4A (Expenses $ 147218506 including grants of $ 0) (Revenue $ 190973469)
HOSPITAL, MEDICAL AND OTHER HEALTH CARE SERVICESST.FRANCIS, LOCATED IN THE TWIN CITIES SOUTHWEST METRO IN THE CITY OF SHAKOPEE, MINNESOTA, DELIVERS HIGH QUALITY, RESPECTFUL HOSPITAL, MEDICAL AND OTHER HEALTH CARE SERVICES TO PATIENTS. AS A CATHOLIC, MISSION-DRIVEN ORGANIZATION, ST.FRANCIS IS COMMITTED TO IMPROVING THE LIFELONG HEALTH OF THE COMMUNITIES IT SERVES. ST. FRANCIS SHARES ITS CAMPUS WITH ST.GERTRUDE'S HEALTH AND REHABILITATION CENTER, ALLINA HEALTH CLINIC, PARK NICOLLET CLINIC, CANCER CENTER, DIALYSIS CENTER, EMERGENCY AND URGENT CARE, MEDICAL AND DENTISTRY, AND MANY OTHER SERVICES AND SPECIALTY CLINICS HOUSED IN ADJOINING MEDICAL OFFICE BUILDINGS. ST. FRANCIS IS JOINTLY OWNED BY ALLINA HEALTH SYSTEM, HPI-RAMSEY, CONTROLLED BY HEALTH PARTNERS,INC. AND ESSENTIA HEALTH.IN 2021 ST. FRANCIS EXPENDED $ 147.2 MILLION TO PROVIDE MEDICAL SERVICES TO PATIENTS THAT INCLUDED NEARLY 5,100 INPATIENT ADMISSIONS, OVER 121,500 OUTPATIENT VISITS AND NEARLY 1,000 BIRTHS.

4B (Expenses $ 11403462 including grants of $ 0) (Revenue $ 0)
COSTS OF PARTICIPATING IN GOVERNMENT PROGRAMSTO PROMOTE ACCESS TO CARE FOR ALL INDIVIDUALS, ST. FRANCIS PARTICIPATES IN THE FOLLOWING PUBLIC HEALTH CARE PROGRAMS: MEDICARE, MEDICAID, MINNESOTACARE, AND GENERAL ASSISTANCE. PAYMENTS FROM THESE PROGRAMS FREQUENTLY DO NOT COVER THE COSTS ST. FRANCIS INCURS TO SERVE PROGRAM BENEFICIARIES. THE FOLLOWING IS A BREAKDOWN ON COSTS RELATED TO THESE PROGRAMS, SERVICES AND ADDITIONAL TAXES AND FEES.COSTS IN EXCESS OF MEDICARE AND MEDICAID PAYMENTSST. FRANCIS PROVIDES SERVICES TO PUBLIC PROGRAM ENROLLEES. SUCH PUBLIC PROGRAMS HAVE HISTORICALLY BEEN REIMBURSED AT AMOUNTS LESS THAN COST. IN 2021, ST. FRANCIS EXPENDED $6.1 MILLION BEYOND REIMBURSEMENTS TO PROVIDE CARE FOR MEDICARE PATIENTS AND AN ADDITIONAL $1.2 MILLION BEYOND REIMBURSEMENTS FOR MEDICAID PATIENTS.MEDICAID SURCHARGEST. FRANCIS IS A PARTICIPANT IN THE MEDICAID SURCHARGE PROGRAM. THE CURRENT PROGRAM INCLUDES A 1.56% SURCHARGE ON A HOSPITAL'S NET PATIENT REVENUE (EXCLUDING MEDICARE REVENUE). REPORTED AMOUNTS ARE NET OF ANY DISPROPORTIONATE SHARE ADJUSTMENTS. IN 2021, ST. FRANCIS PAID $1.7 MILLION FOR THE MEDICAID SURCHARGE.MINNESOTACARE TAXST. FRANCIS ALSO PARTICIPATES IN THE FUNDING OF MEDICAL CARE FOR PEOPLE WHO ARE UNINSURED THROUGH A MINNESOTACARE TAX OF 1.8% ON CERTAIN NET REVENUE. PATIENTS WHO ARE UNABLE TO GET INSURANCE THROUGH THEIR EMPLOYER ARE ELIGIBLE TO PARTICIPATE IN MINNESOTACARE. ST. FRANCIS PAID $2.26 MILLION FOR MINNESOTACARE TAX IN 2021.

4C (Expenses $ 3757600 including grants of $ 0) (Revenue $ -6556256)
UNCOMPENSATED CARECHARITY CAREST. FRANCIS PROVIDES MEDICAL CARE WITHOUT CHARGE OR AT REDUCED COST TO RESIDENTS OF THE COMMUNITIES THAT IT SERVES THROUGH THE PROVISION OF CHARITY CARE. OUR CHARITY CARE PROGRAM KNOWN AS ALLINA HEALTH PARTNERS CARE PROGRAM WAS ESTABLISHED TO ASSIST PATIENTS WHO DO NOT QUALIFY FOR MEDICAL ASSISTANCE SUCH AS MEDICAID AND WHOSE ANNUAL INCOMES ARE AT OR BELOW 275% OF THE FEDERAL POVERTY LEVEL. CHARITY CARE DOES NOT INCLUDE BAD DEBT (CHARGES WRITTEN OFF FOR PROVIDING SERVICES TO PERSONS ABLE, BUT UNWILLING, TO PAY FOR THESE SERVICES). THROUGH THIS PROGRAM, ST. FRANCIS STRIVES TO ENSURE THAT ALL MEMBERS OF THE COMMUNITY RECEIVE QUALITY MEDICAL CARE; REGARDLESS OF ABILITY TO PAY. IN 2021, ST. FRANCIS PROVIDED $0.88 MILLION IN CHARITY CARE.UNINSURED DISCOUNT PROGRAMFOR UNINSURED PATIENTS WHO DO NOT QUALIFY FOR MEDICAID OR MEET THE FINANCIAL THRESHOLD FOR CHARITY CARE, BUT REQUIRE SOME FINANCIAL ASSISTANCE, ST. FRANCIS PROVIDES A SLIDING SCALE DISCOUNT. ALL UNINSURED PATIENTS ARE ELIGIBLE FOR A MINIMUM OF A 25 PERCENT DISCOUNT ON BILLED CHARGES AND MAY QUALIFY FOR DISCOUNTS UP TO 44 PERCENT BASED ON ELIGIBILITY CRITERIA. IN 2021, ST. FRANCIS PROVIDED $2.87 MILLION IN SUCH DISCOUNTS TO LOW-INCOME, UNINSURED INDIVIDUALS. BAD DEBTST. FRANCIS PROVIDES MEDICAL CARE TO ALL IN NEED. THERE ARE TIMES WHEN PATIENT ACCOUNT BALANCES GO UNPAID, KNOWN AS BAD DEBT. THESE BAD DEBT CHARGES IN 2021 TOTALED $6.56 MILLION. BAD DEBT EXPENSE HAS NOT BEEN INCLUDED IN FORM 990, PART IX, LINE 25 BUT HAS BEEN REPORTED AS A REDUCTION TO PATIENT SERVICE REVENUE ON FORM 990, PART VIII LINE 2B.

4D (Expenses $ 1641272 including grants of $ 97996) (Revenue $ 0)
COMMUNITY SERVICESST. FRANCIS IS COMMITTED TO SUPPORTING PROGRAMS AND SERVICES THAT ADDRESS COMMUNITY NEEDS. IN 2021, ST. FRANCIS CONTRIBUTED $0.9 MILLION TO COMMUNITY PROGRAMS AND SERVICES TO ADVANCE THE HEALTH OF THE BROADER COMMUNITY. BELOW ARE EXAMPLES OF PROGRAMS AND SERVICES ST. FRANCIS SUPPORTS WITHIN THE COMMUNITIES WE SERVE UNDER THE CATEGORIES PROVIDED BY THE CATHOLIC HEALTHCARE ASSOCIATION (CHA) AND VHA, INC. THE ACTIVITIES IMPROVE COMMUNITY HEALTH AND DO NOT GENERATE INPATIENT OR OUTPATIENT BILLS. ST. FRANCIS SUPPORTS MANY PROGRAMS THAT FALL UNDER THIS CATEGORY. A FEW EXAMPLES INCLUDE:RIVER VALLEY HEALTH SERVICES:ST. FRANCIS PROVIDES FINANCIAL SUPPORT TO RIVER VALLEY HEALTH SERVICES (RIVER VALLEY). RIVER VALLEY PROVIDES SAFE, HIGH-QUALITY PUBLIC HEALTH NURSING AND BI-LINGUAL COMMUNITY RESOURCE REFERRALS AND CASE MANAGEMENT AT SITES IN SCOTT AND CARVER COUNTIES TO PEOPLE WHO ARE UNINSURED AND UNDERINSURED. IN 2021 RIVER VALLEY RESUMED IN PERSON CLIENT VISITS, CLINIC SESSIONS WHICH BEGAN AGAIN IN SEPTEMBER 2021 AND CONTINUED WITH TELEHEALTH SCREENINGS. THIS PREVENTATIVE MODEL HAS PROVEN EFFECTIVE IN PROVIDING ACCESS TO CARE AS 100% OF THE CLIENTS ARE UNINSURED OR UNDERINSURED. RIVER VALLEY HELPS PEOPLE WITH COMPLEX PROBLEMS NAVIGATE THROUGH THE COMMUNITY AGENCIES AND PROGRAMS AVAILABLE TO THEM. IN 2021, RIVER VALLEY MANAGED CARE FOR 700+ HIGH RISK CLIENTS.ESPERANZA(PART OF THE CARVER-SCOTT-DAKOTA CAP AGENCY):THE MISSION OF CAP IS TO ASSIST AND EMPOWER PEOPLE TO ACHIEVE SOCIAL AND ECONOMIC WELL-BEING IN PARTNERSHIP WITH OUR COMMUNITY. OUR GOAL IS TO CREATE A STRONG, HEALTH COMMUNITY OF CONNECTED INDIVIDUALS AND FAMILIES BY MEETING BASIC NEEDS, CREATING ACCESSIBLE, HIGH-QUALITY EDUCATION, AND SAFE AND STABLE HOUSING AND ENERGY SUPPORT. ESPERANZA BECAME PART OF CAP AGENCY IN 2020. DURING 2021 ST FRANCIS AND ALLINA HEALTH PROVIDED FUNDING TO THE ESPERANZA SUMMER CAMP AND SOCCER PROGRAMMING. THE EXPERANZA PROGRAM PROVIDES YOUTH THE OPPORTUNITY TO LEARN SKILLS RELATED TO HEALTH EATING, ACTIVE LIVING, MENTAL HEALTH AND WELLNESS, ACADEMIC SUCCESS, LEADERSHIP DEVELOPMENT AND POSITIVE HABITS. THE SOCCER PROGRAMMING IS 5 WEEKS AND SERVED 100 STUDENTS. THE SUMMER CAMP IS 6 WEEKS AND SERVED 100 STUDENTS (INCLUDING PRE-K). PARTICIPANTS IN THE ACTIVITIES ARE PRE-K THROUGH 12TH GRADE, PREDOMINATELY LOW-INCOME, HISPANIC-LATINO YOUTH. ESPERANZA IS A UNIQUE PROGRAM PROVIDING STABILITY, POSITIVE INFLUENCE, AND HEALTH HABITS FOR HISPANIC-LATINO YOUTH. ESPERANZA SPECIFICALLY SEEKS STAFF AND VOLUNTEERS WHO ARE HISPANIC-LATINO TO BUILD TRUST AND POSITIVE ROLE MODELS WITHIN THE COMMUNITY.ST. MARY'S HEALTH CLINICST. MARY'S HEALTH CLINIC PROVIDES QUALITY, FREE HEALTH SERVICES TO PEOPLE WHO ARE UNINSURED AND UNDERINSURED. FOR MANY YEARS, ST. FRANCIS HAS PROVIDED FINANCIAL SUPPORT, CLINIC SPACE AND SUPPLIES TO ALLOW ST. MARY'S HEALTH CLINIC TO OPERATE IN SHAKOPEE. ST. MARY'S HEALTH CLINICS PROVIDES LABORATORY TESTING, RADIOLOGY, OUTPATIENT CARE AND MEDICAL SUPPLIES. THE ST. MARY'S CLINIC IN SHAKOPEE PROVIDES A CONTINUUM OF FREE HEALTH CARE SERVICES TO LOW-INCOME, UNINSURED PEOPLE IN SCOTT, CARVER AND WESTERN DAKOTA COUNTIES. VOLUNTEER DOCTORS AND NURSES PROVIDE CARE INCLUDING PRIMARY CARE VISITS, LAB TESTS, DIAGNOSTIC SERVICES, HEALTH SCREENING, RADIOLOGY SERVICES, PRESCRIPTION MEDICATIONS AND ANY OTHER MEDICALLY NECESSARY OUTPATIENT MEDICAL SERVICES. INTERPRETING SERVICES ARE PROVIDE, AND THE DIABETES EDUCATION ENHANCEMENT PROGRAM (DEEP) PROVIDES ONE-TO-ONE DIABETES SCREENING AND CARE MANAGEMENT TO PATIENTS. OVER 99% OF THE PATIENTS SEEN AT SMHC IN SHAKOPEE ARE LATINX AND 100% OF THE PATIENTS ARE AT OR BELOW THE 275% OF FEDERAL POVERTY GUIDELINES. ALL SERVICES ARE PROVIDED FREE OF CHARGE TO THE PATIENTS. DURING THE FISCAL YEAR ENDING ON JUNE 30, 2021, ST. MARY'S PROVIDED ONGOING PRIMARY CARE TO A TOTAL OF 375 PATIENTS ACROSS 1,065 APPOINTMENTS WITH PROVIDERS.HEALTH PROFESSIONS EDUCATION ST. FRANCIS ACTIVELY SUPPORTS NUMEROUS MEDICAL EDUCATION ACTIVITIES FOR PROVIDERS, HEALTH CARE STUDENTS AND OTHER HEALTH PROFESSIONALS. IN 2021, ST. FRANCIS INVESTED $332,053 IN INTERNSHIP OPPORTUNITIES, MENTORING PARTNERSHIPS, AND GRADUATE MEDICAL EDUCATION PROGRAMMING. ST. FRANCIS IS COMMITTED TO THE EDUCATION, TRAINING AND DEVELOPMENT OF FUTURE HEALTH CARE PROFESSIONALS AND ENSURES THE AVAILABILITY OF A HIGHLY TRAINED WORKFORCE TO MEET THE COMMUNITY'S HEALTH CARE NEEDS. FINANCIAL AND IN-KIND CONTRIBUTIONSST. FRANCIS PROVIDES NUMEROUS IN-KIND AND MONETARY CONTRIBUTIONS TO NOT-FOR-PROFIT ORGANIZATIONS TO SUPPORT COMMUNITY NEEDS. IN 2021, ST. FRANCIS FUNDED $120 THOUSAND FOR DONATIONS TO COMMUNITY PROGRAMS, EQUIPMENT, SUPPLIES, AND STAFF TIME, ST. FRANCIS PARTNERS WITH LOCAL ORGANIZATIONS POSSESSING EXPERTISE, VOLUNTEERS AND STAFF NEEDED TO IMPROVE THE HEALTH OF PEOPLE IN NEED. COMMUNITY-BUILDING ACTIVITIESST. FRANCIS AND ITS EMPLOYEES ARE ACTIVE PARTICIPANTS IN VARIOUS COMMUNITY ACTIVITIES THAT TARGET THE ROOT CAUSES OF HEALTH PROBLEMS, SUCH AS POVERTY, HOMELESSNESS AND HUNGER. EXAMPLES INCLUDE COMMUNITY HEALTH IMPROVEMENT ADVOCACY, WORKFORCE DEVELOPMENT, PARTICIPATING IN VARIOUS COMMUNITY COALITIONS AND DISASTER PREPAREDNESS PLANNING. IN 2021, THE VALUE ST. FRANCIS PROVIDED IS VALUED AT $1,000.RELATED ORGANIZATIONS - ST. FRANCIS ALSO INDIRECTLY SUPPORTS THE NUMEROUS CHARITABLE PURPOSES SUPPORTED BY ITS RESPECTIVE JOINT MEMBER ORGANIZATIONS OF ESSENTIA HEALTH, ALLINA HEALTH SYSTEM AND HPI-RAMSEY.

