SANFORD: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization: SANFORD (EIN 45-3791176)
Tax period: 2017-07-01 to 2018-06-30
Filed: 2019-05-15
IRS object ID: 201941359349305554
Schema version: 2017v2.3
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule F
Schedule H
Schedule I
Schedule J
Schedule K
Schedule K
Schedule K
Schedule L
Schedule M
Schedule N
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2019-05-15T11:27:21-05:00	ReturnTs
Tax Period End	2018-06-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	861065772	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	Deloitte Tax LLP	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	50 South Sixth Street Suite 2800	AddressLine1Txt
City	Minneapolis	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	55402	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2017-07-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	453791176	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Sanford Group Return	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	SANF	BusinessNameControlTxt
Phone	6053331000	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	PO Box 5039 Rte 5218	AddressLine1Txt
City	Sioux Falls	CityNm
State Abbreviation	SD	StateAbbreviationCd
ZIP	571175039	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	Bill Marlette	PersonNm
Person Title	Treasurer	PersonTitleTxt
Phone	6053331000	PhoneNum
Signature	2019-05-15	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	Chris Meskimen	PreparerPersonNm
PTIN	P01314196	PTIN
Phone	6123974000	PhoneNum

Filing Security Information FilingSecurityInformation

IP Address IPAddress

Field	Value	IRS element (for citing)
I Pv4 Address	206.208.217.34	IPv4AddressTxt

Field	Value	IRS element (for citing)
IP	2019-05-15	IPDt
IP Tm	11:26:52	IPTm
IP Timezone	CD	IPTimezoneCd
Filing License Type	P	FilingLicenseTypeCd
At Submission Creation Device Id	06548BEA0FB372D2A4E2920B5E56EB060CD9C54A	AtSubmissionCreationDeviceId
At Submission Filing Device Id	E5BC8B5E57121AB33B8A1607D3C50835A925FFE9	AtSubmissionFilingDeviceId

Field	Value	IRS element (for citing)
Tax	2017	TaxYr
Build TS	2019-02-21 02:37:17Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	Kelby Krabbenhoft	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	2301 East 60th St	AddressLine1Txt
City	Sioux Falls	CityNm
State Abbreviation	SD	StateAbbreviationCd
ZIP	57104	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$3,930,672,208	GrossReceiptsAmt
Group Return For Affiliates	Yes (1)	GroupReturnForAffiliatesInd
All Affiliates Included	Yes (1)	AllAffiliatesIncludedInd
Group Exemption	5851	GroupExemptionNum
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	www.sanfordhealth.org	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Activity Or Mission	"Dedicated to the Work of Health and Healing"	ActivityOrMissionDesc
Contract Termination	Yes (X)	ContractTerminationInd
Voting Members Governing Body	14	VotingMembersGoverningBodyCnt
Voting Members Independent	6	VotingMembersIndependentCnt
Total Employee	32693	TotalEmployeeCnt
Total Volunteers	2105	TotalVolunteersCnt
Total Gross UBI	$67,165,448	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$1,487,885	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$70,015,308	PYContributionsGrantsAmt
CY Contributions Grants	$72,701,349	CYContributionsGrantsAmt
PY Program Service Revenue	$3,669,768,613	PYProgramServiceRevenueAmt
CY Program Service Revenue	$3,844,742,598	CYProgramServiceRevenueAmt
PY Investment Income	-$1,365,155	PYInvestmentIncomeAmt
CY Investment Income	$3,638,552	CYInvestmentIncomeAmt
PY Other Revenue	$3,059,111	PYOtherRevenueAmt
CY Other Revenue	$3,011,493	CYOtherRevenueAmt
PY Total Revenue	$3,741,477,877	PYTotalRevenueAmt
CY Total Revenue	$3,924,093,992	CYTotalRevenueAmt
PY Grants And Similar Paid	$22,990,888	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$29,331,220	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$2,181,401,280	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$2,285,593,789	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$1,398,380,656	PYOtherExpensesAmt
CY Other Expenses	$1,496,162,556	CYOtherExpensesAmt
PY Total Expenses	$3,602,772,824	PYTotalExpensesAmt
CY Total Expenses	$3,811,087,565	CYTotalExpensesAmt
PY Revenues Less Expenses	$138,705,053	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$113,006,427	CYRevenuesLessExpensesAmt
Total Assets BOY	$2,760,585,976	TotalAssetsBOYAmt
Total Assets EOY	$2,835,813,206	TotalAssetsEOYAmt
Total Liabilities BOY	$1,598,658,494	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$1,553,506,154	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$1,161,927,482	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$1,282,307,052	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	Part of the Sanford Health System, Sanford is committed to the healthcare needs of communities throughout South Dakota, North Dakota, Minnesota and Iowa. Sanford provides a full range of primary and specialty health care services.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$3,244,372,653	ExpenseAmt
Grant	$29,328,180	GrantAmt
Revenue	$3,769,499,749	RevenueAmt
Desc	Sanford is the nation's largest not-for-profit integrated rural health system providing medical services at every level from critical access hospitals to tertiary and quaternary care. The Sanford footprint includes over 220,000 square miles with a nine state service area including a network of children's primary care clinic locations across the country and the world. Sanford operates full-time emergency centers and provides emergency care to everyone regardless of their ability to pay. Sanford facilities and clinics provide services to remote and medically underserved areas that would otherwise not have access to even primary care services. Sanford financially supports health and wellness, education and community development activities to improve the quality of life and strengthen communities throughout the region. Each of Sanford's facilities promotes health and healing that responds to the unique needs of the patients in the communities that Sanford serves, ensuring access to comprehensive and specialized services. A recently completed and published community health needs assessment indicated the important need for behavioral health services for our community members. Sanford is meeting this need through an integrated delivery system providing behavioral health within the medical home structure.Please see Schedule H for a description of additional services, community benefit activities, and the full spectrum of charity care that Sanford provides within the community.	Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

Field	Value	IRS element (for citing)
Expense	$24,181,248	ExpenseAmt
Revenue	$3,873,734	RevenueAmt
Desc	Medical education is an important service for Sanford. Sanford provides the medical community with high quality educational and professional development that is evidence and research based; accredited for physicians, nurses, pharmacists, and Allied Health Professionals and scientists; inclusive of cultural diversity and addresses the need for specialty training.Sanford is dedicated to preparing health care professionals for the future. The Sanford PROMISE program connects students, educators and communities with science and research in health care at a secondary education age. Sanford works in partnership with the University of South Dakota - Sanford School of Medicine, and the University of North Dakota - School of Medicine to provide rotations for medical students, residencies and fellowships. Sanford works in partnership with an extensive group of higher learning organizations to provide student training and learning opportunities in many venues across our region.	Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

Field	Value	IRS element (for citing)
Expense	$25,803,175	ExpenseAmt
Grant	$3,040	GrantAmt
Revenue	$4,203,667	RevenueAmt
Desc	Sanford Research is a non-profit health research organization with more than 200 scientists and staff as well as centers, including: Children's Health, focused on pediatric rare diseases and cancer; The Sanford Project, seeking a cure for type 1 diabetes through the body's natural ability to regenerate cells; Health Outcomes and Prevention focusing on sudden infant death syndrome and birth-related disorders at study sites including United States Native American Reservations and South Africa; Genomic and Molecular Medicine with an emphasis on genomics, molecular biology, biobanking and immunotherapy; Edith Sanford Breast Cancer focusing on advanced molecular research and personalized treatment; and Clinical Research including participation in drug and device studies, the National Cancer Institute Community Clinical Oncology Program and the National Community Cancer Center Pilot Project.Sanford Research offers exciting challenges for researchers both in well-established projects and ever expanding research opportunities. Sanford offers opportunities to participate in clinical trials and to be a part of the changing face of medicine.	Desc

Field	Value	IRS element (for citing)
Total Program Service Expenses	$3,294,357,076	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	Yes (1)	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	0	CreditCounselingInd
Temp Or Permanent Endowments	Yes (1)	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	0	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	Yes (1)	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (1)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	0	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (1)	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	Yes (1)	ForeignActivitiesInd
More Than5000 K To Org	Yes (1)	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	Yes (1)	GrantsToOrganizationsInd
Grants To Individuals	Yes (1)	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	Yes (1)	TaxExemptBondsInd
Invest Tax Exempt Bonds	0	InvestTaxExemptBondsInd
Escrow Account	0	EscrowAccountInd
On Behalf Of Issuer	0	OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	Yes (1)	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	Yes (1)	BusinessRlnWithFamMemInd
Business Rln With Officer Ent	Yes (1)	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	Yes (1)	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	Yes (1)	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	Yes (1)	DisregardedEntityInd
Related Entity	Yes (1)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (1)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	Yes (1)	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	Yes (1)	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
Info In Schedule O Part V	Yes (X)	InfoInScheduleOPartVInd
IRP Document	3195	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	32693	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (1)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (1)	Form990TFiledInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	0	QuidProQuoContributionsInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	14	GoverningBodyVotingMembersCnt
Independent Voting Member	6	IndependentVotingMemberCnt
Family Or Business Rln	Yes (1)	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (1)	MembersOrStockholdersInd
Election Of Board Members	Yes (1)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (1)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	Yes (1)	LocalChaptersInd
Policies Reference Chapters	Yes (1)	PoliciesReferenceChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	Yes (1)	InvestmentInJointVentureInd
Written Policy Or Procedure	Yes (1)	WrittenPolicyOrProcedureInd
States Where Copy Of Return Is Fld	MN	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	OR	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	CA	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	JoAnn Kunkel CFO	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	6053331000	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	2301 East 60th Street	AddressLine1Txt
City	Sioux Falls	CityNm
State Abbreviation	SD	StateAbbreviationCd
ZIP	57104	ZIPCd

Field	Value	IRS element (for citing)
Info In Schedule O Part VII	Yes (X)	InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (40 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	OfficerOfficerInd	Key EmployeeKeyEmployeeInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd	Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
Barb Everist
Trustee	3.90	1.70	Yes (X)	$725	$0	$0
Andy North
Trustee	5.90	1.70	Yes (X)	$121,718	$0	$0
Brent Teiken
Vice Chair	3.90	1.70	Yes (X)	$1,215	$0	$0	Yes (X)
David Beito
Past Chair	3.90	1.70	Yes (X)	$0	$0	$0	Yes (X)
Don Jacobs
Treasurer	3.90	1.70	Yes (X)	$0	$0	$0	Yes (X)
Don Morton through 1217
Trustee	3.90	1.70	Yes (X)	$1,353	$0	$0
James Cain
Secretary	3.90	1.70	Yes (X)	$0	$0	$0	Yes (X)
Maria Bell MD
Trustee/Research Administrator	58.30	1.70	Yes (X)	$789,033	$0	$29,050
Mark Lundeen MD
Trustee/Orthopedics Services Chair	58.40	1.60	Yes (X)	$726,619	$0	$29,050
Mark Paulson MD
Chair/Physician Regional Chair	58.30	1.70	Yes (X)	$266,366	$0	$26,202	Yes (X)
Melissa Hinton
Trustee	3.90	1.70	Yes (X)	$0	$0	$0
Michael LeBeau MD
Trustee/Senior VP - Bismarck Clinic	58.40	1.60	Yes (X)	$1,414,632	$0	$29,050
Patrick Durick
Trustee	3.90	1.70	Yes (X)	$1,177	$0	$0
Thomas Hruby
Trustee	3.90	1.70	Yes (X)	$1,360	$0	$0
Kelby K Krabbenhoft
Sanford President & CEO	46.10	13.90	Yes (X)	$2,276,185	$0	$12,726	Yes (X)
Kelby K Krabbenhoft Def Comp
Sanford President & CEO	46.10	13.90	Yes (X)	$0	$0	$877,405	Yes (X)
JoAnn L Kunkel
Chief Financial Officer	46.10	13.90		$1,020,341	$0	$43,188	Yes (X)
Randy Bury
Chief Administrative Officer	40.00	20.00		$1,072,754	$0	$28,257		Yes (X)
Randy Bury Deferred Comp
Chief Administrative Officer	40.00	20.00		$0	$0	$15,683		Yes (X)
Bill Gassen
Chief Human Resources Officer	55.00	5.00		$663,044	$0	$28,245		Yes (X)
Kim Patrick
Chief Legal Officer (through 12/17)	55.00	5.00		$760,169	$0	$40,401		Yes (X)
Jennifer Grennan
Chief Legal Officer	55.00	5.00		$412,996	$0	$34,701		Yes (X)
Allison Wierda-Suttle MD
Sr. VP, Chief Med Officer	60.00	0.00		$844,889	$0	$35,182		Yes (X)
Bill Marlette
Treasurer	55.00	5.00		$941,344	$0	$1,470		Yes (X)
Bill Marlette Def Comp
Treasurer	55.00	5.00		$0	$0	$211,820		Yes (X)
Micah Aberson
Chief Global Brand Officer	10.00	50.00		$539,386	$0	$39,501		Yes (X)
Bryan Nermoe
President, Bemidji	60.00	0.00		$644,061	$0	$38,481		Yes (X)
Craig Lambrecht
President, Bismarck	60.00	0.00		$922,924	$0	$40,403		Yes (X)
Nate White
COO, President Fargo	55.00	5.00		$1,432,723	$0	$51,351		Yes (X)
Michelle Micka
Sr. VP Finance, Corporate Controller	55.00	5.00		$466,467	$0	$35,601		Yes (X)
Michelle Bruhn
Sr. VP Finance, Health Services	55.00	5.00		$630,740	$0	$27,195		Yes (X)
Paul Hanson
President, Sioux Falls	60.00	0.00		$915,810	$0	$44,601		Yes (X)
Paul Richard
Exec VP Fargo	55.00	5.00		$931,503	$0	$26,226		Yes (X)
Richard Adcock
Chief Innovation Officer	60.00	0.00		$675,499	$0	$19,916		Yes (X)
William Brunner
Physician	60.00	0.00		$2,668,987	$0	$29,050			Yes (X)
Larry Burris
Physician	60.00	0.00		$2,269,260	$0	$29,050			Yes (X)
Scott Pham
Physician	60.00	0.00		$2,897,398	$0	$29,050			Yes (X)
Adam Stys
Physician	60.00	0.00		$2,475,403	$0	$29,050			Yes (X)
Tomasz Stys
Physician	60.00	0.00		$2,657,592	$0	$29,050			Yes (X)
Daniel Olson
Former Exec VP Bemidji	0.00	0.00		$317,442	$0	$26,226				Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$31,761,115	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$1,937,181	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	2781	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	Yes (1)	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
Owens & Minor Inc
12199 Collection Center	Chicago	IL	60693	Medical Services	$70,984,503
GE Healthcare
1053 W Grand Ave	Chicago	IL	60642	Medical Services	$41,838,237
Medtronic USA
710 Medtronic Parkway	Minneapolis	MN	55432	Medical Services	$41,587,243
Henry Carlson Construction
1205 Russell Street	Sioux Falls	SD	57104	Construction	$24,870,115
Weatherby Healthcare
6451 North Federal Hwy Suite 700	Fort Lauderdale	FL	33308	Locum Tenens	$12,470,321

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	1107	CntrctRcvdGreaterThan100KCnt
Related Organizations	$43,056,142	RelatedOrganizationsAmt
Government Grants	$19,860,216	GovernmentGrantsAmt
All Other Contributions	$9,784,991	AllOtherContributionsAmt
Noncash Contributions	$5,112,030	NoncashContributionsAmt
Total Contributions	$72,701,349	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt
Patient Services	621400	$1,939,146,185	$1,939,146,185
Medicare/Medicaid	621400	$1,539,089,097	$1,539,089,097
340B Revenue	900099	$159,110,926	$159,110,926
Durable Med Equip Sale	446199	$114,564,142	$105,143,496	$9,420,646
Management Fee	900099	$35,151,946		$35,151,946

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$57,680,302	TotalRevenueColumnAmt
Related Or Exempt Func Income	$28,338,725	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$22,592,856	UnrelatedBusinessRevenueAmt
Exclusion	$6,748,721	ExclusionAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$3,844,742,598	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$2,149,652	TotalRevenueColumnAmt
Exclusion	$2,149,652	ExclusionAmt

Royalties Revenue RoyaltiesRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$157,790	TotalRevenueColumnAmt
Exclusion	$157,790	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$4,845,011	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$1,991,308	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$2,853,703	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$2,853,703	TotalRevenueColumnAmt
Exclusion	$2,853,703	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Other	$6,075,808	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Other	$4,586,908	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Other	$1,488,900	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$1,488,900	TotalRevenueColumnAmt
Exclusion	$1,488,900	ExclusionAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$3,924,093,992	TotalRevenueColumnAmt
Related Or Exempt Func Income	$3,770,828,429	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$67,165,448	UnrelatedBusinessRevenueAmt
Exclusion	$13,398,766	ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$29,226,624	TotalAmt
Program Services	$29,226,624	ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

Field	Value	IRS element (for citing)
Total	$43,613	TotalAmt
Program Services	$43,613	ProgramServicesAmt

Foreign Grants ForeignGrantsGrp

Field	Value	IRS element (for citing)
Total	$60,983	TotalAmt
Program Services	$60,983	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$32,554,058	TotalAmt
Program Services	$28,227,789	ProgramServicesAmt
Management And General	$4,326,269	ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

Field	Value	IRS element (for citing)
Total	$329,622	TotalAmt
Management And General	$329,622	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$1,872,038,031	TotalAmt
Program Services	$1,623,539,477	ProgramServicesAmt
Management And General	$248,498,554	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$80,740,429	TotalAmt
Program Services	$65,000,431	ProgramServicesAmt
Management And General	$15,739,998	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$184,604,087	TotalAmt
Program Services	$153,673,259	ProgramServicesAmt
Management And General	$30,930,828	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$115,327,562	TotalAmt
Program Services	$97,633,077	ProgramServicesAmt
Management And General	$17,694,485	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$12,581,225	TotalAmt
Management And General	$12,581,225	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$1,180,761	TotalAmt
Management And General	$1,180,761	ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$1,072,254	TotalAmt
Management And General	$1,072,254	ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

Field	Value	IRS element (for citing)
Total	$43,191	TotalAmt
Management And General	$43,191	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$192,858,195	TotalAmt
Program Services	$162,793,163	ProgramServicesAmt
Management And General	$30,065,032	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$17,464,114	TotalAmt
Program Services	$13,710,480	ProgramServicesAmt
Management And General	$3,753,634	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$44,431,322	TotalAmt
Program Services	$30,800,976	ProgramServicesAmt
Management And General	$13,630,346	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$60,104,165	TotalAmt
Program Services	$6,276,991	ProgramServicesAmt
Management And General	$53,827,174	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$90,743,005	TotalAmt
Program Services	$70,517,087	ProgramServicesAmt
Management And General	$20,225,918	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$16,869,498	TotalAmt
Program Services	$13,459,344	ProgramServicesAmt
Management And General	$3,410,154	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$7,133,467	TotalAmt
Program Services	$3,616,788	ProgramServicesAmt
Management And General	$3,516,679	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$39,460,042	TotalAmt
Program Services	$39,160,189	ProgramServicesAmt
Management And General	$299,853	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$164,619,813	TotalAmt
Program Services	$136,224,634	ProgramServicesAmt
Management And General	$28,395,179	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$14,931,964	TotalAmt
Program Services	$12,246,521	ProgramServicesAmt
Management And General	$2,685,443	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
Medical Supplies	$797,698,843	$782,621,590	$15,077,253
Certificates/Licenses	$7,318,678	$5,325,905	$1,992,773
MinnesotaCare Tax	$6,417,941	$6,417,941
CME	$5,702,199	$5,702,199

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$15,531,879	TotalAmt
Program Services	$8,078,015	ProgramServicesAmt
Management And General	$7,453,864	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$3,811,087,565	TotalAmt
Program Services	$3,294,357,076	ProgramServicesAmt
Management And General	$516,730,489	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Field	Value	IRS element (for citing)
Joint Costs	Yes (X)	JointCostsInd

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$32,062,918	BOYAmt
EOY	$64,909,066	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$46,887,242	BOYAmt
EOY	$67,766,348	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$503,537,992	BOYAmt
EOY	$518,552,739	EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

Field	Value	IRS element (for citing)
BOY	$42,248,539	BOYAmt
EOY	$47,761,146	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$75,876,025	BOYAmt
EOY	$79,897,564	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$34,055,950	BOYAmt
EOY	$43,448,694	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$3,299,410,347	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$1,587,845,833	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$1,708,586,916	BOYAmt
EOY	$1,711,564,514	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$2,021,421	BOYAmt
EOY	$2,465,285	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$389	BOYAmt
EOY	$0	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$51,235,834	BOYAmt
EOY	$52,629,304	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$54,608,534	BOYAmt
EOY	$53,816,458	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$209,464,216	BOYAmt
EOY	$193,002,088	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$2,760,585,976	BOYAmt
EOY	$2,835,813,206	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$385,982,229	BOYAmt
EOY	$388,864,448	EOYAmt

Grants Payable GrantsPayableGrp

Field	Value	IRS element (for citing)
BOY	$2,004,207	BOYAmt
EOY	$1,831,478	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$1,759,629	BOYAmt
EOY	$2,167,502	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$933,378,635	BOYAmt
EOY	$901,784,327	EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

Field	Value	IRS element (for citing)
BOY	$196,029	BOYAmt
EOY	$226,634	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$70,004,924	BOYAmt
EOY	$58,059,178	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$205,332,841	BOYAmt
EOY	$200,572,587	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$1,598,658,494	BOYAmt
EOY	$1,553,506,154	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$1,161,916,292	BOYAmt
EOY	$1,282,295,862	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$8,190	BOYAmt
EOY	$8,190	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$3,000	BOYAmt
EOY	$3,000	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$1,161,927,482	BOYAmt
EOY	$1,282,307,052	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$2,760,585,976	BOYAmt
EOY	$2,835,813,206	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$113,006,427	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$2,134,072	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$5,239,071	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	Yes (1)	FederalGrantAuditRequiredInd
Federal Grant Audit Performed	Yes (1)	FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd
Supported Organizations	18	SupportedOrganizationsCnt
Supported Organizations Total	18	SupportedOrganizationsTotalCnt

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
List of orgaizations and public charity status:	Sanford Health 509(a)(3) Sanford Medical Center 170(b)(1)(A)(iii) Sanford Clinic 170(b)(1)(A)(iii) Sanford Research 170(b)(1)(A)(iii) Sanford Home Health 509(a)(2) Sanford Health Network 170(b)(1)(A)(iii) Sanford World Clinics 170(b)(1)(A)(iii) Sanford North 509(a)(3) Sanford Medical Center Fargo 170(b)(1)(A)(iii) Sanford Clinic North 509(a)(2) Sanford Health Network North 509(a)(3) Sanford Medical Center Thief River Falls 170(b)(1)(A)(iii) Sanford Medical Center Mayville 170(b)(1)(A)(iii) Sanford Medical Center Wheaton 170(b)(1)(A)(iii) Sanford Hillsboro 170(b)(1)(A)(iii) Sanford Health of Northern Minnesota 170(b)(1)(A)(iii) Baker Park, Inc. 509(a)(2) Sanford West 509(a)(3) Sanford Bismarck 170(b)(1)(A)(iii) Sanford Living Centers 509(a)(2)
Schedule A, Part I	Part I, Line 12b - Sanford Health, Sanford North, Sanford West and Sanford Health Network North are Type II supporting organizations. Detail for Schedule A, Part I Line 12, Column: (i) Sanford Medical Center; (ii) 46-0227855; (iii) 170(b)(1)(A)(iii); (iv) Yes; (v) $38,470,450 Line 12, Column: (i) Sanford Clinic; (ii) 46-0447693; (iii) 170(b)(1)(A)(iii); (iv) Yes; (v) $4,918,559 Line 12, Column: (i) Sanford Research; (ii) 46-0450378; (iii) 170(b)(1)(A)(iii); (iv) Yes; (v) $788,155 Line 12, Column: (i) Sanford Home Health; (ii) 46-0282134; (iii) 509(a)(2); (iv) Yes; (v) $247,870 Line 12, Column: (i) Sanford Health Network; (ii) 46-0388596; (iii) 170(b)(1)(A)(iii); (iv) Yes; (v) $10,830,536 Line 12, Column: (i) Sanford Clinic North; (ii) 91-1770748; (iii) 509(a)(2); (iv) Yes; (v) $5,707,821 Line 12, Column: (i) Sanford Medical Center Fargo; (ii) 45-0226909; (iii) 170(b)(1)(A)(iii); (iv) Yes; (v) $45,166,271 Line 12, Column: (i) Sanford Medical Center Thief River Falls; (ii) 41-0709579; (iii) 170(b)(1)(A)(iii); (iv) Yes; (v) $5,198,542 Line 12, Column: (i) Sanford Medical Center Mayville; (ii) 45-0228899; (iii) 170(b)(1)(A)(iii); (iv) Yes; (v) $582,050 Line 12, Column: (i) Sanford Medical Center Wheaton; (ii) 27-2042143; (iii) 170(b)(1)(A)(iii); (iv) Yes; (v) $500,988 Line 12, Column: (i) Sanford Hillsboro; (ii) 45-0230400; (iii) 170(b)(1)(A)(iii); (iv) Yes; (v) $773,018 Line 12, Column: (i) Sanford World Clinics; (ii) 26-2707628; (iii) 170(b)(1)(A)(iii); (iv) Yes; (v) $325,983 Line 12, Column: (i) Sanford Health of Northern Minnesota; (ii) 41-1266009; (iii) 170(b)(1)(A)(iii); (iv) Yes; (v) $11,278,037 Line 12, Column: (i) Baker Park, Inc.; (ii) 41-1372480; (iii) 509(a)(2); (iv) Yes; (v) $25,255 Line 12, Column: (i) Sanford Health Foundation North; (ii) 45-0398104; (iii) 170(b)(1)(A)(vi); (iv) Yes; (v) $347,659 Line 12, Column: (i) Sanford Bismarck; (ii) 45-0226700; (iii) 170(b)(1)(A)(iii); (iv) Yes; (v) $19,386,445 Line 12, Column: (i) Sanford Living Centers; (ii) 45-0416454; (iii) 509(a)(2); (iv) Yes; (v) $0 Line 12, Column: (i) Sanford Health Foundation West; (ii) 45-0397196; (iii) 170(b)(1)(A)(vi); (iv) Yes; (v) $158,665
Schedule A, Part III	Detail for Schedule A, Part III Line 1 - column: (a) 625,251; (b) 232,693; (c) 221,829; (d) 159,929; (e) 279,310; (f) 1,519,012 Line 2 - column: (a) 195,263,418; (b) 214,359,949; (c) 229,728,673; (d) 205,167,015; (e) 159,680,023 (f) 1,004,199,078 Line 6 - column: (a) 195,888,669; (b) 214,592,642; (c) 229,950,502; (d) 205,326,944 ; (e) 159,959,333 (f) 1,005,718,090 Line 8 - column: (f) 1,005,718,090 Line 9 - column: (a) 195,888,669; (b) 214,592,642; (c) 229,950,502; (d) 205,326,944; (e) 159,959,333; (f) 1,005,718,090 Line 10a - column: (a) 970,589; (b) 671,284; (c) 718,153; (d) 713,259; (e) 1,664,637; (f) 4,737,922 Line 10c - column: (a) 970,589; (b) 671,284; (c) 718,153; (d) 713,259; (e) 1,664,637; (f) 4,737,922 Line 11 - column: (a) 279,896; (b) 400,943; (c) 274,195; (d) 410,742; (e) 783,554; (f) 2,149,330 Line 13 - column: (a) 197,139,154; (b) 215,664,869; (c) 230,942,850; (d) 206,450,944; (e) 162,407,524; (f) 1,012,605,342 Line 15: 99.32% Line 16: 99.53% Line 17: 0.47% Line 18: 0.34% Line 19a: X Line 19b: X Part IV, Section A Line 1: Yes Line 2: No Line 3a: No Line 4a: No Line 5a: No Line 6: No Line 7: No Line 8: No Line 9a: No Line 9b: No Line 9c: No Line 10a: No Line 11a: No Line 11b: No Line 11c: No Part IV, Section C Line 1: Yes

Schedule B IRS990ScheduleB

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	VolunteersInd
Paid Staff Or Management	Yes (1)	PaidStaffOrManagementInd
Media Advertisements	0	MediaAdvertisementsInd
Mailings Members	Yes (1)	MailingsMembersInd
Publications Or Broadcast	0	PublicationsOrBroadcastInd
Grants Other Organizations	0	GrantsOtherOrganizationsInd
Direct Contact Legislators	Yes (1)	DirectContactLegislatorsInd
Direct Contact Legislators	$572,506	DirectContactLegislatorsAmt
Rallies Demonstrations	0	RalliesDemonstrationsInd
Other Activities	Yes (1)	OtherActivitiesInd
Other Activities	$1,572,003	OtherActivitiesAmt
Total Lobbying Expenditures	$2,144,509	TotalLobbyingExpendituresAmt
Not Described Section501c3	0	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part II-B, Line 1:	FormAndLineReferenceDesc
Explanation	The filing organization has memberships in the South Dakota Association of Healthcare Organizations, North Dakota Hospital Association, Minnesota Hospital Association, Iowa Hospital Association, American Hospital Association, North Dakota Long Term Care Association, North Dakota Medical Group Management Association,Iowa Alliance in Home Care and Health Policy Consortium. A percentage of membership dues paid to these organizations relate to lobbying expenses. In addition, the organization employs certain individuals, and contracts with various lobbyists, to monitor legislative acts important to all Sanford entities on both state and national levels. Occasionally, Sanford employees send mailings to legislators on issues that may affect healthcare.	ExplanationTxt

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Agent Trustee Etc	0	AgentTrusteeEtcInd
Incl Escrow Custodial Acct Liab	Yes (1)	InclEscrowCustodialAcctLiabInd
Explanation Provided	Yes (X)	ExplanationProvidedInd

CY Endwmt Fund CYEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$60,166,967	BeginningYearBalanceAmt
Contributions	$4,233,247	ContributionsAmt
Grants Or Scholarships	$751,526	GrantsOrScholarshipsAmt
End Year Balance	$63,648,688	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$62,584,497	BeginningYearBalanceAmt
Contributions	-$2,436,209	ContributionsAmt
Investment Earnings Or Losses	$18,679	InvestmentEarningsOrLossesAmt
End Year Balance	$60,166,967	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$58,142,005	BeginningYearBalanceAmt
Contributions	$4,442,491	ContributionsAmt
End Year Balance	$62,584,497	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$54,120,507	BeginningYearBalanceAmt
Contributions	$4,007,618	ContributionsAmt
Investment Earnings Or Losses	$25,086	InvestmentEarningsOrLossesAmt
Other Expenditures	$6,372	OtherExpendituresAmt
Administrative Expenses	$4,834	AdministrativeExpensesAmt
End Year Balance	$58,142,005	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$48,229,852	BeginningYearBalanceAmt
Contributions	$5,316,297	ContributionsAmt
Investment Earnings Or Losses	$654,694	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$54,813	GrantsOrScholarshipsAmt
Other Expenditures	$6,949	OtherExpendituresAmt
Administrative Expenses	$18,574	AdministrativeExpensesAmt
End Year Balance	$54,120,507	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Prmnnt Endowment Balance EOY	1.00000	PrmnntEndowmentBalanceEOYPct
Endowments Held Unrelated Org	0	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	Yes (1)	EndowmentsHeldRelatedOrgInd
Related Org List Sch R	Yes (1)	RelatedOrgListSchRInd

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$108,520,505	OtherCostOrOtherBasisAmt
Book Value	$108,520,505	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$1,538,272,323	OtherCostOrOtherBasisAmt
Depreciation	$587,600,500	DepreciationAmt
Book Value	$950,671,823	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$76,594,247	OtherCostOrOtherBasisAmt
Depreciation	$45,343,171	DepreciationAmt
Book Value	$31,251,076	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$1,538,836,043	OtherCostOrOtherBasisAmt
Depreciation	$932,904,777	DepreciationAmt
Book Value	$605,931,266	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$37,187,229	OtherCostOrOtherBasisAmt
Depreciation	$21,997,385	DepreciationAmt
Book Value	$15,189,844	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$1,711,564,514	TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (6 entries)

DescDesc	Book ValueBookValueAmt
Non-operating property	$68,250,164
Deferred compensation assets held for investment	$116,144,069
Other assets	$7,077,737
Enhanced Benefits	$1,398,765
Interest Receivable	$45,291
Cash Value-Insurance Policies	$86,062

Field	Value	IRS element (for citing)
Total Book Value Other Assets	$193,002,088	TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)

DescDesc	AmtAmt
Deferred compensation liability	$136,417,020
Defined benefit pension liability	$57,410,705
Other non-current liabilities	$5,841,617
Lease Settlement Payable	$735,191
Market Value of Int Rate Swap	$168,054

Field	Value	IRS element (for citing)
Total Liability	$200,572,587	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part IV, Line 2b:	Long term care facilities hold security deposits for tenants.
Part V, Line 4:	Sanford Health Foundation, Sanford Health Foundation North, Sanford Health Foundation Hillsboro, Sanford Health Foundation of Northern Minnesota, Sandford Health Foundation of Thief River Falls and Sanford Health Foundation West hold endowment funds on behalf of the filing organization to be used for assistance in its activities and for providing health care, medical, or educational services.
Part X, Line 2:	Certain controlled organizations are subject to income taxes. Deferred income tax assets and liabilities are recognized for the differences between the financial and income tax reporting basis of assets and liabilities based on enacted tax rates and laws. A tax benefit from an uncertain tax position may be recognized when it is more likely than not that the position will be sustained upon examination. The deferred income tax provision or benefit generally reflects the net change in deferred income tax assets and liabilities during the year. The current income tax provision reflects the tax consequences of revenues and expenses currently taxable or deductible on various income tax returns for the year reported. Sanford Group did not have a material income tax liability at June 30, 2018; some related organizations have established reserves.

