4A (Expenses $ 81526760 including grants of $ 4820) (Revenue $ 85818274)
SEE SCHEDULE H

PART V, SECTION A:
OP CLINICS: URGENT CARE, CARDIOLOGY, NEUROLOGY, FAMILY MEDICINE, PEDIATRICS, INTERNAL MEDICINE, ORTHOPEDICS, GENERAL SURGERY, OBSTETRICS/GYNAECOLOGY, ONCOLOGY AND PSYCHIATRY

MERCY MEDICAL CENTER
PART V, SECTION B, LINE 5: TO HELP INFORM FUTURE DECISIONS AND STRATEGIC PLANNING, CHI ST. ALEXIUS HEALTH WILLISTON CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN 2021, THE PREVIOUS CHNA HAVING BEEN CONDUCTED IN 2019. THE CENTER FOR RURAL HEALTH (CRH) AT THE UNIVERSITY OF NORTH DAKOTA SCHOOL OF MEDICINE & HEALTH SCIENCES (UNDSMHS) FACILITATED THE ASSESSMENT PROCESS, WHICH SOLICITED INPUT FROM AREA COMMUNITY MEMBERS AND HEALTHCARE PROFESSIONALS AS WELL AS ANALYSIS OF COMMUNITY HEALTH-RELATED DATA. TO GATHER FEEDBACK FROM THE COMMUNITY, RESIDENTS OF THE AREA WERE GIVEN THE OPPORTUNITY TO PARTICIPATE IN A SURVEY. TWO HUNDRED NINETY-TWO CHI ST. ALEXIUS HEALTH WILLISTON SERVICE AREA RESIDENTS COMPLETED THE SURVEY. ADDITIONAL INFORMATION WAS COLLECTED THROUGH FIVE KEY INFORMANT INTERVIEWS WITH COMMUNITY MEMBERS. THE INPUT FROM THE RESIDENTS, WHO PRIMARILY RESIDE IN WILLIAMS COUNTY, REPRESENTED THE BROAD INTERESTS OF THE COMMUNITIES IN THE SERVICE AREA. TOGETHER WITH SECONDARY DATA, GATHERED FROM A WIDE RANGE OF SOURCES, THE SURVEY PRESENTS A SNAPSHOT OF THE HEALTH NEEDS AND CONCERNS IN THE COMMUNITY.

MERCY MEDICAL CENTER
PART V, SECTION B, LINE 6B: CENTER FOR RURAL HEALTH (CRH) AT THE UNIVERSITY OF NORTH DAKOTA SCHOOL OF MEDICINE AND HEALTH SCIENCES (UNDSMHS) AND UPPER MISSOURI DISTRICT HEALTH

