4A (Expenses $ 64422453 including grants of $ 234850) (Revenue $ 75243582)
SEE SCHEDULE H

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - Albany Area Hospital and Medical Center. SEVERAL INDIVIDUALS FROM THROUGHOUT THE COMMUNITY PROVIDED INPUT INTO OUR 2016 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THESE PEOPLE INCLUDED BOTH STAKEHOLDERS AS WELL AS THE GENERAL PUBLIC. A WIDE RANGE OF PEOPLE FROM MORRISON COUNTY PUBLIC HEALTH AND MORRISON COUNTY SOCIAL SERVICES, INCLUDING PUBLIC HEALTH DIRECTOR KATY KIRCHNER, WERE INTERVIEWED. OTHER PUBLIC HEALTH AND SOCIAL SERVICES STAFF INCLUDED LYNETTE GESSELL, RACHEL BARTA, AND PUBLIC HEALTH MEDICAL DIRECTOR DR. GREGORY MCNAMARA. ROUNDING OUT THE LIST OF 20 INDIVIDUALS WHO WERE SPECIFICALLY INTERVIEWED WERE: ANDREA LAUER, MAYOR OF ROYALTON; BEKA SWISHER, EARLY CHILDHOOD EDUCATOR; BRIDGET BRITZ, DIRECTOR OF HORIZON HEALTH; GEORGE WEBER, PIERZ SUPERINTENDENT OF SCHOOLS; GREGG VALENTINE, MORRISON COUNTY CHAPLAIN; JULIE LEIKVOLL, NORTHERN PINES MENTAL HEALTH COUNSELOR; KATE BJORGE FROM LIVE BETTER LIVE LONGER HEALTHY COMMUNITIES COLLABORATIVE; DR. KURT DEVINE, FAMILY PHYSICIAN AND OPIOID TASK FORCE CHAMPION; LINDA LIPPERT, RN, EMERGENCY NURSE; MARILYN KEITH, PIERZ SCHOOLS, JUVENILE JUSTICE; PAUL MCINTYRE,GOLD CROSS AMBULANCE; SHAWN LARSEN, MORRISON COUNTY SHERIFF; SHEILA FUNK, LITTLE FALLS SCHOOLS; SUSAN DORAN, SWANVILLE; TAMMY FILLIPI, EARLY CHILDHOOD SPECIALIST; AND TERRI WEYER, FROM THE SENIOR CENTER. NUMEROUS OTHER INDIVIDUALS PROVIDED INPUT INTO THE IMPLEMENTATION STRATEGY DEVELOPMENT PROCESS.

Schedule H, Part V, Section B, Line 6b Facility , 1
Facility , 1 - Albany Area Hospital and Medical Center. The CHNA was conducted with Morrison County Public Health and Morrison County Social Services.

Schedule H, Part V, Section B, Line 7 Facility , 1
Facility , 1 - Albany Area Hospital and Medical Center. THE CHNA IS ALSO EMAILED TO SPECIFIC INDIVIDUALS THROUGHOUT MORRISON COUNTY.

Schedule H, Part V, Section B, Line 11 Facility , 1
Facility , 1 - Albany Area Hospital and Medical Center. The implementation strategy development team used a voting process to identify the highest health priorities for CHI St. Gabriel's Health and Morrison County. Team participants were asked to select their top health priorities taking into account all of the information gathered as part of the CHNA as well as the specific visit information available through the Epic electronic health record. Participants were asked to select their top 3-5 health issues as their highest priorities to address in the coming three years. After an objective voting process, the top five priority areas for participants on the implementation team were: 1) mental health (easily the highest priority among team members); 2) substance abuse/chemical dependency; 3) obesity; 4) accessibility to health care; and 5) parenting. Each of the five priority areas will be addressed separately, as well as additional priorities that are the current focus of CHI St. Gabriel's Health's action plans, most notably chronic disease and domestic violence. Out of the highest priorities identified by the CHNA process, the implementation strategy team decided to concentrate efforts on the two highest priorities-mental health and substance abuse/chemical dependency, while continuing to address the other top three priority areas: obesity, accessibility to health care and parenting. The highest priority area not specifically included in the implementation strategy is dental care, although a separate group of individuals from the hospital and county social services are exploring options to expand dental care for low-income individuals in the county. It was determined that since CHI St. Gabriel's Health does not employ dental practitioners, it was not in a position to lead efforts to expand dental care. That being said, the hospital agreed to work with AppleTree Dental and both Morrison County Public Health and Morrison County Social Services to identify potential funding sources to remodel existing hospital space to accommodate an expanded low-income dental clinic. Currently, the clinic is only open a few days a month and demand far exceeds the number of appointment slots available for patients to receive services. Health Priority Area 1: Improve the mental health of the people of Morrison County. Goal 1A) Enhance access to mental health services in Morrison County Objectives: 1A.1) Performs gap analysis to determine where the lack or underutilization of services exists by January 31, 2017. 1A.2) Works with South Country Health Alliance to determine what resources are being spent to provide access to mental health services by January 31, 2017. 1A.3) Continue to pursue dementia-friendly community certification by June 30, 2017. 1A.4) Pursue Behavioral Health Home certification if available by September 30, 2017. 1A.5) Utilize new mental health-psychiatric nurse practitioner to provide services to people with mental illness beginning in October 2016. 1A.6) Increase awareness of mental health services available in Morrison County through advertising and awareness-building strategies. Health Priority 2: Reduce the Impact of Chemical Dependency on Morrison County Individuals, Families and the Community Goal 2A): Reduce youth substance use in Morrison County Objectives: 2A.1) Reduce the percentage of Morrison County 8th, 9th, and 11th graders reporting any use of alcohol in the past 30 days from 19.5% to 16% by June 30, 2019 (Minnesota rate in 2013 is 16.8%) 2A.2) Increase the percentage of Morrison County 5th, 8th, 9th, and 11th graders reporting parental disapproval for youth alcohol use from 88.7% to 92% by June 30, 2019 (Minnesota rate in 2013 is 92%) 2A.3) Decrease the percentage of Morrison County 8th, 9th, and 11th graders reporting smoking one or more cigarettes in the past 30 days from 8.8% to 7% by June 30, 2019 (Minnesota Student Survey, Minnesota rate in 2013 is 7.8%) 2A.4) Increase the percentage of Morrison County 8th, 9th, and 11th graders reporting a perception of moderate or great risk of harm by using prescription drugs not prescribed for them from 78.5% to 92% by June 30, 2019. (Minnesota rate in 2013 is 81.3%) 2A.5) Expand the number of school districts/communities engaged in youth substance use prevention initiatives to all Morrison County communities. As previously noted, the implementation strategy team chose five priority areas to focus on in developing a three-year action plan in response to our Community Health Needs Assessment (CHNA). The specific goals, objectives, measures/indicators and evidenced-based strategies for the remaining three priority areas-Obesity, Accessibility and Parenting-will continue to be part of the ongoing community health strategies for CHI St. Gabriel's Health. In addition to the remaining three priority areas, CHI St. Gabriel's Health, in its role as the primary health agency in Morrison County, will continue to address these areas. Each concern will be discussed separately in the following paragraphs. Obesity - The objectives related to obesity fall under two primary categories-workplace wellness and youth/family strategies. CHI St. Gabriel's Health and its community partners will continue to support efforts that encourage healthy activities and eating. Some of the specific partners in this priority area include the Live Better Live Longer Eat, Move and Belong Teams; the Sprout kitchen and CSA shares program, the WIC Supplemental Food Program; the public health Statewide Health Improvement Program (SHIP) grant; Community Gardens; Ruby's Pantry; Oasis Share-A-Meal; Fare for All; local food shelves. Other community assets to address obesity include the Open Streets/Falls Festival on Foot, Climbing Wall at Lindbergh Elementary, the disc golf course, local fitness facilities, Headstart and the extension office. CHI St. Gabriel's Health is continuing to support local efforts to reduce obesity in a variety of ways. Accessibility to Health Care - CHI St. Gabriel's Health is enhancing efforts to increase accessibility to health care, also in a variety of ways. A new telemedicine/virtual clinic in the Little Falls Community Schools began this fall. The integrated electronic medical record (Epic) has made sharing data and communication among providers and patients more effective. A variety of government and non-government community assets are assisting in the expansion of resources, most notably South Country Health Alliance for individuals on Medical Assistance. CHI St. Gabriel's Health has programs to assist with securing financial resources to deliver care. Much effort has been made to expand hours in order to increase access to care and there are a variety of grant programs addressing such issues as the prescription drug initiative and domestic violence and the patient-centered medical home. CHI St. Gabriel's Health will continue to partner with Morrison County Social Services, Morrison County Public Health and other community agencies in the delivery of services. In addition, the hospital has an ongoing recruitment program in order to expand the range of services available locally. Internal medicine and pediatrics are two such critical needs in the community, given the high rate of people age 65 and older in the county. Parenting - Parenting was the fifth and final priority identified by the implementation strategy team. The Love and Logic, Morrison County Families, Nurse-Family Partnership and ASQ screening hub are among the resources being used to address these priorities. Morrison County Public Health and Morrison County Social Services tend to coordinate the parenting strategies through its MCICC, maternal child health, WIC and Headstart programs. The Live Better Live Longer (LBLL) healthy communities collaborative, an arm of CHI St. Gabriel's Health plays a significant role as well. The Belong Team of LBLL helps to connect families with the resources they need to assist with parenting.

