Community Benefit Insight - Tax-exempt hospital

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Sanford Group Return

PO Box 5039 Rte 5218

Sioux Falls, SD 57117

EIN: 453791176

The hospital that you have selected is part of a multi-facility organization that reports community benefit expenditures in the aggregate and not by individual hospital. The data shown below are for the multi-facility organization. We encourage you to contact the individual hospital directly if you would like community benefit information on the hospital.Learn more

Individual Facility Details: Sanford Medical Center Canton

440 North Hiawatha Drive
Canton, SD 57013

Bed count	11	Medicare provider number	431333	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

Sanford Group ReturnDisplay data for year:

Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

6.98%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2021

Additional data

Community Benefit Expenditures: 2021

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 87,612,517 1.81 %
Medicaid as % of operating expenses	$ 127,149,960 2.63 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 23,293,324 0.48 %
Subsidized health services as % of operating expenses	$ 49,451,962 1.02 %
Research as % of operating expenses	$ 14,703,410 0.30 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 17,674,898 0.37 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 17,509,337 0.36 %
Community building* as % of operating expenses	$ 30,087,320 0.62 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	YES
Number of activities or programs (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 30,087,320 0.62 %
Physical improvements and housing as % of community building expenses	$ 0 0 %
Economic development as % of community building expenses	$ 6,520,760 21.67 %
Community support as % of community building expenses	$ 17,704,009 58.84 %
Environmental improvements as % of community building expenses	$ 1,000 0.00 %
Leadership development and training for community members as % of community building expenses	$ 2,575 0.01 %
Coalition building as % of community building expenses	$ 15,469 0.05 %
Community health improvement advocacy as % of community building expenses	$ 24,414 0.08 %
Workforce development as % of community building expenses	$ 5,819,093 19.34 %
Other as % of community building expenses	$ 0 0 %
Direct offsetting revenue	$ 2,000
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 2,000
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 65,652,861 1.36 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2021 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 0 0 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2021

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES

Supplemental Information: 2021

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 4752539326 including grants of $ 47401573) (Revenue $ 5023563794)
SANFORD IS THE NATION'S LARGEST NOT-FOR-PROFIT INTEGRATED RURAL HEALTH SYSTEM PROVIDING MEDICAL SERVICES AT EVERY LEVEL FROM CRITICAL ACCESS HOSPITALS TO TERTIARY AND QUATERNARY CARE. THE SANFORD FOOTPRINT INCLUDES OVER 220,000 SQUARE MILES WITH A NINE STATE SERVICE AREA INCLUDING A NETWORK OF CHILDREN'S PRIMARY CARE CLINIC LOCATIONS ACROSS THE COUNTRY AND THE WORLD. SANFORD OPERATES FULL-TIME EMERGENCY CENTERS AND PROVIDES EMERGENCY CARE TO EVERYONE REGARDLESS OF THEIR ABILITY TO PAY. SANFORD FACILITIES AND CLINICS PROVIDE SERVICES TO REMOTE AND MEDICALLY UNDERSERVED AREAS THAT WOULD OTHERWISE NOT HAVE ACCESS TO EVEN PRIMARY CARE SERVICES. SANFORD FINANCIALLY SUPPORTS HEALTH AND WELLNESS, EDUCATION AND COMMUNITY DEVELOPMENT ACTIVITIES TO IMPROVE THE QUALITY OF LIFE AND STRENGTHEN COMMUNITIES THROUGHOUT THE REGION. EACH OF SANFORD'S FACILITIES PROMOTES HEALTH AND HEALING THAT RESPONDS TO THE UNIQUE NEEDS OF THE PATIENTS IN THE COMMUNITIES THAT SANFORD SERVES, ENSURING ACCESS TO COMPREHENSIVE AND SPECIALIZED SERVICES. A RECENTLY COMPLETED AND PUBLISHED COMMUNITY HEALTH NEEDS ASSESSMENT INDICATED THE IMPORTANT NEED FOR BEHAVIORAL HEALTH SERVICES FOR OUR COMMUNITY MEMBERS. SANFORD IS MEETING THIS NEED THROUGH AN INTEGRATED DELIVERY SYSTEM PROVIDING BEHAVIORAL HEALTH WITHIN THE MEDICAL HOME STRUCTURE.PLEASE SEE SCHEDULE H FOR A DESCRIPTION OF ADDITIONAL SERVICES, COMMUNITY BENEFIT ACTIVITIES, AND THE FULL SPECTRUM OF CHARITY CARE THAT SANFORD PROVIDES WITHIN THE COMMUNITY.

4B (Expenses $ 14621871 including grants of $ 0) (Revenue $ 18728490)
MEDICAL EDUCATION IS AN IMPORTANT SERVICE FOR SANFORD. SANFORD PROVIDES THE MEDICAL COMMUNITY WITH HIGH QUALITY EDUCATIONAL AND PROFESSIONAL DEVELOPMENT THAT IS EVIDENCE AND RESEARCH BASED; ACCREDITED FOR PHYSICIANS, NURSES, PHARMACISTS, AND ALLIED HEALTH PROFESSIONALS AND SCIENTISTS; INCLUSIVE OF CULTURAL DIVERSITY AND ADDRESSES THE NEED FOR SPECIALTY TRAINING.SANFORD IS DEDICATED TO PREPARING HEALTH CARE PROFESSIONALS FOR THE FUTURE. THE SANFORD PROMISE PROGRAM CONNECTS STUDENTS, EDUCATORS AND COMMUNITIES WITH SCIENCE AND RESEARCH IN HEALTH CARE AT A SECONDARY EDUCATION AGE. SANFORD WORKS IN PARTNERSHIP WITH THE UNIVERSITY OF SOUTH DAKOTA - SANFORD SCHOOL OF MEDICINE, AND THE UNIVERSITY OF NORTH DAKOTA - SCHOOL OF MEDICINE TO PROVIDE ROTATIONS FOR MEDICAL STUDENTS, RESIDENCIES AND FELLOWSHIPS. SANFORD WORKS IN PARTNERSHIP WITH AN EXTENSIVE GROUP OF HIGHER LEARNING ORGANIZATIONS TO PROVIDE STUDENT TRAINING AND LEARNING OPPORTUNITIES IN MANY VENUES ACROSS OUR REGION.

4C (Expenses $ 38807342 including grants of $ 15100) (Revenue $ 4262840)
SANFORD RESEARCH AND SANFORD RESEARCH NORTH ARE BOTH NON-PROFIT HEALTH RESEARCH ORGANIZATIONS. COMBINED, BOTH ENTITIES HAVE MORE THAN 200 SCIENTISTS AND STAFF AS WELL AS CENTERS, INCLUDING: CHILDREN'S HEALTH, FOCUSED ON PEDIATRIC RARE DISEASES AND CANCER; THE SANFORD PROJECT, SEEKING A CURE FOR TYPE 1 DIABETES THROUGH THE BODY'S NATURAL ABILITY TO REGENERATE CELLS; HEALTH OUTCOMES AND PREVENTION FOCUSING ON SUDDEN INFANT DEATH SYNDROME AND BIRTH-RELATED DISORDERS AT STUDY SITES INCLUDING UNITED STATES NATIVE AMERICAN RESERVATIONS AND SOUTH AFRICA; GENOMIC AND MOLECULAR MEDICINE WITH AN EMPHASIS ON GENOMICS, MOLECULAR BIOLOGY, BIOBANKING AND IMMUNOTHERAPY; EDITH SANFORD BREAST CANCER FOCUSING ON ADVANCED MOLECULAR RESEARCH AND PERSONALIZED TREATMENT; NEUROSCIENCES, FOCUSED ON THE AREA OF EATING DISORDERS, OBESITY AND BARIATRIC SURGERY OUTCOMES AS WELL AS PHYSIOLOGICAL ASPECTS OF EATING AND ADDICTION AND CLINICAL RESEARCH INCLUDING PARTICIPATION IN DRUG AND DEVICE STUDIES, THE NATIONAL CANCER INSTITUTE COMMUNITY CLINICAL ONCOLOGY PROGRAM AND THE NATIONAL COMMUNITY CANCER CENTER PILOT PROJECT.SANFORD RESEARCH AND SANFORD RESEARCH NORTH OFFER EXCITING CHALLENGES FOR RESEARCHERS BOTH IN WELL-ESTABLISHED PROJECTS AND EVER EXPANDING RESEARCH OPPORTUNITIES. SANFORD OFFERS OPPORTUNITIES TO PARTICIPATE IN CLINICAL TRIALS AND TO BE A PART OF THE CHANGING FACE OF MEDICINE.

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

PART V, SECTION B
FACILITY REPORTING GROUP A

FACILITY REPORTING GROUP A CONSISTS OF:
- FACILITY 1: SANFORD USD MEDICAL CENTER, - FACILITY 3: SANFORD BROADWAY MEDICAL CENTER FARGO, - FACILITY 4: SANFORD MEDICAL CENTER SOUTH UNIVERSITY, - FACILITY 5: SANFORD BISMARCK MEDICAL CENTER, - FACILITY 6: SANFORD BEMIDJI MEDICAL CENTER, - FACILITY 7: SANFORD MEDICAL CENTER THIEF RIVER FALLS, - FACILITY 8: SANFORD ABERDEEN MEDICAL CENTER, - FACILITY 9: SANFORD WORTHINGTON MEDICAL CENTER, - FACILITY 10: SANFORD SHELDON MEDICAL CENTER, - FACILITY 11: SANFORD VERMILLION MEDICAL CENTER, - FACILITY 12: SANFORD CHAMBERLAIN MEDICAL CENTER, - FACILITY 13: SANFORD LUVERNE MEDICAL CENTER, - FACILITY 14: SANFORD CANBY MEDICAL CENTER, - FACILITY 15: SANFORD JACKSON MEDICAL CENTER, - FACILITY 16: SANFORD TRACY MEDICAL CENTER, - FACILITY 17: SANFORD HILLSBORO MEDICAL CENTER, - FACILITY 18: SANFORD MEDICAL CENTER MAYVILLE, - FACILITY 19: SANFORD WEBSTER MEDICAL CENTER, - FACILITY 20: SANFORD MEDICAL CENTER WHEATON, - FACILITY 21: SANFORD BAGLEY MEDICAL CENTER, - FACILITY 22: SANFORD CANTON-INWOOD MEDICAL CENTER, - FACILITY 23: SANFORD CLEAR LAKE MEDICAL CENTER, - FACILITY 24: SANFORD WESTBROOK MEDICAL CENTER, - FACILITY 2: SANFORD MEDICAL CENTER FARGO

GROUP A-FACILITY 1 -- SANFORD USD MEDICAL CENTER PART V, SECTION B, LINE 5:
SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/HEALTH-NEEDS-ASSESSMENT-SURVEY/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE.

GROUP A-FACILITY 1 -- SANFORD USD MEDICAL CENTER PART V, SECTION B, LINE 6A:
SANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER

GROUP A-FACILITY 1 -- SANFORD USD MEDICAL CENTER PART V, SECTION B, LINE 7D:
SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED.

GROUP A-FACILITY 1 -- SANFORD USD MEDICAL CENTER PART V, SECTION B, LINE 11:
THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO CAREACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE HEALTH CARE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET. SANFORD HAS MADE ACCESS TO CARE A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO INCREASE ACCESS TO AND AWARENESS OF AFFORDABLE CARE OPTIONS AND TO IMPROVE ACCESS THROUGH VIRTUAL CARE OPTIONS. IT IS SANFORD'S GOAL TO IMPROVE COMMUNITY ACCESS SO CARE IS AVAILABLE AND AFFORDABLE FOR ALL. PRIORITY 2: CHRONIC DISEASE PREVENTIONSANFORD USD MEDICAL CENTER TAKES AN INTEGRATED APPROACH TO DISEASE PREVENTION. SANFORD PROMOTES THE IMPORTANCE OF HAVING A PRIMARY CARE PROVIDER AND OFFERS SCREENING OPPORTUNITIES FOR EARLY DETECTION AND INTERVENTION OF CHRONIC DISEASE.SANFORD HAS MADE CHRONIC DISEASE PREVENTION A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO BROADEN COMMUNITY AWARENESS OF THE IMPORTANCE OF PRIMARY AND PREVENTIVE CARE AND IMPROVE CARE FOR CHILDREN AT RISK FOR OBESITY. IT IS SANFORD'S GOAL TO IMPROVE CHRONIC DISEASE MANAGEMENT AND REDUCTION OF OBESITY.PRIORITY 3: MENTAL HEALTH AND ADDICTIONMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH AND ADDICTION SIGNIFICANT PRIORITIES AND HAS DEVELOPED STRATEGIES TO EXPAND ACCESS TO TIMELY BEHAVIORAL HEALTH CARE AND REDUCE THE NEGATIVE IMPACT OF ADDICTION AND SUBSTANCE ABUSE ON THE COMMUNITY. IT IS SANFORD'S GOAL TO IMPROVE CARE MANAGEMENT FOR RESIDENTS SUFFERING FROM SUBSTANCE ABUSE AND MENTAL HEALTH ISSUES.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEAR:ACCESS TO CAREFINANCIAL COUNSELORS ARE AVAILABLE TO HELP PATIENTS WHO NEED FREE OR DISCOUNTED CARE. SANFORD HEALTH PLAN OPTIONS CAN ALSO BE REVIEWED FOR THOSE SEEKING AFFORDABLE HEALTH INSURANCE COVERAGE. WALK-INS, VIDEO VISITS, E-VISITS, ONLINE SCHEDULING, AND SAME-DAY ACCESS ARE AVAILABLE AT ALL PRIMARY CARE LOCATIONS. SANFORD USD MEDICAL CENTER PROVIDES NURSE CASE MANAGERS IN THE EMERGENCY DEPARTMENT TO SUPPORT COMPLEX PATIENTS WHO ACCESS CARE IN THIS SETTING, WORKING WITH THE MULTIDISCIPLINARY TEAM TO SUPPORT THE NEEDS OF THE INDIVIDUAL. BEHAVIORAL HEALTH CARE ACCESS HAS BEEN ENHANCED WITH THE RECRUITMENT OF ADDITIONAL PROVIDERS AND PLACING BEHAVIORAL HEALTH TRIAGE THERAPISTS IN ALL PRIMARY CARE CLINICS. CHRONIC DISEASE PREVENTIONSANFORD USD MEDICAL CENTER TAKES AN INTEGRATED APPROACH TO DISEASE PREVENTION. SANFORD PROMOTES THE IMPORTANCE OF HAVING A PRIMARY CARE PROVIDER AND OFFERS SCREENING OPPORTUNITIES FOR EARLY DETECTION AND INTERVENTION OF CHRONIC DISEASE. SANFORD PROVIDES NURSE CASE MANAGERS, DIETICIANS, AND BEHAVIORAL HEALTH THERAPISTS, AMONG OTHER RESOURCES, TO HOLISTICALLY ADDRESS PATIENT NEEDS. SANFORD PROVIDES A VARIETY OF COMMUNITY EDUCATION OPPORTUNITIES. SANFORD DIETICIANS GIVE NUTRITION EDUCATION PRESENTATIONS TO EMPLOYEES OF SIOUX FALLS BUSINESSES. SANFORD PROVIDES FITCARE CLASSES FOR CHILDCARE PROVIDERS IN THE REGION AND THE SANFORD FIT PROGRAM IS AVAILABLE IN AREA SCHOOLS AND ONLINE. SANFORD ALSO WORKS IN PARTNERSHIP WITH THE SIOUX FALLS HEALTH DEPARTMENT ON NUMEROUS HEALTH PROMOTION PROGRAMS. MENTAL HEALTH AND ADDICTIONSANFORD HAS RECRUITED BOTH ADULT AND CHILD PSYCHIATRY PROVIDERS TO INCREASE THE SIZE OF THE CURRENT SANFORD PSYCHIATRY GROUP. A LICENSED ADDICTION COUNSELOR IS ALSO AVAILABLE TO PROVIDE OUTPATIENT ADDICTION/CHEMICAL DEPENDENCY CARE. SANFORD PLACES BEHAVIORAL HEALTH TRIAGE THERAPISTS IN ALL PRIMARY CARE CLINICS TO PROVIDE IMMEDIATE ACCESS TO MENTAL HEALTH SCREENING AS NEED IS IDENTIFIED. SANFORD ALSO INVESTS IN 24/7 ACCESS TO INPATIENT MENTAL HEALTH COUNSELORS AND PSYCHIATRY AND PSYCHOLOGY. SANFORD HAS BEEN A KEY PARTNER IN THE COMMUNITY BEHAVIORAL HEALTH INITIATIVE WHICH ESTABLISHED THE LINK COMMUNITY TRIAGE CENTER IN 2021. THE LINK OFFERS AN INNOVATIVE APPROACH TO ADDRESS GAPS IN CRITICAL SERVICES FOR PEOPLE LIVING WITH MENTAL HEALTH AND SUBSTANCE ABUSE CHALLENGES.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE: LONG-TERM CAREPUBLIC TRANSPORTATIONAFFORDABLE HOUSINGSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS.

GROUP A-FACILITY 1 -- SANFORD USD MEDICAL CENTER PART V, SECTION B, LINE 13H:
OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE.

GROUP A-FACILITY 1 -- SANFORD USD MEDICAL CENTER PART V, SECTION B, LINE 16J:
OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY

GROUP A-FACILITY 3 -- SANFORD BROADWAY MEDICAL CENTER FARGO PART V, SECTION B, LINE 5:
SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/HEALTH-NEEDS-ASSESSMENT-SURVEY/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE.

GROUP A-FACILITY 3 -- SANFORD BROADWAY MEDICAL CENTER FARGO PART V, SECTION B, LINE 6A:
SANFORD USD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER

GROUP A-FACILITY 3 -- SANFORD BROADWAY MEDICAL CENTER FARGO PART V, SECTION B, LINE 7D:
SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED.

GROUP A-FACILITY 3 -- SANFORD BROADWAY MEDICAL CENTER FARGO PART V, SECTION B, LINE 11:
THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO AFFORDABLE HEALTH CAREACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE HEALTH CARE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET. NDSU REPORTED HEALTH CARE ACCESSIBILITY AND COST AS TWO SEPARATE HEALTH NEEDS. THE CASS-CLAY WORKING GROUP DETERMINED THAT THE TWO TOPICS ARE MOST APPROPRIATELY ADDRESSED AS A COMBINED TOPIC FOR PURPOSES OF THE LOCAL CHNA PROCESS.SANFORD HAS MADE HEALTHCARE ACCESS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO EXPAND HEALTHCARE ACCESS AND ACCESS TO PRIMARY CARE SERVICES. IT IS SANFORD'S GOAL THAT THE COMMUNITY WOULD SEE THAT PATIENTS WILL HAVE GREATER EASE TO ACCESS PRIMARY CARE PROVIDERS FOR VIRTUAL OR IN-PERSON VISITS, HOME VISITS AND INCREASED EXPANDED HOURS. PATIENTS MAY EXPERIENCE LESS FREQUENT UTILIZATION OF EMERGENCY CARE, WHICH IS OFTEN MORE EXPENSIVE THAN PREVENTATIVE AND SCREENING SERVICES.PRIORITY 2: MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSEMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSE SIGNIFICANT PRIORITIES AND HAS DEVELOPED STRATEGIES TO RECRUIT PROVIDERS, INCREASE ACCESS TO CARE AND MENTAL HEALTH PROMOTION. IT IS SANFORD'S GOAL TO HAVE BETTER ACCESS TO AND UTILIZATION OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES DUE TO SERVICES BEING PROVIDED AT THE RIGHT TIME AND RIGHT PLACE. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEAR: ACCESS TO AFFORDABLE HEALTH CARESANFORD HEALTH IS POSITIONED LOCALLY TO HAVE A POSITIVE IMPACT ON HEALTH CARE ACCESS WITHIN THE COMMUNITY. THIS EFFORT WILL FOCUS ON TWO PRIMARY GOALS TO EXPAND HEALTHCARE ACCESS AND SUPPORT SERVICES AND EXPANDED PLATFORM TO ACCESS PRIMARY CARE SERVICES, AREAS OF FOCUS IDENTIFIED IN THE STAKEHOLDER MEETING.SANFORD IS ADDRESSING THE NEED BY INCLUDING ACCESS TO HEALTHCARE AS A PRIORITY FOCUS AREA FOR THE 2022-2024 IMPLEMENTATION PLAN. WE LAUNCHED HOME BASED PRIMARY CARE IN 2021. THE GOAL IS TO PROVIDE QUALITY MEDICAL CARE AT HOME TO PATIENTS WHO HAVE DIFFICULTY ACCESSING MEDICAL CARE BECAUSE OF PHYSICAL DISABILITY OR DEMENTIAS. AN INTERDISCIPLINARY TEAM SEES THE PATIENT IN THEIR HOME AND CONSISTS OF SOCIAL WORKER, CARE MANAGER, LPN AND PHYSICIAN/APP. FAMILY MEDICINE RESIDENT CLINIC NOW SEES PATIENTS IN LOCAL SHELTERS, YWCA, HEADSTART AND WILL BEGIN IN ONE OF THE FARGO SCHOOLS IN LATE FALL 2021. THE GOAL OF THESE OUTREACH SITES IS TO IMPROVE ACCESS TO CARE FOR THESE PATIENTS. SANFORD WILL BE EXPANDING PRIMARY CARE CLINIC LOCATIONS BY ADDING A HORACE CLINIC IN LATE 2022. USING TELEHEALTH, WE HAVE EXPANDED OUR ACCESS IN CLINICS FOR PATIENTS UNABLE TO TRAVEL TO THE CLINIC.MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSE SANFORD HEALTH IS POSITIONED LOCALLY TO HAVE A POSITIVE IMPACT ON MENTAL HEALTH / BEHAVIORAL HEALTH AND SUBSTANCE ABUSE WITHIN THE COMMUNITY. THIS EFFORT WILL FOCUS ON THREE PRIMARY GOALS RECRUITMENT AND ACCESS TO MENTAL HEALTH PROVIDERS, DEVELOPMENT OF A COMMUNITY STRATEGY FOR MENTAL HEALTH PROMOTION, AND SUBSTANCE ABUSE.MENTAL HEALTH: SANFORD HEALTH CONTINUES TO RECRUIT PROVIDERS TO IMPROVE ACCESS TO MENTAL HEALTH SERVICES. WE HAVE EXPANDED SCHOOL PARTNERSHIPS TO INCREASE WORKFORCE FOR OUR MENTAL HEALTH PROVIDERS. A MENTAL HEALTH CONSULT TEAM STARTED IN 2021 WITH A GOAL OF EMBEDDING THERAPISTS ON HOSPITAL UNITS. USING TELEHEALTH, WE HAVE EXPANDED OUR ACCESS IN CLINICS FOR PATIENTS UNABLE TO TRAVEL TO THE CLINIC. SANFORD HEALTH IS HOSTING COMMUNITY MENTAL HEALTH COLLABORATION MEETINGS WITH OUR COMMUNITY PARTNERS WITH A GOAL OF IMPROVING THE MENTAL HEALTH PROVIDED IN THE COMMUNITY, TO SERVE THOSE IN A BEHAVIORAL HEALTH CRISIS.A GRANT HAS BEEN SUBMITTED FOR OUR COMMUNITY MENTAL HEALTH COLLABORATION PROJECT, WITH NOTICE OF AWARD TIMEFRAME IN DECEMBER 2021. WE CURRENTLY SCREEN FOR DEPRESSION AT CLINIC VISITS AND HAVE INTEGRATED HEALTH THERAPISTS EMBEDDED IN ALL OF THE PRIMARY CARE CLINICS.SUBSTANCE ABUSE: PATIENTS IDENTIFIED BY THEIR PRIMARY CARE PROVIDER AS HAVING AN OPIOID USE DISORDER ARE ABLE TO RECEIVE TREATMENT WITH OUR SUBOXONE CLINIC AND MAT COMMUNITY PARTNERS. PATIENTS ARE SEEN BY OUR INTEGRATIVE HEALTH THERAPISTS FOR A COMPREHENSIVE BEHAVIORAL HEALTH EVALUATION, FOLLOWED BY A REFERRAL TO THE APPROPRIATE BEHAVIORAL HEALTH PROVIDER (E.G. ADDICTION TREATMENT, THERAPY, PSYCHIATRY). THE PATIENT THEN IS SCHEDULED WITH ONE OF OUR FOUR CERTIFIED PHYSICIANS WHO PRESCRIBE SUBOXONE FOR INDUCTION. SANFORD HEALTH'S COLLABORATION WITH A FARGO-BASED PEER-TO-PEER SUBSTANCE ABUSE PROGRAM PROVIDER, F5, BEGAN IN 2019. THE COLLABORATION REMAINS STRONG AND THE F5 TEAM BEGIN COUNSELING SESSIONS WITHIN OUR HOSPITAL FOR PATIENTS WITH DRUG/ALCOHOL ADDICTION. SANFORD SUPPORTS MANY COMMUNITY PARTNERS TO ADDRESS THE SUBSTANCE ABUSE IN OUR COMMUNITY. PARTNERSHIPS INCLUDE FARGO CASS PUBLIC HEALTH (MOBILE CRISIS UNIT) AND RECOVERY REINVENTED.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:PHYSICAL ACTIVITY AND NUTRITIONSENIOR HOUSING AND LONG-TERM CAREPUBLIC TRANSPORTATIONAFFORDABLE HOUSING, EMPLOYMENT, ECONOMIC DEVELOPMENTDIVERSITY, INCLUSION, HEALTH EQUITYCHILDCAREHEALTH LITERACY AND NAVIGATIONSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS.

