREND OF SEXUALLY TRANSMITTED DISEASES IN THE COMMUNITY A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO INCREASE SEXUALLY TRANSMITTED DISEASE TESTING WITHIN THE COMMUNITY (WITH A SPECIFIC FOCUS ON RESERVATIONS AND HIGH SCHOOL STUDENTS) AND TO REDUCE COST BARRIERS AND INCREASE AWARENESS OF HOME TESTING OPTIONS.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARREDUCE PHYSICAL AND PERCEPTUAL BARRIERS TO SEEKING MENTAL HEALTH CARE SANFORD OFFERS A NUMBER OF MENTAL HEALTH RESOURCES, INCLUDING FAMILY GRIEF SUPPORT GROUP, SUICIDE SURVIVOR SUPPORT GROUP, AND SUPPORTS "LOVE BIG," A LOCAL PROJECT FORMED TO BRING COMMUNITY AWARENESS AND SUPPORT ON MENTAL HEALTH WELLNESS. SANFORD OFFERS MENTAL HEALTH FIRST AIDE AND BEHEARD YOUTH TRAININGS AND, IN PARTNERSHIP WITH THE CHAMBERLAIN SCHOOL DISTRICT, A MENTAL HEALTH PROFESSIONAL EMBEDDED IN THE JUNIOR HIGH AND HIGH SCHOOL DURING THE WEEK. REDUCE THE INCREASING TREND OF SEXUALLY TRANSMITTED DISEASES IN THE COMMUNITY CURRENT WORK INCLUDES UTILIZING SOUTH DAKOTA DEPARTMENT OF HEALTH EDUCATIONAL MATERIAL AT CLINICIAN AND NURSING MEETINGS TO ESCALATE THE KNOWN INCREASE OF STDS IN OUR SERVICE AREA. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO AFFORDABLE HEALTH CAREACCESS TO PROVIDERS AND QUALITY HEALTH CAREPUBLIC TRANSPORTATIONAFFORDABLE HOUSINGSANFORD 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. SANFORD HEALTH FURTHER SUPPORTS THROUGH ITS FINDHELP RESOURCE, AN ONLINE TOOL TO INCORPORATE CONTACT AND REFERRAL INFORMATION TO CONNECT COMMUNITY-BASED ORGANIZATIONS WITH PATIENTS TO MEET THEIR HEALTH RELATED-SOCIAL CARE NEEDS. A LINK IS INCLUDED ON EVERY AFTER-VISIT SUMMARY PROVIDED TO PATIENTS AND IS AVAILABLE ON SANFORDHEALTH.ORG AND MYCHART. 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 2023 THROUGH DECEMBER 2024, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2025-2027. 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.CHI ST. ALEXIUS HEALTH AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTERESSENTIA HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH CLAY COUNTY PUBLIC HEALTHFARGO CASS PUBLIC HEALTHFAMILY HEALTHCARESIOUX FALLS DEPARTMENT OF HEALTHBISMARCK-BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION WESTERN PLAINS PUBLIC HEALTHLIMITATIONSTHE 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 RESPONDENTS 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 COMMUNITY RESIDENTS WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS, PARTICIPATING ORGANIZATIONS NOTED PREVIOUSLY, AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND HEALTH NEEDS. 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 FOR THEIR RANKING. 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.THE SURVEY WAS THE FIRST OF MULTIPLE EFFORTS TO ENGAGE COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE SENT THE SURVEY AND ASKED TO COMPLETE THE INSTRUMENT AND THEN FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT.SANFORD INVESTED IN A MULTIFACETED CAMPAIGN THAT INCLUDED AN EARNED MEDIA CAMPAIGN ON LOCAL MEDIA OUTLETS AND THE PUBLIC-FACING SANFORD HEALTH NEWS (HTTPS://NEWS.SANFORDHEALTH.ORG/). THE SYSTEM ALSO PROMOTED THE SURVEY INTERNALLY THROUGH THE ORGANIZATION'S INTRANET, ALL-STAFF EMAILS, AND NEWSLETTERS.INTERNAL EFFORTS WERE SUPPORTED WITH A ROBUST ADVERTISING CAMPAIGN THAT INCLUDED, AMONG OTHER EFFORTS, A DIGITAL MEDIA PROGRAM YIELDING 3.6 MILLION IMPRESSIONS AND A PRINT AD CAMPAIGN ENCOURAGING NATIVE AMERICAN COMMUNITIES TO PARTICIPATE THROUGH PLACEMENTS IN DEBAHJIMON MAGAZINE, ANISHINAABEG MAGAZINE AND MHA TIMES (MANDAN, HIDATSA, ARIKARA). FURTHER SUPPORT WAS GIVEN TO COLLECTING SURVEYS AT VARIOUS COMMUNITY EVENTS. THE GOAL OF THESE EFFORTS WAS TO INCREASE PARTICIPATION BY THOSE UNDERREPRESENTED THE PREVIOUS CYCLE, INCLUDING LOWER INCOME, MINORITY, AND MEDICALLY UNDERSERVED POPULATIONS.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. PROMOTION INVESTMENTS BY THE SYSTEM YIELDED A TOTAL OF 9,714 COMPLETED SURVEYS FROM ACROSS THE SANFORD FOOTPRINT, AN INCREASE FROM 6,748 THE PREVIOUS CYCLE. THE RESPONSES GENERATED 48,643 OPEN-ENDED RESPONSES AND 1.76 MILLION PIECES OF DATA.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, BUILDING 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. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS 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 WERE ALSO INCLUDED IN THE FINDINGS.THE CENTER FOR SOCIAL RESEARCH VALIDATES THE FINDINGS OF THE PRIMARY RESEARCH BY ENGAGING AT LEAST TWO INTERNAL REVIEWERS. EACH REVIEWER HAS THEIR OWN TECHNIQUE AND STRENGTHS TO REVIEW THE FINDINGS; HOWEVER, THEY CHECK FOR ACCURACY IN THE DATA BY REVIEWING THE CODE AND SYNTAX, THE OUTPUT, THE CORRECT REPRESENTATION OF THE DATA IN THE REPORT, VERBIAGE, CONSISTENCY, CONTEXT, AND OVERALL READABILITY. BOTH REVIEWERS ALSO SUPPORTED PREVIOUS CHNA REPORTS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO LOCATE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT LOCAL RESOURCES ARE AVAILABLE.COMMUNITY STAKEHOLDER MEETINGSNEEDS, AS IDENTIFIED BY NDSU CENTER FOR SOCIAL RESEARCH, WERE PRESENTED TO COMMUNITY STAKEHOLDERS. FACILITATED DISCUSSION COMMENCED AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS IDENTIFIED 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 AND PRIORITIZATION OF LOCAL NEEDS. PARTICIPANTS IN THE MEETINGS INCLUDED COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS.THE PARTICIPANTS PROVIDED INFORMATION TO ANSWER THE FOLLOWING TYPES OF QUESTIONS AS IT RELATES TO IDENTIFIED NEEDS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHAT OPPORTUNITIES EXIST, WHERE CAN WE HAVE THE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ALREADY WORK BEING DONE ON THESE NEEDS?WHAT ARE THE RESOURCES CURRENTLY NOT UTILIZED WITHIN THE COMMUNITY THAT COULD ADDRESS THIS TOPIC?WHICH NEEDS FALL WITHIN THE PURVIEW OF HEALTH CARE SYSTEM AND WHICH DO NOT? CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES OR ORGANIZATIONS?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2025-2027 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: REDUCE PHYSICAL AND PERCEPTUAL BARRIERS TO SEEKING MENTAL HEALTH CAREMENTAL 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 LUVERNE MEDICAL CENTER (SLMC) HAS MADE REDUCING PHYSICAL AND PERCEPTUAL BARRIERS TO SEEKING MENTAL HEALTH CARE A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE AN INCREASE IN THE NUMBER OF RESIDENTS UTILIZING MENTAL HEALTH RESOURCES. IT IS SANFORD'S GOAL TO ENSURE THOSE STRUGGLING WITH MENTAL HEALTH SYMPTOMS HAVE ACCESS TO THE CARE NEEDED AND TO DESTIGMATIZE ENGAGING IN MENTAL HEALTH CARE BY ENHANCING COMMUNITY AWARENESS ON THE IMPORTANCE OF MENTAL HEALTH.PRIORITY 2: INCREASE AWARENESS OF LOCAL SUBSTANCE USE SERVICES AND ADD LOCAL AVAILABILITY FOR MAT (MEDICATED ASSISTED TREATMENT)SURVEY RESPONDENTS IN THE LUVERNE AREA WHO INDICATED THEY WOULD LIKE TO SEE SPECIFIC SERVICES OFFERED OR IMPROVED IN THEIR COMMUNITY, INDICATED ADDICTION TREATMENT AS ONE OF THE TOP PRIORITIES.SLMC HAS MADE INCREASING AWARENESS OF LOCAL SUBSTANCE USE SERVICES AND ADDING LOCAL AVAILABILITY FOR MAT A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE AN INCREASE IN UNDERSTANDING AMONG THE COMMUNITY OF AVAILABLE SUBSTANCE USE RESOURCES. IT IS SANFORD'S GOAL TO IMPLEMENT MAT AND TO CONTINUE TO FOCUS ON EDUCATION AND TRAINING ON THE OPIOID EPIDEMIC, THE ADMINISTRATION OF NALOXONE, AND ACCESS TO CARE LOCALLY.PRIORITY 3: ACCESS TO HEALTH CARE PROVIDERSWHEN SURVEY RESPONDENTS IN THE LUVERNE AREA WERE ASKED ABOUT THE MOST IMPORTANT HEALTH CARE ISSUES IMPACTING THEIR COMMUNITY, HAVING ACCESS TO MEDICAL CARE AND HEALTH CARE PROVIDERS WAS AMONG THE LEADING ISSUES. 75 PERCENT OF RESPONDENTS HAVE TRAVELED FOR CARE IN THE PAST THREE YEARS, A RATE WHICH IS HIGHER THAN THE COMPARISON GROUP AVERAGE. WHEN ASKED WHY, RESPONDENTS INDICATED THE TRAVEL WAS DUE TO NEEDING SPECIALTY CARE THAT WAS NOT AVAILABLE LOCALLY, THEY TRAVELED FOR BETTER OR HIGHER QUALITY CARE, OR THEY WERE REFERRED BY A PHYSICIAN. SLMC HAS MADE ACCESS TO HEALTH CARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE ADDITIONAL APPOINTMENT AVAILABILITY THROUGH THE CLINIC OR VIRTUAL CARE OPTIONS. IT IS SANFORD'S GOAL TO IMPROVE ACCESS TO SPECIALTY CARE AND EXPAND VIRTUAL ACCESS TO SPECIALTY SERVICES. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARREDUCE PHYSICAL AND PERCEPTUAL BARRIERS TO SEEKING MENTAL HEALTH CAREMENTAL HEALTH CONTINUES TO REMAIN A PRIORITY FOR SLMC FOR THE NEXT 3-YEAR CYCLE. SLMC WILL SHARE THE RESULTS OF THIS SURVEY WITH COMMUNITY PARTNERS TO BUILD ACCESS TO MENTAL HEALTH SERVICES. SANFORD LUVERNE'S INTEGRATED HEALTH THERAPIST HAS BEEN INTEGRALLY INVOLVED IN LEADING INITIATIVES TO LOOK AT ACCESS, FUNDING FOR CARE, AND REDUCING STIGMA. SLMC WILL CONTINUE TO SUPPORT WORK IN THE MENTAL HEALTH SPACE FOCUSING ON INCREASING AWARENESS, ACTIVITIES TO PROMOTE MENTAL HEALTH, AND IMPROVING ACCESS TO CARE. SANFORD LUVERNE'S INTEGRATED HEALTH THERAPIST LED INITIATIVE TO ESTABLISH THE GAP (GRANT ASSISTED PROGRAM) WITHIN THE LOCAL FOUNDATION TO ASSIST WITH PAYMENT FOR SERVICES FOR INDIVIDUALS TO QUALIFY. THIS FUND IS IN PART SUPPORTED WITH COUNTY FUNDS. SLMC IS PRESENTLY RECRUITING A SECOND BEHAVIORAL HEALTH THERAPIST TO JOIN OUR TEAM.INCREASE AWARENESS OF LOCAL SUBSTANCE USE SERVICES AND ADD LOCAL AVAILABILITY FOR MAT (MEDICATED ASSISTED TREATMENTSANFORD LUVERNE'S SUD (SUBSTANCE USE DISORDER) DEPARTMENT OFFERS COMPREHENSIVE ASSESSMENT OF SUD, REFERRALS FOR SUD TREATMENT AND PROVIDES ADULT OUTPATIENT SUD TREATMENT. SANFORD LUVERNE'S SUD DEPARTMENT PROVIDES EDUCATION AND TRAINING ON SUD AND ARE TRAINED TO PROVIDE EDUCATION ON OPIOID EPIDEMIC AND ADMINISTRATION OF NALOXONE. SANFORD LUVERNE'S SUD PROGRAM IS A NAP (NALOXONE ACCESS POINT).IN 2024, SUBSTANCE USE COUNSELORS WORKED WITH THE HIGH SCHOOL HEALTH CLASSES FOR PRESENTATIONS ON SUBSTANCE USE/ABUSE. SUBSTANCE USE COUNSELORS CONTINUE TO BE INVOLVED IN THE LOCAL COUNTY TREATMENT COURTS. SUBSTANCE USE COUNSELORS CONTINUE TO WORK ON OPIOID RESPONSE AND NALOXONE TRAININGS FOR FAMILY SERVICES, COURTS, COMMUNITY ORGANIZATIONS, AND SCHOOLS (TEACHERS/STAFF/STUDENTS). SUBSTANCE USE COUNSELORS AND OUR INTEGRATED HEALTH THERAPIST (IHT) SPOKE ON BRAIN HEALTH TO THE WOMEN'S GIVING CIRCLE GROUP IN LUVERNE. 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.ACCESS TO HEALTH CARE PROVIDERSSLMC HAS ADDED A FAMILY MEDICINE PHYSICIAN AS WELL AS A NURSE PRACTITIONER OVER THE PAST 3-YEAR CYCLE TO IMPROVE SAME DAY ACCESS TO CARE. THERE WAS CONCERN VOICED IN THE FOCUS GROUP ABOUT ACCESS TO SPECIALTY CARE AND THE NEED TO TRAVEL. SLMC, AS PART OF SANFORD HEALTH, RECEIVES SPECIALTY CARE PROVIDED AS AN OUTREACH SERVICE. IN ADDITION, THE EDGERTON CLINIC IS NOW OPEN ONE FULL DAY/WEEK AS OF JANUARY 1, 2024 TO IMPROVE LOCAL ACCESS TO PRIMARY CARE.CLINIC PROVIDERS CONTINUE TO PARTNER WITH THE MOBILE DENTAL UNIT THAT 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, CARING HANDS NOW HAS A SEVERAL WEEK WAIT TIME FOR SERVICE.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO AFFORDABLE HEALTH CAREHEALTHY LIVINGCHILDCARE QUALITYAFFORDABLE HOUSINGCOMMUNITY 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. SANFORD HEALTH FURTHER SUPPORTS THROUGH ITS FINDHELP RESOURCE, AN ONLINE TOOL TO INCORPORATE CONTACT AND REFERRAL INFORMATION TO CONNECT COMMUNITY-BASED ORGANIZATIONS WITH PATIENTS TO MEET THEIR HEALTH RELATED-SOCIAL CARE NEEDS. A LINK IS INCLUDED ON EVERY AFTER-VISIT SUMMARY PROVIDED TO PATIENTS AND IS AVAILABLE ON SANFORDHEALTH.ORG AND MYCHART. 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 2023 THROUGH DECEMBER 2024, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2025-2027. 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.CHI ST. ALEXIUS HEALTH AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTERESSENTIA HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH CLAY COUNTY PUBLIC HEALTHFARGO CASS PUBLIC HEALTHFAMILY HEALTHCARESIOUX FALLS DEPARTMENT OF HEALTHBISMARCK-BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION WESTERN PLAINS PUBLIC HEALTHLIMITATIONSTHE 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 RESPONDENTS 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 COMMUNITY RESIDENTS WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS, PARTICIPATING ORGANIZATIONS NOTED PREVIOUSLY, AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND HEALTH NEEDS. 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 FOR THEIR RANKING. 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.THE SURVEY WAS THE FIRST OF MULTIPLE EFFORTS TO ENGAGE COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE SENT THE SURVEY AND ASKED TO COMPLETE THE INSTRUMENT AND THEN FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT.SANFORD INVESTED IN A MULTIFACETED CAMPAIGN THAT INCLUDED AN EARNED MEDIA CAMPAIGN ON LOCAL MEDIA OUTLETS AND THE PUBLIC-FACING SANFORD HEALTH NEWS (HTTPS://NEWS.SANFORDHEALTH.ORG/). THE SYSTEM ALSO PROMOTED THE SURVEY INTERNALLY THROUGH THE ORGANIZATION'S INTRANET, ALL-STAFF EMAILS, AND NEWSLETTERS.INTERNAL EFFORTS WERE SUPPORTED WITH A ROBUST ADVERTISING CAMPAIGN THAT INCLUDED, AMONG OTHER EFFORTS, A DIGITAL MEDIA PROGRAM YIELDING 3.6 MILLION IMPRESSIONS AND A PRINT AD CAMPAIGN ENCOURAGING NATIVE AMERICAN COMMUNITIES TO PARTICIPATE THROUGH PLACEMENTS IN DEBAHJIMON MAGAZINE, ANISHINAABEG MAGAZINE AND MHA TIMES (MANDAN, HIDATSA, ARIKARA). FURTHER SUPPORT WAS GIVEN TO COLLECTING SURVEYS AT VARIOUS COMMUNITY EVENTS. THE GOAL OF THESE EFFORTS WAS TO INCREASE PARTICIPATION BY THOSE UNDERREPRESENTED THE PREVIOUS CYCLE, INCLUDING LOWER INCOME, MINORITY, AND MEDICALLY UNDERSERVED POPULATIONS.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. PROMOTION INVESTMENTS BY THE SYSTEM YIELDED A TOTAL OF 9,714 COMPLETED SURVEYS FROM ACROSS THE SANFORD FOOTPRINT, AN INCREASE FROM 6,748 THE PREVIOUS CYCLE. THE RESPONSES GENERATED 48,643 OPEN-ENDED RESPONSES AND 1.76 MILLION PIECES OF DATA.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, BUILDING 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. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS 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 WERE ALSO INCLUDED IN THE FINDINGS.THE CENTER FOR SOCIAL RESEARCH VALIDATES THE FINDINGS OF THE PRIMARY RESEARCH BY ENGAGING AT LEAST TWO INTERNAL REVIEWERS. EACH REVIEWER HAS THEIR OWN TECHNIQUE AND STRENGTHS TO REVIEW THE FINDINGS; HOWEVER, THEY CHECK FOR ACCURACY IN THE DATA BY REVIEWING THE CODE AND SYNTAX, THE OUTPUT, THE CORRECT REPRESENTATION OF THE DATA IN THE REPORT, VERBIAGE, CONSISTENCY, CONTEXT, AND OVERALL READABILITY. BOTH REVIEWERS ALSO SUPPORTED PREVIOUS CHNA REPORTS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO LOCATE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT LOCAL RESOURCES ARE AVAILABLE.COMMUNITY STAKEHOLDER MEETINGSNEEDS, AS IDENTIFIED BY NDSU CENTER FOR SOCIAL RESEARCH, WERE PRESENTED TO COMMUNITY STAKEHOLDERS. FACILITATED DISCUSSION COMMENCED AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS IDENTIFIED 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 AND PRIORITIZATION OF LOCAL NEEDS. PARTICIPANTS IN THE MEETINGS INCLUDED COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS.THE PARTICIPANTS PROVIDED INFORMATION TO ANSWER THE FOLLOWING TYPES OF QUESTIONS AS IT RELATES TO IDENTIFIED NEEDS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHAT OPPORTUNITIES EXIST, WHERE CAN WE HAVE THE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ALREADY WORK BEING DONE ON THESE NEEDS?WHAT ARE THE RESOURCES CURRENTLY NOT UTILIZED WITHIN THE COMMUNITY THAT COULD ADDRESS THIS TOPIC?WHICH NEEDS FALL WITHIN THE PURVIEW OF HEALTH CARE SYSTEM AND WHICH DO NOT? CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES OR ORGANIZATIONS?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2025-2027 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: PROMOTE OUTREACH SERVICING PROVIDERS THAT COME TO THE FACILITYTHE NEED TO TRAVEL FOR CARE IS EVIDENCED IN CHR DATA WHICH INDICATE THAT WHEN COMPARED TO SIMILAR-SIZED MARKETS, THE CANBY AREA HAS HIGHER THAN AVERAGE RATIOS OF POPULATION TO PROVIDERS. IN ADDITION, CHR DATA INDICATE THAT WHEN COMPARED TO SIMILAR-SIZED MARKETS, THE CANBY AREA HAS THE HIGHEST RATE OF PREVENTABLE HOSPITAL STAYS AND A BELOW AVERAGE MAMMOGRAPHY SCREENING RATE AND FLU VACCINATION RATE.SANFORD HAS MADE PROMOTING OUTREACH SERVICING PROVIDERS COMING TO THE FACILITY A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO FOCUS ON TWO PRIMARY GOALS: TO PROMOTE OUTREACH SERVICES IN PUBLIC SPACES TO ENHANCE AWARENESS OF ALL COMMUNITY MEMBERS, REGARDLESS OF CURRENT SYSTEM ATTRIBUTION, AND TO EDUCATE PATIENTS AND PROVIDERS ON AVAILABLE OUTREACH SERVICES WITHIN THE CLINICAL SETTING DURING A FOCUSED COMMUNICATION EVENT. PRIORITY 2: PROVIDE COMMUNITY EDUCATION SURROUNDING BEHAVIORAL/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.ACCORDING TO CHR, ADULTS IN THE CANBY AREA AVERAGE 4.4 MENTALLY UNHEALTHY DAYS EACH MONTH AND 15 PERCENT OF ADULTS AVERAGE AT LEAST 14 DAYS OF MENTAL DISTRESS PER MONTH; BOTH RATES ARE AMONG THE HIGHEST WHEN COMPARED TO SIMILAR-SIZED MARKETS SERVED BY SANFORD HEALTH.SANFORD HAS MADE PROVIDING COMMUNITY EDUCATION SURROUNDING BEHAVIORAL/MENTAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO FOCUS ON TWO PRIMARY GOALS: TO UTILIZE SANFORD MYCHART AND INTERNAL RESOURCES TO INCREASE AWARENESS OF BEHAVIORAL HEALTH RESOURCES LOCALLY AND TO REDUCE THE STIGMA OF BEHAVIORAL HEALTH AND INCREASE AWARENESS OF SERVICES AVAILABLE FOR SCHOOL-AGED STUDENTS.PRIORITY 3: INCREASE TELEMEDICINE USAGE FOR SPECIALTY PROVIDERS PROVIDING SERVICE TO THE FACILITYDESPITE SURVEY RESPONDENTS IN THE CANBY AREA RATING THEIR OWN ABILITY TO ACCESS HEALTH CARE AS GOOD, WHEN THEY WERE ASKED ABOUT THE MOST IMPORTANT HEALTH CARE ISSUES IMPACTING THEIR COMMUNITY, ACCESS TO HEALTH CARE SERVICES AND PROVIDERS WAS THE TOP ISSUE (MORE SO THAN AFFORDABILITY CONCERNS). AND WHILE RESPONDENTS RATED THE OVERALL QUALITY OF HEALTH CARE IN THEIR COMMUNITY AS GOOD, THE AVERAGE SCORE WAS SLIGHTLY LOWER THAN THE COMPARISON GROUP AVERAGE. IN ADDITION, 85 PERCENT OF SURVEY RESPONDENTS IN THE CANBY AREA REPORTED TRAVELING OUTSIDE OF THEIR COMMUNITY TO RECEIVE HEALTH CARE SERVICES IN THE PAST THREE YEARS (ONE OF THE HIGHEST PERCENTAGES WHEN COMPARED TO SIMILAR-SIZED MARKETS SERVED BY SANFORD HEALTH). WHEN ASKED WHY, MOST OF THOSE WHO TRAVELED FOR CARE INDICATED THAT THEY NEEDED SPECIALTY CARE, OR THE SERVICES NEEDED WERE NOT AVAILABLE LOCALLY. SANFORD HAS MADE INCREASING TELEMEDICINE USAGE FOR SPECIALTY PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO FOCUS ON TWO PRIMARY GOALS: TO INCREASE KNOWLEDGE OF TELEMEDICINE SERVICES AVAILABLE LOCALLY IN THE COMMUNITY AND TO REDUCE BARRIERS TO TELEMEDICINE USAGE.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARPROMOTE OUTREACH SERVICING PROVIDERS THAT COME TO THE FACILITYSANFORD CANBY CURRENTLY HAS SEVEN OUTREACH PROVIDERS THAT PROVIDE CARE FOR PATIENTS REQUIRING CARE FROM GENERAL SURGERY, GASTROENTEROLOGY, PODIATRY, VASCULAR, UROLOGY, ORTHOPEDICS AND OB/GYN. CURRENTLY, OUTREACH PROVIDERS ARE ON SITE 10 DAYS PER MONTH. PROVIDE COMMUNITY EDUCATION SURROUNDING BEHAVIORAL/MENTAL HEALTH SANFORD CANBY HAS PRESENTED MENTAL HEALTH RESOURCES IN THE COMMUNITY AT VARIOUS CIVIC MEETINGS, FACILITY MEETINGS, COMMUNITY MEETINGS AS WELL AS COMMUNITY CELEBRATIONS REACHING A VAST DEMOGRAPHIC. INCREASE TELEMEDICINE USAGE FOR SPECIALTY PROVIDERS PROVIDING SERVICE TO THE FACILITY THE MARKETING OF THE TELEMEDICINE PROVIDERS IN OUR AREA TO DATE HAS BEEN LIMITED. OUR DESIRE IS TO ESPECIALLY INCREASE THE USE OF MYCHART BEHAVIORAL HEALTH VISITS AS AN OPTION IN THE UPCOMING 2025-2027 PLAN YEARS. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:CHILD CARE QUALITYAFFORDABLE 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. SANFORD HEALTH FURTHER SUPPORTS THROUGH ITS FINDHELP RESOURCE, AN ONLINE TOOL TO INCORPORATE CONTACT AND REFERRAL INFORMATION TO CONNECT COMMUNITY-BASED ORGANIZATIONS WITH PATIENTS TO MEET THEIR HEALTH RELATED-SOCIAL CARE NEEDS. A LINK IS INCLUDED ON EVERY AFTER-VISIT SUMMARY PROVIDED TO PATIENTS AND IS AVAILABLE ON SANFORDHEALTH.ORG AND MYCHART. 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 2023 THROUGH DECEMBER 2024, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2025-2027. 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.CHI ST. ALEXIUS HEALTH AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTERESSENTIA HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH CLAY COUNTY PUBLIC HEALTHFARGO CASS PUBLIC HEALTHFAMILY HEALTHCARESIOUX FALLS DEPARTMENT OF HEALTHBISMARCK-BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION WESTERN PLAINS PUBLIC HEALTHLIMITATIONSTHE 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 RESPONDENTS 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 COMMUNITY RESIDENTS WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS, PARTICIPATING ORGANIZATIONS NOTED PREVIOUSLY, AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND HEALTH NEEDS. 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 FOR THEIR RANKING. 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.THE SURVEY WAS THE FIRST OF MULTIPLE EFFORTS TO ENGAGE COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE SENT THE SURVEY AND ASKED TO COMPLETE THE INSTRUMENT AND THEN FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT.SANFORD INVESTED IN A MULTIFACETED CAMPAIGN THAT INCLUDED AN EARNED MEDIA CAMPAIGN ON LOCAL MEDIA OUTLETS AND THE PUBLIC-FACING SANFORD HEALTH NEWS (HTTPS://NEWS.SANFORDHEALTH.ORG/). THE SYSTEM ALSO PROMOTED THE SURVEY INTERNALLY THROUGH THE ORGANIZATION'S INTRANET, ALL-STAFF EMAILS, AND NEWSLETTERS.INTERNAL EFFORTS WERE SUPPORTED WITH A ROBUST ADVERTISING CAMPAIGN THAT INCLUDED, AMONG OTHER EFFORTS, A DIGITAL MEDIA PROGRAM YIELDING 3.6 MILLION IMPRESSIONS AND A PRINT AD CAMPAIGN ENCOURAGING NATIVE AMERICAN COMMUNITIES TO PARTICIPATE THROUGH PLACEMENTS IN DEBAHJIMON MAGAZINE, ANISHINAABEG MAGAZINE AND MHA TIMES (MANDAN, HIDATSA, ARIKARA). FURTHER SUPPORT WAS GIVEN TO COLLECTING SURVEYS AT VARIOUS COMMUNITY EVENTS. THE GOAL OF THESE EFFORTS WAS TO INCREASE PARTICIPATION BY THOSE UNDERREPRESENTED THE PREVIOUS CYCLE, INCLUDING LOWER INCOME, MINORITY, AND MEDICALLY UNDERSERVED POPULATIONS.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. PROMOTION INVESTMENTS BY THE SYSTEM YIELDED A TOTAL OF 9,714 COMPLETED SURVEYS FROM ACROSS THE SANFORD FOOTPRINT, AN INCREASE FROM 6,748 THE PREVIOUS CYCLE. THE RESPONSES GENERATED 48,643 OPEN-ENDED RESPONSES AND 1.76 MILLION PIECES OF DATA.