MERCY MEDICAL CENTER
PART V, SECTION B, LINE 11: THE MOST RECENT CHNA AND CORRESPONDING IMPLEMENTATION PLAN WAS COMPLETED IN THE TAX REPORTING YEAR 2022. THE FOLLOWING OUTLINES THE CURRENT IMPLEMENTATION PLAN PRIORITIES AND STRATEGIES. THIS PLAN WAS POSTED PUBLICLY ON HTTPS://WWW.CHISTALEXIUSHEALTH.ORG/COMMUNITY-HEALTH-NEED-ASSESSMENTSTHE COMMUNITY IDENTIFIED THE FOLLOWING PRIORITIES AS TOP HEALTH NEEDS THROUGH PRIMARY AND SECONDARY DATA FROM KEY INFORMANT INTERVIEWS IN COMMUNITY MEETINGS HELD WITH UND CENTER FOR RURAL HEALTH AS WELL AS COMMUNITY WORKGROUP MEETINGS THAT FOCUSED ON RELATED NEEDS. TOP TEN IDENTIFIED HEALTH NEEDS (FROM APRIL 2022 CHNA): 1. NOT ENOUGH AFFORDABLE HOUSING2. HAVING ENOUGH CHILD DAYCARE SERVICES3. HAVING ENOUGH QUALITY SCHOOL RESOURCES 4. ABILITY TO RETAIN PRIMARY CARE PROVIDERS IN THE COMMUNITY5. LONG TERM/NURSING HOME CARE OPTIONS 6. ALCOHOL USE AND ABUSE - YOUTH AND ADULT 7. AVAILABILITY OF RESOURCES TO HELP THE ELDERLY STAY IN THEIR HOMES 8. DEPRESSION AND ANXIETY - ALL AGES 9. DRUG USE AND ABUSE - YOUTH AND ADULT10. AVAILABILITY OF SPECIALISTSFOR THIS PLAN THE HOSPITAL PRIORITIZED THE FOLLOWING HEALTH NEEDS:PRIORITY HEALTH NEED #1: AFFORDABLE HOUSING (WHICH WILL ADDRESS NOT ENOUGH AFFORDABLE HOUSING AND AVAILABILITY OF RESOURCES TO HELP THE ELDERLY STAY IN THEIR HOMES)TO ADDRESS THIS NEED THE HOSPITAL WILL IMPLEMENT THE FOLLOWING STRATEGIES IN FISCAL YEARS 2023- 2025:- CITY/COUNTY CODE REVIEW - REVIEW OF THE CURRENT CITY/COUNTY CODE TO SEE IF THERE ARE BARRIERS TO AFFORDABLE HOUSING DEVELOPMENTS BEING CREATED IN THE COMMUNITY. WORK WILL BE DONE TO ENSURE BARRIERS ARE ELIMINATED AND EDUCATION IS PROVIDED TO DECISION MAKERS ON WHAT THE ISSUES ARE IN REGARD TO DEVELOPMENT- COORDINATION AND COMMUNICATION - IMPROVE COORDINATION BETWEEN ENTITIES THROUGH A COMMON TOUCHPOINT IN THE COMMUNITY FOR RESOURCES AND INFORMATION AS TO RESOURCES AND PROGRAMS AVAILABLE, INCLUDING BUDGETING/FINANCE EDUCATION. - DEVELOPMENT PROGRAMS - REVIEW/UPDATE AND PROMOTION OF AVAILABLE CITY AND COUNTY PROGRAMS, OR THE ADDITION OF NEW PROGRAMS, THAT MAY ENCOURAGE THE DEVELOPMENT OF MORE AFFORDABLE HOUSING IN THE COMMUNITY, WHETHER THAT BE LOWER PRICED HOMES, TINY HOMES, ETC.- HOMELESS/TRANSITIONAL/SUPPORTIVE HOUSING SHELTER - ASSESSMENT OF THE FEASIBILITY OF A SHELTER OF SOME KIND IN THE WILLISTON AREA.PLANNED COLLABORATORS: CHI ST. ALEXIUS HEALTH, CITY OF WILLISTON, WILLIAMS COUNTY, LOCAL PARISHES, NORTHWEST HUMAN SERVICE CENTER, NORTH DAKOTA LEGISLATURE DISTRICTS 1, 2, 23, 26PRIORITY HEALTH NEED #2: BEHAVIORAL HEALTH (WHICH WILL ADDRESS ALCOHOL USE AND ABUSE ADULTS, DRUG USE AND ABUSE - YOUTH AND ADULT, DEPRESSION/ANXIETY - ALL AGES)TO ADDRESS THIS NEED THE HOSPITAL WILL IMPLEMENT THE FOLLOWING STRATEGIES IN FISCAL YEARS 2023- 2025:- STAFFING/RECRUITMENT PROGRAMS - STAFFING IS AN IDENTIFIED CRITICAL NEED AND LEGISLATION OR LOCAL MATCH DOLLARS FOR SCHOLARSHIP AND TUITION REIMBURSEMENT PROGRAMS SHOULD BE LEVERAGED TO ENCOURAGE INDIVIDUALS TO GO INTO THE BEHAVIORAL HEALTH FIELD. A. CAREER BUILDERS PROGRAM CONSIDER SIMPLIFICATION OF PROGRAM B. CHALLENGE GRANTS AND ASSOCIATED AMOUNT OF AVAILABLE FUNDS C. RURAL HEALTH GRANT TRANSLATE INTO LEGISLATION FOR POSSIBLE EXPANSION TO APPLICATION FOR BEHAVIORAL HEALTH D. ADDRESS BARRIERS TO RECIPROCITY FOR BEHAVIORAL HEALTH PROVIDERS LICENSED IN OTHER STATES TO BECOME LICENSED TO PRACTICE IN ND.- INPATIENT BEHAVIORAL HEALTH - CONTINUE WORK TOWARD BRINGING TEN INPATIENT BEDS TO CHI ST. ALEXIUS HEALTH IN WILLISTON. THIS WORK WILL BE FUNDED IN COOPERATION WITH COMMONSPIRIT, LOCAL, COUNTY, AND STATE GOVERNMENT.- OUTPATIENT BEHAVIORAL HEALTH - COOPERATIVE AGREEMENTS AND ARRANGEMENTS WITH CARE SITES TO ENSURE PATIENTS AND CUSTOMERS ARE GETTING APPROPRIATE CARE AND ARE REFERRED TO THE APPROPRIATE PLACE THE FIRST TIME AS OPPOSED TO A TRIAL AND ERROR APPROACH. A. REVIEW OPPORTUNITIES TO BRING OUTPATIENT OPTIONS TO THE CHI CLINIC IN WILLISTON TO IMPROVE AVAILABILITY OF CARE. B. ANALYZE AVAILABILITY AND NEED FOR JUVENILE SERVICES- EDUCATION PROGRAMMING - COORDINATION WITH WILLISTON STATE COLLEGE, THE NORTH DAKOTA UNIVERSITY SYSTEM, AND THE STATE OF NORTH DAKOTA TO MEET THE NEEDS THROUGH THE DEVELOPMENT OF EDUCATIONAL PROGRAMS THAT WILL PROVIDE STAFF FOR BEHAVIORAL HEALTH. A. INTERNSHIP AND JOB SHADOWING PROGRAMS FOR INDIVIDUALS TO SEE IF THEY'D LIKE TO PURSUE A CAREER IN BEHAVIORAL HEALTH. B. EXPLORE EXISTING AND IDENTIFY NEW CLINICAL TRAINING OPPORTUNITIES.- COORDINATION AND COMMUNICATION - IMPROVE COORDINATION BETWEEN ENTITIES THROUGH A COMMON TOUCHPOINT IN THE COMMUNITY FOR RESOURCES AND INFORMATION AS TO RESOURCES AND PROGRAMS AVAILABLE.PLANNED COLLABORATORS: CHI ST. ALEXIUS HEALTH, CITY OF WILLISTON, WILLIAMS COUNTY, LOCAL PARISHES, NORTHWEST HUMAN SERVICE CENTER, NORTH DAKOTA LEGISLATURE DISTRICTS 1, 2, 23, 26, WILLISTON STATE COLLEGE, STATE OF NORTH DAKOTA, NORTH DAKOTA UNIVERSITY SYSTEMPRIORITY HEALTH NEED #3: CHILDCARE/YOUTH CONCERNS (WILL WORK TO ADDRESS ALCOHOL USE AND ABUSE - YOUTH AND ADULT, DEPRESSION/ANXIETY - ALL AGES, HAVING ENOUGH CHILD DAYCARE SERVICES, HAVING ENOUGH QUALITY SCHOOL RESOURCES)TO ADDRESS THIS NEED THE HOSPITAL WILL IMPLEMENT THE FOLLOWING STRATEGIES IN FISCAL YEARS 2023- 2025:-DAYCARE DEVELOPMENT - CONTINUED SUPPORT OF THE DAYCARE CENTER OPENED WITH THE ASSISTANCE OF CHI ST. ALEXIUS WILLISTON IN THE FALL OF 2022 ON OUR CAMPUS- CHILDCARE PROGRAMS - ENCOURAGE THE DEVELOPMENT, RENEWAL AND CONTINUATION OF COMMUNITY AND STATE BASED GRANT PROGRAMS TO ENABLE INDIVIDUALS TO OPEN NEW OR EXPAND EXISTING DAYCARE FACILITIES TO INCREASE CAPACITY. A. INCENTIVES FOCUSED SPECIFICALLY ON BRINGING BUILDINGS UP TO CODE B. REGULATORY AND CODE REVIEW FOR EFFICIENCIES- EARLY CHILDHOOD EDUCATION - COORDINATION WITH WILLISTON STATE COLLEGE TO MEET THE NEEDS THROUGH THE DEVELOPMENT OF EDUCATIONAL PROGRAMS THAT WILL PROVIDE STAFF FOR DAYCARE CENTERS. A. DEVELOPMENT OF PROGRAMS THAT WILL INCENTIVIZE INDIVIDUALS TO PARTICIPATE IN THESE PROGRAMS THROUGH SCHOLARSHIPS OR TUITION REIMBURSEMENT B. EDUCATION SHADOW AND INTERNSHIP WORK TO GAIN ON THE JOB EXPERIENCE WITH SCHOOL CREDIT PRIOR TO GRADUATION- YOUTH PROGRAMMING - COORDINATION ACROSS AGENCIES THAT WORK DIRECTLY WITH YOUTH, WHETHER THAT BE THE SCHOOL SYSTEM, PARKS AND RECREATION, OR LOCAL CLUBS TO BRING ADDITIONAL PROGRAMMING TO THE AREA THAT MAY NOT CURRENTLY BE OFFERED.- COORDINATION AND COMMUNICATION - LEVERAGE COMMUNITY PRESENCE OF ALL ORGANIZATIONS TO PUBLICIZE AND PROMOTE THE ACTIVITIES CURRENTLY ONGOING AND ACTIVE IN THE COMMUNITY TO ADDRESS THIS NEED TO INCREASE VISIBILITY AND DEMONSTRATE THE COMMITMENT TO ADDRESSING ITPLANNED COLLABORATORS: CHI ST. ALEXIUS HEALTH, CITY OF WILLISTON, WILLIAMS COUNTY, LOCAL PARISHES, NORTHWEST HUMAN SERVICE CENTER, NORTH DAKOTA LEGISLATURE DISTRICTS 1, 2, 23, 26, WILLISTON STATE COLLEGE, STATE OF NORTH DAKOTA, NORTH DAKOTA UNIVERSITY SYSTEM, WILLISTON PUBLIC SCHOOLS, AREA SCHOOL DISTRICTSPRIORITY HEALTH NEED #4: ELDER CONCERNS (ABILITY TO RETAIN PRIMARY CARE PROVIDERS IN THE COMMUNITY, AVAILABILITY OF RESOURCES TO HELP ELDERLY STAY IN THEIR HOMES, LONG-TERM/NURSING HOME CARE OPTIONS, NOT ENOUGH AFFORDABLE HOUSING)TO ADDRESS THIS NEED THE HOSPITAL WILL IMPLEMENT THE FOLLOWING STRATEGIES IN FISCAL YEARS 2023- 2025:- TRANSPORTATION - INCREASE OPPORTUNITIES FOR TRANSPORTATION IN THE COMMUNITY FOR THOSE WHO CAN NO LONGER OPERATE, OR CANNOT AFFORD TO HAVE A VEHICLE OF THEIR OWN. A. ASSESSMENT FEASIBILITY OF ROUTE STRUCTURE AND POTENTIAL EXPANSION OF ROUTE. B. ENSURE ACCESSIBILITY OF TRANSPORTATION AND QUALIFICATIONS/PROPER TRAINING OF TRANSPORTATION STAFF. C. LOOK INTO THE POSSIBILITY OF TRANSPORTATION VOUCHERS FOR THE LESS FORTUNATE SO THEY CAN GET TO MEDICAL APPOINTMENTS, SHOPPING AND EMPLOYMENT OPPORTUNITIES.- EMPLOYMENT/VOLUNTEER PROGRAMS - ASSESSMENT OF CURRENT AND NEW OPPORTUNITIES FOR EMPLOYMENT FOR THE AGED POPULATION IN WILLISTON TO ALLOW LIVABLE WAGES TO SUPPORT THEMSELVES AND THEIR FAMILIES A. ASSESSMENT OF CURRENT AND NEW OPPORTUNITIES FOR VOLUNTEERING FOR THE AGED POPULATION IN WILLISTON B. PROVIDING SUPPORT FOR THE ELDERLY TO HAVE A QUALITY OF LIFE THAT RESPECTS THEIR DIGNITY. - CARE COORDINATION AND COMMUNICATION - LEVERAGE COMMUNITY PRESENCE OF ALL ORGANIZATIONS TO PUBLICIZE AND PROMOTE THE ACTIVITIES CURRENTLY ONGOING AND ACTIVE IN THE COMMUNITY TO ADDRESS THIS NEED TO INCREASE VISIBILITY AND DEMONSTRATE THE COMMITMENT TO ADDRESSING IT.A. COOPERATIVE AGREEMENTS AND ARRANGEMENTS WITH CARE SITES TO ENSURE PATIENTS AND CUSTOMERS ARE GETTING APPROPRIATE CARE AND ARE REFERRED TO THE APPROPRIATE PLACE THE FIRST TIME AS OPPOSED TO A TRIAL AND ERROR APPROACH.

