4A (Expenses $ 704277979 including grants of $ 625924) (Revenue $ 931817874)
CENTRACARE HEALTH IS PRIMARILY ENGAGED IN SUPPORTING AND DIRECTING HEALTHCARE DELIVERY THROUGH ITS AFFILIATED ENTITIES. CENTRACARE OPERATES AS THE PARENT CORPORATION TO THE SAINT CLOUD HOSPITAL WHICH STRIVES TO IMPROVE THE QUALITY AND EXPAND THE CLINICAL SCOPE OF, ENHANCE ACCESS TO, AND ASSURE AFFORDABILITY OF, HEALTH SERVICES FOR RESIDENTS IN THE ST. CLOUD AREA AND CENTRAL MINNESOTA. THESE AIMS ARE SUPPORTED BY CENTRACARE'S COMMITMENT TO ADVANCE MEDICAL EDUCATION, TRAINING AND RESEARCH. AS A HIGH QUALITY REGIONAL MEDICAL CENTER, ST CLOUD HOSPITAL PROVIDES A BROAD RANGE OF ACUTE INPATIENT SERVICES. WITH 489 LICENSED INPATIENT BEDS, ST CLOUD HOSPITAL CARED FOR 21,538 INPATIENT ADMISSIONS WITH 110,973 ASSOCIATED PATIENT DAYS DURING FISCAL 2022. INPATIENT SERVICES INCLUDE MEDICAL AND SURGICAL CARE, BIRTHING SERVICES, CHILDREN'S SERVICES INCLUDING NEONATAL INTENSIVE CARE AND PEDIATRIC INTENSIVE CARE, BEHAVIORAL HEALTH CARE SERVICES FOR ADULTS AND ADOLESCENTS, ALONG WITH SPECIALIZED CARE IN CARDIOLOGY, NEUROSCIENCES, NEUROSURGERY, ORTHOPEDICS AND REHABILITATION SERVICES.

4B (Expenses $ 34574402 including grants of $ 0) (Revenue $ 34170849)
AS PART OF THE ST CLOUD HOSPITAL, ST BENEDICTS SENIOR COMMUNITY PROVIDES RESIDENTIAL HEALTH CARE SERVICES INCLUDING INDEPENDENT LIVING, ASSISTED LIVING AND SHORT AND LONG TERM SKILLED NURSING SERVICES. IN FISCAL 2022 THERE WERE 198 SKILLED STAFFED BEDS AND RESIDENT DAYS OF 46,507. SHORT STAY SKILLED SERVICES INCLUDE AN EXTENSIVE REHABILITATIVE CARE PROGRAM WITH THE GOAL OF ENABLING RESIDENTS TO RETURN TO THEIR HOMES. IN FISCAL 2022 THERE WERE 383 HOUSING UNITS AND TENANT DAYS OF 126,242. ASSISTED LIVING AND INDEPENDENT LIVING COMMUNITIES ARE DESIGNATED AS HOUSING WITH SERVICES. HOMECARE SERVICES ARE PROVIDED TO THESE TENANTS ON A BASE RATE PLUS POINTS SYSTEM.

4C (Expenses $ 0 including grants of $ 0) (Revenue $ 0)
AS A HIGH QUALITY REGIONAL MEDICAL CENTER, ST CLOUD HOSPITAL PROVIDES A BROAD RANGE OF OUTPATIENT SERVICES. OUTPATIENT ENCOUNTERS DURING FISCAL YEAR 2022 WERE 345,132 AND INCLUDED EMERGENCY ROOM SERVICES, BEHAVIORAL HEALTH CARE, CANCER TREATMENT, DIALYSIS, IMAGING PROCEDURES, DIAGNOSTIC HEART PROCEDURES, REHABILITATION THERAPY, SAME DAY SURGERY AND OTHER AMBULATORY CARE SERVICES.