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, BUILDING 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. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS 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 WERE ALSO INCLUDED IN THE FINDINGS.THE CENTER FOR SOCIAL RESEARCH VALIDATES THE FINDINGS OF THE PRIMARY RESEARCH BY ENGAGING AT LEAST TWO INTERNAL REVIEWERS. EACH REVIEWER HAS THEIR OWN TECHNIQUE AND STRENGTHS TO REVIEW THE FINDINGS; HOWEVER, THEY CHECK FOR ACCURACY IN THE DATA BY REVIEWING THE CODE AND SYNTAX, THE OUTPUT, THE CORRECT REPRESENTATION OF THE DATA IN THE REPORT, VERBIAGE, CONSISTENCY, CONTEXT, AND OVERALL READABILITY. BOTH REVIEWERS ALSO SUPPORTED PREVIOUS CHNA REPORTS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO LOCATE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT LOCAL RESOURCES ARE AVAILABLE.COMMUNITY STAKEHOLDER MEETINGSNEEDS, AS IDENTIFIED BY NDSU CENTER FOR SOCIAL RESEARCH, WERE PRESENTED TO COMMUNITY STAKEHOLDERS. FACILITATED DISCUSSION COMMENCED AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS IDENTIFIED 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 AND PRIORITIZATION OF LOCAL NEEDS. PARTICIPANTS IN THE MEETINGS INCLUDED COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS.THE PARTICIPANTS PROVIDED INFORMATION TO ANSWER THE FOLLOWING TYPES OF QUESTIONS AS IT RELATES TO IDENTIFIED NEEDS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHAT OPPORTUNITIES EXIST, WHERE CAN WE HAVE THE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ALREADY WORK BEING DONE ON THESE NEEDS?WHAT ARE THE RESOURCES CURRENTLY NOT UTILIZED WITHIN THE COMMUNITY THAT COULD ADDRESS THIS TOPIC?WHICH NEEDS FALL WITHIN THE PURVIEW OF HEALTH CARE SYSTEM AND WHICH DO NOT? CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES OR ORGANIZATIONS?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2025-2027 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: REDUCE PHYSICAL AND PERCEPTUAL BARRIERS TO THOSE SEEKING MENTAL HEALTH CAREMENTAL 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 JACKSON MEDICAL CENTER (SJMC) HAS MADE REDUCING PHYSICAL AND PERCEPTUAL BARRIERS TO THOSE SEEKING MENTAL HEALTH CARE A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO INCREASE AWARENESS AND COORDINATION OF MENTAL HEALTH SERVICES WITHIN THE COMMUNITY. IT IS SANFORD'S GOAL TO ADVANCE INTEGRATED HEALTHCARE IN THE COMMUNITY AND TO INCREASE AWARENESS AND PROVIDE EDUCATION ON SUICIDE PREVENTION.PRIORITY 2: ACCESS TO MEDICAL CARE AND HEALTH CARE PROVIDERSWHILE MANY SURVEY RESPONDENTS IN THE JACKSON AREA HAVE A PRIMARY CARE PROVIDER, HAVE BEEN IN FOR A ROUTINE CHECKUP OR SCREENING IN THE PAST YEAR, AND HAVE RECEIVED NECESSARY HEALTH CARE FOR THEMSELVES AND THEIR FAMILY IN THE PAST YEAR, THE PERCENTAGES ARE AMONG THE LOWEST WHEN COMPARED TO SIMILAR-SIZED MARKETS SERVED BY SANFORD HEALTH. IN ADDITION, 75 PERCENT OF RESPONDENTS HAVE TRAVELED FOR CARE IN THE PAST THREE YEARS, A RATE WHICH IS HIGHER THAN THE COMPARISON GROUP AVERAGE. THE NEED TO TRAVEL FOR CARE IS EVIDENT IN CHR DATA WHICH INDICATES THAT WHEN COMPARED TO SIMILAR-SIZED MARKETS, THE JACKSON AREA HAS HIGHER/WORSE-THAN-AVERAGE RATIOS OF POPULATION TO PROVIDERS. SJMC HAS MADE ACCESS TO MEDICAL CARE AND HEALTH CARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE INCREASED UTILIZATION OF TELEHEALTH SERVICES AND IN-PERSON APPOINTMENTS. IT IS SANFORD'S GOAL TO INCREASE THE TELEHEALTH OFFERINGS OF SPECIALTY PROVIDERS AND FOCUS ON PHYSICIAN RECRUITMENT.PRIORITY 3: SUBSTANCE ABUSEOF SURVEY RESPONDENTS IN THE JACKSON AREA WHO WOULD LIKE TO SEE SPECIFIC SERVICES OFFERED OR IMPROVED IN THEIR COMMUNITY, ADDICTION TREATMENT WAS ONE OF THE TOP SERVICES ON THE LIST. THE POTENTIAL NEED FOR ADDITIONAL SUBSTANCE ABUSE SERVICES, EDUCATION AND AWARENESS REGARDING SUBSTANCE ABUSE WERE ALSO CONSIDERED. SJMC HAS MADE SUBSTANCE ABUSE A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO INCREASE COORDINATION OF SUBSTANCE ABUSE RESOURCES AND OPPORTUNITIES TO ADDRESS THE NEED. IT IS SANFORD'S GOAL TO SUPPORT AND CONTINUE TO ENGAGE IN PARTNERSHIPS WITH COMMUNITY PROGRAMS WITH OTHER COMMUNITY MEMBERS COMMITTED TO REDUCING SUBSTANCE ABUSE AND TO INCREASE EDUCATION FOR STAFF ABOUT SUBSTANCE ABUSE SO THEY CAN BETTER SERVE OUR PATIENTS.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARREDUCE PHYSICAL AND PERCEPTUAL BARRIERS TO THOSE SEEKING MENTAL HEALTH CARESJMC FACILITATES COMMUNITY BEHAVIORAL HEALTH TASK FORCE MEETINGS WHERE MENTAL HEALTH ISSUES ARE IDENTIFIED AND KEY STAKEHOLDERS ARE AVAILABLE TO COLLABORATE, MAKE RECOMMENDATIONS AND INSTILL CHANGE. SJMC HAS A NUMBER OF RESOURCES AND PROVIDERS, SUCH AS INTEGRATED HEALTH THERAPISTS, AVAILABLE LOCALLY. ACCESS TO MEDICAL CARE AND HEALTH CARE PROVIDERSSJMC OFFERS A VARIETY OF SERVICES THROUGH LOCALLY BASED AND OUTREACH PROVIDERS. LABORATORY AND RADIOLOGY SERVICES ARE AVAILABLE 24 HOURS A DAY, WITH STAFF SERVING THE HOSPITAL, ATTACHED MEDICAL CLINIC, AND TWO SATELLITE CLINICS. CLINIC SERVICES INCLUDE FAMILY MEDICINE AND VARIOUS SPECIALTY OUTREACH SERVICES. A VARIETY OF SURGICAL PROCEDURES ARE PERFORMED IN THE SURGICAL SUITE AT SJMC. SJMC EMPLOYS SEVEN CLINICIANS, INCLUDING PHYSICIANS AND ADVANCED PRACTICE PROVIDERS. PERIODIC MARKETING IS IN PLACE TO GAIN EXPOSURE OF PRIMARY CARE SERVICES AND PROVIDERS VIA MEDIA OUTLETS SUCH AS RADIO, PRINT AND SOCIAL MEDIA.SUBSTANCE ABUSESJMC PARTNERS WITH SEVERAL COMMUNITY ORGANIZATIONS AND COALITIONS TO PROVIDE EDUCATION AND RAISE AWARENESS REGARDING SUBSTANCE ABUSE. THESE PARTNERSHIPS INCLUDE DES MOINES VALLEY HEALTH AND HUMAN SERVICES, POSITIVE COMMUNITY NORM AND THE POSITIVE ACTIONS THROUGH HEALTH (PATH) COALITION, JACKSON COUNTY ADDICTION PREVENTION AND SAFETY COALITION AND JACKSON COUNTY LAW ENFORCEMENT. IN MARCH 2025, THE ORGANIZATION "BE EXTRAORDINARY, BE YOU!" IS PLANNING A PRESENTATION TARGETING MIDDLE SCHOOL AND HIGH SCHOOL STUDENTS AT JACKSON COUNTY CENTRAL. THIS EVENT WILL INCLUDE A "CANNABIS PANEL," FEATURING LOCAL LEADERS WHO WILL DISCUSS THE IMPACTS OF MARIJUANA USE AND RELATED EFFECTS. ADDITIONALLY, IN JUNE, JACKSON COUNTY LAW ENFORCEMENT WILL PROVIDE TRAINING FOR SJMC PROVIDERS FOCUSING ON THE VARIOUS SUBSTANCES BEING IDENTIFIED IN OUR COMMUNITY. THIS INITIATIVE AIMS TO EQUIP HEALTHCARE PROFESSIONALS WITH THE NECESSARY KNOWLEDGE TO ADDRESS SUBSTANCE-RELATED ISSUES MORE EFFECTIVELY. MOVING FORWARD, SJMC REMAINS COMMITTED TO IDENTIFYING ADDITIONAL OPPORTUNITIES TO ADDRESS AND COMBAT SUBSTANCE ABUSE IN OUR COMMUNITY, FOSTERING PARTNERSHIPS AND INNOVATIVE APPROACHES TO PROMOTE HEALTH AND SAFETY. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO AFFORDABLE HOUSINGACCESS TO AFFORDABLE HEALTH CAREHEALTHY LIVINGSANFORD 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. SANFORD HEALTH FURTHER SUPPORTS THROUGH ITS FINDHELP RESOURCE, AN ONLINE TOOL TO INCORPORATE CONTACT AND REFERRAL INFORMATION TO CONNECT COMMUNITY-BASED ORGANIZATIONS WITH PATIENTS TO MEET THEIR HEALTH RELATED-SOCIAL CARE NEEDS. A LINK IS INCLUDED ON EVERY AFTER-VISIT SUMMARY PROVIDED TO PATIENTS AND IS AVAILABLE ON SANFORDHEALTH.ORG AND MYCHART. 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 2023 THROUGH DECEMBER 2024, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2025-2027. 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.CHI ST. ALEXIUS HEALTH AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTERESSENTIA HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH CLAY COUNTY PUBLIC HEALTHFARGO CASS PUBLIC HEALTHFAMILY HEALTHCARESIOUX FALLS DEPARTMENT OF HEALTHBISMARCK-BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION WESTERN PLAINS PUBLIC HEALTHLIMITATIONSTHE 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 RESPONDENTS 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 COMMUNITY RESIDENTS WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS, PARTICIPATING ORGANIZATIONS NOTED PREVIOUSLY, AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND HEALTH NEEDS. 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 FOR THEIR RANKING. 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.THE SURVEY WAS THE FIRST OF MULTIPLE EFFORTS TO ENGAGE COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE SENT THE SURVEY AND ASKED TO COMPLETE THE INSTRUMENT AND THEN FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT.SANFORD INVESTED IN A MULTIFACETED CAMPAIGN THAT INCLUDED AN EARNED MEDIA CAMPAIGN ON LOCAL MEDIA OUTLETS AND THE PUBLIC-FACING SANFORD HEALTH NEWS (HTTPS://NEWS.SANFORDHEALTH.ORG/). THE SYSTEM ALSO PROMOTED THE SURVEY INTERNALLY THROUGH THE ORGANIZATION'S INTRANET, ALL-STAFF EMAILS, AND NEWSLETTERS.INTERNAL EFFORTS WERE SUPPORTED WITH A ROBUST ADVERTISING CAMPAIGN THAT INCLUDED, AMONG OTHER EFFORTS, A DIGITAL MEDIA PROGRAM YIELDING 3.6 MILLION IMPRESSIONS AND A PRINT AD CAMPAIGN ENCOURAGING NATIVE AMERICAN COMMUNITIES TO PARTICIPATE THROUGH PLACEMENTS IN DEBAHJIMON MAGAZINE, ANISHINAABEG MAGAZINE AND MHA TIMES (MANDAN, HIDATSA, ARIKARA). FURTHER SUPPORT WAS GIVEN TO COLLECTING SURVEYS AT VARIOUS COMMUNITY EVENTS. THE GOAL OF THESE EFFORTS WAS TO INCREASE PARTICIPATION BY THOSE UNDERREPRESENTED THE PREVIOUS CYCLE, INCLUDING LOWER INCOME, MINORITY, AND MEDICALLY UNDERSERVED POPULATIONS.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. PROMOTION INVESTMENTS BY THE SYSTEM YIELDED A TOTAL OF 9,714 COMPLETED SURVEYS FROM ACROSS THE SANFORD FOOTPRINT, AN INCREASE FROM 6,748 THE PREVIOUS CYCLE. THE RESPONSES GENERATED 48,643 OPEN-ENDED RESPONSES AND 1.76 MILLION PIECES OF DATA.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, BUILDING 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. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS 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 WERE ALSO INCLUDED IN THE FINDINGS.THE CENTER FOR SOCIAL RESEARCH VALIDATES THE FINDINGS OF THE PRIMARY RESEARCH BY ENGAGING AT LEAST TWO INTERNAL REVIEWERS. EACH REVIEWER HAS THEIR OWN TECHNIQUE AND STRENGTHS TO REVIEW THE FINDINGS; HOWEVER, THEY CHECK FOR ACCURACY IN THE DATA BY REVIEWING THE CODE AND SYNTAX, THE OUTPUT, THE CORRECT REPRESENTATION OF THE DATA IN THE REPORT, VERBIAGE, CONSISTENCY, CONTEXT, AND OVERALL READABILITY. BOTH REVIEWERS ALSO SUPPORTED PREVIOUS CHNA REPORTS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO LOCATE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT LOCAL RESOURCES ARE AVAILABLE.COMMUNITY STAKEHOLDER MEETINGSNEEDS, AS IDENTIFIED BY NDSU CENTER FOR SOCIAL RESEARCH, WERE PRESENTED TO COMMUNITY STAKEHOLDERS. FACILITATED DISCUSSION COMMENCED AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS IDENTIFIED 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 AND PRIORITIZATION OF LOCAL NEEDS. PARTICIPANTS IN THE MEETINGS INCLUDED COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS.THE PARTICIPANTS PROVIDED INFORMATION TO ANSWER THE FOLLOWING TYPES OF QUESTIONS AS IT RELATES TO IDENTIFIED NEEDS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHAT OPPORTUNITIES EXIST, WHERE CAN WE HAVE THE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ALREADY WORK BEING DONE ON THESE NEEDS?WHAT ARE THE RESOURCES CURRENTLY NOT UTILIZED WITHIN THE COMMUNITY THAT COULD ADDRESS THIS TOPIC?WHICH NEEDS FALL WITHIN THE PURVIEW OF HEALTH CARE SYSTEM AND WHICH DO NOT? CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES OR ORGANIZATIONS?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2025-2027 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: 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 TRACY HAS MADE MENTAL HEALTH A SIGNIFICANT PRIORITY. IT IS SANFORD'S GOAL TO INCREASE AWARENESS AND EXPAND ACCESS OF MENTAL HEALTH SERVICES AT SANFORD TRACY AND IN THE SERVING AREA AND TO CREATE AND IMPLEMENT POLICY/PROCEDURE/PROTOCOLS TO BE PUT IN PLACE IN AREA SCHOOL SYSTEMS IN THE EVENT OF A MENTAL HEALTH CRISIS AND ALSO CREATE/IMPLEMENT CALMING SPACES THROUGHOUT THE SCHOOLS.PRIORITY 2: HEALTHY/ACTIVE LIVINGWHEN SURVEY RESPONDENTS IN THE TRACY AREA WERE ASKED ABOUT THE BIGGEST HEALTH CONCERNS FOR THEMSELVES AND THEIR FAMILY, CHRONIC HEALTH ISSUES, ALONG WITH DIET AND EXERCISE, WERE AMONG THE TOP CONCERNS.SANFORD HEALTH TRACY HAS MADE HEALTHY/ACTIVE LIVING A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES FOR THE COMMUNITY TO SEE IMPROVED OVERALL PHYSICAL AND NUTRITIONAL HEALTH IN PATIENTS AT SANFORD HEALTH. IT IS SANFORD'S GOAL TO CREATE ACCESS TO HEALTHY FOOD CHOICES AND PROVIDE EDUCATIONAL OPPORTUNITIES FOR MAKING HEALTHY CHOICES AND TO INCREASE THE ACTIVITY LEVEL OF COMMUNITY MEMBERS IN OUR SANFORD TRACY SERVICE AREA.PRIORITY 3: 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 TRACY HAS MADE TRANSPORTATION A SIGNIFICANT PRIORITY. IT IS SANFORD'S GOAL TO INCREASE AWARENESS OF TRANSPORTATION SERVICES AND INCREASE ACCESS TO TRANSPORTATIONS SERVICES IN THE SANFORD TRACY SERVICE AREA.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARMENTAL HEALTHSANFORD TRACY WILL CONTINUE TO SHARE THE RESULTS OF THIS SURVEY WITH COMMUNITY PARTNERS TO BUILD ACCESS TO MENTAL HEALTH. IN ADDITION, SANFORD TRACY OFFERS BEHAVIORAL HEALTH SCREENINGS WITH A STRETCH GOAL OF ACHIEVING A 100% SCREENING RATE FOR ALL PATIENTS TWELVE YEARS AND OLDER WITH A PRIOR HISTORY OF DEPRESSION OR ANXIETY. A NEW INTEGRATED HEALTH THERAPIST WAS HIRED IN 2023 TO COMPLEMENT THE ONE OUTREACH TELEMEDICINE PSYCHIATRIST THAT CONTINUES TO SEE PATIENTS AS NEEDED.HEALTHY/ACTIVE LIVINGSANFORD TRACY WILL CONTINUE TO WORK TO MAKE A POSITIVE IMPACT ON IMPROVING THE HEALTH OF COMMUNITY MEMBERS THROUGH BOTH PHYSICAL ACTIVITY AND HEALTHY LIFESTYLE CHOICES. THE SANFORD TRACY MEDICAL CENTER OFFERS DIETICIAN AND HEALTH COACHING SERVICES IN ADDITION TO PROGRAMMING FOR CHILDREN THROUGH THE SANFORD FIT PROGRAM. A NEW INTEGRATED HEALTH THERAPIST (IHT) WAS HIRED IN 2023. SANFORD TRACY ALSO CONTINUES TO OFFER A FOOD PANTRY PROGRAM WITH REFERRALS TO THE LOCAL FOOD PANTRY.TRANSPORTATIONOVER THE NEXT THREE YEARS, SANFORD TRACY WILL INCREASE COMMUNITY AWARENESS OF TRANSPORTATION ACCESS ISSUES THROUGH TARGETED OUTREACH CAMPAIGNS AND EDUCATIONAL INITIATIVES.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO AFFORDABLE HEALTH CAREACCESS TO MEDICAL CARE AND HEALTH CARE PROVIDERSAFFORDABLE 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. SANFORD HEALTH FURTHER SUPPORTS THROUGH ITS FINDHELP RESOURCE, AN ONLINE TOOL TO INCORPORATE CONTACT AND REFERRAL INFORMATION TO CONNECT COMMUNITY-BASED ORGANIZATIONS WITH PATIENTS TO MEET THEIR HEALTH RELATED-SOCIAL CARE NEEDS. A LINK IS INCLUDED ON EVERY AFTER-VISIT SUMMARY PROVIDED TO PATIENTS AND IS AVAILABLE ON SANFORDHEALTH.ORG AND MYCHART. 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 2023 THROUGH DECEMBER 2024, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2025-2027. 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.CHI ST. ALEXIUS HEALTH AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTERESSENTIA HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH CLAY COUNTY PUBLIC HEALTHFARGO CASS PUBLIC HEALTHFAMILY HEALTHCARESIOUX FALLS DEPARTMENT OF HEALTHBISMARCK-BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION WESTERN PLAINS PUBLIC HEALTHLIMITATIONSTHE 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 RESPONDENTS 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 COMMUNITY RESIDENTS WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS, PARTICIPATING ORGANIZATIONS NOTED PREVIOUSLY, AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND HEALTH NEEDS. 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 FOR THEIR RANKING. 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.THE SURVEY WAS THE FIRST OF MULTIPLE EFFORTS TO ENGAGE COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE SENT THE SURVEY AND ASKED TO COMPLETE THE INSTRUMENT AND THEN FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT.SANFORD INVESTED IN A MULTIFACETED CAMPAIGN THAT INCLUDED AN EARNED MEDIA CAMPAIGN ON LOCAL MEDIA OUTLETS AND THE PUBLIC-FACING SANFORD HEALTH NEWS (HTTPS://NEWS.SANFORDHEALTH.ORG/). THE SYSTEM ALSO PROMOTED THE SURVEY INTERNALLY THROUGH THE ORGANIZATION'S INTRANET, ALL-STAFF EMAILS, AND NEWSLETTERS.INTERNAL EFFORTS WERE SUPPORTED WITH A ROBUST ADVERTISING CAMPAIGN THAT INCLUDED, AMONG OTHER EFFORTS, A DIGITAL MEDIA PROGRAM YIELDING 3.6 MILLION IMPRESSIONS AND A PRINT AD CAMPAIGN ENCOURAGING NATIVE AMERICAN COMMUNITIES TO PARTICIPATE THROUGH PLACEMENTS IN DEBAHJIMON MAGAZINE, ANISHINAABEG MAGAZINE AND MHA TIMES (MANDAN, HIDATSA, ARIKARA). FURTHER SUPPORT WAS GIVEN TO COLLECTING SURVEYS AT VARIOUS COMMUNITY EVENTS. THE GOAL OF THESE EFFORTS WAS TO INCREASE PARTICIPATION BY THOSE UNDERREPRESENTED THE PREVIOUS CYCLE, INCLUDING LOWER INCOME, MINORITY, AND MEDICALLY UNDERSERVED POPULATIONS.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. PROMOTION INVESTMENTS BY THE SYSTEM YIELDED A TOTAL OF 9,714 COMPLETED SURVEYS FROM ACROSS THE SANFORD FOOTPRINT, AN INCREASE FROM 6,748 THE PREVIOUS CYCLE. THE RESPONSES GENERATED 48,643 OPEN-ENDED RESPONSES AND 1.76 MILLION PIECES OF DATA.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, BUILDING 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. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS 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 WERE ALSO INCLUDED IN THE FINDINGS.THE CENTER FOR SOCIAL RESEARCH VALIDATES THE FINDINGS OF THE PRIMARY RESEARCH BY ENGAGING AT LEAST TWO INTERNAL REVIEWERS. EACH REVIEWER HAS THEIR OWN TECHNIQUE AND STRENGTHS TO REVIEW THE FINDINGS; HOWEVER, THEY CHECK FOR ACCURACY IN THE DATA BY REVIEWING THE CODE AND SYNTAX, THE OUTPUT, THE CORRECT REPRESENTATION OF THE DATA IN THE REPORT, VERBIAGE, CONSISTENCY, CONTEXT, AND OVERALL READABILITY. BOTH REVIEWERS ALSO SUPPORTED PREVIOUS CHNA REPORTS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO LOCATE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT LOCAL RESOURCES ARE AVAILABLE.COMMUNITY STAKEHOLDER MEETINGSNEEDS, AS IDENTIFIED BY NDSU CENTER FOR SOCIAL RESEARCH, WERE PRESENTED TO COMMUNITY STAKEHOLDERS. FACILITATED DISCUSSION COMMENCED AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS IDENTIFIED 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 AND PRIORITIZATION OF LOCAL NEEDS. PARTICIPANTS IN THE MEETINGS INCLUDED COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS.THE PARTICIPANTS PROVIDED INFORMATION TO ANSWER THE FOLLOWING TYPES OF QUESTIONS AS IT RELATES TO IDENTIFIED NEEDS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHAT OPPORTUNITIES EXIST, WHERE CAN WE HAVE THE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ALREADY WORK BEING DONE ON THESE NEEDS?WHAT ARE THE RESOURCES CURRENTLY NOT UTILIZED WITHIN THE COMMUNITY THAT COULD ADDRESS THIS TOPIC?WHICH NEEDS FALL WITHIN THE PURVIEW OF HEALTH CARE SYSTEM AND WHICH DO NOT? CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES OR ORGANIZATIONS?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2025-2027 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: REDUCE PHYSICAL AND PERCEPTUAL BARRIERS TO SEEKING MENTAL HEALTH CAREMENTAL 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 HILLSBORO HAS MADE REDUCING PHYSICAL AND PERCEPTUAL BARRIERS TO SEEKING MENTAL HEALTH CARE A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE AN INCREASE OF PATIENTS SCREENED FOR DEPRESSION AND PROVIDE A GREATER AWARENESS OF RESOURCES AVAILABLE LOCALLY. IT IS SANFORD'S GOAL TO REDUCE STIGMA AND INCREASE SCREENINGS FOR BEHAVIORAL HEALTH CARE AND IMPROVE ACCESS TO MENTAL HEALTH RESOURCES IN THE COMMUNITY. PRIORITY 2: PROMOTION OF HEALTHY ACTIVE LIFESTYLEWHEN SURVEY RESPONDENTS WERE ASKED ABOUT THE BIGGEST HEALTH CONCERNS FOR THEMSELVES AND THEIR FAMILY (CONCERNS THEY FACE ON A REGULAR BASIS), CHRONIC HEALTH ISSUES, ALONG WITH DIET AND EXERCISE, WERE AMONG THE TOP CONCERNS. SANFORD HEALTH HILLSBORO HAS MADE THE PROMOTION OF A HEALTHY, ACTIVE LIFESTYLE A SIGNIFICANT PRIORITY AND HAS DEVELOPED A STRATEGY TO SEE AN INCREASE IN RESIDENTS UTILIZING LOCAL RESOURCES AND A DECLINE IN RELATED VISITS AT THE CLINIC. IT IS SANFORD'S GOAL TO PROVIDE OPPORTUNITIES FOR ADULTS AND YOUTH TO MEET RECOMMENDED PHYSICAL ACTIVITY AND TO DEVELOP SUSTAINABLE STRATEGIES THAT ENCOURAGE RESIDENTS TO MAKE HEALTHY CHOICES.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARREDUCE PHYSICAL AND PERCEPTUAL BARRIERS TO SEEKING MENTAL HEALTH CARE SANFORD CURRENTLY PROVIDES MENTAL HEALTH SCREENINGS WITHIN THE CLINIC. INTEGRATED HEALTH THERAPISTS HAVE BEEN AVAILABLE IN THE PAST, PRIMARILY THROUGH VIRTUAL CARE, BUT WERE LIMITED DUE TO A RESIGNATION. THE SYSTEM PROVIDES SANFORD.FINDHELP.COM AS A CONSUMER FACING RESOURCE TO FIND CARE AND MENTAL HEALTH RESOURCES.PROMOTION OF HEALTHY ACTIVE LIFESTYLESANFORD CURRENTLY SUPPORTS THE HILLSBORO RUNNING CLUBS RUN/WALK EVENT IN JUNE AND SUPPORTS THE MAYVILLE YOUTH CENTER. THE BRIDGING CENTERS IN BOTH MAYVILLE AND HILLSBORO PROMOTE THE BETTER CHOICES BETTER HEALTH CLASS AND OUR DIETITIANS ON BOTH CAMPUSES PROVIDE NUTRITIONAL EDUCATION.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO HEALTH CARE PROVIDERSACCESS 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. SANFORD HEALTH FURTHER SUPPORTS THROUGH ITS FINDHELP RESOURCE, AN ONLINE TOOL TO INCORPORATE CONTACT AND REFERRAL INFORMATION TO CONNECT COMMUNITY-BASED ORGANIZATIONS WITH PATIENTS TO MEET THEIR HEALTH RELATED-SOCIAL CARE NEEDS. A LINK IS INCLUDED ON EVERY AFTER-VISIT SUMMARY PROVIDED TO PATIENTS AND IS AVAILABLE ON SANFORDHEALTH.ORG AND MYCHART. 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 2023 THROUGH DECEMBER 2024, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2025-2027. 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.CHI ST. ALEXIUS HEALTH AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTERESSENTIA HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH CLAY COUNTY PUBLIC HEALTHFARGO CASS PUBLIC HEALTHFAMILY HEALTHCARESIOUX FALLS DEPARTMENT OF HEALTHBISMARCK-BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION WESTERN PLAINS PUBLIC HEALTHLIMITATIONSTHE 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 RESPONDENTS 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 COMMUNITY RESIDENTS WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS, PARTICIPATING ORGANIZATIONS NOTED PREVIOUSLY, AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND HEALTH NEEDS. 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 FOR THEIR RANKING. 