ST FRANCIS REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 5: IN 2019, EACH ALLINA HOSPITAL CONDUCTED ITS 2020-2022 CHNA INDEPENDENTLY. EACH HOSPITAL WORKED CLOSELY WITH LOCAL PUBLIC HEALTH TO COMPLETE ITS CHNA. THESE INCLUDE REPRESENTATIVES FROM THESE COUNTIES: ANOKA COUNTY, BROWN COUNTY, CARVER COUNTY, DAKOTA COUNTY, HENNEPIN COUNTY, ISANTI COUNTY, RAMSEY COUNTY, STEELE COUNTY, SCOTT COUNTY, WASHINGTON COUNTY, WRIGHT COUNTY, AND PIERCE COUNTY. AT A MINIMUM, LOCAL PUBLIC HEALTH WORKED WITH ALLINA HEALTH TO REVIEW HOSPITAL, STATE AND LOCAL DATA AND HELP DEFINE 2020-2022 CHNA PRIORITIES. ADDITIONALLY, TO INCREASE THEIR UNDERSTANDING OF COMMUNITY MEMBERS' PERSPECTIVES ON IDENTIFIED HEALTH ISSUES AND IDEAS FOR ADDRESSING THEM, STAFF SOLICITED INPUT FROM INDIVIDUALS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY SUCH AS STAFF FROM SOCIAL SERVICE AND PUBLIC HEALTH ORGANIZATIONS AND RESIDENTS. STAFF COLLECTED FEEDBACK THROUGH A RANGE OF METHODS, INCLUDING FOCUS GROUPS AND INTERVIEWS. COMMUNITY INPUT CAME FROM DIVERSE GROUPS IN TERMS OF AGE, RACE/ETHNICITY, CULTURAL GROUP, AND OTHER DEMOGRAPHICS. A SPECIAL EFFORT WAS MADE TO REACH HISTORICALLY UNDERSERVED COMMUNITIES INCLUDING, BUT NOT LIMITED TO: WEST AFRICAN, SOMALI, LATINX, LGBTQ, FARMING, AFRICAN AMERICAN, PEOPLE EXPERIENCING MENTAL HEALTH CONDITIONS, PEOPLE LIVING ON LESS AND LOW-INCOME HOUSING RESIDENTS. WHERE POSSIBLE, THE HOSPITAL ALIGNED THEIR PROCESS WITH ASSESSMENTS BEING CONDUCTED BY LOCAL PUBLIC HEALTH AND OTHER COMMUNITY AGENCIES. IN MANY CASES, THE HOSPITALS CONDUCTED THE CHNA JOINTLY WITH PARTNERS, WITH SHARED LEADERSHIP THROUGHOUT.THE ST. FRANCIS MEDICAL CENTER APPROACH:ST. FRANCIS DEVELOPED ITS CHNA IN PARTNERSHIP WITH SCOTT COUNTY PUBLIC HEALTH, WHICH WAS SIMULTANEOUSLY LEADING ITS COMMUNITY HEALTH IMPROVEMENT PLANNING (CHIP) PROCESS. THE PROCESS WAS ALSO INFLUENCED BY STAFF'S PARTICIPATION IN THE SCOTT COUNTY HEALTH CARE SYSTEM COLLABORATIVE, SCOTT COUNTY HEALTH IMPROVEMENT PARTNERSHIP'S COMMUNITY LEADERSHIP TEAM, THE CARVER COUNTY PUBLIC HEALTH CHIP PROCESS AND OTHER COMMUNITY EFFORTS. THESE GROUPS INCLUDED COMMUNITY MEMBERS AND REPRESENTATIVES FROM 19 AGENCIES AND ORGANIZATIONS. AS PART OF THIS PROCESS, THE SCOTT COUNTY HEALTH CARE COLLABORATIVE HOSTED A PRIMARY DATA COLLECTION EVENT IN OCTOBER 2017 THAT WAS HEAVILY PROMOTED TO ENSURE ATTENDANCE BY A BROAD CROSS-SECTION OF COMMUNITY. APPROXIMATELY 140 RESIDENTS PARTICIPATED. HALF OF PARTICIPANTS IDENTIFIED AS INDIGENOUS OR PEOPLE OF COLOR. A WIDE RANGE OF AGES WERE REPRESENTED: ALMOST 25 PERCENT OF PARTICIPANTS WERE YOUTH UNDER AGE 24 YEARS, AND 39 PERCENT OF PARTICIPANTS IDENTIFIED AND GENERATION X. THE EVENT INCLUDED AN ENGAGEMENT PROCESS CALLED INTENTIONAL SOCIAL INTERACTION, WHICH CONSISTS OF FOCUSED CONVERSATIONS ABOUT SCOTT COUNTY ASSETS, CULTURAL WELLNESS TRADITIONS AND GAPS IN CARE. AS PART OF THE PRIORITIZATION PROCESS CONDUCTED BY SCOTT COUNTY PUBLIC HEALTH CARE SYSTEM COLLABORATIVE AND SCOTT COUNTY HEALTH IMPROVEMENT PARTNERSHIP'S COMMUNITY LEADERSHIP TEAM TO REVIEW STATE AND LOCAL SECONDARY DATA RESOURCES, SUCH AS HEALTH ISSUE BROCHURES PREPARED BY SCOTT COUNTY PUBLIC HEALTH, SCOTT COUNTY RESPONSES ON THE MINNESOTA STUDENT SURVEY, SCOTT COUNTY CHRONIC DISEASE DASHBOARD AND SCOTT COUNTY 10-YEAR DEATH DATA. ADDITIONALLY, THE SCOTT COUNTY PRIORITIZATION GROUP REVIEWED SELECT ALLINA HEALTH PATIENT DATA, CHOSEN BASED ON PRIORITIES DEFINED BY THE CENTER FOR COMMUNITY HEALTH AND ALLINA HEALTH EQUITY PRIORITIES. ADDITIONALLY, SCOTT COUNTY PUBLIC HEALTH CONDUCTED A COMMUNITY INPUT SURVEY, CREATED IN PARTNERSHIP WITH ST. FRANCIS AND HEALTH PARTNERS/PARK NICOLLET FOUNDATION. IN THE SUMMER OF 2018, STAFF DISTRIBUTED ENGLISH AND SPANISH VERSIONS OF THE SURVEY AT EVENTS, SUCH AS THE SHAKOPEE INTERNATIONAL FESTIVAL, SCOTT COUNTY FAIR, VISION 2040 POP-UPS AND COMMUNITY AREAS LIKE LAUNDRY MATS, ETHNIC GROCERY STORES AND THE DEPARTMENT OF MOTOR VEHICLES. THE SURVEY ASKED COMMUNITY RESIDENTS TO LIST THEIR TOP THREE COMMUNITY HEALTH CONCERNS FROM A LIST THAT INCLUDED EXPERIENCES WITH TRAUMA AND HEALTH CONDITIONS, BEHAVIORS AND PERCEPTIONS. A TOTAL OF 1,125 COMMUNITY MEMBERS COMPLETED THE SURVEY. STAFF ANALYZED THE SURVEY RESULTS BY COMMUNITY AND DEMOGRAPHIC INDICATORS, INCLUDING GENDER, RACE, ETHNICITY, AGE AND INCOME.BASED ON THE DATA REVIEW AND COMMUNITY FEEDBACK, SCOTT COUNTY PUBLIC HEALTH CHIP PARTICIPANTS GENERATED A LIST OF 16 HEALTH ISSUES FOR FINAL REVIEW. IN NOVEMBER 2018, SCOTT COUNTY PUBLIC HEALTH HOSTED A PRIORITIZATION MEETING IN WHICH PARTICIPANTS VOTED ON THEIR TOP THREE LOCAL HEALTH PRIORITIES. THIS VOTING PROCESS RESULTED IN THE FOLLOWING NEEDS BEING IDENTIFIED FOR SCOTT COUNTY: - ALCOHOL AND DRUG USE BY YOUTH- OBESITY- MENTAL HEALTH CONCERNSTO BUILD ON PREVIOUS WORK AND DUE TO THE OVERLAP IN PRIORITIES IDENTIFIED THROUGH THE SCOTT COUNTY PUBLIC HEALTH ASSESSMENT PROCESS WITH THOSE IDENTIFIED FOR ST. FRANCIS' 2016 CHNA, ST. FRANCIS CHOSE TO CONTINUE ITS EXISTING PRIORITIES FOR ACTION IN 2020-2022: - MENTAL WELLNESS AND SUBSTANCE ABUSE - HEALTHY WEIGHT- ACCESS TO CARE

ST FRANCIS REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 6B: PUBLIC HEALTH AGENCY STAFF WERE VERY INVOLVED IN MEETING TO REVIEW DATA AND PLAN THE FOCUS GROUP AND COMMUNITY DIALOGUE. COUNTIES INVOLVED IN THE ST. FRANCIS CHNA INCLUDE: CARVER COUNTY, DAKOTA COUNTY, AND SCOTT COUNTY.