ST. CLOUD HOSPITAL
PART V, SECTION B, LINE 3J: CENTRACARE UTILIZED THE MAPP (MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS) PROCESS TO CONDUCT THE CHNA AND PREPARE THE IMPLEMENTATION STRATEGY WHICH WE CALLED THE COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). THE MAPP PROCESS INCLUDES A LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT, STAKEHOLDER INTERVIEWS, COMMUNITY HEALTH SURVEY JOINTLY FUNDED AND MANAGED WITH THREE COUNTY PUBLIC HEALTH DEPARTMENTS, AND SEVERAL COMMUNITY MEETINGS TO GATHER INFORMATION ON FORCES THAT CREATE HEALTH, TRENDS, FACTORS AND EVENTS AFFECTING HEALTH, AND STRATEGIES TO OVERCOME BARRIERS TO HEALTHY LIVING. THE CHNA INCLUDED A HEALTH EQUITY ASSESSMENT AND INFORMATION ON NATIONAL, STATE, AND OTHER LOCAL PLANNING PROCESSES RELATED TO HEALTH.AS A FOLLOW UP TO THE PRIOR CHNA PROCESS WHERE PUBLIC HEALTH DATA WAS A SIGNIFICANT GAP, THIS CHNA AND SUBSEQUENT CHIP WAS A COLLABORATIVE EFFORT EXECUTED WITH BENTON COUNTY PUBLIC HEALTH, SHERBURNE COUNTY PUBLIC HEALTH, AND STEARNS COUNTY PUBLIC HEALTH. THE RESULT WAS A JOINT CHNA AND CHIP.

ST. CLOUD HOSPITAL
"PART V, SECTION B, LINE 5: CENTRACARE POPULATION HEALTH CONDUCTED SPECIFIC AND COMPREHENSIVE EVALUATION OF ZIP CODE 56304 THAT HAS THE WORST HEALTH OUTCOMES IN THE THREE COUNTIES INCLUDED IN THE CHNA AND CHIP. THIS EVALUATION INCLUDED DATA EVALUATION, KEY INFORMANT INTERVIEWS, AND HEALTH INDICATORS FOR MINORITY GROUPS. THE CENTRAL MN ALLIANCE ALSO COMPLETED SEVERAL SURVEYS AND ASSESSMENTS TO GET INPUT FROM MULTIPLE SECTORS OF EACH COMMUNITY REPRESENTING DIFFERENT POPULATIONS IN ORDER TO COMPILE A LIST OF TOP PRIORITIES IN THE REGION:THE COMMUNITY HEALTH STATUS ASSESSMENT (CHSA) WAS DATA COLLECTED FROM THE COMMUNITY HEALTH ASSESSMENT COMPLETED IN 2018, CENTRACARE PATIENT DATA, MINNESOTA STUDENT SURVEY DATA, AND MINNESOTA PUBLIC HEALTH VITAL STATISTICS. THIS DATA WAS COMPARED TO DOCUMENTS AND DATASETS FROM THE MN STATEWIDE HEALTH ASSESSMENT (SHA), CENTRAL MN COMMUNITY HEALTH SURVEY DATA, PREVIOUS PLANNING PROCESS PRIORITY LISTS, HEALTH EQUITY DATA ANALYSES (HEDA) FROM EACH COUNTY, TYPES OF DATA REQUESTS OUR AGENCIES WERE GETTING FROM THE PUBLIC, AND THE MN DEPARTMENT OF HEALTH DATA INDICATOR LIST. A ""COMMUNITY PRIORITY CATEGORY"" WAS ASSIGNED TO EACH DATA POINT TO IDENTIFY A LIST OF COMMUNITY PRIORITIES.THE COMMUNITY THEMES AND STRENGTHS ASSESSMENT (CTSA) WAS CONDUCTED IN THE FORM OF KEY STAKEHOLDER INTERVIEWS VIA PHONE WITH A WIDE VARIETY OF COMMUNITY PARTNERS THROUGHOUT THE THREE COUNTIES. A TOTAL OF 50 STAKEHOLDERS WERE INTERVIEWED FROM 20 DIFFERENT SECTORS INCLUDING YOUTH, PARENT, SMALL BUSINESS OWNER, CORPORATE BUSINESS OWNER, MEDIA, SCHOOL/EDUCATION, YOUTH-SERVING ORGANIZATION, LAW