2024-05-08T08:08:13-05:00 2023-06-30 990 2022-07-01 411878730 SMDC MEDICAL CENTER SMDC 2187868364 502 E 2ND ST DULUTH MN 55805 KEVIN BOREN VICE PRESIDENT, FINANCE 2187868364 2024-05-08 KEVIN BOREN 999009999 1 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z ESSENTIA HEALTH DULUTH VICKI SCHEER 502 E 2ND ST DULUTH MN 55805 709070126 0 X WWW.ESSENTIAHEALTH.ORG X 1997 MN WE ARE CALLED TO MAKE A HEALTHY DIFFERENCE IN PEOPLE'S LIVES. 3 2 3085 190 1034296 352558 10901159 9530386 664879054 684912160 10920797 1258698 10642146 6052269 697343156 701753513 1054847 892633 0 0 371982684 393969252 0 0 0 284271130 316988819 657308661 711850704 40034495 -10097191 1095781940 1125848886 875639411 913306647 220142529 212542239 X WE ARE CALLED TO MAKE A HEALTHY DIFFERENCE IN PEOPLE'S LIVES. 0 0 664069673 892633 689099889 SMDC MEDICAL CENTER, DBA ESSENTIA HEALTH DULUTH, IS ORGANIZED AND OPERATED EXCLUSIVELY FOR CHARITABLE, SCIENTIFIC, AND EDUCATIONAL PURPOSES. IN FURTHERANCE OF ITS PURPOSES, ESSENTIA HEALTH DULUTH PROVIDES HEALTH CARE SERVICES IN MINNESOTA THROUGH ITS 165 BED HOSPITAL AND 8 MULTI-SPECIALTY CLINICS, INCLUDING CHARITABLE CARE TO PERSONS UNABLE TO PAY.THE HOSPITAL AND CLINICS OFFER A BROAD RANGE OF INPATIENT AND OUTPATIENT SERVICES FOR ITS PATIENTS, INCLUDING MEDICAL SURGICAL CARE, BEHAVIORAL HEALTH, REHABILITATION, ORTHOPEDICS, NEUROSCIENCE, DIGESTIVE HEALTH, BURN TREATMENT, FAMILY AND PEDIATRICS SERVICES, AND HEART AND VASCULAR SERVICES. IN ADDITION TO THE HOSPITAL AND CLINICS, ESSENTIA HEALTH DULUTH ALSO OPERATES OPTICAL CENTERS, INFUSION THERAPY CENTERS, OUTPATIENT SURGERY CENTERS, AND A CANCER CENTER. THROUGH AMBERWING CENTER FOR YOUTH & FAMILY WELL-BEING, ESSENTIA HEALTH DULUTH PROVIDES MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES TO CHILDREN, ADOLESCENTS, YOUNG ADULTS AND THEIR FAMILIES.ESSENTIA HEALTH DULUTH EMPLOYS 1,865 FULL TIME EQUIVALENTS. THE HOSPITAL PROVIDED APPROXIMATELY 32,000 HOSPITAL PATIENT DAYS AND 43,000 OUTPATIENT VISITS DURING THE FISCAL YEAR ENDED JUNE 30, 2023. THE CLINICS HAD NEARLY 581,000 ENCOUNTERS DURING THE SAME TIME PERIOD.DURING THE FISCAL YEAR ENDED JUNE 30, 2023, ESSENTIA HEALTH DULUTH PROVIDED THE FOLLOWING COMMUNITY BENEFITS: $1.3 MILLION IN CHARITY CARE, $37.8 MILLION COSTS IN EXCESS OF MEDICAID PAYMENTS, $747,000 IN COMMUNITY SERVICES, AND $435,000 IN HEALTH PROFESSION EDUCATION.ESSENTIA HEALTH DULUTH IS THE SOLE MEMBER OF ESSENTIA HEALTH VIRGINIA, LLC DBA ESSENTIA HEALTH VIRGINIA. ESSENTIA HEALTH VIRGINIA IS ORGANIZED EXCLUSIVELY FOR CHARITABLE PURPOSES. ESSENTIA HEALTH VIRGINIA HAS A 83-BED HOSPITAL AND SIX CLINICS SERVING NORTHEASTERN MINNESOTA. ESSENTIA HEALTH VIRGINIA OFFERS EMERGENCY CARE 24 HOURS A DAY, SEVEN DAYS A WEEK. IT IS A LEVEL IV TRAUMA CENTER AND A STROKE READY HOSPITAL. THE HOSPITAL OFFERS 24/7 SURGICAL SERVICES, OBSTETRICS AND BIRTHING SERVICES, INTENSIVE CARE, URGENT CARE, AND REHABILITATION SERVICES.ESSENTIA HEALTH VIRGINIA HAS A 77-BED SKILLED NURSING FACILITY WITHIN ITS MEDICAL CAMPUS ALLOWING RESIDENTS AND THEIR FAMILIES EASY ACCESS TO A FULL RANGE OF HOSPITAL, CLINIC, AND OTHER RELATED SERVICES.ESSENTIA HEALTH VIRGINIA EMPLOYS 480 FULL TIME EQUIVALENTS. THE HOSPITAL PROVIDED APPROXIMATELY 7,000 PATIENT DAYS AND 58,000 OUTPATIENT VISITS DURING THE FISCAL YEAR ENDED JUNE 30, 2023. THE CLINIC HAD NEARLY 126,000 ENCOUNTERS AND THE SKILLED NURSING FACILITY PROVIDED 11,000 RESIDENT DAYS DURING THE SAME TIME PERIOD.DURING THE FISCAL YEAR ENDED JUNE 30, 2023, ESSENTIA HEALTH VIRGINIA PROVIDED THE FOLLOWING COMMUNITY BENEFITS: $580,000 IN CHARITY CARE, $8.1 MILLION COSTS IN EXCESS OF MEDICAID PAYMENTS, $74,000 IN COMMUNITY SERVICES, AND $162,000 IN HEALTH PROFESSION EDUCATION. 664069673 1 1 0 1 0 0 0 0 1 1 1 0 0 0 1 0 0 1 0 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 1 0 0 1 X 0 0 3085 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 3 2 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 MN X KEVIN BOREN 2187868364 502 E 2ND ST DULUTH MN 55805 JON PRYOR MD PRESIDENT - EAST 1.00 59.00 X 1131335 0 37830 BRADLEY BEARD CHIEF OPERATING OFFICER 1.00 59.00 X 932410 0 137485 ANNE STEPHEN MD CHIEF MEDICAL OFFICER 1.00 59.00 X 876444 0 107371 DANIEL NIKCEVICH MD BOARD DIRECTOR 1.00 59.00 X 0 908427 58140 JANICE SCHADE SENIOR VICE PRESIDENT, OPERATIONS 1.00 59.00 X 541628 0 88128 RHONDA KAZIK CHIEF NURSING OFFICER 1.00 59.00 X 538327 0 90800 KEVIN BOREN VICE PRESIDENT, FINANCE 1.00 59.00 X 528452 0 89011 KRISTA SKORUPA MD REGIONAL PRACTICES CHAIR 1.00 59.00 X 533408 0 69831 TAMMY KRITZER SENIOR VICE PRESIDENT, OPERATIONS 1.00 59.00 X 468127 0 65835 SAMUEL STONE ADMINISTRATIOR - VIRGINIA 60.00 0.00 X 287112 0 53919 BETH MOLDEN REGISTERED NURSE 60.00 0.00 X 281207 0 50906 ERIK JULSRUD MEDICAL PHYSICS MANAGER 60.00 0.00 X 255695 0 53117 VICKI SCHEER ADMINISTRATOR 60.00 0.00 X 192251 0 50061 CYNTHIA KENT FORMER SNR VP, NURSING EXCELLENCE 0.00 0.00 X 222503 0 7863 JOSEPH MIHALEK BOARD CHAIR 2.00 12.00 X X 0 8800 0 THOMAS RENIER BOARD VICE CHAIR THRU 12/22 2.00 12.00 X X 0 8600 0 RENEE WACHTER BOARD VICE CHAIR 2.00 12.00 X X 0 6400 0 6788899 932227 960297 324 1 1 0 0 98979 8655861 775546 2035 9530386 INPATIENT AND OUTPATIENT REVENUES 621110 680837089 680221695 615394 SKILLED NURSING FACILITY 623000 4075071 4075071 684912160 1124268 1124268 125266 0 125266 125266 125266 7074090 156520 7002330 93850 71760 62670 134430 134430 2614 2415 199 199 681733 218018 463715 413562 50153 MSA REVENUE-DULUTH FAMILY PRACTIC 541900 4187729 4187729 CAFETERIA REVENUE 722514 996518 996518 PARKING REVENUE 812930 167852 167852 110990 5340 105650 5463089 701753513 688484495 1034296 2704336 X 889469 889469 3164 3164 5758391 883548 4874843 66364 66364 322794884 305293329 17501555 14976979 13806909 1170070 31451734 28907365 2544369 18920900 17667599 1253301 4564 4564 14766 14766 131544 131544 54058795 42133568 11925227 431530 319815 111715 15474335 7860370 7613965 35721521 33854554 1866967 15140064 14305102 834962 2437214 2146006 291208 343897 197753 146144 -7186 -7186 21805330 20629276 1176054 6475717 6388000 87717 UNRELATED BUSINESS INCO 81789 81789 MEDICAL SUPPLIES 94169207 94169207 AFFILIATE SUPPORT FEE 76167689 36964180 39203509 BAD DEBT EXPENSE 17083574 17083574 -22545531 20574071 -43119602 711850704 664069673 47781031 0 304732 226177 21827217 2452434 89328665 83590386 1458055 2528055 19605081 20717393 12112635 16053553 1251187618 284289363 773432149 966898255 83956004 2447955 81434978 4338359 924994 824986 11397430 25771333 1095781940 1125848886 90997595 82820781 70780 9000 676239175 674767897 17153 15627 1462808 2171807 106851900 153521535 875639411 913306647 X 219856097 211754555 286432 787684 220142529 212542239 1095781940 1125848886 X -10097191 2055967 440934 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 14766 14766 0 PART II-B, LINE 1: LOBBYING ACTIVITY EXPLANATION: ESSENTIA HEALTH DULUTH PAYS DUES TO CERTAIN ORGANIZATIONS RELATED TO THE INDUSTRY WHICH HAVE LOBBYING EXPENSES. THE AMOUNT LISTED IS THE PERCENTAGE OF THE DUES PAID THAT WERE USED FOR LOBBYING. 0 1 X 34000 34000 34000 34000 34000 34000 34000 34000 34000 34000 0.00000 1.00000 0.00000 0 0 7429185 7429185 202941591 114122298 88819293 4307624 3219057 1088567 209391059 162162746 47228313 827118159 4785262 822332897 966898255 PAYABLES TO RELATED TAX-EXEMPT ORGANIZATIONS 139141494 OPERATING LEASES 9728563 ASSET RETIREMENT OBLIGATION FIN 47 3187162 POST RETIREMENT BENEFIT - NON PENSION 955711 DEFINED BENEFIT PENSION LIABILITY 372294 POST RETIREMENT BENEFIT - HEALTH 136311 153521535 PART IV, LINE 2B: ESSENTIA HEALTH VIRGINIA ACTS AS CUSTODIAN FOR THE FUNDS OF THE SKILLED NURSING FACILITY RESIDENTS. RESIDENT TRUST FUNDS TOTALED $15,627 AT JUNE 30, 2023. PART V, LINE 4: THE ENDOWMENT FUND IS A PERMANENTLY RESTRICTED FUND USED TO ESTABLISH THE MILLER MEMORIAL HOSPITAL. NORTH AMERICA 0 0 SEND AGENTS TO SEMINAR 19120 0 0 0 0 0 0 19120 0 19120 0 0 0 0 0 0 PART III ACCOUNTING METHOD: 1 1 X 1 X 0 1 1 0 1 1 1865176 1865176 0.00270 120556842 74706717 45850125 0.06600 122422018 74706717 47715301 0.06870 820886 820886 0.00120 887896 290550 597346 0.00090 1708782 290550 1418232 0.00210 124130800 74997267 49133533 0.07080 143000 143000 0.00020 141164 141164 0.00020 284164 284164 0.00040 1 17083574 97810216 151782289 -53972073 X 1 1 2 1 ESSENTIA HEALTH DULUTH 502 E 2ND ST DULUTH MN 55805 WWW.ESSENTIAHEALTH.ORG 410322 X X X 2 ESSENTIA HEALTH VIRGINIA 901 9TH ST N VIRGINIA MN 55792 WWW.ESSENTIAHEALTH.ORG 410779 X X X X ESSENTIA HEALTH DULUTH 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X WWW.ESSENTIAHEALTH.ORG/ABOUT/CHNA/ X SEE PART V, PAGE 8 X 1 21 1 WWW.ESSENTIAHEALTH.ORG/ABOUT/CHNA/ 0 1 X 200.000000000000 X X X X X 1 1 X X X X 1 X WWW.ESSENTIAHEALTH.ORG/PATIENTS-VISITORS/BILLING/FINANCIAL-ASSISTANCE X WWW.ESSENTIAHEALTH.ORG/PATIENTS-VISITORS/BILLING/FINANCIAL-ASSISTANCE X WWW.ESSENTIAHEALTH.ORG/PATIENTS-VISITORS/BILLING/FINANCIAL-ASSISTANCE X X X X X 1 X 0 X X X X 1 X 0 0 ESSENTIA HEALTH VIRGINIA 2 0 0 1 X X X X X X X X X 21 1 1 1 1 X WWW.ESSENTIAHEALTH.ORG/ABOUT/CHNA/ X 1 21 1 WWW.ESSENTIAHEALTH.ORG/ABOUT/CHNA/ 0 1 X 200.000000000000 X X X X X 1 1 X X X X 1 X WWW.ESSENTIAHEALTH.ORG/PATIENTS-VISITORS/BILLING/FINANCIAL-ASSISTANCE X WWW.ESSENTIAHEALTH.ORG/PATIENTS-VISITORS/BILLING/FINANCIAL-ASSISTANCE X WWW.ESSENTIAHEALTH.ORG/PATIENTS-VISITORS/BILLING/FINANCIAL-ASSISTANCE X X X X X 1 X 0 X X X X 1 X 0 0 ESSENTIA HEALTH DULUTH PART V, SECTION B, LINE 5: ESSENTIA HEALTH DULUTH AND ESSENTIA HEALTH ST. MARY'S MEDICAL CENTER SOLICITED BROAD FEEDBACK FROM THE COMMUNITY THROUGH A COMMUNITY SURVEY AND A VIRTUAL MEETING OF COMMUNITY STAKEHOLDERS; THE SURVEY WAS ADMINISTERED 9/16/2021 TO 11/5/2021, AND THE VIRTUAL MEETING OF COMMUNITY STAKEHOLDERS WAS HELD ON 10/27/2021. THE SURVEY COLLECTED 340 RESPONSES, AND 92 PEOPLE REPRESENTING 41 COMMUNITY ORGANIZATIONS PARTICIPATED IN THE VIRTUAL MEETING.THROUGHOUT THE PROCESS, A HEAVY EMPHASIS WAS PLACED ON CONSIDERING THE INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY, SPECIFICALLY INDIVIDUALS FROM LOW-INCOME, MEDICALLY UNDERSERVED, OR MINORITY POPULATIONS AND THOSE WITH A SPECIAL KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH.THE BRIDGING HEALTH DULUTH STEERING COMMITTEE, WHICH GUIDED THE PROCESS, INCLUDED REPRESENTATION FROM ST. LUKE'S HOSPITAL, ST. LOUIS COUNTY PUBLIC HEALTH AND HUMAN SERVICES, GENERATIONS HEALTH CARE INITIATIVES, LAKE SUPERIOR COMMUNITY HEALTH CENTER, WILDERNESS HEALTH, NATIONAL RURAL HEALTH RESOURCE CENTER, ZEITGEIST CENTER FOR ARTS & COMMUNITY, DULUTH BRANCH NAACP, AND HEALTH EQUITY NORTHLAND.ESSENTIA HEALTH DULUTH, ESSENTIA HEALTH ST. MARY'S MEDICAL CENTER, AND ST. LUKE'S HOSPITAL DID NOT RECEIVE ANY COMMENTS ON ITS PREVIOUS CHNA. IF RECEIVED, ANY COMMENTS WOULD HAVE BEEN TAKEN INTO CONSIDERATION IN THE CHNA UPDATE PROCESS. ESSENTIA HEALTH VIRGINIA PART V, SECTION B, LINE 5: ESSENTIA HEALTH VIRGINIA SOLICITED BROAD FEEDBACK FROM THE COMMUNITY THROUGH FOCUS GROUPS AND A COMMUNITY SURVEY; THE FOCUS GROUPS WERE CONDUCTED IN FALL 2021, AND THE SURVEY WAS ADMINISTERED 11/16/2021 TO 1/24/2022. THROUGHOUT THE PROCESS, A HEAVY EMPHASIS WAS PLACED ON CONSIDERING THE INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY, SPECIFICALLY INDIVIDUALS FROM LOW-INCOME, MEDICALLY UNDERSERVED, OR MINORITY POPULATIONS AND THOSE WITH A SPECIAL KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH.FOCUS GROUP PARTICIPANTS, WHICH TOTALED 98 PEOPLE IN SIX GROUPS, INCLUDED STUDENTS FROM ROCK RIDGE SCHOOLS AND MESABI EAST SCHOOLS, AND MEMBERS OF THE BOIS FORTE BAND OF CHIPPEWA. 