ST FRANCIS REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 7D: UPON REQUESTSCHEDULE H PART V, LINE 7A AND 10A: WWW.STFRANCIS-SHAKOPEE.COM/MEDIA/14831/STFRANCIS-CHNA.PDFSCHEDULE H PART V, LINE 7B: HTTP://WWW.ALLINAHEALTH.ORG/ABOUT-US/COMMUNITY-INVOLVEMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS

ST FRANCIS REGIONAL MEDICAL CENTER
"PART V, SECTION B, LINE 11: AT THE END OF 2019, ALLINA HEALTH COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT. THE 2019 ASSESSMENT IDENTIFIED HEALTHY EATING/ACTIVE LIVING, MENTAL HEALTH AND SUBSTANCE USE AND SOCIAL DETERMINANTS OF HEALTH AS PRIORITY NEEDS FOR 2020-2022 ACROSS ALL ALLINA HEALTH GEOGRAPHIES. MANY PLANNED ACTIVITIES AND EVENTS WERE PUT ON HOLD DUE TO COVID-19 PANDEMIC, AFFECTING THE SCOPE AND FOCUS OF WORK IN 2020 FOR THE ALLINA HEALTH SYSTEM AND INDIVIDUAL HOSPITALS. HOWEVER, MANY EFFORTS WERE MADE TO CONTINUE IMPROVING THE HEALTH OF THE COMMUNITIES BY ADVANCING ADVOCACY WORK AND DEEPENING HOSPITALS' RELATIONSHIP AND COLLABORATION WITH THE COMMUNITIES ALLINA HEALTH SERVES.EXAMPLES OF SYSTEM-WIDE INITIATIVES IN THESE AREAS INCLUDE:CHANGE TO CHILL - CHANGE TO CHILL (CTC) IS A FREE, ONLINE RESOURCE THAT PROVIDES STRESS REDUCTION TIPS, LIFE BALANCE TECHNIQUES AND HEALTH EDUCATION SERVICES FOR TEENS. SINCE 2018, THE PROGRAM HAS ALSO INCLUDED AN IN-PERSON COMPONENT-THE CHANGE TO CHILL SCHOOL PARTNERSHIP (CTCSP). COMPONENTS OF CTCSP INCLUDE STAFF TRAINING ON CTC, CTC MESSAGING FOR PARENTS, A PAID STUDENT INTERNSHIP AND FUNDING FOR A ""CHILL ZONE""-A DESIGNATED SPACE FOR STUDENTS AND STAFF TO PRACTICE SELF-CARE. INITIAL EVALUATIONS OF CTCSP HAVE SHOWN INCREASES IN CONFIDENCE IN ABILITY TO COPE WITH STRESS AMONG STUDENTS WHO PARTICIPATE IN PROGRAM COMPONENTS. IN 2020 AND 2021, COVID-19 CAUSED FEAR, ANXIETY, UNCERTAINTY AND STRESS IN POPULATIONS ACROSS MINNESOTA AND SCHOOLS TRANSITIONED TO DISTANCE LEARNING. CTC MET THE CHANGING NEEDS OF THE COMMUNITY BY TRANSFORMING IN-PERSON TRAININGS AND CTCSP TO A VIRTUAL MODEL, OFFERING A VIRTUAL CARE PACKAGES TO FAMILIES, CREATING NEW ONLINE RESOURCES LIKE A VIRTUAL CHILL ZONE, AND ENHANCING EXISTING PROGRAM CONTENT RELATED TO COPING WITH GRIEF, LOSS AND CHANGE. IN 2021, MORE THAN 30,000 USERS VISITED THE CTC WEBSITE.BE THE CHANGE - ALLINA HEALTH HAS BEEN A LEADER IN ELIMINATING STIGMA AROUND MENTAL HEALTH AND ADDICTION CONDITIONS WITHIN THE HEALTHCARE INDUSTRY. BE THE CHANGE, WAS A CAMPAIGN TO ELIMINATE STIGMA AROUND MENTAL HEALTH AND ADDICTION CONDITIONS AT ALLINA HEALTH AND ENSURE ALL PATIENTS RECEIVE THE SAME CONSISTENT, EXCEPTIONAL CARE. AT THE CAMPAIGN'S LAUNCH, 500 ALLINA HEALTH EMPLOYEES VOLUNTEERED TO LEAD THE EFFORT AS TRAINED BE THE CHANGE CHAMPIONS AND HELP EDUCATE AND GENERATE AWARENESS AMONG THEIR COLLEAGUES ABOUT MENTAL HEALTH AND ADDICTION CONDITIONS THROUGH PRESENTATIONS AND EDUCATION EVENTS. BE THE CHANGE TRANSITIONED FROM A CAMPAIGN TO AN EMPLOYEE RESOURCE GROUP. THE PURPOSE OF THIS GROUP IS TO CREATE AN INCLUSIVE, WELCOMING AND SUPPORTIVE ENVIRONMENT FOR PEOPLE LIVING WITH DISABILITIES, MENTAL HEALTH CONDITIONS AND/OR ADDICTION AND CONTINUE TO WORK TO ELIMINATE STIGMA AROUND MENTAL HEALTH, ADDICTION AND DISABILITY CONDITIONS.IN ADDITION, ST FRANCIS IS ADDRESSING NEEDS IDENTIFIED THROUGH THE CHNA; GOAL 1: INCREASE RESILIENCE AND HEALTHY COPING SKILLS IN COMMUNITIES. TO INCREASE SOCIAL CONNECTEDNESS AND RESILIENCE AMONG SCHOOL AGE YOUTH AND OTHER COMMUNITY MEMBERS, ST. FRANCIS IS REPRESENTED ON THE STEERING TEAM AND PARENTAL RESILIENCE COMMITTEE FOR TOGETHER WE CAN WORK TO END CHILD ABUSE AND NEGLECT (TOGETHER WE CAN), A COMMUNITY DRIVEN MOVEMENT WITH MORE THAN 50 PARTNERS WHO HAVE THE SHARED GOAL OF ENDING CHILD MALTREATMENT IN SCOTT COUNTY WITHIN A GENERATION. FOUNDED ON THE BELIEF THAT PARENTAL WELLBEING IS INEXTRICABLY LINKED TO CHILD WELLBEING, TOGETHER WE CAN WORKS TO MITIGATE THE IMPACT OF PAST TRAUMA WHILE PREVENTING FUTURE TRAUMA, MEETING FAMILIES WHERE THEY ARE TO SUPPORT EMOTIONAL AND ECONOMIC STABILITY. ST. FRANCIS IS HAPPY TO PROMOTE COMMUNITY EDUCATION AND AWARENESS EVENTS REGARDING MENTAL HEALTH, RESILIENCE, AND HEALTHY COPING SKILLS. ST. FRANCIS PROVIDED FUNDING TO THE NAMI MN HISPANIC MENTAL HEALTH FAIR AND PROVIDED FUNDING AS WELL AS INFORMATION ABOUT CHANGE TO CHILL AND HEALTH POWERED KIDS TO THE STUDENT ORGANIZED SHAKOPEE HIGH SCHOOL MENTAL HEALTH FAIR.WE KNOW SAFE, STABLE HOUSING IS ESSENTIAL TO HEALTH AND RESILIENCE. ST. FRANCIS IS A MEMBER OF HEADING HOME SCOTT CARVER AND HAS PROVIDED CHARITABLE CONTRIBUTIONS TO SECURE OVERNIGHT HOUSING VOUCHERS FOR PEOPLE EXPERIENCING HOMELESSNESS, TO SUPPORT YOUNG WOMEN THROUGH THE NEW BEGINNINGS PROGRAM FOR PREGNANT AND PARENTING TEENS TO CREATE HOUSING WITH SUPPORTIVE SERVICES FOR YOUTH AND YOUNG ADULTS WHO HAVE BEEN HOMELESS. GOAL 2: REDUCE BARRIERS TO MENTAL HEALTH AND SUBSTANCE USE SERVICES. ST. FRANCIS OPENED ADDITIONAL EMERGENCY DEPARTMENT ROOMS TO INCREASE THE ACCESS AND ABILITY OF ST. FRANCIS TO CARE FOR PATIENTS NEEDING EMERGENCY CARE DURING A MENTAL HEALTH CRISIS. THE EXPANSION BROUGHT THE TOTAL NUMBER OF EMERGENCY MENTAL HEALTH ROOMS FROM TWO TO A SUITE OF FOUR, WITH THE OPTION TO EXPAND TO SIX ROOMS, AS NEEDED. MOST PATIENTS SEEKING EMERGENCY MENTAL HEALTH CARE NEED A SAFE SETTING WHERE THEY CAN BE MONITORED AND TREATED WHILE WAITING FOR A BED IN AN INPATIENT MENTAL HEALTH UNIT, OR UNTIL A SAFE OUTPATIENT TREATMENT PLAN IS SECURED. THE NEW MENTAL HEALTH SUITE PROVIDES A SECURE, MORE PRIVATE SETTING TO PROVIDE A HEALING EXPERIENCE, INCLUDING SHOWERS, ON-SITE NUTRITION SERVICES, DEDICATED STAFF AND THE ABILITY TO MOVE ABOUT IN A SAFE AND COMFORTABLE ENVIRONMENT WITHIN THE ST. FRANCIS EMERGENCY DEPARTMENT.IN ORDER TO REDUCE BARRIERS TO MENTAL HEALTH AND SUBSTANCE USE SERVICES, ALLINA HEALTH IS CONTRACTING WITH MIGHTY CONSULTING TO FACILITATE THE SOUTH METRO ROUND TABLE (SMRT), AN INFORMAL PARTNERSHIP CONVENING STAKEHOLDERS FOR PROBLEM SOLVING IN SCOTT COUNTY'S MENTAL HEALTH AND SUBSTANCE USE CRISIS SYSTEM. FORMED IN LATE 2020, SMRT HAS PARTICIPATION FROM LOCAL GOVERNMENT, HEALTH CARE, PROVIDERS, LAW ENFORCEMENT AND COMMUNITY MEMBERS. ST. FRANCIS CONTINUES TO REPRESENT CONTINUES TO REPRESENT HEALTH CARE ON THE SMRT AND PARTICIPATES IN ALL COMMITTEES OF THE SMRT. INITIAL GOALS OF THE PARTNERSHIP WERE TO: (1) IMPROVE THE ABILITY OF FIRST RESPONDERS TO SERVE INDIVIDUALS IN CRISIS, (2) IMPROVE THE INTEGRATION AND COORDINATION OF OUR EXISTING SERVICES, AND (3) INCREASE THE RESOURCES AVAILABLE FOLLOWING AN INDIVIDUAL'S SUBSTANCE USE CRISIS. IN 2021, THE SMRT CREATED A WEBSITE TO HELP COMMUNITY MEMBERS FIND THE RIGHT CARE AT THE RIGHT TIME WHEN IN NEED: HTTPS://SOUTHMETROROUNDTABLE.ORG/.GOAL 3: INCREASE HEALTHY EATING AND PHYSICAL ACTIVITY. TO IMPROVE ACCESS TO HEALTHY FOOD AMONG PEOPLE WITH LIMITED INCOME, ST. FRANCIS HELD ANNUAL HEALTHY FOOD DRIVES, COLLECTING OVER 1,200 POUNDS OF FOOD AND MADE CHARITABLE DONATIONS DURING MARCH FOOD SHARE MONTH. TO INCREASE ACCESS TO PHYSICAL ACTIVITY OPPORTUNITIES IN THE COMMUNITY, ST. FRANCIS HELPED THE THREE RIVERS PARK DISTRICT AND SCOTT COUNTY OBTAIN A GRANT TO PROVIDE FREE MENTAL HEALTH-FOCUSED, BEGINNER-FRIENDLY PROGRAMMING TO GET PEOPLE MOVING. THE PROJECT ALSO PROVIDES NEW PROGRAM OFFERINGS DESIGNED TO CONNECT VISITORS TO PARK RESOURCES AND ENCOURAGE FUTURE PARK USE WITH WELLNESS TOOLS THAT CAN BE USED IN ANY OPEN OR GREEN SPACE. ST. FRANCIS ALSO PROVIDES NUMEROUS CHARITABLE CONTRIBUTIONS TO PARTNERS WHO ARE EMBEDDED IN THE COMMUNITY. FOR EXAMPLE, IN 2021, ST. FRANCIS PROVIDED CHARITABLE CONTRIBUTIONS TOTALING $25,000 TO ESPERANZA/CARVER SCOTT DAKOTA CAP AGENCY AND MI CASA/SHAKOPEE COMMUNITY EDUCATION IN SUPPORT OF PHYSICAL ACTIVITY SUCH AS SOCCER AND SPECIAL ENRICHMENT ACTIVITIES. STAFF AND VOLUNTEERS ARE PREDOMINANTLY HISPANIC-LATINA WHO BUILD TRUST AND PROVIDE POSITIVE ROLE MODELS WITHIN THE COMMUNITY. THE CHARITABLE CONTRIBUTIONS MADE IT POSSIBLE FOR MORE THAN 200 CHILDREN AND YOUTH TO PARTICIPATE IN CAMPS OVER THE COURSE OF SIX WEEKS EACH SUMMER. ALSO IN 2021, ST. FRANCIS MADE A CHARITABLE CONTRIBUTION TO ADVOCATES FOR THRIVING COMMUNITIES, A NON-PROFIT WORKING WITH MEMBERS OF OUR SOMALI COMMUNITY. ADVOCATES FOR THRIVING COMMUNITIES EMPOWERS OVER 100 COMMUNITY RESIDENTS TO IMPROVE THEIR HEALTH AND WELLBEING BY PROVIDING ESSENTIAL TOOLS FOR HEALTHY LIFESTYLES.ADDITIONALLY, ST. FRANCIS CONTINUES TO SUPPORT THE WORK OF LET'S GO FISHING SCOTT COUNTY THROUGH CHARITABLE CONTRIBUTIONS. LET'S GO FISHING BENEFITS BOTH PHYSICAL AND MENTAL HEALTH OF APPROXIMATELY 1,000 RIDERS EACH YEAR. RIDERS ARE SENIORS, VETERANS AND PEOPLE LIVING WITH DISABILITIES. LET'S GO FISHING ALSO HELPS CREATE A SENSE OF COMMUNITY AND BELONGING FOR MORE THAN 80 VOLUNTEERS EACH YEAR."