ENFORCEMENT, RELIGIOUS OR FAITH-BASED ORGANIZATION, PRIMARY HEALTHCARE, BEHAVIORAL HEALTH, HOSPITAL-BASED HEALTHCARE, STATE/LOCAL GOVERNMENT- ELECTED, STATE/LOCAL GOVERNMENT- NON-ELECTED, NON-PROFIT, CIVIC/VOLUNTEER GROUP, VETERANS INTEREST GROUP, AGING POPULATION INTEREST GROUP, ENVIRONMENTAL INTEREST GROUP, AND MINORITY INTEREST GROUP.FOR THE LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT (LPHSA) BENTON, SHERBURNE, AND STEARNS COUNTY LPH AGENCIES PARTICIPATED IN A CAPACITY ASSESSMENT TO HELP DETERMINE THE EXTENT TO WHICH REQUIRED LOCAL PUBLIC HEALTH ACTIVITIES ARE IN PLACE STATEWIDE. THE ASSESSMENT QUESTIONS WERE THEN UTILIZED TO FORMULATE A SURVEY FOR THREE SECTORS OF THE LOCAL PUBLIC HEALTH SYSTEM: EMERGENCY PREPAREDNESS, ENVIRONMENTAL HEALTH, AND HEALTHCARE ACCESS/INFECTIOUS DISEASE. COMMUNITY PARTNERS WERE INVITED TO PARTICIPATE IN THE SURVEY VIA EMAIL. AFTER ANALYZING THE RESULTS, THE LPHSA SUBGROUP DEVELOPED A LIST OF THEIR TOP 10 RECOMMENDATIONS FROM ALL 3 SECTORS TO SUPPORT THE DEVELOPMENT OF THE COMMUNITY COMMUNITY HEALTH IMPROVEMENT PLAN.THE FORCES OF CHANGE (FOC) ASSESSMENT WAS COMPLETED IN THE FORM OF A COMUNITY MEETING IN AUGUST OF 2018 TO IDENTIFY FORCES THAT MAY AFFECT A COMMUNITY AND OPPORTUNITIES AND THREATS ASSOCIATED WITH THOSE FORCES. THE AGENDA INCLUDED A BRAINSTORMING ACTIVITY AND TIME IN SMALL GROUP AND LARGE GROUP DISCUSSION. A FLIER ADVERTISING THE MEETING WAS DISTRIBUTED TO COMMUNITY MEMBERS VIA EMAIL. THERE WERE 68 PEOPLE THAT ATTENDED REPRESENTING 27 ORGANIZATIONS AND TWO THAT IDENTIFIED THEIR AFFILIATION AS 'COMMUNITY MEMBER'. AS A FOLLOW UP TO THE FORCES OF CHANGE COMMUNITY MEETING, A WORLD CAFE WAS HELD IN JANUARY 2019 FOR MEMBERS OF THE COMMUNITY TO COME AND TALK ABOUT THEIR PERCEPTION OF NEEDS IN THE SURROUNDING COMMUNITIES. THERE WERE 94 PEOPLE THAT ATTENDED THE MEETING REPRESENTING 32 ORGANIZATIONS AND THREE THAT IDENTIFIED THEIR AFFILIATION AS 'COMMUNITY MEMBER'. ORGANIZATIONS THAT WERE REPRESENTED AT BOTH COMMUNITY MEETINGS INCLUDED LOCAL GOVERNMENT, HEALTHCARE, LOCAL NONPROFITS, EDUCATION, UNDERREPRESENTED COMMUNITIES, FAITH COMMUNITY, AND OTHERS.IN ORDER TO BETTER ENGAGE INDIVIDUALS OR ORGANIZATIONS WITH A PERSPECTIVE OF AT-RISK POPULATIONS, A HEALTH EQUITY ASSESSMENT WAS ALSO COMPLETED. FOCUS-GROUP MEETINGS WERE HELD ON THREE SEPARATE OCCASIONS AT THE GREAT RIVER REGIONAL LIBRARY IN ST. CLOUD, AND COMMUNITY INPUT WAS GATHERED AT THE BENTON, SHERBURNE, AND STEARNS COUNTY FAIRS TO REACH OUT TO A VARIETY OF COMMUNITIES. IN TOTAL, THERE WERE 30 SOMALI ADULTS WHO DISCUSSED POSITIVES, NEGATIVES, AND AREAS-TO-IMPROVE-ON WITHIN THE COMMUNITY. AT THE COUNTY FAIRS, INFORMATION WAS GATHERED FROM RESPONDENTS FROM THE 56304-ZIP CODE."

