4A (Expenses $ 95501164 including grants of $ 0) (Revenue $ 113539133)
"Grand Itasca Clinic & Hospital is an integrated multi-specialty clinic and hospital. The facility is licensed for 45 beds. In addition to providing traditional hospital services, the facility has a surgery center, full complement of imaging services, a 24-hour emergency department, outpatient rehabilitation services, and outpatient clinic services. The facility employs over 700 people, including over 60 healthcare providers. The organization has over 250,000 patient encounters each year, including emergency visits, surgeries, births, home health and clinic visits. Grand Itasca serves the patient regardless of the person's ability to pay. During the calendar year, the system provided $1,082,756 of charity care, $962,712 of discounts to the uninsured and absorbed $8,279,962 of unpaid Medicare and Medicaid costs. Grand Itasca also paid $1,708,930 in payments for Minnesota Care Tax and Medicaid Surcharges, which were used to fund care for the indigent and underinsured. Grand Itasca Clinic and Hospital is part of Fairview Health Services which is an industry-leading, award-winning, nonprofit, integrated health system providing exceptional health care across the full spectrum of health care services. Founded in 1906, Fairview serves the twelve-county Minneapolis/St. Paul Metro Area, as well as communities throughout greater Minnesota and portions of Northern Iowa and Western Wisconsin and is one of the most comprehensive and geographically accessible systems in Minnesota. Fairview, the University of Minnesota and the University of Minnesota Physicians approved an agreement which became effective in late 2018 (the ""M Health Fairview Agreement""). While the parties maintain their separate governance, the M Health Fairview Agreement further integrated operations across the clinical delivery system and enhances research and education by creating a joint clinical enterprise among the parties. The M Health Fairview Agreement brings together not only UMMC and its related service lines, but also Fairview's other hospitals, primary care clinics, and other services. All are part of a shared care delivery system that is led by a single structure that includes academic physician leadership. The goal of the joint clinical enterprise is to create a nationally-renowned academic health system. This care system was united under a single brand, M Health Fairview, which is inclusive of the Fairview Hospitals and Clinics In March 2020, the World Health Organization declared the COVID-19 outbreak a pandemic. The pandemic has had a significant negative effect on the healthcare industry. Fairview continues to follow guidance from the Center for Disease Control and Prevention and the Minnesota Department of Health and is coordinating its activities with state and local governments as well as other health systems in the state and region. First and foremost, Fairview's focus is on caring for its patients during this ongoing pandemic. Fairview continues to provide COVID-19 vaccines to all individuals ages 5 and older. Fairview is committed to educating the community and distributing vaccines. Fairview has administered the most vaccines in the State of Minnesota. As of December 31, 2021, Fairview has administered more than 540,000 doses to patients in the system. A remarkable program called the Minnesota Immunization Network Initiative (MINI), a collaboration led by Fairview and supported by over 120 community partners, works to reduce barriers to influenza vaccinations for communities experiencing disparities. MINI provides flu immunizations free of charge to community members six months and older. Since inception, more than 100,000 immunizations have been given to prevent influenza. MINI clinics are hosted at non-traditional locations such as churches, mosques, temples, schools, community centers, libraries, food pantries, and homeless shelters. The clinics are hosted by a local partner who provides the space, promotion, and serves as a trusted messenger for community members. Fairview provides the vaccine and clinical team, including interpreters, support staff and information about other local community resources. Influenza vaccinations are provided at no charge to participants, six months and older. MINI clinics have expanded their reach to include other vaccinations such as Hepatitis A, blood pressure screening and cardiovascular health education, free dental varnish treatments and oral health education. These services are often provided in conjunction with MINI flu shots clinics or on their own. During the COVID-19 pandemic, the MINI program leveraged over 15 years of experience providing mobile clinical services in diverse settings to respond to the urgent public health crisis. MINI launched a large scale, low barrier testing initiative in partnership with Saint Paul Ramsey County Public Health and the Minnesota Department of Health. This collaboration enabled thousands of community members to receive a free COVID-19 test in convenient, trusted community spaces. In total, MINI supported 47 testing events and administered almost 20,000 tests. To date, MINI has provided 800 community based COVID vaccination clinics and given over 49,800 vaccinations. MINI continued to provide influenza vaccinations throughout the pandemic and administered over 4,000 free flu shots in 2021. The Fairview system consists of 11 hospitals, it controls and operates University of Minnesota Medical Center, the adult and pediatric teaching hospital of the University of Minnesota Medical School, has 10 community based general acute care hospitals and 1 long-term acute care hospital; over 80 primary and specialty care clinics; offers over 100 specialty care services; urgent care clinics; occupational health clinics; 36 retail and specialty pharmacies; pharmacy benefit management services; rehabilitation centers; counseling; hospice services; 90+ owned and managed senior care facilities and long-term care housing facilities (through Ebenezer Society, a Fairview subsidiary); and emergency medical transportation. Fairview's 34,000+ employees and network of 5,000+ system providers embrace innovation and new thinking to drive a healthier future through healing, discovery and education. The health care and medical services which Fairview provides to the community include, but are not limited to: primary, specialty, tertiary, and quaternary care; hospital and physician services; senior services; assisted living; long-term care; urgent care and emergency services; pharmacy; care of mothers and children; physical therapy/sports medicine; rehabilitation services; and inpatient and outpatient behavioral health care and chemical dependency services. Fairview provides specialized care for the treatment of cancer, heart disease, diabetes, wound care, chronic conditions, solid organ transplant, blood and marrow transplant, and many other specialties. Fairview also offers social work services, health education and support groups and services for various health issues."