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.THE SURVEY WAS THE FIRST OF MULTIPLE EFFORTS TO ENGAGE COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE SENT THE SURVEY AND ASKED TO COMPLETE THE INSTRUMENT AND THEN FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT.SANFORD INVESTED IN A MULTIFACETED CAMPAIGN THAT INCLUDED AN EARNED MEDIA CAMPAIGN ON LOCAL MEDIA OUTLETS AND THE PUBLIC-FACING SANFORD HEALTH NEWS (HTTPS://NEWS.SANFORDHEALTH.ORG/). THE SYSTEM ALSO PROMOTED THE SURVEY INTERNALLY THROUGH THE ORGANIZATION'S INTRANET, ALL-STAFF EMAILS, AND NEWSLETTERS.INTERNAL EFFORTS WERE SUPPORTED WITH A ROBUST ADVERTISING CAMPAIGN THAT INCLUDED, AMONG OTHER EFFORTS, A DIGITAL MEDIA PROGRAM YIELDING 3.6 MILLION IMPRESSIONS AND A PRINT AD CAMPAIGN ENCOURAGING NATIVE AMERICAN COMMUNITIES TO PARTICIPATE THROUGH PLACEMENTS IN DEBAHJIMON MAGAZINE, ANISHINAABEG MAGAZINE AND MHA TIMES (MANDAN, HIDATSA, ARIKARA). FURTHER SUPPORT WAS GIVEN TO COLLECTING SURVEYS AT VARIOUS COMMUNITY EVENTS. THE GOAL OF THESE EFFORTS WAS TO INCREASE PARTICIPATION BY THOSE UNDERREPRESENTED THE PREVIOUS CYCLE, INCLUDING LOWER INCOME, MINORITY, AND MEDICALLY UNDERSERVED POPULATIONS.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. PROMOTION INVESTMENTS BY THE SYSTEM YIELDED A TOTAL OF 9,714 COMPLETED SURVEYS FROM ACROSS THE SANFORD FOOTPRINT, AN INCREASE FROM 6,748 THE PREVIOUS CYCLE. THE RESPONSES GENERATED 48,643 OPEN-ENDED RESPONSES AND 1.76 MILLION PIECES OF DATA.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, BUILDING 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. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS 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 WERE ALSO INCLUDED IN THE FINDINGS.THE CENTER FOR SOCIAL RESEARCH VALIDATES THE FINDINGS OF THE PRIMARY RESEARCH BY ENGAGING AT LEAST TWO INTERNAL REVIEWERS. EACH REVIEWER HAS THEIR OWN TECHNIQUE AND STRENGTHS TO REVIEW THE FINDINGS; HOWEVER, THEY CHECK FOR ACCURACY IN THE DATA BY REVIEWING THE CODE AND SYNTAX, THE OUTPUT, THE CORRECT REPRESENTATION OF THE DATA IN THE REPORT, VERBIAGE, CONSISTENCY, CONTEXT, AND OVERALL READABILITY. BOTH REVIEWERS ALSO SUPPORTED PREVIOUS CHNA REPORTS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO LOCATE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT LOCAL RESOURCES ARE AVAILABLE.COMMUNITY STAKEHOLDER MEETINGSNEEDS, AS IDENTIFIED BY NDSU CENTER FOR SOCIAL RESEARCH, WERE PRESENTED TO COMMUNITY STAKEHOLDERS. FACILITATED DISCUSSION COMMENCED AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS IDENTIFIED 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 AND PRIORITIZATION OF LOCAL NEEDS. PARTICIPANTS IN THE MEETINGS INCLUDED COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS.THE PARTICIPANTS PROVIDED INFORMATION TO ANSWER THE FOLLOWING TYPES OF QUESTIONS AS IT RELATES TO IDENTIFIED NEEDS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHAT OPPORTUNITIES EXIST, WHERE CAN WE HAVE THE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ALREADY WORK BEING DONE ON THESE NEEDS?WHAT ARE THE RESOURCES CURRENTLY NOT UTILIZED WITHIN THE COMMUNITY THAT COULD ADDRESS THIS TOPIC?WHICH NEEDS FALL WITHIN THE PURVIEW OF HEALTH CARE SYSTEM AND WHICH DO NOT? CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES OR ORGANIZATIONS?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2025-2027 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: REDUCE PHYSICAL AND PERCEPTUAL BARRIERS TO SEEKING MENTAL HEALTH CARE. INCLUDES ACCESS TO HEALTH CARE AND MENTAL HEALTH NEEDSMENTAL 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 REDUCING PHYSICAL AND PERCEPTUAL BARRIERS TO SEEKING MENTAL HEALTH CARE A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE AN INCREASE OF PATIENTS SCREENED FOR DEPRESSION AND SEE GREATER AWARENESS OF RESOURCES AVAILABLE LOCALLY. IT IS SANFORD'S GOAL TO REDUCE STIGMA AND INCREASE SCREENINGS FOR BEHAVIORAL HEALTH AND IMPROVE ACCESS TO MENTAL HEALTH RESOURCES IN THE COMMUNITY.PRIORITY 2: PROMOTION OF HEALTHY ACTIVE LIFESTYLEWHEN SURVEY RESPONDENTS IN THE HILLSBORO-MAYVILLE WERE ASKED ABOUT THE BIGGEST HEALTH CONCERNS FOR THEMSELVES AND THEIR FAMILY (CONCERNS THEY FACE ON A REGULAR BASIS), CHRONIC HEALTH ISSUES ALONG WITH DIET AND EXERCISE WERE AMONG THE TOP CONCERNS.SANFORD HEALTH MAYVILLE HAS MADE THE PROMOTION OF A HEALTHY ACTIVE LIFESTYLE A SIGNIFICANT PRIORITY AND HAS DEVELOPED A STRATEGY TO SEE AN INCREASE IN RESIDENTS UTILIZING LOCAL RESOURCES AND A DECLINE IN RELATED VISITS AT THE CLINIC. IT IS SANFORD'S GOAL TO PROVIDE OPPORTUNITIES FOR ADULTS AND YOUTH TO MEET RECOMMENDED PHYSICAL ACTIVITY AND TO DEVELOP SUSTAINABLE STRATEGIES THAT ENCOURAGE RESIDENTS TO MAKE HEALTHY CHOICES.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARREDUCE PHYSICAL AND PERCEPTUAL BARRIERS TO SEEKING MENTAL HEALTH CARE. INCLUDES ACCESS TO HEALTH CARE AND MENTAL HEALTH NEEDSSANFORD CURRENTLY PROVIDES MENTAL HEALTH SCREENINGS WITHIN THE CLINIC. INTEGRATED HEALTH THERAPISTS HAVE BEEN AVAILABLE IN THE PAST, PRIMARILY THROUGH VIRTUAL CARE, BUT WERE LIMITED DUE TO A RESIGNATION. THE SYSTEM PROVIDES SANFORD.FINDHELP.COM AS A CONSUMER FACING RESOURCE TO FIND CARE AND MENTAL HEALTH RESOURCES.PROMOTION OF HEALTHY ACTIVE LIFESTYLESANFORD CURRENTLY SUPPORTS THE HILLSBORO RUNNING CLUBS RUN/WALK EVENT IN JUNE AND SUPPORTS THE MAYVILLE YOUTH CENTER. THE BRIDGING CENTERS IN BOTH MAYVILLE AND HILLSBORO PROMOTE THE BETTER CHOICES BETTER HEALTH CLASS AND OUR DIETITIANS IN BOTH CAMPUSES PROVIDE NUTRITIONAL EDUCATION.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO HEALTH CARE PROVIDERSACCESS TO AFFORDABLE 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. SANFORD HEALTH FURTHER SUPPORTS THROUGH ITS FINDHELP RESOURCE, AN ONLINE TOOL TO INCORPORATE CONTACT AND REFERRAL INFORMATION TO CONNECT COMMUNITY-BASED ORGANIZATIONS WITH PATIENTS TO MEET THEIR HEALTH RELATED-SOCIAL CARE NEEDS. A LINK IS INCLUDED ON EVERY AFTER-VISIT SUMMARY PROVIDED TO PATIENTS AND IS AVAILABLE ON SANFORDHEALTH.ORG AND MYCHART. 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 2023 THROUGH DECEMBER 2024, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2025-2027. 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.CHI ST. ALEXIUS HEALTH AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTERESSENTIA HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH CLAY COUNTY PUBLIC HEALTHFARGO CASS PUBLIC HEALTHFAMILY HEALTHCARESIOUX FALLS DEPARTMENT OF HEALTHBISMARCK-BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION WESTERN PLAINS PUBLIC HEALTHLIMITATIONSTHE 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 RESPONDENTS 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 COMMUNITY RESIDENTS WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS, PARTICIPATING ORGANIZATIONS NOTED PREVIOUSLY, AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND HEALTH NEEDS. 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 FOR THEIR RANKING. 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.THE SURVEY WAS THE FIRST OF MULTIPLE EFFORTS TO ENGAGE COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE SENT THE SURVEY AND ASKED TO COMPLETE THE INSTRUMENT AND THEN FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT.SANFORD INVESTED IN A MULTIFACETED CAMPAIGN THAT INCLUDED AN EARNED MEDIA CAMPAIGN ON LOCAL MEDIA OUTLETS AND THE PUBLIC-FACING SANFORD HEALTH NEWS (HTTPS://NEWS.SANFORDHEALTH.ORG/). THE SYSTEM ALSO PROMOTED THE SURVEY INTERNALLY THROUGH THE ORGANIZATION'S INTRANET, ALL-STAFF EMAILS, AND NEWSLETTERS.INTERNAL EFFORTS WERE SUPPORTED WITH A ROBUST ADVERTISING CAMPAIGN THAT INCLUDED, AMONG OTHER EFFORTS, A DIGITAL MEDIA PROGRAM YIELDING 3.6 MILLION IMPRESSIONS AND A PRINT AD CAMPAIGN ENCOURAGING NATIVE AMERICAN COMMUNITIES TO PARTICIPATE THROUGH PLACEMENTS IN DEBAHJIMON MAGAZINE, ANISHINAABEG MAGAZINE AND MHA TIMES (MANDAN, HIDATSA, ARIKARA). FURTHER SUPPORT WAS GIVEN TO COLLECTING SURVEYS AT VARIOUS COMMUNITY EVENTS. THE GOAL OF THESE EFFORTS WAS TO INCREASE PARTICIPATION BY THOSE UNDERREPRESENTED THE PREVIOUS CYCLE, INCLUDING LOWER INCOME, MINORITY, AND MEDICALLY UNDERSERVED POPULATIONS.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. PROMOTION INVESTMENTS BY THE SYSTEM YIELDED A TOTAL OF 9,714 COMPLETED SURVEYS FROM ACROSS THE SANFORD FOOTPRINT, AN INCREASE FROM 6,748 THE PREVIOUS CYCLE. THE RESPONSES GENERATED 48,643 OPEN-ENDED RESPONSES AND 1.76 MILLION PIECES OF DATA.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, BUILDING 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. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS 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 WERE ALSO INCLUDED IN THE FINDINGS.THE CENTER FOR SOCIAL RESEARCH VALIDATES THE FINDINGS OF THE PRIMARY RESEARCH BY ENGAGING AT LEAST TWO INTERNAL REVIEWERS. EACH REVIEWER HAS THEIR OWN TECHNIQUE AND STRENGTHS TO REVIEW THE FINDINGS; HOWEVER, THEY CHECK FOR ACCURACY IN THE DATA BY REVIEWING THE CODE AND SYNTAX, THE OUTPUT, THE CORRECT REPRESENTATION OF THE DATA IN THE REPORT, VERBIAGE, CONSISTENCY, CONTEXT, AND OVERALL READABILITY. BOTH REVIEWERS ALSO SUPPORTED PREVIOUS CHNA REPORTS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO LOCATE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT LOCAL RESOURCES ARE AVAILABLE.COMMUNITY STAKEHOLDER MEETINGSNEEDS, AS IDENTIFIED BY NDSU CENTER FOR SOCIAL RESEARCH, WERE PRESENTED TO COMMUNITY STAKEHOLDERS. FACILITATED DISCUSSION COMMENCED AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS IDENTIFIED 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 AND PRIORITIZATION OF LOCAL NEEDS. PARTICIPANTS IN THE MEETINGS INCLUDED COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS.THE PARTICIPANTS PROVIDED INFORMATION TO ANSWER THE FOLLOWING TYPES OF QUESTIONS AS IT RELATES TO IDENTIFIED NEEDS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHAT OPPORTUNITIES EXIST, WHERE CAN WE HAVE THE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ALREADY WORK BEING DONE ON THESE NEEDS?WHAT ARE THE RESOURCES CURRENTLY NOT UTILIZED WITHIN THE COMMUNITY THAT COULD ADDRESS THIS TOPIC?WHICH NEEDS FALL WITHIN THE PURVIEW OF HEALTH CARE SYSTEM AND WHICH DO NOT? CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES OR ORGANIZATIONS?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2025-2027 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: IMPROVE ACCESS TO PROVIDERS AND QUALITY HEALTH CAREWHILE MOST WEBSTER AREA SURVEY RESPONDENTS HAVE A PRIMARY CARE PROVIDER AND HAVE BEEN IN FOR A CHECKUP IN THE PAST YEAR, 17 PERCENT DID NOT RECEIVE NECESSARY HEALTH CARE FOR THEMSELVES AND THEIR FAMILY IN THE PAST YEAR. IN ADDITION, 86 PERCENT OF RESPONDENTS REPORTED TRAVELING OUTSIDE OF THEIR COMMUNITY TO RECEIVE HEALTH CARE SERVICES IN THE PAST THREE YEARS. MOST OF THOSE WHO TRAVELED FOR CARE INDICATED THAT THEY NEEDED SPECIALTY CARE, OR THE NEEDED SERVICES WERE NOT AVAILABLE LOCALLY.CRITICAL FOR TELEHEALTH OPTIONS IS RELIABLE INTERNET ACCESS AND CHR DATA INDICATE THAT THE WEBSTER AREA HAS ONE OF THE LOWEST RATES OF BROADBAND COVERAGE WHEN COMPARED TO SIMILAR-SIZED MARKETS. CHR DATA ALSO INDICATE THAT WHEN COMPARED TO SIMILAR-SIZED MARKETS, THE WEBSTER AREA HAS AN ABOVE-AVERAGE RATE OF PREVENTABLE HOSPITAL STAYS, ONE OF THE LOWEST FLU VACCINATION RATES, AND ONE OF THE HIGHEST INJURY DEATH RATES.SANFORD HAS MADE IMPROVING ACCESS TO PROVIDERS AND QUALITY HEALTH CARE A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES FOR THE COMMUNITY TO SEE AN INCREASE IN THE TOTAL NUMBER OF PATIENTS ENGAGING IN THEIR FIRST APPOINTMENT AND A REDUCTION IN THE NO-SHOW RATE. IT IS SANFORD'S GOAL TO INCREASE ACCESS TO BEHAVIORAL HEALTH THROUGH IN PERSON AND TELEMEDICINE VISITS AND EXCEED ENTERPRISE BENCHMARKS FOR WELLNESS WITH A FOCUS ON IMPROVEMENTS FOR AT-RISK POPULATIONS.PRIORITY 2: IMPROVE CHILDCARE AVAILABILITY IN THE COMMUNITY AND POSITIVELY IMPACT PHYSICAL ACTIVITY SURVEY RESPONDENTS IN THE WEBSTER AREA RATED THE QUALITY OF CHILDCARE, DAY CARE, AND PRESCHOOL AS LESS THAN GOOD AND HAD THE LOWEST SCORE WHEN COMPARED TO SIMILAR-SIZED MARKETS SERVED BY SANFORD HEALTH. SURVEY RESPONDENTS IN THE WEBSTER AREA RATED THEIR OWN PERSONAL HEALTH AND WELLNESS AS GOOD, BUT LOWER THAN THE COMPARISON GROUP AVERAGE. IN ADDITION, SURVEY RESPONDENTS RATED COMMUNITY ACCESS TO EXERCISE OPPORTUNITIES AS GOOD AND ACCESS TO HEALTHY FOODS AS GOOD; HOWEVER, BOTH SCORES WERE ALSO LOWER THAN THE COMPARISON GROUP AVERAGE. SANFORD HAS MADE IMPROVING CHILDCARE AVAILABILITY IN THE COMMUNITY, ALONG WITH POSITIVELY IMPACTING PHYSICAL ACTIVITY, A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE AN INCREASE IN AVAILABLE CHILDCARE OPENINGS IN THE LOCAL COMMUNITY AND AN INCREASE IN WELLNESS OPPORTUNITIES THROUGH CHILDCARE PROVIDERS. IT IS SANFORD'S GOAL TO ACTIVELY PARTICIPATE IN COMMUNITY INITIATIVES TO EXPAND CHILDCARE OPPORTUNITIES IN THE COMMUNITY AND TO PROVIDE ANCILLARY RESOURCES TO DAYCARE PROVIDERS TO POSITIVELY IMPACT PEDIATRIC WELLNESS. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARIMPROVE ACCESS TO PROVIDERS AND QUALITY HEALTH CARESANFORD OFFERS A RANGE OF SERVICES THROUGH A COMBINATION OF LOCAL AND OUTREACH PROVIDERS. THE LOCAL MEDICAL GROUP CONSISTS OF ONE MD AND FOUR APPS. LOCAL CARE INCLUDES THE HOSPITAL, OUTPATIENT CLINIC, AND NURSING HOME WITH SEVERAL ANCILLARY SERVICES, INCLUDING LAB AND PHARMACY. TELEMEDICINE IS AVAILABLE, INCLUDING IN THE EMERGENCY ROOM, WHICH IS RANKED IN THE 95TH PERCENTILE FOR PATIENT SATISFACTION. DIAGNOSTIC SERVICES, INCLUDING PFTS, SLEEP STUDIES, EEGS, EKGS, AND OTHERS ARE AVAILABLE LOCALLY. RADIOLOGY SUITES WERE RECENTLY UPDATED WITH AN ONSITE 64-SLICE CT, DIGITAL MAMMOGRAPHY, DEXA, ULTRASOUND AND MOBILE MRI AND NUCLEAR MEDICINE. RESPIRATORY, PHYSICAL, OCCUPATIONAL & SPEECH THERAPY, AND CARDIOPULMONARY REHAB ARE ALSO AVAILABLE.IMPROVE CHILDCARE AVAILABILITY IN THE COMMUNITY AND POSITIVELY IMPACT PHYSICAL ACTIVITYSANFORD DOES NOT OFFER CHILDCARE SERVICES FOR EMPLOYEES BUT SUPPORTS EFFORTS TO INCREASE LOCAL AVAILABILITY. SANFORD FIT IS DESIGNED TO GET KIDS THINKING DIFFERENTLY ABOUT THEIR CHOICES IN A FUN AND ENGAGING WAY. IT FOCUSES ON FOUR KEY ELEMENTS OF A HEALTHY LIFE: FOOD, MOVE, MOOD, RECHARGE. THE HOSPITAL ALSO OFFERS DIETICIAN SERVICES, WEIGHT MANAGEMENT PROGRAMS, IN ADDITION TO PREVENTATIVE CARE SCREENINGS AND VACCINATION CLINICS.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ECONOMIC CLIMATEAFFORDABLE HOUSING AND PUBLIC TRANSPORTATIONRESOURCE SHARINGSANFORD 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. SANFORD HEALTH FURTHER SUPPORTS THROUGH ITS FINDHELP RESOURCE, AN ONLINE TOOL TO INCORPORATE CONTACT AND REFERRAL INFORMATION TO CONNECT COMMUNITY-BASED ORGANIZATIONS WITH PATIENTS TO MEET THEIR HEALTH RELATED-SOCIAL CARE NEEDS. A LINK IS INCLUDED ON EVERY AFTER-VISIT SUMMARY PROVIDED TO PATIENTS AND IS AVAILABLE ON SANFORDHEALTH.ORG AND MYCHART. 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 2023 THROUGH DECEMBER 2024, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2025-2027. 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.CHI ST. ALEXIUS HEALTH AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTERESSENTIA HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH CLAY COUNTY PUBLIC HEALTHFARGO CASS PUBLIC HEALTHFAMILY HEALTHCARESIOUX FALLS DEPARTMENT OF HEALTHBISMARCK-BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION WESTERN PLAINS PUBLIC HEALTHLIMITATIONSTHE 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 RESPONDENTS 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 COMMUNITY RESIDENTS WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS, PARTICIPATING ORGANIZATIONS NOTED PREVIOUSLY, AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND HEALTH NEEDS. 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 FOR THEIR RANKING. 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.THE SURVEY WAS THE FIRST OF MULTIPLE EFFORTS TO ENGAGE COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE SENT THE SURVEY AND ASKED TO COMPLETE THE INSTRUMENT AND THEN FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT.SANFORD INVESTED IN A MULTIFACETED CAMPAIGN THAT INCLUDED AN EARNED MEDIA CAMPAIGN ON LOCAL MEDIA OUTLETS AND THE PUBLIC-FACING SANFORD HEALTH NEWS (HTTPS://NEWS.SANFORDHEALTH.ORG/). THE SYSTEM ALSO PROMOTED THE SURVEY INTERNALLY THROUGH THE ORGANIZATION'S INTRANET, ALL-STAFF EMAILS, AND NEWSLETTERS.INTERNAL EFFORTS WERE SUPPORTED WITH A ROBUST ADVERTISING CAMPAIGN THAT INCLUDED, AMONG OTHER EFFORTS, A DIGITAL MEDIA PROGRAM YIELDING 3.6 MILLION IMPRESSIONS AND A PRINT AD CAMPAIGN ENCOURAGING NATIVE AMERICAN COMMUNITIES TO PARTICIPATE THROUGH PLACEMENTS IN DEBAHJIMON MAGAZINE, ANISHINAABEG MAGAZINE AND MHA TIMES (MANDAN, HIDATSA, ARIKARA). FURTHER SUPPORT WAS GIVEN TO COLLECTING SURVEYS AT VARIOUS COMMUNITY EVENTS. THE GOAL OF THESE EFFORTS WAS TO INCREASE PARTICIPATION BY THOSE UNDERREPRESENTED THE PREVIOUS CYCLE, INCLUDING LOWER INCOME, MINORITY, AND MEDICALLY UNDERSERVED POPULATIONS.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. PROMOTION INVESTMENTS BY THE SYSTEM YIELDED A TOTAL OF 9,714 COMPLETED SURVEYS FROM ACROSS THE SANFORD FOOTPRINT, AN INCREASE FROM 6,748 THE PREVIOUS CYCLE. THE RESPONSES GENERATED 48,643 OPEN-ENDED RESPONSES AND 1.76 MILLION PIECES OF DATA.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, BUILDING 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. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS 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 WERE ALSO INCLUDED IN THE FINDINGS.THE CENTER FOR SOCIAL RESEARCH VALIDATES THE FINDINGS OF THE PRIMARY RESEARCH BY ENGAGING AT LEAST TWO INTERNAL REVIEWERS. EACH REVIEWER HAS THEIR OWN TECHNIQUE AND STRENGTHS TO REVIEW THE FINDINGS; HOWEVER, THEY CHECK FOR ACCURACY IN THE DATA BY REVIEWING THE CODE AND SYNTAX, THE OUTPUT, THE CORRECT REPRESENTATION OF THE DATA IN THE REPORT, VERBIAGE, CONSISTENCY, CONTEXT, AND OVERALL READABILITY. BOTH REVIEWERS ALSO SUPPORTED PREVIOUS CHNA REPORTS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO LOCATE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT LOCAL RESOURCES ARE AVAILABLE.COMMUNITY STAKEHOLDER MEETINGSNEEDS, AS IDENTIFIED BY NDSU CENTER FOR SOCIAL RESEARCH, WERE PRESENTED TO COMMUNITY STAKEHOLDERS. FACILITATED DISCUSSION COMMENCED AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS IDENTIFIED 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 AND PRIORITIZATION OF LOCAL NEEDS. PARTICIPANTS IN THE MEETINGS INCLUDED COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS.THE PARTICIPANTS PROVIDED INFORMATION TO ANSWER THE FOLLOWING TYPES OF QUESTIONS AS IT RELATES TO IDENTIFIED NEEDS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHAT OPPORTUNITIES EXIST, WHERE CAN WE HAVE THE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ALREADY WORK BEING DONE ON THESE NEEDS?WHAT ARE THE RESOURCES CURRENTLY NOT UTILIZED WITHIN THE COMMUNITY THAT COULD ADDRESS THIS TOPIC?WHICH NEEDS FALL WITHIN THE PURVIEW OF HEALTH CARE SYSTEM AND WHICH DO NOT? CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES OR ORGANIZATIONS?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2025-2027 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: IMPROVING MENTAL HEALTH AND CHEMICAL DEPENDENCY AVAILABILITY IN THE COMMUNITY 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 IMPROVING MENTAL HEALTH AND CHEMICAL DEPENDENCY AVAILABILITY IN THE COMMUNITY A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE AN INCREASE IN THE NUMBER OF PATIENTS SEEN FOR VIRTUAL BEHAVIORAL HEALTH APPOINTMENTS AND PATIENTS SEEN THROUGH A CHEMICAL DEPENDENCY SOCIAL WORKER. IT IS SANFORD'S GOAL TO REDUCE BARRIERS TO CARE AND INCREASE TELE BEHAVIORAL HEALTH UTILIZATION AND TO MEET THE COMMUNITY NEED FOR CHEMICAL DEPENDENCY SERVICES. PRIORITY 2: IMPROVE PHYSICAL ACTIVITY OPPORTUNITIESSANFORD HAS MADE IMPROVING PHYSICAL ACTIVITY OPPORTUNITIES A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE INCREASED OPPORTUNITIES FOR RESIDENTS TO ENGAGE IN FREE AND REDUCED PRICED PHYSICAL ACTIVITY. IT IS SANFORD'S GOAL TO INCREASE THE AVAILABILITY OF BIKING AND WALKING PATHS IN THE COMMUNITY TO INCREASE PHYSICAL ACTIVITY OPTIONS, TO INCREASE SAFETY FOR STUDENTS AND TO EXPAND FITNESS FACILITIES FOR RESIDENTS.PRIORITY 3: ADDRESS FOOD INSECURITIES FOR AREA RESIDENTS AND PATIENTSSANFORD HAS MADE ADDRESSING FOOD INSECURITIES FOR AREA RESIDENTS AND PATIENTS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE ADDITIONAL FOOD AVAILABILITY FOR FAMILIES IN NEED. IT IS SANFORD'S GOAL TO EXPAND SERVICES AVAILABLE IN THE HOSPITAL AND CLINIC FOR PATIENTS THAT NEED NUTRITION ASSISTANCE AND TO INCREASE FOOD SUPPORT FOR STUDENTS IN NEED OF NUTRITION ASSISTANCE THROUGH PARTNERSHIPS WITH LOCAL STAKEHOLDERS.ADDRESSING OF SIGNIFICANT NEEDS DURING THE CURRENT YEARIMPROVING MENTAL HEALTH AND CHEMICAL DEPENDENCY AVAILABILITY IN THE COMMUNITYTELEPSYCH SERVICES ARE CURRENTLY AVAILABLE AT SANFORD MEDICAL CENTER WHEATON, INCLUDING WITHIN THE EMERGENCY DEPARTMENT. SANFORD HAS EXPANDED LOCAL ACCESSIBILITY THROUGH THE ADDITION OF A PSYCHIATRIC NURSE PRACTITIONER IN 2024. THE TEAM IS ALSO ADDING A LICENSED DRUG AND ALCOHOL COUNSELOR. SANFORD WHEATON CONTINUES TO WORK ON DEVELOPING A PARTNERSHIP AND PLANNING WITH CURRENT PARTNERS TO FILL THE NEED WITHIN THE REGION AND COMMUNITY, INCLUDING HORIZON PUBLIC HEALTH.IMPROVE PHYSICAL ACTIVITY OPPORTUNITIESTHE COMMUNITY HAS A PARTIAL WALKING BIKE PATH AVAILABLE AND RESIDENTS HAVE ACCESS TO THE LOCAL HIGH SCHOOL TRACK.SANFORD HAS PARTNERED 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.ADDRESS FOOD INSECURITIES FOR AREA RESIDENTS AND PATIENTSSANFORD WHEATON PROVIDES NUTRITION SERVICES TO UNDERSERVED POPULATIONS THAT PROVIDE A BASE OFF WHICH TO EXPAND. THE HOSPITAL 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. SANFORD WHEATON ALSO PARTNERS TO PROVIDE FOOD SECURITY BOXES AND PARTICIPATES IN THE FOOD RX PROGRAM.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN:ACCESS TO MEDICAL CARE AND HEALTH CARE PROVIDERSACCESS TO AFFORDABLE HEALTH CAREPUBLIC TRANSPORTATIONLONG-TERM SENIOR CARECHILD 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. SANFORD HEALTH FURTHER SUPPORTS THROUGH ITS FINDHELP RESOURCE, AN ONLINE TOOL TO INCORPORATE CONTACT AND REFERRAL INFORMATION TO CONNECT COMMUNITY-BASED ORGANIZATIONS WITH PATIENTS TO MEET THEIR HEALTH RELATED-SOCIAL CARE NEEDS. A LINK IS INCLUDED ON EVERY AFTER-VISIT SUMMARY PROVIDED TO PATIENTS AND IS AVAILABLE ON SANFORDHEALTH.ORG AND MYCHART. 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 2023 THROUGH DECEMBER 2024, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2025-2027. 