4A (Expenses $ 219747614 including grants of $ 112700) (Revenue $ 263164356)
Patient services: Founded in 1897, Gillette's vision is a world in which every child is able to create their own story. In collaboration with patients, families and partners, we redefine what is possible for children with brain, bone and movement conditions through clinical leadership, research and global advocacy. Gillette is dedicated to providing high quality subspecialty care to children with complex and/or disabling conditions. During 2021, the organization served 26,120 patients from all 87 Minnesota counties, 44 U.S. states and territories, and 5 international countries. Gillette operates a 60 licensed-bed specialty hospital in St. Paul, Minnesota; clinics in Alexandria, Baxter, Bemidji, Burnsville, Duluth, Mankato, Maple Grove, St. Cloud, Willmar, and St. Paul, Minnesota, and outreach and virtual telemedicine collaborations across Minnesota and the Upper Midwest.Gillette cares for patients who have some of the most complex, rare and traumatic conditions in pediatric medicine, including cerebral palsy, epilepsy, spina bifida, hydrocephalus, complex orthopedic conditions, craniofacial anomalies, genetic disorders, neurological conditions and brain and spinal cord injuries. Care at Gillette is clinically integrated, bringing experts together from multiple areas to coordinate and care for patients from initial diagnosis through the lifetime of their condition, with individualized care planning at the center of our work. This integrated care model has differentiated us from traditional health systems. For nearly 125 years, Gillette has led in the diagnosis and management of complex medical conditions through the development of innovative medical and surgical interventions, proven rehabilitative therapies and the novel application of customized services from compassionate health care professionals, Gillette's care helps ensure every child can create their own story and realize their full potential.Gillette is a regional referral center healthcare destination for people who have complex, rare and traumatic conditions that began in childhood. The diagnosis and management of these conditions requires significant clinical expertise and an integrated and proactive care planning system that support the delivery of a comprehensive treatment plan. The majority of conditions Gillette specializes in treating have courses of care that run for months, years, or an entire lifetime. Although a number of hospitals can and do provide certain pediatric specialty services, Gillette is unique in the region for specializing exclusively in the care and rehabilitation needs of individuals with medical complexity and lifelong conditions that affect the musculoskeletal and neurological systems.Gillette clinics in greater Minnesota improve access to care for families who live outside the Twin Cities metro area, and support local providers by facilitating collaboration with Gillette specialists. Gillette continues to enhance its presence around the state, aiming for a more consistent presence in key communities and providing more consistent scheduling and give families greater access to care. Gillette continues work to implement virtual care (telemedicine) services into its clinics and other care settings. Virtual care enables providers to hold consultations with patients via video conference.During 2021, Gillette treated 26,120 patients from all 87 Minnesota counties, 44 U.S. states and territories, and eight countries. A large and geographically diverse network of referring physicians has driven growth, with over 2,500 physicians referring patients to Gillette. There were 2,011 inpatient admissions, with an average length of stay of 5.4 days, and 142,360 outpatient visits during 2021. Gillette physicians performed 3,531 inpatient and outpatient surgeries in 2021. The top five conditions seen at Gillette include cerebral palsy, limb-length discrepancy, developmental dysplasia of the hip, epilepsy, and adolescent idiopathic scoliosis. Over 70% of Gillette patients see providers in more than more than one specialty. Gillette's areas of expertise, key conditions and services include the following:Cerebral Palsy: Gillette is an internationally recognized leader in the diagnosis and management of spasticity resulting from cerebral palsy and other causes. Gillette offers comprehensive, coordinated care designed to manage the symptoms of cerebral palsy. Services range from infant evaluations to diagnose the condition, to medical and surgical interventions to manage spasticity and related comorbidities as children grow into adulthood. Individualized treatment plans might include developmental assessments, rehabilitation therapies, orthoses, specialized seating, mobility and communicative supports, spasticity management techniques (including surgery), gait and motion analysis, and orthopedic care. Individuals with cerebral palsy often have complex and wide-ranging health care needs. Gillette's unique expertise in the field provides families with healthcare professionals who are aware of the variety of comorbidities commonly associated with cerebral palsy and who are able to identify them early and employ appropriately coordinated management of these conditions. Gillette treats more than 4,000 cerebral palsy patients every year. Gillette is an innovative clinical leader in treating cerebral palsy - from developing new devices to assist in patient care, to the assessments done at the at the James R Gage Center for Gait and Motion Analysis, Gillette is sought out for its care around the world.