GROUP A-FACILITY 3 -- SANFORD BROADWAY MEDICAL CENTER FARGO PART V, SECTION B, LINE 13H:
OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE.

GROUP A-FACILITY 3 -- SANFORD BROADWAY MEDICAL CENTER FARGO PART V, SECTION B, LINE 16J:
OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY

GROUP A-FACILITY 4 -- SANFORD MEDICAL CENTER SOUTH UNIVERSITY PART V, SECTION B, LINE 5:
SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/HEALTH-NEEDS-ASSESSMENT-SURVEY/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE.

GROUP A-FACILITY 4 -- SANFORD MEDICAL CENTER SOUTH UNIVERSITY PART V, SECTION B, LINE 6A:
SANFORD USD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER

GROUP A-FACILITY 4 -- SANFORD MEDICAL CENTER SOUTH UNIVERSITY PART V, SECTION B, LINE 7D:
SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED.

GROUP A-FACILITY 4 -- SANFORD MEDICAL CENTER SOUTH UNIVERSITY PART V, SECTION B, LINE 11:
THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO AFFORDABLE HEALTH CARE ACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE HEALTH CARE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET. NDSU REPORTED HEALTH CARE ACCESSIBILITY AND COST AS TWO SEPARATE HEALTH NEEDS. THE CASS-CLAY WORKING GROUP DETERMINED THAT THE TWO TOPICS ARE MOST APPROPRIATELY ADDRESSED AS A COMBINED TOPIC FOR PURPOSES OF THE LOCAL CHNA PROCESS.SANFORD HAS MADE HEALTHCARE ACCESS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO EXPAND HEALTHCARE ACCESS AND ACCESS TO PRIMARY CARE SERVICES. IT IS SANFORD'S GOAL THAT THE COMMUNITY WOULD SEE THAT PATIENTS WILL HAVE GREATER EASE TO ACCESS PRIMARY CARE PROVIDERS FOR VIRTUAL OR IN-PERSON VISITS, HOME VISITS AND INCREASED EXPANDED HOURS. PATIENTS MAY EXPERIENCE LESS FREQUENT UTILIZATION OF EMERGENCY CARE, WHICH IS OFTEN MORE EXPENSIVE THAN PREVENTATIVE AND SCREENING SERVICES.PRIORITY 2: MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSEMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSE SIGNIFICANT PRIORITIES AND HAS DEVELOPED STRATEGIES TO RECRUIT PROVIDERS, INCREASE ACCESS TO CARE AND MENTAL HEALTH PROMOTION. IT IS SANFORD'S GOAL TO HAVE BETTER ACCESS TO AND UTILIZATION OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES DUE TO SERVICES BEING PROVIDED AT THE RIGHT TIME AND RIGHT PLACE. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEAR: ACCESS TO AFFORDABLE HEALTH CARESANFORD HEALTH IS POSITIONED LOCALLY TO HAVE A POSITIVE IMPACT ON HEALTH CARE ACCESS WITHIN THE COMMUNITY. THIS EFFORT WILL FOCUS ON TWO PRIMARY GOALS TO EXPAND HEALTHCARE ACCESS AND SUPPORT SERVICES AND EXPANDED PLATFORM TO ACCESS PRIMARY CARE SERVICES, AREAS OF FOCUS IDENTIFIED IN THE STAKEHOLDER MEETING.SANFORD IS ADDRESSING THE NEED BY INCLUDING ACCESS TO HEALTHCARE AS A PRIORITY FOCUS AREA FOR THE 2022-2024 IMPLEMENTATION PLAN. WE LAUNCHED HOME BASED PRIMARY CARE IN 2021. THE GOAL IS TO PROVIDE QUALITY MEDICAL CARE AT HOME TO PATIENTS WHO HAVE DIFFICULTY ACCESSING MEDICAL CARE BECAUSE OF PHYSICAL DISABILITY OR DEMENTIAS. AN INTERDISCIPLINARY TEAM SEES THE PATIENT IN THEIR HOME AND CONSISTS OF SOCIAL WORKER, CARE MANAGER, LPN AND PHYSICIAN/APP. FAMILY MEDICINE RESIDENT CLINIC NOW SEES PATIENTS IN LOCAL SHELTERS, YWCA, HEADSTART AND WILL BEGIN IN ONE OF THE FARGO SCHOOLS IN LATE FALL 2021. THE GOAL OF THESE OUTREACH SITES IS TO IMPROVE ACCESS TO CARE FOR THESE PATIENTS. SANFORD WILL BE EXPANDING PRIMARY CARE CLINIC LOCATIONS BY ADDING A HORACE CLINIC IN LATE 2022. USING TELEHEALTH, WE HAVE EXPANDED OUR ACCESS IN CLINICS FOR PATIENTS UNABLE TO TRAVEL TO THE CLINIC.MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSESANFORD HEALTH IS POSITIONED LOCALLY TO HAVE A POSITIVE IMPACT ON MENTAL HEALTH / BEHAVIORAL HEALTH AND SUBSTANCE ABUSE WITHIN THE COMMUNITY. THIS EFFORT WILL FOCUS ON THREE PRIMARY GOALS RECRUITMENT AND ACCESS TO MENTAL HEALTH PROVIDERS, DEVELOPMENT OF A COMMUNITY STRATEGY FOR MENTAL HEALTH PROMOTION, AND SUBSTANCE ABUSE.MENTAL HEALTH: SANFORD HEALTH CONTINUES TO RECRUIT PROVIDERS TO IMPROVE ACCESS TO MENTAL HEALTH SERVICES. WE HAVE EXPANDED SCHOOL PARTNERSHIPS TO INCREASE WORKFORCE FOR OUR MENTAL HEALTH PROVIDERS. A MENTAL HEALTH CONSULT TEAM STARTED IN 2021 WITH A GOAL OF EMBEDDING THERAPISTS ON HOSPITAL UNITS. USING TELEHEALTH, WE HAVE EXPANDED OUR ACCESS IN CLINICS FOR PATIENTS UNABLE TO TRAVEL TO THE CLINIC. SANFORD HEALTH IS HOSTING COMMUNITY MENTAL HEALTH COLLABORATION MEETINGS WITH OUR COMMUNITY PARTNERS WITH A GOAL OF IMPROVING THE MENTAL HEALTH PROVIDED IN THE COMMUNITY, TO SERVE THOSE IN A BEHAVIORAL HEALTH CRISIS.A GRANT HAS BEEN SUBMITTED FOR OUR COMMUNITY MENTAL HEALTH COLLABORATION PROJECT, WITH NOTICE OF AWARD TIMEFRAME IN DECEMBER 2021. WE CURRENTLY SCREEN FOR DEPRESSION AT CLINIC VISITS AND HAVE INTEGRATED HEALTH THERAPISTS EMBEDDED IN ALL OF THE PRIMARY CARE CLINICS.SUBSTANCE ABUSE: PATIENTS IDENTIFIED BY THEIR PRIMARY CARE PROVIDER AS HAVING AN OPIOID USE DISORDER ARE ABLE TO RECEIVE TREATMENT WITH OUR SUBOXONE CLINIC AND MAT COMMUNITY PARTNERS. PATIENTS ARE SEEN BY OUR INTEGRATIVE HEALTH THERAPISTS FOR A COMPREHENSIVE BEHAVIORAL HEALTH EVALUATION, FOLLOWED BY A REFERRAL TO THE APPROPRIATE BEHAVIORAL HEALTH PROVIDER (E.G. ADDICTION TREATMENT, THERAPY, PSYCHIATRY). THE PATIENT THEN IS SCHEDULED WITH ONE OF OUR FOUR CERTIFIED PHYSICIANS WHO PRESCRIBE SUBOXONE FOR INDUCTION. SANFORD HEALTH'S COLLABORATION WITH A FARGO-BASED PEER-TO-PEER SUBSTANCE ABUSE PROGRAM PROVIDER, F5, BEGAN IN 2019. THE COLLABORATION REMAINS STRONG AND THE F5 TEAM BEGIN COUNSELING SESSIONS WITHIN OUR HOSPITAL FOR PATIENTS WITH DRUG/ALCOHOL ADDICTION. SANFORD SUPPORTS MANY COMMUNITY PARTNERS TO ADDRESS THE SUBSTANCE ABUSE IN OUR COMMUNITY. PARTNERSHIPS INCLUDE FARGO CASS PUBLIC HEALTH (MOBILE CRISIS UNIT) AND RECOVERY REINVENTED.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:PHYSICAL ACTIVITY AND NUTRITIONSENIOR HOUSING AND LONG-TERM CAREPUBLIC TRANSPORTATIONAFFORDABLE HOUSING, EMPLOYMENT, ECONOMIC DEVELOPMENTDIVERSITY, INCLUSION, HEALTH EQUITYCHILDCAREHEALTH LITERACY AND NAVIGATIONSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS.

GROUP A-FACILITY 4 -- SANFORD MEDICAL CENTER SOUTH UNIVERSITY PART V, SECTION B, LINE 13H:
OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE.

GROUP A-FACILITY 4 -- SANFORD MEDICAL CENTER SOUTH UNIVERSITY PART V, SECTION B, LINE 16J:
OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY

GROUP A-FACILITY 5 -- SANFORD BISMARCK MEDICAL CENTER PART V, SECTION B, LINE 5:
SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/HEALTH-NEEDS-ASSESSMENT-SURVEY/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE.

GROUP A-FACILITY 5 -- SANFORD BISMARCK MEDICAL CENTER PART V, SECTION B, LINE 6A:
SANFORD USD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER

GROUP A-FACILITY 5 -- SANFORD BISMARCK MEDICAL CENTER PART V, SECTION B, LINE 7D:
SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED.

GROUP A-FACILITY 5 -- SANFORD BISMARCK MEDICAL CENTER PART V, SECTION B, LINE 11:
THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: IMPROVE ACCESS TO BEHAVIORAL HEALTH SERVICESMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE ACCESS TO BEHAVIORAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE AN IMPROVED CONTINUUM OF CARE APPROACH TO ADDRESSING MENTAL AND BEHAVIORAL HEALTH NEEDS AND SUBSTANCE USE DISORDERS. PRIORITY 2: IMPROVE ACCESS TO AFFORDABLE CAREACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE HEALTH CARE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET. SANFORD HAS MADE HEALTHCARE ACCESS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO PROMOTE AND IMPROVE ACCESS TO SERVICES. IMPROVING ACCESS TO HEALTHCARE SERVICES HAS BOTH FINANCIAL AND QUALITY OF LIFE IMPLICATIONS ON THE COMMUNITY. BY HELPING COMMUNITY MEMBERS ACCESS THE RIGHT CARE AT THE RIGHT TIME IN THE RIGHT PLACE, THEY ARE BETTER ABLE TO PREVENT AND MANAGE CHRONIC DISEASE AND ENJOY A BETTER QUALITY OF LIFE. FROM A FINANCIAL PERSPECTIVE, BETTER ACCESS TO CARE CAN BE MEASURED IN REDUCED UNNECESSARY EMERGENCY VISITS AND HOSPITALIZATIONS. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEAR IMPROVE ACCESS TO BEHAVIORAL HEALTH SERVICESIN ADDITION TO PROVIDING MORE THAN 130,000 BEHAVIORAL HEALTH-RELATED VISITS PER YEAR, SANFORD HEALTH PARTNERS WITH SEVERAL COMMUNITY ORGANIZATIONS TO SUPPORT ACCESS TO COMMUNITY RESOURCES AND TO STREAMLINE CONNECTING INDIVIDUALS TO THE SERVICES THEY NEED. IN ADDITION TO PROVIDING CARE WITHIN OUR FACILITIES, SANFORD BEGAN OFFERING ONSITE SCHOOL-BASED BEHAVIORAL HEALTH SERVICES AS PART OF A BISMARCK PUBLIC SCHOOL DISTRICT PILOT PROJECT IN 2020.CLINICALLY, SANFORD INTEGRATES BEHAVIORAL HEALTH SPECIALISTS INTO THE PRIMARY CARE CLINIC SETTING. THE SPECIALISTS COLLABORATE WITH PRIMARY CARE TEAMS AND PROVIDE DIRECT CLINICAL SERVICES CRISIS INTERVENTION, COUNSELING, AND EDUCATION TO PATIENTS. SANFORD ALSO SCREENS PATIENTS FOR DEPRESSION ON ANNUAL BASIS TO INCREASE DIAGNOSING AND TREATING MENTAL HEALTH CONDITIONS EARLY, SANFORD. PATIENTS WHO SCORE OUT AT RISK ARE IMMEDIATELY CONNECTED WITH APPLICABLE CLINICAL AND COMMUNITY RESOURCES AND/OR SUICIDE PREVENTION SERVICES. IMPROVE ACCESS TO AFFORDABLE CARESANFORD HEALTH HAS IMPLEMENTED SEVERAL PROGRAMS AND SERVICES TO IMPROVE ACCESS TO AFFORDABLE CARE. TO ADDRESS HEALTHCARE COVERAGE FOR UNINSURED AND UNDERINSURED, SANFORD INTEGRATED FULLTIME ONSITE FINANCIAL ADVOCATES TO HELP PATIENTS AND THEIR FAMILIES ENROLL IN HEALTH COVERAGE PROGRAMS. SANFORD'S FINANCIAL ASSISTANCE PROGRAM HELPS THOUSANDS OF PATIENTS EACH YEAR REDUCE OR ELIMINATE MEDICAL BILLS THEY CAN AFFORD TO PAY. SANFORD ALSO ASSISTS AT RISK POPULATIONS WITH ENROLLMENT IN PUBLIC HEALTHCARE COVERAGE PROGRAMS. TO HELP BRIDGE THE GAP BETWEEN HEALTH CARE SERVICES PROVIDED IN OUR FACILITIES TO WHAT AT-RISK PATIENTS OUTSIDE OUR WALLS, SANFORD CREATED A COMMUNITY HEALTH WORKER PROGRAM. THE CHW WORKS WITH PATIENTS IN THE COMMUNITY TO ASSIST WITH SOCIAL SERVICES, COMMUNITY RESOURCES, TRANSPORTATION NEEDS, FOOD STABILITY AND OTHER KEY SOCIAL DETERMINANTS OF HEALTH. TO HELP THE COMMUNITY'S MOST VULNERABLE PATIENTS BETTER MANAGE CHRONIC DISEASES INCLUDING DIABETES, ASTHMA AND DEPRESSION, SANFORD ESTABLISHED BETTER CHOICES, BETTER HEALTH, A SELF-MANAGEMENT PROGRAM DESIGNED TO HELP ADULTS BETTER UNDERSTAND THEIR HEALTH AND BETTER MANAGE THEIR SYMPTOMS. ADDITIONAL FREE HEALTHCARE CLASSES INCLUDE FAMILY PARENTING AND SIBLING CLASSES, BIRTHING CLASSES, BREASTFEEDING CLASSES, AND CARING FOR YOUR NEWBORN CLASS.SUBSIDIZED HEALTH SERVICES CLINICAL PROGRAMS THAT ARE PROVIDED DESPITE A FINANCIAL LOSS ARE PROVIDED TO MEET IDENTIFIED COMMUNITY NEEDS AND IF IT WERE NOT OFFERED BY SANFORD, IT WOULD EITHER BE UNAVAILABLE OR FALL TO THE RESPONSIBILITY OF GOVERNMENT OR ANOTHER NOT-FOR-PROFIT ORGANIZATION. EXAMPLES OF SUBSIDIZED HEALTH SERVICES INCLUDE BEHAVIORAL HEALTH SERVICES, RENAL DIALYSIS SERVICES, TRAUMA CARE AND WOMEN'S AND CHILDREN'S SERVICES. SANFORD HEALTH SERVES AS THE REGION'S SAFETY NET HOSPITAL, PROVIDING FREE AND DISCOUNTED CARE TO THOUSANDS OF PATIENTS UNABLE TO AFFORD HEALTHCARE COSTS. SANFORD ALSO WORKS PROACTIVELY WITH PATIENTS AND COMMUNITY MEMBERS TO HELP INDIVIDUALS APPLY FOR HEALTHCARE COVERAGE PROGRAMS INCLUDING MEDICAID, MEDICARE AND PRIVATE COVERAGE.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:HEALTHY LIVING ACCESS TO HEALTH CARE PROVIDERSLONG-TERM CARE PUBLIC TRANSPORTATIONAFFORDABLE HOUSINGSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS.

GROUP A-FACILITY 5 -- SANFORD BISMARCK MEDICAL CENTER PART V, SECTION B, LINE 13H:
OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE.

GROUP A-FACILITY 5 -- SANFORD BISMARCK MEDICAL CENTER PART V, SECTION B, LINE 16J:
OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY

GROUP A-FACILITY 6 -- SANFORD BEMIDJI MEDICAL CENTER PART V, SECTION B, LINE 5:
SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/HEALTH-NEEDS-ASSESSMENT-SURVEY/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE.

GROUP A-FACILITY 6 -- SANFORD BEMIDJI MEDICAL CENTER PART V, SECTION B, LINE 6A:
SANFORD USD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER

GROUP A-FACILITY 6 -- SANFORD BEMIDJI MEDICAL CENTER PART V, SECTION B, LINE 7D:
SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED.

GROUP A-FACILITY 6 -- SANFORD BEMIDJI MEDICAL CENTER PART V, SECTION B, LINE 11:
THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO HEALTH CARE: MENTAL HEALTHMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO ADD ADDITIONAL BEHAVIORAL HEALTH PROVIDERS, PROGRAMS, IMPROVED ACCESS AND ALTERNATE WAYS TO ENGAGE WITH BEHAVIORAL HEALTH PROVIDERS. IT IS SANFORD'S GOAL TO PROVIDE ACCESS TO QUALITY AND TIMELY HEALTH CARE RELATED TO MENTAL HEALTH AND SUBSTANCE ABUSE. PRIORITY 2: HEALTHY LIVINGIN THE UNITED STATES, MANY OF THE LEADING CAUSES OF DEATH AND DISEASE ARE ATTRIBUTED TO UNHEALTHY BEHAVIORS. FOR EXAMPLE, POOR NUTRITION AND LOW LEVELS OF PHYSICAL ACTIVITY ARE ASSOCIATED WITH HIGHER RISK OF CARDIOVASCULAR DISEASE, TYPE 2 DIABETES, AND OBESITY. TOBACCO USE IS ASSOCIATED WITH HEART DISEASE, CANCER, AND POOR PREGNANCY OUTCOMES IF THE MOTHER SMOKES DURING PREGNANCY. EXCESSIVE ALCOHOL USE IS ASSOCIATED WITH INJURIES, CERTAIN TYPES OF CANCERS, AND CIRRHOSIS. SANFORD HAS MADE HEALTHY LIVING A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO SEE AN INCREASE IN OPTIONS AND ASSISTANCE FOR HEALTHY LIVING. IT IS SANFORD'S GOAL TO FOCUS ON HEALTHY LIVING TO INCLUDE ASSESSMENT AND TREATMENT OF CHRONIC HEALTH ISSUES, LEVELS OF PHYSICAL ACTIVITY AND FOOD INSECURITY.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARACCESS TO HEALTH CARE: MENTAL HEALTHTHE FIRST PRIORITY ENCOMPASSES STRATEGIES TO ADDRESS TWO SIGNIFICANT HEALTH NEEDS NOTED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT: ACCESS TO HEALTH CARE AND MENTAL HEALTH.OUTREACH TO COMMUNITIES HAS GROWN TO 9 DIFFERENT COMMUNITIES IN THE REGION IN ADDITION TO LEVERAGING SPECIALISTS FROM FARGO WHO COME TO BEMIDJI. OF THESE LOCATIONS THERE ARE MORE THAN 14 DIFFERENT BEMIDJI SPECIALISTS THAT OUTREACH. SANFORD CONTINUES RECRUITMENT FOR SPECIALISTS FOCUSING CURRENTLY ON CARDIOLOGY, DERMATOLOGY, ONCOLOGY, UROLOGY, ORTHOPEDICS, AND NEUROLOGY.UNDERSTANDING PATIENT EXPERIENCE IS OF HIGH IMPORTANCE TO SANFORD. PATIENT FEEDBACK IS COLLECTED THROUGH TWO SURVEY PROCESSES. THE FIRST IS A PAPER CAHPS SURVEY COMPLETED BY MAIL IN WHICH THE PATIENT HAS 42 DAYS TO RESPOND FROM THEIR ENCOUNTER DATE. THE SECOND IS A REAL-TIME SURVEY CONDUCTED BY EMAIL OR AN INTERACTIVE VOICE PHONE CALL. IN THIS CASE, THE PATIENT HAS TWO WEEKS FROM THE ENCOUNTER DATE TO RESPOND.SANFORD BEMIDJI IS COMMITTED TO THE MENTAL HEALTH OF OUR REGIONAL POPULATION BY IMPLEMENTING A BEST PRACTICES MODEL RECOMMENDED BY THE SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA), THE FEDERAL GOLD STANDARD FOR COMMUNITY BEHAVIORAL HEALTH SERVICES. THE IMPLEMENTATION OF THIS NEW MODEL WILL INCREASE ACCESS TO QUALITY SERVICES. DEVELOPMENT OF THESE NEW SERVICES INCLUDES A CRISIS CENTER FACILITY WHICH HOUSES INPATIENT PSYCHIATRIC HOSPITAL BEDS AND EMPATH UNIT. WE ARE TREATING THE NEEDS OF OUR MOST ACUTE POPULATION, FURTHER ADDRESSING THE IMPORTANCE FOR OUR PATIENTS TO STAY IN THE COMMUNITY IN WHICH THEY AND THEIR FAMILIES LIVE. A RESIDENTIAL WITHDRAWAL MANAGEMENT (DETOX) UNIT IS SCHEDULED TO BE OPERATIONAL EARLY 2023. AS SANFORD TRANSITIONS TO CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINIC (CCBHC) STATUS, COORDINATION OF CARE BETWEEN WITHDRAWAL MANAGEMENT, MEDICATED ASSISTED TREATMENT (MAT), AND OUTPATIENT SUBSTANCE USE AND/OR DUAL DISORDER TREATMENT PROVIDERS WILL SIGNIFICANTLY INCREASE ACCESS TO TIMELY AND QUALITY CARE.SANFORD HEALTH IS COMMITTED TO WORKING WITH THE SCHOOLS TO PROVIDE CULTURALLY SENSITIVE, AGE APPROPRIATE AND FAMILY-ORIENTED PREVENTION PROGRAMS TO CREATE AND GIVE CHILDREN A HEALTHY START IN LIFE. SANFORD HEALTH WILL BUILD UPON CURRENT RELATIONSHIPS WITH AREA SCHOOLS TO IDENTIFY IN-SCHOOL AND/OR TELEHEALTH PROGRAMS AND SERVICES THAT WILL AUGMENT AND SUPPORT HEALTHY LEARNING, EMOTIONAL AND BEHAVIORAL DEVELOPMENT. SANFORD OFFERS FINANCIAL SUPPORT FOR BEMIDJI AREA SERVICE COLLABORATIVE AND PEACEMAKER RESOURCES SO THAT SOCIAL AND EMOTIONAL LEARNING CURRICULUM COULD BE IMPLEMENTED IN ALL K-3 CLASSROOMS IN ISD.MOBILE CRISIS RESPONSE SERVICES ARE OFFERED TO ALL CHILDREN 24/7. THE CRISIS SERVICES ARE PROVIDED AS NEEDED IN ALL SCHOOL LOCATIONS. CHILDREN'S THERAPEUTIC SERVICES AND SUPPORTS (CTSS) SERVICES WILL BE EXPANDED BEYOND SCHOOLS TO INCLUDE IN-HOME SERVICES TO SUPPORT FAMILIES. ADDITIONAL SUPPORTS TO AREA SCHOOLS WILL BE PROVIDED THROUGH SANFORD'S NEW PEDIATRIC PSYCHIATRIST. HEALTHY LIVINGSANFORD HEALTH PROVIDES FUNDING TO ISD # 31 AND THE UNITED WAY OF BEMIDJI AREA TO SUPPORT THE NO CHILD HUNGRY INITIATIVE. THIS INITIATIVE INCLUDES FINANCIAL SUPPORT OF ISD 31'S ANGEL FUND, WHICH COVERS THE UNPAID MEAL BALANCE FOR THE DISTRICT. BY PAYING THIS BALANCE, IT ALLOWS ISD #31 TO CONTINUE TO PROVIDE ALL CHILDREN BREAKFAST AND LUNCH REGARDLESS OF THE FAMILY'S ABILITY TO PAY. NO CHILD HUNGRY ALSO PROVIDES FUNDING TO THE UNITED WAY OF BEMIDJI AREA BACKPACK BUDDIES FOOD PACK PROGRAM. THIS PROGRAM SENDS FOOD PACKS HOME WITH CHILDREN OVER THE WEEKEND AND SERVES 400+ KIDS WITHIN ISD 31. IN 2020, WE PROVIDED ADDITIONAL FUNDING WHICH SUPPORTED EXPANDING THIS PROGRAM TO THE BI-CAP HEAD START, THE BLACKDUCK SCHOOL DISTRICT, AND THE KELLIHER SCHOOL DISTRICT.SANFORD IS ALSO MOVING FORWARD A WELLNESS CENTER PROJECT IN COLLABORATION WITH A LOCAL DEVELOPER AND THE CITY OF BEMIDJI. THE CENTER WOULD HOUSE A FITNESS FACILITY, COMMUNITY AND EDUCATIONAL SPACE, A MULTI-PURPOSE AREA FOR INDOOR SPORTS, AND AQUATICS AREA AND ICE RINKS. THE PROJECT IS IN THE PLANNING STAGE, WITH SITE ANALYSIS AND FEASIBILITY STUDIES BEING CONDUCTED.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:EMPLOYMENT AND INCOMEACCESS TO AFFORDABLE HEALTH CAREAFFORDABLE HOUSINGPUBLIC TRANSPORTATIONCHILD CARE QUALITYCOMMUNITY SAFETYSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS.