Schedule F IRS990ScheduleF

Field	Value	IRS element (for citing)
Grant Records Maintained	Yes (1)	GrantRecordsMaintainedInd

Account Activities Outside US AccountActivitiesOutsideUSGrp (9 entries)

RegionRegionTxt	Type Of Activities ConductedTypeOfActivitiesConductedTxt	Specific Services ProvidedSpecificServicesProvidedTxt	Region Total ExpendituresRegionTotalExpendituresAmt
East Asia and the Pacific	Investments	Clinic operations, investment of potential additional clinic sites	$903,000
Europe (Including Iceland & Greenland)	Program Services	Travel, conferences, and purchased goods and services	$38,000
North America	Program Services	Travel, conference, purchased goods and services	$14,000
Sub-Saharan Africa	Investments	Clinic operations and investment in potential additional clinic sites	$4,466,000
Central America and the Caribbean	Investments	Investigation of potential clinic sites, travel	$42,000
East Asia and the Pacific	Program Services	Purchased goods/services, travel	$14,000
Europe (Including Iceland & Greenland)	Investments	Clinic operations, hospital, investigation of clinic sites, travel, purch goods, services	$12,888,000
Middle East and North Africa	Program Services	Purchased Goods/Services	$2,000
North America	Investments	Investigation of potential clinic sites, travel	$13,000

Field	Value	IRS element (for citing)
Subtotal Offices	0	SubtotalOfficesCnt
Subtotal Employees	0	SubtotalEmployeesCnt
Continuation Total Office	0	ContinuationTotalOfficeCnt
Continuation Total Employee	0	ContinuationTotalEmployeeCnt
Total Office	0	TotalOfficeCnt
Total Employee	0	TotalEmployeeCnt
Subtotal Spent	$18,367,000	SubtotalSpentAmt
Continuation Spent	$13,000	ContinuationSpentAmt
Total Spent	$18,380,000	TotalSpentAmt

Grants To Org Outside US GrantsToOrgOutsideUSGrp

Field	Value	IRS element (for citing)
Region	East Asia and the Pacific	RegionTxt
Purpose Of Grant	Subaward of Gray Foundation Grant	PurposeOfGrantTxt
Cash Grant	$60,983	CashGrantAmt
Manner Of Cash Disbursement	Bank Transfer	MannerOfCashDisbursementTxt
Valuation Method Used	Cost	ValuationMethodUsedDesc

Field	Value	IRS element (for citing)
Total501c3 Org	1	Total501c3OrgCnt
Total Other Org	0	TotalOtherOrgCnt
Transfer To Foreign Corp	Yes (1)	TransferToForeignCorpInd
Interest In Foreign Trust	0	InterestInForeignTrustInd
Foreign Corp Ownership	Yes (1)	ForeignCorpOwnershipInd
Passive Foreign Investmest Co	0	PassiveForeignInvestmestCoInd
Foreign Partnership	0	ForeignPartnershipInd
Boycott Countries	0	BoycottCountriesInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part I, Line 2:	FormAndLineReferenceDesc
Explanation	Prior to disbursement all grant fund requests are reviewed to ensure the receiving organization and proposed use of funds align with Sanford's mission. Grants are disbursed by the organization only after the expenditure has been made and properly authorized by the organization along with related documentation to ensure the funds are not diverted for non-charitable use.	ExplanationTxt

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (1)	FinancialAssistancePolicyInd
Written Policy	Yes (1)	WrittenPolicyInd
All Hospitals Policy	Yes (X)	AllHospitalsPolicyInd
FPG Reference Free Care	Yes (1)	FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd
Free Care Other	225.000000000000	FreeCareOtherPct

Field	Value	IRS element (for citing)
FPG Reference Discounted Care	Yes (1)	FPGReferenceDiscountedCareInd

Discounted Care Oth Percentage DiscountedCareOthPercentageGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd
Discounted Care Other	375.000000000000	DiscountedCareOtherPct

Field	Value	IRS element (for citing)
Free Care Medically Indigent	Yes (1)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (1)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	Yes (1)	ExpensesExceedBudgetInd
Unable To Provide Care	0	UnableToProvideCareInd
Annual Community Bnft Report	Yes (1)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (1)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$72,271,034	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$72,271,034	NetCommunityBenefitExpnsAmt
Total Expense	0.01900	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$516,441,336	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$343,930,325	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$172,511,011	NetCommunityBenefitExpnsAmt
Total Expense	0.04530	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$588,712,370	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$343,930,325	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$244,782,045	NetCommunityBenefitExpnsAmt
Total Expense	0.06430	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$10,501,695	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$789,969	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$9,711,726	NetCommunityBenefitExpnsAmt
Total Expense	0.00250	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$24,181,248	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$3,873,734	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$20,307,514	NetCommunityBenefitExpnsAmt
Total Expense	0.00530	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$474,169,582	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$412,809,904	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$61,359,678	NetCommunityBenefitExpnsAmt
Total Expense	0.01610	TotalExpensePct

Research ResearchGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$32,802,185	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$18,701,133	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$14,101,052	NetCommunityBenefitExpnsAmt
Total Expense	0.00370	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$19,912,155	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$19,912,155	NetCommunityBenefitExpnsAmt
Total Expense	0.00520	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$561,566,865	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$436,174,740	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$125,392,125	NetCommunityBenefitExpnsAmt
Total Expense	0.03280	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,150,279,235	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$780,105,065	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$370,174,170	NetCommunityBenefitExpnsAmt
Total Expense	0.09710	TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$155	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$155	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Economic Development EconomicDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$3,733	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$3,733	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$31,276	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$4,418	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$26,858	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,621	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$1,621	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Coalition Building CoalitionBuildingGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$705,586	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$705,586	NetCommunityBenefitExpnsAmt
Total Expense	0.00020	TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$576,274	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$576,274	NetCommunityBenefitExpnsAmt
Total Expense	0.00020	TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$31,549	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$31,549	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,350,194	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$4,418	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,345,776	NetCommunityBenefitExpnsAmt
Total Expense	0.00040	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$50,285,952	BadDebtExpenseAmt
Reimbursed By Medicare	$881,110,124	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$936,620,572	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$55,510,448	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (1)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (1)	FinancialAssistancePrvsnInd

Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp

Entity Name EntityName

Field	Value	IRS element (for citing)
Business Name Line1	1 Everist Health	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Primary Activities	Prevention of heart and cardiovascular disease through unique medical tech	PrimaryActivitiesTxt
Org Profit Or Ownership	0.22840	OrgProfitOrOwnershipPct
Ofcr Etc Profit Or Ownership	0.15340	OfcrEtcProfitOrOwnershipPct

Field	Value	IRS element (for citing)
Hospital Facilities	25	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp (25 entries)

FacilityFacilityNum	Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Website AddressWebsiteAddressTxt	State LicenseStateLicenseNum	Business Name Line1SubordinateHospitalName/BusinessNameLine1Txt	Subordinate Hospital EINSubordinateHospitalEIN	Licensed HospitalLicensedHospitalInd	General Medical And SurgicalGeneralMedicalAndSurgicalInd	Childrens HospitalChildrensHospitalInd	Teaching HospitalTeachingHospitalInd	Emergency Room24 HrsEmergencyRoom24HrsInd	Facility Reporting GroupFacilityReportingGroupCd	Critical Access HospitalCriticalAccessHospitalInd	OtherOtherDesc
Sanford USD Medical Center
1	1305 W 18th Street	Sioux Falls	SD	57117	www.sanfordhealth.org	SD 10564	Sanford Medical Center	460227855	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	A
Sanford Medical Center Fargo
2	5225 23rd Avenue S	Fargo	ND	58104	www.sanfordhealth.org	ND 5070	Sanford Medical Center Fargo	450226909	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	A
Sanford Broadway Medical Center Fargo
3	801 Broadway North	Fargo	ND	58122	www.sanfordhealth.org	ND 5018A	Sanford Medical Center Fargo	450226909	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	A
Sanford Medical Center South University
4	1720 South University	Fargo	ND	58103	www.sanfordhealth.org	ND 5068A	Sanford Medical Center Fargo	450226909	Yes (X)	Yes (X)		Yes (X)		A
Sanford Bismarck Medical Center
5	300 N 7th Street	Bismarck	ND	58501	www.sanfordhealth.org	ND 5003A	Sanford Bismarck	450226700	Yes (X)	Yes (X)		Yes (X)	Yes (X)	A
Sanford Bemidji Medical Center
6	1300 Anne Street NW	Bemidji	MN	56601	www.sanfordhealth.org	MN 371073	Sanford Health of Northern Minnesota	411266009	Yes (X)	Yes (X)			Yes (X)	A
Sanford Medical Center Thief River Falls
7	3001 Sanford Parkway	Thief River Falls	MN	56701	www.sanfordhealth.org	MN 371500	Sanford Health Network North	450409348	Yes (X)	Yes (X)			Yes (X)	A	Yes (X)	Inpatient Mental Health
Sanford Aberdeen Medical Center
8	2905 3rd Avenue SE	Aberdeen	SD	57401	www.sanfordhealth.org	SD 65089	Sanford Health Network	460388596	Yes (X)	Yes (X)			Yes (X)	A
Sanford Worthington Medical Center
9	1018 6th Avenue	Worthington	MN	56187	www.sanfordhealth.org	MN 371449	Sanford Health Network	460388596	Yes (X)	Yes (X)			Yes (X)	A
Sanford Sheldon Medical Center
10	118 N 7th Avenue	Sheldon	IA	51201	www.sanfordhealth.org	IA 161381	Sanford Health Network	460388596	Yes (X)	Yes (X)			Yes (X)	A	Yes (X)	Nursing Facility
Sanford Vermillion Medical Center
11	20 S Plum Street	Vermillion	SD	57069	www.sanfordhealth.org	SD 53082	Sanford Health Network	460388596	Yes (X)	Yes (X)			Yes (X)	A	Yes (X)	Nursing Facility
Sanford Chamberlain Medical Center
12	300 S Byron Blvd	Chamberlain	SD	57325	www.sanfordhealth.org	SD 50302	Sanford Health Network	460388596	Yes (X)	Yes (X)			Yes (X)	A	Yes (X)	Nursing Facility
Sanford Luverne Medical Center
13	1600 N Kniss Avenue	Luverne	MN	56156	www.sanfordhealth.org	MN 371352	Sanford Health Network	460388596	Yes (X)	Yes (X)			Yes (X)	A	Yes (X)
Sanford Canby Medical Center
14	112 St Olaf Avenue S	Canby	MN	56220	www.sanfordhealth.org	MN 371019	Sanford Health Network	460388596	Yes (X)	Yes (X)			Yes (X)	A	Yes (X)	Nursing Facility
Sanford Jackson Medical Center
15	1430 N Highway	Jackson	MN	56143	www.sanfordhealth.org	MN 371002	Sanford Health Network	460388596	Yes (X)	Yes (X)			Yes (X)	A	Yes (X)
Sanford Tracy Medical Center
16	251 5th Street E	Tracy	MN	56175	www.sanfordhealth.org	MN 371440	Sanford Health Network	460388596	Yes (X)	Yes (X)			Yes (X)	A	Yes (X)
Sanford Rock Rapids Medical Center
17	801 S Greene Street	Rock Rapids	IA	51246	www.sanfordhealth.org	IA 161321	Sanford Health Network	460388596	Yes (X)	Yes (X)			Yes (X)	A	Yes (X)
Sanford Hillsboro Medical Center
18	12 3rd Street SE	Hillsboro	ND	58045	www.sanfordhealth.org	ND 5026A	Sanford Health Network North	450409348	Yes (X)	Yes (X)			Yes (X)	A	Yes (X)
Sanford Medical Center Mayville
19	42 6th Avenue SE	Mayville	ND	58257	www.sanfordhealth.org	ND 5034A	Sanford Health Network North	450409348	Yes (X)	Yes (X)			Yes (X)	A	Yes (X)
Sanford Webster Medical Center
20	1401 W 1st Street	Webster	SD	57274	www.sanfordhealth.org	SD 10573	Sanford Health Network	460388596	Yes (X)	Yes (X)			Yes (X)	A	Yes (X)
Sanford Medical Center Wheaton
21	401 12th Street N	Wheaton	MN	56296	www.sanfordhealth.org	MN 371390	Sanford Health Network North	450409348	Yes (X)	Yes (X)			Yes (X)	A	Yes (X)
Sanford Bagley Medical Center
22	203 4th Street NW	Bagley	MN	56621	www.sanfordhealth.org	MN 371484	Sanford Health of Northern Minnesota	411266009	Yes (X)	Yes (X)			Yes (X)	A	Yes (X)
Sanford Canton-Inwood Medical Center
23	440 N Hiawatha Drive	Canton	SD	57013	www.sanfordhealth.org	SD 51569	Sanford Health Network	460388596	Yes (X)	Yes (X)			Yes (X)	A	Yes (X)
Sanford Clear Lake Medical Center
24	701 3rd Avenue S	Clear Lake	SD	57226	www.sanfordhealth.org	SD 10533	Sanford Health Network	460388596	Yes (X)	Yes (X)			Yes (X)	A	Yes (X)
Sanford Westbrook Medical Center
25	920 Bell Avenue	Westbrook	MN	56183	www.sanfordhealth.org	MN 371439	Sanford Health Network	460388596	Yes (X)	Yes (X)			Yes (X)	A	Yes (X)

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	Facility Reporting Group - A	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
First Licensed CY Or PY	0	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	0	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (1)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Prior CHNA Impact	Yes (X)	PriorCHNAImpactInd
CHNA Conducted	15	CHNAConductedYr
Take Into Account Others Input	Yes (1)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	Yes (1)	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	0	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (1)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	www.sanfordhealth.org/about/community-health-needs-assessment	OwnWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Rpt Available Thru Other Method	Yes (X)	RptAvailableThruOtherMethodInd
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	15	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (1)	StrategyPostedWebsiteInd
Strategy Website URL	www.sanfordhealth.org/about/community-health-needs-assessment	StrategyWebsiteURLTxt
Organization Incur Excise Tax	0	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (1)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	225.000000000000	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	375.000000000000	FPGFamilyIncmLmtDscntCarePct
Asset Level Criteria	Yes (X)	AssetLevelCriteriaInd
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Insurance Status Criteria	Yes (X)	InsuranceStatusCriteriaInd
Underinsurance Stat Criteria	Yes (X)	UnderinsuranceStatCriteriaInd
Residency Criteria	Yes (X)	ResidencyCriteriaInd
Other Criteria	Yes (X)	OtherCriteriaInd
Explained Basis	Yes (1)	ExplainedBasisInd
App Financial Asst Expln	Yes (1)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Provided Nonprofit Contact	Yes (X)	ProvidedNonprofitContactInd
Includes Publicity Measures	Yes (1)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	see narrative for full url	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	see narrative for full url	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	see narrative for full url	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill Display	Yes (X)	NotifiedFAPCopyBillDisplayInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
FAP Translated	Yes (X)	FAPTranslatedInd
Other Publicity	Yes (X)	OtherPublicityInd
FAP Actions On Nonpayment	Yes (1)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	0	CollectionActivitiesInd
Provided Written Notice	Yes (X)	ProvidedWrittenNoticeInd
Made Effort Orally Notify	Yes (X)	MadeEffortOrallyNotifyInd
Processed FAP Application	Yes (X)	ProcessedFAPApplicationInd
Made Presumptive Elig Determ	Yes (X)	MadePresumptiveEligDetermInd
Nondis Emergency Care Policy	Yes (1)	NondisEmergencyCarePolicyInd
Look Back Medicare Private	Yes (X)	LookBackMedicarePrivateInd
Amounts Generally Billed	0	AmountsGenerallyBilledInd
Gross Charges	0	GrossChargesInd