4B (Expenses $ 4420280 including grants of $ 0) (Revenue $ 959693)
Research: Gillette research activities concentrate on clinical applications devoted to finding effective medical interventions for disabling conditions and their related effects. Research at Gillette consists of seven major emphasis areas (gait and motion, health outcomes, neurosciences, nursing, orthopedics, rehabilitation, and spine), all of which seek to improve the lives of children who have disabilities and complex conditions. During 2021, 140 active studies were underway and over 86 studies were published in peer-reviewed journals. Additionally, 54 research projected were supported by extramural funding. In collaboration with clinical patient care, Gillette's research activities advance our mission to help children create their own stories.

4C (Expenses $ 1568427 including grants of $ 0) (Revenue $ 261935)
Education: Gillette provides graduate medical education in collaboration with the University of Minnesota and provides seminars and other educational programs with the goal to share expertise that benefits all children who have complex conditions. Gillette offers residencies and fellowships in orthopedics, and pediatric rehabilitation medicine. Through fellowships, seminars and other educational programs, Gillette strives to share expertise that benefits all children who have complex conditions.Gillette facilities are made available for training of health care students through arrangements with area educational institutions. Gillette offers residencies and fellowships in such specialties as pediatrics, orthopedics, and pediatric rehabilitation medicine. A teaching hospital, Gillette trains residents from the University of Minnesota and Henry Ford Health in Detroit, who spend one to three months under the mentorship of Gillette's medical staff. In many cases, Gillette offers physicians their only exposure during residency to patients with certain disabilities. Gillette also offers shadowing and mentorship programs for students, along with professional education opportunities in such areas as physical therapy, radiology, nursing, respiratory care and assistive technology. Some of the students who make use of these training programs ultimately join the staff of Gillette.Gillette also provides extensive Continuing Medical Education services to physicians and other health care providers in our area of expertise. Participants travel from around the region and globe to learn from Gillette experts each year. These programs also support the ongoing development of referral and partnership arrangements and relationships that direct patients to Gillette for their care. Gillette covers the unreimbursed costs of medical education and is fully accredited by the Minnesota Medical Association to provide continuing medical education (CME). Gillette sponsors conferences on topics such as cerebral palsy, orthopedics, Duchenne muscular dystrophy, Rett syndrome, and motion analysis. In 2021, Gillette provided over 100 hours of clinical medical education to more than 400 physicians and 1,500 other health care providers. Typical audiences include pediatricians, family practitioners, nurse practitioners, physician assistants, nurses, physical therapists, occupational therapists, and orthotists.

Gillette Children's Specialty Healthcare
Part V, Section B, Line 5: In 2016, Gillette focused its CHNA efforts on the needs of children and families in Minnesota because most families they serve fall into this geography. In 2019, Gillette expanded the scope of their CHNA by focusing on gathering feedback from parents and community stakeholders in and outside of Minnesota and building upon Gillette's understanding of the needs identified in 2016 by asking additional, broader questions to identify emerging needs, additional nuances surrounding existing needs and thoughts about addressing needs.A multi-method evaluation approach was developed to gather feedback from a variety of individuals who are familiar with the needs of children and adults with complex medical conditions, including caregivers, community partners, patients, and Gillette staff. The data collection strategies used throughout the assessment included: - Literature Review- Telephone interviews with parents of children or adult patients who receive services at Gillette- Key informant interviews with community partners- Key informant interviews with Gillette staffThe full CHNA report is available on the following website: https://www.gillettechildrens.org/assets/uploads/general/Legal_Documents/CHNA_2019.pdf