GROUP A-FACILITY 6 -- SANFORD BEMIDJI MEDICAL CENTER PART V, SECTION B, LINE 13H:
OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE.

GROUP A-FACILITY 6 -- SANFORD BEMIDJI MEDICAL CENTER PART V, SECTION B, LINE 16J:
OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY

GROUP A-FACILITY 7 -- SANFORD MEDICAL CENTER THIEF RIVER FALLS PART V, SECTION B, LINE 5:
SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/HEALTH-NEEDS-ASSESSMENT-SURVEY/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE.

GROUP A-FACILITY 7 -- SANFORD MEDICAL CENTER THIEF RIVER FALLS PART V, SECTION B, LINE 6A:
SANFORD USD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER

GROUP A-FACILITY 7 -- SANFORD MEDICAL CENTER THIEF RIVER FALLS PART V, SECTION B, LINE 7D:
SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED.

GROUP A-FACILITY 7 -- SANFORD MEDICAL CENTER THIEF RIVER FALLS PART V, SECTION B, LINE 11:
THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: MENTAL HEALTHMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO FOR MENTAL HEALTH PROMOTION, SUICIDE PREVENTION AND EDUCATION FOR PARENTING RELATED SKILLS. IT IS SANFORD'S GOAL TO INCREASE ACCESS TO MENTAL/BEHAVIORAL HEALTH AND SUBSTANCE ABUSE SERVICES, IN PARTICULAR FOR AT RISK YOUTH AND TO DECREASE THE NUMBER OF SUICIDES.PRIORITY 2: ACCESS TO HEALTHCARE PROVIDERSACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE HEALTH CARE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET. SANFORD HAS MADE ACCESS TO HEALTHCARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO DEVELOP A FULLTIME DERMATOLOGY CLINIC AND TO EXPAND ACCESS TO TELEHEALTH TECHNOLOGIES IN BEHAVIORAL HEALTH. IT IS SANFORD'S GOAL TO INCREASE NUMBER OF LOCAL PROVIDERS SERVICING THIEF RIVER FALLS THROUGH LOCALLY BASED PROVIDERS, OUTREACH FROM OTHER SANFORD FACILITIES, OR TELEHEALTH/VIRTUAL CARE PLATFORMS. INCREASED PROVIDERS WILL EXPAND THE NUMBER OF AVAILABLE SERVICES AND APPOINTMENTS AVAILABLE TO THE LOCAL COMMUNITY.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARMENTAL HEALTH SANFORD THIEF RIVER FALLS CONTINUES TO RECRUIT PROVIDERS TO ADDRESS THE DIFFICULTIES IN TIMELY APPOINTMENT AND FOLLOW-UP. IN THE PAST YEAR WE HAVE ADDED FIVE NEW PROVIDERS AND ARE IN THE PROCESS OF LICENSING A NEW FACILITY FOR SUBSTANCE USE DISORDERS (SUDS). ADOLESCENT CARE PROVIDERS HAVE BEEN A FOCUS IN RECRUITMENT BUT DUE TO THE SPECIALIZATION IT IS A DIFFICULT RECRUIT. WE CONTINUE TO RECRUIT FOR ADDITIONAL PROVIDERS, PARTICULARLY WITH TRAINING IN ADOLESCENT CARE AND TREATMENT. THE SHIFT TO TELEHEALTH, PARTICULARLY VIDEO, WAS ENABLED BY TIME-LIMITED, REGULATORY CHANGES RELATED TO REIMBURSEMENT, PRIVACY STANDARDS FOR TELEHEALTH TECHNOLOGY, AND LICENSURE. POST-COVID-19 POLICIES WILL DETERMINE WHETHER TELEHEALTH REMAINS CENTRAL TO US HEALTH CARE OR RETURNS TO THE PERIPHERY.ACCESS TO HEALTHCARE PROVIDERSACCESS TO PROVIDERS HAS BEEN AND CONTINUES TO BE A HIGH PRIORITY IN THIEF RIVER FALLS. THROUGH TELEHEALTH TECHNOLOGIES WE HAVE BEEN ABLE TO EXPAND ACCESS BEYOND THE TRADITIONAL FACE TO FACE ENCOUNTERS. TELEHEALTH OPPORTUNITIES ARE MANY, HOWEVER CONSTRAINED TO SOME DEGREE BY PAYMENT MODELS AND WHETHER INSURANCE PAYORS WILL RECOGNIZE TELEHEALTH AS A COVERED SERVICE. THE COVID PANDEMIC HAS ACCELERATED THE ACCEPTANCE OF TELEHEALTH BY THE CONSUMER, PROVIDERS AND INSURERS HOWEVER IT REMAINS TO BE SEEN WHETHER SUPPORT AND ADOPTION OF THIS SERVICE OPTION WILL CONTINUE AT THE PACE EXPERIENCED DURING THE PANDEMIC. WITH REGARD TO NURSE PRACTITIONERS, THERE IS CERTAINLY OPPORTUNITY TO WORK WITH OUR PARTNERS TO INCREASE AWARENESS AMONG THE GENERAL COMMUNITY OF THE EXPERT CARE THEY CAN PROVIDE.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO QUALITY HEALTHCAREAFFORDABLE HOUSINGLONG-TERM CAREPUBLIC TRANSPORTATIONSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS.

GROUP A-FACILITY 7 -- SANFORD MEDICAL CENTER THIEF RIVER FALLS PART V, SECTION B, LINE 13H:
OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE.

GROUP A-FACILITY 7 -- SANFORD MEDICAL CENTER THIEF RIVER FALLS PART V, SECTION B, LINE 16J:
OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY

GROUP A-FACILITY 8 -- SANFORD ABERDEEN MEDICAL CENTER PART V, SECTION B, LINE 5:
SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/HEALTH-NEEDS-ASSESSMENT-SURVEY/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE.

GROUP A-FACILITY 8 -- SANFORD ABERDEEN MEDICAL CENTER PART V, SECTION B, LINE 6A:
SANFORD USD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER

GROUP A-FACILITY 8 -- SANFORD ABERDEEN MEDICAL CENTER PART V, SECTION B, LINE 7D:
SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED.

GROUP A-FACILITY 8 -- SANFORD ABERDEEN MEDICAL CENTER PART V, SECTION B, LINE 11:
THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: IMPROVING PHYSICAL ACTIVITY AND NUTRITION FOR YOUTH AND ADULTSTHE ENVIRONMENTS WHERE PEOPLE LIVE, LEARN, WORK, AND PLAY AFFECT ACCESS TO HEALTHY FOOD AND OPPORTUNITIES FOR PHYSICAL ACTIVITY WHICH, ALONG WITH GENETIC FACTORS AND PERSONAL CHOICES, SHAPE HEALTH AND THE RISK OF BEING OVERWEIGHT AND OBESE. SANFORD HAS MADE PHYSICAL ACTIVITY AND NUTRITION A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO PROMOTE AND IMPROVE CARE OF PATIENTS WITH OBESITY DIAGNOSIS AND TO PROVIDE EDUCATION TO SCHOOLS REGARDING PHYSICAL ACTIVITY AND NUTRITION. IT IS SANFORD'S GOAL TO IMPROVE PHYSICAL ACTIVITY AND NUTRITION FOR THE COMMUNITY. PRIORITY 2: ACCESS TO HEALTH CARE PROVIDERS, PARTICULARLY FOR MENTAL HEALTH SERVICES AND EDUCATIONACCORDING TO THE COUNTY HEALTH RANKINGS FOR CLINICAL CARE, ACCESS TO HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE HEALTH CARE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET.SANFORD HAS MADE HEALTHCARE ACCESS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO PROMOTE AND IMPROVE ACCESS TO SERVICES AND EDUCATION. IT IS SANFORD'S GOAL THAT ALL PATIENTS REQUIRING ACCESS TO HEALTHCARE ARE SUCCESSFUL IN SECURING TIMELY APPOINTMENTS AND TO IMPROVING MENTAL HEALTH SERVICES IN THE COMMUNITY. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARIMPROVING PHYSICAL ACTIVITY AND NUTRITION FOR YOUTH AND ADULTSSANFORD ABERDEEN MEDICAL CENTER (SAMC) IS COMMITTED TO IMPROVING CARE OF PATIENTS WITH OBESITY DIAGNOSIS THROUGH REFERRING PATIENTS TO INTERNAL AND EXTERNAL SERVICES, INCLUDING REGISTERED DIETITIANS, EXERCISE PHYSIOLOGISTS, AND HEALTH COACHES. SANFORD EMPLOYS A REGISTERED DIETICIAN AND FOOD PRODUCTION STAFF WITHIN THE HOSPITAL WHICH AND WILL UTILIZE THESE RESOURCES TO EDUCATE THE LOCAL COMMUNITY ON HEALTHY EATING AND HOW TO UTILIZE LIMITED FOOD RESOURCES FOR FULL MEAL PLANNING. IN 2021, SAMC STAFF PROVIDED EDUCATION TO LOCAL SCHOOLS AND CHILDCARE CENTERS ABOUT THE SANFORD FIT INITIATIVE, A CHILDHOOD OBESITY PREVENTION INITIATIVE. FIT IS THE ONLY INITIATIVE PROGRAM FOCUSING EQUALLY ON THE FOUR KEY CONTRIBUTING FACTORS TO CHILDHOOD OBESITY: FOOD (NUTRITION), MOVE (ACTIVITY), MOOD (BEHAVIORAL HEALTH), AND RECHARGE (SLEEP). ACCESS TO HEALTH CARE PROVIDERS, PARTICULARLY FOR MENTAL HEALTH SERVICES AND EDUCATIONSAMC SEEKS TO ENSURE THAT MENTAL HEALTH SERVICES ARE AVAILABLE IN ABERDEEN AND THE SURROUNDING AREA. WE AIM TO IMPROVE CARE OF PATIENTS WITH DEPRESSION DIAGNOSIS THROUGH IMPROVING PHQ-9 SCORES FOR PATIENTS WITH MAJOR DEPRESSION. TO THIS END, SANFORD ABERDEEN CLINIC IS OFFERING TELEMEDICINE OPTIONS FOR PSYCHIATRY SERVICES TO INCREASE OVERALL ACCESS TO MENTAL HEALTH CARE. TO IDENTIFY NEEDS AND ENSURE ACCESS TO APPROPRIATE CARE, PCP VISITS INCLUDE A QUESTIONNAIRE ASSESSMENT TOOL THAT IS ALIGNED WITH SANFORD HEALTH ENTERPRISE PROTOCOLS FOR SCREENING. THIS APPROACH IS A MORE HOLISTIC MANNER BY EMBEDDING AN INTEGRATED HEALTH THERAPIST (IHT) IN OUR PRIMARY CARE CLINICS. THE IHT ALSO OFFERS ONGOING EDUCATION ON SERVICES OFFERED THROUGH PRIMARY CARE. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO AFFORDABLE HEALTH CAREPUBLIC TRANSPORTATIONAFFORDABLE HOUSINGSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS.

GROUP A-FACILITY 8 -- SANFORD ABERDEEN MEDICAL CENTER PART V, SECTION B, LINE 13H:
OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE.

GROUP A-FACILITY 8 -- SANFORD ABERDEEN MEDICAL CENTER PART V, SECTION B, LINE 16J:
OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY

GROUP A-FACILITY 9 -- SANFORD WORTHINGTON MEDICAL CENTER PART V, SECTION B, LINE 5:
SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/HEALTH-NEEDS-ASSESSMENT-SURVEY/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE.

GROUP A-FACILITY 9 -- SANFORD WORTHINGTON MEDICAL CENTER PART V, SECTION B, LINE 6A:
SANFORD USD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTER

GROUP A-FACILITY 9 -- SANFORD WORTHINGTON MEDICAL CENTER PART V, SECTION B, LINE 7D:
SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED.

GROUP A-FACILITY 9 -- SANFORD WORTHINGTON MEDICAL CENTER PART V, SECTION B, LINE 11:
THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO PROVIDERS (BILINGUAL MENTAL HEALTH AND PEDIATRIC DENTAL CARE)ACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE HELPS INDIVIDUALS AND FAMILIES ACCESS NEEDED PRIMARY CARE, SPECIALISTS, AND EMERGENCY CARE, BUT DOES NOT ENSURE ACCESS ON ITS OWN. IT IS ALSO NECESSARY FOR PROVIDERS TO OFFER AFFORDABLE CARE, BE AVAILABLE TO TREAT PATIENTS, AND BE IN RELATIVELY CLOSE PROXIMITY TO PATIENTS.SANFORD HAS MADE ACCESS TO HEALTH CARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO INCREASE SCREENING OF MENTAL HEALTH AND REFERRAL SOURCES FOR MENTAL HEALTH SUPPORT AND TO INCREASE ACCESS TO PEDIATRIC DENTAL CARE FOR AT-RISK PATIENTS. IT IS SANFORD'S GOAL THAT MORE AREA RESIDENTS WILL HAVE ACCESS TO PROVIDERS OF BILINGUAL MENTAL HEALTH AND PEDIATRIC DENTAL CARE.PRIORITY 2: TEEN PREGNANCYTEEN PREGNANCY RESULTS IN SUBSTANTIAL SOCIAL, ECONOMIC, AND HEALTH COSTS THROUGH IMMEDIATE AND LONG-TERM IMPACTS ON TEEN PARENTS AND THEIR CHILDREN. STUDIES SHOW THAT THE CHILDREN OF TEENAGE MOTHERS ARE MORE LIKELY TO HAVE LOWER SCHOOL ACHIEVEMENT AND TO DROP OUT OF HIGH SCHOOL, HAVE MORE HEALTH PROBLEMS, BE INCARCERATED AT SOME TIME DURING ADOLESCENCE, AND FACE UNEMPLOYMENT AS A YOUNG ADULT, THAN CHILDREN BORN TO OLDER MOTHERS.SANFORD HAS MADE TEEN PREGNANCY A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO INCREASE LINKAGES BETWEEN TEEN PREGNANCY PREVENTION PROGRAMS AND COMMUNITY-BASED CLINICAL SERVICES. IT IS SANFORD'S GOAL THAT THE COMMUNITY WILL BENEFIT FROM STRONG LOCAL PARTNERSHIPS THROUGH SANFORD'S FOCUS ON THIS ISSUE. FAMILY PRACTICE AND PEDIATRIC PROVIDERS WILL PROVIDE PATIENT EDUCATION, RECOMMEND, AND SUPPORT SPECIALTY REFERRALS. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARACCESS TO PROVIDERS (BILINGUAL MENTAL HEALTH AND PEDIATRIC DENTAL CARE)SANFORD HEALTH WILL POSITIVELY IMPACT ACCESS BY SERVING AS PRIMARY CARE PROVIDERS TO THOUSANDS OF LOCAL RESIDENTS, ASSESSING NEEDS, PROVIDING EDUCATION, AND SUPPORTING SPECIALTY REFERRALS. THE RN CARE MANAGER, COMMUNITY HEALTH WORKERS, AND INTEGRATED HEALTH THERAPISTS (IHT) ASSIST WITH IMMEDIATE NEEDS AND REFERRALS TO APPROPRIATE RESOURCES.THE LOCATION HAS RECENTLY HIRED A BILINGUAL SPANISH CHW WHO CAN HELP FILL GAPS IN COMPLETION OF THE MENTAL HEALTH ASSESSMENT AND APPROPRIATE REFERRAL TO MENTAL HEALTH SERVICES. THE IHT POSITION FOR THE CLINIC HAS BEEN POSTED. TEEN PREGNANCYSANFORD WORTHINGTON WILL PRIORITIZE TEEN PREGNANCY IN EFFORT TO CONTINUE THE POSITIVE DOWNWARD TRAJECTORY IN THE TEEN PREGNANCY RATE FOR THE AREA. SANFORD WORTHINGTON SUPPORTS DONATIONS TO HELPING HANDS PREGNANCY CENTER'S ANNUAL FUNDRAISING EVENT. SANFORD PROVIDERS, RN CARE MANAGERS, COMMUNITY HEALTH WORKERS, AND INTEGRATED HEALTH THERAPISTS ASSIST WITH IMMEDIATE NEEDS AND REFERRALS TO APPROPRIATE RESOURCES.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:INCOME AND POVERTYPUBLIC TRANSPORTATIONAFFORDABLE HOUSINGACCESS TO AFFORDABLE HEALTH CAREPHYSICAL ACTIVITY AND NUTRITIONCHILDCARE QUALITYLONG-TERM CARESANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS.

GROUP A-FACILITY 9 -- SANFORD WORTHINGTON MEDICAL CENTER PART V, SECTION B, LINE 13H:
OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE.

GROUP A-FACILITY 9 -- SANFORD WORTHINGTON MEDICAL CENTER PART V, SECTION B, LINE 16J:
OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY

GROUP A-FACILITY 10 -- SANFORD SHELDON MEDICAL CENTER PART V, SECTION B, LINE 5:
SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/HEALTH-NEEDS-ASSESSMENT-SURVEY/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE.

GROUP A-FACILITY 10 -- SANFORD SHELDON MEDICAL CENTER PART V, SECTION B, LINE 6A:
SANFORD USD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER

GROUP A-FACILITY 10 -- SANFORD SHELDON MEDICAL CENTER PART V, SECTION B, LINE 7D:
SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED.

GROUP A-FACILITY 10 -- SANFORD SHELDON MEDICAL CENTER PART V, SECTION B, LINE 11:
THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO AFFORDABLE HEALTH CARE ACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE HEALTH CARE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET. SANFORD HAS MADE ACCESS TO AFFORDABLE HEALTH CARE A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO EDUCATE THE COMMUNITY ON THE FULL SCOPE OF LOCALLY AVAILABLE SERVICES AND OFFER COMMUNITY EDUCATIONAL AND SCREENING EVENTS TO ENHANCE PREVENTATIVE CARE AND REDUCE OUT-OF-POCKET COSTS. IT IS SANFORD'S GOAL TO INCREASE THE PUBLIC EDUCATION ON THE PROMOTION OF SERVICES AVAILABLE IN SHELDON, REDUCING OUT-OF-POCKET COSTS DUE TO TRAVEL TIME AND TIME AWAY FROM THEIR EMPLOYMENT.PRIORITY 2: ACCESS TO HEALTH CARE PROVIDERSACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE HELPS INDIVIDUALS AND FAMILIES ACCESS NEEDED PRIMARY CARE, SPECIALISTS, AND EMERGENCY CARE, BUT DOES NOT ENSURE ACCESS ON ITS OWNIT IS ALSO NECESSARY FOR PROVIDERS TO OFFER AFFORDABLE CARE, BE AVAILABLE TO TREAT PATIENTS, AND BE IN RELATIVELY CLOSE PROXIMITY TO PATIENTS.SANFORD HAS MADE ACCESS TO HEALTH CARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO ENHANCE MARKETING AND PROMOTIONAL ACTIVITIES TO IMPROVE ACCESS AND TO PROMOTE VIRTUAL CARE TO AUGMENT ACCESS TO MENTAL AND BEHAVIORAL HEALTH CARE. IT IS SANFORD'S GOAL TO ENHANCE ACCESS TO CARE FOR RESIDENTS OF SHELDON AND THE SURROUNDING AREA.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARACCESS TO AFFORDABLE HEALTH CARESANFORD SHELDON MEDICAL CENTER PROVIDES FINANCIAL ASSISTANCE TO PATIENTS THAT QUALIFY. RN HEALTH COACHES WORK WITH PATIENTS TO PROVIDE ASSISTANCE OBTAINING AFFORDABLE PRESCRIPTION MEDICATIONS. UNINSURED PATIENTS ARE OFFERED FINANCIAL ASSISTANCE APPLICATION AND POLICY AS WELL AS ASSISTANCE TO APPLY FOR INSURANCE WITH MEDDATA. SANFORD SHELDON PROVIDES A WIDE RANGE OF SERVICES AND HOURS OF OPERATIONS. ACCESS TO HEALTH CARE PROVIDERSSANFORD WILL EDUCATE THE COMMUNITY ON THE PRIMARY CARE AND SPECIALTY PHYSICIANS PROVIDING SERVICES IN SHELDON. SPECIALTY COVERAGE WILL BE ANALYZED TO DETERMINE THE AVAILABILITY OF OFFERING ADDITIONAL SERVICES. SANFORD SHELDON WILL ALSO INCLUDE MENTAL HEALTH ACCESS AS A FOCUS AREA. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:PHYSICAL ACTIVITY AND NUTRITIONAFFORDABLE HOUSINGPUBLIC TRANSPORTATIONLONG-TERM CAREENVIRONMENTAL HEALTHSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS.

GROUP A-FACILITY 10 -- SANFORD SHELDON MEDICAL CENTER PART V, SECTION B, LINE 13H:
OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE.

GROUP A-FACILITY 10 -- SANFORD SHELDON MEDICAL CENTER PART V, SECTION B, LINE 16J:
OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY

GROUP A-FACILITY 11 -- SANFORD VERMILLION MEDICAL CENTER PART V, SECTION B, LINE 5:
SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/HEALTH-NEEDS-ASSESSMENT-SURVEY/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE.

GROUP A-FACILITY 11 -- SANFORD VERMILLION MEDICAL CENTER PART V, SECTION B, LINE 6A:
SANFORD USD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER

GROUP A-FACILITY 11 -- SANFORD VERMILLION MEDICAL CENTER PART V, SECTION B, LINE 7D:
SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED.