ST. CLOUD HOSPITAL
PART V, SECTION B, LINE 6A: ST. CLOUD HOSPITAL CONDUCTED THE CHNA WITH CENTRACARE PAYNESVILLE, CENTRACARE MELROSE, AND CENTRACARE SAUK CENTRE.

ST. CLOUD HOSPITAL
PART V, SECTION B, LINE 6B: ST. CLOUD HOSPITAL CONDUCTED THE CHNA WITH BENTON COUNTY PUBLIC HEALTH, SHERBURNE COUNTY PUBLIC HEALTH AND STEARNS COUNTY PUBLIC HEALTH.

ST. CLOUD HOSPITAL
PART V, SECTION B, LINE 11: THE PRIORITIZATION PROCESS TOOK PLACE WHILE UTILIZING THE MAPP PROCESS. THE WORK OF EACH OF THE FOUR MAPP ASSESSMENT SUB-GROUPS RESULTED IN FOUR LISTS OF 10 COMMUNITY PRIORITIES. AS A REMINDER, THE FOUR ASSESSMENTS INCLUDE: COMMUNITY HEALTH STATUS ASSESSMENT, COMMUNITY THEMES AND STRENGTHS ASSESSMENT, LOCAL PUBLIC HEALTH STATUS ASSESSMENT, AND FORCES OF CHANGE ASSESSMENT. THOSE FOUR LISTS OF 10 ARE INCLUDED IN THE NARRATIVE EARLIER IN THIS DOCUMENT.THE CORE SUPPORT TEAM WAS PROVIDED THOSE FOUR LISTS OF TEN PRIORITIES. THEY TOOK THOSE LISTS AND TALKED WITH THEIR AGENCY STAFF TO IDENTIFY ANY THEMES OR COMMONALITIES AMONGST THE FOUR LISTS. THE CORE SUPPORT TEAM THEN CAME TOGETHER IN A MEETING AND WENT THROUGH A FACILITATED PROCESS USING THE CENTRAL MN ALLIANCE VISION AS A GUIDE TO COME UP WITH A TOP 10 LIST TO SEND ON TO THE DELEGATED AUTHORITIES.THE DELEGATED AUTHORITIES MET AND CONTINUED THE DISCUSSION ABOUT THE PRIORITY LIST. THE PRIORITIES PASSED ON BY THE CORE SUPPORT TEAM WERE RUN THROUGH TWO PRIORITIZATION EXERCISES. THE FIRST WAS A RANKING DISCUSSION WITH POINTS ASSIGNED FOR CERTAIN CRITERIA. RANKS INCLUDED 3 FOR HIGH, 2 FOR MEDIUM, AND 1 FOR LOW. THE CRITERIA INCLUDED: URGENCY: IS THIS A PRIORITY ISSUE THAT NEEDS TO BE ADDRESSED IN THE NEXT 1-3 YEARS? POTENTIAL IMPACT: IS IT LIKELY THAT ADDRESSING THIS CRITICAL ISSUE WILL HAVE A SIGNIFICANT IMPACT ON ONE OR MORE SPECIFIC POPULATIONS? DO YOU HAVE REASON TO BELIEVE YOU CAN BE SUCCESSFUL ON THIS ISSUE? ACTIONABLE/FEASIBLE: ARE THERE OPPORTUNITIES FOR ACTION TO ADDRESS THE CRITICAL ISSUE? IS THERE ROOM TO MAKE MEANINGFUL IMPROVEMENT ON THE ISSUE? RESOURCES: ARE RESOURCES (FUNDS, STAFF, & EXPERTISE) EITHER READILY AVAILABLE OR LIKELY RESOURCES CAN BE OBTAINED TO ADDRESS THE CRITICAL ISSUE? ARE THERE RESOURCES THROUGH THE STATE AND COMMUNITY MEMBERS TO WORK ON THE ISSUE? IF NOT, CAN RESOURCES BE ACQUIRED? COMMUNITY READINESS: IS THIS A CRITICAL ISSUE IDENTIFIED AS IMPORTANT BY THE COMMUNITY? ARE PEOPLE IN THE COMMUNITY INTERESTED IN THE ISSUE? IS THERE COMMUNITY MOMENTUM TO MOVE THIS INITIATIVE FORWARD? INTEGRATION: IS THERE OPPORTUNITY FOR COLLABORATION? IS THERE OPPORTUNITY TO BUILD ON EXISTING INITIATIVES? WILL THIS DUPLICATE EFFORTS? FINALLY, THE PRIORITIES WERE PLACED ON A CONTROL/INFLUENCE GRID.THE PRIORITIES IDENTIFIED WERE AS FOLLOWS IN COMMUNITY INFORMED RANKING: 1) BUILDING FAMILIES, 2) MENTAL HEALTH, 3) ENCOURAGING SOCIAL CONNECTION, 4) ADVERSE CHILDHOOD EXPERIENCES (ACES), 5) TOBACCO/NICOTINE USE, 6) HEALTH CARE, 7) RISKY YOUTH BEHAVIOR, 8) FINANCIAL STRESS, 9) TRAUMA, AND 10) EDUCATING POLICY MAKERS AND KEY COMMUNITY STAKEHOLDERS. DUE TO THE NEWNESS OF THE COLLABORATION ON THIS WORK, A DECISION WAS MADE TO FOCUS ON THE TOP TWO PRIORITIES (BUILDING FAMILIES AND MENTAL HEALTH) FOR THE COMMUNITY HEALTH IMPROVEMENT PLAN. THE PRIORITIES ENCOURAGING SOCIAL CONNECTION, ADVERSE CHILDHOOD EXPERIENCES (ACES), TOBACCO/NICOTINE USE, HEALTH CARE, RISKY YOUTH BEHAVIOR, FINANCIAL STRESS, TRAUMA, AND EDUCATING POLICY MAKERS AND KEY COMMUNITY STAKEHOLDERS WILL NOT SPECIFICALLY BE ADDRESSED THROUGH ACTION PLANNING OR MEASUREMENT DUE TO FUNDING AND STAFFING, HOWEVER, THERE ARE WAYS MANY OF THESE PRIORITIES ARE BEING ADDRESSED EITHER WITHIN THE TOP TWO PRIORITIES OR THE COMMUNITY. IN THE FUTURE, THE GROUP WILL ASSESS THE CAPACITY TO EXPAND THE NUMBER OF PRIORITIES BEING ADDRESSED AND MEASURED. ALTHOUGH NOT DIRECTLY ADDRESSED IN THE PLAN, CENTRACARE DOES ACTIVELY SUPPORT OTHER ORGANIZATIONS WITHIN THE COMMUNITY WHO ARE WORKING ON DETERMINANTS OF HEALTH IDENTIFIED DURING THE CHNA PROCESS LIKE ACES, TOBACCO, TRAUMA, EDUCATING POLICYMAKERS, ETC.THE COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) IS THE ACTION PLAN THAT USES GUIDING PRINCIPLES AND STRATEGIES TO ADDRESS THE COMMUNITY PRIORITIES IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS. THE TOP PRIORITIES ARE BUILDING FAMILIES AND MENTAL HEALTH. WE WILL USE THE GUIDING PRINCIPLES OF COMMUNITY COLLABORATION, AWARENESS, RESILIENCE, EQUITY, EDUCATION, AND HEALTH ORGANIZATIONS TO DRIVE OUR STRATEGIES.THE ST. CLOUD HOSPITAL, CENTRACARE- MELROSE HOSPITAL, CENTRACARE- SAUK CENTRE, AND CENTRACARE- PAYNESVILLE WILL MAINTAIN THEIR ENGAGEMENTS WITH THE CENTRAL MN ALLIANCE AND FOLLOW THE MAPP LEADERSHIP STRUCTURE TO CARRY OUT THE STRATEGIES OUTLINED IN THE CHIP. THERE WILL BE MEETINGS AS OUTLINED IN THE CHIP UNDER LEADERSHIP SYSTEM & PROCESS FOR MONITORING AND REVISION. TO SEE THE FULL CHIP GO TO THE CENTRACARE WEBSITE AT HTTPS://WWW.CENTRACARE.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/.