ST FRANCIS REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 13B: SEE RESPONSE TO FORM 990, SCHEDULE H, PART I, LINE 3C INCLUDED IN FORM 990, SCHEDULE H , PART VI FOR EXPLANATION OF CRITERIA.

ST FRANCIS REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 24: NON-MEDICAL NECESSARY OR RETAIL/COSMETIC PROCEDURES WOULD NOT QUALIFY FOR THE UNINSURED DISCOUNT.

PART I, LINE 3C:
"CHARITY CARE PROGRAM - ALLINA PARTNER'S CARE PROGRAM:A KEY COMPONENT OF ST. FRANCIS REGIONAL MEDICAL CENTER'S (ST. FRANCIS) MISSION IS TO DELIVER COMPASSIONATE, HIGH QUALITY, AFFORDABLE HEALTH CARE SERVICES AND TO ADVOCATE FOR THOSE WITH LIMITED FINANCIAL MEANS. ST FRANCIS STRIVES TO ENSURE THAT THE FINANCIAL CAPACITY OF PEOPLE WHO NEED HEALTH CARE SERVICES DOES NOT PREVENT THEM FROM SEEKING OR RECEIVING MEDICAL CARE. THEREFORE, ST. FRANCIS HAS SEVERAL FINANCIAL ASSISTANCE PROGRAMS INCLUDING A ROBUST CHARITY CARE PROGRAM KNOWN AS ALLINA PARTNER'S CARE PROGRAM, WHICH PROVIDES FREE CARE TO ALL PERSONS AT OR BELOW 275 PERCENT OF THE FEDERAL POVERTY GUIDELINES AS PUBLISHED ANNUALLY IN THE FEDERAL REGISTRAR.THE CHARITY CARE PROGRAM ALSO PROVIDES FOR THE CONSIDERATION OF SPECIAL CIRCUMSTANCES FOR THE ""MEDICALLY INDIGENT"". ST. FRANCIS EXTENDS THE CHARITY CARE PROGRAM IN INSTANCES THAT ST. FRANCIS DETERMINES THE PATIENT IS UNABLE TO PAY SOME OR ALL OF THEIR MEDICAL BILLS DUE TO CATASTROPHIC CIRCUMSTANCES EVEN THOUGH THEY HAVE INCOME OR ASSETS THAT OTHERWISE EXCEED THE GENERALLY APPLICABLE ELIGIBILITY CRITERIA FOR THE FREE CARE PROGRAM OR THE DISCOUNTED CARE PROGRAM (DESCRIBED BELOW) UNDER ST. FRANCIS' FINANCIAL ASSISTANCE PROGRAM GUIDELINES. DISCOUNTED CARE PROGRAM - UNINSURED DISCOUNT PROGRAM ST. FRANCIS ALSO HAS A FINANCIAL ASSISTANCE PROGRAM KNOWN AS THE UNINSURED DISCOUNT PROGRAM THAT PROVIDES A DISCOUNT ON BILLED CHARGES TO UNINSURED PATIENTS, AND INSURED PATIENTS WHO RECEIVE UNINSURED TREATMENT, FOR MEDICALLY NECESSARY CARE RECEIVED. THE UNINSURED DISCOUNT PROGRAM DOES NOT USE FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY. INSTEAD, UNINSURED PATIENTS AND INSURED PATIENTS WHO RECEIVE UNINSURED TREATMENT ARE ELIGIBLE FOR A DISCOUNT BASED UPON THEIR INCOME LEVEL. ALL PATIENTS WITH AN ANNUAL INCOME AT OR BELOW $125,000 ARE ELIGIBLE FOR A DISCOUNT. THE DISCOUNT IS ALSO GENERALLY EXTENDED TO PATIENTS WITH AN ANNUAL INCOME ABOVE $125,000. ST. FRANCIS' UNINSURED DISCOUNT PROGRAM PROVIDES A SUBSTANTIAL DISCOUNT TO BILLED CHARGES FOR UNINSURED PATIENTS. THE DISCOUNT IS UPDATED ANNUALLY AND IS BASED ON THE REIMBURSEMENT RATE OF THE NON-GOVERNMENTAL THIRD PARTY PAYER WHICH PROVIDED ST. FRANCIS THE MOST REVENUE DURING THE PREVIOUS YEAR."

PART I, LINE 6A:
ST. FRANCIS' ANNUAL COMMUNITY BENEFIT REPORT IS AVAILABLE UPON REQUEST. SEE CONTACT INFORMATION CONTAINED IN SCHEDULE O TO OBTAIN A COPY.

PART I, LINE 7:
WHERE APPROPRIATE, ST. FRANCIS USES A RATIO OF PATIENT CARE COSTS TO CHARGES (COST TO CHARGE RATIO) TO CALCULATE THE AMOUNTS REPORTED FOR PART I, LINE 7 (THE TABLE).

PART I, LINE 7G:
THE AMOUNT REPORTED AS SUBSIDIZED HEALTH SERVICES DOES NOT INCLUDE ANY COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC.

PART I, LN 7 COL(F):
BAD DEBT EXPENSE HAS NOT BEEN INCLUDED IN FORM 990, PART IX, LINE 25 AND HAS NOT BEEN USED FOR THE PURPOSE OF CALCULATING THE AMOUNTS REPORTED IN COLUMN 7F. IT HAS BEEN REPORTED AS A REDUCTION TO PATIENT SERVICE REVENUE ON FORM 990, PART VIII LINE 2B.

PART II, COMMUNITY BUILDING ACTIVITIES:
COMMUNITY-BUILDING ACTIVITIESUNDERSTANDING THAT GOOD HEALTH IS DEPENDENT ON SOCIETAL, COMMUNITY, AND FAMILY ENVIRONMENTS AS WELL AS INDIVIDUAL CHOICES, AND IS BIGGER THAN THE PROVISION OF HEALTH CARE, ST. FRANCIS ENGAGES IN COMMUNITY ACTIVITIES THAT ADDRESS THE ROOT CAUSES OF HEALTH PROBLEMS SUCH AS POVERTY AND HOMELESSNESS. RESEARCH SHOWS THAT MANY OF THESE ROOT CAUSES ARE DIRECTLY TIED TO POOR HEALTH IF IGNORED, PARTICULARLY AMONG LOW-INCOME, MINORITY POPULATIONS. BELOW ARE A FEW EXAMPLES OF WAYS THAT ST. FRANCIS PARTICIPATED IN COMMUNITY-BUILDING ACTIVITIES IN 2021:COMMUNITY COALITIONSST. FRANCIS PARTICIPATES ON LOCAL COMMUNITY COALITIONS, SUCH AS THE SCOTT COUNTY COMMUNITY HEALTH IMPROVEMENT COMMITTEE AND COMMUNITY ADVISORY TEAMS IN ORDER TO RESPOND TO COMMUNITY NEEDS THROUGH COLLABORATION AND PARTNERSHIP. THESE COALITIONS PROVIDE ST. FRANCIS THE OPPORTUNITY TO BUILD RELATIONSHIPS TO DETERMINE HOW BEST TO LEVERAGE LOCAL RESOURCES TO ADDRESS COMMUNITY NEEDS THAT EXIST OUTSIDE THE TRADITIONAL REALM OF HEALTH CARE. IN ADDITION, ST. FRANCIS PARTICIPATES ON THE SCOTT-DAKOTA COUNTY WORKFORCE INVESTMENT BOARD, THE SCOTT COUNTY LOCAL ADVISORY COMMITTEE FOR MENTAL HEALTH AND TOGETHER WE CAN, A LOCAL COALITION TO PREVENT CHILDHOOD ABUSE AND NEGLECT IN SCOTT COUNTY. DISASTER PREPAREDNESSIN ADDITION TO COMMUNITY-BUILDING ACTIVITIES THAT RELATED TO ROOT CAUSES OF HEALTH, ST. FRANCIS ENGAGED IN AND LED DISASTER PREPAREDNESS PLANNING TO ENSURE SAFETY, EFFICIENCY AND EXCELLENT HEALTH CARE DURING TIMES OF TRAGEDY AND/OR UPSET. THIS INCLUDED PLANNING MEETINGS AND COMMUNITY MEETINGS/TRAININGS, AMONG OTHER THINGS. THESE PROGRAMS AND SERVICES, AMONG OTHERS, GIVE ST. FRANCIS THE OPPORTUNITY TO IMPACT COMMUNITY HEALTH BEFORE IT BECOMES PROBLEMATIC AND EXPENSIVE. IN ADDITION, THIS IMPORTANT WORK IS SUPPORTED BY THE MISSION OF OUR ORGANIZATION AND IS OUR RESPONSIBILITY AS A NOT-FOR-PROFIT HEALTH CARE ORGANIZATION. ST. FRANCIS WILL CONTINUE TO CONTRIBUTE TO IMPROVING THE HEALTH OF THE COMMUNITIES IT SERVES THROUGH PROMOTION OF COMMUNITY HEALTH.