Gillette Children's Specialty Healthcare
Part V, Section B, Line 11: Five priority health topics were identified in the 2019 CHNA: (1) care management; (2) patient education; (3) community resources; (4) patient access; and (5) patient access and financial advocacy.The following implementation strategies (among others) are currently being implemented by Gillette to address these topics:- Proactively share patients' pertinent care plans with primary care providers/healthcare home and homecare agencies.- Create and implement a one-call access line for patients/families enrolled in Care Management programs.- For care managers of patients enrolled in Care Management: Meet with patients and families to create goals, proactively address transition planning from adolescence to adulthood with the patient and family, work to identify potential parental support, screen patients for social determinants of health and refer them to the appropriate resources.- Increase patient and family education offerings and access on website and the patient portal.- Enhance patient education modalities at inpatient and outpatient visit discharge. - Leverage mobile applications for pre-op and post-op education.- Roll out social determinants of health screening program. - Post a list of community resources for patients and families on website and patient portal.- Implement a patient engagement platform to facilitate improved communication between patient access staff and families, allowing for multiple methods for outreach and response. - Implement self-scheduling functionality for targeted appointments to allow easier direct scheduling and to create capacity. - Implement waitlist functionality to allow families to take advantage of late cancellations. - Revise workflow to track outpatient order volume and the percentage of orders that convert to active appointments.- Create a financial advocate position.- Set up financial advocates as a dedicated resource for patients, families, physicians and staff to assist in answering financial coverage questions and concerns both pre- and post-service. - Increase awareness and participation in the Gillette Assistance Program.- Continued expansion of virtual care services to patients.

Part V, Line 7a, Hospital Facility's Website:
The full CHNA report and implementation strategy are available on the following website: https://www.gillettechildrens.org/assets/uploads/general/Legal_Documents/CHNA_2019.pdf

Part V, Line 10a, Link for Implementation Strategy:
The full CHNA report and implementation strategy are available on the following website: https://www.gillettechildrens.org/assets/uploads/general/Legal_Documents/CHNA_2019.pdf

Part V, Line 16a, FAP Website:
https://www.gillettechildrens.org/your-visit/patient-services-and-resources/understand-costs-insurance-and-the-gillette-assistance-program/get-help-paying-your-gillette-bills

Part V, Line 16b, FAP Application Website:
https://www.gillettechildrens.org/your-visit/patient-services-and-resources/understand-costs-insurance-and-the-gillette-assistance-program/get-help-paying-your-gillette-bills

Part V, Line 16c, FAP Plain Language Summary Website:
https://www.gillettechildrens.org/your-visit/patient-services-and-resources/understand-costs-insurance-and-the-gillette-assistance-program/get-help-paying-your-gillette-bills

Part I, Line 3c:
The Gillette Assistance Program provides discounts to eligible patients up to 100% of total charges and amounts owed. Federal poverty guidelines are used to determine eligibility and discount amounts. Patient applications are reviewed on a case-by-case basis, and policy exceptions may be granted under other specific circumstances where patients and families have difficulty meeting their financial obligations.

Part I, Line 7:
Finance assistance at cost is calculated using a cost-to-charge ratio. Other community benefits are calculated using internal cost accounting methodologies, less direct offsetting revenues. The cost accounting methodologies record revenues and direct expenses for all inpatient and outpatient services for each revenue-producing cost center. All non-revenue-producing cost centers are allocated back to revenue-producing cost centers using applicable statistics to arrive at fully allocated cost for each cost center.

Part I, Ln 7 Col(f):
Bad debt is not included in Form 990, Part IX as an expense. Implicit price discounts (formerly known as the provision for bad debts) are presented as a reduction of patient service revenue on Form 990, Part VIII in accordance with generally accepted accounting principles.

Part III, Line 2:
The provision for bad debts is determined using actual experience and management estimates, including historical and expected collections, trends in the healthcare industry, and other factors. Bad debt associated with patient eligible for financial assistance is calculated after discounts have been applied, using the same methodology. In accordance with generally accepted account principles, bad debt is reported net against patient service revenue.

Part III, Line 3:
Bad debt attributable to patients that may qualify for financial assistance, but were unable or unwilling to provide necessary eligibility information, is estimated based review of accounts classified as bad debt, industry trends, and management judgement.

Part III, Line 4:
Gillette's consolidated audited financial statements include footnote disclosures in the Net Patient Service Revenue and Patient Accounts Receivable sections on pages 10 through 13.