GROUP A-FACILITY 11 -- SANFORD VERMILLION MEDICAL CENTER PART V, SECTION B, LINE 11:
THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO AFFORDABLE HEALTH CAREACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE HEALTH CARE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET.SANFORD VERMILLION HAS MADE ACCESS TO AFFORDABLE HEALTH CARE A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO ENSURE PATIENTS AND COMMUNITY PARTNERS ARE AWARE OF ITS FINANCIAL ASSISTANCE PROGRAM AND OTHER PROGRAMS AVAILABLE TO ELIGIBLE PATIENTS TO ASSIST WITH MEDICATIONS AND PREVENTATIVE CARE. IT IS SANFORD'S GOAL TO SEE LESS ACCOUNTS GOING TO COLLECTIONS OR WRITTEN OFF TO BAD DEBT AND A GREATER SHARE WRITTEN OFF TO OUR FINANCIAL ASSISTANCE PROGRAM. THERE ARE OTHER ASSISTANCE PROGRAMS FOR MEDICATIONS AND WOMEN'S PREVENTATIVE CARE THAT WE CAN HELP PATIENTS GET SIGNED UP FOR AS WELL.PRIORITY 2: HEALTH CARE ACCESS: MENTAL HEALTH/BEHAVIORAL HEALTHACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE HELPS INDIVIDUALS AND FAMILIES ACCESS NEEDED PRIMARY CARE, SPECIALISTS, AND EMERGENCY CARE, BUT DOES NOT ENSURE ACCESS ON ITS OWNIT IS ALSO NECESSARY FOR PROVIDERS TO OFFER AFFORDABLE CARE, BE AVAILABLE TO TREAT PATIENTS, AND BE IN RELATIVELY CLOSE PROXIMITY TO PATIENTS.SANFORD HAS MADE HEALTH CARE ACCESS: MENTAL HEALTH/BEHAVIORAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO PROMOTE ALTERNATIVE VISIT TYPES AND TO ALLOW OPEN SCHEDULING AND EXPANSION OF WEEKEND HOURS. IT IS SANFORD'S GOAL TO OFFER THE ALTERNATIVE VISITS, ADDING OPEN SCHEDULING AND EXPANSION OF OUR WEEKEND HOURS, THUS ALLOWING GREATER ACCESS TO OUR PROVIDERS FOR THE COMMUNITY AND WILL ADVERTISE THESE SO THE COMMUNITY IS AWARE.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARACCESS TO AFFORDABLE HEALTH CARESANFORD VERMILLION WILL WORK WITH PATIENTS AND ITS COMMUNITY PARTNERS TO ENSURE ALL ARE AWARE OF ITS FINANCIAL ASSISTANCE PROGRAM AND OTHER PROGRAMS AVAILABLE TO ELIGIBLE PATIENTS TO ASSIST WITH MEDICATIONS AND PREVENTATIVE CARE.SANFORD VERMILLION CURRENTLY OFFERS A GENEROUS FINANCIAL ASSISTANCE PROGRAM TO ELIGIBLE PATIENTS, BUT PATIENTS MAY BE RELUCTANT TO ASK ABOUT IT OR UNAWARE IT EXISTS AS WE STILL WRITE OFF A NUMBER OF ACCOUNTS TO BAD DEBT. OUR TEAM UTILIZES SANFORD HEALTH PLAN'S WEBSITE AND RELATED RESOURCES TO PROVIDE RELEVANT INSURANCE INFORMATION AS NEEDED. WE WORK WITH BOTH SANFORD HEALTH PLAN REPRESENTATIVES AND LOCAL INSURANCE AGENTS TO GIVE PATIENTS INFORMATION ON INSURANCE PRODUCTS AND SERVICES. SANFORD HEALTH IS ALSO PART OF SOUTH DAKOTANS DECIDE HEALTH CARE A BROAD COALITION ADVOCATING FOR MEDICAID EXPANSION IN SD. MEDICAID EXPANSION WILL HELP SOUTH DAKOTA FAMILIES WHO ARE SLIPPING THROUGH THE CRACKS IN OUR HEALTHCARE SYSTEM AND WILL HELP KEEP RURAL HOSPITALS OPEN ENSURING ACCESS TO EMERGENCY CARE. ADDITIONALLY, PATIENTS WHO CALL WITH CONCERNS ABOUT PAYING BILLS AND/OR COST OF THEIR BILL ARE ALL REFERRED TO OUR FINANCIAL ASSISTANCE PROGRAM WHICH IF THEY QUALIFY PROVIDES PARTIAL TO FULL DISCOUNT ON THEIR SANFORD BILLS FOR UP TO ONE YEAR. WE EDUCATE ALL OF OUR PROVIDERS TO TELL PATIENTS NOT TO DELAY OR DENY SERVICES BASED ON COST CONCERNS AS WE WILL WORK WITH PATIENTS ON THEIR BILL WHETHER IT'S PAYMENT PLANS, PROMPT PAY DISCOUNTS OR APPLYING FOR OUR FINANCIAL ASSISTANCE PROGRAM. HEALTH CARE ACCESS: MENTAL HEALTH/BEHAVIORAL HEALTH SANFORD VERMILLION WILL PROMOTE VERBAL AND TELEHEALTH/VIDEO VISITS IF CMS CONTINUES TO ALLOW THEM TO IMPROVE ACCESS TO PROVIDERS. SANFORD VERMILLION IS ALSO WORKING WITH IT TO OFFER OPEN SCHEDULING FOR PATIENTS TO GO ONLINE AND SCHEDULE THEIR OWN APPOINTMENTS WITH ANY PROVIDER OF THEIR CHOICE, INCLUDING MENTAL HEALTH PROVIDERS. SANFORD VERMILLION WILL ALSO BE WORKING WITH MARKETING DEPARTMENT TO PROMOTE AVAILABILITY OF ALL PROVIDERS AND START ADVERTISING AVAILABLE OUTREACH SPECIALTY PROVIDERS AND MENTAL HEALTH PROVIDERS AVAILABLE LOCALLY.SANFORD VERMILLION CURRENTLY HAS A NUMBER OF SPECIALTIES AND TWO MENTAL HEALTH PROVIDERS WHO PROVIDE SERVICES AT OUR CLINIC. AWARENESS IN THE COMMUNITY OF THESE COULD BE IMPROVED. WE ALSO SAW A DECREASE IN NO SHOW VISIT RATES DURING COVID-19 WHEN WE WERE ABLE TO OFFER MORE VERBAL, VIDEO AND TELEHEALTH VISITS SO WE HOPE TO CONTINUE TO BE ABLE TO OFFER THESE TYPES OF VISITS. THERE ARE ALSO MENTAL HEALTH SERVICES AVAILABLE TO UNIVERSITY OF SOUTH DAKOTA STUDENTS ON CAMPUS AT NO CHARGE TO THEM. IN THE VERMILLION COMMUNITY, THERE IS ALSO A MENTAL HEALTH COUNSELOR WHO HAS A PRIVATE PRACTICE AND LEWIS AND CLARK BEHAVIORAL HEALTH HAS AN OFFICE IN VERMILLION WITH MENTAL HEALTH COUNSELORS AND ALCOHOL AND SUBSTANCE ABUSE COUNSELORS AVAILABLE TO THE VERMILLION COMMUNITY. THEY ARE ALSO WORK IN THE SCHOOL DISTRICT TO MAKE VISITS ON SITE AT THE SCHOOLS. WE CONTINUE TO EVALUATE SERVICE DEMAND AND MAY RECRUIT ADDITIONAL PROVIDERS IN THE FUTURE IF NEEDED.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:AFFORDABLE HOUSINGPUBLIC TRANSPORTATIONSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS.

GROUP A-FACILITY 11 -- SANFORD VERMILLION MEDICAL CENTER PART V, SECTION B, LINE 13H:
OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE.

GROUP A-FACILITY 11 -- SANFORD VERMILLION MEDICAL CENTER PART V, SECTION B, LINE 16J:
OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY

GROUP A-FACILITY 12 -- SANFORD CHAMBERLAIN MEDICAL CENTER PART V, SECTION B, LINE 5:
SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/HEALTH-NEEDS-ASSESSMENT-SURVEY/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE.

GROUP A-FACILITY 12 -- SANFORD CHAMBERLAIN MEDICAL CENTER PART V, SECTION B, LINE 6A:
SANFORD USD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER

GROUP A-FACILITY 12 -- SANFORD CHAMBERLAIN MEDICAL CENTER PART V, SECTION B, LINE 7D:
SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED.

GROUP A-FACILITY 12 -- SANFORD CHAMBERLAIN MEDICAL CENTER PART V, SECTION B, LINE 11:
THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: IMPROVE MENTAL HEALTH AND DECREASE ADDICTION/SUBSTANCE ABUSE IN THE COMMUNITYMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO ADD ADDITIONAL MENTAL HEALTH RESOURCES IN THE COMMUNITY AND TO INCREASE ACCESSIBILITY TO MENTAL HEALTH CARE FOR YOUTH. IT IS SANFORD'S GOAL TO INCREASE MENTAL HEALTH COUNSELING AND SUBSTANCE ABUSE COUNSELING OPTIONS IN THE COMMUNITY. PRIORITY 2: INCREASE ACCESS TO SPECIALTY CARE IN THE COMMUNITYACCESS TO CARE REQUIRES NOT ONLY FINANCIAL COVERAGE, BUT ALSO ACCESS TO PROVIDERS. WHILE HIGH RATES OF SPECIALIST PHYSICIANS HAVE BEEN SHOWN TO BE ASSOCIATED WITH HIGHER (AND PERHAPS UNNECESSARY) UTILIZATION, SUFFICIENT AVAILABILITY OF PRIMARY CARE PHYSICIANS IS ESSENTIAL FOR PREVENTIVE AND PRIMARY CARE, AND, WHEN NEEDED, REFERRALS TO APPROPRIATE SPECIALTY CARE.SANFORD HAS MADE ACCESS TO SPECIALTY HEALTH CARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO PROMOTE NEW SPECIALTY CARE SERVICES INCLUDING OPHTHALMOLOGY AND ORTHOPEDICS AND CREATE AWARENESS OF VIRTUAL CARE OPTIONS FOR SPECIALTY SERVICES. IT IS SANFORD'S GOAL TO PROVIDE ENHANCED ACCESS TO A VARIETY OF SPECIALTY CARE SERVICES IN THE COMMUNITY.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARIMPROVE MENTAL HEALTH AND DECREASE ADDICTION/SUBSTANCE ABUSE IN THE COMMUNITYSANFORD HEALTH IS POSITIONED LOCALLY TO HAVE A POSITIVE IMPACT ON IMPROVING MENTAL HEALTH AND DECREASING ADDICTION/SUBSTANCE ABUSE IN THE COMMUNITY AS A WHOLE. IN PARTICULAR, WE INTEND TO ADD RESOURCES AND CONTINUE PARTNERSHIP WITH THE LOCAL SCHOOLS. SANFORD IS FURTHER DEVELOPING THE MENTAL HEALTH SERVICES IN CENTRAL SOUTH DAKOTA, THROUGH HIRING ADDITIONAL MENTAL HEALTH THERAPISTS, TO SERVE CENTRAL SOUTH DAKOTA AT SANFORD CHAMBERLAIN.INCREASE ACCESS TO SPECIALTY CARE IN THE COMMUNITYSANFORD HEALTH IS POSITIONED LOCALLY TO HAVE A POSITIVE IMPACT ON INCREASING ACCESS TO SPECIALTY CARE WITHIN THE COMMUNITY. THIS EFFORT WILL FOCUS ON TWO PRIMARY GOALS PROMOTING SERVICES ALREADY OFFERED THAT MAY BE UNDERUTILIZED OR UNKNOWN AND, LEVERAGING VIRTUAL CARE FOR SERVICES THAT ARE NOT OFFERED LOCALLY. SANFORD CHAMBERLAIN IS USING ROBUST MARKETING IN PROMOTING SPECIALTY SERVICES INCLUDING SOCIAL MEDIA AND A WEBPAGE. THERE IS A TELEHEALTH COORDINATOR ON SITE THAT PROMOTES VIRTUAL SERVICES TO PATIENTS AND PROVIDERS.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO AFFORDABLE HEALTH CAREPHYSICAL ACTIVITY AND NUTRITIONSEXUAL ACTIVITYCOMMUNITY SAFETYCHILDCARE QUALITYAFFORDABLE HOUSINGPUBLIC TRANSPORTATION AND THE INTERNETSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD SHARED THE FINDINGS OF THE CHNA RESEARCH AND THESE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS.

GROUP A-FACILITY 12 -- SANFORD CHAMBERLAIN MEDICAL CENTER PART V, SECTION B, LINE 13H:
OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE.

GROUP A-FACILITY 12 -- SANFORD CHAMBERLAIN MEDICAL CENTER PART V, SECTION B, LINE 16J:
OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY

GROUP A-FACILITY 13 -- SANFORD LUVERNE MEDICAL CENTER PART V, SECTION B, LINE 5:
SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/HEALTH-NEEDS-ASSESSMENT-SURVEY/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE.

GROUP A-FACILITY 13 -- SANFORD LUVERNE MEDICAL CENTER PART V, SECTION B, LINE 6A:
SANFORD USD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER

GROUP A-FACILITY 13 -- SANFORD LUVERNE MEDICAL CENTER PART V, SECTION B, LINE 7D:
SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED.

GROUP A-FACILITY 13 -- SANFORD LUVERNE MEDICAL CENTER PART V, SECTION B, LINE 11:
THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1 MENTAL HEALTHMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO EXPAND MENTAL HEALTH OPPORTUNITIES AND DECREASE SUBSTANCE ABUSE IN THE COMMUNITY. IT IS SANFORD'S GOAL THAT THE COMMUNITY WOULD SEE EXPANDED ACCESS TO MENTAL HEALTH SERVICES WITHIN THE COMMUNITY.PRIORITY 2: ACCESS TO HEALTH CARE PROVIDERSACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE HELPS INDIVIDUALS AND FAMILIES ACCESS NEEDED PRIMARY CARE, SPECIALISTS, AND EMERGENCY CARE, BUT DOES NOT ENSURE ACCESS ON ITS OWNIT IS ALSO NECESSARY FOR PROVIDERS TO OFFER AFFORDABLE CARE, BE AVAILABLE TO TREAT PATIENTS, AND BE IN RELATIVELY CLOSE PROXIMITY TO PATIENTS.SANFORD HAS MADE ACCESS TO HEALTH CARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO INCREASE ACCESS TO PRIMARY CARE AND EXPAND TELEHEALTH AND DENTAL ACCESS. IT IS SANFORD'S GOAL TO PROVIDE GREATER ACCESS TO CARE USING THE VISIT STYLE PREFERRED BY THE PATIENT. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARMENTAL HEALTHSANFORD LUVERNE WILL CONTINUE TO SHARE THE RESULTS OF THIS SURVEY WITH COMMUNITY PARTNERS TO BUILD ACCESS TO MENTAL HEALTH. IN ADDITION, SANFORD LUVERNE WILL CONTINUE TO LOOK AT ACCESS POINTS WITHIN THE CLINIC, BOTH IN PERSON AND VIRTUAL TO IMPROVE ACCESS TO MENTAL HEALTH. SANFORD LUVERNE WILL SPEND TIME OVER THE NEXT THREE YEARS EXPLORING WAYS TO ASSIST THE SCHOOL WITH MENTAL HEALTH OPPORTUNITIES AS WELL AS FOCUSING ON CAREGIVER MENTAL HEALTH AND RESILIENCY. SANFORD LUVERNE'S TEAM FOCUSING ON THIS INITIATIVE WILL CONSIST OF TWO SUBSTANCE USE COUNSELORS AND ONE INTEGRATED HEALTH THERAPIST.ACCESS TO HEALTH CARE PROVIDERSSANFORD LUVERNE HAS WORKED TO IMPROVE ACCESS TO PROVIDERS OVER THE PAST 3 YEARS AS WE FOCUSED ON RECRUITMENT OF HIGH-QUALITY PROVIDERS TO ENSURE ACCESS TO CARE WITH A COUPLE LONGER TERM PHYSICIAN RETIREMENTS. WE HAVE RECENTLY ADDED A NURSE PRACTITIONER AND WILL HAVE A NEW FAMILY MEDICINE PHYSICIAN JOINING THE PRACTICE IN FEBRUARY 2022. OVER 2020-2021, SANFORD HEALTH DEPLOYED ACCESS TO VIDEO VISITS AND PATIENTS CAN CONTINUE TO ACCESS AN ACUTE CARE PROVIDER VIA TELEHEALTH OR CALLING THE CLINIC TO DO A VIDEO VISIT WITH THEIR PRIMARY CARE PROVIDER. WE ANTICIPATE THAT TELEHEALTH VISITS WILL CONTINUE TO GROW AND SERVES TO PROVIDE AFTER HOURS ACCESS WITHOUT A TRIP TO THE EMERGENCY ROOM. SANFORD LUVERNE WILL CONTINUE TO LOOK AT ALL POINTS OF ACCESS TO CARE OVER THE UPCOMING 3-YEAR CYCLE FOCUSING ON AFTER HOURS, ER, PRIMARY CARE ACCESS, AND SPECIALTY OUTREACH CARE WITHIN LUVERNE. SANFORD LUVERNE LEADERSHIP WILL CONTINUE TO SHARE THE RESULTS OF THIS SURVEY WITH THE DENTAL COMMUNITY AND LUV1LUVALL COMMITTEE. IN ADDITION, SANFORD LUVERNE WILL CONTINUE TO LOOK FOR WAYS TO SUPPORT THE LUV1LUVALL DENTAL ACCESS TO HELP ENSURE ALL RESIDENTS HAVE ACCESS TO CARE.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO AFFORDABLE HEALTH CAREPHYSICAL ACTIVITY AND NUTRITIONAFFORDABLE HOUSINGCHILDCARE/DAYCARE SERVICESSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS.

GROUP A-FACILITY 13 -- SANFORD LUVERNE MEDICAL CENTER PART V, SECTION B, LINE 13H:
OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE.

GROUP A-FACILITY 13 -- SANFORD LUVERNE MEDICAL CENTER PART V, SECTION B, LINE 16J:
OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY

GROUP A-FACILITY 14 -- SANFORD CANBY MEDICAL CENTER PART V, SECTION B, LINE 5:
SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/HEALTH-NEEDS-ASSESSMENT-SURVEY/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE.

GROUP A-FACILITY 14 -- SANFORD CANBY MEDICAL CENTER PART V, SECTION B, LINE 6A:
SANFORD USD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER

GROUP A-FACILITY 14 -- SANFORD CANBY MEDICAL CENTER PART V, SECTION B, LINE 7D:
SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED.

GROUP A-FACILITY 14 -- SANFORD CANBY MEDICAL CENTER PART V, SECTION B, LINE 11:
THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: MENTAL HEALTH WITH A BROAD FOCUS, KEEPING IN MIND THE SPECIFIC CHALLENGES FACED BY AREA YOUTH MENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO FOCUS ON TWO PRIMARY GOALS: EXPANDING AWARENESS OF THE SANFORD CANBY AMBULATORY CARE MANAGER'S ROLE IN MENTAL HEALTH AND PROVIDING AND/OR SUPPORTING MENTAL HEALTH RESOURCES TO AREA YOUTH. IT IS SANFORD'S GOAL TO MAKE THE COMMUNITY MORE AWARE OF MENTAL HEALTH RESOURCES THAT ARE AVAILABLE IN THEIR LOCAL COMMUNITY.PRIORITY 2: INCREASEING ACCESS TO PROVIDERS, SPECIFICALLY TO INCREASE ACCESS TO PRIMARY CARE PROVIDERS AND IMPROVE MARKETING AROUND SPECIALTY OUTREACH SERVICES ACCESS TO CARE REQUIRES NOT ONLY FINANCIAL COVERAGE, BUT ALSO ACCESS TO PROVIDERS. WHILE HIGH RATES OF SPECIALIST PHYSICIANS HAVE BEEN SHOWN TO BE ASSOCIATED WITH HIGHER (AND PERHAPS UNNECESSARY) UTILIZATION, SUFFICIENT AVAILABILITY OF PRIMARY CARE PHYSICIANS IS ESSENTIAL FOR PREVENTIVE AND PRIMARY CARE, AND, WHEN NEEDED, REFERRALS TO APPROPRIATE SPECIALTY CARE.SANFORD HAS MADE ACCESS TO HEALTH CARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO IMPROVE ACCESS TO PROVIDERS, SPECIFICALLY TO INCREASE ACCESS TO PRIMARY CARE PROVIDERS AND IMPROVE MARKETING AROUND SPECIALTY OUTREACH SERVICES. IT IS SANFORD'S GOAL THAT THE COMMUNITY WOULD FEEL EMPOWERED TO TAKE OWNERSHIP OF PREVENTATIVE HEALTH MAINTENANCE AND SEE PROGRESS TOWARDS AN OVERALL HEALTHIER POPULATION. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARMENTAL HEALTH WITH A BROAD FOCUS, KEEPING IN MIND THE SPECIFIC CHALLENGES FACED BY AREA YOUTHSANFORD CANBY MEDICAL CENTER UTILIZES THE PHQ-9 SCREENING TOOL WITHIN THE ELECTRONIC MEDICAL RECORD TO HELP IN THE IDENTIFICATION OF MENTAL HEALTH NEEDS. THROUGH THE MEDICAL HOME PROGRAM, RN AMBULATORY CARE MANAGER, AND PHQ-9 SCREENING, WE CAN OFFER AND REFER MENTAL HEALTH SERVICES TO THOSE WITH SCORES INDICATIVE OF DEPRESSION. PATIENTS ARE ASSESSED AT EACH PRIMARY CARE VISIT. SANFORD CANBY ALSO OFFERS PSYCHIATRY SERVICES VIA TELEMEDICINE AND BEHAVIORAL HEALTH REFERRALS ARE MADE FOR PATIENTS WHO PRESENT WITH NEEDS IN THE EMERGENCY DEPARTMENT. IN ADDITION, SANFORD CANBY PROVIDES SPONSORSHIP SUPPORT FOR VARIOUS COMMUNITY EVENTS INCLUDING A TEEN SAFETY FAMILY NIGHT HELD IN MARCH 2019 THAT COVERED SOCIAL MEDIA AND ONLINE SAFETY, ADVERSE CHILDHOOD EXPERIENCES, AND MENTAL HEALTH AWARENESS. THE SANFORD CANBY PATHWAYS SUPPORT GROUP WAS DEVELOPED TO PROVIDE SUPPORT FOR THOSE AFFECTED BY CHRONIC ILLNESS.INCREASING ACCESS TO PROVIDERS, SPECIFICALLY TO INCREASE ACCESS TO PRIMARY CARE PROVIDERS AND IMPROVE MARKETING AROUND SPECIALTY OUTREACH SERVICESDURING THE COVID-19 PANDEMIC, SANFORD BEGAN FOCUSING ON BRINGING PATIENTS BACK IN TO SEE THEIR PRIMARY CARE PROVIDERS FOR PREVENTATIVE HEALTH MAINTENANCE SERVICES. A PRIMARY CARE MARKETING CAMPAIGN WAS LAUNCHED TO ASSURE PATIENTS THAT IT WAS SAFE TO SEE THEIR PROVIDERS.IN ADDITION TO REGULARLY SCHEDULED APPOINTMENTS, SANFORD CANBY OFFERS WALK-IN CLINIC SERVICES MONDAY THROUGH SATURDAY. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:AFFORDABLE HOUSINGEMPLOYMENT AND ECONOMIC OPPORTUNITIESSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS.

GROUP A-FACILITY 14 -- SANFORD CANBY MEDICAL CENTER PART V, SECTION B, LINE 13H:
OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE.

GROUP A-FACILITY 14 -- SANFORD CANBY MEDICAL CENTER PART V, SECTION B, LINE 16J:
OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY

GROUP A-FACILITY 15 -- SANFORD JACKSON MEDICAL CENTER PART V, SECTION B, LINE 5:
SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/HEALTH-NEEDS-ASSESSMENT-SURVEY/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE.

GROUP A-FACILITY 15 -- SANFORD JACKSON MEDICAL CENTER PART V, SECTION B, LINE 6A:
SANFORD USD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER

GROUP A-FACILITY 15 -- SANFORD JACKSON MEDICAL CENTER PART V, SECTION B, LINE 7D:
SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED.

GROUP A-FACILITY 15 -- SANFORD JACKSON MEDICAL CENTER PART V, SECTION B, LINE 11:
THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: MENTAL HEALTH MENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO ADVANCE INTEGRATED HEALTHCARE IN THE COMMUNITY AND TO INCREASE AWARENESS AND EDUCATION ON SUICIDE PREVENTION. IT IS SANFORD'S GOAL TO INCREASE THE NUMBER OF PATIENTS THAT SANFORD PROVIDES INTEGRATED HEALTH THERAPIST SERVICES TO IN THE JACKSON AREA. PRIORITY 2: ACCESS TO HEALTH CARE PROVIDERSACCESS TO CARE REQUIRES NOT ONLY FINANCIAL COVERAGE, BUT ALSO ACCESS TO PROVIDERS. WHILE HIGH RATES OF SPECIALIST PHYSICIANS HAVE BEEN SHOWN TO BE ASSOCIATED WITH HIGHER (AND PERHAPS UNNECESSARY) UTILIZATION, SUFFICIENT AVAILABILITY OF PRIMARY CARE PHYSICIANS IS ESSENTIAL FOR PREVENTIVE AND PRIMARY CARE, AND, WHEN NEEDED, REFERRALS TO APPROPRIATE SPECIALTY CARE.SANFORD HAS MADE ACCESS TO HEALTH CARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO INCREASE COMMUNITY AWARENESS OF LOCAL PROVIDERS AND INCREASE ACCESS TO SPECIALTY CARE AT SANFORD JACKSON MEDICAL CENTER. IT IS SANFORD'S GOAL TO INCREASE AWARENESS OF PRIMARY CARE PROVIDERS AND SPECIALTY CARE.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARMENTAL HEALTHSANFORD HEALTH IS POSITIONED LOCALLY TO HAVE A POSITIVE IMPACT ON MENTAL HEALTH NEEDS IN THE COMMUNITY. SANFORD JACKSON LEADERSHIP WILL SHARE THE RESULTS OF THE CHNA RESEARCH WITH OTHER COMMUNITY PARTNERS TO PROVIDE AN OPPORTUNITY TO COLLABORATE, IDENTIFY, AND PRIORITIZE BEHAVIORAL HEALTH NEEDS IN THE COMMUNITY. FACILITATE COMMUNITY BEHAVIORAL HEALTH TASK FORCE MEETINGS WHERE MENTAL HEALTH ISSUES ARE IDENTIFIED AND KEY STAKEHOLDERS ARE AVAILABLE TO COLLABORATE, MAKE RECOMMENDATIONS AND INSTILL CHANGE. SANFORD JACKSON HAS A NUMBER OF RESOURCES AND PROVIDERS, SUCH AS INTEGRATED HEALTH THERAPISTS AVAILABLE LOCALLY. MENTAL HEALTH WAS INCLUDED IN THE PREVIOUS COMMUNITY HEALTH NEEDS ASSESSMENT AND A SUMMARY OF THOSE EFFORTS ARE AVAILABLE LATER IN THE REPORT.ACCESS TO HEALTH CARE PROVIDERSSANFORD HEALTH IS POSITIONED LOCALLY TO HAVE A POSITIVE IMPACT ON PROVIDING PRIMARY CARE SERVICES WITHIN THE COMMUNITY AND EXPANDING OVERALL ACCESS TO CARE.SANFORD JACKSONS OFFERS A VARIETY OF SERVICES LOCALLY THROUGH LOCALLY BASED AND OUTREACH PROVIDERS. LABORATORY AND RADIOLOGY SERVICES ARE AVAILABLE 24 HOURS A DAY, WITH STAFF SERVING THE HOSPITAL, ATTACHED MEDICAL CLINIC, AND TWO SATELLITE CLINICS. CLINIC SERVICES INCLUDE FAMILY MEDICINE AND VARIOUS SPECIALTY OUTREACH SERVICES. A VARIETY OF SURGICAL PROCEDURES ARE PERFORMED IN THE SURGICAL SUITE AT SANFORD JACKSON MEDICAL CENTER. SANFORD JACKSON EMPLOYS SEVEN CLINICIANS, INCLUDING PHYSICIANS AND ADVANCED PRACTICE PROVIDERS. PERIODIC MARKETING IS IN PLACE TO GAIN EXPOSURE OF PRIMARY CARE SERVICES AND PROVIDERS VIA MEDIA OUTLETS SUCH AS RADIO, PRINT AND SOCIAL MEDIA. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:PHYSICAL ACTIVITY AND NUTRITIONHUMAN IMMUNODEFICIENCY VIRUS (HIV)ALCOHOL-RELATED DRIVING DEATHSAFFORDABLE HOUSINGSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS.