Schedule H, Part V, Section B, Line 3E
Fairview is committed to transparency and accountability in all we do, including our efforts to assess - and respond to - our community's most pressing health needs. The community benefit work that we do across Fairview must reflect our community's actual needs, not our assumptions about what those needs might or should be. Because we understand that change cannot happen when we work in silos, and it cannot happen in a single year, we grounded our 2021 CHNA process in alignment with our 2018 CHNA needs, existing data, and the voices of community members and community partners. Once we had collected, analyzed, and synthesized the information we received from both primary and secondary data sources, we established a prioritization process through which we could identify the community health needs that, if effectively addressed, would have the greatest positive impact on our communities and particularly on our priority populations. Having a consistent, defined process helps reduce the skewing effect of conscious and unconscious biases and enables us to define priority need areas that reflect our community's top health needs rather than our perception of those needs. We evaluated areas of need based on four broad criteria: -Has this need been voiced by the community? Has this need been vetted by the community? -Does this need align with Fairview's strategies and priorities? -Does this need align with existing public health strategies and community health assessments? -Does this need build upon Fairview's 2018 CHNA priority needs? Our process resulted in the identification of three priority need areas. They are: -Navigating and accessing care and resources -Healing, connectedness, and mental health -Addressing structural racism and barriers to achieving health equity.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - Grand Itasca Clinic and hospital. The assessment process and data collection methods we used during this CHNA cycle were different than ever before due to the COVID-19 pandemic. COVID- 19 caused delays in data collection among local, state, and national organizations. As a result of these delays, the U.S. Census Bureau had not yet released finalized data from the 2020 U.S. Census by the time we began the CHNA process. As a result, we used 2015-2019 American Community Survey data. Local public health agencies also were not able to provide updated data as they have in the past. We acknowledge that, due to these setbacks, the data we used is less recent than desired. Additionally, COVID-19 required us to add new safety precautions to our method of gathering community voice data. For example, all conversations and interviews, which had previously been in-person meetings, took place in a virtual format instead. We collected additional community voice data by convening a broad array of stakeholders, with special focus on the priority populations. The process included discussions with community benefit and assessment committees, our community advisory council, the HOPE Commission listening and learning sessions, and key stakeholder interviews. Throughout this process, community members, local business leaders, government representatives, nonprofit and community organizations, and content experts shared their voices and perspectives about their community's health needs. Each hospital within Fairview has a community committee that is involved in the CHNA process throughout the three-year cycle. Each committee is comprised of local community and organizational leaders and is staffed by the Grand Itasca Community Relations department and the Fairview Community Advancement department. Community health steering committees met four times between April and October in 2021, three of which were individual committee meetings and one of which was a system-wide Community Impact Summit that brought all the committees together. Each committee meeting consisted of facilitated discussions through which our team gathered input about top community needs. The Fairview Community Advisory Council, composed of key community leaders and staffed by Community Advancement, reviews the CHNA report and written implementation strategy and recommends it to the Patient Care and Experience Committee of the Fairview Board of Directors for review and adoption. Each member represents the member's respective community, and members represent a broad range of sectors, among them community organizations serving cultural communities, higher education organizations, banks, and a nonprofit electric company. The Community Advisory Council met from May through November 2021 to participate in the CHNA process, give feedback, and ultimately recommend the CHNA and implementation strategy for adoption. The HOPE Commission is a multi-year transformational change effort of M Health Fairview to drive more equitable outcomes and inclusive environments and experiences for our patients, employees, and communities. The Commission conducted a series of listening and learning sessions in 2020 and 2021. The objective was to hold a mirror to Fairview to assess where we are now and how we can make lasting change. Part of being an anti-racist health system is developing a candid understanding of our shortcomings. We particularly sought to hear perspectives and ideas from the most impacted populations: BIPOC employees and patients, front-line workers who care for underserved and marginalized patients, and those patients themselves. A survey was also made available each year to gather insights and suggestions from employees and patients who could not directly participate in a listening and learning session. In 2020, the commission convened 32 virtual listening and learning sessions and two town halls involving more than 1,500 participants across Fairview sites. The sessions focused on employees but included patients and community members as well. In September 2021, the HOPE Commission continued the listening and learning sessions following the same model. In this iteration, however, the focus was primarily on gathering input from patients (and employees as patients). In both 2020 and 2021's listening and learning sessions, the facilitators and note takers reflected the community represented by the session's group to the greatest degree possible. In August and September 2021, Fairview's Community Advancement team conducted a series of interviews with staff members who work with communities. Each conversation followed a consistent interview protocol developed for this purpose, and each interview was captured by means of detailed notes. The goal of these interviews was to draw on staff expertise to gain a deeper understanding of our priority needs and to determine whether there are any emerging needs that we should be considering. Between Aug. 31 and Sept.17, 2021, we conducted 17 interviews. In August 2021, we held two focus groups in partnership with other organizations. We convened the first focus group in partnership with HealthPartners and Allina Health, and the participants were faith community nurses. We convened the second focus group in partnership with the organizations that are a part of the East Side Health and Well-being Collaborative. This meeting's focus was on accessing care and resources for different cultural communities. Fairview also participated in two large surveys. KRC Research conducted a survey around health and health care needs in St. Paul between June 8 and July 7, 2021, and administered it to community members, Fairview employees, patients, and community partners. Responses were received from 294 residents, more than 1,000 employees, 221 patients, and 20 partners. The survey was offered online and by phone and in five languages: English, Spanish, Hmong, Somali, and Karen. Fairview also supported and was a partner organization in Bridge to Health, a survey that assesses the health needs of northern Minnesota residents. The Bridge to Health survey was administered between Aug. 28 and Oct. 23, 2020. The geographic areas that were sampled included Aitkin, Carlton, Cook, Itasca, Koochiching, Lake, St. Louis, and Pine counties in Minnesota, as well as Douglas County in Wisconsin. As a foundational part of program planning and evaluation, Community Advancement staff are continuously soliciting feedback from community partners and program participants. We capture this information on an ongoing basis and use it to provide valuable context and drive insights into the needs of the communities we serve. Fairview staff developed standardized tools, processes, instructions, and facilitator, interviewer, and note-taker protocols and training. All primary data was compiled, cleaned, and analyzed. Community conversations lasted various lengths from 30-120 minutes. All community input was captured by a note-taker. The Fairview team contracted with the following groups to support our assessment process: -Loren Blinde, PhD of Writing Power, a copywriter and content strategist, on the writing of the report. -Kristi Fordyce, an independent contractor, for analysis support. -Weber Shandwick, for data collection and analysis of focus groups and stakeholder interviews focused on St. Paul. -KRC Research for the administration and analysis of the St. Paul Community Survey