Supplemental Information SupplementalInformationGrp (146 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part V, Section B	Facility Reporting Group A
Facility Reporting Group A consists of:	- Facility 1: Sanford USD Medical Center, - Facility 3: Sanford Broadway Medical Center Fargo, - Facility 4: Sanford Medical Center South University, - Facility 5: Sanford Bismarck Medical Center, - Facility 6: Sanford Bemidji Medical Center, - Facility 7: Sanford Medical Center Thief River Falls, - Facility 8: Sanford Aberdeen Medical Center, - Facility 9: Sanford Worthington Medical Center, - Facility 10: Sanford Sheldon Medical Center, - Facility 11: Sanford Vermillion Medical Center, - Facility 12: Sanford Chamberlain Medical Center, - Facility 13: Sanford Luverne Medical Center, - Facility 14: Sanford Canby Medical Center, - Facility 15: Sanford Jackson Medical Center, - Facility 16: Sanford Tracy Medical Center, - Facility 17: Sanford Rock Rapids Medical Center, - Facility 18: Sanford Hillsboro Medical Center, - Facility 19: Sanford Medical Center Mayville, - Facility 20: Sanford Webster Medical Center, - Facility 21: Sanford Medical Center Wheaton, - Facility 22: Sanford Bagley Medical Center, - Facility 23: Sanford Canton-Inwood Medical Center, - Facility 24: Sanford Clear Lake Medical Center, - Facility 25: Sanford Westbrook Medical Center, - Facility 2: Sanford Medical Center Fargo
Group A-Facility 1 -- Sanford USD Medical Center Part V, Section B, line 5:	Sanford conducted a community health needs assessment during FY 2016 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2016 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County, North Dakota and Clay County, Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor, to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding community health, their personal health, preventive health, and the prevalence of disease. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during FY 2017-2019. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and response to the community health needs assessment and the implementations strategies are welcome on the Sanford website under "About Sanford" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA
Group A-Facility 1 -- Sanford USD Medical Center Part V, Section B, line 6a:	Sanford Fargo Medical CenterSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
Group A-Facility 1 -- Sanford USD Medical Center Part V, Section B, line 7d:	Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
Group A-Facility 1 -- Sanford USD Medical Center Part V, Section B, line 11:	The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Crime/Safety - Pharmaceutical Narcotics in the CommunitySanford USD Medical Center will standardize narcotic prescribing protocols across the enterprise to reduce usage. Narcotic prescriptions will be tracked internally and areas for improvement will be identified.Priority 2: Chronic DiseaseSanford is dedicated to improving health outcomes by monitoring BMI through quality metrics and referring to internal/external services to improve the care of patients with overweight or obesity diagnosis. The Sanford fit Program will be available to all local schools, students and families in the area through the classroom modules and the fit website. Sanford will address diabetes by adopting optimal diabetes care for patients ages 18-75 with diabetes. Sanford will standardize hypertension protocols in all primary care settings, and will adopt standardized protocols for optimal vascular care.Addressing of Significant Needs during Current Year:Priority 1: Crime/Safety- Reduce Pharmaceutical Narcotics in the CommunitySanford developed strategy to reduce narcotic use across the system by providing alternative pain management methods. Policies and procedures to address the prescription of narcotics have been standardized across the healthcare system. The measureable outcome for this implementation strategy is to track narcotic prescriptions and identify areas for improvement. Pain medication prescriptions are continuously tracked and studied to identify areas for improvement. There has been a 28% reduction in the prescription of narcotics since beginning this initiative in 2017.Priority 2: Chronic DiseasePhysical HealthSanford has set strategy to improve the care of patients with overweight or obesity diagnosis. Patients who are overweight will be referred to internal and external services including registered dietitians, exercise physiologists, and RN Health Coaches. The measureable outcome for this implementation strategy is to track the referrals. From 2017 through Q3 of 2018, the referrals for follow-up interventions have increased. The current rate of referral is 46.2%.The Sanford fit initiative, http://sanfordfit.org/, a childhood obesity prevention initiative, continues to grow and mature while refining the offerings and enabling broad replication and meaningful use. Supported by the clinical experts of Sanford, fit educates, empowers and motivates families to live a healthy lifestyle through a comprehensive suite of resources for children, parents, teachers and clinicians. fit is the only initiative focusing equally on the four key contributing factors to childhood obesity: Food (nutrition), Move (activity), Mood (behavioral health), and Recharge (sleep). Sanford's fit initiative has come a long way since its inception in 2010. Through fit, healthy lifestyles are actively being promoted in homes, schools, daycares, clinical settings, and throughout the community by way of technology, engaging programs, and utilizing key role models in a child's life. Since 2017, Sanford has presented the Sanford fit program to live audiences and has reached 5,075 individuals through interactive engagement. Sanford fit is available in classrooms across the Sioux Falls area with 8,179 students currently using the curriculum. The Sanford fit online program is available nationwide and has over 22 million views with 198,000 engagements.DiabetesSanford has set strategy to provide optimal diabetes care and to measure the outcomes for systolic and diastolic blood pressure, LDL cholesterol, hemoglobin A1C, tobacco use and aspirin use. These outcomes are part of the optimal care recommendations for people living with diabetes. The measureable outcomes are systolic blood pressure of <140, diastolic blood pressure of <90, LDL per statin indication, HbA1C < 8, tobacco free, and a daily aspirin if ischemic vascular disease. Currently at Sanford, 49.4% of patients with diabetes are at optimal outcomes.HypertensionSanford has set strategy to address hypertension through standardized protocol, frequent blood pressure monitoring, and referral. Outcomes measures include a blood pressure of less than 140/90 for all ages 18-59, and for age 60+ with diabetes, vascular or renal disease. For patients 60 or older without diabetes, vascular or renal disease the goal is a blood pressure of 150/90. Eighty-eight percent of patients with hypertension are now under control with a blood pressure of <140/90.Ischemic Vascular DiseaseSanford has set strategy to address ischemic vascular disease by standardizing protocols for optimal vascular care. Outcome measures include systolic blood pressure <140, diastolic blood pressure < 90, LDL statin indications, tobacco free recommendations, and a daily use of aspirin. Currently at Sanford 63% have met the outcomes for optimal care.Identified needs not directly addressed by this facility include: Aging - Cost of long term care Child and Youth - Bullying Access to Health Care - Access to affordable health insurance, Access to affordable health, Access to affordable prescription drugs Mental Health - Underage drug use and abuse, Alcohol abuse
Group A-Facility 1 -- Sanford USD Medical Center Part V, Section B, line 13h:	Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
Group A-Facility 1 -- Sanford USD Medical Center Part V, Section B, line 16j:	Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
Group A-Facility 3 -- Sanford Broadway Medical Center Fargo Part V, Section B, line 5:	Sanford conducted a community health needs assessment during FY 2016 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2016 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County, North Dakota and Clay County, Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor, to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding community health, their personal health, preventive health, and the prevalence of disease. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during FY 2017-2019. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and response to the community health needs assessment and the implementations strategies are welcome on the Sanford website under "About Sanford" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA
Group A-Facility 3 -- Sanford Broadway Medical Center Fargo Part V, Section B, line 6a:	Sanford USD Medical Center Sioux FallsSanford Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
Group A-Facility 3 -- Sanford Broadway Medical Center Fargo Part V, Section B, line 7d:	Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
Group A-Facility 3 -- Sanford Broadway Medical Center Fargo Part V, Section B, line 11:	The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: HypertensionSanford Fargo Medical Center will reduce the number of patients with uncontrolled hypertension. Standardized nursing protocol for blood pressure checks and rechecks is a strategy that has been implemented throughout the medical center.Priority 2: DepressionSanford has prioritized depression as a top priority and has implemented strategy to perform assessments for depression and to improve PHQ-9 scores and the severity for patients with depression.Priority 3: Flu Vaccines Sanford has prioritized flu vaccines and has implemented strategy to increase the number of flu vaccines provided to community members. Sanford will develop consumer education materials, and conduct flu blitz clinics at various locations in the community. Addressing of Significant Needs during Current Year:Priority 1: HypertensionHypertension is a risk factor for cardiovascular disease, and contributes to premature death from heart attack, stroke, diabetes and renal disease. The North Dakota Department of Health reports that 27.7% of the population in Cass County has been told by their provider that they have hypertension.Sanford prioritized hypertension as a top priority for 2017-2019, and has set strategy to standardize nursing protocol for blood pressure checks and rechecks. The goal is to reduce the number of patients with uncontrolled hypertension. The measureable outcome is the number of patients with blood pressure < 140/90. This goal has been reached for 87.8% of patients with hypertension.Priority 2: DepressionDepression is a common but serious illness that can interfere with daily life. Many people with a depressive illness never seek treatment. However, the majority, even those with the most severe depression, can get better with treatment. The North Dakota Department of Health reports that 11.9% of residents in Cass County have reported fair or poor mental health days. County Health Rankings for Clay County indicate that 11% of the residents have fair or poor mental health.Sanford has prioritized depression as a top priority and has set strategy to perform assessments for depression and to improve PHQ-9 scores for patients who are diagnosed with depression. The goal is to improve PHQ-9 scores for patients with depression. The measurable outcome is the percentage of patients with major depression or dysthymia and an initial PHQ-9 score greater than 9 whose 6-month PHQ-9 score is less than 5. This goal has been reached by 10.7% of patients with a depression diagnosis.Priority 3: Flu VaccinesThe CDC states that influenza is a serious disease that can lead to hospitalization and sometimes even death. Every flu season is different, and influenza infection can affect people differently. Even healthy people can get very sick from the flu and spread it to others. The North Dakota Department of Health reports that 33.5% of adults age 65 and older did not receive a flu vaccine in the past year. Respondents to the CHNA generalizable survey report that 26% of children 18 years and younger did not receive a flu vaccine in the past year.Sanford has prioritized flu vaccines as a top priority and has set strategy to increase the number of flu vaccines provided to community members. The goal is to increase the number of flu vaccines provided to community members. The measurable outcomes are the number of flu vaccines given to adults each year and the number of flu vaccines given to the pediatric population each year. The combined number of flu vaccines given in FY 2016 was 2675, in FY 2017, it was 2518 and in FY 2018, the total was 2017.Identified needs not directly addressed by this facility include: Economics - Availability of affordable housing, Hunger Aging - Cost of long term care, Availability of memory care, Availability of LTC Children and Youth - Bullying, Cost of quality child care, Cost of quality infant care, Availability of quality child care, Availability of quality infant care, Cost of services for at risk youth Safety - Presence of street drugs and alcohol in the community, Presence of drug dealers in the community, Crime, Child abuse and neglect, Domestic violence, Presence of gang activity in the community, Sex trafficking Health care - Access to affordable health insurance, Access to affordable health care, Access to affordable prescription drugs, Timely access to substance abuse providers, Cost of affordable dental insurance coverage, Use of emergency room for primary care, Cost of affordable vision insuranceAll assessed needs that are healthcare related are being addressed at Sanford. Sanford is not developing strategies to address the cost of long term care and the availability of long term care and memory care in the Fargo-Moorhead area. Long-term care cost and access is an area of care that Sanford is not directly addressing because there are organizations in the community that are working on these needs. Additional concerns that will not be addressed directly by strategy include bullying among children and youth, the cost of quality child care and the cost of quality infant care. The results of the CHNA have been shared with community leaders, and those who have expertise in the areas that are not being addressed directly by Sanford. Sanford Medical Center Fargo will standardize narcotic prescribing protocols across the enterprise to reduce usage. Narcotic prescriptions will be tracked internally and areas for improvement will be identified.
Group A-Facility 3 -- Sanford Broadway Medical Center Fargo Part V, Section B, line 13h:	Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
Group A-Facility 3 -- Sanford Broadway Medical Center Fargo Part V, Section B, line 16j:	Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
Group A-Facility 4 -- Sanford Medical Center South University Part V, Section B, line 5:	Sanford conducted a community health needs assessment during FY 2016 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2016 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County, North Dakota and Clay County, Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor, to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding community health, their personal health, preventive health, and the prevalence of disease. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during FY 2017-2019. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and response to the community health needs assessment and the implementations strategies are welcome on the Sanford website under "About Sanford" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA
Group A-Facility 4 -- Sanford Medical Center South University Part V, Section B, line 6a:	Sanford USD Medical Center Sioux FallsSanford Fargo Medical CenterSanford Broadway Medical Center FargoSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
Group A-Facility 4 -- Sanford Medical Center South University Part V, Section B, line 7d:	Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
Group A-Facility 4 -- Sanford Medical Center South University Part V, Section B, line 11:	The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: HypertensionSanford Medical Center South University will reduce the number of patients with uncontrolled hypertension. Standardized nursing protocol for blood pressure checks and rechecks is a strategy that has been implemented throughout the medical center.Priority 2: DepressionSanford has prioritized depression as a top priority and has implemented strategy to perform assessments for depression and to improve PHQ-9 scores and the severity for patients with depression. PHQ-9 score is a standardized tool used to assess depression. The goal is to lower the score from the original starting point. Sanford uses the PHQ-9 screening tool in primary care settings across the system.Priority 3: Flu Vaccines Sanford has prioritized flu vaccines and has implemented strategy to increase the number of flu vaccines provided to community members. Sanford will develop consumer education materials, and conduct flu blitz clinics at various locations in the community. Addressing of Significant Needs during Current Year:Priority 1: HypertensionHypertension is a risk factor for cardiovascular disease, and contributes to premature death from heart attack, stroke, diabetes and renal disease. The North Dakota Department of Health reports that 27.7% of the population in Cass County has been told by their provider that they have hypertension.Sanford prioritized hypertension as a top priority for 2017-2019, and has set strategy to standardize nursing protocol for blood pressure checks and rechecks. The goal is to reduce the number of patients with uncontrolled hypertension. The measureable outcome is the number of patients with blood pressure < 140/90. This goal has been reached for 87.8% of patients with hypertension.Priority 2: DepressionDepression is a common but serious illness that can interfere with daily life. Many people with a depressive illness never seek treatment. However, the majority, even those with the most severe depression, can get better with treatment. The North Dakota Department of Health reports that 11.9% of residents in Cass County have reported fair or poor mental health days. County Health Rankings for Clay County indicate that 11% of the residents have fair or poor mental health.Sanford has prioritized depression as a top priority and has set strategy to perform assessments for depression and to improve PHQ-9 scores for patients who are diagnosed with depression. The goal is to improve PHQ-9 scores for patients with depression. The measurable outcome is the percentage of patients with major depression or dysthymia and an initial PHQ-9 score greater than 9 whose 6-month PHQ-9 score is less than 5. This goal has been reached by 10.7% of patients with a depression diagnosis.Priority 3: Flu VaccinesThe CDC states that influenza is a serious disease that can lead to hospitalization and sometimes even death. Every flu season is different, and influenza infection can affect people differently. Even healthy people can get very sick from the flu and spread it to others. The North Dakota Department of Health reports that 33.5% of adults age 65 and older did not receive a flu vaccine in the past year. Respondents to the CHNA generalizable survey report that 26% of children 18 years and younger did not receive a flu vaccine in the past year.Sanford has prioritized flu vaccines as a top priority and has set strategy to increase the number of flu vaccines provided to community members. The goal is to increase the number of flu vaccines provided to community members. The measurable outcomes are the number of flu vaccines given to adults each year and the number of flu vaccines given to the pediatric population each year. The combined number of flu vaccines given in FY 2016 was 2675, in FY 2017, it was 2518 and in FY 2018, the total was 2017.Identified needs not directly addressed by this facility include: Economics - Availability of affordable housing, Hunger Aging - Cost of long term care, Availability of memory care, Availability of LTC Children and Youth - Bullying, Cost of quality child care, Cost of quality infant care, Availability of quality child care, Availability of quality infant care, Cost of services for at risk youth Safety - Presence of street drugs and alcohol in the community, Presence of drug dealers in the community, Crime, Child abuse and neglect, Domestic violence, Presence of gang activity in the community, Sex trafficking Health care - Access to affordable health insurance, Access to affordable health care, Access to affordable prescription drugs, Timely access to substance abuse providers, Cost of affordable dental insurance coverage, Use of emergency room for primary care, Cost of affordable vision insuranceAll assessed needs that are healthcare related are being addressed at Sanford. Sanford is not developing strategies to address the cost of long term care and the availability of long term care and memory care in the Fargo-Moorhead area. Long-term care cost and access is an area of care that Sanford is not directly addressing because there are organizations in the community that are working on these needs. Additional concerns that will not be addressed directly by strategy include bullying among children and youth, the cost of quality child care and the cost of quality infant care. The results of the CHNA have been shared with community leaders, and those who have expertise in the areas that are not being addressed directly by Sanford. Sanford Medical Center South University will standardize narcotic prescribing protocols across the enterprise to reduce usage. Narcotic prescriptions will be tracked internally and areas for improvement will be identified.
Group A-Facility 4 -- Sanford Medical Center South University Part V, Section B, line 13h:	Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
Group A-Facility 4 -- Sanford Medical Center South University Part V, Section B, line 16j:	Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
Group A-Facility 5 -- Sanford Bismarck Medical Center Part V, Section B, line 5:	Sanford conducted a community health needs assessment during FY 2016 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2016 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County, North Dakota and Clay County, Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor, to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding community health, their personal health, preventive health, and the prevalence of disease. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during FY 2017-2019. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and response to the community health needs assessment and the implementations strategies are welcome on the Sanford website under "About Sanford" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA
Group A-Facility 5 -- Sanford Bismarck Medical Center Part V, Section B, line 6a:	Sanford USD Medical Center Sioux FallsSanford Fargo Medical CenterSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
Group A-Facility 5 -- Sanford Bismarck Medical Center Part V, Section B, line 7d:	Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
Group A-Facility 5 -- Sanford Bismarck Medical Center Part V, Section B, line 11:	The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Access to affordable careSanford Bismarck Medical Center is increasing the percentage of community members accessing preventive and acute care in appropriate settings. Sanford is establishing a Family Wellness Center to provide year-round health and wellness opportunities for community members and is also providing education to make patients aware of the best coverage options through a "no wrong door" policy to help community members secure health coverage and/or financial assistance through the Sanford financial assistance (Community Care) program.Priority 2: Substance abuseSanford will work with community stakeholders to identify gaps in the community's substance abuse continuum of care and to improve access to care. Sanford Bismarck Medical Center will standardize narcotic prescribing protocols across the enterprise to reduce usage. Narcotic prescriptions will be tracked internally and areas for improvement will be identified.Addressing of Significant Needs during Current Year:Priority 1: Access to Affordable CareTo help uninsured and underinsured patients secure access to care, Sanford integrated full-time, on-site financial advocates help uninsured and underinsured patients apply for health coverage and apply for Sanford's financial assistance program. Sanford worked with local public health officials to help patients in need to access care and prescription medication. Sanford provided support and assistance to underserved and vulnerable populations via community volunteer work, including the Bismarck/Mandan emergency homeless shelter, and provided Medicaid enrollment assistance on site at the Standing Rock Sioux Reservation. Sanford also facilitated MyChart access for Ruth Meiers transitional housing residents.To increase access to services and facilities that foster healthy lifestyles, Sanford completed construction of the Family Wellness Center in 2017, which is a partnership between Sanford and the Missouri Valley Family YMCA. The community facility features more than 70 fitness classes for members of all ages, a gymnasium, indoor track and child watch services. In 2017, more than 2,000 Bismarck-Mandan area individuals and families joined Family Wellness and more than $12,000 in financial assistance was granted to children and families in need.Sanford hosted the Edith Sanford Run/Walk for Breast Cancer, an annual breast cancer awareness event that features a 5K run and walk as well as a comprehensive education fair that includes information regarding prevention, screening, treatment and community support programs.Sanford also established Better Choices, Better Health, a chronic disease self-management program designed to help adults manage the symptoms of diabetes, arthritis, heart disease, stroke, asthma, lung disease, pain, depression and anxiety. The evidence-based program is free to patients with chronic disease and caregivers.Priority 2: Substance AbuseSanford built partnerships with community stakeholders and donated leadership for one year to launch Face It TOGETHER, a community-based approach to addressing addiction in Bismarck-Mandan. Serving as interim director, Sanford leadership focused on increasing community stakeholder awareness of addiction recovery services and securing funding to hire a full-time executive director.Sanford served in a community collaborative to bring Caring for Our Community: Time to Talk Opioids, a six-part opioid education series designed for healthcare providers and community members, to the provider community and to community key stakeholders. Topics include recognizing addiction in the workplace, removing stigma and shame barriers, socioeconomic impact, diversion, strategies to reduce overdose-related deaths, and evidenced-based treatment programs including peer recovery coaching and medication assisted treatment (MAT).During 2016, Sanford executed the Sanford Opioid Stewardship initiative through the Sanford Quality Cabinet to reduce the volume of opioids prescribed to patients experiencing pain while integrating evidence-based, best practice strategies to manage pain effectively. From January 2016 to June 2017 Sanford providers reduced the number of opioid prescriptions by 30%.Sanford also facilitated a community stakeholder project to eliminate barriers to help law enforcement appropriately triage individuals under the influence of drugs or alcohol.Identified needs not directly addressed by this facility include: Aging Population - Cost of long term care, Availability of memory care, Availability of long term care, Availability of resources to help elderly stay in their homes, Availability of resources for family/friends caring/making decisions for elders Children and Youth - Cost of quality child care, Availability of quality child care, Cost of quality infant care, Availability of quality infant care, Bullying, Youth crime Crime/Safety - Presence of street drugs, prescription drugs and alcohol, Crime, Presence of drug dealers in the community, Child abuse and neglect, Sex trafficking, Domestic violence, Presence of gang activity, Elder abuse Economics - Availability of affordable housing, Homelessness, Hunger Physical Health - Chronic disease, Inactivity/lack of exercise, Poor nutrition, Obesity Diversity - Access to translators/bilingual providers Mental Health - Depression, Stress, Suicide, Other psychiatric diagnosis, Dementia and Alzheimer's disease Transportation - Driving habits, Availability of good walking or biking options Environment - Hazardous water, Water quality, Air quality, Home septic systems
Group A-Facility 5 -- Sanford Bismarck Medical Center Part V, Section B, line 13h:	Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
Group A-Facility 5 -- Sanford Bismarck Medical Center Part V, Section B, line 16j:	Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
Group A-Facility 6 -- Sanford Bemidji Medical Center Part V, Section B, line 5:	Sanford conducted a community health needs assessment during FY 2016 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2016 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County, North Dakota and Clay County, Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor, to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding community health, their personal health, preventive health, and the prevalence of disease. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during FY 2017-2019. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and response to the community health needs assessment and the implementations strategies are welcome on the Sanford website under "About Sanford" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA
Group A-Facility 6 -- Sanford Bemidji Medical Center Part V, Section B, line 6a:	Sanford USD Medical Center Sioux FallsSanford Fargo Medical CenterSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
Group A-Facility 6 -- Sanford Bemidji Medical Center Part V, Section B, line 7d:	Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
Group A-Facility 6 -- Sanford Bemidji Medical Center Part V, Section B, line 11:	The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Behavioral healthSanford Bemidji Medical Center has set strategy to reduce mortality and morbidity from chemical addiction and mental health disease by participating in a community partnership to develop a continuum of care for behavioral health services and to offer psychiatry and psychology services in the ambulatory setting. Sanford will also enhance the level of behavioral health services available in the inpatient setting. Sanford Bemidji Medical Center will standardize narcotic prescribing protocols across the enterprise to reduce usage. Narcotic prescriptions will be tracked internally and areas for improvement will be identified.Priority 2: Children and YouthSanford has set strategy to reduce the number of infants born to mothers who are opioid users by developing a case management system to work with pregnant women and to also coordinate medical assisted therapy options for pregnant women at risk of opioid use. Additionally, Sanford will enhance the level of care available to high risk infants born in Sanford Bemidji Medical Center.Sanford will also provide the Sanford fit program to the local schools and make the program available to families in the area through the fit website.Addressing of Significant Needs during Current Year:Priority 1: Behavioral HealthGoal 1: Participate in the planning for development of a community-based continuum of behavioral health servicesA community collaborative of 15-20 individuals in several community service organizations has been working on a mental health service inventory, a gap analysis, a prioritization of community need's and program start up. Since the inception of this effort in 2016, Sanford has been part of the start-up of an Assertive Community Treatment program for mentally ill adults, the expansion of several other mental health programs, the start-up of a Medication Therapy Program and the associated chemical dependency treatment services, and the development of a residential treatment center and detoxification beds. The plan developed by the collaborative calls for the development of added CD treatment, youth programs and other community-based programs.The ACT program, which now serves over 40 people with serious and persistent mental illness, affected the community by providing a host of supportive services so individuals can live in their own homes, secure jobs, avoid readmission to acute psychiatric medical centers, and stay out of jail and emergency rooms. The individuals served through these services report that their quality of life is much improved.Goal 2: Offer psychiatry and psychology services in the ambulatory settingIn 2017 and 2018, Sanford Bemidji has added three psychiatric nurse practitioners, four psychologists and several other independent licensed therapists. Recruitment of psychiatry remains a high priority and telemedicine psychiatry is available for inpatients and clinic patients on a scheduled basis.Goal 3: Enhance the level of behavioral health services available to patients hospitalized at Sanford Bemidji Medical CenterThe implementation of scheduled tele-psychiatry for inpatients has improved the ability to evaluate and treat inpatients at Sanford Bemidji Medical Center appropriately. With the affiliation with Upper Mississippi Mental Health Center, the access to the mobile crisis team has improved by placement of this staff directly in the medical center, allowing them to respond to behavioral health crises both in the ER and in the inpatient units.Priority 2: Children and YouthGoal 1: Reduce the number of infants born addicted to opioidsWith the support of a grant from PrimeWest, Sanford Bemidji implemented a program entitled First Steps to Healthy Newborns, providing education, prevention, early intervention and support for opioid exposed newborns and mothers. In addition to the development of community educational material, this program includes chemical dependency counseling, case management and medication-assisted therapy for pregnant women using opioids.Although it is early in the program's existence, First Steps to Healthy Newborns saw an impact. For the first time in several years, the number of opioid exposed babies born at Sanford Bemidji Medical Center did not increase but remained flat during 2017. The program is currently expanding to include other adults, not just pregnant women.Goal 2: Enhance the level of care available for high-risk infants born in Sanford Bemidji Medical CenterThe volume of high-risk deliveries in the Sanford Bemidji Medical Center is high in proportion to the number of total deliveries. The population served by Sanford Bemidji has several high-risk factors. The need to assure fast, safe access to caesarian section capabilities and immediate access to a higher level of nursery care for infants were two identified strategies to improve care for infants and mothers.In 2017, a new Level 2 nursery was constructed, offering individual nursery bays, expanded nutritional services and other secondary services to support lower weight infants born in Bemidji.In June of 2018, Sanford Bemidji Medical Center opened a surgical suite on its obstetrics floor, dedicated to performing C-section deliveries and other OB-related procedures. This new OR suite assures faster, safer, more responsive care for babies and for families requiring C-section deliveries.Goal 3: Improve the availability of programs for youth across the communityIn 2017, Sanford affiliated with the Upper Mississippi Mental Health Center to better support the development and growth of mental health programs in the region. This has allowed Sanford to add new staff to better serve children in the local schools by growing the resources in Sanford children's mental health programs.In 2018, Sanford sponsored a program called No Hungry Child, funding meals and underwriting costs for the area schools to provide meals year round to children and, in summer months, their families, so no child goes without food. Sanford also underwrote the expansion of a program called Backpack Buddies to all local schools, where backpacks with healthy meals are sent home on Fridays with students who might otherwise not have food over the weekend.Additionally, Sanford is exploring the feasibility of a community Sports and Wellness Center to offer children and families an environment for healthy physical activities, educational programs on healthy living and cooking, wellness and fitness classes, as well as a recreational sports and swimming venue. This project is still in the evaluation stage and does not have a target completion date.Identified needs not directly addressed by this facility include: Economics - Availability of affordable housing Transportation - Availability of public transportation Aging - Cost of long term care, Availability of long term care, Availability of resources for caregivers making decisions, Availability of memory care, Availability of resources to help the elderly stay in their homes, Availability of resources for grandparent caregivers for grandchildren, Understanding of advanced care directives Safety - Child abuse and neglect, Crime, Presence of street drugs, prescription drugs and alcohol, Presence of drug dealers, Domestic violence, Presence of gang activity, Elder abuse, Safe places for outdoor youth activities, Sex trafficking Health care - Access to affordable health insurance, Access to affordable health care, Access to affordable prescription drugs, Cost of affordable dental insurance, Use of emergency services for primary care, Cost of affordable vision insurance, Timely access to mental health/behavioral health providers, Availability of non-traditional hours, Timely access to physician specialists, Coordination of care between providers and services Physical Health - Cancer, Inactivity, Obesity Chronic disease, Poor nutrition Preventive Health - Flu shots
Group A-Facility 6 -- Sanford Bemidji Medical Center Part V, Section B, line 13h:	Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
Group A-Facility 6 -- Sanford Bemidji Medical Center Part V, Section B, line 16j:	Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
Group A-Facility 7 -- Sanford Medical Center Thief River Falls Part V, Section B, line 5:	Sanford conducted a community health needs assessment during FY 2016 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2016 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County, North Dakota and Clay County, Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor, to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding community health, their personal health, preventive health, and the prevalence of disease. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during FY 2017-2019. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and response to the community health needs assessment and the implementations strategies are welcome on the Sanford website under "About Sanford" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA
Group A-Facility 7 -- Sanford Medical Center Thief River Falls Part V, Section B, line 6a:	Sanford USD Medical Center Sioux FallsSanford Fargo Medical CenterSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
Group A-Facility 7 -- Sanford Medical Center Thief River Falls Part V, Section B, line 7d:	Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
Group A-Facility 7 -- Sanford Medical Center Thief River Falls Part V, Section B, line 11:	The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Mental Health/Behavioral HealthSanford Thief River Falls Medical Center has set strategy for the Behavioral Health Center to become CMS certified as a free-standing psychiatric hospital. Sanford will also develop a partial hospitalizations program and work to develop partnerships with regional behavioral health organizations.Priority 2: Physical HealthSanford will expand the wellness center and focus on a Kids Unite wellness center. Sanford will Partner with community organizations to plan and develop a self-sustaining community center. Additionally, Sanford will provide Sanford Fit program was introduced to local schools and child care organizations and will continue to enroll patients into the Medical Home. Addressing of Significant Needs during Current Year:Priority 1: Mental Health/Behavioral HealthIn October 2015, Sanford Thief River Falls moved into the newly renovated space for the Sanford Behavioral Health Center, a 16-bed freestanding psychiatric medical center and the only one in the Sanford Enterprise. In order to receive payments from Federal and commercial payors it was necessary to become certified by the Centers for Medicare and Medicaid Services (CMS). The survey was conducted in January 2016 and the center received Federal certification in April 2016. Federal surveyors contracted by CMS rather than the Minnesota Department of Health surveyors performed the survey. The reason for this was because there are so few freestanding psychiatric medical centers in Minnesota that the Department of Health cannot maintain surveyor proficiency and competencies. Obtaining certification was an arduous process but well worth the effort - bringing a higher level of behavioral and mental health services to the region. It has also enabled Sanford to recruit more professionals to the area, improving access and services available to the region that is served.After an extensive analysis of the regulatory requirements, reimbursement systems for the partial hospitalization program and the elements required to provide a quality program of care, it was determined that at this point in time a partial hospitalization program would not be economically feasible. This initiative has been tabled for review in the future.The Sanford Behavioral Health Center has worked very hard since certification to develop partnerships with other local, regional and state programs, and agencies having a role in delivering behavioral and mental health services. The term "partnership" is used rather loosely as it is often more akin to developing relationships that provide additional resources to Sanford's patient population, whether on an inpatient or outpatient basis. Critical or high priority relationships continue to be cultivated with the surrounding county social service agencies, as they most often have reasons to interface with a large proportion of the individuals seeking behavioral or mental healthcare. These relationships are crucial to delivering high quality, high impact services throughout the region.Priority 2: Physical HealthGoal 1: Expanded Wellness CenterSince 2016 Sanford Thief River Falls has expanded the physical footprint of the Wellness Center by 30,000 square feet, making it the largest wellness center in Thief River Falls and within a 60-mile radius as well. The most significant expansion project was the addition of a kid's area, funded entirely through the Sanford Foundation Thief River Falls which contributed nearly $300,000 for this initiative. The Wellness Center now has an area that is the best in this region, specifically focused on children and addressing all levels of fitness, through integrated play systems, instructor-led classes and space for relaxation. Memberships, both family and individual, have also grown significantly (by nearly 33%) since the opening of the kid's fitness area. The Wellness Center currently has over 1,600 members, doubling from 800 members when moving into the current space in September 2014. Growth has been steady.Goal 2: Develop a community centerThis initiative requires the collaboration of many local/regional organizations as well as governmental agencies if Thief River Falls is ever to see a community center developed. Since 2016 interest in developing a community center in Thief River Falls has lost traction among the needed partners and as such has not progressed. This initiative is still very much on the minds of the community; undoubtedly surfacing in the years to come with Sanford Thief River Falls ready to partner with the community when the time comes.Goal 3: Improve the availability for exercise and nutrition education across the communityThe primary impact Sanford has had on this goal has been through the relocation and expansion of the Wellness Center. As noted above, memberships have doubled in four years with no slowing in momentum. The interest in exercise, individual as well as group classes, has exceeded expectations and has required a number of additions to the teaching staff. Sanford has a number of dietetic nutrition counselors in the primary care clinic, working hand in hand with providers, providing nutrition counseling and education for patients and families.Goal 4: Continued growth of Sanford Medical HomeThis is an area where Sanford Thief River Falls has not seen as much growth in as previously predicted. The focus initially has been on patients with chronic conditions. However, with the recent transition to team-based care in the primary clinic there is an opportunity to expand this emphasis to every patient.Identified needs not directly addressed by this facility include: Economics - Availability of affordable housing Transportation - Availability of good walking or biking paths Aging - Cost of long term care, Availability of memory care, Availability of resources to help the elderly stay safe in their homes Children and Youth - Availability of quality infant care, Availability of quality child care, Availability of activities for children and youth, Cost of activities for children and youth, Cost of quality infant care, Bullying, Cost of quality child care, Teen pregnancy, Availability of services for at-risk youth Safety - Presence of street drugs and alcohol in the community, Presence of drug dealers in the community, Domestic violence Health care - Access to affordable health insurance, Access to affordable prescription drugs, Access to affordable health care, Availability of non-traditional hours, Cost of affordable dental insurance coverage, Use of emergency services for primary care Preventive health - Flu shots, Immunizations, Not seeing a health care provider or dentist within the past yearSanford will not directly develop strategy to address the availability of affordable housing, walking and biking paths, the availability and cost of quality infant and child care, the availability and cost of activities for children and youth (except for the Sanford fit Program), bullying, teen pregnancy, services for at-risk youth, the presence of street drugs, drug dealers in the community, and domestic violence. However, Sanford serves as a partner in many community groups that have the expertise to address these unmet needs. Sanford has shared the findings of the CHNA and the needs with community leaders and public health agencies in the area. Sanford Medical Center Thief River Falls will standardize narcotic prescribing protocols across the enterprise to reduce usage. Narcotic prescriptions will be tracked internally and areas for improvement will be identified.
Group A-Facility 7 -- Sanford Medical Center Thief River Falls Part V, Section B, line 13h:	Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
Group A-Facility 7 -- Sanford Medical Center Thief River Falls Part V, Section B, line 16j:	Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
Group A-Facility 8 -- Sanford Aberdeen Medical Center Part V, Section B, line 5:	Sanford conducted a community health needs assessment during FY 2016 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2016 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County, North Dakota and Clay County, Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor, to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding community health, their personal health, preventive health, and the prevalence of disease. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during FY 2017-2019. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and response to the community health needs assessment and the implementations strategies are welcome on the Sanford website under "About Sanford" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA
Group A-Facility 8 -- Sanford Aberdeen Medical Center Part V, Section B, line 6a:	Sanford USD Medical Center Sioux FallsSanford Fargo Medical CenterSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
Group A-Facility 8 -- Sanford Aberdeen Medical Center Part V, Section B, line 7d:	Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
Group A-Facility 8 -- Sanford Aberdeen Medical Center Part V, Section B, line 11:	The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Physical Health/ObesitySanford Aberdeen Medical Center will provide the Sanford fit Program to all students and families through classroom modules and the fit website.Priority 2: Mental Health/DepressionSanford is committed to improving the care of patients with depression diagnosis and will perform depression assessments, and implement health coaches and primary care staff into the care process.Addressing of Significant Needs during Current Year:Priority 1: Physical Health/ObesitySanford Aberdeen Medical Center focused on the pediatrics population by providing Sanford fit program materials to area schools and childcare centers and promoting health and wellness. Sanford fit is available to all students and families through classroom and/or online through the Sanford fit website.In addition, Sanford continues to offer educational sessions for the community:Cooking classes and nutrition education to student athletesNutrition presentations to groups with cancer and other chronic conditions (breast cancer, COPD, diabetes, etc.)Participation in community health fairsNutrition education for pregnant women and new moms (B4 Baby)Introduction of Solids (nutrition class series) for new parentsParticipation in TV, radio, and newspaper interviews regarding nutrition topics in the newsDiabetes Prevention ProgramCooking with the Cardiologist for community members to attendParticipation in various community youth events through the schools (middle school/high school) promoting good nutritionPriority 2: Mental Health/DepressionSanford developed a depression assessment tool for patients to complete during a clinic visit. Sanford Aberdeen Medical Center also added an Integrated Health Therapist (IHT) to the team as a resource along with RN Health Coaches and a care coordination assistant.The Integrated Health Therapist (IHT) serves as an integral core team member within the patient- centered Medical Home. The IHT works with the physician, advanced practice provider, RN Health Coach, nurses, care coordinator assistant, peer support advocate and community partners, all of whom work collaboratively to provide the best care to patients. The IHT is an important resource for patients and team members for issues related to mental and behavioral health, chemical health, psychosocial aspects of health and disease, and lifestyle management to support optimal patient functioning.Identified needs not directly addressed by this facility include: Economics - Availability of affordable housing Environment - Good water quality Aging - Cost of long term care, Availability of memory care Children and Youth - Bullying, Cost of quality infant care Safety - Presence of street drugs and alcohol in the community, Domestic violence, Child abuse Health care - Access to affordable health insuranceSanford will not directly develop strategy to address the availability of affordable housing, good water quality, the cost of long term care and the availability of memory care, the cost of quality infant care, and the presence of street drugs and alcohol in the community. However, Sanford serves as a partner in many community groups that have the expertise to address these unmet needs. Sanford has shared the results of the CHNA and the unmet needs with community leaders. Sanford Aberdeen Medical Center will standardize narcotic prescribing protocols across the enterprise to reduce usage. Narcotic prescriptions will be tracked internally and areas for improvement will be identified.
Group A-Facility 8 -- Sanford Aberdeen Medical Center Part V, Section B, line 13h:	Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
Group A-Facility 8 -- Sanford Aberdeen Medical Center Part V, Section B, line 16j:	Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
Group A-Facility 9 -- Sanford Worthington Medical Center Part V, Section B, line 5:	Sanford conducted a community health needs assessment during FY 2016 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2016 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County, North Dakota and Clay County, Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor, to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding community health, their personal health, preventive health, and the prevalence of disease. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during FY 2017-2019. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and response to the community health needs assessment and the implementations strategies are welcome on the Sanford website under "About Sanford" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA
Group A-Facility 9 -- Sanford Worthington Medical Center Part V, Section B, line 6a:	Sanford USD Medical Center Sioux FallsSanford Fargo Medical CenterSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical Center
Group A-Facility 9 -- Sanford Worthington Medical Center Part V, Section B, line 7d:	Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
Group A-Facility 9 -- Sanford Worthington Medical Center Part V, Section B, line 11:	The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: AccessSanford Worthington Medical Center has implemented strategy to improve access by helping community members understand the resources and financial assistance that is available through Sanford Health. Sanford will also partner with community entities to increase holistic care and with an employer group to increase education relative to health career services and insurance.Priority 2: Physical HealthSanford will fully implement the Medical Home model, increase provider education of registered dietitian services, improve the availability of exercise and nutrition education across the community, and increase the implementation of preventive health care. Addressing of Significant Needs during Current Year:Priority 1: AccessSanford Worthington initiated a monthly health topic page in the local newspaper. As a result of this campaign, Sanford Worthington also enlisted local employees engaged in care delivery to talk about services offered at the medical center and clinic that corresponded with the monthly health topic. Sanford Worthington contributed 20 health topic articles to the local newspaper and 32 radio talks to improve health literacy about available services in the community. Topics ranging from health promotion through routine screening, as well as recognition of serious medical conditions to seek medical care immediately were presented. Sanford Worthington became recognized as a consistent provider for the community's health needs.Sanford Worthington collaborated with JBS, a local employer, to refer patients to an employee program called JBS Strong. This program provided mentoring and coaching for lifestyle changes to employees with classes located at the workplace. Through collaboration between Sanford Worthington and JBS, 51 patients were referred to the JBS Strong program. Sanford Worthington gave YMCA memberships to six graduates of this program. This incentive was provided to encourage graduates to continue holistic care that was started by JBS. To reach this goal Sanford Worthington also envisioned a partnership with the YMCA to provide a consistent partner for referral of patients under the care of clinic RN Health Coaches. This collaboration began with referrals and will expand to formalize this relationship.Sanford Worthington began a relationship with JBS to improve health literacy among the plant's workforce. A relationship developed with the plant human resources department, union officials, and health plan agents. A need was identified for improved education about health topics. To meet this need, Sanford Worthington and JBS developed a health topic kiosk in employee break areas. This central location was used to deliver a health topic education during break times at the plant. JBS human resources and Sanford Worthington worked together to provide medical information on the kiosk in several languages to bring health education to those who were unable to obtain information from other sources due to a language barrier. Sanford Worthington offered 16 health topic education messages on the kiosk during this assessment cycle. Sanford Worthington clinic staff were on site twice per month at the plant to offer services to employees including educational presentations, assisting plant employee health leaders with employee blood draws, and participating in health fair programming. Sanford Worthington Medical Center assisted with the drawing, processing and distribution of up to 1,000 individual employee's annual health assessment data. This goal will continue as the collaboration with JBS continues which will result in improved access for its employees.Priority 2: Physical Health and Mental HealthSanford Worthington embarked on a journey to revamp its care delivery system for primary care. Sanford Worthington participated as a pilot site for the Medical Home model of care delivery. Primary care physicians and advance practice providers joined with nurses and clinical care assistants, RN Health Coaches and Integrated Health Therapists to provide a comprehensive care model for patients. Sanford Worthington achieved certification as a Medical Home during the 2016 cycle period, and has recently achieved recertification and recognition for the advancement of the care delivery model over the past three years. Patients with the chronic diseases of hypertension and diabetes, as well as patients at risk for developing diabetes, were offered behavior modification programs and personal care management with RN Health Coaches. The comorbid factor of mental health was also addressed for many patients in one setting through the use of the Integrated Health Therapist into the patient's primary care appointment. Evidence of the advantage of this model of care include improved performance in community healthcare measures including colorectal screening. Colorectal screening increased from 65% to 68% during this time frame. A colorectal screening performance improvement project was also undertaken to improve patient scheduling processes to make it more convenient to schedule a screening exam. Sanford Worthington Medical Center also entered into an agreement with the Minnesota Department of Health to be a SAGE Scopes provider for free colorectal screening. Through this grant program community residents who are underinsured and uninsured can access care without a burden of cost.Sanford Worthington hired a Licensed Independent Social Worker to provide integrated care in collaboration with medical providers at the clinic. The objective of this Integrated Health Therapist (IHT) position was to be present and available to physician and patient on an as-needed basis for rapid assessment and collaboration of care. On a daily basis, the IHT maintains a visible presence to all clinic staff and functions as point of contact for any questions/issues related to behavioral/chemical health. They were available for immediate team "handoffs" of patients requiring immediate assessment or intervention. They triaged patients with high-risk behavioral profiles and coordinating services with specialty care resources, performed brief, limited follow-up visits with selected patients using behavioral or problem solving strategies for symptom reduction, and acted as a consultant to the clinic as it relates to universal screening procedures, outcome data management, and fidelity measures.Sanford Worthington offered an intensive behavior therapy program for weight loss to assist patients to overcome poor eating habits and develop better lifelong habits. Providers and RN Health Coaches were able to refer patients to the program with positive outcomes for the patients. During this assessment cycle, 71 intensive behavior therapy sessions were completed for program enrollees.Sanford Worthington introduced the Sanford fit website to local school teachers and childcare centers in the community. School nurses employed by Sanford Worthington created a collaboration to bring healthy habit education to young children when health habits are developing. Sanford Worthington Employee Health and Marketing coordinated an education session in the spring of 2017 to provide education to elementary school nurses and physical education teachers about Sanford fit. This education has the potential to reach over 3,000 students in public and private education in Nobles County.Identified needs not directly addressed by this facility include: Economics - Availability of affordable housing Transportation - Availability of public transportation Environment - Water quality Aging - Cost of long term care, Availability of memory care, Availability of long term care, Availability of resources for family friends/ caring for and making decisions for elders, Availability of resources to help the elderly stay safe in their homes Children and Youth - Availability of quality infant care, Availability of quality child care, Bullying, Cost of quality child care, Cost of quality infant care, Availability of activities for children and youth, Teen pregnancy, Cost of activities for children and youth, Availability of services for at risk youth, Teen births Safety - Presence of street drugs and alcohol in the community, Domestic violence, Presence of drug dealers in the community, Child abuse
Group A-Facility 9 -- Sanford Worthington Medical Center Part V, Section B, line 13h:	Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
Group A-Facility 9 -- Sanford Worthington Medical Center Part V, Section B, line 16j:	Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
Group A-Facility 10 -- Sanford Sheldon Medical Center Part V, Section B, line 5:	Sanford conducted a community health needs assessment during FY 2016 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2016 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County, North Dakota and Clay County, Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor, to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding community health, their personal health, preventive health, and the prevalence of disease. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during FY 2017-2019. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and response to the community health needs assessment and the implementations strategies are welcome on the Sanford website under "About Sanford" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA
Group A-Facility 10 -- Sanford Sheldon Medical Center Part V, Section B, line 6a:	Sanford USD Medical Center Sioux FallsSanford Fargo Medical CenterSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
Group A-Facility 10 -- Sanford Sheldon Medical Center Part V, Section B, line 7d:	Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
Group A-Facility 10 -- Sanford Sheldon Medical Center Part V, Section B, line 11:	The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Mental Health/Behavioral HealthSanford Sheldon Medical Center has developed strategy to reduce mortality and morbidity from chemical addiction and mental health diseases by recruiting a triage therapist, and working to reduce drug and alcohol abuse in the community. Sanford will work with the high school counselor to enhance curriculum to include abuse issues. Sanford Sheldon Medical Center will standardize narcotic prescribing protocols across the enterprise to reduce usage. Narcotic prescriptions will be tracked internally and areas for improvement will be identified.Priority 2: Children and YouthSanford has developed strategy to support the youth in the community by enhancing the community environment through structured after school programming, day care expansion, and education sessions for youth and parents.Addressing of Significant Needs during Current Year:Priority 1: Mental Health/Behavioral HealthSanford Sheldon Medical Center has increased the availability of mental health counseling with the addition of an Integrated Health Therapist. The IHT addresses the immediate need for mental health counseling at Sanford Clinic Sheldon.Priority 2: Children and YouthSanford Sheldon Medical Center provides 75 backpacks to the Shop with a Cop program, which provides children in need with the opportunity to go back to school with new school supplies. Sanford supports the summer lunch program that is facilitated at a local church and provides meals to students in need during the summer months when school is not in session. A farm safety course is taught to all children in the second grade at all Sheldon schools. Sanford invites third grade students from all Sheldon schools and other nearby community schools to tour the medical facility. The tour helps to increase the students' comfort level with the facility and staff. Sanford hosts events such as the Glow Walk that is promoted as a family fun wellness event.Identified needs not directly addressed by this facility include: Aging - Cost of long term care Safety - Presence of street drugs, prescription drugs and alcohol in the community, Child abuse and neglect, Domestic violence Health Care - Use of emergency services for primary health care, Access to affordable health insurance, Timely access to physician specialists, Availability of non-traditional hours, Timely access to doctors, PAs or NPs, Timely access to mental health providers Physical Health - Cancer, Chronic disease, Obesity, Poor nutrition, Inactivity Preventive Health - Flu shots, Immunizations
Group A-Facility 10 -- Sanford Sheldon Medical Center Part V, Section B, line 13h:	Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
Group A-Facility 10 -- Sanford Sheldon Medical Center Part V, Section B, line 16j:	Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
Group A-Facility 11 -- Sanford Vermillion Medical Center Part V, Section B, line 5:	Sanford conducted a community health needs assessment during FY 2016 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2016 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County, North Dakota and Clay County, Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor, to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding community health, their personal health, preventive health, and the prevalence of disease. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during FY 2017-2019. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and response to the community health needs assessment and the implementations strategies are welcome on the Sanford website under "About Sanford" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA
Group A-Facility 11 -- Sanford Vermillion Medical Center Part V, Section B, line 6a:	Sanford USD Medical Center Sioux FallsSanford Fargo Medical CenterSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
Group A-Facility 11 -- Sanford Vermillion Medical Center Part V, Section B, line 7d:	Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
Group A-Facility 11 -- Sanford Vermillion Medical Center Part V, Section B, line 11:	The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Mental HealthSanford Vermillion Medical Center has developed strategy to increase mental health services in the Vermillion community through additional mental health counselors and providers as well as offering psychiatry telemedicine services. Sanford Vermillion Medical Center will standardize narcotic prescribing protocols across the enterprise to reduce usage. Narcotic prescriptions will be tracked internally and areas for improvement will be identified.Priority 2: Physical Health Sanford Vermillion has set strategies to reduce obesity, hypertension and high cholesterol and realize an overall improvement in physical health by offering a variety of classes, fitness programs and screenings.Addressing of Significant Needs during Current Year:Priority 1: Mental HealthDepression is a common but serious illness that can interfere with daily life. Many people with a depressive illness never seek treatment. But the majority, even those with the most severe depression, can get better with treatment. County Health Rankings for Clay County indicated that 11% of the residents have fair or poor mental health.Sanford has prioritized depression as a top priority and has set strategy to perform assessments for depression and to improve PHQ-9 scores for patients who are diagnosed with depression. The goal was to improve PHQ-9 scores for patients with depression, which has experienced a 4% improvement in this short time with the percentage of patients with major depression or dysthymia who had an initial PHQ-9 score greater than 9 whose 6-month PHQ-9 score was less than 5.The goal of increasing the availability and number of mental health services in the Vermillion community was also set by Sanford Vermillion. Several strategies have been implemented to achieve this goal. The mental health counselor now offers evening appointments in addition to regular daytime appointments. Sanford Vermillion has also hired a psychologist as their Integrated Health Therapist who works full-time offering mental health services to the extended community via face-to-face visits and through telehealth visits.Sanford Vermillion has also continued to provide a Certified Nurse Practitioner who specializes in psychiatry to its monthly outreach services. She provides psychiatric services for patients of all ages from pediatrics to elderly monthly at the Sanford Clinic Vermillion.Sanford Vermillion also credentialed and added to their allied health staff a Licensed Addiction Counselor to assist with patients in need of evaluation and/or rehabilitation services in the clinic, emergency room and inpatient setting.Sanford Vermillion has the equipment and medical staff credentialed to provide psychiatric outreach services via telemedicine services through the facility and Sanford USD Medical Center as another strategy to increase availability of services in the community and also collaborates with USD through the student health contract to offer the USD students counseling services on campus at the USD Counseling Center and the USD Psychological Services Center.Priority 2: Physical HealthFor reducing obesity in the community, several strategies have been established. For children, Sanford Vermillion has been working with the Vermillion School district for several years implementing the Sanford fit initiative. This initiative continues to grow and has reached approximately 750 children this past year in grades kindergarten through fifth grade. It has been very well received in the community. Supported by clinical experts of Sanford, fit is the only initiative focusing equally on the four key contributing factors to childhood obesity: Food/nutrition, Move/activity, Mood/behavioral health and Recharge/sleep. Sanford's fit initiative has come a long way since its inception in 2010. Through Sanford fit, healthy lifestyles are actively being promoted in homes, schools, and throughout the community by way of technology, engaging programs and utilizing key role models in a child's life. For Sanford Vermillion, the athletic trainer is being utilized to implement the program in the schools.Sanford Vermillion also continues to encourage the Vermillion community to engage in all forms of exercise including sponsoring and hosting a number of events throughout the year such as Relay for Life. The annual community Great Strides walking program is hosted every spring for 6 weeks where 200 to 300 community members participate.The RN Health Coach at Sanford Clinic Vermillion also continues to work with the diabetic and hypertension patients proactively to ensure they come in for their health maintenance visits and labs. Sanford has set strategies to provide optimal diabetic care and to measure outcomes for systolic and diastolic blood pressures, LDL cholesterol, hemoglobin A1c, tobacco use, and aspirin use for people living with diabetes.Sanford Vermillion has also set strategies to address hypertension through a standardized protocol, frequent blood pressure monitoring, and referral as appropriate for patients with hypertension.Outcome measures include a blood pressure of less than 140/90 for all ages 18-59 and for age 60+ with diabetes, vascular or renal disease. For patients age 60 or older without diabetes, vascular or renal disease the goal is blood pressure of 150/90 or less. Sanford Vermillion is currently meeting this goal with 92.1% of hypertension patients having blood pressure of less than 140/90.The Sanford Vermillion wellness program also makes over 3,000 community contacts per year through its various health screening and community vaccination events. The annual health fair with free and reduced health screenings and a variety of reduced laboratory tests is available along with a wealth of community educational offerings in which approximately 350 community members attend annually.Educating the community on healthy nutrition was another strategy that Sanford Vermillion implemented by working with the on-site dietitian and a visiting cardiologist.Identified needs not directly addressed by this facility include: Economics - Availability of affordable housing Aging - Cost of long term care, Availability of memory care Children and Youth - Bullying Safety - Presence of street drugs and alcohol in the community, Child abuse and neglect Health Care - Access to affordable health insurance, Cost of affordable vision insurance, Access to affordable health care, Cost of affordable dental insurance coverage
Group A-Facility 11 -- Sanford Vermillion Medical Center Part V, Section B, line 13h:	Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
Group A-Facility 11 -- Sanford Vermillion Medical Center Part V, Section B, line 16j:	Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
Group A-Facility 12 -- Sanford Chamberlain Medical Center Part V, Section B, line 5:	Sanford conducted a community health needs assessment during FY 2016 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2016 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County, North Dakota and Clay County, Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor, to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding community health, their personal health, preventive health, and the prevalence of disease. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during FY 2017-2019. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and response to the community health needs assessment and the implementations strategies are welcome on the Sanford website under "About Sanford" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA
Group A-Facility 12 -- Sanford Chamberlain Medical Center Part V, Section B, line 6a:	Sanford USD Medical Center Sioux FallsSanford Fargo Medical CenterSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
Group A-Facility 12 -- Sanford Chamberlain Medical Center Part V, Section B, line 7d:	Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
Group A-Facility 12 -- Sanford Chamberlain Medical Center Part V, Section B, line 11:	The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Physical HealthSanford Chamberlain Medical Center has developed strategy to help the community improve their physical health and chronic health conditions. The Medial Home model will be fully integrated into the clinic setting, and quality measures for patients with diabetes, elevated lipids and asthma will be monitored. A patient advisory council will convene to improve patient and clinic communications. Sanford fit will be offered to the local school districts, and resources will be available to students, families, and leaders. Priority 2: Mental Health/Behavioral HealthSanford will integrate the Medical Home model into the clinic primary care setting and will utilize PHQ-9 assessments to evaluate for depression. Health coaches and a Master's prepared social worker will be dedicated to mental health/behavioral health services. The facilitated support group will be a focus for additional patient engagement.Addressing of Significant Needs during Current Year:Priority 1: Physical HealthSanford Family FIT night was established with the Chamberlain School District. Sanford Chamberlain staff are on site during parent teacher conferences at the elementary school (K-5), where Sanford hosts various booths discussing healthy lifestyle choices, teaching the children and parents the importance of mental health in young people, avoiding drug use, promoting an active lifestyle, and heart health. The community prescription take-back program is also promoted.Camp FUEL, held every summer as a three-day camp, is free of charge and focuses on the importance of healthy eating, healthy lifestyle choices and physical exercise.Priority 2: Mental Health/Behavioral HealthSanford Chamberlain works with Indian Health Services (IHS) and tribal leaders to participate in health fairs, providing hands-on education about substance abuse, mental health, healthy eating, and also conducts blood pressure and cholesterol checks.Identified needs not directly addressed by this facility include: Safety - Presence of street drugs and alcohol in the community, Presence of drug dealers in the community, Child abuse and neglect Substance Use and Abuse - Drug use and abuse, Underage drug use and abuse, Alcohol use and abuse, Underage drinking, Smoking and tobacco use Children and Youth - Bullying, Youth crime, Availability of quality child care, Availability of quality infant care, High rates of teen births Health Care - Access to affordable health care, Need for medical care, Need for prescription medications, Unmet mental health needsSanford will not develop strategy to address the presence of street drugs and alcohol in the community, the presence of drug dealers, and child abuse. However, Sanford serves as a partner in many community groups that have the expertise to address these unmet needs. Sanford shared the findings of the CHNA research and these unmet needs with community leaders and community stakeholders. Sanford Chamberlain Medical Center will standardize narcotic prescribing protocols across the enterprise to reduce usage. Narcotic prescriptions will be tracked internally and areas for improvement will be identified.
Group A-Facility 12 -- Sanford Chamberlain Medical Center Part V, Section B, line 13h:	Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
Group A-Facility 12 -- Sanford Chamberlain Medical Center Part V, Section B, line 16j:	Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
Group A-Facility 13 -- Sanford Luverne Medical Center Part V, Section B, line 5:	Sanford conducted a community health needs assessment during FY 2016 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2016 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County, North Dakota and Clay County, Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor, to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding community health, their personal health, preventive health, and the prevalence of disease. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during FY 2017-2019. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and response to the community health needs assessment and the implementations strategies are welcome on the Sanford website under "About Sanford" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA
Group A-Facility 13 -- Sanford Luverne Medical Center Part V, Section B, line 6a:	Sanford USD Medical Center Sioux FallsSanford Fargo Medical CenterSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
Group A-Facility 13 -- Sanford Luverne Medical Center Part V, Section B, line 7d:	Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
Group A-Facility 13 -- Sanford Luverne Medical Center Part V, Section B, line 11:	The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Physical HealthSanford Luverne Medical Center will address chronic disease management and monitor MN community measure scores for improvement. Sanford will engage the community around wellness, healthy eating and dental health.Priority 2: Mental HealthSanford has developed strategy to improve access to mental health and substance abuse resources. PHQ-9 scores will be monitored and referrals to behavioral health triage therapists, care coordinators and chemical dependency staff with be made as determined by assessment.Addressing of Significant Needs during Current Year:Priority 1: Physical HealthSanford Luverne set a strategic goal focused on improving chronic disease management. Throughout the past three years, the core team focused on using Healthy Planet population registries to ensure patients are receiving all recommended preventive care. The team is focusing on asthma, diabetes and mental health/depression. The quality scores in each of these areas have demonstrated improvements.Depression remission scores at 6 months measured 5.6% in July 2015, and as of July 2018, 18.1% patients noted they were in remission at 6 months and 25.1% at 12 months. Optimal diabetes management was reported for 36% of patients in December 2014, and as of July 2018, 53.6% of patients have met the goals for optimal diabetes management. In July 2015, 45.2% of patients had an asthma control test completed. In July 2018, 63.5% of patients had an asthma action plan in place - noting that metrics for measurement changed during this time period.In addition, Sanford Luverne's registered dietician has utilized a variety of platforms to bring forward education on healthy eating options, including the local senior meal site. Sanford Luverne has supported the efforts of the City of Luverne to expand the Luverne LOOP walking trail. Sanford Luverne partnered with the City on a task force looking at wellness within the community, and has sponsored several wellness challenges. Despite this focus (and following national trends), higher obesity rates are prevailing but Sanford's strategies will continue to focus on diet and exercise.Sanford Luverne leadership reached out to bring dental services to the community through mobile services, but the request was denied. A task force is now working to address dental access, such as bringing dental screenings into the school and bringing more access within the community as part of the Blandin poverty initiative.Priority 2: Mental HealthSanford Luverne employs a part-time therapist to assist with treatment and triage of mental health issues for patients. Additionally, a second Integrative Health Therapist has joined the Sanford Luverne staff, providing additional access for Medicare beneficiaries. The Sanford Luverne therapists work closely with local mental health providers. In addition, the facility sponsored mental health first aid training for the community. Sanford's therapist has completed the training to become a Mental Health First Aid trainer. Sanford Luverne was awarded a grant to look at mental health services and care coordination and has developed a release of information form that allows for greater care coordination across all entities. This form was reviewed and approved by all agencies involved. Sanford Luverne has seen an improvement in depression remission scores over the past three years. Sanford Luverne is in the process of implementing tele-psychiatry for improved access. The Sanford Luverne substance use program has actively been involved in Rock, Nobles, Pipestone, and Murray drug courts and is actively engaged in providing community education and serving on various community boards to decrease substance use issues within the county.Identified needs not directly addressed by this facility include: Aging - Cost of long term care, Availability of memory care Children and Youth - Availability of quality infant care, Availability of quality child care Safety - Presence of street drugs and alcohol in the community Health Care - Access to affordable health insurance Preventive Health - Flu shots, ImmunizationsSanford will not develop strategy to address the cost of long term care, the availability of memory care, the availability of quality infant and child care and the presence of street drugs in the community. However, Sanford shared the results of the CHNA research with community leaders and agencies with expertise to the identified needs. Sanford serves as a partner in many community groups that have the expertise to address these unmet needs. Sanford Luverne Medical Center will standardize narcotic prescribing protocols across the enterprise to reduce usage. Narcotic prescriptions will be tracked internally and areas for improvement will be identified.
Group A-Facility 13 -- Sanford Luverne Medical Center Part V, Section B, line 13h:	Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
Group A-Facility 13 -- Sanford Luverne Medical Center Part V, Section B, line 16j:	Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
Group A-Facility 14 -- Sanford Canby Medical Center Part V, Section B, line 5:	Sanford conducted a community health needs assessment during FY 2016 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2016 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County, North Dakota and Clay County, Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor, to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding community health, their personal health, preventive health, and the prevalence of disease. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during FY 2017-2019. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and response to the community health needs assessment and the implementations strategies are welcome on the Sanford website under "About Sanford" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA
Group A-Facility 14 -- Sanford Canby Medical Center Part V, Section B, line 6a:	Sanford USD Medical Center Sioux FallsSanford Fargo Medical CenterSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
Group A-Facility 14 -- Sanford Canby Medical Center Part V, Section B, line 7d:	Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
Group A-Facility 14 -- Sanford Canby Medical Center Part V, Section B, line 11:	The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Physical Health Sanford Canby Medical Center will implement the Together Canby Can initiative to promote healthy lifestyles, and will work with the public schools and parochial schools to bring Sanford fit to school age youth. Sanford will also implement the MN Community Measurement application for blood pressure screening and follow-up.Priority 2: Mental HealthSanford will implement an education program for awareness and prevention and will determine the availability of resources for mental health within the geographical area in partnership with public health. Sanford Canby Medical Center will standardize narcotic prescribing protocols across the enterprise to reduce usage. Narcotic prescriptions will be tracked internally and areas for improvement will be identified.Addressing of Significant Needs during Current Year:Priorities 1 & 2: Physical Health and Mental HealthA goal was set to reduce the negative health effects of obesity and to control hypertension in the community of Canby. The BMI reduction initiative was started in the Sanford Canby Clinic with the aim to identify patients who would benefit from weight loss and commit to a 12-week weight loss program. The initiative began in February 2017 and new class sessions start every six weeks.The Sanford Canby RN Health Coach performed readiness assessments on each participant. The assessment included data collection to record initial weight, BMI, and blood pressure. Each participantset individual smart goals, and throughout the course of the program participants completed a weekly one-on-one check-in with the purpose of reassessing goals and reporting weights. A monthly re-charge session was also conducted. During this session, participants could discuss activity, diet, mood, and share personal stories. The session also provided a platform for sharing healthy recipes and sampling of healthy food choices.Four groups (a total of 26 participants) completed the 2017 sessions. The groups lost a total of 140 pounds collectively. All but one participant lost weight except for two participants who maintained their weight. All but one participant reduced their blood pressure except for two who maintained their blood pressure. Participants noted that one-on-one sessions offered accountability to the program.The electronic medical record (EMR) has been upgraded with the capability to calculate BMI. If the calculation meets or exceeds a BMI of 30 (defined as obese by CDC definition), providers are alerted, allowing them to specifically address lifestyle and other health factors. The EMR allows providers to refer patients to weight loss programs, a dietician, bariatric surgery, an RN Health Coach, behavioral health, and/or pulmonology services. With the added functionality in the EMR, a patient's BMI can be addressed at every patient visit. Additionally, the Together. Canby Can initiative promoting healthy lifestyles within the community continues with 75 community members participating. The strategy of this initiative was to address both mental and physical health. Through this initiative monthly wellness education classes for the general public focus on nutrition, healthy routines, mental health, better balance, etc.The Sanford fit kids program focuses on four areas - Food, Move, Recharge, and Mood. Sanford Canby brought this program to both Canby Public School and St. Peter's Catholic School in the fall and spring of 2016-2017. Kindergarten through sixth grade classes were able to take part in the program. Approximately 350 students participated in this program learning healthy lifestyle and healthy mental health strategies.Identified needs not directly addressed by this facility include: Aging - Cost of long term care, Availability of memory care Children and Youth - Bullying, Availability of activities for children and youth, Cost of activities for children and youth Safety - Presence of street drugs and alcohol in the community Health Care - Access to affordable health insurance, Cost of affordable vision insurance, Access to affordable prescription drugs, Cost of affordable dental insurance coverage
Group A-Facility 14 -- Sanford Canby Medical Center Part V, Section B, line 13h:	Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
Group A-Facility 14 -- Sanford Canby Medical Center Part V, Section B, line 16j:	Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
Group A-Facility 15 -- Sanford Jackson Medical Center Part V, Section B, line 5:	Sanford conducted a community health needs assessment during FY 2016 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2016 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County, North Dakota and Clay County, Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor, to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding community health, their personal health, preventive health, and the prevalence of disease. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during FY 2017-2019. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and response to the community health needs assessment and the implementations strategies are welcome on the Sanford website under "About Sanford" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA
Group A-Facility 15 -- Sanford Jackson Medical Center Part V, Section B, line 6a:	Sanford USD Medical Center Sioux FallsSanford Fargo Medical CenterSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
Group A-Facility 15 -- Sanford Jackson Medical Center Part V, Section B, line 7d:	Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
Group A-Facility 15 -- Sanford Jackson Medical Center Part V, Section B, line 11:	The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Children and YouthSanford Jackson Medical Center will utilize Sanford Fit tools at the Family Fun nights and will bring the curriculum to the area schools. Priority 2: Mental Health Sanford has developed strategy to reduce drug abuse by educating the public on the take back program in the community. Additionally, Sanford will consider the availability of the mobile mental health unit in Jackson County as a collaborative partnership for mental health services.Sanford Jackson Medical Center will standardize narcotic prescribing protocols across the enterprise to reduce usage. Narcotic prescriptions will be tracked internally and areas for improvement will be identified.Addressing of Significant Needs during Current Year:Priority 1: Children and YouthSanford Jackson Medical Center leadership distributed the Sanford fit program information to the schools and day care centers in the Jackson/Lakefield area. In May of 2016, 2017 and 2018, the Sanford fit program was promoted at the annual Family Fun Night. Over 300 parents and children attended this event each year. The annual Sanford Tri for Health for youth celebrated its 10th year in 2018 with over 120 youth ages 4-14 participating. Sanford Jackson Medical Center continued to support free activities in the community such as Jackson Food 4 Kids, which provides weekly food packs for food insecure children, summer library programs, and the free summer lunch program. With the financial support of Sanford Jackson and Sanford Sioux Falls, Sanford committed to a multi-year pledge in support of building a splash pad in Jackson. The splash pad will provide free admission May-September each year.Priority 2: Mental HealthSanford Jackson Medical Center developed strategies to meet the needs for mental health and substance abuse services. A licensed counselor is now available to provide mental health services. The added service provides for immediate access when a crisis presents.When underage drug use and abuse was identified as a community concern, Sanford Jackson committed to providing education on the topic of the Take Back program. An Ask the Expert column in the local newspaper featured this program.Another successful tactic in relation to mental health collaboration was facility leadership participation in the Integrated Behavioral Health Strategic Planning session with community partners. A community task force was started and meets quarterly. Current accomplishments include a decrease from 47% to 23% for the behavioral health patients discharged from the emergency room to inpatient behavioral health facilities. Additionally, the length of stay in the emergency room for patients with behavioral health primary encounter diagnoses has dropped from 4:38 hours to 2:45 hours.Identified needs not directly addressed by this facility include: Economics - Availability of affordable housing Aging - Cost of long term care, Availability of memory care, Availability of resources for family/friends caring for and making decisions for elders Safety - Presence of street drugs and alcohol in the community, Presence of drug dealers in the community, Child abuse and neglect, Domestic violence, Violent crime Health Care - Availability of no-traditional hours, Access to affordable health insurance, Access to affordable health care, Access to affordable prescription drugs, Cost of affordable dental insurance coverage Physical Health - Cancer, Inactivity or lack of exercise, Poor nutrition, Obesity, Chronic disease Preventive Health - Flu shots, Not seeing a health care provider or dentist in the past year
Group A-Facility 15 -- Sanford Jackson Medical Center Part V, Section B, line 13h:	Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
Group A-Facility 15 -- Sanford Jackson Medical Center Part V, Section B, line 16j:	Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
Group A-Facility 16 -- Sanford Tracy Medical Center Part V, Section B, line 5:	Sanford conducted a community health needs assessment during FY 2016 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2016 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County, North Dakota and Clay County, Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor, to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding community health, their personal health, preventive health, and the prevalence of disease. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during FY 2017-2019. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and response to the community health needs assessment and the implementations strategies are welcome on the Sanford website under "About Sanford" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA
Group A-Facility 16 -- Sanford Tracy Medical Center Part V, Section B, line 6a:	Sanford USD Medical Center Sioux FallsSanford Fargo Medical CenterSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
Group A-Facility 16 -- Sanford Tracy Medical Center Part V, Section B, line 7d:	Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
Group A-Facility 16 -- Sanford Tracy Medical Center Part V, Section B, line 11:	The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Mental HealthSanford Tracy Medical Center has developed strategy to improve the access time for patients waiting to be placed for mental health services from the ER. Sanford will also work with community partners to create new recovery program options for community members, and will work with the MN DOH on a pilot project for integrating behavioral health into critical access hospitals.Sanford Tracy Medical Center will standardize narcotic prescribing protocols across the enterprise to reduce usage. Narcotic prescriptions will be tracked internally and areas for improvement will be identified.Priority 2: Physical HealthSanford will address chronic disease through utilization of Medical Home, health coaches, and the Sanford fit Program.Addressing of Significant Needs during Current Year:Priority 1: Mental HealthThe mental health strategy continues to be a top priority and a work in progress for Sanford Tracy. Work continues on implementing a telehealth behavioral health placement program for the Sanford Tracy emergency room. Mental health placement has been and continues to be a major issue throughout the state of Minnesota, especially in rural areas. Although the Minnesota Department of Health project did not come to fruition, Sanford Tracy continues to search for opportunities to develop and grow the behavioral health services in Tracy. Child psychiatric care is provided via telemedicine, and locally through a family nurse practitioner and two LICSW providers. A recruitment plan is in place to seek additional specialists and telemedicine opportunities for Sanford Tracy. Sanford Tracy continues to provide presentations and media coverage to make the public and community partners aware of the services that are available.Priority 2: Physical HealthThe RN Health Coach continues to work closely with providers to reach patients and help them manage their chronic illnesses.Beginning in January of 2016, Sanford Tracy completed a 19-week Sanford fit program with the Tracy Area Elementary School fourth grade classes. The program was a customized version of Sanford fitClub. Two Sanford Tracy staff members met with the Tracy Area Elementary fourth grade physical education classes once a week for 25 minutes each. The students learned all about Sanford fit and about making good, healthy choices regarding their food, move (exercise), mood, and recharge (sleep/rest). In addition, the students had weekly challenge cards they took home to complete during the remainder of the week. By bringing back completed challenge cards, students worked their way towards end-of-year prizes, but also took home activities and exposed their families to fit. The program completed its second year in May of 2018. After a successful pilot year, at the beginning of the 2018 program, the students completed a fitClub "test". The students would take this test again in May after 19 weeks of learning about fit. The students increased their correct answers by more than 24% from the first test to the last. Each week, the Sanford Tracy staff could see the students engaging and absorbing the information through the fun activities. The program received positive feedback by the Tracy Area Elementary School physical education teacher and principal and will continue into the coming years.Identified needs not directly addressed by this facility include: Aging - Cost of long term care Safety - Presence of drug dealers in the community, Presence of street drugs and alcohol in the community Health Care - Cost of affordable dental insurance coverage, Access to affordable health insurance Preventive Health - Flu shots, Immunizations, STDs
Group A-Facility 16 -- Sanford Tracy Medical Center Part V, Section B, line 13h:	Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
Group A-Facility 16 -- Sanford Tracy Medical Center Part V, Section B, line 16j:	Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
Group A-Facility 17 -- Sanford Rock Rapids Medical Center Part V, Section B, line 5:	Sanford conducted a community health needs assessment during FY 2016 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2016 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County, North Dakota and Clay County, Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor, to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding community health, their personal health, preventive health, and the prevalence of disease. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during FY 2017-2019. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and response to the community health needs assessment and the implementations strategies are welcome on the Sanford website under "About Sanford" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA
Group A-Facility 17 -- Sanford Rock Rapids Medical Center Part V, Section B, line 6a:	Sanford USD Medical Center Sioux FallsSanford Fargo Medical CenterSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
Group A-Facility 17 -- Sanford Rock Rapids Medical Center Part V, Section B, line 7d:	Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
Group A-Facility 17 -- Sanford Rock Rapids Medical Center Part V, Section B, line 11:	The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Mental Health/Behavioral HealthSanford Rock Rapids Medical Center will enhance access to mental health and substance abuse resources, and access to resources to help the elderly stay in their homes. Behavioral health triage therapists and mental health providers will be added to improve access for mental health and behavioral health. Additionally, Sanford will work with local facilities and pharmacists on discharge to home and home options to ensure independence and safety at home. Sanford Rock Rapids Medical Center will standardize narcotic prescribing protocols across the enterprise to reduce usage. Narcotic prescriptions will be tracked internally and areas for improvement will be identified.Priority 2: Physical Health/Chronic DiseaseSanford will focus on the MN Community Measures Scores, continue the disease registry, and expand beyond diabetes to target evolving needs. Medication management, community education, and the promotion of physical activity in the community will be addressed. Sanford will also work with local dentists and mobile dental services to seek options to increase the availability of dental services that accept Medicaid.Addressing of Significant Needs during Current Year:Priority 1: Enhanced Access to Mental Health and Substance Abuse Resources and Services for SeniorsSanford Rock Rapids is partnering with area mental health services and refers patients to outpatient services. Sanford is also partnering with area providers to bring consulting services to patients who are in a mental health crisis in the emergency room. Sanford Rock Rapids is also in process of moving forward with telehealth mental health services.Sanford Rock Rapids is partnering with area nursing homes and home health services to refer patients who need additional care after discharge. Sanford Rock Rapids provides follow-up phone calls to patients after discharge. Patients are scheduled for follow-up provider visits prior to discharge, either within 7 days or within 14 days, depending on the risk for potential readmission. Readmission scores to this Sanford facility are currently 7.7%, with a goal of under 7%. This number has trended down over the past three years. The Sanford Rock Rapids pharmacist provides medication management and partners with the RN Health Coach and dietician to review high-risk patient cases and implement the best management to prevent a medical center admission.Priority 2: Physical Health/Chronic Disease Sanford Rock Rapids has worked hard to improve quality metrics for chronic conditions over the past three years. In January 2015, 32.5% of diabetic patients had optimal management, and in June of 2018, this grew to 50.6%. Optimal vascular was at 53% in January 2015, and is now at 57.1%. In June of 2015, 84.5% of hypertension patients had optimal management and today the optimal management is at 90.5%. Breast cancer screening was completed on 70.4% of eligible women in January 2015, and this indicator has seen improvements with a current score of 73.3%. Colorectal screening has also increased from 65.4% to 71.8%. Sanford Rock Rapids will continue to focus on obesity and will continue to be a community partner to promote individual and community health.Identified needs not directly addressed by this facility include: Economics - Availability of affordable housing Aging - Cost of long term care, Availability of memory care, Availability of resources to help the elderly stay safe in their homes Children and Youth - Bullying, Availability of quality infant care, Cost of quality infant care, Availability of quality child care Safety - Presence of street drugs, prescription drugs and alcohol in the community Health Care - Access to affordable health insurance, Access to affordable prescription drugs, Cost of affordable dental insurance, Access to affordable health care, Cost of affordable vision insurance Preventive Health - Flu shots, ImmunizationsSanford will not directly develop strategy to address the availability of affordable housing, bullying among children and youth, and the cost and availability of infant and child care. However, Sanford serves as a partner in many community groups that have the expertise to address these unmet needs. Sanford will share the concerns and the results of the CHNA with community leaders who do have expertise in their areas.
Group A-Facility 17 -- Sanford Rock Rapids Medical Center Part V, Section B, line 13h:	Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
Group A-Facility 17 -- Sanford Rock Rapids Medical Center Part V, Section B, line 16j:	Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
Group A-Facility 18 -- Sanford Hillsboro Medical Center Part V, Section B, line 5:	Sanford conducted a community health needs assessment during FY 2016 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2016 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County, North Dakota and Clay County, Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor, to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding community health, their personal health, preventive health, and the prevalence of disease. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during FY 2017-2019. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and response to the community health needs assessment and the implementations strategies are welcome on the Sanford website under "About Sanford" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA
Group A-Facility 18 -- Sanford Hillsboro Medical Center Part V, Section B, line 6a:	Sanford USD Medical Center Sioux FallsSanford Fargo Medical CenterSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
Group A-Facility 18 -- Sanford Hillsboro Medical Center Part V, Section B, line 7d:	Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
Group A-Facility 18 -- Sanford Hillsboro Medical Center Part V, Section B, line 11:	The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Physical HealthSanford Hillsboro Medical Center will focus on exercise programs for community members, including walking clubs, biking clubs and fitness challenges in partnership with the local wellness center and the medical center's therapy department. Sanford will also provide the Sanford fit program to the local schools and childcare providers.Priority 2: Mental Health ServicesSanford will implement the PHQ-9 assessment to identify patients with depression and develop plans to reduce the severity of depression. Sanford will also distribute a directory of available resources to patients, local groups and entities to create awareness in the community. Sanford Hillsboro Medical Center will standardize narcotic prescribing protocols across the enterprise to reduce usage. Narcotic prescriptions will be tracked internally and areas for improvement will be identified.Addressing of Significant Needs during Current Year:Priority 1: Physical HealthSanford Hillsboro developed strategy to increase physical activity for the Hillsboro community. Sanford staff presented the Sanford fit program to the three area schools within the Hillsboro service area. Sanford fit is an online curriculum that is available for all students, faculty and community members. Sanford also supports the annual 5/10K run that the Hillsboro Running Club puts on during Hillsboro Days.Priority 2: Mental HealthSanford Hillsboro Medical Center developed strategy to address mental health in the community. The Sanford Hillsboro Clinic has implemented a comprehensive behavioral health screening tool (BHS6) for all new patients and for all patients receiving comprehensive physicals. Sanford Hillsboro Medical Center has added availability of an Integrated Health Therapist through visits by telehealth. This service is available during all clinic hours.Identified needs not directly addressed by this facility include: Aging - Cost of long term care, Availability of memory care Children and Youth - Bullying, Availability of activities for children and youth, Cost of activities for children and youth Safety - Seat belt usage, Presence of street drugs and alcohol in the community Health Care - Access to affordable health insurance, Cost of affordable vision insurance, Access to affordable prescription drugs, Cost of affordable dental insurance coverage Preventive Health - Flu shots, ImmunizationsSanford will not develop strategy to address the cost of long term care and the availability of memory care because the state of North Dakota through the Department of Human Services controls the cost. Memory care cannot be added to the LTC facility. Safety issues such as seat belt usage and the presence of street drugs are issues that the city council and the sheriff's office are issues that the community stakeholders are addressing. Sanford serves as a partner in many community groups that have the expertise to address these unmet needs.
Group A-Facility 18 -- Sanford Hillsboro Medical Center Part V, Section B, line 13h:	Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
Group A-Facility 18 -- Sanford Hillsboro Medical Center Part V, Section B, line 16j:	Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
Group A-Facility 19 -- Sanford Medical Center Mayville Part V, Section B, line 5:	Sanford conducted a community health needs assessment during FY 2016 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2016 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County, North Dakota and Clay County, Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor, to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding community health, their personal health, preventive health, and the prevalence of disease. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during FY 2017-2019. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and response to the community health needs assessment and the implementations strategies are welcome on the Sanford website under "About Sanford" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA
Group A-Facility 19 -- Sanford Medical Center Mayville Part V, Section B, line 6a:	Sanford USD Medical Center Sioux FallsSanford Fargo Medical CenterSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
Group A-Facility 19 -- Sanford Medical Center Mayville Part V, Section B, line 7d:	Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
Group A-Facility 19 -- Sanford Medical Center Mayville Part V, Section B, line 11:	The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Physical Health Sanford Mayville Medical Center will improve the availability of nutrition and exercise programs for community members. Additionally, the Sanford fit Program will be available to all students and families through classroom curriculum and through the Sanford Fit website.Priority 2: Mental Health ServicesSanford will implement the PHQ-9 assessment to identify patients with depression and develop plans to reduce the severity of depression. Sanford will also distribute a directory of available resources to patients, local groups and entities to create awareness in the community. Sanford Medical Center Mayville will standardize narcotic prescribing protocols across the enterprise to reduce usage. Narcotic prescriptions will be tracked internally and areas for improvement will be identified.Addressing of Significant Needs during Current Year:Priority 1: Physical HealthSanford Mayville Medical Center staff developed strategies to address physical health in the community. The Sanford fit program was made available to the four area schools within the Sanford Mayville service area. Teachers and school administration have found the fit program to be a very positive addition. Sanford Mayville's dietitian presented mini-seminars on Better Nutrition for Better Living at the Mayville Senior Center.Priority 2: Mental HealthSanford Mayville Medical Center determined that mental health was a top priority for the community. Sanford Mayville Clinic has implemented a comprehensive behavioral health screening tool (BHS6) for all new patients and for patients who are scheduled for comprehensive physicals. Additionally, Integrated Health Therapists are immediately available through telehealth services. Sanford Mayville has a pilot project, Bridging Health and Home, which is a free service to complement clinical services.Identified needs not directly addressed by this facility include: Aging - Cost of long term care, Availability of memory care Children and Youth - Bullying, Availability of activities for children and youth, Cost of activities for children and youth Safety - Seat belt usage, Presence of street drugs and alcohol in the community Health Care - Access to affordable health insurance, Cost of affordable vision insurance, Access to affordable prescription drugs, Cost of affordable dental insurance coverage Preventive Health - Flu shots, ImmunizationsSanford will not directly develop strategy to address the cost of long term care and the availability of memory care because the state of North Dakota through the Department of Human Services controls the cost. Sanford has deferred to the local nursing home which does have an Alzheimer's unit. Safety issues such as seat belt usage and the presence of street drugs are issues that the city council and the sheriff's office are addressing. Sanford serves as a partner in many community groups that have the expertise to address these unmet needs.
Group A-Facility 19 -- Sanford Medical Center Mayville Part V, Section B, line 13h:	Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
Group A-Facility 19 -- Sanford Medical Center Mayville Part V, Section B, line 16j:	Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
Group A-Facility 20 -- Sanford Webster Medical Center Part V, Section B, line 5:	Sanford conducted a community health needs assessment during FY 2016 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2016 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County, North Dakota and Clay County, Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor, to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding community health, their personal health, preventive health, and the prevalence of disease. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during FY 2017-2019. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and response to the community health needs assessment and the implementations strategies are welcome on the Sanford website under "About Sanford" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA
Group A-Facility 20 -- Sanford Webster Medical Center Part V, Section B, line 6a:	Sanford USD Medical Center Sioux FallsSanford Fargo Medical CenterSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
Group A-Facility 20 -- Sanford Webster Medical Center Part V, Section B, line 7d:	Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
Group A-Facility 20 -- Sanford Webster Medical Center Part V, Section B, line 11:	The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: SafetySanford Webster Medical Center will address safety by offering MOAB (management of aggressive behavior) training for employees and to local schools, businesses and the public. Sanford will present a DUI drama program to high school juniors and seniors to reduce the number of alcohol and drug related accidents among teens. Sanford will conduct an annual sports power program to discourage drug and alcohol abuse.Priority 2: Physical Health Sanford will offer the use of PT equipment for the public to increase physical health. Sanford will also increase the number of nutrition consults and provide American Cancer Society referral cards for clinic and hospital visitors and patients.Sanford Webster Medical Center will standardize narcotic prescribing protocols across the enterprise to reduce usage. Narcotic prescriptions will be tracked internally and areas for improvement will be identified.Addressing of Significant Needs during Current Year:Priority 1: SafetyAccording to the CDC, every day, 28 people in the United States die in motor vehicle accidents in the United States. Sanford Webster Medical Center decided to combat this community concern by working with the local Key Club and giving presentations to this community audience. Sanford's Lola Pollard, PA, who is also the Key Club President, gave presentations and education sessions about the local accident rate and how to combat those situations. Local law enforcement also continues to do DUI checkpoints in the county to help with these statistics and to keep the population safe.As drug use and violence continues to increase in this area, South Dakota and the United States, Sanford's staff took the MOAB training. MOAB training presents principles, techniques, and skills for recognizing, reducing and managing violent and aggressive behavior. As Sanford continues to work in and care for this population, the training has been helpful in many of the situations that are faced on a daily basis.Priority 2: Physical HealthSanford Webster's strategy of opening up the physical therapy equipment to the community has been a definite success. On average there have been around 15-20 community members each week who use the equipment. The Sanford physical therapy staff has also offered Better Balance classes in the community to help people who are struggling with physical health or those who want to maintain their physical status.The Sanford Webster dietician meets with patients and individuals on a referral basis in the clinic. This has been a very successful program for those who need the services. The dietician meets with people who are experiencing chronic conditions, and with patients who need overall healthy lifestyle management and medical nutrition therapy. Medical nutrition therapy is an important service for patients and the Webster community.Identified needs not directly addressed by this facility include: Aging - Cost of long term care Children and Youth - Bullying, Availability of activities for children and youth Health Care - Access to affordable health insurance, Cost of affordable dental insurance, Cost of affordable vision insurance, Access to affordable health care, Access to affordable prescription drugs Mental Health - Underage drug use and abuse, Alcohol use and abuse, Drug use and abuse, Underage drinking, Smoking and tobacco use, Stress, Depression
Group A-Facility 20 -- Sanford Webster Medical Center Part V, Section B, line 13h:	Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
Group A-Facility 20 -- Sanford Webster Medical Center Part V, Section B, line 16j:	Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
Group A-Facility 21 -- Sanford Medical Center Wheaton Part V, Section B, line 5:	Sanford conducted a community health needs assessment during FY 2016 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2016 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County, North Dakota and Clay County, Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor, to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding community health, their personal health, preventive health, and the prevalence of disease. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during FY 2017-2019. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and response to the community health needs assessment and the implementations strategies are welcome on the Sanford website under "About Sanford" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA
Group A-Facility 21 -- Sanford Medical Center Wheaton Part V, Section B, line 6a:	Sanford USD Medical Center Sioux FallsSanford Fargo Medical CenterSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Worthington Medical Center
Group A-Facility 21 -- Sanford Medical Center Wheaton Part V, Section B, line 7d:	Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
Group A-Facility 21 -- Sanford Medical Center Wheaton Part V, Section B, line 11:	The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Mental HealthSanford Medical Center Wheaton will expand Medical Home patients who have a PHQ-9 assessment indicating depression. Evidence-based guidelines for mental health will be implemented, and Sanford will work with the TRF psychiatry team and the Traverse County mental health providers to increase the number of available appointments for services. Sanford will also promote the early identification of mental health needs through early childhood wellness exams. Sanford will support parents with healthy social and emotional development tools.Priority 2: SafetySanford will work with law enforcement to provide safe collection sites for unused drugs.Priority 3: Children and YouthSanford will increase access to healthy food options to decrease hunger among children in the community, and support the development of local 4-H groups.Sanford Medical Center Wheaton will standardize narcotic prescribing protocols across the enterprise to reduce usage. Narcotic prescriptions will be tracked internally and areas for improvement will be identified.Addressing of Significant Needs during Current Year:Priority 1: Mental HealthWith the increasing need for mental health services, Sanford Wheaton worked with the Sanford Thief River Falls psychiatry team and Traverse County Mental Health providers to increase the number of available appointments for services and decrease ER visits. Telehealth visits were utilized to provide these services so no one had to drive out of town for services and children did not need to miss a large amount of school time. Sanford Wheaton has added another mental health group, Peterson Medical Clinic that will see all ages of patients and has availability for emergency needs. These services are provided by telehealth. Appointments are available weekly and for emergency cases. Psychiatrist services that are readily available have helped the family practice providers with prescription management.Another strategy was to expand the Medical Home and utilization of an RN Health Coach to provide follow-up for those patients who have PHQ-9 scores that indicate depression. Additional screening tools at timed intervals assess the need for follow-up or demonstrates improvement. A panel specialist will utilize the report for those who are not meeting the PHQ-9 goals for improvement or who are due for re-screening. Quality scores for depression have improved from 2.3 to 4.3. The goal is 5.In addition to the PHQ-9 assessment, Sanford Wheaton implemented evidence-based practice guidelines for patients seen for mental health. Early identification of mental health needs is important and has become standard practice within Sanford. To assist in identifying mental health needs Sanford will work to increase the number of wellness exams and to make them more timely. Sports physicals are now considered well exams and have been expanded with the necessary tools for screening and early detection of mental health issues.Parents of at-risk children also need to have extra support in understanding how to work with and develop healthy social and emotional development skills. During well exams, children and parents are presented with an age-appropriate Reach Out and Read book.Priority 2: SafetySanford Wheaton worked with law enforcement agencies and the Drug Enforcement Agency (DEA) to provide safe collection sites in the community for unused drugs. These sites were established and the amounts that are being turned in are much larger than anticipated. Sanford as a system has taken on the task of reducing opioid prescriptions in an attempt to have less drugs in the community, reduce the number of chronic opioid drug users, and reduce the number of drug seekers in the community.Priority 3: Children and YouthSanford Wheaton's third goal was to provide children with access to healthy food when they are not able to have meals at the school. A large majority of children did not have healthy food from Friday at lunch until they came back on Monday morning for breakfast. Increased access to food was needed to decrease the hunger among children as there are many proven studies that enforce the fact that children who are adequately fed improve their success at school both in learning and behavior. Sanford Wheaton started a food backpack program and worked with the school officials to help identify the individuals who needed food and then proceeded to distribute the bags. Sanford was careful to protect the privacy of families. The program started with distribution during the school year but it was found that the program was going to be needed during the summer also. Current distribution numbers are at 60 on a regular basis. A focus is to have presence at the back-to-school events to make sure that all parents and their families are aware of the food program and to provide some samples of the products so they feel comfortable about registering to receive them.Sanford also supports local 4-H groups in their projects for community gardens, education activities, and financial support to encourage participation in the county fair and other community projects. Sanford also discusses drug abuse and the need for healthy food choices and availability of the food backpack program at the wellness exams.Identified needs not directly addressed by this facility include: Aging - Cost of long term care, Availability of memory care Physical Health - Cancer, Inactivity or lack of exercise, Obesity Preventive Health - Flu shots
Group A-Facility 21 -- Sanford Medical Center Wheaton Part V, Section B, line 13h:	Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
Group A-Facility 21 -- Sanford Medical Center Wheaton Part V, Section B, line 16j:	Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
Group A-Facility 22 -- Sanford Bagley Medical Center Part V, Section B, line 5:	Sanford conducted a community health needs assessment during FY 2016 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2016 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County, North Dakota and Clay County, Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor, to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding community health, their personal health, preventive health, and the prevalence of disease. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during FY 2017-2019. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and response to the community health needs assessment and the implementations strategies are welcome on the Sanford website under "About Sanford" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA
Group A-Facility 22 -- Sanford Bagley Medical Center Part V, Section B, line 6a:	Sanford USD Medical Center Sioux FallsSanford Fargo Medical CenterSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
Group A-Facility 22 -- Sanford Bagley Medical Center Part V, Section B, line 7d:	Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
Group A-Facility 22 -- Sanford Bagley Medical Center Part V, Section B, line 11:	The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Children and YouthSanford Bagley Medical Center has made children and youth a significant priority and has developed strategies to improve the health of newborns and young children, and to enhance the level of care that is available for high risk infants. Sanford clinic nurses will communicate with providers and other staff members about the services that are available to at-risk youth in the community. Sanford Ambassadors will provide educational materials and Text 4 Life bracelets at community events. Additionally, Sanford Fit is an on-line community health activation initiative created by Sanford Health that provides engaging programs and resources to kids, families, leaders and role models across numerous settings to promote and activate healthy choices.Priority 2: Mental Health Sanford has developed strategies to reduce mortality and morbidity from tobacco use, and has set strategies for suicide prevention.Sanford will not directly develop strategy to address the availability of affordable housing and public transportation. However, Sanford serves as a partner in many community groups that have the expertise to address these unmet needs. Sanford will share the formally assessed issues with community leaders who have expertise in these areas.Sanford Bagley Medical Center will standardize narcotic prescribing protocols across the enterprise to reduce usage. Narcotic prescriptions will be tracked internally and areas for improvement will be identified.Addressing of Significant Needs during Current Year:Priority 1: Children and YouthSanford Bagley Medical Center placed a great deal of emphasis on getting resources and materials to children and their parents to help them to become more aware of health goals and wellness options. The Bagley Ambassadors group holds 4-5 events per year that provide interaction and learning opportunities for youth. These include booths at the county fair and high school events, a Teddy Bear Clinic, Spring Fling, and Haunted Hallway. The goal of these programs is to engage the youth in the community to make wellness a conversation and to make heath care a familiar, non-threatening part of their lives. The information provided at these events reaches hundreds of individuals. This work is ongoing and will continue to be a priority for the community.Priority 2: Mental HealthSanford Bagley Medical Center's goal of adding tobacco cessation services and providing Test4Life bracelets serves as a constant reminder of the importance of seeking mental health services for optimal mental health. These services provide the community with the opportunity to have tobacco cessation services available at the local level. The strategic goals have been met, and Sanford will continue to provide services for the community.Identified needs not directly addressed by this facility include: Economics - Availability of affordable housing Transportation - Availability of public transportation Aging - Cost of long term care, Availability of long term care, Availability of resources for caregivers making decisions, Availability of memory care, Availability of resources to help the elderly stay in their homes, Availability of resources for grandparent caregivers for grandchildren, Understanding of advanced care directives Safety - Child abuse and neglect, Crime, Presence of street drugs, prescription drugs and alcohol, Presence of drug dealers, Domestic violence, Presence of gang activity, Elder abuse, Safe places for outdoor youth activities, Sex trafficking Health Care - Access to affordable health insurance, Access to affordable health care, Access to affordable prescription drugs, Cost of affordable dental insurance, Use of emergency services for primary care, Cost of affordable vision insurance, Timely access to mental health/behavioral health providers, Availability of non-traditional hours, Timely access to physician specialists, Coordination of care between providers and services Physical Health - Cancer, Inactivity, Obesity Chronic disease, Poor nutrition Preventive Health - Flu shots
Group A-Facility 22 -- Sanford Bagley Medical Center Part V, Section B, line 13h:	Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
Group A-Facility 22 -- Sanford Bagley Medical Center Part V, Section B, line 16j:	Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
Group A-Facility 23 -- Sanford Canton-Inwood Medical Center Part V, Section B, line 5:	Sanford conducted a community health needs assessment during FY 2016 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2016 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County, North Dakota and Clay County, Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor, to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding community health, their personal health, preventive health, and the prevalence of disease. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during FY 2017-2019. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and response to the community health needs assessment and the implementations strategies are welcome on the Sanford website under "About Sanford" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA
Group A-Facility 23 -- Sanford Canton-Inwood Medical Center Part V, Section B, line 6a:	Sanford USD Medical Center Sioux FallsSanford Fargo Medical CenterSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
Group A-Facility 23 -- Sanford Canton-Inwood Medical Center Part V, Section B, line 7d:	Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
Group A-Facility 23 -- Sanford Canton-Inwood Medical Center Part V, Section B, line 11:	The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Children and YouthSanford Canton-Inwood Medical Center will implement the Sanford fit Program curriculum in the local schools and childcare facilities, and will make the program available for families through the website.Priority 2: Physical Health Sanford will develop a wellness challenge, create a community health fair and bike rodeo to increase opportunities to improve physical health in the community. Sanford Canton-Inwood Medical Center will standardize narcotic prescribing protocols across the enterprise to reduce usage. Narcotic prescriptions will be tracked internally and areas for improvement will be identified.Addressing of Significant Needs during Current Year:Priority 1: Children and YouthWith the growing obesity epidemic, the Sanford Canton-Inwood Medical Center leadership team worked closely with the City of Canton and the Canton School System on strategies to give families more opportunities to be physically fit. Sanford Canton-Inwood Medical Center explored how to enhance youth activities. Work began on improving the summer recreation plan for youth ages 5 to 12 years.The group tailored the 2018 summer recreation program based on the feedback from parents and families. The enrollment for the 2018 recreation program increased to 148 youth participants. Changes were made to incorporate more activities like baseball, ultimate Frisbee, football, kickball and volleyball, but also adding Friday field trips to state parks, museums, and other local attractions. Sanford's community Board of Directors was supportive of this project and provided over $6,000 in funding to help purchase the equipment needed for the new programs and to sponsor some of the field trips for the children and their families.Sanford also worked with the Canton schools to increase activities by providing the Canton Elementary School, which includes approximately 300 students K-5), with a Sanford fit program that help kids understand and manage moods, eat better, enhance their energy, and include physical activity in their healthy lifestyle. The Sanford Canton-Inwood Medical Center Board of Directors invested in funding a strength and conditioning coach for the local schools. The new position started in July 2018 and was geared not only toward student athletes, but also to those students wanting to build confidence and become healthier.Priority 2: Physical HealthThe Sanford Canton-Inwood Medical Center staff and Board of Directors have joined forces with the Canton Chamber of Commerce on a community wellness challenge. The program was developed as a competition and gives points to the individuals on each team for things like eating vegetables, fruits, exercising, attending community events, volunteering, and many other things. Each week the results are tallied and posted for teams to see how they compare to each other. The length of the competition has been anywhere from 6 weeks up to 10 weeks in duration.Identified needs not directly addressed by this facility include: Economics - Availability of affordable housing Transportation - Availability of good walking or biking options Aging - Cost of long term care, Availability of memory care, Availability of long term care, Availability of resources to help the elderly stay safe in their homes, Availability of activities for seniors, Availability of resources for family/friends caring for and making decisions for elders, Cost of activities for seniors Safety - Presence of street drugs and alcohol in the community, Presence of drug dealers in the community Health Care - Access to affordable health insurance, Cost of affordable vision insurance, Use of the emergency room services for primary health care Mental Health/Behavioral Health - Underage drug use and abuse, Underage drinking, Depression, Smoking and tobacco use, Stress, Dementia and Alzheimer's disease, Binge drinkingSanford will not develop strategy to address the need for affordable housing or the availability of good walking and biking option. However, Sanford serves as a partner in many community groups that have the expertise to address these unmet needs. Sanford has convened community leaders to learn of the findings of the formalized assessment and the unmet needs in the community.
Group A-Facility 23 -- Sanford Canton-Inwood Medical Center Part V, Section B, line 13h:	Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
Group A-Facility 23 -- Sanford Canton-Inwood Medical Center Part V, Section B, line 16j:	Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
Group A-Facility 24 -- Sanford Clear Lake Medical Center Part V, Section B, line 5:	Sanford conducted a community health needs assessment during FY 2016 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2016 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County, North Dakota and Clay County, Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor, to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding community health, their personal health, preventive health, and the prevalence of disease. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during FY 2017-2019. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and response to the community health needs assessment and the implementations strategies are welcome on the Sanford website under "About Sanford" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA
Group A-Facility 24 -- Sanford Clear Lake Medical Center Part V, Section B, line 6a:	Sanford USD Medical Center Sioux FallsSanford Fargo Medical CenterSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
Group A-Facility 24 -- Sanford Clear Lake Medical Center Part V, Section B, line 7d:	Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
Group A-Facility 24 -- Sanford Clear Lake Medical Center Part V, Section B, line 11:	The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Mental Health/Behavioral HealthThrough the Medical Home program, RN Health Coach, and PHQ-9 screening, Sanford offers/refers to mental health services for patients with scores indicative of depression. The goal was to evaluate 100% of Medical Home patients for mental health needs. Sanford has met this goal, and continues to complete the PHQ-9 screening every six months for patients with a depression diagnosis, as well as diabetes diagnosis, and those who are a part of Medical Home. Additionally, screenings occur with well child checks including athletic physicals for children and youth age 12 and older. The Columbia Suicide Screening tool is also used to identify patients at risk for suicide.Sanford has worked to identify patients with mental health needs who do not have a primary care provider (PCP) listed in the EMR. This strategy has been successful and a formal process has been implemented. When patients present for a visit, the registrar discusses the PCP and inquires with the patient if a PCP can be named in the EMR. If the patient agrees, the patient is registered with a provider at Sanford Clear Lake Medical Center allowing us to address preventive health maintenance.With the limited mental health resources available in the Clear Lake community, research was conducted to develop and distribute a Clear Lake Area Resource Directory. This strategy has been successful for addressing both mental and physical health within the population. The directory not only includes resources to address mental and physical health, but also resources such as employment, financial assistance, housing, nutrition, pre-planning, protective services, support groups, education, just to name a few. The resource directory is readily available for patients in the clinic setting when these needs are identified. Additionally, the directory is distributed to each medical center patient upon admission.Priority 2: Physical HealthSanford Clear Lake Medical Center projected a positive impact for the community by increasing compliance with preventive screening recommendations. Sanford's strategy for meeting this goal included describing the various preventive services available to 100% of its patients. Through the use of the EMR, 100% of Sanford's patients with overdue health maintenance screenings are easily identified. The clinic support nurse reviews overdue health maintenance with patients and offers these services at each visit. The nurse prepares orders as patients agree to the services. If a patient refuses, a gap sheet indicating the patient's refusal is given to the provider to use as a tool to educate the patient on the importance of preventive health and encourage the patient to complete the preventive health maintenance. Providers are involved in the improvements and progress made through performance improvement and quality assurance studies and Sanford Clear Lake is helping patients manage their optimal health.Addressing of Significant Needs during Current Year:Priority 1: Mental Health/Behavioral HealthThe medical home patients are reviewed each month and all clinic patients are screened using the PHQ9. The counseling services available in our area are listed in the community resources book. Tele-health is available for counseling. Priority 2: Physical HealthFit test kits for colon cancer screening were provided during influenza vaccine clinics at Sanford Clear Lake. Working with health coach and clinic nursing on preventative health screenings. Identified needs not directly addressed by this facility include: Aging - Cost of long term care, Availability of resources for family/friends caring for and making decisions for elders, Availability of memory care Children and Youth - Bullying, Availability of activities for children and youth, Cost of activities for children and youth, Children living in poverty, Children in single parent households Health Care - Access to affordable health insurance, Cost of affordable vision insurance, Cost of affordable dental insurance coverage, Access to affordable prescription drugs, Access to affordable health care, Unmet medical needs, Unmet mental health needs, Need prescription medications Safety - Presence of street drugs and alcohol in the community Substance Use and Abuse - Underage drinking, Underage drug use and abuse, Smoking and tobacco use, Alcohol use and abuse Preventive Health - Flu shots, Immunizations, Not seeing a health care provider or dentist in the past year
Group A-Facility 24 -- Sanford Clear Lake Medical Center Part V, Section B, line 13h:	Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
Group A-Facility 24 -- Sanford Clear Lake Medical Center Part V, Section B, line 16j:	Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
Group A-Facility 25 -- Sanford Westbrook Medical Center Part V, Section B, line 5:	Sanford conducted a community health needs assessment during FY 2016 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2016 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County, North Dakota and Clay County, Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor, to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding community health, their personal health, preventive health, and the prevalence of disease. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during FY 2017-2019. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and response to the community health needs assessment and the implementations strategies are welcome on the Sanford website under "About Sanford" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA
Group A-Facility 25 -- Sanford Westbrook Medical Center Part V, Section B, line 6a:	Sanford USD Medical Center Sioux FallsSanford Fargo Medical CenterSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
Group A-Facility 25 -- Sanford Westbrook Medical Center Part V, Section B, line 7d:	Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
Group A-Facility 25 -- Sanford Westbrook Medical Center Part V, Section B, line 11:	The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Mental Health/Behavioral HealthSanford Westbrook Medical Center has set strategy to decrease the time for patients who seek mental health services to be in the ER before placement, and to work with community partners to create new recovery program options. Sanford will also work with the Minnesota Department of Health on a pilot for integrating behavioral health into critical access hospitals.Priority 2: Physical Health Sanford has set strategy to improve the care of patients with chronic disease, overweight and obesity diagnosis. Patients will work with registered dietitians, exercise specialists, and Health Coaches. Additionally, Sanford will work with the local school leadership to implement Sanford fit into the schools and community.Sanford Westbrook Medical Center will standardize narcotic prescribing protocols across the enterprise to reduce usage. Narcotic prescriptions will be tracked internally and areas for improvement will be identified.Addressing of Significant Needs during Current Year:Priority 1: Mental Health/Behavioral HealthSanford Westbrook continues to improve access to mental health services and decreasing the time for patients to be in its ER. A goal is to provide telehealth for behavioral health services for the Sanford Westbrook emergency room, which has been a work in progress for a few years. Placement of patients with mental health needs has been and continues to be a major issue throughout the state of Minnesota, and especially in rural areas.Sanford Westbrook Medical Center provides child psychiatric care via telemedicine and through consults with a nurse practitioner and LICSW. Sanford Westbrook has worked hard to make the public and community partners aware of the services available.Priority 2: Physical HealthSanford Westbrook has shown great impact through their RN Health Coach and Sanford fit programs, which is demonstrated by the increase in the patient chronic conditions registry and the Minnesota measurement scores.During January of 2016, Sanford Westbrook completed a 19-week Sanford fit program with the Westbrook Walnut Grove Elementary School fourth grade class. The program was a customized version of Sanford fitClub. Two Sanford Westbrook staff members met with the Westbrook Walnut Grove Elementary fourth grade physical education class once a week for 25 minutes each session. The students learned all about Sanford fit and making good, healthy choices regarding their food, move (exercise), mood and recharge (sleep/rest). In addition, the students had weekly challenge cards they took home to complete during the remainder of the week. The completed challenge cards were placed in a drawing and students worked their way towards end-of-year prizes, but also took home activities and exposed their families' to fit. The program completed its second year in May of 2018. After a successful pilot year, at the beginning of the 2018 program the students completed a fitclub "test and were tested again at the end of the year. The students increased their correct answers by more than 24% from the first test to the last. Each week, the Sanford Westbrook staff could see the students engaging and absorbing the information through the fun activities. The program received positive feedback by the Westbrook Walnut Grove Elementary School physical education teacher and principal and will continue into the coming years.Identified needs not directly addressed by this facility include: Aging - Cost of long term care, Availability of memory care, Availability of resources for family/friends caring for and making decisions for elders Children and Youth - Bullying Safety - Presence of street drugs and alcohol in the community Health Care - Access to affordable health insurance, Access to affordable health care, Access to affordable prescription drugs
Group A-Facility 25 -- Sanford Westbrook Medical Center Part V, Section B, line 13h:	Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
Group A-Facility 25 -- Sanford Westbrook Medical Center Part V, Section B, line 16j:	Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy

