4A (Expenses $ 470561810 including grants of $ 459501) (Revenue $ 509500713)
ORGANIZATIONAL COMMITMENT TO PROVIDING COMMUNITY BENEFIT: A. OUR MISSION IS TO SERVE AS A LEADING PROVIDER OF QUALITY HEALTHCARE SERVICES IN OUR LOCAL COMMUNITY AND THE SURROUNDING REGION OF NORTHEASTERN MINNESOTA, NORTHWESTERN WISCONSIN, AND THE UPPER PENINSULA OF MICHIGAN. AS THE FEDERALLY DESIGNATED REGIONAL TRAUMA CENTER FOR THIS REGION, ST. LUKE'S PROVIDES CRITICAL ACCESS TO HIGH QUALITY ACUTE HEALTHCARE SERVICES.B. ST. LUKE'S RECOGNIZES ITS RESPONSIBILITY TO THE COMMUNITY BY PROVIDING FINANCIAL SUPPORT TO COMMUNITY ORGANIZATIONS; OFFERING EDUCATIONAL PROGRAMS, OUTREACH PROGRAMS, AND SUPPORTING THE COMMUNITY THROUGH EMPLOYEE VOLUNTEER EFFORTS AND DONATIONS. WE SUPPORT THE LAKE SUPERIOR COMMUNITY HEALTH CENTER AND THE HEALTH CARE ACCESS OFFICE. IN 2021, ST. LUKE'S DONATED MORE THAN 2,000 HOURS TO ENRICH THE HEALTHCARE OF THE COMMUNITY, INCLUDING SERVING ON BOARDS OF THE MN HOMECARE ASSOCIATION, UNITED WAY, AND OTHER NON-PROFIT ORGANIZATIONS IN OUR COMMUNITY.C. ST. LUKE'S SERVES A DISPROPORTIONATE SHARE OF MEDICARE AND MEDICAID PATIENTS. THROUGH OUR PATIENT ASSISTANCE PROGRAM, WE PROVIDE FULL OR PARTIALLY SUBSIDIZED SERVICES TO INDIVIDUALS AND FAMILIES WHO ARE UNABLE TO PAY. AT ADMISSION AND THROUGH PATIENT HANDBOOKS, PATIENTS ARE GIVEN INFORMATION TO CONTACT ST. LUKE'S FINANCIAL COUNSELORS FOR INFORMATION ON OUR FINANCIAL ASSISTANCE PROGRAMS. INFORMATION IS ALSO AVAILABLE ON OUR WEBSITE. ALSO, ST. LUKE'S PROVIDES MEDICAL TRANSPORT SERVICES AT LESS THAN COST TO OUR PATIENTS IN THE REGION. DURING 2021, THERE WERE 10,867 ADMISSIONS, 61,943 PATIENT DAYS, 58,471 EMERGENCY/URGENT CARE VISITS, 168,778 OUTPATIENT REGISTRATIONS AND 700,812 CLINIC VISITS.