Schedule H, Part V, Section B, Line 11 Facility , 2
Facility , 2 - Albany Area Hospital and Medical Center. The 2016 CHNA identified 10 priorities through the written survey: 1) illegal drug use among teens; 2) adult obesity; 3) smoking/other tobacco use; 4) alcohol abuse among adults; 5) poor parenting skills; 6) prescription drug abuse; 7) underage alcohol use/abuse; 8) childhood obesity; 9) heart disease and stroke; and 10) bullying. Several items on this list are being addressed in our Implementation Strategy (November 2016), even though the list is not an exact match. The Implementation Strategy Team went through a prioritization process that selected five items on which to focus our health improvement activities. Those five include: a) mental health, b) chemical dependency, c) obesity, d) health care access, and e) parenting skills. Although specific work plans are still being developed, several items in our Top 10 list are currently being addressed under the broader item of chemical dependency (i.e., smoking, prescription drug abuse, and underage alcohol use/abuse), only two items that was on our Top 10 list (heart disease/stroke and bullying) are not specifically being addressed as part of our priority focus areas. Both, however, are being addressed. We made chronic disease a priority during our last (2013) CHNA and that work, specifically the use of a patient-centered medical home, is continuing to be a priority for CHI St. Gabriel's Health/Unity Family Healthcare. The medical home is highly effective in dealing with chronic disease and we have developed registries for tracking the effectiveness of our efforts to address these chronic conditions. Likewise, bullying is the focus of an initiative through a CHI Mission and Ministry Fund Violence Prevention grant. We fund Kindness Retreats and other evidenced-based bullying prevention strategies, especially if we are successful in renewing grant funding for bullying/violence prevention. These efforts will continue to be a secondary focus for our organization and will be reported on an annual basis.

Schedule H, Part V, Section B, Line 13 Facility , 1
Facility , 1 - Albany Area Hospital and Medical center. UNITY FAMILY HEALTHCARE BASES ITS FINANCIAL ASSISTANCE ELIGIBILITY ON HUD'S 130% OF VERY LOW INCOME GUIDELINES BASED ON GEOGRAPHY, AND AFFORDS THE UNINSURED AND UNDERINSURED THE ABILITY TO OBTAIN FINANCIAL ASSISTANCE WRITE-OFFS, BASED ON A SLIDING SCALE, RANGING FROM 25%- 100% OF CHARGES. AN INDIVIDUAL'S INCOME UNDER THE HUD GUIDELINES IS A SIGNIFICANT FACTOR IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE. HOWEVER, IN DETERMINING WHETHER TO EXTEND DISCOUNTED OR FREE CARE TO A PATIENT, THE PATIENT'S ASSETS MAY ALSO BE TAKEN INTO CONSIDERATION. FOR EXAMPLE, A PATIENT SUFFERING A CATASTROPHIC ILLNESS MAY HAVE A REASONABLE LEVEL OF INCOME, BUT A LOW LEVEL OF LIQUID ASSETS SUCH THAT THE PAYMENT OF MEDICAL BILLS WOULD BE SERIOUSLY DETRIMENTAL TO THE PATIENT'S BASIC FINANCIAL (AND ULTIMATELY PHYSICAL) WELL-BEING AND SURVIVAL. SUCH A PATIENT MAY BE EXTENDED DISCOUNTED OR FREE CARE BASED UPON THE FACTS AND CIRCUMSTANCES.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - St. Gabriel's Hospital. SEVERAL INDIVIDUALS FROM THROUGHOUT THE COMMUNITY PROVIDED INPUT INTO OUR 2016 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THESE PEOPLE INCLUDED BOTH STAKEHOLDERS AS WELL AS THE GENERAL PUBLIC. A WIDE RANGE OF PEOPLE FROM MORRISON COUNTY PUBLIC HEALTH AND MORRISON COUNTY SOCIAL SERVICES, INCLUDING PUBLIC HEALTH DIRECTOR KATY KIRCHNER, WERE INTERVIEWED. OTHER PUBLIC HEALTH AND SOCIAL SERVICES STAFF INCLUDED LYNETTE GESSELL, RACHEL BARTA, AND PUBLIC HEALTH MEDICAL DIRECTOR DR. GREGORY MCNAMARA. ROUNDING OUT THE LIST OF 20 INDIVIDUALS WHO WERE SPECIFICALLY INTERVIEWED WERE: ANDREA LAUER, MAYOR OF ROYALTON; BEKA SWISHER, EARLY CHILDHOOD EDUCATOR; BRIDGET BRITZ, DIRECTOR OF HORIZON HEALTH; GEORGE WEBER, PIERZ SUPERINTENDENT OF SCHOOLS; GREGG VALENTINE, MORRISON COUNTY CHAPLAIN; JULIE LEIKVOLL, NORTHERN PINES MENTAL HEALTH COUNSELOR; KATE BJORGE FROM LIVE BETTER LIVE LONGER HEALTHY COMMUNITIES COLLABORATIVE; DR. KURT DEVINE, FAMILY PHYSICIAN AND OPIOID TASK FORCE CHAMPION; LINDA LIPPERT, RN, EMERGENCY NURSE; MARILYN KEITH, PIERZ SCHOOLS, JUVENILE JUSTICE; PAUL MCINTYRE,GOLD CROSS AMBULANCE; SHAWN LARSEN, MORRISON COUNTY SHERIFF; SHEILA FUNK, LITTLE FALLS SCHOOLS; SUSAN DORAN, SWANVILLE; TAMMY FILLIPI, EARLY CHILDHOOD SPECIALIST; AND TERRI WEYER, FROM THE SENIOR CENTER. NUMEROUS OTHER INDIVIDUALS PROVIDED INPUT INTO THE IMPLEMENTATION STRATEGY DEVELOPMENT PROCESS.

Schedule H, Part V, Section B, Line 6b Facility , 1
Facility , 1 - St. Gabriel's Hospital. The CHNA was conducted with Morrison County Public Health and Morrison County Social Services.

Schedule H, Part V, Section B, Line 7 Facility , 1
Facility , 1 - St. Gabriel's Hospital. THE CHNA IS ALSO EMAILED TO SPECIFIC INDIVIDUALS THROUGHOUT MORRISON COUNTY.