PART III, LINE 2:
SCH H, PART III, SECTION A, LINES 2 & 3SEE SCHEDULE H, PART III, SECTION A, LINE 3 NARRATIVE BELOW.

PART III, LINE 4:
SEE ATTACHED AUDIT, PAGE 9, 2(J).

PART VI, LINE 3:
"AS A FAITH-BASED, NOT-FOR-PROFIT HOSPITAL, ST. FRANCIS DELIVERS COMPASSIONATE, HIGH QUALITY, AFFORDABLE HEALTH CARE SERVICES AND ADVOCATES FOR PEOPLE WITH LIMITED FINANCIAL MEANS. ST. FRANCIS WORKS TO ENSURE THAT THE FINANCIAL CAPACITY OF PEOPLE WHO NEED HEALTH CARE SERVICES DOES NOT PREVENT THEM FROM SEEKING OR RECEIVING CARE AT ST. FRANCIS. PROVIDING CONVENIENT ACCESS TO NECESSARY MEDICAL CARE REGARDLESS OF ONE'S ABILITY TO PAY FOR THOSE SERVICES IS IMPORTANT TO ST. FRANCIS. THROUGH ALLINA HEALTH SYSTEM, ST. FRANCIS HAS ESTABLISHED THE FOLLOWING FINANCIAL ASSISTANCE PROGRAMS: - ALLINA PARTNER'S CARE PROGRAM, PROVIDING CHARITY CARE - UNINSURED DISCOUNTS PROGRAM- SPECIAL CIRCUMSTANCES ASSISTANCE (INDIVIDUAL, CASE-BY-CASE BASIS)- MEDELIGIBLE SERVICES- MEDCREDIT FINANCIAL SERVICES ST. FRANCIS EMPLOYS FINANCIAL COUNSELORS TO ASSIST PEOPLE WHO WILL BE RECEIVING CARE IN BOTH THE INPATIENT AND OUTPATIENT SETTING. THE FINANCIAL COUNSELOR WORKS WITH INDIVIDUALS ON A CASE-BY-CASE BASIS. ST. FRANCIS ALSO EMPLOYS A FINANCIAL COUNSELOR FOR ITS EMERGENCY DEPARTMENT. THIS ALLOWS ST. FRANCIS TO ENROLL UNINSURED PATIENTS INTO PROGRAMS THE PATIENT MAY NOT OTHERWISE KNOW THEY ARE ENTITLED TO PARTICIPATE IN. IT ALSO ALLOWS ST. FRANCIS TO CONNECT THE PATIENTS WITH COMMUNITY RESOURCES LIKE THE RIVER VALLEY NURSING CENTER AND ST. MARY'S HEALTH CLINICS, BOTH OF THESE COMMUNITY PROGRAMS RECEIVE CHARITABLE CONTRIBUTIONS FROM ST. FRANCIS. ST. FRANCIS' CHARITY CARE POLICY AND UNINSURED DISCOUNT POLICY ARE AVAILABLE IN MULTIPLE LANGUAGES.FOR MORE INFORMATION ON ANY OF THE ST. FRANCIS FINANCIAL ASSISTANCE PROGRAMS, YOU MAY VISIT WWW.STFRANCIS-SHAKOPEE.COM OR WWW.ALLINAHEALTH.ORG AND CLICK ON THE FINANCIAL ASSISTANCE LINK.ST. FRANCIS PARTICIPATES IN ALL ALLINA HEALTH SYSTEM PROGRAMMING WITH RESPECT TO FINANCIAL ASSISTANCE, INCLUDING THE FOLLOWING:CHARITY CARE PROGRAM - ALLINA PARTNER'S CARE PROGRAM PROVIDES FREE MEDICALLY NECESSARY CARE TO ALL PERSONS AT OR BELOW 275 PERCENT OF THE FEDERAL POVERTY GUIDELINES AS PUBLISHED ANNUALLY IN THE FEDERAL REGISTER. THE PROGRAM WAS ESTABLISHED TO ASSIST PATIENTS WHO DO NOT QUALIFY FOR MEDICAL ASSISTANCE OR MINNESOTA CARE AND WHOSE ANNUAL INCOMES ARE AT OR BELOW 275 PERCENT OF THE FEDERAL POVERTY LEVEL. THE APPLICATION IS BRIEF AND ASKS FOR INFORMATION ON FAMILY SIZE, EMPLOYMENT, INCOME, BANKING AND INSURANCE. IF A PATIENT MEETS THE ELIGIBILITY GUIDELINES, THEIR TOTAL BALANCE WILL BE ZERO. THEY WILL RECEIVE FREE MEDICAL CARE. AN ELIGIBLE INDIVIDUAL WILL BE COVERED BY THE PROGRAM FOR UP TO ONE YEAR BARRING ANY SIGNIFICANT CHANGE IN INCOME. PATIENTS MAY BE ASKED TO APPLY FOR MEDICAL ASSISTANCE AND MINNESOTA CARE AND BE FOUND INELIGIBLE FOR THOSE PROGRAMS BEFORE THEY QUALIFY FOR ST FRANCIS' PARTNER'S CARE PROGRAM.THE UNINSURED DISCOUNT PROGRAM PROVIDES A DISCOUNT ON BILLED CHARGES TO UNINSURED PATIENTS, AND INSURED PATIENTS WHO RECEIVE UNINSURED TREATMENT, FOR MEDICALLY NECESSARY CARE RECEIVED FROM ANY ALLINA HOSPITAL, HOSPITAL BASED CLINIC AND WHOLLY-OWNED AMBULATORY SURGERY CENTERS. UNINSURED PATIENTS AND INSURED PATIENTS WHO RECEIVE UNINSURED TREATMENT ARE ELIGIBLE FOR A DISCOUNT BASED UPON THEIR INCOME LEVEL AND THE LOCATION OF THE SERVICES PROVIDED. ALL PATIENTS WITH AN ANNUAL INCOME AT OR BELOW $125,000 ARE ELIGIBLE FOR A DISCOUNT. THE DISCOUNT IS ALSO GENERALLY EXTENDED TO PATIENTS WITH AN ANNUAL INCOME ABOVE $125,000. THERE ARE THREE DISCOUNTS LEVELS ESTABLISHED, ONE FOR METRO HOSPITALS, ONE FOR REGIONAL HOSPITALS, AND ONE FOR HOSPITAL BASED CLINICS WITHIN THE ALLINA SYSTEM. SPECIAL CIRCUMSTANCES ASSISTANCE (ON INDIVIDUAL CASE BY CASE BASIS) - ST. FRANCIS PROVIDES FOR THE CONSIDERATION OF SPECIAL CIRCUMSTANCES FOR THE ""MEDICALLY INDIGENT."" ST. FRANCIS EXTENDS THE CHARITY CARE PROGRAM IN INSTANCES IT DETERMINES THE PATIENT IS UNABLE TO PAY SOME OR ALL OF THEIR MEDICAL BILLS DUE TO CATASTROPHIC CIRCUMSTANCES EVEN THOUGH THEY HAVE INCOME OR ASSETS THAT OTHERWISE EXCEED THE GENERALLY APPLICABLE ELIGIBILITY CRITERIA FOR THE FREE CARE PROGRAM OR THE DISCOUNTED CARE PROGRAM (DESCRIBED BELOW) UNDER ST. FRANCIS' FINANCIAL ASSISTANCE PROGRAM GUIDELINES. FINANCIAL ASSISTANCE SERVICES WILL PROVIDE AN EVALUATION OF PATIENTS WITH SPECIAL CIRCUMSTANCES. THERE MAY BE A CIRCUMSTANCE WHERE PATIENTS EXPERIENCE A CATASTROPHIC EVENT THAT PUTS THEM IN A DEVASTATING FINANCIAL POSITION WHEREBY THE PROGRAM REPRESENTATIVES WILL DETERMINE HOW TO BEST SUPPORT THEM FINANCIALLY. MEDELIGIBLE SERVICES PROVIDE ADVOCACY SUPPORT TO PATIENTS WHO HAVE DIFFICULTY PAYING THEIR MEDICAL BILLS. THEY CAN ASSIST PATIENTS WITH APPLYING FOR FEDERAL, STATE AND COUNTY BENEFIT PROGRAMS. THE MEDELIGIBLE SERVICES PERSONNEL ARE ADVOCATES WHO EDUCATE PATIENTS AND FAMILIES ABOUT THE ADVANTAGES OF PROGRAMS AND ASSIST THEM WITH GETTING HELP. PERSONNEL CAN PROVIDE ASSISTANCE WITH MEDICAID AND MEDICARE, SOCIAL SECURITY, VETERAN'S ADMINISTRATION, FOOD STAMPS, EMERGENCY FOOD, AND SHELTER. MEDCREDIT FINANCIAL SERVICES PROVIDES FINANCIAL LOANS TO PATIENTS WHO CANNOT AFFORD TO PAY THEIR MEDICAL BILLS. THE PATIENT CAN CONSOLIDATE ALL MEDICAL EXPENSES FROM PARTICIPATING PROVIDERS SUCH THAT THE PATIENT HAS ONLY ONE MONTHLY PAYMENT. THERE IS NO CREDIT APPLICATION REQUIRED AND NO ANNUAL FEES OR DUES. THE ANNUAL PERCENTAGE INTEREST RATE IS 8 PERCENT. ONCE A PATIENT HAS ESTABLISHED A MEDCREDIT ACCOUNT, AMOUNTS CAN BE ADDED ON ANY ADDITIONAL MEDICAL EXPENSES FOR THEMSELVES AND THEIR FAMILY. PAYMENT PLANS-IF A PATIENT INDICATES THEY ARE UNABLE OR UNWILLING TO PAY THE BALANCE IN FULL, ST. FRANCIS OFFERS A PAYMENT PLAN WHICH CANNOT EXCEED TWELVE MONTHS AND CANNOT BE LESS THAN THIRTY DOLLARS PER MONTH. IF THE PATIENT IS UNABLE TO MEET THESE PARAMETERS, MEDCREDIT IS OFFERED TO THEM. THE FINANCIAL ASSISTANCE SERVICES INFORMATION AND EDUCATION METHODS - ALLINA HAS ROBUST METHODS TO INFORM AND EDUCATE PATIENTS AND PERSONS WHO ARE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER ITS FINANCIAL ASSISTANCE PROGRAMS, INCLUDING ITS CHARITY CARE PROGRAM, AND ALSO ABOUT GOVERNMENT PROGRAMS FOR WHICH THEY MAY BE ELIGIBLE TO RECEIVE BENEFITS. EACH PATIENT BILLING STATEMENT CONTAINS INFORMATION ABOUT THE FINANCIAL ASSISTANCE PROGRAMS AND INCLUDES CONTACT INFORMATION. THE ST. FRANCIS WEBSITE HOMEPAGE AT WWW.STFRANCIS-SHAKOPEE.COM PROMINENTLY CONTAINS A LINK TO THE FINANCIAL ASSISTANCE SERVICES PAGE WHICH DESCRIBES ST FRANCIS' FINANCIAL ASSISTANCE PROGRAMS AND INCLUDES CONTACT INFORMATION. ST. FRANCIS POSTS SUMMARIES OF ITS FINANCIAL ASSISTANCE PROGRAMS IN BROCHURES IN ADMISSIONS AREAS, EMERGENCY ROOMS, AND OTHER AREAS ST. FRANCIS' FACILITIES WHERE ELIGIBLE PATIENTS ARE LIKELY TO BE PRESENT.THE BROCHURES CONTAIN SUMMARIES OF THE FINANCIAL ASSISTANCE PROGRAMS AND INCLUDE CONTACT INFORMATION FOR THE PROGRAMS. THIS INFORMATION IS ALSO AVAILABLE IN SOMALI AND SPANISH. REGISTRATION, ADMISSIONS AND INTAKE PERSONNEL ARE TRAINED TO PROVIDE FINANCIAL ASSISTANCE PROGRAM INFORMATION TO ANYONE EXPRESSING A CONCERN ABOUT THEIR ABILITY TO PAY FOR SERVICES. ALL ""SELF-PAY"" PATIENTS (THE PATIENT IS NOT COVERED BY INSURANCE OR A GOVERNMENT PROGRAM) THAT COMES TO ST. FRANCIS' EMERGENCY ROOM RECEIVES A PACKET OF INFORMATION CONTAINING EVERYTHING NECESSARY TO APPLY FOR ST. FRANCIS' FINANCIAL ASSISTANCE PROGRAMS AND CERTAIN GOVERNMENT PROGRAMS. THERE IS CONTACT INFORMATION AND TELEPHONE NUMBERS THEY CAN CALL WITH ANY QUESTIONS OR TO RECEIVE ASSISTANCE IN COMPLETING APPLICATIONS. FINANCIAL ASSISTANCE PROGRAM PERSONNEL ALSO MEET DIRECTLY WITH ANY SELF-PAY PATIENT ADMITTED TO THE HOSPITAL. PERSONNEL WILL MEET WITH PATIENTS WHEREVER IT IS MOST CONVENIENT FOR THE PATIENT SUCH AS THE HOSPITAL, A CLINIC, ST. FRANCIS' OFFICES OR THE PATIENT'S HOME. ST. FRANCIS HAS AN INTERPRETER SERVICES TEAM THAT PROVIDES INTERPRETERS TO PATIENTS, COMPANIONS AND FAMILIES WHO HAVE LIMITED ENGLISH PROFICIENCY (LEP) OR ARE DEAF OR HARD OF HEARING (DHH). THIS SERVICE IS PROVIDED AT NO COST TO THE PATIENT. LEP AND DHH PERSONNEL ARE TRAINED TO INFORM AND EDUCATE PATIENTS ABOUT THE FINANCIAL ASSISTANCE PROGRAMS. ALL PERSONNEL RESPONSIBLE FOR ST. FRANCIS' COLLECTION ACTIVITIES ARE EXTENSIVELY TRAINED ON ST. FRANCIS' FINANCIAL ASSISTANCE PROGRAMS. ANY TIME A PATIENT EXPRESSES A CONCERN REGARDING THEIR ABILITY TO PAY FOR SERVICES, THE PERSONNEL EXPLAIN THE FINANCIAL ASSISTANCE PROGRAMS, ASK CERTAIN QUESTIONS TO OBTAIN INFORMATION AND TO DETERMINE WHICH FINANCIAL ASSISTANCE PROGRAMS THE PATIENT MAY QUALIFY AND BEST FITS THE PATIENTS' NEEDS."

