2022-11-07T15:03:03-06:00 2021-12-31 346565596 Ernst & Young US LLP 155 N Wacker Drive Chicago IL 60606 990 2021-01-01 363517697 Fairview Bethesda Hospital fka HealthEast Care System FAIR 6126724986 2450 Riverside Avenue MINNEAPOLIS MN 55454 James Hereford President/CEO 2022-11-07 false James Hereford 999009999 Jessica Wagener P01622613 3128792000 2021 2022-09-23 18:48:47Z X James Hereford 2450 Riverside Avenue MINNEAPOLIS MN 55454 49092426 false X www.fairview.org X 1983 MN Fairview is driven to heal, discover, and educate for longer, healthier lives. 18 17 0 0 1481014 1480014 4887934 229872 60062767 47987090 4377040 51324 767170 69327741 49035456 0 0 44604941 28829287 0 0 20382675 18841530 64987616 47670817 4340125 1364639 56564733 49125402 201473670 194049467 -144908937 -144924065 X Fairview is driven to heal, discover, and educate for longer, healthier lives. false true 18451697 14495909 HealthEast Care System is part of the Fairview Health Services system and has provided post-acute care to patients at HealthEast Bethesda Hospital following a catastrophic illness or injury for more than a century. These patients have clinical needs justifying a hospital stay beyond 20 days, require a daily physician visit, and need interdisiplinary support and multiple therapy disciplines. In December 2020, a new mission transformed the Bethesda Hospital site to a community's need for providing shelter to homeless people in partnership with Ramsey County. The long-term acute care facility, or LTACH, remains a needed service within our community. The LTACH, although in a new physical location, continues its specialty inpatient care with 15 licensed beds. In 2022 there is a name change for this entity to Fairview Bethesda Hospital. The organization's revenues include payments from the Medicare and Medicaid programs. All services relate directly to the exempt purpose of caring for sick, infirm, aged, and injured persons regardless of their race, color, creed, religion, national origin, sex, marital status, status with regard to public assistance, membership, or activity in a local commission, disability, sexual orientation, gender identity or expression, age or genetic information. HealthEast seeks to be a welcoming and inclusive provider of care providing optimal health and well-being for our patients, our communities and ourselves. Fairview Health Services 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. 18365323 33491181 HealthEast Care System offered emergency medical services through HealthEast Medical Transportation (HEMT). These services will be transitioned to Fairview Heath Services in the future. For the services reflected in this return, HealthEast Medical Transportation continues to be a Twin Cities leader in emergency and scheduled transportation services. Services provided to meet the needs of the community are: * Ground Ambulance Services (Advanced and Basic Life Support and Critical Care) * Emergency Communications Services * Fleet Maintenance Services * Emergency Vehicle Conversion Services * Training and Education through EMS Academy * Special Event Medical Standbys * Programs including Community Paramedicine, Community CPR and Care Seat Checks. * Wheelchair Transportation Services (MedKab) * HealthEast Care System Inter-facility Courier Services * Tactical Emergency Medical Services (TEMS) for High-Risk Situations HealthEast Medical Transportation has been serving the Twin Cities for more than 100 years under different company names. Our service began in 1910 as Olsen Ambulance. In 1986, we became HealthEast Medical Transportation when HealthEast Care System was formed. Today we provide wheelchair transport, and basic, advanced and critical care life support transportation throughout the Twin Cities. We are also proud to provide 9-1-1 advanced life support for northern Dakota County. Revenues include payments from the Medicare and Medicaid programs. All of these services relate directly to the exempt purpose of caring for sick, infirm, aged and injured persons regardless of their race, color, creed, religion, national origin, sex, marital status, status with regard to public assistance, membership or activity in a local commission, disability, sexual orientation, gender identity or expression, age or genetic information. HealthEast seeks to be a welcoming and inclusive provider of care providing optimal health and well-being for our patients, our communities and ourselves. This organization provides emergency and medically necessary non-emergency services regardless of ability to pay. 36817020 true false false false false false false false false true false true true true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true false false false true X 0 0 0 true true false false false false false false false false false false false X 18 17 false false true false true true true true true false false true true true true true true true true false MN X Dawn Ksepka 6126724986 1700 University Ave W St Paul MN 55104 Ann Lowry MD Vice Chair 0.0 2.0 X X 0 25000 0 Jakub Tolar MD Vice Chair 0.0 2.0 X X 0 0 0 James Hereford President/CEO 2.0 40.0 X X 0 2262435 512663 Karen Grabow Secretary 0.0 2.0 X X 0 25000 0 Rich Ostlund Chair 0.0 2.0 X X 0 35000 0 Barclay Berdan Director 0.0 2.0 X 0 20000 0 Brad Wallin Director 0.0 3.0 X 0 20000 0 Brian Burnett Director, end 1-2021 0.0 2.0 X 0 0 0 David Levy Director, new 2021 2.0 X 0 15000 0 Jodi Richard Director 0.0 2.0 X 0 25000 0 John Heinmiller Director 0.0 2.0 X 0 25000 0 Julie Causey Director 0.0 2.0 X 0 20000 0 Kenneth Roering Director 0.0 2.0 X 0 20000 0 Melissa Geller MD Director 0.0 2.0 X 0 0 0 Michael