ST. CLOUD HOSPITAL
PART V, SECTION B, LINE 13H: A NON-CITIZEN CAN BE DENIED CARE IF THEY CAME TO THE US SPECIFICALLY TO RECEIVE FREE CARE.PRESUMPTIVE ELIGIBILITY - IF PATIENTS FAIL TO SUPPLY SUFFICIENT INFORMATION TO SUPPORT FINANCIAL ASSISTANCE ELIGIBILITY, CENTRACARE HEALTH MAY REFER TO OR RELY ON EXTERNAL SOURCES AND/OR OTHER PROGRAM ENROLLMENT RESOURCES TO DETERMINE ELIGIBILITY WHEN:(A) PATIENT IS HOMELESS(B) PATIENT IS ELIGIBLE FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS(C) PATIENT IS ELIGIBLE FOR FOOD STAMPS OR SUBSIDIZED SCHOOL LUNCH PROGRAM(D) PATIENT IS ELIGIBLE FOR A STATE-FUNDED PRESCRIPTION MEDICATION PROGRAM(E) PATIENT'S VALID ADDRESS IS CONSIDERED LOW-INCOME OR SUBSIDIZED HOUSING(F) PATIENT RECEIVES FREE CARE FROM A COMMUNITY CLINIC AND IS REFERRED TO HOSPITAL FOR FURTHER TREATMENT

ST. CLOUD HOSPITAL
PART V, SECTION B, LINE 16J: PATIENTS WHO ARE AT A SELF PAY STATUS RECEIVE FINANCIAL ASSISTANCE INFORMATION EITHER VIA A TELEPHONE CALL OR ON BILLING STATEMENTS.

ST. CLOUD HOSPITAL
PART V, SECTION B, LINE 20E: OUR CREDIT COLLECTION AGENCIES ARE REQUIRED TO PROVIDE CHARITY CARE INFORMATION AS PART OF THEIR COLLECTION PROCESS PRIOR TO ANY CONSIDERATION OF LEGAL ACTION AGAINST A PATIENT.