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.CHI ST. ALEXIUS HEALTH AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTERESSENTIA HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH CLAY COUNTY PUBLIC HEALTHFARGO CASS PUBLIC HEALTHFAMILY HEALTHCARESIOUX FALLS DEPARTMENT OF HEALTHBISMARCK-BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION WESTERN PLAINS PUBLIC HEALTHLIMITATIONSTHE 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 RESPONDENTS 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 COMMUNITY RESIDENTS WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS, PARTICIPATING ORGANIZATIONS NOTED PREVIOUSLY, AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND HEALTH NEEDS. 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 FOR THEIR RANKING. 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.THE SURVEY WAS THE FIRST OF MULTIPLE EFFORTS TO ENGAGE COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE SENT THE SURVEY AND ASKED TO COMPLETE THE INSTRUMENT AND THEN FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT.SANFORD INVESTED IN A MULTIFACETED CAMPAIGN THAT INCLUDED AN EARNED MEDIA CAMPAIGN ON LOCAL MEDIA OUTLETS AND THE PUBLIC-FACING SANFORD HEALTH NEWS (HTTPS://NEWS.SANFORDHEALTH.ORG/). THE SYSTEM ALSO PROMOTED THE SURVEY INTERNALLY THROUGH THE ORGANIZATION'S INTRANET, ALL-STAFF EMAILS, AND NEWSLETTERS.INTERNAL EFFORTS WERE SUPPORTED WITH A ROBUST ADVERTISING CAMPAIGN THAT INCLUDED, AMONG OTHER EFFORTS, A DIGITAL MEDIA PROGRAM YIELDING 3.6 MILLION IMPRESSIONS AND A PRINT AD CAMPAIGN ENCOURAGING NATIVE AMERICAN COMMUNITIES TO PARTICIPATE THROUGH PLACEMENTS IN DEBAHJIMON MAGAZINE, ANISHINAABEG MAGAZINE AND MHA TIMES (MANDAN, HIDATSA, ARIKARA). FURTHER SUPPORT WAS GIVEN TO COLLECTING SURVEYS AT VARIOUS COMMUNITY EVENTS. THE GOAL OF THESE EFFORTS WAS TO INCREASE PARTICIPATION BY THOSE UNDERREPRESENTED THE PREVIOUS CYCLE, INCLUDING LOWER INCOME, MINORITY, AND MEDICALLY UNDERSERVED POPULATIONS.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. PROMOTION INVESTMENTS BY THE SYSTEM YIELDED A TOTAL OF 9,714 COMPLETED SURVEYS FROM ACROSS THE SANFORD FOOTPRINT, AN INCREASE FROM 6,748 THE PREVIOUS CYCLE. THE RESPONSES GENERATED 48,643 OPEN-ENDED RESPONSES AND 1.76 MILLION PIECES OF DATA.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, BUILDING 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. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS 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 WERE ALSO INCLUDED IN THE FINDINGS.THE CENTER FOR SOCIAL RESEARCH VALIDATES THE FINDINGS OF THE PRIMARY RESEARCH BY ENGAGING AT LEAST TWO INTERNAL REVIEWERS. EACH REVIEWER HAS THEIR OWN TECHNIQUE AND STRENGTHS TO REVIEW THE FINDINGS; HOWEVER, THEY CHECK FOR ACCURACY IN THE DATA BY REVIEWING THE CODE AND SYNTAX, THE OUTPUT, THE CORRECT REPRESENTATION OF THE DATA IN THE REPORT, VERBIAGE, CONSISTENCY, CONTEXT, AND OVERALL READABILITY. BOTH REVIEWERS ALSO SUPPORTED PREVIOUS CHNA REPORTS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO LOCATE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT LOCAL RESOURCES ARE AVAILABLE.COMMUNITY STAKEHOLDER MEETINGSNEEDS, AS IDENTIFIED BY NDSU CENTER FOR SOCIAL RESEARCH, WERE PRESENTED TO COMMUNITY STAKEHOLDERS. FACILITATED DISCUSSION COMMENCED AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS IDENTIFIED 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 AND PRIORITIZATION OF LOCAL NEEDS. PARTICIPANTS IN THE MEETINGS INCLUDED COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS.THE PARTICIPANTS PROVIDED INFORMATION TO ANSWER THE FOLLOWING TYPES OF QUESTIONS AS IT RELATES TO IDENTIFIED NEEDS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHAT OPPORTUNITIES EXIST, WHERE CAN WE HAVE THE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ALREADY WORK BEING DONE ON THESE NEEDS?WHAT ARE THE RESOURCES CURRENTLY NOT UTILIZED WITHIN THE COMMUNITY THAT COULD ADDRESS THIS TOPIC?WHICH NEEDS FALL WITHIN THE PURVIEW OF HEALTH CARE SYSTEM AND WHICH DO NOT? CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES OR ORGANIZATIONS?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2025-2027 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: INCREASE ACCESS TO PREVENTATIVE AND SPECIALTY HEALTHCARE SERVICESSANFORD BAGLEY MEDICAL CENTER (SBMC) PLAYS A VITAL ROLE IN ENSURING THAT PATIENTS IN RURAL MINNESOTA HAVE ACCESS TO HEALTH CARE SERVICES. AS THE COMMUNITY AGES AND CHALLENGES WITH CLINICIAN RECRUITMENT AND HEALTH CARE INFRASTRUCTURE CHANGES ARISE, MAINTAINING ROBUST AND SUSTAINABLE HEALTH CARE ACCESS BECOMES INCREASINGLY CRITICAL. SBMC IS COMMITTED TO ENSURING THAT THE QUALITY OF CARE IS NOT INFLUENCED BY A PATIENT'S LOCATION. SANFORD HEALTH IS POSITIONED LOCALLY TO HAVE A POSITIVE IMPACT ON INCREASED ACCESS TO PREVENTATIVE AND SPECIALTY HEALTHCARE SERVICES WITHIN THE COMMUNITY. THIS EFFORT WILL FOCUS ON TWO PRIMARY GOALS: TO INCREASE ACCESS TO WOMEN'S HEALTH CARE AND PREVENTATIVE SCREENINGS AND TO INCREASE ACCESS FOR VACCINATIONS.PRIORITY 2: CONTINUED EXPANSION OF BEHAVIORAL HEALTH SERVICES AND SUBSTANCE ABUSE PROGRAMSINCREASING BEHAVIORAL HEALTH SERVICES AND EXPANDING ACCESS TO SUBSTANCE ABUSE TREATMENT ARE CRITICAL FOR ADDRESSING THE GROWING MENTAL HEALTH AND ADDICTION CRISES. BY PROVIDING COMPREHENSIVE SUPPORT AND ACCESSIBLE CARE, WE CAN HELP INDIVIDUALS MANAGE THEIR CONDITIONS, REDUCE STIGMA, AND PROMOTE RECOVERY. STRENGTHENING THESE SERVICES IS ESSENTIAL FOR IMPROVING OVERALL PUBLIC HEALTH, ENHANCING QUALITY OF LIFE, AND BUILDING HEALTHIER COMMUNITIES.SANFORD HEALTH IS POSITIONED LOCALLY TO HAVE A POSITIVE IMPACT ON BEHAVIORAL HEALTH SERVICES AND SUBSTANCE ABUSE PROGRAMS WITHIN THE COMMUNITY. THIS EFFORT WILL FOCUS ON TWO PRIMARY GOALS: TO INCREASE ACCESS TO VIRTUAL VISITS FOR BEHAVIORAL HEALTH CARE AND TO INCREASE ACCESS TO SUBSTANCE USE SERVICES.PRIORITY 3: INCREASE ACCESS TO HEALTHY FOODSURVEY RESPONDENTS IN THE BAGLEY AREA RATED ACCESS TO HEALTHY FOODS AS LESS THAN GOOD. THE MOST COMMON BARRIER CITED NOTED WAS THE HIGH COST ASSOCIATED WITH HEALTHY EATING. THESE CONCERNS ARE EVIDENT IN CHR DATA WHICH INDICATE THAT 12 PERCENT OF THE POPULATION IN THE BAGLEY AREA DID NOT HAVE ACCESS TO A RELIABLE SOURCE OF FOOD DURING THE PAST YEAR. OVERALL, BY IMPLEMENTING SYSTEMATIC SCREENING, PROVIDING EDUCATIONAL RESOURCES, OFFERING PERSONALIZED SUPPORT, AND COLLABORATING WITH COMMUNITY RESOURCES, SBMC CAN IMPROVE OPPORTUNITIES TO SCREEN AND SUPPORT THE NUTRITIONAL NEEDS OF THE PEDIATRIC PATIENTS WE SERVE, ULTIMATELY PROMOTING THE HEALTH AND WELL-BEING OF THE CHILDREN UNDER SANFORD'S CARE.SANFORD HEALTH IS POSITIONED LOCALLY TO HAVE A POSITIVE IMPACT ON INCREASED ACCESS TO HEALTHY FOOD. THIS EFFORT WILL FOCUS ON TWO PRIMARY GOALS: TO IMPROVE OPPORTUNITIES TO SCREEN FOR NUTRITIONAL NEEDS OF PEDIATRIC PATIENTS AND TO SUPPORT NUTRITIONAL NEEDS OF THE PEDIATRIC PATIENTS SERVED AT SANFORD BAGLEY CLINIC.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARINCREASE ACCESS TO PREVENTATIVE AND SPECIALTY HEALTHCARE SERVICESSBMC ACTIVELY PROMOTES OUTREACH SPECIALTY SERVICES AVAILABLE WITHIN THE COMMUNITY. THESE OUTREACH SERVICES BRING SPECIALTY PROVIDERS TO BAGLEY FACILITIES TO PROVIDE CARE CLOSE TO HOME. CURRENT OUTREACH SERVICES OFFERED INCLUDE PEDIATRIC CARE, DERMATOLOGY, OBSTETRICAL, GYNECOLOGY, SLEEP MEDICINE, BARIATRICS, AND MENTAL HEALTH. SBMC ALSO HOLDS FLU SHOT EVENTS AND PLANS TO EXPAND THE LOCATION OF THESE.CONTINUED EXPANSION OF BEHAVIORAL HEALTH SERVICES AND SUBSTANCE ABUSE PROGRAMS OVER THE LAST SEVERAL YEARS, SBMC INITIATED A GROUP BASED BEHAVIORAL HEALTH PROGRAM FOR SENIORS. DUE TO ISSUES WITH INSURANCE COVERAGE, CONTRACT DIFFICULTIES, AND LOW NUMBERS, SANFORD SHIFTED GEARS TO EXPANDING BEHAVIORAL HEALTH COUNSELING IN THE CLINIC SETTING AND VIA TELEHEALTH. THE CHANGE ALLOWED BEHAVIORAL HEALTH SERVICES TO BE SPREAD TO A LARGER AGE RANGE AND FOR AN INCREASED VOLUME OF PEOPLE. IN ADDITION, SANFORD HAS PARTNERED TO SUPPORT STELLHER HUMAN MENTAL HEALTH SERVICES IN THE SCHOOL SYSTEM BY FUNDING A ONE DAY A WEEK VIRTUAL OPTION FOR PEDIATRICS AGE TEN AND OLDER. INDIVIDUALS ARE ALSO SERVED BY SBMC'S MEDICATION ASSISTANCE THERAPY STAFF FOLLOWING THEIR ER VISITS.INCREASE ACCESS TO HEALTHY FOODSBMC HAS PARTNERED WITH UNITED WAY IN SPONSORING THE BACKPACK BUDDIES AND PROVIDES VOLUNTEERS FOR THE FOOD DROPS PROGRAM. IN 2024, 43 CHILDREN IN CLEARWATER COUNTY RECEIVED FOOD THROUGH BACKPACK BUDDIES AND 144,000 POUNDS OF FOOD WAS DISTRIBUTED IN THE COUNTY THROUGH THE FOOD DROPS PROGRAM. IN ADDITION, SANFORD WILL CONTINUE TO SUPPORT FRIENDS IN THE KITCHEN, A COOKING CLASS FOR THOSE AGE 55 AND OLDER. THIS PROGRAM IS DESIGNED TO BRING RURAL SENIORS TOGETHER TO A SAFE PLACE FOR EDUCATION ON HOW TO EAT HEALTHY ON A LIMITED BUDGET. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO AFFORDABLE HEALTH CAREEMPLOYMENT & ECONOMIC OPPORTUNITYCHILD CARE QUALITYPUBLIC TRANSPORTATIONAFFORDABLE HOUSING & LONG-TERM SENIOR 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. SANFORD HEALTH FURTHER SUPPORTS THROUGH ITS FINDHELP RESOURCE, AN ONLINE TOOL TO INCORPORATE CONTACT AND REFERRAL INFORMATION TO CONNECT COMMUNITY-BASED ORGANIZATIONS WITH PATIENTS TO MEET THEIR HEALTH RELATED-SOCIAL CARE NEEDS. A LINK IS INCLUDED ON EVERY AFTER-VISIT SUMMARY PROVIDED TO PATIENTS AND IS AVAILABLE ON SANFORDHEALTH.ORG AND MYCHART. 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 2023 THROUGH DECEMBER 2024, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2025-2027. 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.CHI ST. ALEXIUS HEALTH AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTERESSENTIA HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH CLAY COUNTY PUBLIC HEALTHFARGO CASS PUBLIC HEALTHFAMILY HEALTHCARESIOUX FALLS DEPARTMENT OF HEALTHBISMARCK-BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION WESTERN PLAINS PUBLIC HEALTHLIMITATIONSTHE 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 RESPONDENTS 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 COMMUNITY RESIDENTS WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS, PARTICIPATING ORGANIZATIONS NOTED PREVIOUSLY, AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND HEALTH NEEDS. 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 FOR THEIR RANKING. 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.THE SURVEY WAS THE FIRST OF MULTIPLE EFFORTS TO ENGAGE COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE SENT THE SURVEY AND ASKED TO COMPLETE THE INSTRUMENT AND THEN FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT.SANFORD INVESTED IN A MULTIFACETED CAMPAIGN THAT INCLUDED AN EARNED MEDIA CAMPAIGN ON LOCAL MEDIA OUTLETS AND THE PUBLIC-FACING SANFORD HEALTH NEWS (HTTPS://NEWS.SANFORDHEALTH.ORG/). THE SYSTEM ALSO PROMOTED THE SURVEY INTERNALLY THROUGH THE ORGANIZATION'S INTRANET, ALL-STAFF EMAILS, AND NEWSLETTERS.INTERNAL EFFORTS WERE SUPPORTED WITH A ROBUST ADVERTISING CAMPAIGN THAT INCLUDED, AMONG OTHER EFFORTS, A DIGITAL MEDIA PROGRAM YIELDING 3.6 MILLION IMPRESSIONS AND A PRINT AD CAMPAIGN ENCOURAGING NATIVE AMERICAN COMMUNITIES TO PARTICIPATE THROUGH PLACEMENTS IN DEBAHJIMON MAGAZINE, ANISHINAABEG MAGAZINE AND MHA TIMES (MANDAN, HIDATSA, ARIKARA). FURTHER SUPPORT WAS GIVEN TO COLLECTING SURVEYS AT VARIOUS COMMUNITY EVENTS. THE GOAL OF THESE EFFORTS WAS TO INCREASE PARTICIPATION BY THOSE UNDERREPRESENTED THE PREVIOUS CYCLE, INCLUDING LOWER INCOME, MINORITY, AND MEDICALLY UNDERSERVED POPULATIONS.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. PROMOTION INVESTMENTS BY THE SYSTEM YIELDED A TOTAL OF 9,714 COMPLETED SURVEYS FROM ACROSS THE SANFORD FOOTPRINT, AN INCREASE FROM 6,748 THE PREVIOUS CYCLE. THE RESPONSES GENERATED 48,643 OPEN-ENDED RESPONSES AND 1.76 MILLION PIECES OF DATA.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, BUILDING 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. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS 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 WERE ALSO INCLUDED IN THE FINDINGS.THE CENTER FOR SOCIAL RESEARCH VALIDATES THE FINDINGS OF THE PRIMARY RESEARCH BY ENGAGING AT LEAST TWO INTERNAL REVIEWERS. EACH REVIEWER HAS THEIR OWN TECHNIQUE AND STRENGTHS TO REVIEW THE FINDINGS; HOWEVER, THEY CHECK FOR ACCURACY IN THE DATA BY REVIEWING THE CODE AND SYNTAX, THE OUTPUT, THE CORRECT REPRESENTATION OF THE DATA IN THE REPORT, VERBIAGE, CONSISTENCY, CONTEXT, AND OVERALL READABILITY. BOTH REVIEWERS ALSO SUPPORTED PREVIOUS CHNA REPORTS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO LOCATE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT LOCAL RESOURCES ARE AVAILABLE.COMMUNITY STAKEHOLDER MEETINGSNEEDS, AS IDENTIFIED BY NDSU CENTER FOR SOCIAL RESEARCH, WERE PRESENTED TO COMMUNITY STAKEHOLDERS. FACILITATED DISCUSSION COMMENCED AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS IDENTIFIED 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 AND PRIORITIZATION OF LOCAL NEEDS. PARTICIPANTS IN THE MEETINGS INCLUDED COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS.THE PARTICIPANTS PROVIDED INFORMATION TO ANSWER THE FOLLOWING TYPES OF QUESTIONS AS IT RELATES TO IDENTIFIED NEEDS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHAT OPPORTUNITIES EXIST, WHERE CAN WE HAVE THE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ALREADY WORK BEING DONE ON THESE NEEDS?WHAT ARE THE RESOURCES CURRENTLY NOT UTILIZED WITHIN THE COMMUNITY THAT COULD ADDRESS THIS TOPIC?WHICH NEEDS FALL WITHIN THE PURVIEW OF HEALTH CARE SYSTEM AND WHICH DO NOT? CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES OR ORGANIZATIONS?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2025-2027 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: IMPROVE HEALTHY LIVING OUTCOMES THROUGH UPSTREAM ENGAGEMENT TO IMPROVE SOCIAL DETERMINANTS OF HEALTHSURVEY RESPONDENTS IN THE CANTON-INWOOD AREA RATED THEIR OWN PERSONAL HEALTH AND WELLNESS AS GOOD AND THE QUALITY OF HEALTH CARE IN THEIR COMMUNITY AS VERY GOOD. DESPITE THIS, WHEN SURVEY RESPONDENTS WERE ASKED ABOUT THE BIGGEST HEALTH CONCERNS FOR THEMSELVES AND THEIR FAMILY (CONCERNS THEY FACE ON A REGULAR BASIS), CHRONIC HEALTH ISSUES WERE A TOP CONCERN, AFTER COST. SANFORD HAS MADE IMPROVING HEALTHY LIVING OUTCOMES A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO ENHANCE COMMUNITY PARTNERSHIPS TO EXTEND CHRONIC DISEASE EDUCATION TO MORE RESIDENTS AND TO EXPAND CURRENT PROGRAMS HAVING A POSITIVE IMPACT ON SOCIAL DETERMINANTS OF HEALTH TO MORE OF THE COMMUNITY.PRIORITY 2: INCREASE ACCESS TO MENTAL HEALTH RESOURCES WITHIN THE COMMUNITY BY INCREASING PARTNERSHIPS WITH LOCAL PROVIDERS, EDUCATING THE COMMUNITY ON RESOURCES, AND DESTIGMATIZING THE SERVICEWHEN SURVEY RESPONDENTS WERE ASKED ABOUT THE MOST IMPORTANT HEALTH CARE ISSUES IMPACTING THEIR COMMUNITY, ACCESS TO HEALTH CARE SERVICES AND PROVIDERS WAS ONE OF THE TOP ISSUES. APPROXIMATELY HALF OF THE SURVEY RESPONDENTS IN THE CANTON-INWOOD AREA INDICATED THAT THERE ARE HEALTH CARE SERVICES THEY WOULD LIKE TO SEE OFFERED OR IMPROVED IN THEIR COMMUNITY. WHEN THESE RESPONDENTS WERE ASKED WHICH HEALTH CARE SERVICES THEY WOULD LIKE TO SEE OFFERED OR IMPROVED, MOST INDICATED BEHAVIORAL AND MENTAL HEALTH SERVICES AS THEIR TOP PRIORITY.SANFORD HAS MADE INCREASING ACCESS TO MENTAL HEALTH RESOURCES WITHIN THE COMMUNITY A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO INCREASE UTILIZATION OF MENTAL HEALTH SERVICES BY STUDENTS AND INCREASE PROACTIVE IDENTIFICATION OF PATIENTS THAT WOULD BENEFIT FROM MENTAL HEALTH SERVICES.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARIMPROVE HEALTHY LIVING OUTCOMES THROUGH UPSTREAM ENGAGEMENT TO IMPROVE SOCIAL DETERMINANTS OF HEALTH THE SANFORD CANTON-INWOOD MEDICAL CENTER CURRENTLY EMPLOYS A CARE MANAGER TO ASSIST PATIENTS IN COORDINATING THEIR CARE AFTER A PROCEDURE. THIS INCLUDES IDENTIFYING AND PROCURING MEDICAL DEVICES, SUCH AS WHEELCHAIRS, AND SCHEDULING POST-PROCEDURE FOLLOW-UP VISITS. BEYOND THE DIRECT CARE OF PATIENTS, SANFORD SUPPORTS FOOD PROGRAMS FOR STUDENTS AND CLASSES TO THE COMMUNITY. INCREASE ACCESS TO MENTAL HEALTH RESOURCES WITHIN THE COMMUNITY BY INCREASING PARTNERSHIPS WITH LOCAL PROVIDERS, EDUCATING THE COMMUNITY ON RESOURCES, AND DESTIGMATIZING THE SERVICE SANFORD HEALTH OFFERS BEHAVIORAL COUNSELING AT THE CANTON CLINIC WITH TWO PROVIDERS THAT OFFER CARE LOCALLY. ADDITIONAL SERVICES AND PROVIDERS ARE AVAILABLE VIA TELEHEALTH OR THROUGH ADDITIONAL SANFORD CLINICS LOCATED IN LINCOLN COUNTY, INCLUDING SANFORD PSYCHIATRY & PSYCHOLOGY ON S. LOUISE AVE IN SIOUX FALLS, APPROXIMATELY 21 MILES FROM CANTON.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO AFFORDABLE HEALTH CARELONG-TERM SENIOR CAREPUBLIC TRANSPORTATION 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. SANFORD HEALTH FURTHER SUPPORTS THROUGH ITS FINDHELP RESOURCE, AN ONLINE TOOL TO INCORPORATE CONTACT AND REFERRAL INFORMATION TO CONNECT COMMUNITY-BASED ORGANIZATIONS WITH PATIENTS TO MEET THEIR HEALTH RELATED-SOCIAL CARE NEEDS. A LINK IS INCLUDED ON EVERY AFTER-VISIT SUMMARY PROVIDED TO PATIENTS AND IS AVAILABLE ON SANFORDHEALTH.ORG AND MYCHART. 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 2023 THROUGH DECEMBER 2024, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2025-2027. 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.CHI ST. ALEXIUS HEALTH AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTERESSENTIA HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH CLAY COUNTY PUBLIC HEALTHFARGO CASS PUBLIC HEALTHFAMILY HEALTHCARESIOUX FALLS DEPARTMENT OF HEALTHBISMARCK-BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION WESTERN PLAINS PUBLIC HEALTHLIMITATIONSTHE 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 RESPONDENTS 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 COMMUNITY RESIDENTS WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS, PARTICIPATING ORGANIZATIONS NOTED PREVIOUSLY, AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND HEALTH NEEDS. 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 FOR THEIR RANKING. 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.THE SURVEY WAS THE FIRST OF MULTIPLE EFFORTS TO ENGAGE COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE SENT THE SURVEY AND ASKED TO COMPLETE THE INSTRUMENT AND THEN FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT.SANFORD INVESTED IN A MULTIFACETED CAMPAIGN THAT INCLUDED AN EARNED MEDIA CAMPAIGN ON LOCAL MEDIA OUTLETS AND THE PUBLIC-FACING SANFORD HEALTH NEWS (HTTPS://NEWS.SANFORDHEALTH.ORG/). THE SYSTEM ALSO PROMOTED THE SURVEY INTERNALLY THROUGH THE ORGANIZATION'S INTRANET, ALL-STAFF EMAILS, AND NEWSLETTERS.INTERNAL EFFORTS WERE SUPPORTED WITH A ROBUST ADVERTISING CAMPAIGN THAT INCLUDED, AMONG OTHER EFFORTS, A DIGITAL MEDIA PROGRAM YIELDING 3.6 MILLION IMPRESSIONS AND A PRINT AD CAMPAIGN ENCOURAGING NATIVE AMERICAN COMMUNITIES TO PARTICIPATE THROUGH PLACEMENTS IN DEBAHJIMON MAGAZINE, ANISHINAABEG MAGAZINE AND MHA TIMES (MANDAN, HIDATSA, ARIKARA). FURTHER SUPPORT WAS GIVEN TO COLLECTING SURVEYS AT VARIOUS COMMUNITY EVENTS. THE GOAL OF THESE EFFORTS WAS TO INCREASE PARTICIPATION BY THOSE UNDERREPRESENTED THE PREVIOUS CYCLE, INCLUDING LOWER INCOME, MINORITY, AND MEDICALLY UNDERSERVED POPULATIONS.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. PROMOTION INVESTMENTS BY THE SYSTEM YIELDED A TOTAL OF 9,714 COMPLETED SURVEYS FROM ACROSS THE SANFORD FOOTPRINT, AN INCREASE FROM 6,748 THE PREVIOUS CYCLE. THE RESPONSES GENERATED 48,643 OPEN-ENDED RESPONSES AND 1.76 MILLION PIECES OF DATA.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, BUILDING 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. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS 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 WERE ALSO INCLUDED IN THE FINDINGS.THE CENTER FOR SOCIAL RESEARCH VALIDATES THE FINDINGS OF THE PRIMARY RESEARCH BY ENGAGING AT LEAST TWO INTERNAL REVIEWERS. EACH REVIEWER HAS THEIR OWN TECHNIQUE AND STRENGTHS TO REVIEW THE FINDINGS; HOWEVER, THEY CHECK FOR ACCURACY IN THE DATA BY REVIEWING THE CODE AND SYNTAX, THE OUTPUT, THE CORRECT REPRESENTATION OF THE DATA IN THE REPORT, VERBIAGE, CONSISTENCY, CONTEXT, AND OVERALL READABILITY. BOTH REVIEWERS ALSO SUPPORTED PREVIOUS CHNA REPORTS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO LOCATE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT LOCAL RESOURCES ARE AVAILABLE.COMMUNITY STAKEHOLDER MEETINGSNEEDS, AS IDENTIFIED BY NDSU CENTER FOR SOCIAL RESEARCH, WERE PRESENTED TO COMMUNITY STAKEHOLDERS. FACILITATED DISCUSSION COMMENCED AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS IDENTIFIED 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 AND PRIORITIZATION OF LOCAL NEEDS. PARTICIPANTS IN THE MEETINGS INCLUDED COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS.THE PARTICIPANTS PROVIDED INFORMATION TO ANSWER THE FOLLOWING TYPES OF QUESTIONS AS IT RELATES TO IDENTIFIED NEEDS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHAT OPPORTUNITIES EXIST, WHERE CAN WE HAVE THE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ALREADY WORK BEING DONE ON THESE NEEDS?WHAT ARE THE RESOURCES CURRENTLY NOT UTILIZED WITHIN THE COMMUNITY THAT COULD ADDRESS THIS TOPIC?WHICH NEEDS FALL WITHIN THE PURVIEW OF HEALTH CARE SYSTEM AND WHICH DO NOT? CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES OR ORGANIZATIONS?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2025-2027 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 CARE AND PROVIDERSWHEN SURVEY RESPONDENTS IN THE CLEAR LAKE AREA WERE ASKED ABOUT THE MOST IMPORTANT HEALTH CARE ISSUES IMPACTING THEIR COMMUNITY, ACCESS TO HEALTH CARE SERVICES AND MEDICAL PROVIDERS WAS THE TOP ISSUE, WITH 84 PERCENT OF RESPONDENTS HAVING TRAVELED TO RECEIVE HEALTH CARE SERVICES WITHIN THE PAST THREE YEARS (WHICH IS HIGHER THAN THE COMPARISON GROUP AVERAGE). WHEN ASKED WHY, THE MAIN REASON WAS DUE TO NEEDING A SPECIALIST OR SERVICE NOT AVAILABLE LOCALLY.NEARLY HALF OF SURVEY RESPONDENTS IN THE CLEAR LAKE AREA INDICATED THAT THERE ARE HEALTH CARE SERVICES THEY WOULD LIKE TO SEE OFFERED OR IMPROVED IN THEIR COMMUNITY. WHEN THESE RESPONDENTS WERE ASKED WHICH HEALTH CARE SERVICES THEY WOULD LIKE TO SEE OFFERED OR IMPROVED, MOST SAID BEHAVIORAL AND MENTAL HEALTH SERVICES. SANFORD HEALTH CLEAR LAKE HAS MADE ACCESS TO CARE AND PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO PROMOTE PROVIDERS DOING OUTREACH AT SANFORD CLEAR LAKE MEDICAL CENTER, TO PROMOTE PROVIDERS OF TELEMEDICINE AND VIRTUAL SERVICES AT SANFORD CLEAR LAKE MEDICAL CENTER AND TO PROVIDE COMMUNITY EDUCATION ON BEHAVIORAL AND MENTAL HEALTH SERVICES AND RESOURCES.PRIORITY 2: PUBLIC 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 PUBLIC TRANSPORTATION A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO ENHANCE PUBLIC TRANSPORTATION ACCESS FOR REGIONAL NEEDS. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARACCESS TO CARE AND PROVIDERS SANFORD CLEAR LAKE MEDICAL CENTER CONSISTENTLY WORKS TO RECRUIT PROVIDERS TO THE COMMUNITY. OUTREACH SERVICES AND VIRTUAL SERVICES ARE ADDITIONAL AVENUES FOR LOCAL RESIDENTS TO RECEIVE A BROAD RANGE OF HEALTH CARE SERVICES CLOSE TO HOME. SANFORD CURRENTLY HAS THREE OUTREACH 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. NEW PROVIDERS ARE INTRODUCED TO THE COMMUNITY THROUGH COORDINATED SOCIAL MEDIA AND NEWSPAPER CAMPAIGNS.PUBLIC TRANSPORTATIONSANFORD CLEAR LAKE MEDICAL CENTER STAFF ASSIST PATIENTS WITH FINDING RESOURCES FOR RIDES TO/FROM MEDICAL APPOINTMENTS TO THE EXTENT POSSIBLE. THE TEAM HAS PARTNERED WITH OTHER INDIVIDUALS AND GROUPS IN THE COMMUNITY TO SEEK SOLUTIONS FOR THE LOCAL TRANSPORTATION ISSUES.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. THEY ARE CURRENTLY WORKING WITH THE SOUTH DAKOTA DEPARTMENT OF TRANSPORTATION ON AN INFRASTRUCTURE IMPROVEMENT PLAN TO ALLOW FOR ENHANCED AND SAFER WALKABILITY IN THE CLEAR LAKE COMMUNITY.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:LONG-TERM SENIOR CAREAFFORDABLE HOUSING 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. SANFORD HEALTH FURTHER SUPPORTS THROUGH ITS FINDHELP RESOURCE, AN ONLINE TOOL TO INCORPORATE CONTACT AND REFERRAL INFORMATION TO CONNECT COMMUNITY-BASED ORGANIZATIONS WITH PATIENTS TO MEET THEIR HEALTH RELATED-SOCIAL CARE NEEDS. A LINK IS INCLUDED ON EVERY AFTER-VISIT SUMMARY PROVIDED TO PATIENTS AND IS AVAILABLE ON SANFORDHEALTH.ORG AND MYCHART. 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 2023 THROUGH DECEMBER 2024, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2025-2027. 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.CHI ST. ALEXIUS HEALTH AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTERESSENTIA HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH CLAY COUNTY PUBLIC HEALTHFARGO CASS PUBLIC HEALTHFAMILY HEALTHCARESIOUX FALLS DEPARTMENT OF HEALTHBISMARCK-BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION WESTERN PLAINS PUBLIC HEALTHLIMITATIONSTHE 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 RESPONDENTS 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 COMMUNITY RESIDENTS WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS, PARTICIPATING ORGANIZATIONS NOTED PREVIOUSLY, AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND HEALTH NEEDS. 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 FOR THEIR RANKING. 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.THE SURVEY WAS THE FIRST OF MULTIPLE EFFORTS TO ENGAGE COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE SENT THE SURVEY AND ASKED TO COMPLETE THE INSTRUMENT AND THEN FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT.SANFORD INVESTED IN A MULTIFACETED CAMPAIGN THAT INCLUDED AN EARNED MEDIA CAMPAIGN ON LOCAL MEDIA OUTLETS AND THE PUBLIC-FACING SANFORD HEALTH NEWS (HTTPS://NEWS.SANFORDHEALTH.ORG/). THE SYSTEM ALSO PROMOTED THE SURVEY INTERNALLY THROUGH THE ORGANIZATION'S INTRANET, ALL-STAFF EMAILS, AND NEWSLETTERS.INTERNAL EFFORTS WERE SUPPORTED WITH A ROBUST ADVERTISING CAMPAIGN THAT INCLUDED, AMONG OTHER EFFORTS, A DIGITAL MEDIA PROGRAM YIELDING 3.6 MILLION IMPRESSIONS AND A PRINT AD CAMPAIGN ENCOURAGING NATIVE AMERICAN COMMUNITIES TO PARTICIPATE THROUGH PLACEMENTS IN DEBAHJIMON MAGAZINE, ANISHINAABEG MAGAZINE AND MHA TIMES (MANDAN, HIDATSA, ARIKARA). FURTHER SUPPORT WAS GIVEN TO COLLECTING SURVEYS AT VARIOUS COMMUNITY EVENTS. THE GOAL OF THESE EFFORTS WAS TO INCREASE PARTICIPATION BY THOSE UNDERREPRESENTED THE PREVIOUS CYCLE, INCLUDING LOWER INCOME, MINORITY, AND MEDICALLY UNDERSERVED POPULATIONS.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. PROMOTION INVESTMENTS BY THE SYSTEM YIELDED A TOTAL OF 9,714 COMPLETED SURVEYS FROM ACROSS THE SANFORD FOOTPRINT, AN INCREASE FROM 6,748 THE PREVIOUS CYCLE. THE RESPONSES GENERATED 48,643 OPEN-ENDED RESPONSES AND 1.76 MILLION PIECES OF DATA.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, BUILDING 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. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS 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 WERE ALSO INCLUDED IN THE FINDINGS.THE CENTER FOR SOCIAL RESEARCH VALIDATES THE FINDINGS OF THE PRIMARY RESEARCH BY ENGAGING AT LEAST TWO INTERNAL REVIEWERS. EACH REVIEWER HAS THEIR OWN TECHNIQUE AND STRENGTHS TO REVIEW THE FINDINGS; HOWEVER, THEY CHECK FOR ACCURACY IN THE DATA BY REVIEWING THE CODE AND SYNTAX, THE OUTPUT, THE CORRECT REPRESENTATION OF THE DATA IN THE REPORT, VERBIAGE, CONSISTENCY, CONTEXT, AND OVERALL READABILITY. BOTH REVIEWERS ALSO SUPPORTED PREVIOUS CHNA REPORTS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO LOCATE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT LOCAL RESOURCES ARE AVAILABLE.COMMUNITY STAKEHOLDER MEETINGSNEEDS, AS IDENTIFIED BY NDSU CENTER FOR SOCIAL RESEARCH, WERE PRESENTED TO COMMUNITY STAKEHOLDERS. FACILITATED DISCUSSION COMMENCED AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS IDENTIFIED 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 AND PRIORITIZATION OF LOCAL NEEDS. PARTICIPANTS IN THE MEETINGS INCLUDED COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS.THE PARTICIPANTS PROVIDED INFORMATION TO ANSWER THE FOLLOWING TYPES OF QUESTIONS AS IT RELATES TO IDENTIFIED NEEDS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHAT OPPORTUNITIES EXIST, WHERE CAN WE HAVE THE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ALREADY WORK BEING DONE ON THESE NEEDS?WHAT ARE THE RESOURCES CURRENTLY NOT UTILIZED WITHIN THE COMMUNITY THAT COULD ADDRESS THIS TOPIC?WHICH NEEDS FALL WITHIN THE PURVIEW OF HEALTH CARE SYSTEM AND WHICH DO NOT? CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES OR ORGANIZATIONS?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2025-2027 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. IT IS SANFORD'S GOAL TO INCREASE AWARENESS AND EXPAND ACCESS OF MENTAL HEALTH SERVICES AT SANFORD WESTBROOK AND IN THE SERVICING AREA AND TO CREATE AND IMPLEMENT POLICY/PROCEDURES/PROTOCOLS TO BE PUT IN PLACE IN AREA SCHOOL SYSTEMS IN THE EVENT OF MENTAL HEALTH CRISIS AND CREATE/IMPLEMENT CALMING SPACES THROUGHOUT THE SCHOOLS.PRIORITY 2: HEALTHY / ACTIVE LIVINGWHEN SURVEY RESPONDENTS IN THE WESTBROOK AREA WERE ASKED ABOUT THE BIGGEST HEALTH CONCERNS FOR THEMSELVES AND THEIR FAMILY, CHRONIC HEALTH ISSUES WERE AMONG THE TOP CONCERNS. SANFORD HAS MADE HEALTHY/ACTIVE LIVING A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE IMPROVED OVERALL PHYSICAL AND NUTRITIONAL HEALTH IN PATIENTS AT SANFORD HEALTH FROM THE COMMUNITY. IT IS SANFORD'S GOAL TO CREATE ACCESS TO HEALTHY FOOD CHOICES AND PROVIDE EDUCATIONAL OPPORTUNITIES TO MAKE HEALTHY CHOICES AND INCREASE THE ACTIVITY LEVEL OF COMMUNITY MEMBERS IN OUR SANFORD WESTBROOK SERVICE AREA.PRIORITY 3: 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 HAS MADE TRANSPORTATION A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE AN INCREASE IN COMMUNITY AWARENESS OF TRANSPORTATION ACCESS AND EXPANDED ACCESSIBILITY THROUGH COLLABORATIONS WITH SANFORD. IT IS SANFORD'S GOAL TO INCREASE AWARENESS OF TRANSPORTATION SERVICES IN THE SANFORD WESTBROOK SERVICE AREA AND TO INCREASE ACCESS TO TRANSPORTATION SERVICES IN OUR AREA.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARMENTAL HEALTHSANFORD WESTBROOK CURRENTLY PROVIDES MENTAL HEALTH SERVICES WITH A PSYCHIATRIST VIA VIRTUAL CARE. LICSWS AND A BEHAVIORAL HEALTH NP ARE ALSO ON STAFF. SANFORD WESTBROOK WILL CONTINUE TO SHARE THE RESULTS OF THIS SURVEY WITH COMMUNITY PARTNERS TO BUILD ACCESS TO MENTAL HEALTH. IN ADDITION, WE WILL CONTINUE TO LOOK AT ACCESS POINTS WITHIN THE CLINIC, BOTH IN PERSON AND VIRTUAL TO IMPROVE ACCESS TO MENTAL HEALTH. SANFORD WESTBROOK WILL HIRE NEW APP STAFF TO ADDRESS INCREASES IN MENTAL HEALTH NEEDS. WE WILL SPEND TIME OVER THE NEXT THREE YEARS EXPLORING WAYS TO ASSIST THE SCHOOL WITH MENTAL HEALTH OPPORTUNITIES THROUGH POSSIBLE SCHOOL-LINKED MENTAL HEALTH COLLABORATIONS, CALMING ROOMS/SPACES, AND RESOURCES TO BRING AWARENESS. SANFORD WESTBROOK WILL COLLABORATE WITH THE AREA SCHOOLS TO ANALYZE AVAILABLE MENTAL HEALTH RESOURCES, AS WELL AS CREATE POLICY/PROCEDURES/PROTOCOL THE LOCAL SCHOOLS CAN UTILIZE IN THE EVENT OF MENTAL HEALTH CRISIS.THE MENTAL HEALTH PRIORITY IS ALSO BEING ADDRESSED THROUGH EXPANDED USE OF CURRENT TELEMEDICINE AND IN-HOUSE MENTAL HEALTH SERVICES AND THE ADDITIONAL GOAL OF INCREASING THE NUMBER OF SCREENING AND REFERRALS TO BEHAVIORAL HEALTH PROVIDERS. HEALTHY / ACTIVE LIVINGSANFORD WESTBROOK WILL CONTINUE TO WORK TO MAKE A POSITIVE IMPACT ON IMPROVING THE HEALTH OF COMMUNITY MEMBERS THROUGH BOTH PHYSICAL ACTIVITY AND HEALTHY LIFESTYLE CHOICES. SANFORD SUPPORTS COMMUNITY EFFORTS TO INCREASE ACCESS TO ACTIVITIES AND FACILITIES THAT PROMOTE HEALTHY AND ACTIVE LIFESTYLES.TRANSPORTATIONOVER THE NEXT THREE YEARS, SANFORD WESTBROOK WILL INCREASE COMMUNITY AWARENESS OF TRANSPORTATION ACCESS ISSUES THROUGH TARGETED OUTREACH CAMPAIGNS AND EDUCATIONAL INITIATIVES. SIMULTANEOUSLY, WE WILL ESTABLISH AT LEAST TWO STRATEGIC PARTNERSHIPS WITH LOCAL ORGANIZATIONS EACH YEAR TO ENHANCE TRANSPORTATION OPTIONS WITHIN OUR SERVICE AREA. THIS INITIATIVE AIMS TO IMPROVE ACCESS TO ESSENTIAL SERVICES AND PROMOTE MOBILITY FOR UNDERSERVED POPULATIONS, ULTIMATELY CONTRIBUTING TO BETTER HEALTH OUTCOMES IN OUR COMMUNITY. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO MEDICAL CARE AND HEALTH CARE PROVIDERSACCESS TO AFFORDABLE HEALTH CAREAFFORDABLE 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. SANFORD HEALTH FURTHER SUPPORTS THROUGH ITS FINDHELP RESOURCE, AN ONLINE TOOL TO INCORPORATE CONTACT AND REFERRAL INFORMATION TO CONNECT COMMUNITY-BASED ORGANIZATIONS WITH PATIENTS TO MEET THEIR HEALTH RELATED-SOCIAL CARE NEEDS. A LINK IS INCLUDED ON EVERY AFTER-VISIT SUMMARY PROVIDED TO PATIENTS AND IS AVAILABLE ON SANFORDHEALTH.ORG AND MYCHART. 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 2023 THROUGH DECEMBER 2024, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2025-2027. 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.CHI ST. ALEXIUS HEALTH AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTERESSENTIA HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH CLAY COUNTY PUBLIC HEALTHFARGO CASS PUBLIC HEALTHFAMILY HEALTHCARESIOUX FALLS DEPARTMENT OF HEALTHBISMARCK-BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION WESTERN PLAINS PUBLIC HEALTHLIMITATIONSTHE 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 RESPONDENTS 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 COMMUNITY RESIDENTS WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS, PARTICIPATING ORGANIZATIONS NOTED PREVIOUSLY, AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND HEALTH NEEDS. 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 FOR THEIR RANKING. 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.THE SURVEY WAS THE FIRST OF MULTIPLE EFFORTS TO ENGAGE COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE SENT THE SURVEY AND ASKED TO COMPLETE THE INSTRUMENT AND THEN FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT.SANFORD INVESTED IN A MULTIFACETED CAMPAIGN THAT INCLUDED AN EARNED MEDIA CAMPAIGN ON LOCAL MEDIA OUTLETS AND THE PUBLIC-FACING SANFORD HEALTH NEWS (HTTPS://NEWS.SANFORDHEALTH.ORG/). THE SYSTEM ALSO PROMOTED THE SURVEY INTERNALLY THROUGH THE ORGANIZATION'S INTRANET, ALL-STAFF EMAILS, AND NEWSLETTERS.INTERNAL EFFORTS WERE SUPPORTED WITH A ROBUST ADVERTISING CAMPAIGN THAT INCLUDED, AMONG OTHER EFFORTS, A DIGITAL MEDIA PROGRAM YIELDING 3.6 MILLION IMPRESSIONS AND A PRINT AD CAMPAIGN ENCOURAGING NATIVE AMERICAN COMMUNITIES TO PARTICIPATE THROUGH PLACEMENTS IN DEBAHJIMON MAGAZINE, ANISHINAABEG MAGAZINE AND MHA TIMES (MANDAN, HIDATSA, ARIKARA). FURTHER SUPPORT WAS GIVEN TO COLLECTING SURVEYS AT VARIOUS COMMUNITY EVENTS. THE GOAL OF THESE EFFORTS WAS TO INCREASE PARTICIPATION BY THOSE UNDERREPRESENTED THE PREVIOUS CYCLE, INCLUDING LOWER INCOME, MINORITY, AND MEDICALLY UNDERSERVED POPULATIONS.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. PROMOTION INVESTMENTS BY THE SYSTEM YIELDED A TOTAL OF 9,714 COMPLETED SURVEYS FROM ACROSS THE SANFORD FOOTPRINT, AN INCREASE FROM 6,748 THE PREVIOUS CYCLE. THE RESPONSES GENERATED 48,643 OPEN-ENDED RESPONSES AND 1.76 MILLION PIECES OF DATA.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, BUILDING 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. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS 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 WERE ALSO INCLUDED IN THE FINDINGS.THE CENTER FOR SOCIAL RESEARCH VALIDATES THE FINDINGS OF THE PRIMARY RESEARCH BY ENGAGING AT LEAST TWO INTERNAL REVIEWERS. EACH REVIEWER HAS THEIR OWN TECHNIQUE AND STRENGTHS TO REVIEW THE FINDINGS; HOWEVER, THEY CHECK FOR ACCURACY IN THE DATA BY REVIEWING THE CODE AND SYNTAX, THE OUTPUT, THE CORRECT REPRESENTATION OF THE DATA IN THE REPORT, VERBIAGE, CONSISTENCY, CONTEXT, AND OVERALL READABILITY. BOTH REVIEWERS ALSO SUPPORTED PREVIOUS CHNA REPORTS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO LOCATE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT LOCAL RESOURCES ARE AVAILABLE.COMMUNITY STAKEHOLDER MEETINGSNEEDS, AS IDENTIFIED BY NDSU CENTER FOR SOCIAL RESEARCH, WERE PRESENTED TO COMMUNITY STAKEHOLDERS. FACILITATED DISCUSSION COMMENCED AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS IDENTIFIED 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 AND PRIORITIZATION OF LOCAL NEEDS. PARTICIPANTS IN THE MEETINGS INCLUDED COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS.THE PARTICIPANTS PROVIDED INFORMATION TO ANSWER THE FOLLOWING TYPES OF QUESTIONS AS IT RELATES TO IDENTIFIED NEEDS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHAT OPPORTUNITIES EXIST, WHERE CAN WE HAVE THE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ALREADY WORK BEING DONE ON THESE NEEDS?WHAT ARE THE RESOURCES CURRENTLY NOT UTILIZED WITHIN THE COMMUNITY THAT COULD ADDRESS THIS TOPIC?WHICH NEEDS FALL WITHIN THE PURVIEW OF HEALTH CARE SYSTEM AND WHICH DO NOT? CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES OR ORGANIZATIONS?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2025-2027 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: 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 A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE INCREASED UTILIZATION OF BEHAVIORAL HEALTH AND SUBSTANCE ABUSE SERVICES FOR THOSE THAT NEED THEM IN THE COMMUNITY. IT IS SANFORD'S GOAL TO IMPROVE TIMELY ACCESS TO MENTAL/BEHAVIORAL HEALTH CARE SERVICES AND TO ENHANCE AND EXPAND SERVICES TO EFFECTIVELY SUPPORT AND TREAT PATIENTS WITH SUBSTANCE USE DISORDERS.PRIORITY 2: ACCESS TO HEALTH CARE PROVIDERS AND QUALITY CAREWHEN RESPONDENTS WERE ASKED ABOUT THE MOST IMPORTANT HEALTH CARE ISSUES IMPACTING THEIR COMMUNITY, HAVING ACCESS TO HEALTH CARE WAS ONE OF THE TOP ISSUES BEHIND COST. AND WHEN RESPONDENTS, WHO RATED THEIR OWN ABILITY TO ACCESS HEALTH CARE AS POOR OR FAIR, WERE ASKED WHY THEY RATED ACCESS AS THEY DID, ISSUES OF LIMITED HOURS, WAIT TIMES, LIMITED LOCATIONS, AND LACK OF PROVIDERS AND SPECIALTY CARE WERE AMONG THE TOP CONCERNS.SANFORD HAS MADE ACCESS TO HEALTH CARE PROVIDERS AND QUALITY CARE A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE INCREASED COLLABORATION WITH EXTERNAL PARTNERS AND IMPROVED ACCESS TO CARE. IT IS SANFORD'S GOAL TO IMPROVE ACCESS TO PRIMARY AND SPECIALTY CARE AND TO COLLABORATIVELY SHARE CHNA INFORMATION WITH PUBLIC AND PRIVATE PARTNERS. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEAR: MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSESANFORD FARGO IS CONTINUING ITS EFFORTS TO IMPROVE ACCESS TO MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSE SERVICES. UTILIZATION OF VIRTUAL VISITS FOR BEHAVIORAL HEALTH HAS CONTINUED TO GROW AND CONTRIBUTE TOWARD IMPROVED ACCESS. TIMELY ACCESS TO ADULT PSYCHIATRY CONTINUES TO BE AN AREA WE ARE WORKING TO IMPROVE AND MONITOR PROGRESS QUARTERLY. SANFORD CURRENTLY OFFERS MENTAL HEALTH AND SUBSTANCE ABUSE PROVIDERS IN THE COMMUNITY THROUGH VARIOUS DELIVERY OPPORTUNITIES. DEPRESSION SCREENING WILL BE UTILIZED IN THE ROOMING NAVIGATOR IN ALL CLINICS TO HELP IDENTIFY THOSE IN NEED OF CARE. OUR SUBOXONE CLINIC CONTINUES TO SERVE PATIENTS IN ADDICTION RECOVERY AND ENGAGES IN HOSPITAL PEER COACHING. 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.ACCESS TO HEALTH CARE PROVIDERS AND QUALITY CARE SANFORD FARGO INCREASED HOME-BASED PRIMARY CARE ACCESS AND CONTINUES TO UTILIZE THIS APPROACH TO IMPROVE ACCESS AS ALL PRIMARY CARE PROVIDERS NOW HAVE ACCESS TO THIS OPTION. PROVIDER RECRUITMENT PLAYS A MAJOR ROLE IN OUR ABILITY TO INCREASE OUR CAPACITY. INVESTING IN OUR EDUCATIONAL PROGRAMS TO SERVE AS A PIPELINE FOR PROVIDERS CONTINUES TO BE A PRIORITY. SANFORD MEDICAL CENTER FARGO IS NORTH DAKOTA'S LARGEST MEDICAL CENTER AND ONE OF THREE SANFORD MEDICAL CENTER CAMPUSES IN FARGO. IT SERVES AS A REGIONAL HEALTH CARE HUB WITH 60 PERCENT OF PATIENTS COMING FROM OUTSIDE THE METRO AREA. IT IS NORTH DAKOTA'S ONLY LEVEL I ADULT TRAUMA CENTER, NORTH DAKOTA'S ONLY LEVEL II PEDIATRIC TRAUMA CENTER, DESIGNATED AS A COMPREHENSIVE STROKE CENTER AND HAS AN AIRMED TRANSPORT SERVICE COVERING A THREE-STATE AREA. THE ONE-MILLION-SQUARE-FOOT SANFORD MEDICAL CENTER FARGO PROVIDES SERVICES INCLUDING EMERGENCY/TRAUMA, FAMILY BIRTH CENTER, CHILDREN'S HOSPITAL, BRAIN AND SPINE SURGERY, CARDIOVASCULAR SURGERY, INTERVENTIONAL CARDIOLOGY, GENERAL SURGERY AND MORE. AS OF 2024, SANFORD MEDICAL CENTER FARGO HAS 292 LICENSED BEDS. SANFORD MEDICAL CENTER FARGO TAKES CARE TO THE NEXT LEVEL, COMBINING EXPERTISE, STATE-OF-THE-ART TECHNOLOGY AND COMPASSIONATE PATIENT CARE. WITH TECHNOLOGICALLY ADVANCED ORS AND GROWING DIGITAL PATHOLOGY CAPABILITIES, SURGEONS CAN CONNECT ACROSS CAMPUSES AND CONSULT WITH SPECIALISTS ACROSS THE NATION. PATIENT ROOMS ARE DESIGNED AROUND THE PATIENT FOR EFFICIENCY, SAFETY AND OPTIMAL CARE.SANFORD MEDICAL CENTER FARGO IS A MAJOR TEACHING HOSPITAL IN PARTNERSHIP WITH MULTIPLE AREA UNIVERSITIES AND TECHNICAL COLLEGES TO PROVIDE CLINICAL TRAINING FOR NURSES, ALLIED HEALTH AND NON-HEALTH CARE FIELDS. AS WELL AS PARTNERSHIP WITH THE UNIVERSITY OF NORTH DAKOTA SCHOOL OF MEDICINE AND HEALTH SCIENCES TO PROVIDE CLINICAL TRAINING FOR HUNDREDS OF MEDICAL STUDENTS, MEDICAL RESIDENTS AND FELLOWS. SANFORD ALSO OFFERS MANY ACTIVITIES AND PROGRAMS TO ATTRACT HIGH SCHOOL AND YOUNGER STUDENTS TO THE HEALTH CARE FIELD THROUGH OUR ASPIRE PROGRAMS. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO AFFORDABLE HEALTH CAREHEALTHY LIVINGPUBLIC TRANSPORTATIONQUALITY CHILDCAREAFFORDABLE 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. SANFORD HEALTH FURTHER SUPPORTS THROUGH ITS FINDHELP RESOURCE, AN ONLINE TOOL TO INCORPORATE CONTACT AND REFERRAL INFORMATION TO CONNECT COMMUNITY-BASED ORGANIZATIONS WITH PATIENTS TO MEET THEIR HEALTH RELATED-SOCIAL CARE NEEDS. A LINK IS INCLUDED ON EVERY AFTER-VISIT SUMMARY PROVIDED TO PATIENTS AND IS AVAILABLE ON SANFORDHEALTH.ORG AND MYCHART. 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 2023 THROUGH DECEMBER 2024, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2025-2027. 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.CHI ST. ALEXIUS HEALTH AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTERESSENTIA HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH CLAY COUNTY PUBLIC HEALTHFARGO CASS PUBLIC HEALTHFAMILY HEALTHCARESIOUX FALLS DEPARTMENT OF HEALTHBISMARCK-BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION WESTERN PLAINS PUBLIC HEALTHLIMITATIONSTHE 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 RESPONDENTS 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 COMMUNITY RESIDENTS WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS, PARTICIPATING ORGANIZATIONS NOTED PREVIOUSLY, AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND HEALTH NEEDS. 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 FOR THEIR RANKING. 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.THE SURVEY WAS THE FIRST OF MULTIPLE EFFORTS TO ENGAGE COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE SENT THE SURVEY AND ASKED TO COMPLETE THE INSTRUMENT AND THEN FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT.SANFORD INVESTED IN A MULTIFACETED CAMPAIGN THAT INCLUDED AN EARNED MEDIA CAMPAIGN ON LOCAL MEDIA OUTLETS AND THE PUBLIC-FACING SANFORD HEALTH NEWS (HTTPS://NEWS.SANFORDHEALTH.ORG/). THE SYSTEM ALSO PROMOTED THE SURVEY INTERNALLY THROUGH THE ORGANIZATION'S INTRANET, ALL-STAFF EMAILS, AND NEWSLETTERS.INTERNAL EFFORTS WERE SUPPORTED WITH A ROBUST ADVERTISING CAMPAIGN THAT INCLUDED, AMONG OTHER EFFORTS, A DIGITAL MEDIA PROGRAM YIELDING 3.6 MILLION IMPRESSIONS AND A PRINT AD CAMPAIGN ENCOURAGING NATIVE AMERICAN COMMUNITIES TO PARTICIPATE THROUGH PLACEMENTS IN DEBAHJIMON MAGAZINE, ANISHINAABEG MAGAZINE AND MHA TIMES (MANDAN, HIDATSA, ARIKARA). FURTHER SUPPORT WAS GIVEN TO COLLECTING SURVEYS AT VARIOUS COMMUNITY EVENTS. THE GOAL OF THESE EFFORTS WAS TO INCREASE PARTICIPATION BY THOSE UNDERREPRESENTED THE PREVIOUS CYCLE, INCLUDING LOWER INCOME, MINORITY, AND MEDICALLY UNDERSERVED POPULATIONS.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. PROMOTION INVESTMENTS BY THE SYSTEM YIELDED A TOTAL OF 9,714 COMPLETED SURVEYS FROM ACROSS THE SANFORD FOOTPRINT, AN INCREASE FROM 6,748 THE PREVIOUS CYCLE. THE RESPONSES GENERATED 48,643 OPEN-ENDED RESPONSES AND 1.76 MILLION PIECES OF DATA.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, BUILDING 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. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS 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 WERE ALSO INCLUDED IN THE FINDINGS.THE CENTER FOR SOCIAL RESEARCH VALIDATES THE FINDINGS OF THE PRIMARY RESEARCH BY ENGAGING AT LEAST TWO INTERNAL REVIEWERS. EACH REVIEWER HAS THEIR OWN TECHNIQUE AND STRENGTHS TO REVIEW THE FINDINGS; HOWEVER, THEY CHECK FOR ACCURACY IN THE DATA BY REVIEWING THE CODE AND SYNTAX, THE OUTPUT, THE CORRECT REPRESENTATION OF THE DATA IN THE REPORT, VERBIAGE, CONSISTENCY, CONTEXT, AND OVERALL READABILITY. BOTH REVIEWERS ALSO SUPPORTED PREVIOUS CHNA REPORTS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO LOCATE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT LOCAL RESOURCES ARE AVAILABLE.COMMUNITY STAKEHOLDER MEETINGSNEEDS, AS IDENTIFIED BY NDSU CENTER FOR SOCIAL RESEARCH, WERE PRESENTED TO COMMUNITY STAKEHOLDERS. FACILITATED DISCUSSION COMMENCED AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS IDENTIFIED 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 AND PRIORITIZATION OF LOCAL NEEDS. PARTICIPANTS IN THE MEETINGS INCLUDED COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS.THE PARTICIPANTS PROVIDED INFORMATION TO ANSWER THE FOLLOWING TYPES OF QUESTIONS AS IT RELATES TO IDENTIFIED NEEDS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHAT OPPORTUNITIES EXIST, WHERE CAN WE HAVE THE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ALREADY WORK BEING DONE ON THESE NEEDS?WHAT ARE THE RESOURCES CURRENTLY NOT UTILIZED WITHIN THE COMMUNITY THAT COULD ADDRESS THIS TOPIC?WHICH NEEDS FALL WITHIN THE PURVIEW OF HEALTH CARE SYSTEM AND WHICH DO NOT? CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES OR ORGANIZATIONS?