Connly Director 0.0 3.0 X 0 25000 0 Myron Frans Director, began 2-2021 2.0 X 0 0 0 Shawntera Hardy Director 2.0 X 0 20000 0 Stephen Swensen Director, began 2-2021 3.0 X 0 15000 0 Timothy Marx Director 0.0 2.0 X 0 25000 0 Andrea Mokros EVP & Chf Public Aff 2.0 40.0 X 0 477461 89462 David Crosby Chief Value Based Solutions 2.0 40.0 X 0 885868 74781 John Batson CFO 2.0 40.0 X 0 1047259 149411 Laura Reed RN COO 2.0 40.0 X 0 1085509 157567 Mark Welton MD Chief Medical Office 2.0 40.0 X 0 889454 140103 Mary Nease Chief People Officer 2.0 40.0 X 0 701028 115764 Robert Beacher Chief of Shared Clin 2.0 40.0 X 0 827814 141184 Sameer Badlani CIO 2.0 40.0 X 0 783708 120111 Scott Weber Chf Mrktg Comm & Dig 2.0 40.0 X 0 491713 88867 Srijoy Mahapatra Chf Strategy Officer 2.0 40.0 X 0 797074 13939 Trudi Trysla Chief Legal Counsel 2.0 40.0 X 0 799805 152560 Abijah Muthyala MD Physician 40.0 0 X 0 440689 40891 John Scanlon MD Physician 40.0 0 X 0 317880 45551 Nathan Frink MD Physician 40.0 0 X 0 402720 24256 Nikila Vuljaj MD HEMT Medical Director 40.0 0 X 0 505615 41080 Seema Maddali MD Physician 40.0 0 X 0 279146 8374 John Doherty Former Officer 0.0 0.0 X 0 242131 0 0 13552310 1916564 0 true true false 0 229872 229872 Patient Revenue 621110 44922101 44922101 Senior Care Revenue 623000 1513628 1513628 Other Operating Revenue 900099 63978 63978 Parking Revenue 812930 6369 6369 Joint Venture Revenue 621400 1481014 1481014 0 0 0 0 47987090 7313 7313 767170 767170 0 767170 767170 100981 56970 0 44011 44011 44011 0 0 0 0 0 49035456 46506076 1481014 818494 21930403 20914462 1015941 1868267 1827387 40880 3615743 3419447 196296 1414874 1355217 59657 46235 41701 4534 1188731 1079306 109425 0 47 47 539760 342401 197359 3334359 2164226 1170133 31057 25284 5773 310607 310607 1412200 1391607 20593 114983 103440 11543 Management Fees 7825738 292759 7532979 Medical Supplies 1441904 1354264 87640 Utilities & Repair 866654 541993 324661 Taxes 951166 946517 4649 778089 706402 71687 0 47670817 36817020 10853797 0 12090925 6491371 0 0 0 0 256080 190117 1469169 97178 9987234 3461206 6767321 6526028 0 22427936 22482111 13553302 13338597 56564733 49125402 1660311 3319271 0 0 195729148 186809540 4084211 3920656 201473670 194049467 -144908937 -144924062 -144908937 -144924062 56564733 49125405 X 1364639 -1379764 X false true X true true true X 2000000 2000000 774596 67074 707522 83957 29600 54357 7111947 3364532 3747415 16734 16734 6526028 Program Related Investments 22482111 C 22482111 Intangible Assets - Goodwill 10003919 Other Long Term Assets 3334678 13338597 Naming Rights 940667 Accretion Expense 1065595 Accrued Pension 858085 Retirement Obligation 827114 Accrued Health Insurance Liability 130887 Other Liabilities 94030 Operating Leases 4278 Lease Clear 3920656 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote HealhtEast Care System is part of Fairview Health Services. Fairview recognizes all tax positions, including those positions in a previously filed tax return or a position expected to be taken in a future tax filing that is reflected in measuring current or deferred income tax assets and liabilities, when it is more likely than not (likelihood of greater than 50%) that, based on technical merits, the position will be sustained upon examination. There are $14,540 and $0 uncertain tax positions recorded on the consolidated balance sheets as of December 31, 2021 and 2020, respectively. Fairview has made reasonable estimates of the provision for income taxes and on existing deferred tax balances based on accounting guidance included in ASC 740, Income Taxes. Fairview does not expect that there will be a significant change in the total amount of unrecognized tax benefits within the next 12 months. true true X true X true X true true true false true true 575434 77079 498355 0.0105 5020730 2277141 2743589 0.0576 0 0.0 0 0 5596164 2354220 3241944 0.0680 138202 138202 0.0029 0 0.0 5224166 4457133 767033 0.0161 0 0.0 0 0.0 0 0 5362368 4457133 905235 0.0190 0 0 10958532 6811353 4147179 0.0870 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 true 466510 9330 4837160 9534505 -4697345 X true true 1 1 HealthEast Bethesda Hospital 45 10th Street West Unit 4100 St Paul MN 55102 mhealthfairview.org/locations/m-health-fairview-bethesda-hospital 406123 X HealthEast Bethesda Hospital 1 false false true X X X X X X X X X 21 true false false true X See Section C, Line 7d X X true 22 true See Section C, Line 7d false true X 200.0 300.0 X X X X X X true true X X X X true X https://www.fairview.org/billing/financial-assistance X http://www.fvfiles.com/2266.pdf X https://www.fairview.org/billing/financial-assistance X X X X X X X true X false X X X X false X X false false 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 - Bethesda 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. A series of conversations were had over an 18-month period from May 2020 to October 2021 with leaders from across sectors that represent or work with community members. During these meetings the results from the St. Paul survey were shared and the proposed priority needs. A discussion was had to vet the results of the St. Paul survey and the priority needs. Discussions covered if the priorities rang true, if any emerging needs were missing, and what within each priority need might be important to emphasize in this community. 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. 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 - HealthEast Bethesda Hospital. The Community Health Needs Assessment Report for Bethesda Hospital are located at: https://stcr-prd-cd.fairview.org/-/media/Files/Local-Health-Needs/Read-full-reports/2021-CHNA-Report-Bethesda-Hospital2125.pdf?