MERCY MEDICAL CENTER
PART V, SECTION B, LINE 13H: THE PATIENT MUST HAVE A MINIMUM ACCOUNT BALANCE OF TEN DOLLARS ($10.00) WITH THE COMMONSPIRIT HOSPITAL ORGANIZATION. MULTIPLE ACCOUNT BALANCES MAY BE COMBINED TO REACH THIS AMOUNT. PATIENTS/GUARANTORS WITH BALANCES BELOW TEN DOLLARS ($10.00) MAY CONTACT A FINANCIAL COUNSELOR TO MAKE MONTHLY INSTALLMENT PAYMENT ARRANGEMENTS. THE PATIENT MUST SUBMIT A COMPLETED FINANCIAL ASSISTANCE APPLICATION. PATIENT COOPERATION STANDARDS - A PATIENT MUST COOPERATE WITH THE HOSPITAL FACILITY IN PROVIDING THE INFORMATION AND DOCUMENTATION NECESSARY TO DETERMINE ELIGIBILITY. SUCH COOPERATION INCLUDES COMPLETING ANY REQUIRED APPLICATIONS OR FORMS. THE PATIENT IS RESPONSIBLE FOR NOTIFYING THE HOSPITAL FACILITY OF ANY CHANGE IN FINANCIAL SITUATION THAT WOULD IMPACT THE ASSESSMENT OF ELIGIBILITY. A PATIENT MUST EXHAUST ALL OTHER PAYMENT OPTIONS, INCLUDING PRIVATE COVERAGE, FEDERAL, STATE AND LOCAL MEDICAL ASSISTANCE PROGRAMS, AND OTHER FORMS OF ASSISTANCE PROVIDED BY THIRD PARTIES PRIOR TO BEING APPROVED. AN APPLICANT FOR FINANCIAL ASSISTANCE IS RESPONSIBLE FOR APPLYING TO PUBLIC PROGRAMS FOR AVAILABLE COVERAGE. HE OR SHE IS ALSO EXPECTED TO PURSUE PUBLIC OR PRIVATE HEALTH INSURANCE PAYMENT OPTIONS FOR CARE PROVIDED BY A COMMONSPIRIT HOSPITAL ORGANIZATION WITHIN A HOSPITAL FACILITY. A PATIENT'S AND, IF APPLICABLE, ANY GUARANTOR'S COOPERATION IN APPLYING FOR APPLICABLE PROGRAMS AND IDENTIFIABLE FUNDING SOURCES, INCLUDING COBRA COVERAGE (A FEDERAL LAW ALLOWING FOR A TIME-LIMITED EXTENSION OF EMPLOYEE HEALTHCARE BENEFITS), SHALL BE REQUIRED. IF A HOSPITAL FACILITY DETERMINES THAT COBRA COVERAGE IS POTENTIALLY AVAILABLE, AND THAT A PATIENT IS NOT A MEDICARE OR MEDICAID BENEFICIARY, THE PATIENT OR GUARANTOR SHALL PROVIDE THE HOSPITAL FACILITY WITH INFORMATION NECESSARY TO DETERMINE THE MONTHLY COBRA PREMIUM FOR SUCH PATIENT, AND SHALL COOPERATE WITH HOSPITAL FACILITY STAFF TO DETERMINE WHETHER HE OR SHE QUALIFIES FOR HOSPITAL FACILITY COBRA PREMIUM ASSISTANCE, WHICH MAY BE OFFERED FOR A LIMITED TIME TO ASSIST IN SECURING INSURANCE COVERAGE. A HOSPITAL FACILITY SHALL MAKE AFFIRMATIVE EFFORTS TO HELP A PATIENT OR PATIENT'S GUARANTOR APPLY FOR PUBLIC AND PRIVATE PROGRAMS.

PART V, SECTION B, LINE 3E:
THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE COMMUNITY'S SIGNIFICANT HEALTH NEEDS IDENTIFIED THROUGH THE CHNA.THE HEALTH NEEDS WILL BE ADDRESSED THROUGH THE CHNA IMPLEMENTATION PLAN ADOPTED BY THE BOARD.