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2025-2027 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: INCREASE ACCESS TO SPECIALTY CARE SERVICES AND SAME-DAY APPOINTMENTSWHEN SURVEY RESPONDENTS IN THE THIEF RIVER FALLS (TRF) MARKET AREA WERE ASKED ABOUT THE MOST IMPORTANT HEALTH CARE ISSUES IMPACTING THEIR COMMUNITY, THREE-FOURTHS OF SURVEY RESPONDENTS INDICATED THAT THERE ARE HEALTH CARE SERVICES THEY WOULD LIKE TO SEE OFFERED OR IMPROVED IN THEIR COMMUNITY. WHEN THESE RESPONDENTS WERE ASKED WHICH HEALTH CARE SERVICES THEY WOULD LIKE TO SEE OFFERED OR IMPROVED, MOST SAID BEHAVIORAL AND MENTAL HEALTH SERVICES, FOLLOWED BY CANCER CARE, ADDICTION TREATMENT, DENTAL CARE, WALK-IN/URGENT CARE, LONG-TERM CARE AND NURSING HOMES, OBGYN/WOMEN'S CARE, FAMILY MEDICINE OR PRIMARY CARE, AND HEART CARE.SANFORD HAS MADE ACCESS TO SPECIALTY CARE SERVICES AND SAME-DAY APPOINTMENTS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE AN INCREASE IN SAME-DAY APPOINTMENT AVAILABILITY. IT IS SANFORD'S GOAL TO EXPAND SAME-DAY APPOINTMENTS WITHIN PRIMARY CARE AND TO ENHANCE ACCESS TO THE TOP THREE SERVICES IDENTIFIED IN THE COMMUNITY SURVEY (MENTAL HEALTH, CANCER CARE AND SUBSTANCE ABUSE).PRIORITY 2: PROMOTE COMMUNITY SERVICES WITH COMMUNITY PARTNERSBY PARTNERING WITH LOCAL ENTITIES, SANFORD TRF BEHAVIORAL HEALTH CENTER (STRFBHC) AIMS TO ADDRESS THE INTERCONNECTED ECONOMIC, SOCIAL, AND HEALTH NEEDS OF OUR COMMUNITY. THIS COLLABORATIVE APPROACH NOT ONLY ENHANCES ACCESS TO ESSENTIAL RESOURCES BUT ALSO FOSTERS A HEALTHIER, MORE RESILIENT POPULATION.SANFORD HAS MADE PROMOTING COMMUNITY SERVICES WITH COMMUNITY PARTNERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO CREATE A LASTING POSITIVE IMPACT ON THE OVERALL WELLBEING OF THE COMMUNITY WE SERVE. IT IS SANFORD'S GOAL TO PARTNER WITH COUNTY HEALTH FOR EDUCATIONAL RESOURCES AND TO PROMOTE SANFORD.FINDHELP.COMPRIORITY 3: INCREASE ACCESS TO 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 INCREASING ACCESS TO MENTAL HEALTH SERVICES A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES FOR THE COMMUNITY TO SEE EXPANDED ACCESS TO GROUP THERAPY SESSIONS AND AN EXPANDED CLINICAL TRAINING PROGRAM TO INCREASE ACCESS. IT IS SANFORD'S GOAL TO REDUCE WAIT TIME FOR MENTAL HEALTH SERVICES BY OFFERING GROUP THERAPY AND TO EXPAND THE CLINICAL TRAINING PROGRAM.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARINCREASE ACCESS TO SPECIALTY CARE SERVICES AND SAME-DAY APPOINTMENTSACCESS TO HEALTHCARE PROVIDERS REMAINS A TOP PRIORITY IN TRF. WE HAVE SUCCESSFULLY LEVERAGED TELEHEALTH TECHNOLOGIES TO EXPAND ACCESS BEYOND TRADITIONAL IN-PERSON CONSULTATIONS. WHILE THE POTENTIAL FOR TELEHEALTH IS SIGNIFICANT, ITS ADOPTION IS SOMEWHAT CONSTRAINED BY EXISTING PAYMENT MODELS AND THE WILLINGNESS OF INSURANCE PAYERS TO RECOGNIZE TELEHEALTH AS A COVERED SERVICE AND THE PERCEPTION OF THIS SERVICE FROM PROVIDERS AND OLDER PATIENTS NOT FEELING THE SAME PROVIDER-PATIENT RELATIONSHIP.PROMOTE COMMUNITY SERVICES WITH COMMUNITY PARTNERSSTRFBHC IS COMMITTED TO BEING AN ENGAGED COMMUNITY PARTNER ACROSS VARIOUS LEVELS AND ORGANIZATIONS. WE ACTIVELY SUPPORT ECONOMIC DEVELOPMENT INITIATIVES, COLLABORATE WITH THE CHAMBER OF COMMERCE, AND ENGAGE WITH THE LOCAL SCHOOL SYSTEM. OUR INVOLVEMENT EXTENDS TO COMMUNITY HEALTH AND FITNESS PROGRAMS, EVENTS, AND A LOCAL YOUNG PROFESSIONALS' NETWORK, CONTRIBUTING TO A VIBRANT AND HEALTHY COMMUNITY.WE ARE ALSO DEDICATED TO INVESTING IN EDUCATIONAL PROGRAMS TAILORED TO ADDRESS CRITICAL HEALTH TOPICS, INCLUDING COURSES FOCUSED ON CARDIAC HEALTH, PREGNANCY, DIABETES, AND MORE. ADDITIONALLY, WE ADVOCATE FOR POLICY CHANGES AT THE LOCAL, STATE, AND FEDERAL LEVELS, WORKING ALONGSIDE ADVOCACY GROUPS TO PROMOTE HEALTH EQUITY AND IMPROVED HEALTH OUTCOMES.INCREASE ACCESS TO MENTAL HEALTH SERVICESSTRFBHC SERVES AS THE ONLY FREESTANDING BEHAVIORAL HEALTH HOSPITAL AND PRIMARY PROVIDER OF INPATIENT PSYCHIATRIC SERVICES FOR NORTHWEST MINNESOTA, WITH 16 INPATIENT PSYCHIATRIC BEDS. THE HOSPITAL OFFERS OUTPATIENT MENTAL HEALTH SERVICES, CHILDREN'S THERAPEUTIC SERVICES AND SUPPORT, AND OUTPATIENT SUBSTANCE USE TREATMENT. THE HOSPITAL IS ACTIVELY RECRUITING BOTH MASTER'S AND DOCTORAL-LEVEL PROFESSIONALS. TELEHEALTH HAS BEEN INSTRUMENTAL IN RETAINING CLINICIANS WHO MIGHT HAVE RELOCATED, ALLOWING US TO MAINTAIN SERVICE CONTINUITY. EIGHT OF OUR CLINICIANS NOW EXCLUSIVELY PROVIDE TELEHEALTH SERVICES, WHILE MANY OTHERS INTEGRATE IT INTO THEIR PRACTICE. THIS EXPANSION OF TELEHEALTH HAS SIGNIFICANTLY IMPROVED ACCESS TO MENTAL HEALTH CARE.WE HAVE INVESTED SIGNIFICANT EFFORT TO IMPROVE OUR INTAKE PROCESS FOR THERAPY SERVICES INCLUDING COMPLETING AN INTAKE SCREENING AND UPDATING OUR WAITLIST TO AID IN BEST ALIGNING CLINICIAN EXPERTISE AND AVAILABILITY WITH PATIENT NEEDS.STRFBHC 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. STRFBHC AND SANFORD HEALTH MEDICAL CENTER STAFF ALSO PARTNERED 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, STRFBHC CONNECTED WITH VARIOUS OTHER AGENCIES, GROUPS, AND COMMUNITIES.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO QUALITY HEALTHCAREPUBLIC TRANSPORTATIONLONG-TERM SENIOR CAREQUALITY CHILD CAREAFFORDABLE 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. SANFORD HEALTH FURTHER SUPPORTS THROUGH ITS FINDHELP RESOURCE, AN ONLINE TOOL TO INCORPORATE CONTACT AND REFERRAL INFORMATION TO CONNECT COMMUNITY-BASED ORGANIZATIONS WITH PATIENTS TO MEET THEIR HEALTH RELATED-SOCIAL CARE NEEDS. A LINK IS INCLUDED ON EVERY AFTER-VISIT SUMMARY PROVIDED TO PATIENTS AND IS AVAILABLE ON SANFORDHEALTH.ORG AND MYCHART. 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 GROUP A-FACILITY 26 -- BLACK HILLS SURGICAL HOSPITAL, LLC PART V, SECTION B, LINE 2: AS OF THE ACQUISION DATE OF NOVEMBER 15, 2024, BLACK HILLS SURGICAL HOSPITAL, LLC TRANSITIONED TO TAX-EXEMPT NONPROFIT STATUS AND BEGAN OPERATING AS PART OF SANFORD HEALTH SYSTEM. AS A FOR-PROFIT HOSPITAL PRIOR TO ACQUISION BY SANFORD HEALTH, A COMMUNITY HEALTH NEEDS ASSESSMENT WAS NOT REQUIRED BY YEAR-END. GROUP A-FACILITY 26 -- BLACK HILLS SURGICAL HOSPITAL, LLC 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 26 -- BLACK HILLS SURGICAL HOSPITAL, LLC 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 252 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 BAGLEY CLINIC 1656 CENTRAL ST W BAGLEY MN 56621 RURAL HEALTH CLINIC 6 - SANFORD BAGLEY EYE CENTER & OPTICAL 1656 CENTRAL ST W BAGLEY MN 56621 EYE CARE CENTER 7 - BAKER PARK INC 803 DEWEY AVENUE BEMIDJI MN 56601 ASSISTED LIVING CENTER 8 - EDITH SANFORD BREAST CENTER BEMIDJI 1233 34TH ST NW BEMIDJI MN 56601 WOMEN'S HEALTH 9 - SANFORD BEHAVIORAL HEALTH HEADWATERS ACT 1705 ANNE ST NW BEMIDJI MN 56601 BEHAVIORAL HEALTH TREATMENT CENTER 10 - SANFORD BEMIDJI 1611 ANNE ST CLINIC 1611 ANNE ST NW BEMIDJI MN 56601 MEDICAL CLINIC 11 - SANFORD BEMIDJI 1705 ANN ST CLINIC 1705 ANNE ST NW BEMIDJI MN 56601 MEDICAL CLINIC 12 - SANFORD BEMIDJI DOWNTOWN EYE CENTER & OPTI 506 BELTRAMI AVE NW BEMIDJI MN 56601 EYE CARE CENTER 13 - SANFORD BEMIDJI EYE CENTER & OPTICAL 1611 ANNE ST NW BEMIDJI MN 56601 EYE CARE CENTER 14 - SANFORD BEMIDJI HOME CARE & HOSPICE 3201 PINE RIDGE AVE NW BEMIDJI MN 56601 HOME CARE AND HOSPICE 15 - SANFORD BEMIDJI MAIN CLINIC 1233 34TH ST NW BEMIDJI MN 56601 MEDICAL CLINIC 16 - SANFORD BEMIDJI OTHOPEDICS & SPORTS MEDICI 1300 ANNE STREET NW BEMIDJI MN 56601 MEDICAL CLINIC 17 - SANFORD DIALYSIS BEMIDJI 1300 ANNE STREET NW BEMIDJI MN 56601 DIALYSIS 18 - SANFORD HEALTH NEILSON PLACE 1000 ANNE ST NW BEMIDJI MN 56601 SKILLED NURSING FACILITY 19 - SANFORD HEALTH PRIMEWEST RESIDENTIAL 3124 HANNAH AVE NW BEMIDJI MN 56601 BEHAVIORAL HEALTH & ADDICTION CENTER 20 - SANFORD HEALTH TRILLIUM 930 ANNE STREET NW BEMIDJI MN 56601 ASSISTED LIVING CENTER 21 - SANFORD HEALTH WINDSONG 1000 ANNE ST NW BEMIDJI MN 56601 ASSISTED LIVING CENTER 22 - SANFORD JOE LUEKEN CANCER CENTER 1233 34TH ST NW BEMIDJI MN 56601 CANCER CENTER 23 - SANFORD CLINIC BERESFORD 600 W CEDAR STREET BERESFORD SD 57004 RURAL HEALTH CLINIC 24 - BISMARCK CANCER CENTER 500 N 8TH STREET BISMARCK ND 58501 CANCER CENTER 25 - SANFORD BIRTH CENTER 300 N 7TH STREET BISMARCK ND 58501 BIRTH CENTER 26 - SANFORD CANCER CENTER BISMARCK 300 N 7TH STREET BISMARCK ND 58501 CANCER CENTER 27 - SANFORD CHILDREN'S NORTH CLINIC 765 W INTERSTATE AVE BISMARCK ND 58503 CHILDREN'S CLINIC 28 - SANFORD CLINIC 222 N 7TH STREET BISMARCK ND 58501 MEDICAL CLINIC 29 - SANFORD EAST INTERSTATE AVE CLINIC 1800 E INTERSTATE AVE BISMARCK ND 58503 MEDICAL CLINIC 30 - SANFORD FIFTH & BROADWAY CLINIC 515 E BROADWAY AVE BISMARCK ND 58501 MEDICAL CLINIC 31 - SANFORD HEALTH CHIROPRACTICOCC MED CLINIC 2603 E BROADWAY AVE BISMARCK ND 58501 MEDICAL CLINIC 32 - SANFORD NORTH CLINIC 2830 N WASHINGTON STREET BISMARCK ND 58503 MEDICAL CLINIC 33 - SANFORD ORTHOPEDIC & SPORTS MEDICINE 225 N 7TH STREET BISMARCK ND 58501 MEDICAL CLINIC 34 - SANFORD SEVENTH & BROADWAY CLINIC 715 E BROADWAY AVE BISMARCK ND 58501 MEDICAL CLINIC 35 - SANFORD SEVENTH & ROSSER CLINIC 414 N 7TH STREET BISMARCK ND 58501 MEDICAL CLINIC 36 - SANFORD SEVENTH & THAYER CLINIC 209 N 7TH STREET BISMARCK ND 58501 MEDICAL CLINIC 37 - SANFORD SOUTH CLINIC 1040 TACOMA AVE BISMARCK ND 58504 MEDICAL CLINIC 38 - SANFORD STATE SREET CLINIC 3318 N 14TH STREET BISMARCK ND 58503 MEDICAL CLINIC 39 - SANFORD TOM & FRANCES LEACH BISMARCK DIALY 209 N 7TH STREET BISMARCK ND 58501 DIALYSIS CENTER 40 - SANFORD BEMIDJI BLACKDUCK CLINIC 81 1ST ST NW BLACKDUCK MN 56630 MEDICAL CLINIC 41 - SANFORD BOYDEN CLINIC 3971 320TH ST BOYDEN IA 51234 MEDICAL CLINIC 42 - SANFORD BRANDON ACUTE CARE & ORTHO FAST TR 1105 E HOLLY BLVD BRANDON SD 57005 MEDICAL CLINIC 43 - SANFORD BRANDON FAMILY MEDICINE & CHILDREN 1105 E HOLLY BLVD BRANDON SD 57005 MEDICAL CLINIC 44 - SANFORD HEALTH BROOKINGS CLINIC 922 - 22ND AVENUE S BROOKINGS SD 57006 MEDICAL CLINIC 45 - SANFORD CANBY CLINIC 112 ST OLAF AVENUE S CANBY MN 56220 MEDICARE CERTIFIED RURAL HEALTH CLINIC 46 - SANFORD CANBY DENTAL CLINIC 11 ST OLAF AVENUE S CANBY MN 56220 DENTAL CLINIC 47 - SANFORD CANBY DIALYSIS UNIT 112 ST OLAF AVENUE S CANBY MN 56220 MEDICARE CERTIFIED END STAGE RENAL DIALYSIS 48 - SANFORD CANBY HOME CARE 213 ST OLAF AVENUE N CANBY MN 56220 MEDICARE CERTIFIED HOME HEALTH AGENCY 49 - SANFORD CANBY MEDICAL CENTER 112 ST OLAF AVENUE S CANBY MN 56220 CLASS F HOME CARE PROVIDER 50 - SANFORD DIALYSIS CANBY 112 ST OLAF AVENUE S CANBY MN 56220 DIALYSIS 51 - SANFORD HEALTH CANBY SYLVAN PLACE 212 ST OLAF AVENUE S CANBY MN 56220 HOUSING WITH SERVICES 52 - SANFORD HEALTH CANISTOTAUSD CLINIC 320 W MAIN ST CANISTOTA SD 57012 RURAL HEALTH CLINIC 53 - SANFORD CANTON CLINIC 400 N HIAWATHA DRIVE CANTON SD 57013 RURAL HEALTH CLINIC 54 - SANFORD HEALTH CANTON HIAWATHA HEIGHTS 398 N HIAWATHA DRIVE CANTON SD 57013 ASSISTED LIVING CENTER 55 - SANFORD BEMIDJI CASS LAKE CLINIC 219 GRANT UTLEY AVE NW CASS LAKE MN 56633 MEDICAL CLINIC 56 - SANFORD CHAMBERLAIN CLINIC 300 S BYRON BLVD CHAMBERLAIN SD 57325 RURAL HEALTH CLINIC 57 - SANFORD DIALYSIS 300 S BYRON BLVD CHAMBERLAIN SD 57325 DIALYSIS 58 - SANFORD HEALTH CHAMBERLAIN CARE CENTER 300 S BYRON BLVD CHAMBERLAIN SD 57325 NURSING FACILITY 59 - SANFORD HOME HEALTH & HOSPICE CHAMBERLAIN 110 W BEEBE AVE CHAMBERLAIN SD 57325 HOME HEALTH CARE & HOSPICE 60 - SANFORD HEALTH CLARK CLINIC 211 N COMMERCIAL STREET CLARK SD 57225 RURAL HEALTH CLINIC 61 - SANFORD CLEAR LAKE CLINIC 701 3RD AVENUE S CLEAR LAKE SD 57226 RURAL HEALTH CLINIC 62 - SANFORD CLEAR LAKE MEDICAL CENTER 701 3RD AVENUE S CLEAR LAKE SD 57226 HOME HEALTH CARE 63 - SANFORD BAGLEY CLEARBROOK CLINIC 22 ELM STREET CLEARBROOK MN 56634 RURAL HEALTH CLINIC 64 - SANFORD HEALTH DAKOTA DUNES CLINIC 350 OAK TREE LN DAKOTA DUNES SD 57049 MEDICAL CLINIC 65 - SANFORD HEALTH DELL RAPIDS ORCHARD HILLS 200 W 10TH STREET DELL RAPIDS SD 57022 ASSISTED LIVING CENTER 66 - SANFORD DIALYSIS 1234 WASHINGTON AVE SUITE B DETROIT LAKES MN 56501 DIALYSIS CENTER 67 - SANFORD HEALTH DETROIT LAKES CLINIC & SAME 1245 WASHINGTON AVENUE DETROIT LAKES MN 56501 AMBULATORY SURGERY CENTER/CLINIC 68 - SANFORD HEALTH DETROIT LAKES EYE CENTER 1234 WASHINGTON AVE SUITE A DETROIT LAKES MN 56501 EYE CARE CENTER 69 - SANFORD HEALTH EAST DICKINSON CLINIC 33 9TH ST W DICKINSON ND 58601 MEDICAL CLINIC 70 - SANFORD HEALTH HEARING CENTER DICKINSON 1531 W VILLARD ST DICKINSON ND 58601 HEARING CENTER 71 - SANFORD HEALTH WEST DICKINSON CLINIC 2615 FAIRWAY STREET DICKINSON ND 58601 MEDICAL CLINIC 72 - SANFORD DERMATOLOGY CLINIC 625 DEMERS AVE NW EAST GRAND FORKS MN 56721 MEDICAL CLINIC 73 - SANFORD HEALTH 621 DEMERS AVE CLINIC 621 DEMERS AVE NW EAST GRAND FORKS MN 56721 MEDICAL CLINIC 74 - SANFORD HEALTH 625 DEMERS AVE CLINIC 625 DEMERS AVE NW EAST GRAND FORKS MN 56721 MEDICAL CLINIC 75 - SANFORD HEALTH 929 CENTRAL AVE CLINIC 929 CENTRAL AVE EAST GRAND FORKS MN 56721 MEDICAL CLINIC 76 - SANFORD HOME CARE EAST GRAND FORKS 404 DEMERS AVE EAST GRAND FORKS MN 56721 HOME HEALTH CARE 77 - SANFORD HEALTH EDGELEY CLINIC 506 2ND ST EDGELEY ND 58433 MEDICAL CLINIC 78 - SANFORD LUVERNE EDGERTON CLINIC 733 MAIN AVE EDGERTON MN 56128 RURAL HEALTH CLINIC 79 - SANFORD HEALTH ELLENDALE CLINIC 141 MAIN ST ELLENDALE ND 58436 RURAL HEALTH CLINIC 80 - SANFORD HEALTH ENDERLIN CLINIC 201 4TH AVENUE ENDERLIN ND 58027 RURAL HEALTH CLINIC 81 - SANFORD CLINIC ESTELLINE 305 HOSPITAL DRIVE ESTELLINE SD 57234 RURAL HEALTH CLINIC 82 - EDITH SANFORD BREAST CENTER FARGO 737 BROADWAY N FARGO ND 58102 WOMEN'S HEALTH 83 - SANFORD 1711 MEDICAL BUILDING 1711 UNIVERSITY DRIVE S FARGO ND 58103 MEDICAL CLINIC 84 - SANFORD 2801 MEDICAL BUILDING 2801 S UNIVERSITY DRIVE FARGO ND 58122 MEDICAL CLINIC 85 - SANFORD BRAIN & SPINE CENTER FARGO 2301 25TH ST S FARGO ND 58103 MEDICAL CLINIC 86 - SANFORD BROADWAY CLINIC 801 BROADWAY N FARGO ND 58102 MEDICAL CLINIC 87 - SANFORD BROADWAY MEDICAL BUILDING 736 BROADWAY N FARGO ND 58102 MEDICAL CLINIC 88 - SANFORD CHILDREN'S BROADWAY CLINIC 737 BROADWAY N FARGO ND 58102 CHILDREN'S CLINIC 89 - SANFORD CHILDREN'S CARE CLINIC 100 4TH STREET S FARGO ND 58103 CHILDREN'S CLINIC 90 - SANFORD CHILDREN'S SOUTHWEST CLINIC 2701 13TH AVE S FARGO ND 58103 CHILDREN'S CLINIC 91 - SANFORD DERMATOLOGY & LASER CLINIC 4656 40TH AVE S FARGO ND 58104 MEDICAL CLINIC 92 - SANFORD DIALYSIS FARGO 2801 S UNIVERSITY DRIVE FARGO ND 58122 DIALYSIS 93 - SANFORD FOOT AND ANKLE CLINIC 1720 S UNIVERSITY DR FARGO ND 58103 MEDICAL CLINIC 94 - SANFORD HOME CARE FARGO 100 4TH STREET S FARGO ND 58103 HOME HEALTH AGENCY 95 - SANFORD I-94 CLINIC 5225 23RD AVENUE SOUTH FARGO ND 58104 MEDICAL CLINIC 96 - SANFORD NEUROSCIENCE CLINIC 700 1ST AVE S FARGO ND 58103 MEDICAL CLINIC 97 - SANFORD NORTH FARGO CLINIC 2601 BROADWAY N FARGO ND 58102 MEDICAL CLINIC 98 - SANFORD ORTHOPEDIC WALK-IN CLINIC FARGO 1720 S UNIVERSITY DR FARGO ND 58103 MEDICAL CLINIC 99 - SANFORD PAIN CENTER FARGO 2301 25TH ST S FARGO ND 58103 MEDICAL CLINIC 100 - SANFORD REPRODUCTIVE MEDICINE CLINIC 1111 HARWOOD DRIVE S FARGO ND 58104 MEDICAL CLINIC 101 - SANFORD ROGER MARIS CANCER CENTER 820 4TH STREET N FARGO ND 58102 CANCER CENTER 102 - SANFORD SOUTH UNIVERSITY CLINIC 1717 S UNIVERSITY DR FARGO ND 58103 MEDICAL CLINIC 103 - SANFORD SOUTH UNIVERSITY EYE CENTER & OPTI 1717 S UNIVERSITY DR FARGO ND 58103 EYE CARE CENTER 104 - SANFORD SOUTHPOINTE CLINIC 2400 32ND AVE S FARGO ND 58103 MEDICAL CLINIC 105 - SANFORD SOUTHPOINTE EYE CENTER & OPTICAL 2400 32ND AVE S FARGO ND 58103 EYE CARE CENTER 106 - SANFORD VETERANS SQUARE CLINIC 3955 56TH ST S FARGO ND 58104 MEDICAL CLINIC 107 - SANFORD HEALTH FINLEY CLINIC 407 WASHINGTON AVE E FINLEY ND 58230 RURAL HEALTH CLINIC 108 - SANFORD HEALTH FORMAN CLINIC 336 MAIN ST FORMAN ND 58032 RURAL HEALTH CLINIC 109 - SANFORD DIALYSIS FORT YATES 10 N RIVER ROAD FORT YATES ND 58538 DIALYSIS CENTER 110 - SANFORD HEALTH GRAND FORKS CLINIC 1750 47TH AVE S GRAND FORKS ND 58201 MEDICAL CLINIC 111 - SANFORD HEALTH GWINNER CLINIC 69 HIGHWAY 13 W GWINNER ND 58040 MEDICAL CLINIC 112 - SANFORD HEALTH HALSTAD CLINIC 445 1ST STREET E HALSTAD MN 56548 RURAL HEALTH CLINIC 113 - SANFORD HEALTH HARTFORD CLINIC 905 N OAKS AVE HARTFORD SD 57033 MEDICAL CLINIC 114 - SANFORD SHELDON HARTLEY CLINIC 512 3RD ST NE HARTLEY IA 51346 MEDICAL CLINIC 115 - SANFORD HAWLEY CLINIC 1412 MAIN ST HAWLEY MN 56549 MEDICAL CLINIC 116 - SANFORD HEALTH COMSTOCK CORNER 12 3RD STREET SE HILLSBORO ND 58045 ASSISTED LIVING CENTER 117 - SANFORD HEALTH HILLSBORO CLINIC 315 EAST CALEDONIA HILLSBORO ND 58045 RURAL HEALTH CLINIC 118 - SANFORD HILLSBORO CARE CENTER 12 3RD STREET SE HILLSBORO ND 58045 HOSPITAL BASED-NURSING FACILITIES LTC 119 - SANFORD HEALTH DIALYSIS HOSPERS 112 SUNRISE DRIVE HOSPERS IA 51238 END STAGE RENAL DIALYSIS 120 - SANFORD HEALTH INTL FALLS EYE CENTER 1400 HIGHWAY 71 INTERNATIONAL FALLS MN 56649 EYE CARE CENTER 121 - SANFORD HEALTH INWOOD CLINIC 303 E JEFFERSON ST INWOOD IA 51240 MEDICAL CLINIC 122 - SANFORD CLINIC IPSWICH 110 5TH AVENUE IPSWICH SD 57451 RURAL HEALTH CLINIC 123 - SANFORD JACKSON CLINIC 1430 NORTH HIGHWAY JACKSON MN 56143 MEDICARE CERTIFIED RURAL HEALTH CLINIC 124 - SANFORD DIALYSIS JAMESTOWN 300 2ND AVENUE NE JAMESTOWN ND 58401 DIALYSIS CENTER 125 - SANFORD DIALYSIS JAMESTOWN 300 2ND AVENUE NE JAMESTOWN ND 58401 DIALYSIS 126 - SANFORD HEALTH HEARING CENTER JAMESTOWN 904 5TH AVE NE JAMESTOWN ND 58401 HEARING CENTER 127 - SANFORD HEALTH JAMESTOWN 2ND AVE CLINIC 300 2ND AVENUE NE JAMESTOWN ND 58401 MEDICAL CLINIC 128 - SANFORD HEALTH JAMESTOWN CLINIC 904 5TH AVE NE JAMESTOWN ND 58401 MEDICAL CLINIC 129 - SANFORD HEALTH KELLIHER CLINIC 243 CLARK AVE N KELLIHER MN 56650 MEDICAL CLINIC 130 - SANFORD HEALTH KIMBALL CLINIC 101 S MAIN ST KIMBALL SD 57355 RURAL HEALTH CLINIC 131 - SANFORD CHILDREN'S CLINIC 3001 DAGGETT ST KLAMATH FALLS OR 97601 MEDICAL CLINIC 132 - SANFORD HEALTH LAKE NORDEN CLINIC 512 MAIN AVE LAKE NORDEN SD 57248 RURAL HEALTH CLINIC 133 - SANFORD HEALTH LAKE PARK CLINIC 215 N MARKET ST LAKE PARK IA 51347 MEDICAL CLINIC 134 - SANFORD JACKSON LAKEFIELD CLINIC 209 MAIN STREET LAKEFIELD MN 56150 MEDICARE CERTIFIED RURAL HEALTH CLINIC 135 - SANFORD HEALTH LAMOURE CLINIC 100 1ST AVE SW LAMOURE ND 58458 RURAL HEALTH CLINIC 136 - SANFORD HEALTH LENNOX CLINIC 108 S MAIN LENNOX SD 57039 RURAL HEALTH CLINIC 137 - SANFORD HEALTH LIDGERWOOD CLINIC 21 WILEY AVE S LIDGERWOOD ND 58053 MEDICAL CLINIC 138 - SANFORD HEALTH LISBON CLINIC 102 10TH AVE W LISBON ND 58054 MEDICAL CLINIC 139 - SANFORD HOME CARE LISBON 404 FOREST ST LISBON ND 58054 HOME HEALTH CARE 140 - SANFORD HOME HEALTH LUVERNE 304 N MCKENZIE ST LUVERNE MN 56156 HOME HEALTH CARE 141 - SANFORD LUVERNE CLINIC 1601 SIOUX VALLEY DR LUVERNE MN 56156 MEDICAL CLINIC 142 - SANFORD LUVERNE HOSPICE 217 N OAKLEY ST LUVERNE MN 56156 MEDICARE CERTIFIED HOSPICE 143 - SANFORD DIALYSIS 323 SW 10TH STREET MADISON SD 57042 END STAGE RENAL DIALYSIS 144 - SANFORD HOSPICE MADISON 900 2ND AVENUE MADISON MN 56256 HOSPICE (LICENSED IN SD) 145 - SANFORD HOME CARE MAHNOMEN 414 W JEFFERSON AVE MAHNOMEN MN 56557 HOME HEALTH CARE 146 - SANFORD HEALTH MAHNOMEN CLINIC 410 W 4TH ST MAHNOMEN MN 56557 RURAL HEALTH CLINIC 147 - SANFORD EAST MANDAN CLINIC 102 MANDAN AVE MANDAN ND 58554 MEDICAL CLINIC 148 - SANFORD HOME CARE BISMARCK 910 18TH STREET NW MANDAN ND 58554 HOME HEALTH AGENCY 149 - SANFORD NORTH MANDAN CLINIC 910 18TH STREET NW MANDAN ND 58554 MEDICAL CLINIC 150 - SANFORD HOME CARE MAYVILLE 49 7TH AVE SE MAYVILLE ND 58257 HOME HEALTH CARE 151 - SANFORD MAYVILLE CLINIC 600 1ST ST SE MAYVILLE ND 58257 MEDICAL CLINIC 152 - SANFORD HEALTH HIGHWAY 2 CLINIC 801 21ST AVE SE MINOT ND 58701 MEDICAL CLINIC 153 - SANFORD HEALTH NORTHWEST CLINIC 1500 21ST AVE NW MINOT ND 58701 MEDICA 154 - SANFORD HEALTH MITCHELL CLINIC 2100 HIGHLAND WAY MITCHELL SD 57301 MEDICAL CLINIC 155 - SANFORD MOORHEAD CAMPUS 4000 28TH AVE S MOORHEAD MN 56560 MEDICAL CLINIC 156 - SANFORD DIALYSIS MORRIS 400 1ST STREET EAST MORRIS MN 56267 DIALYSIS 157 - SANFORD HEALTH MOUNTAIN LAKE CLINIC 308 N 8TH STREET MOUNTAIN LAKE MN 56159 MEDICARE CERTIFIED RURAL HEALTH CLINIC 158 - SANFORD HEALTH OAKES CLINIC 420 7TH ST S OAKES ND 58474 MEDICAL CLINIC 159 - SANFORD CHILDREN'S CLINIC 3605 VISTA WAY OCEANSIDE CA 92056 CHILDREN'S CLINIC 160 - SANFORD HEALTH PARK RAPIDS CLINIC 110 7TH ST W PARK RAPIDS MN 56470 MEDICAL CLINIC 161 - SANFORD HEALTH PARKERS PRAIRIE CLINIC 115 E SOO STREET PARKERS PRAIRIE MN 56361 MEDICAL CLINIC 162 - SANFORD HEALTH PELICAN RAPIDS CLINIC 211 EAST MILL STREET PELICAN RAPIDS MN 56572 RURAL HEALTH CLINIC 163 - SANFORD HOME CARE PELICAN RAPIDS 211 EAST MILL STREET PELICAN RAPIDS MN 56572 HOME HEALTH CARE 164 - SANFORD HEALTH PIERRE CLINIC 521 E SIOUX AVE PIERRE SD 57501 MEDICAL CLINIC 165 - SANFORD VERMILLION PONCA CLINIC 111 E 2ND STREET PONCA NE 68770 MEDICAL CLINIC 166 - SANFORD DIALYSIS RED LAKE 24760 HOSPITAL DRIVE RED LAKE MN 56671 DIALYSIS 167 - SANFORD ROCK RAPIDS CLINIC 104 BUNCOMBE DRIVE ROCK RAPIDS IA 51246 RURAL HEALTH CLINIC 168 - SANFORD SHELDON SANBORN CLINIC 321 MAIN STREET SANBORN IA 51248 MEDICAL CLINIC 169 - SANFORD HEALTH SHELDON CARE CENTER 118 NORTH SEVENTH AVENUE PO BOX 250 SHELDON IA 51201 HOSPITAL BASED-NURSING FACILITIES 170 - SANFORD SHELDON CLINIC 800 OAK STREET SHELDON IA 51201 RURAL HEALTH CLINIC 171 - SANFORD SHELDON HOME HEALTH & HOSPICE 118 NORTH SEVENTH AVENUE PO BOX 250 SHELDON IA 51201 HOME HEALTH AGENCY AND HOSPICE 172 - AVA'S HOUSE 1320 W 17TH STREET SIOUX FALLS SD 57104 HOSPICE 173 - SANFORD 10TH & PHILLIPS ACUTE CARE CLINIC 136 S PHILLIPS AVE SIOUX FALLS SD 57104 MEDICAL CLINIC 174 - SANFORD 26TH & SYCAMORE FAMILY MEDICINE 4405 E 26TH ST SIOUX FALLS SD 57103 MEDICAL CLINIC 175 - SANFORD 32ND & ELLIS CLINIC 2601 S ELLIS ROAD SIOUX FALLS SD 57106 MEDICAL CLINIC 176 - SANFORD 49TH & OXBOW FAMILY MEDICINE 3401 W 49TH STREET SIOUX FALLS SD 57106 MEDICAL CLINIC 177 - SANFORD 4TH & SYCAMORE FAMILY MEDICINE 600 N SYCAMORE AVE SIOUX FALLS SD 57110 MEDICAL CLINIC 178 - SANFORD 69TH & LOUISE FAMILY MEDICINE 6101 S LOUISE AVE SIOUX FALLS SD 57108 MEDICAL CLINIC 179 - SANFORD 69TH & MINNESOTA FAMILY MEDICINE 6110 S MINNESOTA AVE SIOUX FALLS SD 57108 MEDICAL CLINIC 180 - SANFORD ACUTE CARE AND ORTHOPEDIC FAST TRA 4000 N HERCULES AVE SIOUX