Schedule H, Part V, Section B, Line 11 Facility , 1
Facility , 1 - St. Gabriel's Hospital. The implementation strategy development team used a voting process to identify the highest health priorities for CHI St. Gabriel's Health and Morrison County. Team participants were asked to select their top health priorities taking into account all of the information gathered as part of the CHNA as well as the specific visit information available through the Epic electronic health record. Participants were asked to select their top 3-5 health issues as their highest priorities to address in the coming three years. After an objective voting process, the top five priority areas for participants on the implementation team were: 1) mental health (easily the highest priority among team members); 2) substance abuse/chemical dependency; 3) obesity; 4) accessibility to health care; and 5) parenting. Each of the five priority areas will be addressed separately, as well as additional priorities that are the current focus of CHI St. Gabriel's Health's action plans, most notably chronic disease and domestic violence. Out of the highest priorities identified by the CHNA process, the implementation strategy team decided to concentrate efforts on the two highest priorities-mental health and substance abuse/chemical dependency, while continuing to address the other top three priority areas: obesity, accessibility to health care and parenting. The highest priority area not specifically included in the implementation strategy is dental care, although a separate group of individuals from the hospital and county social services are exploring options to expand dental care for low-income individuals in the county. It was determined that since CHI St. Gabriel's Health does not employ dental practitioners, it was not in a position to lead efforts to expand dental care. That being said, the hospital agreed to work with AppleTree Dental and both Morrison County Public Health and Morrison County Social Services to identify potential funding sources to remodel existing hospital space to accommodate an expanded low-income dental clinic. Currently, the clinic is only open a few days a month and demand far exceeds the number of appointment slots available for patients to receive services. Health Priority Area 1: Improve the mental health of the people of Morrison County. Goal 1A) Enhance access to mental health services in Morrison County Objectives: 1A.1) Performs gap analysis to determine where the lack or underutilization of services exists by January 31, 2017. 1A.2) Works with South Country Health Alliance to determine what resources are being spent to provide access to mental health services by January 31, 2017. 1A.3) Continue to pursue dementia-friendly community certification by June 30, 2017. 1A.4) Pursue Behavioral Health Home certification if available by September 30, 2017. 1A.5) Utilize new mental health-psychiatric nurse practitioner to provide services to people with mental illness beginning in October 2016. 1A.6) Increase awareness of mental health services available in Morrison County through advertising and awareness-building strategies. Health Priority 2: Reduce the Impact of Chemical Dependency on Morrison County Individuals, Families and the Community Goal 2A): Reduce youth substance use in Morrison County Objectives: 2A.1) Reduce the percentage of Morrison County 8th, 9th, and 11th graders reporting any use of alcohol in the past 30 days from 19.5% to 16% by June 30, 2019 (Minnesota rate in 2013 is 16.8%) 2A.2) Increase the percentage of Morrison County 5th, 8th, 9th, and 11th graders reporting parental disapproval for youth alcohol use from 88.7% to 92% by June 30, 2019 (Minnesota rate in 2013 is 92%) 2A.3) Decrease the percentage of Morrison County 8th, 9th, and 11th graders reporting smoking one or more cigarettes in the past 30 days from 8.8% to 7% by June 30, 2019 (Minnesota Student Survey, Minnesota rate in 2013 is 7.8%) 2A.4) Increase the percentage of Morrison County 8th, 9th, and 11th graders reporting a perception of moderate or great risk of harm by using prescription drugs not prescribed for them from 78.5% to 92% by June 30, 2019. (Minnesota rate in 2013 is 81.3%) 2A.5) Expand the number of school districts/communities engaged in youth substance use prevention initiatives to all Morrison County communities. As previously noted, the implementation strategy team chose five priority areas to focus on in developing a three-year action plan in response to our Community Health Needs Assessment (CHNA). The specific goals, objectives, measures/indicators and evidenced-based strategies for the remaining three priority areas-Obesity, Accessibility and Parenting-will continue to be part of the ongoing community health strategies for CHI St. Gabriel's Health. In addition to the remaining three priority areas, CHI St. Gabriel's Health, in its role as the primary health agency in Morrison County, will continue to address these areas. Each concern will be discussed separately in the following paragraphs. Obesity - The objectives related to obesity fall under two primary categories-workplace wellness and youth/family strategies. CHI St. Gabriel's Health and its community partners will continue to support efforts that encourage healthy activities and eating. Some of the specific partners in this priority area include the Live Better Live Longer Eat, Move and Belong Teams; the Sprout kitchen and CSA shares program, the WIC Supplemental Food Program; the public health Statewide Health Improvement Program (SHIP) grant; Community Gardens; Ruby's Pantry; Oasis Share-A-Meal; Fare for All; local food shelves. Other community assets to address obesity include the Open Streets/Falls Festival on Foot, Climbing Wall at Lindbergh Elementary, the disc golf course, local fitness facilities, Headstart and the extension office. CHI St. Gabriel's Health is continuing to support local efforts to reduce obesity in a variety of ways. Accessibility to Health Care - CHI St. Gabriel's Health is enhancing efforts to increase accessibility to health care, also in a variety of ways. A new telemedicine/virtual clinic in the Little Falls Community Schools began this fall. The integrated electronic medical record (Epic) has made sharing data and communication among providers and patients more effective. A variety of government and non-government community assets are assisting in the expansion of resources, most notably South Country Health Alliance for individuals on Medical Assistance. CHI St. Gabriel's Health has programs to assist with securing financial resources to deliver care. Much effort has been made to expand hours in order to increase access to care and there are a variety of grant programs addressing such issues as the prescription drug initiative and domestic violence and the patient-centered medical home. CHI St. Gabriel's Health will continue to partner with Morrison County Social Services, Morrison County Public Health and other community agencies in the delivery of services. In addition, the hospital has an ongoing recruitment program in order to expand the range of services available locally. Internal medicine and pediatrics are two such critical needs in the community, given the high rate of people age 65 and older in the county. Parenting - Parenting was the fifth and final priority identified by the implementation strategy team. The Love and Logic, Morrison County Families, Nurse-Family Partnership and ASQ screening hub are among the resources being used to address these priorities. Morrison County Public Health and Morrison County Social Services tend to coordinate the parenting strategies through its MCICC, maternal child health, WIC and Headstart programs. The Live Better Live Longer (LBLL) healthy communities collaborative, an arm of CHI St. Gabriel's Health plays a significant role as well. The Belong Team of LBLL helps to connect families with the resources they need to assist with parenting.

Schedule H, Part V, Section B, Line 11 Facility , 2
Facility , 2 - St. Gabriel's Hospital. The 2016 CHNA identified 10 priorities through the written survey: 1) illegal drug use among teens; 2) adult obesity; 3) smoking/other tobacco use; 4) alcohol abuse among adults; 5) poor parenting skills; 6) prescription drug abuse; 7) underage alcohol use/abuse; 8) childhood obesity; 9) heart disease and stroke; and 10) bullying. Several items on this list are being addressed in our Implementation Strategy (November 2016), even though the list is not an exact match. The Implementation Strategy Team went through a prioritization process that selected five items on which to focus our health improvement activities. Those five include: a) mental health, b) chemical dependency, c) obesity, d) health care access, and e) parenting skills. Although specific work plans are still being developed, several items in our Top 10 list are currently being addressed under the broader item of chemical dependency (i.e., smoking, prescription drug abuse, and underage alcohol use/abuse), only two items that was on our Top 10 list (heart disease/stroke and bullying) are not specifically being addressed as part of our priority focus areas. Both, however, are being addressed. We made chronic disease a priority during our last (2013) CHNA and that work, specifically the use of a patient-centered medical home, is continuing to be a priority for CHI St. Gabriel's Health/Unity Family Healthcare. The medical home is highly effective in dealing with chronic disease and we have developed registries for tracking the effectiveness of our efforts to address these chronic conditions. Likewise, bullying is the focus of an initiative through a CHI Mission and Ministry Fund Violence Prevention grant. We fund Kindness Retreats and other evidenced-based bullying prevention strategies, especially if we are successful in renewing grant funding for bullying/violence prevention. These efforts will continue to be a secondary focus for our organization and will be reported on an annual basis.

Schedule H, Part V, Section B, Line 13 Facility , 1
Facility , 1 - St. Gabriel's Hospital. UNITY FAMILY HEALTHCARE BASES ITS FINANCIAL ASSISTANCE ELIGIBILITY ON HUD'S 130% OF VERY LOW INCOME GUIDELINES BASED ON GEOGRAPHY, AND AFFORDS THE UNINSURED AND UNDERINSURED THE ABILITY TO OBTAIN FINANCIAL ASSISTANCE WRITE-OFFS, BASED ON A SLIDING SCALE, RANGING FROM 25%- 100% OF CHARGES. AN INDIVIDUAL'S INCOME UNDER THE HUD GUIDELINES IS A SIGNIFICANT FACTOR IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE. HOWEVER, IN DETERMINING WHETHER TO EXTEND DISCOUNTED OR FREE CARE TO A PATIENT, THE PATIENT'S ASSETS MAY ALSO BE TAKEN INTO CONSIDERATION. FOR EXAMPLE, A PATIENT SUFFERING A CATASTROPHIC ILLNESS MAY HAVE A REASONABLE LEVEL OF INCOME, BUT A LOW LEVEL OF LIQUID ASSETS SUCH THAT THE PAYMENT OF MEDICAL BILLS WOULD BE SERIOUSLY DETRIMENTAL TO THE PATIENT'S BASIC FINANCIAL (AND ULTIMATELY PHYSICAL) WELL-BEING AND SURVIVAL. SUCH A PATIENT MAY BE EXTENDED DISCOUNTED OR FREE CARE BASED UPON THE FACTS AND CIRCUMSTANCES.