GROUP A-FACILITY 15 -- SANFORD JACKSON MEDICAL CENTER PART V, SECTION B, LINE 13H:
OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE.

GROUP A-FACILITY 15 -- SANFORD JACKSON MEDICAL CENTER PART V, SECTION B, LINE 16J:
OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY

GROUP A-FACILITY 16 -- SANFORD TRACY MEDICAL CENTER PART V, SECTION B, LINE 5:
SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/HEALTH-NEEDS-ASSESSMENT-SURVEY/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE.

GROUP A-FACILITY 16 -- SANFORD TRACY MEDICAL CENTER PART V, SECTION B, LINE 6A:
SANFORD USD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER

GROUP A-FACILITY 16 -- SANFORD TRACY MEDICAL CENTER PART V, SECTION B, LINE 7D:
SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED.

GROUP A-FACILITY 16 -- SANFORD TRACY MEDICAL CENTER PART V, SECTION B, LINE 11:
THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: PHYSICAL ACTIVITY AND NUTRITIONTHE ENVIRONMENTS WHERE PEOPLE LIVE, LEARN, WORK, AND PLAY AFFECT ACCESS TO HEALTHY FOOD AND OPPORTUNITIES FOR PHYSICAL ACTIVITY WHICH, ALONG WITH GENETIC FACTORS AND PERSONAL CHOICES, SHAPE THE HEALTH AND THE RISK OF BEING OVERWEIGHT AND OBESE.SANFORD HEALTH TRACY HAS MADE PHYSICAL ACTIVITY AND NUTRITION SIGNIFICANT PRIORITIES AND HAS DEVELOPED STRATEGIES TO CONTINUE THE RN HEALTH COACH PROGRAM AND TO BEGIN A DIABETIC EDUCATION PROGRAM. IN ADDITION, SANFORD HAS DEVELOPED A STRATEGY TO PROVIDE AN ALTERNATIVE OPTION FOR THOSE COMMUNITY MEMBERS WHO ARE HUNGRY AND/OR LACKING FOOD OPTIONS. IT IS SANFORD'S GOAL TO PROVIDE A POSITIVE IMPACT ON PHYSICAL WELLBEING SPECIFICALLY RELATED TO OBESITY AND CHRONIC ILLNESS LIKE HIGH BLOOD PRESSURE AND DIABETES, AS WELL AS A POSITIVE IMPACT ON THE LACK OF NUTRITIONAL FOOD ACCESS.PRIORITY 2: MENTAL HEALTHMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO INCREASE SCREENING FOR DEPRESSION AND TO PROMOTE AND IMPROVE ACCESS TO SERVICES. IT IS SANFORD'S GOAL THAT, THE COMMUNITY WOULD SEE A LOWERED NUMBER OF MENTAL HEALTH DAYS FROM COMMUNITY MEMBERS AND A POSITIVE INCREASE IN AWARENESS OF MENTAL HEALTH SERVICES IN THE COMMUNITY.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARPHYSICAL ACTIVITY AND NUTRITIONSANFORD HEALTH IS POSITIONED LOCALLY TO HAVE A POSITIVE IMPACT ON PHYSICAL ACTIVITY AND NUTRITION WITHIN THE COMMUNITY. THIS EFFORT WILL FOCUS ON TWO PRIMARY GOALS:1. RN HEALTH COACH PROGRAM AND DIABETIC EDUCATION PROGRAM2. PROVIDE ALTERNATIVE OPTIONS FOR THOSE COMMUNITY MEMBERS WHO ARE HUNGRY AND/OR LACKING FOOD OPTIONS.SANFORD TRACY CURRENTLY HAS AN RN HEALTH COACH AVAILABLE TO WORK WITH PATIENTS TO ESTABLISH HEALTH LIFESTYLE HABITS. SANFORD TRACY ALSO OFFERS FIT CLUB CLASSES AT OUR LOCAL ELEMENTARY SCHOOL WHICH TEACHES STUDENTS ABOUT EATING RIGHT, EXERCISING, GETTING ENOUGH REST, AND EMOTIONAL WELL-BEING.MENTAL HEALTHSANFORD HEALTH IS POSITIONED LOCALLY TO HAVE A POSITIVE IMPACT ON MENTAL HEALTH WITHIN THE COMMUNITY. THIS EFFORT WILL FOCUS ON TWO PRIMARY GOALS:1. INCREASE SCREENING FOR DEPRESSION AND REFERRALS TO BEHAVIORAL HEALTH SPECIALISTS.2. RAISE AWARENESS OF MENTAL HEALTH AND BEHAVIORAL HEALTH PROVIDERS AND SERVICES AT SANFORD TRACY.SANFORD TRACY CURRENTLY HAS BEHAVIORAL HEALTH SERVICES AVAILABLE IN THE CLINIC. WE ALSO OFFER PSYCHIATRY TELEMEDICINE SERVICES. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO HEALTH CARE PROVIDERSACCESS TO AFFORDABLE HEALTH CAREEMPLOYMENT AND ECONOMIC OPPORTUNITIESPUBLIC TRANSPORTATIONAFFORDABLE HOUSINGSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS.

GROUP A-FACILITY 16 -- SANFORD TRACY MEDICAL CENTER PART V, SECTION B, LINE 13H:
OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE.

GROUP A-FACILITY 16 -- SANFORD TRACY MEDICAL CENTER PART V, SECTION B, LINE 16J:
OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY

GROUP A-FACILITY 17 -- SANFORD HILLSBORO MEDICAL CENTER PART V, SECTION B, LINE 5:
SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/HEALTH-NEEDS-ASSESSMENT-SURVEY/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE.

GROUP A-FACILITY 17 -- SANFORD HILLSBORO MEDICAL CENTER PART V, SECTION B, LINE 6A:
SANFORD USD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER

GROUP A-FACILITY 17 -- SANFORD HILLSBORO MEDICAL CENTER PART V, SECTION B, LINE 7D:
SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED.

GROUP A-FACILITY 17 -- SANFORD HILLSBORO MEDICAL CENTER PART V, SECTION B, LINE 11:
THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: MENTAL HEALTH SERVICESMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH SERVICES A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO IMPROVE ACCESS, USE OF INTEGRATED HEALTH THERAPISTS AND IMPROVE SCREENING PROCEDURES. IT IS SANFORD'S GOAL TO REDUCE THE SEVERITY OF DEPRESSION THROUGH SCREENING AND CARE DELIVERY EFFORTS. PRIORITY 2: TRANSPORTATIONTRANSPORTATION SYSTEMS HELP ENSURE THAT PEOPLE CAN REACH EVERYDAY DESTINATIONS, SUCH AS JOBS, SCHOOLS, HEALTHY FOOD OUTLETS, AND HEALTH CARE FACILITIES, SAFELY AND RELIABLY. PUBLIC TRANSPORTATION SERVICES PLAY AN IMPORTANT ROLE FOR PEOPLE WHO ARE UNABLE TO DRIVE, PEOPLE WITHOUT ACCESS TO PERSONAL VEHICLES, CHILDREN, INDIVIDUALS WITH DISABILITIES, AND OLDER ADULTS.SANFORD HEALTH HILLSBORO HAS MADE TRANSPORTATION A SIGNIFICANT PRIORITY AND HAS DEVELOPED A STRATEGY TO WORK IN COLLABORATION WITH CITY AND COUNTY LEADERSHIP TO EXPLORE OPTIONS FOR THE LOCAL COMMUNITY AND COUNTY MEMBERS. IT IS SANFORD'S GOAL TO IMPROVE THE AVAILABILITY OF PUBLIC TRANSPORTATION THROUGH BOTH THE PROMOTION OF CURRENT RESOURCES WITHIN THE HOSPITAL AND CLINIC SETTINGS, BUT ALSO IN WORKING TO ESTABLISH NEW RESOURCES THAT EXPAND OPPORTUNITIES.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARMENTAL HEALTH SERVICES SANFORD IS ADDRESSING THE NEED BY INCLUDING MENTAL HEALTH SERVICES AS A PRIORITY FOCUS AREA FOR THE 2022-2024 IMPLEMENTATION PLAN. SANFORD WILL IMPROVE MENTAL HEALTH SERVICES BY SEEKING AVENUES TO INCREASE ACCESS AMONG THOSE POPULATIONS AGED 65 AND OVER AND REDUCING THE SEVERITY OF DEPRESSION THROUGH USE OF INTEGRATED HEALTH THERAPISTS AND IMPROVED SCREENING PROCEDURES.SANFORD IS UTILIZING THE PHQ-9 PATIENT HEALTH QUESTIONNAIRE ON INITIAL AND CERTAIN FOLLOW-UP APPOINTMENTS AND APPROPRIATE PATIENTS TO ENSURE THOSE IN NEED OF MENTAL HEALTH SERVICES ARE IDENTIFIED AND OFFERED TREATMENT. WE HAVE IMPLEMENTED IHTS (INTEGRATED HEALTH THERAPIST) INTO THE CLINICS, MOSTLY BY TELE-HEALTH DUE TO THE COVID-19 PANDEMIC. 1-3 PATIENTS PER DAY ARE BEING SEEN BY TELEHEALTH FROM EACH CLINIC.TRANSPORTATIONSANFORD AND LOCAL STAKEHOLDERS HAVE A WELL-ESTABLISHED WORKING RELATIONSHIP WITH THE AIM OF IMPROVING TRANSPORTATION OPTIONS FOR RURAL COMMUNITIES.SANFORD HAS COORDINATED WITH TRAILL COUNTY TO PROVIDE A PUBLIC DIRECTORY OF TRANSPORTATION OPTIONS, WHICH IS AVAILABLE THROUGHOUT THE COUNTY. TRAILL COUNTY HAS A BUS/VAN AVAILABLE FOR USE AND SEEMED TO BE WORKING VERY WELL IN THE COMMUNITY. UNFORTUNATELY, COVID-19 STOPPED ALL TRANSPORTATION IN 2020. FROM A HEALTHCARE PERSPECTIVE, SANFORD OFFERS AND PROMOTES SEVERAL VIRTUAL HEALTHCARE OPTIONS IN RESPONSE TO COVID-19 AND THE SUBSEQUENT IMPACT ON TRAVEL. OFFERINGS INCLUDE VIDEO VISITS, TELEHEALTH, AND E-VISITS.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO HEALTH CAREPHYSICAL ACTIVITY AND NUTRITIONACCESS TO QUALITY CHILDCARE AND AFFORDABLE HOUSINGSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS.

GROUP A-FACILITY 17 -- SANFORD HILLSBORO MEDICAL CENTER PART V, SECTION B, LINE 13H:
OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE.

GROUP A-FACILITY 17 -- SANFORD HILLSBORO MEDICAL CENTER PART V, SECTION B, LINE 16J:
OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY

GROUP A-FACILITY 18 -- SANFORD MEDICAL CENTER MAYVILLE PART V, SECTION B, LINE 5:
SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/HEALTH-NEEDS-ASSESSMENT-SURVEY/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE.

GROUP A-FACILITY 18 -- SANFORD MEDICAL CENTER MAYVILLE PART V, SECTION B, LINE 6A:
SANFORD USD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER

GROUP A-FACILITY 18 -- SANFORD MEDICAL CENTER MAYVILLE PART V, SECTION B, LINE 7D:
SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED.

GROUP A-FACILITY 18 -- SANFORD MEDICAL CENTER MAYVILLE PART V, SECTION B, LINE 11:
THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: MENTAL HEALTH SERVICESMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO IMPROVE ACCESS TO MENTAL HEALTH SERVICES AND REDUCE THE SEVERITY OF DEPRESSION THROUGH USE OF INTEGRATED HEALTH THERAPISTS AND IMPROVE SCREENING PROCEDURES REDUCE MORTALITY AND MORBIDITY FROM MENTAL HEALTH AND BEHAVIORAL HEALTH AND SUBSTANCE ABUSE. IT IS SANFORD'S GOAL TO REDUCE THE SEVERITY OF DEPRESSION THROUGH SCREENING AND CARE DELIVERY EFFORTS.PRIORITY 2: TRANSPORTATIONTRANSPORTATION SYSTEMS HELP ENSURE THAT PEOPLE CAN REACH EVERYDAY DESTINATIONS, SUCH AS JOBS, SCHOOLS, HEALTHY FOOD OUTLETS, AND HEALTH CARE FACILITIES, SAFELY AND RELIABLY. PUBLIC TRANSPORTATION SERVICES PLAY AN IMPORTANT ROLE FOR PEOPLE WHO ARE UNABLE TO DRIVE, PEOPLE WITHOUT ACCESS TO PERSONAL VEHICLES, CHILDREN, INDIVIDUALS WITH DISABILITIES, AND OLDER ADULTS.SANFORD HEALTH MAYVILLE HAS MADE TRANSPORTATION A SIGNIFICANT PRIORITY AND HAS DEVELOPED A STRATEGY TO WORK IN COLLABORATION WITH CITY AND COUNTY LEADERSHIP TO EXPLORE OPTIONS FOR THE LOCAL COMMUNITY AND COUNTY MEMBERS. IT IS SANFORD'S GOAL TO IMPROVE AAVAILABILITY OF PUBLIC TRANSPORTATION THROUGH BOTH THE PROMOTION OF CURRENT RESOURCES WITHIN THE HOSPITAL AND CLINIC SETTINGS, BUT ALSO IN WORKING TO ESTABLISH NEW RESOURCES THAT EXPAND OPPORTUNITIES.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARMENTAL HEALTH SERVICES SANFORD IS ADDRESSING THE NEED BY INCLUDING MENTAL HEALTH SERVICES AS A PRIORITY FOCUS AREA FOR THE 2022-2024 IMPLEMENTATION PLAN. SANFORD WILL IMPROVE MENTAL HEALTH SERVICES BY SEEKING AVENUES TO INCREASE ACCESS AMONG THOSE POPULATIONS AGED 65 AND OVER AND REDUCING THE SEVERITY OF DEPRESSION THROUGH USE OF INTEGRATED HEALTH THERAPISTS AND IMPROVED SCREENING PROCEDURES.SANFORD IS UTILIZING THE PHQ-9 PATIENT HEALTH QUESTIONNAIRE ON INITIAL AND CERTAIN FOLLOW-UP APPOINTMENTS AND APPROPRIATE PATIENTS TO ENSURE THOSE IN NEED OF MENTAL HEALTH SERVICES ARE IDENTIFIED AND OFFERED TREATMENT. WE HAVE IMPLEMENTED IHTS (INTEGRATED HEALTH THERAPIST) INTO THE CLINICS, MOSTLY BY TELE-HEALTH DUE TO THE COVID-19 PANDEMIC. 1-3 PATIENTS PER DAY ARE BEING SEEN BY TELEHEALTH FROM EACH CLINIC.TRANSPORTATIONSANFORD AND LOCAL STAKEHOLDERS HAVE A WELL-ESTABLISHED WORKING RELATIONSHIP WITH THE AIM OF IMPROVING TRANSPORTATION OPTIONS FOR RURAL COMMUNITIES.SANFORD HAS COORDINATED WITH TRAILL COUNTY TO PROVIDE A PUBLIC DIRECTORY OF TRANSPORTATION OPTIONS, WHICH IS AVAILABLE THROUGHOUT THE COUNTY. TRAILL COUNTY HAS A BUS/VAN AVAILABLE FOR USE AND SEEMED TO BE WORKING VERY WELL IN THE COMMUNITY. UNFORTUNATELY, COVID-19 STOPPED ALL TRANSPORTATION IN 2020.FROM A HEALTHCARE PERSPECTIVE, SANFORD OFFERS AND PROMOTES SEVERAL VIRTUAL HEALTHCARE OPTIONS IN RESPONSE TO COVID-19 AND THE SUBSEQUENT IMPACT ON TRAVEL. OFFERINGS INCLUDE VIDEO VISITS, TELEHEALTH, AND E-VISITS.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO HEALTH CAREPHYSICAL ACTIVITY AND NUTRITIONACCESS TO QUALITY CHILDCARE AND AFFORDABLE HOUSINGSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS.

GROUP A-FACILITY 18 -- SANFORD MEDICAL CENTER MAYVILLE PART V, SECTION B, LINE 13H:
OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE.

GROUP A-FACILITY 18 -- SANFORD MEDICAL CENTER MAYVILLE PART V, SECTION B, LINE 16J:
OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY

GROUP A-FACILITY 19 -- SANFORD WEBSTER MEDICAL CENTER PART V, SECTION B, LINE 5:
SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/HEALTH-NEEDS-ASSESSMENT-SURVEY/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE.

GROUP A-FACILITY 19 -- SANFORD WEBSTER MEDICAL CENTER PART V, SECTION B, LINE 6A:
SANFORD USD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER

GROUP A-FACILITY 19 -- SANFORD WEBSTER MEDICAL CENTER PART V, SECTION B, LINE 7D:
SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED.

GROUP A-FACILITY 19 -- SANFORD WEBSTER MEDICAL CENTER PART V, SECTION B, LINE 11:
THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: PHYSICAL ACTIVITY AND NUTRITIONTHE ENVIRONMENTS WHERE PEOPLE LIVE, LEARN, WORK, AND PLAY AFFECT ACCESS TO HEALTHY FOOD AND OPPORTUNITIES FOR PHYSICAL ACTIVITY WHICH, ALONG WITH GENETIC FACTORS AND PERSONAL CHOICES, SHAPE THE HEALTH AND THE RISK OF BEING OVERWEIGHT AND OBESE.SANFORD HAS MADE PHYSICAL ACTIVITY AND NUTRITION A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO INCREASE THE NUMBER OF PATIENTS ENGAGING WITH DIETICIANS TO IMPROVE NUTRITION AND TO CREATE A COMPREHENSIVE APPROACH TO CARE MANAGEMENT. IT IS SANFORD'S GOAL TO SEE IMPROVED HEALTH AND WELLNESS AND BETTER OVERALL MANAGEMENT OF CHRONIC DISEASES.PRIORITY 2: COMMUNITY SAFETYACCIDENTS AND VIOLENCE AFFECT HEALTH AND QUALITY OF LIFE IN THE SHORT- AND LONG-TERM, FOR THOSE BOTH DIRECTLY AND INDIRECTLY AFFECTED, AND LIVING IN UNSAFE NEIGHBORHOODS CAN IMPACT HEALTH IN A MULTITUDE OF WAYS. SANFORD HAS MADE COMMUNITY SAFETY A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO PROMOTE AND LEVERAGE RESOURCES TO ADDRESS SUBSTANCE ABUSE ISSUES AND EXPAND ACCESS TO MENTAL HEALTH AND BEHAVIORAL HEALTH CARE. IT IS SANFORD'S GOAL TO INCREASE GREATER AWARENESS OF RESOURCES AVAILABLE TO MITIGATE COMMUNITY SAFETY ISSUES. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARPHYSICAL ACTIVITY AND NUTRITIONSANFORD WEBSTER IS POSITIONED TO HAVE A POSITIVE IMPACT ON PHYSICAL ACTIVITY AND NUTRITION, TO INCLUDE EDUCATION AND PREVENTATIVE MEASURES TO MITIGATE SERIOUS HEALTH EVENTS AND CHRONIC DISEASE WITHIN THE COMMUNITY. OUR MEDICAL STAFF, CHRONIC CARE MANAGEMENT STAFF, HEALTH COACH AND DIETICIAN WILL OFFER ADDITIONAL INTERVENTIONS TO RESIDENTS OF THE COMMUNITY. SANFORD WEBSTER PROVIDERS AND STAFF ARE CONTINUALLY FOCUSED ON CHRONIC DISEASE MANAGEMENT, WORKING WITH OUR PATIENTS TO ENCOURAGE HEALTHY LIFESTYLES DURING CLINIC VISITS. DIETITIANS ARE AVAILABLE TO PROVIDE MEDICAL NUTRITION THERAPY AND EXERCISE SPECIALISTS PROVIDE EXERCISE THERAPY.COMMUNITY SAFETYSANFORD HEALTH INTENDS TO POSITIVELY IMPACT COMMUNITY SAFETY, INCLUDING ALCOHOL AND SUBSTANCE ABUSE AND MENTAL HEALTH, IN THE COMMUNITY. SANFORD WEBSTER WILL UTILIZE MENTAL HEALTH RESOURCES TO BE AN ADVOCATE FOR POTENTIAL VICTIMS OF VIOLENCE. WE WILL ALSO SHARE ASSESSMENT RESULTS WITH KEY COMMUNITY STAKEHOLDERS AND PARTNER AS APPROPRIATE. ALL PATIENTS ARE ASSESSED BY PRIMARY CARE PROVIDERS. INTEGRATIVE HEALTH TRIAGE THERAPISTS ARE IN CLINICS TO PROVIDE EARLY INTERVENTION AND REFERRAL. TREATMENT SERVICES ARE ALSO AVAILABLE WITHIN OUR BEHAVIORAL HEALTH SERVICES.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO AFFORDABLE HEALTH CAREEMPLOYMENT AND ECONOMIC OPPORTUNITIESSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS.

GROUP A-FACILITY 19 -- SANFORD WEBSTER MEDICAL CENTER PART V, SECTION B, LINE 13H:
OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE.

GROUP A-FACILITY 19 -- SANFORD WEBSTER MEDICAL CENTER PART V, SECTION B, LINE 16J:
OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY

GROUP A-FACILITY 20 -- SANFORD MEDICAL CENTER WHEATON PART V, SECTION B, LINE 5:
SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/HEALTH-NEEDS-ASSESSMENT-SURVEY/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE.

GROUP A-FACILITY 20 -- SANFORD MEDICAL CENTER WHEATON PART V, SECTION B, LINE 6A:
SANFORD USD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER

GROUP A-FACILITY 20 -- SANFORD MEDICAL CENTER WHEATON PART V, SECTION B, LINE 7D:
SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED.