SCHEDULE H, PART V, SECTION B, LINE 7A
HTTPS://WWW.CHISTALEXIUSHEALTH.ORG/COMMUNITY-HEALTH-NEED-ASSESSMENTS

SCHEDULE H, PART V, SECTION B, LINE 16A
HTTPS://WWW.CHISTALEXIUSHEALTH.ORG/PATIENTS-VISITORS/OUR-PATIENTS/FINANCIAL-ASSISTANCE

SCHEDULE H, PART V, SECTION B, LINE 16B
HTTPS://WWW.CHISTALEXIUSHEALTH.ORG/PATIENTS-VISITORS/OUR-PATIENTS/FINANCIAL-ASSISTANCE

SCHEDULE H, PART V, SECTION B, LINE 16C
HTTPS://WWW.CHISTALEXIUSHEALTH.ORG/PATIENTS-VISITORS/OUR-PATIENTS/FINANCIAL-ASSISTANCE

PART V, SECTION B, LINE 11: CONTINUED
"- RECRUITMENT AND RETENTION PROGRAMS - STAFFING IS AN IDENTIFIED CRITICAL NEED AND LEGISLATION OR LOCAL MATCH DOLLARS FOR SCHOLARSHIP AND TUITION REIMBURSEMENT PROGRAMS SHOULD BE LEVERAGED TO ENCOURAGE INDIVIDUALS TO GO INTO THE LONG-TERM NURSING AND BEHAVIORAL HEALTH FIELD.A. RECRUITMENT INITIATIVES AND PROGRAMS TO INCENTIVIZE MOVING TO NORTH DAKOTA.B. INTERNATIONAL RECRUITMENT PROGRAMS- EDUCATION PROGRAMMING - COORDINATION WITH WILLISTON STATE COLLEGE TO MEET THE NEEDS THROUGH THE DEVELOPMENT OF EDUCATIONAL PROGRAMS THAT WILL PROVIDE STAFF FOR LONG-TERM CARE. A. EDUCATION SHADOW AND INTERNSHIP WORK TO GAIN ON THE JOB EXPERIENCE WITH SCHOOL CREDIT PRIOR TO GRADUATION B. EXPLORE EDUCATION OPTIONS FOR NON-TRADITIONAL STUDENTS AT THE POST HIGH SCHOOL LEVEL. C. SEEK AREA EMPLOYERS TO ASSIST IN CLINICAL TRAINING OPPORTUNITIES.PLANNED COLLABORATORS: CHI ST. ALEXIUS HEALTH, CITY OF WILLISTON, WILLIAMS COUNTY, LOCAL PARISHES, NORTHWEST HUMAN SERVICE CENTER, NORTH DAKOTA LEGISLATURE DISTRICTS 1, 2, 23, 26, WILLISTON STATE COLLEGE, BETHEL LUTHERAN NURSING HOMEPRIORITY HEALTH NEED #5: AVAILABILITY OF SPECIALISTSTO ADDRESS THIS NEED THE HOSPITAL WILL IMPLEMENT THE FOLLOWING STRATEGIES IN FISCAL YEARS 2023- 2025:- RECRUITMENT AND RETENTION - IMPROVEMENTS AND EFFICIENCIES IN THE RECRUITMENT PROCESS WILL BE ANALYZED. A. DEVELOPMENT OF A ""LOCAL PROSPECTS"" LIST THAT FOCUSES ON THOSE INDIVIDUALS MOST LIKELY TO REMAIN IN WILLISTON OR BE INTERESTED IN VISITING WILLISTON LONG-TERM. B. BUILD A SUSTAINABLE CULTURE AMONG PROVIDERS THAT ENCOURAGES RETENTION.- COORDINATION AND COMMUNICATION - COORDINATION WITH CHI AND SANFORD TO NOT DUPLICATE EFFORTS AND PROVIDE SERVICES THAT DO NOT LEAD TO REDUNDANCY, BUT ENHANCE THE OVERALL CARE PICTURE OF WILLISTON AND THE REGION- SCHOLARSHIP AND TUITION PROGRAMS - SUPPORT AND DEVELOPMENT OF SCHOLARSHIP AND TUITION REIMBURSEMENT PROGRAMS THAT INCENTIVE PROVIDERS TO COME TO AND PRACTICE IN WILLISTON AND THE SURROUNDING AREA- IDENTIFY COMMUNITY NEEDS - ONGOING EFFORTS TO IDENTIFY AREAS THAT MAKE FINANCIAL SUCCESS TO BRING TO THE COMMUNITY IN TERMS OF CARE AND ARE SUSTAINABLE LONG-TERM.PLANNED COLLABORATORS: CHI ST. ALEXIUS HEALTH, TRINITY HEALTH, SANFORD HEALTH, COMMUNITY LEADERS, BUSINESS LEADERS, WILLISTON STATE COLLEGEALL NEEDS IDENIFITED IN THE CHNA WILL BE ADDRESSED. SEVERAL SIMILAR NEEDS HAVE BEEN COMBINED INTO OVERARCHING PRIORITIES. THE FOLLOWING HEALTH NEEDS WILL BE ADDRESSED THROUGH EACH OF THE PRIORITY HEALTH NEEDS AND IMPLEMENTATION STRATEGIES DESCRIBED ABOVE:- AVAILABILITY OF RESOURCES TO HELP THE ELDERLY STAY IN THEIR HOMES- THIS IS BEING ADDRESSED THROUGH PRIORITY #1- AFFORDABLE HOUSING AND PRIORITY 4- ELDER CONCERNS.- ALCOHOL USE AND ABUSE YOUTH AND ADULT- THIS IS BEING ADDRESSED THROUGH PRIORITY #2- BEHAVIORAL HEALTH.- DEPRESSION/ANXIETY ALL AGES- THIS IS BEING ADDRESSED THROUGH PRIORITY #2- BEHAVIORAL HEALTH.- DRUG USE AND ABUSE YOUTH AND ADULT- THIS IS BEING ADDRESSED THROUGH PRIORITY #2- BEHAVIORAL HEALTH.- HAVING ENOUGH QUALITY SCHOOL RESOURCES- THIS IS BEING ADDRESSED THROUGH PRIORITY #3- CHILDCARE/ YOUTH.- ABILITY TO RETAIN PRIMARY CARE PROVIDERS IN THE COMMUNITY- THIS IS BEING ADDRESSED THROUGH PRIORITY #4- ELDER CONCERNS AND #5- AVAILABILITY OF SPECIALISTS.- LONG TERM/NURSING HOME CARE OPTIONS- THIS IS BEING ADDRESSED THROUGH PRIORITY #4- ELDER CONCERNS AND #5- AVAILABILITY OF SPECIALISTS.THE FOLLOWING TOP HEALTH NEEDS WERE IDENTIFIED AND PRIORITIZED AS PART OF THE CHNA AND IMPLEMENTATION STRATEGY PLAN APPROVED IN 2019. ALTHOUGH A MORE RECENT CHNA WAS COMPLETED IN 2022, THE RELATED IMPLEMENTATION PLAN WAS NOT APPROVED UNTIL OCTOBER 2022. THEREFORE THE WORK DESCRIBED BELOW IS TIED TO THE 2019 ASSESSMENT AND PLANS AND REPRESENTS WORK CARRIED OUT BY THE HOSPITAL DURING FISCAL YEAR 2022.THE COMMUNITY IDENTIFIED THE FOLLOWING PRIORITIES AS TOP HEALTH NEEDS THROUGH PRIMARY DATA OBTAINED THROUGH THE COMMUNITY HEALTH SURVEY AND KEY INFORMANT SURVEY, AS WELL AS A REVIEW OF SECONDARY DATA ON A VARIETY OF HEALTH INDICATORS.TOP HEALTH NEEDS (FROM 2019 CHNA): SOURCE FROM SIGNIFICANT HEALTH NEEDS OR FINDINGS SECTION OF THE CHNATOP FOUR NEEDS FROM THE CHNA:I. ABILITY TO GET APPOINTMENTS FOR HEALTH SERVICES WITHIN 48 HOURS;II. RETAINING PRIMARY CARE PROVIDERS;III. PROVIDING EXTRA HOURS FOR APPOINTMENTS, SUCH AS EVENINGS AND WEEKENDS; ANDIV. INCREASING CHILD DAYCARE SERVICES.THE ABILITY TO GET A PRIMARY CARE APPOINTMENT AND HAVING EXTENDED HOURS FOR APPOINTMENTS WERE TWO CONCERNS OUTLINED IN OUR 2019 COMMUNITY HEALTH NEEDS ASSESSMENT. IN NOVEMBER 2019 WE BEGAN ""NEED CARE NOW"" APPOINTMENTS. IN SEPTEMBER 2020 WE EXTENDED OUR PRIMARY CLINIC HOURS TO 7:00AM-5:30PM. THE LATEST EXPANSION OF OUR PRIMARY CLINIC WAS ESTABLISHING A WALK-IN CLINIC. OUR WALK-IN CLINIC BEGAN ON 4-12-21.THE VOLUME IN THE WALK-IN CLINIC HAS BEEN CONSISTENTLY HIGH SINCE THE DOORS OPENED. THERE ARE MANY MOVING PIECES TO THIS, BUT WE FEEL THAT IT IS THE BEST FOR THE PATIENT EXPERIENCE AND THOSE THAT WORK IN THE WALK-IN CLINIC.WE HAVE RECRUITED TWO ADDITIONAL NPS WHO WILL BE DEDICATED TO THE WALK-IN CLINIC. IN THE LAST TWO YEARS, WE HIRED 3 FPS AND HAVE ADDED ORTHOPEDIC SERVICES AGAIN. RECRUITMENT WORK CONTINUES AND WE ARE WORKING ON FINALIZING THE RECRUITMENT OF AN ENT ALONG WITH OTHERS. THE CAPITAL PROJECT TO RENOVATE THE SISTERS OF MERCY HOUSE AND BUILD A DAYCARE WAS COMPLETED AND OPENED IN AUGUST OF 2022."