4B (Expenses $ 0 including grants of $ 0) (Revenue $ 0)
ORGANIZATIONAL DESCRIPTION FOR TAX EXEMPTION:ST. LUKE'S IS A NOT-FOR-PROFIT, COMMUNITY-BASED, NON-DENOMINATIONAL HOSPITAL, GOVERNED BY A VOLUNTEER BOARD OF DIRECTORS. OUR MEDICAL STAFF IS OPEN TO ALL QUALIFIED PHYSICIANS AND ALLIED HEALTH PROFESSIONALS. ST. LUKE'S EMERGENCY DEPARTMENT SERVES PATIENTS REGARDLESS OF ABILITY TO PAY. ST. LUKE'S RESEARCH DEPARTMENT, THE WHITESIDE INSTITUTE FOR CLINICAL RESEARCH, PARTICIPATES IN INVESTIGATIONAL DRUG PROTOCOLS THAT ARE NON-FUNDED OR UNDER-FUNDED.ST. LUKE'S IS A CLINICAL TRAINING SITE FOR MANY HEALTHCARE STUDENTS. IN ADDITION TO MEDICAL STUDENTS AND RESIDENTS, WE PROVIDE CLINICAL TRAINING FOR STUDENTS IN NURSING, PHYSICAL MEDICINE, RADIOLOGY, RESPIRATORY, LAB, MEDICAL ASSISTANT, OCCUPATIONAL THERAPY, PHYSICIAN ASSISTANT, DIETETICS, SOCIAL WORK, MEDICAL RECORD CODING, PARAMEDIC, HEALTH UNIT COORDINATOR, SURGICAL TECHNOLOGY, ANESTHESIA, AND PHARMACY. WE CONTRIBUTED TO SCHOLARSHIP FUNDS FOR MEDICAL STUDENTS AT THE UNIVERSITY OF MINNESOTA, DULUTH SCHOOL OF MEDICINE AND NURSING STUDENTS AT THE COLLEGE OF ST. SCHOLASTICA AND LAKE SUPERIOR COLLEGE.OTHER EDUCATION ACTIVITIES REACH TENS OF THOUSANDS OF PEOPLE THROUGH COMMUNITY EDUCATION AND OUTREACH, HEALTH SCREENINGS, SUPPORT GROUPS, AND OTHER COMMUNITY SERVICES. OUR SPEAKERS BUREAU OFFERED PROGRAMS AT NO CHARGE TO THOUSANDS MORE. TOPICS PRESENTED INCLUDED MEN'S HEALTH, WOMEN AND BREAST CANCER, CHILDREN'S NUTRITION, MENTAL HEALTH ISSUES, CARDIAC ISSUES, FALL PREVENTION, FIRST AID, DIABETES, EYE AND LUNG ISSUES, AND INFECTION CONTROL. WE ALSO OFFERED TOURS TO DOZENS OF COMMUNITY AND SCHOOL GROUPS, MADE MEDICAL SUPPLIES/EQUIPMENT DONATIONS TO COMMUNITY AND MEDICAL RELIEF ORGANIZATIONS, DONATED NEWSPAPER ADVERTISING SPACE FOR THE JUNIOR LEAGUE OF DULUTH, PARTICIPATED IN THE COMMUNITY COALITION FOR FALL PREVENTION AND OFFERED BROCHURE PRINTING SERVICES TO A LOCAL MEDICAL PROFESSIONAL GROUP. ANNUALLY, WE PROVIDE RENT-FREE, HUNDREDS OF HOURS OF FREE MEETING SPACE FOR COMMUNITY GROUPS, SUCH AS LYME DISEASE SUPPORT GROUP, MOTHERS OF MULTIPLES AND THE OSTOMY CLUB, AND ORGANIZATIONS SUCH AS THE MINNESOTA HOMECARE ASSOCIATION, THE BOY SCOUTS, AND THE COLLEGE OF ST. SCHOLASTICA.WE OFFER SUPPORT GROUPS TO THE COMMUNITY, INCLUDING:- HEART-TO-HEART SUPPORT GROUP- PARKINSON'S DISEASE- LOOK GOOD, FEEL GOOD GROUP (THROUGH THE AMERICAN CANCER SOCIETY)- CANCER INFORMATION AND SUPPORT GROUP- OSTOMY CLUB- BREAST CANCER SUPPORT GROUP- DIABETES SUPPORT GROUP (SPONSORED BY ST. LUKE'S, DULUTH DIABETES CENTER, AND THE DULUTH FAMILY PRACTICE CENTER)- INSULIN PUMP SUPPORT GROUP (SPONSORED BY ST. LUKE'S DULUTH DIABETES CENTER, AND THE DULUTH FAMILY PRACTICE CENTER)- CELIAC SUPPORT GROUP (SPONSORED BY ST. LUKE'S AND ST. MARY'S/DULUTH CLINIC)WE PARTICIPATE IN MEDICAID, MEDICARE, CHAMPUS, TRICARE, AND OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS.

ST. LUKE'S HOSPITAL OF DULUTH
PART V, SECTION B, LINE 5: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED AS A COLLABORATION AND PARTNERSHIP BETWEEN ESSENTIA HEALTH-DULUTH, ESSENTIA HEALTH-ST. MARY'S MEDICAL CENTER, ST. LUKE'S HOSPITAL, LAKE VIEW MEMORIAL HOSPITAL, LAKE SUPERIOR COMMUNITY HEALTH CENTER, AND ST. LOUIS COUNTY PUBLIC HEALTH. ASSESSMENT PARTNERS ALSO INCLUDED STAKEHOLDERS FROM COMMUNITY ORGANIZATIONS WORKING TO IMPROVE HEALTH OUTCOMES AND REDUCE INEQUITIES INCLUDING: GENERATIONS HEALTHCARE INITIATIVES, ZEITGEIST CENTER FOR ARTS AND COMMUNITY, HEALTHY NORTHLAND, MINNESOTA DEPARTMENT OF HEALTH, VOICES FOR RACIAL JUSTICE, DULUTH PUBLIC SCHOOLS, CHURCHES UNITED IN MINISTRY, COMMUNITY ACTION DULUTH, ARROWHEAD PARISH NURSE ASSOCIATION, AMERICAN LUNG ASSOCIATION, FAIR FOOD ACCESS, FUSE DULUTH, DULUTH NEWS TRIBUNE, INN ON LAKE SUPERIOR, WESTERN LAKE SUPERIOR SANITARY DISTRICT, KRAUS-ANDERSON, DF DESIGN, WOODLAND HILLS, PAVSA (PROGRAM TO AID VICTIMS OF SEXUAL VIOLENCE), CAIR, ALL NATIONS INDIGENOUS CENTER, LIFE HOUSE, AICHO (AMERICA INDIAN COMMUNITY HOUSING ORGANIZATION), DULUTH LISC, MAURICES, NATIONAL BANK OF COMMERCE, GREATER DOWNTOWN COUNCIL, LAKE SUPERIOR COMMUNITY HEALTH CENTER, MYERS-WILKINS COMMUNITY SCHOOL, PEACE CHURCH, ST. SCHOLASTICA, WOMEN OF ELCA, INSTITUTE FOR A SUSTAINABLE FUTURE, PROTECT MINNESOTA, CROSS CULTURAL ALLIANCE OF DULUTH, HEALTH & WELLNESS TABLE, PS RUDIE CLINIC. THESE PARTNERS ASSISTED IN DEVELOPING THE COMMUNITY-CENTERED PROCESS, FOCUS GROUPS, AND COMMUNITY DIALOGUES AS WELL AS PRIORITIZING COMMUNITY NEEDS.COMMUNITY INPUT WAS GATHERED THROUGH A SERIES OF FOCUS GROUPS AND COMMUNITY MEETINGS THAT TOOK PLACE BETWEEN JULY 2018 AND MAY 2019. THIS INPUT INCLUDED INDIVIDUALS REPRESENTING PERSONS WITH EXPERTISE IN PUBLIC HEALTH; LEADERS, REPRESENTATIVES AND MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS; AND POPULATIONS WITH CHRONIC DISEASE NEEDS FROM THE COMMUNITY SERVED BY THE HOSPITAL.