PART VI, LINE 6:
PURSUANT TO A JOINT MEMBERSHIP AGREEMENT, ALLINA HEALTH SYSTEM, HPI-RAMSEY, AND ESSENTIA HEALTH ARE JOINT MEMBERS OF ST. FRANCIS REGIONAL MEDICAL CENTER (ST. FRANCIS).UNDER THE MEMBERSHIP AGREEMENT, ALLINA HEALTH HAS THE AUTHORITY AND RESPONSIBILITY FOR THE OPERATION AND MAINTENANCE OF ST. FRANCIS, INCLUDING PROMOTING THE HEALTH OF THE COMMUNITIES SERVED BY ST. FRANCIS. THE JOINT MEMBERS HAVE CERTAIN JOINT RESERVE POWERS. ALLINA HEALTH AND ESSENTIA HEALTH HAVE CERTAIN EXCLUSIVE RESERVE POWERS RELATING TO GOVERNANCE OF ST. FRANCIS.

PART VI, LINE 7, REPORTS FILED WITH STATES
MN

PART III, LINE 8:
"ST. FRANCIS USED THE AMOUNT REPORTED IN THE MEDICARE COST REPORT AS THE SOURCE FOR THE AMOUNTS REPORTED ON PART III, LINES 5 & 6 AS OUTLINED IN THE FORM 990, SCHEDULE H INSTRUCTIONS. FOR MEDICARE COST REPORTS, ST. FRANCIS USES A RATIO OF PATIENT CARE COSTS TO CHARGES (COST TO CHARGE RATIO) TO DETERMINE MEDICARE ALLOWABLE COSTS. GENERALLY, THE RATIO IS CALCULATED AS THE TOTAL MEDICARE ALLOWABLE PATIENT COSTS OVER THE TOTAL PATIENT CHARGES. MEDICARE CHARGES MULTIPLIED BY THIS RATIO EQUALS THE MEDICARE ALLOWABLE COSTS REPORTED IN THE MEDICARE COST REPORTS. ST. FRANCIS BELIEVES THAT AT LEAST SOME PORTION OF THE COSTS IT INCURS IN EXCESS OF PAYMENTS RECEIVED FROM THE FEDERAL GOVERNMENT FOR PROVIDING MEDICAL SERVICES TO MEDICARE ENROLLEES AND BENEFICIARIES UNDER THE FEDERAL MEDICARE PROGRAM (SHORTFALL OR MEDICARE SHORTFALL) CONSTITUTES A COMMUNITY BENEFIT. ST. FRANCIS' PROVIDING OF THESE SERVICES CLEARLY LESSENS THE BURDENS OF GOVERNMENT BY ALLEVIATING THE FEDERAL GOVERNMENT FROM HAVING TO DIRECTLY PROVIDE THESE MEDICAL SERVICES. AS DEMONSTRATED AND CALCULATED ON FORM 990, SCHEDULE H, PART III, LINE 7, ST. FRANCIS' MEDICARE ""ALLOWABLE COSTS"" CLEARLY EXCEED THE PAYMENTS IT RECEIVES FOR PROVIDING THESE MEDICAL SERVICES UNDER THE MEDICARE PROGRAM. THE TRUE COMMUNITY BENEFIT FOR ST. FRANCIS' PARTICIPATION IN THE CURRENT MEDICARE PROGRAM IS DEPENDENT ON HOW EFFICIENTLY AND COST EFFECTIVELY THE FEDERAL GOVERNMENT COULD OPERATE A DIRECT MEDICAL CARE MEDICARE PROGRAM OR ALTERNATIVELY THE COST TO THE GOVERNMENT TO CONTRACT OUT SUCH SERVICES THROUGH A COMPETITIVE BIDDING PROCESS IN THE OPEN MARKETS FOR THE SAME OR SIMILAR SERVICES FACTORING IN ITEMS SUCH AS QUALITY OF CARE, OUTCOMES AND SIMILAR IMPORTANT FACTORS AS COMPARED TO ST. FRANCIS' ACTUAL COSTS OF PROVIDING THE MEDICAL CARE. THE MEDICARE SHORTFALL CALCULATION ON THE FORM 990, SCHEDULE H, LINE 7 SIGNIFICANTLY UNDERSTATES ST. FRANCIS' ACTUAL MEDICARE SHORTFALL FOR TWO REASONS. FIRST, ST. FRANCIS INCURS SIGNIFICANT COSTS IN EXCESS OF PAYMENTS UNDER THE MEDICARE PROGRAM FOR PROVIDING CERTAIN SERVICES THAT ARE NOT SUBJECT TO MEDICARE COST REPORTING AND THEREFORE NOT REFLECTED IN ST. FRANCIS' COST AMOUNTS ON LINE 6. SECOND, LINE 6 LIMITS ST. FRANCIS' REPORTED COSTS TO ONLY MEDICARE ""ALLOWABLE COSTS"" AS SOLELY DETERMINED BY THE FEDERAL GOVERNMENT MEDICARE PROGRAM. FOR THESE TWO REASONS, THE MEDICARE SHORTFALL REPORTED ON LINE 7 SIGNIFICANTLY UNDERSTATES THE ACTUAL MEDICARE SHORTFALL AND THE ACTUAL COST OF PROVIDING MEDICAL CARE TO MEDICARE PROGRAM PARTICIPANTS.ST. FRANCIS BELIEVES A DIRECT MEDICAL SERVICE MEDICARE PROGRAM OPERATED BY THE FEDERAL GOVERNMENT AND THE COST TO THE GOVERNMENT TO CONTRACT OUT THE SERVICES UNDER A COMPETITIVE BIDDING PROCESS MAY PROVE TO BE EVEN MORE EXPENSIVE TO THE FEDERAL GOVERNMENT THAN ST. FRANCIS' REPORTED MEDICARE ""ALLOWABLE COSTS"" ON LINE 6 GIVEN ST. FRANCIS' QUALITY OF CARE, SUCCESSFUL OUTCOMES AND THE SIGNIFICANT DIFFERENCE BETWEEN ACTUAL COSTS ST. FRANCIS INCURS AND MEDICARE ""ALLOWABLE COSTS"" IN PROVIDING CARE UNDER THE MEDICARE PROGRAM. THEREFORE, ST. FRANCIS FIRMLY BELIEVES THAT THERE IS A TRUE COMMUNITY BENEFIT COMPONENT TO ITS PARTICIPATION IN THE FEDERAL MEDICARE PROGRAM."

PART III, LINE 9B:
ST. FRANCIS' WRITTEN DEBT COLLECTION POLICY AND COLLECTION PRACTICES APPLY UNIFORMLY TO ALL PATIENTS AND INCLUDE PROVISIONS RELATED TO ITS CHARITY CARE PROGRAM AND OTHER FINANCIAL ASSISTANCE PROGRAMS. IF A PATIENT IS KNOWN TO QUALIFY FOR A FINANCIAL ASSISTANCE PROGRAM, THEY ARE AUTOMATICALLY AFFORDED THE PROGRAM BENEFITS FOR UP TO ONE YEAR AS THEY WOULD HAVE ALREADY PROVIDED INFORMATION NECESSARY FOR ST. FRANCIS TO MAKE SUCH A DETERMINATION. FOR EXAMPLE, A PATIENT THAT QUALIFIED FOR ST. FRANCIS' CHARITY CARE PROGRAM BEFORE RECEIVING SERVICES WOULD NOT RECEIVE A BILLING STATEMENT FOR THE MEDICAL SERVICES PROVIDED. IN THE CASE OF A PATIENT QUALIFYING FOR THE CHARITY CARE PROGRAM AFTER RECEIVING SERVICES AND THE COMMENCEMENT OF CERTAIN COLLECTION ACTIVITIES, THE AMOUNTS ARE DISCHARGED AS CHARITY CARE AND ALL COLLECTION ACTIVITIES CEASE. AS DISCUSSED IN THE RESPONSE TO PART VI, LINE 3, PATIENTS ARE INFORMED AND EDUCATED ON ST. FRANCIS' FINANCIAL ASSISTANCE PROGRAMS INCLUDING ITS CHARITY CARE PROGRAM AS PART OF THE ROUTINE REGISTRATION, ADMISSION, INTAKE, BILLING AND COLLECTION PROCESSES. IF A PATIENT DESIRES TO APPLY FOR THE CHARITY CARE PROGRAM, PERSONNEL WILL SEND AN APPLICATION TO THE PATIENT. IF COLLECTION ACTIVITIES HAVE COMMENCED, THOSE ACTIVITIES WILL BE SUSPENDED FOR THIRTY (30) DAYS TO ALLOW TIME FOR THE APPLICATION PROCESS. COLLECTION ACTIVITY MAY RESUME IF, AFTER 30 DAYS, A COMPLETED APPLICATION HAS NOT BEEN RECEIVED. IN THE CASE OF AN INCOMPLETE APPLICATION, ST. FRANCIS MAY RESUME COLLECTION ACTIVITIES IF REQUESTS FOR ADDITIONAL INFORMATION ARE NOT MET WITH A TIMELY RESPONSE. IF AN APPLICANT DOES NOT MEET THE ELIGIBILITY CRITERIA AND THE APPLICATION IS DENIED, COLLECTION ACTIVITY MAY RESUME UPON DENIAL. HOWEVER, THE PATIENT MAY STILL BE ELIGIBLE FOR OTHER FINANCIAL ASSISTANCE PROGRAMS THAT ARE APPLIED AS WARRANTED BASED UPON THE INFORMATION PROVIDED. SUCH ACTIVITIES ARE FULLY EXPLAINED TO THE PATIENT DURING THE COLLECTION PROCESS.