PART I, LINE 3C:
UNLESS ELIGIBLE FOR PRESUMPTIVE FINANCIAL ASSISTANCE, THE FOLLOWING ELIGIBILITY CRITERIA MUST BE MET IN ORDER FOR A PATIENT TO QUALIFY FOR FINANCIAL ASSISTANCE:- THE PATIENT MUST HAVE A MINIMUM ACCOUNT BALANCE OF TEN DOLLARS ($10.00) WITH THE COMMONSPIRIT HOSPITAL ORGANIZATION. MULTIPLE ACCOUNT BALANCES MAY BE COMBINED TO REACH THIS AMOUNT. PATIENTS/GUARANTORS WITH BALANCES BELOW TEN DOLLARS ($10.00) MAY CONTACT A FINANCIAL COUNSELOR TO MAKE MONTHLY INSTALLMENT PAYMENT ARRANGEMENTS.- THE PATIENT MUST COMPLY WITH PATIENT COOPERATION STANDARDS.- THE PATIENT MUST SUBMIT A COMPLETED FINANCIAL ASSISTANCE APPLICATION (FAA).FOR PATIENTS AND GUARANTORS WHO ARE UNABLE TO PROVIDE REQUIRED DOCUMENTATION, A HOSPITAL FACILITY MAY GRANT PRESUMPTIVE FINANCIAL ASSISTANCE BASED ON INFORMATION OBTAINED FROM OTHER RESOURCES. IN PARTICULAR, PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE:- RECIPIENT OF STATE-FUNDED PRESCRIPTION PROGRAMS;- HOMELESS OR ONE WHO RECEIVED CARE FROM A HOMELESS OR FREE CARE CLINIC;- PARTICIPATION IN WOMEN, INFANTS AND CHILDREN PROGRAMS (WIC);- FOOD STAMP ELIGIBILITY;- ELIGIBILITY OR REFERRALS FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS (E.G., MEDICAID);- LOW INCOME/SUBSIDIZED HOUSING IS PROVIDED AS A VALID ADDRESS; OR- PATIENT IS DECEASED WITH NO KNOWN SPOUSE OR KNOWN ESTATE.

PART I, LINE 7:
"COMMONSPIRIT HEALTH HOSPITALS USE A COST ACCOUNTING SYSTEM OR AN ADJUSTED COST TO CHARGE RATIO CALCULATED IN A MANNER CONSISTENT WITH WORKSHEET 2 FOR EACH REPORTING FACILITY, TO DERIVE THE REPORTED COSTS OF FINANCIAL ASSISTANCE, MEDICAID AND OTHER MEANS-TESTED PROGRAMS. WORKSHEET 3 OR THE EQUIVALENT IN THE COMMUNITY BENEFIT INVENTORY FOR SOCIAL ACCOUNTABILITY (""CBISA"") SOFTWARE ARE USED TO CALCULATE EXPENSE AND REVENUE, INCLUDING WHERE APPLICABLE MEDICAID PROVIDER FEES AND PAYMENTS FROM UNCOMPENSATED CARE PROGRAMS. ACTUAL OR ESTIMATED COST AND ANY DIRECT OFFSETTING REVENUE IS REPORTED, AND SCHEDULE H WORKSHEETS OR THEIR EQUIVALENTS ARE USED, FOR OTHER COMMUNITY BENEFIT ACTIVITIES SUCH AS COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY BENEFIT OPERATIONS, HEALTH PROFESSIONS EDUCATION, SUBSIDIZED HEALTH SERVICES, RESEARCH, AND CASH AND IN-KIND DONATIONS."

PART III, LINE 2:
THE AMOUNT OF THE ORGANIZATION'S BAD DEBT AT COST IS DETERMINED BY APPLYING THE COST TO CHARGE RATIO TO PATIENT CHARGES THAT ARE DEEMED TO BE UNCOLLECTIBLE. THIS AMOUNT REPRESENTS THE COST OF SERVICES PROVIDED TO PATIENTS WHO ARE UNABLE OR REFUSE TO PAY THEIR BILLS AND DO NOT QUALIFY FOR FREE OR DISCOUNTED CARE, GOVERNMENT SPONSORED PROGRAMS OR OTHER PAYMENT ASSISTANCE, AND ARE OTHERWISE UNINSURED.THE FILING ORGANIZATION PROVIDES FREE CARE TO ANY PATIENT WHOSE FAMILY INCOME IS AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL, OR DISCOUNTED CARE TO UNINSURED OR UNDER-INSURED INDIVIDUALS WHOSE FAMILY INCOME IS ABOVE 201% BUT LOWER THAN 400% OF THE FEDERAL POVERTY LEVEL. THE FILING ORGANIZATION ALSO PROVIDES OPTIONS FOR PROMPT PAY DISCOUNTS, AND INTEREST-FREE EXTENDED PAYMENT PLANS FOR PATIENTS WHO HAVE DEMONSTRATED GOOD FAITH AND ARE COOPERATING IN RESOLVING THEIR HOSPITAL BILLS. ALL ACCOUNTS FOR ELIGIBLE UNINSURED PATIENTS AT ALL FACILITIES RECEIVE AN AUTOMATIC UNINSURED DISCOUNT. THE EXPECTED PATIENT PAYMENT AMOUNT ON THE PATIENT'S BILL REFLECTS THIS DISCOUNT. DISCOUNTS ARE ACCOUNTED FOR AS DEDUCTIONS FROM REVENUE, NOT AS BAD DEBT EXPENSE.