105 COMMUNITY MEMBERS OF ALL AGE GROUPS PARTICIPATED IN THE COMMUNITY SURVEY.THE STEERING COMMITTEE, WHICH GUIDED THE PROCESS, INCLUDED REPRESENTATION FROM FAIRVIEW RANGE MEDICAL CENTER, ST. LOUIS COUNTY PUBLIC HEALTH AND HUMAN SERVICES, KOOCHICHING COUNTY PUBLIC HEALTH AND HUMAN SERVICES, UNIVERSITY OF MINNESOTA EXTENSION, CITY OF VIRGINIA, ARROWHEAD ECONOMIC OPPORTUNITY AGENCY, RANGE MENTAL HEALTH, ARROWHEAD AREA AGENCY ON AGING, AND NORTH ST. LOUIS COUNTY SOIL AND WATER CONSERVATION DISTRICT.ESSENTIA HEALTH VIRGINIA DID NOT RECEIVE ANY COMMENTS ON ITS PREVIOUS CHNA. IF RECEIVED, ANY COMMENTS WOULD HAVE BEEN TAKEN INTO CONSIDERATION IN THE CHNA UPDATE PROCESS. ESSENTIA HEALTH DULUTH PART V, SECTION B, LINE 6A: TO ALIGN RESOURCES AND STRENGTHS TO BETTER SERVE OUR COMMUNITY, THE CHNA WAS CONDUCTED IN COLLABORATION WITH ESSENTIA HEALTH ST. MARY'S MEDICAL CENTER (A RELATED HOSPITAL FACILITY) AND ST. LUKE'S HOSPITAL (AN UNRELATED HOSPITAL FACILITY). ESSENTIA HEALTH VIRGINIA PART V, SECTION B, LINE 6A: TO ALIGN RESOURCES AND STRENGTHS TO BETTER SERVE OUR COMMUNITY, THE CHNA WAS CONDUCTED IN COLLABORATION WITH FAIRVIEW RANGE, AN UNRELATED HOSPITAL LOCATED IN HIBBING, MN. ESSENTIA HEALTH DULUTH PART V, SECTION B, LINE 6B: ESSENTIA HEALTH DULUTH WORKED COLLABORATIVELY ON THE ASSESSMENT PROCESS WITH DULUTH BRANCH NAACP, GENERATIONS HEALTHCARE INITIATIVES, LAKE SUPERIOR COMMUNITY HEALTH CENTER, NATIONAL RURAL HEALTH RESOURCE CENTER, ST. LOUIS COUNTY PUBLIC HEALTH, WILDERNESS HEALTH, HEALTH EQUITY NORTHLAND, ZEITGEIST CENTER FOR ARTS & COMMUNITY, AMERICAN INDIAN COMMUNITY HOUSING ORGANIZATION, ARROWHEAD AREA AGENCY ON AGING, DULUTH COMMUNITY SCHOOLS COLLABORATIVE, FAMILY RISE TOGETHER, HEALTHY HILLSIDE, FIRST LADIES OF THE HILLSIDE, LINCOLN PARK CHILDREN AND FAMILIES COLLABORATIVE, RECOVERY ALLIANCE DULUTH, UNIVERSITY OF MINNESOTA-DULUTH, UNIVERSITY OF MINNESOTA EXTENSION, DULUTH FARM TO SCHOOL, CHUM, SECOND HARVEST NORTHERN LAKES FOOD BANK, COMMUNITY ACTION DULUTH, LINCOLN PARK MIDDLE SCHOOL, UNIVERSITY OF MINNESOTA-DULUTH LAND LAB, ECOLIBRIUM3, FOND DU LAC, DULUTH HOUSING AND REDEVELOPMENT AUTHORITY, LIFE HOUSE, CENTER FOR ALCOHOL AND DRUG TREATMENT, STEVE O'NEIL APARTMENTS, ONE ROOF COMMUNITY HOUSING, AND DULUTH COMMUNITY GARDEN PROGRAM. ESSENTIA HEALTH VIRGINIA PART V, SECTION B, LINE 6B: ESSENTIA HEALTH VIRGINIA WORKED COLLABORATIVELY ON THE ASSESSMENT PROCESS WITH ST. LOUIS COUNTY PUBLIC HEALTH, KOOCHICHING COUNTY PUBLIC HEALTH, UNIVERSITY OF MINNESOTA EXTENSION, VIRGINIA POLICE DEPARTMENT, THE CITY OF VIRGINIA, ARROWHEAD ECONOMIC OPPORTUNITY AGENCY/RUTABAGA PROJECT, RANGE MENTAL HEALTH, ARROWHEAD AREA AGENCY ON AGING, NORTH ST. LOUIS COUNTY SOIL AND WATER CONSERVATION DISTRICT, VIRGINIA FIRE DEPARTMENT, ROCK RIDGE PUBLIC SCHOOL, MESABI EAST PUBLIC SCHOOL, AND BOIS FORTE BAND. ESSENTIA HEALTH DULUTH PART V, SECTION B, LINE 11: DURING FY 2023, ESSENTIA HEALTH DULUTH AND ESSENTIA HEALTH ST. MARY'S MEDICAL CENTER ADDRESSED SIGNIFICANT NEEDS IDENTIFIED IN THE FY 2022 ASSESSMENT: SUBSTANCE USE, MENTAL AND SOCIAL WELL-BEING, FOOD SECURITY, AND HOUSING. THEY HAVE APPROACHED THESE NEEDS COLLABORATIVELY AS A MEMBER OF BRIDGING HEALTH DULUTH (BHD), A COALITION THAT COMBINES RESOURCES, SKILLS, AND EXPERTISE TO IMPROVE THE HEALTH OF ALL PEOPLE IN DULUTH.OTHER HEALTH NEEDS IDENTIFIED IN THE CHNA PROCESS INCLUDE ECONOMIC OPPORTUNITY, CHRONIC CONDITIONS, AND HEALTHCARE ACCESS. THESE NEEDS WILL BE ADDRESSED IN PART THROUGH SELECTED PRIORITIES AS THEY ARE INTERRELATED, AND ARE ALSO BEING ADDRESSED THROUGH COMMUNITY INITIATIVES OUTSIDE OF BRIDGING HEALTH DULUTH.THE FOLLOWING DESCRIBES SIGNIFICANT ACCOMPLISHMENTS AND OUTCOMES.PRIORITY AREA #1: SUBSTANCE USETO RESPOND TO SUBSTANCE USE NEEDS, ESSENTIA HEALTH COLLABORATED WITH TWO ORGANIZATIONS. ESSENTIA HEALTH PARTNERED WITH THE AMERICAN LUNG ASSOCIATION OF MINNESOTA TO UPDATE THE "DON'T BLOW IT: ANTI-VAPING CAMPAIGN" TOOLKIT, AN EXISTING RESOURCE DESIGNED FOR USE BY SECONDARY SCHOOL EDUCATORS IN A CLASSROOM SETTING. WITH A DESIRE TO ENHANCE THE EXISTING TOOLKIT WITH MORE DIVERSE VOICES, THE CAMPAIGN ASSETS WERE UPDATED SUCCESSFULLY AND WILL BE ROLLED OUT FOR THE 2023-24 ACADEMIC YEAR. ESSENTIA HEALTH ALSO PARTICIPATED AS A MEMBER OF THE HOUSING AND HOMELESSNESS COMMITTEE, A MULTI-DISCIPLINARY COALITION SERVING THE NEEDS OF PEOPLE BATTLING HOMELESSNESS IN DULUTH. THROUGH THIS PARTICIPATION, ESSENTIA HEALTH HELPED CREATE AND DISTRIBUTE 500 "WOUND CARE KITS" THROUGHOUT THE COMMUNITY TO EDUCATE ABOUT AND PREVENT INFECTION DUE TO SUBSTANCE USE.PRIORITY AREA #2: MENTAL AND SOCIAL WELL-BEINGTO PROMOTE MENTAL AND SOCIAL WELL-BEING, ESSENTIA HEALTH PARTNERED WITH SEVERAL ORGANIZATIONS. ON OCTOBER 23, 2022, ESSENTIA HEALTH WORKED ALONGSIDE FAMILY RISE TOGETHER TO BRING THE AFRICAN HERITAGE HUB HEALING SUMMIT TO DULUTH AUDIENCES. WITH A GOAL TO PURPOSELY BUILD A CULTURE OF GENERATIONAL SUCCESS FOR BLACK COMMUNITIES IN NORTHERN MINNESOTA, THE VIRTUAL EVENT ATTRACTED AND CONNECTED 50 PEOPLE. ESSENTIA HEALTH ALSO PARTNERED WITH THE BOYS AND GIRLS CLUBS OF THE NORTHLAND TO INTEGRATE MENTAL HEALTH SERVICES INTO ITS PROGRAMMING. THROUGH THE INTRODUCTION OF A MENTAL HEALTH TEAM AT THE BOYS AND GIRLS CLUBS, THE MENTAL HEALTH ACCESS PROGRAM BENEFITED 558 CLUB PARTICIPANTS THROUGHOUT THE YEAR. ESSENTIA HEALTH PARTNERED WITH CLOQUET SCHOOL DISTRICT TO SUPPORT SOCIAL EMOTIONAL LEARNING (SEL) CURRICULUM AT WASHINGTON ELEMENTARY SCHOOL. REACHING 496 STUDENTS WITH THE CURRICULUM, 100% OF STUDENTS IDENTIFIED UNDERSTANDING AND ABILITY TO USE CALMING/COPING MECHANISMS FOLLOWING THE EDUCATION. ESSENTIA HEALTH PARTNERED WITH NORTHERN EXPRESSIONS ARTS COLLECTIVE TO PROVIDE PROGRAMMING FOR YOUTH AND THEIR FAMILIES IN THE LINCOLN PARK NEIGHBORHOOD OF DULUTH. HELD AT HARRISON PARK COMMUNITY CENTER, THE WEEKLY PROGRAMS FACILITATED CONNECTIONS AMONG 75 REGULAR ATTENDEES WITH ACTIVITIES RANGING FROM HEALTHY COOKING CLASSES TO CAREER DEVELOPMENT PRESENTATIONS FROM COMMUNITY LEADERS. LOOKING TO ADDRESS SAFE ACCESS TO VITAL SERVICES AND SOCIAL OPPORTUNITIES, ESSENTIA HEALTH ALSO PROVIDED BIKE AND HELMET SAFETY EDUCATION THROUGHOUT THE ESSENTIA HEALTH-DULUTH SERVICE AREA. THROUGH SCHOOL CLASSROOM VISITS BY ESSENTIA HEALTH'S SAFE KIDS COALITION, 682 4TH GRADE STUDENTS ACROSS THE GREATER DULUTH AREA RECEIVED EDUCATION ABOUT SAFE BIKING AND HELMET USE.PRIORITY AREA #3: FOOD SECURITYTO SUPPORT FOOD ACCESS IN DULUTH, ESSENTIA HEALTH CONTINUED SOME LONG-TERM PARTNERSHIPS AND STARTED NEW RELATIONSHIPS. ESSENTIA HEALTH CONTINUED TO WORK ALONGSIDE COMMUNITY ACTION DULUTH (CAD) TO PROVIDE FRESH FOOD PROMOTION PROGRAMS AT ITS CENTRAL HILLSIDE FARMERS MARKET (HOSTED ON ESSENTIA HEALTH'S HOSPITAL CAMPUS), LINCOLN PARK FARMERS MARKET, AND THE CAD MOBILE MARKET. SPECIFICALLY PROVIDING FREE PRODUCE TO CHILDREN AND ELDERS THROUGH THE POWER OF PRODUCE (POP) PROGRAM AND MATCHING EBT DOLLARS THROUGH ITS MARKET BUCKS PROGRAM, CAD DISTRIBUTED $8,620 IN PRODUCE FOR THE POP PROGRAMS (2,155 UNIQUE MARKET VISITS) AND PROVIDED $16,626 IN MATCHING DOLLARS FOR EBT USERS (APPROXIMATELY 1,109 UNIQUE MARKET VISITS) AT THE 2022 MARKETS. ESSENTIA HEALTH ALSO PARTNERED WITH ST. LOUIS COUNTY TO DELIVER FARM TO SCHOOL PROGRAMMING IN THE DULUTH SCHOOL DISTRICT. THROUGH THIS PROGRAMMING, 1,400 POUNDS OF PRODUCE WERE HARVESTED FROM SCHOOL GARDENS, 1,125 KINDERGARTEN AND SECOND GRADE STUDENTS RECEIVED LESSONS ABOUT GARDENING AND NUTRITION, AND IN OCTOBER 2022, 6,000 STUDENTS PARTICIPATED IN THE GREAT LAKES APPLE CRUNCH. ESSENTIA HEALTH ALSO WORKED ALONGSIDE THE FIRST LADIES OF THE HILLSIDE TO LAUNCH "FOOD FORWARD," A SOCIAL ENTERPRISE PROJECT TO CONNECT DULUTH HILLSIDE RESIDENTS WITH NUTRITIOUS MEALS. THROUGH A PROGRAM WHERE LOW-INCOME WOMEN USE LOCALLY GROWN FOOD TO DEVELOP PARTIALLY PREPARED MEALS, FOOD FORWARD SERVED 33 LOW-INCOME FAMILIES (92 PEOPLE) PROVIDING A TOTAL OF OVER 2,000 MEALS AND 6,000 SNACKS THROUGHOUT THE YEAR. RESPONDING TO AN AREA WITH THE GREATEST FOOD ACCESS DISPARITIES, ESSENTIA HEALTH ALSO COLLABORATED WITH HEALTH EQUITY NORTHLAND ON DEVELOPING ST. MARK'S GIVING GARDEN, IN CONNECTION WITH ST. MARK AFRICAN METHODIST EPISCOPAL CHURCH. LOCATED IN DULUTH'S CENTRAL HILLSIDE NEIGHBORHOOD, THE COMMUNITY GARDEN HOSTED NUMEROUS PROGRAMS THROUGHOUT THE YEAR AND INSPIRED OUTREACH TO 10,325 PEOPLE WITH MESSAGES OF COMMUNITY AND NUTRITIOUS FOODS.PRIORITY AREA #4: HOUSINGTO ADDRESS HOUSING ISSUES IN DULUTH, ESSENTIA HEALTH WORKED ALONGSIDE NUMEROUS PARTNERS. RESPONDING TO THE NEEDS OF YOUNG OR EXPECTING MOTHERS WITHOUT STABLE HOUSING, ESSENTIA HEALTH PARTNERED WITH YWCA DULUTH IN SUPPORT OF ITS "YOUNG MOTHERS PROGRAM." PROVIDING CHILDCARE, CAREER READINESS TRAINING, AND PARENTING EDUCATION IN ADDITION TO TRANSITIONAL HOUSING, THE PROGRAM SERVED 66 PEOPLE DURING THE YEAR. 90% OF THE MOMS WHO PARTICIPATED TRANSITIONED INTO STABLE HOUSING AT THE END OF THE PROGRAM. ESSENTIA HEALTH PARTNERED WITH ANNIE'S HOUSE OF REFUGE AND RESTORATION TO PROVIDE HOUSING AND WRAPAROUND SERVICES TO YOUNG BIPOC MOTHERS. ALSO PROVIDING LIFE SKILLS EDUCATION AND TRANSPORTATION TO VITAL SERVICES, ANNIE'S HOUSE PROVIDED SERVICES TO 16 YOUNG MOTHERS. ESSENTIA HEALTH ALSO WORKED WITH FAMILY RISE TOGETHER TO PROVIDE MENTAL HEALTH AND HOUSING STABILIZATION SERVICES TO BIPOC COMMUNITIES IN DULUTH, RECOGNIZING A CONNECTION BETWEEN MENTAL ILLNESS AND CHRONIC HOMELESSNESS. ONCE THE PROGRAM ONBOARDED A MENTAL HEALTH PRACTITIONER, FAMILY RISE TOGETHER SERVED 60 PEOPLE WITH THESE SERVICES. IN ADDITION, ESSENTIA HEALTH WAS SELECTED TO PARTICIPATE IN THE GREATER MINNESOTA HOUSING FUND'S HEALTHCARE AND HOUSING FELLOWSHIP PROGRAM; A COHORT OF SIX ESSENTIA HEALTH LEADERS BEGAN WORK IN MARCH 2023 TO IDENTIFY HOW ESSENTIA HEALTH CAN LEVERAGE ITS RESOURCES TO RESPOND TO THE AREA'S HOUSING CRISIS. ESSENTIA HEALTH VIRGINIA PART V, SECTION B, LINE 11: DURING FY 2023, ESSENTIA HEALTH VIRGINIA ADDRESSED SIGNIFICANT NEEDS IDENTIFIED IN THE FY 2022 ASSESSMENT: SOCIAL CONNECTEDNESS AND ACCESS TO HEALTHY FOOD. SOME ACTIVITIES WERE LED BY THE HOSPITAL WHILE OTHERS WERE PART OF LARGER COLLABORATIVE EFFORTS WITH LOCAL PARTNERS.OTHER HEALTH NEEDS IDENTIFIED THROUGH THE CHNA PROCESS ARE INTERNET ACCESS AND TRANSPORTATION. TRANSPORTATION WILL BE ADDRESSED IN PART THROUGH SELECTED PRIORITIES AS THEY ARE INTERRELATED, WHILE INTERNET ACCESS IS BEING ADDRESSED BY OTHER PARTNERS. THE FOLLOWING DESCRIBES SIGNIFICANT ACCOMPLISHMENTS AND OUTCOMES.PRIORITY AREA #1: SOCIAL CONNECTEDNESS TO PROMOTE SOCIAL WELL-BEING, ESSENTIA HEALTH PARTNERED WITH NUMEROUS ORGANIZATIONS TO ENCOURAGE COMMUNITY BUILDING AND HEALTHY RELATIONSHIPS. IN THE REALM OF YOUTH SOCIAL CONNECTEDNESS, ESSENTIA HEALTH PARTNERED WITH THE BOYS AND GIRLS CLUBS OF THE NORTHLAND TO LAUNCH A BOYS AND GIRLS CLUB BRANCH IN HIBBING. WITH PROGRAMMING IN AREAS OF ACADEMIC SUCCESS, HEALTHY LIFESTYLES, AND GOOD CHARACTER AND CITIZENSHIP, THE BOYS AND GIRLS CLUB OF HIBBING ATTRACTED 107 PARTICIPANTS FROM AGES SIX THROUGH 18 IN ITS FIRST YEAR OF OPERATION. IN THE SCHOOLS, ESSENTIA HEALTH ENGAGED WITH HIBBING HIGH SCHOOL'S STUDENT COUNCIL; THROUGH THIS COLLABORATION, 40 STUDENT LEADERS BUILT STRONGER BONDS AMONG EACH OTHER AND THEIR COMMUNITY THROUGH A SERVICE-LEARNING PROJECT TO DEVELOP PROGRAMMING FOR THEIR IN-SCHOOL "ROOM OF REQUIREMENT," WHERE FELLOW STUDENTS CAN CONFIDENTIALLY GO TO FILL UNMET BASIC NEEDS LIKE FOOD AND CLOTHING. ESSENTIA HEALTH ALSO PARTNERED WITH FAMILIES AND COMMUNITIES TOGETHER TO SUPPORT YOUTH EMPOWERMENT SUPPORT AND SAFETY (YESS) IN EVERY SCHOOL ACROSS THE ESSENTIA HEALTH-VIRGINIA SERVICE AREA. YESS PROVIDED MENTORSHIP AND SUPPORT TO LGBTQI2SA+ STUDENTS THROUGH MULTIPLE AVENUES (GROUP LEARNING, IN-PERSON COUNSELING, TEXT SUPPORT) AND SERVED 93 STUDENTS ON A WEEKLY BASIS DURING THE 2022-23 ACADEMIC YEAR. ON JUNE 22, 2023, ESSENTIA HEALTH PARTNERED WITH FAIRVIEW RANGE TO BRING THE ANNUAL YOUTH MENTAL HEALTH NIGHT TO THE MINNESOTA DISCOVERY CENTER IN CHISHOLM, MINNESOTA. AT THE EVENT, ESSENTIA HEALTH ENGAGED AND SHARED MENTAL WELL-BEING RESOURCES WITH 127 YOUTH COMMUNITY MEMBERS. ESSENTIA HEALTH PARTNERED WITH THE UNITED WAY OF NORTHEASTERN MINNESOTA TO RELAUNCH AND PROMOTE THE UNITED WAY'S GETCONNECTED VOLUNTEER PORTAL, WHICH PROMOTES SOCIAL CONNECTIONS THROUGH VOLUNTEERISM BY MATCHING VOLUNTEERS WITH VOLUNTEER OPPORTUNITIES. THE PORTAL CURRENTLY HAS APPROXIMATELY 1,000 VOLUNTEER PROFILES AND 20 ORGANIZATION PROFILES, WITH MATCHES MADE DAILY. THROUGH PARTNERSHIP WITH FAIRVIEW RANGE, ESSENTIA HEALTH ALSO FOUNDED THE IRON RANGE NONPROFIT NETWORK, A GROUP WHERE NONPROFIT PROFESSIONALS FROM ACROSS NORTHERN ST. LOUIS COUNTY CAN CONNECT AND COLLABORATE; IN ITS FIRST YEAR, THE NETWORK ATTRACTED 40 MEMBERS TO ITS MONTHLY COMMUNICATIONS LIST AND CONNECTED 15 COMMUNITY LEADERS MONTHLY THROUGH VIRTUAL VIDEO CONFERENCE CALLS.PRIORITY AREA #2: ACCESS TO HEALTHY FOODTO SUPPORT COMMUNITY ACCESS TO HEALTHY FOOD, ESSENTIA HEALTH WORKED ALONGSIDE ORGANIZATIONS WITH A FOCUS ON CONNECTING NUTRITIOUS, LOCAL FOODS TO COMMUNITY MEMBERS. ESSENTIA HEALTH PARTNERED WITH THE IRON RANGE PARTNERSHIP FOR SUSTAINABILITY (IRPS) TO PROVIDE THE COMMUNITY GARDEN PROGRAM IN VIRGINIA DURING THE 2022 GROWING SEASON. BY OFFERING AND MAINTAINING COMMUNITY GARDEN PLOTS IN RAISED PLANTERS THROUGHOUT THE CITY, THE PROGRAM ATTRACTED 36 PEOPLE TO UTILIZE AND FILL ALL 42 AVAILABLE GARDEN PLOTS DURING THE SEASON. ALSO ALONGSIDE IRPS, ESSENTIA HEALTH PARTNERED TO TEACH YOUNG PEOPLE IN VIRGINIA ABOUT GARDENING AND FOOD PRODUCTION THROUGH THE LIL' GARD'NERS PROGRAM. DURING SUMMER 2022, 30 VIRGINIA HEAD START STUDENTS (AGES 3-5) ENGAGED IN INTERACTIVE LESSONS ABOUT GARDENING AND FRESH FOOD. ESSENTIA HEALTH WORKED ALONGSIDE THE HIBBING FARMERS MARKET TO MAKE ACCESSIBILITY UPGRADES AT THE FARMERS MARKET GROUNDS AS WELL. IN TURN, HIBBING FARMERS MARKET WAS ABLE TO WELCOME 5,898 PEOPLE OF ALL ABILITIES TO PURCHASE LOCAL, FRESH FOODS DURING THE 2022 MARKET SEASON. ESSENTIA HEALTH PARTNERED WITH THE BOIS FORTE FOOD SOVEREIGNTY GROUP TO PROMOTE INDIGENOUS FOOD TRADITIONS RELATED TO MANOOMIKE (WILD RICE) HARVESTING. WITH ESSENTIA HEALTH'S SUPPORT, AN ELDER CRAFTED 30 SETS OF TRADITIONAL WILD RICE KNOCKING STICKS AND AGREED TO PERFORM A KNOCKING STICK DEMONSTRATION. SEVEN KNOCKING STICK SETS WERE GIFTED TO INDIVIDUALS ACTIVE IN THE 2022 ODE'IMINI GIIZIS FARMERS MARKET. TWO CANOES AND 23 SETS OF KNOCKING STICKS WILL BE TRANSFERRED TO THE BOIS FORTE TRIBAL GOVERNMENT STAFF TO HOST RICING CLINICS IN FUTURE SEASONS WITH COMMUNITY MEMBERS AND THE TOOLS SHARED AS COMMON PROPERTY. LASTLY, ON JUNE 6, 2023, ESSENTIA HEALTH AND ST. LOUIS COUNTY PUBLIC HEALTH CO-HOSTED A "FOOD ACCESS WALK AUDIT" FOR COMMUNITY LEADERS IN VIRGINIA. 