SCH H , PART III, SECTION A, LINE 3
"ST. FRANCIS HAS ADOPTED HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION [HFMA] STATEMENT NO. 15, VALUATION AND FINANCIAL STATEMENT PRESENTATION OF CHARITY CARE, IMPLICIT PRICE CONCESSIONS AND BAD DEBTS BY INSTITUTIONAL HEALTHCARE PROVIDERS (STATEMENT 15). AS DISCLOSED IN THE FOOTNOTES TO ST. FRANCIS' AUDITED FINANCIAL STATEMENTS (SEE RESPONSE TO PART III, LINE 4), THE PROVISIONS FOR BAD DEBT AND CHARITY CARE ARE 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. THEREFORE, THE BAD DEBT AMOUNT STATED FOR FINANCIAL REPORTING PURPOSES IS REPORTED ""NET"" OF ANY ANTICIPATED PATIENT DISCOUNTS OR IMPLICIT PRICE CONCESSIONS TO WHICH THE PATIENT MAY BE ELIGIBLE INCLUDING, BUT NOT LIMITED TO, THE UNINSURED DISCOUNT PROGRAM (DISCUSSED ABOVE) AND REFLECTS THE ESTIMATED AMOUNT REPORTED AS ""NET PATIENT SERVICE REVENUE"" DURING THE CURRENT PERIOD OR ANY PREVIOUS PERIOD. THIS DOES NOT NECESSARILY EQUAL THE ""COST"" TO PROVIDE THE MEDICAL SERVICES. ALSO, NOTE THAT AMOUNTS RELATED TO PATIENTS WHO HAVE QUALIFIED UNDER THE CHARITY CARE PROGRAM ARE NOT INCLUDED IN EITHER NET PATIENT REVENUE OR IN BAD DEBT EXPENSE. IN OTHER WORDS, THE BAD DEBT EXPENSE AS REPORTED IN THE REVENUE SECTION OF THE FINANCIAL STATEMENTS OF THE FORM 990 DOES NOT INCLUDE AMOUNTS RELATED TO QUALIFIED CHARITY CARE PATIENTS AND IS STATED AT THE ""NET"" EXPECTED OR ANTICIPATED COLLECTION AMOUNT, WHICH MAY BE SIGNIFICANTLY DIFFERENT THAN PATIENT CHARGES DUE TO THE APPLICATION OF DISCOUNTS SUCH AS THOSE PROVIDED UNDER THE UNINSURED DISCOUNT PROGRAM. THIS AMOUNT ALSO CONSTITUTES A DIFFERENT AMOUNT THAN ST. FRANCIS' ACTUAL COST TO PROVIDE THE MEDICAL SERVICES. TO ARRIVE AT THE BAD DEBT ""AT COST"" AS REPORTED IN FORM 990, SCHEDULE H, PART III, LINE 2, ST. FRANCIS HAS APPLIED A RATIO OF PATIENT CARE COST TO CHARGES (COST-TO-CHARGE RATIO) TO THE ESTIMATED PATIENT CHARGE AMOUNT INCLUDED IN BAD DEBT AFTER REMOVING THE ANTICIPATED DISCOUNTS. THIS PROCESS PROVIDES A VERY CONSERVATIVE ESTIMATE OF ST. FRANCIS' BAD DEBT (AT COST) REPORTED ON LINE 2.ST. FRANCIS HAS A ROBUST PROCESS FOR ADMINISTERING ITS FINANCIAL ASSISTANCE PROGRAMS INCLUDING THE CHARITY CARE AND UNINSURED DISCOUNT PROGRAM DESCRIBED IN FURTHER DETAIL IN PART VI, LINE 3. EACH PATIENT IS PROVIDED NUMEROUS OPPORTUNITIES TO APPLY TO ALLINA PARTNER'S CARE PROGRAM AND TO PARTICIPATE, IF QUALIFIED, TO RECEIVE FREE OR DISCOUNTED MEDICAL CARE OR BE ENROLLED IN A GOVERNMENT SPONSORED MEDICAL CARE PROGRAM UNDER ST. FRANCIS'S VARIOUS FINANCIAL ASSISTANCE PROGRAMS. THE ADMINISTRATIVE PROCESS INCLUDES IDENTIFYING ANY PATIENT WITH A FINANCIAL CONCERN, AS WELL AS INFORMING, COUNSELING, QUALIFYING AND ASSISTING PATIENTS TO APPLY FOR THE ST. FRANCIS' CHARITY CARE AND OTHER FINANCIAL ASSISTANCE PROGRAMS. ALTHOUGH EACH PATIENT IS PROVIDED NUMEROUS OPPORTUNITIES TO RECEIVE FINANCIAL ASSISTANCE AND INFORMED MULTIPLE TIMES OF THE CHARITY CARE PROGRAM PRIOR TO ST. FRANCIS CLASSIFYING THE AMOUNTS AS BAD DEBT, IT IS POSSIBLE THAT PATIENTS WHO WOULD QUALIFY FOR CHARITY CARE DO NOT COMPLETE THE APPLICATION. THIS AMOUNT IS NOT REASONABLY ESTIMABLE.AS A TAX-EXEMPT HOSPITAL, ST. FRANCIS IS REQUIRED TO PROVIDE NECESSARY MEDICAL CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR THE SERVICES PROVIDED. DUE TO CIRCUMSTANCES BEYOND ST. FRANCIS' CONTROL, A PERSON WHO WOULD OTHERWISE QUALIFY UNDER THE CHARITY CARE PROGRAM MAY NOT PROVIDE ST. FRANCIS THE NECESSARY INFORMATION, FAIL TO QUALIFY FOR THE PROGRAM, AND FAIL TO RECEIVE FREE CARE. ULTIMATELY, THOSE AMOUNTS ARE WRITTEN-OFF AND REPORTED AS BAD DEBT EXPENSE. ANY METHODOLOGY ST. FRANCIS COULD USE TO QUANTIFY AND PROVIDE AN ESTIMATE OF HOW MUCH BAD DEBT (AT COST AND IF ANY) REPORTED ON LINE 2 REASONABLY COULD BE ATTRIBUTABLE TO PERSONS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER ST. FRANCIS' CHARITY CARE POLICY AND FOR ST. FRANCIS TO PROVIDE AN ESTIMATE OF WHAT PORTION OF BAD DEBT, IF ANY, ST. FRANCIS BELIEVES SHOULD CONSTITUTE COMMUNITY BENEFIT WOULD BE PURELY SPECULATIVE, IMPRECISE AND SUBJECT TO INHERENT METHODOLOGY FLAWS. WHILE ST. FRANCIS FIRMLY BELIEVES, FOR THE REASONS STATED ABOVE, THAT SOME COMPONENT OF ITS REPORTED BAD DEBT EXPENSE (AT COST) ON LINE 2 CONSTITUTES AMOUNTS RELATED TO PERSONS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER ST FRANCIS' CHARITY CARE PROGRAM, ST. FRANCIS CANNOT REASONABLY QUANTIFY THE AMOUNT AND RESPECTFULLY DECLINES THE OPPORTUNITY TO PROVIDE AN AMOUNT. THEREFORE, ST. FRANCIS HAS REPORTED ZERO OR NONE FOR FORM 990, SCHEDULE H, PART III, LINE 3."

PART VI, LINE 5:
GOVERNING BODY A MAJORITY OF ST. FRANCIS' GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION NOR FAMILY MEMBERS THEREOF. OPEN MEDICAL STAFFTHE MEDICAL STAFF AT ST. FRANCIS IS OPEN, WITH THE EXCEPTION OF CERTAIN DEPARTMENTS (SUCH AS RADIOLOGY, PATHOLOGY, EMERGENCY MEDICINE) WITH WHICH ST. FRANCIS HAS ENTERED INTO EXCLUSIVE CONTRACTS WITH PARTICULAR MEDICAL GROUPS. THE HOSPITAL ENTERS INTO THESE CONTRACTS WHEN IT DETERMINES SUCH ARRANGEMENTS WILL IMPROVE CARE AND OPERATIONS IN THE HOSPITAL BY, FOR EXAMPLE, IMPROVING THE QUALITY OF PATIENT CARE, ASSURING THE AVAILABILITY OF SPECIFIC SERVICES, REDUCING THE COSTS OF PROVIDING HEALTH CARE, ALLOCATING HOSPITAL RESOURCES MORE EFFICIENTLY, SECURING GREATER PATIENT SATISFACTION, OR FACILITATING THE ORDERLY OPERATIONS OF THE HOSPITAL. IT DOES NOT ENTER INTO THESE ARRANGEMENTS SOLELY TO BENEFIT OR EXCLUDE SPECIFIC PROVIDERS OR TO RESTRAIN COMPETITION.ST. FRANCIS ENGAGES IN A BROAD ARRAY OF ACTIVITIES THAT PROMOTE GOOD HEALTH IN OUR COMMUNITY. SEVERAL DEPARTMENTS ENGAGE IN COMMUNITY OUTREACH ACTIVITIES INCLUDING SUPPORT GROUPS (DIABETES, CANCER, GRIEF AND LOSS), EDUCATIONAL CLASSES (CPR ANYTIME, NUTRITION), AND FREE SCREENINGS (SKIN CANCER, CERVICAL CANCER, AND DIABETES). ST. FRANCIS PARTNERS WITH SEVERAL LOCAL ORGANIZATIONS IN STRENGTHENING THE CONTINUUM OF CARE FOR PEOPLE WHO ARE UNINSURED AND UNDERINSURED. ST. FRANCIS PROVIDED FINANCIAL SUPPORT FOR RIVER VALLEY HEALTH SERVICES WHICH OFFERS FREE PUBLIC HEALTH NURSING AND SOCIAL SERVICES REFERRALS FOR THE UNINSURED AND UNDERINSURED IN SCOTT AND EASTERN CARVER COUNTY. RIVER VALLEY HEALTH SERVICES COORDINATES CARE FOR THE UNINSURED POPULATION, HELPING PEOPLE NAVIGATE THE HEALTH AND SOCIAL SERVICES SYSTEM AND CONNECT WITH THE MOST APPROPRIATE CARE PROVIDER FOR THE CLIENT'S PARTICULAR NEED. IN 2020, THEY HAD OVER 1,400 CLIENT VISITS. ST. FRANCIS PROVIDES FINANCIAL SUPPORT AND IN-KIND CLINIC SPACE ON THE ST. FRANCIS CAMPUS FOR ST. MARY'S HEALTH CLINICS TO ENSURE FREE MEDICAL CARE FOR UNINSURED AT ST. MARY'S SHAKOPEE LOCATION.