PART V, SECTION B, LINE 22B
"THE FOLLOWING DISCLOSURE IS IN ACCORDANCE WITH REV. PROC. 2015-21 SECTION 7 IN REGARDS TO SCHEDULE H, PART V, SECTION B, LINE 22B. DURING THE TAX PERIOD ENDED JUNE 30, 2022, THE FINANCIAL ASSISTANCE POLICY DID NOT INCLUDE THE PERCENTAGE CALCULATED FOR THE ""AMOUNTS GENERALLY BILLED"" USING THE LOOK BACK METHOD. CENTRACARE IDENTIFIED THIS ERROR IN MARCH 2022 DURING THE PREPARATION OF THE FORM 990 FOR THE TAX PERIOD ENDED JUNE 30, 2021 AND CORRECTED THIS ERROR IN APRIL 2022. THIS ERROR WAS MINOR AND INADVERTENT AND CORRECTIVE ACTIONS WERE TAKEN AFTER THE DISCOVERY OF THE ERROR."

PART V, SECTION B, LINE 7A:
HTTPS://WWW.CENTRACARE.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/

PART V, SECTION B, LINE 10A:
HTTPS://WWW.CENTRACARE.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/

PART I, LINE 6A:
CENTRACARE HEALTH SYSTEM PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT THAT INCLUDES ALL RELATED ORGANIZATIONS.

PART I, LINE 7:
THE ORGANIZATIONS TOTAL EXPENSES WERE REDUCED BY THEIR NON-OPERATING REVENUE, MEDICAID SURCHARGE AND MN CARE TAX. THE NET TOTAL EXPENSES WERE THEN DIVIDED BY GROSS CHARGES TO DETERMINE THE COST TO CHARGE RATIO. THE COST TO CHARGE RATIO WAS THEN APPLIED TO THE FINANCIAL ASSISTANCE ON LINE 7A. MEDICAID COMMUNITY BENEFIT EXPENSE AND DIRECT OFFSETTING REVENUES ON LINE 7B ARE REPORTED AT COST. COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS ON LINE 7E ARE REPORTED AT COST. HEALTH PROFESSIONALS EDUCATION AND DIRECT OFFSETING REVENUES ON LINE 7F ARE REPORTED AT COST. SUBSIDIZED HEALTH SERVICES AND DIRECT OFFSETTING REVENUES ON LINE 7G ARE REPORTED AT COST. RESEARCH ON LINE 7H ARE REPORTED AT COST. CASH AND IN-KIND CONTRIBUTIONS FOR COMMUNITY BENEFIT ON LINE 7I ARE REPORTED AT COST.

PART I, LINE 7, COLUMN (F):
THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 15,198,428.

PART II, COMMUNITY BUILDING ACTIVITIES:
THE ACTIVITIES INCLUDED IN COMMUNITY BUILDING ACTIVITIES INCLUDE COMMUNITY SUPPORT WHICH CONSISTS OF SEVERAL ST. CLOUD HOSPITAL DIRECTORS PARTICIPATING IN A VARIETY OF COMMITTEES SUCH AS THE BOARD OF BIG BROTHERS/BIG SISTERS, REHAB BOARD ETC. UNDER COMMUNITY HEALTH IMPROVEMENTS ADVOCACY, EMPLOYEES PARTICIPATED WITH CREATE COMMUNITY, WHICH IS A COLLABORATION TO BUILD INCLUSION AMONGST DIVERSE POPULATION AND SEVERAL COUNTY TASK FORCES TO ADVOCATE FOR MENTAL AND CHEMICAL HEALTH. FINALLY UNDER WORKFORCE DEVELOPMENT, AN EMPLOYEE IS A BOARD MEMBER OF THE STEARNS BENTON WORKFORCE COUNCIL AND STUDENTS WERE GIVEN TOURS OF THE HOSPITAL AND ATTENDED PRESENTATIONS ON CAREERS IN HEALTHCARE.THE HEALTH SYSTEM PROVIDED DRIVE THROUGH TEST SITES, FREE VACCINATION CLINICS, MANDATED EMPLOYEE VACCINATION, TRAINING, SCREENING, PRODUCTS TO ENSURE SAFE ENVIRONMENTS, AND OTHER VARIOUS SERVICES/PRODUCTS.

PART III, LINE 2:
THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS.