Schedule H, Part VI, Line 7 States Community Benefit Report Filed
"Minnesota hospitals ARE required to file hospital-specific community benefit information to the Minnesota Department of Health through the Health Care Cost Information System (HCCIS). Hospitals do this by filling out the Hospital Annual Report, which the Minnesota Hospital Association administers for MDH. MHA then files all of the information in the Hospital Annual Report to MDH as public information. A key issue with this report is that it is limited to ""hospital-only"" costs and the elements included in the community benefits section is limited. For example, MDH does not allow for the counting of the MinnesotaCare provider tax or MA (Medical Assistance) Surcharge as community benefits costs. Through a separate, voluntary effort, MHA collects community benefit data by health system and creates a statewide summary report for advocacy purposes. (MHA) collects this data by requesting access to summary data from all Minnesota facilities using the Community Benefit Inventory for Social Accountability (CBISA) software and UFH grants MHA such access. This advocacy collection effort also includes some of the real life stories of community benefits provided by hospitals that change lives and the health of their communities. MHA does not file that information with the state or share the hospital/system level data publically."

Schedule H, Part VI Schedule H Part II and Schedule H Part VI Lines 2 & 5
"Unity Family Healthcare's (UFH/CHI St. Gabriel's Health) mission is to nurture the healing ministry of the Church, supported by education and research. Fidelity to the Gospel urges us to emphasize human dignity and social justice as we create healthier communities. Our vision is to create the best possible health care experience by igniting the spirit for superior care and service. UFH was founded by the Franciscan Sisters of Little Falls to carry out the organization's healing ministry. The cornerstone of UFH (also commonly and collectively referred to as CHI St. Gabriel's Health) is St. Gabriel's Hospital, a 25-bed Critical Access Hospital (CAH), which originally was organized in May of 1891 and received its first patients in January of 1892. St. Gabriel's Hospital and the other organizations that comprise UFH-Family Medical Center, Little Falls Orthopedics and St. Camillus Place-serve all persons in the community on a non-discriminatory basis. The two hospitals operate emergency services departments that are open to all persons regardless of their ability to pay and have open medical staffs with privileges available to all qualified physicians and advanced practice clinicians (ACPs) such as physician assistants, nurse practitioners, etc. The UFH board of directors is an eleven-member governing board of independent individuals who serve as representatives of the community and oversee operations of the UFH facilities. Only two members of the governing board are not directly serving as representatives of the community-the market president and the senior vice president of operations from the Catholic Health Initiatives (CHI) division office in Fargo, ND. St. Gabriel's Hospital engages in the training of health professionals, especially nurses, pharmacists, radiologic technologists, physical therapists, nurse anesthetists and physician assistants. St. Gabriel's Hospital also has been an active participant in the University of Minnesota's Rural Physician Associate Program (RPAP) since its inception in 1973. RPAP provides a ""hands-on"" experience of serving the primary care needs of people in rural areas. UFH facilities participate in all government-sponsored health care programs such as Medicaid, Medicare, CHAMPUS, MinnesotaCare, MNsure, Tri-Care, and other government health care programs (i.e., the SAGE program, formerly called the Minnesota Breast & Cervical Cancer Control Program, which provides free or low-cost screening services to women at or below 200% of federal poverty guidelines). St. Gabriel's Hospital is a critical access hospitals (CAH) and operates a 24-hour emergency room, open 365 days per year. The emergency room is open to all individuals regardless of ability to pay. Furthermore, the hospital has an open medical staff, participates in Medicare and Medicaid, and has an active charity care/financial assistance program. The hospital does not discriminate on the basis of any non-merit factor, including race, national origin, color, religion, sex, sexual orientation, gender identity, disability (physical or mental), age, status as a parent, or genetic information. Community service and improving the health of the people we serve have always been at the core of UFH activities. For example, UFH was the first organization in the region to offer prenatal education to expectant mothers through St. Gabriel's Hospital in the 1950s. Other notable efforts to improve health from recent years include: the Youth Recreation Initiative, Youth as Resources (YAR), the Live Better Live Longer breastfeeding initiative, the Bridges: Youth, Family, Community program, which provided behavioral health counseling and other services to youth in the public schools and other services to families utilizing community resources, the Violence Prevention Initiative and the Prescription Drug Abuse Reduction Initiative. The programs and services described throughout this report not only serve all persons in the community, but also help to reduce the burdens on local government through a spirit of collaboration thanks to, in large, part, our success in securing grant funding for community-based health initiatives, some of which will be discussed later in this document. St. Gabriel's Hospital provides charity care, in addition to a wide range of community benefit activities associated with serving the needs of the poor. Performing these services and picking up the related costs helps local government agencies which might otherwise have to fund the services. UFH also contributes to the quality of life for area residents in one additional significant way-- through its extensive volunteer program. Apart from the many community benefit hours donated to such activities as the emergency medical system and other community health initiatives, UFH has multiple staff members who donate volunteer time to coaching, serving on church boards, etc., that enhance life in central Minnesota. Beyond these efforts, many community members donate their time and talents to serve the people who utilize our facilities. Our volunteer services department is well known throughout the community and the entire Fargo Division of Catholic Health Initiatives for having a comprehensive, well-developed volunteer program. How well-developed? In FYE June 30, 2016, a total of 313 volunteers contributed 21,061 hours of service to UFH. These hours not only contribute mightily to UFH facilities, but also offer a variety of intrinsic rewards that the volunteers say give meaning to their lives. Finally, the hospital is included in the Official Catholic Directory as a tax-exempt hospital. Community Health Needs Assessment Process Since its inception in 1891, St. Gabriel's Hospital has been intimately involved in community health collaboration, initially working with local lumbering companies to develop plans to care for their workers in the late 1800s and early 1900s. More recently, St. Gabriel's has been collaborating with Morrison County Public Health and Morrison County Social Services since the 1980s to examine area health issues, enabling the three partners to set priorities and plans for health improvement. St. Gabriel's Hospital continues our deep commitment and involvement in the community health assessment and action planning today."