FALLS SD 57110 MEDICAL CLINIC 181 - SANFORD CANCER CENTER 1309 W 17TH ST SIOUX FALLS SD 57104 CANCER CENTER 182 - SANFORD CARDIOVASCULAR INSTITUTE 1301 W 18TH STREET SIOUX FALLS SD 57105 MEDICAL CLINIC 183 - SANFORD CHILDREN'S MB2 CLINIC 1205 S GRANGE AVE SIOUX FALLS SD 57105 CHILDREN'S CLINIC 184 - SANFORD CHILDREN'S RESIDENCY CLINIC 6101 S LOUISE AVE SIOUX FALLS SD 57108 CHILDREN'S CLINIC 185 - SANFORD CHILDREN'S SPECIALTY CLINIC 1600 W 22ND STREET SIOUX FALLS SD 57117 CHILDREN'S CLINIC 186 - SANFORD DERMATOLOGY CLINIC 1310 W 22ND STREET SIOUX FALLS SD 57105 MEDICAL CLINIC 187 - SANFORD DIABETES & THYROID CLINIC 1305 W 18TH STREET SIOUX FALLS SD 57105 MEDICAL CLINIC 188 - SANFORD DIALYSIS SIOUX FALLS 1321 W 22ND STREET SIOUX FALLS SD 57117 DIALYSIS CENTER 189 - SANFORD EAR NOSE AND THROAT CLINIC 1310 W 22ND STREET SIOUX FALLS SD 57105 MEDICAL CLINIC 190 - SANFORD EYE CENTER & OPTICAL 1621 S MINNESOTA AVE SIOUX FALLS SD 57105 EYE CARE CENTER 191 - SANFORD HEALTH EYE CLINIC 2310 S MARION RD 140 SIOUX FALLS SD 57106 EYE CARE CENTER 192 - SANFORD HEALTH MB2 CLINIC 1205 S GRANGE AVE SIOUX FALLS SD 57105 MEDICAL CLINIC 193 - SANFORD HOME HEALTH SIOUX FALLS 2710 WEST 12TH STREET SIOUX FALLS SD 57104 HOME HEALTH CARE 194 - SANFORD HOSPICE SIOUX FALLS 2710 WEST 12TH STREET SIOUX FALLS SD 57104 HOSPICE (LICENSED IN MN AND SD) 195 - SANFORD IMAGENETICS 1321 W 22ND STREET SIOUX FALLS SD 57117 GENETICS 196 - SANFORD INTERNAL MEDICINE CLINIC 1321 W 22ND STREET SIOUX FALLS SD 57117 MEDICAL CLINIC 197 - SANFORD MADISON AND VETERANS PARKWAY 5920 E MADISON ST SIOUX FALLS SD 57110 MEDICAL CLINIC 198 - SANFORD MATERNAL-FETAL MEDICINE 1500 W 22ND STREET SIOUX FALLS SD 57105 MEDICAL CLINIC 199 - SANFORD OBSTETRICS & GYNECOLOGY CLINIC 1500 W 22ND STREET SIOUX FALLS SD 57105 MEDICAL CLINIC 200 - SANFORD PSYCHIATRY & PSYCHOLOGY CLINIC 2400 W 49TH STREET SIOUX FALLS SD 57105 MEDICAL CLINIC 201 - SANFORD SURGICAL ASSOCIATES 1508 W 22ND STREET SIOUX FALLS SD 57105 AMBULATORY SURGERY CENTER/CLINIC 202 - SANFORD USD 34TH & KIWANIS FAMILY MEDICINE 2701 S KIWANIS AVE SIOUX FALLS SD 57105 MEDICAL CLINIC 203 - SANFORD VAN DEMARK CLINIC 1210 W 18TH STREET SIOUX FALLS SD 57104 MEDICAL CLINIC 204 - SANFORD VASCULAR ASSOCIATES 1305 W 18TH STREET SIOUX FALLS SD 57105 MEDICAL CLINIC 205 - SANFORD WOMEN'S PRIMARY CARE CLINIC 5019 S WESTERN AVE SIOUX FALLS SD 57108 MEDICAL CLINIC 206 - THE BIRTH PLACE 1500 W 22ND STREET SIOUX FALLS SD 57105 BIRTH CENTER 207 - NORTHERN LIGHTS COMMUNITY RESIDENCE 921 ATLANTIC AVE N THIEF RIVER FALLS MN 56701 RESIDENTIAL BEHAVIORAL HEALTH 208 - SANFORD BEHAVIORAL HEALTH OUTPATIENT CLINI 120 LABREE AVENUE S THIEF RIVER FALLS MN 56701 BEHAVIORAL HEALTH TREATMENT CENTER 209 - SANFORD DIALYSIS THIEF RIVER FALLS 120 LABREE AVENUE S THIEF RIVER FALLS MN 56701 DIALYSIS 210 - SANFORD HEALTH THIEF RIVER FALLS EYE CENTE 1720 HIGHWAY 59 S THIEF RIVER FALLS MN 56701 EYE CARE CENTER 211 - SANFORD HEALTH THIEF RIVER FALLS SOUTHEAST 1720 HIGHWAY 59 S THIEF RIVER FALLS MN 56701 MEDICAL CLINIC 212 - SANFORD THIEF RIVER FALLS CLINIC 3001 SANFORD PKWY THIEF RIVER FALLS MN 56701 MEDICAL CLINIC 213 - SANFORD HEALTH TRACY O'BRIEN COURT 410 STATE STREET TRACY MN 56175 HOUSING WITH SERVICES 214 - SANFORD TRACY CLINIC 249 FIFTH STREET E TRACY MN 56175 MEDICARE CERTIFIED RURAL HEALTH CLINIC 215 - SHETEK HOME CARE SERVICES 251 5TH ST E TRACY MN 56175 HOME HEALTH CARE 216 - SANFORD HEALTH TWIN VALLEY CLINIC 501 2ND ST NW TWIN VALLEY MN 56584 RURAL HEALTH CLINIC 217 - SANFORD HEALTH ULEN CLINIC 108 VIKING AVENUE W ULEN MN 56585 RURAL HEALTH CLINIC 218 - SANFORD HEALTH VALLEY CITY CLINIC 520 CHAUTAUQUA BLVD VALLEY CITY ND 58072 MEDICAL CLINIC 219 - SANFORD HEALTH VERMILLION CARE CENTER 125 WALKER STREET VERMILLION SD 57069 NURSING FACILITY 220 - SANFORD HEALTH VERMILLION DAKOTA GERDENS 126 S PLUM STREET VERMILLION SD 57069 RESIDENTIAL LIVING CENTER 221 - SANFORD HOSPICE VERMILLION 848 EAST CHERRY STREET VERMILLION SD 57069 HOSPICE 222 - SANFORD VERMILLION CLINIC 20 S PLUM STREET VERMILLION SD 56069 MEDICAL CLINIC 223 - SANFORD DIALYSIS 111 WASHINGTON AVE NW WAGNER SD 57380 DIALYSIS CENTER 224 - SANFORD HEALTH WAHPETON CLINIC 332 2ND AVE N WAHPETON ND 58075 MEDICAL CLINIC 225 - SANFORD HEALTH WAHPETON EYE CENTER & OPTIC 332 2ND AVE N WAHPETON ND 58075 EYE CARE CENTER 226 - SANFORD HEALTH WAHPETON PT & PSYCHOLOGY 123 2ND AVE N WAHPETON ND 58075 MEDICAL CLINIC 227 - SANFORD HEALTH WALKER CLINIC 614 MICHIGAN AVENUE WALKER MN 56484 RURAL HEALTH CLINIC 228 - SANFORD TRACY WALNUT GROVE CLINIC 810 8TH ST WALNUT GROVE MN 56180 MEDICARE CERTIFIED RURAL HEALTH CLINIC 229 - SANFORD HEALTH WATERTOWN CLINIC 901 4TH STREET NW WATERTOWN SD 57201 MEDICAL CLINIC 230 - SANFORD HEALTH HEARING CENTER 116 8TH STREET NE WATFORD CITY ND 58854 HEARING CENTER 231 - SANFORD HEALTH WATFORD CITY CLINIC 709 4TH AVE NE WATFORD CITY ND 58854 MEDICAL CLINIC 232 - SANFORD WEBSTER CLINIC 101 PEABODY DRIVE WEBSTER SD 57274 RURAL HEALTH CLINIC 233 - SANFORD WEST FARGO CLINIC 1220 SHEYENNE STREET WEST FARGO ND 58078 MEDICAL CLINIC 234 - SANFORD HEALTH WESTROOK PETERSON ESTATES 1012 9TH STREET WESTBROOK MN 56183 HOUSING WITH SERVICES 235 - SANFORD WESTBROOK CLINIC 920 BELL AVENUE WESTBROOK MN 56183 MEDICARE CERTIFIED RURAL HEALTH CLINIC 236 - SANFORD HOME CARE WHEATON 405 12TH ST N WHEATON MN 56926 HOME HEALTH CARE 237 - SANFORD WHEATON CLINIC 401 12TH ST N WHEATON MN 56926 RURAL HEALTH CLINIC 238 - SANFORD 11TH & GATE CLINIC 17100 11TH ST W WILLISTON ND 58801 MEDICAL CLINIC 239 - SANFORD CLINIC WINDOM 591 2ND AVENUE N WINDOM MN 56101 MEDICARE CERTIFIED RURAL HEALTH CLINIC 240 - SANFORD HOSPICE WINNER 745 E 8TH STREET WINNER SD 57580 HOSPICE 241 - SANFORD DIALYSIS 1018 SIXTH AVENUE WORTHINGTON MN 56187 DIALYSIS CENTER 242 - SANFORD HEALTH CANCER CENTER 1018 SIXTH AVENUE WORTHINGTON MN 56187 CANCER CENTER 243 - SANFORD HOSPICE WORTHINGTON 1935 WOODLAND CT WORTHINGTON MN 56187 HOSPICE (LICENSED IN SD) 244 - SANFORD WORTHINGTON CLINIC 1680 DIAGONAL ROAD WORTHINGTON MN 56187 MEDICAL CLINIC 245 - SANFORD WORTHINGTON MEDICAL CENTER 1018 SIXTH AVENUE WORTHINGTON MN 56187 MEDICARE CERTIFIED END STAGE RENAL DIALYSIS 246 - SANFORD WORTHINGTON OBGYN CLINIC 1018 SIXTH AVENUE WORTHINGTON MN 56187 MEDICAL CLINIC 247 - BLACK HILLS IMAGING CENTER 215 ANAMARIA DRIVE RAPID CITY SD 57701 DIAGNOSTIC IMAGING CENTER 248 - BLACK HILLS OCCUPATIONAL MEDICINE 1730 HAINES AVENUE RAPID CITY SD 57701 MEDICAL CLINIC 249 - BLACK HILLS OUTREACH CLINIC 120 E MICHIGAN STREET SPEARFISH SD 87783 MEDICAL CLINIC 250 - BLACK HILLS URGENT CARE 741 MOUNTAIN VIEW ROAD RAPID CITY SD 57702 MEDICAL CLINIC 251 - BLACK HILLS URGENT CARE 2201 S DOUGLAS HIGHWAY GILLETTE WY 82718 MEDICAL CLINIC 252 - NORTHEAST WYOMING SURGERY CENTER 1307 W 3RD STREET GILLETTE WY 82716 AMBULATORY SURGERY CENTER PART I, LINE 3C: SANFORD HEALTH DOES NOT DENY CARE TO ANYONE BASED ON THE ABILITY TO PAY. SANFORD HEALTH'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 HEALTH 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 HEALTH PATIENT REGISTRATION AREA.THE PRIMARY SCOPE OF SANFORD HEALTH'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 HEALTH 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 HEALTH 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 HEALTH AGB DISCOUNT AMOUNT. PART I, LINE 5B: SANFORD HEALTH AS A WHOLE DID NOT EXCEED ITS FINANCIAL ASSISTANCE BUDGET FOR CY 2024, 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 HEALTH 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 HEALTH. EACH LOSS HAS BEEN CALCULATED AFTER REMOVING LOSSES ASSOCIATED WITH BAD DEBTS, FINANCIAL ASSISTANCE AND MEDICAID. ALTHOUGH THESE SERVICES GENERATE OVERALL LOSSES TO SANFORD HEALTH, THEY CONTINUE TO MEET THE NEEDS OF THE COMMUNITIES SERVED. VARIOUS SERVICES THAT GENERATE LOSSES ARE PROVIDED BY SANFORD HEALTH THROUGH PHYSICIAN PRACTICES. FOR CY 2024, SUBSIDIZED HEALTH SERVICES PROVIDED THROUGH CLINIC PHYSICIAN PRACTICES GENERATED LOSSES OF $268,371,188. 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 HEATH IS COMMITTED TO GIVING BACK TO THE COMMUNITIES IN WHICH ITS EMPLOYEES AND PATIENTS LIVE AND WORK. SANFORD HEALTH 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 HEALTH WORKFORCE TO DELIVER THE BEST PATIENT CARE AND MUCH NEEDED MEDICAL RESEARCH. SANFORD HEALTH 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 BASED ON AMOUNTS RECORDED IN THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). BAD DEBT REPRESENTS SERVICES PROVIDED TO PATIENTS WHO WERE EXPECTED TO PAY BUT DID NOT, AFTER REASONABLE COLLECTION EFFORTS. DISCOUNTS AND ALLOWANCES ARE ACCOUNTED FOR SEPARATELY FROM BAD DEBT EXPENSE. PART III, LINE 3: IT IS SANFORD HEALTH'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 HEALTH 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 HEALTH 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 HEALTH INCURRED WERE INCLUDED ON THE MEDICARE COST REPORT; THIS WOULD SHOW A SHORTFALL OF APPROXIMATELY $735,627,035. SANFORD HEALTH 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 HEALTH. PART III, LINE 9B: SANFORD HEALTH 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 HEALTH 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 HEALTH HAS ZERO TOLERANCE FOR ABUSIVE, HARASSING, OPPRESSIVE, FALSE, DECEPTIVE, OR MISLEADING LANGUAGE OF COLLECTIONS CONDUCT. THIS ZERO TOLERANCE APPLIES TO INTERNAL SANFORD HEALTH STAFF AND THIRD PARTY COLLECTION VENDORS AND ATTORNEYS.NEITHER SANFORD HEALTH NOR ANY OF ITS THIRD PARTY COLLECTION VENDORS WILL TAKE ANY EXTRAORDINARY COLLECTION EFFORTS UNTIL SANFORD HEALTH 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 HEALTH AND ANOTHER HEALTH SYSTEM BOTH OPERATE. ADDITIONALLY, SANFORD HEALTH 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 HEALTH VIEWS THE FINDINGS AS A COMMUNITY ASSET THAT CAN FURTHER THE POSITIVE IMPACT ON COMMUNITY HEALTH OUTSIDE THE WALLS OF THE SYSTEM.RECENTLY, SANFORD HEALTH 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 HEALTH 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 HEALTH'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 HEALTH 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 HEALTH. OTHER ENGAGEMENTS AND ASSESSMENTS INCLUDE LEADERSHIP AND MEMBERSHIP IN STATE HEALTHCARE ASSOCIATIONS AND VIZIENT. THE DEVELOPMENT OF PATIENT FAMILY ADVISORY AND HEALTH EQUITY AND EXPERIENCE 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 HEALTH 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 HEALTH EMPLOYS A VARIETY OF STRATEGIES TO MAKE CERTAIN THAT THE ORGANIZATION IS TRANSPARENT IN THE COMMUNICATION OF FINANCIAL ASSISTANCE GUIDELINES. THE STAFF AT SANFORD HEALTH MAKES EVERY EFFORT TO IDENTIFY PATIENTS NEEDING FINANCIAL ASSISTANCE AS EARLY IN THE REVENUE CYCLE AS POSSIBLE. ALL SANFORD HEALTH 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 HEALTH 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 HEALTH'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 HEALTH MAKES FINANCIAL ASSISTANCE INFORMATION AVAILABLE TO COMMUNITY AGENCIES AND REFERRAL ORGANIZATIONS. FINANCIAL ASSISTANCE INFORMATION IS ALSO AVAILABLE ON THE SANFORD HEALTH 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 56 MEDICAL CENTERS AND 288 CLINICS. SANFORD HEALTH'S APPROXIMATE 53,000 EMPLOYEES, INCLUDING 4,000 PHYSICIANS/ADVANCED PRACTICE PROVIDERS AND 10,164 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 2024 U.S. CENSUS BUREAU ESTIMATES A TOTAL POPULATION OF 209,289 FOR SIOUX FALLS. ACCORDING TO THE 2024 COUNTY HEALTH RANKINGS, THE POPULATION OF MINNEHAHA COUNTY IS 79.9% WHITE, 6.8% AFRICAN AMERICAN, 3.0% AMERICAN INDIAN, 2.2% ASIAN AND 6.1% 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 $75,600.SANFORD MEDICAL CENTER FARGO - FARGO, NORTH DAKOTAFARGO IS THE LARGEST CITY IN NORTH DAKOTA, ACCOUNTING FOR 17.5% OF THE STATE'S POPULATION. FARGO IS ALSO THE COUNTY SEAT OF CASS COUNTY. THE 2024 UNITED STATES CENSUS ESTIMATES THE POPULATION OF FARGO WAS 136,285. ACCORDING TO THE 2024 COUNTY HEALTH RANKINGS, THE POPULATION OF CASS COUNTY IS 83.2% WHITE, 6.8% AFRICAN AMERICAN, 1.6% AMERICAN INDIAN, 3.2% ASIAN AND 3.2% HISPANIC. ONLY 1% OF THE POPULATION IS REPORTED TO BE NOT PROFICIENT IN ENGLISH. THE MEDIAN HOUSEHOLD INCOME OF CASS COUNTY, ND IS $70,000. 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 2024 UNITED STATES CENSUS ESTIMATES, THE POPULATION OF BEMIDJI IS 15,733. ACCORDING TO THE 2024 COUNTY HEALTH RANKINGS, THE POPULATION OF BELTRAMI COUNTY IS 71.3% WHITE, 0.8% AFRICAN AMERICAN, 22.0% AMERICAN INDIAN, 0.8% ASIAN AND 2.7% HISPANIC. 0% OF THE POPULATION IS REPORTED TO BE NOT PROFICIENT IN ENGLISH. THE MEDIAN HOUSEHOLD INCOME IS $59,900.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 77,772. ACCORDING TO THE 2024 COUNTY HEALTH RANKINGS, THE POPULATION OF BURLEIGH COUNTY IS 87.4% WHITE, 2.1% AFRICAN AMERICAN, 4.7% AMERICAN INDIAN, 1.0% ASIAN AND 3.1% HISPANIC. 0% OF THE POPULATION IS REPORTED TO BE NOT PROFICIENT IN ENGLISH. THE MEDIAN HOUSEHOLD INCOME IS $83,100.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 4,000 PHYSICIANS PROVIDING SERVICES IN THE US AS WELL AS INTERNATIONALLY. PART VI, LINE 5: SANFORD HEALTH MAINTAINS AN OPEN MEDICAL STAFF. COMMUNITY BOARDS - THE SANFORD HEALTH BOARD OF TRUSTEES WAS COMPRISED OF 12 MEMBERS AT THE END OF THE CALENDAR YEAR, INCLUDING 10 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 SIOUX FALLS, SOUTH DAKOTA. IT IS ONE OF THE LARGEST RURAL HEALTH SYSTEMS IN THE NATION WITH 56 MEDICAL CENTERS AND 288 CLINIC LOCATIONS IN THE UPPER MIDWEST INCLUDING WYOMING, NORTH DAKOTA, SOUTH DAKOTA, IOWA, MINNESOTA, WISCONSIN, AND THE UPPER PENINSULA OF MICHIGAN AND THREE COUNTRIES. SANFORD HEALTH'S APPROXIMATE 53,000 EMPLOYEES, INCLUDING A NETWORK OF MORE THAN 4,000 PHYSICIANS AND ADVANCED PRACTICE PROVIDERS AND APPROXIMATELY 10,000 REGISTERED NURSES DELIVERING CARE IN MORE THAN 80 SPECIALTY AREAS, MAKE IT THE LARGEST EMPLOYER IN NORTH DAKOTA AND SOUTH DAKOTA.SANFORD HEALTH PROVIDES SERVICES AT EVERY LEVEL FROM CRITICAL ACCESS HOSPITALS TO TERTIARY AND QUATERNARY CARE. THE SANFORD SERVICE AREA COVERS A POPULATION OF APPROXIMATELY FIVE MILLION WITHIN WYOMING, NORTH DAKOTA, SOUTH DAKOTA, NORTHWEST IOWA, MINNESOTA, WISCONSIN, AND THE UPPER PENINSULA OF MICHIGAN AND INCLUDES 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 ABBOTT HOUSE INC 909 COURT MERRILL ST MITCHELL SD 57301 460229822 501(C)(3) 10000 0 PHYSICAL IMPROVEMENTS AND HOUSING ABERDEEN DEVELOPMENT CORP 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 1224 S 3RD ST ABERDEEN SD 57401 460423109 501(C)(3) 44000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES, WORKFORCE DEVELOPMENT ACTIVE GENERATIONS 2300 W 46TH ST SIOUX FALLS SD 57105 460305500 501(C)(3) 30590 0 COMMUNITY SUPPORT AMERICAN CANCER SOCIETY 250 WILLIAMS ST 4TH FL ATLANTA GA 30303 131788491 501(C)(3) 15500 0 COMMUNITY HEALTH IMPROVEMENT SERVICES AMERICAN FOUNDATION FOR SUICIDE PREVENTION 199 WATER ST FLOOR 11 NEW YORK NY 10038 133393329 501(C)(3) 7500 0 COMMUNITY HEALTH IMPROVEMENT SERVICES AMERICAN GOLD GYMNASTICS 2001 17TH AVE S FARGO ND 58103 450333196 501(C)(3) 40000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES AMERICAN HEART ASSOCIATION 7272 GREENVILLE AVENUE DALLAS TX 75231 135613797 501(C)(3) 36000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES AMERICAN RED CROSS 2925 E 57TH ST SIOUX FALLS SD 57108 530196605 501(C)(3) 33000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY SUPPORT AUGUSTANA 2001 S SUMMIT AVE SIOUX FALLS SD 57197 460224588 501(C)(3) 2166750 0 COALITION BUILDING, COMMUNITY SUPPORT, ECONOMIC DEVELOPMENT, HEALTH PROFESSIONS EDUCATION, WORKFORCE DEVELOPMENT BAGLEY FIRE DEPARTMENT 18 MAIN AVE SOUTH BAGLEY MN 56621 416037185 501(C)(3) 10000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES BEEF LOGIC INC 316 S COTEAU AVE PIERRE SD 57501 872043795 501(C)(3) 27500 0 COMMUNITY SUPPORT BELTRAMI COUNTY 701 MINNESOTA AVE NW SUITE 220 BEMIDJI MN 56601 416005757 115 0 1233609 FAIR VALUE DONATION OF BEMIDJI CRISIS CENTER ECONOMIC DEVELOPMENT BEMIDJI AREA SCHOOL DISTRICT 31 502 MINNESOTA AVE BEMIDJI MN 56619 416000181 115 116021 0 COMMUNITY HEALTH IMPROVEMENT SERVICES, WORKFORCE DEVELOPMENT BEMIDJI COMMUNITY ARENA CORP PO BOX 1726 BEMIDJI MN 566191726 813622011 501(C)(3) 60000 0 ECONOMIC DEVELOPMENT BEMIDJI STATE UNIVERSITY 1500 BIRCHMONT DR NE BEMIDJI MN 56601 411687554 115 76000 0 COMMUNITY SUPPORT, ECONOMIC DEVELOPMENT BEMIDJI YOUTH SOCCER PO BOX 265 BEMIDJI MN 56619 411870778 501(C)(3) 5500 0 COMMUNITY HEALTH IMPROVEMENT SERVICES BENEDICTINE SISTERS MOTHER OF GOD MONASTERY 2527 PRAIRIE PARK TRAIL SE WATERTOWN SD 57201 460284619 501(C)(3) 6000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES BISMARCK CANCER CENTER 500 N 8TH STREET BISMARCK ND 58501 450454363 501(C)(3) 11876 0 COMMUNITY SUPPORT BISMARCK MANDAN CHAMBER EDC 1640 BURNT BOAT DR BISMARCK ND 58503 450116753 501(C)(6) 6538 0 COMMUNITY HEALTH IMPROVEMENT SERVICES, ECONOMIC DEVELOPMENT, WORKFORCE DEVELOPMENT BISMARCK MARATHAN PO BOX 7023 BISMARCK ND 585077023 208441757 501(C)(3) 10609 0 ECONOMIC DEVELOPMENT BISMARCK PUBLIC SCHOOLS 806 N WASHINGTON ST BISMARCK ND 58501 450442960 501(C)(3) 135000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES, HEALTH PROFESSIONS EDUCATION, PHYSICAL IMPROVEMENTS AND HOUSING BISMARCK STATE COLLEGE 1500 EDWARDS AVE BISMARCK ND 43942 450343495 115 131171 0 HEALTH PROFESSIONS EDUCATION BOARD OF EDUCATION OF THE CITY OF FARGO 700 7TH ST S FARGO ND 57192 456000294 115 120000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES BOY SCOUTS NORTHERN LIGHTS COUNCIL 4200 19TH AVE S FARGO ND 581037207 450226415 501(C)(3) 7500 0 COMMUNITY HEALTH IMPROVEMENT SERVICES BOYS AND GIRLS CLUBS OF THE RED RIVER VALLEY 2500 18TH ST S FARGO ND 58103 450316132 501(C)(3) 40000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES BRANDON VALLEY BOOSTER CLUB PO BOX 572 BRANDON SD 57005 460393971 501(C)(3) 31814 0 COMMUNITY HEALTH IMPROVEMENT SERVICES BRANDON VALLEY SCHOOL DISTRICT 49-2 300 S SPLITROCK BLVD BRANDON SD 57005 466002577 115 44800 0 WORKFORCE DEVELOPMENT BURKE COMMUNITY MEMORIAL HOSPITAL PO BOX 319 809 JACKSON ST BURKE SD 57523 460219795 501(C)(3) 25000 0 PHYSICAL IMPROVEMENTS AND HOUSING BUTTERFLY HOUSE & AQUARIUM 4320 S OXBOW AVE SIOUX FALLS SD 57106 522370420 501(C)(3) 25000 0 ECONOMIC DEVELOPMENT CANTON SCHOOL DISTRICT 800 N MAIN ST CANTON SD 57013 466002143 115 16444 0 WORKFORCE DEVELOPMENT CHAMBER OF COMMERCE FARGO MOORHEAD WEST FARGO PO BOX 2443 FARGO ND 581082443 450448041 501(C)(6) 24356 0 ECONOMIC DEVELOPMENT CHILDRENS HOME SOCIETY OF SOUTH DAKOTA 801 N SYCAMORE SIOUX FALLS SD 57110 460224542 501(C)(3) 6000 0 COMMUNITY SUPPORT CHURCHES UNITED FOR THE HOMELESS 1901 1ST AVE N MOORHEAD MN 56560 411594892 501(C)(3) 50000 0 COMMUNITY HEALTH IMPROVEMENT ADVOCACY CITY OF BEMIDJI 1111 EVENT CENTER DR NE BEMIDJI MN 56601 270941862 115 200000 0 ECONOMIC DEVELOPMENT CITY OF MITCHELL 612 NORTH MAIN STREET MITCHELL SD 57301 466000305 115 10000 0 COMMUNITY SUPPORT CITY OF SIOUX FALLS 224 W NINTH ST SIOUX FALLS SD 571046407 466000425 115 0 6300000 FAIR VALUE DONATION OF TEA-ELLIS WELLNESS CENTER COMMUNITY HEALTH IMPROVEMENT SERVICES CITY OF TRACY MN 336 MORGAN ST TRACY MN 56175 416005581 115 10000 0 COMMUNITY SUPPORT CLEARWATER LIFE CENTER 256 2ND AVE SW CLEARBROOK MN 56634 770643868 501(C)(3) 6500 0 COMMUNITY HEALTH IMPROVEMENT SERVICES CONCORDIA COLLEGE 901 8TH STREET S MOORHEAD MN 565609981 410693977 501(C)(3) 3306000 0 ECONOMIC DEVELOPMENT, HEALTH PROFESSIONS EDUCATION, WORKFORCE DEVELOPMENT CRIBS FOR KIDS 5450 SECOND AVE PITTSBURGH PA 15207 251442806 501(C)(3) 0 9186 COST PAK N PLAYS FOR UNDERPRIVILEGED CHILDREN COMMUNITY HEALTH IMPROVEMENT SERVICES CULLEN CHILDREN'S FOUNDATION PO BOX 594 WEST FARGO ND 58078 770636521 501(C)(3) 15000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES DAKOTA ALLIANCE SOCCER CLUB (DASC) 401 W 39TH ST SIOUX FALLS SD 57105 460359817 501(C)(3) 60000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES DAKOTA MEDICAL FOUNDATION (DMF) 4141 28TH AVE SOUTH FARGO ND 58104 456012318 501(C)(3) 9550 0 COMMUNITY HEALTH IMPROVEMENT SERVICES DEAR NICU MAMA 19 8TH ST S FARGO ND 58103 842458534 501(C)(3) 5750 0 COMMUNITY HEALTH IMPROVEMENT SERVICES DETROIT LAKES PUBLIC SCHOOLS 702 LAKE AVENUE DETROIT LAKES MN 56501 410971772 115 20000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES DICKINSON PUBLIC SCHOOLS 444 4TH ST W DICKINSON ND 58601 456001585 115 10000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES DOWNTOWN COMMUNITY PARTNERSHIP 210 BROADWAY STE 202 FARGO ND 58102 464472309 501(C)(6) 20750 0 ECONOMIC DEVELOPMENT DSU HERITAGE FOUNDATION 230 8TH AVE W DICKINSON ND 58601 475378716 501(C)(3) 70000 0 ECONOMIC DEVELOPMENT ELEVATE RAPID CITY 525 UNIVERSITY LOOP STE 102 RAPID CITY SD 57701 460118545 501(C)(6) 100000 0 ECONOMIC DEVELOPMENT EMBE 300 W 11TH ST SIOUX FALLS SD 57104 460234998 501(C)(3) 9010 0 COMMUNITY SUPPORT EMILY'S HOPE 6225 S MINNESOTA AVE SIOUX FALLS SD 57108 833324332 501(C)(3) 6500 0 COMMUNITY SUPPORT FAMILY ADVOCACY CENTER OF NORTHERN MINNESOTA 1000 PAUL BUNYAN DRIVE NW UNIT 118 BEMIDJI MN 56601 202102302 501(C)(3) 30000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES FARGO PARK DISTRICT 701 MAIN AVE FARGO ND 58103 456002070 501(C)(6) 445288 0 ECONOMIC DEVELOPMENT FARGO RONALD MCDONALD 4757 AGASSIZ XING S FARGO ND 58104 450365598 501(C)(3) 104510 0 COMMUNITY SUPPORT FEEDING SOUTH DAKOTA 3511 N 1ST AVENUE SIOUX FALLS SD 57104 363293534 501(C)(3) 14500 0 COMMUNITY SUPPORT FOLDS OF HONOR SOUTH DAKOTA PO BOX 91541 SIOUX FALLS SD 57109 301250357 501(C)(3) 5500 0 COMMUNITY SUPPORT FORWARD SIOUX FALLS PO BOX 907 SIOUX FALLS SD 57101 460396647 501(C)(6) 250000 0 ECONOMIC DEVELOPMENT FRESH START SURGICAL GIFTS 2011 PALOMAR AIRPORT RD STE 206 CARLSBAD CA 92011 330460177 501(C)(3) 75000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES FRIENDS OF LEVITT SHELL SIOUX FALLS 400 N MAIN AVE SUITE 202 SIOUX FALLS SD 57104 611699910 501(C)(3) 15000 0 ECONOMIC DEVELOPMENT GATEWAY TO SCIENCE CENTER INC 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) 13100 0 COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY SUPPORT, WORKFORCE DEVELOPMENT GRAND FORKS REGION ECONOMIC DEVELOPMENT 120 NORTH 4TH STREET GRAND FORKS ND 58203 450410198 501(C)(6) 10000 0 ECONOMIC DEVELOPMENT GREAT NORTH POLE 675 13TH AVE E STE 101 WEST FARGO ND 58078 821969429 501(C)(3) 29120 0 COMMUNITY SUPPORT GREATER NORTH DAKOTA CHAMBER PO BOX 2639 BISMARCK ND 58502 450141100 501(C)(6) 16300 0 ECONOMIC DEVELOPMENT GREATLIFE CARES FOUNDATION 3800 W 53RD ST SIOUX FALLS SD 57106 472447820 501(C)(3) 40185 0 COMMUNITY SUPPORT HARRISBURG