PART III, LINE 4:
"THE FOLLOWING IS FROM THE ""ACCOUNTS RECEIVABLE"" PARAGRAPH INCLUDED IN NOTE 2 ON PAGE 10 OF THE ORGANIZATION'S AUDITED FINANCIALS.""CENTRACARE REPORTS PATIENT AND RESIDENT SERVICE REVENUE AT THE AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH THE SYSTEM EXPECTS TO BE ENTITLED TO IN EXCHANGE FOR PROVIDING PATIENT CARE. THESE AMOUNTS ARE DUE FROM PATIENTS AND THIRD-PARTY PAYORS (INCLUDING MEDICARE, MEDICAID, BLUE CROSS AND OTHER THIRD-PARTY PAYORS). CERTAIN REIMBURSEMENT ARRANGEMENTS INCLUDE VARIABLE CONSIDERATION FOR AMOUNTS SUBJECT TO RETROACTIVE AUDIT AND ADJUSTMENT. DIFFERENCES BETWEEN AMOUNTS ORIGINALLY RECORDED AND FINALLY SETTLED ARE INCLUDED IN OPERATIONS IN THE YEAR IN WHICH THE DIFFERENCES ARE KNOWN. REVENUE IS RECOGNIZED AS PERFORMANCE OBLIGATIONS ARE SATISFIED."""

PART III, LINE 8:
THE AMOUNT ON LINE 6 OF PART III WAS DETERMINED BY UTILIZING THE MEDICARE COST REPORT, PRIMARILY THE D SERIES AND E SERIES.

PART III, LINE 9B:
THE COLLECTION POLICIES AT ST. CLOUD HOSPITAL REQUIRE COLLECTION STAFF TO OFFER CHARITY TO PATIENTS WHO INDICATE THAT PAYMENT MAY BE AN ISSUE. IF A PATIENT DOES QUALIFY FOR FULL CHARITY, ALL OTHER COLLECTION EFFORTS MUST CEASE. IF A PATIENT QUALIFIES FOR PARTIAL CHARITY, COLLECTION EFFORTS WILL CONTINUE ON THE BALANCE OF THE ACCOUNT. THESE PROVISIONS APPLY TO BOTH HOSPITAL EMPLOYED COLLECTION STAFF AND COLLECTION AGENCY STAFF. NO PATIENTS, WHETHER THEY QUALIFY FOR CHARITY OR NOT, ARE REPORTED TO CREDIT REPORTING AGENCIES.

PART VI, LINE 2:
ST. CLOUD HOSPITAL FOUNDATION HAS IN PLACE A COMMUNITY COLLABORATION COMMITTEE WHICH HAS A MEMBERSHIP OF OVER 30 MEMBERS. THIS COMMITTEE IS MADE UP OF COMMUNITY LEADERS FROM BOTH THE HEALTHCARE AND BUSINESS WORLD. THESE MEMBERS MEET MONTHLY TO ADDRESS COMMUNITY HEALTH ISSUES (SEE PROMOTION OF COMMUNITY HEALTH FOR MORE DETAIL). THESE IDENTIFIED HEALTH NEEDS ARE THEN COMMUNICATED TO ST. CLOUD HOSPITAL.

PART VI, LINE 3:
INPATIENTS WHO ARE SELF PAY ARE IDENTIFIED, AND A REPRESENTATIVE OF THE ORGANIZATION'S BILLING DEPARTMENT EXPLAINS THE CHARITY CARE POLICY TO PATIENTS. THEY ALSO EXPLAIN THE SELF PAY DISCOUNT AND SCREENS THE PATIENT FOR ELIGIBILITY FOR ANY STATE OR FEDERAL PROGRAMS. THEY ALSO ASSIST THE PATIENT WITH ANY PAPERWORK REQUIRED TO APPLY FOR SUCH PROGRAMS. OUTPATIENTS WHO ARE SELF PAY RECEIVE AN AUTOMATIC SELF PAY DISCOUNT. IF THE PATIENT DOES NOT REMIT PAYMENT, COLLECTION STAFF ATTEMPT TO REACH THE PATIENT BY PHONE. PATIENTS ARE TOLD ABOUT THE CHARITY PROGRAM. FOR BOTH INPATIENTS AND OUTPATIENTS, ALL STATEMENTS CONTAIN A LETTER REGARDING THE AVAILABILITY OF CHARITY CARE. ALSO ALL PRECOLLECTION LETTERS HAVE THIS SAME LANGUAGE INDICATING THE AVAILABILITY AND PROCESS OF OBTAINING CHARITY CARE.