Schedule H, Part VI Schedule H Part II and Schedule H Part VI Lines 2 & 5 (continued)
"UFH regularly performs a community health needs assessment (CHNA) every three years in compliance to the Affordable Care Act (ACA). Prior to implementation of the ACA, the CHNAs were performed every three to five years in partnership with Morrison County Social Services (MCSS) and Morrison County Public Health (MCPH). The CHNAs include a written survey as well as stakeholder interviews (health, social services, school and court staff, elected officials, etc.). Occasionally, focus groups around particular community health issues or access concerns are also included as part of the assessment process. The three partners have shared the expenses for the CHNAs that were performed in 1989, 1994, 1999, 2004, 2009, 2013 and 2016. The most recent CHNA was conducted in FY2016 and posted on the UFH website (www.chistgabriels.com) on July 1, 2016. St. Gabriel's Hospital has always taken the leadership role in coordinating the community health needs assessment. This past year, in addition to the three long-term partners (MCPH, MCSS and the hospital), the hospital was asked to participate in a regional effort that included the public health agencies in Todd and Wadena counties in addition to Morrison County. As was done in 2013, additional collaborators will be part of the implementation strategy development for the CHNA. For the 2016 CHNA, among the people involved were the St. Gabriel's Health Foundation director, the director of the Healthy Communities Collaborative of Morrison County (HCC), the clinic administrator, the vice president of patient care, the public health medical director, representatives from Northern Pines Mental Health, law enforcement, area schools, Camp Ripley (an Army National Guard training facility located in Morrison County), and the Violence Prevention Council of Morrison County. Special attention was given to inviting people familiar with issues related to mental health and chemical dependency, since these two issues were considered of foremost concern in the county. Thanks to a Catholic Health Initiatives (CHI) Mission and Ministry Fund planning grant, St. Gabriel's Hospital led the formation of the Healthy Communities Collaborative (HCC) in 2005. In the past year, the HCC changed its name to Live Better Live Longer (LBLL) in 2015. The hospital is the corporate sponsor of the LBLL, a multi-organization entity working to address various community health issues with representatives from area schools, clergy as well as the county public health and social services agencies. Each year, the LBLL identifies programs and services that are needed in the community and helps to write a project grant to develop initiatives that address community needs. UFH also sponsors the Violence Prevention Initiative (VPI) of Morrison County, a community-based project and local Violence Prevention Council with representation from local enforcement, courts, social services, other not-for-profit organizations and individuals (including former victims) that addresses partner violence, a significant community health concern in the county. The VPI has three core goals: 1) reduce the number of domestic assaults charged in Morrison County; 2) reduce the number of Orders for Protection issued in the county each year; and 3) reduce violations of Orders for Protection that occur each year. In 2015, CHI St. Gabriel's Health began an initiative to reduce opioid abuse as an Accountable Communities for Health (ACH) grant project with State Innovation Model funding. The initiative began because of concerns about narcotic use in the community, as evidenced by the high numbers of emergency room visits, observed narcotic-seeking behavior, and excessive narcotic prescriptions. Comprehensive activities and strategies to confront the issue focused on changes within the healthcare setting and improved community collaboration and communication. Through this project, a controlled substance care team consisting of a social worker, RN health navigator, a pharmacist, and provider was established. The care team sees patients on long-term narcotics use and develop care plans to help them achieve health goals. The controlled substance care team identifies other unmet social needs creating barriers to managing pain effectively and connects patients to other community services, such as housing assistance, mental health services, transportation, food assistance, and financial assistance to name a few. As part of the initiative, CHI St. Gabriel's Health has developed a strong partnership with several community stakeholders. Each month, a prescription drug abuse prevention task force meets to address the issue. Representatives from law enforcement, long-term care and home health agencies, schools, public health, social services, courts, corrections, mental health, and pharmacy are part of this task force. The group has organized community educational outreach, promoted proper disposal of unused medications, developed policies and practices to reduce opioid abuse. As previously stated, the most-recent (2016) CHNA has been posted on the UFH website (www.chistgabriels.com. The report reflects the compilation and analysis of extensive data sources to identify issues having a significant impact on the health and general well-being of area residents. The community health needs assessment process for the hospital-St. Gabriel's Hospital-produced $16,825 in community benefit in FY2016, demonstrating the organization's significant investment in examining the health issues of the community and creating an implementation plan to address those issues. Summary of Assessment Findings The ""Health of Morrison County"" community health needs assessment is a multi-pronged process. The assessment has six sections: 1) What the People Told Us (a written survey conducted by Marketing Systems Group of Horsham, PA, with oversight from the Minnesota Department of Health, that was distributed through the U.S.); 2) What Stakeholders Told Us (individual interviews with 20-plus people from throughout the county); 3) What the Secondary Data Told Us (a comprehensive review of multiple state, federal and private data sources on a wide-ranging list of health care topics); 4) What is Available (a comprehensive list of community health resources in Morrison County); 5) Summary and Conclusions; and 6) Implementation Strategy (a three-year action plan to improve the health of residents of Morrison County)."

Schedule H, Part VI Schedule H Part II and Schedule H Part VI Lines 2 & 5 (continued)
"The mail survey listed 27 possible community health issues and asked respondents to identify them as ""a serious problem,"" ""a moderate problem,"" ""a minor problem,"" or ""no problem."" Out of the top 10 issues from among the 27 possible choices, half of the issues are related to alcohol/chemical dependency/drug use/tobacco. Obesity among adults was identified as the second-most significant health issue, identified by 73.8% as a serious or moderate problem. The complete list of the top ten follows: 1. Illegal Drug Use Among Teens 2. Obesity Among Adults 3. Smoking/Other Tobacco Use 4. Alcohol Abuse Among Those 21+ 5. Parents with Inadequate or Poor Parenting Skills 6. Prescription Drug Abuse/Misuse 7. Alcohol Use Among Those <21 8. Obesity Among Children 9. Heart Disease and Stroke 10. Bullying in Schools The range of health issues impacting Morrison County, as evidenced by the collection of primary and secondary data, led St. Gabriel's Hospital and its CHNA partners to adopt an Implementation Strategy that focuses on five goal areas, which were developed by the implementation strategy team using a voting process, in which team participants were asked to select their top health priorities taking into account all of the information gathered as part of the CHNA as well as the specific visit information available through the Epic electronic health record. After the voting process, the top five priority areas for participants on the implementation team were: 1) mental health (easily the highest priority among team members); 2) substance abuse/chemical dependency; 3) obesity; 4) accessibility to health care; and 5) parenting. Each of the five priority areas will be addressed separately, as well as additional priorities that are the current focus of CHI St. Gabriel's Health's action plans, most notably chronic disease and domestic violence. The Implementation Strategy identifies specific strategies/actions over a three-year period when the next CHNA will be conducted (FY2019). St. Gabriel's Hospital and its CHNA partners recognize the limited resources available in the county to address mental health, chemical dependency and other issues in the county identified through the CHNA/implementation strategy process. Still, the collaborators decided to further work with Morrison County Social Services, Morrison County Public Health and South Country Health Alliance, a partner with Morrison County is serving people with Medical Assistance, to explore options to address these health concerns. The hospital was successful in receiving a Minnesota Department of Health Statewide Innovation Model (SIM) grant to address prescription drug abuse issues among seniors and youth in the county. The SIM initiative focuses on addressing prescription abuse through a Triple AIM approach utilizing our recently certified Patient-Centered Medical Home health coaches. CHI St. Gabriel's also received grant funding to work with Apple Tree Dental to provide dental services to people of low-income and received an extension of its SIM funding for a third year. The partners are continuing to explore additional grant funding, legislative solutions and other ways to further enhance grant initiatives through collaborative strategies that address different components of health issues impacting the county/service area. QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT Community Outreach for the Poor Translation Services - One area that has shown continued growth as the community has become more diverse, has been the increase in translation services. In 2010, the amount spent for providing translation services was approximately $8,500, which has increased to approximately $28,387 in 2013 (an increase of over 300%) and was $30,629 (nearly 400% since 2010) in FY 2014 and slightly decreased to $24,473 in FY2015. In FY2016, the amount was $32,179. Miscellaneous Initiatives for the Poor - Unity Family Healthcare's facilities also donate staff time toward coordinating fund-raising activities for the poor. These range from assisting individuals with accessing financial assistance programs to purchasing school supplies and Christmas presents for needy families, although the individual gifts purchased at Christmas do not qualify as community benefit, since individual staff members make those gifts, the estimated value of these benefits is approximately $75,655 and the number of people impacted is over 300 annually. Community Outreach for the Broader Community Youth Development, Partner Violence Prevention, Chronic Disease Management (Patient-Centered Medical Home), and Prescription Drug Abuse Initiatives - UFH continues to strategically apply for, receive and manage grants that align both with our community health needs assessment (CHNA) implementation plan and the health needs and issues of the people of Morrison County. In 2013, UFH received a two-year grant that specifically targeted improving the health of the people of Morrison County through a youth development and breastfeeding enhancement initiative. This initiative had two primary focuses: 1) making mini-grants to youth-led, youth-initiated projects, and 2) increasing the number of women in Morrison County who breastfeed their babies. The grant initiative met with overall success (a summary is available upon request) and the initiative ended on June 30, 2015. A second grant UFH has received continuously since 2009 has been focused on reducing partner violence (domestic violence) in Morrison County as measured by the number of domestic assaults charged, the number of Orders for Protection issued and the number of charged violations of Orders for Protection. By all three measures, things improved."