Field	Value	IRS element (for citing)
Facility	193	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (193 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
1 - Sanford Clinic Aberdeen
3015 3rd Avenue SE	Aberdeen	SD	57401	Medical Clinic
2 - Sanford Clinic Aberdeen Surgical Center
3015 3rd Avenue SE	Aberdeen	SD	57401	Ambulatory Surgery Center
3 - Sanford Health Adrian Clinic
201 Maine Ave	Adrian	SD	56110	Rural Health Clinic
4 - Sanford Health Broadway Clinic
1527 Broadway Street	Alexandria	MN	56308	Medical Clinic
5 - Sanford Health Easton Place Clinic
510 - 22nd Avenue E Suite 602	Alexandria	MN	56308	Medical Clinic
6 - Sanford Bagley Clinic
1656 Central St W	Bagley	MN	56621	Rural Health Clinic
7 - Sanford Bagley Eye Center & Optical
14 2nd St NE	Bagley	MN	56621	Eye Care Center
8 - Sanford Tracy Balaton Clinic
551 Highway 14 E	Balaton	MN	56115	Medicare Certified Rural Health Clinic
9 - Sanford Health Bassett Family Clinic
103 Clark St	Bassett	NE	68714	Medical Clinic
10 - Sanford Health Baudette Eye Center
103 Main St	Baudette	MN	56623	Eye Care Center
11 - Baker Park Inc
803 Dewey Avenue	Bemidji	MN	56601	Assisted Living Center
12 - Edith Sanford Breast Center Bemidji
1233 34th St NW	Bemidji	MN	56601	Women's Health
13 - Sanford Bemidji 1611 Anne St Clinic
1611 Anne St NW	Bemidji	MN	56601	Medical Clinic
14 - Sanford Bemidji 1705 Ann St Clinic
1705 Anne St NW	Bemidji	MN	56601	Medical Clinic
15 - Sanford Bemidji Downtown Eye Center & Op
506 Beltrami Ave NW	Bemidji	MN	56601	Eye Care Center
16 - Sanford Bemidji Home Care & Hospice
3201 Pine Ridge Ave NW	Bemidji	MN	56601	Home Care and Hospice
17 - Sanford Bemidji Main Clinic
1233 34th St NW	Bemidji	MN	56601	Medical Clinic
18 - Sanford Dialysis Bemidji
1300 Anne Street NW	Bemidji	MN	56601	Dialysis
19 - Sanford Health Neilson Place
1000 Anne St NW	Bemidji	MN	56601	Skilled Nursing Facility
20 - Sanford Health Trillium
930 Anne Street NW	Bemidji	MN	56601	Assisted Living Center
21 - Sanford Health Windsong
1010 Anne Street N	Bemidji	MN	56601	Assisted Living Center
22 - Sanford Joe Lueken Cancer Center
1233 34th St NW	Bemidji	MN	56601	Cancer Center
23 - Sanford Clinic Beresford
600 W Cedar Street	Beresford	SD	57004	Rural Health Clinic
24 - Bismarck Cancer Center
500 N 8th Street	Bismarck	ND	58501	Cancer Center
25 - Sanford Birth Center
300 N 7th Street	Bismarck	ND	58501	Birth Center
26 - Sanford Cancer Center Bismarck
300 N 7th Street	Bismarck	ND	58501	Cancer Center
27 - Sanford Tom & Frances Leach Bismarck Dia
209 N 7th Street	Bismarck	ND	58501	Dialysis Center
28 - Sanford Clinic
222 N 7th Street	Bismarck	ND	58501	Medical Clinic
29 - Sanford Children's North Clinic
765 W Interstate Ave	Bismarck	ND	58503	Children's Clinic
30 - Sanford Bemidji Blackduck Clinic
81 1st St NW	Blackduck	MN	56630	Medical Clinic
31 - Sanford Boyden Clinic
3971 320th St	Boyden	IA	51234	Medical Clinic
32 - Sanford Brandon Family Medicine Clinic
1105 E Holly Blvd	Brandon	SD	57005	Medical Clinic
33 - Sanford Health Brookings Clinic
922 - 22nd Avenue S	Brookings	SD	57006	Medical Clinic
34 - Sanford Canby Clinic
112 St Olaf Avenue	Canby	MN	56220	Medicare Certified Rural Health Clinic
35 - Sanford Canby Dental Clinic
11 St Olaf Ave S	Canby	MN	56220	Dental Clinic
36 - Sanford Canby Dialysis Unit
112 St Olaf Avenue S	Canby	MN	56220	Medicare Certified End Stage Renal Dialysis
37 - Sanford Canby Medical Center
112 St Olaf Avenue S	Canby	MN	56220	Medicare Certified Home Health Agency
38 - Sanford Canby Medical Center
112 St Olaf Avenue S	Canby	MN	56220	Class F Home Care Provider
39 - Sanford Health Canby Sylvan Place
212 St Olaf Avenue S	Canby	MN	56220	Housing with Services
40 - Sanford Health CanistotaUSD Clinic
320 W Main St	Canistota	SD	57012	Rural Health Clinic
41 - Sanford Canton Clinic
400 N Hiawatha Drive	Canton	SD	57013	Rural Health Clinic
42 - Sanford Health Canton Hiawatha Heights
398 N Hiawatha Drive	Canton	SD	57013	Assisted Living Center
43 - Sanford Bemidji Cass Lake Clinic
219 Grant Utley Ave NW	Cass Lake	MN	56633	Medical Clinic
44 - Sanford Chamberlain Clinic
300 S Byron Blvd	Chamberlain	SD	57325	Rural Health Clinic
45 - Sanford Health Chamberlain Care Center
300 S Byron Blvd	Chamberlain	SD	57325	Nursing Facility
46 - Sanford Home Health & Hospice Chamberlai
110 W Beebe Ave	Chamberlain	SD	57325	Home Health Care & Hospice
47 - Sanford Health Clark Clinic
211 N Commercial Street	Clark	SD	57225	Rural Health Clinic
48 - Sanford Clear Lake Clinic
701 3rd Avenue S	Clear Lake	SD	57226	Rural Health Clinic
49 - Sanford Clear Lake Medical Center
701 3rd Avenue S	Clear Lake	SD	57226	Home Health Care
50 - Sanford Bagley Clearbrook Clinic
22 Elm Street	Clearbrook	MN	56634	Rural Health Clinic
51 - Sanford Health Dakota Dunes Clinic
350 Oak Tree Ln	Dakota Dunes	SD	57049	Medical Clinic
52 - Sanford Health Dell Rapids Orchard Hills
200 W 10th Street	Dell Rapids	SD	57022	Assisted Living Center
53 - Sanford Dialysis
114 Frazee St E	Detroit Lakes	MN	56501	Dialysis Center
54 - Sanford Health Detroit Lakes Clinc & Sam
1245 Washington Avenue	Detroit Lakes	MN	56501	Ambulatory Surgery Center/Clinic
55 - Sanford Health Detroit Lakes Eye Center
1245 Washington Avenue	Detroit Lakes	MN	56501	Eye Care Center
56 - Sanford Health West Dickinson Clinic
2615 Fairway Street	Dickinson	ND	58601	Medical Clinic
57 - Sanford Health East Dickinson Clinic
33 9th St W	Dickinson	ND	58601	Medical Clinic
58 - Sanford Health Hearing Center Dickinson
1531 W Villard St	Dickinson	ND	58601	Hearing Center
59 - Sanford Health 621 DeMers Ave Clinic
621 DeMers Ave NW	East Grand Forks	MN	56721	Medical Clinic
60 - Sanford Health 929 Central Ave Clinic
929 Central Ave	East Grand Forks	MN	56721	Medical Clinic
61 - Sanford Health EGF Dermatology Clinic
625 DeMers Ave NW	East Grand Forks	MN	56721	Medical Clinic
62 - Sanford Home Care East Grand Forks
404 DeMers Ave	East Grand Forks	MN	56721	Home Health Care
63 - Sanford Health Edgeley Clinic
506 2nd St	Edgeley	ND	58433	Medical Clinic
64 - Sanford Luverne Edgerton Clinic
733 Main Ave	Edgerton	MN	56128	Rural Health Clinic
65 - Sanford Health Ellendale Clinic
141 Main St	Ellendale	ND	58436	Rural Health Clinic
66 - Sanford Health Enderlin Clinic
201 4th Avenue	Enderlin	ND	58027	Rural Health Clinic
67 - Sanford Clinic Estelline
305 Hospital Drive	Estelline	SD	57234	Rural Health Clinic
68 - Edith Sanford Breast Center Fargo
737 Broadway N	Fargo	ND	58102	Women's Health
69 - Sanford 1711 Medical Building
1711 University Drive S	Fargo	ND	58103	Medical Clinic
70 - Sanford 1717 Medical Building
1717 Medical Buildingq	Fargo	ND	58103	Medical Clinic
71 - Sanford Broadway Clinic
801 Broadway N	Fargo	ND	58102	Medical Clinic
72 - Sanford Children's Broadway Clinic
737 Broadway	Fargo	ND	58102	Medical Clinic
73 - Sanford Dialysis Fargo
2801 S University Drive	Fargo	ND	58122	Dialysis
74 - Sanford I-94 Clinic
5225 23rd Avenue South	Fargo	ND	58104	Medical Clinic
75 - Sanford Home Care Fargo
100 4th Street S	Fargo	ND	58103	Home Health Agency
76 - Sanford Roger Maris Cancer Center
840 4th Street N	Fargo	ND	58102	Cancer Center
77 - Sanford South University Eye Center & Op
1717 S University Dr	Fargo	ND	58103	Eye Care Center
78 - Sanford Children's Southwest Clinic
2701 13th Ave S	Fargo	ND	58103	Children's Clinic
79 - Sanford Southpointe Eye Center & Optical
2400 32nd Ave S	Fargo	ND	58103	Eye Care Center
80 - Sanford Health Finley Clinic
407 Washington Ave	Finley	ND	58230	Rural Health Clinic
81 - Sanford Health Forman Clinic
336 Main St SW	Forman	ND	58032	Rural Health Clinic
82 - Sanford Dialysis Fort Yates
100 N River Road	Fort Yates	ND	58538	Dialysis Center
83 - Sanford Health Fosston Eye Center & Opti
111 2nd St NE	Fosston	MN	56542	Eye Care Center
84 - Sanford Rock Rapids George Clinic
101 N Main	George	IA	51237	Rural Health Clinic
85 - Sanford Health Gwinner Clinic
69 ND 13	Gwinner	ND	58040	Rural Health Clinic
86 - Sanford Health Halstad Clinic
445 1st Street E	Halstad	MN	56548	Rural Health Clinic
87 - Sanford Health Hartford Clinic
905 N Oaks Ave	Hartford	SD	57033	Medical Clinic
88 - Sanford Sheldon Hartley Clinic
512 3rd St NE	Hartley	IA	51346	Medical Clinic
89 - Sanford Hawley Clinic
1412 Main St	Hawley	MN	56549	Medical Clinic
90 - Sanford Health Comstock Corner
12 3rd Street SE	Hillsboro	ND	58045	Hospital Based-Nursing Facilities
91 - Sanford Health Hillsboro Clinic
315 East Caledonia	Hillsboro	ND	58045	Rural Health Clinic
92 - Sanford Health Dialysis Hospers
112 Sunrise Drive	Hospers	IA	51238	End Stage Renal Dialysis
93 - Sanford Health International Falls Eye C
1400 Highway 71	International Falls	MN	56649	Eye Care Center
94 - Sanford Health Inwood Clinic
303 E Jefferson St	Inwood	IA	51240	Medical Clinic
95 - Sanford Clinic Ipswich
110 5th Avenue	Ipswich	SD	57451	Rural Health Clinic
96 - Sanford Jackson Clinic
1430 North Highway	Jackson	MN	56143	Medicare Certified Rural Health Clinic
97 - Sanford Dialysis Jamestown
300 2nd Avenue NE	Jamestown	ND	58401	Dialysis Center
98 - Sanford Health Hearing Center Jamestown
904 5th Ave NE	Jamestown	ND	58401	Hearing Center
99 - Sanford Health Jamestown 2nd Ave Clinic
300 2nd Avenue NE	Jamestown	ND	58401	Medical Clinic
100 - Sanford Health Jamestown 5th Ave Clinic
904 5th Ave NE	Jamestown	ND	58401	Medical Clinic
101 - Sanford Health Kelliher Clinic
243 Clark Ave N	Kelliher	MN	56650	Medical Clinic
102 - Sanford Chamberlain Kimball Clinic
101 S Main St	Kimball	SD	57355	Rural Health Clinic
103 - Sanford Children's Clinic
3001 Daggett St	Klamath Falls	OR	97601	Medical Clinic
104 - Sanford Health Lake Norden Clinic
512 Main Ave	Lake Norden	SD	57248	Rural Health Clinic
105 - Sanford Jackson Lakefield Clinic
209 Main Street	Lakefield	MN	56150	Medicare Certified Rural Health Clinic
106 - Sanford Health LaMoure Clinic
101 1st Ave SW	LaMoure	ND	58458	Rural Health Clinic
107 - Sanford Health Lennox Clinic
108 S Main	Lennox	SD	57039	Rural Health Clinic
108 - Sanford Health Lidgerwood Clinic
21 Wiley Ave S	Lidgerwood	ND	58053	Rural Health Clinic
109 - Sanford Health Lisbon Clinic
102 10th Ave W	Lisbon	ND	58054	Rural Health Clinic
110 - Sanford Home Care Lisbon
404 Forest St	Lisbon	ND	58054	Home Health Care
111 - Sanford Home Health Luverne
304 N McKenzie St	Luverne	MN	56156	Home Health Care
112 - Sanford Luverne Clinic
1601 Sioux Valley Dr	Luverne	MN	56156	Medical Clinic
113 - Sanford Luverne Hospice
217 N Oakley St	Luverne	MN	56156	Medicare Certified Hospice
114 - Sanford Dialysis
323 SW 10th Street	Madison	SD	57042	End Stage Renal Dialysis
115 - Sanford Hospice Madison
900 2nd Avenue	Madison	MN	56256	Hospice (licensed in SD)
116 - Sanford Health Mahnomen Clinic
410 W 4th St	Mahnomen	MN	56557	Rural Health Clinic
117 - Sanford Home Care Mahnomen
414 W Jefferson Ave	Mahnomen	MN	56557	Home Health Care
118 - Sanford Home Care Bismarck
910 18th Street NW	Mandan	ND	58554	Home Health Agency
119 - Sanford East Mandan Clinic
102 Mandan Ave	Mandan	ND	58554	Medical Clinic
120 - Sanford Home Care Mayville
49 7th Ave SE	Mayville	ND	58257	Home Health Care
121 - Sanford Mayville Clinic
600 1st St SE	Mayville	ND	58257	Rural Health Clinic
122 - Sanford Health Highway 2 Clinic
801 21st Ave SE	Minot	ND	58701	Medical Clinic
123 - Sanford Health Northwest Clinic
1500 21st Ave NW	Minot	ND	58701	Medica
124 - Sanford Health Minneota Clinic
700 N Monroe St	Minneota	MN	56264	Rural Health Clinic
125 - Sanford Health Mitchell Clinic
2100 Highland Way	Mitchell	SD	57301	Medical Clinic
126 - Sanford Dialysis Morris
400 1st Street East	Morris	MN	56267	Dialysis
127 - Sanford Health Mountain Lake Clinic
308 N 8th Street	Mountain Lake	MN	56159	Medicare Certified Rural Health Clinic
128 - Sanford Health Oakes Clinic
420 7th St S	Oakes	ND	58474	Medical Clinic
129 - Sanford Children's Clinic
3605 Vista Way	Oceanway	CA	92056	Children's Clinic
130 - Sanford Health Park Rapids Clinic
110 7th St W	Park Rapids	MN	56470	Medical Clinic
131 - Sanford Health Parkers Prairie Clinic
115 E Soo Street	Parkers Prairie	MN	56361	Rural Health Clinic
132 - Sanford Health Pelican Rapids Clinic
211 East Mill Street	Pelican Rapids	MN	56572	Rural Health Clinic
133 - Sanford Home Care Pelican Rapids
211 East Mill Street	Pelican Rapids	MN	56572	Home Health Care
134 - Sanford Health Pierre Clinic
521 E Sioux Ave	Pierre	SD	57501	Medical Clinic
135 - Sanford Dialysis Red Lake
24760 Hospital Drive	Red Lake	MN	56671	Dialysis
136 - Sanford Rock Rapids Clinic
803 South Green Street	Rock Rapids	IA	51246	Rural Health Clinic
137 - Sanford Sheldon Sanborn Clinic
321 Main Street	Sanborn	IA	51248	Medical Clinic
138 - Sanford Health Sheldon Care Center
118 North Seventh Avenue PO Box 250	Sheldon	IA	51201	Home Health Agency and Hospice
139 - Sanford Senior Care Sheldon
118 North Seventh Avenue PO Box 250	Sheldon	IA	51201	Hospital Based-Nursing Facilities
140 - Sanford Sheldon Clinic
800 Oak Street	Sheldon	IA	51201	Rural Health Clinic
141 - Ava's House
1320 W 17th Street	Sioux Falls	SD	57104	Nursing Facility
142 - Sanford 10th & Phillips Acute Care & Ort
136 S Phillips Ave	Sioux Falls	SD	57104	Medical Clinic
143 - Sanford 27th & Sycamore Family Medicine
4405 E 26th St	Sioux Falls	SD	57103	Medical Clinic
144 - Sanford 32nd & Ellis Clinic
2601 S Ellis Road	Sioux Falls	SD	57106	Medical Clinic
145 - Sanford Family Medicine 34th & Kiwanis
2701 S Kiwanis Ave	Sioux Falls	SD	57105	Medical Clinic
146 - Sanford 49th & Oxbow Family Medicine
3401 W 49th Street	Sioux Falls	SD	57106	Medical Clinic
147 - Sanford 4th & Sycamore Family Medicine
600 N Sycamore Ave	Sioux Falls	SD	57110	Medical Clinic
148 - Sanford Cancer Center
1309 W 17th St	Sioux Falls	SD	57104	Cancer Center
149 - Sanford Children's MB2 Clinic
1205 S Grange Ave	Sioux Falls	SD	57105	Children's Clinic
150 - Sanford Children's Residency Clinic
6101 S Louise Ave	Sioux Falls	SD	57108	Children's Clinic
151 - Sanford Children's Specialty Clinic
1605 W 22nd St	Sioux Falls	SD	57117	Children's Clinic
152 - Sanford Dialysis Sioux Falls
1321 W 22nd Street	Sioux Falls	SD	57117	Dialysis Center
153 - Sanford Eye Center & Optical
1621 S Minnesota Ave	Sioux Falls	SD	57105	Eye Care Center
154 - Sanford Fetal Care Center
1500 W 22nd Street	Sioux Falls	SD	57105	Birth Center
155 - Sanford Health Midtown Family Planning C
1205 S Grange Ave	Sioux Falls	SD	57105	Medical Clinic
156 - Sanford Hospice
2710 West 12th Street	Sioux Falls	SD	57104	Hospice (licensed in MN and SD)
157 - Sanford Imagenetics
1321 W 22nd Street	Sioux Falls	SD	57117	Genetics
158 - Sanford Home Health Sioux Falls
2710 West 12th Street	Sioux Falls	SD	57104	Home Health Care
159 - The Birth Place
1305 W 18th Street	Sioux Falls	SD	57105	Birth Center
160 - Northern Lights Community Residence
324 E 10th St	Thief River Falls	MN	56701	Community Residence
161 - Pathfinder Children's Treatment Center
921 Atlantic Ave N	Thief River Falls	MN	56701	Treatment Center
162 - Sanford Behavioral Health Outpatient Cli
120 Labree Avenue S	Thief River Falls	MN	56701	Behavioral Health Treatment Center
163 - Sanford Dialysis Thief River Falls
120 Labree Avenue S	Thief River Falls	MN	56701	Dialysis
164 - Sanford Health Thief River Falls Eye Cen
1720 Highway 59 S	Thief River Falls	MN	56701	Eye Care Center
165 - Sanford Medical Center Thief River Falls
1720 Highway 59 S	Thief River Falls	MN	56701	Medical Clinic
166 - Sanford Health Tracy O'Brien Court
410 State Street	Tracy	MN	56175	Housing with Services
167 - Sanford Tracy Clinic
249 Fifth Street E	Tracy	MN	56175	Medicare Certified Rural Health Clinic
168 - Shetek Medical Services
251 5th St E	Tracy	MN	56175	Medical Clinic
169 - Sanford Health Twin Valley Clinic
501 2nd St NW	Twin Valley	MN	56584	Rural Health Clinic
170 - Sanford Health Ulen Clinic
108 Viking Avenue W	Ulen	MN	56585	Rural Health Clinic
171 - Sanford Health Valley City Clinic
520 Chautauqua Blvd	Valley City	ND	58072	Medical Clinic
172 - Sanford Health Vermillion Clinic
20 S Plum Street	Vermillion	SD	56069	Medical Clinic
173 - Sanford Health Vermillion Dakota Gerdens
126 S Plum Street	Vermillion	SD	57069	Residential Living Center
174 - Sanford Hospice
848 East Cherry Street	Vermillion	SD	57069	Hospice
175 - Sanford Vermillion Care Center
20 S Plum Street	Vermillion	SD	57069	Nursing Facility
176 - Sanford Dialysis
111 Washington Ave NW	Wagner	SD	57380	Dialysis Center
177 - Sanford Clinic Wahpeton
332 2nd Ave N	Wahpeton	ND	58075	Medical Clinic
178 - Sanford Health Wahpeton Eye Center & Opt
332 2nd Ave N	Wahpeton	ND	58075	Eye Care Center
179 - Sanford Health Walker Clinic
614 Michigan Avenue	Walker	MN	56484	Rural Health Clinic
180 - Sanford Tracy Walnut Grove Clinic
810 8th St	Walnut Grove	MN	56180	Medicare Certified Rural Health Clinic
181 - Sanford Health Watertown Clinic
901 4th Street NW	Watertown	SD	57201	Medical Clinic
182 - Sanford Webster Clinic
101 Peabody Drive	Webster	SD	57274	Rural Health Clinic
183 - Sanford Health Westrook Peterson Estates
1012 9th Street	Westbrook	MN	56183	Housing with Services
184 - Sanford Westbrook Clinic
920 Bell Avenue	Westbrook	MN	56183	Medicare Certified Rural Health Clinic
185 - Sanford Home Care Wheaton
405 12th St N	Wheaton	MN	56926	Home Health Care
186 - Sanford Wheaton Clinic
401 12th St N	Wheaton	MN	56926	Medical Clinic
187 - Sanford Clinic Windom
591 2nd Avenue N	Windom	MN	56101	Medicare Certified Rural Health Clinic
188 - Sanford Hospice Winner
745 E 8th Street	Winner	SD	57580	Hospice
189 - Sanford Dialysis
1018 Sixth Avenue	Worthington	MN	56187	Dialysis Center
190 - Sanford Health Cancer Center
1018 Sixth Avenue	Worthington	MN	56187	Cancer Center
191 - Sanford Hospice
1151 Ryans Road Suite 100	Worthington	MN	56187	Hospice (licensed in SD)
192 - Sanford Worthington Clinic
1680 Diagonal Road	Worthington	MN	56187	Medical Clinic
193 - Sanford Worthington Medical Center
1018 Sixth Avenue	Worthington	MN	56187	Medicare Certified End Stage Renal Dialysis