PART VI, LINE 4:
ST. CLOUD HOSPITAL'S SERVICE AREA CONSISTS OF 12 COUNTIES (STEARNS, BENTON, SHERBURNE, CROW WING, DOUGLAS, KANDIYOHI, MEEKER, MILLE LACS, MORRISON, POPE, TODD AND WRIGHT). THERE ARE 2 MAIN HOSPITALS WITHIN THE ST. CLOUD AREA. COLLECTIVELY THEIR ESTIMATED POPULATION IN 2023 IS 775,296 AND IS PROJECTED TO CHANGE BY 2.98% IN 20287.THE PROJECTED POPULATION CHANGE BY AGE BRACKET FOR 2023 TO 2028 IS 0-17, 0.12%; 18-44, 2.11%; 45-64, -1.73% AND 65+ 14.52%. THE ESTIMATED 2023 ETHNIC MIX IS AS FOLLOWS: CAUCASION: 85.02%, AFRICAN AMERICAN: 4.50%, ASIAN: 1.33%, HISPANIC: 4.40%, OTHER 4.75%. THE ESTIMATED 2023 AVERAGE INCOME IS $100,855. THE ESTIMATED MEDICAL UNDERSERVICE SCORE IS 58.0.

PART VI, LINE 6:
THE ORGANIZATION IS PART OF CENTRACARE HEALTH SYSTEM (CCHS) WHICH PROVIDES A BROAD RANGE OF HEALTH CARE SERVICES TO THE PATIENTS OF CENTRAL MINNESOTA. CCHS IS DEDICATED TO IMPROVING THE HEALTH OF PEOPLE LIVING AND WORKING IN THE COMMUNITIES IT SERVES. TO ACCOMPLISH ITS GOALS IT WORKS ACTIVELY WITH ITS AFFILIATE HEALTH CARE ORGANIZATIONS. CCHS CONTINUES TO FOCUS ON PROVIDING THE BEST CARE POSSIBLE AND IN REINVESTING INTO THE COMMUNITY. CCHS ALSO PROMOTES WELLNESS BY SPONSORING PROGRAMS AND EVENTS IN LOCAL COMMUNITIES THAT FOCUS ON HEALTHY EATING AND EXERCISE, AND BY CONDUCTING SCREENINGS FOR CONDITIONS SUCH AS HIGH BLOOD PRESSURE.

PART VI, LINE 7, REPORTS FILED WITH STATES
MN

PART VI, LINE 5:
THE CENTRACARE FOUNDATION BOARD OF DIRECTORS HAS A MEMBERSHIP OF OVER 20 PERSONS REPRESENTING HEALTHCARE AND COMMUNITY NEEDS ACROSS CENTRAL MINNESOTA. A MAJORITY OF THE COMMITTEE IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA THAT ARE NOT EMPLOYEES OR INDEPENDENT CONTRACTORS OF THE ORGANIZATION AND ARE NOT FAMILY MEMBERS THEREOF.THE BOARD MEETS QUARTERLY TO DISCUSS WAYS TO ADDRESS TYPICAL HEALTH ISSUES THROUGH AWARENESS BUILDING, EDUCATION AND ADVOCACY WITHIN CENTRACARE AS WELL AS THE COMMUNITY. THERE ARE SEVERAL COMMUNITY HEALTHY OUTREACH INITIATIVES THAT THE FOUNDATION HAS DEPLOYED FUNDING TOWARDS INCLUDING: ACES TRAUMA-INFORMED CARE - INCREASE AWARENESS AND INTERVENTIONS SURROUNDING ADVERSE CHILDHOOD EXPERIENCES, STATE-OF-THE-ART $2.9 MILLION SIMULATION CENTER RENOVATION AVAILABLE FOR COMMUNITY USE, ADULT AND PEDIATRIC BARIATRIC WEIGHT MANAGEMENT COLLABORATIVES, CHILD ADVOCACY CENTER HELPS CHILDREN WHO HAVE BEEN PHYSICALLY, SEXUALLY OR EMOTIONALLY ABUSED. BY WORKING CLOSELY WITH LAW ENFORCEMENT, CHILD PROTECTION, COUNTY ATTORNEYS, ADVOCATES, MENTAL HEALTH AND MEDICAL PROFESSIONALS IN ONE LOCATION, WE CAN ENSURE CHILDREN RECEIVE THE PROPER CARE AND SUPPORT DURING AND AFTER A CHILD ABUSE INVESTIGATION. 408 VICTIMS OF CHILD ABUSE FROM BENTON AND STEANS COUNTIES HAVE RECEIVED CARE IN THE FIRST TWO YEARS AT THE CAC WITH NO COST TO THEIR FAMILIES, CAREER ONE SUMMER INTERNSHIP PROGRAM FOR YOUTH. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS OR SPECIALTIES AND FACILITIES AND EQUIPMENT, PATIENT CARE, MEDICAL TRAINING, EDUCATION AND RESEARCH.