PART III, LINE 3:
MERCY MEDICAL CENTER MAKES EVERY EFFORT TO DETERMINE IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE UPON ADMISSION. MERCY MEDICAL CENTER'S FINANCIAL ASSISTANCE POLICY IS COMMUNICATED TO PATIENTS UPON ADMISSION AND IS AVAILABLE IN THE LANGUAGES PRIMARILY SPOKEN IN THE COMMUNITY. IT IS ALSO POSTED IN VARIOUS COMMON AREAS OF THE HOSPITAL, SUCH AS EMERGENCY ROOMS, URGENT CARE CENTERS, ADMITTING AND REGISTRATION DEPARTMENTS, HOSPITAL BUSINESS OFFICES LOCATED ON FACILITY CAMPUSES, AND OTHER PUBLIC PLACES, AND IS PROVIDED UPON BILLING IF ELIGIBILITY IS NOT PREVIOUSLY DETERMINED. ELIGIBILITY IS REEVALUATED AS NEEDED AND AMOUNTS ARE CLASSIFIED AS CHARITY AS SOON AS ELIGIBILITY IS KNOWN. MERCY MEDICAL CENTER ALSO UTILIZES A PAYMENT ASSISTANCE RANK ORDERING (PARO) SCORING SYSTEM TO ASSIST IN DETERMINING IF AN UNINSURED PATIENT MAY QUALIFY FOR PAYMENT ASSISTANCE EVEN THOUGH THEY HAVE NOT APPLIED FOR IT. PARO IS A METHODOLOGY THAT APPLIES CONSISTENT SCREENING AND APPLICATION STANDARDS TO ALL UNINSURED PATIENTS UTILIZING HISTORICAL DATA TO DEVELOP A PREDICTIVE MODEL FOR HEALTHCARE PAYMENT ASSISTANCE. IN ITS DEVELOPMENT, SPECIAL ATTENTION WAS PAID TO THOSE SOCIOECONOMIC FACTORS THAT MIGHT ADVERSELY AFFECT THOSE PATIENTS DESERVING THE MOST ATTENTION. OTHER CRITERIA ARE ALSO UTILIZED TO ENSURE THAT SERVICES THAT HAVE QUALIFIED AS FINANCIAL ASSISTANCE ARE NOT REPORTED AS BAD DEBT. AS SUCH, MERCY MEDICAL CENTER DOES NOT BELIEVE THAT ANY AMOUNTS INCLUDED IN PART III, LINE 2, ARE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S PAYMENT ASSISTANCE POLICY, AND THEREFORE, NO PORTION OF BAD DEBT EXPENSE IS INCLUDED AS COMMUNITY BENEFIT EXPENSE.

PART VI, LINE 2:
WE HAVE GOOD RELATIONSHIPS WITH CITY GOVERNMENT, BUSINESS, CHURCH, AND PUBLIC HEALTH LEADERS IN THE COMMUNITY. THOSE RELATIONSHIPS, ALONG WITH OUR OWN HISTORY OF DOING CHNAS GIVES US A PRETTY ACCURATE VIEW OF OUR HEALTH NEEDS. NOT MENTIONED IN THE DISCUSSION ABOVE ARE TWO NEEDS THAT COME UP IN ANY DISCUSSION ABOUT HEALTHCARE IN WILLISTON, ND: MENTAL HEALTH SERVICES AND ADDICTION TREATMENT. THESE ARE PERENNIAL CHNA TOP CONCERNS AND WERE IN THE 2019 SURVEY, TOO. OVER AND OVER AGAIN, HOWEVER, WE HAVE BEEN UNSUCCESSFUL IN ATTRACTING PARTNERS, PROVIDERS, OR EVEN CONTRACTORS TO PROVIDE THESE SERVICES (OTHER THAN TELEHEALTH). DISCUSSIONS WITH PROVIDERS, CITY AND COUNTY LEADERS, AND OTHER ORGANIZATIONS CONTINUE TO STALL WHEN CONFRONTING THE ISSUE OF FUNDING THESE TYPES OF SERVICES.

PART VI, LINE 7, REPORTS FILED WITH STATES
ND

PART III, LINE 4:
"MERCY MEDICAL CENTER DOES NOT ISSUE SEPARATE COMPANY AUDITED FINANCIAL STATEMENTS. HOWEVER, THE ORGANIZATION IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF COMMONSPIRIT HEALTH. THE FOLLOWING IS AN EXCERPT FROM COMMONSPIRIT'S CONSOLIDATED ANNUAL AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2022, RELATED TO PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT REVENUE. THE ENTIRE FOOTNOTE CAN BE VIEWED IN THE ATTACHED COMMONSPIRIT CONSOLIDATED FINANCIAL STATEMENTS ON PAGES 12-13.""PATIENT SERVICE REVENUE IS REPORTED AT THE AMOUNTS THAT REFLECT THE CONSIDERATION COMMONSPIRIT EXPECTS TO BE PAID IN EXCHANGE FOR PROVIDING PATIENT CARE. THESE AMOUNTS ARE DUE FROM PATIENTS, THIRD-PARTY PAYORS (INCLUDING HEALTH INSURERS AND GOVERNMENT PROGRAMS), AND OTHERS, AND INCLUDE CONSIDERATION FOR RETROACTIVE REVENUE ADJUSTMENTS DUE TO SETTLEMENT OF AUDITS AND REVIEWS. GENERALLY, PERFORMANCE OBLIGATIONS FOR PATIENTS RECEIVING INPATIENT ACUTE CARE SERVICES AND OUTPATIENT SERVICES ARE RECOGNIZED OVER TIME AS SERVICES ARE PROVIDED. NET PATIENT REVENUE IS PRIMARILY COMPRISED OF HOSPITAL AND PHYSICIAN SERVICES."""

PART III, LINE 8:
COMMONSPIRIT HEALTH HOSPITALS PREPARE MEDICARE COST REPORTS IN A MANNER THAT COMPORTS WITH PROVIDER REIMBURSEMENT MANUAL (PRM) 15-1 AND PRM 15-2 CHAPTER 40 (TRANSMITTAL 13). AS SUCH, THE FOLLOWING LANGUAGE PER PRM 15-1 DESCRIBES THE COMPUTATION OF COSTS PER THE MEDICARE COST REPORT: TOTAL ALLOWABLE COSTS OF A PROVIDER ARE APPORTIONED BETWEEN PROGRAM BENEFICIARIES AND OTHER PATIENTS SO THAT THE SHARE BORNE BY THE PROGRAM IS BASED UPON ACTUAL SERVICES RECEIVED BY PROGRAM BENEFICIARIES. THE RATIO OF COVERED BENEFICIARY CHARGES TO TOTAL PATIENT CHARGES FOR THE SERVICES OF EACH ANCILLARY DEPARTMENT IS APPLIED TO THE COST OF THE DEPARTMENT. ADDED TO THIS AMOUNT IS THE COST OF ROUTINE SERVICES FOR PROGRAM BENEFICIARIES, DETERMINED ON THE BASIS OF A SEPARATE AVERAGE COST PER DIEM FOR ALL PATIENTS FOR GENERAL ROUTINE PATIENT CARE AREAS. ANOTHER FACTOR CONSIDERED IS A SEPARATE AVERAGE COST PER DIEM FOR EACH INTENSIVE CARE UNIT, CORONARY CARE UNIT, AND OTHER SPECIAL CARE INPATIENT HOSPITAL UNITS. COMMONSPIRIT HEALTH AND ITS SUBORDINATE CORPORATIONS BELIEVE THAT THE ENTIRE MEDICARE SHORTFALL FOR THE CONSOLIDATED ENTITIES CONSTITUTES COMMUNITY BENEFIT. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. MEDICARE SHORTFALLS MUST BE ABSORBED BY COMMONSPIRIT HEALTH HOSPITALS IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITIES. THE HOSPITALS PROVIDE CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVE THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR MEDICARE BENEFICIARIES. MERCY MEDICAL CENTER'S SHORTFALL, AS REPORTED ON PART III, SECTION B, LINE 7, OF $5,750,035 REPRESENTS THE FILING ORGANIZATION'S MEDICARE COST REPORTS.