ST. LUKE'S HOSPITAL OF DULUTH
PART V, SECTION B, LINE 6A: THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CONDUCTED IN PARTNERSHIP BY ESSENTIA HEALTH - DULUTH, ESSENTIA HEALTH - ST. MARY'S MEDICAL CENTER, AND ST. LUKE'S HOSPITAL OF DULUTH.

ST. LUKE'S HOSPITAL OF DULUTH
PART V, SECTION B, LINE 6B: ST. LUKE'S COLLABORATED WITH GENERATIONS HEALTH CARE INITIATIVES, ST. LOUIS COUNTY PUBLIC HEALTH, AND ZEITGEIST CENTER FOR ARTS AND COMMUNITY IN CONDUCTING THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA).

ST. LUKE'S HOSPITAL OF DULUTH
PART V, SECTION B, LINE 7D: THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ONLINE AT HTTPS://WWW.SLHDULUTH.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/.

ST. LUKE'S HOSPITAL OF DULUTH
"PART V, SECTION B, LINE 11: THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CONDUCTED IN PARTNERSHIP BY ESSENTIA HEALTH-DULUTH, ESSENTIA HEALTH- ST. MARY'S MEDICAL CENTER, ST. LUKE'S HOSPITAL, ST. LOUIS COUNTY PUBLIC HEALTH, LAKE SUPERIOR COMMUNITY HEALTH CENTER, GENERATIONS HEALTH CARE INITIATIVES AND THE ZEITGEIST CENTER FOR ARTS AND COMMUNITY. THIS COLLABORATION IS KNOWN AS BRIDGING HEALTH DULUTH. BRIDGING HEALTH DULUTH PARTNERS DEVELOPED A COMMUNITY-CENTERED PROCESS, INCLUDING FOCUS GROUPS AND COMMUNITY DIALOGUES WHICH SERVED TO PRIORITIZE COMMUNITY NEEDS AND BUILD THE IMPLEMENTATION PLAN THROUGH A COLLECTIVE IMPACT MODEL.BRIDGING HEALTH DULUTH PUBLIC PRESENTATION ""SHAPING A HEALTHIER COMMUNITY"" OF WHICH ST LUKE'S WAS A CO-SPONSOR AND CO-ORGANIZER. THE 2020-2022 COMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY HEALTH IMPROVEMENT PLAN WAS SHARED AND SOUGHT COMMUNITY INVOLVEMENT IN WORK AROUND THREE PRIORITY AREAS: YOUTH SUBSTANCE USE, MENTAL HEALTH, AND FOOD INSECURITY. THE EVENT INCLUDED OPPORTUNITIES FOR ATTENDEES TO CONNECT WITH COMMUNITY PROFESSIONALS, EXPLORE THE ASSESSMENT RESULTS AND ACTION PLAN, LEARN ABOUT BRIDGING HEALTH DULUTH'S WORK, DISCUSS COMMUNITY EFFORTS TO ADDRESS HEALTH DISPARITIES, AND FIND OUT HOW TO GET INVOLVED. THE FREE COMMUNITY LUNCH AND PRESENTATION WAS WIDELY COVERED BY LOCAL PRESS. EVERY THREE YEARS, BRIDGING HEALTH DULUTH CONDUCTS A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) TO SYSTEMATICALLY IDENTIFY, ANALYZE AND PRIORITIZE COMMUNITY HEALTH NEEDS. THE MISSION OF BRIDGING HEALTH DULUTH IS TO SUPPORT A HEALTHIER COMMUNITY FOR ALL. BRIDGING HEATH DULUTH SEEKS OUT AND BRINGS TOGETHER INDIVIDUALS AND ORGANIZATIONS WHO ARE INTERESTED IN POSITIVELY IMPACTING THE PRIORITY AREAS IDENTIFIED IN THE CHNA. WE BELIEVE THROUGH COLLABORATION AND COMPLEMENTARY INITIATIVES, WE WILL HAVE THE GREATEST POSITIVE IMPACT ON THE HEALTH OF DULUTHIANS. THE IMPLEMENTATION PLANNING PROCESS WAS ALSO CONDUCTED IN COLLABORATION WITH MANY PARTNERS INCLUDING ORGANIZATIONS OR INDIVIDUALS THAT REPRESENT BOARD INTERESTS IN THE COMMUNITY, INCLUDING THOSE MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND POPULATIONS THAT ARE AT HIGHER RISK FOR ILL HEALTH. ONCE PRIORITY HEALTH NEEDS WERE IDENTIFIED, BRIDGING HEALTH DULUTH DESIGNED AN IMPLEMENTATION STRATEGY TO ADDRESS THE NEEDS