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part I, Line 3c:	Sanford Health does not deny care to anyone based on the ability to pay. Sanford's Financial Assistance (charity care) policy provides discounted and free services to patients who lack the resources to be fully responsible for the healthcare they receive. The Financial Assistance Policy is designed to ensure the entire community served by Sanford has access to needed healthcare services. Eligibility for discounted or free services under the Financial Assistance Policy is based on income levels and family size. Generally, individuals earning income of up to 375% of the Federal Poverty Income Guidelines are eligible for varying levels of discounts, including full discounts for certain income levels. Applications for coverage under the program may be obtained at any Sanford patient registration area.The primary scope of Sanford's financial assistance matrix considers family income and family size to objectively determine financial need. The family income range varies from 0-225% up to 375% of the Federal Poverty Level (FPL). An applicant over 375% may be eligible for some level of financial assistance based on a review of additional factors such as: the size of the account balance, debt-to-income ratio, current assets, current liabilities, IRS food expense allowances, monthly cash flow, etc.Additionally, it is possible for a family to qualify in one segment (based on income and family size alone) but be moved to a more generous (for the patient) segment based on the other financial variables mentioned above. An applicant may be denied if they have substantial assets and applicants are considered on a case by case basis.The Amount Generally Billed (AGB) discount percentage is the least amount Sanford can discount for any patient qualifying under the Sanford Financial Assistance Policy. It is the percentage used for the lowest level of assistance granted for those qualifying under the Sanford Financial Assistance Policy as listed on Appendix 1 - Sliding Discount Schedule for Assistance. Anyone else qualifying for assistance at greater levels will receive discount amounts greater than the Sanford AGB discount amount. Part I, Line 5b: Sanford as a whole did exceed its financial assistance budget for FY 2018, however, exceeding that budget did not impact the ability to serve any patients and no patients were disallowed services. The organization provided free or discounted services to patients who were eligible for free or discounted care.Part I, Line 6: Sanford Health's 2017 Community Benefit Annual Report is posted annually on the Sanford website at:http://www.sanfordhealth.org/about/community-benefit
Part I, Line 7:	The Amount Generally Billed (AGB) discount percentage is the least amount Sanford can discount for any patient qualifying under the Sanford Financial Assistance Policy. It is the percentage used for the lowest level of assistance granted for those qualifying under the Sanford Financial Assistance Policy as listed on Appendix 1 - Sliding Discount Schedule for Assistance. Anyone else qualifying for assistance at greater levels will receive discount amounts greater than the Sanford AGB discount amount. Cost to Charge Ratios are used to calculate the amounts on Line 7a - 7c (Financial Assistance, Medicaid Shortfall, and Other Means-Tested Government Programs) and also Line 7g (Subsidized Health Services) for each of the subsidiaries included in the return. All other amounts for Lines 7e, 7f, 7h and 7i would come from the books and records of specific segments of the organization and would not be based on a Cost to Charge Ratio, or similar cost accounting methodology. These costs still represent the costs to provide benefits.
Part I, Line 7g:	Subsidized health services are clinical services provided to both inpatients and outpatients despite a financial loss to Sanford. Each loss has been calculated after removing losses associated with bad debts, financial assistance and Medicaid. Although these services generate overall losses to Sanford, they continue to meet the needs of the communities served. Various services that generate losses are provided by Sanford through physician practices. For FY 2018, subsidized health services provided through these physician practices generated losses of $51,308,768.
Part II, Community Building Activities:	Sanford Health is a not-for-profit organization dedicated to the work of health and healing for the public good. Sanford is committed to giving back to the communities in which its employees and patients live and work. Sanford invests resources in order to produce the best outcomes for patient care, education, research, and community enrichment, and partners with others to ensure that the community is a welcoming, healthy environment and one that attracts and sustains a diverse Sanford workforce to deliver the best patient care and much needed medical research. Sanford considers requests for funding and in kind support for new and ongoing programs with all areas supporting the above goals, such as basic human services, education and workforce development by recruiting physicians and other health professionals to medical shortage or underserved areas and collaborating with educational institutions to train and recruit health professionals, advocating community health improvement through efforts to support policies and programs that safeguard or improve public health and help to ensure access to health care services.
Part III, Line 2:	Bad debt expense at cost is determined using the same cost to charge ratios that are used to calculate Financial Assistance and Medicaid Shortfall. Discounts and allowances are accounted for separately from Bad Debt Expense.
Part III, Line 3:	It is Sanford's policy to make financial assistance available to patients who fit the financial assistance criteria. It is the organization's goal to make certain that Sanford is proactive in identification of the patients who need help with financial concerns. Financial counselors make every effort to ensure that financial assistance eligible patients do not progress to bad debt. For this reason, a dollar amount for bad debt is not included.
Part III, Line 4:	The audited financial statements of Sanford do not include a bad debt footnote. Sanford reports bad debt in accordance with generally accepted accounting principles (GAAP).
Part III, Line 8:	Per IRS instructions, Sanford has identified the cost associated with providing Medicare services from the Medicare cost report. The Medicare cost report calculations are total expense less expenses deemed "unallowable" per Medicare regulations. The net expense is then used to calculate the cost per day and cost to charge ratios which are multiplied by the Medicare days and ancillary charges to determine the cost of providing Medicare services. If all expenses that Sanford incurred were included on the Medicare cost report; this would show a shortfall of approximately $246,321,201. Sanford believes this shortfall should be considered community benefit because these services would need to be provided by either another charitable organization or the government if it was not provided by Sanford.
Part III, Line 9b:	Sanford will provide services at no cost or reduced cost to patients who qualify for the program. Patients with incomes at or below 225% of the United States Department of Health and Human Services poverty guideline will receive a 100% reduction of their payment responsibility. Patients with income between 225% - 375% of the poverty guideline will be given a discount based on a sliding scale and assets are considered in the calculation of the income of the patient, with the exception of the patient's principal residence. Patients above 375% of the FPG will be reviewed for additional factors such as size of medical debt before a final determination. Patients must make their financial need known to appropriate personnel and be engaged in filing appropriate and complete applications. The program is available to those patients without health care benefits from any source as well as to those who have coverage for health care costs through a government program, commercial insurance, or other health benefit plan but continue to have a remaining balance after benefits have been applied to the charges. Sanford will not deny financial assistance based on race, creed, sex, national origin, handicap or age.Every effort is made to identify patients with financial need as early as possible in the revenue cycle.Sanford has zero tolerance for abusive, harassing, oppressive, false, deceptive, or misleading language of collections conduct. This zero tolerance applies to internal Sanford staff and third party collection vendors and attorneys.Neither Sanford nor any of its third party collection vendors will take any extraordinary collection efforts until Sanford and the third party collection vendor have made reasonable efforts to determine if a patient is eligible for financial assistance under the Financial Assistance Policy.
Part VI, Line 2:	Sanford conducted a community health needs assessment during FY 2016 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2016 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area -Cass County, North Dakota and Clay County, Minnesota, the Bemidji area - Beltrami County in MN, the Bismarck area - Burleigh and Morton counties in ND, and the Sioux Falls area - Minnehaha, Lincoln, Turner and McCook counties in SD. A stratified random sample was obtained through a qualified vendor, to ensure that appropriate proportions from each of the counties were included. A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding community health, their personal health, preventive health, and the prevalence of disease. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during FY 2017-2019. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity.Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and response to the community health needs assessment and the implementations strategies are welcome on the Sanford website under "About Sanford" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University -Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA
Part VI, Line 3:	Sanford employs a variety of strategies to make certain that the organization is transparent in the communication of financial assistance guidelines. The staff at Sanford makes every effort to identify patients needing financial assistance as early in the revenue cycle as possible. All Sanford entities display signage in registration areas advising patients of their ability to request financial assistance. The signage was made available in English and Spanish. Financial Assistance applications were available in English or Spanish upon request. All healthcare workers who identify patients with financial need are encouraged to provide patients or their designees a financial application. This may include, but not be limited to the following areas: Administration, Admissions, Patient Financial Services, Financial Counselors, Social Services, Physicians, Nursing, Clinic Director, Reception staff and Human Resources.Financial Counselors are trained to work individually with patients to determine the financial need and recommend appropriate assistance in application for charity care, government programs or discounted services.Sanford's Financial Assistance Program is available to anyone who qualifies for assistance. This program ensures that all people receive the care they need, regardless of their financial situation. Sanford makes Financial Assistance information available to community agencies and referral organizations. Financial Assistance information is also available on the Sanford website at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policyfinancial-assistance-policy
Part VI, Line 4:	Sanford Health is an integrated health system headquartered in the Dakotas. It is one of the largest health systems in the nation with 43 hospitals and nearly 250 clinics in nine states and three countries. Sanford Health's approximately 33,000 employees, including 1,400 physicians, make it the largest employer in the Dakotas. Sanford USD Medical Center - Sioux Falls, South DakotaSioux Falls is the largest city in the state of South Dakota and is the County seat of Minnehaha County. Sioux Falls also extends into Lincoln County. The 2017 U.S. Census Bureau estimates a total population of 176,888 for Sioux Falls. According to the 2017 County Health Rankings, the population of Minnehaha County is 84.0% white, 4.5% African American, 2.8% American Indian, 2.0% Asian and 4.9% Hispanic. Sioux Falls is a significant regional health care center. Only 2% of the population is reported to be not proficient in English. The median household income in Sioux Falls is $55,600.Sanford Medical Center Fargo - Fargo, North DakotaFargo is the largest city in North Dakota, accounting for 15% of the state's population. Fargo is also the county seat of Cass County. The 2017 United States Census estimates the population of Fargo was 122,359. According to the 2017 County Health Rankings, the population of Cass County is 87.5% white, 4.0% African American, 1.4% American Indian, 2.8% Asian and 2.6% Hispanic. Only 1% of the population is reported to be not proficient in English. The median household income is $55,900. Sanford Bemidji Medical Center - Bemidji, MinnesotaBemidji is located in Beltrami County, Minnesota. Bemidji houses many Native American Services, including the Indian Health Service. The city is the central hub of the Red Lake Indian Reservation, White Earth Indian Reservation, and the Leech Lake Indian Reservation. According to the 2017 United States Census estimates, the population of Bemidji is 15,366. According to the 2017 County Health Rankings, the population of Beltrami County is 73.1% white, 0.8% African American, 21.2% American Indian, 0.7% Asian and 2.0% Hispanic. 0% of the population is reported to be not proficient in English. The median household Income is $46,000.Sanford Bismarck Medical Center - Bismarck, North DakotaBismarck is a city located in Burleigh County in central North Dakota. Bismarck is experiencing fast-paced growth as a direct result of oil development throughout the western part of the state. Bismarck is the state capital and is the second largest city in the state of North Dakota with a population 72,865. According to the 2017 County Health Rankings, the population of Burleigh County is 90.1% white, 1.4% African American, 4.2% American Indian, 0.7% Asian and 2.1% Hispanic. 0% of the population is reported to be not proficient in English. The median household income is $66,100.Sanford Network HospitalsSanford Health Network Hospitals is a network of rural hospitals located throughout South Dakota, North Dakota, Minnesota, and Iowa.Sanford ClinicsSanford Clinic is a multi-specialty clinic comprised of 1,400 physicians providing services in the US as well as internationally.
Part VI, Line 5:	Sanford maintains an open medical staff. Community Boards - The Sanford Board of Trustees was comprised of 14 members at the end of the fiscal year, including 9 volunteer community members, 4 physicians and the CEO. Surplus Funds - Surplus funds are invested back into the community, as well as to resource development and facility development to better serve patients and communities.
Part VI, Line 6:	Sanford Health is an integrated health system headquartered in the Dakotas. It is one of the largest health systems in the nation with 43 hospitals and nearly 250 clinics in nine states and three countries. Sanford Health's 27,000 employees, including 1,400 physicians, make it the largest employer in the Dakotas.Sanford Health provides services at every level from critical access hospitals to tertiary and quaternary care. The Sanford footprint includes over 220,000 square miles with a nine state service area and a network of children's primary care clinic locations across the country and world. Sanford Health operates full-time emergency centers and provides emergency care to everyone regardless of their ability to pay. Sanford facilities and clinics provide services to remote and medically underserved areas that would otherwise not have access to even primary care services. Sanford Health financially supports health and wellness, education and community development activities to improve the quality of life and strenghten communities throughout the region. Each facility promotes health and healing that responds to the unique needs of the patients in the community, ensuring access to comprehensive and specialized services. Part VI, Line 7: Community benefit reporting is not required and therefore not filed in North Dakota, South Dakota, Nebraska or Iowa. Filing in Minnesota is voluntary.