13 STAKEHOLDERS - REPRESENTING GOVERNMENT, AGING AND DISABILITY ADVOCACY, BUSINESS, AND HEALTHCARE - PARTICIPATED IN THE EVENT TO EXPERIENCE AND ANALYZE THE BARRIERS PEOPLE WHO ARE WALKING/ROLLING FACE WHEN TRYING TO ACCESS FRESH FOOD RETAILERS IN THE VIRGINIA COMMUNITY. ESSENTIA HEALTH DULUTH PART V, SECTION B, LINE 23: OCCASIONALLY CERTAIN FAP-ELIGIBLE PATIENTS ARE CHARGED MORE THAN AMOUNTS GENERALLY BILLED ON SERVICES. THIS COULD OCCUR IF THE PATIENT PAYMENTS ARE APPLIED ON PATIENT BILLS BEFORE AND/OR AFTER THE FINANCIAL ASSISTANCE POLICY (FAP) ADJUSTMENTS WERE APPLIED. THE HOSPITAL PROVIDES THOSE PATIENTS WITH A $5 OR MORE OVERPAYMENT WITH A REFUND CHECK, EXPLANATION LETTER, AND DETAILED SUMMARY OF SERVICES IMPACTED.THE NUMBER OF PATIENTS AFFECTED AND THE TOTAL DOLLAR AMOUNT INVOLVED FOR FY23 WAS 2 INDIVIDUALS & $114.ESSENTIA HEALTH'S REVENUE CYCLE DEPARTMENT CONFIRMS IF ANY PATIENT PAYMENTS ARE MADE AFTER THE FAP APPLICATION HAS BEEN RECEIVED. IF SO, THE PATIENT PAYMENT IS UNAPPLIED AND THEN THE FAP ADJUSTMENT IS APPLIED. THE PATIENT PAYMENT IS THEN POSTED, AND IF THE PATIENT PAYMENT IS GREATER THAN THE REMAINING BALANCE ON THE BILL, A REFUND TO THE PATIENT IS PROVIDED. THERE COULD BE A FAP-ELIGIBLE PATIENT OVERPAYMENT DEPENDING ON THE TIMING OF THE PATIENT PAYMENT OR IF THE PATIENT IS STILL PAYING THEIR CO-PAYMENT AT THE TIME OF SERVICE. WE CONTACT THESE PATIENTS TO REMIND THEM THAT THEY HAVE CHARITY CARE AND DO NOT NEED TO PAY THEIR CHARGES UNTIL THEIR FAP ADJUSTMENTS HAVE BEEN MADE. WE REQUEST THE REFUND AT THE TIME OF PROCESSING THE FAP APPLICATION IF APPLICABLE. WE ALSO PERFORM AUDITS FOR ANY FAP OVERPAYMENTS DUE TO THE TIMING OF PATIENT PAYMENTS. ESSENTIA HEALTH VIRGINIA PART V, SECTION B, LINE 23: OCCASIONALLY CERTAIN FAP-ELIGIBLE PATIENTS ARE CHARGED MORE THAN AMOUNTS GENERALLY BILLED ON SERVICES. THIS COULD OCCUR IF THE PATIENT PAYMENTS ARE APPLIED ON PATIENT BILLS BEFORE AND/OR AFTER THE FINANCIAL ASSISTANCE POLICY (FAP) ADJUSTMENTS WERE APPLIED. THE HOSPITAL PROVIDES THOSE PATIENTS WITH A $5 OR MORE OVERPAYMENT WITH A REFUND CHECK, EXPLANATION LETTER, AND DETAILED SUMMARY OF SERVICES IMPACTED.THE NUMBER OF PATIENTS AFFECTED AND THE TOTAL DOLLAR AMOUNT INVOLVED FOR FY23 WAS 2 INDIVIDUALS & $226.ESSENTIA HEALTH'S REVENUE CYCLE DEPARTMENT CONFIRMS IF ANY PATIENT PAYMENTS ARE MADE AFTER THE FAP APPLICATION HAS BEEN RECEIVED. IF SO, THE PATIENT PAYMENT IS UNAPPLIED AND THEN THE FAP ADJUSTMENT IS APPLIED. THE PATIENT PAYMENT IS THEN POSTED, AND IF THE PATIENT PAYMENT IS GREATER THAN THE REMAINING BALANCE ON THE BILL, A REFUND TO THE PATIENT IS PROVIDED. THERE COULD BE A FAP-ELIGIBLE PATIENT OVERPAYMENT DEPENDING ON THE TIMING OF THE PATIENT PAYMENT OR IF THE PATIENT IS STILL PAYING THEIR CO-PAYMENT AT THE TIME OF SERVICE. WE CONTACT THESE PATIENTS TO REMIND THEM THAT THEY HAVE CHARITY CARE AND DO NOT NEED TO PAY THEIR CHARGES UNTIL THEIR FAP ADJUSTMENTS HAVE BEEN MADE. WE REQUEST THE REFUND AT THE TIME OF PROCESSING THE FAP APPLICATION IF APPLICABLE. WE ALSO PERFORM AUDITS FOR ANY FAP OVERPAYMENTS DUE TO THE TIMING OF PATIENT PAYMENTS. ADDITIONAL DISCLOSURES NOT REQUIRED FOR PART V, SECTION C: PART V, LINE 3E:ESSENTIA HEALTH DULUTH:ESSENTIA HEALTH ST. MARY'S MEDICAL CENTER AND ESSENTIA HEALTH DULUTH CONDUCTED A NEW CHNA IN FY22 AND CHOSE FOUR PRIORITY HEALTH NEEDS TO ADDRESS BASED ON THE FEEDBACK OF 340 COMMUNITY MEMBERS. THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY ARE MENTAL AND SOCIAL WELLBEING, FOOD SECURITY, SUBSTANCE USE, AND HOUSING. THE NEEDS ARE NOT RANKED IN ORDER; ALL FOUR HEALTH NEEDS ARE CONSIDERED PRIORITIES. THE HOSPITAL WILL WORK ON ADDRESSING EACH NEED SIMULTANEOUSLY FROM FY23 - FY25.ESSENTIA HEALTH VIRGINIA:ESSENTIA HEALTH VIRGINIA CONDUCTED A NEW CHNA IN FY22 AND CHOSE TO ADDRESS TWO PRIORITY HEALTH NEEDS BASED ON THE FEEDBACK OF 105 COMMUNITY MEMBERS. THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY ARE SOCIAL CONNECTEDNESS AND ACCESS TO HEALTHY FOOD. THE NEEDS ARE NOT RANKED IN ORDER; BOTH HEALTH NEEDS ARE CONSIDERED PRIORITIES. THE HOSPITAL WILL WORK ON ADDRESSING EACH NEED SIMULTANEOUSLY FROM FY23 - FY25.PART V, SECTION B, LINE 7B:ESSENTIA HEALTH DULUTH:THE CHNA IS ALSO POSTED AT: WWW.SLHDULUTH.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ AND BRIDGINGHEALTHDULUTH.ORG/ASSESSMENTS-AND-PRIORITIES/.PART V, SECTION B, LINE 16I:ESSENTIA HEALTH DULUTH AND ESSENTIA HEALTH VIRGINIA:DUE TO THE SMALL SIZES OF THE LIMITED ENGLISH PROFICIENCY (LEP) POPULATIONS OF THE COMMUNITIES SERVED BY THE ORGANIZATION, THE ORGANIZATION WAS NOT REQUIRED TO TRANSLATE THE FINANCIAL ASSISTANCE POLICY (FAP), THE FAP APPLICATION FORM, OR THE PLAIN LANGUAGE SUMMARY OF THE FAP TO OTHER LANGUAGES. ALTHOUGH IT WAS NOT REQUIRED, THE ORGANIZATION TRANSLATED THE FAP APPLICATION FORM INTO SPANISH. 16 1 - ESSENTIA HEALTH DULUTH CLINIC - 3RD STRE 400 E 3RD ST DULUTH MN 55805 MULTI-SPECIALTY CLINIC 2 - ESSENTIA HEALTH DULUTH CLINIC - 1ST STRE 420 E 1ST ST DULUTH MN 55805 MULTI-SPECIALTY CLINIC 3 - ESSENTIA HEALTH VIRGINIA CLINIC 1101 9TH ST N VIRGINIA MN 55792 MULTI-SPECIALTY CLINIC 4 - ESSENTIA HEALTH DULUTH CLINIC - 2ND STRE 502 E 2ND ST DULUTH MN 55805 MULTI-SPECIALTY CLINIC 5 - ESSENTIA HEALTH WEST DULUTH CLINIC 4212 GRAND AVE DULUTH MN 55807 MULTI-SPECIALTY CLINIC 6 - ESSENTIA HEALTH HERMANTOWN CLINIC 4855 W ARROWHEAD RD HERMANTOWN MN 55811 MULTI-SPECIALTY CLINIC 7 - ESSENTIA HEALTH LAKEWALK CLINIC 1502 LONDON RD DULUTH MN 55812 MULTI-SPECIALTY CLINIC 8 - ESSENTIA HEALTH LAKESIDE CLINIC 4621 E SUPERIOR ST DULUTH MN 55804 MULTI-SPECIALTY CLINIC 9 - ESSENTIA HEALTH INTERNATIONAL FALLS CLIN 2501 KEENAN DR INTERNATIONAL FALLS MN 56649 MULTI-SPECIALTY CLINIC 10 - ESSENTIA HEALTH ELY CLINIC 300 W CONAN ST ELY MN 55731 MULTI-SPECIALTY CLINIC 11 - ESSENTIA HEALTH VIRGINIA MEDICAL ARTS CL 901 9TH ST N VIRGINIA MN 55792 MULTI-SPECIALTY CLINIC 12 - ESSENTIA HEALTH HIBBING CLINIC 730 EAST 34TH STREET HIBBING MN 55746 MULTI-SPECIALTY CLINIC 13 - ESSENTIA HEALTH PROCTOR CLINIC 211 S BOUNDRY AVE PROCTOR MN 55810 MULTI-SPECIALTY CLINIC 14 - ESSENTIA HEALTH BABBITT CLINIC 71 S DR BABBITT MN 55706 PRIMARY CARE CLINIC 15 - ESSENTIA HEALTH VIRGINIA - IRON RANGE RE 901 9TH ST N STE 100 VIRGINIA MN 55792 REHABILITATION CENTER 16 - ESSENTIA HEALTH VIRGINIA CARE CENTER 901 9TH ST N VIRGINIA MN 55792 SKILLED NURSING FACILITY PART I, LINE 3C: ASSETS WILL BE CONSIDERED ALONG WITH THE PATIENT'S INCOME TO DETERMINE ELIGIBILITY FOR THE FINANCIAL ASSISTANCE PROGRAM. TO BE ELIGIBLE, REPORTABLE ASSETS MAY NOT EXCEED $75,000 FOR A HOUSEHOLD OF ONE (1), OR $150,000 FOR A HOUSEHOLD OF TWO (2) OR MORE. ASSETS MAY INCLUDE, BUT ARE NOT LIMITED TO, SUCH ITEMS AS CHECKING AND SAVINGS ACCOUNTS, IRAS, 401(K)S, PENSIONS, HEALTH SAVINGS ACCOUNTS, ADDITIONAL PROPERTY, AND ANY OTHER RETIREMENT FUNDING. PART I, LINE 6A: THE ORGANIZATION'S COMMUNITY BENEFIT INFORMATION IS INCLUDED ON ESSENTIA HEALTH'S (EMPLOYER IDENTIFICATION NUMBER 20-0360007) WEBSITE AT WWW.ESSENTIAHEALTH.ORG. ESSENTIA HEALTH, HEADQUARTERED IN DULUTH, MINNESOTA, IS THE PARENT OF A FULLY INTEGRATED HEALTH SYSTEM SERVING PATIENTS IN MINNESOTA, WISCONSIN, AND NORTH DAKOTA. PART I, LINE 7: THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES WAS USED TO CALCULATE THE COSTS FOR THE FOLLOWING COMMUNITY BENEFITS: CHARITY CARE AND UNREIMBURSED MEDICAID. ACTUAL COSTS WERE USED FOR THE REMAINDER OF THE COMMUNITY BENEFITS REPORTED. PART I, LN 7 COL(F): BAD DEBT EXPENSE THAT WAS SUBTRACTED FROM TOTAL EXPENSE TO OBTAIN THE % OF COMMUNITY BENEFIT TO TOTAL EXPENSE AMOUNTED TO $17,083,574. PART II, COMMUNITY BUILDING ACTIVITIES: THE HOSPITAL IS LOCATED IN A FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREA AND AS SUCH INCLUDES PHYSICIAN RECRUITMENT AS A COMMUNITY BUILDING ACTIVITY PER THE RECOMMENDATION OF THE CATHOLIC HEALTH ASSOCIATION COMMUNITY BENEFIT GUIDE. THE OTHER LINE ITEM REPRESENTS CONTRIBUTIONS TO ORGANIZATIONS THAT ARE PERFORMING COMMUNITY BUILDING ACTIVITIES. EXAMPLES INCLUDE SUPPORT TO NOT-FOR-PROFIT ORGANIZATIONS THAT PROVIDE RESOURCES TO VULNERABLE POPULATIONS FOR SUPPORTING SOCIAL DETERMINANTS OF HEALTH INCLUDING HOUSING, CHILDCARE, ACCESS TO EDUCATION, AND OPPORTUNITIES FOR ACTIVE LIVING. PART III, LINE 2: DISCOUNTS, CHARITY CARE, AND BAD DEBT EXPENSE ARE ACCOUNTED FOR AS REDUCTIONS TO REVENUE. BAD DEBT EXPENSE IS CALCULATED AFTER ALL ESTIMATED DISCOUNTS AND APPLICABLE PAYMENTS ARE APPLIED TO A PATIENT ACCOUNT. BAD DEBT EXPENSE IS A COMBINATION OF THE ACTUAL ACCOUNT WRITE-OFFS TO A COLLECTION AGENCY FOR ACCOUNTS DEEMED UNCOLLECTIBLE, ALONG WITH ESTIMATED EXPENSE FOR ACCOUNTS WITH A REMAINING BALANCE IN ACCOUNTS RECEIVABLE. IF, DURING THE COLLECTION PROCESS, IT BECOMES KNOWN THAT THE PATIENT QUALIFIES FOR CHARITY CARE, THE AMOUNTS INCLUDED WITHIN BAD DEBT EXPENSE WOULD BE RECLASSIFIED TO CHARITY CARE. PART III, LINE 3: ESSENTIA HEALTH PROVIDES FULL CHARITY CARE THROUGH ITS TRADITIONAL APPLICATION PROCESS. FULL CHARITY CARE IS A COMPLETE WRITE-OFF OF ELIGIBLE GROSS HOSPITAL AND CLINIC CHARGES. THIS IS BASED ON THE PATIENT'S INCOME IN RELATION TO THE FEDERAL POVERTY GUIDELINES. CATASTROPHIC CHARITY CARE IS FINANCIAL ASSISTANCE THAT PROVIDES A ONE-TIME DISCOUNT BASED ON AN APPLICATION FOR TRADITIONAL CHARITY CARE AND DOES NOT QUALIFY BUT HAS A BALANCE GREATER THAN $5,000. PATIENT, OR THEIR GUARANTOR, MAY BE GRANTED CATASTROPHIC CHARITY CARE ASSISTANCE FOR ELIGIBLE SERVICES IF THEY COMPLETE A FINANCIAL ASSISTANCE APPLICATION AND PROVIDE REQUIRED DOCUMENTATION. THE PATIENT AND/OR GUARANTOR WILL NOT PAY MORE THAN 20% OF ANNUAL INCOME BASED ON ELIGIBLE CHARGES.ESSENTIA HEALTH ALSO RECOGNIZES THAT IT IS NOT FEASIBLE, OR SOMETIMES NECESSARY, FOR ALL PATIENTS TO COMPLETE FINANCIAL ASSISTANCE APPLICATIONS AND PROVIDE DOCUMENTATION REQUIRED THROUGH THE TRADITIONAL PROCESS. ESSENTIA HEALTH IMPLEMENTED AN ALTERNATIVE DOCUMENTATION AND PRESUMPTIVE PROCESS USING A TOOL THAT IDENTIFIES ACCOUNTS THAT AUTOMATICALLY QUALIFY FOR CHARITY CARE AND RECLASSIFIED THOSE ACCOUNTS TO CHARITY CARE ALLOWANCE. AS A RESULT, WE ESTIMATE $0 OF PATIENT ACCOUNTS WRITTEN OFF TO BAD DEBT WOULD QUALIFY FOR CHARITY CARE.ESSENTIA HEALTH DULUTH AND ESSENTIA HEALTH VIRGINIA ARE A PART OF A LARGER ORGANIZATION, ESSENTIA HEALTH. ESSENTIA HEALTH AND ITS MEMBER ORGANIZATIONS INCORPORATE THE COST OF BAD DEBT AS A COMMUNITY BENEFIT. AS A TAX-EXEMPT HOSPITAL, WE MUST PROVIDE THE NECESSARY SERVICES REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR THAT CARE. IN DOING SO, ESSENTIA HEALTH MAKES QUALITY PATIENT CARE AVAILABLE TO ALL IN OUR COMMUNITY, REGARDLESS OF THEIR ECONOMIC MEANS. PART III, LINE 4: PAGES 16-18 OF ESSENTIA HEALTH'S CONSOLIDATED AUDIT REPORT CONTAIN THE FOOTNOTE DESCRIBING THE ORGANIZATION'S BAD DEBT EXPENSE. PART III, LINE 8: RECONCILIATION FOR MEDICARE SHORTFALL BETWEEN TOTAL MEDICARE PROGRAM AND WHAT IS ALLOWED ON THE COST REPORT:ESSENTIA HEALTH DULUTH AND ESSENTIA HEALTH VIRGINIA'S TOTAL MEDICARE SHORTFALL IS $94,716,033, OF WHICH A SHORTFALL OF $53,972,073 (CONSISTING OF $97,810,216 REVENUE AND $151,782,289 COST) IS INCLUDED IN PART III, SECTION B, LINES 5-7, AND A SHORTFALL OF $40,743,960 (CONSISTING OF $109,136,943 REVENUE AND $149,880,903 COST) REPRESENT ALL OTHER MEDICARE SERVICES NOT INCLUDED IN THE ANNUAL COST REPORT.THE COSTING METHODOLOGY USED IN DETERMINING THE MEDICARE ALLOWABLE COST REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT AS REFLECTED IN THE AMOUNT REPORTED IN PART III, LINE 6:THE METHODOLOGY USED IN DETERMINING THE REPORTED MEDICARE ALLOWABLE COST BEGINS WITH THE HOSPITAL'S GENERAL LEDGER SYSTEM. THE COSTS ARE OBTAINED FROM THE GENERAL LEDGER AND THEN ADJUSTED AND REPORTED IN ACCORDANCE WITH CENTERS FOR MEDICARE SERVICES (CMS) "COST FINDING" GUIDELINES AS PUBLISHED IN THEIR PROVIDER REIMBURSEMENT MANUAL. ONCE THE MEDICARE ALLOWABLE COSTS ARE DETERMINED FROM THE HOSPITAL'S COST REPORT, ANY COSTS ATTRIBUTED TO SUBSIDIZED HEALTH SERVICES, AND MEDICAL EDUCATION, ARE REMOVED AND REPORTED SEPARATELY.EXPLANATION FOR ANY PRIOR YEAR SETTLEMENTS FOR MEDICARE-RELATED SERVICES IN THE CURRENT TAX YEAR:EACH ESSENTIA HEALTH HOSPITAL IS REQUIRED TO FILE A MEDICARE COST REPORT 5 MONTHS AFTER THE CLOSE OF THEIR FISCAL YEAR. THE COST REPORT PROVIDES MEDICARE WITH INFORMATION THAT IS USED TO DETERMINE UTILIZATION AND SPENDING TRENDS BUT ALSO IS USED TO SET FUTURE PAYMENT RATES FOR MOST MEDICARE