_ga=2.XXX-XX-XXXX.1916792193.1654267916-XXX-XX-XXXX.1594916074 The Community Health Needs Assessment Implementation Strategy Report for Bethesda Hospital are located at: https://stcr-prd-cd.fairview.org/-/media/Files/Local-Health-Needs/CHNA-Implementation-Strategy-Report-20222024-Bethesda.pdf?_ga=2.XXX-XX-XXXX.1916792193.1654267916-XXX-XX-XXXX.1594916074 Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - HealthEast Bethesda Hospital. Over the course of 2021, Fairview's hospitals and medical centers, including M Health Bethesda 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 achieving health 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 M Health Bethesda 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: M Health Fairview Bethesda Hospital offered Cultural Brokers. East Side partners designed the position of Cultural Broker serving St. Paul's East Side of Saint Paul Community to build stress resilience and holistic wellbeing among community members. The Cultural Broker co-navigates mainstream systems with clients and helps bridge those systems within culture, as well as locates resources and advocates for residents' interests. This support results in improved access to culturally relevant mental health care and other resources that build stress resilience over the long term. The 2021 anticipated impact for the Cultural Brokers was an increase in participants' connectedness to others in the community. The anticipated impact was assigned a value of "green". 2021 Impact: Green - Outcome: 20% increase from pre- assessment (50%) to post-assessment (70%) in response to the following: I strongly agree or agree that I feel connected to others in the community. M Health Fairview Bethesda 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: 30% increase from pre-survey (70%) to post-survey (100%) in response to the following: I strongly agree or agree that I can recognize and correct misconceptions about mental health, substance use and mental illness as I encounter them. Evaluation of survey results was done on a program level. M Health Fairview Bethesda Hospital offered the Mobile Substance Use Disorder Support Program, serving adult residents (18+) in Ramsey, Dakota and Washington Counties who have substance use issues through Mobile SUDs team who are professional peer recovery specialists and clinical staff who collaborate to develop individual recovery plans. 2021 Outcome: This program was discontinued in 2021. A similar program will be developed within the Mental Health & Addiction Transition Clinic for short-term treatment of patients after an emergency room visit. M Health Fairview Bethesda Hospital offered the evidence-based Stress Reduction Suite which included two programs (1) Flourish a restorative four-week series, that lets participants experience a variety of mind-body practices designed to promote a sense of calm, joy, connection, and inner strength. A few of the practices explored are moving meditation, journaling, guided imagery, and mindfulness. (2) Resiliency and Stress Management Training Series a restorative six-week series, based on Center Mind Body Medicine, 90-minute sessions. Participants experience a variety of mind-body practices designed to promote a sense of calm, joy, connection, and inner strength. A few of the practices explored by participants include moving meditation, journaling, guided imagery, and mindfulness. This mind body Series is a proven method to reduce stress, increase self-esteem, and improve a person's overall quality of life. The 2021 anticipated impact for the Stress Reduction Suite was a decrease in participants' perceived stress. The anticipated impact was assigned a value of "green". 2021 Impact: Green - Outcome: 0.20 points decrease from pre-program-survey to post-program-survey in response to the following metric: participants' perceived stress. Average change Schedule H, Part V, Section B, Line 11 Facility , 2 Facility , 2 - HealthEast Bethesda Hospital. (decrease) in participants' perceived stress on a 10 point scale - the higher the score, the more the perceived stress. Evaluation of survey results was done on a program level. M Health Fairview Bethesda Hospital offered the Trauma Informed Congregations program, the implementation of the Risking Connection in Faith Communities curriculum across Faith Communities. Risking Connection helps clergy understand the nature of trauma, its impact on people and how faith leaders can support and bring healing to trauma survivors. The 2021 anticipated impact for the Trauma Informed Congregations program was an increase in clergy/leader understanding of the impact of trauma on trauma survivors. The anticipated impact was assigned a value of "green". 2021 Impact: Green - Outcome: 100% of participants reported they understand the impact trauma can have on their clients. Evaluation of survey results was done on a program level. M Health Fairview Bethesda Hospital collaborated in policy, systems and environmental (PSE) change around responding to trauma in settings such as schools and faith communities. This initiative includes activities and milestones linked to PSE evaluation steps (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. 