WITH INTERNAL STAKEHOLDERS AND COMMUNITY PARTNERS. THE PLAN IS DESIGNED TO LEVERAGE EXISTING COMMUNITY STRENGTHS AND RESOURCES AVAILABLE TO IMPROVE HEALTH FOR DULUTHIANS. FROM JULY 2018 TO MAY 2019, BRIDGING HEALTH DULUTH ANALYZED DATA, CONVENED COMMUNITY PARTNERS, SOUGHT INPUT FROM COMMUNITY MEMBERS, AND LED A PROCESS TO IDENTIFY THE FOLLOWING PRIORITY AREAS FOR THE 2020 2022 COMMUNITY HEALTH NEEDS ASSESSMENT: 1. MENTAL HEALTH2. YOUTH SUBSTANCE USE3. FOOD INSECURITYBRIDGING HEALTH DULUTH SUPPORTS A HEALTHIER COMMUNITY FOR ALL. TO FULFILL THAT MISSION, WE SEEK OPPORTUNITIES TO BOTH ENHANCE THE CARE WE PROVIDE AND IMPROVE THE HEALTH OF OUR COMMUNITIES. IN CONDUCTING THE COMMUNITY HEALTH NEEDS ASSESSMENT, BRIDGING HEALTH DULUTH HAS COLLABORATED WITH COMMUNITY PARTNERS TO EMBRACE THESE GUIDING PRINCIPLES: - COLLABORATE TOWARDS SOLUTIONS WITH MULTIPLE STAKEHOLDERS (E.G. SCHOOLS, WORKSITES, MEDICAL CENTERS, PUBLIC HEALTH) TO IMPROVE COMMUNITY HEALTH.- BUILD TRUST THROUGH COLLABORATION WITH COMMUNITY MEMBERS EXPERIENCING HEALTH DISPARITIES.- PRIORITIZE SUSTAINABLE EVIDENCE-BASED EFFORTS AROUND THE GREATEST COMMUNITY GOOD.- CREATE CLEAR, SPECIFIC, REALISTIC, AND ACTION-ORIENTED GOALS TO IMPROVE PRIORITY HEALTH INDICATORS.THE GOALS OF THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT WERE TO:1. ASSESS THE HEALTH NEEDS, DISPARITIES, ASSETS AND FORCES OF CHANGE IN DULUTH.2. PRIORITIZE HEALTH NEEDS BASED ON COMMUNITY INPUT AND FEEDBACK.3. DESIGN AND IMPLEMENTATION STRATEGY TO REFLECT THE OPTIMAL USAGE OF RESOURCES IN OUR COMMUNITY.4. ENGAGE OUR COMMUNITY PARTNERS AND STAKEHOLDERS IN ALL ASPECTS OF THE COMMUNITY HEALTH NEEDS.5. ASSESSMENT PROCESS, INCLUDING DATA COLLECTION, DATA ANALYSIS, ISSUE PRIORITIZATION, IMPLEMENTATION.6. PLAN CREATION AND MONITORING OF RESULTS.DURING 2021, ST. LUKE'S TOOK THE FOLLOWING STEPS TO ADDRESS SIGNIFICANT COMMUNITY HEALTH NEEDS:- TWO ST LUKE'S STAFF WERE INVOLVED IN THE BRIDGING HEALTH DULUTH STEERING COMMITTEE AND PARTICIPATED IN DEVELOPING THE INFRASTRUCTURE FOR ACTION TEAMS- ST LUKE'S STAFF ASSISTED WITH DATA DEVELOPMENT AND ANALYSIS IN DEVELOPING THE CHNA- ASSISTANCE WITH PLANNING, CO-HOSTING AND ADVERTISING THE SHAPING A HEALTHIER COMMUNITY SESSION - OFFERED ""TRAIN THE TRAINER"" PROGRAM FOR SBIRT INTERVENTION, AN EVIDENCE-BASED TOOL FOR CLINICIANS TO REDUCE SUBSTANCE ABUSE AND RISKY BEHAVIORS- NOTE THIS POSITION WAS WITH WILDERNESS HEALTH FUNDING - BEGAN IMPLEMENTING THE MN HOSPITAL ASSOCIATION'S NEONATAL ABSTINENCE SYNDROME ROADMAP, TO DEVELOP A SAFE MOM AND BABY PROGRAM FOR THOSE WITH SUBSTANCE ABUSE.SIGNIFICANT NEEDS NOT ADDRESSED IN THE CHNA:OTHER ISSUES IDENTIFIED THROUGH THE PROCESS BUT NOT INCLUDED AMONG THE TOP THREE PRIORITIES INCLUDED DISABILITY, MATERNAL HEALTH, ACCESS TO HEALTHCARE, HEART CONDITIONS, DIABETES, AND CANCER. THESE NEEDS WILL BE ADDRESSED IN PART THROUGH THE SELECTED PRIORITIES AS THEY ARE INTERRELATED. ADDITIONALLY, BRIDGING HEALTH DULUTH WILL CONTINUE TO FOCUS EFFORTS ON THE HIGHEST NEEDS AND COLLABORATE WITH LOCAL PARTNERS TO ADDRESS OTHER ISSUES NOT INCLUDED IN THE TOP THREE PRIORITIES."