Schedule H, Part V, Section B, Line 7 Facility , 1
Facility , 1 - Grand Itasca Clinic and hospital. The Community Health Needs Assessment Report for Grand Itasca Clinic and Hospital are located at: https://stcr-prd-cd.fairview.org/-/media/Files/Local-Health-Needs/Read-full-reports/2021-CHNA-Report-Grand-Itasca-Clinic-and-Hospital2125.pdf?_ga=2.XXX-XX-XXXX.1916792193.1654267916-XXX-XX-XXXX.1594916074 The Community Health Needs Assessment Implementation Strategy Report for Grand Itasca Clinic and Hospital are located at: https://stcr-prd-cd.fairview.org/-/media/Files/Local-Health-Needs/CHNA-Implementation-Strategy-Report-20222024-GICH-1.pdf?_ga=2.XXX-XX-XXXX.1916792193.1654267916-XXX-XX-XXXX.1594916074

Schedule H, Part V, Section B, Line 11 Facility , 1
"Facility , 1 - Grand Itasca Clinic and hospital. Over the course of 2021, Fairview's hospitals and medical centers, including Grand Itasca Clinic & Hospital, conducted our Community Health Needs Assessment (CHNA) process to determine our priority needs and our response. As part of this process, we listened and learned much about our community's most pressing needs. Through those conversations, and supported by community data, we prioritized the following needs: Navigating and accessing care and resources, Healing, connectedness, and mental health, and Addressing structural racism and barriers to equity. The CHNA Implementation Strategy Report outlines the major strategies and actions we will deploy throughout the 2022-2024 assessment cycle. The current generation will be the first generation in American history to experience shorter life expectancy than their parents did.1 Over the past decade, rates of poverty, food insecurity, isolation, mental illness, addiction, and other determinants of poor health have continued to rise and these do not impact everyone equally - Minnesota has some of the nation's largest racial, ethnic, and geographic health inequities. To impact these devastating trends, we must respond in ways that align with the factors that research has shown to have a significant effect on an individual's health and wellbeing. Studies estimate that eighty percent of a person's health outcomes are influenced by factors outside a healthcare setting,2 and a person's zip code matters more than their genetic code when it comes to long-term health.3 Given these realities, our response must reach outside the health system's walls and must focus on those experiencing health inequities to be most effective. Since the 2010 passage of the Affordable Care Act, our health system has engaged in four CHNA cycles. During each cycle, we have found the same or similar needs have existed for our communities. This means that our communities have largely faced the same challenges for more than a decade - and that despite our efforts to address these issues, these problems are not relenting. In fact, in many cases, these conditions have worsened over the past decade. Over the past 10 years of responding to our communities' biggest needs we have learned important lessons which have guided us in the development of our Fairview Health Services 2022-2024 implementation strategies. An essential part of the 2018 CHNA process was the identification of priority needs in the local community. The hospitals and/or medical centers identified the following priority needs for Grand Itasca Clinic & Hospital: Mental health and well-being, Healthy lifestyles, Access to care and services. Each hospital and/or medical center developed a hospital specific implementation plan around its priority health issues along with a system focus on policy, system, and environmental (PSE) change to address the identified priority needs. Each program is evaluated on an annual basis against program specific anticipated impacts. As part of the evaluation process each program indicator is assigned a value of ""green"", ""yellow"" or ""red"" based upon the following criteria. A rating of ""green"" means that the program (a) met, or exceeded, 2021 hospital goal/s as written in hospital implementation plan (b) it has count data tied to both goal/s and anticipated impact/s (c) there is an evaluation tool with measure tied to anticipated impact/s. A rating of ""yellow"" means that the program (a) had partial completion of 2021 hospital goal/s as written in hospital implementation plan (b) it has count data tied to either goal/s or anticipated impact/s but not both (c) there is an evaluation tool without measure tied to anticipated impact/s. A rating of ""red"" means that the program (a) did not complete the 2021 hospital goal/s written in hospital implementation plan (b) there was no count data (c) there was no evaluation tool/s. Policy, System, and