SERVICES. IF THE INTERIM PAYMENTS PAID TO A HOSPITAL ARE HIGHER OR LOWER THAN THE FILED COST REPORT ALLOWABLE REIMBURSEMENT, THERE WILL BE A SETTLEMENT FOR THAT FISCAL YEAR. THIS CAN BE DUE TO CHANGES IN UTILIZATION OR COST OF PROVIDING SERVICES FOR CRITICAL ACCESS HOSPITALS (CAH) OR DIFFERENCES BETWEEN INTERIM AND FINAL PAYMENT FACTORS FOR DISPROPORTIONATE SHARE, BAD DEBTS, OR INDIRECT MEDICAL EDUCATION FOR NON-CAH HOSPITALS. AN ESTIMATE FOR THESE SETTLEMENTS IS RECORDED AT THE CLOSE OF THE FISCAL YEAR. IF THE ESTIMATE VARIES FROM THE FINAL SETTLEMENT RECEIVED 6-7 MONTHS AFTER THE FISCAL YEAR ENDS, THEN THESE AMOUNTS ARE RECORDED AS PRIOR YEAR MEDICARE REVENUE.THE EXTENT TO WHICH ANY SHORTFALL REPORTED IN PART III, LINE 7 SHOULD BE TREATED AS A COMMUNITY BENEFIT AND THE RATIONALE FOR THE ORGANIZATION'S OPINION:ESSENTIA HEALTH DULUTH AND ESSENTIA HEALTH VIRGINIA ARE A PART OF A LARGER ORGANIZATION, ESSENTIA HEALTH. ESSENTIA HEALTH AND ITS MEMBER ORGANIZATIONS INCORPORATE THE FULL VALUE OF THE MEDICARE SHORTFALL AS A COMMUNITY BENEFIT. THE RATIONALE FOR THE ORGANIZATION'S OPINION IS PROVIDING CARE FOR THE ELDERLY AND SERVING MEDICARE PATIENTS IS AN ESSENTIAL PART OF THE COMMUNITY BENEFIT STANDARD. MEDICARE, LIKE MEDICAID, DOES NOT PAY THE FULL COST OF CARE AND IT IS LIKELY TO GET WORSE. MANY MEDICARE BENEFICIARIES ARE POOR AND ARE ELIGIBLE FOR MEDICAID IN ADDITION TO MEDICARE. MEDICARE UNDERPAYMENT MUST BE SHOULDERED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE COMMUNITY'S ELDERLY AND POOR. THESE UNDERPAYMENTS REPRESENT A REAL COST OF SERVING THE COMMUNITY. PART III, LINE 9B: THE POLICIES AND PROCEDURES FOR INTERNAL AND EXTERNAL COLLECTION PRACTICES TAKE INTO ACCOUNT THE EXTENT TO WHICH THE PATIENT QUALIFIES FOR ESSENTIA HEALTH'S FINANCIAL ASSISTANCE POLICY (FAP) AND FINANCIAL ASSISTANCE, A PATIENT'S GOOD FAITH EFFORT TO APPLY FOR A GOVERNMENTAL PROGRAM OR FOR FINANCIAL ASSISTANCE FROM ESSENTIA HEALTH, AND THE PATIENT'S GOOD FAITH EFFORT TO COMPLY WITH HIS/HER PAYMENT AGREEMENTS. THE ORGANIZATION OFFERS EXTENDED PAYMENT PLANS TO ELIGIBLE PATIENTS AND WILL NOT IMPOSE LIENS ON PRIMARY RESIDENCES NOR REPORT PATIENTS TO A CREDIT RATING AGENCY FOR OUTSTANDING PATIENT BILLS. THE ORGANIZATION WILL NOT CHARGE A PATIENT THE GROSS AMOUNT OF CHARGES FOR ANY UNINSURED TREATMENT. UNINSURED DISCOUNTS WILL BE APPLIED TO THE GROSS CHARGES PRIOR TO ANY FINANCIAL ASSISTANCE OR OTHER DISCOUNTS. IF AT ANY TIME THE ORGANIZATION RECOGNIZES THAT A PATIENT MAY BE ELIGIBLE FOR STATE OR FEDERAL PROGRAMS, A REPRESENTATIVE WILL ASSIST THE PATIENT IN OBTAINING INFORMATION ABOUT THESE PROGRAMS OR PROVIDE CONTACT INFORMATION FOR THESE PROGRAMS. THE ORGANIZATION CONTRACTS WITH AN OUTSIDE PATIENT ADVOCACY AGENCY, WHICH MAY PROVIDE ASSISTANCE TO THE UNINSURED PATIENT IN APPLYING TO CERTAIN STATE AND FEDERAL PROGRAMS. AT ANY STAGE OF THE PATIENT EXPERIENCE AND UP THROUGH THE COLLECTION PROCESS, THE PATIENT MAY EXPRESS A CONCERN THAT THEY ARE UNABLE TO PAY THEIR BILL IN FULL OR MEET THE PAYMENT PLAN REQUIREMENTS. AT THAT TIME, THE PATIENT WILL BE GIVEN EVERY OPPORTUNITY TO COMPLETE AND SUBMIT AN APPLICATION FOR FINANCIAL ASSISTANCE.THE ORGANIZATION TRAINS ITS OUTSIDE DEBT COLLECTION AGENCIES AND ATTORNEYS ABOUT THE FAP AND HOW A PATIENT MAY OBTAIN MORE INFORMATION ABOUT THE FAP OR SUBMIT AN APPLICATION FOR FINANCIAL ASSISTANCE. THE ORGANIZATION REQUIRES ITS OUTSIDE COLLECTION AGENCIES AND ATTORNEYS TO REFER PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE TO ESSENTIA HEALTH. IF A PATIENT HAS SUBMITTED AN APPLICATION FOR FINANCIAL ASSISTANCE AFTER AN ACCOUNT HAS BEEN REFERRED FOR COLLECTION ACTIVITY, THE ORGANIZATION SUSPENDS ALL COLLECTION ACTIVITY UNTIL THE PATIENT'S FINANCIAL ASSISTANCE APPLICATION HAS BEEN PROCESSED AND ESSENTIA HEALTH HAS NOTIFIED THE PATIENT OF ITS DECISION. PATIENTS ARE ADVISED AT THAT TIME TO NOTIFY THE COLLECTION AGENCY TO HOLD THEIR ACCOUNT. THE OUTSIDE DEBT COLLECTION AGENCIES ARE NOTIFIED BY ESSENTIA HEALTH ONCE AN ACCOUNT ADJUSTMENT HAS BEEN MADE. PART VI, LINE 2: NEEDS ASSESSMENT:WE ASSESS AND RESPOND TO THE HEALTH CARE NEEDS OF THE COMMUNITIES WE SERVE THROUGH MANY WAYS, INCLUDING THE FOLLOWING:MARKETING RESEARCH - THE ESSENTIA HEALTH MARKETING RESEARCH DEPARTMENT CONDUCTS SURVEYS, FOCUS GROUPS, AND REVIEWS INTERNAL DATA TO BETTER UNDERSTAND THE NEEDS AND USE(S) OF OUR SERVICES. THIS INCLUDES ACCESS TO SERVICE AREAS (E.G., PRIMARY CARE), PAYOR INFORMATION (E.G., ESSENTIA CARE), AND OVERALL GAPS IN SERVICES. ASSESSMENTS HAVE RESULTED IN INTERNAL CHANGES IN BOTH STAFFING AND PROCESSES.ESSENTIA HEALTH POPULATION CARE MANAGEMENT - WE USE AN ANALYSIS OF MULTIPLE POPULATIONS; ONE SUCH GROUP IS "ACO POPULATIONS." THE ANALYSES DONE INCLUDE THE IDENTIFICATION OF PATIENTS WHO HAVE UNCONTROLLED ASTHMA, UNCONTROLLED DIABETES, ARE PRE-DIABETIC, OR WHO HAVE DEPRESSION; THE RESULTS ARE USED IN TARGETED OUTREACH BY THE POPULATION CARE TEAM. TARGETED OUTREACH HAS PROVEN TO LEAD TO BETTER OUTCOMES FOR THESE POPULATIONS.COMMUNITY GIVING - THROUGH OUR COMMUNITY GIVING PROCESS WE ENGAGE TO UNDERSTAND COMMUNITY NEEDS ACROSS A BROAD SPECTRUM OF COMMUNITY ORGANIZATIONS. WE REVIEW REQUESTS FOR FINANCIAL SUPPORT GENERATED BY COMMUNITY NON-PROFITS AND EVALUATE FUNDING BASED ON POTENTIAL OF PROGRAMS AND PROJECTS TO HAVE A POSITIVE AND SUSTAINABLE IMPACT ON THE HEALTH AND VITALITY OF OUR COMMUNITIES. THIS INCLUDES COMPLEMENTING OUR COMMUNITY FUNDING BY GATHERING PERSPECTIVES ON COMMUNITY EFFORTS AND THE ROLE ESSENTIA HEALTH CAN PLAY IN ADDRESSING COMMUNITY NEEDS AS A COLLABORATIVE PARTNER.INTERNAL QUALITY INDICATORS - WE TRACK DATA THAT LEADS TO THE IMPROVED CARE AND TREATMENT OF PATIENTS WITH CHRONIC DISEASES, TOBACCO USE, AND MENTAL HEALTH CONDITIONS. THIS DATA INCLUDES PATIENT ACTIVITY AND OUTCOMES, WHICH ALLOWS ESSENTIA HEALTH TO BETTER IDENTIFY THE NEEDS OF THE PATIENTS AND CAN BE UTILIZED TO ASSESS THE OVERALL HEALTH OF THE COMMUNITIES WE SERVE.HEALTH DATA PROVIDED BY PAYOR ORGANIZATIONS, NAMELY GOVERNMENT AND COMMERCIAL HEALTH INSURERS - THIS HEALTH DATA TYPICALLY INVOLVES MEDICAL TREATMENT AND OUTCOMES THAT REFLECT TRENDS OF UNHEALTHY LIFESTYLES AND BEHAVIORS. OUR OBJECTIVE IS TO UNDERSTAND THESE RELATIONSHIPS AND TO DEVELOP ACTION STEPS TO INTERVENE ON THE FRONT END TO PREVENT SUCH MEDICAL SITUATIONS FROM OCCURRING.ESSENTIA HEALTH HUMAN RESOURCES DEPARTMENT - THE ANALYSIS OF CURRENT STAFFING TRENDS AIDS IN PROVIDING HEALTHCARE ACCESS APPROPRIATELY TO THE COMMUNITIES WE SERVE.ESSENTIA INSTITUTE OF RURAL HEALTH (EIRH) - EIRH PROVIDES RESEARCH OF PATIENT DATA, COMMUNITY DATA, AND THE OUTCOMES ASSOCIATED WITH CURRENT CLINICAL PRACTICES, INTERVENTIONS, AND PREVENTION STRATEGIES (E.G., OPIOID USE DISORDER, SOCIAL DETERMINANTS OF HEALTH). PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:THE ORGANIZATION MAKES INFORMATION ON ITS FINANCIAL ASSISTANCE POLICY (FAP) READILY AVAILABLE TO PATIENTS. INFORMATION ABOUT FINANCIAL ASSISTANCE PROGRAMS IS AVAILABLE ON THE ESSENTIA HEALTH WEBSITE (WWW.ESSENTIAHEALTH.ORG, SELECT PATIENTS & VISITORS) WHERE THE INFORMATION AND APPLICATION IS EASILY ACCESSIBLE TO BE VIEWED, DOWNLOADED, AND PRINTED AT NO CHARGE TO THE PATIENT. PATIENTS CAN ALSO APPLY FOR FAP VIA MYCHART. NOTICES ON THE AVAILABILITY OF FINANCIAL ASSISTANCE ARE CONSPICUOUSLY POSTED IN EMERGENCY ROOM DEPARTMENTS. FINANCIAL ASSISTANCE INFORMATION IS AVAILABLE DURING THE PRE-ADMISSION FINANCIAL SCREENING, AT THE TIME OF REGISTRATION, AND PRIOR TO A HOSPITAL DISCHARGE. INFORMATION ABOUT THE FAP IS IN ALL COLLECTION LETTERS AND PATIENT STATEMENTS.FAP INFORMATION AND/OR APPLICATIONS ARE MADE AVAILABLE TO APPROPRIATE COMMUNITY HEALTH SERVICES AGENCIES AND OTHER ORGANIZATIONS THAT ASSIST PEOPLE IN NEED. THE ORGANIZATION EDUCATES STAFF MEMBERS WHO WORK CLOSELY WITH PATIENTS PROVIDING DIRECT PATIENT TREATMENT AND WHO WORK IN ADMISSIONS, BILLING, AND COLLECTIONS, ABOUT THE EXISTENCE OF THE FAP AND HOW A PATIENT MAY OBTAIN MORE INFORMATION. ANNUAL EDUCATION/AWARENESS OF THE FAP IS PROVIDED TO ENSURE ALL EMPLOYEES WITH PATIENT CONTACT ARE AWARE OF THE PROGRAM AND HOW PATIENTS CAN OBTAIN ADDITIONAL INFORMATION. CLINICAL AND HOSPITAL STAFF WHO PROVIDE DIRECT PATIENT CARE HAVE KNOWLEDGE OF THE FAP AND KNOW TO DIRECT PATIENTS TO A REGISTRATION INTERVIEWER OR BUSINESS OFFICE REPRESENTATIVE. REGISTRATION STAFF HAVE AN UNDERSTANDING OF THE POLICY, KNOWLEDGE OF WHERE THE RELATED DOCUMENTS ARE LOCATED, AND WHERE TO DIRECT THE PATIENT FOR MORE INFORMATION ON THE FAP. DESIGNATED EMPLOYEES (PATIENT FINANCIAL SERVICES COUNSELORS & PATIENT FINANCIAL SERVICES REPRESENTATIVES) HAVE A THOROUGH UNDERSTANDING OF THE FAP AND OFFER THE INFORMATION ON THE FAP TO THOSE PATIENTS WHO MAKE AN INQUIRY ABOUT THE PROGRAM OR ARE DETERMINED THROUGH A FINANCIAL SCREENING TO BE ELIGIBLE FOR THIS PROGRAM. PATIENT ADVOCACY SERVICES ALSO INFORM THE PATIENT ABOUT THE AVAILABILITY OF ASSISTANCE. A REQUEST FOR FINANCIAL ASSISTANCE MAY BE MADE BY THE PATIENT, A PATIENT'S GUARANTOR, A FAMILY MEMBER, CLOSE FRIEND, OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS. THE ORGANIZATION RESPONDS TO ANY ORAL OR WRITTEN REQUESTS FOR MORE GENERAL INFORMATION ON THE FAP MADE BY A PATIENT OR ANY INTERESTED PARTY. PART VI, LINE 4: COMMUNITY INFORMATION:ESSENTIA HEALTH DULUTH:ESSENTIA HEALTH DULUTH IS LOCATED IN DULUTH, MN. ESSENTIA HEALTH DULUTH IS A PART OF ESSENTIA HEALTH, WHICH IS DEFINED IN PART VI, LINE 6. ESSENTIA HEALTH DULUTH OPERATES 1 HOSPITAL AND 8 CLINICS THAT SERVE THE ST. LOUIS COUNTY AREA. THE OVERALL COMMUNITY IS CLASSIFIED AS SUBURBAN. ESSENTIA HEALTH DULUTH COVERS A SERVICE AREA OF APPROXIMATELY 172,000 PEOPLE. THE SERVICE AREA AGE DISTRIBUTION IS 19% UNDER THE AGE OF 18; 62% BETWEEN THE AGES OF 18 AND 65; AND 19% OVER THE AGE OF 65. THE RACIAL MAKEUP OF THE SERVICE AREA IS 91% CAUCASIAN; 2% AFRICAN AMERICAN; 1% ASIAN; 2% HISPANIC; AND 4% OTHER. THE GENDER SPLIT RATIO IS 50% WOMEN AND 50% MEN. THE AVERAGE INCOME FOR THE SERVICE AREA IS APPROXIMATELY $55,000. ESSENTIA HEALTH DULUTH, AS PART OF ESSENTIA HEALTH, IS COMMITTED TO SERVE PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. APPROXIMATELY 0.8% GROSS REVENUE DOLLARS WERE FROM SELF-PAY PATIENTS AND 16.5% FROM MEDICAID RECIPIENTS. ST. LOUIS COUNTY IS CURRENTLY DESIGNATED AS A MEDICALLY UNDERSERVED AREA. AS MENTIONED ABOVE, ESSENTIA HEALTH DULUTH IS PART OF ESSENTIA HEALTH. ESSENTIA HEALTH STAFFS HOSPITALS AND CLINICS IN FEDERALLY-RECOGNIZED UNDERSERVED AREAS AND SUPPORTS THE HEALTH OF ITS COMMUNITIES THROUGH AN ACTIVE OUTREACH PROGRAM THAT BRINGS SPECIALISTS LIKE ONCOLOGISTS, CARDIOLOGISTS, NEUROLOGISTS, AND OTHERS INTO ITS SMALLER COMMUNITIES. THIS ELIMINATES BARRIERS TO CARE FOR MANY PATIENTS, PARTICULARLY THOSE WHO ARE ELDERLY, LIVING ON LOW INCOMES, OR ARE FACED WITH OTHER CHALLENGES THAT MAKE IT DIFFICULT TO TRAVEL LONG DISTANCES FOR CARE. THERE ARE 13 OTHER HOSPITALS OUTSIDE OF THE ESSENTIA HEALTH UMBRELLA THAT SERVICE THE COMMUNITY.ESSENTIA HEALTH VIRGINIA:ESSENTIA HEALTH VIRGINIA IS LOCATED IN VIRGINIA, MN. ESSENTIA HEALTH VIRGINIA IS A PART OF ESSENTIA HEALTH, WHICH IS DEFINED IN PART VI, LINE 6. ESSENTIA HEALTH VIRGINIA OPERATES 1 HOSPITAL, 6 CLINICS, A REHABILITATION CENTER, AND 1 SKILLED NURSING FACILITY THAT SERVE NORTHERN ST. LOUIS COUNTY. THE OVERALL COMMUNITY IS CLASSIFIED AS RURAL. ESSENTIA HEALTH VIRGINIA COVERS A SERVICE AREA OF APPROXIMATELY 26,000 PEOPLE. THE SERVICE AREA AGE DISTRIBUTION IS 18% UNDER THE AGE OF 18; 55% BETWEEN THE AGES OF 18 AND 65; AND 27% OVER THE AGE OF 65. THE RACIAL MAKEUP OF THE SERVICE AREA IS 93% CAUCASIAN; 1% AFRICAN AMERICAN; 1% ASIAN; 1% HISPANIC; AND 4% OTHER. THE GENDER SPLIT RATIO IS 50% WOMEN AND 50% MEN. THE AVERAGE INCOME FOR THE SERVICE AREA IS APPROXIMATELY $54,000. ESSENTIA HEALTH VIRGINIA, AS PART OF ESSENTIA HEALTH, IS COMMITTED TO SERVE PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. APPROXIMATELY 1.5% GROSS REVENUE DOLLARS WERE FROM SELF-PAY PATIENTS AND 17.8% FROM MEDICAID RECIPIENTS. ESSENTIA HEALTH VIRGINIA HAS CLINICS IN VIRGINIA, BABBITT, ELY, HIBBING, AND INTERNATIONAL FALLS, MN WHICH ARE CURRENTLY DESIGNATED AS MEDICALLY UNDERSERVED AREAS. AS MENTIONED ABOVE, ESSENTIA HEALTH VIRGINIA IS PART OF ESSENTIA HEALTH. ESSENTIA HEALTH STAFFS HOSPITALS AND CLINICS IN FEDERALLY-RECOGNIZED UNDERSERVED AREAS AND SUPPORTS THE HEALTH OF ITS COMMUNITIES THROUGH AN ACTIVE OUTREACH PROGRAM THAT BRINGS SPECIALISTS LIKE ONCOLOGISTS, CARDIOLOGISTS, NEUROLOGISTS AND OTHERS INTO ITS SMALLER COMMUNITIES. THIS ELIMINATES BARRIERS TO CARE FOR MANY PATIENTS, PARTICULARLY THOSE WHO ARE ELDERLY, LIVING ON LOW INCOMES, OR ARE FACED WITH OTHER CHALLENGES THAT MAKE IT DIFFICULT TO TRAVEL LONG DISTANCES FOR CARE. THERE IS 1 OTHER HOSPITAL OUTSIDE OF THE ESSENTIA HEALTH UMBRELLA THAT SERVICES THE COMMUNITY. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH:THE ORGANIZATION'S BOARD OF DIRECTORS IS COMPOSED MAINLY OF VOLUNTEER REPRESENTATIVES FROM THE COMMUNITIES IT SERVES. THE ORGANIZATION HAS AN OPEN MEDICAL STAFF, SO ANY QUALIFIED PHYSICIAN OF THE COMMUNITY IS ALLOWED TO APPLY. ALL APPLICANTS WHO APPLY MUST MEET THE CREDENTIALING STANDARDS AND BE APPROVED BY THE ESSENTIA HEALTH EAST GOVERNING BOARD, IN ACCORDANCE WITH THE RESERVED POWERS, IN ORDER TO PROVIDE SERVICES AT ESSENTIA HEALTH. IN ADDITION, THE HOSPITAL PROVIDES ON-SITE CLINICAL EXPERIENCES FOR MEDICAL STUDENTS AND RESIDENTS, ADVANCED PRACTICE AND PRE-LICENSURE NURSES, PHARMACISTS, THERAPISTS, TECHNICIANS, AND THOSE IN OTHER HEALTHCARE VOCATIONS.WE REINVEST IN THE ORGANIZATION BY ACQUIRING THE LATEST STATE-OF-THE-ART EQUIPMENT AND BY INVESTING IN PROGRAMS THAT ARE NEEDED IN OUR COMMUNITY.IN ADDITION TO THE ACTIVITIES LISTED IN PART I, LINE 7 AS WELL AS PART V, SECTION B, LINE 11, THE ORGANIZATION SUPPORTS THE HEALTH AND VITALITY OF OUR COMMUNITIES THROUGH A SPECIAL DEDICATION TO MAKING A DIFFERENCE IN AREAS THAT POSITIVELY IMPACT THE SOCIAL DETERMINANTS OF HEALTH. WE MAKE SIGNIFICANT CONTRIBUTIONS TO COMMUNITY NON-PROFITS WORKING TO IMPROVE HOUSING, ACCESS TO HEALTHY FOODS AND HEALTHY YOUTH DEVELOPMENT. ADDITIONALLY, WE ENCOURAGE OUR COLLEAGUES TO CONTRIBUTE THEIR TIME IN MEANINGFUL WAYS THROUGH A FORMAL EMPLOYEE VOLUNTEER PROGRAM THAT INCENTIVIZES COMMUNITY VOLUNTEERING BY PROVIDING A $100 DONATION TO A NONPROFIT OF THE EMPLOYEE'S CHOICE AFTER VOLUNTEERING AT LEAST 20 HOURS. IN FY23, MORE THAN 18,000 IMPACTFUL VOLUNTEER HOURS WERE REPORTED FOR ESSENTIA HEALTH COLLEAGUES. OUR LEADERS ARE ACTIVELY ENGAGED IN LENDING THEIR EXPERTISE ON COMMUNITY BOARDS, INCLUDING WORKFORCE DEVELOPMENT EFFORTS THAT CONTRIBUTE TO THE ECONOMIC VITALITY OF OUR REGION. LASTLY, THE HOSPITAL ENGAGES COMMUNITIES IN COMING TOGETHER AND CREATING SOCIAL CONNECTIVITY THROUGH SUPPORT OF VARIOUS LOCAL EVENTS, FUNDRAISERS, AND OUTINGS, MANY OF WHICH INVOLVE PHYSICAL ACTIVITY AND SUPPORT BUSINESSES THAT ENHANCE THE VIABILITY OF OUR COMMUNITIES.ESSENTIA HEALTH DULUTH AND ESSENTIA HEALTH VIRGINIA ARE A PART OF ESSENTIA HEALTH, A FULLY INTEGRATED HEALTH SYSTEM WITH FACILITIES IN MINNESOTA, WISCONSIN, AND NORTH DAKOTA. AS A NON-PROFIT ORGANIZATION, ESSENTIA HEALTH REINVESTS SURPLUS REVENUES INTO MEDICAL TRAINING, PROGRAMS, AND TECHNOLOGY DESIGNED TO REDUCE THE RISK OF PREVENTABLE HARM TO OUR PATIENTS AND INCREASE THE HEALTH AND VITALITY OF THE COMMUNITIES WE SERVE.ESSENTIA HEALTH PROVIDES SERVICES PREDOMINANTLY IN RURAL COMMUNITIES AND IS COMMITTED TO ELIMINATING GEOGRAPHIC BARRIERS TO CARE. MANY OF ESSENTIA HEALTH'S CLINICS AND COMMUNITY HOSPITALS ARE LOCATED IN COMMUNITIES THAT ARE FEDERALLY RECOGNIZED AS BEING MEDICALLY UNDERSERVED. WE INVEST IN FACILITY UPGRADES, TECHNOLOGY, AND STAFFING THAT ENHANCE CARE IN THESE COMMUNITIES TO ENSURE PATIENTS CAN RECEIVE AS MUCH CARE AS POSSIBLE CLOSE TO HOME. THIS IS A VITAL COMPONENT OF COMMUNITY HEALTH IN AREAS WHERE RESIDENTS ARE OFTEN ELDERLY, LIVING ON LIMITED INCOMES, AND RESTRICTED IN THEIR TRANSPORTATION OPTIONS.RESIDENTS OF GEOGRAPHICALLY ISOLATED COMMUNITIES SERVED BY ESSENTIA HEALTH ALSO BENEFIT FROM TELEHEALTH SERVICES THAT PROVIDE LOCAL ACCESS TO SPECIALISTS AND SPECIALTY SERVICES USUALLY AVAILABLE ONLY IN LARGER URBAN AREAS. SERVICES ARE AVAILABLE IN MORE THAN 30 SPECIALTIES, RANGING FROM BEHAVIORAL HEALTH TO PHYSICAL, OCCUPATIONAL, AND SPEECH-LANGUAGE THERAPY. PATIENTS TREATED IN SMALLER ESSENTIA HEALTH EMERGENCY DEPARTMENTS BENEFIT FROM TELEHEALTH CONNECTIONS THAT ALLOW COMMUNITY HOSPITAL PHYSICIANS AND NURSES TO COMMUNICATE WITH TRAUMA AND OTHER SPECIALISTS LOCATED IN ESSENTIA HEALTH'S LARGER HOSPITALS. PATIENTS CAN ALSO STAY IN THEIR HOME FOR FOLLOW-UP VISITS WITH THEIR PRIMARY CARE PROVIDER OR SPECIALISTS, WHEN APPROPRIATE, WHICH ALLOWS THEM TO ACCESS THEIR PROVIDERS WITHIN THE COMFORT OF THEIR HOME. IN ADDITION, PATIENTS CAN RECEIVE THE CARE THEY NEED WHERE AND WHEN THEY WANT IT. ESSENTIA OFFERS 24/7 VIDEO VISITS ON DEMAND FOR URGENT NEEDS ANY TIME, ONLINE E-VISITS FOR 20 COMMON CONDITIONS AND FREE MEDICAL ADVICE FROM OUR REGISTERED NURSES ANY TIME OF THE DAY OR NIGHT THROUGH OUR NURSE CARE LINE.WE FOLLOW CORE STANDARDS OF VALUE-BASED CARE ORGANIZATIONS, INCLUDING PATIENT-CENTERED PRIMARY CARE, ACCESS TO CARE, CARE COORDINATION, AND QUALITY IMPROVEMENT. PATIENT-CENTERED PRIMARY CARE ENCOMPASSES STRATEGIES AND SERVICES ORIENTED AROUND THE PATIENT TO ACHIEVE THEIR BEST HEALTH. IMPROVING PATIENTS' ACCESS TO CARE IS AN IMPORTANT FOCUS IN OUR POPULATION HEALTH PROGRAM. AT THE CORE OF PATIENT-CENTERED CARE IS THE CONNECTION VIA THE ELECTRONIC HEALTH RECORD (EHR). CLINICAL DATA REGISTRIES ARE CREATED TO INTEGRATE EHR AND PAYER DATA. THE REGISTRIES STRATIFY THE POPULATION, IDENTIFYING THOSE WITH THE HIGHEST LEVEL OF NEEDS. USING THIS INFORMATION, THE TEAM CAN ENGAGE WITH THE PATIENT TO DEVELOP AN INDIVIDUALIZED CARE MANAGEMENT PLAN AND CLOSE ANY CARE GAPS. OUR CARE TEAMS WORK TOGETHER TO DEVELOP PROGRAMS THAT ADDRESS THE NEEDS OF OUR PATIENTS, INCLUDING THOSE IN GOVERNMENT-BASED PROGRAMS AND THOSE PATIENTS AT HIGHER RISK FOR ADVERSE OUTCOMES. THESE EFFORTS RESULT IN IMPROVED HEALTH OUTCOMES, BETTER PATIENT EXPERIENCE, AND LOWER OVERALL UTILIZATION AND COST.SINCE MOST HEALTH CARE COSTS ARE DIRECTLY RELATED TO CARING FOR PATIENTS WHO HAVE CHRONIC CONDITIONS, ESSENTIA HEALTH IS COMMITTED TO IMPROVING HEALTH OUTCOMES FOR PATIENTS, ESPECIALLY THOSE WITH CHRONIC DISEASES. FOR EXAMPLE, ESSENTIA HEALTH OFFERS ONE-ON-ONE TOBACCO CESSATION COUNSELING AT NEARLY 30 SITES ACROSS MINNESOTA, WISCONSIN, AND NORTH DAKOTA. THESE SITES COVER A WIDE GEOGRAPHY, FROM SMALL RURAL COMMUNITIES TO LARGER URBAN AREAS, AND OFTEN SERVE PEOPLE LIVING ON LOW AND MODERATE INCOMES.ESSENTIA HEALTH OFFERS DIABETES PREVENTION EDUCATION AND FALLS PREVENTION PROGRAMS IN OUR COMMUNITIES. THIS WORK HAS BEEN RECOGNIZED BY A NUMBER OF COMMENDATIONS AND AWARDS FROM GOVERNMENT AGENCIES. THESE COMMUNITY-BASED EFFORTS ARE FREE TO THE PUBLIC AND ALL INDIVIDUALS ARE WELCOME.ADDRESSING SOCIAL DETERMINANTS OF HEALTH AND IMPROVING HEALTH EQUITY IS A KEY FOCUS FOR ESSENTIA HEALTH AS WELL. ACROSS OUR SERVICE AREA, FOOD INSECURITY REMAINS A PROBLEM WITH SOME COUNTIES SEEING AS HIGH AS 18% OF THE POPULATION WITH FOOD INSECURITY COMPARED TO THE MINNESOTA STATE AVERAGE OF 10%. A FIVE-QUESTION "SOCIAL NEEDS" QUESTIONNAIRE IS SENT TO ALL PRIMARY CARE AND PEDIATRIC PATIENTS THROUGH MYCHART, WHICH OFFERS PATIENTS SECURE, 24/7 ONLINE ACCESS TO THEIR MEDICAL RECORD. PATIENTS WHO ANSWER THAT THEY HAVE A SOCIAL-DETERMINANT NEED AND WOULD LIKE SUPPORT ARE CONNECTED WITH OUR COMMUNITY CARE ASSOCIATES AND COMMUNITY HEALTH WORKERS. THESE ESSENTIA HEALTH COLLEAGUES DEVELOP A TRUSTING RELATIONSHIP WITH PATIENTS, MAKE REFERRALS TO CONNECT THEM WITH SERVICES, AND FOLLOW UP WITH THEM TO ENSURE NEW RESOURCES AND REFERRALS ARE HELPFUL.IN 2021, ESSENTIA HEALTH PARTNERED WITH FIND HELP TO PROVIDE A FREE ONLINE RESOURCE GUIDE (WEARERESOURCEFUL.ORG) TO HELP OUR COMMUNITY MEMBERS FIND FREE AND REDUCED COST SERVICES. RESOURCEFUL HELPS PEOPLE CONNECT TO SOCIAL SERVICE PROGRAMS, INCLUDING FOOD, SHELTER, HEALTH CARE, WORK, TRANSPORTATION, FINANCIAL ASSISTANCE AND OTHER RESOURCES. RESOURCEFUL IS USED BY OUR CARE TEAM MEMBERS TO PLACE AND TRACK REFERRALS TO COMMUNITY RESOURCES. IT'S ALSO USED BEYOND THE WALLS OF OUR HOSPITALS AND CLINICS BY COMMUNITY ORGANIZATIONS, HELPERS AND NAVIGATORS, FAMILIES, AND INDIVIDUALS FOR FREE. AS OF SPRING 2023, MORE THAN 13,000 REFERRALS TO COMMUNITY RESOURCES HAD BEEN PLACED THROUGH THE PLATFORM.ADDITIONALLY, ESSENTIA HEALTH SUPPORTS THE HEALTH OF OUR COMMUNITIES THROUGH ACTIVE RESEARCH AND CLINICAL TRIALS THROUGH THE ESSENTIA INSTITUTE OF RURAL HEALTH (INSTITUTE). THE INSTITUTE CONDUCTS CLINICAL, TRANSLATIONAL, AND HEALTH SERVICES RESEARCH WITH A PRIMARY FOCUS ON THE NEEDS OF RURAL AMERICANS. VARIOUS ESSENTIA HEALTH ORGANIZATIONS CONTRIBUTED APPROXIMATELY $3.8 MILLION IN SUPPORT TO THE INSTITUTE DURING THE PAST YEAR. ESSENTIA HEALTH IS ALSO A PRIMARY SUPPORTER OF MEDICAL EDUCATION, PARTICULARLY IN THE AREA OF RURAL PRIMARY CARE. ESSENTIA HEALTH PHYSICIANS SERVE AS FACULTY AND PRECEPTORS FOR THE UNIVERSITY OF MINNESOTA SCHOOL OF MEDICINE IN DULUTH, MN. ESSENTIA HEALTH ALSO PROVIDES FUNDING, ADMINISTRATIVE SUPPORT, AND RESIDENCY OPPORTUNITIES FOR THE DULUTH FAMILY PRACTICE RESIDENCY PROGRAM. THIS PROGRAM IS VITAL IN ADDRESSING THE GROWING SHORTAGE OF PRIMARY CARE PHYSICIANS IN RURAL COMMUNITIES. PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM:ESSENTIA HEALTH DULUTH AND ESSENTIA HEALTH VIRGINIA ARE PART OF ESSENTIA HEALTH, A FULLY INTEGRATED HEALTH SYSTEM WITH 14 HOSPITALS, APPROXIMATELY 78 CLINICS, SIX LONG-TERM CARE FACILITIES, TWO ASSISTED LIVING FACILITIES, THREE INDEPENDENT LIVING FACILITIES, SEVERAL REHABILITATION CENTERS, SEVEN AMBULANCE SERVICES, 27 RETAIL PHARMACIES, ONE RESEARCH INSTITUTE, AND HOME HEALTH SERVICES IN THREE STATES: MINNESOTA, WISCONSIN, AND NORTH DAKOTA. ESSENTIA HEALTH SERVES A PREDOMINANTLY RURAL POPULATION WHOSE MEDIAN INCOMES GENERALLY FALL BELOW THE AVERAGES OF THE STATES WHERE THEY LIVE. THE PRESENCE OF OUR CLINICS AND HOSPITALS ENSURES THAT PEOPLE WITH FEW ECONOMIC RESOURCES DO NOT HAVE TO DRIVE AN HOUR OR MORE TO RECEIVE BASIC (AND IN SOME CASES LIFESAVING) MEDICAL CARE.IN ADDITION TO STAFFING HOSPITALS AND CLINICS IN FEDERALLY RECOGNIZED UNDERSERVED AREAS, ESSENTIA HEALTH SUPPORTS THE HEALTH OF COMMUNITIES THROUGH ACTIVE OUTREACH PROGRAMS THAT BRING ONCOLOGISTS, CARDIOLOGISTS, AND OTHERS INTO SMALL HOSPITALS AND CLINICS. ESSENTIA HEALTH'S SIZE AND INTEGRATED STRUCTURE ALSO ALLOW THE ORGANIZATION TO EXTEND SERVICES LIKE CHEMOTHERAPY, WOUND CARE, AND HOSPICE CARE TO SMALLER COMMUNITIES.PATIENTS ARE ABLE TO TRAVEL SEAMLESSLY BETWEEN ESSENTIA HEALTH'S SMALLER COMMUNITY CLINICS AND ITS LARGER SPECIALTY CARE CENTERS THANKS TO SIGNIFICANT INVESTMENTS IN ELECTRONIC HEALTH RECORDS (EHRS). ALMOST EVERY ESSENTIA HEALTH HOSPITAL AND CLINIC IS LINKED TO THIS SYSTEM, ALLOWING CLINICIANS TO SHARE EVERYTHING FROM LAB RESULTS AND RADIOLOGY IMAGES TO NOTES ON CLINIC VISITS, HOSPITAL STAYS, AND SERVICES LIKE PHYSICAL REHABILITATION.THE EHR IS ALSO AN INCREASINGLY VALUABLE TOOL FOR PATIENTS AND THEIR FAMILIES, THANKS TO MYCHART, WHICH OFFERS PATIENTS SECURE, 24/7 ONLINE ACCESS TO THEIR MEDICAL RECORD. MYCHART ALSO ALLOWS PATIENTS TO CONTACT THEIR PHYSICIAN OR CLINIC, SCHEDULE APPOINTMENTS, AND ORDER MEDICATION REFILLS. THESE SERVICES ARE ALL OFFERED AT NO COST TO PATIENTS AND THEIR AUTHORIZED FAMILY, FRIENDS, AND CAREGIVERS.ESSENTIA HEALTH ALSO PROMOTES THE HEALTH OF ALL OF ITS COMMUNITIES THROUGH ADHERENCE TO EVIDENCE-BASED BEST PRACTICE STANDARDS AND CLINICAL QUALITY GOALS DESIGNED TO ENSURE THAT PATIENTS RECEIVE THE SAME HIGH STANDARD OF CARE AT ANY ESSENTIA HEALTH HOSPITAL OR CLINIC.THE ESSENTIA INSTITUTE OF RURAL HEALTH (INSTITUTE) ACTIVELY SUPPORTS COMMUNITY HEALTH THROUGH ITS TRANSLATIONAL AND HEALTH SERVICES RESEARCH WITH A PRIMARY FOCUS ON THE NEEDS OF RURAL AMERICANS. THE INSTITUTE ALSO SPONSORS A NUMBER OF CONFERENCES AND OTHER EDUCATIONAL EVENTS, OPEN TO ALL MEDICAL PROFESSIONALS IN THE REGION, TO ENSURE THAT RURAL CLINICIANS HAVE ACCESS TO CURRENT MEDICAL EDUCATION AND TRAINING CLOSE TO HOME.TELEHEALTH ALLOWS PATIENTS TO RECEIVE CARE FROM A SPECIALIST WHO IS NOT AVAILABLE IN THEIR HOME COMMUNITY. TELEHEALTH APPOINTMENTS TAKE PLACE IN LOCAL CLINICS OR HOSPITALS THROUGH SECURE INTERACTIVE VIDEOCONFERENCING. PATIENTS FEEL LIKE THEY ARE IN THE SAME ROOM AS THEIR DOCTOR. THIS EXPERIENCE OFFERS THE SAME HIGH-QUALITY CARE THAT PATIENTS EXPECT DURING AN IN-PERSON VISIT. TELEHEALTH CAN BE USED FOR SERVICES SUCH AS BEHAVIORAL HEALTH, CARDIOLOGY, STROKE CARE, PRIMARY CARE, AND ENDOCRINOLOGY/DIABETES CARE. IN ADDITION, PATIENTS CAN RECEIVE THE CARE THEY NEED WHERE AND WHEN THEY WANT IT. ESSENTIA OFFERS 24/7 VIDEO VISITS ON DEMAND FOR URGENT NEEDS ANY TIME, ONLINE E-VISITS FOR MORE THAN 20 COMMON CONDITIONS AND FREE MEDICAL ADVICE FROM OUR REGISTERED NURSES ANY TIME OF THE DAY OR NIGHT THROUGH OUR NURSE CARE LINE.ESSENTIA HEALTH'S HOSPITALS AND CLINICS PLAY ADDITIONAL ROLES IN PROMOTING HEALTH WITHIN THEIR COMMUNITIES. EACH ESSENTIA HEALTH HOSPITAL CONDUCTS A COMMUNITY HEALTH ASSESSMENT TO DETERMINE THE UNIQUE HEALTH NEEDS OF COMMUNITY RESIDENTS. THESE ASSESSMENTS, WHICH ARE BASED ON INPUT FROM A BROAD RANGE OF COMMUNITY RESIDENTS AND STAKEHOLDERS, ARE THE BASIS FOR ACTION PLANS AIMED AT ADDRESSING THE COMMUNITY'S MOST PRESSING HEALTH NEEDS. MOST RECENTLY, TOPICS OF CONCERN HAVE INCLUDED ELIMINATING SOCIAL AND ECONOMIC BARRIERS TO HEALTH AND WELLNESS, IMPROVING MENTAL HEALTH SERVICES AND AWARENESS, ADDRESSING YOUTH SUBSTANCE ABUSE, FOOD INSECURITY, AND OBESITY. THESE ISSUES ARE THEN ADDRESSED THROUGH COLLABORATION WITH PRIVATE BUSINESSES, GOVERNMENT AGENCIES, AND OTHER