ST. LUKE'S HOSPITAL OF DULUTH
"PART V, SECTION B, LINE 13B: PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON THE BALUE OF THEIR INCOME AND ASSETS COMPUTED ON THE ""ST. LUKE'S FINANCIAL ASSISTANCE ELIGIBILITY WORKSHEET""."

ST. LUKE'S HOSPITAL OF DULUTH
"PART V, SECTION B, LINE 16J: A ""PATIENT NOTICE OF FINANCIAL ASSISTANCE"" WILL BE POSTED IN PUBLIC AREAS ACCESSIBLE TO PATIENTS. IN ADDITION, THE NOTICE IS AVAILABLE TO PATIENTS IN PRINTED FORM, INCLUDING A NOTICE OF FINANCIAL ASSISTANCE AVAILABILITY PRINTED ON A PATIENT'S BILL. WEBSITE AVAILABILITY AT:HTTPS://WWW.SLHDULUTH.COM/PATIENTS-VISITORS/FINANCIAL-SERVICES/ST-LUKES-FINANCIAL-ASSISTANCE-PROGRAM/"

PART I, LINE 3C:
"PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON THE VALUE OF THEIR INCOME AND ASSETS COMPUTED ON THE ""ST. LUKE'S FINANCIAL ASSISTANCE ELIGIBILITY WORKSHEET"". PATIENT HAS TO RECEIVE MEDICALLY NECESSARY CARE, LIVE IN ST. LUKE'S PRIMARY OR SECONDARY MARKET SERVICE AREA (UNLESS THEY PRESENT WITH AN URGENT, EMERGENT, OR LIFE-THREATENING MEDICAL CONDITION), AND COMPLETE A FINANCIAL ASSISTANCE APPLICATION WITHIN THE REQUIRED TIME LIMIT."

PART I, LINE 7:
ST. LUKE'S USED COST-TO-CHARGE RATIOS DERIVED FROM THE MOST RECENT COMPLETED MEDICARE COST REPORT FOR FINANCIAL ASSISTANCE AND GOVERNMENT PROGRAM; AND ACTUAL COSTS FOR OTHER COMMUNITY BENEFITS.

PART I, LINE 7G:
ST. LUKE'S INCLUDED SUBSIDIZED HEALTH SERVICES FROM MENTAL HEALTH SERVICES, WOMEN AND CHILDREN SERVICES, AND HOMECARE/HOSPICE SERVICES.

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 $ 7,619,607.

PART II, COMMUNITY BUILDING ACTIVITIES:
ST. LUKE'S COMMUNITY-BUILDING ACTIVITIES INCLUDE CASH, IN-KIND DONATIONS, AND OTHER EXPENDITURES FOR THE DEVELOPMENT OF THE COMMUNITY HEALTH PROGRAMS AND PARTNERSHIPS SUCH AS: ECONOMIC DEVELOPMENT EVENTS, MEETINGS, AND MEMBERSHIP WITH AREA CHAMBERS OF COMMERCE, CITY COUNSEL, AND ST. LOUIS COUNTY; COMMUNITY SUPPORT OF LOCAL FUNDRAISERS, ORGANIZATIONS AND EVENTS; LEADERSHIP DEVELOPMENT, TRAINING, AND EDUCATION; COALITION BUILDING WITH AREA ASSOCIATIONS TO PROMOTE COLLABORATION ON WELLNESS INITIATIVES; COMMUNITY HEALTH IMPROVEMENT ADVOCACY IN PARTNERSHIP WITH LOCAL ORGANIZATIONS, EVENTS, AND SERVICES; AND WORKFORCE DEVELOPMENT VIA EDUCATION, MENTORSHIP, PANEL PRESENTATIONS, AND OTHER STUDENT PROGRAMS.