2021 Impact: Opened Minnesota's first EmPATH unit- or Emergency Psychiatric Assessment, Treatment, and Healing- a pioneering approach to emergency mental health that offers rapid, comprehensive care in a calming environment at Fairview Southdale Hospital. Planning underway for opening a second unit at University of Minnesota Medical Center. Conducted HOPE Listening and Learning sessions and a survey, to assess the experiential needs of patients and caregivers when accessing care in our system. Planning for Virtual Health Hubs that will break down barriers and allow people to access mental health care despite physical location. Member partner of both the Mental Well Being Task Force for the Hennepin County Community Health Improvement Partnership (CHIP) and Ramsey County Mental Health and Wellness Action Team (MHWAT). In partnership with Ebenezer Senior Living, developed a new quarterly speaking series called HOPE, that address topics such as Adverse Childhood Experiences (ACEs), trauma, and pandemic fatigue. In the development/planning stage for a Wellness Hub that will include providing comprehensive mental health care in a calming, relaxing space. Priority: Healthy lifestyles: M Health Fairview Bethesda Hospital offered the evidence-based Falls Prevention Suite which included two programs (1) Matter of Balance a program designed to reduce the fear of falling and increase activity levels among older adults. It includes 8 sessions for a small group of 8-12 participants led by two trained facilitators. Participants learn to view falls and fear of falling as controllable, set realistic goals to increase activity, change their environment to reduce fall risk factors, and exercise to increase strength and balance. (2) Tai Ji Quan a research-based 12-week program that is designed to keep older adults mobile and independent. The program meets twice a week for one hour. The classes will help participants improve balance, strengthen muscles, and reduce the risk of falling. The 2021 anticipated impact for the Falls Prevention Suite was a decrease participants' fear of falling. The anticipated impact was assigned a value of "green". 2021 Impact: Green - Outcome: D 14% decrease from pre-survey (86%) to post-survey (73%) in participants that responded with a little, somewhat, or a lot to the following: How fearful are you of falling? Evaluation of survey results was done on a program level. M Health Fairview Bethesda 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: 89% 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). Evaluation of survey results was done on a program level. M Health Fairview Bethesda Hospital offered Veggie Rx a program intended to decrease food insecurity by distributing vegetables to populations of color and those experiencing poverty who are food insecure, have diet related chronic disease and would benefit from increased access to nutritious food. The Hmong American Farmers Association (HAFA) provides CSA (community shared agriculture) shares for this program. The 2021 anticipated impact for Veggie Rx was an increase vegetable consumption in food insecure patients. The anticipated impact was assigned a value of "yellow". 2021 Impact: Green - Outcome: 12% decrease from pre-survey (50%) to post-survey (38%) in response to the following question: I consume three or more servings of vegetable per day. While we don't know exactly why participants reported a decrease in the number of servings of vegetables, we know that this program serves food insecure patients who have been disproportionality impacted by the impacts of COVID-19. Over the course of 2022 we will explore the survey results with clinic leads and participants and improve our processes as needed. M Health Fairview Bethesda Hospital collaborated in policy, systems and environmental (PSE) change around healthy food transformation addressing issues such as food insecurity, food access, and changes to cafeteria menus. This initiative includes activities and milestones linked to PSE evaluation steps (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. 2021 Impact: Green - Outcome: Strengthened partnerships with local food organizations such as Second Harvest Heartland and Sanneh Foundation. Includes planning for a Wellness Hub that will be a new distribution site for food and provide workforce development opportunities for youth in the food sector. Continue to serve as a backbone partner in the Food Justice Network. Expanded Community Supported Agriculture (CSA) program to new CSA farms to meet the differing needs of clinic participants and support new farmer partners. Planning to offer, in partnership with Keystone Community Services, a mobile food pantry at clinics. Signed contact for Now Pow which will screen patients for social determinants such as food security and provide resources and referrals. Priority: Access to care and resources: M Health Fairview Bethesda Hospital conducted Minnesota Immunization Network Initiative (MINI) Clinics. MINI is a multi-sector, community collaboration providing free flu shots to uninsured, underserved, and minority populations. The MINI clinics bring flu vaccine, educational materials, and volunteers to community locations such as churches or community centers and with its partners, ensure a culturally and linguistically appropriate experience in a safe and trusted environment. The 2021 anticipated impact for the MINI clinics was an increase in the number of clinics with culturally and/or linguistically appropriate materials around accessing care and resources. The anticipated impact was assigned a value of "green". 2021 Impact: Green - 4 new partner clinics. 