Schedule H, Part VI Schedule H Part II and Schedule H Part VI Lines 2 & 5 (continued)
"In July 1, 2014, this grant initiative received another three years of funding. Thirdly, the patient-centered medical home development initiative (PCMHDI), which seeks to improve the health of residents of Morrison County, especially those with chronic disease, by using a Triple AIM approach, has been very well-received in the community and in FY 2014 received certification from the Minnesota Department of Health (MDH) as a medical home. The PCMH recently received re-certification as a medical home by MDH. Finally, the aforementioned prescription drug abuse reduction initiative is making a difference in the lives impacted by such abuse. Together, these grant initiatives (and a few minor initiatives) resulted in $145,273 in community benefits in FY2016. The latter three of these initiatives (excluding the breastfeeding initiative) have received funding for fiscal year 2016 so these community benefit efforts are continuing. Furthermore, in a time of tight government budgets, the grant initiatives are enabling the hospital to pursue projects that address well-defined community needs as outlined in our CHNA. Youth Recreation Initiative In 1997, St. Gabriel's Hospital received a CHI Mission & Ministry Fund grant to enhance recreation opportunities in partnership with the Little Falls Area Schools. Prior to 1997, there had been substantial cuts in a collaborative between the City of Little Falls and the local school district to address youth recreation. The Youth Recreation Initiative, as it is called, has continued despite the fact that grant funding through the Mission & Ministry has long been discontinued. The program has been so favorably received in the community that the leadership of St. Gabriel's Hospital has chosen to continue supporting the program. That level of support totaled more than $49,967 in fiscal year 2016 and impacted 11,732 people. Early on in the program's history, there was a noticeable decline in youth delinquency as measured by interactions with the judicial system and that decline has been maintained. We believe the decline was due to the increased opportunities created for area youth. Support Groups UFH facilities offer a variety of support groups and similar activities, including such activities as the Prostate Cancer Support Group, Eating Disorders Support Group, Adoption Support group, the Alanon Group, the Hospice Family Support activities and the special spiritual services (empty arm for miscarriages, hospice memorial services, etc.). In 2016, the value of the support for this activity has been decreasing due to the retirement of some staff involved in the groups. It still totaled $1,311. The support groups served 36 people in 2016. Health Screenings/Health Fairs UFH facilities, especially St. Gabriel's Hospital, offer a variety of free health screenings and health fairs for the communities in which we serve. The total value of these activities was nearly $17,800 in FY 2016, with 1,165 (includes health fair and blood pressure screening numbers) people participating in the health fairs/screenings. The screenings include such things as blood pressure checks at a local extended care facility (not part of UFH), other screenings, firemen physicals, pulmonary screening and flu shots. The increase over the prior year is due largely to the Little Falls Area Health Fair, which is held in the spring of even-numbered years. That event alone had 500 participants in 2016. Donated Space UFH facilities donate the use of our facilities to non-profit organizations. Some of these include TOPS (Take Off Pounds Sensibly), the Mental Health Support Group, and OASIS Share-A-Meal, to name just a few. The total value of the donated space in fiscal year 2016 was $14,305, with approximately 422 people using the facilities. UFH Participation on Community Health Initiatives One of the larger community benefit activities that UFH supports is the participation on community health initiatives. This involves everything from the Healthy Communities Collaborative to the Violence Prevention Council to the Morrison County EMS board to the Morrison County Ministerial Association and the Elder Network. This activity directly impacted nearly 200 people in 2016, and was valued at more than $33,408. Senior Companion Program Finally, health care providers and community service organizations recognize the benefits provided through the St. Gabriel's Hospital Senior Companions program. Patients connect with their individual ""companions"" before they leave the hospital. Once home, the companions continue to regularly visit with the patients while they continue their recovery. In the past fiscal year (FY2016), the program served 9 different people in the community, with a total community benefit of $1,040. Donations In the fiscal year ending June 30, 2016, UFH made over $19,459 in cash to local/regional entities to such local entities as the Morrison County Relay for Life sponsored by the American Cancer Society, the Albany Senior Center, Oasis Share-A-Meal and other not-for-profit organizations. In-kind donations totaled another $7,872 with an estimated 3,057 people served. Subsidized Health Services UFH has one much-needed and appreciated community service that operates as a loss to the organization. That service is St. Gabriel's Hospital's home care program-CHI Health at Home Little Falls (formerly Unity Family Home Care). In FY2015, it generated over $393,097 in community benefit. The home care provided 5,749 visits in fiscal 2016 so the benefit to the community is substantial. Physician Recruitment Our primary service area (Morrison County, MN) has a population of approximately 32,821, of which over 17.9% are age 65 or older. This elderly population, in particular, requires the skills of two medical specialties--internal medicine and general surgery. Based on the community health needs assessment and physician specialty by population studies, it was determined that at least one and up to four (depending upon the mix of family practice and internal medicine) internists and two general surgeons are needed in the community to adequately serve patients' health needs. In addition, due to the retirement of one pediatrician, a second is needed. Physician/provider recruitment has been complicated and created additional challenges due to the fact that there are Health Professional Shortage Areas in Morrison County. The total cost of expenses associated with physician recruitment and retention in these much-needed specialties was over $425,412 in fiscal 2016. Health Professions Education UFH's acute care facility--St. Gabriel's Hospital--serves as clinical education sites for medical professionals. In fiscal year 2016, St. Gabriel's Hospital assisted in the education of the following health professionals: medical students (through the Rural Physician Associate Program); nursing students; pharmacists, radiologic technologists, pharmacists; and nurse anesthetists. The community benefit claimed for that training totaled $3,773 and 102 people received those services. Community Building Activities Live Better Live Longer (formerly the Healthy Communities Collaborative of Morrison County) is a collaborative effort of over 20 organizations. It is a county-wide community health status improvement initiative. LBLL's mission is, ""Through collaboration, we build and nurture the total health and well-being of people in Morrison County."" Its vision reads, ""Morrison County stands out as a vibrant, interconnected community for all to live, work, learn, worship and play."" Unity Family Healthcare is the sponsoring agency for LBLL and UFH staff members serve on its board and communities. LBLL has on three tenets Eat, Move, and Belong, which encourages people in the county to eat better, more nutritious meals (including breast milk for young children); exercise regularly; and become involved in the Morrison County community, whether it's through recreation, book clubs, churches or whatever the individual chooses. Unity Family Healthcare staff members are not only involved in the LBLL board and committees, it also partners with other public and private entities on many other health initiatives such as 5-2-1-0, community transformation, etc., in order to improve the health of the people of Morrison County. Individual staff members also donate significant time to coaching and other leadership positions in the community."

Schedule H, Part V, Section B, Line 3 Albany Area Hospital and Medical Center
Albany Area Hospital and Medical Center was closed on 12/31/15. Albany Area Hospital and Medical Center LAST CONDUCTED A CHNA IN TAX YEAR 2012. PURSUANT TO TREAS. REG. SECTION 1.503(R)-3(D)(4) A HOSPITAL ORGANIZATION IS NOT REQUIRED TO MEET THE REQUIREMENTS OF SECTION 501(R)(3) WITH RESPECT TO A HOSPITAL FACILITY IN A TAXABLE YEAR IF, BEFORE THE END OF THAT TAXABLE YEAR, THE HOSPITAL ORGANIZATION TRANSFERS ALL OWNERSHIP OF THE HOSPITAL FACILITY TO ANOTHER ORGANIZATION OR OTHERWISE CEASES ITS OPERATION OF THE HOSPITAL FACILITY OR THE FACILITY CEASES TO BE LICENSED, REGISTERED, OR SIMILARLY RECOGNIZED AS A HOSPITAL BY A STATE.

Schedule H, Part V, Section C Albany Area Hospital and Medical Center
Albany Area Hospital and Medical Center was closed on 12/31/15. AS A RESULT, SCHEDULE H HAS BEEN COMPLETED USING THE INFORMATION FROM THE 2012 CHNA, AS THAT WAS THE MOST RECENT ONE CONDUCTED PRIOR TO THE closure.

Schedule H, Part I, Line 3c Eligibility criteria for free or discounted care
"When Catholic Health Initiatives (the ultimate parent organization to Unity Family Healthcare (UFH) established its charity care policy, it was determined that implementing a household income scale based on the HUD very low income guidelines would most accurately reflect the socioeconomic dispersions among the 100+ urban and rural communities in 19 states served by CHI hospitals and health care facilities. In comparing HUD guidelines to the Federal Poverty Guidelines (""FPG""), we find that, on average, HUD guidelines compute to approximately 200% to 250% (and sometimes 300%) of the FPG. UFH bases its charity care eligibility on a person being 130% of HUD's Very-Low Income Guidelines. This scale is based on geography, and affords the uninsured and underinsured the ability to obtain financial assistance write-offs, based on a sliding scale, ranging from 25%-100% of charges. While an individual's income using the HUD guidelines is a significant factor in determining eligibility for charity care, the patient's assets may also be taken into consideration when determining whether to extend discounted or free care to a patient. For example, a patient suffering a catastrophic illness may have an income in excess of HUD guidelines, but a low level of liquid assets such that the payment of medical bills would be seriously detrimental to the patient's financial and physical well-being. An individual's socioeconomic facts and circumstances may dictate the patient receiving free or discounted health care services."