PART III, LINE 2:
BAD DEBT ACCOUNTS WILL MEET AT ALL OF THE FOLLOWING CRITERIA:I. ATTEMPTS HAVE BEEN MADE TO CONTACT THE PATIENT OR GUARANTOR BY MAIL AND TELEPHONE.II. PATIENT OR GUARANTOR HAS NOT RESPONDED DURING THE COLLECTION CYCLE IN A TIMELY AND RESPONSIBLE MANNER OR HAS DEFAULTED ON A PAYMENT ASSESSMENT.III. THERE ARE NO KNOWN CIRCUMSTANCES WHICH WOULD JUSTIFY RECONSIDERATION FOR FINANCIAL ASSISTANCE.APPROVAL FOR BAD DEBT WRITE-OFFS ARE AS FOLLOWS:$0 TO $2,499 - PATIENT ACCOUNTS MANAGER OR CBO MANAGER$2,500 TO $9,999 - BUSINESS SERVICES DIRECTOR OR CBO MANAGER$10,000 AND OVER - CHIEF FINANCIAL OFFICER

PART III, LINE 3:
ST. LUKE'S HOSPITAL OF DULUTH CANNOT REASONABLY ESTIMATE THE PORTION OF ITS BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE BUT DID NOT COMPLETE AN APPLICATION.

PART III, LINE 4:
"SEE THE ""PATIENT RECEIVABLES NOTE ON PAGE 11 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS."

PART III, LINE 8:
THE MEDICARE SHORTFALL SHOULD BE CONSIDERED COMMUNITY BENEFIT BECAUSE THE INDIVIDUALS WHO PARTICIPATE IN THE MEDICARE PROGRAM ARE FREQUENTLY UNABLE TO AFFORD MEDICAL CARE WITHOUT THIS PROGRAM AND ST. LUKE'S HOSPITAL PARTICIPATES IN THE MEDICARE PROGRAM TO ASSIST THESE INDIVIDUALS DESPITE THE SIGNIFICANT FINANCIAL COST/LOSS TO THE HOSPITAL. THE COST-TO-CHARGE RATIO WAS THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED ON SCHEDULE H, PART III, LINE 6.

PART III, LINE 9B:
ST. LUKE'S HAS DEVELOPED POLICIES AND PROCEDURES FOR INTERNAL AND EXTERNAL COLLECTION PRACTICES THAT TAKE INTO ACCOUNT THE EXTENT TO WHICH THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE AND THE PATIENT'S GOOD FAITH EFFORT TO COMPLY WITH THEIR PAYMENT AGREEMENTS.IN THE EVENT THAT A PATIENT FAILS OR REFUSES TO FULFILL THEIR FINANCIAL OBLIGATION, ST. LUKE'S MAY ENGAGE IN EXTRAORDINARY COLLECTION ACTIONS, INCLUDING:A. REFERRAL OF UNPAID BALANCES TO EXTERNAL COLLECTION AGENCIES;B. ACTIONS THAT REQUIRE A LEGAL OR JUDICIAL PROCESS SUCH AS A LIEN ON PROPERTY OR GARNISHMENT OF WAGES.PRIOR TO INITIATING ECA'S, ST. LUKE'S WILL FOLLOW ALL APPLICABLE REGULATIONS AND MAKE REASONABLE EFFORTS TO DETERMINE WHETHER AN INDIVIDUAL WHO HAS AN UNPAID ACCOUNT IS ELIGIBLE FOR FAP. ST. LUKE'S WILL REFRAIN FROM ANY ECA'S FOR AT LEAST 120 DAYS AFTER SENDING THE FIRST POST-DISCHARGE BILLING STATEMENT AND ALLOWING AT LEAST 240 DAYS TO APPLY FOR FINANCIAL ASSISTANCE.THE BILLING AND COLLECTIONS POLICY IS AVAILABLE TO THE PUBLIC ONLINE AT HTTPS://WWW.SLHDULUTH.COM/PATIENTS-VISITORS/FINANCIAL-SERVICES/ST-LUKES-FINANCIAL-ASSISTANCE-PROGRAM/ AND PAPER COPIES OF THE POLICY ARE AVAILABLE UPON REQUEST AND WITHOUT CHARGE BY MAIL, IN THE EMERGENCY ROOM, AND IN ALL ADMISSIONS AREAS.