PART VI, LINE 2:
IN 2019, ALLINA HEALTH CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT FOR EACH OF THE HOSPITALS IN THE SYSTEM. THE PURPOSE WAS TO IDENTIFY LOCAL PRIORITIES FOR EACH HOSPITAL AS WELL AS OVER-ARCHING THEMES FOR THE HEALTH SYSTEM TO ADDRESS FOR FY 2020-2022.TO RESPOND TO LOCAL NEEDS AND RESOURCES, EACH ALLINA HEALTH HOSPITAL CONDUCTED ITS 2020-2022 CHNA INDEPENDENTLY. THE HOSPITALS WORKED CLOSELY WITH LOCAL PUBLIC HEALTH. THESE INCLUDE REPRESENTATIVES FROM THESE COUNTIES: ANOKA COUNTY, BROWN COUNTY, CARVER COUNTY, DAKOTA COUNTY, HENNEPIN COUNTY, ISANTI COUNTY, RAMSEY COUNTY, STEELE COUNTY, SCOTT COUNTY, WASHINGTON COUNTY, WRIGHT COUNTY, AND PIERCE COUNTY. SOME ALSO COLLABORATED WITH OTHER HEALTH SYSTEMS AND COMMUNITY ORGANIZATIONS. WHERE POSSIBLE, THE HOSPITAL ALIGNED THEIR PROCESS WITH ASSESSMENTS BEING CONDUCTED BY LOCAL PUBLIC HEALTH AND OTHER COMMUNITY AGENCIES. IN MANY CASES, THE HOSPITALS CONDUCTED THE CHNA JOINTLY WITH PARTNERS, WITH SHARED LEADERSHIP THROUGHOUT. THE CHNA PROCESS OCCURRED IN THREE STEPS: DATA REVIEW AND PRIORITIZATION, COMMUNITY INPUT AND THE DEVELOPMENT OF A THREE-YEAR IMPLEMENTATION PLAN. MOST HOSPITALS USED THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP) COMMUNITY-DRIVEN STRATEGIC PLANNING PROCESS FOR IMPROVING COMMUNITY HEALTH. THE OFFICIAL CHNA PROCESS BEGAN IN JUNE 2018 AND WAS COMPLETED IN AUGUST 2019. EACH HOSPITAL'S CHNA TEAM REVIEWED COUNTY-SPECIFIC DATA RELATED TO DEMOGRAPHICS, SOCIAL AND ECONOMIC FACOTRS, HEALTH BEHAVIORS, PREVALENCE OF HEALTH CONDITIONS AND HEALTH CARE ACCESS. SOURCES VARIED, BUT INCLUDED THE MINNESOTA STUDENT SURVEY, HEALTH SURVEYS CONDUCTED BY LOCAL PUBLIC HEALTH DEPARTMENTS, LOCAL RESEARCH STUDIES ON TOPICS SUCH AS HOUSING AND SECONDARY PUBLIC HEALTH DATA AVAILABLE THROUGH THE MINNESOTA DEPARTMENT OF HEALTH. ADDITIONALLY, TEAMS REVIEWED SELECT COUNTY-SPECIFIC ALLINA HEALTH PATIENT DATA. MANY HOSPITALS ALSO COLLECTED FEEDBACK ON PERCEIVED COMMUNITY HEALTH NEEDS FROM LOCAL STAKEHOLDERS THROUGH COMMUNITY DIALOGUES, INTERVIEWS AND SURVEYS. BASED ON THE DATA REVIEW AND COMMUNITY FEEDBACK, LOCAL CHNA TEAMS CHOSE CHNA PRIORITIES FOR THE 2020-2022 CYCLE. SPECIFIC PRIORITIZATION CRITERIA WAS DETERMINED LOCALLY, BUT SIZE AND SERIOUSNESS OF THE PROBLEM, IMPORTANCE TO THE COMMUNITY AND ORGANIZATIONAL CAPACITY TO ADDRESS THE NEED WERE ALL CONSIDERED. HOSPITAL PRIORITIES INCLUDE:- MENTAL HEALTH AND WELLNESS, INCLUDING SUBSTANCE ABUSE- OBESITY, PHYSICAL ACTIVITY AND NUTRITION- ACCESS TO CARE- SOCIAL DETERMINANTS OF HEALTH- SOCIAL ISOLATION- VIOLENCE- DENTAL CAREST. FRANCIS SPECIFIC PRIORITIES INCLUDE:- MENTAL HEALTH AND WELLNESS, INCLUDING SUBSTANCE ABUSE- HEALTHY WEIGHT- ACCESS TO CARETO INCREASE THEIR UNDERSTANDING OF COMMUNITY MEMBERS' PERSPECTIVES ON IDENTIFIED HEALTH ISSUES AND IDEAS FOR ADDRESSING THEM, STAFF SOLICITED INPUT FROM INDIVIDUALS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY SUCH AS STAFF FROM SOCIAL SERVICE AND PUBLIC HEALTH ORGANIZATIONS AND RESIDENTS. STAFF COLLECTED FEEDBACK THROUGH A RANGE OF METHODS, INCLUDING FOCUS GROUPS AND INTERVIEWS. FOCUSED OUTREACH OCCURRED TO HISTORICALLY UNDERSERVED COMMUNITIES WHO EXPERIENCE HEALTH DISPARITIES. IN FEBRUARY AND APRIL 2019, COMMUNITY ENGAGEMENT LEADERS FROM EACH OF ALLINA HEALTH'S HOSPITALS DISCUSSED THE RESULTS OF EACH HOSPITAL'S DATA REVIEW, PRIORITIZATION AND COMMUNITY INPUT PROCESSES. PRIORITIES AND COMMON THEMES FOR ACTION WERE IDENTIFIED ACROSS ALL GEOGRAPHIES. TOGETHER, THEY IDENTIFIED MENTAL HEALTH (INCLUDING SUBSTANCE ABUSE) AND OBESITY CAUSED BY PHYSICAL INACTIVITY AND POOR NUTRITION AS PRIORITY NEEDS IN ALL ALLINA HEALTH GEOGRAPHIES. THEY ALSO IDENTIFIED SOCIAL DETERMINANTS OF HEALTH, PARTICULARLY ACCESS TO HEALTHY FOOD AND STABLE HOUSING, AS KEY FACTORS CONTRIBUTING TO HEALTH. ALL ALLINA HEALTH ASSESSMENTS AND ACTION PLANS WERE APPROVED BY LOCAL FACILITIES AND THE ALLINA HEALTH BOARD OF DIRECTORS BY DECEMBER 2019. COPIES OF EACH FACILITY'S NEEDS ASSESSMENT REPORT AND ACTION PLAN, INCLUDING THE REPORT AND ACTION PLAN FOR ST. FRANCIS, CAN BE FOUND AT: HTTPS://WWW.ALLINAHEALTH.ORG/ABOUT-US/COMMUNITY-INVOLVEMENT/NEED-ASSESSMENTS/2020-2022-NEEDS-ASSESSMENTS-AND-IMPLEMENTATIONS-PLANS. ONCE IMPLEMENTATION PLANS ARE CREATED, MORE DETAILED PLANNING CONTINUES WITH STAKEHOLDER TO DEVELOP AND DELIVER SPECIFIC PROGRAMS, SERVICES AND ACTIVITIES EITHER LOCALLY OR SYSTEM-WIDE.

PART VI, LINE 4:
ALLINA HEALTH SYSTEM (ALLINA HEALTH) IS A NOT-FOR-PROFIT SYSTEM OF CLINICS, HOSPITALS AND OTHER HEALTH CARE SERVICES. ALLINA HEALTH OWNS AND OPERATES 11 HOSPITALS, MORE THAN 90 CLINICS AND HEALTH CARE SERVICES, INCLUDING HOME CARE, HOSPICE CARE, PALLIATIVE CARE, OXYGEN AND MEDICAL EQUIPMENT, PHARMACIES AND EMERGENCY MEDICAL TRANSPORTATION IN OPERATION WITHIN MINNESOTA AND WESTERN WISCONSIN. NEARLY ALL ALLINA HOSPITAL PATIENTS COME FROM MINNESOTA AND WISCONSIN, THE MAJORITY OF WHICH COME FROM THE COUNTIES SURROUNDING ITS HOSPITALS AND CLINICS, INCLUDING THE SEVEN-COUNTY TWIN CITIES METRO AND SUBURBAN AND RURAL COMMUNITIES IN WESTERN WISCONSIN, SOUTHERN MINNESOTA AND CENTRAL MINNESOTA. COMMUNITIES SERVED BY ALLINA HEALTH ARE ASSIGNED INTO ONE OF NINE REGIONS AND EACH REGION INCLUDES AT LEAST ONE HOSPITAL WITHIN OUR SYSTEM. COMMUNITY ENGAGEMENT LEADS ARE ASSIGNED TO EACH REGION TO ENGAGE COMMUNITY IN COMMUNITY BENEFIT ACTIVITIES. ST. FRANCIS REPRESENTS THE SOUTH METRO.WEST METRO THE WEST METRO REGION INCLUDES ABBOTT NORTHWESTERN HOSPITAL AND PHILLIPS EYE INSTITUTE AND SERVES MOST COMMUNITIES WITHIN HENNEPIN COUNTY, THE LARGEST COUNTY IN MINNESOTA. THE CITY OF MINNEAPOLIS IS ITS LARGEST CITY AND THE COUNTY SEAT. THE WEST METRO REGION SERVES BOTH URBAN AND SUBURBAN COMMUNITIES AND INCLUDES A RANGE OF SOCIOECONOMIC STATUSES AS WELL AS A BROAD REPRESENTATION OF RACES AND ETHNICITIES. EAST METRO THE EAST METRO REGION INCLUDES UNITED HOSPITAL AND SERVES RAMSEY, WASHINGTON AND DAKOTA COUNTIES. THIS REGION SPANS THE EASTERN EDGE OF THE TWIN CITIES METRO, INCLUDING THE CITY OF ST. PAUL AND ITS SURROUNDING COMMUNITIES. ST. PAUL IS THE CAPITAL AND SECOND-MOST POPULOUS CITY IN THE STATE. THE EAST METRO REGION IS HIGHLY DIVERSE; GEOGRAPHICALLY, SOCIOECONOMICALLY AND RACIALLY. NORTHWEST METRO THE NORTHWEST METRO REGION INCLUDES MERCY HOSPITAL AND ITS UNITY CAMPUS AND PRIMARILY SERVES COMMUNITIES WITHIN ANOKA COUNTY, BUT ALSO INCLUDES AREAS WITHIN RAMSEY, SHERBURNE AND HENNEPIN COUNTIES. ANOKA COUNTY IS THE FOURTH-MOST POPULOUS COUNTY IN THE STATE OF MINNESOTA AND INCLUDES THE NORTHWEST METROPOLITAN AREA THAT IS PREDOMINANTLY SUBURBAN IN NATURE. SOUTH METRO THE SOUTH METRO REGION INCLUDES ST. FRANCIS REGIONAL MEDICAL CENTER, A PARTIALLY-OWNED HOSPITAL WITHIN THE ALLINA SYSTEM, AND PRIMARILY SERVES SCOTT AND EASTERN CARVER COUNTIES, BUT ALSO INCLUDES COMMUNITIES IN SIBLEY, LE SUEUR, DAKOTA AND HENNEPIN COUNTIES. THIS REGION INCLUDES BOTH SUBURBAN AND SMALL COMMUNITIES IN THE SOUTHWEST AREA OF THE MINNEAPOLIS-ST. PAUL METROPOLITAN AREA. NORTHWEST REGIONAL THE NORTHWEST REGIONAL AREA INCLUDES BUFFALO HOSPITAL AND IS LOCATED WEST OF THE METROPOLITAN AREA OF MINNEAPOLIS AND ST. PAUL. THIS REGION PRIMARILY SERVES WRIGHT COUNTY, BUT ALSO SERVES COMMUNITIES WITHIN STEARNS, MEEKER AND HENNEPIN COUNTIES. THIS REGION IS MADE UP OF BOTH SMALL AND RURAL COMMUNITIES. NORTH REGIONALTHE NORTH REGIONAL AREA INCLUDES CAMBRIDGE MEDICAL CENTER AND SERVES SMALL AND RURAL COMMUNITIES WITHIN ISANTI, CHISAGO, KANABEC AND PINE COUNTIES NORTH OF THE METROPOLITAN AREA OF MINNEAPOLIS AND ST. PAUL. SOUTHWEST REGIONALTHE SOUTHWEST REGIONAL AREA IS LOCATED IN SOUTH CENTRAL MINNESOTA AND INCLUDES NEW ULM MEDICAL CENTER. THE REGION SERVES COMMUNITIES AND RURAL AREAS IN AND AROUND BROWN COUNTY AND COMMUNITIES WITHIN SIBLEY AND NICOLLET COUNTIESSOUTH REGIONALLOCATED SOUTH OF THE TWIN CITIES METROPOLITAN AREA, THE SOUTH REGIONAL REGION PRIMARILY SERVES MID-SIZED SUBURBAN CITIES AND RICE, STEELE AND SOUTHERN DAKOTA COUNTIES AS WELL AS COMMUNITIES AND RURAL AREAS ACROSS DODGE, WASECA, AND GOODHUE COUNTIES. OWATONNA HOSPITAL AND DISTRICT ONE HOSPITALS SERVE THESE AREAS.EAST REGIONALTHE EAST REGIONAL REGION IS LOCATED IN EASTERN MINNESOTA AND WESTERN WISCONSIN. IT INCLUDES REGINA HOSPITAL AND RIVER FALLS AREA HOSPITALS, SERVING COMMUNITIES IN DAKOTA COUNTY IN MINNESOTA, AND PIERCE AND ST. CROIX COUNTIES IN WISCONSIN.