NON-PROFITS.CURRENTLY, TWO OF THE MOST PROMINENT COLLABORATIONS ARE WITH CROW WING ENERGIZED AND BRIDGING HEALTH DULUTH, JOINT PUBLIC-PRIVATE PARTNERSHIPS AIMED AT IMPROVING THE OVERALL HEALTH STATUS OF THESE COMMUNITIES THROUGH COORDINATED PROGRAMMING AIMED AT LIFESTYLE ISSUES RANGING FROM EXERCISE TO HEALTHY EATING TO ADDRESS SOCIAL DETERMINANTS OF HEALTH.IN AN EFFORT TO HELP SOME OF OUR COMMUNITIES' AT-RISK POPULATIONS REMAIN AT HOME AND OUT OF THE HOSPITAL OR NURSING HOME, ESSENTIA HEALTH HAS COMMUNITY PARAMEDIC PROGRAMS IN FARGO, ND, AS WELL AS BRAINERD, DETROIT LAKES, DEER RIVER, AND DULUTH, MN. PARAMEDICS MAKE HOUSE CALLS TO PATIENTS WHO HAVE BEEN IDENTIFIED AS AT RISK FOR EMERGENCY DEPARTMENT VISITS. DURING THE CALLS, THEY TAKE VITAL SIGNS, ASSESS POSSIBLE HEALTH AND SAFETY RISKS, AND DETERMINE IF PATIENTS MAY BENEFIT FROM ADDITIONAL COMMUNITY RESOURCES.ESSENTIA HEALTH EMPLOYEES CONTRIBUTE DIRECTLY TO THE HEALTH AND WELLNESS OF THEIR COMMUNITIES BY VOLUNTEERING IN PROGRAMS RANGING FROM HABITAT FOR HUMANITY TO UNITED WAY TO FOOD AND CLOTHING DRIVES. THEY ARE ACTIVE FUNDRAISERS FOR HEALTH-RELATED ORGANIZATIONS IN THEIR COMMUNITIES, LIKE LOCAL CHAPTERS OF THE AMERICAN HEART ASSOCIATION. ESSENTIA HEALTH ENCOURAGES AND SUPPORTS THESE VOLUNTEER EFFORTS IN A VARIETY OF WAYS, INCLUDING SPONSORSHIPS, FINANCIAL CONTRIBUTIONS, AND VOLUNTEER RECOGNITION.WE ALSO SUPPORT COMMUNITY HEALTH THROUGH CONTRIBUTIONS THAT FOCUS ON PROGRAMS AND SERVICES THAT BENEFIT THE OVERALL HEALTH OF THE COMMUNITIES WE SERVE. SOME EXAMPLES OF THESE PROGRAMS ARE FARMERS MARKETS, COMMUNITY GARDENS, WORKFORCE DEVELOPMENT PROGRAMS, AND TRANSPORTATION ACCESS PROGRAMS. PART VI, LINE 7, REPORTS FILED WITH STATES MN 1 ARROWHEAD ECONOMIC OPPORTUNITY AGENCY 702 3RD AVE S VIRGINIA MN 55792 416052144 501(C)3 9680 0 PROGRAM SUPPORT ARROWHEAD PARISH NURSE ASSOCIATION PO BOX 16328 DULUTH MN 55816 461527679 501(C)3 15000 0 PROGRAM SUPPORT BIWABIK AREA CIVIC ASSOCIATION PO BOX 309 BIWABIK MN 55708 411501528 501(C)4 8702 0 PROGRAM SUPPORT BOYS & GIRLS CLUB OF THE NORTHLAND 102 S 29TH AVE W 200 DULUTH MN 55816 410969947 501(C)3 20000 0 PROGRAM SUPPORT CENTRAL RANGE PICKLEBALL CLUB 2222 6TH AVE E HIBBING MN 55746 882917260 501(C)3 10000 0 PROGRAM SUPPORT CHISHOLM KIDS PLUS 301 SW 4TH ST CHISHOLM MN 55719 201241174 501(C)3 10000 0 PROGRAM SUPPORT CHURCHES UNITED IN MINISTRY 102 WEST 2ND ST DULUTH MN 55802 411227969 501(C)3 10100 0 PROGRAM SUPPORT CITY OF VIRGINIA 327 SOUTH 1ST STREET VIRGINIA MN 55792 416005595 CITY OF VIRGINIA 14200 0 PROGRAM SUPPORT COLLEGE OF ST SCHOLASTICA 1200 KENWOOD AVE DULUTH MN 55806 410698301 501(C)3 8000 0 PROGRAM SUPPORT DAMIANO CENTER 206 W 4TH STREET DULUTH MN 55806 411453521 501(C)3 10000 0 PROGRAM SUPPORT ELY COMMUNITY HEALTH CENTER 105 E CONAN STREET ELY MN 55731 475399418 501(C)3 10000 0 PROGRAM SUPPORT ESSENTIA HEALTH FOUNDATION 502 E 2ND STREET DULUTH MN 55805 271984704 501(C)3 70350 0 PROGRAM SUPPORT FIRST WITNESS CHILD ABUSE RESOURCE CENTER 4 WEST 5TH ST DULUTH MN 55806 411737291 501(C)3 30750 0 PROGRAM SUPPORT GLORIA DEI LUTHERAN CHURCH 219 N 6TH AVE EAST DULUTH MN 55805 410718322 501(C)3 25000 0 PROGRAM SUPPORT GREEN NEW DEAL HOUSING 1831 E 8TH ST STE 103 DULUTH MN 55812 841819301 501(C)3 8000 0 PROGRAM SUPPORT HEALTH ALLIANCES MATTER TO ALL PO BOX 7258 DULUTH MN 55807 861658208 501(C)3 27200 0 PROGRAM SUPPORT HISTORIC CIVIC CENTER FOUNDATION PO BOX 144 WASHBURN WI 54891 463236754 501(C)3 5300 0 PROGRAM SUPPORT IRON RANGE PARTNERSHIP FOR SUSTAINABILITY PO BOX 1165 VIRGINIA MN 55792 275050532 501(C)3 8860 0 PROGRAM SUPPORT JUST KIDS DENTAL INC PO BOX 146 TWO HARBORS MN 55616 272311353 501(C)3 40000 0 PROGRAM SUPPORT KIDS CLOSET OF DULUTH 727 CENTRAL AVE DULUTH MN 55807 201878745 501(C)3 7500 0 PROGRAM SUPPORT LAURENTIAN ARTS & CULTURE ALLIANCE 501-514 CHESTNUT STREET VIRGINIA MN 55792 411902528 501(C)3 5500 0 PROGRAM SUPPORT LEGACY OF EXCELLENCE FOUNDATION 312 ELM AVE MOOSE LAKE MN 55767 844042393 501(C)3 5100 0 PROGRAM SUPPORT LOCAL INITIATIVES SUPPORT CORP 501 SEVENTH AVENUE SEVENTH FLOOR NEW YORK NY 10018 133030229 501(C)3 15000 0 PROGRAM SUPPORT LUTHERAN SOCIAL SERVICE OF MN 2485 COMO AVE ST PAUL MN 55108 410872993 501(C)3 15000 0 PROGRAM SUPPORT MILLER DWAN FOUNDATION 502 E 2ND STREET DULUTH MN 55805 237396466 501(C)3 133715 0 PROGRAM SUPPORT MOOSE LAKE TOWNSHIP CARLTON COUNTY PO BOX 193 MOOSE LAKE MN 55767 411624466 COUNTY GOVERNMENT 15000 0 PROGRAM SUPPORT NORTH ST LOUIS COUNTY HABITAT FOR HUMANITY PO BOX 24 VIRGINIA MN 55792 411791050 501(C)3 23000 0 PROGRAM SUPPORT NORTHERN WATERS PARISH NURSE MINISTRY INC 3500 TOWER AVE SUPERIOR WI 54880 392001278 501(C)3 18000 0 PROGRAM SUPPORT NORTHLAND FOUNDATION 202 W SUPERIOR ST STE 610 DULUTH MN 55802 411554455 501(C)3 20000 0 PROGRAM SUPPORT ONE ROOF COMMUNITY HOUSING 12 E 4TH ST STE 1 DULUTH MN 55805 411678328 501(C)3 30000 0 PROGRAM SUPPORT QUARRY KIDS CHILD CARE CENTER 132 ORIOLE ST E SANDSTONE MN 55072 871353836 501(C)3 15000 0 PROGRAM SUPPORT SOAR CAREER SOLUTIONS 205 W 2ND ST 101 DULUTH MN 55802 411449179 501(C)3 20000 0 PROGRAM SUPPORT ST ANN'S HOME 330 EAST THIRD STREET DULUTH MN 55805 410696491 501(C)3 9999 0 PROGRAM SUPPORT ST PAUL & MINNESOTA FOUNDATION 101 5TH ST E STE 2400 ST PAUL MN 55101 416031510 501(C)3 10100 0 PROGRAM SUPPORT STARBASE MINNESOTA 659 MUSTANG AVE ST PAUL MN 55111 411756817 501(C)3 12500 0 PROGRAM SUPPORT STONE LAKE LIONS CLUB PO BOX 194 STONE LAKE WI 54876 237061536 501(C)4 10000 0 PROGRAM SUPPORT UNITED WAY OF NORTHEASTERN MINNESOTA 608 EAST DR CHISHOLM MN 55719 410908454 501(C)3 30000 0 PROGRAM SUPPORT YWCA OF DULUTH 32 EAST FIRST ST STE 202 DULUTH MN 55802 410696493 501(C)3 10000 0 PROGRAM SUPPORT 36 2 PART I, LINE 2: PROCEDURES FOR MONITORING USE OF GRANT FUNDS: ESSENTIA HEALTH DULUTH PROVIDES GRANT MONIES TO ORGANIZATIONS THAT DEMONSTRATE THE MISSION OR VALUES OF ESSENTIA HEALTH. THE BOARD APPROVES GRANT MONIES TO COMMUNITY ORGANIZATIONS THAT MAKE A HEALTHY DIFFERENCE IN THE NORTHLAND. THE BOARD ALSO APPROVES GRANTS FOR HEALTHCARE INITIATIVES THAT MAKE A POSITIVE DIFFERENCE IN THE LIVES OF PATIENTS IN THE AREA IT SERVES. THE BOARD IS PROVIDED AN ANNUAL REPORT OF THE USE OF FUNDS. GRANT RECIPIENTS ARE REQUIRED TO PROVIDE A WRITTEN REPORT FOR GRANTS OVER $5,000. X X X 1 1 0 0 0 0 0 0 0 JON PRYOR MD PRESIDENT - EAST 785922 0 331316 0 14097 0 24400 0 13430 0 1169165 0 0 0 BRADLEY BEARD CHIEF OPERATING OFFICER 600630 0 256508 0 75272 0 98483 0 39002 0 1069895 0 43259 0 ANNE STEPHEN MD CHIEF MEDICAL OFFICER 456170 0 197482 0 222792 0 75729 0 31642 0 983815 0 190490 0 DANIEL NIKCEVICH MD BOARD DIRECTOR 0 768532 0 0 0 139895 0 20705 0 37435 0 966567 0 134962 JANICE SCHADE SENIOR VICE PRESIDENT, OPERATIONS 353161 0 154116 0 34351 0 59011 0 29117 0 629756 0 25995 0 RHONDA KAZIK CHIEF NURSING OFFICER 381088 0 151426 0 5813 0 64447 0 26353 0 629127 0 0 0 KEVIN BOREN VICE PRESIDENT, FINANCE 394711 0 85550 0 48191 0 49069 0 39942 0 617463 0 32212 0 KRISTA SKORUPA MD REGIONAL PRACTICES CHAIR 336583 0 143215 0 53610 0 54798 0 15033 0 603239 0 0 0 TAMMY KRITZER SENIOR VICE PRESIDENT, OPERATIONS 326304 0 139215 0 2608 0 50738 0 15097 0 533962 0 0 0 SAMUEL STONE ADMINISTRATIOR - VIRGINIA 241996 0 35998 0 9118 0 13040 0 40879 0 341031 0 0 0 BETH MOLDEN REGISTERED NURSE 281191 0 0 0 16 0 14557 0 36349 0 332113 0 0 0 ERIK JULSRUD MEDICAL PHYSICS MANAGER 255024 0 0 0 671 0 13488 0 39629 0 308812 0 0 0 VICKI SCHEER ADMINISTRATOR 191664 0 0 0 587 0 10186 0 39875 0 242312 0 0 0 CYNTHIA KENT FORMER SNR VP, NURSING EXCELLENCE 0 0 0 0 222503 0 0 0 7863 0 230366 0 0 0 PART I, LINE 3 ESTABLISHING CEO'S COMPENSATION: ESSENTIA HEALTH, AS A RELATED ORGANIZATION, USED THE FOLLOWING METHODS TO ESTABLISH ESSENTIA HEALTH DULUTH'S ADMINISTRATOR'S COMPENSATION: A COMPENSATION COMMITTEE, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINES 4A-B SEVERANCE PAYMENT: FORMER KEY EMPLOYEE CYNTHIA KENT RECEIVED PAYMENTS TOTALING $222,503 IN CALENDAR YEAR 2022 RELATED TO A TERMINATION AGREEMENT. UNDER THE TERMS OF THE AGREEMENT, KENT WILL RECEIVE PAY TOTALING $461,635 & BENEFITS TOTALING $38,623 FROM FEBRUARY 1, 2021 TO AUGUST 1, 2022. SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: ESSENTIA HEALTH'S NONQUALIFIED RETIREMENT PLAN IS OFFERED TO DESIGNATED ESSENTIA HEALTH EXECUTIVES. THERE IS A MINIMUM FOUR YEAR VESTING DATE, OR VESTING IS AUTOMATIC UPON REACHING RETIREMENT AGE, DEATH, DISABILITY OR INVOLUNTARY TERMINATION WITHOUT CAUSE. BENEFITS ARE SUBJECT TO INCOME TAXES UPON VESTING AND PAYABLE FROM ESSENTIA HEALTH'S GENERAL ASSETS. REPORTED AS OTHER REPORTABLE COMPENSATION IN SCHEDULE J, PART II, COLUMN B (III), THE FOLLOWING INDIVIDUALS LISTED IN FORM 990, PART VII, SECTION A, LINE 1A RECEIVED PAYMENT OF THE VESTED BENEFIT FROM THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN DURING THE YEAR: BRADLEY BEARD $63,788 ANNE STEPHEN, MD $211,981 DANIEL NIKCEVICH, MD $134,962 JANICE SCHADE $25,995 KEVIN BOREN $32,212 REPORTED AS RETIREMENT AND OTHER DEFERRED COMPENSATION IN SCHEDULE J, PART II, COLUMN C, ESSENTIA HEALTH MADE CONTRIBUTIONS, SUBJECT TO THE VESTING TERMS, DURING THE YEAR INTO THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN ON BEHALF OF THE FOLLOWING INDIVIDUALS LISTED IN FORM 990, PART VII, SECTION A, LINE 1A: BRADLEY BEARD $74,083 ANNE STEPHEN, MD $51,329 JANICE SCHADE $34,611 RHONDA KAZIK $40,047 KEVIN BOREN $24,669 KRISTA SKORUPA, MD $30,398 TAMMY KRITZER $28,674 A DULUTH ECONOMIC DEVELOPMENT AUTHORITY 900848286 26444CHF2 2018-11-01 704253406 SRS 2018A (SEE PART VI) 0 0 0 B DULUTH ECONOMIC DEVELOPMENT AUTHORITY 900848286 000000000 2020-05-15 65000000 SRS 2020D (SEE PART VI) 0 0 0 A 687157762 84275359 5561412 597320991 1 0 1 1 B 3311077 51200303 339052 49064573 1796678 0 0 0 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 0 0 0 1 0 0 1 SEE PART VI 1 1 1 B 0 1 0 0 0 0 0 1 1 A 1 B 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: DULUTH ECONOMIC DEVELOPMENT AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 06/30/2023 SCHEDULE K: ADDITIONAL INFORMATION/COMMENTS RELATING TO THE REPORTING OF LIABILITIES BY RELATED ORGANIZATIONS: ESSENTIA HEALTH HAS AN OBLIGATED GROUP CREATED UNDER THE MASTER TRUST INDENTURE WHICH IS COMPOSED OF THE FOLLOWING MEMBERS: ESSENTIA HEALTH, ESSENTIA HEALTH EAST, ESSENTIA HEALTH ST. JOSEPH'S MEDICAL CENTER, ESSENTIA HEALTH ST. MARY'S-DETROIT LAKES, ESSENTIA HEALTH ST. MARY'S MEDICAL CENTER, ESSENTIA HEALTH DULUTH, ESSENTIA HEALTH POLINSKY MEDICAL REHABILITATION CENTER, ESSENTIA HEALTH ST. MARY'S HOSPITAL-SUPERIOR, ESSENTIA HEALTH BRAINERD SPECIALTY CLINIC, BRAINERD LAKES INTEGRATED HEALTH SYSTEM, ST. MARY'S INNOVIS HEALTH, THE DULUTH CLINIC, LTD. AND ESSENTIA HEALTH WEST (THE "OBLIGATED GROUP MEMBERS"). THE OBLIGATED GROUP MEMBERS ARE JOINTLY AND SEVERALLY OBLIGATED ON ALL INDEBTEDNESS EVIDENCED OR SECURED BY NOTES ISSUED UNDER THE MASTER TRUST INDENTURE. SERIES 2018A: THE SERIES 2018A BONDS ARE SECURED BY NOTES ISSUED UNDER THE MASTER TRUST INDENTURE. THE OBLIGATED GROUP MEMBERS: ESSENTIA HEALTH, ESSENTIA HEALTH EAST, THE DULUTH CLINIC, LTD., ESSENTIA HEALTH DULUTH, ESSENTIA HEALTH ST. MARY'S MEDICAL CENTER, ESSENTIA HEALTH ST. JOSEPH'S MEDICAL CENTER, ESSENTIA HEALTH ST. MARY'S-DETROIT LAKES, BRAINERD LAKES INTEGRATED HEALTH SYSTEM, ESSENTIA HEALTH BRAINERD SPECIALTY CLINIC, AND ESSENTIA HEALTH WEST ARE THE CONDUIT BORROWERS OF THE SERIES 2018A BONDS. THE CONDUIT BORROWERS ESSENTIA HEALTH, ESSENTIA HEALTH ST. MARY'S-DETROIT LAKES, ESSENTIA HEALTH DULUTH, THE DULUTH CLINIC, LTD., ESSENTIA HEALTH WEST, AND ESSENTIA HEALTH ST. JOSEPH'S MEDICAL CENTER HAVE RECORDED A PORTION OF THE BOND LIABILITY ON THEIR BALANCE SHEETS WHICH ARE CONSOLIDATED WITH ESSENTIA HEALTH. SERIES 2020D: THE SERIES 2020D BONDS ARE SECURED BY NOTES ISSUED UNDER THE MASTER TRUST INDENTURE. THE OBLIGATED GROUP MEMBERS: ESSENTIA HEALTH, ESSENTIA HEALTH WEST, ESSENTIA HEALTH EAST, AND BRAINERD LAKES INTEGRATED HEALTH SYSTEM ARE THE CONDUIT BORROWERS OF THE SERIES 2020D BONDS. THE OBLIGATED GROUP MEMBERS ESSENTIA HEALTH DULUTH, ESSENTIA HEALTH ST. MARY'S-DETROIT LAKES, AND ESSENTIA HEALTH ST. JOSEPH'S MEDICAL CENTER ARE INDIRECT BENEFICIARIES OF THE SERIES 2020D BORROWING AND HAVE RECORDED A PORTION OF THE BOND LIABILITY ON THEIR BALANCE SHEETS WHICH ARE CONSOLIDATED WITH ESSENTIA HEALTH. SCHEDULE K, PART I, COLUMN (F): DESCRIPTION OF PURPOSE: SERIES 2018A: ACQUIRE, CONSTRUCT, BUILD, AND EQUIP MEDICAL CAMPUS PROJECT IN DULUTH, MN; REFUND SERIES 2008E BONDS ISSUED MAY 2, 2008 TO REFINANCE SERIES 1997 BONDS ISSUED DECEMBER 18, 1997 TO FINANCE EQUIPMENT PURCHASES IN DULUTH, MN AND FINANCE PROPERTY ACQUISITIONS, CAPITAL IMPROVEMENTS AND EQUIPMENT PURCHASES IN NORTHERN MINNESOTA; AND REFUND SERIES 2014 BONDS ISSUED JULY 29, 2014 TO REFINANCE PRIOR NOTE USED FOR CAPITAL IMPROVEMENTS TO SKILLED NURSING FACILITY LOCATED IN DETROIT LAKES, MN AND VARIOUS CONSTRUCTION PROJECTS AND