Environmental (PSE) change initiatives often take multiple years to plan and implement. Using a CDC evaluation framework each PSE initiative is monitored and evaluated annually against anticipated activities and milestones linked to the six connected PSE evaluation steps. The six connected steps of PSE change we tracked for monitoring and evaluation purposes are (1) engage stakeholders, (2) describe the program, (3) focus the evaluation design, (4) gather credible evidence, (5) justify conclusions, and (6) ensure use and share lessons learned. In 2021 COVID-19 impacted many of our Community Health Improvement Plan (CHIP) programs and other offerings with impacts such as transitioning in person classes and services to virtual, adjusting participant surveys, and pivoting some programs to broaden their scope and more directly respond to COVID-19 related needs in the community. Priority: Mental health and wellbeing Grand Itasca Clinic & Hospital offered the evidence-based Mental Health First Aid program. The program introduces risk factors and warning signs of common mental health and substance use disorders, builds understanding of their impact, and reviews support options. The interactive course teaches participants how to offer initial help to an individual who may be experiencing a mental health concern or crisis and connect them to the appropriate resources. Youth Mental Health First Aid is the second core program which focuses on mental health concerns among youth ages 12-18. The 2021 anticipated impact for the Mental Health First Aid programs was an increase in participants' ability to recognize and correct misconceptions about mental health and mental illness. The anticipated impact was assigned a value of ""green"". 2021 Impact: Green - Outcome: 50% increase from pre-survey (50%) to postsurvey (100%) in response to the following: I strongly agree or agree that I can recognize when an individual should be referred to a mental health professional. In 2021, the Psychological First Aid program was implemented in place of Mental Health First Aid. Wording of question asked was adjusted slightly to better fit with the program curriculum. Priority: Healthy lifestyles: Grand Itasca Clinic & Hospital offered the evidence-based Living Well Suite which included three programs that were developed by Stanford University's Patient Education Research Center. (1) Chronic Disease Self-Management is a workshop given 2.5 hours once a week, for six weeks offered to individuals and their caregivers who are living with chronic conditions. Subjects addressed include medication use, communication with doctors and caregivers, nutrition, and fitness- with practical exercises and advice designed to meet participants' needs. (2) Chronic Pain Self-Management is a workshop given 2 hours once a week, for six weeks, in community settings. The workshop helps participants, and their support person, deal with the ongoing issues associated with chronic pain. (3) Diabetes Self-Management is a 6 week once a week program developed to helps those living with diabetes or pre-diabetes to improve their general health. The 2021 anticipated impact for the Living Well Suite was an increase participants' perception of positive lifestyle changes. The anticipated impact was assigned a value of ""green"". 2021 Impact: Green - Outcome: 90% of participants that responded to the post program survey indicated that they strongly agree or agree with the following statement: The program has helped them manage chronic condition(s). Priority: Access to care and resources Grand Itasca Clinic & Hospital offered the evidence-based Living Well Suite which included three programs that were developed by Stanford University's Patient Education Research Center. (1) Chronic Disease Self-Management is a workshop given 2.5 hours once a week, for six weeks offered to individuals and their caregivers who are living with chronic conditions. Subjects addressed include medication use, communication with doctors and caregivers, nutrition, and fitness- with practical exercises and advice designed to meet participants' needs. (2) Chronic Pain Self-Management is a workshop given 2 hours once a week, for six weeks, in community settings. The workshop helps participants, and their support person, deal with the ongoing issues associated with chronic pain. (3) Diabetes Self-Management is a 6 week once a week program developed to helps those living with diabetes or pre-diabetes to improve their general health. The 2021 anticipated impact for the Living Well Suite was an increase in participants who agree that the program helps them work with their health care providers. The anticipated impact was assigned a value of ""green""."