Part III, Line 8:
Gillette's mission is to redefine possibilities for children with brain, bone and movement conditions, including provision of services to children and adults with disabilities. In providing these mission-driven services, Gillette incurs losses from the Medicare program. Gillette accepts such losses as part of providing an important public service. Gillette's internal cost-accounting system was used to calculate the Medicare allowable costs. The entire shortfall amount is considered community benefit, but only a portion is included on Schedule H, Part I, Line 7.

Part III, Line 9b:
Gillette is committed to providing medically necessary care to all patients, regardless of their ability to pay. Eligibility for financial assistance and charity care is evaluated on a case-by-case basis in accordance with the Gillette Assistance Plan (GAP) financial assistance policy. For patients who have difficulty meeting their financial obligations, Gillette attempts to qualify patients for public assistance programs or GAP, as appropriate. Requirements for GAP eligibility are detailed in the policy, including completion of an application and verification of income. Gillette attempts to identify patients qualifying for GAP prior to services being performed, though applications are accepted and reviewed at any time during the billing process. The GAP policy and plain language summaries are available to all patients and families at registration at all locations, including self-pay and uninsured patients. Financial counselors and social workers are also available to assist with financial questions related to patient visits. Gillette billing statements contain language referencing the available forms of financial assistance. In situations where debt collection efforts are necessary, leadership approval is required and related correspondence is done in accordance with required extraordinary collection effort language and other legal requirements. All billing and collection is done in accordance with the criteria established for all Minnesota hospitals by the Minnesota attorney general's office.Part V, Section D:Gillette operated four pediatric clinics in the Twin Cities metro area (two in St. Paul, Maple Grove and Burnsville); one adult clinic in St. Paul; seven clinics in greater Minnesota (Alexandria, Baxter, Bemidji, Duluth, Mankato, St Cloud and Willmar); and various collaborations across Minnesota and the Upper Midwest. All clinics are licensed under Gillette Children's Specialty Healthcare.

Part VI, Line 3:
Gillette provides free or reduced-cost medical care to community residents, primarily by:- Providing services at no charge to uninsured patients.- Providing uninsured patients who do not qualify for charity care approximately the same discount as our third party payers.- Covering the difference between public-program payments (primarily Medicare and Medicaid) and the related costs of providing such services.- Providing services to patients who express a willingness to pay but who are unable to do so because of socioeconomic factors.- Coordinating care with a patient's primary-care physician, school, and community agencies.During 2021, a majority of Gillette inpatient stays were patients eligible for or covered under Medical Assistance (Minnesota's Medicaid program). Gillette has a documented policy for providing financial assistance in the form of charity care to patients who are financially without the means to pay for medically necessary care and who satisfy certain requirements. Each patient's situation is evaluated according to relevant circumstances, such as income, assets and other resources. Gillette staff will identify a family's charity-care needs before services are performed, whenever possible, as part of the admission process. Families complete a financial assistance application that Gillette provides. Proof of participation in Medicaid or any other public assistance program indicates that the patient has been deemed financially indigent and, therefore, the patient is not required to provide his/her income on Gillette's assistance application. In addition to doing so during the admission process, Gillette makes patients aware of financial assistance programs by listing them on patient statements and the Gillette website.

Part VI, Line 4:
Gillette provides specialized health care for people who have complex and often rare diagnoses or traumatic injuries. Gillette treated patients from all 87 Minnesota counties in 2021. Some patients come to the Twin Cities for care; others receive care through our greater Minnesota locations. Gillette staff members also see patients who come to Gillette for care from throughout the U.S. and other countries. During 2021, Gillette served patients from 44 states and territories and 5 international countries.