Schedule H, Part I, Line 7g Subsidized Health Services
There are no physician clinics included in subsidized health services.

Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation
1747220

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
A cost accounting system was not used to compute amounts in the table; rather costs in the table were computed using the organization's cost-to-charge ratio. The cost-to-charge ratio covers all patient segments. The cost-to-charge ratios for the year ended June 30, 2016 were computed using the following formula: Operating expense (before restructuring, impairment and other losses) divided by gross patient revenue. Based on that formula, ST. GABRIEL'S HOSPITAL AND ALBANY AREA HOSPITAL HAD COST-TO-CHARGE RATIOS OF 49.09% AND 71.24% RESPECTIVELY. Worksheet 2 was not used to derive the cost-to-charge ratio.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
Costing methodology for amounts reported on line 2 is determined using the Unity Family Healthcare's cost/charge ratios of 49.22% for St. Gabriel's Hospital. When discounts are extended to self-pay patients, these patient account discounts are recorded as a reduction in revenue, not as bad debt expense.

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
Unity Family Healthcare does not believe that any portion of bad debt expense could reasonably be attributed to patients who qualify for financial assistance since amounts due from those individuals' accounts will be reclassified from bad debt expense to charity care within 30 days following the date that the patient is determined to qualify for charity care.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
"Unity Family Healthcare does not issue separate company audited financial statements. However, the organization is included in the consolidated financial statements of Catholic Health Initiatives. The consolidated footnote reads as follows: ""The provision for bad debts is based upon management's assessment of historical and expected net collections considering historical business and economic conditions, trends in health care coverage, and other collection indicators. Management routinely assesses the adequacy of the allowances for uncollectible accounts based upon historical write-off experience by payor category. The results of these reviews are used to modify, as necessary, the provision for bad debts and to establish appropriate allowances for uncollectible net patient accounts receivable. After satisfaction of amounts due from insurance, CHI follows established guidelines for placing certain patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by each facility."""

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
"Unity Family Healthcare is designated as a Critical Access Hospital (""CAH""). CAHs are rural community hospitals that are certified to receive cost-based reimbursement from Medicare. The reimbursement that CAHs receive is intended to improve their financial performance and thereby reduce hospital closures. CAHs are certified under a different set of Medicare Conditions of Participation (CoP). Shortfalls are created when a facility receives payments that are less than the costs of caring for program beneficiaries. Because shortfalls are based on costs, not charges, Unity Family Healthcare, due to its designation as a CAH, received cost-based reimbursement for Medicare purposes, and does not experience significant Medicare-related shortfalls. The total shortfall for FY2016 was $235,480 or approximately 1.2%. Although not presented on the Medicare cost report, in order to facilitate a more accurate understanding of the ""true"" cost of services (for ""shortfall"" purposes) the CHI Workbook allows a health care facility not to offset costs that Medicare considers to be non-allowable, but for which the facility can legitimately argue are related to the care of the facility's patients. In addition, although not reportable on the Medicare cost report, the CHI workbook includes the cost of services that are paid via a set fee-schedule rather than being reimbursed based on costs (e.g. outpatient clinical laboratory). Finally, the CHI Workbook allows a facility to include other health care services performed by a separate facility (such as a physician practice) that are maintained on separate books and records (as opposed to the main facility's books and records which has its costs of service included within a cost report). True costs of Medicare computed using this methodology: Total Medicare Revenue: $19,790,581 Total Medicare costs: $20,026,061 Surplus (or Shortfall): ($235,480) Unity Family Healthcare believes that excluding Medicare losses from community benefit makes the overall community benefit report more credible for these reasons: * Unlike subsidized areas such as burn units or behavioral-health services, Medicare is not a differentiating feature of tax-exempt health care organizations. In fact, for-profit hospitals focus on attracting patients with Medicare coverage, especially in the case of well-paid services that include cardiac and orthopedics. Significant effort and resources are devoted to ensuring that hospitals are reimbursed appropriately by the Medicare program. The Medicare Payment Advisory Commission (MedPAC), an independent Congressional agency, carefully studies Medicare payment and the access to care that Medicare beneficiaries receive. The commission recommends payment adjustments to Congress accordingly. * Though Medicare losses are not included by Catholic hospitals as community benefit, the Catholic Health Association guidelines allow hospitals to count as community benefit some programs that specifically serve the Medicare population. For instance, if hospitals operate programs for patients with Medicare benefits that respond to identified community needs, generate losses for the hospital, and meet other criteria, these programs can be included in the CHA framework in Category C as ""subsidized health services."" At Unity Family Healthcare, our hospice and home care department-CHI Health at Home (formerly) Unity Family Home Care & Hospice-is an example subsidized health service. * Medicare losses are different from Medicaid losses, which are counted in the CHA community benefit framework, because Medicaid reimbursements generally do not receive the level of attention paid to Medicare reimbursement. Medicaid payment is largely driven by what states can afford to pay, and is typically substantially less than what Medicare pays."

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
"Unity Family Healthcare, along with its affiliated outpatient facilities, are part of Catholic Health Initiatives ""CHI."" CHI has a written policy (Stewardship policy No. 16) governing the procedures for collections of past due accounts. All hospital facilities included in the filing organization have adopted this policy and follow these practices with regards to collections: PROCEDURES CHI Entities utilize standard procedures in collecting Self-Pay Balances as follows: Permissible Collections Activity Each facility must adhere to the following requirements in relation to the pursuit of Self-Pay Balances: * Fair Pursuit. Each facility shall ensure that all patient and patient guarantor accounts are pursued fairly. * Ethics and Integrity. Each facility shall ensure that all collection activities consistently reflect the highest standards of ethics and integrity. * Reasonable Payment Terms. Each facility shall offer reasonable payment schedules and terms to each patient and patient guarantor with Self-Pay Balances. All collection activities conducted by the facility or its third-party collection agents will be in conformance with all federal and state laws governing debt collection practices. Collection activity may be in the form of letters, emails, phone calls, and/or credit reporting and may also include wage garnishments, placing of liens on buildings or residences other than personal residences, initiation of lawsuit, and/or other actions as required, except as prohibited by Impermissible Collections Actions below. Pre-Collections Activity * Timing. Generally, accounts will not be referred to collections until they are 120 days old. However, in circumstances where invoices to non-Medicare patients are returned undelivered with no known address, those Self-Pay Balances may be referred to collections prior to expiration of 120 days. * Limitations - Financial Assistance Eligibility. The facility shall perform a reasonable review of each patient account prior to turning an account over to a third-party collection agent and prior to instituting any legal action for non-payment (including, but not limited to, reporting the account to a collection agency) to ensure that the patient and patient guarantor are not eligible for any assistance program (e.g., Medicaid) and do not qualify for coverage through the facility's financial assistance policy. That reasonable review will include one or more of the following: Notification to patient of the availability of financial assistance on admission, prior to discharge, and/or in the billing process; Review of Financial Assistance Application submitted by or on behalf of the patient; or Review of the patient's eligibility using patient account statistical scoring software. Cooperating Efforts. No facility shall send any unpaid self-pay account to a third-party collection agent as long as the patient and patient guarantor are cooperating with the facility in efforts to settle the account balance within a reasonable time frame (generally 18 months). Subsequent Assessment. After having been turned over to a third-party collection agent, any account that subsequently is determined to qualify for financial assistance shall be returned immediately by the third-party collection agent to the facility for appropriate follow-up. CHI shall direct its staff and third-party collection agents to continually assess each patient and patient guarantor's ability to pay or to be determined eligible for financial assistance. Collections The facility may use a third-party collection agent as a representative, acting in the name of the facility and engaged on a contractual basis, for the express purposes of following-up on and potentially collecting any patient accounts receivable balances. The facility shall contractually define the standards and scope of practices to be used by third-party collection agents. Those standards and scope of practices shall be consistent with this policy and shall, at a minimum, include the following: Statement Message. The facility shall require its third-party collection agents to include a message on all statements indicating that if a patient or patient guarantor meets certain stipulated income requirements, the patient or patient guarantor may be eligible for facility or other financial assistance programs. Advance Settlement Approvals. The facility shall instruct its third-party collection agents to seek approval from the authorized and designated facility staff member before any settlement, as a result of bankruptcy proceedings, shall be accepted. Standards of Conduct. The facility shall require that the third-party collection agents conduct themselves in compliance with the highest standards of business ethics and integrity and applicable legal requirements, as reflected in the CHI Standards of Conduct, as may be amended by CHI, available at the following website: http://www.catholichealthinitiatives.org/corporateresponsibility. Prohibited Collections Actions. The facility shall prohibit the third-party collection agents from engaging in prohibited collections actions as defined in Impermissible Collections Actions below. Annual Adherence Audit. The facility or its designee shall be permitted to audit its third-party collection agents at least annually for adherence to these standards. Impermissible Collections Actions CHI Entities shall direct their staff and third-party collection agents that the following actions are always prohibited in relation to the pursuit of Self-Pay Balances. Unemployed without Significant Income/Assets. No facility shall pursue any legal action for non-payment of any bills against any patient or patient guarantor who is known to be unemployed and who has been determined in accordance with CHI Stewardship Policy No. 15, Hospital Financial Assistance, on the basis of a completed Financial Assistance Application, to be without significant income or assets. Principal Residence. No facility shall pursue any legal action against any patient or patient guarantor by seeking a remedy that would involve foreclosing upon the principle residence of a patient or patient guarantor, placing a lien on the principal residence, taking any other action that could result in the involuntary sale or transfer of such residence, or informing any patient or patient guarantor that he/she may be subject to any such action. Other Impermissible Collection Tactics. No facility shall charge interest on outstanding balances; No facility shall require patients or patient guarantors to incur debt or loans with recourse to the patient's or guarantor's personal or real property assets (""recourse indebtedness""); and No facility shall invoke so-called ""body attachments"" (i.e., the arrest or jailing of patients in default on their accounts, such as for missed court appearances). In addition to the written policy all of Catholic Health Initiatives' hospitals' contracts with third party collection agencies include the following standards: Neither CHI hospitals nor their collection agencies will request bench or arrest warrants as a result of non-payment; Neither CHI hospitals nor their collection agencies will seek liens that would require the sale or foreclosure of a primary residence; and No Catholic Health Initiatives' collection agency may seek court action without hospital approval. Finally, collection agencies are trained on the Catholic Health Initiatives Mission, Core Values and Standard of Conduct to make sure all patients are treated with dignity and respect."