PART III, LINE 9B:
COMMONSPIRIT HEALTH ENSURES THAT PATIENT ACCOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. COMMONSPIRIT HEALTH'S BILLING AND COLLECTION POLICY CONTAINS PROVISIONS THAT PROHIBIT THE COLLECTION OF AMOUNTS DUE FROM PATIENTS WHO THE ORGANIZATION KNOWS QUALIFY FOR FINANCIAL ASSISTANCE. ACCOUNTS WITH INCORRECT OR INCOMPLETE DEMOGRAPHIC INFORMATION ARE ASSIGNED TO A COLLECTION AGENCY IF THE COMMONSPIRIT HEALTH FACILITY, OR BILLING COMPANY RETAINED BY COMMONSPIRIT HEALTH, IS UNABLE TO OBTAIN AN UPDATED ADDRESS THROUGH SKIP TRACING OR OTHER MEANS. FOR PATIENTS WHO HAVE AN APPLICATION PENDING FOR EITHER GOVERNMENT-SPONSORED ASSISTANCE OR FOR ASSISTANCE UNDER COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE POLICY, OR WHERE THE PATIENT IS ATTEMPTING IN GOOD FAITH TO SETTLE AN OUTSTANDING BILL WITH THE FACILITY VIA PAYMENT PLANS, COMMONSPIRIT HEALTH WILL NOT KNOWINGLY SEND THAT PATIENT'S BILL TO AN OUTSIDE COLLECTION AGENCY. ON SELF-PAY ACCOUNTS THAT DO NOT MEET THE CRITERIA NOTED ABOVE, THE INITIAL DETERMINATION OF ASSIGNMENT TO A COLLECTION AGENCY WILL VARY DEPENDING ON THE NATURE OF THE ACCOUNT WITH THE FINAL DECISION BEING AT THE DISCRETION OF THE BILLING COMPANY RETAINED BY COMMONSPIRIT HEALTH. UPON ASSIGNMENT OF SUCH A PATIENT ACCOUNT TO A COLLECTION AGENCY, COMMONSPIRIT HEALTH REQUIRES THE AGENCY TO COMPLY WITH THE FAIR DEBT COLLECTION PRACTICES ACT.

PART VI, LINE 3:
INFORMATION ABOUT COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE PROGRAM AND A CONTACT NUMBER ARE MADE AVAILABLE TO PATIENTS AND THE PUBLIC. PATIENTS ARE INFORMED OF COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE PROGRAM VIA SIGNAGE IN ALL ADMITTING AREAS AND IN VARIOUS COMMON AREAS OF THE HOSPITAL. FINANCIAL ASSISTANCE PROGRAM INFORMATION NOTICES ARE POSTED IN THE EMERGENCY AND ADMITTING DEPARTMENTS AND AT OTHER PUBLIC PLACES AS EACH FACILITY MAY ELECT. SUCH INFORMATION IS PROVIDED IN THE PRIMARY LANGUAGES SPOKEN IN THE COMMUNITIES COMMONSPIRIT HEALTH SERVES. THE SIGNAGE INCLUDES NOTIFICATION THAT FURTHER DISCOUNTS MAY BE PROVIDED UPON THE COMPLETION AND SUBMISSION OF A FINANCIAL ASSISTANCE APPLICATION AND HOW TO REACH STAFF THAT CAN ASSIST WITH ANSWERING QUESTIONS AND GUIDE PATIENTS THROUGH THE APPLICATION PROCESS. INFORMATION CAN ALSO BE FOUND ON THE FACILITY WEBSITES. IF FINANCIAL ASSISTANCE ELIGIBILITY IS NOT DETERMINED PRIOR TO BILLING, INITIAL BILLING STATEMENTS TO PATIENTS INCLUDE A REQUEST TO THE PATIENT TO PROVIDE ANY INSURANCE INFORMATION THAT WAS VALID FOR THE DATES OF SERVICE BILLED AND A STATEMENT INFORMING PATIENTS HOW TO CONTACT US REGARDING FINANCIAL ASSISTANCE. ADDITIONALLY, CONTRACT TERMS WITH COLLECTION VENDORS WORKING ON BEHALF OF COMMONSPIRIT HEALTH REQUIRE THEY FOLLOW COMMONSPIRIT HEALTH FINANCIAL ASSISTANCE POLICY. ALSO, REFERRAL OF PATIENTS FOR FINANCIAL ASSISTANCE MAY BE MADE BY ANY MEMBER OF THE COMMONSPIRIT HOSPITAL ORGANIZATION NON-MEDICAL OR MEDICAL STAFF, INCLUDING PHYSICIANS, NURSES, FINANCIAL COUNSELORS, SOCIAL WORKERS, CASE MANAGERS, CHAPLAINS, AND RELIGIOUS SPONSORS. A REQUEST FOR ASSISTANCE MAY BE MADE BY THE PATIENT OR A FAMILY MEMBER, CLOSE FRIEND OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS.