PART VI, LINE 2:
ST. LUKE'S HAS A LONG HISTORY OF PARTICIPATING IN SUCCESSFUL, SUSTAINABLE COLLABORATIVE INITIATIVES ON LOCAL, REGIONAL, AND NATIONAL LEVELS. 1) ST. LUKE'S RESEARCH DEPARTMENT, THE WHITESIDE INSTITUTE FOR CLINICAL RESEARCH, WAS FORMED IN 1996 AS THE RESULT OF A PARTNERSHIP WITH THE UNIVERSITY OF MINNESOTA MEDICAL SCHOOL, DULUTH (UMMSD), AND CONTINUES TO PROVIDE SERVICES TO ST. LUKE'S PATIENTS IN ACCESS TO LOCAL, NATIONAL, AND MULTI-NATIONAL CLINICAL STUDIES AS WELL AS TO ST. LUKE'S STAFF IN DEVELOPMENT OF RESEARCH STUDIES, REFERRAL TO UM COLLABORATORS, AND GRANT WRITING RESOURCES. 2) ST. LUKE'S HAS COLLABORATED WITH THE MULTI-STATE CONSORTIUM OF ABOUT 64 SUPPORTING ORGANIZATIONS INCLUDING COUNTY PUBLIC HEALTH DEPARTMENTS, HOSPITALS, AND CLINICS TO FUND THE BRIDGE TO HEALTH SURVEY. THIS PROJECT COLLECTED POPULATION-BASED, HEALTH STATUS DATA ON ADULTS (AGED 18+) IN THE REGION USING A SURVEY FORMAT AND WAS CONDUCTED IN 1995, 2000, 2005, 2010, 2015 AND 2020. TO ADDRESS A NEED THAT BECAME APPARENT AS A RESULT OF THE BRIDGE TO HEALTH SURVEY, ST. LUKE'S JOINED WITH OTHER HEALTHCARE PROVIDERS IN THE COMMUNITY TO DEVELOP TWO PROGRAMS: SHARECARE, WHICH ESTABLISHED SLIDING FEE SCALES FOR CLINIC AND OUTPATIENT SERVICES TO DIMINISH THE FINANCIAL BARRIER TO PREVENTIVE, MENTAL HEALTH, AND PRIMARY CARE SERVICES; AND HEALTHSHARE, WHICH IS A COVERAGE MODEL FOR SMALL BUSINESSES FUNDED COLLABORATIVELY BY THE EMPLOYERS, EMPLOYEES, AND THE COMMUNITY. THIS COVERAGE MODEL PROVIDES A CONTINUUM OF HEALTH CARE SERVICES FOR EMPLOYEES WITHIN A DEFINED NETWORK OF COMMUNITY PROVIDERS. 3) ST. LUKE'S WAS A LEAD PARTICIPANT IN THE WILDERNESS COALITION PHARMACY SERVICES PROJECT FUNDED BY THE AGENCY FOR HEALTHCARE RESEARCH AND QUALITY. THIS 3-YEAR PROJECT SUCCESSFULLY IMPLEMENTED 24/7 PROFESSIONAL PHARMACY SERVICES FOR 10 RURAL HOSPITALS IN NORTHEASTERN MINNESOTA USING ST. LUKE'S 24-HOUR PHARMACY, AN ITV-BASED SYSTEM OF CONTINUING EDUCATION FOR SITES, PHARMACY POLICIES AND PROCEDURES ADAPTABLE FOR INDIVIDUAL SITES, AS WELL AS BEDSIDE VERIFICATION OF MEDICATION ADMINISTRATION AND MEDICATION BAR CODING AT SOME LOCATIONS. THOUGH PROJECT FUNDING HAS ENDED, THE SERVICES REMAIN AND THE PROGRAM IS NOW SELF-SUSTAINING.

PART VI, LINE 7, REPORTS FILED WITH STATES
MN

PART VI, LINE 3:
ST. LUKE'S INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT ELIGIBILITY FOR ASSISTANCE THE FOLLOWING WAYS:- INFORMATION IS INCLUDED ON THE ST. LUKE'S WEBSITE (WWW.SLHDULUTH.COM) REGARDING WHO PATIENTS SHOULD CONTACT FOR INFORMATION OR FINANCIAL ASSISTANCE.- THERE ARE POSTINGS IN ALL REGISTRATION AREAS WITH CONTACT INFORMATION AND PHONE NUMBERS REGARDING HOW PATIENTS CAN OBTAIN ASSISTANCE (BOTH FROM ST. LUKE'S AND EXTERNAL ORGANIZATIONS).- ALL ST. LUKE'S EXTERNAL BILLING AND COLLECTION VENDORS HAVE BEEN INSTRUCTED TO REFER ANY PATIENT INDICATING THEY LACK THE FINANCIAL WHEREWITHAL TO MEET THEIR FINANCIAL OBLIGATIONS TO ST. LUKE'S FINANCIAL COUNSELORS. AS REQUIRED UNDER A BILLING AND COLLECTION AGREEMENT WITH THE MINNESOTA ATTORNEY GENERAL, ST. LUKE'S PERFORMS AN ANNUAL AUDIT OF ALL EXTERNAL VENDORS TO ENSURE COMPLIANCE WITH THIS INSTRUCTION AND ALL OTHER ST. LUKE'S POLICIES AND PROCEDURES.- ST. LUKE'S FINANCIAL COUNSELORS' BUSINESS CARDS ARE PROMINENTLY DISPLAYED AND AVAILABLE AT ALL REGISTRATION AREAS (INCLUDING THE EMERGENCY/URGENT CARE AREA) WITH THEIR CONTACT INFORMATION AND PHONE NUMBERS. PATIENTS ARE ENCOURAGED TO CONTACT FINANCIAL COUNSELORS.- THE ST. LUKE'S FINANCIAL COUNSELORS' PHONE NUMBER IS LISTED PROMINENTLY ON THE PATIENT BILLING STATEMENTS.- THE FINANCIAL COUNSELORS ARE AVAILABLE WEEKDAYS BY PHONE OR IN PERSON TO DISCUSS AND APPLY FOR FINANCIAL ASSISTANCE PROGRAMS.- ST. LUKE'S HAS ENGAGED AN EXTERNAL VENDOR TO MEET WITH PATIENTS AT BEDSIDE TO DISCUSS ELIGIBILITY FOR ASSISTANCE WITH GOVERNMENTAL ASSISTANCE PROGRAMS OR ST. LUKE'S FINANCIAL ASSISTANCE PROGRAM.- ST. LUKE'S INPATIENT BOOKLET CONTAINS INFORMATION REGARDING FINANCIAL ASSISTANCE AND CONTACT INFORMATION.- AT LEAST ANNUALLY, THE ST. LUKE'S AND MEDICAL STAFF NEWSLETTERS CONTAIN ARTICLES REGARDING PATIENT FINANCIAL ASSISTANCE. HOSPITAL AND MEDICAL STAFF MEMBERS ARE INFORMED THAT THEY HAVE THE RESPONSIBILITY TO LISTEN FOR FINANCIAL CONCERNS EXPRESSED BY PATIENTS AND TO PROACTIVELY REFER THOSE PATIENTS TO ST. LUKE'S FINANCIAL COUNSELORS.