EQUIPMENT PURCHASES IN BAXTER, FRAZEE, AND PELICAN RAPIDS, MN AND FINANCE CAPITAL EXPENDITURES TO REPLACE THE CHILLER UNIT FOR ESSENTIA HEALTH VIRGINIA, RENOVATE APPROXIMATELY 118,000 SQUARE FEET OF CLINIC SPACE FOR ESSENTIA HEALTH BRAINERD SPECIALTY CLINIC, REMODEL AND EQUIP EXISTING CLINIC SPACE IN EMILY, MN FOR ESSENTIA HEALTH ST. JOSEPH'S MEDICAL CENTER, AND EXPAND AND REMODEL THE IMAGING AREA IN THE EMERGENCY ROOM OF ESSENTIA HEALTH ST. MARY'S-DETROIT LAKES' HOSPITAL. SERIES 2020D: ACQUIRE, CONSTRUCT, RENOVATE, AND EQUIP CERTAIN HEALTH FACILITIES IN DULUTH, CLOQUET, PARK RAPIDS, AND PINE RIVER, MN. SCHEDULE K, PART II, LINE 3: ISSUE PRICE: THE SERIES 2018A AND 2020D BONDS WERE ISSUED BY THE ESSENTIA HEALTH OBLIGATED GROUP. THE ISSUE PRICE LISTED IN ESSENTIA HEALTH DULUTH'S SCHEDULE K, PART I, COLUMN (E) REPRESENTS THE ESSENTIA HEALTH OBLIGATED GROUP'S TOTAL BORROWING. IN ADDITION, THE SERIES 2018A AND 2020D TOTAL PROCEEDS ARE NOT IDENTICAL TO THE ISSUE PRICE LISTED IN PART I, COLUMN (E) DUE TO INVESTMENT EARNINGS. SCHEDULE K, PART II, LINES 3 THROUGH 12: PROCEEDS: THE SERIES 2018A AND 2020D BONDS WERE ISSUED BY THE ESSENTIA HEALTH OBLIGATED GROUP. A PORTION OF THE SERIES 2018A AND 2020D BORROWINGS WERE ALLOCATED TO ESSENTIA HEALTH DULUTH, AN ESSENTIA HEALTH OBLIGATED GROUP MEMBER. THE PROCEEDS LISTED IN ESSENTIA HEALTH DULUTH'S SCHEDULE K, PART II, LINES 3 THROUGH 12 REPRESENT ESSENTIA HEALTH DULUTH'S ALLOCATED PORTION OF THE PROCEEDS. SCHEDULE K, PART IV, LINE 5B: NAME OF PROVIDER OF GIC: NATIXIS FUNDING CORP & THE TORONTO-DOMINION BANK BROOKE SCHEER RELATED TO VICKI SCHEER 13282 COMPENSATION OF FAMILY MEMBER OF OFFICER 0 DALE SCHEER RELATED TO VICKI SCHEER 53082 COMPENSATION OF FAMILY MEMBER OF OFFICER 0 MINNESOTA POWER SUBSTANTIAL CONTRIBUTOR 2287785 INDEPENDENT CONTRACTOR ARRANGEMENT 0 FORM 990, PART V, LINE 1A: 1099 REPORTING: VENDOR PAYMENTS AND FORM 1099S WERE PROCESSED THROUGH ESSENTIA HEALTH ON BEHALF OF THE LEGAL ENTITIES COMPRISING ESSENTIA HEALTH. FORM 990, PART VI, SECTION A, LINE 6 MEMBERS OF ORGANIZATION: ESSENTIA HEALTH EAST MAY ELECT ONE OR MORE MEMBERS OF THE GOVERNING BODY AS DESCRIBED IN SCHEDULE O, PART VI, LINE 7A. ESSENTIA HEALTH AND ESSENTIA HEALTH EAST HAVE RESERVED POWERS WITH RESPECT TO ESSENTIA HEALTH DULUTH AS DESCRIBED IN SCHEDULE O, PART VI, LINE 7B. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS WITH RIGHT TO ELECT GOVERNING BODY: ESSENTIA HEALTH EAST APPOINTS AND REMOVES ESSENTIA HEALTH DULUTH'S GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B MEMBER WITH RIGHT TO APPROVE GOVERNING BODY DECISION: ESSENTIA HEALTH DULUTH IS A SUBSIDIARY OF ESSENTIA HEALTH, WHOSE BOARD OF DIRECTORS HAS RESERVED POWERS WITH RESPECT TO THESE CORPORATIONS AND THEIR SUBSIDIARIES, AND ALL OF THE OTHER DIRECT AND INDIRECT SUBSIDIARIES OF ESSENTIA HEALTH (COLLECTIVELY, THE "SYSTEM"). ESSENTIA HEALTH'S RESERVED POWERS ARE AS FOLLOWS: STRATEGIC AND BUSINESS PLANS. AUTHORITY TO CREATE, AND TO APPROVE, THE SYSTEM'S STRATEGIC AND BUSINESS PLANS. MISSION. AUTHORITY TO CREATE, AND TO APPROVE, THE MISSION, PURPOSE AND VISION STATEMENTS FOR ALL ENTITIES IN THE SYSTEM BY THE AFFIRMATIVE VOTE OF AT LEAST 67% OF THE ESSENTIA HEALTH BOARD OF DIRECTORS. DEBT. APPROVAL OF THE INCURRENCE OF DEBT BY, AND THE CREATION OF ALL MORTGAGES, LIENS, SECURITY INTERESTS, OR OTHER ENCUMBRANCES ON THE ASSETS OF, ALL ENTITIES IN THE SYSTEM IN EXCESS OF THE SINGLE OR ANNUAL AGGREGATE DOLLAR LIMITS PRESCRIBED IN WRITING BY THE ESSENTIA HEALTH BOARD OF DIRECTORS, AND THE AUTHORITY TO CAUSE ALL ENTITIES IN THE SYSTEM TO PARTICIPATE IN SYSTEM BORROWING. GOVERNING INSTRUMENTS. AUTHORITY TO CAUSE, AND TO APPROVE, AMENDMENTS OF THE ARTICLES OF INCORPORATION AND BYLAWS AND/OR CERTIFICATES OF FORMATION AND OPERATING AGREEMENTS OF ALL ENTITIES IN THE SYSTEM. MERGERS AND ACQUISITIONS. AUTHORITY TO CAUSE, AND TO APPROVE, ALL MERGERS, CONSOLIDATIONS, AND DISSOLUTIONS OF ALL ENTITIES IN THE SYSTEM. AFFILIATIONS AND JOINT VENTURES. AUTHORITY TO CAUSE, AND TO APPROVE, ALL AFFILIATIONS, JOINT VENTURES AND OTHER ALLIANCES WITH THIRD PARTIES OF ALL ENTITIES IN THE SYSTEM. TRANSFER OF ASSETS WITHIN THE SYSTEM. AUTHORITY TO TRANSFER ASSETS, INCLUDING CASH, BETWEEN AND AMONG ENTITIES WITHIN THE SYSTEM; PROVIDED, HOWEVER, THAT ESSENTIA HEALTH SHALL NOT HAVE AUTHORITY TO REQUIRE ANY ENTITY IN THE SYSTEM TO TRANSFER ASSETS (A) THAT WOULD CAUSE SUCH ENTITY TO BE IN DEFAULT OF ITS COVENANTS OR OBLIGATIONS UNDER ANY BOND OR OTHER FINANCING DOCUMENTS; (B) FROM THE CATHOLIC ENTITIES TO THE SECULAR ENTITIES OR FROM THE SECULAR ENTITIES TO THE CATHOLIC ENTITIES IN A MANNER OR TO AN EXTENT THAT WOULD CAUSE THE CATHOLIC ENTITIES TO BE IN VIOLATION OF THE ETHICAL AND RELIGIOUS DIRECTIVES FOR CATHOLIC HEALTH CARE SERVICES (ERDS) IN THE JUDGMENT OF THE LOCAL ORDINARY; OR (C) SUCH THAT MONEY GENERATED BY SERVICES AT SECULAR FACILITIES WITHIN THE SYSTEM BY PROCEDURES THAT ARE CONTRARY TO THE ERDS WOULD BE USED AT THE CATHOLIC ENTITIES OR MONEY GENERATED BY CATHOLIC ENTITIES WOULD BE USED IN THE PROVIDING OF SERVICES CONTRARY TO THE ERDS AT SECULAR FACILITIES WITHIN THE SYSTEM. TRANSFER OF ASSETS OUTSIDE THE SYSTEM. AUTHORITY TO CAUSE, AND TO APPROVE, THE SALE, LEASE OR OTHER TRANSFER OF ASSETS OF ALL ENTITIES IN THE SYSTEM TO PARTIES OUTSIDE OF THE SYSTEM WHEN THE ASSET'S VALUE EXCEEDS THE SINGLE OR ANNUAL AGGREGATE LIMITS PRESCRIBED IN WRITING BY THE ESSENTIA HEALTH BOARD OF DIRECTORS. SERVICES. AUTHORITY TO CAUSE, AND TO APPROVE, THE DISCONTINUANCE OF SERVICES AND SERVICE LOCATIONS WITHIN ALL ENTITIES IN THE SYSTEM. BUDGETS. APPROVAL OF CAPITAL AND OPERATING BUDGETS OF ALL ENTITIES IN THE SYSTEM. PROFESSIONAL SERVICES. SELECTION OF THE GENERAL LEGAL COUNSEL AND EXTERNAL AUDITORS OF ENTITIES IN THE SYSTEM. ACQUISITIONS. AUTHORITY TO CAUSE, AND TO APPROVE, ALL ACQUISITIONS BY AND FORMATIONS OF ENTITIES IN THE SYSTEM. MARKETING. AUTHORITY TO IMPLEMENT SYSTEM-WIDE MARKETING AND PROMOTIONAL ACTIVITIES. COMPLIANCE PLANS. AUTHORITY TO CREATE, AND TO APPROVE, CORPORATE COMPLIANCE, SAFETY AND RISK MANAGEMENT PLANS FOR ENTITIES WITHIN THE SYSTEM. QUALITY PLAN. AUTHORITY TO CREATE, AND TO APPROVE, THE SYSTEM'S QUALITY PLAN. NON-BUDGETED PURCHASES. APPROVAL OF NON-BUDGETED CAPITAL PURCHASES AND LEASES IN EXCESS OF THE SINGLE OR ANNUAL AGGREGATE DOLLAR LIMITS PRESCRIBED IN WRITING BY ESSENTIA HEALTH FOR ENTITIES WITHIN THE SYSTEM. HUMAN RESOURCES. AUTHORITY TO CREATE HUMAN RESOURCE POLICIES AND PROCEDURES WITHIN THE SYSTEM. RESERVED POWERS. AUTHORITY TO CREATE ADDITIONAL ESSENTIA HEALTH RESERVED POWERS BY THE AFFIRMATIVE VOTE OF AT LEAST 80% OF THE ESSENTIA HEALTH BOARD OF DIRECTORS (EXCLUDING THE ESSENTIA HEALTH CEO); PROVIDED, HOWEVER, THAT ANY ADDITIONAL ESSENTIA HEALTH RESERVED POWERS SHALL NOT CONTRAVENE OR HINDER THE RESERVED POWERS OF BENEDICTINE SISTERS BENEVOLENT ASSOCIATION. ESSENTIA HEALTH EAST HAS THE FOLLOWING RESERVED POWERS OVER ALL ITS SUBSIDIARIES: QUALITY, SAFETY AND SERVICE. AUTHORITY TO RECOMMEND QUALITY AND SAFETY INITIATIVES AND TO REVIEW AND EXECUTE APPROVED QUALITY AND SAFETY PLANS FOR THE EAST MARKET. MISSION, VISION AND VALUES. AUTHORITY TO CREATE A MISSION AND A VISION THAT SUPPORT THE MISSION AND VISION OF ESSENTIA HEALTH; RESPONSIBILITY TO OVERSEE THE MISSION PERFORMANCE, INCLUDING CHARITY CARE, OF ALL FACILITIES WITHIN THE EAST MARKET; RESPONSIBILITY TO ADOPT THE VALUES OF ESSENTIA HEALTH. OPERATING AND FINANCIAL PERFORMANCE. RESPONSIBILITY TO OVERSEE THE OPERATING AND FINANCIAL PERFORMANCE OF THE EAST MARKET. DEVELOPMENT OF BUDGETS, STRATEGIC PLANS AND STRATEGY MAP. AUTHORITY TO DEVELOP AND RECOMMEND, BASED ON ESSENTIA HEALTH TARGETS, CAPITAL AND OPERATING BUDGETS FOR THE EAST MARKET AND ITS FACILITIES; AUTHORITY TO RECOMMEND, WITHIN THE ESSENTIA HEALTH CONTEXT, MARKET AND LOCAL STRATEGIC PLANS FOR THE EAST MARKET; AUTHORITY TO DEVELOP EAST MARKET GOVERNANCE STRATEGY MAP AND BALANCED SCORECARD WITHIN ESSENTIA HEALTH'S SYSTEM STRATEGY TO MEET SYSTEM GOALS. NON-BUDGETED EXPENDITURES. AUTHORITY TO APPROVE NON-BUDGETED CAPITAL PURCHASES AND LEASES FOR EAST MARKET FACILITIES WITHIN DOLLAR LIMITS DEFINED BY ESSENTIA HEALTH. ACCREDITATION AND LICENSURE. RESPONSIBILITY TO OVERSEE ACCREDITATION AND LICENSURE COMPLIANCE FOR THE FACILITIES OF THE EAST MARKET. AFFILIATIONS, ACQUISITIONS AND JOINT VENTURES. AUTHORITY TO RECOMMEND PROPOSED AFFILIATIONS, ACQUISITIONS, JOINT VENTURES AND OTHER ALLIANCES; RESPONSIBILITY TO OVERSEE NEGOTIATION AND IMPLEMENTATION OF APPROVED ACQUISITIONS AND OPERATION OF ALL APPROVED AFFILIATIONS, JOINT VENTURES AND OTHER ALLIANCES WITH THIRD PARTIES WITHIN THE EAST MARKET. APPOINTMENT OF DIRECTORS. AUTHORITY TO APPOINT OR ELECT DIRECTORS OF THE DIRECT SUBSIDIARIES, AND TO REMOVE SUCH DIRECTORS, WITH OR WITHOUT CAUSE. SATISFACTION. RESPONSIBILITY TO EXECUTE, EVALUATE AND OVERSEE PATIENT, FAMILY AND CUSTOMER SATISFACTION WITH RESPECT TO SERVICES PROVIDED WITHIN THE EAST MARKET AND TO ENSURE ESTABLISHED GOALS ARE MET. JOB SATISFACTION. RESPONSIBILITY TO OVERSEE JOB SATISFACTION AND STAFF MORALE WITHIN THE EAST MARKET FACILITIES. HUMAN RESOURCES. RESPONSIBILITY TO OVERSEE IMPLEMENTATION OF ESSENTIA HEALTH HUMAN RESOURCE POLICIES AND PROCEDURES THROUGHOUT THE EAST MARKET. COMPLIANCE. RESPONSIBILITY TO EXECUTE THE APPROVED ESSENTIA HEALTH CORPORATE COMPLIANCE AND RISK MANAGEMENT PLANS FOR THE EAST MARKET. CREDENTIALING. RESPONSIBILITY TO OVERSEE MEDICAL STAFF CREDENTIALING FOR THE EAST MARKET FACILITIES. AMENDMENTS. AUTHORITY TO SUGGEST PROPOSED AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS OF THIS CORPORATION, THE DIRECT SUBSIDIARIES, AND ANY SUBSIDIARIES THEREOF. COMPENSATION PLANS. RESPONSIBILITY TO REVIEW AND APPROVE COMPENSATION OF EAST MARKET EXECUTIVES AND PHYSICIANS FOR REASONABLENESS AND CONSISTENCY WITH THE LAW AND ESSENTIA HEALTH'S COMPENSATION PHILOSOPHY. PRESIDENT/CHIEF MEDICAL OFFICER. BY ACTION OF THE PRESIDENT OF ESSENTIA HEALTH EAST, AUTHORITY TO APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, THE PRESIDENT/CHIEF MEDICAL OFFICER OF ANY OF THE DIRECT SUBSIDIARIES. PUBLIC POLICY. RESPONSIBILITY TO SUPPORT ESSENTIA HEALTH PUBLIC POLICY AND ADVOCACY PLANS. MARKETING. RESPONSIBILITY TO COORDINATE LOCAL MARKETING AND PROMOTIONAL ACTIVITIES CONSISTENT WITH ESSENTIA HEALTH MARKETING PLANS. PHILANTHROPY. RESPONSIBILITY TO COORDINATE PHILANTHROPY CONSISTENT WITH ESSENTIA HEALTH FOUNDATION POLICIES. PROFESSIONAL SERVICES. RESPONSIBILITY TO OVERSEE EAST MARKET MANAGEMENT'S COOPERATION WITH EXTERNAL AUDITORS AND GENERAL LEGAL COUNSEL SELECTED BY ESSENTIA HEALTH AND COORDINATION OF LEGAL SERVICES THROUGH THE ESSENTIA HEALTH OFFICE OF GENERAL COUNSEL. CATHOLIC FACILITIES. RESPONSIBILITY TO OVERSEE IMPLEMENTATION OF BSBA-APPROVED METHODS, POLICIES AND PROCEDURES PERTAINING TO ADHERENCE BY THE EAST MARKET CATHOLIC FACILITIES WITH THE ETHICAL AND RELIGIOUS DIRECTIVES FOR CATHOLIC HEALTH CARE SERVICES AND USE OF RELIGIOUS SYMBOLS, DISTINGUISHING ELEMENTS AND PRAYERS. PROJECTS INVOLVING REAL ESTATE. AUTHORITY TO RECOMMEND FACILITY DEVELOPMENT PROJECTS, SUBJECT TO THE APPROVAL OF ESSENTIA HEALTH; RESPONSIBILITY TO OVERSEE EXECUTION OF APPROVED DEVELOPMENT PROJECTS ACCORDING TO ESSENTIA HEALTH POLICIES. FORM 990, PART VI, SECTION A, LINE 8B COMMITTEES: THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 REVIEW PROCESS: THE 2022 FORM 990, INCLUDING ALL SCHEDULES, WAS REVIEWED BY MANAGEMENT AND THE GOVERNING BODY PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. THE FINANCE LEADER REVIEWED THE FORM AND SCHEDULES AND ANY QUESTIONS WERE DISCUSSED. EACH CURRENT DIRECTOR OF THE GOVERNING BODY RECEIVED A FINAL COPY OF THE 2022 FORM 990. FORM 990, PART VI, SECTION B, LINE 12C MONITORING AND ENFORCING CONFLICT OF INTEREST POLICY: ESSENTIA HEALTH'S COMPREHENSIVE CONFLICT OF INTEREST PROGRAM PREVENTS, DETECTS, AND RESOLVES ACTUAL CONFLICTS OF INTERESTS OR THE ACTUAL OR POTENTIAL APPEARANCE OF SUCH. FIDUCIARIES, DEFINED AS AN ESSENTIA HEALTH BOARD MEMBER/TRUSTEE, OFFICER, BOARD COMMITTEE MEMBER, SENIOR MANAGEMENT EMPLOYEE, OR ANY OTHERS CONSIDERED TO BE IN A POSITION OF INFLUENCE, ARE COVERED UNDER ESSENTIA HEALTH'S CONFLICT OF INTEREST PROGRAM. UPON INITIAL APPOINTMENT, EACH FIDUCIARY MUST COMPLETE AN INITIAL CONFLICT OF INTEREST STATEMENT AND DISCLOSURE QUESTIONNAIRE. AT THE CONCLUSION OF EACH CALENDAR YEAR, EACH FIDUCIARY MUST COMPLETE AN ANNUAL CONFLICT OF INTEREST STATEMENT AND DISCLOSURE QUESTIONNAIRE. AS NEEDED, A FIDUCIARY WILL UPDATE HIS/HER MOST RECENTLY COMPLETED QUESTIONNAIRE EACH TIME THE FIDUCIARY BECOMES AWARE OF A FINANCIAL INTEREST, A POTENTIAL CONFLICT, OR CHANGE TO ANY INFORMATION THAT THE FIDUCIARY PREVIOUSLY REPORTED. ESSENTIA HEALTH'S CHIEF COMPLIANCE OFFICER WILL COLLECT THE QUESTIONNAIRES AND EVALUATE THE DISCLOSURES. IF A FIDUCIARY HAS A POTENTIAL CONFLICT OF INTEREST, THE CHIEF COMPLIANCE OFFICER OR DESIGNEE MAY