Schedule H, Part V, Section B, Line 16a FAP website
- Albany Area Hospital and Medical Center: Line 16a URL: http://www.chistgabriels.com/financial-assistance.htm; - St. Gabriel's Hospital: Line 16a URL: http://www.chistgabriels.com/financial-assistance.htm;

Schedule H, Part V, Section B, Line 16b FAP Application website
- Albany Area Hospital and Medical Center: Line 16b URL: http://www.chistgabriels.com/financial-assistance.htm; - St. Gabriel's Hospital: Line 16b URL: http://www.chistgabriels.com/financial-assistance.htm;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
- Albany Area Hospital and Medical Center: Line 16c URL: http://www.chistgabriels.com/financial-assistance.htm; - St. Gabriel's Hospital: Line 16c URL: http://www.chistgabriels.com/financial-assistance.htm;

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
"Unity Family Healthcare (UFH) along with its affiliated outpatient facilities, are part of Catholic Health Initiatives ""CHI."" CHI has a written policy (Stewardship policy No. 15) governing the procedures for determining and informing patients about the entity's financial assistance policy. All hospital facilities included in the filing organization have adopted the policy. The policy states the organization will include information concerning its financial assistance policy on its website. In addition, UFH prominently displays its financial assistance policy in both English and Spanish in obvious locations throughout the hospitals, including the emergency rooms and other patient intake areas, as well as UFH outpatient facilities, including Family Medical Center (multi-specialty 25-provider primary and selected specialty care clinic) and Little Falls Orthopedics (an orthopedic clinic offering podiatry and physical therapy, in addition to orthopedic services, at six central Minnesota locations. In addition, UFH registration clerks are trained to identify patients who have no insurance or potentially inadequate insurance and connect such individuals with UFH's financial counselors concerning their options including application for Medicaid and for financial assistance under UFH's financial assistance policy. Upon registration (and once all EMTALA requirements are met), patients who are identified as uninsured (and not covered by Medicare or Medicaid) are provided with a packet of information that addresses the financial assistance policy and procedures including an application for assistance UFH registration clerks read the organization's medical assistance policy to those who appear to be incapable of reading, and provide translators for non-English-speaking individuals. UFH staff will also assist the patient/guarantor with applying for other available coverage (such as Medicaid), if necessary. Counselors assist Medicare eligible patients in enrollment by providing referrals to the appropriate government agencies."

Schedule H, Part VI, Line 4 Community information
"St. Gabriel's Hospital is located in central Minnesota in the city of Little Falls and serves the people of Morrison County, Minnesota, and small portions in the surrounding counties. Morrison County has a population of 32,821 according the most recent (July 2016) estimate from the U.S. Census Bureau (QuickFacts Morrison County, Minnesota, July 2016. Source: U.S. Census Bureau, Population Division). On average, Morrison County is older and ""poorer"" on average than the population of the state of Minnesota overall. In the county, 17.9% of the population is age 65 or older compared to 14.7% of Minnesotans. The median age for Morrison County is 41.2 and for Minnesota, it is 37.7. The median household income for the county is $50,049 and the per capita income is $24,984, in comparison to $61,492 and $32,157, respectively for Minnesota. The percentage of persons below the poverty level (2011-2015) in the county is 11.8%, while in the state, it is 11.5% Morrison County has a largely Caucasian population with 97.3% of the population ""white."" This is in comparison to the state of Minnesota as a whole, which is 85.4% white. Similarly, only 1% of the population is foreign born, while Minnesota foreign-born population is 7.7%. There are 29.5 persons per square mile in the county and for Minnesota as a whole, there are 66.6 persons per square mile. The percentage of people in Morrison County with a disability is 7.5%, compared to 7.1% for the state. A few areas of the county have been designated as Health Professional Shortage Areas (HPSAs), primarily due to economic factors. According to the Towncharts, the median earnings per worker is $39,180 for Morrison County compared to $47,607 for all of Minnesota, which is 21.5% less in Morrison County than the state. The county unemployment rate is currently (February 2017) 8.4%. The state rate is 4.8%. Over the past year, the unemployment rate for the county has ranged from 4.1 to 9.3%, and in the state it has ranged from 3.3% to 5.0%. The total number of jobs in the county is 17,786 (2017 MNDEED-LMI estimate). The average hourly rate in Morrison County is $19.08/hour compared to $24.09/hour for Minnesota. Similarly, the average weekly wage for the county is $651/week, approximately 38% less than the state average of $1,053/week."

Schedule H, Part VI, Line 6 Affiliated health care system
"Unity Family Healthcare, along with its affiliated outpatient facilities, are part of Catholic Health Initiatives. Catholic Health Initiatives, a nonprofit, faith-based health system formed in 1996 through the consolidation of four Catholic health systems, expresses its mission each day by creating and nurturing healthy communities in the hundreds of sites across the nation where it provides care. One of the nation's largest health systems, the Englewood, CO-based CHI operates in 19 states and comprises over 100 hospitals, including four academic health centers and major teaching hospitals and 30 critical-access facilities; community health-services organizations; accredited nursing colleges; home-health agencies; and other facilities that span the inpatient and outpatient continuum of care. In fiscal year 2016, CHI provided over $1.1 billion in financial assistance and community benefit - more than a 14% increase over the previous year -- for programs and services for the poor, free clinics, education and research. Financial assistance and community benefit totaled more than $2.1 billion with the inclusion of the unpaid costs of Medicare. CHI's exempt purpose is to serve as an integral part of its national system of hospitals and other charitable entities, which are described as market-based organizations, or MBOs. An MBO is a direct provider of care or services within a defined market area that may be an integrated health system and/or a stand-alone hospital or other facility or service provider. CHI provides strategic planning and management services as well as centralized ""shared services"" for the MBOs. The provision of centralized management and shared services - including areas such as accounting, human resources, payroll and supply chain -- provides economies of scale and purchasing power to the MBOs. The cost savings achieved through CHI's centralization enable MBOs to dedicate additional resources to high-quality health care and community outreach services to the most vulnerable members of our society. UFH operates with its wholly owned affiliates and community partners, along with its fundraising arm, the St. Gabriel's Health Foundation, to serve the health care needs of the Morrison County."