PART VI, LINE 4:
"WILLISTON IS LOCATED IN THE NORTHWEST CORNER OF NORTH DAKOTA, JUST 60 MILES FROM THE CANADIAN BORDER AND 18 MILES FROM THE MONTANA BORDER. ITS ECONOMY IS BASED PRIMARILY ON THE OIL AND GAS INDUSTRY, AGRICULTURE, AND THE SERVICE SECTOR. IT IS THE SIXTH LARGEST CITY IN NORTH DAKOTA WITH A POPULATION OF 29,160 AS OF APRIL 1, 2020 (US CENSUS BUREAU). WILLISTON IS A SMALL TOWN WITH MANY AMENITIES THAT HAS EXPERIENCED AMAZING AND POSITIVE GROWTH IN THE LAST FEW YEARS. BRISK GROWTH HAS ALSO MADE IT A CITY WITH VIRTUALLY NO UNEMPLOYMENT AND A PER CAPITA INCOME OF $43,515. MEDIAN HOUSEHOLD INCOME IS ALMOST TWICE THAT AMOUNT.CURRENTLY, HOWEVER, WITH THE FALLING OF OIL PRICES, MANY OIL COMPANIES HAVE SLOWED DOWN AND LAID OFF WORKERS, THAT SLUMP AFFECTS HOUSING, AND SHOPPING CONCERNS IN THE AREA, TOO. MORE AND MORE FAMILIES ARE CHOOSING TO STAY HERE, HOWEVER; THOUGH THEIR CURRENT PROSPECTS HERE ARE WEAKER, THEY ARE BETTER THAN IN THE COMMUNITIES FROM WHICH THEY HAVE COME.IN ADDITION TO CHI ST. ALEXIUS HEALTH WMC, OTHER HOSPITALS ARE LOCATED IN THE SERVICE AREA. SPECIFICALLY, OTHER CRITICAL ACCESS HOSPITALS ARE LOCATED IN CROSBY, TIOGA, AND WATFORD CITY, NORTH DAKOTA, AS WELL AS POPLAR, SIDNEY, AND WOLF POINT, MONTANA. INDIAN HEALTH SERVICE ALSO MAINTAINS A SERVICE UNIT IN ROOSEVELT COUNTY, MONTANA, WITH FACILITIES IN POPLAR AND WOLF POINT.OTHER HEALTHCARE FACILITIES AND SERVICES IN THE NORTH DAKOTA PORTION OF THE AREA INCLUDE, A 168-BED NURSING HOME IN WILLISTON, A 19-BED BASIC CARE AND REHABILITATION CENTER IN WILLISTON, A 71 BED BASIC CARE FACILITY IN WILLISTON, A 42-BED NURSING HOME IN CROSBY, A 16-BED BASIC CARE FACILITY IN CROSBY, A 47-BED NURSING HOME IN WATFORD CITY (MCKENZIE COUNTY), A 9-BED BASIC CARE FACILITY IN WATFORD CITY, A 30-BED NURSING HOME IN TIOGA, AND SEVERAL INDEPENDENT LIVING COMMUNITIES FOR SENIORS. IN ADDITION TO THE PHARMACY AT CHI ST. ALEXIUS HEALTH WMC, THERE ARE FOUR RETAIL PHARMACIES IN WILLISTON; RETAIL PHARMACIES ARE ALSO LOCATED IN CROSBY, TIOGA, AND WATFORD CITY. ON THE MONTANA SIDE, OTHER HEALTHCARE FACILITIES INCLUDE A 40-BED ASSISTED LIVING FACILITY IN SIDNEY, AN EIGHT-BED ASSISTED LIVING FACILITY IN SAVAGE, A 93-BED LONG-TERM CARE FACILITY IN SIDNEY, AND A 60-BED LONG-TERM CARE FACILITY IN WOLF POINT.THIS MULTI-COUNTY REGION IS A MEDICALLY UNDERSERVED AREA AND OUR HOSPITAL BEING THE LARGEST IN THE REGION TREATS A SIGNIFICANT NUMBER OF MEDICAID PATIENTS, AND NATIVE AMERICAN PATIENTS THROUGH OUR MANY CLINICS OR THE HOSPITAL ITSELF. OUR HOMELESS POPULATION HAS DECREASED SIGNIFICANTLY SINCE 2014 AND NOW THIS GROUP IS MOSTLY SEASONAL AND GENERALLY TEMPORARY AS WE HAVE NO SHELTERS IN WILLISTON. WE STILL DO SEE A SIGNIFICANT NUMBER OF PEOPLE HOWEVER THAT STILL MEET ""HOMELESS"" CRITERIA. A FEW LIVE ""ROUGH OR IN THEIR CARS, BUT MOST ARE STAYING PRECARIOUSLY WITH FRIENDS OR COWORKERS IN LESS THAN DESIRABLE CONDITIONS."

PART VI, LINE 5:
THE HOSPITAL DOES HAVE AN OPEN MEDICAL STAFF AND WE ARE PARTICIPANTS IN THE PHARMACY 340B PROGRAM - THE SAVINGS OF WHICH DIRECTLY IMPROVES PATIENT CARE. WE COLLABORATE WITH SEVERAL ACTIVE EDUCATION PROGRAMS IN PLACE INCLUDING WILLISTON STATE COLLEGE NURSING ASSOCIATE DEGREE PROGRAM AND THE UNIVERSITY OF NORTH DAKOTA FAMILY RESIDENCY PROGRAM. OUR ONCOLOGY CLINIC PROVIDES ASSISTANCE FOR GAS AND LODGING FOR PATIENTS THAT TRAVEL FROM OUTSIDE OUR IMMEDIATE SERVICE AREA. ADDITIONALLY, THE LAB SPONSORS A SEMI-ANNUAL BLOOD DRAW FOR AREA RESIDENTS. PRIMARY CARE ALSO SPONSORS ANNUAL FLU VACCINATIONS, AND ROUTINE BLOOD PRESSURE CLINICS. OUR HEALTHY COMMUNITY INITIATIVE IS A COLLABORATION WITH THE DISTRICT HEALTH UNIT UTILIZING THEIR STAFF AND OURS TO COORDINATE WELL BABY PROGRAMS AND OTHERS ASSOCIATED WITH BUILDING HEALTHY FAMILIES. IN ADDITION, WE SPONSOR SEVERAL EDUCATION PROGRAMS IN CONJUNCTION WITH OUR VIOLENCE PREVENTION PROGRAM.

PART VI, LINE 6:
THE ORGANIZATION IS AFFILIATED WITH COMMONSPIRIT HEALTH. COMMONSPIRIT HEALTH WAS CREATED BY THE ALIGNMENT OF CATHOLIC HEALTH INITIATIVES AND DIGNITY HEALTH IN EARLY 2019. COMMONSPIRIT HEALTH, A NONPROFIT, FAITH-BASED HEALTH SYSTEM IS COMMITTED TO BUILDING HEALTHIER COMMUNITIES, ADVOCATING FOR THOSE WHO ARE POOR AND VULNERABLE, AND INNOVATING HOW AND WHERE HEALING CAN HAPPEN BOTH INSIDE ITS HOSPITALS AND OUT IN THE COMMUNITY. COMMONSPIRIT HEALTH OWNS AND OPERATES HEALTH CARE FACILITIES IN 21 STATES AND IS THE SOLE CORPORATE MEMBER (PARENT CORPORATION) OF OTHER PRIMARILY NONPROFIT CORPORATIONS THAT ARE EXEMPT FROM FEDERAL AND STATE INCOME TAXES. AS OF JUNE 30, 2022, COMMONSPIRIT HEALTH IS COMPRISED OF APPROXIMATELY 2,200 CARE SITES, CONSISTING OF 142 HOSPITALS, INCLUDING ACADEMIC HEALTH CENTERS, MAJOR TEACHING HOSPITALS, AND CRITICAL ACCESS FACILITIES, COMMUNITY HEALTH SERVICES ORGANIZATIONS, ACCREDITED NURSING COLLEGES, HOME HEALTH AGENCIES, LIVING COMMUNITIES, A MEDICAL FOUNDATION AND OTHER AFFILIATED MEDICAL GROUPS, AND OTHER FACILITIES AND SERVICES THAT SPAN THE INPATIENT AND OUTPATIENT CONTINUUM OF CARE. IN FISCAL YEAR 2022, COMMONSPIRIT HEALTH PROVIDED MORE THAN $3.16 BILLION IN FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT FOR PROGRAMS AND SERVICES FOR THE POOR, FREE CLINICS, EDUCATION AND RESEARCH. FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT TOTALED MORE THAN $4.89 BILLION WITH THE INCLUSION OF THE UNPAID COSTS OF MEDICARE. THE HEALTH SYSTEM, WHICH GENERATED OPERATING REVENUES OF $33.9 BILLION IN FISCAL YEAR 2022, HAS TOTAL ASSETS OF APPROXIMATELY $50.31 BILLION.COMMONSPIRIT HEALTH PROVIDES STRATEGIC PLANNING AND MANAGEMENT SERVICES AS WELL AS CENTRALIZED SERVICES FOR ITS DIVISIONS. 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 DIVISIONS. THE COST SAVINGS ACHIEVED THROUGH COMMONSPIRIT HEALTH'S CENTRALIZATION ENABLE DIVISIONS TO DEDICATE ADDITIONAL RESOURCES TO HIGH-QUALITY HEALTH CARE AND COMMUNITY OUTREACH SERVICES TO THE MOST VULNERABLE MEMBERS OF OUR SOCIETY.