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Grant Records Maintained	Yes (1)	GrantRecordsMaintainedInd

Recipient Table RecipientTable (238 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Recipient EINRecipientEIN	IRC SectionIRCSectionDesc	Cash GrantCashGrantAmt	Purpose Of GrantPurposeOfGrantTxt	Non Cash AssistanceNonCashAssistanceAmt	Valuation Method UsedValuationMethodUsedDesc	Non Cash AssistanceNonCashAssistanceDesc	Address Line2USAddress/AddressLine2Txt
ABERDEEN CATHOLIC SCHOOL
1400 N Dakota Street	Aberdeen	SD	57401	460334005	501(c)(3)	$27,850	GENERAL SUPPORT
ABERDEEN DEVELOPMENT CORP
416 Production St N	Aberdeen	SD	57401	466011831	501(c)(6)	$8,500	GENERAL SUPPORT
ABERDEEN FAMILY YMCA
5 South State Street	Aberdeen	SD	57401	460255779	501(c)(3)	$20,500	PLEDGE
ABERDEEN PUBLIC SCHOOLS FOUNDATION
1224 3rd St South	Aberdeen	SD	57401	460423109	501(c)(3)	$40,000	GENERAL SUPPORT
ABERDEEN SCHOOL DISTRICT
1224 3rd St South	Aberdeen	SD	57401	466000912	115	$5,300	KNIGHT FOR A PRINCESS DONATIO
ALEXANDER MITCHELL PUBLIC LIBRARY
519 S Kline Street	Aberdeen	SD	57401	460428183	501(c)(3)	$10,000	GENERAL SUPPORT
ALZHEIMERS ASSOCATION
1000 N West Avenue Ste 250	Sioux Falls	SD	57104	133039601	501(c)(3)	$9,000	GENERAL SUPPORT
AMERICAN FOUNDATION FOR SUICIDE
1040 N Main Ave Unit D	Tea	SD	57064	133393329	501(c)(3)	$7,000	GENERAL SUPPORT
AMERICAN HEART ASSOCIATION INC
7272 Greenville Ave	Dallas	TX	75231	135613797	501(c)(3)	$124,000	GENERAL SUPPORT
AMERICAN LEGION
1701 W Legion Dr	Sioux Falls	SD	57104	386902131	501(c)(3)	$6,620	GENERAL SUPPORT
AMERICAN RED CROSS
808 West Ave	Sioux Falls	SD	57104	530196605	501(c)(3)	$30,000	GENERAL SUPPORT
AMERICAN CANCER SOCIETY
4904 S Technopolis Dr	Sioux Falls	SD	57106	410724036	501(c)(3)	$294,400	SUPPORT ACS EVENTS
AMERICAN GOLD GYMNASTICS
2001 17th Ave S	Fargo	ND	58103	450333196	501(c)(3)	$22,250	GOLF SCRAMBLE TEE BOX SPONSOR
ARTHRITIS FOUNDATION - UPPER MIDWEST REGION
PO Box 1208	Fargo	ND	58107	390860526	501(c)(3)	$30,500	GENERAL SUPPORT
ARTS PARTNERSHIP
1104 2nd Ave S Suite 315	Fargo	ND	58103	237108936	501(c)(3)	$25,500	CREATING GOOD DONATION
AUGSBURG COLLEGE
2211 Riverside Ave	Minneapolis	MN	55454	410694721	501(c)(3)	$7,500	ADVANCEMENT PEACE ACTION SPON
AUGUSTANA UNIVERSITY
2001 S Summit Ave	Sioux Falls	SD	57197	460224588	501(c)(3)	$1,515,818	DONATION
BEMIDJI BLUE OX MARATHON
PO Box 633	Bemidji	MN	56619	461700357	501(c)(3)	$15,000	DONATION
BEMIDJI STATE UNIVERSITY
1500 Birchmont Dr NE	Bemidji	MN	56601	237044156	501(c)(3)	$74,625	GENERAL SUPPORT
BEMIDJI YOUTH LEAGUE INC
PO Box 1677	Bemidji	MN	56619	411763981	501(c)(3)	$5,500	DONATION
BIG BROTHERS BIG SISTERS OF AMERICA
2502 n Rocky Point Dr	Tampa	FL	33607	231365190	501(c)(3)	$10,000	GENERAL SUPPORT
BISMARCK EVENT CENTER
315 S 5th St	Bismarck	ND	58504	456002036	115	$5,804	SANFORD CLASSIC TOURNEY
BISMARCK RECREATION COUNCIL
400 E Front Ave	Bismarck	ND	58504	450384442	501(C)(3)	$10,000	ICE EXPANSION -BRC
BISMARCK PUBLIC SCHOOLS
806 N Washington St	Bismarck	ND	58501	450442960	501(c)(3)	$104,000	GENERAL SUPPORT
BISMARCK STATE COLLEGE FOUNDATION
PO Box 5587	Bismarck	ND	58506	450358929	501(c)(3)	$523,718	GENERAL SUPPORT
BOYS & GIRLS CLUB
824 E 14th St	Sioux Falls	SD	57104	460399482	501(c)(3)	$41,334	GENERAL SUPPORT
BRANDON VALLEY BASEBALL ASSOC
PO Box 605	Brandon	SD	57005	460401362	501(c)(3)	$28,000	LEGENDS 2017 GRANT FENCING
BRANDON VALLEY BOOSTER CLUB
PO Box 572	Brandon	SD	57005	466002577	501(c)(6)	$10,500	DONATION SCOREBOARD 2
BRANDON VALLEY FOOTBALL
301 S Splitrock Blvd	Brandon	SD	57005	466002577	501(c)(6)	$5,015	2017 LEGENDS FB GRANT
BRANDON VALLEY SCHOOL
PO Box 572	Brandon	SD	57005	466002577	501(c)(6)	$14,800	YEARLY DONATION
BROOKINGS HEALTH SYSTEM FOUNDATION
300 22nd Ave	Brookings	SD	57006	271785343	501(c)(3)	$20,000	GENERAL SUPPORT
CANTON INWOOD AREA HEALTH
PO Box 292	Canton	SD	57013	460210400	501(c)(3)	$5,500	GENERAL SUPPORT
CATHOLIC COMMUNITY FOUNDATION
523 N Duluth Ave	Sioux Falls	SD	57104	466068924	501(C)(3)	$10,000	GENERAL SUPPORT
45CENTRAL CASS PUBLIC SCHOOLS
802 5th St N	Casselton	ND	58012	456000306	115	$20,000	WELLNESS CTR DONATION
CENTRAL LYON SCHOOL DISTRICT
104 Riverview Dr	Rock Rapids	IA	51246	421515405	501(c)(3)	$15,500	DIGITAL BOARD SPONSORSHIP
CHAD GREENWAY FOUNDATION
59 Cavalier Blvd Ste 310	Florence	KY	41042	261782419	501(c)(3)	$18,400	SPONSOSHIP-CELEB WAITER/FOOTB
CHAMBER OF COMMERCE
200 N Phillips Ave Sute 200	Sioux Falls	SD	57104	460189300	501(c)(6)	$35,755	DONATION
CHAMBER OF COMMERCE BIS-MAN
PO Box 1675	Bismarck	ND	58502	450116753	501(c)(6)	$5,935	2018 TRC CAMPAIGN SPONSOR
CHAMBER OF COMMERCE FMWF
PO Box 2443	Fargo	ND	58108	450448041	501(c)(6)	$47,755	105 HOMETOWN HERO SPONSOR
CHARIS MINISTRY PARTNERS
1300 E 10th Street	Sioux Falls	SD	57103	383775128	501(c)(3)	$7,000	DONATION TO HEALTHY RIDES MIN
CHILDREN OF THE NATIONS
PO Box 3970	Silverdale	WA	98383	911702551	501(c)(3)	$12,500	DONATION
CHILDRENS HOME SOCIETY OF SD
801 N Sycamore Ave	Sioux Falls	SD	57110	460224542	501(c)(3)	$12,500	GENERAL SUPPORT
CHILDRENS HOSPITAL LOS ANGELES
4650 Sunset Blvd	Los Angeles	CA	90027	951690977	501(c)(3)	$212,500	CONSORTIUM COLLABORATION FUND
CHILDRENS WORLD
1221 E 6th St	Sheldon	IA	51201	421036015	501(c)(3)	$6,000	GENERAL SUPPORT
CITY OF FARGO
PO Box 1607	Fargo	ND	58107	456002069	115	$10,000	GENERAL SUPPORT
CITY OF SHELDON
416 9th Street PO Box 276	Sheldon	IA	51201	426005194	115	$50,000	DONATION PLEDGE PAYMENT
COMMUNITIES FOUNDATION OF OKLAHOMA
PO Box 21210	Oklahoma City	OK	73156	731396320	115	$10,000	GENERAL SUPPORT
COMMUNITY INDOOR TENNIS CENTER
4210 N Bobhalla Dr	Sioux Falls	SD	57107	452784394	501(c)(3)	$25,000	GENERAL SUPPORT
COMMUNITY MEMORIAL HOSPITAL
PO Box 319	Burke	SD	57523	460219795	501(c)(3)	$25,000	GENERAL SUPPORT
CONCORDIA COLLEGE
901 8th St	Moorhead	MN	56560	410693977	501(c)(3)	$1,388,100	TED HEIMARCK PROFESSOR PLEDGE
CYSTIC FIBROSIS FOUNDATION
8011 34th Ave S Ste 116	Bloomington	MN	55425	131930701	501(c)(3)	$36,750	SUPPORT: CORKS & KEGS DONATION
DAKOTA ALLIANCE SOCCER CLUB
401 W 39th Street	Sioux Falls	SD	57105	460359817	501(c)(3)	$61,000	CONTRACT DONATION
DAKOTA BOYS AND GIRLS RANCH
PO Box 5007	Minot	ND	58702	450333670	501(c)(3)	$15,000	DONATION
DAKOTA MEDICAL FOUNDATION
4141 28th Ave S	Fargo	ND	58104	456012318	501(c)(3)	$25,000	DONATION SUPPORT
DAKOTA SCHOOLERS
1809 W Oak Street	Sioux Falls	SD	57105	203452350	501(c)(3)	$37,500	DONATION CONTRACT PAYMENT
DAKOTA STATE UNIVERSITY
820 N Washington Ave	Madison	SD	57042	466000364	501(c)(3)	$6,000	GALA 2018 SUPPORT
DETROIT MOUNTAIN
Po Box 1039	Detroit Lakes	MN	56502	272089583	501(c)(3)	$10,000	GENERAL SUPPORT
DICKINSON STATE UNIVERSITY
PO Box 19	Dickinson	ND	58602	475378716	501(c)(3)	$10,000	MULTIPURPOSE RM NAMING RIGHTS
DILWORTH GLYNDON FELTON PUBLIC SCHOOLS
513 Parke Ave	Glyndon	MN	56547	061400159	115	$5,050	NEW SCOREBOARD DONATION
DOW RUMMEL
1321 West Dow Rummel St	Sioux Falls	SD	57104	460271277	501(c)(3)	$25,000	DONATION
DUNCAN REGIONAL HEALTH (OK)
1407 Whisenant Dr	Duncan	OK	73533	202772056	501(c)(3)		DONATION OF CLINIC	$2,234,776	FMV	CLINIC BUILDING
Edith Sanford Breast Cancer Foundation
P O Box 5039 Rte 5218	Sioux Falls	SD	571175039	450404126	501(c)(3)	$8,382	GENERAL SUPPORT
EL RIAD SHRINERS
510 S Phillips Ave PO Box 1203	Sioux Falls	SD	571011203	460129703	501(c)(3)	$8,300	DONATION
EMBE
300 West 11th Street	Sioux Falls	SD	571046306	460234998	501(c)(3)	$15,250	GENERAL SUPPORT
EMERGING PRAIRIE
4141 28th Ave S	Fargo	ND	58104	200520386	501(c)(3)	$30,000	TEDX 2017 SPONSORSHIP
FACE IT TOGETHER
231 S Phillips Ave No 201	Sioux Falls	SD	57104	272501220	501(c)(3)	$25,000	GENERAL SUPPORT
FAMILY ADVOCACY CENTER OF NORTHERN MINNESOTA
800 Bemidji Ave N Ste 4	Bemidji	MN	56601	202102302	501(C)(3)	$32,000	GENERAL SUPPORT
FAMILY HEALTHCARE CENTER
301 NP Avenue	Fargo	ND	58102	450430628	501(c)(3)	$10,130	GENERAL SUPPORT
FARGO MARATHON
405 W Main Ave No 1D	West Fargo	ND	58078	432043293	501(c)(3)	$92,500	EDITH BRANDING DONATION
FARGO PARK DISTRICT FOUNDATION
701 Main Ave	Fargo	ND	58103	471248968	501(c)(3)	$8,143	LEAGUE TEAM FEE DONATION
FARGO SCHOOLS
415 4th St N	Fargo	ND	57192	456012318	501(c)(3)	$11,000	SIGN SPONSORSHIP
FARGO HOCKEY ASSOCIATION
831 17TH Ave N	Fargo	ND	58102	363548649	501(C)(3)	$12,250	HOCKEY NIGHT IN FARGO 2018
FEEDING SOUTH DAKOTA
3511 N 1st Avenue	Sioux Falls	SD	57104	363293534	501(c)(3)	$10,000	DONATION
FELLOWSHIP OF CHRISTIAN ATHLETES
8701 Leeds Rd	Kansas City	MO	64129	440610626	501(c)(3)	$7,500	GENERAL SUPPORT
FIRST TEE OF SOUTH DAKOTA
4809 W 41st St Suite 202	Sioux Falls	SD	57106	460449824	501(c)(3)	$90,000	DONATION
FM SYMPHONY
808 3rd Ave S Ste 300	Fargo	ND	58103	450275135	501(c)(3)	$20,000	2017-2018 SPONSORSHIP
FORWARD SIOUX FALLS
PO Box 907	Sioux Falls	SD	57101	460396647	501(c)(6)	$350,000	GENERAL SUPPORT
FRIENDS OF THE ND GOVERNORS RESIDENCE
PO Box 2024	Bismarck	ND	58502	363646958	501(c)(3)	$150,000	GENERAL SUPPORT
FRIENDS OF THE UNIV OF STELLENBOSCH FOUNDATION
1000 N West St Suite 1200	Wilmington	DE	19801	134091453	501(c)(3)	$100,000	GENERAL SUPPORT
GIRL SCOUTS
1101 S Marion Road	Sioux Falls	SD	57106	460250744	501(c)(3)	$11,500	DONATION
GIRLS ON THE RUN
300 West 11th Street	Sioux Falls	SD	571046306	460234998	501(c)(3)	$6,000	GENERAL SUPPORT
GLOBAL HEALTH CORPS INC
1 Penn Plaza Suite 6271	New York	NY	10119	800512336	501(c)(3)	$1,000,000	GENERAL SUPPORT
GOOD SAMARITAN CENTER (SOCIETY)
401 W 2nd St	Sioux Falls	SD	57104	460349951	501(c)(3)	$26,500	ANNL CONFERENCE
GOVERNORS OFFICE OF ECONOMIC DEVELOPMENT
711 E Wells Ave	Pierre	SD	57501	466000364	115	$15,000	GENERAL SUPPORT
GREAT PLAINS FOOD BANK
1720 3rd Ave N	Fargo	ND	58102	450226421	501(c)(3)	$25,000	FEED THE FUTURE
GREAT PLAINS ZOO
805 S Kiwanis Ave	Sioux Falls	SD	57104	466015015	501(c)(3)	$195,317	DONATION
GREAT RIDES FARGO
425 Broadway N	Fargo	ND	58102	461849025	501(c)(3)	$15,000	GENERAL SUPPORT
Greater Fargo Moorhead Economic Development Corporation
51 Broadway Suite 500	Fargo	ND	58102	456011769	501(c)(6)	$40,000	GENERAL SUPPORT
GROUND WORKS
201 N Weber Ste 201	Sioux Falls	SD	57103	452767053	501(c)(3)	$17,500	TEACHING GARDEN EXPANS DONATE
HEALING HOPE MINISTRIES
30185 475th Ave	Alcester	SD	57001	812069424	501(c)(3)	$27,500	DONATION OPERATING EXPENSES
HELPLINE CENTER INC
1000 N West Ave Suite 310	Sioux Falls	SD	57104	237424387	501(c)(3)	$21,000	2018 CORPORATE CONTRIBUTION
HILLSBORO PUBLIC SCHOOLS
128 4th St NE PO Box 579	Hillsboro	ND	58045	456001736	501(c)(3)	$6,250	SPORTS COMPLEX SPONS
HOPE HAVEN INC
PO Box 70	Rock Valley	IA	51247	420890017	501(c)(3)	$7,500	DESSERT AUCTION & GOLF BNFT
HOSPICE OF MURRAY COUNTY
36 Park Dr	Slayton	MN	56172	411593410	501(c)(3)	$8,000	GENERAL SUPPORT
HUNGRY HEARTS
4701 E 54TH ST	SIOUX FALLS	SD	57110	474744673	501(c)(3)	$10,000	DONATION SF SCHOOL LUNCH
ICE SPORTS ASSOCIATION
108 S Dakota Ave	Sioux Falls	SD	57104	271234271	501(c)(3)	$155,600	1984 ZAMBONI ICE RESURFACER
IMPACT FOUNDATION
4141 28th Ave S	Fargo	ND	58104	200520386	501(c)(3)	$12,500	DONATION
INDEPENDENT SCHOOL DISTRICT FARGO
415 N 4th Street	Fargo	ND	58102	456000294	115	$15,000	VETERANS MEM CTR
JAMESTOWN PARK & RECREATION FOUNDATION
1002 2ND Ave SE	Jamestown	ND	58401	751597713	501(C)(3)	$5,700	TWO RIVERS ACTIVITY CENTER
JDRF
2301 East 60th St North	Sioux Falls	SD	57104	231907729	501(c)(3)	$25,000	GENERAL SUPPORT
JEREMIAH PROGRAM
615 1st Ave NE No 210	Minneapolis	MN	55413	411801834	501(c)(3)	$5,500	JOURNEY FOR HOPE DONATION
JUNIOR ACHIEVEMENT
1000 N West Ave No 110	Sioux Falls	SD	57104	460306352	501(c)(3)	$37,950	DONATION MATCHING GIFTS
KIDS CHANCE OF SOUTH DAKOTA
300 S Main Ave	Sioux Falls	SD	57104	474439997	501(c)(3)	$8,000	DONATION SCHOLARSHIP FUNDING
LEADERSHIP SOUTH DAKOTA
PO Box 675	Platte	SD	57369	460398115	501(c)(3)	$10,000	GENERAL SUPPORT
Legends Of Gold Inc
Box 287	Beresford	SD	57004	273794971	501(c)(3)	$21,425	GENERAL SUPPORT
LEWIS & CLARK FORT MANDAN FDTN
PO Box 607	Washburn	ND	58577	364012431	501(c)(3)	$6,500	DONATION
HI-LINE HEALTH FOUNDATION INCLIBERTY MEDICAL CENTER
PO Box 705	Chester	MT	59522	810453568	501(c)(3)	$9,000	GENERAL SUPPORT
LIFESCAPE
2501 W 26th St	Sioux Falls	SD	57105	465151247	501(c)(3)	$51,000	GENERAL SUPPORT
LIFESOURCE
2225 West River Road N	Minneapolis	MN	55411	363584029	501(c)(3)	$15,000	GENERAL SUPPORT: DONATION
LINCOLN HIGH SCHOOL
201 E 38th Street	Sioux Falls	SD	57105	466002586	501(c)(3)	$34,960	ANNL CONTRIBUTION
LUTHERAN SCHOOLS
308 W 37th St	Sioux Falls	SD	57105	460343381	501(c)(3)	$3,000,000	GENERAL SUPPORT
LUTHERAN SOCIAL SERVICES
705 East 41st Street Ste 200	Sioux Falls	SD	571056048	460224731	501(c)(3)	$15,250	DONATION
MAKE A WISH
1400 W 17th St	Sioux Falls	SD	57104	460375953	501(c)(3)	$25,280	DONATION
MANDAN PUBLIC SCHOOLS
901 Division St NW	Mandan	ND	58554	456001098	115	$15,000	ATHLETIC DONATION
MAYVILLE STATE UNIVERSITY
330 3rd St NE	Mayville	ND	58257	456002485	501(c)(3)	$10,000	CORP AD PROGRAM
MCCROSSAN BOYS RANCH
47135 260th Street	Sioux Falls	SD	57107	460311913	501(c)(3)	$11,000	BANQUET AUCTION DONATION
MCKENZIE COUNTY HEALTHCARE SYS
516 N Main	Watford City	ND	58854	770637498	501(c)(3)	$100,000	CONTRIBUTION CONTRACT PAYMENT
Metro Area Tournament Committee
415 4th St N	Fargo	ND	58102	450458883	501(c)(3)	$14,000	GENERAL SUPPORT
MHCH Foundation (Matson Halverson Christiansen Hamilton)
201 S Main Street PO Box 84	Kimball	SD	57355	460461691	501(c)(3)	$15,000	GENERAL SUPPORT
MIKE MILLER FOUNDATION
2107 Quiett Lane	Mitchell	SD	57301	300015773	501(c)(3)	$10,000	MIKE MILLER CLASSIC DONATION
MN STATE UNIVERSITY MANKATO FOUNDATION
236 Wigley Administration Center	Mankato	MN	56001	416033423	501(c)(3)	$250,000	GENERAL SUPPORT
MOORHEAD BUSINESS ASSOC
PO Box 612	Moorhead	MN	56560	274254782	501(c)(6)	$5,750	OHS AND AHS 4TH OF JULY EVENT
MOORHEAD PUBLIC SCHOOLS
2300 4th Ave S	Moorhead	MN	56560	262502312	501(c)(3)	$5,555	GAME DAY PROGRAM AD
MSUM
1104 7th Ave S	Moorhead	MN	56563	237106061	501(c)(3)	$205,200	FY18 PLEDGE
MUSCULAR DYSTROPHY ASSOC
7401 Metro Blvd 325	Edina	MN	55439	131665552	501(c)(3)	$7,500	GENERAL SUPPORT DONATION
NAMI SD
PO Box 88808	Sioux Falls	SD	57109	363593027	501(c)(3)	$6,000	DONATION DANCING W/STARS
NATL KIDNEY FOUNDATION
30 E 33rd St	New York	NY	10016	131673104	501(c)(3)	$28,250	DONATION PAY PLEDGE
NATL MS SOCIETY
733 3rd Ave	New York	NY	10017	135661935	501(c)(3)	$25,000	2017-18 DONATION PLEDGE PYMNT
NAVY LEAGUE OF THE US SD COUNC
201 S Phillips Ave Ste 790	Sioux Falls	SD	57104	813858674	501(c)(3)	$25,000	USS SD SSN 790 COMSG COMTE
ND HOSPITAL ASSOC
PO Box 7340	Bismarck	ND	58507	450274165	501(c)(6)	$10,000	2017 CONV SPONSOR DIAMOND LVL
ND SAFETY COUNCIL
1710 Canary Ave Suite A	Bismarck	ND	58501	450353009	501(c)(3)	$15,000	GENERAL SUPPORT
NDSCS FOUNDATION
800 6TH ST NO	Wahpeton	ND	58076	450407617	501(c)(3)	$24,300	GENERAL SUPPORT
NDSU
PO Box 6050 NDSU Dept 1200	Fargo	ND	58108	456014085	501(c)(3)	$1,459,600	SUSTAINING PARTNER
NICKLAUS CHILDRENS HOSPITAL FOUNDATION
3100 SW 62nd Ave	Miami	FL	33155	590638499	501(c)(3)	$1,000,000	GENERAL SUPPORT
NICKLAUS CHILDRENS HEALTH CARE FOUNDATION
11770 US Highway 1 No 308	North Palm Beach	FL	33408	571154352	501(c)(3)	$250,000	GENERAL SUPPORT
NORTHERN STATE UNIVERSITY FOUNDATION
620 15th Ave SE	Aberdeen	SD	57401	237002314	501(c)(3)	$558,000	GENERAL SUPPORT
Northland Comm & Tech College Foundation
1101 Highway One East	Thief River Falls	MN	56701	411287038	501(c)(3)	$10,000	GENERAL SUPPORT
NORTHWESTERN COLLEGE
101 7th Street SW	Orange City	IA	51041	420698196	501(c)(3)	$50,000	DONATION
NSIC
2999 County Rd 42 West Suite 136	Burnsville	MN	55306	411783486	501(c)(3)	$240,000	GENERAL SUPPORT
OAK GROVE LUTHERAN SCHOOL
124 North Terrace	Fargo	ND	58102	450226473	501(c)(3)	$11,250	GENERAL SUPPORT
OUTDOOR ADVENTURE FOUNDATION
415 38th St S Suite E	Fargo	ND	58103	270192316	501(c)(3)	$12,500	DREAMAKERS DONATION SUPPORT
PEACEMAKER RESOURCES
2301 Johanneson Dr NW Suite 106	Bemidji	MN	56601	450507287	501(c)(3)	$16,750	GENERAL SUPPORT
PHEASANTS FOREVER
1783 Buerkle Cir	St Paul	MN	55110	411429149	501(c)(3)	$41,500	GENERAL SPRT DONATION 2017
PHILANTHROPY PROMOTIONS INC
2601 W 60th Street North	Sioux Falls	SD	57107	870695596	501(c)(3)	$20,000	DONATION HOT HARLEY NIGHTS
PLAINS ART MUSEUM
PO Box 2338	Fargo	ND	58108	411260780	501(c)(3)	$22,500	PLAINSART4ALL PLEDGE
PRESIDENTS BOWL
201 East 38th Street	Sioux Falls	SD	57105	466002586	501(c)(3)	$10,000	DONATION
PROJECT PREP OLYMPIC DEVELOP PROGRAM
PO Box 385970 6101 Old Shakopee Rd	Bloomington	MN	55438	043644163	501(c)(3)	$12,500	GENERAL SUPPORT
PROJECT SCHOOL SAFE ASSOC
43407 218th St	De Smet	SD	57231	473199527	501(c)(3)	$24,000	PROJECT STAND UP DONATION
RADY CHILDRENS HOSPITAL FOUNDA
3020 Childrens Way MC 5001	San Diego	CA	92123	330170626	501(c)(3)	$287,500	CONSORTIUM COLLABORATION FUND
REACH
629 S Minnesota Ave	Sioux Falls	SD	57104	460396579	501(c)(3)	$6,000	DONATION BREWHAHA FUNDRAISING
REALTORS FOR KIDS
2415 W 57th St	Sioux Falls	SD	57108	262681308	501(c)(3)	$6,000	DONATION AUCTION FUNDRAISER
RED RIVER CHILDRENS ADVOCACY
100 S 4th St No 302	Fargo	ND	58103	201095721	501(c)(3)	$25,000	DONATION
RED RIVER ZOOLOGICAL SOCIETY
4255 23rd Avenue S	Fargo	ND	58104	363938878	501(c)(3)	$25,000	SANTA CLAUS 2017 SPONSORSHIP
REINBOWS INC
43341 480th Avenue	Windom	MN	56101	208775427	501(c)(3)	$6,000	GENERAL Support
ROCK RAPIDS KIDS CLUB
309 North Story Street	Rock Rapids	IA	51246	205156803	501(c)(3)	$10,080	DONATION
ROGER MARIS CELEBRITY GOLF
Po Box 3202	Fargo	ND	58108	450425333	501(c)(3)	$10,000	MAJOR SPONSORSHIP
RONALD MCDONALD HOUSE
825 S Lake Ave	Sioux Falls	SD	57104	460371152	501(c)(3)	$140,000	DONATION PLEDGE PAYMENT
ROOSEVELT HIGH SCHOOL
201 E 38th Street	Sioux Falls	SD	57105	466002586	501(c)(3)	$51,457	DONATION
SAMARITANS FEET INTERNATIONAL
PO Box 78992	Charlotte	NC	28271	141880905	501(c)(3)	$6,500	HURRICANE HARVEY RELIEF DONAT
SANFORD HEALTH FOUNDATION NORTH
P O Box 5039 Rte 5218	Sioux Falls	SD	571175039	450398104	501(c)(3)	$15,200	MAYVILLE COUPLES GOLF TOURN
SD BASKETBALL COACHES ASSOC
1404 Yosemite Ln	Brookings	SD	57706	811379554	501(c)(3)	$7,500	DONATION
SD BIOTECH ASSOC
2329 N Career Ave Ste 115	Sioux Falls	SD	57107	371518658	501(c)(6)	$9,500	DONATION 2018 MEMBER DUES
SD CATTLEMANS ASSOC
215 E Prospect PO Box 29	Pierre	SD	57501	462773322	501(c)(3)	$15,000	DONATION
SD CHORALE
300 S Minnesota Avenue	Sioux Falls	SD	57104	452709374	501(c)(3)	$25,000	3RD/FINAL PAYMENT CONTRACT
SD CORN GROWERS ASSOCIATION
4712 S Technopolis Dr	Sioux Falls	SD	57106	460392991	501(c)(5)	$6,000	DONTATION
SD GOLF ASSOCIATION
4809 W 41st St Suite 202	Sioux Falls	SD	57106	460310847	501(c)(4)	$11,500	DONATION 1ST TEE OF SD
SD HALL OF FAME
1480 S Main Ave	Chamberlain	SD	57325	460324210	501(c)(3)	$50,000	PLEDGE PAY #1 OF 5 SUPPORT
SD HIGH SCHOOL ACTIVITIES
PO Box 1217 804 North Euclid Ave	Pierre	SD	575011217	460226882	501(c)(3)	$125,000	ATTN: DR DAN SWARTOS -SUPPORT				Ste 102
SD HIGH SCHOOL COACHES ASSOC
801 W Eagle Ridge St	Sioux Falls	SD	57108	237297479	501(c)(3)	$10,000	DONATION
SD LAW ENFORCEMENT CHARITIES
5214 Sweetbriar Court	Sioux Falls	SD	57108	460440378	501(c)(3)	$10,000	SUPPORT CHARITY FUNDRAISING
SD PARKS & WILDLIFE FOUNDATION
523 E Capitol Ave	Pierre	SD	57501	460387968	501(c)(3)	$10,000	BLOOD RUN
SD STATE UNIVERSITY
815 Medary Ave PO Box 525	Brookings	SD	57007	460273801	501(c)(3)	$2,619,990	DONATION 11112017
SD SYMPHONY ORCHESTRA
300 North Dakota Ave Ste 116	Sioux Falls	SD	57104	466017026	501(c)(3)	$57,400	DONATION
SD SYNOD
2001 S Summit Ave	Sioux Falls	SD	57197	363512774	501(c)(3)	$265,000	DONATION
SF AREA COMMUNITY FOUNDATION
200 N Cherapa Place	Sioux Falls	SD	57103	311748533	501(c)(3)	$57,000	DONATION
SF CHRISTIAN HIGH SCHOOL
6120 Charger Circle	Sioux Falls	SD	571091110	460340024	501(c)(3)	$18,500	PLEDGE AGEREMENT
SF CYCLONES
PO Box 361	Sioux Falls	SD	57101	274705069	501(c)(3)	$31,727	LEGENDS GOLF BAG ASSISTANCE
SF JAZZ & BLUES SOCIETY
123 S Main Ave Ste 204	Sioux Falls	SD	57104	460418356	501(c)(3)	$15,000	CHILDRENS JAZZ QUEST DONATION
SF Jr Stampede (Hat Trick Hockey Corp)
3213 Nicann Ct	Sioux Falls	SD	57103	471795011	501(c)(3)	$15,000	GENERAL SUPPORT
SF LITTLE LEAGUE JUNIOR DIV
PO Box 91921	Sioux Falls	SD	57109	352590301	501(c)(3)	$7,000	GENERAL SUPPORT DONATION
SF SWIM TEAM INC
PO Box 2736	Sioux Falls	SD	571012736	460452453	501(c)(3)	$25,000	DONATION
SF YOUTH HOCKEY ASSOC
4235 West Mesa Pass	Sioux Falls	SD	57106	460427805	501(c)(3)	$27,000	SUPPORT
SHEYENNE VALLEY COMMUNITY FOUNDATION
250 West Main ST	Valley City	ND	58072	464371645	501(c)(3)	$6,000	GENERAL SUPPORT
SHILOH CHRISTIAN SCHOOL
1915 Shiloh Dr	Bismarck	ND	58503	450348120	501(c)(3)	$72,000	GENERAL SUPPORT
Sioux Council Boy Scouts Of America Inc
800 N West Avenue	Sioux Falls	SD	57104	460224599	501(c)(3)	$5,500	GENERAL SUPPORT
SIOUX EMPIRE ARTS COUNCIL
PO Box 1165	Sioux Falls	SD	57101	208535871	501(c)(3)	$10,000	2017 GENERAL DONATION PLEDGE
SIOUX EMPIRE YOUTH WRESTLING
3509 S Genevieve Ave	Sioux Falls	SD	57103	822705107	501(c)(3)	$35,000	DONATION
SIOUX FALLS CATHOLIC SCHOOLS
3100 W 41st St	Sioux Falls	SD	57105	460413591	501(c)(3)	$65,500	DONATION
FamilyFest LLC
P O Box 90646	Sioux Falls	SD	57109	203789203	501(c)(3)	$10,000	GENERAL SUPPORT
SIOUX FALLS AREA CASA PROGRAM
300 N Dakota Ave Suite 609	Sioux Falls	SD	57104	460430647	501(c)(3)	$10,000	DONATION
SIOUX FALLS FIREFIGHTERS
PO Box 340	Sioux Falls	SD	57101	680589701	501(c)(3)	$7,500	STEP UP FOR HEROES 0917
SIOUX FALLS SCHOOL DISTRICT
201 E 38th Street	Sioux Falls	SD	57105	466002586	501(c)(3)	$83,275	GENERAL SUPPORT
SIOUX FALLS SPORTS AUTHORITY
200 N Phillips Ave No 304	Sioux Falls	SD	57104	205850491	501(c)(3)	$2,453,000	GOLF TOURNAMENT AND MARATHON
SIOUX FALLS WOMEN RUN LLC
5235 S Sweetbriar Ct	Sioux Falls	SD	57108	813518734	501(c)(6)	$10,000	DONATION
SOUTHEAST EDUCATION COOP
1305 9th Ave S	Fargo	ND	58103	475548763	501(c)(3)	$15,000	DONATION
SOUTHEAST TECHNICAL INSTITUTE
2320 N Career Ave	Sioux Falls	SD	57107	364112897	501(c)(3)	$10,000	DONATION
SPECIAL OLYMPICS
305 W 39th St	Sioux Falls	SD	57105	460359776	501(c)(3)	$19,750	DONATION
SPECIAL OLYMPICS SOUTH DAKOTA
800 E I-90 Lane	Sioux Falls	SD	57104	460359776	501(c)(3)	$6,500	LEGENDS GRANT EQUIPMENT
ST MARYS FOUNDATION
1027 Washington Ave	Detroit Lakes	MN	56501	271984704	501(c)(3)	$25,000	DETROIT LAKES HELIPAD
STEM FOR LIFE FOUNDATION
420 Lexington Ave Sute 350	New York	NY	10170	261150435	501(c)(3)	$500,000	stem for life contribution
STOCKYARDS AG EXPERIENCE
PO Box 2042	Sioux Falls	SD	57101	465391991	501(c)(3)	$25,000	SUPPORT CHAMBER APPEALS 1OF3
SUSAN G KOMEN BREAST CANCER
5005 LBJ Freeway Suite 526	Dallas	TX	75244	751835298	501(c)(3)	$35,000	RACE FOR CURE SPONSORSHIP
THE BANQUET
900 E 8th St	Sioux Falls	SD	57103	460387495	501(c)(3)	$5,260	RUN FOR FOOD
THEODORE ROOSEVELT PRESIDENTIAL LIBRARY AND MUSEUM
PO Box 700	Dickinson	ND	58602	471324043	501(c)(3)	$100,000	GENERAL SUPPORT
TNT KIDS FITNESS
2800 Main Ave	Fargo	ND	58103	203459549	501(c)(3)	$21,500	BREAK BARRIERS PARTNER SPONS
TRI CITY STORM SOCCER CLUB
1323 23rd St S Ste A	Fargo	ND	58103	363346894	501(c)(3)	$10,000	2017-2018 SPONSORSHIP
TUITION4TECHSTUDENTS
101 N Main Ave Ste 321	Sioux Falls	SD	57104	822410074	501(c)(3)	$25,000	DONATION INITIATED MEASURE
UCODEGIRL
325 5th St N	Fargo	ND	58102	812623993	501(c)(3)	$6,000	DONATION
UNITED WAY
1000 North West Ave 120	Sioux Falls	SD	571041314	460233701	501(c)(3)	$278,600	DONATION
UNIV OF ND FOUNDATION
3501 University Ave	Grand Forks	ND	58202	450348296	501(c)(3)	$100,100	GENERAL SUPPORT
UNIV OF SD FOUNDATION
1110 N Dakota Po Box 5555	Vermillion	SD	57069	466018891	501(c)(3)	$500,000	GENERAL SUPPORT
UNIV OF SIOUX FALLS
1101 W 22nd St	Sioux Falls	SD	57105	460224600	501(c)(3)	$10,000	HYVEE/SANFORD LEGENDS SCHOLAR
University Of South Dakota FoundationUniversity of South Dakota
414 E Clark	Vermillion	SD	57069	466018891	501(c)(3)	$186,753	GENERAL SUPPORT
University Of Wisconsin Foundation
600 Highland Ave K4/646	Madison	WI	53792	390743975	501(c)(3)	$154,100	GENERAL SUPPORT
UNIVERSITY OF JAMESTOWN
6088 College Lane	Jamestown	ND	58405	450231180	501(c)(3)	$15,000	GENERAL SUPPORT
UNIVERSITY OF MARY
7500 University Dr	Bismarck	ND	58504	450273403	501(c)(3)	$10,000	HYVEE/SANFORD LEGENDS
UP AQUATICS INC
3740 Aspyn Ln N	Fargo	ND	58102	271181382	501(c)(3)	$30,000	2018 PLEDGE 3RD YR
USD SCHOOL OF MEDICINE
1400 W 22nd Street	Sioux Falls	SD	57105	460418678	501(c)(3)	$55,796	Dr. Freeman Neuro Ed Service
VALLEY CITY STATE UNIVERSITY FOUNDATION
101 College St SW	Valley City	ND	58072	237178785	501(c)(3)	$5,500	GENERAL SUPPORT
VILLAGE FAMILY SERVICE CENTER
PO Box 9859	Fargo	ND	58106	450226423	501(c)(3)	$101,000	BOBCAT OPEN HOLE SIGN SPONSOR
VOLUNTEERS OF AMERICA DAKOTAS
1309 W 51st St	Sioux Falls	SD	57105	237353508	501(c)(3)	$20,500	GENERAL SUPPORT DONATION
WAHPETON SCHOOLS
1021 N 11th St	Wahpeton	ND	58074	456001462	115	$5,350	SPONSORSHIP 2017-2018
WASHINGTON HIGH SCHOOL
501 N Sycamore Ave	Sioux Falls	SD	57110	466002586	501(c)(3)	$6,005	HEATHER WALKER - DONATION
WASHINGTON PAVILION
301 S Main Ave PO Box 984	Sioux Falls	SD	57101	460435791	501(c)(3)	$79,272	GENERAL SUPPORT
WATERTOWN COMMUNITY FOUNDATION
PO Box 116	Watertown	SD	57201	460350319	501(c)(3)	$20,000	GENERAL SUPPORT
WATERTOWN DEVELOPMENT COMPANY
PO Box 332	Watertown	SD	57201	470813269	501(c)(3)	$15,000	GENERAL SUPPORT
WAVE
513 Main St	Webster	SD	57274	201307620	501(c)(3)	$15,000	PLEDGE
WEST CENTRAL BASEBALL ASSOC
904 Nordic Cir	Hartford	SD	57033	464596999	501(c)(3)	$5,160	LEGENDS SCOREBOARD
WEST FARGO SCHOOLS
801 9th St E	West Fargo	ND	58078	456000298	115	$7,200	7TH GR TEAM ZEN DONATION
WESTERN GOVERNORS FOUNDATION
1600 Broadway Suite 1700	Denver	CO	80202	742368923	501(c)(3)	$15,000	WORKSHOP
WESTERN ND AREA HEALTH EDUC
P O Box 615	Hettinger	ND	58639	456002485	501(c)(3)	$12,000	FUTURE HEALTH PROFESSIONALS
WHEATON AREA SCHOOLS
1700 3rd Ave S	Wheaton	MN	56296	416004390	501(c)(3)	$10,050	TRACK DONATION
WINDOM YOUTH HOCKEY
PO Box 41	Windom	MN	56101	411290460	501(c)(3)	$8,333	GENERAL SUPPORT
WINNER REGIONAL HEALTHCARE CTR
745 E 8th St	Winner	SD	57580	460274380	501(c)(3)	$101,000	DONATION
WOUNDED WARRIOR PROJECT
4899 Belfort Road Suite 300	Jacksonville	FL	32256	202370934	501(c)(3)	$8,500	DONATION
YELLOW JACKET FOUNDATION
1200 University St No 9506	Spearfish	SD	57799	510151319	501(c)(3)	$50,000	PLEDGE PAYMENT
YMCA SIOUX FALLS REGION
230 S Minnesota Ave	Sioux Falls	SD	57104	460225021	501(c)(3)	$35,500	PLEDGE
YOUTH VILLAGESJANIES FUND
3320 Brother Blvd	Memphis	TN	38133	621652079	501(c)(3)	$205,000	DONATION-STEVEN TYLER FUNDRAISER

Field	Value	IRS element (for citing)
Total501c3 Org	223	Total501c3OrgCnt
Total Other Org	15	TotalOtherOrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (3 entries)

Grant TypeGrantTypeTxt	RecipientRecipientCnt	Cash GrantCashGrantAmt	Non Cash AssistanceNonCashAssistanceAmt
Donation to parent for child receiving treatment	2	$25,000
Donation - State Powerlifting Championships	1	$10,000
Donation - Dakota United Rugby Club	1	$8,613	$0

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part I, Line 2:	FormAndLineReferenceDesc
Explanation	Prior to disbursement all grant fund requests are reviewed to ensure the receiving organization and proposed use of funds align with Sanford's mission.	ExplanationTxt

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
First Class Or Charter Travel	Yes (X)	FirstClassOrCharterTravelInd
Travel For Companions	Yes (X)	TravelForCompanionsInd
Idemnification Gross Up Pmts	Yes (X)	IdemnificationGrossUpPmtsInd
Club Dues Or Fees	Yes (X)	ClubDuesOrFeesInd
Written Policy Ref T And E Expnss	Yes (1)	WrittenPolicyRefTAndEExpnssInd
Substantiation Required	Yes (1)	SubstantiationRequiredInd
Compensation Committee	Yes (X)	CompensationCommitteeInd
Independent Consultant	Yes (X)	IndependentConsultantInd
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	0	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	Yes (1)	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	Yes (1)	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	0	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	0	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	Yes (1)	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	0	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	Yes (1)	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (30 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Maria Bell MD
Trustee/Research Administrator	$775,124	$0	$10,000	$0	$3,909	$0	$0	$0	$29,050	$0	$818,083	$0	$0	$0
Mark Lundeen MD
Trustee/Orthopedics Services Chair	$725,227	$0	$0	$0	$1,392	$0	$0	$0	$29,050	$0	$755,669	$0	$0	$0
Mark Paulson MD
Chair/Physician Regional Chair	$268,457	$0	$0	$0	-$2,091	$0	$0	$0	$26,202	$0	$292,568	$0	$0	$0
Michael LeBeau MD
Trustee/Senior VP - Bismarck Clinic	$1,342,178	$0	$3,000	$0	$69,454	$0	$0	$0	$29,050	$0	$1,443,682	$0	$0	$0
Kelby K Krabbenhoft
Sanford President & CEO	$1,644,254	$0	$542,500	$0	$89,431	$0	$0	$0	$12,726	$0	$2,288,911	$0	$0	$0
Kelby K Krabbenhoft Def Comp
Sanford President & CEO	$0	$0	$0	$0	$0	$0	$877,405	$0	$0	$0	$877,405	$0	$0	$0
JoAnn L Kunkel
Chief Financial Officer	$703,270	$0	$202,500	$0	$114,571	$0	$21,375	$0	$21,813	$0	$1,063,529	$0	$0	$0
Randy Bury
Chief Administrative Officer	$724,232	$0	$225,000	$0	$123,522	$0	$21,375	$0	$6,882	$0	$1,101,011	$0	$0	$0
Randy Bury Deferred Comp
Chief Administrative Officer	$0	$0	$0	$0	$0	$0	$15,683	$0	$0	$0	$15,683	$0	$0	$0
Bill Gassen
Chief Human Resources Officer	$458,075	$0	$130,500	$0	$74,469	$0	$13,275	$0	$14,970	$0	$691,289	$0	$0	$0
Kim Patrick
Chief Legal Officer (through 12/17)	$510,765	$0	$150,083	$0	$99,321	$0	$14,175	$0	$26,226	$0	$800,570	$0	$0	$0
Jennifer Grennan
Chief Legal Officer	$306,150	$0	$72,500	$0	$34,346	$0	$8,475	$0	$26,226	$0	$447,697	$0	$0	$0
Allison Wierda-Suttle MD
Sr. VP, Chief Med Officer	$617,672	$0	$150,000	$0	$77,217	$0	$18,405	$0	$16,777	$0	$880,071	$0	$0	$0
Bill Marlette
Treasurer	$621,534	$0	$180,000	$0	$139,810	$0	$0	$0	$1,470	$0	$942,814	$0	$0	$0
Bill Marlette Def Comp
Treasurer	$0	$0	$0	$0	$0	$0	$211,820	$0	$0	$0	$211,820	$0	$0	$0
Micah Aberson
Chief Global Brand Officer	$395,781	$0	$86,250	$0	$57,355	$0	$13,275	$0	$26,226	$0	$578,887	$0	$0	$0
Bryan Nermoe
President, Bemidji	$457,008	$0	$112,500	$0	$74,553	$0	$12,255	$0	$26,226	$0	$682,542	$0	$0	$0
Craig Lambrecht
President, Bismarck	$658,075	$0	$162,500	$0	$102,349	$0	$18,375	$0	$22,028	$0	$963,327	$0	$0	$0
Nate White
COO, President Fargo	$861,156	$0	$363,500	$0	$208,067	$0	$25,125	$0	$26,226	$0	$1,484,074	$0	$0	$0
Michelle Micka
Sr. VP Finance, Corporate Controller	$347,118	$0	$83,750	$0	$35,599	$0	$9,375	$0	$26,226	$0	$502,068	$0	$0	$0
Michelle Bruhn
Sr. VP Finance, Health Services	$456,739	$0	$112,500	$0	$61,501	$0	$12,225	$0	$14,970	$0	$657,935	$0	$0	$0
Paul Hanson
President, Sioux Falls	$650,764	$0	$160,000	$0	$105,046	$0	$18,375	$0	$26,226	$0	$960,411	$0	$64,318	$0
Paul Richard
Exec VP Fargo	$650,764	$0	$160,000	$0	$120,739	$0	$0	$0	$26,226	$0	$957,729	$0	$0	$0
Richard Adcock
Chief Innovation Officer	$425,765	$0	$184,500	$0	$65,234	$0	$0	$0	$19,916	$0	$695,415	$0	$0	$0
William Brunner
Physician	$2,671,215	$0	$0	$0	-$2,228	$0	$0	$0	$29,050	$0	$2,698,037	$0	$0	$0
Larry Burris
Physician	$2,270,657	$0	$0	$0	-$1,397	$0	$0	$0	$29,050	$0	$2,298,310	$0	$0	$0
Scott Pham
Physician	$2,899,659	$0	$0	$0	-$2,261	$0	$0	$0	$29,050	$0	$2,926,448	$0	$0	$0
Adam Stys
Physician	$2,470,741	$0	$0	$0	$4,662	$0	$0	$0	$29,050	$0	$2,504,453	$0	$0	$0
Tomasz Stys
Physician	$2,656,360	$0	$0	$0	$1,232	$0	$0	$0	$29,050	$0	$2,686,642	$0	$0	$0
Daniel Olson
Former Exec VP Bemidji	$285,238	$0	$300	$0	$31,904	$0	$0	$0	$26,226	$0	$343,668	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part I, Line 1a	On Part I, Questions Regarding Compensation, Sanford checked several of the items as provided to listed persons: First Class or Charter Travel - Charter travel for business purposes is provided for individuals as needed and as cost appropriate, in accordance with written policies. These costs are not included in the W-2's of the individuals as they are incurred for business purposes of Sanford. Travel for Companions - Limited travel for companions is required for certain annual meetings. These costs are not included in the W-2's of the individuals as they are incurred for business purposes of Sanford. Tax Indemnification and gross-up payments - Certain compensation may be grossed up to include appropriate tax amounts. Health or social club dues or initiation fees - All Sanford employees are eligible for discounted wellness memberships, a portion of these discounts and other club dues are included as fringe benefits, and taxed as such. Part I, Line 3: The Executive Compensation Committee of the Sanford Board of Trustees directly engages a nationally recognized independent compensation consulting firm annually to review the total compensation arrangements of the officers and executives of the organization, including the CEO, and to report the findings to them for deliberation and action. The deliberations and actions are recorded in the minutes of the Sanford Board of Trustees. The most recent study was completed in 2018.
Part I, Lines 4b-c	Part I, Line 4b: Certain executives participate in a defined contribution SERP Plan. Part I, Line 4c: Certain executives participate in a KEYSOP Plan.
Part I, Line 6	Sanford physicians are compensated based on the professional services they perform within the clinic in which they provide care. Generally, the model is based on production.
Part I, Line 7	Certain employees are eligible for a discretionary incentive bonus. Bonuses are paid based on the achievement of financial and other goals.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (4 entries)

Bond ReferenceBondReferenceCd	Bond Issuer EINBondIssuerEIN	CUSIPCUSIPNum	Bond IssuedBondIssuedDt	Issue PriceIssuePriceAmt	PurposePurposeDesc	DefeasedDefeasedInd	On Behalf Of IssuerOnBehalfOfIssuerInd	Pool FinancingPoolFinancingInd
South Dakota Health and Educational Facilities Authority
A	460315509	83755VHY3	2004-09-14	$70,073,989	2004: New construction of healthcare facilities	0	0	0
South Dakota Health and Educational Facilities Authority
B	460315509	83755VNZ3	2009-09-29	$71,015,042	2009: New construction and remodeling of healthcare facilities	0	0	0
City of Fargo
C	456002069	307479CK9	2011-02-09	$134,069,821	2011: Refunding bonds issued 12/5/1996, 11/8/2000, and 6/18/2002	0	0	0
South Dakota Health and Educational Facilities Authority
D	460315509	83755VVM3	2012-11-01	$128,733,641	2012E: New construction and remodeling of healthcare facilities	0	0	0

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (4 entries)

Bond ReferenceBondReferenceCd	RetiredRetiredAmt	Total ProceedsTotalProceedsAmt	In Reserve FundInReserveFundAmt	Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt	Capital ExpendituresCapitalExpendituresAmt	Substantial CompletionSubstantialCompletionYr	Current RefundingCurrentRefundingInd	Advance RefundingAdvanceRefundingInd	Final Allocation MadeFinalAllocationMadeInd	Adequate Books And Rec MaintAdequateBooksAndRecMaintInd	Other Spent ProceedsOtherSpentProceedsAmt
A	$55,565,000	$71,581,953	$237,887	$764,068	$70,817,885	2006	0	0	Yes (1)	Yes (1)
B	$6,545,000	$71,393,241	$543	$997,167	$70,396,074	2012	0	0	Yes (1)	Yes (1)
C	$37,020,000	$134,069,821	$1,389			2012	Yes (1)	Yes (1)	Yes (1)	Yes (1)	$134,069,821
D		$129,135,779	$616	$1,470,647	$127,665,132	2013	0	0	Yes (1)	Yes (1)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (3 entries)

Bond ReferenceBondReferenceCd	Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd	Engage Bond Counsel ContractsEngageBondCounselContractsInd
A	Yes (1)	Yes (1)
B	Yes (1)	Yes (1)
D	Yes (1)	Yes (1)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (4 entries)

Bond ReferenceBondReferenceCd	Exception To RebateExceptionToRebateInd	No Rebate DueNoRebateDueInd	Variable Rate IssueVariableRateIssueInd
A	0	Yes (1)	Yes (1)
B	0	Yes (1)	0
C	0	Yes (1)	0
D	Yes (1)	0	0