25% of new partner clinic sites had culturally and/or linguistically appropriate materials around accessing care and resources. M Health Fairview Bethesda Hospital offered the evidence-based Falls Prevention Suite which included two programs (1) Matter of Balance a program designed to reduce the fear of falling and increase activity levels among older adults. It includes 8 sessions for a small Schedule H, Part V, Section B, Line 11 Facility , 3 Facility , 3 - HealthEast Bethesda Hospital. group of 8-12 participants led by two trained facilitators. Participants learn to view falls and fear of falling as controllable, set realistic goals to increase activity, change their environment to reduce fall risk factors, and exercise to increase strength and balance. (2) Tai Ji Quan a research-based 12-week program that is designed to keep older adults mobile and independent. The program meets twice a week for one hour. The classes will help participants improve balance, strengthen muscles, and reduce the risk of falling. The 2021 anticipated impact for the Falls Prevention Suite was an increase in participants' comfort talking to their health care provider about medications and other possible risks of falling. The anticipated impact was assigned a value of "green". 2021 Impact: Green - Outcome: Outcome: 67% of participants that responded to the post program survey indicated that they strongly agree or agree with the following statement: I feel more comfortable talking to my health care provider about my medications and other possible risks for falling. Evaluation of survey results was done on a program level. M Health Fairview Bethesda 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". 2021 Impact: Green - Outcome: 86% 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. Evaluation of survey results was done on a program level. M Health Fairview Bethesda 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: 31% increase from pre-survey (67%) to post-survey (98%) in response to the following: I strongly agree or agree that I can assist someone who may be dealing with a mental health problem, substance use challenge or crisis in seeking professional help. Evaluation of survey results was done on a program level M Health Fairview Bethesda Hospital offered Veggie Rx a program intended to decrease food insecurity by distributing vegetables to populations of color and those experiencing poverty who are food insecure, have diet related chronic disease and would benefit from increased access to nutritious food. The Hmong American Farmers Association (HAFA) provides CSA (community shared agriculture) shares for this program. The 2021 anticipated impact for Veggie Rx was an Increase participants' knowledge about where to buy locally grown produce. The anticipated impact was assigned a value of "green". 2021 Impact: Green - Outcome: 78% of participants reported they strongly agree or agree to the following: Where to buy locally grown produce in your area. Results did not reflect a percent change. M Health Fairview Bethesda Hospital offered Cultural Brokers. East Side partners designed the position of Cultural Broker serving St. Paul's East Side of Saint Paul Community to build stress resilience and holistic wellbeing among community members. The Cultural Broker co-navigates mainstream systems with clients and helps bridge those systems within culture, as well as locates resources and advocates for residents' interests. This support results in improved access to culturally relevant mental health care and other resources that build stress resilience over the long term. The 2021 anticipated impact for the Cultural Brokers was an increase in participants' confidence to access services themselves. The anticipated impact was assigned a value of "green". 2021 Impact: Green - Outcome: 10% increase from pre- assessment (80%) to post-assessment (90%) in response to the following: I feel confident I can access the services I need. 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, M Health Fairview Bethesda 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 M Health Fairview Bethesda Hospital resources can support at this time. 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. 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. Language barriers: This issue will be addressed as part of patient care but falls outside the scope of the community-based CHNA Implementation Strategy. Patient advocacy: 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 M Health Fairview Bethesda Hospital resources can support at this time. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - HealthEast Bethesda 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 - HealthEast Bethesda Hospital. The organization attaches a summary of the policy to billing invoices and also communicates to patients during admission, financial counseling and collection calls that there is a financial assistance program and that an application can be provided to them. A summary of the Financial Assistance Policy is posted in various locations in the hospital. 0 Schedule H, Part I, Line 7f Exclusions from Percent of Total Expense 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 I, Line 3c PATIENTS THAT ARE ELIGIBLE FOR THE FAIRVIEW COMMUNITY CARE PROGRAM OR OTHER CHARITY CARE PLANS MAY RECEIVE A REDUCTION ON AMOUNTS OWED OR UP TO 100% OF TOTAL CHARGES. FAIRVIEW INFORMS PATIENTS ABOUT THE COMMUNITY CARE PROGRAM PRIOR TO DELIVERY OF SERVICES IF FEASIBLE AND AS APPROPRIATE AND DURING THE BILLING PROCESS. PATIENTS WITH HOUSEHOLD INCOME UP TO 200% OF THE FEDERAL POVERTY LEVEL QUALIFY FOR A 100% DISCOUNT OF TOTAL CHARGES. PATIENTS WITH A HOUSEHOLD INCOME OF 201%-300% OF THE FEDERAL POVERTY LEVEL QUALIFY FOR A PARTIAL DISCOUNT OF TOTAL CHARGES BASED ON THE AMOUNT GENERALLY BILLED OR EQUAL TO THE RATE FROM FAIRVIEW'S HIGHEST VOLUME PRIVATE PAYOR CONTRACT, WHICHEVER IS HIGHER. UNINSURED PATIENTS WHO ARE RESIDENTS OF MINNESOTA OR WISCONSIN AND WITH A HOUSEHOLD INCOME GREATER THAN 300% OF THE FEDERAL POVERTY LEVEL AND RECEIVE MEDICALLY NECESSARY HOSPITAL OR HOSPITAL BASED SERVICES ARE CHARGED A DISCOUNT RATE EQUAL TO THE RATE FROM FAIRVIEW'S HIGHEST VOLUME PRIVATE PAYOR CONTRACT. 