Part VI, Line 7, Reports Filed With States
MN

Part VI, Line 2:
In 2016, Gillette focused their CHNA efforts on the needs of children and families in Minnesota because most families they serve fall into this geography. In 2019, Gillette Children's Specialty Healthcare contracted with Wilder Research to complete conduct their community health needs assessment (CHNA). Gillette decided to expand the scope of their CHNA by focusing on gathering feedback from parents and community stakeholders in and outside of Minnesota and building upon Gillette's understanding of the needs identified in 2016 by asking additional, broader questions to identify emerging needs, additional nuances surrounding existing needs and thoughts about addressing needs. The following questions guided the assessment process: What are the characteristics of children Gillette currently serves? What are the biggest needs of families with medically complex children? What challenges do families experience in accessing services at Gillette? What services and supports outside of Gillette are missing or inaccessible to families? What support can Gillette provide to help families coordinate care and treatment? What support can Gillette provide in providing or referring families to community services?Gillette conducts surveys on health services using various tools to gather information, such as online surveys, focus groups with families, phone calls, and one-on-one interviews. In addition, Gillette conducts specific assessments when considering new programs or services. Such new programs and services usually arise from suggestions by patients and families, referring physicians, or Gillette's own staff. More generally, Gillette staff members assess community health care needs by the number of patients they see. During 2021, 26,120 children and adults came to Gillette due to the specialized skills and advanced technology the Gillette provides for patient needs. Gillette treated patients from all 87 Minnesota counties, 44 U.S. states and territories, and 5 international countries during 2021.Gillette cares for patients who have some of the most complex, rare and traumatic conditions in pediatric medicine, including cerebral palsy, epilepsy, spina bifida, hydrocephalus, complex orthopedic conditions, craniofacial anomalies, genetic disorders, neurological conditions and brain and spinal cord injuries. Care at Gillette is clinically integrated, bringing experts together from multiple areas to coordinate and care for patients from initial diagnosis through the lifetime of their condition, with individualized care planning at the center of our work. This emphasis on the longitudinal aspects of care have differentiated us from traditional health systems. For more than 120 years Gillette has led in the diagnosis and management of complex medical conditions through the development of innovative medical and surgical interventions, proven rehabilitative therapies and the novel application of customized services from compassionate health care professionals, Gillette helps children thrive and live happy, healthy, and productive lives.Over time, the organization anticipates a proportionate increase in children with needs for specialized health care requiring Gillette's unique services. In addition, there are shortages of pediatric specialists in many areas of the five-state Midwest region, which will continue to bring patients to Gillette. By establishing suburban and greater Minnesota clinics, and developing collaborative relationships with other health systems, Gillette has made a concerted effort to meet the needs of patients outside the Twin Cities metro region. Gillette's continuing focus on meeting the needs of underserved and rural populations who require specialized pediatric services will also contribute to steady organizational growth.Gillette is also teaching hospital committed to training the physicians of the future. Because Gillette focuses primarily on specialty care for children who have disabilities and complex medical conditions, it is a regional resource of specialists, technology, facilities and comprehensive services. In 2021, residents and fellows from the University of Minnesota and Henry Ford Health in Detroit spent one to three months under the mentorship of Gillette's medical staff. In many cases, Gillette offers trainees their only exposure during residency to patients who have complex conditions like cerebral palsy or spina bifida, and rare disorders like osteogenesis imperfect or Rett syndrome. Gillette's physician training programs include the specialties of orthopedics, pediatrics, neurodevelopmental pediatrics, and rehabilitation medicine. Gillette has a surgery simulation center that allows teams to practice performing complex procedures and using new technologies. New staff members, medical residents and multidisciplinary teams learn and practice in a true-to-life environment. The result is hands-on education for staff and enhanced safety for patients.Gillette also provides extensive continuing medical education services to physicians and other health care providers in our area of expertise. Participants travel from around the region and globe to learn from Gillette experts each year. These programs also support the ongoing development of referral and partnership arrangements and relationships that direct patients to Gillette for their care. Gillette is fully accredited by the Minnesota Medical Association to provide continuing medical education. Gillette covers the unreimbursed costs of medical education.