GROUP A-FACILITY 20 -- SANFORD MEDICAL CENTER WHEATON PART V, SECTION B, LINE 11:
THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: MENTAL HEALTH AND SUBSTANCE ABUSE MENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH AND SUBSTANCE ABUSE SIGNIFICANT PRIORITIES AND HAS DEVELOPED STRATEGIES TO IMPROVE ACCESS TO SERVICES. IT IS SANFORD'S GOAL TO INCREASE ACCESS TO PSYCHOLOGY AND PSYCHIATRY AND TO EXPAND TELEHEALTH SERVICES. PRIORITY 2: PHYSICAL ACTIVITY AND NUTRITIONTHE ENVIRONMENTS WHERE PEOPLE LIVE, LEARN, WORK, AND PLAY AFFECT ACCESS TO HEALTHY FOOD AND OPPORTUNITIES FOR PHYSICAL ACTIVITY WHICH, ALONG WITH GENETIC FACTORS AND PERSONAL CHOICES, SHAPE THE HEALTH AND THE RISK OF BEING OVERWEIGHT AND OBESE.SANFORD HAS MADE PHYSICAL ACTIVITY AND NUTRITION SIGNIFICANT PRIORITIES HAS DEVELOPED STRATEGIES IMPROVE ACCESS TO NUTRITION AND TO PROMOTE AND SUPPORT OPPORTUNITIES FOR PHYSICAL ACTIVITY. IT IS SANFORD'S GOAL TO HAVE ADDITIONAL FOOD SOURCES AND AVAILABILITY FOR FOOD OPTIONS AND TO IMPROVE AND EXPAND COMMUNITY AREAS FOR PHYSICAL ACTIVITY.ADDRESSING OF SIGNIFICANT NEEDS DURING THE CURRENT YEARMENTAL HEALTH AND SUBSTANCE ABUSETELEHEALTH SERVICES ARE CURRENTLY AVAILABLE, AND SANFORD WHEATON IS LOOKING INTO EXPANSION OPPORTUNITIES.PHYSICAL ACTIVITY AND NUTRITIONCURRENT ACTIVITIES INCLUDE A BACKPACK PROGRAM WITH FOOD DELIVERED BI-WEEKLY TO STUDENTS ENROLLED AND A LOCAL FOOD PANTRY.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN:ACCESS TO HEALTH CARE PROVIDERSEMPLOYMENT AND ECONOMIC OPPORTUNITIESSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS.

GROUP A-FACILITY 20 -- SANFORD MEDICAL CENTER WHEATON PART V, SECTION B, LINE 13H:
OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE.

GROUP A-FACILITY 20 -- SANFORD MEDICAL CENTER WHEATON PART V, SECTION B, LINE 16J:
OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY

GROUP A-FACILITY 21 -- SANFORD BAGLEY MEDICAL CENTER PART V, SECTION B, LINE 5:
SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/HEALTH-NEEDS-ASSESSMENT-SURVEY/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE.

GROUP A-FACILITY 21 -- SANFORD BAGLEY MEDICAL CENTER PART V, SECTION B, LINE 6A:
SANFORD USD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER

GROUP A-FACILITY 21 -- SANFORD BAGLEY MEDICAL CENTER PART V, SECTION B, LINE 7D:
SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED.

GROUP A-FACILITY 21 -- SANFORD BAGLEY MEDICAL CENTER PART V, SECTION B, LINE 11:
THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO HEALTH CARE PROVIDERSACCESS TO CARE REQUIRES NOT ONLY FINANCIAL COVERAGE, BUT ALSO ACCESS TO PROVIDERS. WHILE HIGH RATES OF SPECIALIST PHYSICIANS HAVE BEEN SHOWN TO BE ASSOCIATED WITH HIGHER (AND PERHAPS UNNECESSARY) UTILIZATION, SUFFICIENT AVAILABILITY OF PRIMARY CARE PHYSICIANS IS ESSENTIAL FOR PREVENTIVE AND PRIMARY CARE, AND, WHEN NEEDED, REFERRALS TO APPROPRIATE SPECIALTY CARE. SANFORD HEALTH IS POSITIONED LOCALLY TO HAVE A POSITIVE IMPACT ON ACCESS TO AFFORDABLE, QUALITY HEALTHCARE WITHIN THE COMMUNITY. THIS EFFORT WILL FOCUS ON TWO PRIMARY GOALS. THE FIRST GOAL IS TO HAVE INCREASED ACCESS TO PRIMARY AND SPECIALTY CARE AND THE SECOND GOAL IS TO HAVE INCREASED UTILIZATION OF TELEMEDICINE SERVICES.PRIORITY 2: SANFORD HEALTH IS POSTIONED LOCALLY TO HAVE A POSTIVE IMPACT ON BEHAVIORAL HEALTH SERVICES WITHIN THE COMMUNITYMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HEALTH IS POSITIONED LOCALLY TO HAVE A POSITIVE IMPACT ON BEHAVIORAL HEALTH SERVICES WITHIN THE COMMUNITY. THIS EFFORT WILL FOCUS ON TWO PRIMARY GOALS. THE FIRST GOAL IS TO PROVIDE ADDITIONAL BEHAVIORAL HEALTH SERVICES WITHIN SANFORD BAGLEY. THE SECOND GOAL IS THE ASSESSMENT AND TREATMENT OF BEHAVIORAL HEALTH CONCERNS WITHIN PRIMARY CARE VISITS.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARACCESS TO HEALTH CARE PROVIDERSSANFORD BAGLEY ACTIVELY PROMOTES OUTREACH SPECIALTY SERVICES AVAILABLE WITHIN THE COMMUNITY. THESE OUTREACH SERVICES BRING SPECIALTY PROVIDERS TO BAGLEY FACILITIES TO PROVIDE ACCESS TO CARE CLOSE TO HOME. CURRENT OUTREACH SERVICES OFFERED ARE GENERAL SURGERY, OBSTETRICS AND GYNECOLOGY, SLEEP MEDICINE, PSYCHIATRY, PEDIATRICS. OPPORTUNITIES TO ADD DERMATOLOGY SERVICES ARE BEING EXPLORED. SANFORD BAGLEY RECENTLY EXPANDED AND UPDATED THE EYE CLINIC AND OPTICAL SHOP IN BAGLEY, MOVING IT TO THE MAIN CLINIC LOCATION. THIS ALLOWS ACCESS TO EYE, PRIMARY CARE, AND SPECIALTY CARE SERVICES IN THE SAME BUILDING.ADDITIONALLY, ALTERNATIVE APPOINTMENT TYPES, SUCH AS TELEMEDICINE VISITS, WILL BE PROMOTED DURING PRIMARY CARE APPOINTMENTS WHICH WILL INCREASE UTILIZATION DUE TO INCREASED AWARENESS OF TELEMEDICINE AVAILABILITY.SANFORD HEALTH IS POSTIONED LOCALLY TO HAVE A POSTIVE IMPACT ON BEHAVIORAL HEALTH SERVICES WITHIN THE COMMUNITYSANFORD BAGLEY IS EXPLORING OPPORTUNITIES TO PROVIDE ADDITIONAL BEHAVIORAL HEALTH SERVICES TO THE BAGLEY COMMUNITY, WHICH INCLUDE AN INTENSIVE OUTPATIENT THERAPY PROGRAM AND EXPANDING TELEMEDICINE AWARENESS AND USE FOR BEHAVIORAL HEALTH APPOINTMENTS. DEPRESSION SCREENINGS ARE PART OF ROUTINE PRIMARY CARE VISITS. SANFORD HEALTH IS COMMITTED TO WORKING WITH THE SCHOOLS TO PROVIDE CULTURALLY SENSITIVE, AGE APPROPRIATE AND FAMILY-ORIENTED PREVENTION PROGRAMS TO CREATE AND GIVE CHILDREN A HEALTHY START IN LIFE. SANFORD HEALTH WILL BUILD UPON CURRENT RELATIONSHIPS WITH AREA SCHOOLS TO IDENTIFY IN-SCHOOL AND/OR TELEHEALTH PROGRAMS AND SERVICES THAT WILL AUGMENT AND SUPPORT HEALTHY LEARNING, EMOTIONAL AND BEHAVIORAL DEVELOPMENT. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:LONG-TERM CARE, NURSING HOMES, AND SENIOR HOUSINGAFFORDABLE HOUSINGCOMMUNITY SAFETY ACCESS TO AFFORDABLE HEALTH CAREPUBLIC TRANSPORTATIONACCESS TO QUALITY HEALTH CARESANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS.

GROUP A-FACILITY 21 -- SANFORD BAGLEY MEDICAL CENTER PART V, SECTION B, LINE 13H:
OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE.

GROUP A-FACILITY 21 -- SANFORD BAGLEY MEDICAL CENTER PART V, SECTION B, LINE 16J:
OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY

GROUP A-FACILITY 22 -- SANFORD CANTON-INWOOD MEDICAL CENTER PART V, SECTION B, LINE 5:
SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/HEALTH-NEEDS-ASSESSMENT-SURVEY/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE.

GROUP A-FACILITY 22 -- SANFORD CANTON-INWOOD MEDICAL CENTER PART V, SECTION B, LINE 6A:
SANFORD USD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER

GROUP A-FACILITY 22 -- SANFORD CANTON-INWOOD MEDICAL CENTER PART V, SECTION B, LINE 7D:
SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED.

GROUP A-FACILITY 22 -- SANFORD CANTON-INWOOD MEDICAL CENTER PART V, SECTION B, LINE 11:
THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO AFFORDABLE HOUSINGTHERE IS A STRONG AND GROWING EVIDENCE BASE LINKING STABLE AND AFFORDABLE HOUSING TO HEALTH. AS HOUSING COSTS HAVE OUTPACED LOCAL INCOMES, HOUSEHOLDS NOT ONLY STRUGGLE TO ACQUIRE AND MAINTAIN ADEQUATE SHELTER, BUT ALSO FACE DIFFICULT TRADE-OFFS IN MEETING OTHER BASIC NEEDS. WHEN THE MAJORITY OF A PAYCHECK GOES TOWARD THE RENT OR MORTGAGE, IT CAN BE DIFFICULT TO AFFORD DOCTOR VISITS, HEALTHY FOODS, UTILITY BILLS, AND RELIABLE TRANSPORTATION TO WORK OR SCHOOL. THIS CAN, IN TURN, LEAD TO INCREASED STRESS LEVELS AND EMOTIONAL STRAIN. SANFORD HAS MADE ACCESS TO AFFORDABLE HOUSING A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO INCREASE HOUSING OPTIONS WHICH WOULD SEE AN INCREASE IN POPULATION AND ABILITY FOR CITIZENS TO AGE IN PLACE VERSUS MOVING OUT OF TOWN DUE TO NO OPTIONS. THIS WORK WILL PROVIDE A MUCH NEEDED ECONOMIC STIMULUS TO THE COMMUNITY, AS WELL AS INCREASED ACCESS TO AFFORDABLE HOUSING OPTIONS. IT IS SANFORD'S GOAL TO WORK WITH THE CANTON ECONOMIC DEVELOPMENT CORPORATION (CEDC) TO RECRUIT A DEVELOPER TO CANTON TO BUILD AFFORDABLE MULTI-FAMILY AND SINGLE-FAMILY HOMES.PRIORITY 2: ACCESS TO SENIOR LIVINGLONG-TERM CARE REFERS TO A BROAD RANGE OF SERVICES AND SUPPORTS TO MEET THE NEEDS OF FRAIL OLDER ADULTS AND OTHER PEOPLE WHO ARE LIMITED IN THEIR ABILITIES FOR SELF-CARE BECAUSE OF CHRONIC ILLNESS, DISABILITY, AGE, OR OTHER HEALTH-RELATED CONDITIONS. THESE SERVICES HELP PEOPLE LIVE AS INDEPENDENTLY AND SAFELY AS POSSIBLE WHEN THEY CAN NO LONGER PERFORM EVERYDAY ACTIVITIES ON THEIR OWN. CARE CAN BE PROVIDED IN THE HOME, A NURSING HOME, OR IN A VARIETY OF OTHER SETTINGS.SANFORD HAS MADE ACCESS TO SENIOR LIVING A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO EXPLORE ADDITIONAL OPTIONS FOR SENIOR CARE, INCLUDING HOME-BASED CARE AND HOUSING ALTERNATIVES. IT IS SANFORD'S GOAL TO DO A HOME HEALTH FEASIBILITY STUDY AND EXPAND SENIOR HOUSING OPTIONS IN THE COMMUNITY.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARACCESS TO AFFORDABLE HOUSINGTHE CANTON AREA IS IN NEED OF MORE AFFORDABLE HOUSING UNITS TO INCREASE THE WELL-BEING OF COMMUNITY MEMBERS. SANFORD CANTON-INWOOD MEDICAL CENTER IS WORKING WITH THE CEDC AND THE FOUNDATION TO SECURE DEVELOPERS TO PURCHASE LAND TO INCREASE HOUSING OPTIONS TO ENHANCE LOCAL CAPACITY.ACCESS TO SENIOR LIVING SANFORD CANTON INWOOD MEDICAL CENTER (SCIMIC) CURRENTLY WORKS HAND IN HAND WITH ITS LOCAL PARTNER, CANTON GOOD SAMARITAN SOCIETY NURSING HOME, TO ADDRESS SENIOR LIVING NEEDS IN THE COMMUNITY. GOING FORWARD, WE WILL EXPLORE ADDITIONAL OPTIONS FOR SENIOR CARE, INCLUDING HOME-BASED CARE AND HOUSING ALTERNATIVES.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:ACCESS TO AFFORDABLE HEALTH CAREMENTAL HEALTH AND SUBSTANCE ABUSEPUBLIC TRANSPORTATION SANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS.

GROUP A-FACILITY 22 -- SANFORD CANTON-INWOOD MEDICAL CENTER PART V, SECTION B, LINE 13H:
OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE.

GROUP A-FACILITY 22 -- SANFORD CANTON-INWOOD MEDICAL CENTER PART V, SECTION B, LINE 16J:
OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY

GROUP A-FACILITY 23 -- SANFORD CLEAR LAKE MEDICAL CENTER PART V, SECTION B, LINE 5:
SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/HEALTH-NEEDS-ASSESSMENT-SURVEY/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE.

GROUP A-FACILITY 23 -- SANFORD CLEAR LAKE MEDICAL CENTER PART V, SECTION B, LINE 6A:
SANFORD USD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER

GROUP A-FACILITY 23 -- SANFORD CLEAR LAKE MEDICAL CENTER PART V, SECTION B, LINE 7D:
SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED.

GROUP A-FACILITY 23 -- SANFORD CLEAR LAKE MEDICAL CENTER PART V, SECTION B, LINE 11:
THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: INCREASE COMMUNITY ACCESS TO PRIMARY CARE PROVIDERS INCLUDING ENHANCED AFFORDABILITYACCESS TO CARE REQUIRES NOT ONLY FINANCIAL COVERAGE, BUT ALSO ACCESS TO PROVIDERS. WHILE HIGH RATES OF SPECIALIST PHYSICIANS HAVE BEEN SHOWN TO BE ASSOCIATED WITH HIGHER (AND PERHAPS UNNECESSARY) UTILIZATION, SUFFICIENT AVAILABILITY OF PRIMARY CARE PHYSICIANS IS ESSENTIAL FOR PREVENTIVE AND PRIMARY CARE, AND, WHEN NEEDED, REFERRALS TO APPROPRIATE SPECIALTY CARE.ACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE HEALTH CARE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET. SANFORD HEALTH CLEAR LAKE HAS MADE ACCESS TO HEALTH CARE PROVIDERS AND AFFORDABLE HEALTH CARE SIGNIFICANT PRIORITIES AND HAS DEVELOPED STRATEGIES TO RECRUIT AN ADDITIONAL PRIMARY CARE PROVIDER AND TO INCREASE ANNUAL WELLNESS VISITS. IT IS SANFORD'S GOAL TO INCREASE MEDICAL STAFF RESULTING IN INCREASED APPOINTMENT AVAILABILITY, AS WELL AS A GREATER PATIENT CHOICE IN PROVIDERS.PRIORITY 2: CONTINUE TO BUILD/IMPROVE COMMUNITY ACCESS TO DAILY TRANSPORTATIONTRANSPORTATION SYSTEMS HELP ENSURE THAT PEOPLE CAN REACH EVERYDAY DESTINATIONS, SUCH AS JOBS, SCHOOLS, HEALTHY FOOD OUTLETS, AND HEALTHCARE FACILITIES, SAFELY AND RELIABLY. PUBLIC TRANSPORTATION SERVICES PLAY AN IMPORTANT ROLE FOR PEOPLE WHO ARE UNABLE TO DRIVE, PEOPLE WITHOUT ACCESS TO PERSONAL VEHICLES, CHILDREN, INDIVIDUALS WITH DISABILITIES, AND OLDER ADULTS.SANFORD HEALTH CLEAR LAKE HAS MADE TRANSPORTATION A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO DEVELOP A SUSTAINABLE PUBLIC TRANSPORTATION SERVICE IN THE CLEAR LAKE COMMUNITY AND TO ESTABLISH AN INFRASTRUCTURE IMPROVEMENT PLAN TO ALLOW FOR ENHANCED WALKABILITY IN THE CLEAR LAKE COMMUNITY. IT IS SANFORD'S GOAL TO IMPROVE AVAILABILITY OF TRANSPORTATION OPTIONS FOR COMMUNITY MEMBERS UNABLE TO KEEP APPOINTMENTS DUE TO LACK OF PERSONAL TRANSPORTATION OPTIONS.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARINCREASE COMMUNITY ACCESS TO PRIMARY CARE PROVIDERS INCLUDING ENHANCED AFFORDABILITYSANFORD HEALTH IS POSITIONED TO HAVE A POSITIVE IMPACT ON IMPROVING ACCESS TO PRIMARY CARE PROVIDERS. THIS EFFORT WILL FOCUS ON TWO PRIMARY GOALS; RECRUITMENT OF A PRIMARY CARE PROVIDER TO ASSURE TWO PROVIDERS ARE AVAILABLE TO SEE PATIENTS IN THE CLINIC MONDAY THROUGH FRIDAY AND INCREASING WELLNESS/PREVENTATIVE HEALTH VISITS BY TEN PERCENT BY THE END OF 2024. INCREASED WELLNESS/PREVENTATIVE HEALTH VISITS WILL ALSO IMPROVE AFFORDABILITY OVER THE LONGER TERM, AS REGULAR PRIMARY CARE IS GENERALLY ASSOCIATED WITH BETTER HEALTH OUTCOMES AND LOWER OVERALL COSTS.WALK-IN CLINIC SERVICES ARE CURRENTLY OFFERED SIX DAYS PER WEEK (MONDAY THROUGH SATURDAY). VIDEO VISITS AND TELEPHONE VISITS ARE ALSO AVAILABLE WHEN APPROPRIATE. THE SANFORD CLEAR LAKE OUTREACH CLINIC OFFERS THE CONVENIENCE OF SEEING A SPECIALIST WITHOUT THE BURDEN OF TRAVELING. TELEMEDICINE VISITS FOR VARIOUS OUTREACH SERVICES ARE ALSO AVAILABLE. DIRECT ACCESS LABORATORY TESTING IS AVAILABLE MONDAY THROUGH FRIDAY. SANFORD CLEAR LAKE OFFERS ANNUAL INFLUENZA CLINICS AND BEGAN OFFERING COVID-19 VACCINATION CLINICS IN LATE 2020. COMMUNITY HEALTH FAIRS, WHICH OFTEN INCLUDE HEALTH SCREENINGS, HAVE ALSO BEEN OFFERED IN THE PAST. PATIENTS EXPERIENCING FINANCIAL HARDSHIPS MAY REQUEST FINANCIAL ASSISTANCE. SANFORD'S FINANCIAL ASSISTANCE POLICY AND INSTRUCTIONS ARE PRINTED ON SANFORD HEALTH BILLING STATEMENTS. FINANCIAL COMPONENTS ARE DISCUSSED AT THE TIME OF ADMISSION FOR INPATIENT STAYS.DURING THE COVID-19 PANDEMIC, SANFORD BEGAN FOCUSING ON BRINGING PATIENTS BACK IN TO SEE THEIR PRIMARY CARE PROVIDERS FOR PREVENTATIVE HEALTH MAINTENANCE SERVICES. A PRIMARY CARE MARKETING CAMPAIGN WAS LAUNCHED TO ASSURE PATIENTS THAT IT WAS SAFE TO SEE THEIR PROVIDERS.SANFORD CLEAR LAKE RECRUITED AN ADDITIONAL ADVANCED PRACTICE PROVIDER (APP) IN 2021. RECRUITMENT EFFORTS ARE CURRENTLY UNDERWAY FOR A THIRD PROVIDER (ADVANCED PRACTICE PROVIDER OR MEDICAL DOCTOR). CONTINUE TO BUILD/IMPROVE COMMUNITY ACCESS TO DAILY TRANSPORTATION SANFORD HEALTH IS POSITIONED TO HAVE A POSITIVE IMPACT ON BUILDING AND IMPROVING COMMUNITY ACCESS TO DAILY TRANSPORTATION. WE WILL FOCUS ON A COLLABORATIVE EFFORT WITH OTHER COMMUNITY STAKEHOLDERS TO ESTABLISH A SUSTAINABLE PUBLIC TRANSPORTATION MODEL AND DEVELOP A PLAN FOR IMPROVING CITY INFRASTRUCTURE TO ALLOW FOR IMPROVED WALKABILITY OF THE COMMUNITY.SANFORD CLEAR LAKE BEGAN WORKING TO ADDRESS THIS HIGH-PRIORITY NEED IN 2019. WE ARE CURRENTLY WORKING WITH COMMUNITY TRANSIT OF WATERTOWN/SISSETON TO ESTABLISH A MORE AFFORDABLE PUBLIC TRANSPORTATION MODEL THAT MEETS THE NEEDS OF THE COMMUNITY.IN 2019, A COMMITTEE OF VOLUNTEERS WAS FORMED WITH THE HELP OF A WELLMARK-SPONSORED PROGRAM HEALTHY HOMETOWN. SANFORD CLEAR LAKE STAFF PARTICIPATE IN THE PROGRAM SPONSORED BY WELLMARK. THIS COMMITTEE UTILIZES A TOOLKIT TO WORK TO IMPLEMENT CHANGES THAT PROMOTE HEALTHY LIVING BY FOCUSING ON THREE AREAS MOVE MORE, EAT WELL, AND FEEL BETTER. A COMPONENT OF THIS PROGRAM ANALYZES WALKABILITY IN THE COMMUNITY AND ASSISTS IN FACILITATING PEOPLE AND RESOURCES IN ORDER TO IMPROVE WALKABILITY.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:MENTAL HEALTHAFFORDABLE HOUSING PHYSICAL ACTIVITY AND NUTRITIONSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS.

GROUP A-FACILITY 23 -- SANFORD CLEAR LAKE MEDICAL CENTER PART V, SECTION B, LINE 13H:
OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE.

GROUP A-FACILITY 23 -- SANFORD CLEAR LAKE MEDICAL CENTER PART V, SECTION B, LINE 16J:
OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY

GROUP A-FACILITY 24 -- SANFORD WESTBROOK MEDICAL CENTER PART V, SECTION B, LINE 5:
SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/HEALTH-NEEDS-ASSESSMENT-SURVEY/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE.

GROUP A-FACILITY 24 -- SANFORD WESTBROOK MEDICAL CENTER PART V, SECTION B, LINE 6A:
SANFORD USD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD SOUTH UNIVERSITY MEDICAL CENTERSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER

GROUP A-FACILITY 24 -- SANFORD WESTBROOK MEDICAL CENTER PART V, SECTION B, LINE 7D:
SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCLUDED.

GROUP A-FACILITY 24 -- SANFORD WESTBROOK MEDICAL CENTER PART V, SECTION B, LINE 11:
THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: MENTAL HEALTHMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HEALTH WESTBROOK HAS MADE MENTAL HEALTH A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO EXPAND THE USE OF TELEMEDICINE AND IN-HOUSE MENTAL HEALTH SERVICES AND INCREASE THE NUMBER OF SCREENINGS AND REFERRALS TO BEHAVIORAL HEALTH PROVIDERS. IT IS SANFORD'S GOAL TO SEE A LOWERED NUMBER OF MENTAL HEALTH DAYS FROM COMMUNITY MEMBERS AND A POSITIVE INCREASE IN AWARENESS OF MENTAL HEALTH SERVICES IN THE COMMUNITY.PRIORITY 2: ACCESS TO HEALTH CARE PROVIDERSACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE HELPS INDIVIDUALS AND FAMILIES ACCESS NEEDED PRIMARY CARE, SPECIALISTS, AND EMERGENCY CARE, BUT DOES NOT ENSURE ACCESS ON ITS OWNIT IS ALSO NECESSARY FOR PROVIDERS TO OFFER AFFORDABLE CARE, BE AVAILABLE TO TREAT PATIENTS, AND BE IN RELATIVELY CLOSE PROXIMITY TO PATIENTS.SANFORD HAS MADE ACCESS TO HEALTH CARE PROVIDERS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO EXPAND OUTREACH SERVICES AND TO ADDRESS THE NEED FOR LIMITED ACCESS TO DENTAL CARE. REDUCE MORTALITY AND MORBIDITY FROM MENTAL HEALTH AND BEHAVIORAL HEALTH AND SUBSTANCE ABUSE. IT IS SANFORD'S GOAL TO INCREASE THE AVAILABILITY OF SPECIALTY SERVICES LOCALLY THROUGH OUTREACH AND/OR TELEHEALTH.ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEARMENTAL HEALTHSANFORD HEALTH IS POSITIONED LOCALLY TO HAVE A POSITIVE IMPACT ON MENTAL HEALTH WITHIN THE COMMUNITY. THIS EFFORT WILL FOCUS ON TWO PRIMARY GOALS:1. EXPAND USE OF CURRENT TELEMEDICINE AND IN-HOUSE MENTAL HEALTH SERVICES2. PROVIDE ALTERNATIVE RESOURCES FOR MENTAL HEALTH SERVICES TO COMMUNITY.SANFORD WESTBROOK CURRENTLY HAS A PSYCHIATRIST VIA TELEMEDICINE AVAILABLE FOR PATIENTS. WE ALSO HAVE TWO LICSWS AND A BEHAVIORAL HEALTH NURSE PRACTITIONER ON STAFF.ACCESS TO HEALTH CARE PROVIDERSSANFORD HEALTH IS POSITIONED LOCALLY TO HAVE A POSITIVE IMPACT ON ACCESS TO HEALTH CARE PROVIDERS WITHIN THE COMMUNITY. THIS EFFORT WILL FOCUS ON TWO PRIMARY GOALS:1. EXPANDING OUTREACH SERVICES2. ADDRESSING NEED FOR LIMITED ACCESS TO DENTAL CARESANFORD WESTBROOK CURRENTLY PROVIDES A NUMBER OF OUTREACH SERVICES IN-HOUSE AND VIA TELEMEDICINE. IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:COMMUNITY SAFETYENVIRONMENTAL HEALTHAFFORDABLE HOUSINGPUBLIC TRANSPORTATIONPHYSICAL ACTIVITY AND NUTRITIONEMPLOYMENT AND ECONOMIC OPPORTUNITIESSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS.