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 bad debt expense reported on Part III, Line 2 is reported at charges as recorded by the organization. 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. 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. 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 III, Line 9b Collection practices for patients eligible for financial assistance AFTER OUR PATIENTS HAVE RECEIVED SERVICES, IT IS THE POLICY OF FAIRVIEW HEALTH SERVICES TO BILL PATIENTS AND THEIR APPLICABLE PAYORS ON A TIMELY AND ACCURATE BASIS. DURING THIS BILLING AND COLLECTION PROCESS, FAIRVIEW STAFF IS COMMITTED TO PROVIDING QUALITY CUSTOMER SERVICE AND TIMELY FOLLOW UP ON ALL OUTSTANDING ACCOUNTS. BILLING: IT IS THE GOAL OF FAIRVIEW TO BILL ALL CLAIMS ACCURATELY AND ON A TIMELY BASIS. ALTHOUGH DEPENDENT ON INFORMATION AND COMMUNICATIONS FROM PATIENTS AND PAYORS, FAIRVIEW 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. FAIRVIEW 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. FAIRVIEW 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, FAIRVIEW 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, FAIRVIEW 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 FAIRVIEW 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 FAIRVIEW 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) FAIRVIEW TAKES REASONABLE MEASURES TO AVOID REFERRING AN ACCOUNT TO COLLECTION UNLESS THERE ARE NO RESPONSES FROM THE PATIENT. IF A PATIENT CONTACTS FAIRVIEW REGARDING COMMUNITY CARE AFTER THEIR ACCOUNT HAS BEEN REFERRED TO A COLLECTION AGENCY OR ATTORNEY, FAIRVIEW 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 FAIRVIEW'S DETERMINATION. Schedule H, Part V, Section B, Line 16a FAP website - HealthEast Bethesda Hospital: Line 16a URL: https://www.fairview.org/billing/financial-assistance; Schedule H, Part V, Section B, Line 16b FAP Application website - HealthEast Bethesda Hospital: Line 16b URL: http://www.fvfiles.com/2266.pdf; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - HealthEast Bethesda Hospital: Line 16c URL: https://www.fairview.org/billing/financial-assistance; 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. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance The organization MAKES INFORMATION ABOUT ITS CHARITY CARE PROGRAMS AVAILABLE ON ITS WEBSITE (WWW.FAIRVIEW.ORG). AT THE TIME OF REGISTRATION FOR SERVICES AND THROUGH WRITTEN MATERIALS IN LOBBIES AND WAITING ROOMS. FOR PATIENTS IDENTIFIED AS SELF-PAY (WHETHER THAT OCCURS BEFORE SERVICES ARE DELIVERED OR DURING THE BILLING CYCLE), FAIRVIEW UTILIZES A STANDARD PROCESS TO ASSIST PATIENTS LEARN ABOUT AND ACCESS ASSISTANCE FROM GOVERNMENT PROGRAMS OR FAIRVIEW'S CHARITY CARE PROGRAM. FOR UNINSURED PATIENTS SEEN IN A FAIRVIEW HOSPITAL, FAIRVIEW PARTNERS WITH AN EXTERNAL VENDOR WHO MEETS WITH SELF-PAY PATIENTS TO ASSIST THEM DETERMINE ELIGIBILITY FOR GOVERNMENT PROGRAMS OF FAIRVIEW'S CHARITY CARE PROGRAM. THE VENDOR WILL ALSO ASSIST PATIENTS WITH COMPLETING THE NECESSARY PAPERWORK TO ACCESS THESE RESOURCES. STAFF IN FAIRVIEW'S CENTRAL BUSINESS OFFICE HAVE A SELF-PAY TEAM, WHICH DIRECTS PATIENTS TO THE APPROPRIATE RESOURCES. THERE IS ALSO A COMMUNITY CARE COORDINATOR WHO ASSISTS IN GETTING PATIENTS CONNECTED TO ADDITIONAL RESOURCES FOR WHICH THEY MAY QUALIFY. 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 Bethesda Hospital community is comprised of 14 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 AS A NONPROFIT HEALTH SYSTEM, the organization REINVESTS ANY EXCESS REVENUES INTO THE CORE OPERATIONS OF THE ORGANIZATION. RESEARCH AND EDUCATION ARE AT THE VERY HEART OF THE MISSION. IN PARTNERSHIP WITH THE UNIVERSITY OF MINNESOTA, FAIRVIEW INVESTS MILLIONS OF DOLLARS EACH YEAR INTO GROUND-BREAKING RESEARCH AND EDUCATION OF OUR NEXT GENERATION OF HEALTHCARE WORKFORCE. FAIRVIEW ALSO PARTNERS WITH A MYRIAD OF HIGHER EDUCATIONAL INSTITUTIONS TO PROVIDE CLINICAL HANDS-ON TRAINING FOR FUTURE NURSES, PHARMACISTS, LABORATORY PROFESSIONALS AND MORE. FAIRVIEW SERVES AS A TRAINING SITE FOR RESIDENTS IN VARIOUS SPECIALTIES AND IS THE CORE TEACHING SITE FOR THE UNIVERSITY OF MINNESOTA RESIDENTS. SENIOR RESIDENTS AND FELLOWS PROVIDE FAIRVIEW SOME DEGREE OF CLINICAL SERVICE THAT WE WOULD OTHERWISE NOT RECEIVE. Schedule H, Part VI, Line 6 Affiliated health care system Bethesda Hospital is part of Fairview Health Services. Bethesda Hospital provides innovative technology, and compassionate care. 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 7 State filing of community benefit report MN true true false false false false false true false James Hereford President/CEO 0 1729577 0 400000 0 132858 0 443315 0 69348 0 2775098 0 0 John Doherty Former Officer 0 0 0 0 0 242131 0 0 0 0 0 242131 0 108075 Sameer Badlani CIO 0 683708 0 100000 0 0 0 96760 0 23351 0 903819 0 0 John Batson CFO 0 896162 0 150000 0 1097 0 122016 0 27395 0 1196670 0 0 Robert Beacher Chief of Shared Clin 0 668801 0 100000 0 59013 0 94280 0 46904 0 968998 0 0 David Crosby Chief Value Based Solutions 0 625606 0 193764 0 66498 0 45885 0 28897 0 960649 0 0 Srijoy Mahapatra Chf Strategy Officer 0 114408 0 0 0 682666 0 13724 0 215 0 811013 0 0 Andrea Mokros EVP & Chf Public Aff 0 377461 0 100000 0 0 0 68452 0 21010 0 566924 0 0 Mary Nease Chief People Officer 0 601028 0 100000 0 0 0 88016 0 27747 0 816791 0 0 Laura Reed RN COO 0 975974 0 100000 0 