Procedures Corrective Action ProceduresCorrectiveActionGrp (4 entries)

Bond ReferenceBondReferenceCd	Procedures Corrective ActionProceduresCorrectiveActionInd
A	0
B	0
C	0
D	0

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Date Rebate Computation Performed	Issuer Name: South Dakota Health and Educational Facilities Authority Date the Rebate Computation was Performed: 09/14/2006 Issuer Name: South Dakota Health and Educational Facilities Authority Date the Rebate Computation was Performed: 09/29/2012 Issuer Name: City of Fargo Date the Rebate Computation was Performed: 02/09/2016 Issuer Name: South Dakota Health and Educational Facilities Authority Date the Rebate Computation was Performed: 03/29/2013
Schedule K, Part I, Bond Issues	Entity 3, Bond Issue A, (c) CUSIP #: 83755VXF6 and 83755VXE9 Entity 1, Bond Issue A, (c) CUSIP #: 83755VHY3 and 83755VHZ0
Part I, Column e and Part II, Line 3	Differences between the issue price (Part I, column e) and total proceeds (Part II, line 3) are due to investment earnings.
Part II, Line 4	The amounts shown here consist of debt service fund deposits.
Part III	Part III has not been completed for the 2013 City of Fargo bonds or for the 3/29/2012 South Dakota Health and Educational Facilities Authority bonds. These bonds refunded pre-2003 debt that does not have to be reported.
Part IV, Line 6	With respect to the 2011 City of Fargo bonds and the 3/29/2012 and 10/21/2015 South Dakota Health and Educational Facilities Authority bonds, this question is being answered without regard to a yield- restricted advance refunding escrow financed with proceeds of bonds.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (4 entries)

Bond ReferenceBondReferenceCd	Bond Issuer EINBondIssuerEIN	CUSIPCUSIPNum	Bond IssuedBondIssuedDt	Issue PriceIssuePriceAmt	PurposePurposeDesc	DefeasedDefeasedInd	On Behalf Of IssuerOnBehalfOfIssuerInd	Pool FinancingPoolFinancingInd
City of Chamberlain
A	460000094	000000000	2010-12-30	$4,000,000	2010 Chamb: New construction of long-term care facilities	0	0	0
South Dakota Health and Educational Facilities Authority
B	460315509	000000000	2012-03-29	$66,185,000	2012AB: Refunding bonds issued 9/12/2001 and 10/15/2002	0	0	0
South Dakota Health and Educational Facilities Authority
C	460315509	000000000	2012-06-14	$45,000,000	2012D:Refinance taxable indebtedness used to construct healthcare facility	0	0	0
South Dakota Health and Educational Facilities Authority
D	460315509	83755VWA8	2014-08-05	$52,083,720	2014A: Current refund 2004A issued 9/14/2004	0	0	0

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (4 entries)

Bond ReferenceBondReferenceCd	RetiredRetiredAmt	Total ProceedsTotalProceedsAmt	Capital ExpendituresCapitalExpendituresAmt	Substantial CompletionSubstantialCompletionYr	Current RefundingCurrentRefundingInd	Advance RefundingAdvanceRefundingInd	Final Allocation MadeFinalAllocationMadeInd	Adequate Books And Rec MaintAdequateBooksAndRecMaintInd	Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt	Other Spent ProceedsOtherSpentProceedsAmt	In Reserve FundInReserveFundAmt
A	$1,659,955	$4,000,000	$4,000,000	2010	0	0	Yes (1)	Yes (1)
B	$13,660,000	$66,185,000		2012	Yes (1)	Yes (1)	Yes (1)	Yes (1)	$24,356	$66,160,644
C	$8,910,000	$45,000,000	$45,000,000	2012	0	0	Yes (1)	Yes (1)
D		$52,083,720		2014	Yes (1)	0	Yes (1)	Yes (1)		$52,083,720	$221

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (3 entries)

Bond ReferenceBondReferenceCd	Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd	Engage Bond Counsel ContractsEngageBondCounselContractsInd
A	Yes (1)	Yes (1)
C	Yes (1)	Yes (1)
D	Yes (1)	Yes (1)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (4 entries)

Bond ReferenceBondReferenceCd	Rebate Not Due YetRebateNotDueYetInd	Exception To RebateExceptionToRebateInd	No Rebate DueNoRebateDueInd	Variable Rate IssueVariableRateIssueInd
A	0	Yes (1)	0	Yes (1)
B	0	0	Yes (1)	Yes (1)
C	0	Yes (1)	0	Yes (1)
D	Yes (1)	0	0	0

Procedures Corrective Action ProceduresCorrectiveActionGrp (4 entries)

Bond ReferenceBondReferenceCd	Procedures Corrective ActionProceduresCorrectiveActionInd
A	0
B	0
C	0
D	0

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (3 entries)

Bond ReferenceBondReferenceCd	Bond Issuer EINBondIssuerEIN	CUSIPCUSIPNum	Bond IssuedBondIssuedDt	Issue PriceIssuePriceAmt	PurposePurposeDesc	DefeasedDefeasedInd	On Behalf Of IssuerOnBehalfOfIssuerInd	Pool FinancingPoolFinancingInd
South Dakota Health and Educational Facilities Authority
A	460315509	83755VXE9	2014-10-28	$207,014,209	2014B: New construction and remodeling of healthcare facilities	0	0	0
South Dakota Health and Educational Facilities Authority
B	460315509	83755VZW7	2015-10-21	$192,641,206	2015:New construction & advanced refunding of bonds issued 4/19/07, 5/22/07	0	0	0
South Dakota Health and Educational Facilities Authority
C	460315509	000000000	2016-10-28	$50,000,000	2016: New Construction, equipment and improvements	0	0	0

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (3 entries)

Bond ReferenceBondReferenceCd	Total ProceedsTotalProceedsAmt	In Reserve FundInReserveFundAmt	Capitalized InterestCapitalizedInterestAmt	Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt	Capital ExpendituresCapitalExpendituresAmt	Substantial CompletionSubstantialCompletionYr	Advance RefundingAdvanceRefundingInd	Final Allocation MadeFinalAllocationMadeInd	Adequate Books And Rec MaintAdequateBooksAndRecMaintInd	RetiredRetiredAmt	Other Spent ProceedsOtherSpentProceedsAmt
A	$207,081,359	$1,293	$31,874	$1,906,127	$205,143,359	2017	0	Yes (1)	Yes (1)
B	$192,707,024	$1,294		$1,431,628	$110,529,233	2017	Yes (1)	Yes (1)	Yes (1)	$5,460,000	$80,746,163
C	$50,000,000			$150,032	$49,849,968	2017	0	Yes (1)	Yes (1)	$5,000,000

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (3 entries)

Bond ReferenceBondReferenceCd	Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd	Engage Bond Counsel ContractsEngageBondCounselContractsInd
A	Yes (1)	Yes (1)
B	Yes (1)	Yes (1)
C	Yes (1)	Yes (1)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (3 entries)

Bond ReferenceBondReferenceCd	Rebate Not Due YetRebateNotDueYetInd	Variable Rate IssueVariableRateIssueInd
A	Yes (1)	0
B	Yes (1)	0
C	Yes (1)	Yes (1)

Procedures Corrective Action ProceduresCorrectiveActionGrp (3 entries)

Bond ReferenceBondReferenceCd	Procedures Corrective ActionProceduresCorrectiveActionInd
A	0
B	0
C	0

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (10 entries)

Relationship DescriptionRelationshipDescriptionTxt	TransactionTransactionAmt	TransactionTransactionDesc	Sharing Of RevenuesSharingOfRevenuesInd
Kathryn Nermoe
B Nermoe - family relationship	$93,220	Compensation	0
Annette White
N White - family relationship	$428,392	Compensation	0
Paige Campbell
P Richard - family relationship	$53,520	Compensation	0
Melinda Anderson
M Paulson - family relationship	$68,310	Compensation	0
Michael Kunkel
J Kunkel - family relationship	$115,801	Compensation	0
John Durick
P Durick - family relationship	$105,195	Compensation	0
Louis Krabbenhoft
K Krabbenhoft - family relationship	$93,174	Compensation	0
Megan Hemmelgarn
M Paulson - family relationship	$37,935	Compensation	0
Barb Everist
Joint Venture in Everist Health	$6,000,000	Sanford contributed $4M into Everist Health during the previous fiscal year. During the current fiscal year, Sanford contributed an additional $2M. As a result, Sanford and Barb Everist both owned more than a 10% interest in this company.	0
Andy North
Business Relationship-Consultant for business and relationship development	$120,000	Independent Contractor	0

Schedule M IRS990ScheduleM

Real Estate Commercial RealEstateCommercialGrp

Field	Value	IRS element (for citing)
Non Cash Checkbox	Yes (X)	NonCashCheckboxInd
Contribution	2	ContributionCnt
Noncash Contributions Rpt F990	$5,112,030	NoncashContributionsRptF990Amt
Method Of Determining Revenues	FMV	MethodOfDeterminingRevenuesTxt

Field	Value	IRS element (for citing)
Form8283 Received	0	Form8283ReceivedCnt
Any Property That Must Be Held	0	AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts	Yes (1)	ReviewProcessUnusualNCGiftsInd
Third Parties Used	Yes (1)	ThirdPartiesUsedInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part I, Column (b):	The organization is reporting the number of contributions.
Part I, Line 32b:	The organization uses third parties for real estate transactions, for appraisals, title work, closings in the normal course of business.

Schedule N IRS990ScheduleN

Liquidation Of Assets Table LiquidationOfAssetsTableGrp

Liquidation Of Assets Detail LiquidationOfAssetsDetail (27 entries)

Assets Distri Or Expnss PaidAssetsDistriOrExpnssPaidDesc	DistributionDistributionDt	Fair Market Value Of AssetFairMarketValueOfAssetAmt	Method Of FMV DeterminationMethodOfFMVDeterminationTxt	EINEIN	Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	IRC SectionIRCSectionTxt
Sanford Health Network North
Sanford Medical Center Thief River Falls 41-0709579 - Cash	2018-02-01	-$7,864	Book Value	450409348	PO Box 5039 Rte 5218	Sioux Falls	SD	571175039	501(c)(3)
Sanford Health Network North
Sanford Medical Center Thief River Falls 41-0709579 - ST Investments	2018-02-01	$543,353	Book Value	450409348	PO Box 5039 Rte 5218	Sioux Fals	SD	571175039	501(c)(3)
Sanford Health Network North
Sanford Medical Center Thief River Falls 41-0709579 - Accounts Receivable (Net)	2018-02-01	$9,217,782	Book Value	450409348	PO Box 5039 Rte 5218	Sioux Falls	SD	571175039	501(c)(3)
Sanford Health Network North
Sanford Medical Center Thief River Falls 41-0709579 - Inventory	2018-02-01	$656,103	Book Value	450409348	PO Box 5039 Rte 5218	Sioux Falls	SD	571175039	501(c)(3)
Sanford Health Network North
Sanford Medical Center Thief River Falls 41-0709579 - Prepaid Expenses	2018-02-01	$240,631	Book Value	450409348	PO Box 5039 Rte 5218	Sioux Falls	SD	571175039	501(c)(3)
Sanford Health Network North
Sanford Medical Center Thief River Falls 41-0709579 - Property & Equipment	2018-02-01	$67,882,316	Book Value	450409348	PO Box 5039 Rte 5218	Sioux Falls	SD	571175039	501(c)(3)
Sanford Health Network North
Sanford Medical Center Thief River Falls 41-0709579 - Other Assets	2018-02-01	$8,520,620	Book Value	450409348	PO Box 5039 Rte 5218	Sioux Falls	SD	571175039	501(c)(3)
Sanford Health Network North
Sanford Medical Center Mayville 45-0228899 - Cash	2018-02-01	$13,109	Book Value	450409348	PO Box 5039 Rte 5218	Sioux Falls	SD	571175039	501(c)(3)
Sanford Health Network North
Sanford Medical Center Mayville 45-0228899 - ST Investments	2018-02-01	$153,474	Book Value	450409348	PO Box 5039 Rte 5218	Sioux Falls	SD	571175039	501(c)(3)
Sanford Health Network North
Sanford Medical Center Mayville 45-0228899 - Accounts Receivable (Net)	2018-02-01	$868,701	Book Value	450409348	PO Box 5039 Rte 5218	Sioux Falls	SD	571175039	501(c)(3)
Sanford Health Network North
Sanford Medical Center Mayville 45-0228899 - Inventory	2018-02-01	$96,322	Book Value	450409348	PO Box 5039 Rte 5218	Sioux Falls	SD	571175039	501(c)(3)
Sanford Health Network North
Sanford Medical Center Mayville 45-0228899 - Prepaid Expenses	2018-02-01	$4,668	Book Value	450409348	PO Box 5039 Rte 5218	Sioux Falls	SD	571175039	501(c)(3)
Sanford Health Network North
Sanford Medical Center Mayville 45-0228899 - Assets Whose Use is Limited BDI	2018-02-01	$16	Book Value	450409348	PO Box 5039 Rte 5218	Sioux Falls	SD	571175039	501(c)(3)
Sanford Health Network North
Sanford Medical Center Mayville 45-0228899 - Property & Equipment	2018-02-01	$2,368,266	Book Value	450409348	PO Box 5039 Rte 5218	Sioux Falls	SD	571175039	501(c)(3)
Sanford Health Network North
Sanford Medical Center Wheaton 27-2042143 - Cash	2018-02-01	$273,644	Book Value	450409348	PO Box 5039 Rte 5218	Sioux Falls	SD	571175039	501(c)(3)
Sanford Health Network North
Sanford Medical Center WheatonSanford Medical Center Wheaton 27-2042143 - ST Investments	2018-02-01	$9,045	Book Value	450409348	PO Box 5039 Rte 5218	Sioux Falls	SD	571175039	501(c)(3)
Sanford Health Network North
Sanford Medical Center Wheaton 27-2042143 - Accounts Receivable (Net)	2018-02-01	$847,502	Book Value	450409348	PO Box 5039 Rte 5218	Sioux Falls	SD	571175039	501(c)(3)
Sanford Health Network North
Sanford Medical Center Wheaton 27-2042143 - Inventory	2018-02-01	$115,894	Book Value	450409348	PO Box 5039 Rte 5218	Sioux Falls	SD	571175039	501(c)(3)
Sanford Health Network North
Sanford Medical Center Wheaton 27-2042143 - Prepaid Expenses	2018-02-01	$20,896	Book Value	450409348	PO Box 5039 Rte 5218	Sioux Falls	SD	571175039	501(c)(3)
Sanford Health Network North
Sanford Medical Center Wheaton 27-2042143 - Assets Whose Use is Limited BDI	2018-02-01	$1	Book Value	450409348	PO Box 5039 Rte 5218	Sioux Falls	SD	571175039	501(c)(3)
Sanford Health Network North
Sanford Medical Center Wheaton 27-2042143 - Propery & Equipment	2018-02-01	$2,099,889	Book Value	450409348	PO Box 5039 Rte 5218	Sioux Falls	SD	571175039	501(c)(3)
Sanford Health Network North
Sanford Medical Center Wheaton 27-2042143 - Other Assets	2018-02-01	$251,376	Book Value	450409348	PO Box 5039 Rte 5218	Sioux Falls	SD	571175039	501(c)(3)
Sanford Health Network North
Sanford Hillsboro 45-0230400 - Cash	2018-02-01	$1,264,765	Book Value	450409348	PO Box 5039 Rte 5218	Sioux Falls	SD	571175039	501(c)(3)
Sanford Health Network North
Sanford Hillsboro 45-0230400 - Accounts Receivable (Net)	2018-02-01	$1,323,567	Book Value	450409348	PO Box 5039 Rte 5218	Sioux Falls	SD	571175039	501(c)(3)
Sanford Health Network North
Sanford Hillsboro 45-0230400 - Inventory	2018-02-01	$38,211	Book Value	450409348	PO Box 5039 Rte 5218	Sioux Falls	SD	571175039	501(c)(3)
Sanford Health Network North
Sanford Hillsboro 45-0230400 - Prepaid Expenses	2018-02-01	$20,456	Book Value	450409348	PO Box 5039 Rte 5218	Sioux Falls	SD	571175039	501(c)(3)
Sanford Health Network North
Sanford Hillsboro 45-0230400 - Property & Equipemnt	2018-02-01	$6,485,604	Book Value	450409348	PO Box 5039 Rte 5218	Sioux Falls	SD	571175039	501(c)(3)

Field	Value	IRS element (for citing)
Director Of Successor	Yes (1)	DirectorOfSuccessorInd
Employee Of Successor	Yes (1)	EmployeeOfSuccessorInd
Owner Of Successor	0	OwnerOfSuccessorInd
Receive Compensation	0	ReceiveCompensationInd
Assets Distributed	Yes (1)	AssetsDistributedInd
Required To Notify AG	Yes (1)	RequiredToNotifyAGInd
Attorney General Notified	Yes (1)	AttorneyGeneralNotifiedInd
Liabilities Paid	Yes (1)	LiabilitiesPaidInd
Bonds Outstanding	0	BondsOutstandingInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Schedule N, Part I, line 2e	FormAndLineReferenceDesc
Explanation	The following Trustees, and Officers are Trustees, and Officers of Sanford Health Network North (the successor organization): Barb Everist, Trustee Andy North, Trustee Brent Teiken, Vice Chair David Beito, Past Chair Don Jacobs, Treasurer James Cain, Secretary Maria Bell, MD, Trustee Mark Lundeen, MD, Trustee Mark Paulson, MD, Trustee Melissa Hinton, Trustee Michael LeBeau, MD, Trustee Patrick Durick, Trustee Thomas Hruby, Trustee Kelby Krabbenhoft, Sanford President & CEO, Officer JoAnn Kunkel, Chief Financial Officer, Officer	ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part V, Line 3a:	Sanford Health, Sanford Medical Center, Sanford North, Sanford Medical Center Fargo, Sanford Clinic North, Sanford Clinic and Sanford Bismarck have unrelated business gross income over $1,000.
Part V, Line 4a:	Sanford World Clinics has an interest in financial accounts in the foreign countries of Ghana, China and Germany.
Form 990, Part VI, Section A, line 2	The following officers, board members, and key employees are employees of Sanford or its related organizations. Many of these employees also serve on other related Sanford boards, or have business relationships with each other that span the organization as a whole: Allison Wierda-Suttle, Bill Gassen, Bill Marlette, Bryan Nermoe, Craig Lambrecht, Jennifer Grennan, JoAnn Kunkel, Kelby Krabbenhoft, Maria Bell, Mark Lundeen, Mark Paulson, Micah Aberson, Michael LeBeau, Michelle Bruhn, Michelle Micka, Nate White, Paul Hanson, Randy Bury.
Form 990, Part VI, Section A, line 6	Sanford is governed by a Board of Trustees (BOT) that has ultimate strategic and decision making authority. The BOT delegates certain activities and responsibilities to Boards of each of Sanford's primary operating subsidiaries. The unique nature and complexity of the subsidiaries requires each to have a delegated Board with a singular entity focus. Such bodies, referred to as Boards of Directors and Boards of Governors, address matters such as credentialing, accreditation standards, developing budgets, programs and facilities on an entity-specific basis, and generally consist of individuals distinct from the BOT. These Boards function much like committees in a traditional corporate structure. The BOT then acts as a holding company Board, synthesizing and reconciling each entity's programs and budgets into a system-wide strategic plan. This structure of governance produces a significant number of trustees, governors and directors. Subsidiaries included within this group tax return consist of Sanford Health, Sanford North, Sanford Medical Center, Sanford Medical Center Fargo, Sanford Clinic, Sanford Clinic North, Sanford Health Network, Sanford Health Network North, Sanford Medical Center Thief River Falls, Sanford Medical Center Mayville, Sanford Medical Center Wheaton, Sanford Home Health, Sanford Research, Sanford World Clinics, Sanford Hillsboro, Sanford Health of Northern Minnesota, Baker Park, Inc., Sanford West, Sanford Bismarck and Sanford Living Centers. The Board of Trustees of Sanford is also the Board of Trustees for Sanford Health, Sanford North and Sanford West, and Sanford is the sole corporate member of these entities. These entities, in turn, are the sole corporate members of the subsidiaries. The actions approved by a subsidiary's Board of Directors are then approved by the Sanford Board of Trustees.
Form 990, Part VI, Section A, line 7a	The Sanford Board of Trustees appoints the board members for the Boards of Directors and Boards of Governors of the subsidiary entities.
Form 990, Part VI, Section A, line 7b	The Sanford Board of Trustees approves the actions approved by the Boards of Directors and Boards of Governors of the subsidiary entities. Form 990, Part VI, Section B, line 10b: Sanford North, Sanford Clinic and Sanford Health Network have local chapters, branches or affiliates over which the organization has the legal authority to exercise direct or indirect supervision and control.
Form 990, Part VI, Section B, line 11b	The Form 990 is prepared internally by Finance and reviewed by executive management. An external accounting firm reviews the return and prepares return highlights and key disclosures for the Board of Trustees meeting prior to the return filing date. Before the return is filed, a complete copy is provided to the current Board of Trustees.
Form 990, Part VI, Section B, line 12c	The annual Conflict of Interest disclosure process is managed by the Chief Compliance Officer (CCO). The CCO is responsible for assuring that all completed forms are returned in a timely and complete manner. Conflict of Interest questionnaires are sent to System Trustees, members of the governing boards of subsidiary entities, officers, and key employees for all entities subject to the IRS Form 990 filings. The disclosures are summarized for review by the executive committee of the Board of Trustees, pursuant to policy. This review allows: 1) The Board to acquire an awareness of financial relationships of board members and key management employees and can invoke the recusal process on a case-by-case basis if potential conflicts are implicated in Board decisions and deliberations, and, 2) Gives the Board the opportunity to seek additional information and clarification about disclosures to determine potential conflicts of interest, and how to manage them.
Form 990, Part VI, Section B, line 15	The Executive Compensation Committee of the Sanford Board of Trustees directly engages a nationally recognized independent compensation consulting firm annually to review the total compensation arrangements of the officers and executives of the organization, including the CEO, and to report the findings to them for deliberation and action. The deliberations and actions are recorded in the minutes of the Sanford Board of Trustees. The most recent study was completed in 2018. Part VI, Line 16a: Sanford Health, Sanford Medical Center, Sanford Clinic and Sanford Clinic North have participated in joint ventures with taxable entities.
Form 990, Part VI, Section C, line 19	Although the organization does not maintain a website where the public can access these documents, it would respond individually to any requests or inquiries from the public for these documents.
Form 990, Part VII, Section A	The Sanford Board of Trustees has ultimate goverance responsibilities for each major operating entity within Sanford. In addition, a Board of Directors is established for each major operating entity. This Board has specific responsibilities delegated from the Board of Trustees. Generally these responsibilities are related to the oversight of the day to day operations of that entity.
Form 990, Part VII, Section B	Amounts listed as compensation for the five highest compensated independent contractors include payments for both materials and services.
Form 990, Part XI, line 9:	Net payroll and other expenses paid on behalf of parent/affiliates -35,020,517. Transfer of Sanford House to Sanford Health 9,781,329. Transfer of restricted funds raised for Sanford House 2,324,421. Liquidation of SAS into Sanford West 1,913,776. Transfer of Restricted Funds for Ava's House 2,939,681. Net Assets released from restrictions for acquisition of property and equip 5,797,290. Pension Plan related changes other than net periodic plan expense 16,441,716. Swap Valuation Change 377,125. Change in Net Assets due to Acquisition 684,250.
Form 990 Elections	Form 990, Page 1, Line H(a) - Listing of Subordinate Organizations: Names, Addresses, and EINs Sanford Health 1305 W 18th Street, PO Box 5039 Sioux Falls, SD 57117-5039 EIN: 31-1527032 Sanford USD Medical Center 1305 W 18th Street, PO Box 5039 Sioux Falls, SD 57117-5039 EIN: 46-0227855 Sanford Home Health 1305 W 18th Street, PO Box 5039 Sioux Falls, SD 57117-5039 EIN: 46-0282134 Sanford Health Network 1305 W 18th Street Sioux Falls, SD 57105 EIN: 46-0388596 Sanford Clinic 1305 W 18th Street, PO Box 5039 Sioux Falls, SD 57117-5039 EIN: 46-0447693 Sanford Research 2301 E 60th Street N Sioux Falls, SD 57104 EIN: 46-0450378 Sanford World Clinics 1305 W 18th Street Sioux Falls, SD 57105 EIN: 26-2707628 Sanford North 801 Broadway Drive, PO Box 2010 Fargo, ND 58122 EIN: 45-0385890 Sanford Clinic North 801 Broadway Drive, PO Box 2010 Fargo, ND 58122 EIN: 91-1770748 Sanford Medical Center Fargo 801 Broadway Drive, PO Box 2010 Fargo, ND 58122 EIN: 45-0226909 Sanford Health Network North 801 Broadway Drive, PO Box 2010 Fargo, ND 58122 EIN: 45-0409348 Sanford Medical Center Thief River Falls 3001 Sanford Parkway Thief River Falls, MN 56701 EIN: 41-0709579 Sanford Medical Center Mayville 801 Broadway Drive, PO Box 2010 Fargo, ND 58122 EIN: 45-0228899 Sanford Medical Center Wheaton 401 12th Street N Wheaton, MN 56296 EIN: 27-2042143 Sanford Hillsboro 12 3rd Street SE, PO Box 609 Hillsboro, ND 58045 EIN: 45-0230400 Sanford Health of Northern Minnesota 1300 Anne Street NW Bemidji, MN 56601 EIN: 41-1266009 Baker Park, Inc. 803 Dewey Avenue NW Bemidji, MN 56601 EIN: 41-1372480 Sanford West 300 N 7th Street Bismarck, ND 58501 EIN: 45-0397195 Sanford Bismarck 300 N 7th Street Bismarck, ND 58501 EIN: 45-0226700 Sanford Living Centers 1000 18th Street NW, Suite 1 Mandan, ND 58554 EIN: 45-0416454

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp (12 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Total IncomeTotalIncomeAmt	End Of Year AssetsEndOfYearAssetsAmt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt
Lincoln County Real Estate Trust
100 S Phillips Ave	Sioux Falls	SD	57104	466126929	Real Estate	SD	$0	$586,468	Sanford Health
PPK Family Trust
100 S Phillips Ave	Sioux Falls	SD	57104	207317570	Rental Real Estate	SD	$23,732	$2,367,386	Sanford Health
Lynx Trust
PO Box 5186	Sioux Falls	SD	57117	266167201	Investment	SD	$0	$1	Sanford Health
National Student Housing Trust-SD
PO Box 5186	Sioux Falls	SD	57117	206831968	Investment	SD	$0	$737	Sanford Health
Sanford HealthCare Accessories LLC
3223 32nd Ave SW	Fargo	ND	58103	202404179	Sales of Durable Medical Equip	ND	$31,243,055	$13,277,787	Sanford North
Healthcare Environmental Services LLC
PO Box 2010	Fargo	ND	58122	205236701	Retail Enterprises	ND	$1,965,664	$5,545,056	Sanford North
North Country Senior Living LLC
1000 Anne St NW	Bemidji	MN	56601	263862586	Senior Housing	CO	$3,373,136	$7,481,083	Sanford Health of Northern Minnesota
1527 Broadway LLC
1527 Broadway	Alexandria	MN	56308	411336392	Real Estate	MN	$554,268	$6,584,557	Sanford Clinic North
Medequip One LLC
626 N 6th Street	Bismarck	ND	58501	450452639	Durable medical equipment, products, and services	ND	$0	$0	Sanford West
Shetek Medical Services LLC
251 5th Street E	Tracy	MN	56175	412004685	Home Health Services	MN	$433,111	$168,133	Sanford Health Network
Sanford Health Mobile Med LLC
2603 E Broadway Avenue	Bismarck	ND	58501	471209528	Mobile Healthcare	ND	$0	$644,118	Sanford Health
Southwest MN Radiation Center LLC
1018 6th Avenue	Worthington	MN	56187	460447693	Radiation Services	MN	$1,093,670	$76,896	Sanford Health Network

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (11 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Controlled OrganizationControlledOrganizationInd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt
Sanford
P O Box 5039 Rte 5218	Sioux Falls	ND	58122	271218956	Supporting Organization	ND	501(c)(3)	12-II	0
Sanford Health Foundation
P O Box 5039 Rte 5218	Sioux Falls	SD	571175039	363297853	Foundation	SD	501(c)(3)	12-II	Yes (1)	Sanford Health
Edith Sanford Breast Cancer Foundation
P O Box 5039 Rte 5218	Sioux Falls	SD	571175039	450404126	Foundation	ND	501(c)(3)	12-II	Yes (1)	Sanford Health
F-M Ambulance Service Inc
P O Box 5039 Rte 5218	Sioux Falls	SD	571175039	450344371	EMT	ND	501(c)(4)		Yes (1)	Sanford North
Sanford Health Foundation North
P O Box 5039 Rte 5218	Sioux Falls	SD	571175039	450398104	Foundation	ND	501(c)(3)	7	Yes (1)	Sanford North
Sanford Health Foundation Hillsboro
P O Box 5039 Rte 5218	Sioux Falls	SD	571175039	363542187	Foundation	ND	501(c)(3)	7	Yes (1)	Sanford Hillsboro
Sanford Health Foundation of Northern Minnesota
P O Box 5039 Rte 5218	Sioux Falls	SD	571175039	411389317	Foundation	MN	501(c)(3)	12-II	Yes (1)	Sanford Health of Northern Minnesota
Sanford Health Foundation West
P O Box 5039 Rte 5218	Sioux Falls	SD	571175039	450397196	Foundation	ND	501(c)(3)	7	Yes (1)	Sanford Bismarck
Medcenter One Inc Auxiliary
P O Box 5039 Rte 5218	Sioux Falls	SD	571175039	237293043	Supporting Organization	ND	501(c)(3)	12-II	Yes (1)	Sanford Bismarck
Sanford Heart of America Health Plan
P O Box 5039 Rte 5218	Sioux Falls	SD	571175039	450346132	Insurance	ND	501(c)(4)		Yes (1)	Sanford Health Plan
Sanford Health Foundation Thief River Falls
P O Box 5039 Rte 5218	Sioux Falls	SD	571175039	411761135	Foundation	MN	501(c)(3)	7	Yes (1)	Sanford Medical Center Thief River Falls

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Predominant Income TypePredominantIncomeTypeTxt	Share Of Total IncomeShareOfTotalIncomeAmt	Share Of EOY AssetsShareOfEOYAssetsAmt	Disproportionate AllocationsDisproportionateAllocationsInd	General Or Managing PartnerGeneralOrManagingPartnerInd	OwnershipOwnershipPct
National Student Housing-South Dakota LLC
100 S Phillips Ave	Sioux Falls	SD	57104	202129839	Investment	SD	Sanford Health	Related	-$2,656	$3,919,813	0	0	0.99990
RAC Rentals LLC
100 S Phillips Ave	Sioux Falls	SD	57104	261961077	Investment	SD	Sanford Health	Related	-$18,872	$3,895,099	0	0	0.99990

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (9 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Entity TypeEntityTypeTxt	Share Of Total IncomeShareOfTotalIncomeAmt	Share Of EOY AssetsShareOfEOYAssetsAmt	OwnershipOwnershipPct	Controlled OrganizationControlledOrganizationInd	Direct Controlling NADirectControllingNACd	Address Line1ForeignAddress/AddressLine1Txt	CityForeignAddress/CityNm	CountryForeignAddress/CountryCd	Legal Domicile Foreign CountryLegalDomicileForeignCountryCd
Sanford Home Medical Equipment Inc
2710 W 12th Street	Sioux Falls	SD	57105	460388597	Healthcare Equipment	SD	Sanford Health	C	$2,847,331	$17,612,055	1.00000	Yes (1)
Sanford Health Plan
300 Cherapa Place	Sioux Falls	SD	57103	911842494	Insurance	SD	Sanford Health	C	$11,876,501	$268,175,876	1.00000	Yes (1)
Sanford Health Plan of MN
300 Cherapa Place	Sioux Falls	SD	57103	460445852	Insurance	MN	Sanford Health	C	-$76,275	$2,340,884	1.00000	Yes (1)
Sanford Frontiers
1305 W 18th Street PO Box 5039	Sioux Falls	SD	571175039	455436599	Weight Loss Management	SD	Sanford Health	C	-$10,929,316	$92,863,190	1.00000	Yes (1)
SOB Inc
2701 S Minnesota Avenue Suite 2	Sioux Falls	SD	57105	460442628	Air Transportation	SD		C				Yes (1)	N/A
Sanford Affiliated Services Inc
300 N 7th Street	Bismarck	ND	58501	450403146	Investment Activity	ND	Sanford West	C	-$5,884		1.00000	Yes (1)
Sanford World Clinics - Ghana
					Healthcare		Sanford World Clinics	C	-$2,496,643	$4,635,496	1.00000	Yes (1)		Sarbah Road Tantri Lorry Station	Cape Coast	GH	GH
Shanghai Sanford Healthcare Management Consulting Co Ltd
					Healthcare		Sanford World Clinics	C	-$322,053	$515,952	1.00000	Yes (1)		188 Yesheng Road Room A-862 Guoma	Shanghai	CH	CH
Sanford International - Munich GmbH
					Healthcare		Sanford World Clinics	C	-$531,206	$11,906,793	1.00000	Yes (1)		Nymphenburger Strasse 3	Munich	GM	GM

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	0	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	Yes (1)	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	Yes (1)	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	0	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	0	DivRelatedOrganizationInd
Asset Sale To Other Org	0	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	0	AssetPurchaseFromOtherOrgInd
Asset Exchange	0	AssetExchangeInd
Rental Of Facilities To Oth Org	0	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	0	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	0	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	0	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	0	SharingOfFacilitiesInd
Paid Employees Sharing	0	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	Yes (1)	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	Yes (1)	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	Yes (1)	TransferToOtherOrgInd
Transfer From Other Org	Yes (1)	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (20 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
Sanford Health Foundation
C	$38,512,577	Cash Basis
Sanford Health Foundation North
C	$2,954,631	Cash Basis
Sanford Health Foundation West
C	$375,062	Cash Basis
Edith Sanford Breast Cancer Foundation
C	$258,630	Cash Basis
Sanford Health Foundation Hillsboro
C	$177,262	Cash Basis
Sanford Health Foundation Thief River Falls
C	$536,832	Cash Basis
Sanford Health Foundation of Northern Minnesota
C	$77,733	Cash Basis
Sanford Heart of America Health Plan
P	$495,788	Cash Basis
Sanford Heart of America Health Plan
Q	$430,357	Cash Basis
Sanford Health Foundation
R	$7,325,611	Cost
Sanford Health Foundation North
R	$1,706,594	Cost
Sanford Health Foundation Thief River Falls
R	$419,094	Cost
Sanford Health Foundation of Northern Minnesota
R	$498,956	Cost
Sanford Health Foundation Hillsboro
R	$102,030	Cost
Sanford Health Plan
R	$8,500,000	Cost
SOB Inc
R	$67,622	Cash Basis
F-M Ambulance Service Inc
S	$4,336,222	Cost
Sanford Frontiers
S	$26,775,345	Cash Basis
Sanford Health Foundation Thief River Falls
S	$535,909	Cost
Edith Sanford Breast Cancer Foundation
B	$799,493	Cost