GROUP A-FACILITY 24 -- SANFORD WESTBROOK MEDICAL CENTER PART V, SECTION B, LINE 13H:
OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE.

GROUP A-FACILITY 24 -- SANFORD WESTBROOK MEDICAL CENTER PART V, SECTION B, LINE 16J:
OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY

GROUP A-FACILITY 2 -- SANFORD MEDICAL CENTER FARGO PART V, SECTION B, LINE 5:
SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/HEALTH-NEEDS-ASSESSMENT-SURVEY/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE.

GROUP A-FACILITY 2 -- SANFORD MEDICAL CENTER FARGO PART V, SECTION B, LINE 6A:
SANFORD USD MEDICAL CENTER SIOUX FALLSSANFORD MEDICAL CENTER FARGOSANFORD BROADWAY MEDICAL CENTER FARGOSANFORD BISMARCK MEDICAL CENTERSANFORD BEMIDJI MEDICAL CENTERSANFORD ABERDEEN MEDICAL CENTERSANFORD BAGLEY MEDICAL CENTERSANFORD CANBY MEDICAL CENTERSANFORD CANTON-INWOOD MEDICAL CENTERSANFORD CHAMBERLAIN MEDICAL CENTERSANFORD CLEAR LAKE MEDICAL CENTERSANFORD HILLSBORO MEDICAL CENTERSANFORD JACKSON MEDICAL CENTERSANFORD LUVERNE MEDICAL CENTERSANFORD MAYVILLE MEDICAL CENTERSANFORD SHELDON MEDICAL CENTERSANFORD THIEF RIVER FALLS MEDICAL CENTERSANFORD TRACY MEDICAL CENTERSANFORD VERMILLION MEDICAL CENTERSANFORD WEBSTER MEDICAL CENTERSANFORD WESTBROOK MEDICAL CENTERSANFORD WHEATON MEDICAL CENTERSANFORD WORTHINGTON MEDICAL CENTER

GROUP A-FACILITY 2 -- SANFORD MEDICAL CENTER FARGO PART V, SECTION B, LINE 7D:
SANFORD INVITED COMMUNITY PARTNERS TO ATTEND PRESENTATIONS AND DISCUSSIONS OF THE RESULTS. COMMUNITY STAKEHOLDERS AND COMMUNITY COUNCILS WERE INCULDED.

GROUP A-FACILITY 2 -- SANFORD MEDICAL CENTER FARGO PART V, SECTION B, LINE 11:
THE FOLLOWING IS A LIST OF THE COMMUNITY'S PRIORITY NEEDS AND WHAT IS BEING DONE TO ADDRESS THEM. PRIORITY NEEDS NOT DIRECTLY ADDRESSED ARE EITHER, NOT WITHIN SANFORD'S EXPERTISE, OR BEING ADDRESSED COLLABORATIVELY WITH COMMUNITY PARTNERS. FOR INFORMATION CONCERNING THOSE ADDITIONAL NEEDS VISIT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPRIORITY 1: ACCESS TO AFFORDABLE HEALTH CAREACCESS TO AFFORDABLE, QUALITY HEALTH CARE IS IMPORTANT TO PHYSICAL, SOCIAL, AND MENTAL HEALTH. HEALTH INSURANCE, LOCAL CARE OPTIONS, AND A USUAL SOURCE OF CARE HELP TO ENSURE ACCESS TO HEALTH CARE. HAVING ACCESS TO CARE ALLOWS INDIVIDUALS TO ENTER THE HEALTH CARE SYSTEM, FIND CARE EASILY AND LOCALLY, PAY FOR CARE, AND GET THEIR HEALTH NEEDS MET. NDSU REPORTED HEALTH CARE ACCESSIBILITY AND COST AS TWO SEPARATE HEALTH NEEDS. THE CASS-CLAY WORKING GROUP DETERMINED THAT THE TWO TOPICS ARE MOST APPROPRIATELY ADDRESSED AS A COMBINED TOPIC FOR PURPOSES OF THE LOCAL CHNA PROCESS.SANFORD HAS MADE HEALTHCARE ACCESS A SIGNIFICANT PRIORITY AND HAS DEVELOPED STRATEGIES TO EXPAND HEALTHCARE ACCESS AND ACCESS TO PRIMARY CARE SERVICES. IT IS SANFORD'S GOAL THAT THE COMMUNITY WOULD SEE THAT PATIENTS WILL HAVE GREATER EASE TO ACCESS PRIMARY CARE PROVIDERS FOR VIRTUAL OR IN-PERSON VISITS, HOME VISITS AND INCREASED EXPANDED HOURS. PATIENTS MAY EXPERIENCE LESS FREQUENT UTILIZATION OF EMERGENCY CARE, WHICH IS OFTEN MORE EXPENSIVE THAN PREVENTATIVE AND SCREENING SERVICES.PRIORITY 2: MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSEMENTAL HEALTH INCLUDES OUR EMOTIONAL, PSYCHOLOGICAL, AND SOCIAL WELL-BEING AND AFFECTS HOW WE THINK, FEEL, AND ACT. IT ALSO HELPS DETERMINE HOW WE HANDLE STRESS, RELATE TO OTHERS, AND MAKE CHOICES. MENTAL HEALTH IS IMPORTANT AT EVERY STAGE OF LIFE, FROM CHILDHOOD AND ADOLESCENCE THROUGH ADULTHOOD.SANFORD HAS MADE MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSE SIGNIFICANT PRIORITIES AND HAS DEVELOPED STRATEGIES TO RECRUIT PROVIDERS, INCREASE ACCESS TO CARE AND MENTAL HEALTH PROMOTION. IT IS SANFORD'S GOAL TO HAVE BETTER ACCESS TO AND UTILIZATION OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES DUE TO SERVICES BEING PROVIDED AT THE RIGHT TIME AND RIGHT PLACE. ADDRESSING OF SIGNIFICANT NEEDS DURING CURRENT YEAR: ACCESS TO AFFORDABLE HEALTH CARESANFORD HEALTH IS POSITIONED LOCALLY TO HAVE A POSITIVE IMPACT ON HEALTH CARE ACCESS WITHIN THE COMMUNITY. THIS EFFORT WILL FOCUS ON TWO PRIMARY GOALS TO EXPAND HEALTHCARE ACCESS AND SUPPORT SERVICES AND EXPANDED PLATFORM TO ACCESS PRIMARY CARE SERVICES, AREAS OF FOCUS IDENTIFIED IN THE STAKEHOLDER MEETING.SANFORD IS ADDRESSING THE NEED BY INCLUDING ACCESS TO HEALTHCARE AS A PRIORITY FOCUS AREA FOR THE 2022-2024 IMPLEMENTATION PLAN. WE LAUNCHED HOME BASED PRIMARY CARE IN 2021. THE GOAL IS TO PROVIDE QUALITY MEDICAL CARE AT HOME TO PATIENTS WHO HAVE DIFFICULTY ACCESSING MEDICAL CARE BECAUSE OF PHYSICAL DISABILITY OR DEMENTIAS. AN INTERDISCIPLINARY TEAM SEES THE PATIENT IN THEIR HOME AND CONSISTS OF SOCIAL WORKER, CARE MANAGER, LPN AND PHYSICIAN/APP. FAMILY MEDICINE RESIDENT CLINIC NOW SEES PATIENTS IN LOCAL SHELTERS, YWCA, HEADSTART AND WILL BEGIN IN ONE OF THE FARGO SCHOOLS IN LATE FALL 2021. THE GOAL OF THESE OUTREACH SITES IS TO IMPROVE ACCESS TO CARE FOR THESE PATIENTS. SANFORD WILL BE EXPANDING PRIMARY CARE CLINIC LOCATIONS BY ADDING A HORACE CLINIC IN LATE 2022. USING TELEHEALTH, WE HAVE EXPANDED OUR ACCESS IN CLINICS FOR PATIENTS UNABLE TO TRAVEL TO THE CLINIC.MENTAL HEALTH/BEHAVIORAL HEALTH AND SUBSTANCE ABUSE SANFORD HEALTH IS POSITIONED LOCALLY TO HAVE A POSITIVE IMPACT ON MENTAL HEALTH / BEHAVIORAL HEALTH AND SUBSTANCE ABUSE WITHIN THE COMMUNITY. THIS EFFORT WILL FOCUS ON THREE PRIMARY GOALS RECRUITMENT AND ACCESS TO MENTAL HEALTH PROVIDERS, DEVELOPMENT OF A COMMUNITY STRATEGY FOR MENTAL HEALTH PROMOTION, AND SUBSTANCE ABUSE.MENTAL HEALTH: SANFORD HEALTH CONTINUES TO RECRUIT PROVIDERS TO IMPROVE ACCESS TO MENTAL HEALTH SERVICES. WE HAVE EXPANDED SCHOOL PARTNERSHIPS TO INCREASE WORKFORCE FOR OUR MENTAL HEALTH PROVIDERS. A MENTAL HEALTH CONSULT TEAM STARTED IN 2021 WITH A GOAL OF EMBEDDING THERAPISTS ON HOSPITAL UNITS. USING TELEHEALTH, WE HAVE EXPANDED OUR ACCESS IN CLINICS FOR PATIENTS UNABLE TO TRAVEL TO THE CLINIC. SANFORD HEALTH IS HOSTING COMMUNITY MENTAL HEALTH COLLABORATION MEETINGS WITH OUR COMMUNITY PARTNERS WITH A GOAL OF IMPROVING THE MENTAL HEALTH PROVIDED IN THE COMMUNITY, TO SERVE THOSE IN A BEHAVIORAL HEALTH CRISIS.A GRANT HAS BEEN SUBMITTED FOR OUR COMMUNITY MENTAL HEALTH COLLABORATION PROJECT, WITH NOTICE OF AWARD TIMEFRAME IN DECEMBER 2021. WE CURRENTLY SCREEN FOR DEPRESSION AT CLINIC VISITS AND HAVE INTEGRATED HEALTH THERAPISTS EMBEDDED IN ALL OF THE PRIMARY CARE CLINICS.SUBSTANCE ABUSE: PATIENTS IDENTIFIED BY THEIR PRIMARY CARE PROVIDER AS HAVING AN OPIOID USE DISORDER ARE ABLE TO RECEIVE TREATMENT WITH OUR SUBOXONE CLINIC AND MAT COMMUNITY PARTNERS. PATIENTS ARE SEEN BY OUR INTEGRATIVE HEALTH THERAPISTS FOR A COMPREHENSIVE BEHAVIORAL HEALTH EVALUATION, FOLLOWED BY A REFERRAL TO THE APPROPRIATE BEHAVIORAL HEALTH PROVIDER (E.G. ADDICTION TREATMENT, THERAPY, PSYCHIATRY). THE PATIENT THEN IS SCHEDULED WITH ONE OF OUR FOUR CERTIFIED PHYSICIANS WHO PRESCRIBE SUBOXONE FOR INDUCTION. SANFORD HEALTH'S COLLABORATION WITH A FARGO-BASED PEER-TO-PEER SUBSTANCE ABUSE PROGRAM PROVIDER, F5, BEGAN IN 2019. THE COLLABORATION REMAINS STRONG AND THE F5 TEAM BEGIN COUNSELING SESSIONS WITHIN OUR HOSPITAL FOR PATIENTS WITH DRUG/ALCOHOL ADDICTION. SANFORD SUPPORTS MANY COMMUNITY PARTNERS TO ADDRESS THE SUBSTANCE ABUSE IN OUR COMMUNITY. PARTNERSHIPS INCLUDE FARGO CASS PUBLIC HEALTH (MOBILE CRISIS UNIT) AND RECOVERY REINVENTED.IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED BY THIS FACILITY'S IMPLEMENTATION PLAN INCLUDE:PHYSICAL ACTIVITY AND NUTRITIONSENIOR HOUSING AND LONG-TERM CAREPUBLIC TRANSPORTATIONAFFORDABLE HOUSING, EMPLOYMENT, ECONOMIC DEVELOPMENTDIVERSITY, INCLUSION, HEALTH EQUITYCHILDCAREHEALTH LITERACY AND NAVIGATIONSANFORD SERVES AS A PARTNER IN MANY COMMUNITY GROUPS THAT HAVE THE EXPERTISE TO ADDRESS THESE UNMET NEEDS. SANFORD HAS SHARED THE RESULTS OF THE CHNA AND THE UNMET NEEDS WITH COMMUNITY LEADERS AND STAKEHOLDERS.

GROUP A-FACILITY 2 -- SANFORD MEDICAL CENTER FARGO PART V, SECTION B, LINE 13H:
OTHER FACTORS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS INCLUDE BALANCE OWED, FAMILY SIZE, DEBT TO INCOME RATIO, SAVINGS AND INVESTMENTS, OTHER DEBT (BOTH MEDICAL AND NON-MEDICAL), PREVIOUS BANKRUPTCIES AND LIENS, PATIENT/GUARANTOR INVOLVEMENT IN OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS, INDIVIDUAL CIRCUMSTANCES, CURRENT EMPLOYMENT STATUS, TOTAL MONTHLY EXPENSES AND THIRD PARTY ANALYTIC SCORE.

GROUP A-FACILITY 2 -- SANFORD MEDICAL CENTER FARGO PART V, SECTION B, LINE 16J:
OTHER MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY INCLUDE PUBLISHING WITH LOCAL PUBLIC HEALTH AGENCIES, COLLECTION AGENCIES AND SUBMISSION TO LAW FIRMS THAT SERVE THE UNDERPRIVILEGED POPULATION.THE FINANCIAL ASSISTANCE PROGRAM SUMMARY, COMPLETE POLICY AND THE SANFORD FINANCIAL ASSISTANCE APPLICATION ARE ALL AVAILABLE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY

Supplemental Information

Schedule H (Form 990) Part VI

PART I, LINE 3C:
SANFORD HEALTH DOES NOT DENY CARE TO ANYONE BASED ON THE ABILITY TO PAY. SANFORD'S FINANCIAL ASSISTANCE (CHARITY CARE) POLICY PROVIDES DISCOUNTED AND FREE SERVICES TO PATIENTS WHO LACK THE RESOURCES TO BE FULLY RESPONSIBLE FOR THE HEALTHCARE THEY RECEIVE. THE FINANCIAL ASSISTANCE POLICY IS DESIGNED TO ENSURE THE ENTIRE COMMUNITY SERVED BY SANFORD HAS ACCESS TO NEEDED HEALTHCARE SERVICES. ELIGIBILITY FOR DISCOUNTED OR FREE SERVICES UNDER THE FINANCIAL ASSISTANCE POLICY IS BASED ON INCOME LEVELS AND FAMILY SIZE. GENERALLY, INDIVIDUALS EARNING INCOME OF UP TO 375% OF THE FEDERAL POVERTY INCOME GUIDELINES ARE ELIGIBLE FOR VARYING LEVELS OF DISCOUNTS, INCLUDING FULL DISCOUNTS FOR CERTAIN INCOME LEVELS. APPLICATIONS FOR COVERAGE UNDER THE PROGRAM MAY BE OBTAINED AT ANY SANFORD PATIENT REGISTRATION AREA.THE PRIMARY SCOPE OF SANFORD'S FINANCIAL ASSISTANCE MATRIX CONSIDERS FAMILY INCOME AND FAMILY SIZE TO OBJECTIVELY DETERMINE FINANCIAL NEED. THE FAMILY INCOME RANGE VARIES FROM 0-225% UP TO 375% OF THE FEDERAL POVERTY LEVEL (FPL). AN APPLICANT OVER 375% MAY BE ELIGIBLE FOR SOME LEVEL OF FINANCIAL ASSISTANCE BASED ON A REVIEW OF ADDITIONAL FACTORS SUCH AS: THE SIZE OF THE ACCOUNT BALANCE, DEBT-TO-INCOME RATIO, CURRENT ASSETS, CURRENT LIABILITIES, IRS FOOD EXPENSE ALLOWANCES, MONTHLY CASH FLOW, ETC.ADDITIONALLY, IT IS POSSIBLE FOR A FAMILY TO QUALIFY IN ONE SEGMENT (BASED ON INCOME AND FAMILY SIZE ALONE) BUT BE MOVED TO A MORE GENEROUS (FOR THE PATIENT) SEGMENT BASED ON THE OTHER FINANCIAL VARIABLES MENTIONED ABOVE. AN APPLICANT MAY BE DENIED IF THEY HAVE SUBSTANTIAL ASSETS AND APPLICANTS ARE CONSIDERED ON A CASE BY CASE BASIS.THE AMOUNT GENERALLY BILLED (AGB) DISCOUNT PERCENTAGE IS THE LEAST AMOUNT SANFORD CAN DISCOUNT FOR ANY PATIENT QUALIFYING UNDER THE SANFORD FINANCIAL ASSISTANCE POLICY. IT IS THE PERCENTAGE USED FOR THE LOWEST LEVEL OF ASSISTANCE GRANTED FOR THOSE QUALIFYING UNDER THE SANFORD FINANCIAL ASSISTANCE POLICY AS LISTED ON APPENDIX 1 - SLIDING DISCOUNT SCHEDULE FOR ASSISTANCE. ANYONE ELSE QUALIFYING FOR ASSISTANCE AT GREATER LEVELS WILL RECEIVE DISCOUNT AMOUNTS GREATER THAN THE SANFORD AGB DISCOUNT AMOUNT. PART I, LINE 5B: SANFORD AS A WHOLE DID NOT EXCEED ITS FINANCIAL ASSISTANCE BUDGET FOR CY 2021, HOWEVER, IF THEY WOULD HAVE EXCEEDED THEIR BUDGET IT WOULD NOT IMPACT THEIR ABILITY TO SERVE ANY PATIENTS AND NO PATIENTS WOULD BE DISALLOWED SERVICES. THE ORGANIZATION PROVIDED FREE OR DISCOUNTED SERVICES TO PATIENTS WHO WERE ELIGIBLE FOR FREE OR DISCOUNTED CARE.PART I, LINE 6: SANFORD HEALTH'S COMMUNITY BENEFIT ANNUAL REPORT IS POSTED ANNUALLY ON THE SANFORD WEBSITE AT:HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-BENEFIT

PART I, LINE 7:
COST TO CHARGE RATIOS ARE USED TO CALCULATE THE AMOUNTS ON LINE 7A - 7C (FINANCIAL ASSISTANCE, MEDICAID SHORTFALL, AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS) AND ALSO LINE 7G (SUBSIDIZED HEALTH SERVICES) FOR EACH OF THE SUBSIDIARIES INCLUDED IN THE RETURN. ALL OTHER AMOUNTS FOR LINES 7E, 7F, 7H AND 7I WOULD COME FROM THE BOOKS AND RECORDS OF SPECIFIC SEGMENTS OF THE ORGANIZATION AND WOULD NOT BE BASED ON A COST TO CHARGE RATIO, OR SIMILAR COST ACCOUNTING METHODOLOGY. THESE COSTS STILL REPRESENT THE COSTS TO PROVIDE BENEFITS.

PART I, LINE 7G:
SUBSIDIZED HEALTH SERVICES ARE CLINICAL SERVICES PROVIDED TO BOTH INPATIENTS AND OUTPATIENTS DESPITE A FINANCIAL LOSS TO SANFORD. EACH LOSS HAS BEEN CALCULATED AFTER REMOVING LOSSES ASSOCIATED WITH BAD DEBTS, FINANCIAL ASSISTANCE AND MEDICAID. ALTHOUGH THESE SERVICES GENERATE OVERALL LOSSES TO SANFORD, THEY CONTINUE TO MEET THE NEEDS OF THE COMMUNITIES SERVED. VARIOUS SERVICES THAT GENERATE LOSSES ARE PROVIDED BY SANFORD THROUGH PHYSICIAN PRACTICES. FOR CY 2021, SUBSIDIZED HEALTH SERVICES PROVIDED THROUGH CLINIC PHYSICIAN PRACTICES GENERATED LOSSES OF $49,451,962.

PART II, COMMUNITY BUILDING ACTIVITIES:
SANFORD HEALTH IS A NOT-FOR-PROFIT ORGANIZATION DEDICATED TO THE WORK OF HEALTH AND HEALING FOR THE PUBLIC GOOD. SANFORD IS COMMITTED TO GIVING BACK TO THE COMMUNITIES IN WHICH ITS EMPLOYEES AND PATIENTS LIVE AND WORK. SANFORD INVESTS RESOURCES IN ORDER TO PRODUCE THE BEST OUTCOMES FOR PATIENT CARE, EDUCATION, RESEARCH, AND COMMUNITY ENRICHMENT, AND PARTNERS WITH OTHERS TO ENSURE THAT THE COMMUNITY IS A WELCOMING, HEALTHY ENVIRONMENT AND ONE THAT ATTRACTS AND SUSTAINS A DIVERSE SANFORD WORKFORCE TO DELIVER THE BEST PATIENT CARE AND MUCH NEEDED MEDICAL RESEARCH. SANFORD CONSIDERS REQUESTS FOR FUNDING AND IN KIND SUPPORT FOR NEW AND ONGOING PROGRAMS WITH ALL AREAS SUPPORTING THE ABOVE GOALS, SUCH AS BASIC HUMAN SERVICES, EDUCATION AND WORKFORCE DEVELOPMENT BY RECRUITING PHYSICIANS AND OTHER HEALTH PROFESSIONALS TO MEDICAL SHORTAGE OR UNDERSERVED AREAS AND COLLABORATING WITH EDUCATIONAL INSTITUTIONS TO TRAIN AND RECRUIT HEALTH PROFESSIONALS, ADVOCATING COMMUNITY HEALTH IMPROVEMENT THROUGH EFFORTS TO SUPPORT POLICIES AND PROGRAMS THAT SAFEGUARD OR IMPROVE PUBLIC HEALTH AND HELP TO ENSURE ACCESS TO HEALTH CARE SERVICES.

PART III, LINE 2:
BAD DEBT EXPENSE AT COST IS DETERMINED USING THE SAME COST TO CHARGE RATIOS THAT ARE USED TO CALCULATE FINANCIAL ASSISTANCE AND MEDICAID SHORTFALL. DISCOUNTS AND ALLOWANCES ARE ACCOUNTED FOR SEPARATELY FROM BAD DEBT EXPENSE.

PART III, LINE 3:
IT IS SANFORD'S POLICY TO MAKE FINANCIAL ASSISTANCE AVAILABLE TO PATIENTS WHO FIT THE FINANCIAL ASSISTANCE CRITERIA. IT IS THE ORGANIZATION'S GOAL TO MAKE CERTAIN THAT SANFORD IS PROACTIVE IN IDENTIFICATION OF THE PATIENTS WHO NEED HELP WITH FINANCIAL CONCERNS. FINANCIAL COUNSELORS MAKE EVERY EFFORT TO ENSURE THAT FINANCIAL ASSISTANCE ELIGIBLE PATIENTS DO NOT PROGRESS TO BAD DEBT. FOR THIS REASON, A DOLLAR AMOUNT FOR BAD DEBT IS NOT INCLUDED.

PART III, LINE 4:
THE AUDITED FINANCIAL STATEMENTS (AFS) OF SANFORD INCLUDE A BAD DEBT FOOTNOTE. SEE FOOTNOTE 3 ON PAGES 13 - 14 OF THE AFS. SANFORD REPORTS BAD DEBT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP).