Part VI, Line 5:
"Gillette provides a wide variety of benefits to the community. In addition to the care Gillette provides its patients, Gillette provides community benefit by serving as an advocate for children who have complex medical conditions inducing efforts related to increasing access, resources and awareness for those the organization serves. Gillette leadership also participates in Minnesota's Rare Disease Advisory Council to help increase research and education related to rare conditions. Gillette serves as a gathering place for interested citizens (including the board of directors, other volunteers, skilled professionals, patients and families) to address the challenges and needs of children who have conditions affecting the musculoskeletal or neurological systems, to define the needs of the families of those children, and to advocate for support of those families in meeting their needs. Gillette has sponsored support sessions for caregivers of children who have disabilities. Gillette is part of the United Cerebral Palsy (UCP) organization; UCP is devoted to educating, advocating for and providing support services to people who have a spectrum of disabilities. In addition, Gillette is a designated Muscular Dystrophy Association (MDA) Care Center to help people receive the services they need throughout all stages of the condition. MDA is the world's leading nonprofit health agency dedicated to finding treatments and cures for muscular dystrophy and other neuromuscular diseases. Gillette also teams with Family Voices of Minnesota to support Parent to Parent, a network connecting experienced families with families of children who have disabilities, cognitive issues and other health needs and who need emotional support.Patients rely on the organization to address the physical, mental and emotional effects of their disabilities from birth through adulthood. Gillette's Child and Family Services (""CFS"") is a team of social workers, psychologists and neuropsychologists, child life specialists, therapeutic recreation specialists and a chaplain. CFS team members work closely with children and families to help them understand their medical care and minimize stress through play, relaxation, and special events and activities. Child life professionals are trained in child development and are part of the multi-disciplinary care team. They partner with the whole family, including siblings, to foster a positive and supportive care experience. Gillette provides educational materials, programs and videos about specific conditions, information services available by telephone (which is free to families and for which Gillette is not reimbursed by insurance programs), and programs to improve the general standards of health in the community. Gillette uses its website and social media channels to share information from its medical experts with the community; topics include working through childhood diagnoses, talking with a child's peers about his or her condition, brain injury prevention, nutrition for children, seasonal safety, and strategies for helping children overcome bullying. Gillette also uses its website and social channels to advocate on behalf of children who have complex conditions.Gillette offers in-hospital schooling to patients who will be hospitalized two weeks or longer during the traditional school year. A partnership between Gillette and St. Paul Public Schools means that children and teens who are recovering from a major surgery or traumatic injury can continue their academic lessons at Gillette. Gillette's classroom is outfitted with the latest technology-including webcams, laptops, a touch-screen computer, and a state-of-the-art SmartBoard. Our teacher works one-on-one with students on lesson plans designed for their unique needs and in collaboration with the student's home district.Gillette funds a program called the Adapted Sports Equipment Fund to help children with disabilities obtain the equipment needed to participate in adapted sports and recreational activities in their communities. Gillette also hosts an annual Adaptive Bike & Sports Expo to help children who have disabilities find customized bicycles and other equipment that meets their unique needs and helps promote independence.In addition, Gillette performs clinical and translational research devoted to finding effective medical interventions for complex conditions and their related effects and to improving outcomes in patients who have disabilities. Gillette researchers were engaged in 140 active studies during 2021. Gillette published over 86 peer-reviewed publications in 2021, conducted 54 research project supported by extramural funding, and clinical and nonclinical research staff members routinely present at medical conferences. Research at Gillette consists of fourteen emphasis areas, all of which seek to improve the lives of children who have disabilities and complex conditions. Gillette operates an aggressive knowledge translation initiative that aims to advance patient outcomes and experience by better incorporating current medical research into ongoing clinical practice.Through community support and generous contributions to Gillette Children's Foundation, Gillette continues to expand, create new services, and research treatments for children with disabilities. The organization's goal remains, as it has for more than 120 years, that of helping children and adults who have disabilities, and their families, to improve their health, achieve greater well-being and enjoy life. In March 2020, the World Health Organization declared the outbreak of a novel strain of coronavirus and related disease (Covid-19) a global pandemic. The resulting social and economic impact on the Gillette and the entire healthcare industry has been significant through 2021. Gillette patients have highly complex medical conditions, which are higher risk of developing complications from Covid-19. Gillette has expanded virtual care services, particularly within provider clinics and rehabilitation services, to ensure our patients continue to receive quality, necessary healthcare during the pandemic. Virtual care appointments are made available via both secure video or telephone services. Gillette also collaborates with other local health systems and governments to ensure sufficient health care resources, including beds, staffing, and personal protective equipment, were available to respond to the pandemic. Facilities were enhanced to ensure that appropriate physical distancing, visitor restrictions, health and wellness screening, universal masking, and rigorous sanitizing and disinfection protocols are in place to ensure the continued safety of patients, families, employees and visitors."