PART VI, LINE 4:
ST. LUKE'S SERVICE AREA CONSISTS OF A 17-COUNTY REGION OF NORTHEASTERN MINNESOTA, NORTHWESTERN WISCONSIN, AND THE WESTERN UPPER PENINSULA OF MICHIGAN WITH A POPULATION OF APPROXIMATELY 500,000. THE PRIMARY MARKET CONSISTS OF DULUTH, CLOQUET, AND TWO HARBORS, MINNESOTA, AND SUPERIOR, WISCONSIN. THIS PRIMARY MARKET SERVES URBAN AND SUBURBAN AREAS WITH A POPULATION OF APPROXIMATELY 166,000.DEMOGRAPHICS OF THE COMMUNITY OR COMMUNITIES (PRIMARY MARKET) PER MOST RECENT CENSUS:POPULATIONS - DULUTH, MN (86,697); SUPERIOR, WI (26,751)MEDIAN HOUSEHOLD INCOME - DULUTH, MN ($54,084); SUPERIOR, WI ($48,830)% OF INDIVIDUALS BELOW FPG - DULUTH, MN (17.7%); SUPERIOR, WI (14.0%)HOSPITALS SERVING THE COMMUNITY OR COMMUNITIES (PRIMARY MARKET):ST. LUKE'S HOSPITAL OF DULUTHLAKE VIEW MEMORIAL HOSPITALCLOQUET COMMUNITY MEMORIAL HOSPITALESSENTIA HEALTH SMDC MEDICAL CENTER (FORMERLY MILLER DAWN)ESSENTIA HEALTH ST. MARY'S HOSPITAL OF SUPERIORESSENTIA HEALTH ST. MARY'S MEDICAL CENTERFEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS OR POPULATIONS PRESENT IN THE COMMUNITY:MUA/P - DULUTH, MN (11); SUPERIOR, WI (7)

PART VI, LINE 5:
ST. LUKE'S HAS BUILT A REPUTATION OF PROVIDING QUALITY CARE AND PUTTING THE PATIENT FIRST. SINCE OPENING IN 1881, ST. LUKE'S HAS GROWN INTO A NATIONALLY RECOGNIZED HEALTH CARE SYSTEM SERVING 17 COUNTIES THROUGHOUT NORTHEASTERN MINNESOTA, NORTHWESTERN WISCONSIN, AND THE UPPER PENINSULA OF MICHIGAN. ST. LUKE'S HOSPITAL, ALONG WITH ITS PRIMARY AND SPECIALTY CARE CLINICS, OFFERS A COMPREHENSIVE CONTINUUM OF CARE THAT INCLUDES TRAUMA, MEDICAL, SURGICAL, DIAGNOSTIC, THERAPEUTIC, AND REHAB SERVICES. MORE THAN 2,000 HEALTHCARE PROFESSIONALS MAKE UP ST. LUKE'S STAFF, INCLUDING A MEDICAL STAFF OF 959, WITH 463 PHYSICIANS AND ADVANCED PRACTICE CLINICIANS. ST. LUKE'S 13 PRIMARY CARE CLINICS ARE LOCATED IN DULUTH AND ACROSS MINNESOTA IN SILVER BAY, HIBBING, MOUNTAIN IRON, AND HERMANTOWN, MN; AS WELL AS IN ASHLAND AND SUPERIOR, WI. AN ADDITIONAL 7 URGENT CARE CLINICS, 2 PHARMACIES, 3 REGIONAL CENTERS IN TRAUMA, HEART & VASCULAR AND CANCER; AND 30 SPECIALTY CLINICS LOCATED PRIMARILY ON THE ST. LUKE'S CAMPUS PROVIDE EXPERTISE IN MANY AREAS OF HEALTH CARE INCLUDING: CANCER CARE, CARDIAC CARE, HOME CARE AND HOSPICE, ADULT PSYCHIATRY, PLASTIC SURGERY, ALLERGY, ENDOCRINOLOGY, DERMATOLOGY, GASTROENTEROLOGY, INFECTIOUS DISEASE, PHYSICAL MEDICINE AND REHAB, UROLOGY, RHEUMATOLOGY, NEUROSURGERY, AND PULMONARY MEDICINE.