Schedule H, Part V, Section B, Line 11 Facility , 2
"Facility , 2 - Grand Itasca Clinic and hospital. 2021 Impact: Green - Outcome: 100% of participants that responded to the post program survey indicated that they strongly agree or agree with the following statement: The program has helped them work with healthcare professionals. Grand Itasca Clinic & Hospital offered the evidence-based Mental Health First Aid program. The program introduces risk factors and warning signs of common mental health and substance use disorders, builds understanding of their impact, and reviews support options. The interactive course teaches participants how to offer initial help to an individual who may be experiencing a mental health concern or crisis and connect them to the appropriate resources. Youth Mental Health First Aid is the second core program which focuses on mental health concerns among youth ages 12-18. The 2021 anticipated impact for the Mental Health First Aid programs was increase participants' confidence in assisting someone to connect with professional resources. The anticipated impact was assigned a value of ""green"". 2021 Impact: Green - Outcome: 0% increase from pre-survey (100%) to postsurvey (100%) in response to the following: I strongly agree or agree that I understand the impact that traumatic events and experiences can have on individuals. In 2021, the Psychological First Aid program was implemented in place of Mental Health First Aid. Wording of question asked was adjusted slightly to better fit with the program curriculum. Needs identified but not addressed: Prioritizing needs that are the root causes of almost all health disparities allows us to develop upstream strategies that will have a large and lasting impact in our communities. All of the significant needs we have identified will ultimately be positively impacted by addressing the root causes we have identified as our priority needs. Although the following health needs were not selected as priority needs, Grand Itasca Clinic & Hospital will continue to support work aligned with addressing these needs as appropriate particularly when doing so would address the social determinants of health and/or the leading causes of premature death. Affordable, healthy, and safe housing: This issue is beyond what Grand Itasca Clinic & Hospital resources can support at this time. Asthma: This issue will be addressed as part of patient care but falls outside the scope of the community-based CHNA Implementation Strategy. Chronic lower respiratory disease: This issue will be addressed as part of patient care but falls outside the scope of the community-based CHNA Implementation Strategy. Clinic hours: This issue will be addressed as part of patient care but falls outside the scope of the community-based CHNA Implementation Strategy. Cost associated with care: This issue will be addressed as part of patient care but falls outside the scope of the community-based CHNA Implementation Strategy. Patient advocate/navigator: This issue will be addressed as part of patient care but falls outside the scope of the community-based CHNA Implementation Strategy. Stroke: This issue will be addressed as part of patient care but falls outside the scope of the community-based CHNA Implementation Strategy. Transportation: This issue is beyond what Grand Itasca Clinic & Hospital resources can support at this time. Wait times to appointment date: This issue will be addressed as part of patient care but falls outside the scope of the community-based CHNA Implementation Strategy."