9535 0 124997 0 32569 0 1243076 0 0 Trudi Trysla Chief Legal Counsel 0 605729 0 100000 0 94077 0 87973 0 64587 0 952365 0 0 Scott Weber Chf Mrktg Comm & Dig 0 446713 0 45000 0 0 0 67212 0 21655 0 580580 0 0 Mark Welton MD Chief Medical Office 0 769694 0 100000 0 19760 0 104369 0 35734 0 1029557 0 0 Nathan Frink MD Physician 0 354132 0 9100 0 39488 0 17400 0 6856 0 426976 0 0 Seema Maddali MD Physician 0 269874 0 0 0 9273 0 8374 0 0 0 287520 0 0 Abijah Muthyala MD Physician 0 371558 0 0 0 69131 0 17400 0 23491 0 481580 0 0 John Scanlon MD Physician 0 292100 0 0 0 25780 0 17400 0 28151 0 363431 0 0 Nikila Vuljaj MD HEMT Medical Director 0 502615 0 3000 0 0 0 17400 0 23680 0 546694 0 0 Schedule J, Part I, Line 4a Severance or change-of-control payment Severance payments made to individuals in 2021: Srijoy Mahapatra $561,774 John Doherty $134,056 Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan Participants in a nonqualified retirement plan who received an accrued contribution: James Hereford $425,915 Laura Reed, RN $107,597 John Batson $104,616 Mark Welton, MD $86,969 Robert Beacher $76,880 Andrea Mokros $51,732 Sameer Badlani $79,360 Trudi Trysla $70,573 Mary Nease $70,616 Srijoy Mahapatra $11,441 Scott Weber $49,812 David Crosby $37,185 Payments from nonqualified retirement plan to individuals were: John Doherty $490,775 Srijoy Mahapatra $36,811 Schedule J, Part I, Line 7 Non-fixed payments Fairview Health Services provides lump sum financial awards based on system-wide, business unit and/or departments financial and quality measures. Annual goals, specifically tied to productivity and quality indicators, are set for the year and an incentive paid out annually if key goals and measures are achieved. Schedule J, Part I, Line 4a Severance benefit payments will commence on the first regularly scheduled pay date that occurs at least five (5) days after the expiration of the rescission period. Payment of severance benefits is contingent upon (i) my having first signed and not rescinded my Service Agreement and Release Agreement and (ii) the return of Fairview's property. Schedule J, Part I, Line 4b The nonqualified plan (the Plan) is only open to a select group of highly compensated employees. The plan contributes the difference of what 403(b) employer contributions were missed for participants who earn more than the IRS limit on eligible compensation for qualified retirement plans. Participants may not elect to defer compensation. Contributions will be made in the form of a credit to the participant's account. Within 60 days after a participant becomes vested in a contribution, the Plan shall pay to the participant an amount equal to the amount the Participant is required to pay Federal, state, local, and foreign income taxes and employment taxes due to the vesting. The remaining amount in the participant's account shall not be paid until the separation from service payment date. A participant's account shall be distributed in cash. The plan complies with section 457(f) of the Code. Form 990, Part III, Line 3 Significant changes in program services HealthEast Care System (HealthEast Bethesda Hospital), the long-term acute care facility, or LTACH, that is part of the Fairview Health Services system, remains a needed service within our community. The LTACH changed its name from HealthEast Care System to Fairview Bethesda Hospital mid-2022 and continues its inpatient bed count and the specialty nature of the care provided there. We expect that Medicare and Medicaid patients will continue to make up the bulk of the hospital's total patients and that hospital will continue to offer care regardless of the patient's ability to pay. HealthEast Care System will also no longer be providing medical transportation services, this program service activity will be moved to Fairview Health Services during 2022. Home Care services stopped being offered by HealthEast Care System during 2020. Form 990, Part V, Line 1a and Line 2a - Section B: Independent Contractors All Form 1099's and Form W-2's were filed by a related organization Fairview Health Services, a 501(c)(3) non-profit, tax-exempt organizations. Form 990, Part VI, Line 4 Significant changes to organizational documents There was a name change causing the Articles of Incorporation to be amended and restated. Form 990, Part VI, Line 6 Classes of members or stockholders The members of the corporation are the individuals who constitute the Directors of this corporation. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body The Board has three categories of directors: 1) 3 ex officio who are Fairview's CEO and the University's Vice President of Medical School and a senior leader of the University Medical School or of the University appointed, from time to time, by the Vice President 2) 10 elected directors who are 1 director elected by the Regents of the University of Minnesota and 9 elected by the Board after nomination from certain components of the Fairview system; and 3) between 3 to 8 at-large directors elected by the Board. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders The Regents of the University of Minnesota have the right to approve proposed amendments to the Articles of Incorporation and Bylaws of the corporation if the amendment would adversely affect their rights and certain sales of substantially all of Fairview's assets. An association of approximately 70 Lutheran churches elects most of the Fairview Southdale Hospital, Fairview Ridges Hospital and part of the UMMC Boards of Trustees, as well as the FPA community directors and the Ebenezer Society Board of Directors and has the right to approve certain Fairview Bylaw amendments. Form 990, Part VI, Line 11b Review of form 990 by governing body The Tax Department conducts a detailed review of the completed return. The Form 990 is then presented to the Executive Committee of the Board for their review and approval on behalf of the Board of Directors. Upon approval from the Board of Directors, the Form 990 is filed. Form 990, Part VI, Line 12c Conflict of interest policy Managers, directors and senior management of Fairview are required to annually complete Fairview's Duty of Loyalty and Conflict of Interest Statement in compliance with Fairview's Conflict of Interest policy. Disclosures are reviewed by the compliance department. Conflicts of interests by Board members and senior management are brought to the Audit and Compliance Committee of the Board, along with additional detailed information, for review. In addition, the Compliance Officer compiles a schedule showing reported conflicts of interest by managers and key employees is also presented to the Conflict of Interest Review Committee for review and discussion. Any problematic issues arising from these disclosures are discussed and resolved by the committee. Board members and management employees are expected to update their conflicts, as necessary, during the year. Form 990, Part VI, Line 15a Process to establish compensation of top management official The determination of executive compensation of the organization is processed by the Human Resources Committee and includes a review of comparability data, review by independent experts and contemporaneous substantiation of the deliberation and decision process. This process is performed annually and was last completed in December 2021. Form 990, Part VI, Line 15b Process to establish compensation of other employees The determination of executive compensation of the organization is processed by the Human Resources Committee and includes a review of comparability data, review by independent experts and contemporaneous substantiation of the deliberation and decision process. This process is performed annually and was last completed in December 2021. Form 990, Part VI, Line 19 Required documents available to the public This organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Inspection of the documents is available at the corporate finance department. Form 990, Part VII, Section B, Line 1 Additional Information Section B: Independent Contractors Form 1099's were filed by a related organization Fairview Health Services, a 501(c)(3) non-profit, tax-exempt organizations. Form 990, Part XI, Line 9 Other changes in net assets or fund balances Pension Plan - 101250; Joint Venture K-1 Activity - -1481014; D&T Facility Management Company 2450 Riverside Avenue Minneapolis MN 55454 411928275 Management MN 501(c)(3) Type I Fairview false Ebenezer Society 7505 Metro Blvd Suite 100 Edina MN 55439 410706141 Nursing MN 501(c)(3) 10 Fairview false Fairview Foundation 2450 Riverside Avenue South Minneapolis MN 55454 411573810 Fundraising MN 501(c)(3) 1 Fairview false Fairview Health Services 2450 Riverside Avenue Minneapolis MN 55454 410991680 Hospital MN 501(c)(3) 3 NA false Fairview Home Care and Hospice 2450 26th Avenue South Minneapolis MN 55454 411434246 Home Health MN 501(c)(3) 10 Fairview false Fairview Physician Associates Netwo 3400 West 66th Street Minneapolis MN 55435 411753325 Clinical MN 501(c)(3) 10 Fairview false Grand Itasca Clinic and Hosptial 1601 Golf Course Road Grand Rapids MN 55744 411865874 Hospital MN 501(c)(3) 3 Fairview false HealthEast Medical Research Institute 2450 Riverside Avenue South Minneapolis MN 55454 411765832 Med Resear MN 501(c)(3) 4 Fairview false HealthEast Professional Services 2450 Riverside Avenue South Minneapolis MN 55454 261226617 Physician MN 501(c)(3) 11 Fairview false HealthEast St John's Hospital 2450 Riverside Avenue South Minneapolis MN 55454 411456897 Hospital MN 501(c)(3) 3 Fairview false HealthEast St Joseph's Hospital 2450 Riverside Avenue South Minneapolis MN 55454 410693880 Hospital MN 501(c)(3) 3 Fairview false HealthEast Woodwinds Hospital 2450 Riverside Avenue South Minneapolis MN 55454 411592761 Hospital MN 501(c)(3) 3 Fairview false PreferredOne Community Health Plan 6105 Golden Hills Drive Golden Valley MN 55416 411796007 Insurance MN 501(c)(4) Fairview false Range Regional Health Services 750 East 34th Street Hibbing MN 55746 411293970 Hospital MN 501(c)(3) 3 Fairview false Ridges Surgery Center LLC 14101 Fairview Drive Ste 400 Burnsville MN 55337 462441825 Surg Cntr MN NA N/A Crosstown Surgery Center LLC 4200 Dahlberg Drive Suite 300 Golden Valley MN 55422 272552748 Surgery Center MN NA N/A SouthHealth ASC LLC 4200 Dahlberg Drive Suite 300 Golden Valley MN 55422 822364607 Surgery Center MN NA N/A Fairview Clinics 2450 Riverside Avenue South Minneapolis MN 55454 411761760 Physician MN NA C Corporation false Fairview Physician and Clinic Services 2450 Riverside Avenue South Minneapolis MN 55454 411544996 Physician MN NA C Corporation false Fairview Development Company 2450 Riverside Avenue South Minneapolis MN 55454 411568579 Leasehold MN NA C Corporation false Fairview Express Care 2450 Riverside Avenue South Minneapolis MN 55454 205996177 Physician MN NA C Corporation false FHS Assurance Limited 2450 Riverside Avenue South Minneapolis MN 55454 980417513 Self insur MN NA C Corporation false HealthEast Diversified Services Inc 2450 Riverside Avenue South Minneapolis MN 55454 411388583 Reference MN NA C Corporation false false false false false false false false false true true false false false false false true true true false