REQUEST ADDITIONAL INFORMATION FROM THE FIDUCIARY, THE MANAGEMENT TEAM, AND OTHERS. DURING THE EVALUATION PROCESS, THE CHIEF COMPLIANCE OFFICER MAY ALSO CONSULT WITH ESSENTIA HEALTH'S BOARD AND AUDIT COMMITTEE CHAIRS, SENIOR MANAGEMENT, LEGAL DEPARTMENT, OR APPROPRIATE REPRESENTATIVES FROM ESSENTIA HEALTH. THE CHIEF COMPLIANCE OFFICER REPORTS TO THE ESSENTIA HEALTH AUDIT COMMITTEE AND THE ESSENTIA HEALTH BOARD OF DIRECTORS ANY ACTUAL OR POTENTIAL CONFLICTS OF INTEREST DISCLOSED BY THE FIDUCIARY, ALONG WITH RECOMMENDED ACTIONS. THE ESSENTIA HEALTH BOARD OF DIRECTORS (OR DESIGNEE) WILL THEN DETERMINE WHETHER TO APPROVE THE SITUATION OR TO IMPLEMENT SPECIAL CONTROLS TO MANAGE THE POTENTIAL CONFLICT OF INTEREST. THE CHIEF COMPLIANCE OFFICER WILL THEN OFFICIALLY NOTIFY THE FIDUCIARY IN WRITING OF THE BOARD'S DECISION. THE DECISION OF WHETHER OR NOT THE DISCLOSURE CONSTITUTES A CONFLICT WILL BE AT THE ESSENTIA HEALTH BOARD OF DIRECTOR'S (OR DESIGNEE) SOLE DISCRETION, AND ITS CONCERN MUST BE THE WELFARE OF ESSENTIA HEALTH AND ITS AFFILIATE(S) AND THE ADVANCEMENT OF ITS PURPOSES. WHEN THE ESSENTIA HEALTH BOARD OF DIRECTORS (OR DESIGNEE) CONSIDERS A FIDUCIARY'S DISCLOSURE AS A CONFLICT OF INTEREST, SPECIAL CONTROLS WILL BE IDENTIFIED TO MANAGE, ELIMINATE OR REDUCE THE LIKELIHOOD AND/OR APPEARANCE OF A CONFLICT ARISING. CONTROLS MAY INCLUDE, BUT ARE NOT LIMITED TO: A. IF THE CONFLICT INVOLVES AN ON-GOING MATTER OR RELATIONSHIP, THE FIDUCIARY MUST NOT PARTICIPATE IN BOARD, BOARD COMMITTEE, OR MANAGEMENT DISCUSSIONS RELATED TO THE CONFLICT AND MUST RECUSE THEMSELVES AND IF APPROPRIATE, WITHDRAW, FROM ANY BOARD MEETING OR PORTION THEREOF WHERE THE MATTER IS BEING DISCUSSED AND DURING THE VOTE ON THE POTENTIAL CONFLICT OF INTEREST. THE FIDUCIARY MAY ANSWER QUESTIONS AT THE BOARD'S OR THE BOARD COMMITTEE'S REQUEST. B. IF THE CONFLICT INVOLVES A SPECIFIC TRANSACTION OR DECISION, THE FIDUCIARY WILL FULLY DISCLOSE THEIR INTEREST AND ALL RELATED MATERIAL FACTS. THE BOARD OR COMMITTEE OF THE BOARD WILL DETERMINE WHETHER THE CONTEMPLATED TRANSACTION MAY BE AUTHORIZED AS JUST, FAIR, AND REASONABLE TO ESSENTIA HEALTH OR ITS AFFILIATE(S). IF THE BOARD DETERMINES A CONFLICT DOES NOT EXIST, THE FIDUCIARY MAY PROCEED WITH THE TRANSACTION; HOWEVER, HE OR SHE WILL NOT BE ELIGIBLE TO VOTE ON RELATED ISSUES SHOULD THEY ARISE. IF THE BOARD DETERMINES A CONFLICT DOES EXIST, THE FIDUCIARY WILL BE NOTIFIED OF THE DECISION REGARDING WHETHER THE CONTEMPLATED TRANSACTION WILL BE AUTHORIZED AS JUST, FAIR, AND REASONABLE. FORM 990, PART VI, LINE 12: POLICY APPLIES TO DISREGARDED ENTITY, ESSENTIA HEALTH VIRGINIA, LLC. FORM 990, PART VI, LINE 13: POLICY APPLIES TO DISREGARDED ENTITY, ESSENTIA HEALTH VIRGINIA, LLC. FORM 990, PART VI, LINE 14: POLICY APPLIES TO DISREGARDED ENTITY, ESSENTIA HEALTH VIRGINIA, LLC. FORM 990, PART VI, LINE 15: POLICY APPLIES TO DISREGARDED ENTITY, ESSENTIA HEALTH VIRGINIA, LLC. FORM 990, PART VI, SECTION B, LINE 15 PROCESS FOR DETERMINING COMPENSATION: THE INDEPENDENT EXECUTIVE COMPENSATION COMMITTEE OF ESSENTIA HEALTH'S BOARD OF DIRECTORS IS AUTHORIZED TO FULFILL THE BOARD'S RESPONSIBILITIES REGARDING EXECUTIVE COMPENSATION CONSISTENT WITH ESSENTIA'S MISSION, VALUES AND TAX-EXEMPT STATUS, AND THE EXECUTIVE COMPENSATION COMMITTEE'S CHARTER. THE EXECUTIVE COMPENSATION COMMITTEE MEETS AT LEAST TWICE ANNUALLY TO CARRY OUT ITS RESPONSIBILITIES, WHICH INCLUDE, BUT ARE NOT LIMITED TO, ESTABLISHING, REVIEWING AND MODIFYING, AS APPROPRIATE, REASONABLE COMPENSATION AND BENEFITS FOR DESIGNATED ESSENTIA EXECUTIVES WHO ARE OFFICERS OR KEY EMPLOYEES OF ESSENTIA OR ANY OF ITS AFFILIATES WHICH MAY BE PAID BY RELATED ORGANIZATIONS. THE EXECUTIVE COMPENSATION COMMITTEE ENGAGES QUALIFIED INDEPENDENT COMPENSATION ADVISORS TO PROVIDE OBJECTIVE AND IMPARTIAL COMPARATIVE DATA AND TO EXPRESS OPINIONS ON TOTAL COMPENSATION REASONABLENESS. THE EXECUTIVE COMPENSATION COMMITTEE MAY REQUEST ITS INDEPENDENT ADVISORS TO: MONITOR COMPARABILITY DATA AND MARKETPLACE TRENDS; MAKE APPROPRIATE RECOMMENDATIONS REGARDING SALARY RANGES; AND PERIODICALLY REVIEW THE MARKET COMPETITIVENESS OF ESSENTIA EXECUTIVE COMPENSATION PACKAGES. PRIOR TO ESTABLISHING OR ADJUSTING EXECUTIVE COMPENSATION, THE EXECUTIVE COMPENSATION COMMITTEE WILL OBTAIN AND RELY UPON APPROPRIATE DATA AS TO COMPARABILITY OF THE PROPOSED COMPENSATION OR ADJUSTMENTS. THE EXECUTIVE COMPENSATION COMMITTEE WILL ADEQUATELY DOCUMENT THE BASIS FOR ITS DETERMINATION CONCURRENTLY WITH MAKING THOSE DETERMINATIONS. THE EXECUTIVE COMPENSATION COMMITTEE MINUTES WILL INCLUDE: THE TERMS OF THE APPROVED COMPENSATION AND THE DATE APPROVED; THE EXECUTIVE COMPENSATION COMMITTEE MEMBERS PRESENT DURING THE REVIEW, DISCUSSION AND APPROVAL OF THE PROPOSED COMPENSATION AND THOSE WHO VOTED ON THE PROPOSED COMPENSATION; IDENTIFICATION OF THE COMPARABILITY DATA OBTAINED AND RELIED UPON BY THE EXECUTIVE COMPENSATION COMMITTEE AND HOW THE DATA WAS OBTAINED; ANY ACTIONS BY A MEMBER OF THE EXECUTIVE COMPENSATION COMMITTEE HAVING A CONFLICT OF INTEREST; AND DOCUMENTATION OF THE BASIS FOR THE DETERMINATION. THE YEAR THIS PROCESS WAS LAST UNDERTAKEN FOR ESSENTIA HEALTH DULUTH'S CHIEF OPERATING OFFICER, CHIEF MEDICAL OFFICER, SENIOR VICE PRESIDENTS OF OPERATIONS, CHIEF NURSING OFFICER, VICE PRESIDENT OF FINANCE, AND ADMINISTRATOR WAS 2023. FORM 990, PART VI, SECTION C, LINE 19 AVAILABILITY OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, & FINANCIAL STATEMENTS TO THE PUBLIC: GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D). FORM 990, PART IX, LINE 24E: AFFILIATE REVENUE AND EXPENSE ALLOCATION: ESSENTIA HEALTH DULUTH, ESSENTIA HEALTH ST. MARY'S MEDICAL CENTER, AND THE DULUTH CLINIC, LTD. ALLOCATE CERTAIN REVENUES AND EXPENSES DIRECTLY TO ESSENTIA HEALTH DULUTH, ESSENTIA HEALTH ST. MARY'S MEDICAL CENTER, THE DULUTH CLINIC, LTD., ESSENTIA HEALTH SANDSTONE, ESSENTIA HEALTH ST. MARY'S HOSPITAL-SUPERIOR, ESSENTIA HEALTH NORTHERN PINES, ESSENTIA HEALTH POLINSKY MEDICAL REHABILITATION CENTER, ESSENTIA HEALTH DEER RIVER, ESSENTIA HEALTH VIRGINIA, AND ESSENTIA HEALTH MOOSE LAKE, ALL RELATED ORGANIZATIONS. NET AFFILIATE REVENUE AND EXPENSE ALLOCATIONS OF ($43,436,262) INCLUDE THE FOLLOWING TYPES OF REVENUE AND EXPENSES: PATIENT REVENUE; NONPATIENT REVENUE; AMORTIZATION AND DEPRECIATION; INTEREST; PROFESSIONAL FEES; PURCHASED SERVICES; REPAIRS AND MAINTENANCE; SALARIES, WAGES, AND RELATED BENEFITS; SUPPLIES; UTILITIES; AGENCY FEES; PROVIDER AND OTHER TAXES; AND OTHER EXPENSES. FORM 990, PART XI, LINE 9: CHANGE IN MINIMUM PENSION LIABILITY 222,640. NET ASSET TRANSFERS WITH RELATED ORG 217,815. GRANT REALLOCATION ADJUSTMENT 479. FORM 990, PART XII, LINE 3: CONSOLIDATED UNIFORM GUIDANCE AUDIT: ESSENTIA HEALTH DULUTH AND ESSENTIA HEALTH VIRGINIA, AS PART OF ESSENTIA HEALTH'S CONSOLIDATED FINANCIAL STATEMENTS, WERE REQUIRED AND UNDERWENT A CONSOLIDATED AUDIT SET FORTH IN THE UNIFORM GUIDANCE, 2 C.F.R. PART 200, SUBPART F. THE CONSOLIDATED AUDIT IS REVIEWED BY THE ESSENTIA HEALTH AUDIT COMMITTEE. ESSENTIA HEALTH VIRGINIA LLC 502 E 2ND ST DULUTH MN 55805 460909870 HOSPITAL/CLINIC/SKILLED NURSING FACILITY DE 139174628 61123889 SMDC MEDICAL CENTER BRAINERD LAKES INTEGRATED HEALTH SYSTEM 2024 S 6TH ST BRAINERD MN 56401 371532145 SUPPORTING ORG MN 501(C)(3) LINE 12B, II ESSENTIA HEALTH 1 BRAINERD MEDICAL CENTER INC 2024 S 6TH ST BRAINERD MN 56401 371532148 CLINIC MN 501(C)(3) LINE 3 BRAINERD LAKES INTEGRATED HEALTH SYSTEM 1 BRIDGES MEDICAL CENTER 201 9TH ST W ADA MN 56510 200479568 HOSPITAL/CLINIC MN 501(C)(3) LINE 3 INNOVIS HEALTH LLC 1 DEER RIVER HEALTHCARE CENTER INC 115 10TH AVE NE DEER RIVER MN 56636 410844574 HOSPITAL/CLINIC/SKILLED NURSING FACILITY MN 501(C)(3) LINE 3 ST MARY'S DULUTH CLINIC HEALTH SYSTEM 1 ESSENTIA HEALTH 502 E 2ND ST DULUTH MN 55805 200360007 SUPPORTING ORG MN 501(C)(3) LINE 12C, III-FI N/A 0 ESSENTIA HEALTH FOUNDATION 502 E 2ND ST DULUTH MN 55805 271984704 FOUNDATION MN 501(C)(3) LINE 7 ESSENTIA HEALTH 1 ESSENTIA HEALTH MOOSE LAKE 4572 COUNTY ROAD 61 MOOSE LAKE MN 55767 845099016 HOSPITAL/CLINIC MN 501(C)(3) LINE 3 ST MARY'S DULUTH CLINIC HEALTH SYSTEM 1 ESSENTIA HEALTH SURGERY CENTERS 502 E 2ND ST DULUTH MN 55805 881577422 SURGERY CENTER MN 501(C)(3) LINE 3 ESSENTIA HEALTH 1 ESSENTIA INSTITUTE OF RURAL HEALTH 502 E 2ND ST DULUTH MN 55805 271291124 RESEARCH MN 501(C)(3) LINE 4 THE DULUTH CLINIC LTD 1 FIRST CARE MEDICAL SERVICES 900 HILLIGOSS BLVD SE FOSSTON MN 56542 410706143 HOSPITAL/CLINIC/SKILLED NURSING FACILITY MN 501(C)(3) LINE 3 INNOVIS HEALTH LLC 1 GRACEVILLE HEALTH CENTER 115 WEST 2ND ST GRACEVILLE MN 56240 410726173 HOSPITAL/CLINIC/SKILLED NURSING FACILITY MN 501(C)(3) LINE 3 INNOVIS HEALTH LLC 1 INNOVIS HEALTH LLC 3000 32ND AVE S FARGO ND 58103 261175213 HOSPITAL/CLINIC DE 501(C)(3) LINE 3 ESSENTIA HEALTH 1 MIDWEST MEDICAL EQUIPMENT AND SUPPLIES INC 502 E 2ND ST DULUTH MN 55805 411674021 MEDICAL EQUIPMENT MN 501(C)(3) LINE 10 ST MARY'S MEDICAL CENTER 1 NORTHERN PINES MEDICAL CENTER 5211 HWY 110 AURORA MN 55705 410841441 HOSPITAL/CLINIC/SKILLED NURSING FACILITY MN 501(C)(3) LINE 3 ST MARY'S DULUTH CLINIC HEALTH SYSTEM 1 PINE MEDICAL CENTER 705 LUNDORFF DR S SANDSTONE MN 55072 411884597 HOSPITAL MN 501(C)(3) LINE 3 ST MARY'S DULUTH CLINIC HEALTH SYSTEM 1 POLINSKY MEDICAL REHABILITATION CENTER 530 E 2ND ST DULUTH MN 55805 410691275 REHABILITATION SERVICES MN 501(C)(3) LINE 3 ST MARY'S MEDICAL CENTER 1 ST JOSEPH'S MEDICAL CENTER 523 N 3RD ST BRAINERD MN 56401 410695602 HOSPITAL/CLINIC MN 501(C)(3) LINE 3 BRAINERD LAKES INTEGRATED HEALTH SYSTEM 1 ST MARY'S DULUTH CLINIC HEALTH SYSTEM 502 E 2ND ST DULUTH MN 55805 411836633 SUPPORTING ORG MN 501(C)(3) LINE 12B, II ESSENTIA HEALTH 1 ST MARY'S EMS 1027 WASHINGTON AVE DETROIT LAKES MN 56501 411805811 EMERGENCY SERVICES MN 501(C)(3) LINE 10 INNOVIS HEALTH LLC 1 ST MARY'S HOSPITAL OF SUPERIOR 3500 TOWER AVE SUPERIOR WI 54880 411811073 HOSPITAL/CLINIC MN 501(C)(3) LINE 3 ST MARY'S MEDICAL CENTER 1 ST MARY'S INNOVIS HEALTH 1027 WASHINGTON AVE DETROIT LAKES MN 56501 262861321 PHARMACY MN 501(C)(3) LINE 3 INNOVIS HEALTH LLC 1 ST MARY'S MEDICAL CENTER 402 E 2ND ST DULUTH MN 55805 410695604 HOSPITAL MN 501(C)(3) LINE 3 ST MARY'S DULUTH CLINIC HEALTH SYSTEM 1 ST MARY'S REGIONAL HEALTH CENTER 1027 WASHINGTON AVE DETROIT LAKES MN 56501 411620386 HOSPITAL/CLINIC/SKILLED NURSING FACILITY MN 501(C)(3) LINE 3 INNOVIS HEALTH LLC 1 THE DULUTH CLINIC LTD 400 E 3RD ST DULUTH MN 55805 410883623 CLINIC MN 501(C)(3) LINE 3 ST MARY'S DULUTH CLINIC HEALTH SYSTEM 1 PMC-GATEWAY IMAGING LLC THRU 1132022 705 LUNDORFF DR S SANDSTONE MN 55072 261634764 IMAGING SERVICES MN N/A N/A 0 0 HORSESHOE SURGERY CENTER LLC 1542 GOLF COURSE ROAD GRAND RAPIDS MN 55744 202137172 SURGERY CENTER MN N/A N/A 0 0 ESSENTIA HEALTH INSURANCE SERVICES SPC LTD PO BOX 1159 GRAND CAYMAN CJ 000000000 SELF INSURANCE CJ N/A C 1 MID DAKOTA CLNIC INC 502 E 2ND ST DULUTH MN 55805 450311334 CLINIC OPERATIONS CEASED 9/30/22 ND N/A C 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 ESSENTIA HEALTH M 76167689 ACTUAL COSTS ESSENTIA HEALTH P 42041443 ACTUAL COSTS ESSENTIA HEALTH R 12250000 ACTUAL COSTS ESSENTIA HEALTH FOUNDATION B 70350 ACTUAL COSTS ESSENTIA HEALTH FOUNDATION C 98979 ACTUAL COSTS ESSENTIA HEALTH SURGERY CENTERS A 2200000 ACTUAL COSTS MIDWEST MEDICAL EQUIPMENT AND SUPPLIES INC A 3712 ACTUAL COSTS MIDWEST MEDICAL EQUIPMENT AND SUPPLIES INC S 1000000 ACTUAL COSTS POLINSKY MEDICAL REHABILITATION CENTER A 1230523 ACTUAL COSTS ST JOSEPH'S MEDICAL CENTER P 72600 ACTUAL COSTS ST MARY'S MEDICAL CENTER A 96180 ACTUAL COSTS ST MARY'S MEDICAL CENTER Q 624429 ACTUAL COSTS ST MARY'S MEDICAL CENTER S 20000000 ACTUAL COSTS THE DULUTH CLINIC LTD A 110310 ACTUAL COSTS SCHEDULE R, PART II, COLUMN (A): THE FOLLOWING ESSENTIA HEALTH ENTITIES HAVE A DOING BUSINESS AS NAME: LEGAL NAME; DOING BUSINESS AS NAME BRAINERD MEDICAL CENTER, INC.; ESSENTIA HEALTH BRAINERD SPECIALTY CLINIC BRIDGES MEDICAL CENTER; ESSENTIA HEALTH ADA DEER RIVER HEALTHCARE CENTER, INC.; ESSENTIA HEALTH DEER RIVER FIRST CARE MEDICAL SERVICES; ESSENTIA HEALTH FOSSTON GRACEVILLE HEALTH CENTER; ESSENTIA HEALTH HOLY TRINITY HOSPITAL INNOVIS HEALTH, LLC; ESSENTIA HEALTH WEST MIDWEST MEDICAL EQUIPMENT AND SUPPLIES, INC.; ESSENTIA HEALTH MEDICAL EQUIPMENT & SUPPLIES NORTHERN PINES MEDICAL CENTER; ESSENTIA HEALTH NORTHERN PINES PINE MEDICAL CENTER; ESSENTIA HEALTH SANDSTONE POLINSKY MEDICAL REHABILITATION CENTER; ESSENTIA HEALTH POLINSKY MEDICAL REHABILITATION CENTER SMDC MEDICAL CENTER; ESSENTIA HEALTH DULUTH ST. JOSEPH'S MEDICAL CENTER; ESSENTIA HEALTH ST. JOSEPH'S MEDICAL CENTER ST. MARY'S DULUTH CLINIC HEALTH SYSTEM; ESSENTIA HEALTH EAST ST. MARY'S EMS; ESSENTIA HEALTH EMS ST. MARY'S HOSPITAL OF SUPERIOR; ESSENTIA HEALTH ST. MARY'S HOSPITAL-SUPERIOR ST. MARY'S MEDICAL CENTER; ESSENTIA HEALTH ST. MARY'S MEDICAL CENTER ST. MARY'S REGIONAL HEALTH CENTER; ESSENTIA HEALTH ST. MARY'S-DETROIT LAKES