BASEBALL ASSOCIATION PO BOX 434 HARRISBURG SD 57032 270606157 501(C)(3) 25000 0 ECONOMIC DEVELOPMENT HARRISBURG SCHOOL DISTRICT 200 WILLOW ST HARRISBURG SD 57032 466002218 115 132300 0 COMMUNITY HEALTH IMPROVEMENT SERVICES, PHYSICAL IMPROVEMENT AND HOUSING HARTFORD 125 N MAIN AVE HARTFORD SD 57033 460354618 501(C)(3) 10000 0 ECONOMIC DEVELOPMENT HELPLINE CENTER INC 1000 N WEST AVE STE 310 SIOUX FALLS SD 571041314 237424387 501(C)(3) 10000 0 COMMUNITY SUPPORT HERO 914 SOUTH DRIVE S FARGO ND 58104 450457109 501(C)(3) 33000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES HUETHER FAMILY MATCH POINTE 4210 N BOBHALLA DR SIOUX FALLS SD 57107 452784394 501(C)(3) 25000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES IMMIGRANT DEVELOPMENT CENTER 810 4TH AVENUE SUITE 100 SOUTH MOORHEAD MN 56560 203368647 501(C)(3) 12000 0 WORKFORCE DEVELOPMENT INDEPENDENT SCHOOL DISTRICT 152 1313 30TH AVE S MOORHEAD MN 56560 416008721 501(C)(3) 140500 0 COMMUNITY HEALTH IMPROVEMENT SERVICES INTERNATIONAL ESPERANZA PROJECT (IEP) 3141 HOOD STREET SUITE 800 DALLAS TX 75219 815106545 501(C)(3) 30296 0 COMMUNITY HEALTH IMPROVEMENT SERVICES JAMESTOWN AREA CHAMBER OF COMMERCE 120 2ND ST SE JAMESTOWN ND 58401 450116780 501(C)(6) 5750 0 ECONOMIC DEVELOPMENT JAMESTOWN PARKS AND RECREATION 1002 2ND AVE SE JAMESTOWN ND 58401 456002100 115 10920 0 COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY SUPPORT, ECONOMIC DEVELOPMENT JUNIOR ACHIEVEMENT 300 S PHILLIPS AVE STE L102 SIOUX FALLS SD 57104 460306352 501(C)(3) 15650 0 WORKFORCE DEVELOPMENT LAKE AGASSIZ HABITAT FOR HUMANITY 210 11TH ST N MOORHEAD MN 56560 411690131 501(C)(3) 10000 0 PHYSICAL IMPROVEMENTS AND HOUSING LAKOTA NATION INVITATIONAL PO BOX 3140 RAPID CITY SD 57709 461310975 501(C)(3) 7000 0 WORKFORCE DEVELOPMENT LEADERSHIP SOUTH DAKOTA PO BOX 91533 SIOUX FALLS SD 57109 820880122 501(C)(3) 25000 0 LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS LEGENDS OF GOLD PO BOX 287 BERESFORD SD 57004 273794971 501(C)(3) 20000 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 FOUNDATION 102 E MAIN ST LUVERNE MN 56156 411512905 501(C)(3) 9680 0 ECONOMIC DEVELOPMENT MAKE A WISH 1400 W 17TH ST SIOUX FALLS SD 57104 460375953 501(C)(3) 10000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES MAYPORT YOUTH CENTER PO BOX 302 PORTLAND ND 58274 450453349 501(C)(3) 25000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES MCCROSSAN BOYS RANCH 47135 260TH STREET SIOUX FALLS SD 57107 460311913 501(C)(3) 13075 0 COMMUNITY SUPPORT MCKENZIE COUNTY HEALTHCARE SYSTEM 709 4TH AVE NE WATFORD CITY ND 58854 770637498 501(C)(3) 100000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES MINNESOTA STATE UNIVERSITY - MANKATO (MSU) 236 WIGLEY ADMINISTRATION CTR MANKOTA MN 56001 416033423 501(C)(3) 200000 0 WORKFORCE DEVELOPMENT MN WEST FOUNDATION 1593 11TH AVENUE GRANITE FALLS MN 56241 363266500 501(C)(3) 10500 0 WORKFORCE DEVELOPMENT MOORHEAD YOUTH HOCKEY ASSOCIATION 707 SE MAIN AVE MOORHEAD MN 56560 237221429 501(C)(3) 50000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES NATIONAL KIDNEY FOUNDATION 30 EAST 33RD STREET NEW YORK NY 10016 131673104 501(C)(3) 9500 0 COMMUNITY HEALTH IMPROVEMENT SERVICES NORTH DAKOTA STATE COLLEGE OF SCIENCE FOUNDATION AT WAHPETON NORTH DAKOTA 800 6TH ST N WAHPETON ND 58076 450407617 501(C)(3) 230000 0 WORKFORCE DEVELOPMENT NORTH DAKOTA STATE UNIVERSITY (NDSU) PO BOX 6050 FARGO ND 581086050 456002439 115 2346667 0 ECONOMIC DEVELOPMENT, HEALTH PROFESSIONS EDUCATION NORTHERN SUN INTERCOLLEGIATE CONFERENCE (NSIC) 2999 COUNTY RD 42 W BURNSVILLE MN 55306 411783486 501(C)3 35000 0 ECONOMIC DEVELOPMENT NORTHWEST MN FOUNDATION 201 3RD ST NW BEMIDJI MN 56601 411556013 501(C)(3) 25350 0 COMMUNITY HEALTH IMPROVEMENT SERVICES, HEALTH PROFESSIONS EDUCATION NORTHWOODS BATTERED WOMEN'S SHELTER PO BOX 563 BEMIDJI MN 566190563 411333404 501(C)(3) 10000 0 PHYSICAL IMPROVEMENTS 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 115 20000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES PARKER SCHOOL DISTRICT BOX 517 PARKER SD 57053 466003129 115 10000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES PATT TILLMAN FOUNDATION 180 N LASALLE ST STE 2910 CHICAGO IL 60601 201072336 501(C)(3) 40000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES PROJECT CAR RIDES FOR WELL BEING 2425 S WESTERN AVE SIOUX FALLS SD 57105 460358227 501(C)(3) 10000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES RAPID CITY CLUB FOR BOYS 320 N 4TH ST RAPID CITY SD 57701 460277778 501(C)(3) 12500 0 COMMUNITY SUPPORT REBUILDING TOGETHER FARGO-MOORHEAD INC 505 BROADWAY N STE 206 FARGO ND 58102 274415410 501(C)(3) 10000 0 PHYSICAL IMPROVEMENTS AND HOUSING ROCK FROM THE HEART 638 MONTROSE AVE DELANO MN 55328 842009806 501(C)(3) 6550 0 COMMUNITY HEALTH IMPROVEMENT SERVICES RONALD MCDONALD HOUSE CHARITIES OF SD 825 S LAKE ROAD SIOUX FALLS SD 57104 460371152 501(C)(3) 35000 0 COMMUNITY SUPPORT SAMARITANS FEET PO BOX 78992 CHARLOTTE NC 282717045 141880905 501(C)(3) 50000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES SD CATTLEMEN'S FOUNDATION PO BOX 29 DE SMET SD 57231 462773322 501(C)(3) 10750 0 COMMUNITY HEALTH IMPROVEMENT SERVICES 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) 15000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES, ECONOMIC DEVELOPMENT 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 INC 1600 W RUSSELL ST SIOUX FALLS SD 57104 832381925 501(C)(3) 250000 0 PHYSICAL IMPROVEMENTS AND 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 ASSOCIATION 2127 S MINNESOTA AVE STE 201 SIOUX FALLS SD 57105 237183054 501(C)(3) 25000 0 COMMUNITY SUPPORT SEATTLE CHILDREN'S HOSPITAL PO BOX 5371 M/S RC-507 SEATTLE WA 981455005 910564748 501(C)(3) 250000 0 RESEARCH SECURED MY SCHOOL 2908 W 37TH CIRCLE STE 603 SIOUX FALLS SD 57105 920653421 501(C)(3) 6000 0 COMMUNITY SUPPORT SF AREA CASA PROGRAM PO BOX 1901 SIOUX FALLS SD 57101 460430647 501(C)(3) 10000 0 COMMUNITY SUPPORT SF HOPE COALITION 2601 S MINNESOTA AVE SIOUX FALLS SD 57105 822097994 501(C)(3) 7500 0 COALITION BUILDING SF POWER HOCKEY 5808 S PRAIRIE VIEW CT SIOUX FALLS SD 57108 471795011 501(C)(3) 40000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES SF PUBLIC SCHOOLS EDUCATION FOUNDATION PO BOX 560 SIOUX FALLS SD 57101 263537657 501(C)(3) 15000 0 WORKFORCE DEVELOPMENT SF SWIM TEAM PO BOX 758 SIOUX FALLS SD 57101 460343732 501(C)(3) 25000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES SF WOMEN RUN 5235 S SWEETBRIAR CT SIOUX FALLS SD 57108 813518734 501(C)(6) 15000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES SHELDON COMMUNITY SCHOOL DISTRICT 1700 E 4TH STREET SHELDON IA 51201 426038825 115 30000 0 PHYSICAL IMPROVEMENTS AND HOUSING SHILOH CHRISTIAN SCHOOL 1915 SHILOH DR BISMARCK ND 58503 450348120 501(C)(3) 10000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES SIOUX EMPIRE TRIAGE CENTER 132 N DAKOTA AVE SIOUX FALLS SD 57104 844806781 501(C)(3) 300000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES SIOUX EMPIRE UNITED WAY 1000 N W AVE 120 SIOUX FALLS SD 571041314 460233701 501(C)(3) 136500 0 COALITION BUILDING, COMMUNITY SUPPORT SIOUX FALLS AREA COMMUNITY FOUNDATION 200 N CHERAPA PL SIOUX FALLS SD 57103 311748533 501(C)(3) 49175 0 COMMUNITY SUPPORT, ECONOMIC DEVELOPMENT, PHYSICAL IMPROVEMENTS AND HOUSING SIOUX FALLS CHRISTIAN SCHOOL 6120 S CHARGER CIRCE SIOUX FALLS SD 57108 460340024 501(C)(3) 104800 0 COMMUNITY HEALTH IMPROVEMENT SERVICES SIOUX FALLS SCHOOL DISTRICT 49-5 201 E 38TH ST SIOUX FALLS SD 57105 466002586 115 310000 0 COMMUNITY SUPPORT, COMMUNITY HEALTH IMPROVEMENT SERVICES, PHYSICAL IMPROVEMENTS 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 SLEEPY HOLLOW THEATRE & ARTS PARK PO BOX 675 BISMARCK ND 58502 450424373 501(C)(3) 6000 0 COMMUNITY SUPPORT SOUTH DAKOTA GOLF ASSOCIATION (SDGA) PO BOX 88938 SIOUX FALLS SD 57109 460310847 501(C)(4) 25000 0 COMMUNITY SUPPORT SOUTH DAKOTA GOLF ASSOCIATION JUNIOR GOLF FOUNDATION PO BOX 88938 SIOUX FALLS SD 57109 460449824 501(C)(3) 35000 0 COMMUNITY SUPPORT SOUTH DAKOTA HIGH SCHOOL ACTIVITIES ASSOCIATION (SDHSAA) 804 N EUCLID AVE SUITE 102 PIERRE SD 57501 460226282 501(C)(3) 62500 0 COMMUNITY HEALTH IMPROVEMENT SERVICES SOUTH DAKOTA PARTNERS IN EDUCATION PO BOX 886 SIOUX FALLS SD 57101 813704298 501(C)(3) 616922 0 WORKFORCE DEVELOPMENT SOUTH DAKOTA STATE UNIVERSITY (SDSU) FOUNDATION 815 MEDARY AVE BROOKINGS SD 57007 460273801 501(C)(3) 2125000 0 ECONOMIC DEVELOPMENT, PHYSICAL IMPROVEMENTS AND HOUSING, WORKFORCE DEVELOPMENT SOUTH SUDANESE FOUNDATION 2037 67TH AVE S FARGO ND 58104 834476088 501(C)(3) 20000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES SOUTHWEST MINNESOTA STATE UNIVERSITY (SMSU) 1501 STATE ST MARCHALL MN 56258 411687554 115 100000 0 WORKFORCE DEVELOPMENT STATE OF SOUTH DAKOTA 500 E CAPITOL PIERRE SD 57501 466000364 115 1432412 0 ECONOMIC DEVELOPMENT, PHYSICAL IMPROVEMENT AND HOUSING, HEALTH PROFESSIONS EDUCATION, WORKFORCE DEVELOPMENT SUMMIT LEAGUE 4000 N HERCULES AVE STE 200 SIOUX FALLS SD 571071401 391417116 501(C)(3) 0 85000 FAIR VALUE DONATION OF RENTAL SPACE COMMUNITY SUPPORT TEA AREA SCHOOL DISTRICT 41-5 131 N POPLAR AVE TEA SD 57064 743076050 115 25000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES TEDDY BEAR DEN 500 S MAIN AVENUE SIOUX FALLS SD 57104 311802800 501(C)(3) 22500 0 COMMUNITY SUPPORT THIEF RIVER FALLS SCHOOLS 230 LABREE AVENUE SOUTH THIEF RIVER FALLS MN 56701 416003126 115 12000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES UND ALUMNI FOUNDATION 3501 UNIVERSITY AVE STOP 8157 GRAND FORKS ND 58202 450348296 501(C)(3) 1036571 0 ECONOMIC DEVELOPMENT, WORKFORCE DEVELOPMENT UNITED WAY OF BEMIDJI AREA PO BOX 27 BEMIDJI MN 56619 411567744 501(C)(3) 48000 0 COALITION BUILDING UNITED WAY OF CASS-CLAY PO BOX 1609 FARGO ND 581071609 410810008 501(C)(3) 102310 0 COALITION BUILDING, ECONOMIC DEVELOPMENT UNITED WAY OF DOUGLAS AND POPE COUNTY 503 HAWTHORNE ST ALEXANDRIA MN 56308 237450908 501(C)(3) 7250 0 COMMUNITY HEALTH IMPROVEMENT SERVICES UNITED WAY OF GRAND FORKS EAST GRAND FORKS & 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 574021065 237086355 501(C)(3) 10000 0 COALITION BUILDING UNIVERSITY OF JAMESTOWN 6085 COLLEGE LANE JAMESTOWN ND 58405 450231180 501(C)(3) 125500 0 COMMUNITY SUPPORT, ECONOMIC DEVELOPMENT UNIVERSITY OF MARY 7500 UNIVERSITY DR BISMARCK ND 58504 450273403 501(C)(3) 647249 0 COMMUNITY SUPPORT, ECONOMIC DEVELOPMENT, HEALTH PROFESSIONS EDUCATION, WORKFORCE DEVELOPMENT UNIVERSITY OF SOUTH DAKOTA (USD) 1110 N DAKOTA ST VERMILLION SD 57069 466018891 501(C)(3) 3604552 0 ECONOMIC DEVELOPMENT, HEALTH PROFESSIONS EDUCATION, RESEARCH, WORKFORCE DEVELOPMENT VALLEY CITY STATE UNIVERSITY 101 COLLEGE ST SW VALLEY CITY ND 58072 456002482 501(C)(3) 50000 0 WORKFORCE DEVELOPMENT VETERANS AFFAIRS 810 VERMONT AVE NW WASHINGTON DC 20420 540846950 115 0 11758005 COST SERVICES - PGX TESTING FOR VETERANS COMMUNITY HEALTH IMPROVEMENT SERVICES VETERANS COMMUNITY PROJECT 8900 TROOST KANSAS CITY MO 64131 474960735 501(C)(3) 60000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES VETERANS HONOR FLIGHT OF NDMN PO BOX 294 HUNTER ND 58048 473473590 501(C)(3) 7500 0 COMMUNITY HEALTH IMPROVEMENT SERVICES VILLAGE FAMILY SERVICE CENTER 1201 25TH ST FARGO ND 58106 450226423 501(C)(3) 100000 0 COALITION BUILDING VILLAGE NORTHWEST UNLIMITED SHELDON IA 330 VILLAGE CIRCLE SHELDON IA 51201 421044017 501(C)(3) 10000 0 COMMUNITY SUPPORT VOLUNTEERS OF AMERICA DAKOTAS PO BOX 89306 SIOUX FALLS SD 57109 237353508 501(C)(3) 10000 0 COMMUNITY SUPPORT WARNER SCHOOL DISTRICT PO BOX 20 WARNER SD 57479 204606639 501(C)(3) 10000 0 PHYSICAL IMPROVEMENTS AND HOUSING WASHINGTON PAVILION 301 S MAIN AVE SIOUX FALLS SD 57104 460435791 501(C)(3) 50000 0 ECONOMIC DEVELOPMENT WATERTOWN DEVELOPMENT COMPANY PO BOX 332 WATERTOWN SD 57201 470813269 501(C)(6) 15000 0 ECONOMIC DEVELOPMENT WEBSTER ACTIVE LIVING TRAIL PO BOX 539 WEBSTER SD 57274 466000530 115 7143 0 PHYSICAL IMPROVEMENTS AND HOUSING WEST CENTRAL SCHOOL DISTRICT PO BOX 252 HARTFORD SD 57033 460284421 115 24800 0 COMMUNITY HEALTH IMPROVEMENT SERVICES WILLISTON PUBLIC SCHOOLS 820 E BROADWAY WILLISTON ND 58801 861316289 115 15000 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 EAST 8TH STREET WINNER SD 57580 363739631 501(C)(3) 100000 0 COMMUNITY HEALTH IMPROVEMENT SERVICES WORTHINGTON PUBLIC SCHOOLS 1117 MARINE AVE WORTHINGTON MN 561871610 416008522 115 110000 0 COMMUNITY HEALTH IMPROVEMENTS, PHYSICAL IMPROVEMENTS AND HOUSING YELLOW JACKET FOUNDATION 1200 UNIVERSITY ST UNIT 9506 BELLE FOURCHE SD 57717 510151319 501(C)(3) 155200 0 ECONOMIC DEVELOPMENT 159 13 GENERAL SUPPORT FOR COMMUNITY PROGRAMS 1063 20609 COST SANFORD CARES CHRISTMAS PROGRAM; WHICH INCLUDES PHYSICAL ACTIVITES, BACKPACKS AND $25 GIFT CARDS. THE NUMBER OF RECIPIENTS WAS ESTIMATED BASED ON THE QUANTITY OF GIFTS AND OTHER ITEMS LISTED ON THE APPLICABLE INVOICES. YOUTH SPORTS PROGRAM ASSISTANCE 576 70000 COST ASSISTANCE FOR UNIFORMS, WARMUPS, GYM RENTALS, AND TRAVEL EXPENSES. THE NUMBER OF RECIPIENTS WAS DETERMINED BY MULTIPLYING THE APPROXIMATE NUMBER OF TEAMS THAT PARTICIPATE IN THESE PROGRAMS EACH YEAR BY THE APPROXIMATE NUMBER IF PLAYERS PER TEAM. SCHOLARSHIPS 38 103000 COST THE SANFORD HEALTH EQUITY IN EDUCATION SCHOLARSHIP IS A TARGETED FINANCIAL SCHOLARSHIP PROGRAM AIDING UNDERREPRESENTED AND TRADITIONALLY UNDERSERVED POPULATIONS SEEKING HIGHER EDUCATION. AN AMOUNT OF $5,000 WAS AWARDED TO FIVE DIFFERENT INDIVIDUALS IN 2024. THE SANFORD HEALTH MILITARY AND VETERAN SCHOLARSHIP IS AWARDED TO ANY VETERAN, GUARD/RESERVE, OR ACTIVE-DUTY MILITARY SERVICE MEMBER WHO HAS DEMONSTRATED EXCEPTIONAL CHARACTER AND LEADERSHIP IN FURTHERING THEIR OWN PROGRESS AND IN ENRICHING THE LIVES OF OTHERS. AN AMOUNT OF $5,000 WAS AWARDED TO FOUR DIFFERENT INDIVIDUALS IN 2024. THE SANFORD HEALTH NETWORK SCHOLARSHIP OFFERS FINANCIAL SUPPORT FOR STUDENTS WHO ARE CONTINUING EDUCATION IN A FIELD THAT CAN ENHANCE THEIR CONTRIBUTIONS ACROSS SANFORD'S FOOTPRINT. BY OFFERING THIS SCHOLARSHIP, SANFORD IS MAKING AN INVESTMENT IN OUR REGION'S FUTURE WORKFORCE AND ALL THE COMMUNITIES WE SERVE. AN AMOUNT OF $2,000 WAS AWARDED TO 29 DIFFERENT INDIVIDUALS IN 2024. 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 1 1 X X X X 1 1 0 1 1 0 0 1 0 BILL GASSEN TRUSTEE, PRESIDENT & CEO 0 2334458 0 1624395 0 455266 0 584349 0 892 0 4999360 0 0 WILLIAM BRUNNER MD PHYSICIAN 3282364 0 0 0 4629 0 16627 0 29937 0 3333557 0 0 0 ADAM STYS MD PHYSICIAN 2941668 0 0 0 308522 0 17250 0 35853 0 3303293 0 0 0 MATT HOCKS EVP, CHIEF OPERATING OFFICER 0 1499992 0 1059337 0 239116 0 240957 0 35576 0 3074978 0 0 TOMASZ STYS MD PHYSICIAN 2748910 0 0 0 163027 0 17250 0 30815 0 2960002 0 0 0 ERIC BELANGER MD PHYSICIAN 2882758 0 0 0 2322 0 16457 0 25505 0 2927042 0 0 0 ALEXANDER DROFA MD PHYSICIAN 2821625 0 0 0 14292 0 17250 0 30965 0 2884132 0 0 0 SCOTT WOOTEN EVP, CFO (END 4/24) 0 245207 0 0 0 2280001 0 43522 0 7698 0 2576428 0 0 JENNIFER GRENNAN EVP, CHIEF ADMIN OFFICER 0 1020580 0 803726 0 167304 0 172875 0 34977 0 2199462 0 0 MICHAEL LEBEAU MD SVP, HEALTH SVC OPERATIONS 0 1034038 0 613493 0 177333 0 174475 0 35213 0 2034552 0 0 PAUL HANSON PRESIDENT & CEO, SIOUX FALLS 0 858148 0 466466 0 147266 0 146495 0 26440 0 1644815 0 0 TIFFANY LAWRENCE PRESIDENT & CEO, FARGO 0 832476 0 456270 0 137506 0 143293 0 36152 0 1605697 0 0 TODD SCHAFFER PRESIDENT & CEO, BISMARCK 0 715457 0 385548 0 123454 0 124825 0 2692 0 1351976 0 0 NICK OLSON EVP, CFO (BEG 4/24) 0 783688 0 138354 0 125834 0 122494 0 892 0 1171262 0 0 SUSAN JARVIS FORMER PRESIDENT & CEO, BEMIDJI 0 654160 0 169974 0 96472 0 117675 0 28660 0 1066941 0 0 BILL MARLETTE INTERIM, EVP, CFO (END 1/24) 0 420002 0 470299 0 4000 0 0 0 275 0 894576 0 0 KARLA EISCHENS PRESIDENT & CEO, BEMIDJI 0 417820 0 231329 0 80461 0 81795 0 25873 0 837278 0 0 ANDY NORTH TRUSTEE, SECRETARY, INDEP CONTRACTOR 379383 0 0 0 0 0 0 0 0 0 379383 0 0 0 MICHELLE BRUHN FORMER EVP, CFO & TREASURER 0 0 0 293725 0 0 0 0 0 0 0 293725 0 0 BRYAN NERMOE FORMER PRESIDENT & CEO, FARGO 0 0 0 0 0 252724 0 0 0 0 0 252724 0 0 DON JACOBS FORMER TRUSTEE 13502 0 0 0 0 0 0 0 0 0 13502 0 0 0 PART I, LINE 1A ON PART I, QUESTIONS REGARDING COMPENSATION, SANFORD CHECKED SEVERAL OF THE ITEMS AS PROVIDED TO LISTED PERSONS: CHARTER TRAVEL IS PERMITTED FOR BUSINESS PURPOSES WHEN APPROVED AS NECESSARY AND REASONABLE BY EXECUTIVE LEADERSHIP. THESE COSTS ARE NOT INCLUDED IN THE W-2'S OF EMPLOYEES BECAUSE THEY ARE INCURRED FOR BUSINESS PURPOSES OF SANFORD. CHARTER AIR TRAVEL FOR PERSONAL USE WAS PROVIDED TO ONE OFFICER. THE ENTIRE BENEFIT WAS TREATED AS TAXABLE COMPENSATION. FOR INTERNATIONAL TRAVEL OUTSIDE OF NORTH AMERICA WITH FLIGHT TIMES IN EXCESS OF 6 HOURS, SANFORD REIMBURSES THE COST OF A BUSINESS CLASS TICKET. TRAVEL FOR COMPANIONS - LIMITED TRAVEL FOR COMPANIONS IS OFFERED FOR CERTAIN MEETINGS AND EVENTS. THESE COSTS ARE INCLUDED IN THE W-2'S OR 1099'S OF THE INDIVIDUALS. FOR CHARTER AIR TRAVEL, SANFORD USES THE SIFL (STANDARD INDUSTRY FARE LEVEL) RATE METHOD TO IMPUTE THE FRINGE BENEFIT TO THE EMPLOYEE, OFFICER OR TRUSTEE. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS - CERTAIN COMPENSATION MAY BE GROSSED UP TO INCLUDE APPROPRIATE TAX AMOUNTS. 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. THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES APPROVES ALL COMPENSATION CHANGES FOR THE CEO IN ADVANCE, RELIES ON THE MARKET DATA PROVIDED BY THE INDEPENDENT CONSULTING FIRM IN MAKING CHANGES, AND DOCUMENTS THE BASIS FOR ANY CHANGES IN COMMITTEE MINUTES. 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 THE PAYMENT AFTER SATISFYING THE CONDITIONS OF THE 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 FOR EXECUTIVES, A PORTION OF THE RETIREMENT AND OTHER DEFERRED COMPENSATION REPORTED RELATES TO A 457(F) SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. THIS PLAN PROVIDES FOR A SUBSTANTIAL RISK OF FORFEITURE AND THERE IS NO GUARANTEE THAT ANY AMOUNT WILL ULTIMATELY BE PAID. 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. LINES 4A AND 4B - PAYMENTS THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE OR CHANGE OF CONTROL PAYMENTS AND/OR SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS: SCOTT WOOTEN: SEPARATION..................................$2,143,876 NONQUALIFIED RETIREMENT PLAN...................$33,255 TOTAL.......................................$2,177,131 BRYAN NERMOE: NON-COMPETE PAYMENT...........................$252,724 PART I, LINE 5 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 A MATERIAL PORTION OF EXECUTIVE COMPENSATION IS LINKED TO ACHIEVING ORGANIZATIONAL GOALS RELATED TO QUALITY OF CARE, PATIENT EXPERIENCE, EMPLOYEE EXPERIENCE AND FINANCIAL PERFORMANCE. THE GOALS ARE SET IN ADVANCE AND APPROVED BY THE BOARD OF TRUSTEES. 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 58375000 71581953 191513 764068 70817885 2006 0 0 1 1 B 3636506 4000000 4000000 2010 0 0 1 1 C 46015000 66185000 24356 66160644 2012 1 1 1 1 D 23800000 45000000 45000000 2012 0 0 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 1 0 0 0 1 B 0 0 1 0 1 0 0 0 1 C 0 0 0 1 1 0 0 0 1 D 0 0 1 0 1 0 0 0 1 A 1 B 1 C 1 D 1 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 BONDS ISSUED 10/28/2014, COLUMN(C) CUSIP #: 83755VXF6 AND 83755VXE9 BONDS ISSUED 10/21/2015, COLUMN(C) CUSIP #: 83755VZW7 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 BONDS ISSUED 08/05/2014, COLUMN(C) CUSIP #: 83755VWA8 BONDS ISSUED 10/28/2014, COLUMN(C) CUSIP #: 83755VXF6 AND 83755VXE9 BONDS ISSUED 10/21/2015, COLUMN(C) CUSIP #: 83755VZW7 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 2400000 52083720 2930 52083720 2014 1 0 1 1 B 33495000 207081359 6903 31874 1906127 205143359 2017 0 0 1 1 C 34650000 192707024 7065 1431628 110529233 80746163 2017 0 1 1 1 D 40000000 50000000 150032 49849968 2017 0 0 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 0 0 1 0 0 0 0 1 D 0 0 1 0 1 0 0 0 1 A 1 B 1 C 1 D 1 PAIGE SCHAFFER FAMILY RELATIONSHIP - TODD SCHAFFER EDUCATION X 20000 17989 0 0 1 17989 KACEY DOYLE FAMILY RELATIONSHIP - MARNIE HERMANN 83066 EMPLOYMENT 0 KRISTI BENZ FAMILY RELATIONSHIP - LAURIS MOLBERT 70204 EMPLOYMENT 0 NICHOLE HESTER FAMILY RELATIONSHIP - ANDY NORTH 68316 INDEPENDENT CONTRACTOR ARRANGEMENT 0 JACOB PEARLSON FAMILY RELATIONSHIP - KARLA EISCHENS 97676 EMPLOYMENT 0 CHRISTINA OLSON FAMILY RELATIONSHIP - NICK OLSON 206891 EMPLOYMENT 0 MALLORY NERMOE FAMILY RELATIONSHIP - BRYAN NERMOE 54860 EMPLOYMENT 0 X SIMIL TRUCK 1 495000 FMV 0 1 0 PART I, COLUMN (B): THE AMOUNT REPORTED ON PART I, COLUMN B REPRESENTS THE NUMBER OF CONTRIBUTIONS. 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, PAUL HANSON, MATT HOCKS, TODD SCHAFFER, MICHAEL LEBEAU, BILL MARLETTE, NICK OLSON, SCOTT WOOTEN, KARLA EISCHENS, AND 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, SANFORD WORLD CLINICS - KLAMATH FALLS, AND SANFORD HEALTH OF SOUTH DAKOTA. THE BOARD OF TRUSTEES OF SANFORD IS ALSO THE BOARD OF TRUSTEES FOR SANFORD HEALTH, SANFORD NORTH, SANFORD WEST, AND SANFORD HEALTH OF SOUTH DAKOTA, 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, SANFORD HEALTH NETWORK, AND SANFORD HEALTH OF SOUTH DAKOTA 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 THE SYSTEM BOARD OF TRUSTEES, MEMBERS OF THE GOVERNING BOARDS OF SUBSIDIARY ENTITIES, OFFICERS, AND KEY EMPLOYEES FOR ALL ENTITIES SUBJECT TO THE IRS FORM 990 FILINGS. THE CCO REVIEWS THE DISCLOSURES AND WHEN A CONFLICT OF INTEREST IS DEEMED TO EXIST, REFERS THE DISCLOSURE TO THE SANFORD EXECUTIVE COMPLIANCE COMMITTEE FOR DEVELOPMENT OF AN ADMINISTRATIVE OR MANAGEMENT PLAN TO ADDRESS OR ELIMINATE THE CONFLICT OF INTEREST. SANFORD WILL NOT ENGAGE IN ANY CONTRACT, TRANSACTION OR ARRANGEMENT INVOLVING A BOARD MEMBER'S CONFLICT OF INTEREST UNLESS A MAJORITY OF THE DISINTERESTED MEMBERS OF THE AUDIT AND COMPLIANCE COMMITTEE DETERMINE THAT APPROPRIATE SAFEGUARDS ARE IN PLACE TO PROTECT SANFORD'S CHARITABLE MISSION. 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 REVIEW AND APPROVAL BY INDEPENDENT PERSONS OR BOARD OF TRUSTEES COMMITTEE, 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. THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES APPROVES ALL COMPENSATION CHANGES FOR THE CEO IN ADVANCE, RELIES ON THE MARKET DATA PROVIDED BY THE INDEPENDENT CONSULTING FIRM IN MAKING CHANGES, AND DOCUMENTS THE BASIS FOR ANY CHANGES IN COMMITTEE MINUTES. 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 168,240,510. PENSION PLAN TERMINATION ADJUSTMENT AND OTHER CHANGES 57,364,410. NET ASSETS RELEASED FOR ACQUIRED PPE 7,100. CAPITAL CONTRIBUTION TO SUBSIDIARIES -21,233,826. NET ASSETS TRANFERRED FOR ACCOUNTS PAYABLE 57,357,310. 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