PART VI, LINE 5:
SANFORD MAINTAINS AN OPEN MEDICAL STAFF. COMMUNITY BOARDS - THE SANFORD BOARD OF TRUSTEES WAS COMPRISED OF 13 MEMBERS AT THE END OF THE CALENDAR YEAR, INCLUDING 9 COMMUNITY MEMBERS, 3 PHYSICIANS AND THE CEO. SURPLUS FUNDS - SURPLUS FUNDS ARE INVESTED BACK INTO THE COMMUNITY, AS WELL AS TO RESOURCE DEVELOPMENT AND FACILITY DEVELOPMENT TO BETTER SERVE PATIENTS AND COMMUNITIES.

PART III, LINE 8:
"PER IRS INSTRUCTIONS, SANFORD HAS IDENTIFIED THE COST ASSOCIATED WITH PROVIDING MEDICARE SERVICES FROM THE MEDICARE COST REPORT. THE MEDICARE COST REPORT CALCULATIONS ARE TOTAL EXPENSE LESS EXPENSES DEEMED ""UNALLOWABLE"" PER MEDICARE REGULATIONS. THE NET EXPENSE IS THEN USED TO CALCULATE THE COST PER DAY AND COST TO CHARGE RATIOS WHICH ARE MULTIPLIED BY THE MEDICARE DAYS AND ANCILLARY CHARGES TO DETERMINE THE COST OF PROVIDING MEDICARE SERVICES. IF ALL EXPENSES THAT SANFORD INCURRED WERE INCLUDED ON THE MEDICARE COST REPORT; THIS WOULD SHOW A SHORTFALL OF APPROXIMATELY $342,442,972. SANFORD BELIEVES THIS SHORTFALL SHOULD BE CONSIDERED COMMUNITY BENEFIT BECAUSE THESE SERVICES WOULD NEED TO BE PROVIDED BY EITHER ANOTHER CHARITABLE ORGANIZATION OR THE GOVERNMENT IF IT WAS NOT PROVIDED BY SANFORD."

PART III, LINE 9B:
SANFORD WILL PROVIDE SERVICES AT NO COST OR REDUCED COST TO PATIENTS WHO QUALIFY FOR THE PROGRAM. PATIENTS WITH INCOMES AT OR BELOW 225% OF THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES POVERTY GUIDELINE WILL RECEIVE A 100% REDUCTION OF THEIR PAYMENT RESPONSIBILITY. PATIENTS WITH INCOME BETWEEN 225% - 375% OF THE POVERTY GUIDELINE WILL BE GIVEN A DISCOUNT BASED ON A SLIDING SCALE AND ASSETS ARE CONSIDERED IN THE CALCULATION OF THE INCOME OF THE PATIENT, WITH THE EXCEPTION OF THE PATIENT'S PRINCIPAL RESIDENCE. PATIENTS ABOVE 375% OF THE FPG WILL BE REVIEWED FOR ADDITIONAL FACTORS SUCH AS SIZE OF MEDICAL DEBT BEFORE A FINAL DETERMINATION. PATIENTS MUST MAKE THEIR FINANCIAL NEED KNOWN TO APPROPRIATE PERSONNEL AND BE ENGAGED IN FILING APPROPRIATE AND COMPLETE APPLICATIONS. THE PROGRAM IS AVAILABLE TO THOSE PATIENTS WITHOUT HEALTH CARE BENEFITS FROM ANY SOURCE AS WELL AS TO THOSE WHO HAVE COVERAGE FOR HEALTH CARE COSTS THROUGH A GOVERNMENT PROGRAM, COMMERCIAL INSURANCE, OR OTHER HEALTH BENEFIT PLAN BUT CONTINUE TO HAVE A REMAINING BALANCE AFTER BENEFITS HAVE BEEN APPLIED TO THE CHARGES. SANFORD WILL NOT DENY FINANCIAL ASSISTANCE BASED ON RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP OR AGE.EVERY EFFORT IS MADE TO IDENTIFY PATIENTS WITH FINANCIAL NEED AS EARLY AS POSSIBLE IN THE REVENUE CYCLE.SANFORD HAS ZERO TOLERANCE FOR ABUSIVE, HARASSING, OPPRESSIVE, FALSE, DECEPTIVE, OR MISLEADING LANGUAGE OF COLLECTIONS CONDUCT. THIS ZERO TOLERANCE APPLIES TO INTERNAL SANFORD STAFF AND THIRD PARTY COLLECTION VENDORS AND ATTORNEYS.NEITHER SANFORD NOR ANY OF ITS THIRD PARTY COLLECTION VENDORS WILL TAKE ANY EXTRAORDINARY COLLECTION EFFORTS UNTIL SANFORD AND THE THIRD PARTY COLLECTION VENDOR HAVE MADE REASONABLE EFFORTS TO DETERMINE IF A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY.

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SANFORD EMPLOYS A VARIETY OF STRATEGIES TO MAKE CERTAIN THAT THE ORGANIZATION IS TRANSPARENT IN THE COMMUNICATION OF FINANCIAL ASSISTANCE GUIDELINES. THE STAFF AT SANFORD MAKES EVERY EFFORT TO IDENTIFY PATIENTS NEEDING FINANCIAL ASSISTANCE AS EARLY IN THE REVENUE CYCLE AS POSSIBLE. ALL SANFORD ENTITIES DISPLAY SIGNAGE IN REGISTRATION AREAS ADVISING PATIENTS OF THEIR ABILITY TO REQUEST FINANCIAL ASSISTANCE. THE SIGNAGE WAS MADE AVAILABLE IN ENGLISH AND SPANISH. ALTERNATE LANGUAGES WERE INCLUDED ON THE SIGNAGE THAT BASICALLY STATED, IF YOU NEED INTERPRETER SERVICES, PLEASE INQUIRE AT THE REGISTRATION DESK. FINANCIAL ASSISTANCE APPLICATIONS WERE AVAILABLE IN ENGLISH, SPANISH, CHINESE, GERMAN, HINDI, KOREAN, LAOTIAN AND VIETNAMESE UPON REQUEST OR ON THE SANFORD WEBSITE. ALL HEALTHCARE WORKERS WHO IDENTIFY PATIENTS WITH FINANCIAL NEED ARE ENCOURAGED TO PROVIDE PATIENTS OR THEIR DESIGNEES A FINANCIAL APPLICATION. THIS MAY INCLUDE, BUT NOT BE LIMITED TO THE FOLLOWING AREAS: ADMINISTRATION, ADMISSIONS, PATIENT FINANCIAL SERVICES, FINANCIAL COUNSELORS, SOCIAL SERVICES, PHYSICIANS, NURSING, CLINIC DIRECTOR, RECEPTION STAFF AND HUMAN RESOURCES.FINANCIAL COUNSELORS ARE TRAINED TO WORK INDIVIDUALLY WITH PATIENTS TO DETERMINE THE FINANCIAL NEED AND RECOMMEND APPROPRIATE ASSISTANCE IN APPLICATION FOR CHARITY CARE, GOVERNMENT PROGRAMS OR DISCOUNTED SERVICES.SANFORD'S FINANCIAL ASSISTANCE PROGRAM IS AVAILABLE TO ANYONE WHO QUALIFIES FOR ASSISTANCE. THIS PROGRAM ENSURES THAT ALL PEOPLE RECEIVE THE CARE THEY NEED, REGARDLESS OF THEIR FINANCIAL SITUATION. SANFORD MAKES FINANCIAL ASSISTANCE INFORMATION AVAILABLE TO COMMUNITY AGENCIES AND REFERRAL ORGANIZATIONS. FINANCIAL ASSISTANCE INFORMATION IS ALSO AVAILABLE ON THE SANFORD WEBSITE AT:HTTPS://WWW.SANFORDHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-POLICY

PART VI, LINE 4:
SANFORD HEALTH IS AN INTEGRATED HEALTH SYSTEM HEADQUARTERED IN THE DAKOTAS. IT IS ONE OF THE LARGEST RURAL HEALTH SYSTEMS IN THE NATION WITH 24 HOSPITALS AND NEARLY 448 CLINICS IN 158 LOCATIONS IN NINE STATES AND THREE COUNTRIES. SANFORD HEALTH'S APPROXIMATELY 36,000 EMPLOYEES, INCLUDING 1,500 PHYSICIANS, MAKE IT THE LARGEST EMPLOYER IN THE DAKOTAS. SANFORD USD MEDICAL CENTER - SIOUX FALLS, SOUTH DAKOTASIOUX FALLS IS THE LARGEST CITY IN THE STATE OF SOUTH DAKOTA AND IS THE COUNTY SEAT OF MINNEHAHA COUNTY. SIOUX FALLS ALSO EXTENDS INTO LINCOLN COUNTY. THE 2021 U.S. CENSUS BUREAU ESTIMATES A TOTAL POPULATION OF 196,528 FOR SIOUX FALLS. ACCORDING TO THE 2021 COUNTY HEALTH RANKINGS, THE POPULATION OF MINNEHAHA COUNTY IS 81.1% WHITE, 6.4% AFRICAN AMERICAN, 2.9% AMERICAN INDIAN, 2.2% ASIAN AND 5.4% HISPANIC. SIOUX FALLS IS A SIGNIFICANT REGIONAL HEALTH CARE CENTER. ONLY 2% OF THE POPULATION IS REPORTED TO BE NOT PROFICIENT IN ENGLISH. THE MEDIAN HOUSEHOLD INCOME IN SIOUX FALLS IS $64,500.SANFORD MEDICAL CENTER FARGO - FARGO, NORTH DAKOTAFARGO IS THE LARGEST CITY IN NORTH DAKOTA, ACCOUNTING FOR 24% OF THE STATE'S POPULATION. FARGO IS ALSO THE COUNTY SEAT OF CASS COUNTY. THE 2021 UNITED STATES CENSUS ESTIMATES THE POPULATION OF FARGO WAS 183,904. ACCORDING TO THE 2021 COUNTY HEALTH RANKINGS, THE POPULATION OF CASS COUNTY IS 84.1% WHITE, 6.3% AFRICAN AMERICAN, 1.5% AMERICAN INDIAN, 3.3% ASIAN AND 2.9% HISPANIC. ONLY 1% OF THE POPULATION IS REPORTED TO BE NOT PROFICIENT IN ENGLISH. THE MEDIAN HOUSEHOLD INCOME IS $61,300. SANFORD BEMIDJI MEDICAL CENTER - BEMIDJI, MINNESOTABEMIDJI IS LOCATED IN BELTRAMI COUNTY, MINNESOTA. BEMIDJI HOUSES MANY NATIVE AMERICAN SERVICES, INCLUDING THE INDIAN HEALTH SERVICE. THE CITY IS THE CENTRAL HUB OF THE RED LAKE INDIAN RESERVATION, WHITE EARTH INDIAN RESERVATION, AND THE LEECH LAKE INDIAN RESERVATION. ACCORDING TO THE 2021 UNITED STATES CENSUS ESTIMATES, THE POPULATION OF BEMIDJI IS 15,279. ACCORDING TO THE 2021 COUNTY HEALTH RANKINGS, THE POPULATION OF BELTRAMI COUNTY IS 71.9% WHITE, 0.7% AFRICAN AMERICAN, 22% AMERICAN INDIAN, 0.8% ASIAN AND 2.5% HISPANIC. 0% OF THE POPULATION IS REPORTED TO BE NOT PROFICIENT IN ENGLISH. THE MEDIAN HOUSEHOLD INCOME IS $58,100.SANFORD BISMARCK MEDICAL CENTER - BISMARCK, NORTH DAKOTABISMARCK IS A CITY LOCATED IN BURLEIGH COUNTY IN CENTRAL NORTH DAKOTA. BISMARCK IS EXPERIENCING FAST-PACED GROWTH AS A DIRECT RESULT OF OIL DEVELOPMENT THROUGHOUT THE WESTERN PART OF THE STATE. BISMARCK IS THE STATE CAPITAL AND IS THE SECOND LARGEST CITY IN THE STATE OF NORTH DAKOTA WITH AN ESTIMATED POPULATION OF 74,138. ACCORDING TO THE 2021 COUNTY HEALTH RANKINGS, THE POPULATION OF BURLEIGH COUNTY IS 88.2% WHITE, 2.2 AFRICAN AMERICAN, 4.5% AMERICAN INDIAN, 0.9% ASIAN AND 2.7% HISPANIC. 0% OF THE POPULATION IS REPORTED TO BE NOT PROFICIENT IN ENGLISH. THE MEDIAN HOUSEHOLD INCOME IS $72,200.SANFORD NETWORK HOSPITALSSANFORD HEALTH NETWORK HOSPITALS IS A NETWORK OF RURAL HOSPITALS LOCATED THROUGHOUT SOUTH DAKOTA, NORTH DAKOTA, AND MINNESOTA.SANFORD CLINICSSANFORD CLINIC IS A MULTI-SPECIALTY CLINIC COMPRISED OF APPROXIMATELY 1,500 PHYSICIANS PROVIDING SERVICES IN THE US AS WELL AS INTERNATIONALLY.

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SANFORD HEALTH, IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS, WITHIN THE LOCAL COMMUNITY AND ACROSS SANFORD'S CARE DELIVERY FOOTPRINT, DEVELOPED A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. THE CHNA WAS CONDUCTED FROM DECEMBER 2020 THROUGH DECEMBER 2021, INCLUDING THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR 2022-2024. A FULL LIST OF SYSTEM AND LOCAL PARTNERS IS AVAILABLE WITHIN THE RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.MEMBERS OF THE FOLLOWING ORGANIZATIONS CONTRIBUTED THEIR EXPERTISE WITH THE PLANNING, DEVELOPMENT AND ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE SYSTEM LEVEL, PROVIDING ADVICE ON THE CHNA PROCESS AND METHODOLOGY AND PARTICIPATING IN THE LOCAL PROCESS BASED UPON THEIR LOCATION. THE LIST BELOW DOES NOT REPRESENT THE FULL PARTICIPANT LIST AND A FULL LISTING OF THE COMMUNITY STAKEHOLDERS AND COMMUNITY LEADERSHIP MEMBERS INVOLVED WITH INDIVIDUAL HOSPITALS CAN BE FOUND IN EACH PUBLISHED CHNA.NORTHERN DENTAL ACCESS CENTER SOUTHWEST HEALTH AND HUMAN SERVICES BELTRAMI COUNTY PUBLIC HEALTH SIOUX FALLS DEPARTMENT OF HEALTH BURLEIGH PUBLIC HEALTHNORTH DAKOTA PUBLIC HEALTH ASSOCIATION MINNESOTA DEPARTMENT OF HEALTH SOUTHWEST HEALTH AND HUMAN SERVICES AVERA HEALTH OTTERTAIL PUBLIC HEALTH ESSENTIA HEALTH BELTRAMI COUNTY HEALTH AND HUMAN SERVICES CHI ST. ALEXIUS HEALTH NORTH DAKOTA STATE UNIVERSITY CENTER FOR SOCIAL RESEARCH LIMITATIONSTHE FINDINGS IN THIS STUDY PROVIDE AN OVERALL SNAPSHOT OF BEHAVIORS, ATTITUDES, AND PERCEPTIONS OF RESIDENTS LIVING IN THE COMMUNITY. A GOOD FAITH EFFORT WAS MADE TO SECURE INPUT FROM A BROAD BASE OF THE COMMUNITY. HOWEVER, GAPS IN INDIVIDUAL DATA SOURCES MAY ARISE WHEN COMPARING CERTAIN DEMOGRAPHIC CHARACTERISTICS (I.E., AGE, GENDER, INCOME, MINORITY STATUS) WITH THE CURRENT POPULATION ESTIMATES. FOR EXAMPLE, THESE GAPS MAY OCCUR DUE TO THE DIFFICULTY IN REACHING THEM THROUGH THE SURVEY PROCESS. TO MITIGATE LIMITATIONS, THE CHNA EVALUATES COMMUNITY HEALTH FROM SEVERAL PERSPECTIVES; A STAKEHOLDER AND COMMUNITY SURVEY, MEETINGS WITH COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATIONS, SECONDARY DATA SOURCES SUCH AS THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS, PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY SANFORD EMPLOYEES LOCALLY AND ACROSS THE SANFORD ENTERPRISE. COMMUNITY AND STAKEHOLDER SURVEY MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS ACROSS THE SANFORD FOOTPRINT TO UNDERSTAND THE NEEDS OF THE COMMUNITY BASED UPON THE UW POPULATION HEALTH MODEL. EACH RESPONDENT WAS ASKED TO RATE COMMUNITY DRIVERS FROM POOR TO EXCELLENT. ANY RESPONSE OTHER THAN EXCELLENT WAS OFFERED A FOLLOW UP OPPORTUNITY TO COMMENT ON THE REASON. RESPONDENTS WERE ALSO ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO SAMPLE POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR. TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS WITH MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. STAKEHOLDERS WERE ASKED TO COMPLETE THE INSTRUMENT AS A RESIDENT OF THE COMMUNITY AND FORWARD THE SURVEY TO THEIR RESPECTIVE POPULATIONS FOR GREATER INVOLVEMENT. THE SURVEY WAS HIGHLIGHTED IN A SANFORD HEALTH NEWS ARTICLE (HTTPS://NEWS.SANFORDHEALTH.ORG/COMMUNITY/HEALTH-NEEDS-ASSESSMENT-SURVEY/) AND PROMOTED THROUGH SOCIAL MEDIA VIA PAID COMMUNICATIONS. THE PAID COMMUNICATIONS YIELDED 344,300 IMPRESSIONS AND 1,150 COMPLETED SURVEYS ACROSS THE SYSTEM.SURVEY DATA FOR THE LOCAL COMMUNITY SHOULD BE CONSIDERED DIRECTIONAL AND BEST UTILIZED IN CONJUNCTION WITH ADDITIONAL DATA. NEARLY 7,000 RESPONDENTS FROM ACROSS THE ENTIRE SANFORD FOOTPRINT COMPLETED THE SURVEY.SECONDARY DATACOUNTY HEALTH RANKINGS ARE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. ALIGNMENT OF THE SURVEY AND SECONDARY DATA WITHIN THE UW POPULATION HEALTH MODEL ALLOWS FOR GREATER CONNECTION OF THE DATA SETS. POPULATION DATA ARE SOURCED TO THE U.S. CENSUS BUREAU. ADDITIONAL DATA SOURCES MAY BE USED AND ARE SOURCED WITHIN THE DOCUMENT.HEALTH NEEDS IDENTIFICATION METHODOLOGYTHE CENTER FOR SOCIAL RESEARCH AT NORTH DAKOTA STATE UNIVERSITY WAS RETAINED TO DEVELOP THE INITIAL COMMUNITY HEALTH NEEDS LIST FOR EACH COMMUNITY WHICH BUILDS UPON THEIR INVOLVEMENT DURING THE PREVIOUS CYCLE. THE FOLLOWING METHODOLOGY WAS USED TO DEVELOP THE SIGNIFICANT HEALTH NEEDS PRESENTED LATER IN THE REPORT:SURVEY DATA WAS STRATIFIED INTO REPRESENTATIVE GROUPS BASED UPON POPULATION: LARGE URBAN COMMUNITIES, MEDIUM SIZED COMMUNITIES, AND RURAL COMMUNITIES. THE THREE GROUPS WERE ANALYZED SEPARATELY. TO IDENTIFY COMMUNITY HEALTH CARE NEEDS, EACH COMMUNITY'S SCORE BY QUESTION WAS COMPARED TO THE AVERAGE STRATIFIED COMPOSITE OF THE COMPARATIVE GROUP. FOR EXAMPLE, IF THE COMPOSITE STRATIFIED SYSTEM-WIDE AVERAGE SCORE IS 4 AND AN INDIVIDUAL COMMUNITY'S AVERAGE RESPONSE WAS 2.5, THAT WOULD SUGGEST AN ISSUE OF CONCERN AND A POTENTIAL COMMUNITY HEALTH CARE NEED TO BE HIGHLIGHTED IN THE SUMMARY FINDINGS. UPON DETERMINATION OF A POTENTIAL STRENGTH OR NEED, COUNTY HEALTH RANKINGS (HTTPS://WWW.COUNTYHEALTHRANKINGS.ORG/) AND RESPONSES FROM OPEN-ENDED QUESTIONS PROVIDED ADDITIONAL INSIGHTS INTO THE DRIVERS OF THE RESPECTIVE NEEDS.A SIMILAR METHODOLOGY WAS ALSO USED TO PROVIDE ADDITIONAL INSIGHTS INTO FINDINGS FROM COUNTY HEALTH RANKINGS DATA WITH RELEVANT HEALTH NEEDS HIGHLIGHTED IN THE SURVEY FINDINGS. HEALTH NEEDS IDENTIFIED THROUGH EITHER THE SURVEY OR COUNTY HEALTH RANKINGS DATA BUT NOT BOTH WERE ALSO INCLUDED IN THE FINDINGS.COMMUNITY ASSET MAPPINGASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE ASSESSED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS.COMMUNITY LISTENING SESSIONS AND INTERVIEWSCOMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. FACILITATED DISCUSSION COMMENCED AFTER THE PRESENTATION, AND EACH PARTICIPANT WAS ASKED TO CONSIDER THE NEEDS THAT SHOULD BE FURTHER DEVELOPED INTO IMPLEMENTATION STRATEGIES. HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS CYCLE BUT NOT RAISED THROUGH THE SURVEY OR COUNTY HEALTH RANKINGS WERE ALSO CONSIDERED. THE MEETING SERVED TO INFORM THE GROUP OF THE FINDINGS BUT ALSO SERVED AS A CATALYST TO DRIVE COLLABORATION. THE FACILITATED DISCUSSION SOUGHT TO INFORM ON SEVERAL ASPECTS:WHAT ARE THE BIGGEST CHALLENGES CURRENTLY WITH THESE NEEDS IN THE COMMUNITY? DOES THE COMMUNITY HAVE GAPS IN SERVICES, ACCESS, OUTREACH, ETC.? WHERE CAN WE HAVE GREATEST IMPACT IN ADDRESSING THESE NEEDS? WHICH ARE MOST URGENT IN NATURE?IS THERE ANY WORK CURRENTLY BEING DONE ON THESE NEEDS?ARE THERE UNDERUTILIZED COMMUNITY RESOURCES THAT COULD ADDRESS THIS TOPIC?WHICH FALL WITHIN THE PURVIEW OF HEALTHCARE SYSTEM AND WHICH DO NOT?CAN THE NON-HEALTHCARE NEEDS BE SHARED WITH OTHER ENTITIES?IS THERE ANYTHING YOU CONSIDER AN URGENT NEED THAT WE HAVE NOT DISCUSSED?COMMUNITY STAKEHOLDERS HELPED TO DETERMINE KEY PRIORITIES FOR 2022-2024 FOR THEIR RESPECTIVE COMMUNITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE AVAILABLE ONLINE AT HTTPS://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. PUBLIC COMMENTS AND QUESTIONS ARE WELCOME THROUGH THE SITE.

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SANFORD HEALTH IS AN INTEGRATED HEALTH SYSTEM HEADQUARTERED IN THE DAKOTAS. IT IS ONE OF THE LARGEST HEALTH SYSTEMS IN THE NATION WITH 24 HOSPITALS AND NEARLY 450 CLINICS IN NINE STATES AND THREE COUNTRIES. SANFORD HEALTH'S 36,000 EMPLOYEES, INCLUDING 1,500 PHYSICIANS, MAKE IT THE LARGEST EMPLOYER IN THE DAKOTAS.SANFORD HEALTH PROVIDES SERVICES AT EVERY LEVEL FROM CRITICAL ACCESS HOSPITALS TO TERTIARY AND QUATERNARY CARE. THE SANFORD FOOTPRINT INCLUDES OVER 220,000 SQUARE MILES WITH A NINE STATE SERVICE AREA AND A NETWORK OF CHILDREN'S PRIMARY CARE CLINIC LOCATIONS ACROSS THE COUNTRY AND WORLD. SANFORD HEALTH OPERATES FULL-TIME EMERGENCY CENTERS AND PROVIDES EMERGENCY CARE TO EVERYONE REGARDLESS OF THEIR ABILITY TO PAY. SANFORD FACILITIES AND CLINICS PROVIDE SERVICES TO REMOTE AND MEDICALLY UNDERSERVED AREAS THAT WOULD OTHERWISE NOT HAVE ACCESS TO EVEN PRIMARY CARE SERVICES. SANFORD HEALTH FINANCIALLY SUPPORTS HEALTH AND WELLNESS, EDUCATION AND COMMUNITY DEVELOPMENT ACTIVITIES TO IMPROVE THE QUALITY OF LIFE AND STRENGHTEN COMMUNITIES THROUGHOUT THE REGION. EACH FACILITY PROMOTES HEALTH AND HEALING THAT RESPONDS TO THE UNIQUE NEEDS OF THE PATIENTS IN THE COMMUNITY, ENSURING ACCESS TO COMPREHENSIVE AND SPECIALIZED SERVICES. PART VI, LINE 7: COMMUNITY BENEFIT REPORTING IS NOT REQUIRED AND THEREFORE NOT FILED IN NORTH DAKOTA, SOUTH DAKOTA, OR NEBRASKA. FILING IN MINNESOTA IS VOLUNTARY.