Schedule H, Part V, Section B, Line 13 Facility , 1
Facility , 1 - Grand Itasca Clinic and Hospital. The Minnesota Attorney General agreement was used in the determination of the eligibility for financial assistance.

Schedule H, Part V, Section B, Line 16 Facility , 1
Facility , 1 - Grand Itasca Clinic and hospital. A summary of the Financial Assistance Policy is posted in various locations in the hospital.

Schedule H, Part I, Line 3c Other Income Based Criteria for Free or Discounted Care
Patients that are eligible for the organization's Community Care Program or other Charity Care Plans may receive a reduction on amounts owed or up to 100% of total charges. The organization informs patients about the Community Care Program prior to delivery of services if feasible and as appropriate and during the billing process. Uninsured patients with household income up to 200% of the federal poverty level qualify for a 100% discount of the total charges. Uninsured patients who are residents of Minnesota or Wisconsin with a household income greater than 300% of the federal poverty level and equal to or below $125,000 AND RECEIVE MEDICALLY NECESSARY HOSPITAL OR HOSPITAL BASED SERVICES are charged a discount rate equal to the rate from the hospital's highest volume private payor contract.

Schedule H, Part I, Line 7f Exclusions from Percent of Total Expense
"There is no bad debt expense included in Form 990 Part IX as an expense. Due to the adoption of new GAAP reporting, the bad debt expense has been included with ""discounts"" netted against patient service revenue on Part VIII of Form 990."

Schedule H, Part I, Line 7g Subsidized Health Services
There are no costs associated with physician clinics included in line 7g.

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
The amounts reported on Form 990, Schedule H, Part I, Line 7a through 7c were determined using the cost to charge ratio derived from Worksheet 2 in the Schedule H, Form 990 Instructions. Form 990, Schedule H, Part I, Lines 7e through 7j are reported at charges as recorded by the organization.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
"The provision for bad debts 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. There is no bad debt expense included in Form 990 Part IX as an expense. Due to the adoption of new GAAP reporting, the bad debt expense has been included with ""discounts"" netted against patient service revenue on Part VIII of Form 990."

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
The bad debt expense attributable to patients that may be eligible for financial assistance 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.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
Subsequent changes that are determined to be the result of an adverse change in the patient's ability to pay (determined on a portfolio basis when applicable) are recorded as bad debt expense. Bad expense for the years ended December 31, 2021 and 2020, was not significant. See page 23 of the audited financial statements for additional information.

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
It is part of the organization's mission that community benefit activity is carried out by staff/leadership at each facility based on the health care needs in that service area. The Medicare cost to charge ratio reporting is calculated service line by service line. Other expenses are calculated using the overall cost to charge ratio. Uncompensated costs resulting from Medicare, Medicaid and state and local indigent care programs are considered a community benefit because of the significant differences between actual costs and reimbursement.

Schedule H, Part V, Section B, Line 16a FAP website
- Grand Itasca Clinic and Hospital: Line 16a URL: https://www.fairview.org/billing/financial-assistance;

Schedule H, Part V, Section B, Line 16b FAP Application website
- Grand Itasca Clinic and Hospital: Line 16b URL: http://www.fvfiles.com/2266.pdf;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
- Grand Itasca Clinic and Hospital: Line 16c URL: https://www.fairview.org/billing/financial-assistance;

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
Grand Itasca has financial advocates working with uninsured patients to assist them in completing application for various programs that may provide them coverage for medical services.

Schedule H, Part VI, Line 4 Community information
The CHNA community of each hospital and medical center is defined as a subset of zip codes within the Fairview service area, where 90 percent of its patients live. Each of the hospitals and medical centers were attributed unique zip codes and geographies. The Grand Itasca Clinic and Hospital is comprised of 11 zip codes. Our definition of communities includes all community members, including those who are patients and employees who live, work, and play in our service areas.

Schedule H, Part VI, Line 5 Promotion of community health
Grand Itasca promotes health in the community by supporting the local free clinic, through the provision of medical supplies, basic lab test and basic x-rays to the patients of this clinic at no charge. Grand Itasca also works with a community coalition to determine the health needs of the community served by Grand Itasca Clinic & Hospital.

Schedule H, Part VI, Line 7 State filing of community benefit report
MN

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
After our patients have received services, it is the policy of the organization to bill patients and their applicable payors on a timely and accurate basis. During this billing and collection process, staff is committed to providing quality customer service and timely follow up on all outstanding accounts. Billing: It is the goal of the organization to bill all claims accurately and on a timely basis. Although dependent on information and communications from patients and payors, the organization will provide sufficient follow up service to ensure that patients receive accurate account and billing information and have the opportunity to make payment and/or apply for community care. The organization has agreed to certain billing and collection practices by an agreement with the Minnesota Attorney General's office. There are financial counselors at every entity Monday through Friday who interact with the patients in person and over the phone to inform of programs available to them as well as assist them in applying for the programs. The information about needing assistance with paying the bill is posted on signs in the hospitals and materials are distributed to self-pay patients by registration staff. The statements sent out after the visit provide this information as well. If a patient/family member calls the Central Business Office customer service staff to ask for assistance with paying their bill, they are informed about options at that time. The organization provides an interpreter service that interprets conversations over the phone. This service can be used either as a three-way phone call or the Financial Counselor, in a room with the patient or family can place the call together to the interpreter phone service. The interpreter services line accommodates close to 200 languages. The billing process will be assisted by the following guidelines: 1) For all insured patients, the organization will bill all third party payor information (as provided by or verified by the patient) on a timely and accurate basis. 2) For all uninsured patients with Minnesota residency receiving hospital based services deemed medically necessary. The organization will apply an uninsured discount equal to the discount provider to our largest contracted non-government payor, any remaining balance will be billed to the patient in a timely and manner. 3) All billed patients have the opportunity to contact the organization regarding financial assistance for their accounts. Financial assistance may include Community Care, payment arrangements, medical assistance or other applicable programs. 4) If a patient contacts the organization regarding Community Care before the account is referred to a collection agency or attorney, an application and required documentation is requested (income verification etc.), the account will then be processed based on the outcome of the Community Care determination. 5) The organization takes reasonable measures to avoid referring an account to collection unless there are no responses from the patient. If a patient contacts the organization regarding Community Care after their account has been referred to a collection agency or attorney, the organization will send an application to the patient provided the account meets the Community Care requirements. If the completed application along with required documentation (income verification, etc.) is submitted, all collection action will be suspended until the patient is notified of the organization's determination.

Schedule H, Part VI, Line 6 Affiliated health care system
Grand Itasca Clinic and Hospital is a community-focused, non-profit health care organization that is part of Fairview Health Services. Grand Itasca Clinic and Hospital provides innovative technology, compassionate care, and a full spectrum of family health services. Fairview Health Services is a Minneapolis-based nonprofit health system driven to heal, discover, and educate for longer, healthier lives. Founded in 1906, Fairview provides exceptional care to patients and communities as one of the most comprehensive and geographically accessible systems in Minnesota, serving the greater Twin Cities metro area and north-central Minnesota. Through a close relationship with the University of Minnesota, Fairview offers access to breakthrough medical research and specialty expertise as part of a continuum of care that reaches all ages and health needs. Our mission: Fairview is driven to heal, discover, and educate for longer, healthier lives. The Fairview system consists of 11 hospitals, it controls and operates University of Minnesota Medical Center, the adult and pediatric teaching hospital of the University of Minnesota Medical School, has 10 community based general acute care hospitals and 1 long-term acute care hospital; over 80 primary and specialty care clinics; offers over 100 specialty care services; urgent care clinics; occupational health clinics; 36 retail and specialty pharmacies; pharmacy benefit management services; rehabilitation centers; counseling; hospice services; 90+ owned and managed senior care facilities and long-term care housing facilities (through Ebenezer Society, a Fairview subsidiary); and emergency medical transportation. Fairview's 34,000+ employees and network of 5,000+ system providers embrace innovation and new thinking to drive a healthier future through healing, discovery and education. Fairview hospitals and medical centers included: Bethesda Hospital (St. Paul) Fairview Lakes Medical Center (Wyoming) Fairview Northland Medical Center (Princeton) Fairview Range Medical Center (Hibbing) Fairview Ridges Hospital (Burnsville) Fairview Southdale Hospital (Edina) Grand Itasca Clinic & Hospital (Grand Rapids) St. John's Hospital (Maplewood) St. Joseph's Hospital (St. Paul) University of Minnesota Medical Center and University of Minnesota Masonic Children's Hospital (Minneapolis) Woodwinds Health Campus (Woodbury)

Schedule H, Part VI, Line 2 Needs assessment
"Our triennial community health needs assessment process provides an important opportunity to engage with and understand our community, analyze what has changed-for better or worse-since the last assessment, and prioritize together with the community the issues we must urgently address in order to improve wellbeing and resilience. Fairview's 2021 Community Health Needs Assessment (CHNA) builds upon previous assessments and was developed in partnership with community members and organizations, local public health agencies, and other hospitals and health systems. It serves as a tool for guiding policy, advocacy, and program planning. It also fulfills Internal Revenue Service (IRS) requirements for CHNA pursuant to the Affordable Care Act of 2010, which requires 501(c)(3) nonprofit hospitals to conduct an assessment at least every three years and provide an annual evaluation of the previous implementation strategy's impact. Through this process, we aim to: -Intentionally engage with community members and organizations, public health agencies, and other hospitals and health systems to identify and understand significant health needs in the community. -Understand the needs of the community it serves by analyzing current demographics and social determinants of health indicators, as well as by collecting direct input from community members and organizations. -Inform the CHNA implementation strategy and action plan development. As part of the 2021 CHNA process, we reexamined and built upon the extensive community insights shared during our 2018 CHNA, while also surveying the community for current and emerging needs. We have identified three system-wide priority need areas, and we will collaborate with our hospitals and shared services to address these priorities. Our specific response will vary by hospital based on the ways in which the priority needs manifest across a given community as well as the partnerships, both ongoing and new, that we have developed to address those needs. Our community commitment - creating a healthier future and Improving the health and wellbeing of our communities. The healthcare people receive in a hospital or clinic is only a small part of a person's overall health. That's why our commitment to advancing health equity goes beyond the walls of our facilities and reaches out into the community. We collaborate with community partners to improve health and wellbeing and advance health equity. Our priorities include: * Bringing clinical services into neighborhoods to expand access * Advancing our anchor mission initiatives - local hiring, local purchasing, local investing, and leading and serving locally * Addressing social risk factors through food access and housing programs and community education and outreach. Why is this a priority for our healthcare system? Nearly 80 percent of health is influenced by factors outside of clinical care. These factors, called the social determinants of health, are our health behaviors and the economic and social conditions in which we live. To help address the social determinants of health, we are creating a health and wellness hub in downtown St. Paul that will focus on health, housing, and supportive services for the community. All this work is closely tied to our HOPE Commission's health equity and anti-racism efforts. It's designed to be culturally appropriate and to meet the specific needs of the community. We seek to do ""with"" and not ""to"" the communities we belong to and are proud to contribute to our community in so many ways. Fairview Health Services is committed to the health and wellbeing of our communities. For generations we have served the people of Minnesota, cared for our patients, and invested in the people and partnerships that make us stronger, together. As a nonprofit health system and an anchor institution-an organization rooted in our communities-we have a commitment to intentionally apply our long-term, place-based economic power and human capital in partnership with community to mutually benefit the long-term wellbeing of both. We recognize that this commitment begins in and with our communities. This work cannot be done alone, we must collaborate with community-based organizations, local public health departments, and other health systems. Our efforts, resources, and commitments are investments in the health and wellbeing of our communities where we live, work, learn, play, and worship. Our community benefit programs and activities focus on our mission to heal, discover, and educate for longer, healthier lives and must meet at least one of these objectives: * Improve access to health care services. * Enhance the health of the community. * Advance medical or health care knowledge. * Relieve the burden of government to improve health. Fairview Health Services, is committed to providing exceptional care, delivering breakthrough research and innovation to healthcare, improving health and wellbeing, and promoting health equity. As anchor institutions rooted in the hearts of the communities we serve, this commitment goes beyond our walls and into the community. THERE ARE DIFFERENT WAYS OUR HEALTH SYSTEM FULFILLS THIS PROMISE INCLUDING: * Allocating resources to benefit the community. The process is guided by our community health needs assessments, developed collaboratively with the communities we serve, and implemented in partnership with local organizations and leaders. - The priority needs identified in our 2021 assessment are: healing, connectedness, and mental health; addressing structural racism and barriers to achieving health equity; and navigating and accessing care and resources. Our efforts will center on people experiencing poverty as well as racial or ethnic populations experiencing health disparities. * Bringing clinical services into neighborhoods to expand access. These free healthcare services are offered in diverse and/or under-resourced neighborhoods. * Addressing social risk factors, known as the social determinants of health, through food access and housing programs, and community education and outreach. The goal is to improve community health and wellbeing. * Advancing our HOPE (Healing, Opportunity, People, and Equity) Commission's - health equity and anti-racism efforts to drive more equitable outcomes and inclusive environments and experiences for our patients, employees, and communities. Success stories include: improving patient sociodemographic data to better understand the populations we serve and more accurately assess for disparities, and increasing the representation of diverse populations in clinical trials."